ACNE VULGARIS
Essentials of Diagnosis
- Starts between 9 and 17 years, is associated with puberty and clear by 30 years.
- At beginning, starts as papules, which have slight itching, discomfort, tenderness and redness.
- Sometimes cysts may be found, which fluctuates on palpation with pain.
- If it is untreated and uncared, leading to blackheads in the surface of the skin.
- Unfortunately, if patient has a keloidal tendency of the skin, keloids may be seen.
- Found in oily skin and often familial.
- Common sites are face, upper chest, back and shoulders.
Management
For promotion of peeling a second or third degree, erythema (E2, E3) dosage is given and repeated only when peeling has stopped. Generally, E2 is used for face and E3 is used for chest and upper back. The treatment will be respond in 6–8 weeks. Excess UVR therapy more than 12 weeks is dangerous.
- Skin to be washed carefully at least twice a day with oil-free soap and dried.
- Avoid squeezing out the whiteheads and blackheads as this leads to scarring.
- Avoid oily foods.
ALOPECIA
Essentials of Diagnosis
- Sudden onset, well-circumscribed, totally bald, smooth patches are seen, which is usually affecting the scalp.
- Nonscarring, affecting hair bearing area.
- Associated with autoimmune diseases like thyroid, vitiligo, Addison's diseases.
- Sebaceous glands are less active.
- Clumps of hair come away in the comb.
- Often familial but other cause of diffuse hair loss include telogen effluvium, protein deficiency, high fever, hemorrhage, sudden starvation, malignancy, impairment of liver and renal function and certain drugs.
Management
- UVR—for improving the general health theraktin may be given a suberythema or E1 dosage, daily for 6–8 treatments.
For promotion of nutrition, Kromayer may be given as E2 or E3 dosage for 2–3 times in a week for 2–3 months. Two to three patches may be treated in one session.
CARBUNCLE
Essentials of Diagnosis
- Deeper and more extensively infiltrated lesion.
- Starts as a tender, erythematous, indurate deep plaque on the back, neck or thigh, associated with malaise and fever.
- Often the whole area sloughs off leaving a deep ulcer.
Management
- UVR—fourth degree erythema or double fourth degree erythema dose to the affected area.
FURUNCLE (COMMON BOIL)
Essentials of Diagnosis
- Staphylococcus aureus, deep-seated infection of the hair follicle around the hair root.
- Painful furuncles found around hairy areas of the body, especially those subjected to friction and maceration.
Management
- SWD—in early stage, coplanar method.
- Infra-red radiation—when discharge has occurred.
- UVR—when boils are not drained or without discharging.
HYPERHIDROSIS
Essentials of Diagnosis
- Hyperactivation of exocrine or apocrine sweat glands.
- Seat pours out of the glands even during relative inactivity.
- Generally affects the age group of 14-35 years.
- Commonly affected sides are palms of hand, soles of feet, axillae.
Management
- Glycopyroneum bromide iontophoresis—low intensity direct current (1–2 mA/in 2 of electrode) for 15–20 minutes. Anode is placed over a pad soaked in the compound or in the bowl of the water in the compound and cathode is placed proximal to the anode.
If patient reports dryness of mouth, the dosage should be reduced. Sips of water during the treatment may help.5
LEPROSY
Essentials of Diagnosis
- Affects mainly peripheral nerves, skin, muscles, bones, testes and internal organs.
- Hypopigmented patches.
- Loss of cutaneous sensation.
- Thickened nerves.
- Presence of acid-fast bacilli in the skin or nasal smears.
- Tropic ulcers.
- Nasal bridge collapse.
- Loss of fingers or toes.
- Claw hand.
- Foot drop.
- Claw toes.
Management
- Soaking the skin or part in warm water and performing passive movements.
- Active exercises in all joints.
- Soaking the part in a soap water, rubbing off thick skin, oiling, self-massage and protecting the part from infection.
- Teach about skin, hand, foot and eye care to group or individual.
- Rest body position and POP cast.
- Elevation, active and passive exercises of swelled limbs.
- Muscle re-education after tendon transfer.
After Surgery
- Management depends upon corrective surgery and physiotherapy measures for those have been discussed in earlier.
MYCOSIS FUNGOIDES
Essentials of Diagnosis
- Red, scaly patches appear on the any part of the body, similar to psoriasis.
- Diagnosis is confirmed by the skin biopsy.
- Skin lesions develop plaques or nodular tumors.
- The disease may progress to the lymph nodes and vital organs.
- Generally distributes in face, particularly around the eyes.
Management
- PUVA—same as for psoriasis. Patient should wear goggles to protect the eyes during treatment.
PITYRIASIS ROSEA
Essentials of Diagnosis
- Rash of red or pink erythematous, maculopapular scaly lesions.
- Self-limiting disease but sometimes it persists.
Management
- UVB—suberythema dose of UVB with the Therektin two or three times a week for 2–3 weeks.
POLYMORPHIC LIGHT ERUPTION (PLE)
Essentials of Diagnosis
- Common photosensitive eruption, in which patient have extreme sensitive to UVR and visible light.
- Begin at any age but teens and twenties are more common.
- Itching, erythema, papules and blisters are seen at lesions.
Management
- PUVA—six week's course of PUVA in the spring or in February or March.
PRESSURE SORES
Essentials of Diagnosis
- Any pressure injury which may vary from an area of erythema to a deep-seated ulceration exposing the underlying bone.
- Found in pressure areas like hip, buttocks, hips, elbows.
- Floor of the sore may be pink and vascular or filled with infected exudates. Around the cavity the skin is red or blue.
- Pain is present, if sensory nerve endings are not destroyed.
- Main cause of sore is immobility.
Management
- Turning—every two hours day and night.
- Special mattress or bed—like water bed, ripple mattress, net bed, air fluidized bed, low air loss bed, roho cushion or sorbo packs.
- Balanced diet.
- Exercises—strengthening/active/relaxed passive movement.
- Ice therapy—ice massage over a reddened area.
- Ultrasound—on the surrounding area, 3 MHz head using a low dosage, e.g. 0.25–0.5 W/cm2 for 5–10 minutes.
- UVR—fourth degree or double fourth degree dose, 2–3 times a week.
- PEME—pulse duration 65 μs, frequency 400 pulses/minute, up to 30 minutes daily.
- Ionozone Therapy—distance 35 cm from the ulcer, for 10-20 minutes.
- Laser—30 mW for 33 seconds. Prob is held at 90.
- Compression and support bandaging—for ulcer edema of surrounding tissues and limited joint movement.
PSORIASIS
Essentials of Diagnosis
- It is a familial, chronic, recurrent disease of unknown origin.
- Clearly defined dry, rounded red patches of various sizes covered with mica-like silvery scales.
- Silvery scales due to light reflecting from the swollen stratum spinosum.
- Removal of the scales may expose a thin membrane giving rise to pinpoint bleeding points.
- Commonly affected sites are extensor aspect of extremities especially elbows, knee, occiput. Face is rarely affected.
Management
- Removal of precipitating cause if known.
- Warm climate helps to check relapse.
- The Goeckerman regimen—application of coal tar 2–3 times a day with general UVB radiation given once a day, as suberythemal or E1 dose.
- Leeds or Ingram regimen—after taking a coal tar bath, patient is irradiated with maximum erythemal dosage of UVB. After irradiation the skin lesions are covered with dithranol cream, which is removed on the next day and again UVR is given to skin as a wavelength of 311 nm.
- PUVA—patient is given 3–6 tablets of psoralen preferably with milk 2 hours before exposure. Tablet dosage is according to body weight.
Patient's weight in kg | Dose (mg) |
|---|---|
30 | 10 |
30–50 | 20 |
51–65 | 30 |
66–80 | 40 |
81–90 | 50 |
90 and over | 60 |
The drug 8–methoxy psoralen is used making the patient highly reactive to UVA. The erythema in PUVA, arise later than the erythema with UVB, and may not reach a peak for 2–4 days.
Treatment is given twice a day, until clearance of disease, which is usually cleared at 12–20 exposures.
Pustular psoriasis—treated by PUVA with a special piece of equipment in which the fluorescent tubes are horizontal and the hands and feet are placed on a grid over them.
VITILIGO
Essentials of Diagnosis
- Irregular patches of the skin become depigmented and appear white against normal skin.
- Lesions are circumscribed, milky white in color and often symmetrical.
- Acquired, sometimes familial.
- Common sites are face, especially around eyes and mouth, axillae, groins, genitalia, hands and feet.
Management
- PUVA—psoralens [try-methyl psoralen (TMP) 8-MOP] may be taken by mouth or painted on the affected areas topically. E1 dosage is recommended for two treatments a week for over a year. Initial dosage must be based on the vitiliginous area and not on the patient's general skin type.