Diagnosing Skin Disease
Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang in 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.
Skin disorders causing post-inflammatory hypopigmentation
Electra Nicolaidou, Clio Dessinioti, Andreas D. Katsambas in Hypopigmentation, 2019
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
Therapeutic effectiveness
Dinesh Kumar Jain in 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.
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).
Clinical contribution of myositis-related antibodies detected by immunoblot to idiopathic inflammatory myositis: A one-year retrospective study
Published in Autoimmunity, 2018
Marie Lecouffe-Desprets, Caroline Hémont, Antoine Néel, Claire Toquet, Agathe Masseau, Mohamed Hamidou, Regis Josien, Jérôme C. Martin
The following IIM symptoms were systematically assessed for every patient:Muscle. Signs of objective proximal muscle fatigue or weakness, and/or elevated muscle enzymes (creatinine phosphokinase (CPK) > 171 IU/ml);Joints. Presence of inflammatory joint pain and/or arthritis;Skin. Presence of typical dermatomyositis (DM) lesions as defined by rash predominant on photo-exposed skin, mid-face erythema, rash along the eyelid margins with or without periorbital edema, dorsal hands rash particularly over the knuckles (Gottron’s papules), changes in the fingers nail folds, Raynaud’s phenomenon, scleroderma-like skin condition (skin fibrosis, sclerodactyly, telangiectasia), digital ulcers, “mechanics hands”;Lungs. Presence of interstitial lung disease (ILD) objectively determined by computed tomography (CT) scan.
Topical treatment for postinflammatory hyperpigmentation: a systematic review
Published in Journal of Dermatological Treatment, 2022
Marcus G. Tan, Whan B. Kim, Christine E. Jo, Karina Nabieva, Carly Kirshen, Arisa E. Ortiz
Erythema, as a clinical indicator of inflammation, is more difficult to appreciate in darker skin phenotypes, and is a risk for under-recognition and under-treatment (21). Topical corticosteroids had high quality studies supporting their use in PIH, suggesting that there was likely subclinical inflammation perpetuating the hyperpigmentation in those with longstanding disease. PIH following stasis dermatitis is due to dermal hemosiderophages, in addition to melanin incontinence, which would account for the lack of efficacy seen with corticosteroids (22). Clinicians should first attempt to identify and treat the underlying dermatosis resulting in PIH, prior to initiating treatment for PIH. Topical retinoids and hydroxy acids also have the potential to cause or worsen PIH. Hence, it is critical that any preexisting inflammation is properly treated.
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