A Simple Guide to Retinal detachment

A Simple Guide to Retinal detachment
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What is Retinal detachment?
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Retinal detachment is a condition in which there is a separation of the neurosensory retina from the underlying retinal pigment epithelium.

It is a medical emergency.

Who is affected by Retinal detachment?
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The following are at risk from Retinal detachment:

1. age above 55 yrs

4. very short sighted (myopia usually above 5-6 diopters)

3. history of serious eye injury (injury to orbits)

4. history of eye cataract surgery

5. Sports activities which can cause injuries to the eye (Boxing, karate etc) or increase pressure in the eye( bunjee jumping, diving etc)

6. family history of Retinal detachment -related to family history of diabetes, sickle cell disease and other underlying condition

What is the cause of Retinal detachment?
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There are 2 types of retinal detachment:

Primary:
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There is a hole in the retina which allows the seepage of vitreous humor between the the neurosensory retinal layer and the retinal pigment eipthelium which cause the separation of the 2 layers.

The holes are usually at the periphery.

It is a degenerative condition which can be aggravated by trauma especially in the severe myopic(short sighted) and senile (old) eyes.

Secondary:
---------------

Other eye diseases which can separate the 2 layers are:

1.Choroiditis- inflammation of the choroid cause exudation of serous fluid under the retina layer

2.Toxemic retinopathy - inflammation of the retina cause exudation of serous fluid under the retina layer

3.proliferative diabetic retinopathy - abnormal blood vessels grow within the retina causing the retina to pull away from the wall of the eye

4.vitreous hemorrhage after injury to the orbits - blood clot and fibrovasular tissue developing from the blood clot can cause separation of the nuerosensory retina and pigmented retina layer.

5.Choroidal melanoma(a malignant tumor) - a growth below the layers of the retina can push the layer of retina from the back of the eye

What are symptoms and signs of Retinal detachment?
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Symptoms:
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1.transient flashes of light

2.a sudden increase of floaters in one eye

3.a ring of floaters at the temporal region of the central vision

4.a feeling of heaviness in the eye

5.presence of cloud in front of the eye so that parts of an object are not seen

6.the sensation of a curtain falling over the central vision of eye

7.Straight lines that become curved

8.Central vision intact at first followed by complete and total loss of vision if untreated

Signs:
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1. In early stage, direct opthalmoscopy show very little abnormality

2. Indirect opthalmoscopy may show the presence of the detachment.

3. The pale white or grey folds of the detachment can be seen

How is Retinal detachment diagnosed?
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1. Indirect opthalmoscopy with slit-lamp examination is the best method to detect early or shallow detachment and to identify the retinal holes.

2.Transillumination and ultrasound may be usefulto detect neoplasm

3.Flourescin angiography may be needed in special cases to establish the presence of retinal detachment.

What are the complications of Retinal detachment?
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Partial to complete loss of vision.

What is the treatment for Retinal detachment?
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Retinal detachment is a medical emergency.

The most important part of treatment is finding the holes or tears and closing them.

Primary:
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1.Vitrectomy (most common procedure)
Vitrectomy involves the removal of the vitreous gel followed by filling the eye with a gas bubble (SF6 or C3F8 gas).
Side effect is the more rapid progression of a cataract in the operated eye.

2.Cryotherapy and Laser Photocoagulation
Cryotherapy (freezing) and laser photocoagulation are used to create a adhesion around the retinal hole so that fluid cannot enter the hole and accumulate behind the retina resulting in the retinal detachment.

3.Adatomed Silicone Oil
Adatomed Silicone Oil is injected into the eye and mechanically holds the retina in place.
The oil is usually removed within a year.

4.Scleral buckle surgery
The choroid and retina are brought together by buckling the sclera with silicone bands sewn by the eye surgeon to the outside of the eyeball.
The most common side effect of this operation is more short sighted after the operation.

5.Pneumatic retinopexy
This operation is done under local anesthesia by injecting a gas bubble (SF6 or C3F8 gas) into the eye after which laser or freezing treatment is applied to the retinal hole. The patient may have to keep his head tilted for several days to keep the gas bubble in contact with the retinal hole in order to seal the hole..

6.Ignipuncture
Ignipuncture involves cauterization of the retina with a very hot pointed instrument.It is no longer used.

After treatment the results are usually good and vision is regained over a period of a few weeks.

Secondary:
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1.Neoplasm: surgical removal of neoplasm

2.Traction detachment: vitreous surgery, prognosis is poor

3.Others:Fluids usually resorbs as underlying condition is treated.

How is Retinal detachment monitored?
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1.regular follow up with the eye doctor.

2.examining the retina for further damage

3.analysing the visual fields.

With proper monitoring and treatment most patients will be less likely to be at risk of blindness.

What is the prognosis of Retinal detachment?
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The prognosis varies depending on the the underlying disease.

Prognosis is good if the condition is diagnosed and treated early although visual acuity may not be as good as before.


How can Retina Detachment be prevented?
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Retinal detachment can be prevented:

1.educating people of the symptoms suggestive of a posterior vitreous detachment.

2.Eye examination to detect retinal tears which can be treated with laser or cryotherapy.

3.Avoid known risk factors for retinal detachment.
a.Cataract surgery
b.Trauma (boxing, kickboxing, karate, etc.)
c.high level of myopia
d.activities that increase pressure in the eye, including diving, skydiving, bungee jumping

A Simple Guide to Gingivitis

A Simple Guide to Gingivitis
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What is Gingivitis?
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Gingivitis is an acute disease which causes inflammation and infection of the gums with redness, swelling and bleeding.


What are the causes of Gingivitis?
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Bacterial Infections:
----------------------------

1.Gram positive bacteria such as Streptococcus and Staphphylococcus may be painful and lead to upper respiratory tract infection

2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia

Non-infectious:
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1.malocclusion

2.food impaction

3.dental calculus

4.dental procedures

5.exposure to heavy metals

6.long term phenytoin treatment

7.Oral contraceptive pills

Systemic diseases:
--------------------

1.diabetes mellitus

2.leukemia

3.Debilitating diseases

4.autoimmune diseases


What are Signs and symptoms of Gingivitis?
---------------------------------------------

Symptoms:

1.Pain in the gums

2.Red swollen inflamed gums

3.bleeding in between the gums

4.Fever may be present

Signs:

1.Red swollen inflamed gums around neck of teeth

2.Swelling of papilla between teeth

3.Gum boils or abscess in the gums

4.Gum ulcers


How is the diagnosis of Gingivitis made?
------------------------------------------

1.Symptoms and signs of red, swollen and inflamed gums

2.blood tests (complete blood count, ESR and blood culture)

3.X-rays of teeth


What are the complications of Gingivitis?
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1.damage to root canals

2.cavity in the teeth

3.upper respiratory tract infection


What is the treatment of Gingivitis?
------------------------------------

1.Rest & fluids

2.Painkiller for pain

3.Antibiotics depending on the organism found:

a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus

b.cephalosporins, gentamycin for pseudomonas

4.Oral application of oral antibiotic cream

What is the prognosis of Gingivitis ?
------------------------------------------

Usually very good.

Surgery for abscess and other gum or tooth problem very rarely needed.


What are the Preventive measures taken for Gingivitis ?
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1.Avoid smoking

2.Healthy lifestyle with balanced diet and exercise.

3.Regular cleaning of gums and teeth by brushing and flossing

4.Gargling of mouth after meals

5.Regular dental checkups

A Simple Guide to High Cholesterol

A Simple Guide to High Cholesterol
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What is High Cholesterol?
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High Cholesterol is the presence of raised amount of total cholesterol in the blood( blood total cholesterol above 200mg/dl).


What is the cause of High Cholesterol?
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Cholesterol is a fat molecule in the body which is needed for many normal body functions.

It is produced mostly in the liver and is present in the cell walls and membranes of the brain, nerves, muscles, skin, heart ,intestine and of course liver.

Cholesterol is used by the body to make the body's hormones(male and female) and bile acids used to digest fats.

20-30% of the cholesterol comes from the food that is eaten.

Animal Fat:
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1.A diet high in saturated fat mainly animal fat, butter, lard

2.Trans-fatty acids in fast food and processed foods

Animal organs:
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Brains of pigs, sheep, fish are particularly high in lipoproteins and fat

Liver, skin fat, etc

Egg yolk:
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Egg yolk and products containing egg yolk like fish roe, cakes, icecream,

Dairy Products:
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full cream milk

Certain other food:
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Peanut butter, peanut oils, coconut oil

Genetic factors - Familial hypercholesterolemia has been known for high cholesterol in families

What is the diagnosis of high cholesterol?
----------------------------------------------------

A blood test for lipid profile measures :

1.total cholesterol

2.LDL (low-density lipoprotein [the bad cholesterol]),

3.HDL (high-density lipoprotein [the good cholesterol])

4. triglycerides—another fatty substance in the blood.

High lipid readings are when the
1.total cholesterol in your blood is more than 200mg/dL,

2.LDL cholesterol is more than 130 mg/dL (130-159 is borderline high; 160 is high; 190 is very high).

3.HDL, the "good cholesterol," should be around 40 mg/dL or greater.
With HDL, the higher the number, the better, and 60 mg/dL is protective against heart disease.

4.Triglycerides is more than 200 mg/dL

What is the danger of High Cholesterol?
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The excess cholesterol will then be deposited in the arterial walls causing narrowing of the arteries and reducing the blood flow to the heart, kidney and the brain.

Therefore any thickening of the arterial wall of blood vessels to the heart, kidney or brain as a result of deposit of cholesterol deposited in the wall of these arteries will reduce the flow of nutrients and oxygen to the heart, kidney or brain resulting in heart attack, kidney failure or stroke.

What is the Treatment of High Cholesterol?
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1.Dietary and lifestyle modification

2. Medications:

1. statins (HMG-CoA reductase inhibitors) has been found to reduce high cholesterol fairly fast especially the more potent ones such as LIpitor and Crestor.
However they also have more side effects particularly damage to the liver(hepatitis) and muscles(myopathy)

2.fibrates is preferred especially if the triglycerides is high or if the patient has liver problem.
Lipanthyl (a fibrate) has been found to be as effective if not more effective than statins.
Side effects are myopathy.

3.Combination treatment of statins and fibrates are more effective but have more side effects such as increased myopathy and rhabdomyolysis in addition to hepatitis.

4.ezetimibe, niacin, bile acid sequestrants, plant sterol-containing products have also been used together with statins for better effect.

Treatment Regime:
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1. Total cholesterol is less than 250mg/dl: Diet and weight control is sufficient.

2.Total cholesterol is 250-300mg/dl: Diet and weight control is a must.
If associated risk factors such as high blood pressure, diabetes, heart disease, obesity and smoking is present, drug therapy is necessary.

3:Total cholesterol is more than 300mg/dl:
drug therapy together with diet and weight control is required.


How to prevent High Cholesterol?
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Diet Control
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1. Reduce intake of fatty meats
Eat lean meat and poultry

2. Avoid organs of animals especially liver, brain
Eat more beans, peas or bean cursd

3. Avoid seafood especially prawns, crabs, lobsters,squids'
Take more fish

4. Avoid deep fried food
Take more steamed food and non-creamy soups

5. Avoid lard and butter
Take margarine or polyunsaturated vegetable oils

6. Avoid creams, coconut milk, cakes
Eat Fish oils(omega 3) ,garlic

7. Avoid alcohol, excess rice, jams, sugars, sweets
Eat more fruits and vegetables

Weight control:
---------------------

Reduce the calories in food

Mild to strenous exercise

Avoid stress which can sometimes make you eat more.

A Simple Guide to Bronchitis

A Simple Guide to Bronchitis
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What is Bronchitis?
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Bronchitis is an acute disease which causes inflammation and infection of the trachea, bronchi and bronchioles of the lungs.

The mucous membranes of the bronchi of the lungs becomes inflamed from bacterial or viral infection or irritated by fumes and dust in the air resulting in swelling of the bronchial mucosa with excess mucous discharge causing narrowing of the air passages.

Because of the congestion of the brochi there is difficulty in breathing and insufficient oxygen to the body thus posing a danger to the patient's life .

What are the causes of Bronchitis?
----------------------------------------

Bacterial Infections:
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1.Gram positive bacteria such as Streptococcus Bronchitise and Staphphylococcus may be serious and fatal in some cases.

2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia

Viral infections:
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Influenza, arbovirus, Severe Acute Respiratory Syndrome(SARS) virus, coxsackie virus

Fungal infections:
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Cryptococcus neoformans

Non-infectious:
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1.chemicals such as fumes can damage the lungs and cause Bronchitis

2.Othostatic Bronchitis occurs in people who are bedridden and are unable to get rid of the fluids accumulated in their lungs

3.Aspiration Bronchitis occurs with saliva or fluids in the throat become sucked into the windpipe and the lungs.
This occurs in comatose patients and people having seizures or stroke.

What are Signs and symptoms of Bronchitis?
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Symptoms:

1.cold or runny nose is usually the first symptom

2.Fever may be present

3.cough initially dry, followed by productive purulent sputum which can yellow, green or bloody

4.Breathlessness due to airway obstruction

5.chest pain especially the sides of the chest due to coughing and fever

6.Myalgia (bodyaches) and headache which may be related to the fever

Signs:

1.Moist sounds and wheezing on auscultation with sthetoscope due to narrowing of the airways(bronchi)

2.rhonchi or wheezing sounds due to narrowing of the airways from pressure in the congested lungs

3.Reduced breath sounds - air movement is reduced in the lungs

4.Hyporesonance on percussion of the lungs

5.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.

This will considered as a medical emergency.

Children and babies with Bronchitis may not have signs of a chest infection.
They are however quite ill, with fever and lethargy.

How is the diagnosis of Bronchitis made?
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1.Symptoms and signs of fever, breathless and productive cough

2.blood tests (complete blood count, ESR and blood culture)

3.Sputum culture to determine the type of micro-organism

4.Chest X-rays to establish site and character of the bronchial infection

5.CT or MRI of the lungs may be done if required especailly if there is suspicion of lung cancer.

What are the complications of Bronchitis?
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1.Pneumonia

2.adult respiratory distress syndrome

3.Emphysema

What is the treatment of Bronchitis?
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1.Rest, fluids and oxygen

2.Bronchidilators such as aminophylline, ventolin, bricanyl

3.Antibiotics depending on the organism found:

a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus

b.cephalosporins, gentamycin for pseudomonas

c.Tetracycline or erythromycin for mycoplasma and chlamydia

d.Erythromycin and rifampicin for Legionaire's disease.

3.Antivirals such as Tamiflu for Influeza infection
Acyclovir may be given for herpes virus infection

4.High dosages of antifungals may be given for Fungal Bronchitis for a prolonged period of time

5.corticosteroids is useful to reduce complications

6.Humidifiers and steam inhalations

5.cough mixtures and mucolytic agents such as bisolvon

What is the prognosis of Bronchitis ?
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This depends on the severity and type of infection.

Most cases if treated early and correctly recovered completely with return of normal lung function.

In elderly and debilitated patients, breathing can be a problem and recurrence can occur.


What are the Preventive measures taken for Bronchitis ?
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1.Avoid smoking and dusty environment.

2.Healthy lifestyle with balanced diet and exercise.

3.Vaccination against the influenza virus may help.

A Simple Guide to Thyroid Nodules

A Simple Guide to Thyroid Nodules
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What are Thyroid Nodules ?
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Thyroid nodules are abnormal swellings in the thyroid gland which occurs when the thyroid tissues starts to proliferate in one part of the thyroid gland.


Who are at risk of thyroid nodule?
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1.Thyroid nodules are more common in females than in male.

2.However the thyroid nodule in males are more prone to malignancy than in females

3.Thyroid nodules occurs more in the 30- 60 age group.


What are the different types of Thyroid Nodules?
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1.solid - solid thyroid nodules which may or not feel hard

2.cystic - the nodules is filled with fluid.

3.benign - non malignant

4.malignant - cancerous


What are the symptoms and signs of Thyroid Nodules?
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In mild cases there is usually no obvious symptoms.

In moderate or severe cases of thyroid nodules:

Symptoms:
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1.Obvious swelling in the thyroid gland

2.Neck swelling -suuggest presence of spread to the lymph node

3.Hoarseness of voice may occur if there is pressure on the vocal cord or recurrent nerve to vocal cord

4.Dyspnea or breathlessness if there is pressure on the trachea

5.Dysphagia or difficuly in swallowing due to pressure on the oesophagus


Signs:
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1.Thyroid nodules are felt only if they are more than 1.5 to 2cm in diameter.

2.Cystic nodules may feel hard while solid nodules may be soft to firm.

3. The vocal cords should always be examined to exclude lesions in the vocal cords causing hoarseness.

4.Malignant thyroid nodules present similarly to benign nodules but can spread to other parts of the body.


How are diagnosis of Thyroid Nodules made?
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1.blood test for thyroxine and TSH levels

2.fine needle aspiration biopsy is a simple way to determine if a nodule is benign or malignant.

The biopsied material is then sent to the lab for tests to look for any malignant cells.

3.ultrasound scans are done to differentiate between solid and cystic nodules,

4.thyroid scans which help to show if a nodule is producing excessive thyroid hormone(hot) or not.

5.CT Scan or MRI are not routine to thyroid nodules investigation except where there is suspected compression of teachea.


What is the Treatment of Thyroid Nodules?
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Benign lumps can be monitored by doctors at regular intervals.

If there are symptoms of compressing a neighbouring organ or the nodule is cancerous, surgery is required.

Patients who has symptoms of hyperthyroidism are advised to go for radioactive iodine treatment or surgery.


What is the Prognosis of Thyroid Nodules?
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Prognosis is good in all benign cases.

Malignant thyroid nodules will depend on any spread to other organs.

A Simple Guide to Otitis media

A Simple Guide to Otitis media
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What is Otitis media?
---------------------------------------

Otitis media is acute or chronic inflammation of the middle ear.

Otitis media occurs in the area between the ear drum (the end of the outer ear) and the inner ear, including a duct known as the Eustachian tube.

Who is affected by Otitis media?
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1.childhood, usually related to viral upper respiratory tract infection

2.family history of middle ear disease.

What are the Causes of Otitis media?
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Bacterial infections:

1.Streptococcus pneumoniae

2.Haemophilus influenzae

3.staphylococcus aureus

4.Moraxella catarrhalis, a gram-negative diplococcus.

5.Mycobacterium tuberculosis.

6.E.coli

Viral infections:

1.common cold.

2.measles

What is the Types of Otitis Media?
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1. Acute otitis media

Acute otitis media ia an acute infection of the middle ear which usually occurs as a result of viral upper respiratory tract infection that can occur at least twice a year

2.Chronic otitis media

Chronic otitis media occurs following acute otitis media with chronic infection of the middle ear and ear perforation.

3.Otitis media with effusion:

Otitis media with effusion occurs when fluid occurs in the middle ear due to blockage of the eustachian tube.

What are the complications of Otitis media?
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1.mastoiditis

2.labrynthitis

3.facial nerve palsy

4.meningitis,

5.brain abscess,

6.febrile seizures.

7.death if a severe infection goes untreated long enough


What are the Symptoms and signs of Otitis media?
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1. cold: stuffy nose

2. earache - The pain lasts a day or two.

3. high fever - may cause seizures if very high

4. discharging pus from the ruptured eardrum
Usually the ruptured drum will usually heal spontaneously

5.Eustachian tube becomes blocked resulting in hearing loss

Signs:

1.Ear drum (tympanic membrane) inflamed and bulging with loss of normal outline

2.Decreased or displaced light reflex of ear drum

3.perforation of ear drum

4.mucopurulent discharge from ear after perforation

How is diagnosis of Otitis media made?
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1.Inflamed ear drum with loss of normal outline, decreased light reflex, bulging and perforation and purulent discharge.

2.Culture and sensitivity of pus swab

3.Nasal and pharyngeal swabs my also be done

4.X-rays or MRI of the mastoid air cells

5.Audiogram for hearing loss

What is the treatment of Otitis media?
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Acute otitis media

1. Antibiotics may be commenced if fever is high or the culture showed bacterial infections.

2.Fever and pain may be treated with paracetamol

3.Antihistamines may be given for rhinitis or runny nose.

4.Decogestants may be necessary for blockage of eustachian tube

5.Bed rest and Fluids

6.Myringoplasty -Puncture of bulging ear drum if painful and aspiration of pus or fluid in the middle ear.

7.Tympanoplasty for eardrum whose perforation does not heal.

8.Mastoidectomy to remove cholesteatoma(growing of skin into middle ear cavity) in chronic otitis media with mastoiditis.


What is the prognosis of Otitis media?
-----------------------------------------

Prognosis with appropriate treatment is generally good.

Ear drum perforation usually heal spontaneously in most cases.

What are Preventive measures for Otitis media?
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Avoid swimming and diving.

Proper ear hygiene.

A Simple Guide to Skin warts

A Simple Guide to Skin warts
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What are Skin warts?
---------------------------------------

Skin warts are benign epithelial hyperplasia raised swellings on the skin caused by one of the human papilloma viruses.

They are infectious by direct contact or indirect contact through contaminated surfaces from one person to the other.

It is the one of the common skin condition.

It is never life threatening.

Who is affected by Skin warts?
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Skin warts is more common in :

1.children than in adults

2.contact with a person with warts

3.families with a patient having warts

What is the Cause of Skin warts?
-----------------------------------------------------

The human papilloma virus is the cause of skin warts.

There are 100 types of HPV which has been identified as causing skin or mucosal infections.

What are the types of Skin warts?
-----------------------------------------------------------

Common wart:
--------------

Common warts are benign swellings in the skin that are caused by human papillomavirus (HPV) infection.

1.Periungual wart

Periungual warts are common warts around or under the fingernail and toenail.

2.Plantar warts

Plantar warts are found on the pressure areas of the foot.

The presure causes inward growth.

They can be single, seedling or mosaic.

3.Mosaic warts

Mosaic warts are plagues of closely set plantar warts

4.Plane warts

Plane warts are flat-topped smooth papules, light brown or skin flesh in color present on the face, legs, and hands often occuring in large numbers.

5.Filiform warts

Filiform warts appear as a single long narrow growth often on the eyelid or face

What are the Symptoms and signs of Skin warts?
-----------------------------------------------------------

Skin warts can present as:

1.round or irregular raised swelling

2.Color may be like normal skin or light brown.

3.Surface is rough(may look like califlower) or smooth

4.Border is sharply demarcated

5.Size varies from 2-10mm in diameter.

5.They are usually found on the fingers, elbows, knees, feet, scalp and face.

How do you make the Diagnosis of Skin warts?
------------------------------------------------------------

1.Skin biopsy under local anesthesia

2.small lesions can be totally removed

3.larger ones are biopsied first and surgically removed later on


What are the complications of Skin warts?
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If skin warts are transmitted to the genital area, there is a risk of genital warts which can cause cervical cancer in women

What is the treatment of Skin warts?
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Many warts resolve spontaneously.

For those that persists or grow bigger, other treatments may be used:

1.Surgery:

Skin warts are removed by surgical excision.

2.Chemical treatment:

a.local therapy with Salicylic-acid preparations which dissolves the protein forming most of both the wart and the thick layer of dead skin above it.

b. 5-fluorouracil(a chemotherapy agent)

3.Cautery:

Electrotherapy by cautery of the warts kills the virus and destroy the tisues underneath which allow them to grow.

4.Cryosurgery:

Aerosol wart treatments freeze warts at a temperature of minus 57 C.

This can kill the virus.

Dermatologists use liquid nitrogen which is considerably colderminus 196 C.

What is the prognosis of Skin warts?
----------------------------------------------------

Prognosis of majority of cases is good if there is complete removal.

Recurrences are common

What are the preventive measures for Skin warts?
-----------------------------------------------------------------

Avoid direct or indirect contact through contaminated surfaces with people having warts

A Simple Guide to Lichen Planus

A Simple Guide to Lichen Planus
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What is Lichen Planus?
----------------------------------

Lichen Planus is a chronic inflammatory disease of the skin which typically consists of red small papules that joined together to from rough scaly patches.

It is often associated with lesions of the mucosal membranes.

What are the types of Lichen Planus?
--------------------------------

There are 2 main types:

1.Skin Lichen Planus is the most common type of Lichen Planus.
About 80% of people have red small papules that joined together to from rough scaly patches.

The skin usually grows very more quickly and are thicker than usual.

2.Mucosal Lichen Planus (small, red papular lesion of the mouth and mucous membranes)

Who Gets Lichen Planus?
-----------------------

Lichen Planus occurs more in females than in males.

It is also more common in the middle ages.

It is rare in children

What causes Lichen Planus?
-------------------------------------

The cause of Lichen Planus is unknown.

1.allergic reactions to medications for high blood pressure(methyl dopa) and arthritis (chloroquine and salicylates),arsenic, gold.

2.chronic hepatitis C virus infection

3.stress aggravate the condition

4.Allergic reactions to amalgam and gold filling can cause oral lesions


What are the symptoms of Lichen Planus?
-------------------------------------------------

Onset is sudden or gradual.

They may last weeks or months and be recurrent.

Frequently they become chronic.

The typical rash of lichen planus is well-defined :
1.pruritic,
2.planar,
3.purple,
4.polygonal
5.papules.

When seen under the microscope the papules have characteristic network of white lines(Wickham's striae)

Lesions are symmetrical, usually on flexor surfaces of the arm near the wrist and the ankle.

Nails are frequently involved with pitting and thinning of the nail plate.

Oral lichen planus occurs in 50% of patients:

1. reticular form - most common rash, occurs as white streaks on the mucosa (known as Wickham's striae) or papules with small raised area .

The lesions are present on the gums, the tongue, palate and lips.

The lesions are present on both sides of the mouth

2. bullous form - fluid-filled vesicles

3. erosive form - erythematous (red) areas which are ulcerated.
This form may become malignant.

Microscopic appearance is typical of lichen planus:

1.Hyperparakeratosis or thickening of the granular cell layer
There is a typical saw-tooth appearance of the rete pegs

2.Degenerated basal cell layer

3.Inflammatory cells present in subepithelial layer of connective tissue

Lichen planus may involve the glan penis and vulvovaginal mucosa

Lichen planus rarely involve the eosophagus where it can cause erosive esophagitis and stricturing.

How does Lichen Planus affects the Patient?
-----------------------------------------

All types of Lichen Planus can affect a person’s quality of life.

Itching, soreness, and ulcers of the mouth are common.

What is the Treatment of Lichen Planus?
-----------------------------------

Treatment depends on the severity and type of Lichen Planus.

1. mild cases may not require any treatment

2.severe Lichen Planus have lesions that affects most of the body and hospitalization is required.

3.Most cases of Lichen Planus lie in between.

Treatments:
1.Topical Medicines include:

topical steroids.
tar lotions, ointments, creams, and shampoo

2.Systemic therapy (oral drugs that affect the whole body system):

cyclosporins, methotrexate
immunosuppressant medications
Oral retinoids
Oral corticosteroids
hydroxychloroquine
tacrolimus
dapsone

3.Phototherapy (with ultraviolet B, psoralen with ultraviolet A, radiation)

4.Combined therapy are frequently used.

5.new therapies such as the biologic agents has improved the condition

At the present moment there is no known cure for lichen planus.

Medicines have been able to reduce the severity of inflammation and improve the quality of life.

Other medicines are used to treat symptoms:

1.Antihistamines for itch

2.Oral topical steroids for mouth ulcers


What is the Prognosis of Lichen Planus?
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There is generally no cure for lichen planus.

Lichen planus may become dormant after being treated.

Recurrences are common even years after being dormant.

Lifelong treatment may be necessary to control signs and symptoms.