Management Of Skin & Nail Diseases
Topical therapy employs a vehicle (ointments, creams, lotions, gels) to deliver an active ingredient to the skin, to provide a protective barrier, or to hydrate and moisturize the skin.
There are many types of topical treatments, including:
- Antipruritics, e.g. calamine, are used to relieve itching
- Keratolytics, e.g. salicylic acid, urea, are used to remove hyperkeratotic skin
- Tars act by reducing the thickness of the epidermis
- Corticosteroids have anti-inflammatory and immunosuppressive effects that are useful in treating many skin disorders
- Calcipotriol (an analogue of 1,25-dihydroxycholecalciferol) reduces epidermal proliferation and is used in local treatment of plaque psoriasis
- Retinoids influence immune function and have some anti-inflammatory activity and are used in acne
- Sunscreens
- Antiseptics, e.g. benzoyl peroxide, chlorhexidine
- Antifungal agents
- Anaesthetics/analgesics
Frequently asked questions
Acne/Pimples Treatment
Acne or pimples can start around adolescence,an age of around 14 and last till the age of 30 yrs in some.
For pimples, after detailed investigation, investigations, patient is put on the package of 6 months to 9 mths, which includes consultations, medications, procedures.
Acne and Acne Scars are commonly seen problems in teenagers and young adults. But some people have the unfortunate hormonal constitution of facing acne related problems throughout their life. A recurring acne problem not only instigates irreparable damage to the skin but also to the mental condition of the sufferer.
Some of the most commonly faced problems related to acne are :
- A Recurrent acne outburst on face and other areas of the body like chest and back
- Atrophic scars – superficial scars in the infected and surrounding area; formed after acne heals
- Ice-pick scars – Very deep rooted scars formed after acne heals
- Redness and skin inflammation due to acne
- Deformation and disfigurement of tissue surrounding acne
Frequently asked questions
Acne is a skin disease whereas Pimple is one of the symptoms for the same.
The onset of Acne is brought by clogging of the skin pores often due to excessive release of oil in the body or from the dust in the atmosphere. Naturally it leads to the formation of the plugged pores called as blackheads, nodules, whiteheads, cysts, or pimples. Usually it appears on the face, but it could also be found on chest, neck, shoulders, back, and arms.
Pimples are red, inflamed and infected plugged oil glands, sometimes filled with pus. This is the most common form of Acne and thus has gained a synonym for itself. However the bacterial growth inside these clogged pores are reasons for its red color and eventually we can see a white fluid accumulate on the surface.
Ringworm/Fungal Infection
What is Ringworm ?
Ringworm, also known as dermatophytosis or tinea, is a fungal infection of the skin. The name “ringworm” is a misnomer, since the infection is caused by a fungus, not a worm.
Ringworm infection can affect both humans and animals. The infection initially presents with red patches on affected areas of the skin and later spreads to other parts of the body. The infection may affect the skin of the scalp, feet, groin, beard, or other areas.
Recognizing Ringworm
Symptoms vary depending on where you’re infected. With a skin infection, you may experience the following:
- red, itchy, scaly, or raised patches
- patches that develop blisters or begin to ooze
- patches that may be redder on the outside edges or resemble a ring
- patches with edges that are defined and raised
If you’re experiencing dermatophytosis in your nails, they may become thicker or discolored, or they may begin to crack. If the scalp is affected, the hair around it may break or fall off, and bald patches may develop.
Types of Ringworm
Ringworm can go by different names depending on the part of the body affected.
- Ringworm of the scalp (tinea capitis) often starts as small sores that develop into itchy, scaly bald patches. It is most common among children.
- Ringworm of the body (tinea corporis) often appears as patches with the characteristic round “ring” shape.
- Jock itch (tinea cruris) refers to ringworm infection of the skin around the groin, inner thighs, and buttocks. It is most common in men and adolescent boys.
- Athlete’s foot (tinea pedis) is the common name for ringworm infection of the foot. It is frequently seen in people who go barefoot in public places where the infection can spread, such as locker rooms, showers, and swimming pools.
How long does Ringworm last?
Skin medications may clear ringworm in two to four weeks. If you’re experiencing severe dermatophytosis that isn’t responding to over-the-counter treatments or treatment at home, your doctor may prescribe antifungal pills to clear up the infection. Most people respond positively to treatment.
Preventing ringworm
You can prevent ringworm by practicing healthy and hygienic behaviors. Many infections come from contact with animals and lack of proper hygiene. Tips to avoid ringworm include:
- Wash your hands after interacting with an animal.
- Disinfect and clean pet living areas.
- Shower and shampoo your hair regularly.
- Wear shoes if showering in community areas.
- Avoid sharing personal items like clothing or hairbrushes with people who might have ringworm.
- Keep your feet clean and dry.
Psoriasis Treatments
Psoriasis treatments
Psoriasis treatments reduce inflammation and clear the skin. Treatments can be divided into three main types: topical treatments, light therapy and systemic medications.
Topical treatments
Used alone, creams and ointments that you apply to your skin can effectively treat mild to moderate psoriasis. When the disease is more severe, creams are likely to be combined with oral medications or light therapy. Topical psoriasis treatments include:
- Topical corticosteroids. These drugs are the most frequently prescribed medications for treating mild to moderate psoriasis. They reduce inflammation and relieve itching and may be used with other treatments.Mild corticosteroid ointments are usually recommended for sensitive areas, such as your face or skin folds, and for treating widespread patches of damaged skin.Your doctor may prescribe stronger corticosteroid ointment for smaller, less sensitive or tougher-to-treat areas.Long-term use or overuse of strong corticosteroids can cause thinning of the skin. Topical corticosteroids may stop working over time. It’s usually best to use topical corticosteroids as a short-term treatment during flares.
- Vitamin D analogues. These synthetic forms of vitamin D slow skin cell growth. Calcipotriene (Dovonex) is a prescription cream or solution containing a vitamin D analogue that treats mild to moderate psoriasis along with other treatments. Calcipotriene might irritate your skin. Calcitriol (Vectical) is expensive but may be equally effective and possibly less irritating than calcipotriene.
- Anthralin. This medication helps slow skin cell growth. Anthralin (Dritho-Scalp) can also remove scales and make skin smoother. But anthralin can irritate skin, and it stains almost anything it touches. It’s usually applied for a short time and then washed off.
- Topical retinoids. These are vitamin A derivatives that may decrease inflammation. The most common side effect is skin irritation. These medications may also increase sensitivity to sunlight, so while using the medication apply sunscreen before going outdoors.The risk of birth defects is far lower for topical retinoids than for oral retinoids. But tazarotene (Tazorac, Avage) isn’t recommended when you’re pregnant or breast-feeding or if you intend to become pregnant.
- Calcineurin inhibitors. Calcineurin inhibitors — tacrolimus (Prograf) and pimecrolimus (Elidel) — reduce inflammation and plaque buildup.Calcineurin inhibitors are not recommended for long-term or continuous use because of a potential increased risk of skin cancer and lymphoma. They may be especially helpful in areas of thin skin, such as around the eyes, where steroid creams or retinoids are too irritating or may cause harmful effects.
- Salicylic acid. Available over-the-counter (nonprescription) and by prescription, salicylic acid promotes sloughing of dead skin cells and reduces scaling. Sometimes it’s combined with other medications, such as topical corticosteroids or coal tar, to increase its effectiveness. Salicylic acid is available in medicated shampoos and scalp solutions to treat scalp psoriasis.
- Coal tar. Derived from coal, coal tar reduces scaling, itching and inflammation. Coal tar can irritate the skin. It’s also messy, stains clothing and bedding, and has a strong odor.Coal tar is available in over-the-counter shampoos, creams and oils. It’s also available in higher concentrations by prescription. This treatment isn’t recommended for women who are pregnant or breast-feeding.
- Moisturizers. Moisturizing creams alone won’t heal psoriasis, but they can reduce itching, scaling and dryness. Moisturizers in an ointment base are usually more effective than are lighter creams and lotions. Apply immediately after a bath or shower to lock in moisture.
Light therapy (phototherapy)
This treatment uses natural or artificial ultraviolet light. The simplest and easiest form of phototherapy involves exposing your skin to controlled amounts of natural sunlight. Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light, either alone or in combination with medications.
- Sunlight. Exposure to ultraviolet (UV) rays in sunlight or artificial light slows skin cell turnover and reduces scaling and inflammation. Brief, daily exposures to small amounts of sunlight may improve psoriasis, but intense sun exposure can worsen symptoms and cause skin damage. Before beginning a sunlight regimen, ask your doctor about the safest way to use natural sunlight for psoriasis treatment.
- UVB phototherapy. Controlled doses of UVB light from an artificial light source may improve mild to moderate psoriasis symptoms. UVB phototherapy, also called broadband UVB, can be used to treat single patches, widespread psoriasis and psoriasis that resists topical treatments. Short-term side effects may include redness, itching and dry skin. Using a moisturizer may help decrease these side effects.
- Narrow band UVB phototherapy. A newer type of psoriasis treatment, narrow band UVB phototherapy may be more effective than broadband UVB treatment. It’s usually administered two or three times a week until the skin improves, and then maintenance may require only weekly sessions. Narrow band UVB phototherapy may cause more-severe and longer lasting burns, however.
- Goeckerman therapy. Some doctors combine UVB treatment and coal tar treatment, which is known as Goeckerman treatment. The two therapies together are more effective than either alone because coal tar makes skin more receptive to UVB light.
- Psoralen plus ultraviolet A (PUVA). This form of photochemotherapy involves taking a light-sensitizing medication (psoralen) before exposure to UVA light. UVA light penetrates deeper into the skin than does UVB light, and psoralen makes the skin more responsive to UVA exposure.This more aggressive treatment consistently improves skin and is often used for more-severe cases of psoriasis. Short-term side effects include nausea, headache, burning and itching. Long-term side effects include dry and wrinkled skin, freckles, increased sun sensitivity, and increased risk of skin cancer, including melanoma.
- Excimer laser. This form of light therapy, used for mild to moderate psoriasis, treats only the involved skin without harming healthy skin. A controlled beam of UVB light is directed to the psoriasis plaques to control scaling and inflammation. Excimer laser therapy requires fewer sessions than does traditional phototherapy because more powerful UVB light is used. Side effects can include redness and blistering.
Oral or injected medications
If you have severe psoriasis or it’s resistant to other types of treatment, your doctor may prescribe oral or injected drugs. This is known as systemic treatment. Because of severe side effects, some of these medications are used for only brief periods and may be alternated with other forms of treatment.
- Retinoids. Related to vitamin A, this group of drugs may help if you have severe psoriasis that doesn’t respond to other therapies. Side effects may include lip inflammation and hair loss. And because retinoids such as acitretin (Soriatane) can cause severe birth defects, women must avoid pregnancy for at least three years after taking the medication.
- Methotrexate. Taken orally, methotrexate (Rheumatrex) helps psoriasis by decreasing the production of skin cells and suppressing inflammation. It may also slow the progression of psoriatic arthritis in some people. Methotrexate is generally well-tolerated in low doses but may cause upset stomach, loss of appetite and fatigue. When used for long periods, it can cause a number of serious side effects, including severe liver damage and decreased production of red and white blood cells and platelets.
- Narrow band UVB phototherapy. A newer type of psoriasis treatment, narrow band UVB phototherapy may be more effective than broadband UVB treatment. It’s usually administered two or three times a week until the skin improves, and then maintenance may require only weekly sessions. Narrow band UVB phototherapy may cause more-severe and longer lasting burns, however.
- Cyclosporine. Cyclosporine (Gengraf, Neoral) suppresses the immune system and is similar to methotrexate in effectiveness, but can only be taken short-term. Like other immunosuppressant drugs, cyclosporine increases your risk of infection and other health problems, including cancer. Cyclosporine also makes you more susceptible to kidney problems and high blood pressure — the risk increases with higher dosages and long-term therapy.
- Drugs that alter the immune system (biologics). Several of these drugs are approved for the treatment of moderate to severe psoriasis. They include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), ustekinumab (Stelara), golimumab (Simponi), apremilast (Otezla), secukinumab (Cosentyx) and ixekizumab (Taltz). Most of these drugs are given by injection (apremilast is oral) and are usually used for people who have failed to respond to traditional therapy or who have associated psoriatic arthritis. Biologics must be used with caution because they have strong effects on the immune system and may permit life-threatening infections. In particular, people taking these treatments must be screened for tuberculosis.
- Other medications. Thioguanine (Tabloid) and hydroxyurea (Droxia, Hydrea) are medications that can be used when other drugs can’t be given.
Treatment considerations
Although doctors choose treatments based on the type and severity of psoriasis and the areas of skin affected, the traditional approach is to start with the mildest treatments — topical creams and ultraviolet light therapy (phototherapy) — in those patients with typical skin lesions (plaques) and then progress to stronger ones only if necessary. Patients with pustular or erythrodermic psoriasis or associated arthritis usually need systemic therapy from the beginning of treatment. The goal is to find the most effective way to slow cell turnover with the fewest possible side effects.
Potential future treatments
There are a number of new medications currently being researched that have the potential to improve psoriasis treatment. These treatments target different proteins that work with the immune system.
Alternative medicine
A number of alternative therapies claim to ease the symptoms of psoriasis, including special diets, creams, dietary supplements and herbs. None have definitively been proved effective. But some alternative therapies are deemed generally safe, and they may be helpful to some people in reducing signs and symptoms, such as itching and scaling. These treatments would be most appropriate for those with milder, plaque disease and not for those with pustules, erythroderma or arthritis.
- Aloe vera. Taken from the leaves of the aloe vera plant, aloe extract cream may reduce redness, scaling, itching and inflammation. You may need to use the cream several times a day for a month or more to see any improvements in your skin.
- Fish oil. Omega-3 fatty acids found in fish oil supplements may reduce inflammation associated with psoriasis, although results from studies are mixed. Taking 3 grams or less of fish oil daily is generally recognized as safe, and you may find it beneficial.
- Oregon grape. Also known as barberry, topical applications of Oregon grape may reduce inflammation and ease psoriasis symptoms.
- If you’re considering dietary supplements or other alternative therapy to ease the symptoms of psoriasis, consult your doctor. He or she can help you weigh the pros and cons of specific alternative therapies.
Pigmentation Diseases
Pigmentation of the skin normally varies according to racial origin and the amount of sun exposure. Pigmentation disorders are often more troublesome in skin of colour.
The pigment cells or melanocytes are located at the base of the epidermis and produce the protein melanin. Melaninis carried by keratinocytes to the skin surface. The melanocytes of dark skinned people produce more melanin than those of people with light skin. More melanin is produced when the skin is injured, for example following exposure to ultraviolet radiation. The melaninisation process in dark skin is protective against sun damage, but melanisation in white skin (for example after sunburn) is much less protective.
Causes Of Pigmentation
- Hormonal effects of oestrogen during pregnancy or due to medication can cause pigmentation of nipples, vulva and abdomen (linea nigra).
- Some skin diseases and conditions result in generalised or localised hyperpigmentation (increased skin colour), hypopigmentation (reduced skin colour), or achromia (absent skin colour).
- A Wood lamp may be used to assess pigmentation during the examination of the skin, as pigmentary changes are often easier to identify while exposing the affected skin to long wavelength ultraviolet rays (UV-A).or patchy missing skin color. Infections, blisters and burns can also cause lighter skin.
Pigmentation means coloring. Skin pigmentation disorders affect the color of your skin. Your skin gets its color from a pigment called melanin. Special cells in the skin make melanin. When these cells become damaged or unhealthy, it affects melanin production. Some pigmentation disorders affect just patches of skin. Others affect your entire body.
If your body makes too much melanin, your skin gets darker. Pregnancy, Addison’s disease, and sun exposure all can make your skin darker. If your body makes too little melanin, your skin gets lighter. Vitiligo is a condition that causes patches of light skin. Albinism is a genetic condition affecting a person’s skin. A person with albinism may have no color, lighter than normal skin color.