A Simple Guide to Dandruff

A Simple Guide to Dandruff
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What is Dandruff?
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Dandruff is an acute to chronic inflammatory scaly disease of the hairy areas of the scalp endowed with sebaceous glands.

As a result scales that are shedded from the the dead skin cells of the scalp are called dandruff or pityriasis capitis.

What are the Causes of Dandruff?
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The cause of Dandruff is not completely known but are related to three possible factors:

1.Excessive sebaceous or oil gland secretions from the skin

2.the fungus Malassezia furfur has been known to be a possible cause of dandruff.
It metabolises the oils present in sebum to a lipid byproduct oleic acid .This oleic acid can cause an inflmmation in the epithelium of the scaly resulting in the shedding of dry scales.

3. allergic reaction to chemicals in hair oils, cream or gel

Certain oily foods may trigger the production of dandruff

Stress has been known to trigger off dandruff


What are the symptoms of Dandruff?
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Onset is usually gradual.

Symptoms:
1.Flaking of scales from the scalp.

2.Itchiness of the scalp

3.Redness of the skin on scalp, forehead and eyebrows

Signs:
1.Dry, rounded, greyish macular or papular lesions on the scalp.

2.The surface consists of dry scales which can be rubbed off

3.Sometimes the lesions can become crusted

4.Some lesions may become purulent with yellow exudate.

What is the Treatment of Dandruff?
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1.Dandruff shampoo such as Sebutone, Genisol, Selsun will help to remove flakes and reduce the lesions.

2.fungus infection should be treated with antifungal orally with ketoconazole
and topical antifungal lotion and shampoo such as salicylate acid lotion, nizoral or ketoconazole shampoo.

3.For more severe cases with bacterial infection a combination of hydrocortisone and tetracycline ointment can be used to remove infected crusts.

4.General hair hygiene -
shampoo hair daily

Avoid too strong hair cream or gels


What is the prognosis of Dandruff?
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Generally good with treatment.

However recurrences are not uncommon.

General hair hygiene is important.

A Simple Guide to Hyperhidrosis

A Simple Guide to Hyperhidrosis
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What is Hyperhidrosis?
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Hyperhidrosis is the condition when a person suffers from excessive perspiration due to overactivity of the sweat glands.

This may cause a social problem in people who need to shake hands or write with sweaty palms.

Excess perspiration with foul odor may also be offensive to people around the patient


What are the causes of Hyperhidrosis?
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The cause of Hyperhidrosis is usually unknown.

It has been linked to :

1.excessive sweat glands

2.psychogenic excess production of sweats under stress and nervous conditions

3.Endocrine disorder such as hyperthyroidism

4.Skin diseases with increased hydration of skin such as in weeping eczema

5.Genetic - inherited as an autosomal dominant trait. Family has a history of Hyperhidrosis

6.diseases of the nervous system


7.Tuberculosis-night sweats are a typical feature of tuberculosis

8.diabetes mellitus and pituitary disorders

9.Certain medicines such as aspirin, paracetamol may provoke excess sweating

10.alcohol, caffiene, and certain food(spices) may stimulate the sweat glands


What are the symptoms and signs of Hyperhidrosis?
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Persons who has Hyperhidrosis has the following:

Symptoms:
1.Genralised sweating

2.localised sweating of palms, soles, axilla and groins

3.Foul smell from the excess sweat is caused by the decomposition of skin cells by bacteria and yeast infection

Signs:
1.Skin may become thickened, fissured or scaly

2.Nail deformities may occur

3.Secondary bacterial and fungal infections may be present


How do you diagnose Hyperhidrosis?
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Diagnosis can usually be made by :
1.Sweaty palms or soles

2.thickened, fissured skin with nail deformities


What is the treatment of Hyperhidrosis?
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1.Treat the underlying cause such as hyperthyroidism, diabetes

2.Clean involved skin frequently with baths etc. Use talcum powder to dry skin.

3.Wear cotton socks and underwear and change daily.

4.Local application of aluminium chloride, hexahydrate, glutaradehyde and even tannic acid from tea.
Some side effects may be allergic dermatitis or staining of skin

5.Anticholinergic drugs can reduce the sweating but has side effects such as dryness of mouth and flushing

6.Surgery in severe cases may be required such as sympathectomy (for palms).

Sweat glands suction by removing some of the sweat glands has been shown to reduce sweating

7.Iontophoresis: may help but may be painful

8.Botox injection may disable the sympathetic nerves to the sweat glands amy lasts for 6-9 months

9.Hypnosis, relaxation and meditation has help to certain extent

10.Radiotherapy has been known to be effective but not used because of the danger of bone cancer.


What is the prognosis of Hyperhidrosis?
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Prognosis is usually palliative as the sweat glands and nerve cells may grow back.

Recurrence is quite common.

A Simple Guide to Prolapsed Intervertebral Disc

A Simple Guide to Prolapsed Intervertebral Disc
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What is Prolapsed Intervertebral Disc?
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Prolapsed Intervertebral Disc is the prolapse of the intervertebral disc(which is the disc between 2 vertebrae) as a result of protrusion of the nucleus pulposus out of its weakened ligamentous ring(annulus fibrosus).

It may protrude in a posterior or postero-lateral direction causing pressure to the nerve roots especially at S1, L5 and L4 vertebrae.

What are the causes of Prolapsed Intervertebral Disc?
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1.Degeneration of the posterior longitudal ligaments and annulus fibrosus occurs with age resulting in the disc being pushed out between the weakened ligaments.

2.Trauma -direct injury to disc, heavy lifting, sneezing can cuse the disc to pop out of the weakened ligaments and prolapse partially or completely.

3.Spinal tumour rarely pushes the disc out of its intervertebral space

What are the symptoms and signs of Prolapsed Intervertebral Disc?
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Symptoms:
1.Low Backache with pain in the lumbar region

2.Sciatica or pain shooting down 1 leg

3.Pain usually follows
severe bending
lifting heavy objects
injury
sneezing or coughing

4.Pain may so bad that the person cannot stand erect.

5.pain is worse when sitting

6.weakness, numbness, difficulty in moving the leg

Signs:
1.Muscle spasm especially spinal extensor muscles

2.Movement of the back and affected led painful and restricted

3.Patient tend to stand stiffly or with slight sciatic scoliosis on the affected side

4.Straight leg raising test is usually restricted on the affected side.

5.Neurological signs such as paraesthesia commonly present on the affected side.

6.Sensory and motor deficit may be present in the affected side

7.Loss of reflex and weakness may help to localise the site of prolapse:
L4 root:
Pain in the medial buttock, lateral thigh, medial tibia and big toe
weakness of big toe and foot dorsiflexion
patella jerk is diminished

L5 root:
Pain in hip, groin,posterolateral thigh, lateral calf and dorsal surface of foot
weakness of the big toe and foot dorsiflexion
no change in patella or ankle reflexes

S1 root:
pain in posterior part of thigh, lower calf border and sole of foot
weakness of knee flexors and plantar flexors
ankle jerk is diminished


How to investigate the cause of Prolapsed Intervertebral Disc?
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1.Full medical history especially of injuries, type of work, onset of pain,radiation to legs,

2. Full medical examination especially of movement of the back ,any deformity of the spine, straight leg raising test

3. X-ray of the Spine: to exclude osteoarthritis, injury, narrowing of disc space, bone tumor,

4.MRI of spine for slipped disc

5.bone scan for osteoporosis

A definite diagnosis can then be made and the cause of the pain treated.


What is the Treatment of Prolapsed Intervertebral Disc?
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Conservative treatment:
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Initial phase:
1.Bed rest with a hard board below the mattress- straighten the back
2.Physiotherapy such as traction, shortwave diathermy

Mobilisation phase:
1.Wearing a corset to strengthen the back and help the traction of the spinal bones
2.gradual mobilisation and exercises to strengthen the spinal extensor muscles

Maintenance phase:
1.Exercises to strengthen the back muscles.
2.Wear a corset
3.Avoidance of postural strain on the back

Drug Therapy:
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1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
2.Muscle relaxant to relax muscles
3.Extradural injection of local anesthetic and long acting steroid may help to relieve the pain

Surgery:
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Surgery is required if there are:
1.persistent pain and neurological symptoms remain after conservative treatment
2.progressive neurological symptoms
3.Disc has protruded more than 75% out of its intervertebral space as seen on MRI

Surgery consists of:
1.laminectomy - removal of the disc and prolapsed material.
2.microdiscectomy- insertion of a titanium disc to replace the removed prolapsed disc

Finally treatment of the underlying cause(eg.space occupying spinal tumors) is important.

What is the prognosis of Prolapsed Intervertebral Disc?
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Prognosis depends on the underlying cause.

Preventative measures are important in preventing recurrences of the prolapse of the intervertebral disc.

What is the Prevention of Prolapsed Intervertebral Disc?
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Avoidance of postural strain on the back

Wear a corset

Exercises to strengthen the back muscles.

A Simple guide to Anal Fistula

A Simple guide to Anal Fistula
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What is Anal Fistula?
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Anal Fistula (or fistula-in-ano) is a chronic granulous track which communicate between the anorectal canal and the perianal skin.

There may be several external openings but only one internal opening

What is the cause of Anal Fistula?
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Anal Fistula usually result from :
1.breakdown of anorectal abscesses

2.follows surgery for anal fissure

3.Less common causes are:
lymphogranuloma

carcinoma of rectum

ulcerative colitis,

regional ileitis

tuberculosis

What are the symptoms of Anal Fistula?
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1.pain especially on sitting down

2.purulent painless discharge(pus) near the anus

3.Recurrent perianal abscesses(pockets of pus around the anus)

4.pruritis ani(itch in anus)

How are Anal Fistula diagnosed?
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1.thorough examination of the perianal region

2.Rectal examination and palpation of the fistula track

3.Pass a probe through the perianal opening to determine the length of the track

4.Sigmoidoscopy and colonoscopy to detect internal opening and other lesions in the rectum and large intestine

5.Barium enema to exclude any ulcerative colitis and regional ileitis


What is the treatment of Anal Fistula?
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There are 2 types of anal fistula:
1.High level fistulas penetrate the levator ani-muscle of the anal sphlinter

2.Low level fistulas are below the levator ani and are more common.

Treatment of lowlevel fistula:
1.lay open the track and curette(scrape the lining and debris in the track out)

Treatment of high level fistula:
1.open the track from within the ischiorectal fossa

2.colostomy may be necessary for multiple fistulas or very high internal opening

General treatment:
1.Treatment of associated diseases like diabetes, ulcerative colitis, regional ilitis, carcinoma

2.Antibiotics - a full course of at least 2 weeks of antibiotics is needed

3.toilet and dressing of the wounds, with application of antibiotic creams

4.tub baths of the anal region several times a day in plain, warm water for about 10 minutes

What is the prognosis of Anal Fistula?
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Good with surgery.

Rarely there may undesirable complication like rectal incontinence.

A Simple Guide to Sciatica

A Simple Guide to Sciatica
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What is Sciatica?
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Sciatica is the symptom of shooting pain down the leg occurring in the sciatic nerve due to inflammation or pressure on the nerve.

What are the causes of Sciatica?
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Sciatica occur as a result of pressure on the sciatic nerve as a result of:

1.slipped disc- a prolapsed intervertebral disc which slipped out of the ligaments holding it may press against the sciatic nerve especially in the lumbar vertebrae

2.disc degeneration - flattening of the disc due to degeneration allows the discs above and below it to compress the sciatic nerve

3.Spinal stenosis- narrowing of the spinal canal can cause compression on the sciatic and other nerves

4.sacroiliatis - inflammation of the sacroliac joint cause swelling of the bones involved in the joint and may compress the sciatic nerve

5.lumbar facet syndrome-the facet bone like any bone in the body can become inflammed, swells and press against the sciatic nerve.

6.Iliolumbar syndrome- the iliolumbar ligament extends from the spine to the iliac crest when inflammed or swollen due to injury can compress the sciatic nerve

7.piriformis syndrome-the piriformis muscle lies on top of the sciatic nerve at the buttock and if inflammed, swells and press on the sciatic nerve.

8.spinal tumour- any tumour in the spine which is near the sciatic nerve may compress it.

What are the symptoms and signs of Sciatica?
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Symptoms:

1.pain may be a continous dull ache in the leg or a shooting pain down the leg

2.pain is present in the buttocks, posterior thigh, and back of outer side of the leg to ankle

3.Pain is usually but not always relieved by rest(lying flat)

4.Pain is aggravated by
a.spinal movements like flexion
b.exercises
c.straining
d.coughing
e.sneezing

5.pain is worse when sitting

6.weakness, numbness, difficulty in moving the leg

Signs:

1.Patient stands with spine rigid.
Sometimes there may sciatic scoliosis to protect the nerve roots on 1 side.

2.Straight leg raising test(SLR) which is normally up to 90 degrees is restricted

3. superficial paresthesia and sensory loss with or without tendon reflexes loss at knee or ankle and muscle weakness depending on severity and site of nerve root compression

What are the investigations required in Sciatica?
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1.Xrays of spine and pelvis for osteoarthritis, disc lesions, ankylosing spondylosis, or metastatic tumours

2.MRI of lumbar spine

3.Electromyogram and nerve conduction studies may give an an indication of the severity of damage to the nerve and the subsequent prognosis

What is the treatment of Sciatica?
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Conservative treatment:
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1.Bed rest with a hard board below the mattress- straighten the back

2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

3.Muscle relaxant to relax muscles

4.Physiotherapy such as traction, massage or expert manipulation of the vertebrae, shortwave diathermy

5.Wearing a corset to straigthen the back and help the traction of the spinal bones

6.After the initial phase of pain is over , gradual mobilisation and exercises to strenghten the spinal extensor muscles

Surgery:
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If conservative methods fail or the pain is too severe, surgical decompression is then considered:

1.microdiscectomy - insertion of a titanium disc to replace the damaged intervertebral disc

2.laminectomy - traditional surgical removal of the damaged intervertebral disc

Finally treatment of the underlying cause is important

What is the prognosis of Sciatica?
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Prognosis depends on the underlying cause.

Mild inflammation of the muscles, ligaments may recover with conservative methods

More severe inflammation of the nerve due to disc or spinal may become worse with time.

How do you prevent Sciatica?
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Avoidance of postural strain on the back- no high heels, avoid bending the back, keep the back straight

Sleep on a hard mattress

Wear a corset

Exercises to strenghten the back muscles.