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Henoch-Schonlein purpura

Definition:
There are many health problems that arise from the fact that the body’s immune system can turn on itself itself and attack its own tissues. These are called autoimmune reactions, and they can happen without warning. Henoch-Schonlein purpura (HSP) is one such reaction.

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In HSP, the immune system is triggered to produce a type of antibody known as IgA which targets and attacks the blood vessels. This causes the blood vessels to become inflamed, a condition called vasculitis.

Although Henoch-Schonlein purpura can affect anyone, it’s most common in children and young adults. Henoch-Schonlein purpura usually improves on its own, but if the kidneys are affected, medical care is generally needed, as well as long-term follow-up to prevent more-serious problems.

Symptoms:
HSP often affects various parts of the body. Most patients are mildly unwell, with a low grade fever. A triad of more specific symptoms usually occurs:

•a characteristic symmetrical skin rash on the lower extremities
•abdominal pain or kidney problems
•arthritis
The characteristic rash of HSP appears as purple spots on the skin, known as purpura which may rapidly merge together to look like bruises. These are usually found over the lower extremities – in particular, the buttocks and lower legs. However, the rash can also appear on the face, trunk and upper extremities – especially the outer side of the arms. It tends to be more prominent in areas where pressure on the skin occurs, from socks or waistbands for example.

When the joints are affected, they may become red, swollen and tender. This is most common in the ankles and knees, but the feet, hands and elbows may also be involved. Fortunately, this is only temporary and permanent deformity doesn’t occur.

Cramping abdominal pain, sometimes with diarrhoea and vomiting, and the passing of blood raises the alarm that the gut has become involved. In up to three percent of cases the bowel may become blocked by a condition called intussusception. Traces of blood or protein found in the urine indicates the kidneys are inflamed (called glomerulonephritis) – this affects up to 50 per cent of older children.

Causes:
In Henoch-Schonlein purpura, some of the body’s small blood vessels become inflamed, which can cause bleeding in the skin, joints, abdomen and kidneys. Why this initial inflammation develops isn’t clear, although it may be the result of an overzealous immune system responding inappropriately to certain triggers.The exact cause for this disorder is unknown.

Some of these triggers may include:

*Viral and bacterial infections, such as strep throat and parvovirus infection — nearly half the children with Henoch-Schonlein purpura develop the disease after an upper respiratory infection

*Certain medicines, including some types of antibiotics and antihistamines

*Insect bites

*Some vaccinations, including those for measles, typhoid, yellow fever and cholera

*Cold weather

*Certain chemicals

* Food allergens.

It’s thought that HSP may be triggered by a viral infection, as up to two-thirds of children will have had a respiratory tract infection (a cough or cold) one to three weeks before HSP appears.

Risk Factors:
*Age. The disease affects primarily children and young adults, with the majority of cases occurring in children between 4 and 6 years of age.

*Sex. Henoch-Schonlein purpura is slightly more common in boys than girls

*Race. White and Asian children are more likely to develop Henoch-Schonlein purpura than black children are.It’s between one and a half and two times more likey to affect boys than girls.

*Illness. Having an upper respiratory infection or other bacterial or viral illness increases a child’s risk.

*Season. Henoch-Schonlein purpura strikes mainly in autumn, winter and spring, and rarely in summer.Every year in the UK about one person in every 5,000 develops HSP

Complications:-
For most people, symptoms of Henoch-Schonlein purpura improve in a few weeks, leaving no lasting problems. Recurrences are fairly common, however. Children who have severe symptoms appear more likely to have a recurrence, but repeat bouts are usually milder than the initial episode.

Kidney damage
The most serious complication of Henoch-Schonlein purpura is kidney damage, which can cause blood in the urine, swelling and high blood pressure. Most children with kidney problems recover fully, but in a very small percentage of cases, Henoch-Schonlein purpura leads to end-stage kidney disease. In that case, dialysis or a kidney transplant may be needed. Adults are at greater risk than children of developing end-stage kidney disease.

The long-term outcome for people with Henoch-Schonlein purpura appears to depend on whether they develop kidney problems and how severe those problems are.

Bowel obstruction
In rare cases, Henoch-Schonlein purpura can cause a kind of bowel obstruction (intussusception) that reduces blood flow to the intestinal tract and leads to inflammation of other organs, including the pancreas.

Future pregnancies
Women who’ve had Henoch-Schonlein purpura during childhood may be at increased risk of high blood pressure during pregnancy. If you’re pregnant and have a history of Henoch-Schonlein purpura, be sure to tell your doctor about it so that you can be monitored appropriately.

Diagnosis:
The diagnosis is based on the combination of the symptoms, as very few other diseases cause the same symptoms together. Blood tests may show elevated creatinine and urea levels (in kidney involvement), raised IgA levels (in about 50%), and raised CRP or erythrocyte sedimentation rate (ESR) results; none are specific for Henoch–Schönlein purpura. The platelet count may be raised, and distinguishes it from diseases where low platelets are the cause of the purpura, such as idiopathic thrombocytopenic purpura and thrombotic thrombocytopenic purpura.

If there is doubt about the cause of the skin lesions, a biopsy of the skin may be performed to distinguish the purpura from other diseases that cause it, such as vasculitis due to cryoglobulinemia; on microscopy the appearances are of a hypersensitivity vasculitis, and immunofluorescence demonstrates IgA and C3 (a protein of the complement system) in the blood vessel wall.[2] However, overall serum complement levels are normal.

On the basis of symptoms, it is possible to distinguish HSP from hypersensitivity vasculitis (HV). In a series comparing 85 HSP patients with 93 HV patients, five symptoms were found to be indicative of HSP: palpable purpura, abdominal angina, digestive tract hemorrhage (not due to intussussception), hematuria and age less than 20. The presence of three or more of these indicators has an 87% sensitivity for predicting HSP.

Biopsy of the kidney may be performed both to establish the diagnosis or to assess the severity of already suspected kidney disease. The main findings on kidney biopsy are increased cells and Ig deposition in the mesangium (part of the glomerulus, where blood is filtered), white blood cells, and the development of crescents. The changes are indistinguishable from those observed in IgA nephropathy.

Microphotograph of a histological section of human skin prepared for direct immunofluorescence using an anti-IgA antibody, the skin is a biopsy of a patient with Henoch-Schönlein purpura. IgA deposits are found in the walls of small superficial capillaries (yellow arrows). The pale wavy green area on top is the epidermis, the bottom fibrous area is the dermis.HSP can develop after infections with streptococci (?-haemolytic, Lancefield group A), hepatitis B, herpes simplex virus, parvovirus B19, Coxsackievirus, adenovirus, Helicobacter pylori,[5] measles, mumps, rubella, Mycoplasma and numerous others.  Drugs linked to HSP, usually as an idiosyncratic reaction, include the antibiotics vancomycin and cefuroxime, ACE inhibitors enalapril and captopril, anti-inflammatory agent diclofenac, as well as ranitidine and streptokinase. Several diseases have been reported to be associated with HSP, often without a causative link. Only in about 35% of cases can HSP be traced to any of these causes.

The exact cause of HSP is unknown, but most of its features are due to the deposition of abnormal antibodies in the wall of blood vessels, leading to vasculitis. These antibodies are of the subclass IgA1 in polymers; it is uncertain whether the main cause is overproduction (in the digestive tract or the bone marrow) or decreased removal of abnormal IgA from the circulation. It is suspected that abnormalities in the IgA1 molecule may provide an explanation for its abnormal behaviour in both HSP and the related condition IgA nephropathy. One of the characteristics of IgA1 (and IgD) is the presence of an 18 amino acid-long “hinge region” between complement-fixating regions 1 and 2. Of the amino acids, half is proline, while the others are mainly serine and threonine. The majority of the serines and the threonines have elaborate sugar chains, connected through oxygen atoms (O-glycosylation). This process is thought to stabilise the IgA molecule and make it less prone to proteolysis. The first sugar is always N-acetyl-galactosamine (GalNAc), followed by other galactoses and sialic acid. In HSP and IgAN, these sugar chains appear to be deficient. The exact reason for these abnormalities is not known

Treatment:
The condition usually settles down within six weeks, although it can go on for several months. It can recur, sometimes more than once, in as many as one in three people. There is no treatment which has been shown to shorten the duration of the disease or reduce the risk of complications, so no specific treatment is required. However, treatment can be used to relieve the symptoms. Paracetamol or non-steroidal anti-inflammatory medication (such as ibuprofen) may be prescribed to relieve any joint pain. If symptoms persist, corticosteroid therapy may be recommended.

The most serious possible consequence of Henoch-Schonlein purpura is kidney damage. Up to five percent of cases develop progressive kidney disease and ultimately kidney failure (this is more likely in older children and adults). For this reason, regular urine tests to monitor kidney function are important, even once someone has recovered from the acute illness.

Prognosis:
Overall prognosis is good in most patients, with one study showing recovery occurring in 94% and 89% of children and adults, respectively (some having needed treatment).

In children under ten, the condition recurs in about a third of all cases and usually within the first four months after the initial attack.Recurrence is more common in older children and adults.

In general, however, the majority of people who develop HSP make a full recovery without any further problems.

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/henoch-schonlein-purpura/DS00838
http://en.wikipedia.org/wiki/Henoch%E2%80%93Sch%C3%B6nlein_purpura
http://www.bbc.co.uk/health/physical_health/conditions/henochschonleinpurpura1.shtml

http://www.nlm.nih.gov/medlineplus/ency/imagepages/19831.htm

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Erythema infectiosum

Alternative Names : Fifth disease,slapped cheek syndrome, slapcheek, slap face or slapped face.

Definition:
Erythema infectiosum  is a peculiar disorder of the skin.  The condition commonly affects children and young adults.  Typically it appears as a red rash on the face that gives a slapped chek appearance.  A few days later a fish net like pattern of redness may appear on the arms and trunk.
.CLICK & SEE THE PICTURES

The incubation period is usually four to 20 days and the virus is spread mainly through droplets in the air. It can also be transmitted through blood transfusions and from mother to unborn child.

It is highly contagious to those who have not had a previous infection. Unfortunately Erythema infectiosum is contagious before the rash appears, not after.  There is no way to prevent exposure.   Because it is such a mild infection no special precautions need to be taken, and children do not need to be kept home from school as they are not contagious once the rash appears.

Any age may be affected although it is most common in children aged five to fifteen years. By the time adulthood is reached about half the population will have become immune following infection at some time in their past. Outbreaks can arise especially in nursery schools, preschools, and elementary schools.

Erythema Infectiosum can also cause serious illness in those with leukemia or cancer, in those who have received an organ transplant, and in those with human immunodeficiency virus (HIV). Fifth disease causes the majority of episodes of transient aplastic crisis (TAC) in persons with chronic hemolytic anemia. Occasionally, serious complications may develop from parvovirus B 19 infection during pregnancy.

Symptoms:
In many cases the early symptoms are so mild they go unnoticed, but they may include a runny nose, headache, mild fever, sore throat and lethargy.

Some children also experience nausea, abdominal pain, diarrhoea and painful joints.

After a few days, a bright red rash may appear on the cheeks, but not on the nose or around the eyes or mouth.

After two to four days the rash, which looks a little like sunburn, usually disappears but another, non-itchy rash may appear on the extremities, including the palms and soles. This fades over a couple of weeks but may recur if the skin is exposed to heat, such as when in the bath, or physical stimuli such as friction.

Teenagers and adults may present with a self-limited arthritis. It manifests in painful swelling of the joints that feels similar to arthritis. Older children and adults with Fifth Disease may have difficulty in walking and in bending joints such as wrists, knees, ankles, fingers, and shoulders.

The disease is usually mild, but in certain risk groups it can have serious consequences:-

*In pregnant women, infection in the first trimester has been linked to hydrops fetalis, causing spontaneous abortion.

*In people with sickle-cell disease or other forms of chronic hemolytic anemia such as hereditary spherocytosis, infection can precipitate an aplastic crisis.

Transmission:
Erythema infectiosum  is transmitted primarily by respiratory secretions (saliva, mucus etc.) but can also be spread by contact with infected blood. The incubation period (the time between the initial infection and the onset of symptoms) is usually between 4 and 21 days. Individuals with fifth disease are most infectious before the onset of symptoms. Typically, school children, day-care workers, teachers and mothers are most likely to be exposed to the virus. When symptoms are evident, there is little risk of transmission; therefore, symptomatic individuals need not be isolated

Causes:
Erythema infectiosum is one of several possible manifestations of infection by erythrovirus previously called parvovirus B19.  The virus is a parvovirus, but not related to the parvovirus that pets may get.  You cannot get this parvovirus from an animal. This is a mild virus, and most people feel well when infected.  A few people may have minor itching, tiredness, a sore throat, or a slight fever. Outbreaks tend to occur in late winter or early spring, in cycles of every four to seven years.

Diagnosis:
The symptoms, especially the typical rash on the face, are a good guide to the diagnosis. Blood tests can be used to confirm it, but are rarely necessary.

Treatment:
It needs no specific treatment, but paracetamol or ibuprofen may be used for fever and discomfort.

It will gradually fade over about one month.  It commonly fades and reappears several times during the month.  Excessive exposure to sun, temperature changes and emotional upsets may stimulate a reappearance.

Most children suffer no long-term effects, but adults, pregnant women and children who are immunocompromised or have anaemia may develop more serious complications and should get medical advice.

Prevention:
*Follow standard precautions. Always wash your hands thoroughly before and after any contact with patients.

*Patients with TAC or chronic B 19 infection should be considered infectious and placed on isolation precautions in private rooms for the duration of their illness or until the infection has cleared. B 19-infected patients may share a room if there are no other contraindications. Persons in close contact with these individuals should wear masks, gowns if soiling is likely, and gloves.

*To avoid the risk of fetal loss and other complications of parvovirus infection, pregnant health care workers should consult their health care professional if there is an outbreak in the workplace.

*Because persons with fifth disease were already contagious before their rash appeared, it is not necessary to exclude them from work, school, or child care centers.

*Instruct patients with chronic hemolytic diseases to be aware of the risk of aplastic crisis if exposed to erythema infectiosum.

*Teach patients that frequent and proper hand washing helps reduce the risk of becoming infected with fifth disease.

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.orlandoskindoc.com/erythema_infectiosum.htm
http://www.bbc.co.uk/health/physical_health/conditions/erythema2.shtml
http://www.health-care-tips.org/diseases/erythema-infectiosum.htm
http://en.wikipedia.org/wiki/Fifth_disease

http://www.aafp.org/afp/20000815/804.html

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Cradle Cap

Alternative Names:  Seborrheic eczema; Cradle cap,infantile or neonatal seborrhoeic dermatitis,
crusta lactea, milk crust, honeycomb disease.

Definition:
Cradle cap  is a yellowish, patchy, greasy, scaly and crusty skin rash that occurs on the scalp of recently born babies. It is usually not itchy, and does not bother the baby. Cradle cap most commonly begins sometime in the first 3 months. Similar symptoms in older children are more likely to be dandruff than cradle cap. The rash is often prominent around the ear, the eyebrows or the eyelids. It may appear in other locations as well, where it is called seborrhoeic dermatitis rather than cradle cap. Some countries use the term pityriasis capitis for cradle cap. It is extremely common, with about half of all babies affected. Most of them have a mild version of the disorder. Severe cradle cap is rare.
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It’s not due to poor hygiene and isn’t contagious or an allergy. Cradle cap tends to run in families, so there may be a genetic predisposition.

Cradle cap usually resolves on its own within a few months. Self-care measures, such as washing your baby’s scalp daily with a mild shampoo, can help loosen and remove the cradle cap scales. If cradle cap persists or seems severe, your doctor may suggest a medicated shampoo, lotion or other treatment.

Symptoms:-
Common signs of cradle cap include:
*Skin lesions
*Plaques over large area
*Greasy, oily areas of skin
*Skin scales — white and flaking, or yellowish, oily, and adherent — “dandruff”
*Itching — may become more itchy if infected
*Mild redness
*Hair loss
*Patchy scaling or thick crusts on the scalp
*Greasy skin covered with flaky white or yellow scales
*Skin flakes or dandruff
*Possibly mild redness

Similar scales may also be present on the ears, eyelids, nose and groin.

Cradle cap is most common in newborns. It isn’t contagious and probably won’t bother your baby. In most cases, the condition isn’t itchy for infants.

Causes:
Cradle cap is not caused by a bacterial infection, allergy, nor from poor hygiene. Doctors are not in agreement as to the causes, but the two most common hypotheses include fungal infection and overactive sebaceous glands.

In many cases, what is commonly called cradle cap is actually a fungal infection. This infection may be related to antibiotics given to the mother just before the infant’s birth, or the infection could be related to antibiotics routinely given to infants during the first week of life. Antibiotics kill both harmful bacteria as well as the helpful bacteria that prevent the growth of yeast, which is why people who are prone to fungal infections will often discover a fungal infection after taking a round of antibiotics. In infants, the fungus is mostly likely to appear on the scalp (cradle cap), diaper area (fungal diaper rash, jock itch), ear (fungal ear infection, or an ear infection that does not respond to antibiotics),or in the mouth (thrush).

Another common cause of cradle cap appears to be a common manifestation of biotin insufficiency. This may be due, in part, to the influence of biotin on fatty acid biosynthesis. Possibly it has to do with overactive sebaceous glands in the skin of newborn babies, due to the mother’s hormones still in the baby’s circulation. The glands release a greasy substance that makes old skin cells attach to the scalp instead of falling off as they dry. There may be a relationship with skin yeasts (Pityrosporum ovale, newly renamed Malassezia furfur). Seborrheic dermatitis is the adult version of cradle cap

SOME SIGNS OF WARNING:-
If the condition thickens, turns red and irritated, starts spreading, appears on other body parts, or if the baby develops thrush (fungal mouth infection), fungal ear infection (an ear infection that does not respond to antibiotics) or a persistent diaper rash, medical intervention is recommended.

Severe cases of cradle cap, especially with cracked or bleeding skin, can provide a place for bacteria to grow. If the cradle cap is caused by a fungal infection which has worsened significantly over days or weeks to allow bacterial growth (impetigo, most commonly), a combination treatment of antibiotics and antifungals may be necessary. Since it is difficult for a layperson to distinguish the difference between sebaceous gland cradle cap, fungal cradle cap, or either of these combined with a bacterial infection, medical advice should be sought if the condition appears to worsen.

Cradle cap is occasionally linked to immune disorders. If the baby is not thriving and has other problems (e.g. diarrhoea), a doctor should be consulted.

Possible Complications:
•Psychological distress, low self esteem, embarrassment
•Secondary bacterial or fungal infections

Treatment:
Treatment other than gentle washing is not necessary in most mild cases (flaking, with or without small patches of yellow crusting), as the problem often resolves itself whether the cause is sebaceous-gland-related or fungal, but since many patients (and/or parents) are concerned about cosmetic issues, the following options are often considered:

-For all ages: Home remedies include the application of various oils, lotions, or petroleum jelly. There is little adequate or controlled research to support or negate the usefulness of most common home remedies at any age, but there is anecdotal evidence to support either position. When cradle cap is related to fungal infection, treatment for other fungal infections can also work. Tinea capitis is one example of a fungal cause. Doctors may prescribe a seven-day daily application of clotrim (commonly prescribed for jock itch or athlete’s foot) or miconazol nitrate (commonly prescribed for vaginal yeast infections).

-For infants: in cases that are related to fungal infection, doctors may recommend once-daily application of clotrim (1%) or miconozal nitrate (2%) for seven to fourteen days.

-Application of  lavender oil may be helpful for fungal infection.

-For toddlers: doctors may recommend a treatment with a mild dandruff shampoo such as Selsun Blue or Neutrogena T-gel, even though the treatment may cause initial additional scalp irritation. A doctor may instead prescribe an antifungal soap such as ketoconazole (2%) shampoo, which can work in a single treatment and shows significantly less irritation than over-the-counter shampoos such as selenium sulfide shampoos, but no adequate and controlled study has been conducted for pediatric use as of 2010.

-For adults: Seborrheic dermatitis (the adult version of cradle cap) usually requires the use of an antifungal shampoo, possibly along with the nightly application of an antifungal cream or an anti-itch cream/gel like Scalpicin. Some doctors also recommend the supplementation of a B-vitamin complex to improve fatty acid metabolism..

Scalp, behind ears, eyebrows:
The common home remedy of applying oil (vegetable, particularly olive oil, or mineral oil) liberally to the scalp and letting it soak in overnight or for lesser periods of time seems to conflict with the fact that Malassezia yeasts thrive in oily environments preferring saturated fats, although anecdotal reports suggest it may be effective. This may be because olive oil is primarily unsaturated fat and does not promote fungal growth. If the cradle cap is not severe, you may try to comb it out gently after bathing. The softened scales can then be brushed away with a soft brush, comb or cloth, but if not done very gently, this can worsen the condition and bring about temporary hair loss. There has been no studies done on these recommendations. Applying petroleum jelly (e.g., Vaseline) liberally overnight is another popular treatment. The softened scales either fall off during the night, or can be brushed off in the morning. Making a paste from sodium bicarbonate (baking soda) and leaving it on the affected area for 10 minutes can also help lift the scales.
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There is broad disagreement regarding the role of shampoos. Some sources warn against frequent shampooing, others recommend it. Mild baby shampoo is often recommended, while never specifying what “mild” actually means. Baby shampoos often contain detergent surfactants, perfumes, quaternium-15 and other eczemagenic irritants. Again, no studies have been performed on non-prescription shampoos.

Keratolytic (dandruff) shampoos (e.g. with sulfur, selenium, zinc pyrithione, or salicylic acid) are generally not recommended as they sting eyes and may worsen the dermatitis. In stubborn cases some doctors do recommend them while others warn against the use of medicated shampoos in newborns due to systemic absorption. Dandruff shampoos often contain sodium dodecyl sulfate, a noted skin irritant.

Steroid and tar preparations have also been used but have significant drawbacks. Immunomodulators (tacrolimus/Protopic, pimecrolimus/Elidel) have not been approved for babies under two years.

Ketoconazole shampoos and creams are taking first place in medical treatment of moderate to serious cradle cap. Research so far indicates that this anti-fungal medication is not absorbed into the bloodstream. Ketoconazole shampoo is currently made with a number of problematic irritants and allergens.

A Swedish study   found good results from massaging the scalp with small amounts of borage oil twice a day.

Other home remedies recommended in various alternative sources and parent forums are herbal washes (e.g. burdock or chamomile), aloe gel, and tea tree oil (Melaleuca oil) shampoo. Tea tree oil and aloe can be sensitizers; any worsening should be an occasion to discontinue the remedy in question. Both remedies have been tested in medical trials and found useful.

Eyelids:…….click & see
Typical medical advice is to use diluted baby shampoo on a cotton swab to cleanse the eyelid. There is no agreement on the dilution, which ranges from a few drops to a half cup warm water, to a 50/50 mix. No studies have been performed on the efficacy or safety of this treatment. (Please note the problems with baby shampoo noted above.) In adults, a study comparing soap and baby shampoo to commercial eyelid scrubs found that patients strongly preferred not to put soap or shampoo on their eyelids. Baking soda has also been recommended (a teaspoonful in a cup of boiled water) and is well accepted by adults. Boiled warm water wash may help.


Prognosis:
As the baby matures this conditions will be cleared.However, studies have shown that the condition occasionally persists into the toddler years, and less commonly into later childhood. It tends to recur in adolescence and persists into adulthood. In an Australian study, about 15 percent of previously diagnosed children still had eczema 10 years later. Sometimes, cradle cap turns into atopic dermatitis. Rarely, it turns out to be misdiagnosed psoriasis.

Prevention:
Shampooing your baby’s hair every few days can help prevent cradle cap. Stick with a mild baby shampoo unless your baby’s doctor recommends something stronger.

The severity of cardle cap can be lessened by controlling the risk factors and by paying careful attention to skin care.

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/cradlecap2.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/000963.htm
http://www.mayoclinic.com/health/cradle-cap/DS01074
http://en.wikipedia.org/wiki/Cradle_cap
http://www.livestrong.com/article/294548-itchy-scalp-behind-my-ears/
http://www.dermis.net/dermisroot/en/39521/image.htm

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Beard rash

Alternative Name:sycosis barbae,Pseudofolliculitis barbae; Tinea barbae; Barber’s itch

Definition:
Beard rash or Barber’s itch is a staph infection of the hair follicles in the beard area of the face, usually the upper lip. Shaving makes it worse. Tinea barbae is similar to barber’s itch, but the infection is caused by a fungus.It  is a cutaneous condition characterized by a chronic infection of the bearded region.

CLICK TO SEE THE PICTURES

CLICK TO SEE

Lost Beard
Lost Beard (Photo credit: Chris and Kris)

Pseudofolliculitis barbae is a disorder that occurs mainly in black men. If curly beard hairs are cut too short, they may curve back into the skin and cause inflammation.

The bacteria most often responsible for beard rash are those usually found on the skin surface such as streptococci or staphylococci. These bacteria can’t normally penetrate the barrier that the skin forms but if the skin is broken during shaving the bacteria may get through the skin’s defenses and start an infection.

Some factors increase the risk of beard rash, such as using or sharing unclean razors, clippers, combs or scissors. Anything that reduces a person’s overall immunity may also increase the risk.

Symptoms;
Common symptoms include a rash, itching, and pimples or pustules near a hair follicle on the beard area and the area becomes red, itchy, sore, lumpy, and often very painful if small abscesses develop. The pimples may crust over and the skin may be left scarred after the rash heals, unless it’s correctly treated.

Diagnosis:
A diagnosis is primarily based on how the skin looks. Lab tests may show which bacteria or fungus is causing the infection.

Treatment :
Your GP will confirm the diagnosis for you and advise you on the most appropriate type of  antibiotics applied to the skin (mupirocin) or taken by mouth (dicloxacillin), or antifungal medications to control the infection. It’s important to complete the whole course.

It can return after treatment, but there are a few things that usually prevent this from happening. Although you may prefer wet shaving, because it gives a clean feel to the skin, it does remove the top layer of skin, leaving nicks and scratches where bacteria can get in. Electric shaving is probably best for the time being since it’s gentler on the skin. The best time to shave is after a bath or shower, when the skin is moist.

A hot, moist compresses may promote drainage of the affected follicles.

Tea-tree oil gel is a good antiseptic and has antibacterial benefits. Get yourself an aftershave that contains this. Never let other people use your shaving equipment and always keep it clean.

Prognosis:
Folliculitis usually responds well to treatment, but may come back.

Possible Complications:
•Folliculitis may return
•Infection may spread to other body [amazon_link asins=’B01F1NWZEY,B00OOMEV5K’ template=’ProductCarousel’ store=’finmeacur-20′ marketplace=’US’ link_id=’c2b2222e-ee7f-11e6-a8ad-6bfa4358fd3f’]areas

Prevention:
To prevent further damage to the hair follicles and infection:

•Reduce friction from clothing
•Avoid shaving the area if possible (if shaving is necessary, use a clean, new razor blade or an electric razor each time)
•Keep the area clean
•Avoid contaminated clothing and washcloths

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/beardrash.shtml
http://en.wikipedia.org/wiki/Sycosis_barbae
http://www.dermnet.com/Sycosis-Barbae
http://www.nlm.nih.gov/medlineplus/ency/article/000823.htm

http://www.skininfection.com/Resources/ImgLib/Folliculitis.html

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Ailmemts & Remedies Pediatric

Diaper rash

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Other Names:-Nappy rash,Diaper dermatitis
Definition:–
Diaper rash  is a generic term applied to skin rashes in the diaper area that are caused by various skin disorders and/or irritants.

Generic rash or irritant diaper dermatitis (IDD) is characterized by joined patches of erythema and scaling mainly seen on the convex surfaces, with the skin folds spared.

{Diaper dermatitis with secondary bacterial or fungal involvement tends to spread to concave surfaces (i.e. skin folds), as well as convex surfaces, and often exhibits a central red, beefy erythema with satellite pustules around the border (Hockenberry, 2003).}

Diaper rash  is a red, patchy irritation found on baby’s skin in the genital area, the folds of the thighs and the buttocks.Almost every baby will get diaper rash at least once during the first 3 years of life, with the majority of these babies 9-12 months old. .

Diaper rash appears on the skin under a diaper. Diaper rash typically occurs in infants and children younger than 2 years, but the rash can also be seen in people who are incontinent or paralyzed. Read more about the causes, symptoms, and treatments for diaper rash.

There are many misconceptions about a baby’s  Diaper Rash: –

*Baby‘s bottom is always  be perfectly smooth and rash-free
*Diaper rash is abnormal
*Diaper rash is a sign of food or formula allergies
*Diaper rash means the baby has bad diarrhea or a yeast infection

CLICK TO SEE THE PICTURES

Having a diaper rash is a normal part of being a baby. There are many ways you can limit the amount of rash, but from time to time it will flare up again.  But sometimes Diaper rash may alarm parents and annoy babies, but most diaper rash cases can be resolved with simple at-home treatments.

Symptoms:–
Diaper rash is characterized by the following:

*Skin signs. Diaper rash is marked by red, puffy and tender-looking skin in the diaper region — buttocks, thighs and genitals.
*Changes in your baby’s disposition. You may notice your baby seems more uncomfortable than usual, especially during diaper changes. A baby with a diaper rash often fusses or cries when the diaper area is washed or touched.

Diaper rashes can occur intermittently, anytime your child wears diapers, but they’re more common in babies during their first 15 months, especially between 8 and 10 months of age.

When to visit  a doctor:-
Diaper rash is usually easily treated and improves within a few days after starting home treatment. If your baby’s skin doesn’t improve after a few days of home treatment with over-the-counter ointment and more frequent diaper changes, talk to your doctor. Sometimes, diaper rash leads to secondary infections that may require prescription medications.

Have your child examined if: –

*The rash is severe
*The rash worsens despite home treatment
Also see your child’s doctor if the rash occurs along with any of the following:

*Fever
*Blisters or boils
*A rash that extends beyond the diaper area
*Pus or weeping discharge


Causes:–
Babies are so susceptible to diaper rash that wet and soiled diapers can irritate baby’s delicate skin. Naturally, if  baby is in a wet diaper for too long, she or he will be more prone to getting a rash.

Some of the most common causes of diaper rash to be aware of are:

*Irritation due to bowel movements
*Irritation due to moisture from sweat and urine
(even the most absorbent diapers leave some wetness behind)
*Not drying the skin thoroughly after a diaper change
*Diaper chafing/friction
*Diarrhea, which may be caused by antibiotics
*Change in food or introducing new foods

Irritant diaper dermatitis develops when skin is exposed to prolonged wetness, decreased skin pH caused by urine and feces, and resulting breakdown of the stratum corneum, or outermost layer of the skin. In adults, the stratum corneum is composed of 25 to 30 layers of flattened dead keratinocytes, which are continuously shed and replaced from below. These dead cells are interlaid with lipids secreted by the stratum granulosum just underneath, which help to make this layer of the skin a waterproof barrier. The stratum corneum’s function is to reduce water loss, repel water, protect deeper layers of the skin from injury and to repel microbial invasion of the skin (Tortora and Grabowski, 2003). In infants, this layer of the skin is much thinner and more easily disrupted.

Effects of urine:-
Although wetness alone macerates the skin, softening the stratum corneum and greatly increasing susceptibility to friction injury, urine has an additional impact on skin integrity because of its effect on skin pH. While studies show that ammonia alone is only a mild skin irritant, when urea breaks down in the presence of fecal urease it increases skin acidity (lower pH), which in turn promotes the activity of fecal enzymes such as protease and lipase (Atherton, 2004; Wolf, Wolf, Tuzun and Tuzun, 2001). These fecal enzymes increase the skin’s permeability to bile salts and act as irritants in and of themselves.

There is no detectable difference in rates of diaper rash in conventional disposable diaper wearers and reusable cloth diaper wearers. “Babies wearing superabsorbent disposable diapers with a central gelling material have fewer episodes of diaper dermatitis compared with their counterparts wearing cloth diapers. However, keep in mind that superabsorbent diapers contain dyes that were suspected to cause allergic contact dermatitis (ACD).” [1] (Kazzi, 2006) Whether wearing cloth or disposable diapers they should be changed frequently to prevent diaper rash, even if they don’t feel wet.

Effects of diet:-
The interaction between fecal enzyme activity and IDD explains the observation that infant diet and diaper rash are linked, since fecal enzymes are in turn affected by diet. Breast-fed babies, for example, have a lower incidence of diaper rash, possibly because their stools have lower pH and lower enzymatic activity (Hockenberry, 2003). Diaper rash is also most likely to be diagnosed in infants 8–12 months old, perhaps in response to an increase in eating solid foods and dietary changes around that age that affect fecal composition. Any time an infant’s diet undergoes a significant change (i.e. from breast milk to formula or from milk to solids) there appears to be an increased likelihood of diaper rash (Atherton and Mills, 2004).

The link between feces and IDD is also apparent in the observation that infants are more susceptible to developing diaper rash after treatment with antibiotics, which affect the intestinal microflora (Borkowski, 2004; Gupta & Skinner, 2004). Also, there is an increased incidence of diaper rash in infants who have suffered from diarrhea in the previous 48 hours, which may be because fecal enzymes such as lipase and protease are more active in feces which have passed rapidly through the gastrointestinal tract (Atherton, 2004).

The incidence of diaper rash is lower among breastfed infants—perhaps due to the less acidic nature of their urine and stool. (Kazzi, 2006)

Treatments:-
The most effective treatment, although not the most practical one, is to discontinue use of diapers, allowing the affected skin to air out. Thorough drying of the skin before diapering is a good preventive measure, since it’s the excess moisture, either from urine and feces or from sweating, that sets the conditions for a diaper rash to occur. Various moisture-absorbing powders, such as talcum or starch, also help prevention.

Another approach is to block moisture from reaching the skin, and commonly recommended remedies using this approach include oil-based protectants or barrier cream, various over-the-counter “diaper creams”, petroleum jelly and other oils. Such sealants sometimes accomplish the opposite if the skin is not thoroughly dry, in which case they serve to seal the moisture inside the skin rather than outside.

Over-the-counter products:-
Various diaper rash medications are available without a prescription. Talk to your doctor or pharmacist for specific recommendations. Some popular over-the-counter ointments are:

*A + D
*Balmex
*Desitin
*Hydrocortisone
*Zinc oxide paste

Zinc oxide is the active ingredient in many diaper rash creams. These products are usually applied in a thin layer to the irritated region throughout the day to soothe and protect your baby’s skin. Zinc oxide can also be used to prevent diaper rash on normal, healthy skin.

Zinc oxide-based ointments are quite effective, especially in prevention, because they have both a drying and an astringent effect on the skin, being mildly antiseptic without causing irritation.

In persistent or especially bad rashes, an antifungal cream often has to be used. In cases that the rash is more of an irritation, a mild topical corticosteroid preparation, e.g. hydrocortisone cream, is used. As it is often difficult to tell a fungal infection apart from a mere skin irritation, many physicians prefer an antifungal-and-corticosteroid combination cream.

Some sources claim that diaper rash is more common with cloth diapers, yet others claim that the type of diaper makes no difference, but that cloth diapers can speed the healing process. In truth the material of the diaper is relevant inasmuch as it can wick and keep moisture away from the baby’s skin.

Prevention:–
A few simple strategies can help decrease the likelihood of diaper rash developing on your baby’s skin:

*Change diapers often. Remove dirty diapers promptly. If your child is in child care, ask staff members to do the same.
*Rinse your baby’s bottom with water as part of each diaper change. You can use a sink, tub or water bottle for this purpose. Moist washcloths and cotton balls also can aid in cleaning the skin. Don’t use wipes that contain alcohol or fragrance.
*Pat your baby dry with a clean towel. Don’t scrub your baby’s bottom. Scrubbing can further irritate the skin.
*Don’t overtighten diapers. Diapers that are too tight prevent airflow into the diaper region, setting up a moist environment favorable to diaper rashes. Tightfitting diapers can also cause chafing at the waist or thighs.
*Give your baby’s bottom more time without a diaper. When possible, let your baby go without a diaper. Exposing skin to air is a natural and gentle way to let it dry. To avoid messy accidents, try laying your baby on a large towel and engage in some playtime while he or she is bare-bottomed.
*Wash cloth diapers carefully. Pre-soak heavily soiled cloth diapers and use hot water to wash them. Use a mild detergent and skip the fabric softeners and dryer sheets because they can contain fragrances that may irritate your baby’s skin. Double rinse your baby’s diapers if your child already has a diaper rash or is prone to developing diaper rash. If you use a diaper service to clean your baby’s diapers, make sure the diaper service takes these steps as well.
*Consider using ointment regularly. If your baby gets rashes often, apply a barrier ointment during each diaper change to prevent skin irritation. Petroleum jelly and zinc oxide are the time-proven ingredients included in many prepared diaper ointments. Using these products on clear skin helps keep it in good condition.
*After changing diapers, wash your hands well. Hand washing can prevent the spread of bacteria or yeast to other parts of your baby’s body, to you or to other children.

Cloth or disposable diapers:-
Many parents wonder about what kind of diapers to use. When it comes to preventing diaper rash, there’s no compelling evidence that cloth diapers are better than disposable diapers or vice versa, though disposables may keep baby’s skin slightly drier. Because there’s no one best diaper — use whatever works best for you and your baby. If one brand of disposable diaper irritates your baby’s skin, try another.

Whether you use cloth diapers, disposables or both kinds, always change your baby as soon as possible after he or she soils the diaper to keep the bottom as clean and dry as possible.

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/Diaper_rash
http://www.dailyglow.com/skin-problems/baby-skin-rash.html?xid=g_&gclid=CJbdvPji26ACFcvV5wodbzUVCA
http://www.mayoclinic.com/health/diaper-rash/DS00069
http://www.askdrsears.com/html/11/T081400.asp
http://www.myadbaby.com/diaper_rash.html?utm_source=google&utm_medium=cpc&utm_term=diaper%2Brash%2Bpictures&utm_campaign=diaper%2Brash&buf=999999

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