An abcess is a localized collection of pus in any part of the body, caused by an infection.
An abscess is a tender, easily pressed mass generally surrounded by a colored area from pink to deep red. The middle of an abscess is full of pus and debris.
Painful and warm to touch, abscesses can show up any place on your body. The most common sites are in your armpits (axillae), areas around your anus and vagina (Bartholin gland abscess), the base of your spine (pilonidal abscess), around a tooth (dental abscess), and in your groin. Inflammation around a hair follicle can also lead to the formation of an abscess, which is called a boil (furuncle).
Acne typically appears on face, neck, chest, back, shoulders and the areas of skin with the largest number of functional oil glands. People with acne frequently have a variety of lesions, some of which are shown in the diagrams below. The basic acne lesion, called the comedo, is simply an enlarged and plugged hair follicle. Acne can take the following forms;
Whiteheads: These are created when the openings of hair follicles become clogged and blocked with oil secretions and dead skin. If the plugged follicle, or comedo, stays beneath the skin, it is called a closed comedo and produceswhite bump called a whitehead.
Blackheads: These are similar to whiteheads, but are open to the skin surface and darken.It appears as black color. This black discoloration is due to changes in sebum as it is exposed to air. It is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.
Other troublesome acne lesions can develop, including the following:
Papules: inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch
Macule: A macule is the temporary red spot left by a healed acne lesion. It is flat, usually red or red-pink, with a well-defined border. A macule may persist for days to weeks before disappearing. When a number of macules are present at one time they can contribute to the “inflamed face” appearance of acne. It shows the “red face” appearance.
Pustules (pimples): These are raised; reddish spots that signal inflammation or infection in the hair follicles. Papules topped by white or yellowpus-filled lesions that may be red at the base
Nodules: large, painful, solid lesions that are lodged deep within the skin
Cysts: These are thick lumps beneath the surface of the skin, which are formed by the buildup of secretions deep within hair follicles. Deep, painful, pus-filled lesions that can cause scarring. After resolution of acne lesions their may be prominent unsightly scars
A boil, also referred to as a skin abscess, is a localized infection deep in the skin. A boil generally starts as a reddened, tender area. Over time, the area becomes firm and hard. Eventually, the center of the abscess softens and becomes filled with infection-fighting white blood cells that the body sends from the blood stream to eradicate the infection. This collection of white blood cells, bacteria, and proteins is known as pus. Finally, the pus “forms a head,” which can be surgically opened or spontaneously drain out through the surface of the skin.
Signs and symptoms of Candida
Red, itchy, scaling rash on skin, usually worse in the skin folds under the breast, stomach, and arm pits. This vaginal infection occurs predominantly in reproductive age women. The main symptoms produced by a candida yeast vaginitis are vaginal and/or vulvar itching (pruritus), or even a vulvar burning sensation. There is a cheese-like (caseous) white to white yellow discharge. Also there can be swelling of the perineum or a redness (erythema) (1). The discharge is not watery and usually not odorous. Symptoms build up over 1-3 days.
Symptoms
• Ulceration of the digits and toes.
• Red nose.
• Skin redness.
• Toe skin inflammation.
• Finger skin inflammation.
• Earlobe inflammation.
• Intense, distressing itching and burning pain.
• Worse from sudden change from cold to hot atmosphere.
Corns are hyperkeratosis of the skin. This thickening of the surface layer of the skin in response to pressure. Corns usually form on the toes, where the bone is prominent and presses the skin against the shoe, ground, or other bones. As corn becomes thick the tissues under the corn are subject to increased irritation. There may be a deep-seated nucleation; this is like a core where the corn is thickest and most painful. As corns become inflamed, there is pain and sometimes swelling and redness. Common places where corns form are; the top surface of the toe, at the tip of the toe, and between the toes.
Symptoms
• Pain in feet or heel on standing or walking.
• Variations in temperature, especially cold, dampness, which cause spontaneous pain.
ETIOLOGY
Exact case is unknown.
Predisposing causes are-
• Individual susceptibility to offending agent.
• Familial predisposition.
• Prolonged exposure to sunlight.
• Exposure to ultra-voilet rays.
• Trauma.
• Infection.
• Psychogenic stress.
• Pre-existing disease.
• Poor general health.
• Hyperhydrosis.
• Focal sepsis.
• Exposure to allergen.
• During hormonal immbalance.
• Sedentry life.
• Constipation.
• Any other condition which lowers local skin resistance.
Symptoms include – Face — red, usually glossy appearance; swollen, hot, may or may not have blisters. Pain . Fever. Chills. Feel ill.
What is Melasma/Chloasma?
A patchy brown or dark brown skin discoloration that usually occurs on face and may result from hormonal changes, as in pregnancy and during the administration of estrogen containing oral contraceptives.
Causes, incidence, and risk factors for Melasma/Chloasma
• Melasma is a very common skin disorder. Though it can affect anyone, young women with brownish skin tones are at greatest risk. Chloasma is especially common in women aged 20-40. It is more common in dark skins than in fair skins.
• Melasma is often associated with the female hormones estrogen and progesterone. It is especially common in pregnant women, women who are taking oral contraceptives (“the pill”), and women taking hormone replacement therapy during menopause.
• Sun exposure is also a strong risk factor for melasma. It is particularly common in tropical climates.
• Melasma develops due to a combination of genetic, hormonal and sun related factors
• Melasma has been referred to as the mask of pregnancy because it often develops during pregnancy. Because of melasma’s relation to pregnancy and oral contraceptives, it is thought that estrogen contributes to its development in predisposed persons.
• Estrogen is not essential to the development of melasma, however, as men may also be affected.
• Both ultraviolet A (UVA) and ultraviolet B (UVB) are believed to contribute to the formation of melasma in predisposed persons.
• It may develop in association with menopause, hormonal imbalance and ovarian disorders.
• Melasma may also be triggered by a medication called Dilantin (phenytoin).
• It is thought that female sex hormones causes melanocytes or the pigment-producing cells to produce and deposit excess pigments.
• Chloasma usually affects women but occasionally is seen in young men who use after-shave lotions, scented soaps, and other toiletries.
• Chloasma is more pronounced during the summer months as a result of sun exposure. It usually fades a few months after delivery. Repeated pregnancies, however, can intensify the pigmentation.
• Sun exposure, following the use of deodorant soaps, scented toiletries, and various cosmetics can also produce this mottled pigmentation. This is called a phototoxic reaction and is due to ultraviolet radiation being absorbed by the chemical substance on the skin.
• Deficiency of Folic Acid during pregnancy can also lead to development of Melasma.
Melasma during pregnancy is relatively common. Sometimes it is called the “mask of pregnancy.” The dark patches typically last until the pregnancy ends. Despite the strong connection to hormones, no one knows exactly what causes the skin discoloration.
Symptom Picture of Chloasma / Melasma:
• Tan, dark brown patches
• Irregular in shape
• These patches usually develop on the upper cheek, upper lip and forehead.
• The dark patches often appear on both sides of the face in a nearly identical pattern. The darker-colored patches of skin can be any shade, from tan to deep brown.
• Rarely, these dark patches may appear on other sun-exposed areas of the body.
• The dark patches often appear on both sides of the face in a nearly identical pattern.
• The darker-colored patches of skin can be any shade, from tan to deep brown.
• Rarely, these dark patches may appear on other sun-exposed areas of the body.
Melasma doesn’t cause any other symptoms besides skin discoloration but may be of great cosmetic concern.
How does someone get genital herpes?
Most people get genital herpes by having sex with someone who is having a herpes “outbreak.” This outbreak means that HSV is active. When active, the virus usually causes visible lesions in the genital area. The lesions shed (cast off) viruses that can infect another person. A person with genital herpes also can infect a sexual partner during oral sex. The virus is spread only rarely, if at all, by touching objects such as a toilet seat or hot tub.
Genital Herpes Symptoms
When a person becomes infected with herpes for the first time, the symptoms will appear within 2 to 10 days. These first episodes of symptoms usually last 2 to 3 weeks.
Early symptoms of a genital herpes outbreak include
• Itching or burning feeling in the genital or anal area
• Pain in the legs, buttocks, or genital area
• Discharge of fluid from the vagina
• Feeling of pressure in the abdomen
Other symptoms that may go with the first episode of genital herpes are fever, headache, muscle aches, painful or difficult urination, vaginal discharge, and swollen glands in the groin area
Can outbreaks recur?
If you have been infected by HSV 1 and/or 2, you will probably have symptoms or outbreaks from time to time. After the virus has finished being active, it then travels to the nerves at the end of the spine where it stays for a while. Even after the lesions are gone, the virus stays inside the nerve cells in a still and hidden state, which means that it’s inactive.
In most people, the virus can become active several times a year. This is called a recurrence. When it becomes active again, it travels along the nerves to the skin, where it makes more viruses near the site of the very first infection. That is where new sores usually will appear.
The frequency and severity of recurrent episodes vary greatly. While some people have only one or two outbreaks in a lifetime, others may have several outbreaks a year. The number and pattern of repeat outbreaks often change over time for a person. Scientists do not know what causes the virus to become active again. Although some people with herpes report that their outbreaks are brought on by another illness, stress, or having a menstrual period, outbreaks often are not predictable. In some cases, outbreaks may be connected to exposure to sunlight.
Shingles is a skin rash caused by the same virus that causes chickenpox. This virus is called the Varicella zoster virus (VZV) and is in the Herpes family of viruses. After an individual has chickenpox, this virus lives in the nervous system and is never fully cleared from the body. Under certain circumstances, such as emotional stress, immune deficiency (from AIDS or chemotherapy), or with cancer, the virus reactivates and causes shingles.
Anyone who has ever had chickenpox is at risk for the development of shingles, although it occurs most commonly in people over the age of 60. The herpes virus that causes shingles and chickenpox is not the same as the herpes viruses that causes genital herpes (which can be sexually transmitted) or herpes mouth sores. Shingles is medically termed Herpes zoster.
ETIOLOGY
CAUSATIVE ORGANISM
• Varicella zoster virus.
Site of pathology
• Posterior root ganglion.
PredisposingCauses
• Physical injury.
• Mental trauma.
• Febrile illness.
• Debility.
• Any condition decreasing local skin resistance.
Age
• Adults, old subjects.
Incubation period
• 7-21 days.
Clinical Features of Herpes Zoster
Onset
• Insidious.
Location
• Trunk (intercostal nerves).
• Face (trigeminal distribution).
• Neck (cervical).
Symptoms
The first symptom is usually one-sided pain, tingling, or burning. The pain and burning may be severe.
Red patches on the skin form, followed by small blisters that look very similar to early chickenpox. The blisters break, forming small ulcers that begin to dry and form crusts. The crusts fall off in 2 to 3 weeks.
The rash usually involves a narrow area from the spine around to the front of the belly area or chest. It may involve face, eyes, mouth and ears.
Additional symptoms may include:
• Abdominal pain
• Chills
• Difficulty moving some of the muscles in the face
• Drooping eyelid (ptosis)
• Fever
• General ill-feeling
• Genital lesions
• Headache
• Hearing loss
• Joint pain
• Loss of eye motion (ophthalmoplegia)
• Swollen glands (lymph nodes)
• Taste problems
• Vision problems
• Severe neuralgic pain.
• Local hyperaesthesia.
Lesion
• Develop 3 days after onset of attack.
• Start as reddish plaques.
• Unilateral distribution, along segmental distribution of affected nerve root.
• Crops of vesicles appear.
• Speedily increase in size.
• Become confluent.
• Vesicles contain serous fluid.
• In few days content become opaque.
• Absorption of contents occurs.
• Brown adherent crusts form.
• In few weeks crusts separate leaving pigmented scars.
• Regional lymph glands enlarged, painful.
Complications
• Another attack of shingles
• Blindness (if lesions occur in the eye)
• Deafness
• Infection, lesions in body organs, encephalitis or sepsis in persons with weakened immune systems
• Post-herpetic neuralgia
• Secondary bacterial skin infections
• Ramsay-hunt syndrome (if geniculate ganglion is affected).
• Corneal ulceration (if ophthalmic division is affected).
General Management of Herpez zoster / Shingles
• Light, nutritious, easily digestible diet.
• Keep affected parts clean.
• Adequate physical, mental rest.
It occurs when the melanocytes, cells responsible for skin pigmentation, die or are unable to function.
.
• Age: onset between 10-30 years.
CLINICAL FEATURES
Onset
• Insidious.
Location
• Common sites, to start with, are pressure points, i.e. knuckles, elbows, lips.
Symptoms
• Lesion do not itch.
Lesion
• Start as white localised macules.
• Rounded, well defined at onset.
• Adjacent lesions coalesce.
• As they increase in size, become irregular.
• Spread to involve greater parts of the body.
• Depigmented lesion is surrounded by area of apparent hyper pigmentation.
• No sensory loss in lesion.
• Every little trauma heals with depigmentation.
• Lesions are hypersensitive to sunlight.
DIAGNOSIS
• Clinical.
Lichen planus may cause a small number of skin lesions or less often affect a wide area of the skin and mucous membranes. In 85% of cases it clears from skin surfaces within 18 months but it may persist longer especially when affecting the mouth or genitals.
Signs and Symptoms of Lichen planus
Classical lichen planus is characterized by shiny, flat-topped, firm papules (bumps) varying from pin point size (‘guttate’) to larger than a centimetre. They are a purple colour and often are crossed by fine white lines (called ‘Wickham’s striae’). They may be close together or widespread, or grouped in lines (linear lichen planus) or rings (annular lichen planus). Linear lichen planus can be the result of scratching or injuring the skin. Although sometimes there are no symptoms, it is often very itchy.
Lichen planus may affect any area, but is most often seen on the front of the wrists, lower back, and ankles. On the palms and soles the papules are firm and yellow. Very thick scaly patches are particularly itchy and are most likely to arise around the ankles (hypertrophic lichen planu).
New lesions may appear while others are clearing. As the lichen planus papules clear they are often replaced by areas of greyish-brown discolouration, especially in darker skinned people. This is called postinflammatory hyperpigmentation and can persist for months.
Moles are small growths on the skin which develop from melanocytes, the pigment-producing cells in the skin. Moles can appear anywhere on the skin and are the most common skin growth. Moles uaully appear as dark brown spots on the skin which are either flat or raised. They may vary in size, shape, number, color, and type. Moles may develop at any age.
Moles are also known as Nevus; nevi are the plural form of the word, they are a cluster of melanocytes that appear as brown spots on the skin. Most birthmarks and moles fall into the category of nevi. The great majority of moles are harmless, but in rare cases, moles may become cancerous.
Types of moles:
Moles are divided into-
1. Common acquired nevi.
2. Congenital nevi
Common acquired nevi.
Common acquired nevi are the most common type, as the name itself suggest. The numbers of these nevi increase as a person ages and they remain throughout the life.
Congenital nevi
It may occur in one out of every 100 people, sometimes more than that. These moles will last a lifelong. It may be large or small in size. Their color ranges from tan to a brown color or even black. Most often, there is also a hair raised out of the middle of the mole. These moles can also become melanoma just like common acquired moles. Giant congenital nevi (picture) which cover a large area of the skin; very rare occur in approximately one out of every 10,000 births.
What causes moles?
Following factors are supposed to be responsible:
Some people are born with moles. Other moles appear over time.
Sun exposure seems to play a role in the development of moles.
Heredity – many families have a type of mole known as dysplastic (atypical), which can be associated with a higher frequency of melanoma or skin cancer.
Moles may be due to potassium deficiency.
Melanin is a natural pigment that gives your skin its color. It’s produced in cells called melanocytes, either in the layer of the skin epidermis and dermis; it is distributed evenly, to the surface cells of skin, but sometimes melanocytes grow together in a cluster, giving rise to moles.
Benign moles develop from an excess accumulation of melanocytes. In rare cases, a benign mole, especially one that is large and varied, may turn into an atypical mole.
What are the signs and symptoms of moles?
• The typical mole is a plain, brown spot, with colors difference, different shapes and sizes; it can be flesh-colored, reddish-brown, medium to dark brown, or blue; vary in shape from oval to round, from pinhead or large enough to cover any body part.
• The surface can be smooth or wrinkled, flat or raised.
• Although most moles develop by age 20, they can continue to appear until midlife. Hormonal changes during adolescence and pregnancy and with the use of birth control pills, moles likely to change larger, darker and become more numerous
• Most people have some benign moles that appear at birth, or during childhood or adolescence.
• Number of moles can also found on the skin [multiple moles/multiple naevi]
Color of the mole is not throughout the same or it has shades of tan, brown, black, red, white or blue.
Diameter of amole is larger than 6mm.
Conventional Treatment of moles:
Mole Removal
Benign moles do not, need to be treated. They can be removed for cosmetic purpose. If malignancy is detected then surgery may be perform along with chemotherapy and radiotherapy according to the case.
Moles, or nevi can be removed by two surgical methods:
Excision (cutting) with stitches.
Excision with cauterization (a tool is used to burn away the mole).
Although laser has been tried for moles, it is not usually the method of choice for most deep moles because the laser light doesn’t penetrate deeply enough.
Typically, the doctor or dermatologist may choose excision with or without stitches depending on the depth of the mole and the type of cosmetic outcome desired.
Molluscum contagiosum (MC) is a viral infection of the skin or occasionally of the mucous membranes. MC has no animal reservoir, infecting only humans, as did smallpox. The infecting human MC virus is a DNA poxvirus called the molluscum contagiosum virus (MCV).
The virus commonly spreads through skin-to-skin contact. This includes sexual contact or touching or scratching the bumps and then touching the skin. Handling objects that have the virus on them, such as a towel, can also result in infection. The virus can spread from one part of the body to another or to other people.
ETIOLOGY/CAUSES
• Molluscum contagiosum is caused by a virus that is a member of the poxvirus family. You can get the infection in a number of different ways.
• This is a common infection in children and occurs when a child comes into direct contact with a lesion. It is frequently seen on the face, neck, armpit, arms, and hands but may occur anywhere on the body except the palms and soles.
• The virus can spread through contact with contaminated objects, such as towels, clothing, or toys.
• The virus also spreads by sexual contact. Early lesions on the genitalia may be mistaken for herpes or warts but, unlike herpes, these lesions are painless.
• Persons with a weakened immune system (due to conditions such as AIDS) may have a rapidly worse case of molluscum contagiosum.
CLINICAL FEATURES
• Onset- insidious.
• Location- trunk, arms, neck, face, thighs.
LESION
• Pearly-white, smooth, umblicated, dome-shaped.
• Multiple, discrete.
• Size- 2-5 mm.
• Hard in consistency.
• When squeezed, cheesy material is discharged.
COURSE
• Self limiting lesions usually clear spontaneously in about a years time without any sequelae, though some lesions may resolve with scarring.
• Large solitary lesions may not resolve spontaneously.
• Persistent, extensive & difficlt to treat lesions in immunocompromised individuals & in patients with atopic dermatitis.
COMPLICATION
• Superimposed secondary infection.
DAIGNOSIS
• Clinicaly.
Differential diagnosis
• Verruca vulgaris.
• Cryptococcosis.
Psoriasis is quite common, affecting around two per cent of the population, although people with very mild symptoms may not be aware they have it. Psoriasis can begin at any age but usually starts either around the age of 20 or between 50 and 60.
The disorder is a chronic recurring condition which varies in severity from minor localized patches to complete body coverage. Fingernails and toenails are frequently affected (psoriatic nail dystrophy) and can be seen as an isolated finding. Psoriasis can also cause inflammation of the joints, which is known as psoriatic arthritis. In contrast to eczema, psoriasis is more likely to be found on the extensor aspect of the joint.
Causes of Psoriasis
As said earlier according to modern medical science the causes of psoriasis are unknown. But the following factors can trigger psoriasis.
Heredity – If one parent is affected then there is 15% of chances for the child to suffer from psoriasis. If both the parents are affected then the possibility of child getting the psoriasis is 60%.
Throat infections trigger psoriasis.
Trauma or hurt on skin like cuts, bruises or burns may cause psoriasis.
Some medicines or skin irritants initiate psoriasis.
Smoking and alcohol are other two factors which activate psoriasis.
Mental stress or psychological trauma may also set off psoriasis.
Due to abnormality in the mechanism in which the skin grows and replaces itself causes psoriasis.
Abnormality with the metabolism of amino acids.
Use of certain medicines.
Due to infections.
Heredity factors are also responsible.
Physical and emotional stress.
Diet- common in non-vegetarians.
Weather- exacerbations in winters & remissions in summers.
Hormonal- worse at or after menopause & remission during pregnancy.
Types
The symptoms of psoriasis can manifest in a variety of forms. Variants include plaque, pustular, guttate and flexural psoriasis.
Plaque psoriasis (psoriasis vulgaris):
Plaque psoriasis is the most common form of psoriasis. It affects 80 to 90% of people with psoriasis. Plaque psoriasis typically appears as raised areas of inflamed skin covered with silvery white scaly skin. These areas are called plaques.
Flexural psoriasis (inverse psoriasis):
Flexural psoriasis appears as smooth inflamed patches of skin. It occurs in skin folds, particularly around the genitals (between the thigh and groin), the armpits, under an overweight stomach (pannus), and under the breasts (inframammary fold). It is aggravated by friction and sweat, and is vulnerable to fungal infections.
Guttate psoriasis:
Guttate psoriasis is characterized by numerous small round spots (differential diagnosis—pityriasis rosea—oval shape lesion). These numerous spots of psoriasis appear over large areas of the body, such as the trunk, limbs, and scalp. Guttate psoriasis is associated with streptococcal throat infection.
Pustular psoriasis:
Pustular psoriasis appears as raised bumps that are filled with non-infectious pus (pustules). The skin under and surrounding the pustules is red and tender. Pustular psoriasis can be localised, commonly to the hands and feet (palmoplantar pustulosis), or generalised with widespread patches occurring randomly on any part of the body.
Psoriasis of a fingernail
Nail psoriasis produces a variety of changes in the appearance of finger and toe nails. These changes include discolouring under the nail plate, pitting of the nails, lines going across the nails, thickening of the skin under the nail, and the loosening (onycholysis) and crumbling of the nail.
Psoriatic arthritis:
Psoriatic arthritis involves joint and connective tissue inflammation. Psoriatic arthritis can affect any joint but is most common in the joints of the fingers and toes. This can result in a sausage-shaped swelling of the fingers and toes known as dactylitis. Psoriatic arthritis can also affect the hips, knees and spine (spondylitis). About 10-15% of people who have psoriasis also have psoriatic arthritis.
Erythrodermic psoriasis:
Erythrodermic psoriasis involves the widespread inflammation and exfoliation of the skin over most of the body surface. It may be accompanied by severe itching, swelling and pain. It is often the result of an exacerbation of unstable plaque psoriasis, particularly following the abrupt withdrawal of systemic treatment. This form of psoriasis can be fatal, as the extreme inflammation and exfoliation disrupt the body’s ability to regulate temperature and for the skin to perform barrier functions.
Psoriasis is a chronic relapsing disease of the skin, which may be classified into nonpustular and pustular types as follows-
Nonpustular psoriasis
• Psoriasis vulgaris (Chronic stationary psoriasis, Plaque-like psoriasis).
• Psoriatic erythroderma (Erythrodermic psoriasis).
Pustular psoriasis
Generalized pustular psoriasis (Pustular psoriasis of von Zumbusch).
Pustulosis palmaris et plantaris (Persistent palmoplantar pustulosis, Pustular psoriasis of the Barber type, Pustular psoriasis of the extremities).
Annular pustular psoriasis.
Acrodermatitis continua.
Impetigo herpetiformis.
Additional types of psoriasis include
Drug-induced psoriasis.
Inverse psoriasis.
Napkin psoriasis.
Seborrheic-like psoriasis.
CLINICAL FEATURES
ONSET
Insidious
LOCATION
Scalp, extensor surfaces of arms, forearms, legs, trunk, joints, nails, palms and soles.
SYMPTOMS
• Red and irritated skin with bright silvery scales.
• Itching characteristically absent.
LESION
Skin:
Start as dry, well defined erythematous papules.
Symmetrical distribution.
Coin shaped (nummular psoriasis).
Layers of silvery scales form.
Papules increase peripherally and coalesce (psoriasis gyrate).
Become thicker (due to accumulation of scales) to form plaques.
Candle-grease sign positive: – when psoriatic lesion is scratched, candle grease like scale is produced even from non-scaling lesions.
Scales looser towards periphery of patch, firmly adherent at centre.
Auspitz sign positive: – complete removal of scale produces pin-point bleeding.
Koebner phenomenon positive in acute phase: – psoriatic lesions appear at site of scratching or trauma.
When patches reach a diameter of 5 cm: – central clearing occurs producing ringed lesions (annular psoriasis).
Lesions heal with faint staining which disappears slowly.
Nails:
Pits of 1 mm diameter.
Transverse ridging of nail plate.
Onycholysis.
Separation of distal portion of nail from nail bed and walls.
Subungual hyperkeratosis causing thickening of nails.
Oil drop sign: – brownish-red areas of discolouration adjacent to nail plate. Oil spots are 2-4 mm in diameter.
COMPLICATIONS
Psoriatic arthropathy.
Exfoliative dermatitis.
Hypoproteinaemia.
COURSE
Chronic, inconstant course.
Remissions and exacerbations.
Disease may remain localised to original site of affection for indefinite period, or completely disappear, recur or spread to other parts.
Nail lesions are resistant to treatment.
Prognosis variable.
DIAGNOSIS
A diagnosis of psoriasis is usually based on the appearance of the skin. There are no special blood tests or diagnostic procedures for psoriasis. Sometimes a skin biopsy, or scraping, may be needed to rule out other disorders and to confirm the diagnosis. Skin from a biopsy will show clubbed Rete pegs if positive for psoriasis. Another sign of psoriasis is that when the plaques are scraped, one can see pinpoint bleeding from the skin below (Auspitz’s sign).
GENERAL MANAGEMENT
• Education.
• Reassurance.
• Avoid exposure to cold.
• Moderate, warm climate is beneficial.
• Adequate exposure to sunlight.
• Avoid undue stress.
• Diet: – Avoid fats, highly seasoned and salty dishes.
High protein diet (cut down animal protein).
Avoid tea, coffee, alcohol.
Maintain good hygiene.
Hot bath in winter, drying and oiling.
Avoid all factors which trigger psoriasis.
Reduce stress levels through meditation and Yoga.
Do not prick, peel or scratch skin. This may trigger psoriasis.
After bath or wash pat dry the skin. Do not rub the towel vigorously on skin.
Avoid soap. Instead use gram flour (besan flour) as soap dries the skin.
After washing, pat the skin dry, don’t irritate it by rubbing vigorously.
Apply moisturizing creams liberally on affected areas after.
Opt for cotton clothes over synthetic ones.
Take a well balanced diet including fruits, vegetables, nuts, seeds, and grains.
Apply a moisturizer to lubricate and soften scaly patches of skin.
Take a daily bath in warm water to soak off the scales.
Try deep breathing and relaxation exercise to reduce stress.
Do not take tea, coffee, all animal fats, and processed foods.
Don’t scratch or rub patches of thickened skin.
Avoid harsh skin products and lotions that contain alcohol. They may dry the skin and make psoriasis worse.
Keep your towel, clothes separate and clean.
The female insect burrows into the skin where she lays 1 – 3 eggs daily. A very small, hard to see, zigzag blister usually marks the trail of the insect as she lays her eggs. Other more obvious symptoms are an intense itching (especially at night) and a red rash that can occur at the area that has been scratched. The most common locations for scabies are on the sides of fingers, between the fingers, on the backs of the hands, on the wrists, heels, elbows, armpits, inner thighs and around the waist (belt line). One of the great problems with scabies always has been misdiagnosis. Scabies is spread by personal contact, e.g., by shaking hands or sleeping together or by close contact with infected articles such as clothing, bedding or towels. It is usually found where people are crowded together or have frequent contact, and is most common among school children, families, roommates, and sexual partners.
People with a scabies infestation have an average of about 12 mites living under their skin. The presence of the mites, their eggs and their faeces cause an allergic reaction resulting in an intense itch and a rash. It is now accepted that mites can spread when a non-infected person stands too close to an infected person. Mites are 0.1mm in diameter.
Scabies can occur at any age, but it’s most common among children.
Other names for the condition include Mite, Itch Mite, Mange, Crusted Scabies, Norwegian Scabies, Sarcoptes scabiei, or The Seven-Year Itch.
Cause
• Sarcoptes scabiei var. hominis.
CLINICAL FEATURES
Symptoms
• Violent itching.
• Compelled to scratch.
• Itching is worse during night.
Signs
Burrows-
• Narrow, tortuous, greyish black line.
• Length- 1-20 mm.
• Point at which parasite enters appears as black dot.
• If roof is lifted with needle, mite or eggs can be seen.
• Excoriations.
• Scratch marks.
DIAGNOSIS
• Finding mites & eggs in burrows.
DIFFERENTIAL DIAGNOSIS
• Papular urticaria.
• Atopic skin lesions in children with maximal lesions on extremeties.
• Generalised pruritus.
• Parasitophobia.
• Dermatitis herpetiformis.
COMPLICATIONS
• Eczematous dermatitis.
• Impetigo.
• Secondary lymphadenitis.
• Urticaria.
GENERAL MANAGEMENT of SCABIES
• Maintain personal hygiene.
• Change clothes, bed linens daily.
• Regular daily bath.
• Clothes & bed linens to be boiled in hot water, dried in sun & ironed.
• Thorough scrubbing with soap & water.
• Through drying of skin after bathing.
• Treat all close contacts.
Infection with mycobacteria is usually caused by inhaling air contaminated by these organisms. The bacteria spread throughout the body, and may cause rubbery enlargement of the lymph nodes in the neck (cervical lymph nodes) as well as elsewhere. If these are not treated, the lymph nodes may become ulcerated, producing draining sores.
Scrofula Tuberculosis – Symptoms
painless swelling of cervical (neck) lymph nodes
ulceration is rare today
lymph nodes may be enlarged elsewhere
fevers, chills, sweats, and weight loss can occur in 20% of individuals
Sebaceous cyst arises due to the blockage of the sebaceous gland. It occurs anywhere in the body except sole and palm.
Causes
• Blocked sebaceous glands.
• Swollen hair follicles.
• Excessive testosterone production.
• Skin trauma.
• Hereditary causes of sebaceous cysts include Gardner’s syndrome, and basal cell nevus syndrome.
CLINICAL FEATURES
Small lumps or bumps that occur just under the skin of the vagina, genitalia, breast, abdomen, face, neck, or elsewhere on the body are the most common symptom of sebaceous cysts.
Symptoms
• Usually painless.
• Pain if infected.
• Redness.
• Tenderness.
• Increased temperature of the skin over the bumps or lumps.
• Greyish white, cheesy, foul smelling material draining from the bump or lump.
• Mild to severe pruritus, with scrotal lesions.
LESION
• Single or multiple nodules.
• Slowly increasing in size.
• Dome shaped.
• Well defined.
• Flesh coloured.
• Firm, malleable (elastic).
• Movable, but attached to skin by remains of duct of sebaceous gland.
• Size: 0.5-5 cm. in diameter.
• Central pore which represents opening of follicle.
• Opening is marked by dark punctum.
• Contains cheesy whitish material.
DIAGNOSIS
• Sebaceous cysts are usually easily diagnosed clinically. In some cases, a biopsy may be necessary to rule out other conditions with a similar appearance.
COMPLICATIONS
• These cysts may occasionally become infected and form painful abscesses.
• The cysts may return after they are surgically removed.
GENERAL MANAGEMENT
• Puncture & expression of contents.
• If recurrence, excision of cyst including sac.
Hives are frequently caused by allergic reactions; however, there are many non-allergic causes. Chronic urticaria (hives lasting longer than six weeks) are rarely due to an allergy, common cause of acute urticaria (viral exanthem). Less common causes of hives include friction, pressure, temperature extremes, exercise, and sunlight. It may be true that hives are more common in those with fair skin.
One hallmark of hives is their tendency to change size rapidly and to move around, disappearing in one place and reappearing in other places, often in a matter of hours.
Types of Urticaria
Acute urticaria
It usually show up a few minutes after contact with the allergen and can last a few hours to several weeks. Food allergic reactions often fit in this category. The most common food allergies are shellfish, nuts, peanuts, eggs, wheat, and soy. It is uncommon for patients to have more than 2 true food allergies. A less common cause is exposure to certain bacteria, such as streptococcus or possibly Helicobacter pylori. In these cases, the hives may be exacerbated by other factors.
Chronic urticaria
It refers to hives that persists for 6 weeks or more. There are no visual differences between acute and chronic urticaria. Some of the more severe chronic cases have lasted more than 20 years, this does mean that in almost half the people it clears up within a year and in 80% it clears up within 20 years or less.
Drug-induced urticaria
It has been known to result in severe cardiorespiratory failure. The anti-diabetic sulphonylurea glimepiride (trade name Amaryl), in particular, has been documented to induce allergic reactions manifesting as urticaria. Other cases include dextroamphetamine, aspirin, penicillin, clotrimazole, sulfonamides and anticonvulsants.
Physical urticarias
They are often categorized into the following:
• Aquagenic: Reaction to water (exceedingly rare)
• Cholinergic: Reaction to body heat, such as when exercising or after a hot shower
• Cold (Chronic cold urticaria): Reaction to cold, such as ice, cold air or water – worse with sudden change in temperature
• Delayed Pressure: Reaction to standing for long periods, bra-straps, elastic bands on undergarments, belts
• Dermatographic: Reaction when skin is scratched (very common)
• Heat: Reaction to hot food or objects (rare)
• Solar: Reaction to direct sunlight (rare, though more common in those with fair skin)
• Vibration: Reaction to vibration (rare)
• Adrenergic: Reaction to adrenaline / noradrenaline (extremely rare)
ETIOLOGY
• Nettles, wasps, bugs, caterpillars.
• Exposure to extremes of heat and cold, sun.
• Fish, prawns, eggs, strawberry, masroom.
• Food preservatives.
• Artificial colours.
DRUGS
• Salicylates.
• Bromides.
• Iodides.
• Focal sepsis
PARASITES
• Round worm.
• Tape worm.
• Hook worm.
• Hydatid disease.
• Filariasis.
PSYCHOGENIC
• Emotional stress.
• Over-exertion.
SYSTEMIC DISEASES
• Rheumatiod Arthritis
• Systemic Lupus Erythmatous
GENETIC PREDISPOSITION
• Angioneurotic oedema.
CLINICAL FEATURES
ONSET
• Abrupt.
LOCATION
• Any part of skin may be affected.
• Mucous membranes of lips, mouth, pharynx, larynx.
• May be localised or generalised.
Symptoms of Urticaria
• Intense itching.
• Burning.
• Sense of heat.
LESION
• Starts as red erythematous macules.
• Soon paleoedematous wheals develop.
• Irregular, asymmetrical.
• Velvetty to touch.
• Erythema well defined, fades on pressure.
• Subside within few hours without leaving any trace.
• Dermographism positive.
• Wheals develop along line of scratching or pressure.
COMPLICATIONS
• Angioneurotic oedema.
• Onset: sudden.
• Swelling of skin, mucous membranes.
• Common sites involved: eyelids, tongue, lips, glottis, genitalia, trunk, hands, feet.
• Wheals large, extensive.
• Lasts from few hours to few days.
GENERAL MANAGEMENT of URTICARIA
• Reassurance.
• Identify and eliminate offending agent.
• Correct underlying cause.
• Avoid precipitating causes.
• During acute attack:
o Simple, bland diet.
o Avoid tea, coffee, alcohol.
It occurs when the melanocytes, cells responsible for skin pigmentation, die or are unable to function. The precise cause of vitiligo is complex and not fully understood. There is some evidence suggesting it is caused by a combination of auto-immune, genetic, and environmental factors.
Causes
• Exact cause is not known.
• Evidence points to autoimmune etiology.
• Genetic predisposition is common.
• Age: onset between 10-30 years.
CLINICAL FEATURES
ONSET
• Insidious.
LOCATION
• Common sites, to start with, are pressure points, i.e. knuckles, elbows, lips.
Symptoms
• Lesion do not itch.
LESION
• Start as white localised macules.
• Rounded, well defined at onset.
• Adjacent lesions coalesce.
• As they increase in size, become irregular.
• Spread to involve greater parts of the body.
• Depigmented lesion is surrounded by area of apparent hyper pigmentation.
• No sensory loss in lesion.
• Every little trauma heals with depigmentation.
• Lesions are hypersensitive to sunlight.
DIAGNOSIS
• Clinical.
GENERAL MANAGEMENT
• Reassurance.
• Treat associated disorder.
• If iatrogenic, identify & withdraw offending agent.
• Avoid physical trauma.
• Adequate mental rest.
• Improve general health.
Warts are a type of infection caused by viruses in the human papillomavirus (HPV) family. They can grow on skin, on the inside of mouth, on genitals and on rectal area.
Warts are common, and are caused by a viral infection and are contagious when in contact with the skin of an infected person. It is also possible to get warts from using towels or other objects used by an infected person. They typically disappear after a few months but can last for years and can recur.
ETIOLOGY
• Causative organism- human papilloma virus.
• Transmission- autoinoculable, close contact, swimming pool.
• Age- common in children, young adults.
• Incubation period- about 90 days.
Types of wart
A range of different types of wart has been identified, varying in shape and site affected, as well as the type of human papillomavirus involved. These include-
Common wart (Verruca vulgaris)
A raised wart with roughened surface, most common on hands and knees.
LOCATION
• Arms, hands, legs, feet, around nails.
LESION
• Rounded or oval papules or nodules.
• Discrete or grouped.
• Grey or brown coloured.
• Size varies from lentil seed to pea.
• Surface corrugated(verrucous).
• Consistency firm.
• Warts around nails may be painful.
Flat wart (Verruca plana)
A small, smooth flattened wart, flesh coloured, which can occur in large numbers; most common on the face, neck, hands, wrists and knees.
LOCATION
• Face, back of hands.
LESIONS
• Multiple small papules.
• Discrete.
• Rounded, with flat tops.
• Flesh coloured.
• Size: 2-5mm.
• Margins irregular.
• Surface smooth.
• Soft to touch.
Filiform or digitate wart
A thread- or finger-like wart, most common on the face, especially near the eyelids and lips.
LOCATION
• Beard region, neck.
LESIONS
• Long, thin, slender, finger like processess.
• Spread by shaving by implantation.
Plantar wart (verruca, Verruca pedis)
A hard sometimes painful lump, often with multiple black specks in the center; usually only found on pressure points on the soles of the feet.
LOCATION
• Ball of foot, heel.
LESION
• Painful hyperkeratotic, circular plaque.
• Usually single.
• Size: 1-1.5cm.
• Deeply set in flask shaped cavity, being wider at bottom.
• Surface corrugated, rough.
• Extremely tender.
• Scraping of wart reveals bleeding points.
Mosaic wart
A group of tightly clustered plantar-type warts, commonly on the hands or soles of the feet.
Genital wart (venereal wart, Condyloma acuminatum, Verruca acuminata)
A wart that occurs on the genitalia.
DIAGNOSIS
• Clinical.
GENERAL MANAGEMENT
• Education.
• Reassurance.
• Maintain personal hygiene.