A Simple Guide to Atopic Dermatitis

A Simple Guide to Atopic Dermatitis
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What is Atopic Dermatitis?
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Atopic Dermatitis is a common skin condition which presents as a chronic, relapsing, and very itchy rash at some point during childhood.

Atopic Dermatitis clears and often disappears with age.

What causes Atopic Dermatitis?
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The causes of Atopic Dermatitis is unknown.
However some possible causes are:
1.Genetic

Genes play a part in Atopic Dermatitis as the condition runs in families

2.External causes

a.abnormal response of the body’s immune system play a part in the development of Atopic Dermatitis.

b.damage to the skin barrier may lead to dryness and inflammation of the skin

c.irritating substances overacts, causing itching and scratching.

Atopic Dermatitis is not contagious .

Who is at risk of Atopic Dermatitis?
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Atopic Dermatitis occurs in both children and adults, but usually appears during infancy.

1.Those who are genetically predisposed

2.Those exposed to environmental triggers

a.rough or coarse materials coming into contact with the skin causes itchiness.

b.feeling too hot and/or sweating will cause an outbreak.

c.certain soaps, detergents, disinfectants,

d.contact with juices from fresh fruits and meats,

e.food allergens in childhood such as cow's milk, hen's egg,peanuts, nuts, shellfish

f.dust mites,

g.animal saliva and faeces may trigger itching.

h.Upper respiratory infections (caused by viruses) may also be triggers.

i.Stress can also sometimes aggravate an existing flare-up.

Many people who have Atopic Dermatitis also suffer from Atopic rhinitis and asthma, or have family members who do.

Atopic Dermatitis affects both sexes equally.

Where does Atopic Dermatitis appear?
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Atopic Dermatitis can occur on just about any part of the body

In infants, Atopic Dermatitis typically occurs on the forehead, cheeks, forearms, legs, scalp, and neck.

In children and adults, Atopic Dermatitis typically occurs on the face, neck, and the insides of the elbows, knees, and ankles.

In some people, Atopic Dermatitis may "bubble up" and ooze.

In others, the condition may appear more scaly, dry, and red.

Chronic scratching usually make the skin worse taking on a leathery texture because the skin thickens (lichenification).

What are the symptoms and signs of Atopic Dermatitis?
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Typical features of Atopic Dermatitis are:

1.dry,

2.red,

3.extremely itchy patches on the skin.

4.Oozing of the rash

5.Thickening of the skin

How is Atopic Dermatitis diagnosed?
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1.History and appearance of the rash

2.Screening test for food allergy

3.Blood test for specific antibodies to food substances

How can Atopic Dermatitis be treated?
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Treatment of an Atopic Dermatitis treatment routine is:

1. prevent scratching.

2. application of lotions or creams to keep the skin as moist as possible after bathing (within three minutes is a common recommendation) so that the moisture from the bath is "locked in."

3.Cold compresses applied directly to itchy skin can also help relieve itching.

4.application of nonprescription corticosteroid creams and ointments to reduce inflammation
if the condition persists, worsens, or does not improve satisfactorily.

Hydrocortisone cream and ointment are preferred to prevent side effects such as skin thinning.

5.For severe flare-ups, your doctor may prescribe oral corticosteroids (this treatment is not recommended for long-term use).

6.topical or oral antibiotics may be needed for the skin infection which may affect the dry inflamed skin.

7.sedative antihistamines are sometimes used to reduce the itch

8.Tar treatments can have positive effects; however, tar can be messy.

9.Phototherapy requires special equipment (lights).

10.cyclosporine A, which modifies immune response; however, this is used only in extreme cases because of its association with serious side effects.

How can Atopic Dermatitis be prevented?
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Atopic Dermatitis outbreaks can usually be avoided with some simple precautions.

The following suggestions may help to reduce the severity and frequency of flare-ups:

Moisturize frequently

Avoid sudden changes in temperature or humidity

Avoid sweating or overheating

Dress the child in breathable cotton clothes

Reduce stress

Avoid scratchy materials (e.g., wool or other irritants)

Avoid harsh soaps, detergents, and solvents

Avoid environmental factors that trigger allergies (e.g., pollens, molds, mites, and animal dander)

Be aware of any foods that may cause an outbreak and avoid those foods

A Simple Guide to Cutaneous Larva migrans

A Simple Guide to Cutaneous Larva migrans
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What is Cutaneous Larva migrans?
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Cutaneous Larva migrans is a common skin condition which appears as a red snake-like itchy rash caused by penetration and subsequent migration of larvae of various worm parasites.

The condition is benign and self-limited.

It is most commonly found in tropical countries.

Who is at risk from Cutaneous Larva migrans?
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1.People of all ages are affected but it is more common in children

2.It is more common in hot tropical climates

3.Certain occupations that involve contact with warm, moist, sandy soil:
Farmer
Gardener

4.Certain hobbies that involve contact with warm, moist, sandy soil:
Tropical climate travellers
Barefoot beach goers
Children building sandcastles

What are the causes of Cutaneous Larva migrans?
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The larvae usually hatch from eggs laid in animal faeces and then penetrate through the intact skin of the children or adults.

After shedding their covering, they begin migrating in the epidermis.

Because they are unable to penetrate through the dermis, the disease remains limited to the skin of humans.

THE MOST COMMON PARASITES ARE:
DOG HOOKWORMS:
Ancylostoma braziliense
Ancylostoma caninum
Uncinaria stenocephala

Rarer causes are:
Ancylostoma tubaeforme (cat hookworm)
Necator americanus (human hookworm)
Ancylostoma duodenale

What are Signs and symptoms of Cutaneous Larva migrans?
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Symptoms:

1.prickling sensation at the site within 30 minutes of larva penetration of the skin

2.Intense itchiness

3.Red linear lesions that moves

4.walking barefoot on the beach in a tropical location

Signs:

1.Itchy, red, raised papules or vesicles

2.snakelike, slightly elevated, red tunnels that are 2-3mm wide and 3-4 cm long from the penetration site

3.Vesicles with clear fluid

4.Tract movement of 1-2 cm/day

5.peripheral eosinophilia (Loeffler syndrome),

6.migratory lung infiltrates,

7.Lesions are typically present on the distal lower extremities,
the dorsa of the feet and the interdigital spaces of the toes,
anogenital region,
the buttocks,
the hands, and
the knees.

How is the diagnosis of Cutaneous Larva migrans made?
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Diagnosis is mostly based on the
1.classic clinical appearance of the eruption.

2.peripheral eosinophilia on a Complete Blood Count

3.increased IgE levels on total serum immunoglobulin determinations.

4. skin biopsy taken just before leading edge of a tract may show
a larva (periodic acid-Schiff positive) in a
suprabasalar burrow,
basal layer tracts,
spongiosis
intraepidermal vesicles,
necrotic keratinocytes,
an epidermal and upper dermal chronic inflammatory infiltrate with many eosinophils.

What are the complications of Cutaneous Larva migrans?
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1. secondary bacterial infection, usually with Streptococcus pyogenes, may lead to cellulitis.

2. Allergic reactions may occur.

What is the treatment of Cutaneous Larva migrans?
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The condition is usually self-limiting.
The intense itchiness and risk for infection may require treatment.

Invasive treatment:
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1.liquid nitrogen cryotherapy for progressive end of larval burrow.

2.electrocautery

Medication:
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1.Thiabendazole
Thiabendazole is the best medication
Topical application is used for early, localized lesions.
The oral route is preferred for widespread lesions or unsuccessful topical treatment.

2.Mebendazole (Vermox)
Broad-spectrum anthelmintic that inhibits microtubule assembly and irreversibly blocks glucose uptake, thereby depleting the parasites' glycogen stores.

Other effective treatments include
3.albendazole,
4.ivermectin.

In most cases there is decreased itchiness within 24-48 hours and lesions resolve in 1 week.

5.Antibiotics are given if there are secondary bacterial superinfections.

6.Antihistamines are given for severe itchiness

What is the prognosis of Cutaneous Larva migrans ?
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The prognosis is excellent.

This is a self-limiting disease.

Humans are accidental hosts and the larva usually dies within 4-8 weeks.

The lesions usually will disappear within 8 weeks to 1 year depending on complications.

What are the Preventive measures taken for Cutaneous Larva migrans ?
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Travellers to tropical regions and pet owners should be made aware of this condition.

Prevention is by avoiding direct skin contact with possible faecally contaminated soil.

A Simple Guide to Prickly Heat

A Simple Guide to Prickly Heat
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What is Prickly Heat?
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Prickly Heat(also known as miliaria) is a common non contagious disease which appears as acute itchy red rash on the body due to retained sweat.


Who is at risk from Prickly Heat?
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People of all ages are affected but it is more common in children and infants due to their underdeveloped sweat glands.

It is more common in hot and humid conditions.


What are the types of Prickly Heat?
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I.Miliaria crystallina-
minute superficial vesicular lesions that normally do not cause any symptoms

2.Miliaria rubra -
deeper layer inflammatory lesions causing the typical appearance of redness (hence rubra) and larger blister-like lesions.

There is intense itching with a lack of sweating to affected areas.

This is the most common form of prickly heat.

3.Miliaria profunda-
the most severe form of miliaria due to the rapid spread and severe burning sensations.

The obstruction is deep in the structure of the sweat gland resulting in the sweat to leak between the superficial and deep layers of the skin.

The rash occurs within hours of an activity provoking sweating and disappear within hours when the stimulus for the sweating is removed.

The risk of heat exhaustion is higher.


What are the causes of Prickly Heat?
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The cause is the result of the keratin or dead skin cells or bacteria such as Staphylococcus epidermidis of the skin blocking the sweat ducts.

The occluded sweat ducts ruptures when sweating occur and the sweat form an intraepidermal vesicle which leads to irritation(prickly sensation) and itchiness.

Secondary infection may occurs from invasion of staphalococcus.


What are Signs and symptoms of Prickly Heat?
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Symptoms:

1.Occurs in humid hot weather

2.Small red papulovesicular rashes

3.Occurs on the face, neck, under the breasts, trunk, under the scrotum, skin folds, behind knee and antecubital fossa.

4.Usually very itchy

5.Rash usually presents with prickly sensation


How is the diagnosis of Prickly Heat made?
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1.Symptoms and signs of small rashes occuring in hot humid condition with itchiness and prickly sensation

2.Skin scraping for microscopic examination.


What are the complications of Prickly Heat?
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1.Fungal infection

2.bacterial infection


What is the treatment of Prickly Heat?
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A. Cool Environment
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1. air-conditioned environment

2. avoid heat and sweat-inducing activities

3. avoid occlusive clothing,

4. take frequent cool showers.

B. Medicines:
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1. topical antibacterials may reduce the symptoms in miliaria rubra

2. anti-itch preparations such as calamine or menthol preparations

3. topical steroid creams,

4. Avoid oil based preparations because they increase blockage to the sweat glands.

5. Oral Antibiotics may be given if there is secondary infection.

6. Oral antihistamines may be given if itch is troublesome.

7. VItamin C or A in high dosages have not been found to be effective


What is the prognosis of Prickly Heat ?
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Generally good to excellent but may recur.

Environmental factors like humidty and heat should be avoided.


What are the Preventive measures taken for Prickly Heat ?
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1.Good skin hygiene

2.Healthy lifestyle with balanced diet and adequate sleep.

3.Wear light clothing

4.Reduce sweating (use air conditioner)

5.Frequent showers should help

6.Avoid heat and humidity.

A Simple Guide to Pityriasis Rosea

A Simple Guide to Pityriasis Rosea
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What is Pityriasis Rosea?
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Pityriasis Rosea is a common non contagious disease which appears as numerous patches of red rash on the trunk of the body.


Who is at risk of Pityriasis Rosea?
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All ages and both sex are affected but occurs more between 10 -35 years of age.


What are the causes of Pityriasis Rosea?
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The cause is unknown but a viral infection is suspected to cause it.


What are Signs and symptoms of Pityriasis Rosea?
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Symptoms:

1.A single red large patch of rashes or herald patch usually occur 1-20 days on the body before the onset of numerous small patches.

2.sore throat may occur before the onset of rashes

3.Numerous Large patches of red oval-shaped rash on the body may occur on the chest, back and neck.

4. As the rashes subside on the body, they may spread to the groin and extremities like the legs and arms

5.Rashes can be extremely itchy

6.breathlessness

7.low-grade fever

8.headache

9.nausea

10.fatigue.


How is the diagnosis of Pityriasis Rosea made?
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1.Symptoms and signs of typical herald patch followed by other patches of rashes

2.Skin scraping for microscopic examination.


What are the complications of Pityriasis Rosea?
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1.Fungal infection

2.bacterial infection


What is the treatment of Pityriasis Rosea?
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1.No treatment may be necessary as the illness is self limiting

2.Itch may be controlled with antihistamines

3.Corticosteroid (oral or cream) may help reduce severe itching and inflammation

4.Soap should be avoided because it irritate the skin.

5.Moisturizer is better because of the dry skin

6.UV therapy sometimes help

7.Antibiotics may be given if there is secondary infection.


What is the prognosis of Pityriasis Rosea ?
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Generally excellent but may recur.


What are the Preventive measures taken for Pityriasis Rosea ?
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1.Good skin hygiene

2.Healthy lifestyle with balanced diet and adequate sleep.

3.Proper skin care of the body.

A Simple Guide to Intertrigo

A Simple Guide to Intertrigo
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What is Intertrigo?
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Intertrigo is a moist red seborrheic (oil gland) skin rash affecting body clefts such as armpits and groins.


What are the causes of Intertrigo?
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The seborrheic glands (oil glands) in the skin secretes excessive sebum(oil) especially in areas which tends to rubs against each other such as armpits, groins, skin under the breasts, and navel.

Because of the irritation of the skin and secretion of sebum, a red moist form of rash appears.


What are Signs and symptoms of Intertrigo?
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Symptoms:

1.moist rash

2.red skin

3.may be oily


Signs:

1.Typical red moist macular rash

2.may have sebum present

3.appears mainly at axilla, groin, submammary skin


How is the diagnosis of Intertrigo made?
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1.Symptoms and signs of moist red seborrheic type of rash

2.Skin scraping to exclude fungal infection.



What are the complications of Intertrigo?
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1.Fungal infection

2.bacterial infection


What is the treatment of Intertrigo?
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1.Control of dandruff and other seborrheic conditions

2.Anifungal and antibiotic cream applied to skin lesions.

3.Corticosteroid cream may help reduce inflammation


What is the prognosis of Intertrigo ?
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Generally excellent but may recur.


What are the Preventive measures taken for Intertrigo ?
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1.Lose weight in obese patient(less friction)

2.Good skin hygiene

3.Healthy lifestyle with balanced diet and adequate sleep.

4.Proper skin care of the axilla, groins, submammary ares, navel