Friday, November 8

Skin diseases - Skin disorders - Skin problems

Skin diseases, disorders and problems
Skin, the outermost organ of the human body, often gets affected by external environmental factors, invading microbes, internal physiological factors and hereditary conditions.
Many skin diseases, disorders and problems resolve by themselves, requiring no treatment. However some situations require medical intervention in order to stop aggravation of the skin disease. The basic knowledge of the various skin disorders and their differentiation guides us in the follow up action to be taken.

Acne scars

Acne scars are either hypertrophic or atrophic. The tissue repair mechanism of the skin based on the level of inflammation and damage causes either of the two types of acne scars. Hypertrophic types of scars are characterized by raised thickened tissue formation on the skin. Atrophic types of scars are depressed areas of skin.

In hypertropic types of acne scars there is over production of collagen and increased tissue formation resulting in raised level of skin. Atrophic types of scars are characterized by loss of skin tissue.

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Albinism

Albinism is an inherited disorder wherein little or no pigment is produced by the body, affecting the color of the skin, eyes and hair. Albinism is usually associated with debilitating health and vision issues. This genetic disorder is found to affect individuals of all racial and ethnic backgrounds.

Albinism involves different genes and hence there are different types. In oculocutaneous albinism (OCA) pigmentation of the skin, hair and eyes is affected. Ocular albinism (OA) is a rare disorder wherein only the pigment in the eyes is affected.

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Angioedema

Allergic reaction to food or medicines can cause edema and swelling of the subcutaneous tissue, known as angioedema. Unlike the allergic reactions in hives which are superficial, angioedema reactions are below the skin. The angioedema swellings may range from small spots to large lesions of several inches in diameter.

Angioedema swellings usually occur on the face, around the eyes and lips, inside the mouth and throat and on the tongue. Swellings affecting the mouth and throat may block the airway and become life threatening.

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Argyria

The presence of silver in the body causes a rare blue skin disorder known as argyria. Protracted excessive exposure to metallic silver, silver salts and silver compounds or their ingestion causes argyria. Apart from skin, sclera, conjunctiva, mucous membranes, nail beds, gums and visceral organs also may get affected with argyria.

Generalized form of argyria results from ingestion of silver salts and silver compounds for prolonged periods. Localized argyria is caused when there is continuous localized excessive skin contacts with silver and its compounds.

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Chronic hives

Hives (aka urticaria) are itchy pink-red welts (wheals) appearing on the skin. If the problem of swelling and redness persists or recurs for more than six weeks, it is considered chronic. Allergic reactions triggered by food, chemicals, physical stimuli or medicines cause hives.

However on many incidences the cause and the trigger are not known or idiopathic. The lesions are pink-red in color and appear as well-marked round, oval or generalized raised skin swellings. In some patients it may last or recur for years.

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Cellulitis

Cellulitis is the 'inflammation of the cells' of dermal and subcutaneous tissues. The inflammation is usually caused by Streptococcus pyogenes and Staphylococcus aureus. The area of skin affected by cellulitis is characterized by swelling, redness and pain. If the infection is severe, the inflammation is accompanied by febrile illness.

Cellulitis caused by the streptococcus and staphylococcus bacteria spreads fast due to the availability of the cell nutrients. The release of the metabolic wastes, toxins and enzymes by the microbes damage the surrounding skin tissues.

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Fordyce spots

Some sebaceous glands on the skin are formed without connection to hair follicles. They are known as Fordyce spots (Fordyce granules or Fordyce disease). Fordyce spots are named after John Addison Fordyce, an American dermatologist. Fordyce granules are ectopic glands and open directly onto the skin surface.

Fordyce spots are seen in both men and women, but are very common in men and about 80% of them have it. Fordyce spots are benign, painless and usually appear as small raised pale, white bumps on the skin on lips, nipple or genitalia.

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Hemangioma

Hemangioma meaning 'blood-vessel-tumor' is a benign tumor, usually appears on the skin, especially on the head, face and neck. It is formed by the abnormal growth and buildup of blood vessels. It may form on the top layer of skin or form deep inside the skin. Hemangioma may also form on the internal organs like liver, spine and vertebrae.

Hemangioma skin lesions may be present at birth or develop in the early infancy. These lesions grow rapidly for twelve months followed by a resting phase of about twelve months. Then the involution phase starts and the lesions disappear by ten years.

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Hereditary angioedema

Hereditary angioedema (HAE) is a rare genetic disorder causing episodic attacks of cutaneous and submucosal swellings. Hereditary angioedema is found to affect up to 0.01% of the population with mortality ranging at 15-33%. The swellings affect the face, extremities, respiratory tract, genitalia and gastrointestinal tract.

Up to 75% of HAE clinical manifestations are familial inheritances. Fresh mutations contribute to 25% of the cases. In some instances involving the throat and mouth, HAE can block airways and become life threatening.

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Idiopathic guttate hypomelanosis

Idiopathic guttate hypomelanosis are hypopigmented pale white spots usually appearing on skin of shins and forearms. The reasons for the development of these spots is not clearly known (idiopathic). Idiopathic guttate hypomelanosis spots are 'drops' like in appearance and are small in size (2-5 mm).

In some rare cases macules as big as 10 mm in diameter have been observed. It is believed that excessive exposure to sunlight might be a causative factor or a trigger. This disorder usually observed from late twenties of age.

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Methemoglobinemia

Methemoglobinemia (aka hemoglobin M disease or Erythrocyte reductase deficiency) is a form of blood hemoglobin disorder. The oxygen carrying capacity of Red blood cells (RBC) is reduced in this disorder and the oxygen supply to the tissues including skin is affected. This leads to bluish discoloration of skin and cyanosis.

Acquired form of methemoglobinemia may be caused on exposure to certain medicines, food products and chemicals. Hereditary form of methemoglobinemia is caused either due to erythrocyte reductase deficiency or generalized reductase deficiency.

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Milk spots - milia

Milk spots (aka milia, oil seeds or baby milk spots) are benign cysts filled with keratin. When dead epidermal skin gets trapped without natural exfoliation in pockets, milia arise. Usually milia appear as whitish or slightly pinkish bumps on the skin. Baby milk spots are usually associated with newborns and infants.

Affecting both boys and girls equally, baby milk spots usually disappear within 15-30 days and may not need any treatment. Milia usually appear on the skin around the eyes, forehead, cheeks, chin and nose. About half of the newborn develop milia.

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Mongolian spot

Mongolian spot (aka congenital dermal melanocytosis or Mongolian birthmark) is a benign asymptomatic skin birthmark. Mongolian blue spot may be present at birth or appears shortly thereafter. These skin macules of hyperpigmentation, usually appearing on lumbosacral area and buttocks, are flat and irregular in shape with indistinct wavy border.

Mongolian spot may also occur on shoulders and other parts of the body. Usually head, face, palms and soles are spared. Erwin Bälz, who was a German and was a personal physician to the Japanese Imperial Family, discovered and named 'Mongolian spot'.

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Nevus depigmentosus

Nevus depigmentosus is a white macule, patch or spot lacking pigmentation. Nevus depigmentosus is congenital, benign and non progressive skin lesion. The cause of this hypopigmentation skin disorder is not fully understood. However during the lifetime of the affected individual, nevus depigmentosus is stable in size as well as in distribution.

Nevus depigmentosus patches usually grow only in proportion to the growth of the body.Though the macules can form on any part of the body, they are found to usually affect the skin of trunk, hands and feet.

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Nevus simplex

Nevus simplex (aka nevus flammeus nuchae or salmon patches) are very common birthmarks found in about 30% newborns. When found on the nape of the neck they are known as 'stork bite'. These vascular birthmarks are congenital skin capillary malformations. They are caused by the dilation and stretching of capillaries under the skin.

Though nevus simplex may appear anywhere on the body, in most of the incidences they are found on the nape of the neck, forehead, on or around eyelids, on or around nose and upper lip. Salmon patches are pink colored, flat and irregularly shaped skin lesions.

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Pityriasis alba

Pityriasis alba is a common atopic dermatitis mostly affecting children of the age between 3 and 16 years. Pityriasis alba appears as fine-scaled oval and round dry pale white patches or spots on the facial skin of the children. More number of boys are affected than girls and is more prevalent in lighter-skinned individuals.

Pityriasis alba may be colored pink or red initially. Later the redness fades leaving a pale hypopigmented patch usually on the cheek, chin and mouth areas. The border of the patches is not clearly marked and blends gradually with the normal skin.

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Raynaud's disease

Raynaud's phenomenon or Raynaud's disease involves the arteries of fingers and toes. In this disease of circulatory system the blood vessels of the fingers and toes undergo sudden vasospasm restricting the blood supply. Raynaud's disease was discovered by a French doctor A. G. Maurice Raynaud (1834–1881).

Hyperactivity of sympathetic nervous system leads to constriction of peripheral arteries and the bluish discoloration on skin of toes and fingers. The condition may last from a few minutes to several hours. In some rare cases ear lobes, nose, lips and nipples may also be involved.

For more information read 'Raynaud's disease'.


Rhinophyma

Rhinophyma is the large, erythemic, bulbous, uneven swelling of the nose. Phymatous rosacea in its advanced-stage can cause rhinophyma. The Greek word 'rhis' means nose and 'phyma' meaning growth, swelling or bulb on the skin. People of English, Irish and Scottish descent are more prone to develop rhinophyma.

Rhinophyma is found to affect middle-aged and elderly men. It rarely occurs in women. Rhinophyma is the hypertrophy of the sebaceous glands on the tip of the nose. Rhinophyma can become unsightly and may even obstruct respiration and vision.

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Tactile defensiveness

Tactile defensiveness is due to the exaggerated tactile sensitivity experienced by the affected patient. It is a sensory processing disorder found in about 75% of the boys with 'fragile X syndrome' and some girls with full X mutation. The affected patient develops a defensive attitude to touch perception and dislikes being touched.

This skin sensory disorder of the midbrain region affects the filtering of the incoming stimuli. This causes overemphasized perception of the touch stimuli of the skin, resulting in great distress, misery and discomfort.

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Tinea versicolor (pityriasis versicolor)

Tinea versicolor (aka pityriasis versicolor) are usually superficial, benign, common, recurrent and not contagious macules or patches formed on the skin. They are fungal infections affecting the stratum corneum layer of the epidermis. Tinea versicolor disease is characterized by hyperpigmented or hypopigmented macules and colored patches.

Tinea versicolor infection is caused mainly by the Malassezia globosa fungus and in a small number of cases Malassezia furfur has been found to be the causative fungus. These skin patches are versicolored appearing in multi colors of white, creamy, pale pink and brown.

For more information read 'tinea versicolor (pityriasis versicolor)'.


Vitiligo

Vitiligo (aka leucoderma or leukoderma) is a skin disorder wherein there is loss of skin pigment causing white depigmented patches. In vitiligo, due to some physiological conditions, genetic disorders, thyroid disorders, psychological stress or autoimmune diseases, there is stoppage of melanin pigment production or death and loss of the melanocytes.

About 1-2% of the world's population is affected by the loss of skin pigment. Patients suffering from autoimmune diseases and thyroid disorders are prone to develop vitiligo. It equally affects both the genders and appears prominent in dark-skinned patients.

For more information read 'vitiligo'.





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