STUDY - Technical - New Dacian's Medicine
Common
Skin Conditions (2)
Translation Draft
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Numulary eczema is characterized by circular or oval coin-like lesions. Initially, this rash consists of small edematous papules that are covered by squamous and crusts. The most common localizations are on the trunk or on the extensor surfaces of the extremities, especially in the pretibial regions or the back of the hands. It occurs most frequently in men and most often in middle age. Etiology is unknown. The hypothesis that numulary eczema is a variant of atopic eczema is controversial. Treatment of nummation eczema is similar to that for other forms of dermatitis.
Chronic simple lichen may represent the final stage of various itchy and eczematisdisordered disorders. It consists of a well-delimited plate or plates with lichenified or thickened skin due to chronic rubbing or scratching. The affected regions usually include the posterior nucal region (the neck), the dorsal face of the legs or ankles. Treatment of chronic simple lichen is centred on the rupture of the cycle of chronic pruritus and grating that often occurs during sleep.
Potent topical glucocorticoids are useful in relieving itching in most cases, but in recalcitrant cases, the application of glucocorticoids under occlusion or intralezional injections of glucocorticoids may be necessary. Oral antihistamines are useful as antipruriginous, primarily due to their sedation action, and are especially useful at bedtime.
Thistotic eczema, also known as xerotic eczema or "winter itching", is a mildly inflammatory variant of dermatitis that most often develops on the extremities of the lower limbs of individuals during dry periods of the year. Thin cracks, with or without erythema, similar to cracks in porcelain, occur characteristically on the anterior surfaces of the lower extremities. The pruritus is variable. Thistotic eczema responds well to avoiding irritants, rehydrating the skin and applying topical emollients.
Let's see what's going on with stasis dermatitis and stasis ulcers! Stasis dermatitis develops on the lower extremities secondary to chronic edema and venous insufficiency. Early changes in stasis dermatitis may consist of mild erythema and descuamare associated with pruritus. The typical initial seat of the condition is above the medial face of the ankle, often over a dilated vein. Dermatitis progresses to become pigmented due to chronic extravasation of erythrocytes leading to the skin deposition of hemosiderin.
As with other forms of dermatitis, stasis dermatitis can become acutely inflamed, with crust formation and exudation. Chronic stasis dermatitis is often associated with dermal fibrosis which is clinically recognized by rigid edema. Stasis dermatitis is often complicated by secondary infection and contact dermatitis. Severe stasis dermatitis may prevent the development of stasis ulcers. Treatment is based on the avoidance of irritants and the use of emollients and/ or topical glucocorticoids of medium potency. Mastering chronic edema is important for preventing calf ulcers.
Patients should be instructed to lift their affected extremity when seated. Compressive stockings with a minimum gradient of 30-40 mmHg are the most effective for the control of edema and are much more effective in preventing chronic edema than antiembolism tights. Basic ulcers are difficult to treat, and healing these lesions is slow even under the best of circumstances. It is extremely important that the affected limb is lifted as far as possible.
The ulcer should be kept free of necrotic material by gentle debridement and covered with a semi-permeable pressure dressing. Glucocorticoids should not be applied to ulcers as they may delay healing. Secondary infected lesions should be treated with appropriate oral antibiotics. but it should be noted that all ulcers will colonize with bacteria, and the goal of antibiotic therapy should not be to eliminate any bacterial growth. Some ulcers may require months to heal and may require skin grafts.
Seborrheic dermatitis is a common chronic disorder characterized by unctuous squamous covering macele or erythematous plaques. The most common localization is on the scalp, where it can be identified as severe dandruff. On the face affects the eyebrows, eyelids, glabela, nasolabial fold or ears. Descuamation in the outer ear is often mistaken for a chronic fungal infection (otomycosis), and retroaurical dermatitis often becomes macerated and sensitive.
In addition, seborrheic dermatitis can occur in the presternal area, armpits, groin, submammary grooves and buttock fold. Rarely can cause generalized disseminated dermatitis. Seborrheic dermatitis is usually symptomatic, patients complaining of burns or itching. Seborrheic dermatitis is usually symptomatic, patients complaining of burns or itching.
Seborrheic dermatitis can be highlighted in the first weeks of life, and in this context appears on the scalp ("swing bone"), face or groin. It is rarely found in children over the age of 2, but becomes evident again during adult life. Although it is common in patients with Parkinson's disease, those who have had cerebrovascular accidents and those infected with HIV, the vast majority of individuals with seborrheic dermatitis do not have an underlying condition.
Treatment with low potency glucocorticoids with shampoos containing charcoal tar shards and/ or salicylic acid is generally sufficient to control the activity of this condition. Solutions with high potency topical glucocorticoids (betamethasone or fluocinonide) are effective for mastering scalp damage. Topical fluorinated glucocorticoids should not be used on the face as they are commonly associated with rebound aggravation and steroid-induced rosacea or atrophy.
And so, we have reached the papuloscuamous disorders "concreted" in psoriasis, lichen plan, pinkish pitiriazis and dermatophyses.
Psoriasis is one of the most common dermatological diseases, affecting up to 1-2% of the world's population. It is a chronic inflammatory skin condition characterized by papules and rounded plaques clearly delineated, covered with silvery micaceous scuba. Skin lesions of psoriasis are variable pruriginous. Traumatized regions often cause psoriasis lesions (the Koebner or isomorphic phenomenon).
In addition, other extreme factors can exacerbate psoriasis, including infections, stress and medicines (lithium, beta-blockers and antimalarials). the most common variety of psoriasis is called plaque psoriasis. Patients with plaque psoriasis will have stable, slow-growing plaques that remain unchanged for long periods of time. The regions most commonly affected by plaque psoriasis are the elbows, knees, interfesier trench and scalp.
The damage tends to be symmetrical. Reverse psoriasis affects the intertriginous regions including the armpit, groin, sub-breast and navel and also tends to affect the scalp, palms and plants. Individual lesions are clearly delineated plates, but can be wet due to their location. The form of plaque psoriasis usually occurs slowly and goes through an indolent evolution. They rarely spontaneously recover. Eruptive psoriasis (gutted psoriasis or "in drops") is most common in children and young adults.
It starts acutely in individuals without psoriasis or in those with chronic plaque psoriasis. Patients present with numerous small, erythematous and squamous papules, often after an upper respiratory tract infection with betahemolytic streptococci. Differential diagnosis should include pinkish pitiriazis and secondary syphilis. Patients with psoriasis may also have pustulous lesions. They can be localized to palms and plants or can be generalized and associated with fever, malaise, diarrhea and arthralgia.
About half of all psoriasis patients have nail damage, presenting as punctable depressions, nail thickening or sub-angle hyperkeratosis. Approximately 5-10% of psoriasiss have associated joint pain, most commonly found in patients with nail damage. Although some have typical rheumatoid arthritis with concomitant occurrence, many have joint disease that falls within one of the following five associated with psoriasis: 1. disease limited to a single or a few small joints (70% of cases), 2. a disease similar to seronegative rheumatoid arthritis, 3. interphalangeal distal joints, 4. severe destructive arthritis, with the development of "mutilans arthritis" and 5. disease limited to the spine.
The etiology of psoriasis is still little understood, but there is clearly a genetic component. More than 50% of psoriasis patients report a positive family history, and twin studies report 65-72% of monozigotic twins. Evidence has been accumulated that clearly indicates a role of T cells in the physiology of psoriasis: psoriasis can become extremely serious in individuals affected with HIV. Stimulation of immune function with interleukin 2 cytokines has been associated with a brutal worsening of pre-existing psoriasis, and bone marrow transplantation has led to the remission of the disease. In addition, agents that inhibit the functioning of activated T cells are often effective in the treatment of severe psoriasis.
Treatment depends on the type, location and extent of the disease. All patients should be instructed to avoid excessive dryness or skin irritation and to maintain adequate hydration. Most patients with plaque localized psoriasis can be treated with topical glucocorticoids of medium potency, although their long-term use is often accompanied by loss of effectiveness (tahyphilaxia).
Coal tar (1-5% in ointment form) is an old but useful method of treatment, in association with ultraviolet light therapy. A topical analogue of vitamin D (calcipotriol) is also effective in the treatment of psoriasis. Ultraviolet light is an effective therapy for patients with disseminated psoriasis. Ultraviolet Spectrum B (UV-B) is effective on its own or can be combined with coal tar (Goeckerman regime) or antraline (Ingram regime). Natural daylight or an artificial light source may be used.
The combination of ultraviolet A with psoraleni, either orally or topically, is also extremely effective in the treatment of psoriasis, but long-term use may be associated with an increased incidence of thyroid cell carcinoma of the skin. Various other agents can be used for disseminated disease. Methotrexate is an effective agent, especially in patients with associated psoriatic arthritis.
Liver toxicity due to long-term use restricts its use in patients with disseminated disease who do not respond to less aggressive ways. Etretinate, a synthetic retinoid, is shown to be effective in some patients with severe psoriasis, but is a powerful teratogen with an extremely long half-life, thus excluding its use in women of childbearing age.
Ready for today...
Let's continue with yesterday's presentations!
Numulary eczema is characterized by circular or oval coin-like lesions. Initially, this rash consists of small edematous papules that are covered by squamous and crusts. The most common localizations are on the trunk or on the extensor surfaces of the extremities, especially in the pretibial regions or the back of the hands. It occurs most frequently in men and most often in middle age. Etiology is unknown. The hypothesis that numulary eczema is a variant of atopic eczema is controversial. Treatment of nummation eczema is similar to that for other forms of dermatitis.
Chronic simple lichen may represent the final stage of various itchy and eczematisdisordered disorders. It consists of a well-delimited plate or plates with lichenified or thickened skin due to chronic rubbing or scratching. The affected regions usually include the posterior nucal region (the neck), the dorsal face of the legs or ankles. Treatment of chronic simple lichen is centred on the rupture of the cycle of chronic pruritus and grating that often occurs during sleep.
Potent topical glucocorticoids are useful in relieving itching in most cases, but in recalcitrant cases, the application of glucocorticoids under occlusion or intralezional injections of glucocorticoids may be necessary. Oral antihistamines are useful as antipruriginous, primarily due to their sedation action, and are especially useful at bedtime.
Thistotic eczema, also known as xerotic eczema or "winter itching", is a mildly inflammatory variant of dermatitis that most often develops on the extremities of the lower limbs of individuals during dry periods of the year. Thin cracks, with or without erythema, similar to cracks in porcelain, occur characteristically on the anterior surfaces of the lower extremities. The pruritus is variable. Thistotic eczema responds well to avoiding irritants, rehydrating the skin and applying topical emollients.
Let's see what's going on with stasis dermatitis and stasis ulcers! Stasis dermatitis develops on the lower extremities secondary to chronic edema and venous insufficiency. Early changes in stasis dermatitis may consist of mild erythema and descuamare associated with pruritus. The typical initial seat of the condition is above the medial face of the ankle, often over a dilated vein. Dermatitis progresses to become pigmented due to chronic extravasation of erythrocytes leading to the skin deposition of hemosiderin.
As with other forms of dermatitis, stasis dermatitis can become acutely inflamed, with crust formation and exudation. Chronic stasis dermatitis is often associated with dermal fibrosis which is clinically recognized by rigid edema. Stasis dermatitis is often complicated by secondary infection and contact dermatitis. Severe stasis dermatitis may prevent the development of stasis ulcers. Treatment is based on the avoidance of irritants and the use of emollients and/ or topical glucocorticoids of medium potency. Mastering chronic edema is important for preventing calf ulcers.
Patients should be instructed to lift their affected extremity when seated. Compressive stockings with a minimum gradient of 30-40 mmHg are the most effective for the control of edema and are much more effective in preventing chronic edema than antiembolism tights. Basic ulcers are difficult to treat, and healing these lesions is slow even under the best of circumstances. It is extremely important that the affected limb is lifted as far as possible.
The ulcer should be kept free of necrotic material by gentle debridement and covered with a semi-permeable pressure dressing. Glucocorticoids should not be applied to ulcers as they may delay healing. Secondary infected lesions should be treated with appropriate oral antibiotics. but it should be noted that all ulcers will colonize with bacteria, and the goal of antibiotic therapy should not be to eliminate any bacterial growth. Some ulcers may require months to heal and may require skin grafts.
Seborrheic dermatitis is a common chronic disorder characterized by unctuous squamous covering macele or erythematous plaques. The most common localization is on the scalp, where it can be identified as severe dandruff. On the face affects the eyebrows, eyelids, glabela, nasolabial fold or ears. Descuamation in the outer ear is often mistaken for a chronic fungal infection (otomycosis), and retroaurical dermatitis often becomes macerated and sensitive.
In addition, seborrheic dermatitis can occur in the presternal area, armpits, groin, submammary grooves and buttock fold. Rarely can cause generalized disseminated dermatitis. Seborrheic dermatitis is usually symptomatic, patients complaining of burns or itching. Seborrheic dermatitis is usually symptomatic, patients complaining of burns or itching.
Seborrheic dermatitis can be highlighted in the first weeks of life, and in this context appears on the scalp ("swing bone"), face or groin. It is rarely found in children over the age of 2, but becomes evident again during adult life. Although it is common in patients with Parkinson's disease, those who have had cerebrovascular accidents and those infected with HIV, the vast majority of individuals with seborrheic dermatitis do not have an underlying condition.
Treatment with low potency glucocorticoids with shampoos containing charcoal tar shards and/ or salicylic acid is generally sufficient to control the activity of this condition. Solutions with high potency topical glucocorticoids (betamethasone or fluocinonide) are effective for mastering scalp damage. Topical fluorinated glucocorticoids should not be used on the face as they are commonly associated with rebound aggravation and steroid-induced rosacea or atrophy.
And so, we have reached the papuloscuamous disorders "concreted" in psoriasis, lichen plan, pinkish pitiriazis and dermatophyses.
Psoriasis is one of the most common dermatological diseases, affecting up to 1-2% of the world's population. It is a chronic inflammatory skin condition characterized by papules and rounded plaques clearly delineated, covered with silvery micaceous scuba. Skin lesions of psoriasis are variable pruriginous. Traumatized regions often cause psoriasis lesions (the Koebner or isomorphic phenomenon).
In addition, other extreme factors can exacerbate psoriasis, including infections, stress and medicines (lithium, beta-blockers and antimalarials). the most common variety of psoriasis is called plaque psoriasis. Patients with plaque psoriasis will have stable, slow-growing plaques that remain unchanged for long periods of time. The regions most commonly affected by plaque psoriasis are the elbows, knees, interfesier trench and scalp.
The damage tends to be symmetrical. Reverse psoriasis affects the intertriginous regions including the armpit, groin, sub-breast and navel and also tends to affect the scalp, palms and plants. Individual lesions are clearly delineated plates, but can be wet due to their location. The form of plaque psoriasis usually occurs slowly and goes through an indolent evolution. They rarely spontaneously recover. Eruptive psoriasis (gutted psoriasis or "in drops") is most common in children and young adults.
It starts acutely in individuals without psoriasis or in those with chronic plaque psoriasis. Patients present with numerous small, erythematous and squamous papules, often after an upper respiratory tract infection with betahemolytic streptococci. Differential diagnosis should include pinkish pitiriazis and secondary syphilis. Patients with psoriasis may also have pustulous lesions. They can be localized to palms and plants or can be generalized and associated with fever, malaise, diarrhea and arthralgia.
About half of all psoriasis patients have nail damage, presenting as punctable depressions, nail thickening or sub-angle hyperkeratosis. Approximately 5-10% of psoriasiss have associated joint pain, most commonly found in patients with nail damage. Although some have typical rheumatoid arthritis with concomitant occurrence, many have joint disease that falls within one of the following five associated with psoriasis: 1. disease limited to a single or a few small joints (70% of cases), 2. a disease similar to seronegative rheumatoid arthritis, 3. interphalangeal distal joints, 4. severe destructive arthritis, with the development of "mutilans arthritis" and 5. disease limited to the spine.
The etiology of psoriasis is still little understood, but there is clearly a genetic component. More than 50% of psoriasis patients report a positive family history, and twin studies report 65-72% of monozigotic twins. Evidence has been accumulated that clearly indicates a role of T cells in the physiology of psoriasis: psoriasis can become extremely serious in individuals affected with HIV. Stimulation of immune function with interleukin 2 cytokines has been associated with a brutal worsening of pre-existing psoriasis, and bone marrow transplantation has led to the remission of the disease. In addition, agents that inhibit the functioning of activated T cells are often effective in the treatment of severe psoriasis.
Treatment depends on the type, location and extent of the disease. All patients should be instructed to avoid excessive dryness or skin irritation and to maintain adequate hydration. Most patients with plaque localized psoriasis can be treated with topical glucocorticoids of medium potency, although their long-term use is often accompanied by loss of effectiveness (tahyphilaxia).
Coal tar (1-5% in ointment form) is an old but useful method of treatment, in association with ultraviolet light therapy. A topical analogue of vitamin D (calcipotriol) is also effective in the treatment of psoriasis. Ultraviolet light is an effective therapy for patients with disseminated psoriasis. Ultraviolet Spectrum B (UV-B) is effective on its own or can be combined with coal tar (Goeckerman regime) or antraline (Ingram regime). Natural daylight or an artificial light source may be used.
The combination of ultraviolet A with psoraleni, either orally or topically, is also extremely effective in the treatment of psoriasis, but long-term use may be associated with an increased incidence of thyroid cell carcinoma of the skin. Various other agents can be used for disseminated disease. Methotrexate is an effective agent, especially in patients with associated psoriatic arthritis.
Liver toxicity due to long-term use restricts its use in patients with disseminated disease who do not respond to less aggressive ways. Etretinate, a synthetic retinoid, is shown to be effective in some patients with severe psoriasis, but is a powerful teratogen with an extremely long half-life, thus excluding its use in women of childbearing age.
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