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Diagnosing Skin Disease
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
A variety of causes are associated with blistering dermatosis, including autoimmune, infectious, and inflammatory etiologies. Autoantibodies against desmogleins 1 and 3, which are components of desmosomes that keep keratinocytes attached to one another, resulting in acantholysis, or a loss in intercellular connections, and can lead to intraepidermal blisters. In contrast, autoantibodies against components of hemidesmosomes of the dermo-epidermal junction in bullous pemphigoid result in subepidermal blisters (Figure 2.6). Herpesvirus infection of the epidermis may result in acantholysis and varying degrees of epidermal necrosis, which can lead to intraepidermal or subepidermal blisters. Significant intercellular edema in allergic contact or nummular dermatitis results in intraepidermal blisters. Any process that weakens the dermo-epidermal junction may result in a subepidermal blister (Figure 2.7). Severe dermal edema from a variety of sources may also result in a subepidermal blister (e.g., lymphedema blister, bullous insect bite, and bullous Sweet syndrome). Depending on the severity and acuity, most interface dermatitides, which are associated with a variable degree of necrosis of keratinocytes at the dermo-epidermal junction, have a subepidermal bullous expression. Examples include bullous erythema multiforme, bullous lichen planus, and bullous fixed-drug eruption.
Therapeutic effectiveness
Published in Dinesh Kumar Jain, Homeopathy, 2022
Now it can be said that various skin diseases tend to recover spontaneously which confuses Hahnemann. Herpes zoster spontaneously resolves in three to four weeks, chickenpox in three to four weeks; pityriasis rosea, a papulosquamous disease which recovers in six to seven weeks; pityriasis alba – a kind of eczematous disorder in which children get hypopigmented spots usually disappears after puberty. Acne vulgaris usually disappears after the age of 25 years. Alopecia areata is the commonest cause of patchy hair loss. It is a self-limiting disease. It usually recovers in four to six months. Majority of the cases having infective dermatosis also tend to recover even if no treatment is given. Patients having pyoderma, dermatophyte infection, and candidiasis tend to improve with the onset of winter without any treatment. Herpes simplex usually disappears in one to two weeks but the virus may reactivate again in a few patients. Facial warts may disappear in most of cases without any treatment in three to six months. Molluscum contagiosum can disappear in more than 50% cases without treatment in three to six months.
Skin disorders causing post-inflammatory hypopigmentation
Published in Electra Nicolaidou, Clio Dessinioti, Andreas D. Katsambas, Hypopigmentation, 2019
Polytimi Sidiropoulou, Dimitrios Sgouros, Dimitris Rigopoulos
Pityriasis alba (PA), a common benign condition, typically occurs during childhood and adolescence, affecting 1% of the general and 9.9% of the pediatric population. Although its pathogenesis remains unknown, it is included among PIH disorders. Excessive sun exposure, skin dryness, and atopic predisposition are strongly implicated in the development of PA. Clinically, the condition is characterized by ill-defined, round to oval, slightly scaly macules and patches with mild to moderate hypopigmentation. The lesions vary in size from 0.5 to 3 cm, but larger lesions can also occur. The face, especially the malar region, is the most frequent site of involvement, but lesions can occasionally develop on the neck, trunk, and extremities. This dermatosis is usually asymptomatic, but some patients complain of itching and burning. Under Wood's lamp examination, the lesions are enhanced. Histopathology of the affected skin reveals subacute spongiotic dermatitis along with reduced numbers of active melanocytes and a decrease in the number and size of melanosomes. Topical corticosteroids may be beneficial, but emollients seem to be equally effective. Recent data reported perfect results with topical calsineurin inhibitors (pimecrolimus, tacrolimus) as well as calcipotriol. Sun protection is of the utmost importance. The hypopigmented patches often remain stable for several months or years and may become more apparent during the summer period when the surrounding skin is tanned. The condition usually, but not always, resolves spontaneously after puberty.4–6,10,13
Mycophenolate mofetil and mycophenolic acid for the treatment of eosinophilic fasciitis: report of two cases and literature review
Published in Journal of Dermatological Treatment, 2022
Ilse Andrea Moreno-Arquieta, Jesus Alberto Cardenas-de la Garza, Jorge Antonio Esquivel-Valerio, Janett Riega-Torres, Adrian Cuellar-Barboza, Maira Elizabeth Herz-Ruelas, Jorge Ocampo-Candiani, Dionicio Angel Galarza-Delgado
A 45-year-old woman was referred to the Rheumatology Department with a disseminated dermatosis. She stated that the dermatosis had started one-and-a-half-years previously in both legs and arms with subsequent proximal spreading. She denied arthritis, Raynaud’s phenomenon, or additional systemic symptoms. Physical examination revealed symmetrical and bilateral hyperpigmented indurated plaques on the arms and legs with involvement of the lower third of the abdominal wall and the presence of the groove sign on the right thigh. Laboratory analyses revealed an elevated ESR, eosinophils within normal limits, and negative anti-nuclear, anti-scleroderma-70, and anticentromere antibodies. She had previously received methotrexate (MTX), high-dose oral corticosteroids, and 6 sessions of PUVA phototherapy with no response. MPA was initiated 1 g/day and tittered up to 2 g/day along with prednisone (PDN) 40 mg/day which were tapered over 4 months. No progression was noted at the two-month follow-up. A complete clinical response was noted after 6 months of treatment.
Fractional CO2 laser therapy of lichen sclerosus in males: a new therapeutic opportunity?
Published in Journal of Dermatological Treatment, 2022
Francesca Ferrara, Stefano Messori, Diego Abbenante, Annalisa Patrizi, Federico Bardazzi
The first studies on the use of laser as LS therapy were carried out in the late 1980s. According to these reports, patients with this type of dermatosis were subjected to vaporization sessions using ablative laser treatments. The wounds could subsequently heal by secondary intention, with the purpose to promote the growth of the healthy surrounding tissue (11). A quite promising study regarding male lichen sclerosus was conducted on 62 men suffering from this disease; they were all subjected to vaporization treatment and showed considerable benefits in both controlling symptoms and in the long-term regression of the pathology as well (12). Fractional CO2 laser is an ablative, surgical type of laser, that needs to be used with special handling, so as to split the light beam: the main photon beam is supposed to be divided into many smaller streams of energy that hit the affected skin region at many different spots, threreby allowing its distribution over a broad area (13).
Efficacy of 30% azelaic acid peel in the nonpharmacological treatment of facial acne
Published in Journal of Dermatological Treatment, 2021
Anna Szymańska, Elzbieta Budzisz, Anna Erkiert-Polguj
Therapeutic difficulties in patients with acne vulgaris result from the multifactorial etiopathogenesis of the disease. The skin condition is affected by both exogenous and endogenous factors. The most important ones for the evolution of dermatosis are genetic conditions, hypertrophy of sebaceous glands, and their excessive activity, keratinization disorders in the sebaceous glands, as well as abnormal growth of bacterial flora. Endocrine disorders may also affect the progress of the disease (1,2,9,10). The influence of hormonal management on the appearance or exacerbation of the disease is particularly evident in patients during changes in hormone levels that occur physiologically in the course of the menstrual cycle. The so-called premenstrual exacerbation is particularly visible in the acne of adult women after the age of 33 years (11–13).