A Simple Guide to Vitiligo

A Simple Guide to Vitiligo
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What is Vitiligo?
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Vitiligo is a skin disorder which presents as white spots or patches on the skin.
It is not contagious.


What are the causes of Vitiligo?
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The cause of Vitiligo is not known.
However many people with Vitiligo may have associated auto immune disease including thyroid disease and pernicous
anemia.
Autoimmune conditions are conditions where the body's own cells attack its cells (in this case the skin cells)
There is a progressive loss of the pigment melanin which gives us our skin color.
The loss of pigment occurs when the pigment cells (melanocytes) are destroyed and melanin cannot be produced.

What are Signs and symptoms of Vitiligo?
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white spots or patches on the skin

Common sites affected by Vitilgo are:

1.Bony surfaces - back of hands and fingers,elbows and knees

2.Body orifices - around the eyes, mouth and nose

3.Body folds - armpits and groins

Vitiligo may also occurs over an area of injury such as a cut or burn.

The hair in the vitilgo patch may be white in color.


How is the diagnosis of Vitiligo made?
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1.typical white patches or spots

2.skin biopsy for microscopic examination.


What is the treatment of Vitiligo?
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There are different treatments for Vitiligo:

1.Corticosteroid creams
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Corticosteroid creams are effective against small patches or spot of vitilgo but there may be side effects such as skin thinning.

2.Topical Immunodulators
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Tacrolimus or pimecrolimus are topical immunodulators which work by:

1.modulating the immune attack against the melanocytes on the skin and
2.stimulating the functions of the melanocytes

3. UltraViolet Light Treatments
a.Psoralen photochemotherapy(PUVA)
PUVA is a combination treatment involving
1.the use of the drug Psoralen(P)
2.and then exposing the skin to UltraViolet A light(UVA)
hence the term PUVA.
Psoralen makes the skin temporarily sensitive to UVA which is part of natural sunlight.
Psoralen can be applied to the skin as a solution or ingested orally with subsequent exposure to ultraviolet light A.
Patient treated with PUVA may need to undergo treatment for 1 year for satisfactory results.
Use of PUVA may result in sunburn and blister fromation.

b.Narrowband UVB
Narrowband UltraViolet light B treatment does not require Psoralen tablets before treatment.
In fact this treatment is safer and as effective if not better than PUVA. Again treatment may require 1 year before satisfactory results.

c.Focused Multiple Wavelength UltraViolet Therapy(Multiclear)
This is a form of targeted light therapy as only the vitiligo areas are treated.
It is useful for small localised lesions.

d.Excimer Laser
This laser emits a certain UVB wavelength but is more costly than Multiclear Light therapy.

4.Surgery
Surgical transplants are meant for patients with stable vitligo that fail to respond to topical or phototherapy.
Stable vitiligo means no new lesions or progressive lesions for 12 to 24 months.
Surgery involve tissue and cellular grafting.

5.Camuoflage Cosmetics.
Cover up camouflage provides good color and camouflage of vitiligo lesions.
They are particularly useful for white patches on the face ansd back of the hands.

6.Sunscreens
Areas of vitiligo exposed to the sun are very prone to sunburn as they lack protective pigments.
Patients should always use broad spectrum sunsceens to protected the affected vitiligo areas.



What is the prognosis of Vitiligo ?
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Generally fair.
Treatment takes time and patience.


What are the Preventive measures taken for Vitiligo ?
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1.Sunscreens

2.Proper skin care

A Simple Guide to Psoriasis

A Simple Guide to Psoriasis
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What is Psoriasis?
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Psoriasis is a disorder of the skin which typically consists of red patches covered by silvery-white scales especially around the trunk, elbows, knees and scalp.

What are the types of Psoriasis?
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There are five types, each with unique signs and symptoms.

1.Plaque psoriasis is the most common type of psoriasis.
About 80% of people who develop psoriasis have plaque psoriasis, which appears as patches of raised, reddish skin covered by silvery-white scale.
These patches, or plaques, frequently form on the elbows, knees, lower back,and scalp.

2.guttate psoriasis (small, red spots on the skin),

3.pustular psoriasis (white pustules surrounded by red skin),

4.inverse psoriasis (smooth, red lesions form in skin folds)

5.erythrodermic psoriasis (widespread redness, severe itching, and pain).

Who Gets Psoriasis?
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Psoriasis occurs about equally in males and females.
Recent studies show that there may be an ethnic link.
It seems that psoriasis is most common in Caucasians and slightly less common in African Americans.
Worldwide, psoriasis is most common in Scandinavia and other parts of northern Europe.
It appears to be far less common among Asians and is rare in Native Americans.

There also is a genetic component associated with psoriasis.
About one-third of people who develop psoriasis have at least one family member with the condition.

Research shows that the signs and symptoms of psoriasis usually appear between 15 and 35 years of age.
About 75% develop psoriasis before age 40.
However, it is possible to develop psoriasis at any age. After age 40, a peak onset period occurs between 50 and 60 years of age.

About 1 in 10 people develop psoriasis during childhood, and psoriasis can begin in infancy.
The earlier the psoriasis appears, the more likely it is to be widespread and recurrent.

What causes Psoriasis?
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Its exact cause is unknown but the result is skin which grows about seven times more quickly and thicker than usual.
It is thought to be due, at least in part, to an abnormal immune reaction against some component of the skin.
Genetic factors play a part.
About half those affected know of someone else in the family with it.

The rash often seems to start after some sort of trigger. This may be emotional stress, skin injury (cuts and scratches for example), a streptococcal sore throat, hormones (it often occurs at puberty), or rarely, certain medications.
Psoriasis is not contagious.

What are the symptoms of Psoriasis?
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Itchy, raised patches of dark pink skin.
White scales on the scalp, knees, elbows and upper body.
Pitting, discolouring and thickening of the fingernails and toenails.
Red, scaly and cracked skin on the palms of the hands or on the soles of the feet.
There may be fluid oozing out of the cracks and movement may become very painful. The itching and discomfort may keep a person awake at night, and the pain can make everyday tasks difficult.

How does Psoriasis affects the Patient?
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All types of psoriasis, ranging from mild to severe, can affect a person’s quality of life.
Living with this lifelong condition can be physically and emotionally challenging.
Itching, soreness, and cracked and bleeding skin are common.
Nail psoriasis can be painful.
Even the simple act of squeezing a tube of toothpaste can hurt.
Several studies have shown that people often feel frustrated.
In some cases, psoriasis limits activities and makes it difficult to perform job responsibilities.
Studies also have shown that stress, anxiety, loneliness, and low self-esteem are part of daily life for people living with psoriasis.
It has been that thoughts of suicide are three times higher for psoriatics than the normal person.
Embarrassment is another common feeling.
What if you extended your hand to someone and the person recoiled?
How would you feel if you spent most of your life trying to hide your skin?

What is the Treatment of Psoriasis?
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Psoriasis is a chronic, meaning lifelong, condition because there is currently no cure. People often experience flares and remissions throughout their life.
Controlling the signs and symptoms typically requires lifelong therapy.
Treatment depends on the severity and type of psoriasis.
Some psoriasis is so mild that the person is unaware of the condition.
A few develop such severe psoriasis that lesions cover most of the body and hospitalization is required. These represent the extremes. Most cases of psoriasis fall somewhere in between.

Topical medications (such as steroid and tar lotions, ointments, creams, and shampoo)
Photo therapy (either ultraviolet B, or UV, radiation or psoralen with ultraviolet A, or PU VA, radiation)
Systemic therapy (oral drugs that affect the whole body system, not just the skin e.g. cyclosporins, methotrexate)

Combinations are often used. These treatments are often given in the order described -- from least to most potent -- as necessary, although the physician may choose a more powerful therapy or use combinations first if the patient's initial condition is severe.

With the emergence of several new therapies, including the biologic agents, more people are experiencing substantial improvements and reporting a greatly improved quality of life.

A Simple Guide to Rheumatoid Arthritis

A Simple Guide to Rheumatoid Arthritis
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What is Rheumatoid Arthritis?
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Rheumatoid arthritis is a systemic autoimmune disease that can cause chronic inflammation of the joints and other areas of the body.

Who gets Rheumatoid Arthritis?
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Rheumatoid Arthritis is one of the most common form of inflammatory arthritis.
It most commonly occurs between the 25 and 50 years.
However it can occur at any age.
Females are 3 times more likely to get Rheumatoid Arthritis than males.

What causes Rheumatoid Arthritis?
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Rheumatoid Arthritis is an autoimmune disease..
Autoimmune diseases are illnesses that occur when the body tissues are mistakenly attacked by its own immune system which consists of cells and antibodies designed normally to "seek and destroy" invaders of the body, particularly infections.
Patients with autoimmune diseases have antibodies in their blood that target their own body tissues .

What are the symptoms of Rheumatoid Arthritis?
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Most common symptoms are pain, swelling, stiffness, warmth and sometimes redness of the joints.

Rheumatoid Arthritis is suspected when there are:
1. Swelling in the joints especially those of the hands,elbows,knees,ankles and feet.

2. Stiffness in the joints in the mornings which can last more than an hour or after prolonged rest

3.redness and warmth in one's joints

4.Persistent pain or tenderness in a joint for more than a month

5.Inability to move or use a joint normally

6. Unexplained weight loss and appetite, fatigue, or weakness together with joint pains

What tests are done to confirm Rheumatoid Arthritis?
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Abnormal blood antibodies can be found in patients with rheumatoid arthritis.

1.A blood antibody called "rheumatoid factor" can be found in 80% of patients.

2.Another antibody called "the antinuclear antibody" (ANA) is also frequently found in patients with rheumatoid arthritis.

3.Another blood test that is used to measure the degree of inflammation present in the body is the C-reactive protein.

4.A blood test called the sedimentation rate (ESR) is a measure of how fast red blood cells fall to the bottom of a test tube. The sed rate is used as a crude measure of the inflammation of the joints.

The rheumatoid factor, ANA, sed rate, and C-reactive protein tests can also be abnormal in other systemic autoimmune and inflammatory conditions. Therefore, abnormalities in these blood tests alone are not sufficient for a firm diagnosis of rheumatoid arthritis

How does the Rheumatoid Arthritis starts?
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Rheumatoid Arthritis may start gradually or with a sudden and severe attack.
It usually attacks many joints at one time.
Rheumatoid arthritis is a chronic disease, characterized by periods of disease flares and remissions.

Where does Rheumatoid Arthritis occur?
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In rheumatoid arthritis, multiple joints are usually affected in a symmetrical pattern.
It most commonly affects the hands and feet,often in a systemic pattern(both right and left joints are affected).
Other joints affected are the elbow,knees,and ankles.
Less common are shoulder,hip and spine.

What are the Complications of Rheumatoid Arthritis?
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Rheumatoid Arthritis can result in joint deformities and disability especially in untreated severe cases.
Daily activities such as bathing,dressing, walking and even writing may be difficult.
Besides the joints, Rheumatoid Arthritis may sometimes affect other organs such as the eyes,lungs,skin,intestines,nerves and bone marrow.
Mild fever, fatigue, loss of appetite and loss of weight may be present.
Severe Rheumatoid Arthritis is associated with an incresed risk of mortality.

How is Rheumatoid Arthritis treated?
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There is no known cure for rheumatoid arthritis.
Therefore the purpose of treatment is to:
1. improve functions and
2. reduce pain and discomfort.

Treatment of Rheumatoid Arthritis can be broadly classified into:
1. Non-drug therapy:
Weight loss is an effective way to reduce the stress on the joints and minimise the pain Walking sticks are useful ways to offload the stress on the affected weight bearing joints such as hips or knee.
Hot packs are useful aids in the morning to soften a stiff arthritic joint whereas braces and knee guards are useful supports to give some comfort to the knee.
Exercises that improve strength, agility and flexibilty are useful to minimise the disability of Rheumatoid Arthritis. A range of motion exercises is useful to keep the joints supple and mobile.
Water based exercises are a good alternative form of aerobic workout by patients afflicted by Rheumatoid Arthritis. The warm water especially is a good medium for joint mobility and together with the buoyancy of water it helps to minimse the body weight impact on the joints.
2. Drug therapy

There are 2 main types of drugs:
1. symptom modifying helps to alleviate the symptoms but do not change the natural history of the conditions. Examples are Non-steroidal Anti-inflamatory Drugs(NSAIDS) like diclofenac.

2. disease modifying drugs such as steroids, methothrexate, sulphasalazine, redaura, hydroxychloroquine have been shown to slow down the damage caused by Rheumatoid Arthritis. However they cause a lot of side effects such as anemia, abnormal white cells, kidney damage,liver damage, vision loss so the medications must be monitored all the time.
It is important that the disease should be controlled before irreversible joint damage occurs.

Newer "second-line" drugs for the treatment of rheumatoid arthritis include leflunomide (Arava), and the "biologic" medications etanercept (Enbrel), infliximab (Remicade), anakinra (Kineret), and adalimumab (Humira).

3. Surgery

Surgery is used as a last result to correct deformities and reduce disability.

The treatment of rheumatoid arthritis optimally involves a combination of patient education, rest and exercise, joint protection, medications, and occasionally surgery.

Early treatment of rheumatoid arthritis results in better outcomes.