Dermatology

Skin is the largest organ of the body and protects it from bacterial infections and other day to day trauma. Since it is constant exposed, so many problems can occur due to environmental causes, infections caused due to microorganisms and some diseases that either is an outcome of skin disease or a systemic disease. Allergies also form a large part of these problems. Some of the most common problems are:

• Acne
• Rosacea
• Contact dermatitis
• Urticaria (itching and subsequent swelling)
• Keratosis
• Alopecia (hair loss)
• Atopic dermatitis
• Eczema (fungal infection)
• Cellulitis
• Chicken pox (viral infection)
• Chronic pruritus
• Corns
• Genital warts
• Measles
• Herpes infection (viral infection)
• Keloids (scarring caused due to over healing)
• Melanoma (skin cancer)
• Moles
• Nevi
• Psoriasis
• Vitiligo
• Scabies
• Vasculitis
• Skin tags (acrochordon)

Acne is a disease involving the pilosebaceous unit. Pilo refers to hair and sebaceous refers to the presence of sebaceous gland that secretes sebum. Acne is most frequent and intense in areas where sebaceous glands are numerous and largest. When sebum production increases, the bacterium Propionibacterium acnes proliferates in it and the follicular epithelial lining becomes altered and forms plugs called comedones. Sebum is the pathogenic factor in the formation of acne. It is irritating and comedogenic. Most patients with acne have a higher than normal level of sebum. The treatment depends on the severity of the disease. Mild acne is treated with retinoid and sometimes topical antibacterials are added. A somewhat more advanced but still categorized as mild form is treated with retinoid along with topical antibacterial or benzoyl peroxide. Sometimes a course of oral antibiotics might be included. Moderate form of acne is treated with topical antibacterials like sulfacetamide plus sulphur or other topical antibiotic with benzoyl peroxide with or without oral antibiotics. Retinoid may be added after a few weeks if the desired result is not achieved. If the acne is severe with scarring, the last resort when all the other forms of treatment have failed is the use of Accutane. You can know more about the best dermatology treatments in India with Mediflam, assuring the best information and medical services. 

Vitiligo is an acquired loss of pigmentation characterized histologically by the absence of epidermal melanocytes (cells responsible for pigmentation of skin). It is an autoimmune disorder and is hereditary. Exposure to phenolic compounds may trigger vitiligo in patients who are genetically predisposed. Skin trauma (e.g. sunburn) and certain medications such as imiquimod and interferon-alpha may induce vitiligo. The most frequent form of vitiligo referred to as common vitiligo begins with well-demarcated white patches on the fingers, hands and face. It progresses symmetrically through the years. The borders may have a red halo (inflammatory vitiligo) or a rim of hyperpigmentation. Vitiligouniversalis is the term used when 80%-90% of the body is affected.

The treatment involves topical corticosteroid application and phototherapy with NB-UVB (narrow band ultraviolet light B rays). Oral minipulse corticosteroid may also be prescribed. Treatment outcome is usually not satisfactory.

Urticaria, also referred to as hives or wheals, is a common and distinctive cutaneous reaction pattern. Hives may occur at any age; up to 20% of the population will have at least one episode. Hives may be more common in atopic patients. A hive or wheal is a circumscribed, erythematous or white, nonpitting, edematous, usually pruritic plaque that changes in size and shape by peripheral extension or regression during the few hours or days that the individual lesion exists. The edematous central area (wheal) can be pale in comparison to the erythematous surrounding area (flare). Urticaria is classified as acute or chronic. The majority of cases are acute, lasting from hours to a few weeks. Angioedema frequently occurs with acute urticaria, which is more common in children and young adults. Chronic urticaria (CU; arbitrarily defined as episodes of urticaria lasting more than 6 weeks) is more common in middleaged women. Because most individuals can diagnose urticaria and realize that it is a self-limited condition, they do not seek medical attention. The cause of acute urticaria is determined in many cases, but the cause of CU is determined in only 5% to 20% of cases. Patients with CU present a frustrating problem in diagnosis and management. History taking is crucial but tedious, and treatment is usually supportive rather than curative.

Treatment involves the use of non-sedating H1antihistamines. Then H2 receptor antagonists are used that are sedating in nature. Then H1and H2 receptor antagonists like doxepin is used. Corticosteroids like prednisone and methylprednisolone help to manage the symptoms quite effectively. Then leukotriene antagonists like Zafirlukast and Montelukast are used. Lastly epinephrine and immunomodulators like cyclosporine and methotrexate can be used when all other treatments have failed and urticaria becomes a chronic unmanageable problem.

Skin is the largest organ and any systemic disease can present itself as symptoms on the skin. A lot of skin problems can suggest of an underlying blood disorder.

Fungal infections in the areas that are warm and moist like the underarms, inside of the thighs, genital regions etc. These infections are usually difficult to treat and may take a long time to heal. Some of the common infections include :

• Eczema

All tinea infections like:

• Tinea amiantacea
• Tinea barbae
• Tinea capitis
• Tinea corporis
• Tineac ruris
• Tinea gladiatorum
• Tinea incognito
• Tinea pedis also called athlete’s foot (the most common one)
• Tinea versicolor

This is the most common inflammatory skin disease and although the term dermatitis is often used to describe an eczematous eruption, this only means inflammation of the skin and is not synonymous with the eczematous process. The most common is atopic eczema. 

There are three stages of eczema: acute, subacute and chronic. Most of the eczematous processes resolve in their own if left alone. It differs in appearance but itch is always accompanied. The causes may vary and may be due to allergy. The other causes which may cause eczema are:

• Problems in the immune system
• Presence of conditions of hay fever and asthma
• Insect bites
• Vein disorders
• Damp hands and feet
• Genetic or environmental factors
• Stress
• Occupational subjection to irritants which include occupations like hair dressing, laundry or dry cleaning

Psoriasis is a papulosquamous disease and is characterized as an autoimmune disorder. It occurs in about 2%-3% of the adult population with two main peaks of onset, 20 to 30 years of age and 50-60 years of age. 30% of psoriasis begins in childhood, and the median age of onset of childhood psoriasis is between the ages of 7 and 10 years of age. The disease is transmitted genetically with at least 10% of people inheriting one or more genes that may lead to psoriasis. The disease is lifelong and characterized by chronic, recurrent exacerbations and remissions that are emotionally and physically debilitating. Psoriasis for most patients is more emotionally than physically disabling. Psoriasis erodes self-image and forces the victim into a life of concealment and self-consciousness.

The clinical manifestations of psoriasis are lesions that are distinctive. They begin as red, scaling papules that coalesce to form round to oval plaques, which can easily be distinguished from the surrounding normal skin. The scale is adherent and silvery white, and reveals bleeding points when removed (Auspitz sign). Scale may become extremely dense, especially on the scalp. Scale forms but is macerated and dispersed in intertriginous areas; therefore the psoriatic plaques of skin folds appear as smooth, red plaques with a macerated surface. The most common site for an intertriginous plaque is the intergluteal fold; this is referred to as gluteal pinking (Figs. 8.3 and 8.4). The deep, rich red color is another characteristic feature and remains constant in all areas. Psoriasis can develop at the site of physical trauma (scratching, sunburn, or surgery), the so-called isomorphic or Koebner phenomenon. Pruritus is highly variable. Although psoriasis can affect any cutaneous surface, certain areas are favoured and should be examined in all patients in whom the diagnosis of psoriasis is suspected. Those areas are the elbows, knees, scalp, gluteal cleft, fingernails, and toenails.

The disease affects the extensor more than the flexor surfaces and usually spares the palms, soles, and face. Most patients have chronic localized disease, but there are several other presentations. Localized plaques may be confused with eczema or seborrheic dermatitis (SD), and the guttate form with many small lesions can resemble secondary syphilis or pityriasis rosea (PR). Many drugs can also precipitate psoriasis.

Being an autoimmune disorder, psoriasis is almost impossible to cure. But it can be managed effectively by Ayurveda and Homeopathy. Ayurveda is an ancient medical science being practised in India since 5000 years. The treatment goal is basically to restore the normal electrolyte balance and other abnormalities that occur in the body. There may be diet and lifestyle changes along with medications which are mostly derived from herbs and mineral sources. Allopathic treatment tends to manage the symptoms which include pain, inflammation and scaling and involves combination of topical creams, oral medications and injections. Some of the drugs used are methoxsalen, immunosuppressant methotrexate, biologics like etanercept, ustekinumab and secukinumab, topical retinoids like tazarotene, vitamin D analogues like calcipotriene and calcineurin inhibitors like tacrolimus and pimecrolimus

Scleroderma is a disease characterized by sclerosis of the skin and visceral organs, vasculopathy (Raynaud phenomenon), and the presence of autoantibodies. The spectrum of disease is wide, with systemic and localized forms. The clinical manifestations of localized form and the systemic form are different. The localized form includes:

• Circumscribed morphea involving the trunk, the limbs, chest, neck, abdomen, thighs, shoulders, back and subcutaneous like tissues, fascia and muscle 
• Generalized morphea on trunk and limbs
• Linear morphea including the extremities and trunk; lesions on forehead, temple or chin
• Pansclerotic morphea including full thickness involvement of the trunk, extremities, face and scalp. Fingertips and toes are generally unaffected. 

• Diffuse (10%) of cases which typically affects face, proximal and distal portions of extremities, truncal and acral areas
• Limited/CREST (90% of cases) which include skin, other confined to fingers, face, feet and forearms. Can be present on face and neck.
• Scleroderma which do not have any skin involvement and the clinical features include Raynaud phenomenon or comparable symptoms, such as pitting scars on digital tips, ulcers, gangrene and/or nail fold capillary abnormalities may be present
• Prescleroderma where the clinical features include Raynaud phenomenon and early or active capillary changes in nail fold and digital ischemia is common.
• Environmentally induced which includes general diffuse distribution of skin sclerosis. There is typically a history of exposure to a suspected triggering agent. These agents include vinyl chloride, epoxy resins and pesticides. Various organic solvents used in paints and chemotherapeutic agents like taxanes are also suspected.
• Overlap syndromes have patients with symptoms similar to other autoimmune rheumatic disease. Examples include SLE (Systemic Lupus Erythematosus), rheumatoid arthritis, dermatomyositis, vasculitis, Sjogren's syndrome and other connective tissue diseases.