Contact dermatitis (CD) is among the most common inflammatory dermatological conditions and includes allergic CD, photoallergic CD, irritant CD, photoirritant CD (also called phototoxic CD) and protein CD. Occupational CD can be of any type and is the most prevalent occupational skin disease. Each CD type is characterized by different immunological mechanisms and/or requisite exposures. Clinical manifestations of CD vary widely and multiple subtypes may occur simultaneously. The diagnosis relies on clinical presentation, thorough exposure assessment and evaluation with techniques such as patch testing and skin-prick testing. Management is based on patient education, avoidance strategies of specific substances, and topical treatments; in severe or recalcitrant cases, which can negatively affect the quality of life of patients, systemic medications may be needed.
Psoriasis is a skin disease that causes a rash with itchy, scaly patches, most commonly on the knees, elbows, trunk and scalp.
Psoriasis is a common, long-term (chronic) disease with no cure. It can be painful, interfere with sleep and make it hard to concentrate. The condition tends to go through cycles, flaring for a few weeks or months, then subsiding for a while. Common triggers in people with a genetic predisposition to psoriasis include infections, cuts or burns, and certain medications.
Treatments are available to help you manage symptoms. And you can try lifestyle habits and coping strategies to help you live better with psoriasis.
My practice was restricted to allergy, but I saw many patients with psoriasis. The red scaly patches made them think they had allergic dermatitis, eczema. Psoriasis on the arm is usually located on the elbow, and atopic dermatitis on the opposite side, in the flexural area. Thick, pitted fingernails are also common in psoriasis. It’s combination with arthritis is worrisome.
Psoriasis will usually develop first, and the psoriatic arthritis will follow years later, but 10% of the time the arthritis Is the first problem. This form of arthritis can be very painful, and cause deformities. It is often worse than rheumatoid arthritis, although does not affect as many joints, and is often asymmetrical. It inflames the area where tendons attach to the bone, which is one of the reasons that it can be more painful than rheumatoid arthritis.
Psoriasis is an autoimmune problem and can involve practically any organ in the body.
It is often associated with metabolic syndrome and diabetes.
Psoriatic arthritis does not have the rheumatoid serum markers that can help diagnose rheumatoid arthritis, and unless psoriasis is also present on the skin, it can be hard to diagnose.
Symptomatic treatment with NSAIDs, physical therapy, phototherapy and topical treatments can be helpful, but very expensive biologics are sometimes needed to help out methotrexate and other first line DMARDs (Disease modifying antirheumatic drugs).
This condition can be progressive. If you develop scaly red patches on your skin, be sure to check with the doctor about the possibility of psoriasis.
Moles are a common skin growth, and most are harmless. But changes in moles and other pigmented patches may be the sign of skin cancer, particularly melanoma.
When it comes to early detection, just remember the ABCDEs.
“A” is for asymmetry.
“You want moles to be perfectly symmetrical, such that you could put a mirror right down the middle of it and the image would look the same,” says Dr. Catherine Degesys, a Mayo Clinic dermatologist.
“B” stands for border.
“You want a nice crisp edge to these pigmented lesions and no scalloped edges or indistinct edges,” says Dr. Degesys.
“C” is for color.
“In general, you want moles to be a homogenous color and not have multiple different pigmented areas,” Dr. Degesys adds.
“D” represents the mole’s diameter. Pigmented lesions being greater than 6 millimeters potentially need further evaluation.
“E” is probably the most important, and that corresponds with evolution, says Dr. Degesys.
“Any pigmented lesion or any moles that are changing are something that really needs to be evaluated by a dermatologist.”
COMMENTARY:
Melanoma is a devastating disease, and must be picked up early to give you any chance.
The memnomic A-B-C-D-E is a reminder of the things you must watch in a dark freckle, or nevus, in order to suspect melanoma. Symmetry, border, color, diameter, and evolution reminds you of things that will alert you.
A-B-C is also a good mnemonic when it comes to evaluating an unconscious person, in order to address the order in which to proceed. Here, it is Airway, Breathing and Circulation. If the airway is blocked, it doesn’t matter whether or not the person is breathing, or the heart is beating, because if you’re not able to move air in and out of the lungs, the breathing attempts and heartbeat will do no good. Secondly, if you’re not breathing, the heart pumping will do no good. Another memnomic is A-B-CPR.
The third memnomic has to do with psychology. Here, it is Affect, Behavior and Cognition. Most activities of the brain can be put into one of these three different areas.
I’m sure there must be more memnomics in a world such as ours, and if you know of any, I would appreciate knowing about them.
Staphylococcus aureus is a highly successful – eg.BAD – disease producing bacterium, or “pathogen”. From the standpoint of the bacterium, it didn’t know it was so bad, and was merely producing factors that break down its surroundings to produce food for multiplication. Unfortunately, the proteins-ENZYMES- produced by the staphylococcus, In its effort to survive, can cause anything from diarrhea, abscesses, high fevers, shock, and kidney failure to death.
The staphylococcus was very successful for thousands of years, until slowed down by penicillin.
Penicillin attached itself to a critical part of the staphylococcal cell wall, which stopped the bacterium from functioning. The staphylococcus retaliated by producing an enzyme, penicillinase, that destroys penicillin. Humans responded by producing methicillin, which resisted destruction by the penicillinase. The Staph responded again by a genetic change in the target of penicillin, PBP, so that the Methicillin wouldn’t attach, hence the term methicillin resistant staphylococcus aureus, MRSA.
Interestingly, the MRSA can send little packets of genes called “plasmids” to other bacteria, even other species, which take in the packets and allow them to resist methecillin also. This is called horizontal transfer of resistance.
The staphylococcus aureus has many other ways of protecting itself, and is a good example of the various ways a bacterium can deal with antibiotics.
It can prevent the antibiotic from gaining entrance, or pump it out of the cell faster. It can destroy the antibiotic, as with penicillinase. It can modify the bacterial target of the antibiotic, as in the PBP that protects from penicillin. It can also develop an alternative metabolic pathway or structure to bypass the effect of the antibiotic.
THIS IS WAR, similar to the human kind. The offense develops the sword. The defense develops the shield. The offense develops mounted archery. The defense develops the castle and so on.
We’re not so very different from the bacteria, and in fact every single cell of our bodies has descended from an ancestral bacterial cell that engulfed another bacterium, which became the mitochondrion, a “slave cell” dedicated to producing thousands of times more energy than the simple bacterium, and leading to multicellular organisms.
Each organism develops appropriate defenses. Penicillium molds developed penicillin to protect themselves from bacteria and we took advantage of this. But it is a dynamic process, with both offense and defense having to adapt repeatedly over time.
In the next article, I will be discussing the bacterium Pseudomonas aeruginosa which is not as dynamic as the staph aureus; It specializes in people with problems, and is called a “facultative pathogen”.
However Pseudomonas is particularly good at exploiting its specialized habitat, which is increasing with the popularity of immunosuppressants and insertion of surgical hardware.
— Nature Reviews Disease Primers (@DiseasePrimers) May 8, 2022
Contact dermatitis happens when the skin becomes irritated or inflamed after coming in contact with a substance that triggers an allergic reaction. It bears some of the same symptoms as the six other types of eczema. But unlike atopic dermatitis — the most common and difficult-to-treat form of eczema — it doesn’t run in families and isn’t linked to other allergic conditions such as hay fever or asthma.
Alcohol. Alcohol can dilate the tiny blood vessels in the face, causing the face to flush. Drink in moderation only on special occasions, if at all. Not only can drinking alcoholic beverages cause flare-ups, but so can topically applied alcohol in various facial cleansing products. Always check product ingredients and avoid those containing alcohol or other overly drying ingredients.
Spicy or hot foods and drinks. Foods that contain spicy ingredients can affect the blushing areas of the face, leading to redness. If you love spicy food, go with mild spice and only enjoy these dishes on occasion. Since hot (temperature-wise) food and drinks often trigger facial flushing, you should allow your food or warm beverage to cool a bit before consuming.
Exercise. Regular exercise is important for everyone, but it’s also a common trigger for rosacea flare-ups. But don’t abandon your exercise routine. Rather, limit outdoor exercising to morning or evening hours to avoid midday heat and sun exposure. When exercising outdoors, use shaded trails for cycling or jogging. And always remember to keep yourself well hydrated.
Sun and wind exposure. Sun exposure, hot and cold temperatures and wind exposure frequently aggravate rosacea symptoms. Always wear a broad spectrum sunscreen when outside, even on cloudy days. If possible, stay inside on particularly hot, humid days. If you must venture out in the cold or wind, cover your cheeks and nose with a scarf.
Anxiety and stress. Stress and anxiety can cause rosacea symptoms to worsen, so use stress management techniques when needed. Make sure to get plenty of rest and practice deep breathing when you feel anxiety creeping up.
Skin cancer is the most common form of cancer in the United States. The good news is, this disease is extremely treatable if caught early. Cleveland Clinic experts break down the 3 main types of skin cancer and how you can spot the signs of each.
Chapters: 0:00 Intro 0:24 What does skin cancer look like? 0:49 What are the signs of skin cancer? 0:59 What are the types of skin cancer? 1:06 What is basal cell carcinoma? 1:35 What is squamous cell carcinoma? 1:52 What is melanoma? 2:26 When should you talk to your doctor about skin cancer?
Vitiligo is the loss of skin color in patches. Most often it is widespread. It tends to occur on the hands, or around the mouth, and can start where there are irritations or injuries to the skin, such as with tattoos. This generalized Vitteligo begins in middle age, but a more localized, or segmental Vitelligo can start earlier, and affect one area or side of the body.
Well-tanned skin, and skin with a darker color make the vitiligo stand out more prominently and give more trouble.
When I was a kid, I had a sort of reverse vitiligo, namely freckles. With freckles, the pigment gathers into small spotty areas, and leaves the rest of the skin without sunburn protection. I can attest to the fact that ANY kind of skin difference will lead to social problems; the main suffering with vitiligo is social.
Vitiligo is considered an autoimmune condition, and carries with it an increased likelihood of other autoimmune conditions, primarily thyroid and other endocrine.
Mimicking vitelligo, skin pigment can also disappear in areas of irritation or surface infection, such as in tinea versacolor and pityriasis alba. There is often a “halo” around a pigmented negus.
There are various treatments which aim to lighten up the surrounding skin area, or Increase pigmentation of the affected area. Such techniques use ultraviolet light, in combination with various various creams and medicines. Even surgery is sometimes used, so great it is the suffering of affected individuals.
Please refer to the accompanying article for more information.
Cryptococcus neoformans and gattii are fungi that most commonly infect people with immunodeficiency, especially AIDS, which is highly prevalent in Africa. Cryptococcus is the final cause of death in perhaps 25% of AIDS patients and preventative treatment is sometimes used if the lymphocyte count is too low.
It is an opportunistic fungus, with similarities to pneumocystis carina, which is discussed in a previous entry.
The areas in the body most commonly affected are the lungs, the skin, and the brain. The lung and skin, being exposed to the environment, are the most common entry points for the fungus, and the brain is a frequently involved area. Chronic meningitis, where the symptoms include headache, blurred vision, and confusion, is frequently caused by cryptococcus.
Sometimes, in healthy people, the skin can be infected with “pigeon breeders disease”. Pigeon droppings are a very common source of cryptococcus organisms.
Infection In the lung is usually restricted to immunocompromised individuals, who develop cough, shortness of breath, and fever. Pulmonary cryptococcosis is a slowly developing disease, can be mistaken for tuberculosis, and frequently gets into the bloodstream and then into the brain.
Treatment is usually with amphotericin B and flucytosine.
Our immune system contains cells that are part of us, and they evolved to protect us. They generally do a good job of this, as witnessed by our survival in a sea of viruses, microbes, and parasites.
However, just like our police force, occasionally the protective function goes awry and damage is done to our own body, in the protective act. For many years I was a practicing allergist, and observed this protective function misfiring. In allergic rhinitis and allergic asthma, tiny harmless particles in the air are interpreted by the body as a threat. The TH2 immune system, initially evolved to fight parasites, is activated, and causes considerable disease and misery.
Some of the antigenic determinants on the surface of the pollen, animal dander or dust particles are interpreted as being dangerous by the immune system, which causes chronic inflammation with acute allergy attacks.
Autoimmunity is a similar misreading, in which our own cells are deemed dangerous. In this case the immune agency is the more powerful Th-1 system, which often causes crippling or even fatal results.
Millions of people are sickened by an immune system that is supposed to defend them.
An article in the September 2021 issue of the Scientific American lists 76 of these disorders, and classifies them as to frequency, patient gender and age of onset. It is worth reviewing, at least for the listing on page 32 and 33.
Auto immunity must be considered as a possible cause in any illness that is not easily diagnosed, common, and well known to your doctor. Many patients have to be their own advocates, and persist in trying to get themselves diagnosed.
Celiac disease, Lupus, and Addison’s disease come to mind as tricky customers. Although “autoimmune disease” in toto is common, many of the individual diseases occur in less than one in 1000 patients, and are not high on the diagnostic list of most doctors.
The skin, nervous system, endocrine system, and digestive system are the most common areas involved. Recent advances in blood and antibody testing offers to give needed diagnostic help to the medical profession. These illnesses must be detected early to avoid functional loss in the tissues and organs affected.
Treatments are improving. In the past, immune suppressing cancer drugs and cortisone were the main drugs available. With increasing knowledge of the mechanisms of the separate diseases, treatment can be directed towards the specific causative antibody, receptor, or interleukin involved, hopefully with less side effects than the shotgun drugs previously available.
As with medicine in general, these modern treatments are excessively expensive as a rule, because much money and research went into their development. Prevention is obviously preferable. A healthy diet, with its attendant healthy microbiome comes to mind, as well as the avoidance of cigarette smoking and environmental toxins.
Proper sleep, exercise, and stress relief should also be helpful.
Doctors Without Waiting Rooms 