Natural Ways to Treat Eczema

Eczema Free Forever Manual

If you have become tired after trying different medications to treat your eczema, you need to consult the e-book titled Eczema Free Forever written by Rachel Anderson. She is an individual who herself suffered from eczema but cured her completely using natural remedies. Included in her program is a variety of avenues and examples which can assist the reader in beating their eczema. She outline symptoms, areas of usual occurrence, and defines what eczema actually is. This book is ideal for those who have been through dose after dose of doctor prescribed medication without any long lasting results, or for those who wish to avoid prescriptions and are seeking a more holistic cure for their eczema issues. More here...

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Eczema and dermatitis

The terms eczema and dermatitis are interchangeable, covering a wide variety of conditions from the child with atopic eczema to the adult with an allergy to cement. If patients are told they have dermatitis they may assume that it is related to their employment with the implication that they may be eligible for compensation. It is not unusual for industrial workers to ask Is it dermatitis, doctor , meaning is it due to my job Eczema is an inflammatory condition of the skin characterised by groups of vesicular lesions with a variable degree of exudate and scaling. In some cases dryness and scaling predominate, with little inflammation. In more acute cases there may be considerable inflammation and vesicle formation, in keeping with the Greek for to boil out, from which the word eczema is derived. Sometimes the main feature may be blisters that become very large. Eczema commonly itches and the clinical appearance may be modified by scratching, which with time may produce lichenification...

Eczematous eruption within cast

A 42-year-old neuropathic man with type 1 diabetes of 40 years' duration was given a total-contact cast for acute Charcot's osteoarthropathy. After 3 weeks he developed an eczematous eruption of the whole area covered by cast and some areas on the other leg and arms. He underwent patch testing by dermatologists, including testing to epoxy resins. These tests were all entirely negative, making a contact eczema rather unlikely, although it is possible that he was allergic to another component of his plaster.

Eczematoid Dermatitis

Eczema of the meatus and surrounding structures may affect any age group. It may be familial atopic dermatitis, acquired-irritant, or allergic eczema. The lesions usually start as small blisters, which itch intensely and are scratched away, leaving skin that becomes lichenified with exaggerated striations and scales. Weeping of sticky clear fluid is often present. Allergy to topical irritants, such as fabrics, soap, hair coloring, or hair spray, as well as other environmental allergens, may be causative. Neomycin allergy from eardrops can cause an acute eczema (Fig. 4.5), aggravating Fig. 4.5 Eczematoid neomycin reaction. Fig. 4.5 Eczematoid neomycin reaction.

Types of eczema

Curing Stasis Dermatitis

Eczema Eczema The many causes of eczema are not consistently related to the distribution and clinical appearance. In general there are either external factors acting on the skin producing inflammatory changes or it is an endogenous condition. It is important to remember there can be more than one cause for example, in atopic eczema or varicose eczema on the ankle an allergic reaction may develop to the treatments used. Atopic eczema affects mainly the flexor surfaces of the elbows and knees as well as the face and neck. To a variable degree it can affect the trunk as well. The typical patient with atopic eczema is a fretful, scratching child with eczema that varies in severity, often from one hour to the next. In the older child or adult, eczema is more chronic and widespread and its occurrence is often related to stress. Atopic eczema is common, affecting 3 of all infants, and runs a chronic course with variable remissions. It normally clears during childhood but may continue into...

Contact dermatitis

The skin normally performs its function as a barrier very effectively. If this is overcome by substances penetrating the epidermis an inflammatory response may occur leading to epidermal damage. These changes may be due to either (a) an allergic response to a specific substance acting as a sensitiser or (b) a simple irritant effect. An understanding of the difference between these reactions is helpful in the clinical assessment of contact dermatitis. Common sources of allergic contact dermatitis Contact dermatitis common sources Allergic contact dermatitis The explanation of the sequence of events in a previously sensitised individual is as follows The antigen penetrates the epidermis and is picked up by a Langerhans cell sensitised to it. It is then transported to the regional lymph node where the paracortical region produces a clone of T cells specifically programmed to react to that antigen. The sensitised T cells accumulate at the site of the antigen and react with it to produce...

Table 34 Causes and associations of trachyonychia

Idiopathic (twenty-nail dystrophy) (Figure 3.34) Alopecia areata (Figure 3.32) Lichen planus (Figures 3.37, 3.38) Eczematous histology Chemicals and alopecia areata makes it common to observe trachyonychia in other conditions frequently associated with alopecia areata, such as atopic dermatitis, ichthyosis or Down's syndrome. Table 3.4 lists the known causes and associations of trachyonychia.

Occupational dermatitis

Inherited tendency to eczema (atopy) Contact dermatitis, which may be either irritant or allergic Infection. In the workplace, all three factors may contribute to dermatitis. For example, a student nurse or trainee hairdresser is exposed to water, detergents, and other factors that will exacerbate any pre-existing eczema. In addition, there may be specific allergies and, as a result of the broken skin, secondary infection can occur making the situation even worse. The following points are helpful in determining the role of occupational causes. Whatever the cause of the dermatitis, the end result may seem the same clinically, because the inflammation and blisters of atopic eczema may be indistinguishable from an allergic reaction to rubber gloves. Generally, contact dermatitis is more common on the dorsal surface of the hands whereas atopic eczema occurs on the palms and sides of the fingers. Irritant contact dermatitis can occur acutely as mentioned above and there is usually a...

Secondary Bacterial Infections Complication Skin Lesions

Diabetic foot infections are divided into non-limb-threatening and limb-threatening. Non-limb-threatening infections are superficial, lack systemic toxicity, have minimal cellulitis that extends < 2 cm from port of entry, and if ulceration is present it does not extend through the skin, and does not show signs of ischemia. Limb-threatening infections are associated with ischemia, have more extensive cellulitis, lymphangitis is present, and the ulcers penetrate through the skin into the subcutaneous tissue. Epidermal cysts in the chest, trunk, extremities, and vulvovaginal and scrotal areas can also become severely infected (11). Other skin lesions that can be secondarily infected with bacteria are the following scabies (12), eczema herpeticum (13), psoriasis (14), poision ivy (15), diaper dermatitis (16), kerion (17), and atopic dermatitis (18).

The management of skin conditions in general practice

One great advantage of general practice is that there is continuity of care and the family doctor has a much more complete overall picture of the patient, their family and social circumstances than can be acquired in a hospital consultation. Increasingly dressings and other treatments are being used by practice nurses in conjunction with the dermatology liaison nurse when necessary. This applies to inflammatory skin conditions such as psoriasis and eczema as well as leg ulcers, but also to conditions such as Darier's disease, dermatitis herpetiformis, and lupus erythematosus where regular supervision and blood tests may be required. There is no reason why continuing treatment with drugs such as ciclosporin and methotrexate cannot be carried out in general practice once the diagnosis and treatment regime have been established. Regular blood tests are mandatory when these drugs are being used.

Diabetic and Other Chronic Superficial Skin Ulcers and Subcutaneous Abscesses

Decubitus ulcers can be colonized and infected by a variety of aerobic and anaerobic bacteria. The distribution of organisms depends on the location of the ulcer. While GABHS and S. aureus can be isolated in all body sites, organisms of oral flora origin (Fusobacterium spp., pigmented Prevotella and Porphyromonas, and Peptostreptococcus spp.) can be isolated in ulcers and wounds proximal to that site, while organisms of colonic or vaginal flora origin (B. fragilis group, Clostridium spp., Peptostreptococcus spp., and Enterobacteriaceae) can be recovered from lesions proximal to the perianal area (28). This principle applies to recovery of organisms in other skin and soft tissue wounds and abscesses (28,29) secondarily infected wounds and skin lesions caused by scabies (12) superficial thrombophlebitis (30) decubitus ulcers (31) diaper dermatitis (16) atopic dermatitis (18) kerion lesions (17) secondarily infected eczema herpeticum (13), psoriasis lesions (14), and poison ivy (15)....

Differential Diagnosis

The clinical diagnosis of SCLE is not always obvious. Annular lesions can be confused with erythema annulare centrifugum, granuloma annulare, erythema gyratum repens, autoinvolutive photoexacerbated tinea corporis (Dauden et al. 2001), or EM. Papulosquamous lesions may be confused with photosensitive psoriasis, lichen planus, eczema, pitiryiasis rubra pilaris, disseminated superficial actinic porokeratosis, contact dermatitis, tinea faciei (Meymandi et al. 2003) and dermatomyositis. Lesional photodistribution, characteristic histopathology and Ro SS-A autoantibodies are useful in distinguishing SCLE from its differential diagnosis.

Skin Anomalies Pathological Noninfective

Classically this condition is the end-result of intense, chronic pruritus that results from repetitive rubbing or scratching. The skin responds by thickening and the increase in skin markings is referred to as lichenification. This occurs mostly in individuals with a history of allergies, eczema, hay fever or asthma. They have sensitive and easily irritated skin. ECZEMA Eczema is a non-infectious condition that may develop following skin irritation or via an immune pathway. Eczema is a collection of clinical findings rather than a particular disease. Patients may present with papules, vesicles, erythema, fissures, weeping and oedema in an acute stage. Itching is often present, and angular and linear erosions produced by finger nails are common. Scaling and lichenification are common in the chronic stage. When lichenification occurs on the mucous membrane of the vulva the skin frequently becomes white. CONTACT DERMATITIS Contact dermatitis of the genital skin falls into two categories...

Skin diseases affecting the nails

Since the nail plate consists of specialised keratin produced by basal cells, it is not surprising that it is affected by skin diseases. Some conditions, such as psoriasis, may produce characteristic changes whereas in other conditions, such as eczema, the changes are much less specific. Eczema may be associated with brittle nails that tend to split. Thickening and deformity of the nail occurs in eczema or contact dermatitis, sometimes with horizontal ridging.

Clinical presentation

Other forms of local bacterial infection include impetigo, folliculitis, and furuncles (boils). These conditions are caused by Staphylococcus aureus and in the case of folliculitis or boils the infection is associated with a local abscess. Staph. aureus colonises the anterior nares or perineum of normal people it also commonly colonises eczema and may cause an acute exacerbation of atopic dermatitis.

Topical immunosuppressants

Tacrolimus (Protopic, Fujisawa) has recently become available as an ointment in two strengths, 0.03 and 0.1 . It has not been evaluated in children under the age of two or in pregnant women. It is recommended that it is only used by dermatologists or those with considerable experience in treating eczema. Although the exact mode of action is unknown it does diminish T cell stimulation by Langerhan cells and diminishes the production of inflammatory mediators from mast cells. It should be used in moderate to severe atopic eczema that has not responded to either treatment. Skin irritation with burning, erythema, and pruritis are the most common side effects. In view of its immunosuppressive activity Pimecrolimus (Elidel, Steeple Novartis) is a similar preparation recommended for intermittent treatment of eczema can also be used as an initial treatment for any flare up of eczema. It diminishes cytokine activity long term relieving both the erythema and pruritis of eczema.

Genetically complex disorders

In atopic eczema, matters are equally complicated. Environmental factors may well be responsible for the recent rise in its prevalence as the gene pool within the population is not likely to have changed greatly, but a genetic component is obvious too, even though affected children can be born to clinically normal parents. Within each family, atopic disorders tend to run true to type, so that, in some, most affected members will have eczema, in others, respiratory allergy predominates. The inheritance of atopic eczema probably involves genes that predispose to the state of atopy, and others that determine whether it is asthma, eczema, or hay fever that develops. One plausible gene for the inheritance of atopy encodes for the p subunit of the high affinity IgE receptor, and lies on chromosome 11q13. However several groups have failed to confirm earlier reports of this linkage, and a gene linked to atopic eczema has recently been found on chromosome 3q21.

Commiphora myrrha Engl Fam Burseraceae

For Damp-Heat with stuffiness and fullness of the abdomen or acute dysentery with jaundice high fever accompanied by impairment of consciousness restlessness and insomnia due to exuberant Fire spitting of blood and epistaxis caused by Heat in the Blood inflammation of the eyes acid reflux toothache diabetes carbuncles and sores externally used for eczema and other skin diseases with exudation purulent discharge from the ear.

Combined B and TCell or Primary TCell Deficiencies

Ataxia telangiectasia (AT) is an autosomal recessive disorder usually presenting between ages 2 and 5 years with ataxia and telangiectasias of the nose, conjunctiva, ears, or shoulders. These patients have T-cell defects secondary to thymic hypoplasia, and IgA deficiency occurs in 50 of patients. A defect in the ATM gene, a protein kinase involved in cell cycle control and DNA repair, is the culprit in this disorder and also leads to the increased risk of malignancy (IUIS Committee, 1999). DiGeorge Syndrome is the result of a congenital defect in migration of the third and fourth branchial arches, leading to thymic hypoplasia and other developmental abnormalities. The severity of the T-cell defect corresponds to degree of thymic aplasia, and those patients with severe T-cell defects are susceptible to opportunistic infections. Wiskott-Aldrich syndrome (WAS) is an X-linked recessive disorder resulting from a defect in the WAS protein, which is involved in intracellular signaling and...

Prevention of Food Allergy

Probiotics offer another means to prevent the development of food allergy. The rationale for using probiotics in allergic diseases is that normal enteric flora established shortly after birth provides counter regulatory signals against a sustained T-helper type 2 cell (Th2)-skewed immune response (Isolauri, 2002). A number of randomized placebo controlled studies show that Lactobacillus GG (also called Lactobacillus rhamnosus ATCC 53103 ) given to women before and during subsequent breastfeeding reduced the occurrence of allergic eczema in their offspring. Other studies suggest that probiotics such as Lactobacillus GG may also be beneficial in ameliorating the severity of allergic responses in established food allergy particularly in younger subjects.

Extraoral Risks Allergy

Allergy to nickel is more common in extra-oral settings, most usually the headgear face bow or head strap. Over 1 of patients have some form of contact dermatitis to zips and buttons studs on clothing. Of these patients, 3 claim to have experienced a similar rash with orthodontic appliances (Fig. 12). The use of sticking plaster over the area in contact with the skin is sufficient to relieve symptoms. Allergy to latex27 and bonding materials has been reported although these are rare.

Genital Ulcer Diseases

Herpes simplex virus typically presents as multiple painful vesicles or pustules, which break down to form erosive ulcers. These are generally painful and may coalesce to form larger areas of painful ulceration. True primary episodes are generally more severe than subsequent episodes, and are often associated with systemic symptoms. Many people, however, are unaware they are infected, as they do not experience symptoms. Asymptomatic shedding of Herpes simplex virus has been shown to occur and is probably an important means of trans-mission.An understanding of asymptomatic shedding can facilitate acceptance of what may become a chronic recurring condition. Differential diagnoses include primary syphilis, candidiasis, contact dermatitis and fixed drug reaction.

Inhibitors Of Orthopoxviruses

Historical data on complication rates from the past will probably not be reliable predictors of future rates should any government undertake the vaccination of large segments of the population to deter or ameliorate the consequences of a potential terrorist use of smallpox. The world's population has changed dramatically since the middle of the twentieth century. Immunocompromised individuals comprise a much larger proportion of the overall population as a result of advances in transplantation and cancer treatment as well as the global devastation caused by HIV. In addition, the incidence of atopic dermatitis has dramatically increased in recent decades. As supplies of vaccinia immune globulin (VIG) are very limited, it may be as or even more important to identify an effective chemotherapeutic agent for the treatment of vaccinia complications as for the treatment of smallpox. Fortunately, as the viruses are closely related, most antiviral agents with activity against one of these...

Palifermin Mucositis [6972

Side effect that can lead to swallowing difficulty, thereby, necessitating total paren-teral nutrition in severe cases. Other complications include potential infections, overuse of opioid analgesics to treat the pain, and extended hospitalization. Palifer-min, a recombinant human keratinocyte growth factor (KGF), has been approved as a novel agent to treat this condition. As a member of the heparin-family of fibroblast growth factors, palifermin provides protection from the damaging effects of chemotherapy and radiation by selectively promoting epithelial cell proliferation, leading to an increased rate of healing. Palifermin is produced by recombinant DNA technology utilizing an expression vector encoding KGFdes1_23. As an N-terminal, truncated version of endogenous KGF having amino acids 1-23 deleted, palifermin has greater stability while retaining biological activity. In Phase I studies, i.v. administration of palifermin generated linear pharmacokinetic parameters with no...

Table 43 Causes and associations of onychogryphosis Dermatological

Pityriasis Rubra Pilaris Nails

Positive, homogeneous, rounded or oval, amorphous masses surrounded by normal squamous cells which are usually separated from each other by empty spaces caused by the fixation process. These clumps, which coalesce and enlarge, have been described in psoriasis of the nail, onychomycosis, eczema and alopecia areata, and also in some hyperkeratotic processes such as subungual warts and pincer nails. The horny excrescences of the nail bed are not very obvious, but the ridged structure may become apparent if the nail plate is cut and shortened. Psoriasis Reiter's syndrome (Figures 4.14, 4.15) Onychomycosis (Figure 4.19) Pityriasis rubra pilaris (Figure 4.20) Pachyonychia congenita (Figures 4.21-4.23) Contact eczema Mineral oils Cement

Molluscum contagiosum

The white, umbilicated papules of molluscum contagiosum are characteristic. Large solitary lesions may cause confusion as can secondarily infected, excoriated lesions. These lesions often itch, particularly in patients with atopy. Resolving lesions may be surrounded by a small patch of eczema.

IgE Receptor Crosslinking And Activation Of Apcs

Thomas Bieber and his group have shown this to be the mechanism for epidermal LCs in their extensive studies on the mechanisms underlying atopic dermatitis. APC activation results in the release of mediators and cytokines, like MIP-1 and MCP-1, which act to attract more APCs to the site of inflammation (4).

AntiRoSSA and AntiLaSSB

The presence of anti-Ro SSA and anti-La SSB autoantibodies is associated with subacute cutaneous lupus erythematosus 107 , photosensitivity, secondary Sjogren's syndrome, and neonatal lupus 108 . Neonatal lupus provides perhaps the strongest clinical evidence for a pathogenic role of these autoantibodies. This syndrome, related to the presence of anti-Ro SSA and anti-La SSB antibodies in the mother, is characterized by skin rash, cytopenia, cholestasis, and or congenital heart block (CHB) 108 . In recent prospective studies of women with anti-Ro SSA antibodies, the risk of complete CHB was found to be 1-2 109, 110 and of transient cutaneous neonatal lupus about 5 110 . Of note, no ef

Skin Disorders of the External Meatus

The three major dermatoses of the external ear are seborrheic dermatitis, eczema, and psoriasis. They have some overlapping characteristics and often affect the same areas, namely, the external canal, its meatus, and the concha. Sometimes adjacent regions, such as the lobule and postauricular areas, are affected. They seldom extend deeper than the outer one-third of the canal. Dermatologists refer to all three as the papulosquamous disorders. Patients afflicted with these disorders complain of itching and weeping of the external canal. Occasionally, there is pain if inflammation or superinfection is present.

Clinical Variants of Pemphigus

Pemphigus Folicaceous Epidermis

Pemphigus herpetiformis is characterized by skin lesions resembling those of dermatitis herpetiformis, eosinophilic spongiosis without apparent acantholysis as well as by the presence of circulating and tissue-bound Ab against the kera-tinocyte surface (Jablonska et al. 1975 Santi et al. 1996). Pemphigus herpetiformis sera have been shown to contain IgG reactive with the Dsg3 antigen of PV (Kubo et al. 1997). Using two recently established ELISA with baculovirus-derived Dsg3 and Dsg1 proteins (ECD), Ishii et al. (1998) demonstrated that sera of patients with herpetiform pemphigus contain Ab against Dsg1 and Dsg3 suggesting that herpetiform pemphigus is a clinical variant of PF and PV.

Latex Food Allergy Syndrome

Latex-food allergy syndrome, also referred to as the latex-fruit syndrome, is a specific form of food allergy in which food antigens cross-react with various latex antigens (Blanco, 2003). Natural rubber latex contains over 200 proteins, 10 of which bind IgE Hevea brasiliensis latex protein allergens (HEV b 1 to 10) and cross-react with a variety of food antigens including kiwi (HEV b 5), potato and tomato (HEV b 7), and avocado, chestnut, and banana (HEV b 6). In latex-sensitive individuals exposure to these foods can result in the same symptoms as if exposed to latex ranging from pruritis, eczema, oral-facial swelling, asthma, GI complaints, and anaphylaxis. A large number of studies from around the world indicate that the natural rubber latex allergy is increasing in prevalence and that the frequency of associated food allergy varies from 21 to 58 (Blanco, 2003). Worldwide, banana, avocado, chestnut and kiwi are the most common causes of food-induced symptoms associated with latex...

The itching skin pruritus

Eczema is associated with itching due to the accumulation of fluid between the epidermal cells that are thought to produce stretching of the nerve fibres. As a result of persistent scratching there is often lichenification which conceals the original underlying areas with eczema. Exposure to irritants and persistent allergic reactions can produce intense itching and should always be considered. Dermatitis herpetiformis is characterised by intense persistent and severe itching that patients often describe as being unendurable. Usual measures such as topical steroids and antihistamines have little if any effect. Eczema or contact dermatitis Atherton DJ. Eczema in childhood. The facts. Oxford Oxford University Press, 1994 Cronin E. Contact dermatitis. Edinburgh Churchill Livingstone, 1980 Fisher AA. Contact dermatitis, 3rd ed. Baltimore Williams and Wilkins, 1986 Foussereau J, Benezra JE, Maibach H. Occupational contact dermatitis. Copenhagen Munksgaard, 1982 Schwanitz HJ. Atopic...

Skin disease involving the scalp

The scalp can be involved in any skin disease, but most commonly in psoriasis and seborrhoeic eczema. A mild degree of scaling from accumulation in skin scales is so common as to be normal (dandruff). Increased accumulation of scales is seen in seborrhoeic dermatitis in which pityrosporum organisms may play a part. Sometimes masses of thick adherent scales develop in pityriasis amiantacea, usually due to psoriasis. Eczema and contact dermatitis can also involve the scalp. Folliculitis decalvans Tinea capitis

Role of Lselectin in disease

In addition to cell-surface adhesion molecules, the soluble forms of these molecules have been receiving an increasing amount of attention. While soluble adhesion molecules have been used successfully as markers of inflammation or disease activity, their role in physiological processes must also be considered (reviewed in 252 ). Specifically, significantly increased levels of sL-selectin have been reported to be associated with a number of different disease conditions including chronic myeloid and lymphocytic leukemia 253-255 , sepsis 19, 256 , HIV infection 19 , atopic dermatitis 257 , psoriasis 258 , and lupus 259 . As discussed above, since sL-selectin retains functional activity, these increased levels may have important physiological effects on leukocyte migration in these patients. In fact, higher levels of sL-selectin in acute myeloid leukemia patients at the time of diagnosis correlated with decreased probability of achieving complete remission, shorter event-free survival,...

Localised lesions with epidermal changes

Psoriasis, seborrhoeic dermatitis, atopic eczema, and contact dermatitis can all present with localised lesions. In atopic eczema the classical sites in children flexures of the elbows and knees and the face may be modified in adults to localised vesicular lesions on the hands and feet in older patients. Some atopic adults develop severe, persistent generalised eczematous changes. Contact dermatitis is usually localised, by definition, to the areas in contact with irritant or allergen. Wide areas can be affected in reactions to clothing or washing powder, and sometimes the reaction extends beyond the site of contact.

Figure 328

It has been shown that regular pitting may convert to rippling or ridging, and these two conditions appear, at times, to be variants of uniform pitting (Figures 3.26-3.28). Nails showing diffuse pitting grow faster than the apparently normal nails in psoriasis. Occasional pits occur on normal nails. Deep pits can be attributed to psoriasis, and profuse pitting is most often due to this condition (Figures 3.29, 3.30). In alopecia areata (Figure 3.31) shallow pits are usually seen and they are often numerous, leading to trachyonychia (rough nail) and twenty-nail dystrophy however, curiously, one nail often remains unaffected for a long time, Pits may also occur in eczema or occupational trauma. In some cases a genetic basis is thought likely. In secondary syphilis and pityriasis rosea pitting occurs rarely. One case of the latter has been observed with the pits distributed on all the finger nails at corresponding levels, analogous to Beau's lines.

Yeast infections

Candida infection may occur in the flexures of infants and elderly or immobilised patients, especially below the breasts and folds of abdominal skin. It needs to be differentiated from (a) psoriasis, which does not itch (b) seborrhoeic dermatitis, a common cause of a flexural rash in infants and (c) contact dermatitis and discoid eczema, which do not have the scaling margin. Candida intertrigo is symmetrical and satellite pustules or papules outside the outer rim of the rash are typical. Yeasts, including Candida albicans, may be found in the mouth and vagina of healthy individuals. Clinical lesions in the mouth white buccal plaques or erythema may develop. Predisposing factors include general debility, impaired immunity (including AIDS), diabetes mellitus, endocrine disorders, such as Cushing's syndrome, and corticosteroid treatment. Vaginal candidosis or thrush is a common infection of healthy young women an underlying predisposition is rarely found. The infection presents with...

Rashes due to drugs

External contact with drugs can cause a contact dermatitis presenting with eczematous changes. This occurs commonly with neomycin and bacitracin. Chloramphenicol and sulphonamides from ophthalmic preparations can also cause dermatitis around the eyes. Penicillin is a potent sensitiser so is not used for topical treatment.

Onchocerciasis

Onchocerciasis (river blindness) occurs in Africa south of the Sahara and in Central America. It is due to Onchocerca volvulus transmitted by the bite of black flies Simuliidae which breed by fast flowing rivers. The inoculation of microfilariae by the bite of a black fly causes intense local inflammation and is followed by an incubation period of many months. The adult worms live in nodules around the hips and cause no harm in themselves. They produce thousands of microfilaria each day which travel to the skin and eyes. In the skin they produce a very itchy rash which looks like lichenified eczema. On the lower legs there is often spotty depigmentation. Involvement of the eyes causes blindness.

Corticosteroids

In addition to topical preparations, systemic steroids may be required for the treatment of severe inflammatory skin conditions such as erythroderma developing from psoriasis or eczema. They are also used in vasculitis and erythema multiforme as well as connective tissue diseases. They are often required for the treatment of pemphigoid and pemphigus together with immunosuppressant drugs.

Tropical dermatology

Skin disease is extemely common in the tropics, affecting up to 50 of the population. Most are infections or infestations such as impetigo, ringworm, and scabies. These can easily be treated but continue to be common because of overcrowding, poverty, and the lack of resources given to health care (training of health personnel and lack of basic medicines). To a large extent such diseases can be controlled with very simple measure suitable for use by those with minimal training. Atopic eczema is just as common in urban areas in the tropics as in the west. Skin cancers are uncommon in those with a black skin because of the protective effect of melanin, but are common in albinos.

Other drugs

These drugs are used in conjunction with long wavelength ultraviolet light as psoralen with ultraviolet A (PUVA) therapy described on page 67. It is used for the treatment of severe psoriasis. It has also proved effective in some cases of atopic eczema, T cell lymphoma of the skin, and occasionally in lichen planus. There is a risk of cataract formation, and a full blood count as well as antinuclear factor tests should be carried out.

Other conditions

Bowen's disease is characterised by a well defined, erythematous macule with little induration and slight crusting. It is a condition of the middle aged and elderly, occurring commonly on the trunk and limbs. It is an intraepidermal carcinoma, which has been reported to follow the ingestion of arsenic in tonics taken in years gone by or exposure to sheep dip, weedkiller, or industrial processes. After many years florid carcinoma may develop with invasion of deeper tissues. It may be confused with a patch of eczema or superficial basal cell carcinoma. Lesions on covered areas may be associated with underlying malignancy. Erythroplasia of Queyrat is a similar process occurring on the glans penis or prepuce. Paget's disease of the nipple presents with unilateral nonspecific erythematous changes on the aureola and nipple, spreading to the surrounding skin. The cause is an underlying adenocarcinoma of the ducts. It should be considered in any patient with eczematous changes of one breast...

Figure 545

These usually disappear before the patient presents to the doctor. Confluent eczematoid changes cover the skin immediately adjacent to the distal edge of the nail. The affected area is pink or of normal skin colour and densely studded with fine scales there is a clear margin between the normal and affected areas. The skin changes may extend to the dorsal aspect of the finger or toe, but usually only the finger tip is affected. The most striking and characteristic change is the hyperkeratosis beneath the nail tip. The nail plate is lifted up, deformed and often thickened. Commonly the deformity produced is asymmetrical and limited to one corner of the distal edge, or at least more pronounced at the corners of the nail. Pitting occurs in some cases rarely, transverse ridging of the nail plate is present. In most cases the condition resolves within a few months, but in some cases it may persist for many years, even into adult life. Histological findings are of some value, including...

Glucagonomas

Involving the trunk and face (Figure 15-6). These patients may have been treated for psoriasis, pemphigus, zinc deficiency, or eczema for several years before the rash is recognized for what it is, prompting a proper diagnosis. These patients also have mild to moderate diabetes mellitus associated with anemia, weight loss, glossitis, and thrombophlebitis. The diagnosis can be proved by demonstration of an elevated serum glucagon level.

Benzoylperoxide

The side effect profile of BPO depends on the galenic formulation of i.p. dryness of the skin and exsiccation eczema. It can bleach the hair and clothes. The following recommendations can be given ideal for mild-to-moderate inflammatory acne papulo-pustulosa optimal combi

Chronic paronychia

Chronic paronychia is an inflammatory disorder of the proximal nail fold, typically affecting hands that are continually exposed to a wet environment and repeated minor trauma causing cuticle damage. When the cuticle is torn or lost, the epidermal barrier of the proximal nail fold is impaired and the nail fold is then exposed to a large number of environmental hazards. Irritants and allergens may easily penetrate the proximal nail fold and produce contact dermatitis that is responsible for the chronic inflammation. A variety of immediate hypersensitivity (type I) reaction to food ingredients may be seen. Sometimes irritant reaction may precede it.

Toxic Effects

There are no reports of toxicity following oral ingestion of the herb although the German Commision E monograph cited in Bisset (1994) states that an abortifacient action has been described and Williamson and Evans (1994) note that it should not be used in pregnancy. There is one report of contact dermatitis described by Kurz and Rapaport (1979). In animals, Forsyth (1968) records one incidence of poisoning in cattle attributed to A. vulgaris.

Systemic Treatment

Dapsone (diaminodiphenylsulfone or DDS), effectively tested on lepra, was shown to possess anti-inflammatory activity for various dermatological diseases, primarily dermatitis herpetiformis in the early 1950s and subcorneal pustular dermatosis in 1956. The sulfones have been widely used to treat other dermatological conditions including bullous diseases, vasculitis, neutrophilic dermatoses, pilosebaceous diseases, infectious diseases, as well as pustular psoriasis and relapsing polychondritis. Dap-sone has been reported to be effective in the management of nodulocystic acne, but the few studies available are based on a limited number of cases 18, 19 . In 1974, we examined 484 patients treated with oral DDS. Patients with acne characterized by papules, pustules and occasional cysts accompanied by inflammatory lesions, did not respond to the medication, although, in some, there was a slight improvement not comparable with the one obtained with tetracycline, in view of which DDS was...

Patch Testing

Diagnostic tests for non-IgE-mediated food allergies include food allergy patch testing, T-cell cytokine assays, and measurements of markers of eosinophil activation. Conventional patch testing is used to diagnose contact hypersensitivity reactions involving T cells and has been applied to the evaluation of food allergy in the setting of atopic dermatitis and allergic eosinophilic esophagitis, primarily to cow's milk proteins (De Boissieu et al, 2003). Other tests may be useful in specific conditions, such as 24hour pH monitoring in eosinophilic esophagitis. Occult parasitic infections should be excluded in order to diagnose idiopathic or allergic eosinophilic syndromes and, occasionally, a course of empiric antihelminthic therapy may be indicated. Histological analysis is important in many presentations of food allergy including eosinophilic esophagitis, food protein-induced enterocolitis and proc-tocolitis, and celiac disease.

Blood Tests

A radioallergosorbent test (RAST) can be used as an alternative to skin testing in very young children, those with severe atopic dermatitis, those who cannot discontinue antihistamines, and those reporting anaphylactic reactions to foods or food additives. The limitations of RAST are the expense, lower sensitivity, and relatively limited number of antigens that can be tested when compared with skin testing. A modification of the traditional RAST test, the CAP System FEIA (Pharmacia), is reported to be more sensitive than a standard RAST. Levels of food-specific IgE above which a patient has a > 95 likelihood of experiencing an allergic reaction after the ingestion of specific food have been established (Sampson, 2002). An oral food challenge is recommended at lower levels of food-specific IgE because the clinical significance of such levels cannot be predicted.

IgE Receptors

IgE is known as the main antibody involved in allergic inflammatory processes such as asthma, atopic dermatitis, and allergic rhinitis. Two distinct receptors have been demonstrated for IgE the high-affinity IgE receptor (FceRI), and the low-affinity IgE receptor (FceRII). The binding of an allergen to the complex of IgE-FceRI and the associated cross-linking of these receptors on FceRI-bearing cells leads to the rapid activation and release of inflammatory mediators and the production of a variety of cytokines by APCs. Observations in atopic dermatitis (AD) patients have shown that this resultant cytokine production by the aggregation of surface FceRI may preferentially induce a TH2 type of cell activation (17,19).

Immunosuppressants

This drug has proved helpful in severe psoriasis within inflammatory lesions and, secondly, in the treatment of severe atopic dermatitis. There are a number of drug interactions and it is important to check renal function and monitor both blood urea and serum creatinine.

Adverse reactions

The majority of patients tolerate penicillins well, the most common adverse effects being mild and gastrointestinal in nature. However, penicillins are also well documented as causing hypersensitivity reactions in some patients, some of which prove to be fatal. If a patient is allergic to one penicillin, then they will also be allergic to the entire class. Additionally, 10 per cent of penicillin-allergic patients will also exhibit an allergy to cephalosporin antibiotics. A skin rash is the most common presenting sign of allergy.

Other Therapies

Apart from N-acetylcysteine treatment for acetaminophen poisoning, therapy for drug-induced liver injury is scant. A short course of high-dose corticosteroid may be used for severe drug-induced liver disease, especially in patients with systemic features of a hypersensitivity reaction. However, corticosteroids have not been proven to be of value in controlled trials. Nevertheless, we recommend a short course of corticosteroids when systemic features of immune hypersensitivity accompany acute hepatitis (eg, phenytoin skin rash and liver injury). In patients with prolonged drug-induced cholestatic liver disease, ursodeoxycholic acid treatment may be of use, although the efficacy is unproved.

Glucagonoma

Glucagonomas result in a migratory necrolytic erythema, weight loss, glucose intolerance, hypoamino-acidemia, and normochromic, normocytic ane-mia.23,24 Other less common features include thromboembolic phenomena, neuropsychiatry disturbances, diarrhea, and nonspecific abdominal pain. Glucagonomas occur in 3 of all patients with MEN type I. The age of onset is middle age or later. They typically occur in the tail of the pancreas. They are often large at presentation, 5 to 10 cm, and malignancy is common. Patients present with signs and symptoms of hyperglycemia, and usually diabetes mellitus precedes the diagnosis of glucagonoma. However, Cushing's syndrome is a far more common cause of hyperglycemia in MEN type I. The diagnosis is made by a glucagon level > 1,000 pg mL often in the presence of the characteristic skin rash.

Diaper Dermatitis

Monilial Dermatitis

Typical candidal diaper dermatitis. Note the symmetric distribution of the rash with involvement of the intertriginous areas. Satellite lesions are often present. The skin is erythematous, swollen and slightly scaly. With healing, areas of depigmentation may occur. This should be differentiated from an ammoniacal diaper dermatitis where the rash is generally asymmetric, the intertriginous areas are spared, and satellite lesions are absent as it is a contact dermatitis. Figure 2.152. Typical candidal diaper dermatitis. Note the symmetric distribution of the rash with involvement of the intertriginous areas. Satellite lesions are often present. The skin is erythematous, swollen and slightly scaly. With healing, areas of depigmentation may occur. This should be differentiated from an ammoniacal diaper dermatitis where the rash is generally asymmetric, the intertriginous areas are spared, and satellite lesions are absent as it is a contact dermatitis.

Groin And Pubic Area

Anti-fungal creams but the nurse should instruct the patient on appropriate hygiene requirements to ensure eradication. Erythema of the pubic skin may also result from other dermatological conditions such as eczema, psoriasis, etc., and patients should be advised to see a general practitioner dermatologist for the management of any non-sexual skin condition.

Pityriasis rosea

Guttate Psoriasis Face

The word pityriasis is from the Greek for bran, and the fine bran-like scales on the surface are a characteristic feature. The numerous pale pink oval or round patches can be confused with psoriasis or discoid eczema. The history helps because this condition develops as an acute eruption and the patient can often point to a simple initial lesion the herald patch. Discoid eczema presents with itching and lesions with erythema, oedema, and crusting rather than scaling. Vesicles may be present. The rash persists unchanged. Clinical features of eczema

Urticaria

In this condition itching red weals develop they resemble the effects of stinging nettle (Urtica dioica) on the skin. The condition may be associated with allergic reactions, infection, or physical stimuli, but in most patients no cause can be found. Similar lesions may precede, or be associated with, vasculitis (urticarial vasculitis), pemphigoid, or dermatitis herpetiformis.

Clinical Features

In the prodromal, non-bullous phase manifestations of BP are frequently nonspecific and, thus, misleading. Patients complain of severe itch accompanied or not by excoriated, eczematiform, papular and or urticarial lesions that may persist for several weeks or months, or even remain the only signs of the disease. Several clinical variants of BP have been described (reviewed in Liu et al. 1986 Korman 1987). Lesions remain occasionally localized, such as on the pretibial area (pretibial pemphigoid), around stomas, on the vulvar region (vulvar pemphigoid), on irradiated areas or confined to a paralyzed limb. Palmo-plantar involvement mimicking dyshidrosiform eczema (dyshidrosi-form pemphigoid) might be observed. Several other variants, such as a prurigo nodularis - (pemphigoid nodularis), and an erythroderma-like form have been described. These variants have all been described with various

Therapy

Controlled clinical trials, dapsone is considered to be more effective than sul-fonamides such as sulphapyridine and sulphamethoxypyridazine. The initial dose of dapsone is approximately 1.5 mg kg daily and if no control of symptoms is achieved, the dose is usually increased by 50 mg daily every 2 weeks leading to a maximum dose of 400 mg daily (Fry 1988). If the skin rash has cleared, the dose should be tapered to the minimal dose required to suppress the symptoms. After a daily dose of 50 mg is achieved, the time interval between each dose should be increased before the drug is discontinued completely. When treating children, the recommended dose of dapsone is 2 mg kg per day (Prendiville and Esterly 1991). Side effects of dapsone include hemolytic anemia, methemoglobinemia and rarely agranulocytosis. Hemolysis occurs early in the treatment and a complete blood count is therefore checked two and four weeks after starting dapsone. Patients of Mediterranean ancestry should be screened...

Rashes

A skin rash generally poses more problems in diagnosis than a single, well defined skin lesion such as a wart or tumour. As in all branches of medicine a reasonable diagnosis is more likely to be reached by thinking firstly in terms of broad diagnostic categories rather than specific conditions. There may have been previous episodes because it is a constitutional condition, such as atopic eczema. In the case of contact dermatitis, regular exposure to a causative agent leads to recurrences that fit with the times of exposure and this is usually apparent from the history. Endogenous conditions such as psoriasis can appear in adults who have had no previous episodes. If there is no family history and several members of the household are affected, a contagious condition, such as scabies, should be considered. A common condition with a familial tendency, such as atopic eczema, may affect several family members at different times. A simplistic approach to rashes is to clarify them as being...

Curing Eczema Naturally

Curing Eczema Naturally

Do You Suffer From the Itching, Redness and Scaling of Chronic Eczema? If so you are not ALONE! It strikes men and women young and old! It is not just

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