Diagnosethis – Treatments, Explanations, Medications, Remedies, Images, Causes, Self Diagnosis,

Miliaria (miliaria rubra, sweat rash, heat rash, or prickly heat) is a skin disease marked by small and itchy rashes. Miliaria is a common ailment in hot and humid conditions, such as in the tropics and during the summer season. Although it affects people of all ages, it is especially common in children and infants due to their underdeveloped sweat glands.

Miliaria occurs when the sweat gland ducts get plugged due to dead skin cells or bacteria such as Staphylococcus epidermidis, a common bacterium that occurs on the skin which is also associated with acne.

Clinical features

Symptoms of miliaria include small red rashes, called papules, which may itch or more often cause an intense ‘pins-and-needles’ prickling sensation. These rashes may simultaneously occur at a number of areas on a sufferer’s body, the most common including the face, neck, under the breasts and under the scrotum. Other areas include skin folds, areas of the body that may rub against clothing, such as the back, chest, and stomach, etc. A related and sometimes simultaneous condition is folliculitis, where hair follicles become plugged with foreign matter, resulting in inflammation.

The symptoms relating to miliaria should not be confused with shingles as they can be very similar. Shingles will restrict itself to one side of the body but also has a rash-like appearance. It is also accompanied by a prickling sensation and pain throughout the region. Those who suspect they have shingles and not miliaria should seek medical advice immediately as the sooner antivirals are taken, the better.

The trapped sweat leads to irritation (prickling), itching and to a rash of very small blisters, usually in a localized area of the skin

Treatment

Medical assistance should be sought for the first episode of a rash with the appearance of miliaria. The differential includes several conditions which an experienced practitioner should be able to recognise and may require treatment distinct from the usual measures taken for miliaria. In most cases the rash of miliaria will resolve without intervention. However, severe cases can last for a number of weeks and cause significant disability. General measures should be recommended for all patients, including moving to an air-conditioned environment if possible, avoiding sweat-provoking activities and occlusive clothing, and taking frequent cool showers.

It has been suggested that the use of topical antibacterials (including the use of antibacterial soaps) may shorten the duration of symptoms in miliaria rubra even in the absence of obvious superinfection. Other topical agents which may reduce the severity of symptoms include anti-itch preparations such as calamine or menthol and/or camphor based preparations, and topical steroid creams, however caution should be used with oil-based preparations (ointments and oily creams as opposed to water based or aqueous lotions) which may increase blockage to the sweat glands and prolong duration of illness. Other agents have been investigated including supplemental vitamin A and C and vitamin A based medications, but it is worth noting that there is little scientific evidence supporting any of the above treatments in terms of actually reducing the duration of symptoms or frequency of complications.

In cases where the rash has developed into open blisters or pustular lesions a doctor should be consulted as other (less benign) conditions should be excluded and/or more aggressive treatment may be required.

Folliculitis is the inflammation of one or more hair follicles. The condition may occur anywhere on the skin.

Causes

Most carbuncles and furuncles and other cases of folliculitis develop from Staphylococcus aureus.

Folliculitis starts when hair follicles are damaged by friction from clothing, an insect bite,blockage of the follicle, shaving or too tight braids too close to the scalp traction folliculitis. In most cases of folliculitis, the damaged follicles are then infected with the bacteria Staphylococcus (staph).

Iron deficiency anemia is sometimes associated with chronic cases

• Tinea barbae is similar to barber’s itch, but the infection is caused by the fungus T. rubrum.

• Malassezia folliculitis, formerly known as Pityrosporum folliculitis, is caused by malassezia yeast.

• Pseudofolliculitis barbae is a disorder occurring primarily in men of African descent. If curly beard hairs are cut too short, they may curve back into the skin and cause inflammation.

• Hot tub folliculitis is caused by the bacteria Pseudomonas aeruginosa often found in new hot tubs.^[1] The folliculitis usually occurs after sitting in a hot tub that was not properly cleaned before use. Symptoms are found around the body parts that sit in the hot tub — typically the legs, hips, and buttocks and surrounding areas. Symptoms are typically amplified around regions that were covered by wet clothing, such as bathing suits.

• Sycosis barbae or Barber’s itch is a staphylococcus infection of the hair follicles in the bearded area of the face, usually the upper lip. Shaving aggravates the condition.

• Eosinophilic folliculitis may appear in persons with impaired immunity (AIDS, blood disorders).

• Herpetic folliculitis may occur when Herpes Simplex Virus infection spreads to nearby hair follicles – mostly around the mouth. It typically occurs in persons with AIDS.

• Gram negative folliculitis may appear after prolonged acne treatment with antibiotics.

• Folliculitis decalvans or tufted folliculitis usually affects scalp. Several hairs arise from the same hair follicle. Scarring and permanent hair loss may follow. The cause is unknown.

• Folliculitis keloidalis causes scars on the nape of the neck. It is most common among males of African descent with curly hair.

• Oil folliculitis is inflammation of hair follicles due to exposure to various oils and typically occurs on forearms or thighs. It is common in refinery workers, road workers, mechanics, sheep shearers. Even makeup may cause it.

Symptoms

• rash (reddened skin area)
• pimples or pustules located around a hair follicle
  • may crust over
  • typically occur on neck, axilla, or groin area
  • may be present as genital lesions
• itching skin
• spreading from leg to arm to body through improper treatment of antibiotics

Treatment

1. Topical antiseptic treatment is adequate for most cases
2. Topical antibiotics such as mupirocin or neomycin containing ointment
3. Some patients may benefit from systemic narrow-spectrum penicillinase-resistant penicillins (such as dicloxacillin in US, or flucloxacillin in UK)

Edema, formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin, or in one or more cavities of the body. Generally, the amount of interstitial fluid is determined by the balance of fluid homeostasis, and increased secretion of fluid into the interstitium or impaired removal of this fluid may cause edema.

Five factors can contribute to the formation of edema:

1. It may be facilitated by increased hydrostatic pressure or,
2. reduced oncotic pressure within blood vessels;
3. by increased blood vessel wall permeability as in inflammation;
4. by obstruction of fluid clearance via the lymphatic; or,
5. by changes in the water retaining properties of the tissues themselves. Raised hydrostatic pressure often reflects retention of water and sodium by the kidney.

Eczema is a disease in a form of dermatitis, or inflammation of the epidermis. The term eczema is broadly applied to a range of persistent skin conditions. These include dryness and recurring skin rashes which are characterized by one or more of these symptoms: redness, skin edema (swelling), itching and dryness, crusting, flaking, blistering, cracking, oozing, or bleeding. Areas of temporary skin discoloration may appear and are sometimes due to healed lesions, although scarring is rare. In contrast to psoriasis, eczema is often likely to be found on the flexor aspect of joints.

Types

The term eczema refers to a set of clinical characteristics. Classification of the underlying diseases has been haphazard and unsystematic, with many synonyms used to describe the same condition. A type of eczema may be described by location (e.g. hand eczema), by specific appearance (eczema craquele or discoid), or by possible cause (varicose eczema). Further adding to the confusion, many sources use the term eczema and the term for the most common type of eczema (atopic eczema) interchangeably.

The European Academy of Allergology and Clinical Immunology (EAACI) published a position paper in 2001 which simplifies the nomenclature of allergy-related diseases including atopic and allergic contact eczemas^. Non-allergic eczemas are not affected by this proposal.

The classification below is ordered by incidence frequency.

Types of common eczemas

• Atopic eczema (aka infantile e., flexural e., atopic dermatitis) is an allergic disease believed to have a hereditary component, and often runs in families whose members also have hay fever and asthma. Itchy rash is particularly noticeable on head and scalp, neck, inside of elbows, behind knees, and buttocks. Experts are urging doctors to be more vigilant in weeding out cases that are, in actuality, irritant contact dermatitis. It is very common in developed countries, and rising.
• Contact dermatitis is of two types: allergic (resulting from a delayed reaction to some allergen, such as poison ivy or nickel), and irritant (resulting from direct reaction to a detergent, such as sodium lauryl sulfate, for example). Some substances act both as allergen and irritant (wet cement, for example). Other substances cause a problem after sunlight exposure, bringing on phototoxic dermatitis. About three quarters of cases of contact eczema are of the irritant type, which is the most common occupational skin disease. Contact eczema is curable provided the offending substance can be avoided, and its traces removed from one’s environment.
• Xerotic eczema (aka asteatotic e., e. craquele or craquelatum, winter itch, pruritus hiemalis) is dry skin that becomes so serious it turns into eczema. It worsens in dry winter weather, and limbs and trunk are most often affected. The itchy, tender skin resembles a dry, cracked, river bed. This disorder is very common among the older population. Ichthyosis is a related disorder.
• Seborrhoeic dermatitis or Seborrheic dermatitis (”cradle cap” in infants) is a condition sometimes classified as a form of eczema which is closely related to dandruff. It causes dry or greasy peeling of the scalp, eyebrows, and face, and sometimes trunk. The condition is harmless except in severe cases of cradle cap. In newborns it causes a thick, yellow crusty scalp rash called cradle cap which seems related to lack of biotin, and is often curable.

Treatment

There is no known cure for eczema, thus treatments aim to control the symptoms: reduce inflammation and relieve itching.

Medications

Corticosteroids

Dermatitis is often treated with corticosteroids. They do not cure eczema, but are highly effective in controlling or suppressing symptoms in most cases. For mild-moderate eczema a weak steroid may be used (e.g. hydrocortisone or desonide), whilst more severe cases require a higher-potency steroid (e.g. clobetasol propionate, fluocinonide). Medium-potency corticosteroids such as clobetasone butyrate (Eumovate), Betamethasone Valerate (Betnovate) or triamcinolone are also available. Generally medical practitioners will prescribe the less potent ones first before trying the more potent ones. In many countries, weak steroids can be purchased ‘over the counter’ (e.g., hydrocortisone in UK, United States, Germany, Czechia, Australia, Iceland), while the more potent ones require a prescription.

Side effects

Prolonged use of topical corticosteroids is thought to increase the risk of possible side effects, the most common of which is the skin becoming thin and fragile (atrophy). Because of this, if used on the face or other delicate skin, only a low-strength steroid should be used. Additionally, high-strength steroids used over large areas, or under occlusion, may be significantly absorbed into the body, causing hypothalamic-pituitary-adrenal axis suppression (HPA axis suppression). Finally by their immunosuppressive action they can, if used without antibiotics or antifungal drugs, lead to some skin infections (fungal or bacterial). Care must be taken to avoid the eyes, as topical corticosteroids applied to the eye can cause glaucoma or cataracts.

Because of the risks associated with this type of drug, a steroid of an appropriate strength should be sparingly applied only to control an episode of eczema. Once the desired response has been achieved, it should be discontinued and replaced with emollients as maintenance therapy. Corticosteroids are generally considered safe to use in the short- to medium-term for controlling eczema, with no significant side effects differing from treatment with non-steroidal ointment.

However, recent research has shown that topically applied corticosteroids did not significantly increase the risk of skin thinning, stretch marks or HPA axis suppression (and where such suppression did occur, it was mild and reversible where the corticosteroids were used for limited periods of time). Further, skin conditions are often under-treated because of fears of side effects. This has led some researchers to suggest that the usual dosage instructions should be changed from “Use sparingly” to “Apply enough to cover affected areas,” and that specific dosage directions using “fingertip units” or FTU’s be provided, along with photos to illustrate FTU’s.

Other forms

In severe cases, oral cortisosteroids such as prednisolone or injections such as triamcinolone injections may also be prescribed. While these usually bring about rapid improvements, they should not be taken for any length of time and the eczema often returns to its previous level of severity once the medication is stopped. In the case of triamcinolone injections, a waiting period between treatments may be required.

Immunomodulators

Topical immunomodulators like pimecrolimus (Elidel and Douglan) and tacrolimus (Protopic) were developed after corticosteroid treatments, effectively suppressing the immune system in the affected area, and appear to yield better results in some populations. The U.S. Food and Drug Administration has issued a public health advisory about the possible risk of lymph node or skin cancer from use of these products,^[15] but many professional medical organizations disagree with the FDA’s findings;

• The postulation is that the immune system may help remove some pre-cancerous abnormal cells which is prevented by these drugs. However, any chronic inflammatory condition such as eczema, by the very nature of increased metabolism and cell replication, has a tiny associated risk of cancer (see Bowen’s disease).
• Current practice by UK dermatologists is not to consider this a significant real concern and they are increasingly recommending the use of these new drugs. The dramatic improvement on the condition can significantly improve the quality of life of sufferers (and families kept awake by the distress of affected children). The major debate, in the UK, has been about the cost of such newer treatments and, given only finite NHS resources, when they are most appropriate to use.
• In addition to cancer risk, there are other potential side effects with this class of drugs. Adverse reactions including severe flushing, photosensitive reactivity and possible drug interaction in patients who consume even small amounts of alcohol.

Antibiotics

When the normal protective barrier of the skin is disrupted (dry and cracked), it allows easy entry for bacteria. Scratching by the patient both introduces infection and spreads it from one area to another. Any skin infection further irritates the skin and a rapid deterioration in the condition may ensue; the appropriate antibiotic should be given.

Immunosuppressants

When eczema is severe and does not respond to other forms of treatment, immunosuppressant drugs are sometimes prescribed. These dampen the immune system and can result in dramatic improvements to the patient’s eczema. However, immunosuppressants can cause side effects on the body. As such, patients must undergo regular blood tests and be closely monitored by a doctor. In the UK, the most commonly used immunosuppressants for eczema are ciclosporin(Cyclosporine), azathioprine and methotrexate. These drugs were generally designed for other medical conditions but have been found to be effective against eczema. Commonly prescribed as an immunosuppressant in the United States for Eczema is the steroid Prednisone.

Itch relief

Anti-itch drugs, often antihistamine, may reduce the itch during a flare up of eczema, and the reduced scratching in turn reduces damage and irritation to the skin (the Itch cycle).

Capsaicin applied to the skin acts as a counter irritant (see: Gate control theory of nerve signal transmission). Other agents

Avoiding dry skin

Moisturizing

Eczema can be exacerbated by dryness of the skin. Moisturizing is one of the most important self-care treatments for sufferers of eczema. Keeping the affected area moistened can promote skin healing and relief of symptoms.

Soaps and harsh detergents should not be used on affected skin because they can strip natural skin oils and lead to excessive dryness. Instead, the use of moisturizing body wash, or an emollient like aqueous cream, will maintain natural skin oils and may reduce some of the need to moisturize the skin. Another option is to try bathing using colloidal oatmeal bath treatments. In addition to avoiding soap, other products that may dry the skin such as powders or perfume should also be avoided.

Moistening agents are called ‘emollients’. In general, it is best to match thicker ointments to the driest, flakiest skin. Light emollients like aqueous cream may not have any effect on severely dry skin. Some common emollients for the relief of eczema include Oilatum, Balneum, Medi Oil, Diprobase, bath oils and aqueous cream. Sebexol, Epaderm ointment, Exederm and Eucerin lotion or cream may also be helpful with itching. Lotions or creams may be applied directly to the skin after bathing to lock in moisture. Moisturizing gloves (gloves which keep emollients in contact with skin on the hands) can be worn while sleeping. Generally, twice-daily applications of emollients work best. While creams are easy to apply, they are quickly absorbed into the skin, and therefore need frequent reapplication. Ointments, with less water content, stay on the skin for longer and need fewer applications, but they can be greasy and inconvenient. Steroids may also be mixed in with ointments.

For unbroken skin, direct application of waterproof tape with or without an emollient or prescription ointment can improve moisture levels and skin integrity which allows the skin to heal. This treatment regimen can also help prevent the skin from cracking, as well as put a stop to the itch cycle. The end result is reduced lichenification (the roughening of skin from repeated scratching). Taping works best on skin away from joints.

There is a disagreement whether baths are desirable or a necessary evil. For example, the Mayo Clinic advises against daily baths to avoid skin drying. On the other hand, the American Academy of Dermatology claims “it is a common misconception that bathing dries the skin and should be kept to a bare minimum” and recommends bathing to hydrate skin. They even suggest up to 3 short baths a day for people with severe eczema. According to them, a moisturizer should be applied within 3 minutes to trap the moisture from bath in the skin. U.S. National Eczema Association and the Eczema Society of Canada make similar recommendations.

Recently, ceramides, which are the major lipid constituent of the stratum corneum, have been used in the treatment of eczema. They are often one of the ingredients of modern moisturizers. These lipids were also successfully produced synthetically in the laboratory.

Eczema and skin cleansers

One of the recommendations is that people suffering from eczema should not use detergents of any kind on their skin unless absolutely necessary. Eczema sufferers can reduce itching by using cleansers only when water is not sufficient to remove dirt from skin.

However, detergents are so ubiquitous in modern environments in items like tissues, and so persistent on surfaces, “safe” soaps are necessary to remove them from the skin in order to control eczema. Although most eczema recommendations use the terms “detergents” and “soaps” interchangeably, and tell eczema sufferers to avoid both, detergents and soaps are not the same and are not equally problematic to eczema sufferers. Detergents, often made from petrochemicals, increase the permeability of skin membranes in a way that soaps and water alone do not. Sodium lauryl sulfate, the most common household detergent, has been shown to amplify the allergenicity of other substances (”increase antigen penetration”).

Unfortunately there is no one agreed-upon best kind of skin cleanser for eczema sufferers. Different clinical tests, sponsored by different personal product companies, unsurprisingly tout various brands as the most skin-friendly based on specific properties of various products and different underlying assumptions as to what really determines skin friendliness. The terms “hypoallergenic” and “doctor tested” are not regulated, and no research has been done showing that products labeled “hypoallergenic” are in fact less problematic than any others.

Dermatological recommendations in choosing a soap generally include:

• Avoid harsh detergents or drying soaps
• Choose a soap that has an oil or fat base; a “superfatted” goat milk soap is best
• Use an unscented soap
• Patch test your soap choice, by using it only on a small area until you are sure of its results
• Use a non-soap based cleanser
• Use plain yogurt instead of soap

Instructions for using soap:

• Use soap sparingly
• Avoid using washcloths, sponges, or loofahs, or anything that will abrade the skin
• Use soap only on areas where it is necessary
• Soap up only at the very end of your bath
• Use a fragrance-free barrier-type moisturizer such as petroleum jelly before drying off
• Use care when selecting lotion, soap, or perfumes to avoid suspected allergens; ask your doctor for recommendations
• Never rub your skin dry, or else your skin’s oil/moisture will be on the towel and not your body; pat dry instead

Environmental measures

While it has been suggested that eczema may sometimes be an allergic reaction to the excrement from house dust mites, with up to 5% of people showing antibodies to the mites, the overall role this plays awaits further corroboration.

Various measures may reduce the amount of mite antigens, in particular swapping carpets for hard surfaces. Effectiveness of vacuum cleaners is dependent upon the characteristics of the carpet pile, but in other studies daily vacuuming did not affect levels of mites. However it is not clear whether such measures actually help patients with eczema. A controlled study suggested that a number of environmental factors such as air exchange rates, relative humidity and room temperature (but not the level of house dust mites) might have an effect on the condition.

Staphylococcus aureus colonies are developed by overly scratching excema. In a 2009 study from Northwestern University, children with moderate or severe eczema were giving diluted bleach baths and this reduced the severity of the disease. Diluted bleach has been know to have antibacterial qualities. In the study, diluted meant a half cup of bleach to a full tub of water and soaking for 5-10 minutes.

Light therapy

Light therapy (or Deep penetrating light therapy) using ultraviolet light can help control eczema. UVA is mostly used, but UVB and Narrow Band UVB are also used. Over exposure to Ultraviolet light carries its own risks, particularly potential skin cancer from exposure.

When light therapy alone is found to be ineffective, the treatment is performed with the application (or ingestion) of a substance called psoralen. This PUVA (Psoralen + UVA) combination therapy is termed photo-chemotherapy. Psoralens make the skin more sensitive to UV light, thus allowing lower doses of UVA to be used. However, the increased sensitivity to UV light also puts the patient at greater risk for skin cancer.

Diet and nutrition

Recent studies provide hints that food allergy may trigger atopic dermatitis. For these people, identifying the allergens could lead to an avoidance diet to help minimize symptoms, although this approach is still in an experimental stage. Dietary elements that have been reported to trigger eczema include dairy products and coffee (both caffeinated and decaffeinated), soybean products, eggs, nuts, wheat and maize (sweet corn), though food allergies may vary from person to person.^{[citation needed]} However, in 2009, researchers at National Jewish Medical and Research Center found that eczema patients were especially prone to misdiagnosis of food allergies.

Recently Margitta Worm et al. discovered that a diet rich in omega-3 (and low in omega-6) polyunsaturated fatty acids may be able to reduce symptoms.

Alternative therapies

Non-conventional medical approaches include traditional Chinese medicine and Western herbalism. There are a wide variety of treatments, each of which may vary from individual to individual as to efficacy or harm. Patients should inform their doctor/allergist/dermatologist if they are pursuing one of these treatment routes.

Alleged remedies include:

• Oatmeal is a common remedy to relieve itching, and can be applied topically as a cream or, as a colloid, in the bath. It is also part of many commercially available products intended for eczema treatment and for other skin conditions. But some recent studies say that oat can provoke a flare-up on some patients.
• Sea water: According to the British Association of Dermatologists, there is considerable anecdotal evidence that salt water baths may help some children with atopic eczema.  One reason might be that seawater has antiseptic properties. The Dead sea is popular for alleviating skin problems including eczema.
• Sulfur has been used for many years as a topical treatment in the alleviation of eczema, although this could be suppressive. It was fashionable in the Victorian and Edwardian eras. Recently sulfur has regained some popularity as a homeopathic alternative to steroids and coal tar. However, there is currently no scientific evidence for the claim that sulfur treatment relieves eczema.^[45]
• Probiotics are live microorganisms taken by mouth, such as the Lactobacillus bacteria found in yogurt. They are not effective for treating eczema, and have a small risk of adverse events such as infection.
• Traditional Chinese medicine: According to American Academy of Dermatology, while certain blends of Chinese herbal medicines have been proven effective in controlling eczema, they have also have proven toxic with severe consequences. In Chinese Medicine diagnosis, eczema is often considered a manifestation of underlying ill health. Treatment aims to improve the overall health of the individual, therefore not only resolving the eczema but improving quality of life (energy level, digestion, disease resistance, etc.). A recent study published in the British Journal of Dermatology describes improvements in quality of life and reduced need for topical corticosteroid application^. Another British trial with ten different plants traditionally used in Chinese medicine for eczema treatment suggest a benefit with herbal remedy, but reviewers noted that the blinding was not maintained, leaving the results invalid.
• Other remedies lacking scientific evidence include chiropractic spinal manipulation .

Patients can also wear clothing designed specifically to manage the itching, scratching and peeling associated with eczema.

Behavioural approach

In the 1980s, Swedish dermatologist Peter Noren developed a behavioural approach to the treatment of long term atopic eczema. This approach has been further developed by dermatologist Richard Staughton and psychiatrist Christopher Bridgett at the Chelsea and Westminster Hospital in London. Patients undergo a 6 week monitored program involving scratch habit reversal and self awareness of scratching levels. For long term eczema sufferers, scratching can become habitual. Sometimes scratching becomes a reflex, resulting in scratching without conscious awareness, rather than from the feeling of itchiness itself. The habit reversal program is done in conjunction with the standard applied emollient/corticosteroid treatments so that the skin can heal. It also reduces future scratching, as well as reduces the likelihood of further flareups. The behavioural approach can give an eczema sufferer some control over the degree of severity of eczema.

Dandruff (also called scurf and historically termed Pityriasis capitis) is the excessive shedding of dead skin cells from the scalp. Dandruff can also be caused by frequent exposure to extreme heat and cold. As it is normal for skin cells to die and flake off, a small amount of flaking is normal and in fact quite common. Some people, however, either chronically or as a result of certain triggers, experience an unusually large amount of flaking, which can also be accompanied by redness and irritation. Most cases of dandruff can be easily treated with specialized shampoos.

Excessive flaking can also be a symptom of seborrhoeic dermatitis, psoriasis, fungal infection or excoriation associated with infestation of head lice.

Those affected by dandruff find that it can cause social or self-esteem problems. Treatment may be important for both physiological and psychological reasons.

Causes

As the epidermal layer continually replaces itself, cells are pushed outward where they eventually die and flake off. In most people, these flakes of skin are too small to be visible. However, certain conditions cause cell turnover to be unusually rapid, especially in the scalp. For people with dandruff, skin cells may mature and be shed in 2–7 days, as opposed to around a month in people without dandruff. The result is that dead skin cells are shed in large, oily clumps, which appear as white or grayish patches on the scalp, skin and clothes.

Dandruff has been shown to be the result of three required factors:

1. Skin oil commonly referred to as sebum or sebaceous secretions
2. The metabolic by-products of skin micro-organisms (most specifically Malassezia yeasts)
3. Individual susceptibility

Common older literature cites the fungus Malassezia furfur (previously known as Pityrosporum ovale) as the cause of dandruff. While this fungus is found naturally on the skin surface of both healthy people and those with dandruff, it was discovered that a scalp specific fungus, Malassezia globosa, is the responsible agent. This fungus metabolizes triglycerides present in sebum by the expression of lipase, resulting in a lipid byproduct oleic acid (OA). Penetration by OA of the top layer of the epidermis, the stratum corneum, results in an inflammatory response in susceptible persons which disturbs homeostasis and results in erratic cleavage of stratum corneum cells.

Rarely, dandruff can be a manifestation of an allergic reaction to chemicals in hair gels/sprays, hair oils, or sometimes even dandruff medications like ketoconazole.

There is convincing evidence that food (especially sugar and yeast), excessive perspiration, and climate have significant roles in the pathogenesis of dandruff^.

Treatment

Shampoos use a combination of ingredients to control dandruff. Salicylic acid (used in Sebulex) removes dead skin cells from the scalp and decrease the rate at which these cells are created. Zinc pyrithione (introduced by Revlon in ZP11 shampoo, now used in Head & Shoulders) kills pityrospora. Selenium sulfide (used in Selsun Blue) achieves the results of both salicylic acid and zinc pyrithione.

Simply increasing usage with normal shampooing will remove flakes. However, elimination of the fungus results in dramatic improvement. Regular shampooing with an anti-fungal product can reduce recurrence.

Soothing preparations may contain Sodium bicarbonate (baking soda), and coal tar based products.

The most common antifungal agents used are Zinc pyrithione, Selenium sulfide and Ketoconazole Other products used include Tea tree oil and Piroctone olamine (Octopirox).

Anti-fungal/anti-dandruff shampoos (includes Head and Shoulders, and Selsun Blue) containing ketoconazole have been shown to be more effective than zinc pyrithione.Although a 1981 study reported selenium sulfide as being the most effective of the tested shampoos at treating dandruff, a 1999 comparative study concluded that ketoconazole was the most effective antifungal agent. (Although ketoconazole had been approved by F.D.A. in 1981, it was not approved for topical use in a shampoo until 1990, and was therefore not included in the 1981 study.)

A cyst is a closed sac having a distinct membrane and division on the nearby tissue. It may contain air, fluids, or semi-solid material. A collection of pus is called an abscess, not a cyst. Once formed, a cyst could go away on its own or may have to be removed through surgery.

What is Chickenpox?

Chickenpox is a common illness among kids, particularly those under age 12. An itchy rash of spots that look like blisters can appear all over the body and may be accompanied by flu-like symptoms. Symptoms usually go away without treatment, but because the infection is very contagious, an infected child should stay home and rest until the symptoms are gone.

Chickenpox is caused by the varicella-zoster virus (VZV). Kids can be protected from VZV by getting the chickenpox (varicella) vaccine, usually between the ages of 12 to 15 months. In 2006, the Centers for Disease Control and Prevention (CDC) recommended a booster shot at 4 to 6 years old for further protection. The CDC also recommends that people 13 years of age and older who have never had chickenpox or received chickenpox vaccine get two doses of the vaccine at least 28 days apart.

Treatment

Although there have been no formal clinical studies evaluating the effectiveness of topical application of calamine lotion, a topical barrier preparation containing zinc oxide and one of the most commonly used interventions, it has an excellent safety profile. It is important to maintain good hygiene and daily cleaning of skin with warm water to avoid secondary bacterial infection. Addition of a small quantity of vinegar to the water is sometimes advocated.

To relieve the symptoms of chicken pox, people commonly use anti-itching creams and lotions. A very effective cream to use is hydrocortisone. These lotions are not to be used on the face or close to the eyes. An oatmeal bath also might help ease discomfort.

Children

If oral acyclovir is started within 24 hours of rash onset it decreases symptoms by one day but has no effect on complication rates. Use of acyclovir therefore is not currently recommended for immunocompetent individuals (ie otherwise healthy persons without known immunodeficiency or on immunosuppressive medication).

Adults

Infection in otherwise healthy adults tends to be more severe and active; treatment with antiviral drugs (e.g. acyclovir) is generally advised, as long as it is started within 24–48 hours from rash onset. Patients of any age with depressed immune systems or extensive eczema are at risk of more severe disease and should also be treated with antiviral medication. In the U.S., 55 percent of chickenpox deaths are in the over-20 age group, even though they are a tiny fraction of the cases.

Cellulite describes a condition that is claimed to occur in most women, where the skin of the lower limbs, abdomen, and pelvic region becomes dimpled after puberty. The term was first used in the 1920s and began appearing in English language publications in the late 1960s, the earliest reference in Vogue magazine, “Like a swift migrating fish the word cellulite has suddenly crossed the Atlantic.”Its existence as a real disorder has been questioned, and the prevailing medical opinion is that it is merely the “normal condition of many women and some men”.One cosmetic company has noted its historical place in industrialised societies as an “inappropriate term used by women to describe curves which they judge to be too plump and not very aesthetic”.

Causes

The causes are poorly understood,and may involve changes in metabolism and physiology such as gender specific dimorphic skin architecture, alteration of connective tissue structure, vascular changes and inflammatory processes.

Treatment

Numerous therapies have been tried. There are no published reports in the scientific literature showing that any of these therapies work. In an interview with the New York Times, Dr. Molly Wanner, an instructor in dermatology at Harvard Medical School and an author of a 2008 evidence-based review of existing treatments, asserted, “At this point, there is no outstanding treatment for cellulite.” Dr. Michael F. McGuire, a clinical associate professor at the David Geffen School of Medicine at the University of California, Los Angeles, confirmed that “realistically there is no cure for cellulite.”

The most beneficial therapy may be to control lifestyle factors. However, Dr. Jeffrey Dover, a director of SkinCare Physicians, a dermatology practice in Chestnut Hill, Mass., says, “Some people have misrepresented the truth to suggest that there’s a lot you can do.”

Physical and mechanical methods

Iontophoresis, ultrasound, thermotherapy, pressotherapy (pneumatic massaging in the direction of the circulation), lymphatic drainage (massage technique to stimulate lymphatic flow), electrolipophoresis (application of a low frequency electric current) have all been tried^.

To administer a lymphatic drainage massage, the individual is positioned so that maximum exposure is given to the target area. Several slaps with the open palm are applied to the area for about two minutes, with occasional pauses to rub the area in a circular motion. The resulting heat, along with the vibration of the skin and rhythmic contractions of the gluteus muscles stimulates the draw of fluid into the capillaries.The absorption of fatty acids and subsequent transport of fat causes the “orange peel” roughness to the skin to disappear.This may take several sessions to accomplish. The massage can be effective not only with Grade 3 cellulite but can be used pro-actively for Grade 1 and 2.

However, these treatments have no proven results, and may only create short lasting effects.

Pharmacological agents

Any number of drugs that act on fatty tissue have been tried as therapeutic agents. Certain drugs act on the fatty tissue and connective tissue and on the microcirculation. They can be used topically, systemically, or transdermally.

These include the methyxanthines (theobromine, theophylline, aminophylline, caffeine), which act through phosphodiesterase inhibition, and pentoxifylline which improves micro-circulation; the adrenergic beta-agonists isoproterenol and adrenaline; the adrenergic alpha-antagonists yohimbine, piperoxan, phentolamine and dihydroergotamine; the methyIxanthine enhancers Coenzyme A and the amino acid l-carnitine; the drugs with connective tissue activity sillicium and Asiatic centella; the microcirculation active drugs Indian chestnut, ginkgo biloba, and rutin; and L-Carnitine.

These drugs are administered orally, as topically applied ointments, and by trans-dermal injection.

No independent scientific study or peer-reviewed literature has shown that pharmacological treatment has any significant effect on cellulite.

Compression garments

Clinical studies have found that compression garments, or shapewear garments, can help reduce the appearance of cellulite on the skin, but do nothing to help the condition itself.

Boil (or furuncle) is a skin disease caused by the infection of hair follicles, resulting in the localized accumulation of pus and dead tissue. Individual boils can cluster together and form an interconnected network of boils called carbuncles.

Symptoms

The symptoms of boils are red, pus-filled lumps that are tender, warm, and extremely painful. A yellow or white point at the center of the lump can be seen when the boil is ready to drain or discharge pus. In a severe infection, multiple boils may develop and the patient may experience fever and swollen lymph nodes. A recurring boil is called chronic furunculosis.

In some people, itching may develop before the lumps begin to form. Boils are most often found on the back, stomach, underarms, shoulders, face, lip, eyes, nose, thighs and buttocks, but may also be found elsewhere.

Sometimes boils will emit an unpleasant smell, particularly when drained or when discharge is present, due to the presence of bacteria in the discharge.

Causes

Usually, the cause are bacteria such as staphylococci. Bacterial colonization begins in the hair follicles and can lead to local cellulitis and abscess formation.

Treatments

Most boils run their course within four to ten days. For most people, self-care by applying a warm compress or soaking the boil in warm water can help alleviate the pain and hasten draining of the pus (colloquially referred to as “bringing the boil to a head”). Once the boil drains, the area should be washed with antibacterial soap and bandaged well. The maturing process may be accelerated by applying Ichthammol-based salve.

In serious cases, prescription oral antibiotics such as dicloxacillin (Dynapen) or cephalexin (Keflex), or topical antibiotics, are commonly used. For patients allergic to penicillin-based drugs, erythromycin (E-base, Erycin) may also be used.

However, some boils are caused by a super bug known as Community-Associated Methicillin-Resistant Staphylococcus Aureus, or CA-MRSA. Appropriate drugs, active against MRSA, must be prescribed relatively soon after such a boil has started to form. MRSA tends to increase the speed of growth of the infection.

Magnesium sulphate (epsom salt) paste applied to the affected area can prevent the growth of bacteria and reduce boils by absorbing pus and drying up the lesion.

Toxicodendron radicans (syn. Rhus toxicodendron, Rhus radicans; Poison ivy ) is a plant in the family Anacardiaceae. The name is sometimes spelled “Poison-ivy” in an attempt to indicate that the plant is not a true Ivy (Hedera). It is a woody vine that is well known for its ability to produce urushiol, a skin irritant that causes an itching rash for most people, technically known as urushiol-induced contact dermatitis.

Effects on the body

The reaction caused by poison ivy, urushiol-induced contact dermatitis, is an allergic reaction. Around 15% to 30%of people have no allergic response, but most people will become sensitized with repeated or more concentrated exposure to urushiol. Reactions can progress to anaphylaxis.

Treatment

For poison Oak and Poison Ivy

Urushiol binds to the skin on contact, where it causes severe itching that develops into reddish colored inflammation or non-colored bumps, and then blistering. These lesions may be treated with Calamine lotion, Burow’s solution compresses or Aveeno baths to relieve discomfort, though recent studies have shown some of these traditional medicines to be ineffective. Antihistamines, bentoquatam and other antipruritics are now recommended by dermatologists as more effective in the treatment of poison ivy and prevention of its effects. In severe cases, clear fluids ooze from open blistered sores and corticosteroids are the necessary treatment. A non-traditional, but effective method of combating itching, is the application of heat (hot, but non-scalding water or a hair dryer), which causes the local area to release histamines, which feels like you’re scratching the area. Care must be taken not to apply too much heat that will damage the skin.

Applying Rubbing alcohol to the affected are using cotton balls will relieve the pain and help with the itching. Use as needed twice a day for 2 weeks and it will clear up. Should your skin be dry after the treatment use lotion to relieve the dryness. (this works very well for poison oak)

The oozing fluids released by itching blisters do not spread the poison. The appearance of a spreading rash indicates that some areas received more of the poison and reacted sooner than other areas or that contamination is still occurring from contact with objects to which the original poison was spread. The blisters and oozing result from blood vessels that develop gaps and leak fluid through the skin; if the skin is cooled, the vessels constrict and leak less. If poison ivy is burned and the smoke then inhaled, this rash will appear on the lining of the lungs, causing extreme pain and possibly fatal respiratory difficulty. If poison ivy is eaten, the digestive tract, airway, kidneys or other organs can be damaged. An untreated rash can last up to four weeks.

Poison Oak Image