STUDY - Technical - New Dacian's Medicine
Common
Skin Conditions (3)
Translation Draft
I don't really deal with all the hey-rups I've ever done... Life demands its tribute of time and "attention." In addition, we have started serious work on other older or new projects on the dorinm.ro. So, officially, "New Medicine" becomes an activity "according to possibilities". But nevertheless, the general dates of "Chapter 3", the one related to allopathic (current) medicine in my posts here, I will complete them by my leave starting on August 18th. Thank you for understanding! So, let's get on with it!
Plan lichen (LP) is a papuloscuamoous condition in which the primary lesions are pruriginous, polygonal, violet, smooth-floored papules. Careful examination of the surface of these papules will often reveal a network of gray lines (Wickham stria). Skin lesions can occur anywhere, but have a predilection for the wrists, pretibial regions, lower back and genitals. Scalp damage can cause hair loss.
LP usually affects the mucous membranes, especially the oral mucosa, where it can present as a whitish, networked rash. Etiology is unknown, but clinically similar rashes LP have been observed after taking numerous drugs, including diuretics, gold, antimalarials, penicilamine and phenothiazide and in patients with skin lesions of graft-versus-host disease. In addition, LP associated with abnormal liver function has been correlated with viral hepatitis, especially in hepatitis C virus infection. Evolution is variable, but most patients have spontaneous remissions within 6 months to 2 years after the onset of the disease. Topical glucocorticoids are the axis of treatment.
Pinkish pitiriazis (PR) is a papuloscuamy eruption of unknown origin that occurs most frequently in spring and autumn. Its first manifestation is the appearance of an annulation lesion of 2-6 cm (heraldic stain). This is followed within a few days to a few weeks by numerous smaller lesions, annulment or papulation, with a predilection for the trunk. Injuries are generally oval, with long axis parallel to the skin's folding lines.
Individual lesions can vary in color from brown red and have a sme adhering only to the peripheral. PR has numerous common clinical characters with the rash of secondary syphilis, but injuries from the palms or plants are extremely rare in PR and common in secondary syphilis. The rash tends to be moderately itchy and lasts 3-8 weeks. Treatment is generally directed towards the improvement of pruritus and consists of oral antihistamines, topical glucocorticoids of medium potency and sometimes the use of UV-B phototherapy.
And so, I got to the skin infections. We'll start with impetigo and ecima.
Impetigo is a superficial bacterial infection commonly caused by beta-hemolytic streptococci in group A or S. aureus. The primary lesion is a superficial pustule that breaks and forms a characteristic yellow-brown crust, "meliceric". Injuries caused by staphylococcus can be clear bubbles in tension and this less common form of disease is called impetigo bullos. Injuries may occur on normal skin or in areas already affected by other skin diseases. Ectima is a variant of impetigo on the lower limbs and produces cut-out ulcerative lesions. Treatment of ectoma and impetigo resort to gentle debridement of adhering crusts, which is facilitated by the use of local baths and antibiotics, along with appropriate oral antibiotics.
It's the turn of dermatophysis. Dermatophytes are fungi that infect the skin, hair and nails and include representation of the genus Trichophyton, Microsporum and Epidermophyton. Infection of the foot (tinea pedis) is extremely common and is often chronic being characterized by variable erythema and edema, formation of scumes, pruritus and sometimes vesicular. The damage can be disseminated or localized, but almost constantly the space of the tooth fingers 4 and 5 of the foot is affected. Nail infection (tinea unguium) occurs in many patients with tinea pedis and is characterized by opaque, thickened nails and sub-angle residues.
The inguinal region is the next area as the frequency of the affectation (tinea cruris), men being affected much more frequently than women. It presents as a descuamative erythematous rash, which respects the scrotum. Microscopic examination of the shama after digestion with potassium hydroxide (preparation with KOH) in tinea pedis and tinea cruris untreated usually shows hyfe. Dermatophytic infection of the scalp (tinea capitis) has returned to epidemic proportions, especially in intra-urban clinics.
The predominant microorganism is Trichophyton tonsurans. It can cause an inflammatory or relatively non-inflammatory infection, which can present as regions either well delineated or irregular, diffuse by mild descuamation and hair loss. Tinea corporis or disseminated infection of the glabre skin may have a variable appearance, depending on the size of the associated inflammatory reaction. It may have the typical annular appearance of herpes circinate ("ringworm") or present as deep inflammatory nodules (on the scalp known as kerion) or as granulomas.
Koh examination of shama or hair from patients with tinea capitis or inflammatory corporis often does not reveal hyfe and diagnosis may require cultures or biopsy. From a treatment point of view, both topical and systemic therapies can be used to treat dermatophytic infection.
Treatment depends on the affected area and the type of infection. Topical therapy is generally effective for uncomplicated cases of tinea corporis, cruris and pedis. It is not effective as monotherapy for tinea capitis or nailium. Imidazoles (myconazole, ketoconazole, econazole, clotrimazole, oxyconazole and sulconazole), triazoles (terconazole) and allylamines (terbinafina and naftifine) can all constitute oral therapies for dermatophyte infections. Haloprogin, undecilenic acid, cyclopiroxolamine and tolnaftate are also effective, but nistatin is not active against dermatophytes.
Treatment should continue until the patient is cured of infection, both in clinical examination and in culture. Tinea pedis often requires longer periods of treatment and is associated in very high percentages with relapse. Griseofulvin is the elective drug for dermatophytic infections requiring systemic therapy. A daily dose given with a fat meal is suitable for most dermatophyte infections.
The most common side effects of griseofulvine are gastrointestinal disorders and headache. It is also rarely associated with haematological abnormalities and liver function and patients with long-term treatments should be monitored at regular intervals. For chronic non-inflammatory tinea pedis, local agents are useful for limiting itching and descuamation, but are rarely curative. Treatment with griseofulvin per bone is effective for tinea pedis, but may require months of treatment for healing.
Even then it is associated with an increased incidence of relapses, especially if the nails are affected. Therapy for tinea corporis depends on the extent of the disease. Localized infection is best treated with topical imidazoles, but disseminated disease, especially in patients with disseminated cellular immunity, requires systemic antimycotic therapy. Dermatophytic infection of hairy regions (such as tinea capitis) requires systemic antimycotic treatment and this should be continued for 6-8 weeks. Complementary use of topical antimycotics in addition to topical therapy is not appropriate.
Intensely inflammatory tinea capitis can lead to scarring and hair loss and systemic or topical glucocorticoids may be useful in preventing these sequelae. Systemic azoles are currently available for oral administration. Ketoconazole was the first wide-spectrum oral azole available but its use is limited by idiosyncratic liver toxicity. Both fluconazole and itraconazole are currently available for systemic fungal infections and studies are ongoing to examine their effectiveness in dermatophyte infections, especially nail infections. These agents could eventually replace griseofulvin as a first-line therapy for dermatophyte infections.
Tinea versicolor is caused by a non-dermatophytic dimorphic fungus that is a saprofit of the skin. In the form of mycelium, Pityrosporum orbicular does not generally cause disease (except folliculitis in certain individuals). However, in certain individuals, it turns into a hifa form and causes characteristic lesions. The expression of infection is favored by heat and humidity. Typical lesions consist of macula, papules and squamous oval spots, concentrated on the chest, shoulders and back and only rarely the face or distal extremities. On dark skin they often appear in the form of hypopigmentation areas, while on light skin are slightly hyperpigmentation.
In some darkly pigmented individuals, it can only appear as squamous spots. A KOH preparation of squamous lesions will highlight a confluence of short hyphes and round spores (so-called meat spaghetti). Solutions containing sulphur, salicylic acid or selenium sulfide will remove the infection if used daily for a week and thereafter intermittently. Topical imidazoles are also effective.
Candidiasis is a fungal infection caused by a related group of fungi, the manifestations of which can be localized to the skin or can rarely be systemic and life-threatening. The microorganism in question is usually Candida albicans, but it can also be C. tropicalis, C. parapsilosis or C. krusei. These organisms are normal saprofitic colonizer of the gastrointestinal tract, but can proliferate (usually due to broad-spectrum antibiotic therapy) and cause disease in several skin localizations.
Other predisposing factors include diabetes mellitus, chronic intertrigo, the use of oral contraceptives and cellular immune deficiency. Candidiasis is a very common infection in HIV-infected individuals. The oral cavity is frequently affected. Injuries can occur on the tongue or mouth mucosa (muguet or bead) and appear as white plaques. Microscopic examination after scraping reveals highlights both pseudohife and mycelial forms. Cracked, macerated lesions of the corner of the mouth (pearl) are commonly found in individuals with inadequately adjusted dentures and may also be associated with candidiasis infection.
In addition, candidiasis infections have an affinity for regions that are constantly wet and macerated and can occur around nails (onixis and paraonixis) and in intertriginal regions. Intertriginous lesions are characteristically edematous, erythematous and squamous, with scattered "satellite pustules". in men there is frequent damage to the penis and scrotum, as well as to the inner face of the thighs. In contrast to dermatophyte infections, candidiasis infections are frequently accompanied by an intense inflammatory response.
Diagnosis is based on the clinical appearance and highlighting of fungi on preparation with KOH or in cultures. Routine treatment includes the removal of any predisposing factors, such as antibiotic therapy or chronic humidity and the use of appropriate topical or systemic antimycotic agents. Effective topical agents include nistatin or topical azoles (myconazole, clotrimazole, econazole or ketonazole). These agents are generally effective in removing mucous or glabre skin disorders in non-immunosuppressed patients.
The associated inflammatory response that frequently accompanies candidiasis infection on the glazed skin should be treated with a mild lotion or glucocorticoid cream (hydrocortisone 2.5%) on a sicative base. Systemic therapy is generally reserved for immunosuppressed patients or individuals with recurrent or chronic conditions who do not respond or tolerate appropriate topical therapy. Vulvovaginal candidiasis responds to treatment with a single dose of fluconazole (150 mg).
I've done another post.
I don't really deal with all the hey-rups I've ever done... Life demands its tribute of time and "attention." In addition, we have started serious work on other older or new projects on the dorinm.ro. So, officially, "New Medicine" becomes an activity "according to possibilities". But nevertheless, the general dates of "Chapter 3", the one related to allopathic (current) medicine in my posts here, I will complete them by my leave starting on August 18th. Thank you for understanding! So, let's get on with it!
Plan lichen (LP) is a papuloscuamoous condition in which the primary lesions are pruriginous, polygonal, violet, smooth-floored papules. Careful examination of the surface of these papules will often reveal a network of gray lines (Wickham stria). Skin lesions can occur anywhere, but have a predilection for the wrists, pretibial regions, lower back and genitals. Scalp damage can cause hair loss.
LP usually affects the mucous membranes, especially the oral mucosa, where it can present as a whitish, networked rash. Etiology is unknown, but clinically similar rashes LP have been observed after taking numerous drugs, including diuretics, gold, antimalarials, penicilamine and phenothiazide and in patients with skin lesions of graft-versus-host disease. In addition, LP associated with abnormal liver function has been correlated with viral hepatitis, especially in hepatitis C virus infection. Evolution is variable, but most patients have spontaneous remissions within 6 months to 2 years after the onset of the disease. Topical glucocorticoids are the axis of treatment.
Pinkish pitiriazis (PR) is a papuloscuamy eruption of unknown origin that occurs most frequently in spring and autumn. Its first manifestation is the appearance of an annulation lesion of 2-6 cm (heraldic stain). This is followed within a few days to a few weeks by numerous smaller lesions, annulment or papulation, with a predilection for the trunk. Injuries are generally oval, with long axis parallel to the skin's folding lines.
Individual lesions can vary in color from brown red and have a sme adhering only to the peripheral. PR has numerous common clinical characters with the rash of secondary syphilis, but injuries from the palms or plants are extremely rare in PR and common in secondary syphilis. The rash tends to be moderately itchy and lasts 3-8 weeks. Treatment is generally directed towards the improvement of pruritus and consists of oral antihistamines, topical glucocorticoids of medium potency and sometimes the use of UV-B phototherapy.
And so, I got to the skin infections. We'll start with impetigo and ecima.
Impetigo is a superficial bacterial infection commonly caused by beta-hemolytic streptococci in group A or S. aureus. The primary lesion is a superficial pustule that breaks and forms a characteristic yellow-brown crust, "meliceric". Injuries caused by staphylococcus can be clear bubbles in tension and this less common form of disease is called impetigo bullos. Injuries may occur on normal skin or in areas already affected by other skin diseases. Ectima is a variant of impetigo on the lower limbs and produces cut-out ulcerative lesions. Treatment of ectoma and impetigo resort to gentle debridement of adhering crusts, which is facilitated by the use of local baths and antibiotics, along with appropriate oral antibiotics.
It's the turn of dermatophysis. Dermatophytes are fungi that infect the skin, hair and nails and include representation of the genus Trichophyton, Microsporum and Epidermophyton. Infection of the foot (tinea pedis) is extremely common and is often chronic being characterized by variable erythema and edema, formation of scumes, pruritus and sometimes vesicular. The damage can be disseminated or localized, but almost constantly the space of the tooth fingers 4 and 5 of the foot is affected. Nail infection (tinea unguium) occurs in many patients with tinea pedis and is characterized by opaque, thickened nails and sub-angle residues.
The inguinal region is the next area as the frequency of the affectation (tinea cruris), men being affected much more frequently than women. It presents as a descuamative erythematous rash, which respects the scrotum. Microscopic examination of the shama after digestion with potassium hydroxide (preparation with KOH) in tinea pedis and tinea cruris untreated usually shows hyfe. Dermatophytic infection of the scalp (tinea capitis) has returned to epidemic proportions, especially in intra-urban clinics.
The predominant microorganism is Trichophyton tonsurans. It can cause an inflammatory or relatively non-inflammatory infection, which can present as regions either well delineated or irregular, diffuse by mild descuamation and hair loss. Tinea corporis or disseminated infection of the glabre skin may have a variable appearance, depending on the size of the associated inflammatory reaction. It may have the typical annular appearance of herpes circinate ("ringworm") or present as deep inflammatory nodules (on the scalp known as kerion) or as granulomas.
Koh examination of shama or hair from patients with tinea capitis or inflammatory corporis often does not reveal hyfe and diagnosis may require cultures or biopsy. From a treatment point of view, both topical and systemic therapies can be used to treat dermatophytic infection.
Treatment depends on the affected area and the type of infection. Topical therapy is generally effective for uncomplicated cases of tinea corporis, cruris and pedis. It is not effective as monotherapy for tinea capitis or nailium. Imidazoles (myconazole, ketoconazole, econazole, clotrimazole, oxyconazole and sulconazole), triazoles (terconazole) and allylamines (terbinafina and naftifine) can all constitute oral therapies for dermatophyte infections. Haloprogin, undecilenic acid, cyclopiroxolamine and tolnaftate are also effective, but nistatin is not active against dermatophytes.
Treatment should continue until the patient is cured of infection, both in clinical examination and in culture. Tinea pedis often requires longer periods of treatment and is associated in very high percentages with relapse. Griseofulvin is the elective drug for dermatophytic infections requiring systemic therapy. A daily dose given with a fat meal is suitable for most dermatophyte infections.
The most common side effects of griseofulvine are gastrointestinal disorders and headache. It is also rarely associated with haematological abnormalities and liver function and patients with long-term treatments should be monitored at regular intervals. For chronic non-inflammatory tinea pedis, local agents are useful for limiting itching and descuamation, but are rarely curative. Treatment with griseofulvin per bone is effective for tinea pedis, but may require months of treatment for healing.
Even then it is associated with an increased incidence of relapses, especially if the nails are affected. Therapy for tinea corporis depends on the extent of the disease. Localized infection is best treated with topical imidazoles, but disseminated disease, especially in patients with disseminated cellular immunity, requires systemic antimycotic therapy. Dermatophytic infection of hairy regions (such as tinea capitis) requires systemic antimycotic treatment and this should be continued for 6-8 weeks. Complementary use of topical antimycotics in addition to topical therapy is not appropriate.
Intensely inflammatory tinea capitis can lead to scarring and hair loss and systemic or topical glucocorticoids may be useful in preventing these sequelae. Systemic azoles are currently available for oral administration. Ketoconazole was the first wide-spectrum oral azole available but its use is limited by idiosyncratic liver toxicity. Both fluconazole and itraconazole are currently available for systemic fungal infections and studies are ongoing to examine their effectiveness in dermatophyte infections, especially nail infections. These agents could eventually replace griseofulvin as a first-line therapy for dermatophyte infections.
Tinea versicolor is caused by a non-dermatophytic dimorphic fungus that is a saprofit of the skin. In the form of mycelium, Pityrosporum orbicular does not generally cause disease (except folliculitis in certain individuals). However, in certain individuals, it turns into a hifa form and causes characteristic lesions. The expression of infection is favored by heat and humidity. Typical lesions consist of macula, papules and squamous oval spots, concentrated on the chest, shoulders and back and only rarely the face or distal extremities. On dark skin they often appear in the form of hypopigmentation areas, while on light skin are slightly hyperpigmentation.
In some darkly pigmented individuals, it can only appear as squamous spots. A KOH preparation of squamous lesions will highlight a confluence of short hyphes and round spores (so-called meat spaghetti). Solutions containing sulphur, salicylic acid or selenium sulfide will remove the infection if used daily for a week and thereafter intermittently. Topical imidazoles are also effective.
Candidiasis is a fungal infection caused by a related group of fungi, the manifestations of which can be localized to the skin or can rarely be systemic and life-threatening. The microorganism in question is usually Candida albicans, but it can also be C. tropicalis, C. parapsilosis or C. krusei. These organisms are normal saprofitic colonizer of the gastrointestinal tract, but can proliferate (usually due to broad-spectrum antibiotic therapy) and cause disease in several skin localizations.
Other predisposing factors include diabetes mellitus, chronic intertrigo, the use of oral contraceptives and cellular immune deficiency. Candidiasis is a very common infection in HIV-infected individuals. The oral cavity is frequently affected. Injuries can occur on the tongue or mouth mucosa (muguet or bead) and appear as white plaques. Microscopic examination after scraping reveals highlights both pseudohife and mycelial forms. Cracked, macerated lesions of the corner of the mouth (pearl) are commonly found in individuals with inadequately adjusted dentures and may also be associated with candidiasis infection.
In addition, candidiasis infections have an affinity for regions that are constantly wet and macerated and can occur around nails (onixis and paraonixis) and in intertriginal regions. Intertriginous lesions are characteristically edematous, erythematous and squamous, with scattered "satellite pustules". in men there is frequent damage to the penis and scrotum, as well as to the inner face of the thighs. In contrast to dermatophyte infections, candidiasis infections are frequently accompanied by an intense inflammatory response.
Diagnosis is based on the clinical appearance and highlighting of fungi on preparation with KOH or in cultures. Routine treatment includes the removal of any predisposing factors, such as antibiotic therapy or chronic humidity and the use of appropriate topical or systemic antimycotic agents. Effective topical agents include nistatin or topical azoles (myconazole, clotrimazole, econazole or ketonazole). These agents are generally effective in removing mucous or glabre skin disorders in non-immunosuppressed patients.
The associated inflammatory response that frequently accompanies candidiasis infection on the glazed skin should be treated with a mild lotion or glucocorticoid cream (hydrocortisone 2.5%) on a sicative base. Systemic therapy is generally reserved for immunosuppressed patients or individuals with recurrent or chronic conditions who do not respond or tolerate appropriate topical therapy. Vulvovaginal candidiasis responds to treatment with a single dose of fluconazole (150 mg).
I've done another post.
Dorin, Merticaru