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Ailmemts & Remedies

Pityriasis rosea

Definition:
Some people say Pityriasis rosea (also known as “Pityriasis rosea Gibert“) is a skin rash. It is non-dangerous but may inflict substantial discomfort on some sufferers.  Classically, it begins with a single “herald patch” lesion, followed in 1 or 2 weeks by a generalized body rash lasting about 6 weeks

Pityriasis rosea is common type of skin rash seen between the ages of ten and 35. It is a skin rash that often sweeps out from the middle of your body, with a shape that resembles drooping pine-tree branches. Pityriasis (pit-ih-RI-uh-sis) rosea usually begins as one large spot on your chest, abdomen or back and then spreads.

The cause isn’t known, but a viral infection is suspected (though it doesn’t seem to be contagious).The overall prevalence of  Pityriasis rosea in the United States has been estimated to be 0.13% in men and 0.14% in women.
You may click to see Pictures of Pityriasis rosea
Symptoms:
The symptoms of Pityriasis rosea include:

*An upper respiratory tract infection may precede all other symptoms in as many as 69% of patients

*A single, 2- to 10-cm oval red “herald” patch appears, classically on the abdomen.  Occasionally, the”herald” patch may occur in a ‘hidden’ position (in the armpit, for example) and not be noticed immediately. The “herald” patch may also appear as a cluster of smaller oval spots, and be mistaken for acne. Rarely, it does not become present at all.

*7-14 days after the herald patch, large patches of pink or red, flaky, oval-shaped rash appear on the torso. In 6% of cases an inverse distribution may occur, with rash mostly on the extremities. The more numerous oval patches generally spread widely across the chest first, following the rib-line in a characteristic “christmas-tree” distribution.  Small, circular patches may appear on the back and neck several days later. It is unusual for lesions to form on the face, but they may appear on the cheeks or at the hairline.

*About one-in-four people with PR suffer from mild to severe symptomatic itching. (Moderate itching due to skin over-dryness is much more common, especially if soap is used to cleanse the affected areas.) The itching is often non-specific, and worsens if scratched. This tends to fade as the rash develops and does not usually last through the entire course of the disease.

*The rash may be accompanied by low-grade fever, headache, nausea and fatigue. Over-the-counter medications can help manage these

Causes:
The cause of pityriasis rosea is not certain, but its clinical presentation and immunologic reactions suggest a viral infection as a cause.  Also, HHV-7 is frequently found in healthy individuals, so its etiologic role is controversial.

It is not contagious,  though there have been reports of small epidemics in fraternity houses and military bases, schools and gyms.

Complications:
Complications of pityriasis rosea aren’t likely, but if they do occur, they may include:

*Severe itching
*Lasting brown spots after the rash has healed, on dark skin

Diagnosis:
Identification of pityriasis rosea can be challenging for a number of reasons. The diagnosis is unclear at the onset of symptoms, and there are no noninvasive tests that confirm the condition. In at least one half of patients, the first symptoms of pityriasis rosea are nonspecific and consistent with a viral upper respiratory infection.1,5 A herald patch then appears, typically on the trunk. This large lesion is commonly 2 to 10 cm in diameter, ovoid, erythematous, and slightly raised, with a typical collarette of scale at the margin.....PIC-1 . At this stage, however, the diagnosis usually remains unclear. Microscopic examination of potassium hydroxide preparations shows no fungal elements. The lesion cannot be differentiated from eczema and often is treated as such.

A few days to a few weeks after the appear ance of the herald patch, crops of smaller lesions, 5 to 10 mm in diameter, develop across the trunk and, less commonly, on the extremities. These lesions are salmon colored, ovoid, raised, and have the same collarette of scale as the herald patch.…PIC-2... . At this stage, the diagnosis usually is clear, particularly if the physician can observe or elicit a history of the herald patch.
If the diagnosis is uncertain, especially if the palms and soles are affected and the patient is sexually active, the physician should consider the possibility of secondary syphilis. Appropriate evaluation includes direct fluorescent antibody testing of lesion exudates, a VDRL test, or dark-field microscopy.11 Other conditions in the differential diagnosis include diffuse nummular eczema, tinea corporis, pityriasis lichenoides, guttate psoriasis, viral exanthem, lichen planus, and medication reaction.

The smaller secondary lesions of pityriasis rosea follow Langer’s lines ..PIC-3.. When the lesions occur on the back, they align in a typical “Christmas tree” or “fir tree” pattern. Elsewhere on the body, the lesions follow the cleavage lines as follows: transversely across the lower abdomen and back, circumferentially around the shoulders, and in a V-shaped pattern on the upper chest12...PIC-4. Pruritus is variable. Except for mild to severe itching in 25 percent of patients, no systemic symptoms typically are present during the rash phase of pityriasis rosea.

Biopsy usually is not indicated in the evaluation of patients with suspected pityriasis rosea. Histology has shown that in addition to non-specific subacute and chronic inflammation, 55 percent of specimens contain epidermal cells that display dyskeratotic degeneration.14

Worsening of the rash or a second wave of lesions is not uncommon before eventual spontaneous resolution of the eruption. Recurrence of the condition later in life is rare.

Although no causal link has been established, multiple drugs have been associated with an extensive and often prolonged form of pityriasis rosea . A review of the literature shows that single case reports account for most of the drug associations.

Treatment:
No treatment is usually required.

Oral antihistamines or topical steroids may be used to decrease itching.[5] Steroids do provide relief from itching, and improve the appearance of the rash, but they also cause the new skin that forms (after the rash subsides) to take longer to match the surrounding skin color. While no scarring has been found to be associated with the rash, itching and scratching should be avoided. Irritants such as soap should be avoided, too; a soap containing moisturizers (such as goat’s milk) may be used, however, any generic moisturizer can help to manage over-dryness.

Direct sunlight makes the lesions resolve more quickly. According to this principle, medical treatment with ultraviolet light has been used to hasten resolution, though studies disagree whether it decreases itching or not. UV therapy is most beneficial in the first week of the eruption

Prognosis:
In most patients, the condition lasts only a matter of weeks; in some cases it can last longer (up to six months). The disease resolves completely without long-term effects. Two percent of patients have recurrence.

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.bbc.co.uk/health/physical_health/conditions/pityriasisrosea.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/000871.htm
http://www.mayoclinic.com/health/pityriasis-rosea/DS00720
http://www.aafp.org/afp/2004/0101/p87.html
http://en.wikipedia.org/wiki/Pityriasis_rosea

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Ailmemts & Remedies

Hidradenitis Suppurativa

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Definition:
Hidradenitis suppurativa or HS is a skin disease that affects areas bearing apocrine sweat glands and hair follicles; such as the underarms, groin and buttocks. It is more commonly found in women and can be present under the breasts.

Hidradenitis suppurativa is a chronic skin inflammation marked by the presence of blackheads and one or more red, tender bumps (lesions). The lesions often enlarge, break open and drain pus. Scarring may result after several occurrences.

The cause of hidradenitis suppurativa isn’t known. But it’s considered a severe form of acne (acne inversa) because it occurs deep in the skin around oil (sebaceous) glands and hair follicles. The parts of the body affected — the groin and armpits, for example — are also the main locations of apocrine sweat glands.

Click to see pictures…>..(1)….…(2).……..(3).……...(4).…….(5)……..(6)……….…(7)

Hidradenitis suppurativa tends to start after puberty, persist for years and worsen over time. There is no cure for hidradenitis suppurativa. But early diagnosis and treatment can help manage the symptoms and prevent new lesions from developing.

Other names for HS
Hidradenitis suppurativa has been referred to by multiple names in the literature, as well as in various cultures. Some of these are also used to describe different diseases, or specific instances of this disease.

*Acne conglobata – not really a synonym – this is a similar process but in classic acne areas of chest and back

*Acne Inversa (AI) – a new term which has not found favour.

*Apocrine Acne – a misnomer, out-dated, based on the disproven concept that apocrine glands are primarily involved

*Apocrinitis – another misnomer, out-dated, based on the disproven concept that apocrine glands are primarily involved

*Fox-den disease – a catchy term not used in medical literature, based on the deep fox den / burrow – like sinuses

*Hidradenitis Supportiva – a misspelling

*Pyodermia sinifica fistulans – an older term, considered archaic now, misspelled here

*Velpeau’s disease – commemorating the French surgeon who first described the disease in 1833

*Verneuil’s disease – recognizing the French surgeon whose name is most often associated with the disorder as a result of his 1854-1865 studies

Stages
HS presents itself in three stages.

1.Solitary or multiple isolated abscess formation without scarring or sinus tracts. (A few minor sites with rare inflammation; may be mistaken for acne.)

2.Recurrent abscesses, single or multiple widely separated lesions, with sinus tract formation. (Frequent inflammations restrict movement and may require minor surgery such as incision and drainage.)

3.Diffuse or broad involvement across a regional area with multiple interconnected sinus tracts and abscesses. (Inflammation of sites to the size of golf balls, or sometimes baseballs; scarring develops, including subcutaneous tracts of infection – see fistula. Obviously, patients at this stage may be unable to function.)
Sign and Symptoms:

Hidradenitis suppurativa commonly occurs around hair follicles where many oil and sweat glands are found, such as the armpits, groin and anal area. It may also occur in areas where skin rubs together, such as the inner thighs, under the breasts or between the buttocks. Hidradenitis suppurativa can affect a single area or multiple areas of the body.

Click to  SEE THE PICTURES
Hidradenitis suppurativa usually appears as one or more red, tender bumps that fill with pus. It commonly occurs where oil (sebaceous) and apocrine sweat glands are found, such as the armpits, groin and anal area.

 

Signs and symptoms of hidradenitis suppurativa include:

*Small pitted areas of skin containing blackheads, often appearing in pairs or a “double-barrel” pattern.

*One or more red, tender bumps (lesions) that fill with pus. The bumps often enlarge, break open and drain pus. The drainage may have an unpleasant odor. Itching, burning and excessive sweating may accompany the bumps.

*Painful, pea-sized lumps that grow under the skin. These hard lumps, which may persist for years, can enlarge and become inflamed.

*Painful bumps or sores that continually leak fluid. These open wounds heal very slowly, if at all, often leading to scarring and the development of tunnels under the skin.

For some people, the disease progressively worsens and affects multiple areas of their body. Other people experience only mild symptoms. Excess weight, stress, hormonal changes, heat or excessive perspiration can worsen symptoms.

Causes:
Hidradenitis suppurativa develops when the oil glands and hair follicle openings become blocked. When oils and other skin products become trapped, they push into surrounding tissue. Bacteria can then trigger infection and inflammation. It’s not known why this occurs, but a number of factors — including hormones, genetics, cigarette smoking and excess weight — may all play a role.

Sometimes hidradenitis suppurativa occurs with other diseases, such as Crohn’s disease, herpes simplex or Grave’s disease.

As this disease is poorly studied, the causes are controversial and experts disagree. However, potential indicators include:

*post-pubescent

*females are more likely than males

*genetic predisposition

*plugged apocrine (sweat) gland or hair follicle

*excessive sweating

*bacterial infection

*sometimes linked with other auto-immune conditions

*androgen dysfunction

*genetic disorders that alter cell structure

*stress can bring on outbreaks

*being overweight makes it worse, however this condition is not caused by obesity and weight loss will improve but not cure it.

*cigarette smoking tends to encourage outbreaks as well

The historical understanding of the disease is that there is a misfunction in either the apocrine glands or hair follicles, possibly triggered by a blocked gland, creating inflammation, pain, and a swollen lesion. More recent studies imply there is an autoimmune component.

HS is not caused by any bacterial infection — any infection is secondary. Most cultures done on HS lesions come back negative for bacteria, so antibiotics should be used only when a bacterial infection has been confirmed by a physician.

Hidradenitis suppurativa is not contagious.

Screening and Diagnosis:
To make a diagnosis, your doctor may ask about your symptoms and medical history, examine your skin, and order blood tests. If pus or drainage is present, your doctor may send a sample of the fluid to a laboratory for testing. This test is known as a culture. Such tests may be necessary to rule out other skin conditions, such as tuberculosis of the skin, a carbuncle or a pilonidal cyst.
General Complications:
Hidradenitis suppurativa often causes complications when the disease is persistent and severe. These complications include:

*Sinus tracts or tunnels that connect and form a network under the skin. The tracts prevent the sores from healing and cause more sores to develop.

*Scars and skin changes. Severe hidradenitis suppurativa may leave thick, raised scars, pitted skin or patches of skin that are darker than normal (hyperpigmentation).

*Restricted movement. The disease may cause limited or painful movement, especially when it affects the armpits or thighs.

*Cellulitis. This potentially serious bacterial infection appears as an area of swollen, red skin that feels hot and tender and that may spread rapidly. Although the initial infection may be superficial, it eventually can affect the tissues underlying your skin or spread to your lymph nodes and bloodstream.

Severe complications:
Left undiscovered, undiagnosed, or untreated, the fistulas from severe stage-3 HS can lead to the development of squamous cell carcinoma in the anus or other affected areas.

Treatments:

There is no cure for hidradenitis suppurativa. But early treatment can help manage the symptoms and prevent new lesions from developing.
Treatments may vary depending upon presentation and severity of the disease. Due to the poorly-studied nature of this disease, the effectiveness of the drugs and therapies listed below is not yet clear, and patients should discuss all options with their doctor or dermatologist. Nearly a quarter of patients state that nothing relieves their symptoms. A list of treatments that are possible treatments for some patients is as follows.

*lifestyle

*changes in diet.

*warm compresses, baths (to induce drainage)
medication
*ntralesional corticosteroid injections (to reduce inflammation)

*oral antibiotics (to treat inflammation and bacterial infection)

*isotretinoin (Accutane), a prescription-only oral acne treatment (benefits for HS are very controversial, but it is generally considered to be ineffective)

*anti-androgen therapy

*sub-cutaneous injection or IV infusion of anti-inflammatory (anti-TNF-alpha) drugs such as infliximab (Remicade), etanercept (Enbrel), and adalimumab. This use of the drugs is not currently Food and Drug Administration (FDA) approved and is

*somewhat controversial, and therefore may not be covered by insurance.
Acitretin

*Zinc gluconate taken orally has been shown to induce remission
surgery (But Obesity, incomplete removal and ongoing skin infections can increase the chances that hidradenitis suppurativa returns, even after surgical treatment.)

*incision and drainage or lancing

*wide local excision (with or without skin grafting), or laser surgery

*radiotherapy

Self-care:
The following suggestions may help relieve discomfort, speed healing and prevent the infection from spreading:

*Apply a warm washcloth or compress to help reduce swelling.

*Gently wash the affected areas with antibacterial soap. After washing, apply an over-the-counter antibiotic.

*Wear loosefitting clothes and underwear to prevent skin irritation.

*Avoid shaving the affected areas to prevent skin irritation.

*Don’t smoke. Smoking can worsen symptoms and trigger new outbreaks.

Excess weight increases the number of areas where skin rubs together — for example, between skin folds — causing friction, increased perspiration and bacterial growth. Though weight loss won’t cure the disease, it may improve symptoms.

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/Hidradenitis_suppurativa
http://www.mayoclinic.com/health/hidradenitis-suppurativa/DS00818/DSECTION

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