Sunday, November 30

What is herpes zoster - Definition of herpes zoster

   ›      ›   What is herpes zoster - Herpes zoster definition.

What is herpes zoster?

Herpes zoster, also known as shingles or zona, is a viral disease caused by the chickenpox virus, varicella zoster virus (VZV).
Herpes zoster virus as a primary infection causes chickenpox in children and young adults. After the episode of primary infection by VZV, causing body rash and blisters, the symptoms resolve in 6-10 days and the patient develops partial immunity. However the herpes virus is not eliminated from the body after the primary infection. The herpes virus remains latent in the nerve ganglia and nerve bodies.

Approximately, 20% of those who had chickenpox may develop shingles later on. The latency period of the herpes virus may last from years to decades. What activates this latent human herpesvirus 3 is not known. However certain triggering factors have been identified. Individuals of all age groups and genders may develop the herpes disease. However, the incidences of its recurrence are greater in older population. Infants, elderly people, transplant patients and those affected by immunosuppression due to diseases or medications are at increased risk.

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Shingles is caused by VZV. VZV belongs to the large family of DNA herpes viruses known as Herpesviridae. Herpes simplex viruses 1 and 2, VZV, Epstein-Barr virus, cytomegalovirus, herpesvirus 6, herpesvirus 7, and Kaposi's sarcoma-associated herpesvirus belong to the family Herpesviridae. All these viral groups are DNA viruses and once infected they remain in the body and can reemerge from latency to cause disease symptoms.

What are the ?

The early symptoms of VZV herpes are fever, headache, body pain and malaise. They are followed by tingling, itching, prickling or burning sensations.
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The sensations may be only at the site of emergence of blister or on the entire dermatome. Simultaneously a small red band of rash appears, which soon develops small blisters. The blisters get filled with serum. Then the herpes blisters may get filled with blood and the resolution phase starts. The skin develops crust which subsequently falls off.

What is the treatment for herpes zoster?

Shingles resolves by itself after 7-10 days. The antiviral drugs such as acyclovir, valacyclovir, and famciclovir can reduce the intensity of the herpes episode and help in rapid healing if taken within three days of the start of symptoms. Herpes vaccine helps in reducing the intensity and recurrence of the episodes.

Definition

  • Definition by medical-dictionary.thefreedictionary.com: "an acute, unilateral, self-limited inflammatory disease of cerebral ganglia and the ganglia of posterior nerve roots and peripheral nerves in a segmented distribution, believed to represent activation of latent human herpesvirus 3 in those who have been rendered partially immune after a previous attack of chickenpox."
  • Definition by webmd.com: "Shingles is a painful skin rash. It is caused by the varicella zoster virus. Shingles usually appears in a band, a strip, or a small area on one side of the face or body."
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    Reference:
    1.Zostavax (Herpes Zoster Vaccine) Questions and Answers (FDA)
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    Current topic in natural skin care: What is herpes zoster and its definition.
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    Saturday, November 29

    Epidermoid cyst treatment - Epidermoid cyst removal

       ›      ›   Epidermoid cyst treatment - Epidermoid cyst removal.
    An epidermoid cyst is a benign condition, and, while annoying, usually does not require any treatment. Sometimes, if there is inflammation or infection, the removal of the cyst becomes necessary.
    Normally these lesions do not have any symptoms. However, cysts appearing on the exposed parts of the body, such as face, neck, arms or scalp are often an embarrassing cosmetic problem and anxiety to the affected person. Sometimes, these lesions may be traumatizing, especially, those on the scalp getting caught while combing. Though most of the lesions are benign, there are some rare cases of malignant tumors arising from epidermoid cysts.

    Inflamed or infected epidermoid cyst can be painful and annoying and may hurt when touched. In such inflamed conditions, the best treatment is its surgical removal so that there is no recurrence. Popping, pinching or squeezing may rupture the lesion and release foul smelling cheesy substance. Unlike acne or pimple, the release of its contents will not resolve the cyst. The capsule like structure lined with squamous epithelium layer will persist giving rise to fresh growth when it is blocked. The capsule's lining of epidermal origin requires complete removal to cure the condition.

    Epidermoid cyst treatment

    Treatment options available are, injecting the lesion with anti inflammatory medicine, incising and draining, vaporizing the cyst with laser or minor surgery.
    epidermal nodule on the ear lobe
    epidermoid cyst removal and treatment
    If surgical removal is not contemplated, non invasive treatment procedures may be followed.
  • Asymptomatic epidermoid cysts may be left alone.
  • If there is inflammation, anti inflammatory medicines like triamcinolone are injected into the lesion to hasten the resolution of inflammation.
  • If the nodule is mildly infected antibiotics may be used to resolve the infection.
  • If the lesion is ruptured and oozing contents, hot saline towel may be applied to hasten and complete the draining. Later a topical antibiotic may applied.

  • Epidermoid cyst removal

    Surgical removal of the benign lesion can be performed under sedation and local anaesthesia.
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    By making an incision in relation to the size of the nodule, the cystic bag is completely resected and removed and the wound is sutured. Precaution is taken not to puncture the cyst while extracting. The extracted tissue is normally sent for histopathological examination for the final diagnosis and also to rule out carcinoma.
  • In case of small lesions, after administering local anaesthesia, a small incision is made to drain the contents. Then the surgeon extracts the lesion wall through the hole; suture is not required. Topical antibiotic may be given to protect the wound from infection.
  • If the lesion is infected, ruptured or inflamed the surgeon may prefer resolving the infection with antibiotic administration before the surgical procedure.
  • If the lesion is badly ruptured and oozing contents, the remaining contents are expressed out and then the empty lesion wall is removed. If any remnants of the cyst wall remain after removal, the lesion may reappear.
  • In case of removal of large epidermoid cyst, to avoid haematoma from forming, resorbable subcutaneous suture is used to close the gaping hole and space.

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    Reference:
    1.Information from your family doctor. Minimal excision technique for removal of an epidermoid cyst. Am Fam Physician. 2002 Apr 1;65(7):1423-4.
    2.2.G.Siva Prasad Reddy, N.V.S.Sekhar Reddy, G.V Reddy, Sriharsha K. Gaint Epidermoid Cyst of External Ear– A Rare Case Report. J Clin Diagn Res. Feb 2014; 8(2): 167–168.
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    Image source:
    1.http://en.wikipedia.org/wiki/File:Epidermal_Cyst_ear.JPG
    Author: JonathanRR | License: CC BY-SA 3.0
    Current topic in natural skin care: Treatment and removal of epidermoid cyst.
    Get fair glowing skin complexion. Remove acne scars and blemishes from face.

    Tuesday, November 25

    Epidermoid cyst causes - Symptoms of epidermoid cyst

       ›      ›   What causes epidermoid cyst - Symptoms of epidermoid cyst.

    What is epidermoid cyst?

    An epidermoid cyst is a benign, slow-growing intradermal or subcutaneous tumor, appearing as a closed capsule or sac-like structure underneath the skin.
    These cysts contain semi solid, cheese-like material. They are usually caused by the trapped epidermal cells and keratin protein below the skin due to damage of skin or hair follicle. Normally they do not cause any symptoms and occur usually on face, trunk, neck, extremities, scrotum and scalp.

    Though these lesions are benign and harmless, rare cases of transformation to malignancy have been reported. Basal cell carcinoma, Bowens disease and melanoma in Situ have developed from epidermoid cysts. These harmless lesions do not require treatment. If they cause a serious cosmetic problem to the patient or develop symptoms of inflammation, they can be removed surgically.

    The epidermoid cysts are also known as epidermal inclusion cysts. They are sometimes wrongly called as as sebaceous cysts. True sebaceous cysts arise from sebaceous glands which secrete sebum to lubricate and moisturize the skin.
    epidermal nodule on the ear lobe
    epidermoid cyst
    Rather we can consider these sebaceous lesions as a type of epidermal nodules.
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    It is noteworthy that epidermal capsules may also appear on body parts devoid of sebaceous glands like lips and buccal mucosa. Milia (milk spots) with symptoms of very small superficial lesions is of exclusive epidermal origin.

    What causes epidermoid cyst?

    Epidermal nodules may arise due several causes. Basically they are caused by the presence of epidermal cells and their growth in dermal layer of the skin or other organs of the body. This may happen during the embryonic growth or caused by the trapped epidermal cells and keratin protein in the dermal layer of skin due to damage, surgery or piercing of skin . The source of downward incursion of the epidermis into the underlying dermis is mostly infundibulum of the hair follicle.
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    Crushing injuries, needle piercing and certain surgical procedures such as skin grafts, rhinoplasty, breast augmentation and liposuction have been found to cause epidermoid cysts. Human papillomavirus (HPV) is found to be a factor in the development of these cysts in palms and soles. In some cases HPV presence has been detected in these lesions from other areas of the body.

    Congenital epidermal lesions of the anterior fontanelle, oral region and genital location are presumably caused during embryonic development. Certain familial syndromes like Gardner syndrome pachyonychia congenita and basal cell nevus syndrome are also found associated with these epidermal nodules. Favre-Racouchot syndrome is an offshoot of sun damage in elderly people characterized by symptoms of nodular cutaneous elastosis with cysts and comedones.

    Symptoms of epidermoid cyst

    These firm round nodules appear flesh-colored or yellowish.
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    Normally these lesions do not cause any symptoms. They are more common in men than women. Except for congenital or hereditary lesions, these nodules are found to arise in the middle age or later. Sometimes they may get infected and give rise to symptoms like inflammation and pain. Infected nodules may discharge foul-smelling pus and other contents. In some cases these lesions become inflamed without any infection, showing symptoms like tenderness and pain.

    Treatment becomes necessary when when these nodules cause cosmetic problems, get infected, rupture, present in the area for constant friction or painful. Surgical excision of the entire epidermoid cyst including its wall will cure the condition.
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    Reference:
    1.Information from your family doctor. Minimal excision technique for removal of an epidermoid cyst. Am Fam Physician. 2002 Apr 1;65(7):1423-4.
    2.2.G.Siva Prasad Reddy, N.V.S.Sekhar Reddy, G.V Reddy, Sriharsha K. Gaint Epidermoid Cyst of External Ear– A Rare Case Report. J Clin Diagn Res. Feb 2014; 8(2): 167–168.


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    Image source:
    1.http://en.wikipedia.org/wiki/File:Epidermal_Cyst_ear.JPG
    Author: JonathanRR | License: CC BY-SA 3.0
    Current topic in natural skin care: Causes and symptoms of epidermoid cyst.
    Get fair glowing skin complexion. Remove acne scars and blemishes from face.

    Friday, November 14

    Cyst in chest - Eruptive vellus hair cysts (EVHCs)

       ›      ›      ›   Eruptive vellus hair cysts in chest and body.

    What are eruptive vellus hair cysts?

    Eruptive vellus hair cysts (EVHCs) are multiple papular eruptions containing vellus hair. These cysts are rare developmental abnormalities of vellus hair follicles.
    In the year 1977, Nancy B. Esterly, David F. Fretzin and Hermann Pinkus observed hyperpigmented monomorphous papular eruption containing multiple fragmented vellus hair shafts in two children. They proposed the term eruptive vellus hair cysts for this condition.

    Eruptive vellus hair cysts are usually asymptomatic and appear as small, 1-3 mm, follicular, atypical, acneiform papules on the central chest and abdomen. The papules are usually flesh colored or hyperpigmented. They may also appear bluish gray, yellow or brown. They are usually localized to the chest, abdomen and flexor aspects of the extremities. In some patients the papules may be generalized and cover extensive areas of the body. Occasional pruritus or tenderness may be present.

    Eruptive vellus hair cysts onset ranges from birth to late teens. Teenagers are the most affected age group and have cosmetic concerns. EVHCs does not have gender or race predilection.
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    About 25% of the papules may resolve by themselves. Some lesions may persist for years together. In some patients the condition is found to be familial. It presents as an autosomal dominant inheritance, being present at birth or arising during infancy.

    Eruptive cysts diagnosis

    The lesions can be diagnosed by punch biopsy and histopathological examination. The small intradermal eruptive cysts are lined by two or three layers of squamous epithelium. The cavity contains keratinous material and multiple transversely fragmented vellus hairs. The lesion is devoid of sebaceous glands. The clinical differential diagnosis include acne, milia, mollluscum contagiosum, infundibular cysts and steatocystoma multiplex. The later two conditions though commonly affect the chest skin, do not involve vellus shafts. Steatocystoma multiplex involves the sebaceous duct.

    Eruptive cysts causes

    The pathogenesis of the eruptive cysts is not clear. It is believed that developmental abnormalities of vellus follicles causes their occlusion leading to retention of strands, follicle dilation and atrophy of the bulb. The follicles appear to be blocked at the level of infundibulum. There are no triggering factors.

    Eruptive vellus hair cysts treatment

    The treatment modalities include topical applications of keratolytic agents, incision and drainage, curettage, cryotherapy, dermabrasion and laser ablation.
    • Application of topical tretinoin or topical tazarotene cream on the affected area had given fairly good results.
    • Application of lactic acid or urea cream also had given significant clearance of the cysts.
    • Oral isotretinoin or systemic vitamin A treatment did not produce encouraging results.
    • Dermabrasion treatment of the affected area though opens up the cysts for draining the contents, does not remove the cysts leading to recurrence of the condition.

    Surgical treatment procedures

    Simple excision or needle evacuation of the eruptive cyst is done, if necessary after applying a topical anesthetic. These treatment procedures are helpful in the diagnosis of the lesions.
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    As the eruptive cysts are to be eliminated individually, this treatment procedure is effective only when the number of lesions are less in number. These procedures cannot be carried out in cases of numerous lesions.
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    Treatment with carbon dioxide laser vaporization was tried successfully, and the lesions did not reappear. There was minimal hyperpigmentation after the treatment. Pulsed erbium:yttrium-aluminum-garnet (Er:YAG) laser treatment was successfully used to drill the cysts and the contents were extracted with a forceps. The cavity is again ablated to remove the remnants, if any. Treatment with nonablative 1540 Er:Glass laser was also tried with greater success in removing the eruptive cysts.
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    Reference:
    1.Swapna Khatu, Resham Vasani, and Shital Amin. Eruptive vellus hair cyst presenting as asymptomatic follicular papules on extremities. Indian Dermatol Online J. 2013 Jul-Sep; 4(3): 213–215.
    2.Kaya TI, Tataroglu C, Tursen U, Ikizoglu G. Eruptive vellus hair cysts: an effective extraction technique for treatment and diagnosis. J Eur Acad Dermatol Venereol. 2006 Mar;20(3):264-8.


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    Current topic in natural skin care: Eruptive vellus hair cysts in chest and body.
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