Tag Archives: Cutaneous conditions

Rosacea

Definition:
Rosacea has been defined as a persistent redness of the central part of the face lasting for at least three months, and often including features such as flushing, red lumps and pustules, and small dilated blood vessels. Exactly which symptoms develop defines which particular subtype of rosacea is present.

It primarily affects Caucasians of mainly northwestern European descent and has been nicknamed the ‘curse of the Celts’ by some in Britain and Ireland, but can also affect people of other ethnicities. Rosacea affects both sexes, but is almost three times more common in women. It has a peak age of onset between 30 and 60.

Rosacea typically begins as redness on the central face across the cheeks, nose, or forehead, but can also less commonly affect the neck, chest, ears, and scalp. In some cases, additional symptoms, such as semi-permanent redness, telangiectasia (dilation of superficial blood vessels on the face), red domed papules (small bumps) and pustules, red gritty eyes, burning and stinging sensations, and in some advanced cases, a red lobulated nose (rhinophyma), may develop.

Clasifications:
There are four identified rosacea subtypes  and patients may have more than one subtype present :176:

1.Erythematotelangiectatic rosacea: Permanent redness (erythema) with a tendency to flush and blush easily. It is also common to have small blood vessels visible near the surface of the skin (telangiectasias) and possibly burning or itching sensations.

2.Papulopustular rosacea: Some permanent redness with red bumps (papules) with some pus filled (pustules) (which typically last 1–4 days); this subtype can be easily confused with acne.

3.Phymatous rosacea: This subtype is most commonly associated with rhinophyma, an enlargement of the nose. Symptoms include thickening skin, irregular surface nodularities, and enlargement. Phymatous rosacea can also affect the chin (gnathophyma), forehead (metophyma), cheeks, eyelids (blepharophyma), and ears (otophyma).   Small blood vessels visible near the surface of the skin (telangiectasias) may be present.

4.Ocular rosacea: Red, dry and irritated eyes and eyelids. Some other symptoms include foreign body sensations, itching and burning.
There are a number of variants of rosacea including:689

*Rosacea conglobata…....click & see
*Rosacea fulminans…...click & see
*Phymas in rosacea…….click & see

Symptoms:
Signs and symptoms of rosacea i.nclude:

*Red areas on your face

*Small, red bumps or pustules on your nose, cheeks, forehead and chin (but not the same as whiteheads or blackheads)

*Red, bulbous nose (rhinophyma)

*Visible small blood vessels on your nose and cheeks (telangiectasia)

*Burning or gritty sensation in your eyes (ocular rosacea)

*Tendency to flush or blush easily
click to see the pictures.>….(01).….(1)…..…(2).…...(3)....(4)…...(5)
Rosacea usually appears in phases:

*Pre-rosacea. Rosacea may begin as a simple tendency to flush or blush easily, and then progress to a persistent redness in the central portion of your face, particularly your nose. This redness results from the dilation of blood vessels close to your skin’s surface. This phase may sometimes be referred to as pre-rosacea.Vascular rosacea. As signs and symptoms worsen, vascular rosacea may develop — small blood vessels on your nose and cheeks swell and become visible (telangiectasia). Your skin may become overly sensitive.

* Vascular rosacea may also be accompanied by oily skin and dandruff.

*Inflammatory rosacea. Small, red bumps or pustules may appear and persist, spreading across your nose, cheeks, forehead and chin. This is sometimes known as inflammatory rosacea.

In addition, about 1 in 2 people with rosacea also experience ocular rosacea — a burning and gritty sensation in the eyes. Rosacea may cause the inner skin of the eyelids to become inflamed or appear scaly, a condition known as conjunctivitis.

Late in the course of rosacea, some people, mainly middle-aged men, may develop red, round, raised bumps (papules) and a bulbous nose, a condition known as rhinophyma.

Causes:
Although the cause isn’t known, a number of factors which may play a part have been identified.
CauseTriggers that cause episodes of flushing and blushing play a part in the development of rosacea. Exposure to temperature extremes can cause the face to become flushed as well as strenuous exercise, heat from sunlight, severe sunburn, stress, anxiety, cold wind, and moving to a warm or hot environment from a cold one such as heated shops and offices during the winter. There are also some food and drinks that can trigger flushing, including alcohol, food and beverages containing caffeine (especially, hot tea and coffee), foods high in histamines and spicy food. Foods high in histamine (red wine, aged cheeses, yogurt, beer, cured pork products such as bacon, etc.) can even cause persistent facial flushing in those individuals without rosacea due to a separate condition, histamine intolerance.

Certain medications and topical irritants can quickly trigger rosacea. Some acne and wrinkle treatments that have been reported to cause rosacea include microdermabrasion and chemical peels, as well as high dosages of isotretinoin, benzoyl peroxide, and tretinoin. Steroid induced rosacea is the term given to rosacea caused by the use of topical or nasal steroids. These steroids are often prescribed for seborrheic dermatitis. Dosage should be slowly decreased and not immediately stopped to avoid a flare up.

A survey by the National Rosacea Society of 1,066 rosacea patients showed which factors affect the most people:

*Sun exposure 81%
*Emotional stress 79%
*Hot weather 75%
*Wind 57%
*Heavy exercise 56%
*Alcohol consumption 52%
*Hot baths 51%
*Cold weather 46%
*Spicy foods 45%
*Humidity 44%
*Indoor heat 41%
*Certain skin-care products 41%
*Heated beverages 36%
*Certain cosmetics 27%
*Medications (specifically stimulants) 15%
*Medical conditions 15%
*Certain fruits 13%
*Marinated meats 10%
*Certain vegetables 9%
*Dairy products 8%

Cathelicidins
Richard L. Gallo and colleagues recently noticed that patients with rosacea had elevated levels of the peptide cathelicidin   and elevated levels of stratum corneum tryptic enzymes (SCTEs). Antibiotics have been used in the past to treat rosacea but they may only work because they inhibit some SCTEs.

Intestinal bacteria
Intestinal bacteria may play a role in causing the disease. A recent study subjected patients to a hydrogen breath test to detect the occurrence of small intestinal bacterial overgrowth (SIBO). It was found that significantly more patients were hydrogen-positive than controls indicating the presence of bacterial overgrowth (47% v. 5%, p<0.001).

Hydrogen-positive patients were then given a 10-day course of rifaximin, a non-absorbable antibiotic that does not leave the digestive tract and therefore does not enter the circulation or reach the skin. 96% of patients experienced a complete remission of rosacea symptoms that lasted beyond 9 months. These patients were also negative when retested for bacterial overgrowth. In the 4% of patients that experienced relapse, it was found that bacterial overgrowth had returned. These patients were given a second course of rifaximin which again cleared rosacea symptoms and normalized hydrogen excretion.

In another study, it was found that some rosacea patients that tested hydrogen-negative were still positive for bacterial overgrowth when using a methane breath test instead. These patients showed little improvement with rifaximin, as found in the previous study, but experienced clearance of rosacea symptoms and normalization of methane excretion following administration of the antibiotic metronidazole, which is effective at targeting methanogenic intestinal bacteria.

These results suggest that optimal antibiotic therapy may vary between patients and that diverse species of intestinal bacteria appear to be capable of mediating rosacea symptoms.

This may also explain the improvement in symptoms experienced by some patients when given a reduced carbohydrate diet.  Such a diet would restrict the available material necessary for bacterial fermentation and thereby reduce intestinal bacterial populations.

Demodex mites:
Studies of rosacea and demodex mites have revealed that some people with Rosacea have increased numbers of the mite, especially those with steroid induced rosacea.  When large numbers are present they may play a role along with other triggers. On other occasions demodicidosis (mange) is a separate condition that may have “rosacea-like” appearances.
Risk Factors:
Although anyone can develop rosacea, you may be more likely to develop rosacea if you:

*Have fair skin and light hair and eye color
*Are between the ages of 30 and 60, especially if you’re going through menopause
*Experience frequent flushing or blushing
*Have a family history of rosacea

Complications:
In severe and rare cases, the oil glands (sebaceous glands) in your nose and sometimes your cheeks become enlarged, resulting in a buildup of tissue on and around your nose — a condition called rhinophyma (ri-no-FI-muh). This complication is much more common in men and develops slowly over a period of years.

Diagnosis:
Most people with rosacea have only mild redness and are never formally diagnosed or treated. There is no single, specific test for rosacea.

In many cases, simple visual inspection by a trained person is sufficient for diagnosis. In other cases, particularly when pimples or redness on less-common parts of the face are present, a trial of common treatments is useful for confirming a suspected diagnosis.

The disorder can be confused with, and co-exist with acne vulgaris and/or seborrhoeic dermatitis. The presence of rash on the scalp or ears suggests a different or co-existing diagnosis as rosacea is primarily a facial diagnosis, although it may occasionally appear in these other areas.

Treatments:
Treating rosacea varies depending on severity and subtypes. A subtype-directed approach to treating rosacea patients is recommended to dermatologists.  Mild cases are often not treated at all, or are simply covered up with normal cosmetics. Therapy for the treatment of rosacea is not curative, and is best measured in terms of reduction in the amount of erythema and inflammatory lesions, decrease in the number, duration, and intensity of flares, and concomitant symptoms of itching, burning, and tenderness. The two primary modalities of rosacea treatment are topical and oral antibiotic agents.   While medications often produce a temporary remission of redness within a few weeks, the redness typically returns shortly after treatment is suspended. Long-term treatment, usually one to two years, may result in permanent control of the condition for some patients.  Lifelong treatment is often necessary, although some cases resolve after a while and go into a permanent remission.

Behaviour
Trigger avoidance can help reduce the onset of rosacea but alone will not normally cause remission for all but mild cases. It is sometimes recommended that a journal be kept to help identify and reduce food and beverage triggers..

Because sunlight is a common trigger, avoiding excessive exposure to sun is widely recommended. Some people with rosacea benefit from daily use of a sunscreen; others opt for wearing hats with broad brims.

People who develop infections of the eyelids must practice frequent eyelid hygiene. Daily, gentle cleansing of the eyelids with diluted baby shampoo or an over-the-counter eyelid cleaner and applying warm (but not hot) compresses several times a day is recommended.

A recent publication discusses how managing pre-trigger events such as prolonged exposure to cool environments can directly influence warm room flushing.

Medications:
Oral tetracycline antibiotics (tetracycline, doxycycline, minocycline) and topical antibiotics such as metronidazole are usually the first line of defense prescribed by doctors to relieve papules, pustules, inflammation and some redness.  Topical azelaic acid such as Finacea (15%) or Skinoren (20%) may help reduce inflammatory lesions, bumps and papules. Using alpha-hydroxy acid peels may help relieve redness caused by irritation, and reduce papules and pustules associated with rosacea.  Oral antibiotics may help to relieve symptoms of ocular rosacea. If papules and pustules persist, then sometimes isotretinoin can be prescribed.  Isotretinoin has many side effects and is normally used to treat severe acne but in low dosages is proven to be effective against papulopustular and phymatous rosacea.

The treatment of flushing and blushing has been attempted by means of the centrally acting ?-2 agonist clonidine, but this is of limited benefit on just this one aspect of the disorder.  The same is true of the beta-blockers nadolol and propranolol. If flushing occurs with red wine consumption, then complete avoidance helps. There is no evidence at all that antihistamines are of any benefit in rosacea. However: people with underlying allergies and who respond strongly to foods that are high in histamine or that release a lot of histamine in the body do find sometimes that their flushing symptoms diminish with oral antihistamines (for instance loratadine). Another medication that can help some people with facial flushing and burning is mirtazapine (remeron).

Recently, a clinically-trialled product range combining plant-sourced methylsulfonylmethane (MSM) and silymarin has been used to treat rosacea, skin redness and flushing.

Laser:
Dermatological vascular laser (single wavelength) or intense pulsed light (broad spectrum) machines offer one of the best treatments for rosacea, in particular the erythema (redness) of the skin.   They use light to penetrate the epidermis to target the capillaries in the dermis layer of the skin. The light is absorbed by oxy-hemoglobin which heat up causing the capillary walls to heat up to 70 °C (158 °F) , damaging them, causing them to be absorbed by the body’s natural defense mechanism. With a sufficient number of treatments, this method may even eliminate the redness altogether, though additional periodic treatments will likely be necessary to remove newly-formed capillaries.

CO2 lasers can be used to remove excess tissue caused by phymatous rosacea. CO2 lasers emit a wavelength that is absorbed directly by the skin. The laser beam can be focused into a thin beam and used as a scalpel or defocused and used to vaporise tissue. Low level light therapies have also been used to treat rosacea. Photorejuvenation can also be used to improve the appearance of rosacea and reduce the redness associated with it
Lifestyle & Homeremedies:
One of the most important things you can do if you have rosacea is to minimize your exposure to anything that causes a flare-up. Find out what factors affect you so that you can avoid them. Keep a list of things that trigger your flare-ups, and try to avoid your triggers.

Here are other suggestions for preventing flare-ups:

*Wear broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or higher to protect your face from the sun.

*Protect your face in the winter with a scarf or ski mask.

*Avoid irritating your facial skin by rubbing or touching it too much.

*Wash problem areas with a gentle cleanser (Dove, Cetaphil).

*Avoid facial products that contain alcohol or other skin irritants.

*When using moisturizer and a topical medication, apply the moisturizer after the medication has dried.

*Use products that are labeled noncomedogenic. These won’t clog your oil and sweat gland openings (pores) as much.

*Avoid overheating.

*If you wear makeup, consider using green- or yellow-tinted pre-foundation creams and powders, because they’re designed to counter skin redness.

*Avoid drinking alcohol.

Alternative medicine:

Many alternative therapies — including colloidal silver, emu oil, laurelwood, oregano oil and vitamin K — have been touted as possible ways to treat rosacea. However, there’s no conclusive evidence that any of these alternative therapies are effective.

If you’re considering dietary supplements or other alternative therapies to treat rosacea, consult your doctor. He or she can help you weigh the pros and cons of specific alternative therapies.
Prognosis:
Rosacea tends to wax and wane over time but eventually, with the use of treatment, most people reach a fairly stable state of relative control of their condition.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.mayoclinic.com/health/rosacea/DS00308
http://www.bbc.co.uk/health/physical_health/conditions/rosacea1.shtml
http://en.wikipedia.org/wiki/Rosacea
http://www.rosacea.org/patients/allaboutrosacea.php
http://wegoodinfo.com/rosacea-symptoms/

Onycholysis

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Definition:
Onycholysis is a diseases whose symptoms appear as the separation of the nail plate from the nail bed on your fingers and toes. But that is not the full definition. The separation must be gradual and must be painless. Onycholysis can happen due to a number of reasons including trauma, onychomycosis or fungal infection in the nails. Onycholysis is generally seen in adulthood and might be symptomatic of other skin diseases or infections, allergic contact to some compounds like acrylic nail products, consequence of an injury, or hyperactive thyroid glands.

click to see

Click to see the picture

Onycholysis disease is not restricted to any one sex but generally women are more prone to it specially those who keep long fingernails. Actually long fingernails result in its tip being hit against hard objects repeatedly. It is also seen that the affected nails don’t show any skin inflammation and the finger nail remains firm and smooth. It is simply because onycholysis is not a disease of the nails tissue matrix.

Symptoms:
It is actually very easy to spot Onycholysis nail disease. You’ll find that the nail lifts itself from its bed and there is a gap between the pink portion of the nail and the white outside edge of the finger nail.
Click to see the picture
One way of determining Onycholysis has set in to check for signs of discoloration underneath the nail since this may occur as a result of secondary infection. The painless and spontaneous separation of the nail plate starts at the distal free margin and gradually progresses proximally. That actually signifies secondary infection making the situation more serious. Secondary infections might also result in the deformation of the shape of the nail plate and appearance of pits and indentations in the nail surface.
Larger portion of the nail may become opaque, get whitened or discolored to yellow or green and this calls for medical attention.

Causes:
*Idiopathic
*Trauma e.g. excessive manicuring
*Infection: especially fungal
*Skin disease: psoriasis, dermatitis
*Impaired peripheral circulation e.g. Raynaud’s
*Systemic disease: hyper- and hypothyroidism, reactive arthritis

Diagnosis:
Diagnosing Onycholysis is simple and straight forward. To diagnose Onycholysis you must examine closely your fingernails and the toenails for nail plate separation, opacity and discoloration and effects the disease might have on the peripheral skin surrounding your nails and toes. If you feel that something is wrong but can’t make a clear diagnostic, you need to go see your doctor or physician who would look for and diagnose for other symptoms and search for other symptomatic signs of the disease such as skin appearance around your nails or the appearance of indentations in the surface or the color and shape of the nails. Doctors search for sign of rashes on the skin or even check for related symptoms linked to thyroid problems. If the diagnostic suspicious of your doctor leans towards fungal infection, some tissues from beneath your nail plate might be scraped out for further testing.

Treatment:

Treatment usually involves tackling the underlying cause, such as a fungal infection.

Nail changes aren’t usually permanent, but they can take many months to resolve, even after treatment.
*Some of the remedial measures one can take for Onycholysis at home include regular trimming of nails to ensure they remain short and clean (manageable too) and using a skin softening hand cream to nourish the nails and hands.
*If Onycholysis has set in due to nail biting, picking or tearing, the person can consider seeking psychological counseling to get the necessary encouragement and guidance to underlying problems to stop this behavior.
*Persons suffering from Onycholysis should wear light cotton gloves under vinyl gloves for wet work and avoid keeping their hands immersed for prolonged periods in water.


*If Onycholysis has set in on the feet, one should avoid wearing tight shoes and trim the nails straight across the top only.

Prevention:
What you can do is to take some preventive steps to avoid the occurrence of onycholysis. You can start with avoiding exposure to harsh chemicals like nail polish remover. You would do well to wear cotton gloves or rubber gloves while immersing your nails in water repeatedly. Nails expand when it is moisten and shrinks when it dries. And yes, clip your nails at the affected portion and try to keep your nails short to avoid further trauma from getting damaged everyday.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://en.wikipedia.org/wiki/Onycholysis
http://www.fuelthemind.com/health/health/Onycholysis_nail_disease.html
http://beautytips.ygoy.com/nail-disorders/onycholysis.php
http://www.nlm.nih.gov/medlineplus/ency/imagepages/2010.htm

http://www.bbc.co.uk/health/physical_health/conditions/onycholysis1.shtml

Onycholysis – Definition, Causes, Symptoms, Pictures and Treatment

http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Clinical%20Images/Onycholysis-18.jpg

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Anthrax

Alternative Names: Woolsorter’s disease; Ragpicker’s disease; Cutaneous anthrax; Gastrointestinal anthrax.

Definition:
Anthrax is a life-threatening infectious disease that normally affects animals, especially ruminants (such as goats, cattle, sheep, and horses). Anthrax can be transmitted to humans by contact with infected animals or their products.
CLICK & SEE
Anthrax is an acute disease caused by the bacterium Bacillus anthracis. Most forms of the disease are lethal. There are effective vaccines against anthrax, and some forms of the disease respond well to antibiotic treatment.

Like many other members of the genus Bacillus, Bacillus anthracis can form dormant endospores (often referred to as “spores” for short, but not to be cnfused with fungal spores) that are able to survive in harsh conditions for decades or even centuries. Such spores can be found on all continents, even Antarctica.  When spores are inhaled, ingested, or come into contact with a skin lesion on a host they may reactivate and multiply rapidly.

Anthrax spores can be produced in vitro and used as a biological weapon. Anthrax does not spread directly from one infected animal or person to another; it is spread by spores. These spores can be transported by clothing or shoes. The dead body of an animal that died of anthrax can also be a source of anthrax spores.

In recent years, anthrax has received a great deal of attention as it has become clear that the infection can also be spread by a bioterrorist attack or by biological warfare.

Symptoms:

There are three different types of anthrax.
1.Cutaneous anthrax ,2.Inhalational anthrax  and 3.Intestinal anthrax

1.Cutaneous anthrax – this type accounts for about 95 per cent of cases. People handling dead animals – such as abattoir workers and tanners – are at most risk. Infection occurs when the bacterium comes into direct contact with a cut or abrasion in the skin.

At first the skin itches. This is soon followed by the appearance of a small, raised itchy bump that looks like an insect bite. This skin lesion is commonly located on the head, forearms or hands.

Within one to two days the skin lesion develops into a vesicle and becomes a painless ulcer, usually about 1cm to 3cm in diameter. After two to six days the black dying central area of the ulcer that’s characteristic of cutaneous anthrax is apparent.

If left untreated, cutaneous anthrax infection can spread and cause blood poisoning, which is fatal in up to 20 per cent of cases, but with effective antibiotic treatment few deaths occur.

2.Inhalational anthrax – when inhaled, the larger spores lodge in the windpipe or throat, while smaller ones lodge further down the respiratory tract in the lungs. The anthrax bacteria produce toxins that enter the bloodstream and cause haemorrhaging and tissue decay.

Initial symptoms of inhalational anthrax, which is rare, are mild and non-specific, similar to the symptoms of a flu-like infection. These include tiredness, weakness, fever, mild non-productive cough and chest pain.

If left untreated, over the next two to six days this mild phase becomes severe, causing breathing problems, sepsis and bleeding. By the time the infection has reached this stage it’s usually fatal.

3.Intestinal anthrax
– a very rare form of food poisoning that may follow the ingestion of contaminated meat.

Initial symptoms are nausea, vomiting, loss of appetite and fever. As the infection becomes more severe, abdominal pain, vomiting of blood and severe diarrhoea occur.

Intestinal anthrax is often fatal.

Cause:-
Bacteria :-

Bacillus anthracis is a rod-shaped, Gram-positive, aerobic bacterium about 1 by 9 micrometers in length. It was shown to cause disease by Robert Koch in 1876. The bacterium normally rests in endospore form in the soil, and can survive for decades in this state. Herbivores are often infected whilst grazing or browsing, especially when eating rough, irritant or spiky vegetation: the vegetation has been hypothesized to cause wounds within the gastrointestinal tract permitting entry of the bacterial endo-spores into the tissues, though this has not been proven. Once ingested or placed in an open cut, the bacterium begins multiplying inside the animal or human and typically kills the host within a few days or weeks. The endo-spores germinate at the site of entry into the tissues and then spread via the circulation to the lymphatics, where the bacteria multiply.

Exposure:-

Occupational exposure to infected animals or their products (such as skin, wool, and meat) is the usual pathway of exposure for humans. Workers who are exposed to dead animals and animal products are at the highest risk, especially in countries where anthrax is more common. Anthrax in livestock grazing on open range where they mix with wild animals still occasionally occurs in the United States and elsewhere. Many workers who deal with wool and animal hides are routinely exposed to low levels of anthrax spores but most exposures are not sufficient to develop anthrax infections. It is presumed that the body’s natural defenses can destroy low levels of exposure. These people usually contract cutaneous anthrax if they catch anything. Throughout history, the most dangerous form of inhalational anthrax was called Woolsorters’ disease because it was an occupational hazard for people who sorted wool. Today this form of infection is extremely rare, as almost no infected animals remain. The last fatal case of natural inhalational anthrax in the United States occurred in California in 1976, when a home weaver died after working with infected wool imported from Pakistan. The autopsy was done at UCLA hospital. To minimize the chance of spreading the disease, the deceased was transported to UCLA in a sealed plastic body bag within a sealed metal container.

Pulmonary:

Respiratory infection in humans initially presents with cold or flu-like symptoms for several days, followed by severe (and often fatal) respiratory collapse. Historical mortality was 92%, but, when treated early (seen in the 2001 anthrax attacks), observed mortality was 45%. Distinguishing pulmonary anthrax from more common causes of respiratory illness is essential to avoiding delays in diagnosis and thereby improving outcomes. An algorithm for this purpose has been developed. Illness progressing to the fulminant phase has a 97% mortality regardless of treatment.

Gastrointestinal:-

Gastrointestinal infection in humans is most often caused by eating anthrax-infected meat and is characterized by serious gastrointestinal difficulty, vomiting of blood, severe diarrhea, acute inflammation of the intestinal tract, and loss of appetite. Some lesions have been found in the intestines and in the mouth and throat. After the bacterium invades the bowel system, it spreads through the bloodstream throughout the body, making even more toxins on the way. Gastrointestinal infections can be treated but usually result in fatality rates of 25% to 60%, depending upon how soon treatment commences.  This form of anthrax is the rarest form. In the United States, there is only one official case reported in 1942 by the CDC.

Cutaneous :

Anthrax skin lesionCutaneous (on the skin) anthrax infection in humans shows up as a boil-like skin lesion that eventually forms an ulcer with a black center (eschar). The black eschar often shows up as a large, painless necrotic ulcer (beginning as an irritating and itchy skin lesion or blister that is dark and usually concentrated as a black dot, somewhat resembling bread mold) at the site of infection. In general, cutaneous infections form within the site of spore penetration between 2 and 5 days after exposure. Unlike bruises or most other lesions, cutaneous anthrax infections normally do not cause pain.

Mode of infection :-
Inhalational anthrax, mediastinal wideningAnthrax can enter the human body through the intestines (ingestion), lungs (inhalation), or skin (cutaneous) and causes distinct clinical symptoms based on its site of entry. In general, an infected human will be quarantined. However, anthrax does not usually spread from an infected human to a noninfected human. But, if the disease is fatal to the person’s body, its mass of anthrax bacilli becomes a potential source of infection to others and special precautions should be used to prevent further contamination. Inhalational anthrax, if left untreated until obvious symptoms occur, may be fatal.

Anthrax can be contracted in laboratory accidents or by handling infected animals or their wool or hides. It has also been used in biological warfare agents and by terrorists to intentionally infect as exemplified by the 2001 anthrax attacks.

Diagnosis:
Other than Gram Stain of specimens, there are no specific direct identification techniques for identification of Bacillus species in clinical material. These organisms are Gram-positive but with age can be Gram-variable to Gram-negative. A specific feature of Bacillus species that makes it unique from other aerobic microorganisms is its ability to produce spores. Although spores are not always evident on a Gram stain of this organism, the presence of spores confirms that the organism is of the genus Bacillus.

All Bacillus species grow well on 5% Sheep blood agar and other routine culture media. PLET (polymyxin-lysozyme-EDTA-thallous acetate) can be used to isolate B.anthracis from contaminated specimens, and bicarbonate agar is used as an identification method to induce capsule formation.

Bacillus sp. will usually grow within 24 hours of incubation at 35 degrees C, in ambient air (room temperature) or in 5% CO2. If bicarbonate agar is used for identification then the media must be incubated in 5% CO2.

B.anthracis appears as medium-large, gray, flat, irregular with swirling projections, often referred to as “medusa head” appearance, and is non-hemolytic on 5% sheep blood agar. It is non-motile, is susceptible to penicillin and produces a wide zone of lecithinase on egg yolk agar. Confirmatory testing to identify B.anthracis includes gamma bacteriophage testing, indirect hemagglutination and enzyme linked immunosorbent assay to detect antibodies.

Treatment:
Anthrax cannot be spread directly from person to person, but a patient’s clothing and body may be contaminated with anthrax spores. Effective decontamination of people can be accomplished by a thorough wash-down with antimicrobial effective soap and water. Waste water should be treated with bleach or other anti-microbial agent. Effective decontamination of articles can be accomplished by boiling contaminated articles in water for 30 minutes or longer. Chlorine bleach is ineffective in destroying spores and vegetative cells on surfaces, though formaldehyde is effective. Burning clothing is very effective in destroying spores. After decontamination, there is no need to immunize, treat or isolate contacts of persons ill with anthrax unless they were also exposed to the same source of infection. Early antibiotic treatment of anthrax is essential—delay significantly lessens chances for survival. Treatment for anthrax infection and other bacterial infections includes large doses of intravenous and oral antibiotics, such as fluoroquinolones, like ciprofloxacin (cipro), doxycycline, erythromycin, vancomycin or penicillin. In possible cases of inhalation anthrax, early antibiotic prophylaxis treatment is crucial to prevent possible death. In May 2009, Human Genome Sciences submitted a Biologic License Application (BLA, permission to market) for its new drug, raxibacumab (brand name ABthrax) intended for emergency treatment of inhaled anthrax.[28] If death occurs from anthrax the body should be isolated to prevent possible spread of anthrax germs. Burial does not kill anthrax spores.

If a person is suspected as having died from anthrax, every precaution should be taken to avoid skin contact with the potentially contaminated body and fluids exuded through natural body openings. The body should be put in strict quarantine. A blood sample taken in a sealed container and analyzed in an approved laboratory should be used to ascertain if anthrax is the cause of death. Microscopic visualization of the encapsulated bacilli, usually in very large numbers, in a blood smear stained with polychrome methylene blue (McFadyean stain) is fully diagnostic, though culture of the organism is still the gold standard for diagnosis. Full isolation of the body is important to prevent possible contamination of others. Protective, impermeable clothing and equipment such as rubber gloves, rubber apron, and rubber boots with no perforations should be used when handling the body. No skin, especially if it has any wounds or scratches, should be exposed. Disposable personal protective equipment is preferable, but if not available, decontamination can be achieved by autoclaving. Disposable personal protective equipment and filters should be autoclaved, and/or burned and buried. Bacillus anthracis bacillii range from 0.5–5.0 ?m in size. Anyone working with anthrax in a suspected or confirmed victim should wear respiratory equipment capable of filtering this size of particle or smaller. The US National Institute for Occupational Safety and Health (NIOSH) and Mine Safety and Health Administration (MSHA) approved high efficiency-respirator, such as a half-face disposable respirator with a high-efficiency particulate air (HEPA) filter, is recommended.[29] All possibly contaminated bedding or clothing should be isolated in double plastic bags and treated as possible bio-hazard waste. The victim should be sealed in an airtight body bag. Dead victims that are opened and not burned provide an ideal source of anthrax spores. Cremating victims is the preferred way of handling body disposal. No embalming or autopsy should be attempted without a fully equipped biohazard laboratory and trained and knowledgeable personnel.

Delays of only a few days may make the disease untreatable and treatment should be started even without symptoms if possible contamination or exposure is suspected. Animals with anthrax often just die without any apparent symptoms. Initial symptoms may resemble a common cold—sore throat, mild fever, muscle aches and malaise. After a few days, the symptoms may progress to severe breathing problems and shock and ultimately death. Death can occur from about two days to a month after exposure with deaths apparently peaking at about 8 days after exposure.[30] Antibiotic-resistant strains of anthrax are known.

In recent years there have been many attempts to develop new drugs against anthrax, but existing drugs are effective if treatment is started soon enough.

Early detection of sources of anthrax infection can allow preventive measures to be taken. In response to the anthrax attacks of October 2001 the United States Postal Service (USPS) installed BioDetection Systems (BDS) in their large scale mail cancellation facilities. BDS response plans were formulated by the USPS in conjunction with local responders including fire, police, hospitals and public health. Employees of these facilities have been educated about anthrax, response actions and prophylactic medication. Because of the time delay inherent in getting final verification that anthrax has been used, prophylactic antibiotic treatment of possibly exposed personnel must be started as soon as possible.

Prognosis:
When treated with antibiotics, cutaneous anthrax is likely to get better. However, up to 20% of people who do not get treatment may die due to anthrax-related blood infections.

People with second-stage inhalation anthrax have a poor outlook, even with antibiotic therapy. Up to 90% of cases in the second stage are fatal.

Gastrointestinal anthrax infection can spread to the bloodstream, and may result in death.

Possible Complications:

Cutaneous anthrax:
•Spread of infection into the bloodstream

Inhalational anthrax:

•Hemorrhagic meningitis
•Swelling of lymph nodes in the chest (mediastinal adenopathy)
•Fluid buildup in the chest (pleural effusion)
•Shock
•Death

Gastrointestinal anthrax
•Severe bleeding (hemorrhage)
•Shock
•Death

Prevention:
There are two main ways to prevent anthrax.

For people who have been exposed to anthrax (but have no symptoms of the disease), doctors may prescribe preventive antibiotics, such as ciprofloxacin, penicillin, or doxycycline, depending on the strain of anthrax.

An anthrax vaccine is available to certain military personnel, but not to the general public. It is given in a series of six doses over 18 months. There is no known way to spread cutaneous anthrax from person to person. People who live with someone who has cutaneous anthrax do not need antibiotics unless they have also been exposed to the same source of anthrax.

An anthrax vaccine licensed by the U.S. Food and Drug Administration (FDA) and produced from one non-virulent strain of the anthrax bacterium, is manufactured by BioPort Corporation, subsidiary of Emergent BioSolutions. The trade name is BioThrax, although it is commonly called Anthrax Vaccine Adsorbed (AVA). It was formerly administered in a six-dose primary series at 0, 2, 4 weeks and 6, 12, 18 months, with annual boosters to maintain immunity. On December 11, 2008, the FDA approved the removal of the 2-week dose, resulting in the currently recommended five-dose series.

Unlike NATO countries, the Soviets developed and used a live spore anthrax vaccine, known as the STI vaccine, produced in Tbilisi, Georgia. Its serious side-effects restrict use to healthy adults.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

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Dyshidrosis

Definition:
Dyshidrosis, also termed Dyshidrotic Eczema, Pompholyx and Dyshidrotic Dermatitis, is a skin condition that is characterized by small blisters on the hands or feet. It is an acute, chronic, or recurrent dermatosis of the fingers, palms, and soles, characterized by a sudden onset of many deep-seated pruritic, clear vesicles; later, scaling, fissures and lichenification occur. Recurrence is common and for many can be chronic. Incidence/Prevalence is said to be 20/100,000 in the USA, however, many cases of eczema are diagnosed as garden-variety atopic eczema without further investigation, so it is possible this figure is misleading.
It is a non-contagious skin problem that is thought to be perhaps a reaction to some environmental irritant; it may also be an autoimmune disease. It is common, slightly more women get it than men, and has been one of the earliest known skin problems. It is rare in children under 10.

This condition is not contagious to others, but due to its unsightly nature can cause significant distress in regards to social interactions with others.

The name comes from the word “dyshidrotic,” meaning “bad sweating,” which was once believed to be the cause. Sometimes called pompholyx (Greek for “bubble”) which is generally reserved for the cases with blisters; in some countries, pompholyx refers to hand dyshidrosis.

……You may click to see the picture.

Symptoms:
Small blisters with the following characteristics:

*Blisters are very small (1 mm or less in diameter). They appear on the tips and sides of the fingers, toes, palms, and soles.

*Blisters are opaque and deep-seated; they are either flush with the skin or slightly elevated and do not break easily.
*Eventually, small blisters come together and form large blisters.

*Blisters may itch, cause pain, or produce no symptoms at all. They worsen after contact with soap, water, or irritating substances.

*Scratching blisters breaks them, releasing the fluid inside, causing the skin to crust and eventually crack. This cracking is painful as well as unsightly and often takes weeks, or even months to heal. The skin is dry and scaly during this period.

*Fluid from the blisters is serum that accumulates between the irritated skin cells. It is not sweat as was previously thought.

*In some cases, as the blistering takes place in the palms or finger. Lymph node swelling may accompany the outbreak. This is characterised by tingling feeling in the forearm and bumps present in the arm pits.

*Nails on affected fingers, or toes, may take on a pitted appearance.

Causes:
Causes of dyshidrosis are unknown. However, a number of triggers to the condition exist:

*Dyshidrosis has been historically linked to excessive sweating during periods of anxiety, stress, and frustration, however, many cases present that have no history of excessive sweating, and the hypothesis of dyshidrosis as a sweating disorder is largely rejected. Some patients reject this link to stress, though as a trigger of vesicular eruption it cannot be overlooked, as with other types of eczema.

*Vesicular eruption of the hands may also be caused by a local infection, with fungal infections being the most common. Sunlight is thought to bring on attacks, some patients link outbreaks to prolonged exposure to strong sunlight from late spring through to early autumn. Others have also noted outbreaks occurring in conjunction with exposure to chlorinated pool water or highly treated city tap waters.

*Soaps, detergents, fragrances and contact with fruit juices or fresh meat also can trigger outbreaks of dyshidrosis, as with other types of eczema.

*Systemic nickel allergies may be related such as foods high nickel content – cocoa, chocolate, whole grains, & nuts.

*Keeping skin damp will trigger or worsen an outbreak. For this reason, people with dyshidrosis should wear gloves, socks, and shoes made of materials which “breathe well”, such as cotton or silk. Certain fabrics may greatly irritate the condition, including wool, nylon and many synthetic fabrics.

*Inherited, not contagious. Often, patients will present with other types of dermatitis, such as seborrheic dermatitis or atopic eczema. For this reason, among others, dyshidrosis is often dismissed as atopic eczema or contact dermatitis.

*Can be the secondary effect of problems in the gut. Some sufferers claim diet can ease symptoms (relieving internal condition of IBS or intestinal yeast infection). Also Inflammatory bowel diseases of Ulcerative colitis and Crohn’s disease.

*Bandages, plasters or other types of skin-tapes may be irritating to dyshidrosis and should be avoided. As the skin needs to breathe, anything that encourages maceration of the palms should be avoided. If the ‘wounds’ are raw enough to warrant covering, pure cotton gloves or gauze should be used. Liquid Band-Aid brand bandage may be tolerated and helpful, refer to the Treatment section, below.

*Latex and vinyl gloves may increase irritation.

*Multiple Chemical Sensitivity

*Allergic reaction to Potassium Dichromate (leather preservative)

*Dyshidrosis can sometimes even be caused by dust mite allergies, with sufferers having to wash and change bedding weekly, sometimes even every 2 days or even every day, to combat symptoms.

*Balsam of Peru is a common irritant among sufferers of hand eczema, more commonly, people with dyshidrotic eczema.

Treatment:
There are many treatments available for dyshidrosis, however, few of them have been developed or tested specifically on the condition.

*Topical steroids – while useful, can be dangerous long-term due to the skin-thinning side-effects, which are particularly troublesome in the context of hand dyshidrosis, due to the amount of toxins and bacteria the hands typically come in contact with.

*Nutritional deficiencies may be related, so addressing diet and vitamin intake is helpful

*Hydrogen Peroxide – posited as a key alleviating treatment (not a cure) on a popular website, it is used in dilutions between 3% and 27% strength, but side-effects of its use include burning and itching, and there is argument as to whether it only attacks the ‘sick cells’.

*Potassium permanganate dilute solution soaks – also popular, and used to ‘dry out’ the vesicles, but can also be very painful and cause significant burning.

*Domeboro (OTC) helps alleviate itching in the short term.

*Emollients during the drying/scaling phase of the condition, to prevent cracking and itching. While petroleum jelly may work well as a barrier cream, it does not absorb into the skin and or allow it to breathe, so may actually be less helpful.

*Salt soaks

*White vinegar soaks

*Avoidance of known triggers – dyshidrosis sufferers may need to abstain from washing their own hair or bodies, or wearing gloves when they do so, however waterproof gloves are often potential irritants.

*Zinc oxide ointment

*Nickel-free diets

*When in the scaling phase of the condition, the scales may cause deep cracks and fissures in the skin. Filing (as with an emery board) may help to minimize this.

*Stress management counseling

*Light treatment: UVA-1, PUVA, Grenz rays, Low Level Light Therapy using a Red + NIR (LED) combination

*Ciclosporin a strong immunosuppressant drug used to combat dyshidrosis caused by ulcerative colitis

*Efalizumab (Raptiva) a medication used to treat psoriasis

*Tacrolimus and Pimecrolimus, potent immunomodulators often used to prevent organ rejection in topical, ointment form, may be used in severe cases.

*Unbleached cotton gloves may be used to cover the hands to prevent scratching and vulnerability of the skin to bacteria

*Plantain (Plantago major) infused in olive or other oil can be soothing.

*Band-Aid brand liquid bandage regularly applied during the (often painful) peeling stage allows the skin to breathe while protecting it from further irritation. Some suffers have found that with regular application the skin will close and reform within 1 to 2 days. Protection is sufficient that the user can (gently) wash their hands with no irritation, however additional application after each hand wash is suggested. It does not cure the condition and only aids healing during the peeling stage. Other spray-on or brush-on liquid bandaids can contain irritating ingredients and have not been found to be helpful, some will aggravate the condition significantly.

*Avoid metal computer keyboards and track pads which contain nickel.

Many sufferers of dyshidrosis will find that treatments that were previously suitable for them no longer work or have induced sensitive reactions, which is common in most types of eczema.

*It may be prudent to wear light cotton gloves while reading newspapers, books and magazines. The inks and paper may irritate the condition.
*Avoid Purell and other hand sanitizing products which contain alcohol. These may aggravate the condition.

*Wash affected hands and feet with cool water and apply a moisturizer as soon as possible.

*On the other hand, hot water usually kills the itch.

*Avoid moisturizers that contain water (cremes and lotions). Stick with ointments.

*Valium in small doses during flare ups
Click to learn more about Dyshidrosis and it’s proper treatment

ABC Homeopathy Forum for Dyshidrosis

Allergy testing:
Allergy testing is a contested subject among eczema communities. Some dermatologists posit that if a sufferer is allergic to a substance, then a general allergy test on the forearm will suffice, yet others believe that in conditions like dyshidrosis, the suspect substances need to be applied to the affected area to induce a reaction. -Often seen in people who are already suseptible to allergies and/or asthma.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Resources:
http://en.wikipedia.org/wiki/Dyshidrosis
http://www.geocities.com/vyera/dyshidrosis/main.html

Bakuchi

Botanical Name: Psoralea corylifolia
Family:
Fabaceae
Genus:
Psoralea
Species:
P.corylifolia
Kingdom:
Plantae
Order:
Fabales

syn. Cyamopsis psoralioides

Common name:
Babchi Seeds, Bavachi, Bavanchalu, Bavanchi Bavchi, Bhavanchi-vittulu, Bawachi, Bhavaj, Bobawachi, Bogi-vittulu, Hakuchi, Kantaka, Karpokarishi, Karu-bogi, Krishnaphala, Latakasturi, Somaraji, Sugandha kantak, Vabkuchi, Vakuchi,Babchi

Habitat: Bakuchi grows throughout the plains of central and east India. The black variety is commonly used  now a days.

Description:
Bakuchi is an evergreen small plant. It grows from 4 and 9 metres. They may live to one hundred years of age. The plant is variable in habit, usually upright to sprawling, and may intertwine with other species. The plant parasitises the roots of other tree species, with a haustorium adaptation on its own roots, but without major detriment to its hosts. An individual will form a non-obligate relationship with a number of other plants. Up to 300 species (including its own) can host the tree’s development – supplying macronutrients phosphorus, nitrogen and potassium, and shade – especially during early phases of development…Click & see

It may propagate itself through wood suckering during its early development, establishing small stands. The reddish or brown bark can be almost black and is smooth in young trees, becoming cracked with a red reveal. The heartwood is pale green to white as the common name indicates. The leaves are thin, opposite and ovate to lanceolate in shape. Glabrous surface is shiny and bright green, with a glaucous pale reverse. Fruit is produced after three years, viable seeds after five. These seeds are distributed by birds.
Cultivation :
The psoralea herb grows and thrives well in any average garden top soil. The plant however, prefers a well-drained soil and enough of sunlight. The psoralea plants are very sensitive in the sense that they cannot endure any disturbance of the root and hence it is advisable while the plants are still small they should be planted outdoors in their stable place. The psoralea enjoys a symbiotic or ‘give-and-take’ rapport with specific bacteria in the soil. These bacteria form lumps on the psoralea roots and attach the much need nitrogen for the plant from the atmosphere on the roots. The amount of nitrogen deposits in the nodules formed by the bacteria are so abundant that while the psoralea plants can utilize some of it, the remaining nitrogen can be used by plants growing in the vicinity.

Propagation:
The psoralea plant is propagated through seeds. The best season to grow the plant is from early to middle of spring. For effective propagation of this variety of climbing beans, soak the seeds in warm water for approximately 24 hours and then sow them early in a greenhouse. It is always better to sow the seeds in separate pots or containers as this will not require any relocation of the plant. Alternatively, the seeds may be sowed in one large pot and the seedlings removed as early as possible, as the psoralea plant cannot tolerate any root disturbance. Continue to grow them in the pots till they are suitable for planting in their permanent place in the outdoors. It may be remembered that it is virtually not possible to transplant this variety of the beans species without afflicting some damage to their roots. The psoralea plant requires a division during the spring. Utmost care should be adopted while undertaking the division process as the plant is averse to any kind of annoyance to its roots. Again, it must be mentioned here that it is almost unfeasible to do the division of the plant with 100 per cent success as there is bound to be some damage to the roots.

click to see

click to see

Medicinal Uses:

Parts Used: Seeds
P. corylifolia contains a number of chemical compounds including flavonoids (neobavaisoflavone, isobavachalcone, bavachalcone, bavachinin, bavachin, corylin, corylifol, corylifolin and 6-prenylnaringenin), coumarins (psoralidin, psoralen, isopsoralen and angelicin) and meroterpenes (bakuchiol and 3-hydroxybakuchiol).

Very high concentrations genistein have been found in the leaves of Psoralea corylifolia.
The chief active principle of the seeds is an essential oil; and a fixed oil, a resin, and traces of a substance of alkaloidal nature.

P. corylifolia L., or Bu Gu Zhi in traditional Chinese medicine (TCM) is an herb used to tonify the kidneys, particularly kidney yang and essence. It is used for helping the healing of bone fractures, for lower back and knee pain, impotence, bed wetting, hair loss, and vitiligo.

 

Remedies For:
Aromatic, anthelmintic, antibacterial, antifungal, diuretic, diaphoretic, laxative, stimulant, aphrodisiac

Action & Uses in Ayurveda & Siddha:
Mathura tikta rasam, katu-vipakam, seetha veeryam, kapha-haram, rasayanam, ruksham, hrithyam, in meham, kushtam, jwaram, krimi, rakta-pittam.

Action & Uses in Unani:
Skin conditions, particularly leucoderma, anti-souda, balghami, fevers, anthelmintic, sedative for internal ulcers.

Dosage:
Five grams powder twice daily before meals with some coriander and honey (to taste); as an external paste.

Properties and Uses: Very powerful herb for variety of problems, such as: skin discoloration, veiling, baldness, conditions involving bilious affections, leprosy, leucoderma, antifungal and antiprotozoal, antitumor, enuresis, impotence, and frequent urination, improves hair and nails condition; tones liver, spleen, and pancreas;
it helps to overcome impotency,
frequent or involuntary urine. Have been used in India, China and Tibet both externally and internally.

A Top Herb for Leprosy, Skin Conditions

This herb has been considered by Ayurveda doctors to be so effective in the treatment of leprosy that it was given the name of ‘Kushtanashini’ (leprosy destroyers).

The powder from the seed is used to treat leprosy and leucoderma internally. It is also applied in the form of paste or ointment externally.

The unsaponified oil has been used with success in case of leucoderma and psoriasis.

It was shown to improve the color of skin (including removing white spots), hair, and nails. For instance, t

An ointment made by combining one part of an alcoholic extract of the seeds with two parts of chaulmugra oil and two parts of lanoline has been found to be effective in treating leucoderma, white leprosy, psoriasis, and other inflammatory skin diseases and febrile conditions. The oil can be used both internally or as a simple ointment externally. Gently rub the oil once or twice daily. The proportion of the active ingredients may be increased if needed.

The herb is also prescribed for
Seeds are also used to make a perfumed oil. They are also used for scorpion sting, and snake-bite.

Safety Precautions: May increase Pitta when taken alone; do not take with low body fluids; do not use with licorice root.

The essential oil varies enormously in its effects on different persons. With the majority (95 per cent) of people, it causes only redness of the leucodermal patches. But in a small number (5 per cent) there is extreme sensitiveness to the oil. It may even cause blistering of the skin. The strength of the oil should therefore be varied in such a way as not to allow its action to go beyond the state of redness of the leucodermic patches.

Disclaimer : The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplement, it is always advisable to consult with your own health care provider.

Source:Hollastic online.com and weight-care.com

http://www.allayurveda.com/bakuchi-herb.asp

http://en.wikipedia.org/wiki/Psoralea_corylifolia

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