Effective Home Remedies For Skin Pigmentation
Thanks to the positive reception of the first edition of the book by the medical community both in Europe and in the USA, the present book has come to its second edition. All the chapters have been thoroughly revised and two new chapters on Vitiligo and Alopecia areata were included.
Characteristic antibodies of AIH type 2 are liver kidney microsomal antibodies (LKM-1) directed against cytochrome P450 (CYP)2D6 and, with lower frequency, against UDP-glucuronosyltransferases (UGT) 35 . In 10 of cases, LKM-3 autoantibodies against UGTs are also present 36, 37 . In contrast to AIH type 1, additional organ-specific autoantibodies are frequently present, such as anti-thyroid, anti-parietal cell, and anti-Langerhans' cell autoantibodies. The number of extrahepatic autoimmune syndromes such as diabetes, vitiligo, and autoimmune thyroid disease is also more prevalent compared to AIH type1 34 .
VITILIGO Vitiligo is thought to be an autoimmune disease in which the melanocytes at the border of the dermis and epidermis are destroyed. It tends to occur around orifices, and genital skin involvement sometimes occurs before involvement of other parts of the body. It is characterised by patches of sharply demarcated milk white skin with no signs of texture change.
Each participant was asked questions about the various symptoms, socioeconomic status, the dietary habits, addiction, past history of major illness, and history of parasitic infestation. A thorough clinical examination of each participant was carried out taking special care to detect skin pigmentation and keratosis, and enlargement of the liver. Specific symptoms like weakness, abdominal pain or nausea (suggesting affection of the alimentary system), tingling and numbness (paresthesia, suggestive of nervous system disorder) were also recorded.
The first interim analysis of this series was published in 1993 (Mayer and Nemeskeri 1993). With a median follow-up time of 3.8 years, 8 of 44 patients (18 ) had developed a LR. Because of poor cosmetic results (a high incidence of changes in skin pigmentation, development of telangiectasias, and fibrosis), the study was closed in 1992 (Mayer and Nemeskeri 1993 Poti et al. 2004). Updated 12-year results of this series showed that the crude LR rate was 24 , with 59 of patients having grade 3 or 4 complications (Poti et al. 2004).
Ash leaf spots are found on the skin of the trunk, buttocks, and limbs in children with tuberous sclerosis. These dull, white areas may be linear or oval, measuring 1 cm across or less. They tend to be sharply pointed at one end and rounded at the other. Cafe-au-lait spots may be present. Ash leaf spots lack the characteristic milky-white appearance of lesions of vitiligo because melanocytes are present in fair numbers but the melanosomes are poorly pigmented.
The timing and pace of pubertal development and its relation to complaints of unwanted hair growth, hair loss, acne, and or obesity should be established. The onset and progression of these complaints should also be established. Drug or medication use and exposure or use of skin irritants should be elicited. A detailed menstrual history should be obtained, with an emphasis on determining whether evidence of ovulatory function (e.g., premenstrual molimina) is present. Change in skin pigmentation or texture, extremity or head size, and changes in facial contour should be noted. A detailed family history of endocrine, reproductive, or metabolic disorders should be obtained. A family history of similar hyperandrogenic signs and symptoms is a powerful clue to the inherited basis of the disorder, although a familial association can be noted for PCOS, HAIR-AN syndrome, NCAH, and IH patients. Clinicians should note that the etiology of hirsutism can often be suspected from the history alone....
Those patients who are symptomatic at the time of diagnosis tend to be older than 40 years of age and are predominantly male. Weakness, lethargy, abdominal pain, arthralgias, and loss of libido are common. The arthropathy seen in HFE-associated HH tends to be symmetric and involves multiple joints. Specifically, the proximal inter-phalangeal, metacarpophalangeal, wrist, knee and vertebral joints are most commonly involved. Hepatomegaly and cirrhosis may be present, along with skin pigmentation and clinical diabetes.
Medieval attitudes towards the leper were based on biblical passages pertaining to ''leprosy,'' a vague term applied to various chronic, progressive skin afflictions, from leprosy and vitiligo to psoriasis and skin cancer. The leper, according to medieval interpretations of the Bible, was ''unclean'' and, therefore, a dangerous source of physical and moral pollution. Biblical rules governing leprosy demanded that persons and things with suspicious signs of leprosy must be brought to the priests for examination. Leprosy was said to dwell not only in human beings, but also in garments of wool or linen, objects made of skins, and even in houses. Diagnostic signs included a scaly eruption, boil, scab, or bright spot. When the signs were ambiguous, the priest shut the suspect away for as long as two weeks for further observations. When a final judgment had been reached, the leper was instructed to dwell in isolation and call out as a warning to those who might approach him, ''unclean,...
Monoclonal expansion of T-cells may be indicative for antigen-driven process either in blood or in tissue. Since each monoclonal TCR can be molecularly defined (see above), a molecular probe specific for the respective CDR3 region can be designed and the individual T-cell clone can either be traced in different compartments or longitudinally over time in a patient. This methodology has been used to tag clonal T-cell populations in autoimmune myositis (25), or in patients with multiple sclerosis (MS) suggesting that expansion of certain TCR VB families may be associated with disease onset or progression (26, 27). Similarly, if a monoclonal T-cell response can be linked to MHC peptide recognition, it allows to visualize monoclonal TCRs with defined specificity in situ, e.g. in a patient with melanoma responding to peptide vaccination An TCR VB16+ Melan-A MART-1 reactive T-cell clone could be demonstrated in a vitiligo lesion associated with destruction of melanin-positive cells (i.e....
Laser and light-assisted hair removal is based on the principle of selective photothermolysis. Selective absorption by hair chromophores of energy from lasers and broadband light sources may result in destruction of hair follicles while leaving the skin undamaged, although there are significant differences according to the specific characteristics of the patients and techniques used (8). In general, laser therapy is more effective in women with darker hair and lighter skin. Efficacy is lower and complications are more common in women with darker skin. Transient erythema and edema are common after laser therapy, and blistering, crusting, or alterations in skin pigmentation may also occur.
Therapy for HH is relatively simple and quite effective. Phlebotomy has been shown to effectively remove excess iron stores without significant side effects. If therapeutic phlebotomy is started before the development of cirrhosis, morbidity and mortality are significantly reduced. Some clinical features of iron overload respond better to phlebotomy than others. Malaise, fatigue, abdominal pain, skin pigmentation, and insulin requirements in diabetic patients tend to improve, whereas arthropathy and hypogonadism are less responsive. Given these findings, early identification and initiation of therapeutic phlebotomy should be the goal.
Thyroid disease is associated with changes in the skin, which may sometimes be the first clinical signs. There may be evidence of the effect of altered concentrations of thyroxine on the skin, with changes in texture and hair growth. Associated increases in thyroid stimulating hormone concentration may lead to pretibial myxoedema. In autoimmune thyroid disease vitiligo and other autoimmune conditions may be present.
Collagenous and lymphocytic colitis are clinicopatho-logic syndromes that represent distinct, possibly autoimmune, forms of idiopathic inflammatory colonic bowel disease. Both disorders present as chronic, watery, noninfectious diarrhea in middle-aged patients with negative radiographic and endoscopic studies. Collagenous colitis predominantly occurs in women lymphocytic colitis is found equally in both genders. Often there is intermittent, diffuse abdominal pain, and, not surprisingly, some patients have a previous diagnosis of irritable bowel syndrome (IBS). Routine blood studies generally show normal results, but elevations in the Westergren sedimentation rate and eosinophil count are not uncommon. Abnormalities in complement levels, serum immunoglobulins (Igs), and pANCA (antineutrophil cytoplasmic antibodies) may be found. Although stool studies are negative for pathogens and blood, up to 55 of patients have white blood cells in stool samples. Other medical conditions reported to...
Three groups of patients will present clinically for evaluation of HH. The first group includes symptomatic patients presenting with stigmata of chronic liver disease and elevated iron indices. This group also includes diabetic patients with hepatomegaly, patients with evidence of cardiac dysfunction, skin pigmentation or sexual dysfunction, and patients presenting with de novo sexual dysfunction or symmetric polyarthropathy. The second group comprises asymptomatic patients who present with abnormal
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