Dermatology: Managing common skin problems

For the ease of our customers we have specified some of the very common problems that can be helped by Nur76 products. These skin problems are very prevalent in the society and we have received hundreds of feedbacks on the efficacy of our products on these skin problems. These are beyond the already known benefits of our products on cosmetic improvements.

As a responsible company, who always puts the benefit of people at their first priority, we explain the basics of some other skin problems. We would like to add that we do not have sufficient evidence or positive feedbacks from our customers on the efficacy of our products on the below mentioned skin problems. We would suggest that you see your doctor before using any of our products for the below mentioned skin problems.

Before you begin searching for information on a particular skin condition, it's important to note research shows that a majority of skin diseases are caused by nutrient imbalances within the body. That's why dermatologists recommend high quality nutritional supplements to help prevent and treat skin problems.

Name of the Condition

Condition Explained

Management

Acne

One of the commonest skin problems. Around 70% of the population have some clinical evidence of at some stage during adolescence.

It is a problem of hair bearing skin in which hair follicles develop obstructing horny plugs (comedones). Because of this there is inflammation around the obstructed follicle, causing tissue distruction and scar formation.

Few tips:
No evidence that acne is made worse or improves by any food items.
No need to scrub, normal washing of the area is sufficient.
Cosmetics should be permitted provided they are not too heavy or greasy. Heavy foundations can make the condition worse.
Please note that Nur76 has been found to benefit our customers with acne
Medications:
Skin applications:
1. Antiseptic washes, antimicrobials/antibiotics, sulphur in calamine lotion, benzoyl peroxide preparations, azelaic acid.

2. To be consumed: tetracyclines, erythromycin, isotretinoin, cyproterone acetate.

Acanthosis nigricans

 It is a comparatively rare condition. Darkening and thickening of skin of the flexures such as in axillae or groins. There is also thickening of palmer skin and oral inner lining skin. The affected areas have increased pigmentation and usually bear skin tags and warts. The conditions presence usually signifies an underlying endocrine disorder or even some types of cancer The condition may resolve with successful treatment of the underlying pathology

Actinic keratosis

 Also known as solar or senile keratosis. It looks like a raised pink or grey, scaling or warty plaque. They are usually 2-5 mm in diameter. They are usually found in chronically sun exposed areas in the elderly, fair skinned people. Multiple lesions are the rule If the number of lesions is small, they can be surgically excised depending on their site and size. If numerous, cryotherapy or liquid nitrogen is used in the treatment. Other modes of treatment include chemotherapy, oral retinoids or injection of interferons in the lesion itself.

AgeSpot

    

Allergic contact dermatitis

 It is a rash that develops after contact with an allergy causing agent. The rash on occasion can spread beyond the contact area also. In acute situation the rash develops within a few hours. Itch is the first symptom followed by redness, swelling and vesicle formation. Most frequent type of allergic contact dermatitis is nickel dermatitis. Nickel is present in articles such as clips on underclothes and inexpensive jewellery. Other items that can cause this condition include some flowers, citrus fruits, formaldehyde, certain dyes and plastics, besides some medications. Identify the sensitizer. Patch tests also help in the diagnosis. Steroids may be used to treat the condition in an acute phase, but the condition is usually self-limiting. Prevention by avoiding the sensitizer is the best treatment in the long run.

Angiofibroma

 Multiple smooth, red papules are noted on the face. They are usually located between the nasal and labial (mouth) folds.  

Angioma

 This is a small vascular malformation. There is blood in these vesicles. The blood clots and turns black, making them difficult to diagnose  

Aphthous ulcers

    

Athletes foot

 A fungal infection. It is present only in 25% of cases who have scaling or maceration between the toes. In the rest of 75% cases, it is due to causes like candida, bacterial infections and poor hygiene. Simple foot hygiene in cases where hygiene is the issue. For the rest, antimicrobial creams or lotions containing povidone iodine or miconazole.
Atopic dermatitis
 A very common and extremely itchy problem of unknown cause. It usually affects the face and flexures of young children and adults. The other affected sites are wrists, ankles, tummy and back. The incessant itching and rubbing of the skin causes considerable injury to the skin. It seems that the immune system plays a role in this condition and hence asthma, hay fever and atopic dermatitis have a common pathogenetic mechanism. It also occurs in families. Around 30% of affected people have at least 1 parent suffering from the same condition. People with this problem are also subject to severe skin infections. Topical steroids are the most useful. But they are not curative, only suppressive. The treatment should always be started with the least potent steroid because of other side effects. Emollients and tar preparations are also beneficial. People who do not respond to these treatments can be offered photochemotherapy with UV radiation, oral steroids, and cyclosporine. For infections, antimicrobials need to be commenced

Atypical mole syndrome

Also known as dysplastic or B-K naevus syndrome
 The moles are quite large compared o ordinary moles and have irregular margins and irregular brown pigmentation. Some may have orange-red hue. They are often present in large numbers and can be on any part of the skin. The risk of this lesion developing into a cancer is 1-10% depending on familial factors.  

Basal cell carcinoma

Also known as rodent ulcer
 This a common, slowly growing locally invading, tumour of the skin. It occurs more commonly in light-exposed areas. Most lesions are due to long term sun exposure and ultraviolet radiation damage. Some may also arise from malformations present at birth. Initially they are flat and scaly. They can also look like pearly nodules which later develop dilated blood vessels over their surface. When larger, these nodules ulcerate and form the appropriately termed rodent ulcer. A biopsy will be able to diagnose the condition. Most of the lesions can be excised. Smaller lesions are curetted and cauterised. These techniques provide 95% cure. Larger lesions may need radiotherapy or cryotherapy.
Berloque dermatitis
 The word berloque means pendent or drop like. This type of dermatitis is a streaky increase in pigmentation that results from application of certain perfumes that contain oil of bergamot. This is a naturally occurring psoralen. After sun exposure, sharp markings and an increase in pigmentation will be seen at the sites of perfume application. There is little or no redness noted. It usually appears after 24 hours after sun exposure and peaks at 48 hours.  

Bullous pemphigoid

Also known as senile pemphigoid
 It is an uncommon acute condition where there is blistering of skin. It occurs mainly in people above the age of 60. Large tense and painful lesions often blood filled blisters develop anywhere on the skin surface. In 85-90% of the cases circulating antibodies by the immune system are the causative agents. High doses of steroids are needed and the person needs admitting and nursed in the hospital. Drugs such as azathioprine or methotrexate are also commenced to suppress the immune system. The blisters themselves need to be treated with wet dressings.

Candidiasis

Also known as moniliasis or thrush
 A frequently occurring infection due to fungus Candida albicans. This fungal variety can exist in the gut and mouth as a commensal. The fungus can cause inflammation of the genital areas in pregnant women and in women taking oral contraceptive pills or antibiotics for acne. This fungus can also invade the nail plate and cause inflammation. Imidazole antifungals such as clotrimazole, econazole, ketoconazole either applied on the skin or taken orally help. Serious infections may require Fluconazole.

Carbuncles and furuncles

 These problems result due to infection of hair follicles by a bacteria Staphyloccocus aureus. Poor hygiene is the main cause. The bacteria lodge in nostrils, genital areas or other body areas where it is difficult to dislodge. The lesions are usually localised, red and painful to touch. Furuncles are relatively small and affect one follicle only. Carbuncles on the other hand are large- 3 or 4 cm in diameter and suggest infection of several follicles. They may develop pus in the middle and may be the cause of widespread infection and fever. Surgical drainage is required if pus is noted. Culture and sensitivity of the infection must be investigated before starting an antibiotic. This is because the bacteria may be resistant to many antibiotics.

Cherry Angioma

Also known as senile angioma or Campbell de Morgan spot

 It is usually accompanied by skin aging. It has a smooth surface, is dome shaped with purple or cherry red appearance. Their appearance can generate distress in the affected person but otherwise they are benign. Surgery is an option but at times, it can leave a scar. Other treatments available include laser treatment and advanced electrolysis
Cold sores/ chilblains
 Chilblains are quite common in UK, but less common in other parts of Europe and USA. It is a mild type of cold injury seen in sea swimmers, yachtsmen, keen joggers and marathon runners. Sometimes they can occur in plump young women who ride horses or in elderly. The lesions appear as raised dusky red or mauve. They are itchy and painful. They are seen over the thighs and buttocks in the youngsters Although there are some ‘traditional’remedies but none with any guarantee. The best way to manage them is to keep the affected part warm and apply a weak steroid cream.

Cysts

A cyst is a cavity lined by a part of the skin, filled with fluid or semisolid material. There are many types of cysts.
Epidermoid-can occur anywhere but are more common on head and neck and upper trunk. They are firm in consistency.
Milia-tiny, no larger than a pinhead, white cysts, noted over upper cheeks and beneath the eyes.
Pilar cysts-less common, multiple, genetic in origin, mostly occurring on scalp and scrotum.
Sebocystoma multiplex- uncommon, multiple, small smooth walled cysts especially over the upper trunk.

Dermoid- oval, firm and less mobile, noted mostly on face around the eyes.		 Surgical excision or any other form of surgical ablation is usually sufficient for conditions with small benign lesions. But histological evidence of the nature of lesion should be taken into consideration.

Chloasma

 Symmetric, dark areas of pigmentation across the cheeks, around the eyes and over the forehead, giving a mask like appearance. 60% of pregnant women and 30% of women on oral contraceptive pills develop this condition. This a physiological change during pregnancy and does not require any specific treatment. Some of our customers have provided us feedback that they have benefited from the application of Nur76 on these pigmented areas.
Cellulitis
 A common, diffuse disorder causing inflammation of the skin and its sub layer. It may be caused due to infection of the skin due to various micro-organisms. It may vary in severity depending on many factors. It is usually seen on the limbs. The person will feel pain, slight swelling with varying degree of redness around the skin. Broad spectrum antibiotics are indicated as the bacteria may be resistant to some antibiotics. Cephradine and flucloxacillin is one of the suitable combinations

Cradle cap

 In the first few weeks of life, crumbly debris forms over the scalp of newborn babies. It is benign in nature and self limiting. It usually disappears in the first few months of birth. A mild detergent based shampoo 2-3 times a week can be applied in such cases. If further action is required, arachis oil or aqueous cream can be applied.

Darier's disease

Also known as keratosis folliculitis
 An uncommon disorder occurring in 1 in every 50,000 people in UK. It is genetically inherited. The lesions look like groups of brownish horny papules over the trunk, shoulders and face. These are easily irritated or infected. Tiny pits on the palms and nail dystrophy can also be seen Topical treatment with 2% salicylic acid or 0.025-0.05% tretinoin may be helpful.

Dermatofibroma

Also known as histiocytoma or sclerosing haemangioma
 Firm or hard , brownish, rough or warty surfaced nodules within the skin are felt. These nodules are usually found on the limbs in 2-3 numbers. It has no serious outcomes, no treatment suggested
Diaper dermatitis
 Red, glazed, fissured and even erode areas develop at the sites which come in contact with the diapers. Flexures are usually spared but the convexities are affected. There is a strong ammoniacal smell when the diaper is removed. Frequent change og diapers is advised and use of soft muslin diapers should be used. Topical 1% hydrocortisone ointment twice daily can be used if condition persists despite the above measures.
Dandruff
    
Dry skin
    
Eczema, atopic is the same as atopic dermatitis
    
Dermatitis herpetiformis
 A chronic, remittent, itchy, blistering disorder with gluten sensitivity. Vesicles appear in crops over knees, elbows, scalp, buttocks and around the axillae. The skin lesions can be suppressed by Dapsone 50-200 mg per day in most cases.
Erythema multiforme
 An acute and short lived inflammation of the skin and mucosa. It occurs in response to a variety of antigenic stimuli. The lesions appear as red or purple which become round or target like and may blister. The face and upper limbs are mostly involved. Mouth may be involved in severe cases. The condition lasts 10-14 days. Only symptomatic treatment is required. Systemic steroids may be given in case there is a serious systemic disturbance.
Erythema nodosum
 A painful disorder in which crops of tender nodules occur in response to antigenic stimuli. Causes of the condition can be tuberculosis, sarcoidosis, brucellosis, ulcerative colitis, leprosy. Lesions are red, raised and tender. They vary in size from 1-3 cm in diameter. Usually seen on shins, and less commonly on forearms. The lesions take 2-6 weeks to resolve leaving a bruised appearance. Rest and mild painkillers are advised

Granuloma Annulare

Granulomatous processes
 A common inflammatory disorder. Ring like papules or plaques are seen especially over the extensor (outer) surface of the fingers, sole of the feet, hands and wrists. It is quite common in children and young adults. The lesions last a few months and disappear automatically. No treatment is indicated. Individual lesions respond to steroids injected within the lesions.

Grovers's disease

Transient acantholytic dermatosis (Grover's disease)
    

Hair loss- Alopecia areata

 A common problem in which hair growth suddenly stops in circumscribed areas. This results in hair fall in these areas. Most commonly it occurs in scalp region but can also occur in beard areas in men. About one-third of cases seem to recover spontaneously in few weeks but in another one-third no regrowth ever occurs. Application of potent steroids to the affected area seems to provoke regrowth in some cases. Other treatments have also been tried such as sensitizing the skin with various agents such as diphencyprone.

Hair loss- Androgenic alopecia
Also known as male pattern baldness

 

This is the most common type of hair loss in men. It starts on the vertex and in ether temple and gradually progresses to the classic bald plate. It is not known to be associated with dandruff.

Male pattern baldness can also occur in women. If severe and progressive, the underlying cause must be sought by a specialist.

In UK finasteride is licensed for treatment of male pattern baldness in men. Also topical application of minoxidil may stimulate limited hair growth for as long as it is used.

For women the most important treatment is treating the underlying cause.

Hair loss- Telogen effluvium

 Diffuse hair loss in women is quite common. Sudden extensive hair loss occurring 4-8 weeks after a precipitating event. These precipitating events may be childbirth, fevers, bleeding, hormonal therapy being started or being changed (including oral contraceptive pills), eating disorders or strict dieting. Most women lose some hair within a few months of childbirth. The precipitating event causes the scalp hair follicles to revert to a resting phase and can cause significant scalp hair loss. This then stops spontaneously. The hair subsequently regrow gradually to its normal state.

Halo naevus

Also known as sutton's naevus
 It is a problem related to vitiligo in which there is a focal loss of pigmentation. There is a white halo around the naevus. The management is similar to vitiligo. Other than reassurance, the person can be helped with staining the skin with 2% hydroxyacetone. Also treatment with corticosteroids, PUVA or topical PUVA is sometimes helpful.

Hand dermatitis

 One of the commonest cause of disability. The skin becomes sore and may be cracked when hands are affected. This may prevent adequate hand movements. In addition, because of scaling and oozing vesicles make it difficult to perform ‘clean’tasks. Rest and avoidance of manual work with abrasive or chemical irritants is advised. Emollients such as BP, E45 was cream, Neutrogena are advised. A less potent topical steroid cream containing hydrocortisone, clobetasone is suggested. Tar is prescribed when the problem is persistent and there is considerable skin thickening and scaling. In people who have vesicles, bathing their hands in very diluted potassium permanganate (1:8000 concentration) will be helpful.
Heat rash
 See sun burn  

Herpes simplex

 

 

It is caused by two types of viruses. Type I causes lesions on face and mouth and type II causes lesions on genitals. The problem can be precipitated by minor pyrexial (fever) disorders or by sun exposure. Commonly the lesions begin around the mouth and lips. The lesions appear as vesicles which later group together and then crust eventually.

The genital lesions affect the glans in men and vulval region or labia in women. It may occur cyclically with menstrual periods. It is transmitted sexually. It is painful and hence inhibits sexual activity.

Cleanliness cannot be overemphasised.

5% Idoxuridine lotion, 5% acyclovir cream or acyclovir tablets can shorten the problem life span.

Herpes zoster

 This commonly affects people aged 50 or above. It is due to reactivation of the virus sitting latent in some of our nerves. The problem starts with a feeling of numbness or pain in the affected nerve region. Pustules are noted which eventually become crusted in the affected region. General body upset and fever are also seen. Around 25% people continue to suffer pain long after the lesions have disappeared.  Most important treatment is to keep the area clean. Topical antibiotics to prevent secondary bacterial infection may be helpful. Acyclovir tablets decrease not only the duration but also the severity of the problem.
Icthyosis

The word is derived from Greek icthyos which means fish. Generalised dry-scaling skin disorders are known as icthyosis.
Commonest type is the least severe and is inherited in 50% of cases if one of their parents has this problem. The scales are large, dingy grey or light brown and shield like in shape. The face and flexures are spared.

Other types include sex-linked which develops only in males, and acquired secondary to an underlying cancer or malabsorption.		 Preparations containing 10-15% of urea or 1-6% salicylic acid are beneficial. A 6% preparation of propylene glycol gel is very effective in removing the thick scales.

Impetigo

 An acute superficial infection of the skin caused by the bacteria Staphylococcus aureus or a b-haemolytic streptococci. Children are usually affected but no age group is exempted. Breaks in the skin predispose to this condition. Golden-yellow crusts affecting the face are seen. The lesions may spread locally and then group together. Blisters may also be formed in some cases. Application of topical mupirocin or fusidic acid is effective in localised lesions. For more widespread lesions oral antibiotics may be required.

Keloid scar

Keloid scars can arise in response to any minor injury. It tends to occur in young adults particularly women. The scars are mostly located in shoulders, upper limbs and upper trunk. It has been noted that black skinned people are more prone. The lesions are raised and sometimes extend a bit into the neighbouring skin. They show little or no tendency to regress on their won. Surgical treatment by itself is usually insufficient. Steroids, radiotherapy and application of retinoic acid have been tried with varying success.

Keratocanthoma

Also known as molluscum sebacum
 It usually appears within a week or two on light exposed skin. It appears as a single nodule with a crater which later enlarges for a few weeks. It has a symmetric cup or flask shaped structure. Excision of the lesion is recommended. If the lesion is small, curettage and cautery may be more suitable. If left to heal spontaneously, scarring is often noticed.
Keratosis pilaris
 A common dry skin problem. Horny plugs are noted in the hair follicles of the outer aspect of the upper arms forming sheets of pink horny papules. Occasionally they can be seen on thighs as well.  It is common in people with Down’s syndrome. It improves in summer months and lessens with age.  
Lichen planus
 An inflammatory disorder of the skin with unknown cause. Itchy polygonal papules erupt with variable extent of typical mauve or pink flat top. Whitish lacework pattern on its surface is usually seen. Mostly seen on front of wrists. In 30% cases lining of the mouth is also involved. There are many varieties of this disorder such as hypertrophic, atrophic, annular, lichen nidus, bullous lichen planus and lichen plano-pilaris. Lichen planus is a benign condition and people are free from it within one year. Repeated attacks may occasionally occur. Weak steroids such as hydrocortisone and clobetasone can be helpful in reducing itching and prominence of eruption. In sever cases oral steroids may be required. Oral retinoid drug etretinate has also been found useful.
Lentigines
    

Lichen simplex chronicus

Also known as circumscribed neurodermatitis
 Mainly seen in tense and anxious middle aged people. Intensely itchy and localised to one or two places thickened and exaggerated skin markings are noted. Mostly seen in inner aspect of ankles, back of scalp, outer aspect of forearms around the wrists and on genitals. It appears as irregular and red plaques with exaggerated skin markings. It is a very stubborn and persistent problem which may remain unchanged for many years. Unfortunately the condition remains regardless of the treatment. But application of potent steroids or coal tar and injection of steroids is sometimes helpful.

Lichen sclerosus et atrophicus

 Small irritating whitish areas noted on the genitalia or around the anus. In men it is mostly seen over the glans penis or prepuce. Good results have been obtained from application of high potency steroids such as clobetasol 17-propionate. Circumcision is recommended for men in such cases.
Lyme disease
 It is a chronic infection involving many systems in the body, presenting with skin changes and progressing to involve joints and nerves. It is caused by a tick borne spirochete Borrelia burgdorferi. A spreading ring like redness is seen at the site of bite. In some cases the problem spreads to appear as nodules and plaques on the feet and hands. Adequate treatment with antibiotics especially penicillins, may prevent the involvement of many bodily systems.
Lymphomatoid papulosis
 It is a benign disorder involving the lymphoid system. It is characterised by recurrent, scaly papules which heal spontaneously laving behind scars. These papules are well circumscribed, red brown indurated with variable sizes upto 2 cm is diameter. They are noted mostly in the inner flexures of the limbs. Biopsy is required for a correct diagnosis. It heals spontaneously but leaves depigmented, atrophic scars.

Mask of pregnancy

Also known as chloasma or melasma
    

Malignant Melanoma

I images-skin cancer-melanoma-2nd page, 4th picture which says colours of melanoma.
 It is a malignant disorder which may arise from an existing mole or from previously normal skin. Irregular pigmentation or black discolouration, irregular surface of the lesion, alteration in size over weeks or months and erosion or appearance of surrounding pigmentation or stellate lesions are all suggestive of the pathology. Although it is a potentially fatal disorder, the early stages are easily curable. Men tend to have a worse prognosis than women. Treatment of choice is excision with generous margins of the surrounding normal skin of at least 2 cm. if the disease has metastasized, anticancer drugs can be tried. Other combinations include retinoids, interferons and interleukin-2.

Melasma

    

Moles

Also known as melanocytic naevi

These are developmental anomalies consisting of immature melanocytes in abnormal numbers. They are very common and on an average every white skinned Caucasian have 16 over their skin. There are different types of moles:
Congenital-they are present since birth. They are usually single, dark brown and more than 1 cm in diameter.
Acquired-arise at some point in childhood or adolescence with unknown cause.
Junctional-this is presumed to be the first stage in the ‘life’of a mole.
Dermal cellular-they are common on face and are often hairy. Their pigmentation density may vary in individuals.
Compound-it is presumed to be in the intermediate stage between the junctional and dermal cellular naevus.

Other varieties include the naevus spilus with large brown naevus, blue naevus, Mongolian spot appearing as a large flat greyish blue macule.		 Congenital naevi, dysplastic naevi, have increased tendency to turn malignant compared to acquired naevi. Hence diagnosis is of importance.
Molluscum contagiosum
 It is caused by a type of virus. Shiny, umblicated, translucent, pink or skin coloured papules are seen. They are slow growing and remain less than 1 cm in diameter. Lesions are noted usually on the head, neck and flexures. They mainly occur in childhood and may be sexually transmitted in adults. They resolve spontaneously within months but to prevent its spread in the community it must be treated. Salicylic acid preparations, curettage and cautery can be helpful.

Mycosis fungoides

 A low grade skin cancer which gives rise to long term, scaly dermatosis and rarely involves lymph nodes as well. Initially the lesions are itchy, scaly, reddish patches of variable size. These are most commonly seen on the trunk and buttocks. Involvement of the scalp may lead to alopecia. It affects males more than females, especially above the age of 60. The disorder is invariably fatal although the rate of progress is variable. Survival ranges from 2-20 years after diagnosis is made.

Myxoid cyst

 Not a true cyst, arising from localised degeneration of tissue. It usually appears as a single, circumscribed, soft and often transparent, upto 5-10 mm in diameter, and is occasionally painful. It is typically found on the outer aspect of the fingers or toes. It can be excised or otherwise extirpated

Nails

Above photo: nails-tinea-unguium

 

Brittle nails are also known as onychorrhexis. Iron and protein deficiency are implicated. The most important factor causing the problem is repeated hydration and drying as in housework, besides mechanical and chemical trauma.
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Brown-black pigmentation of the nails is seen due to melanin pigment or haemosiderin pigment secondary to injury.
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Ringworm of the nails is also known as tinea unguium. The affected nails are thickened, crumbly and discoloured yellow or yellowish-white.

There is no adequate treatment for the discolouration.

 

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Application of allylamines such as terbinafine are quite effective. In resistant cases, oral drugs such as Griseofulvin, ketoconazole, itraconazole may help.

Necrobiosis lipoidica

It consists of well demarcated plaques of skin atrophy with a yellowish discolouration associated with degeneration of skin. It commonly occurs in young and middle aged adults and is seen as atrophic plaques on the shins. The central area may ulcerate while the peripheral area extends. Around 66% of people have or will develop diabetes. Skin biopsy is required and investigation for diabetes should be initiated.

Nickel allergy

See contact dermatitis
    

Nummular eczema

Also known as discoid eczema
 It is a common disorder with unknown origin. The lesions are slightly raised, pink-reddish scaling rounded areas, varying from 1-4 cm in diameter on the arms and legs. It mostly occurs in middle aged and the elderly. Weak and moderately strong steroids such as 1% hydrocortisone, clobetasone or desoximethasone can be applied. Tar preparations alone or in combination with steroids can also be helpful. Emollients can be used as adjuncts.

Perioral dermatitis
Rosacea and perioral dermatitis

 A common inflammatory problem of the skin around the mouth. Papules and pus containing vesicles are commonly seen. Cheeks and forehead never get involved and there is no background redness at the lesions. The conditions develops slowly. It is mostly seen in young women aged 15-25 years. Application of steroids on the lesions can make the condition worse. Oral tetracyclines are usually helpful.

Pityriasis alba

 A common, acquired condition with decreased pigmentation where the lesions are poorly circumscribed, fine scaly, macules noted on the face of children. It is most easily seen in dark skinned children.  

Pityriais lichenoides

 A disorder that commonly affects children and young adults with males affected more than females. The cause remains unknown. The lesions are multiple papules and plaques which develop in crops on the trunk and limbs. Successful treatment has been noted with long-term erythromycin or tetracyclines or phototherapy.
Pityriasis rubra pilaris
It is a rare acquired inflammatory disorder of unknown origin. There are 5 categories of the disorder type1-5. Follicular redness and plugging is seen in the background of an orangish hue to the skin. The condition spreads from head to down over period of a few weeks. Or months. The outer aspects of the fingers are usually affected. It is most commonly seen in middle age and affects both sexes equally. Most people respond to oral retinoids by mouth. Treatment by methotrexate has also been suggested.
Pimples
    
Plantar dermatosis
 This problem has become more common in recent years, affecting children aged 6-12 years predominantly. It seems to be a form of eczema which affects soles of feet. The affected skin looks like scaly, cracked and glazed. Unfortunately the treatment is usually difficult. The condition tends to resist treatment and recurs spontaneously. Treatment with emollients, application of steroids and weak tar preparations is recommended.

Pompholyx

 It is a sever type of eczema of the palms and soles. Vesicles upto 10 mm in diameter can develop. Grouping together of these vesicles produces large bullae with usually cause severe itching. There might be secondary bacterial infection. Its onset is usually between 10-40 years of age. Treatment with wet dressings and weak steroid application helps. After the lesions have healed it is advised to keep the skin clean and avoid any unnecessary injury.

Pregnancy and skin

Chloasma, also known as melasma or mask of pregnancy

Striae gravidarum or stretch marks are straight areas of apparent atrophy of the skin due to disruption of the skin tissue. They occur at the sites of skin stretching when there is excess ambient glucocorticoid activity. They also occur as normal phenomenon in early adolescence, in cushing’s disease, besides pregnancy.
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Skin vascularity is one of the oddest phenomenon that occur in pregnancy. Small vessel malformations known as spider naevi are formed. It may be due to excess of oestrogen activity during pregnancy.

It has been claimed that application of tretinoin preparations and formulations of organic hydroxyacids remove or reduce these lines.

 

 

 

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They invariably gradually fade after delivery.

Pruritus in pregnancy

Pruritus in pregnancy -  generalised itching is sometimes a problem for pregnant women. In some cases it is due to due to bile retention in the last trimester.

Emollients and mentholated calamine preparations may be helpful.

Herpes gestationalis

Herpes gestationis is an uncommon but extremely irritant blistering rash which occurs in the last trimester of pregnancy. The eruption is first noted in the flanks over the abdomen.
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Impetigo herpetiformis is a rare but serious form of generalised pustular psoriasis seen in late pregnancy. It seems to be precipitated by low calcium levels, but the cause and management are not yet known.

The rash usually remits shortly after birth but may recur in later pregnancies or sometimes even on taking oral contraceptive pills.

Psoriasis

It is one of the most important skin disorders because of this high frequency, persistence and recurrent nature. It is genetically determined, inflammatory skin disorder of unknown cause. The lesions are well demarcated raised red scaling patches located mostly on the outer aspects of knees, elbows and scalp. It is found more commonly in men than women. Around 1-3% of population of USA and UK have this problem at any given time.
There are many types of psorisis:
Guttate-seen in children aged 7-14.
Napkin-lesions develop on scalp and trunk.
Erythrodermic-which is widespread in location. Such patients are seriously unwell.

Arthropathic-psoriasis occurs in people with rheumatoid like arthritis.		 When lesions are small in number, emollients such as soft paraffin with 2% salicylic acid is beneficial. In case there are large number of lesions, tar preparations such as ointments and shampoos(for scalp) are used. Tar baths are also helpful in acses with multiple lesions. Dithranol  is a potent reducing agent. It is one of the most effective remedies and clears the lesions in 80% cases in 6 weeks time. For severe cases, methotrexate can be helpful because of its antiproliferative properties. Retinoids are analogues of retinol (Vitamin A) and oral administration on these have been found to be of value in psoriasis. UV radiation has also shown benefit in managing the problem. Cyclosporine which is a immunosuppressant is also dramatically effective in psoriasis.

Ring worm

Tinea corporis

 Tinea cruris

 Tinea pedis

Tinea manuum-

Three species of ringworm are responsible for this group of skin infections. The infection is confirmed by direct observation under a microscope or culture of the organism in the laboratory.
Types of infections:
Tinea corporis-affects the skin of the body and of limbs. The infected patches are itchy, red and scaly.
Tinea cruris-affects the groin and is very itchy. It is a disorder mostly seen in young men.
Tinea pedis-affects the feet. It is a very common problem noted in young and middle aged men.
Tinea manuum-is less common and usually involves one palm only.
Tinea capitis-affects the scalp of children exclusively.

Tinea unguium-affects the nail plate and nail bed.  		For ordinary ringworm of the hairy skin, miconazole, econazole and clotrimazole preparations are effective. Orally administered medications such as Griseofulvin, ketoconazole, itraconazole and terbinafine may be required in acses where multiple areas are affected or when topical application of medications has failed.

Rosacea

 It is a chronic inflammatory problem of the skin of the face. There is persistent redness besides episodes of swelling and popular lesions. The cheeks, forehead and chin are the most commonly involved places. It can cause considerable social discomfort and often marked depression. The complications of this condition include rhinophyma, lymphoedema, eye problems and lupoid rosacea. The acute episodes can be managed with oral tetracycline, erythromycin or metronidazole. The dosages can be reduced once the acute episodes subsides. Application of steroids is not at all advised. Emollients, sunscreens and application of metronidazole preparations are helpful.

Scabies

 This disoreder is caused due to infestation with human scabies mite Acarus hominis. This mite is spread by close human contact and the female of the mite lives in a layer of the skin. The female lays eggs in this skin layer. The condition causes intense itch. The primary lesion looks like a burrow or run which are tiny raised linear white marks, some 1-4 mm long. The most commonly affected sites are palms and interdigit areas of fingers, elbows, axillary folds, buttock folds, genitalia, knees, ankles and even soles. Treatment should be offered to all who live with the affected person. Lotions or creams are applied to whole body except head and neck. The preparations usually used are : benzylbenzoate 25%, permethrin 1%, crotamiton 10%. Benzylbenzoate is irritant to children and hence best avoided in them.

Schamberg's disease

 This is a type of inflammation of the capillaries. The lesions mostly occur on the lower legs and thighs. They look like cayenne pepper like in colour. This problem usually causes little disability and disappears spontaneously after a variable period. No treatment is required.

Sebaceous gland hyperplasia

 It is a common phenomenon occurring in up to one fifth of all elderly population. There are one or more yellowish skin coloured papules which develop over cheeks, forehead, nose or chin. Some of them may have a central opening.  They are only enlarged lobules of normal hai follicular glands. These are benign in nature and require no treatment.
Seborrhoeic dermatitis
 This is a commonly occurring problem which occurs in hairy areas of the body. Red, itchy papules appear at the affected sites. These lesions may later become scaly or start to exude fluid and become crusted eventually. The most commonly affected sites are on the scalp, over eyebrows, in the folds between the nose and mouth and on the chin. Itchy and red lesions also occur commonly in the groins in the overweight middle aged and elderly people. Application of 1% hydrocortisone or miconazole or clotrimazole should be sufficient. If resistant condition is noted, preparation of sulphur and salicylic acid should be tried. If there are lesions large in number, exuding fluid, bed rest is advised to avoid friction between surfaces. Also oral antibiotics such as ampicillin or a tetracycline will have to be initiated.
Seborrhoeic warts
 These are benign, pigmented warty lesions that appear in middle-life and gradually increase in number. They are especially common in areas exposed to light, but are more prolific over the trunk. They seem like being stuck on the skin surface. They do not need any treatment. But if a person does want them removed, the best treatment is to curette them off using a local anaesthesia and cauterise the base. They rarely return at the same site again.
Skin changes in the elderly
 The epidermis and dermis parts of the skin become thinner on non-light exposed areas. These changes are less evident on light exposed areas due to the skins response to the ultraviolet rays over the years. Also blood vessels decrease in number and thickness. Hairs lessen but paradoxically the sebaceous glands on the face enlarge. Pigment cells are become fewer in number and smaller. Wound healing is slower and may be less complete. There can be irregular pigmentation on the sun exposed parts. Rate of sebum secretion from the glands decreases. The skin tends to become dryer and itchier. This tendency is increased because of relatively low humidity, frequent hot bathing, vigorous towelling and other illnesses. Eczema in elderly can be discoid (nummular), eczema craqelee, photosentivity eczema, and atopic eczema. Eczema craqelee is very specific to the elderly. Eczema can spread relatively rapidly in the elderly and make it disabling. Treatment of eczema in the elderly is not different from any other age group. Emollients are more important in the elderly than in younger age group. Since there is slow healing process in the elderly, oral medications such as cyclosporine, azathioprine, and steroids should be ready looked into

Senile keratosis

Also known as solar keratosis
 A common localised area of irregular growth of skin due to long term sun exposure. Long term exposure to the ultraviolet radiation is the most important causative factor. Around 50% of the population over the age of 40 suffers from this condition in subtropical parts of Australia. The lesions are typically raised, pink or grey, scaly and thick papules. They are mostly 2-5 mm in diameter, but may be at times larger. They are usually found on sun exposed areas of fair skinned people. Single lesions can be surgically excised or curetted off. When larger numbers are present, cryotherapy or liquid nitrogen can be used. Chemotherapy with application of 5-fluorouracil as 5% ointment can be tried when there are large number of lesion present. Systemic retinoids such as etretinate or isotretinoin can be used for people when other types of therapy are not suitable. Injection of alpha-2beta or gamma interferon, into the lesion directly has also shown improvements.
Subacute cutaneous lupus erythematosus
 Widespread reddish eruption over light exposed surfaces associated with photosensitivity is seen. Lesions are reddish, sharply demarcated, annular, and in a symmetrical distribution. Children of mothers suffering this condition are at risk of developing heart block and neonatal lupus erythematosus Avoiding the sensitizer is all that is required. In cases where there is itching, antihistamines can be helpful. It is of paramount importance that the condition is diagnosed early in pregnancy to prevent congenital heart block.

Squamous cell carcinoma

Squamous cell carcinoma and actinic keratosis

 It is a malignant cancer of the skin. Most of the lesions are warty nodules or plaques that enlarge and become ulcerated. The lesions are usually single in number. Spread to other parts of the body occurs later if the primary lesions are left untreated. The cancer can spread to local lymph nodes, local skin sites, and finally to lungs, bone and brain. Long term ultraviolet exposure, x-rays, persistent heat injury, papilloma virus infection and exposure to chemical carcinogens are all predisposing factors to this cancer. Excision with adequate margin to ensure inclusion of all cancerous tissue and some healthy tissue provides cure to 95% cases. For elderly, who have single, large, difficult to operate lesions, radiotherapy is beneficial. In cases with multiple lesions, oral retinoids are useful.

Statis dermatitis

Also known as gravitational eczema or venous eczema

 This type of eczema occurs predominantly on the lower legs in people with long term venous hypertension. Itchy pink scaling areas are noted. These areas exude fluid and and become fissured in the backdrop of chronic venous hypertension. The affected areas are around venous ulcers. In most cases the eczema is due to an allergic contact reaction to any substances used to treat the venous ulcer Care must be taken to identify the contact hypersensitivity agent. Application of soft paraffin is good enough as an emollient and 1% hydrocortisone can be used to reduce inflammation.

Sun damage

The ultraviolet rays which are from 250 to 400 nm in range are of greatest biological importance. It is divided into UVA (320-400 nm), UVB (280-320 nm) and UVC (250-280 nm). The medium wave spectrum (UVB), especially radiation around 290 nm is mainly responsible for sunburn as well as for sun tan. This wave band penetrates the skin to the bottom of epidermis which is a part of skin. This causes cells to burn and die. The injured cells release chemicals which indirectly lead to increase in melanocyte production.

UVA on the other hand is less effective in causing redness of the skin. But it is thought that this type of radiation may be associated with appearance of aging and also to photosensitivity reactions. The skin changes due to chronic exposure to UV rays is more evident in the fair skinned, blue eyed, subjects in north west Europe (types I and II) who sunburn easily. Persistent sun exposure leads to damage both in the dermal and epidermal layers of the skin.

Prevention is always better than cure. Avoidance of exposure is the best form of prevention. The next best things is to reduce the UV raysby avoiding direct exposure in between hours of 11 AM and 2 PM, seeking shade wherever possible, use of protective clothing and use of sunscreens. Reflective substances such as titanium dioxide and zinc oxide protect against both UVA and UVB.
Also worth remembering is that UVR is readily reflected from whitish surfaces such as sand, snow and white walls and this increases UVR exposure. A certain amount of UVR diffuses through cloudy skies, so sunburn can happen even on dull days!

It has been found, the more nearer the equator, and higher the latitude, the more direct the UVR and more the sunburn.

Sweat rash

 Sun exposure is also responsible for this problem as a result of heating infrared component of sun rays. A common form occurs due to blockage of sweat gland openings near the skin surface. Numerous tiny delicate vesicles are seen. The most effective treatment of these tiny vesicles is to cool the person to prevent further sweating, using air conditioning, fans and cold water bandaging. For severe cases oral antibiotics and anti-inflammatory drugs may be required.

Urticaria

Also known as hives, nettlerash, or wheals

 It is an extremely common disorder and there are only a few individuals who do not experience this condition in some form or other during their lifetime. The lesions are itchy red papules and plaques of variable size that often arise within a few minutes and last 6 -24 hours. The ultimate cause of urticaria is release of histamine, a chemical released by mast cells in the body. Some of the causes of urticaria include foods such as fish, prawns, crabs, milk, penicillins, aspirins, hot baths, exercise, cold and light or persistent pressure over skin. Any identifiable causes should be avoided. H1 antihistamines are the most effective agents to relieve symptoms in this problem. The ‘older’generation such as promethazine, chlorpheniramine and diphenhydramine also have sedative effects. Newer generation antihistamines such as terfenadine, astemizole, cetrizine and loratidine are less sedative. Acute and severe attack may require oral steroids. In cases where it is life threatening, intravenous steroids is used.

Urticaria pigmentosa

Also known as mastocytosis

 This is a term to describe a group of disorders in which there are excess mast cells in may tissues in the body but they are manifested in the skin. This condition generally begins in infancy or childhood. With adult onset, there is a risk of it developing into a generalised systemic mast cell disease. Lesions are multiple reddish-brown representing abnormal collections of mast cells. The pigmentation is due to melanin present in increased amounts in the skin. Itch is a common complaint. Juvenile form of the disorder remits spontaneously during adolescence and no treatment is required. In adult form there is no need to have any particular concern and no functional deficits occur in vast majority of people.

Vitiligo

 A common skin disorder in which there is focal failure of pigmentation due to destruction of melanin producing cells. It is thought to be due to immunological mechanisms. There are sharply defined areas of depigmentation which are slightly pink at the start of the disorder. The areas are much more evident in summer months when the surrounding skin becomes sunburnt. It is a serious cosmetic issue for dark skinned people. The condition mostly starts in childhood. It occurs in 1-2% of the population and is more common when other members of the family are affected. The condition is very resistant to treatment. If the person needs to camouflage, staining the skin with 2% hydroxyacetone may help. Treatments with application of steroids, PUVA are sometimes helpful in stimulating re-pigmentation

Warts

See Seborrhoeic warts
    

Xanthomata

 

They are deposits of lipid deposits in skin and may be associated with normal or elevated lipid levels in the body.

 

Xanthalasma

It is a common form of xanthoma in which lesions appear as papules around the eyes.

If they are cosmetically displeasing, one can get them removed surgically or by application of trichloracetic acid. This can be dangerous since the acid can produce serious burns if applied incorrectly.

Xanthoma tuberosum

 These are large nodules that develop around tendons and outer aspects of joints in people who have familial hyperlipidaemia. Mostly affected sites are Achilles tendon, knees and elbows.

Lipid lowering agents need to be instituted to lower the levels. Drugs used are clofibrate, bezafibrate or gemfibrozil.

Xerosis

 People can have varying degrees of dryness of their skin. For some it is not a major issue, but for some who have gross scaling, and thickening of skin surfaces, it can be virtually crippling. Major causes of scaling include all varieties of eczema, skin infections such as ringworm, psoriasis, and icthyotic disorders.

Emollients hydrate the skin surface and help. One can also have the same effects by bath oils such as oilatum emollient or soap. Agents such as 1-6% salicylic acid, that promote desquamation smooth the skin surface.

Practical advise to people with dry skin is to avoid central heating too much, avoid frequent hot baths, patting dry is better than vigorous towelling, try to wear cotton rather than woollen clothings.