Common skin Diseases
    Scabies
    Acne
    Fungal Infections
    Leprosy
    Psoriasis
    Vitiligo
    Hyper pigmentation
    Moles & Nevi
       
Scabies
     
  ·
Scabies is a highly contagious condition caused by a mite known as Sarcoptes scabiei. Persons infected with this mite develops severe itching over the whole body more in axillae, groins, pubic area & genitals.
 

Any age group can be involved but more commonly seen in
   
  · school going kids  
  · crowded families  
  · poor hygienic condition  
       
    The disease is characterized by itchy papules seen particularly on genitals, abdomen , thighs , and axillae & intee digital spaces of the hands. The lesions infected. Diagnosis is usually done by clinical examinations but in cases of doubt scrapings can be taken from the skin, which would show the mite (causative agent for scabies)
   
Treatment consist of wide range of anti scabatic preparations like : Gamma Benzene Hexachloride , Permethrin , sulphar Ointment & Crotaminton ointments The formulations have to be applied overnight from neck to feet followed by warm bath in the morning.
   
Recently oral preparation like Ivermectol is also found to be very effective for the treatment. It is essential that all the affected family members should be treated at the same time & bed linen & clothing requires attention.
     
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Acne
 
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Acne , is a disease of younger age groups characterised by involvment of Pilo sebaceous glands The person having acne develops any of the following lesions graded as follows :
 
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Grade 1. small black comedones & few skin colored white heads
  ·
Grade 2. Erythematous papules & few pustules
 
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Grade 3. Many pustules , nodules & few cysts
 
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Grade 4. Large nodular lesions , cysts & communicating sinuses
 
 
  ·
Few patients have associated problems like mental & physical stress , overuse of cosmetics ,menstrual irregularities & working in hot, humid & polluted environment which is likely to aggravate the existing acne.
 
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Lesions are Usually seen on face, back, chest, upper arms & neck. If the person has a habit of picking the lesions it can lead to pigmentation when it heals. Severe form of acne can lead to extensive scarring & associated anxiety & depression.

 
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If acne is associated with menstrual irregularities , obesity or excess hair growth it needs complete hormonal check up & sonographic studies.
 
     
 
There is a wide range of drugs available for the treatment which is required to be taken for a minimum of 3- 4 months.

Medication available:
   
Local
Systemic
  ·
local Antibiotics
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Antibiotics
  ·
Benzoyl Peroxide
 ·
Vitamins
  ·
Topical Retinoids
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Hormonal therapy
      ·
Systemic Retinoids
    Cleansing agents : Soaps & Liquids
   
   
A proper combination of above treatments lead to complete clearance of acne. In case of scaring & pigmentation various surgical procedures like Chemical peeling, Miero dermabrasion are available.
   
Fungal Infections of skin [ Tinea ] :
 
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Fungal infections of the skin are caused by a superficial fungus which is most commonly seen during summer & monsoon months. Any part of the body from head to toe can be involved and in some cases nails are affected.
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According to the site of involvement , fungal infections are named liked Tinea of groins [ Tinea Cruris ], Tinea Pedis , Tinea Capitis, Tinea Corporis , Tinea Ungium.
  ·
It present as ring like red lesion having severe itching & discomfort. More likely to develop at sites of excessive sweating like groins , waistline & breast folds. However any part of the body can be involved.
  ·
If not cured early can spread fast & also develops superimposed bacterial infection.
  ·
Commonly seen in diabetics , over weight ,patients on long term steroids, patients who sweat a lot & patients working in hot / humid atmosphere.
  · Dignosis can be confirmed by examination of skin scrapings which will show fungal elements & on culture will growth of fungal elements from the skin & nail scraps.
  · Treatment is very effective. A wide range of medicines are available for external use which clear the lesions, however when extensive involvement is present then oral medicine like Griseofulvin , Itraconazole , Terbinafine etc are very helpful.
     
   
Leprosy
 
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It is the oldest bacterial disease known to mankind which is related to social stigmata.
 
Symptoms:
  ·
A person having this disease develops light skin colored patch or patches over the body with loss of sensation to touch, hot, cold & pain. In other cases red nodules & change of facial configuration is also seen.
 
Clinical features:
  ·
The patch could be red with thick raised shiny skin. There could be associated tingling and numbness on hands & feet with or without sensation loss. Red nodules on the face, ears & inner parts of the legs. Loss of sensation in long standing cases can lead to
  · Ulcers on the soles & finger tips
  · Deformation of fingers & toes
  · Paralysis of foot / hand/ legs.
  · Reactions are known in Leprosy & they need urgent treatment.
 
  · Skin smear for AFB is done which shows Mycobacterium Leprae ,
the causative agent for Leprosy.
  · Skin Biopsy will confirm the disease
  · Newer serum testing methods are available at higher centers.
     
 
Treatment:
   
Early diagnosis and treatment limits the spread of disease and disabilities.

It is a completely curable disease, which requires long term – multi drug therapy of about 6 – 12 months regularly.

For older cases with deformities or disabilities ,the following modalities are available:
  · Corrective Physiotherapy
  ·
Reconstructive Plastic Surgery
   


   
It is a mildly contagious disease, which requires prolonged close contact with patient. eg.: spouse, kids, brother, sister. These all-family members are required to be checked once as a routine by doctor or leprosy worker.
    Vaccine treatment is now available which helps to control the infection along with the drug therapy
     
   
Psoriasis
 
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Psoriasis is characterized by development of well defined, scaly red patches over the skin ,involving the scalp , chest , back, abdomen, elbows , knees ,hands & feet. It commonly appears in the younger age groups however, it can start at any age. It can affect the extensively whole body ,known as EXFOLIATIVE PSORIASIS. In few patients joint can also be involved, when it is known as PSORIATIC ARTHROPATHY ( seen in 15—20 % cases)
  ·
A positive family history is seen in 10 – 20 % cases. Environmental factors play a major role, the disease is precipitated by dry & cold weather , upper respiratory tract infection, some drugs & stressful situations.
 
The different types of Psoriasis are:
  ·
Psoriasis of the whole body
  ·
Scalp Psoriasis
  ·
Nail Psoriasis
  ·
Guttate Psoriasis
  ·
Exfoliative Psoriasis
  ·
Pustular Psoriasis
  ·
Arthropathic psoriasis
  ·
Flexural Psoriasis
  ·
Psoriasis of Palms & soles
     
 

Investigations
    In some difficult cases skin biopsy is confirmatory.
     
 
Treatment
  ·
The most important point to emphasize is that this disease is partially curable & even once ,completely cleared it can relapse. Hence the patient has to accept this notion & take care of certain factors like:
  ·
Using of moisturizing agents in winter season
  · Avoid too much soaps & shampoos.
  ·
In case of any major illness , stress, operation , post pregnancy
treatment may be required
     
    A wide range of treatment modalities is available.
   
 
Local treatments
  · Topical cortisone ointments
  · Tars
  · Salicylic Acid
  · Vitamin D & its analogues
  · Tazarotene
     
 
Systemic Therapy
  · Anti biotics
  · Retinoids , like Etretinate , Acitretin
  · Anti metabolic drugs like Methotraxate,Cyclosporin
     
 

Photo Therapy
  · PUVA
  · NB UVB
  · PUVASOL
   
Vitiligo
 
· (Safaid dagh, white spots, kodh)
  ·
This term is used for a lesion, which is milky white, well-defined patch. Often showing variable no of depigmented hairs with or without any change in skin texture.
 
 

Clinical Features

  · The number, size, shape & texture vary widely. It can affect any areas of body. It is common in younger age group of patients.
   
 
Clinical Features :
  ·
Onset is slow. The course is virtually unpredictable. While some lesions may show signs of repigmentation. New lesion may continue to develop on other parts simultaneously. No definite factor can be ascertained for such events. A positive family history can be seen in < 20% cases.
 
Poor prognosis in following circumstances
  · Involvement of sites like – bony areas , palms , soles , nipples, genitals & lips
  · lesions having lot of white hair
  · Positive family history
  · Extensive long standing disease
  · Old age.
  · Rapidly spreading type
   
 

Good Prognosis in following

  · Involvement of face, back & hands
  · Recent Origin
  · Young Patients
     
 

Treatment
  ·
Patient should understand the nature and unpredictable course & prognosis of this disease. Need of good health & balanced nutritious diet with adequate amount of Vitamins & Minerals. Avoid emotional stress, physical & chemical damage to skin , excess of Vitamin C.
     
 
Medical treatment includes:
  · Psoralens –Natural or synthetic with sun exposure
  · Phenylalamine
  · NBUVB, PUVA- Photothearapy under medical supervision.
 
 
Other Drugs
  · Cortico steroids
  · Levamisole
  · Dapsone
  · Placental Extracts
     
   

Hyper pigmentation
 
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Hyper pigmentation is a common, usually harmless condition in which patches of skin become darker in color than the normal surrounding skin. This darkening occurs when an excess of melanin, the brown pigment that produces normal skin color, form deposits in the skin.

   

Age or Liver spots are a common form of hyper pigmentation. They occur due to sun damage, and are referred to by doctors as solar lentigines. These small, darkened patches are usually found on the hands, face and other areas frequently exposed to the sun.


Melasma or chloasma spots are similar in appearance to age spots but are larger arrears of darkened skin that appears most often as a result of hormonal changes. Pregnancy, for example, can trigger overproduction of melanin that causes the “mask of pregnancy” on the face and darkened skin of the abdomen and other areas. Women who take birth control pill may also develop hyper pigmentation because their bodies undergo similar kind of hormonal changes that occur during pregnancy.
  ·


Changes in skin color can result from outside causes. For example, skin diseases such as acne may leave dark spots after the condition clear. Other causes of dark spots are injuries to the skin, including some surgeries. Freckles are small brown spots that can appear anywhere on the body, but are most common on the face and arms. Freckles are an inherited characteristic.

Freckles, age spots and other darkened skin patches can become darker or more pronounced when skin is exposed to the sun. This happens because melanin absorbs the energy of the sun’s harmful ultraviolet ray in order to protect the skin from over exposure. The usual result of this process is skin tanning, which tends to darken areas that are already Hyper pigmented. Wearing a sunscreen is a must. The sunscreen must be “broad spectrum” (i.e. it blocks both ultraviolet A and B). A single day of excess sun can undo months of treatment.

Most prescription creams used to lighten the skin contain Hydroquinone. Bleaches lighten and fade darkened skin patches by slowing the production melanin so that dark spots gradually fade to match normal skin coloration. In more sever cases prescription creams with tretinoin or kozic acid and a cortisone cream are added. These are somewhat irritating to sensitive skin and will take 3-6 month to produce improvement.

There are now several highly effective laser treatments. The q-switched ruby laser and for other pigmented lesions laser often removes pigment without scaring.

     
   

Moles & Nevi
 
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The medical term for a mole is a NEVUS (mole is Latin for “spot”) Congenital nevi are moles present at birth; acquired nevi developed anything later. Nevi are made of a particular type of cell, and the name is used to distinguish them form other, similar appearing fleshy growths.
  ·
Most moles acquired in life are usually less that 1 cm in size. Many of those that form in childhood and early adult life are now thought to be due to sun damage. Most people think of a mole as being a dark brown spot, but moles have a much wider range of appearance. They can be raised from the skin and very noticeable, or they may contain dark hairs. Moles can appear anywhere on the skin. Alone or in group. They usually are brown or black in color and can be various sizes and shapes. Special cells contain pigment melanin that cause the brown color.

Facial moles are probably determined before a person is born. Some may not appear until later in life, but moles that appear after age 50 should be regarded with suspicion. Moles may darken, which can happen after exposure to the sun, pregnancy and sometimes during therapy with certain steroid drugs. There is little risk of melanoma cancer developing in these moles particularly in Asian community.
   


Congenital nevi:

Only a few babies, about 1 in 100, are born with mole, the congenital nevus These can vary in size from being less than 1cm. to covering almost the entire body. Large nevi can vary greatly in size, shape, color, surface texture, and hairiness. Some are reddish-brown, others are almost black. Most are shades of brown. Some have few many hairs; many have long, thick, darker hair.

Nevi measuring 4 inches (10cm) or more at birth occur in about one in every 20,000 children. Giant congenital nevi involving much of the surface are less common, possibly around one in every 200,000 to 500,000 births.

Congenital moles will grow in proportion to body growth. Their color may stay the same, lighten slowly, or darken slowly over time. Changes in growth, in color, in surface texture, pain, bleeding, or itching are all of concern. Any such changes should be evaluated medically if they last longer than a few weeks.

   

Treatment:

Improving cosmetic appearance is another reason for excision, but all surgery leaves some scarring. Smaller nevi can be “shaved off”. Larger ones can be cut out directly and the wound edge sewn together. Much larger Nevi need a plastic surgeon’s Consultation.