Skin Disease: Diagnosis And Treatment

Skin Disease: Diagnosis And Treatment

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Skin diseases include all conditions that irritate, clog or damage your skin, as well as skin cancer. You may inherit a skin condition or develop a skin disease. Many skin diseases cause itchiness, dry skin or rashes. Often, you can manage these symptoms with medication, proper skin care and lifestyle changes. However, treatment can reduce symptoms and may even keep them at bay for months at a time. Many skin conditions never go away completely. Also, remember to check your skin for any changes, including new or non-healing spots or changes in moles. Most skin cancers can be cured if diagnosed and treated early.

Chronic pruritus arises not only from dermatoses, but also, in up to half of cases, from extracutaneous origins. A multitude of systemic, neurological, psychiatric, and somatoform conditions are associated with pruritus in the absence of skin disease. Moreover, pruritus is a frequently observed side effect of many drugs. It is therefore difficult for physicians to make a correct diagnosis. Chronic pruritus patients frequently present to the dermatologist with skin lesions secondary to a long-lasting scratching behavior, such as lichenification and prurigo nodularis. A structured clinical history and physical examination are essential in order to evaluate the pruritus, along with systematic, medical history-adapted laboratory and radiological tests carried out according to the differential diagnosis. For therapeutic reasons, a symptomatic therapy should be promptly initiated parallel to the diagnostic procedures. Once the underlying factor(s) leading to the pruritus are identified, a targeted therapy should be implemented. Importantly, the treatment of accompanying disorders such as sleep disturbances or mental symptoms should be taken into consideration. Even after successful treatment of the underlying cause, pruritus may persist, likely due to chronicity processes including peripheral and central sensitization or impaired inhibition at spinal level. A vast arsenal of topical and systemic agents targeting these pathophysiological mechanisms has been used to deter further chronicity. The therapeutic options currently available are, however, still insufficient for many patients. Thus, future studies aiming to unveil the complex mechanisms underlying chronic pruritus and develop new therapeutic agents are urgently needed.

In 2009, the guidelines for the management of patients with DH were published by our group.1 However, according to recent literature, several new findings have been reported about the clinical and immunopathological features of DH; moreover, the novel guidelines for the management of CD from the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) were developed in 2012.8 Therefore, an update on the diagnosis and treatment of DH would be helpful to improve the care of the patients.

DIF has a sensitivity and a specificity close to 100% for the diagnosis of DH. Moreover, according to the ESPGHAN guidelines for CD, a positive DIF in a patient with suspected DH allows for the diagnosis of CD without the need of duodenal biopsy.8 DIF should be performed on uninvolved perilesional skin, since in skin lesions IgA can be removed by inflammatory cells. Moreover, patients must be on normal diet, because IgA deposits can disappear from the skin in period of times variable from weeks to months in patients on a gluten-free diet. If the patient is on a gluten-free diet, a normal gluten-containing diet should be administered and the biopsy taken after at least 1 month.

The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases.

In-office procedure for HS: Some patients can benefit from a treatment plan that uses both medication and an in-office procedure. In-office procedures are especially important if HS has made tunnels in your skin.

Medications and light-based therapies are available to help restore skin color or even out skin tone, though results vary and are unpredictable. And some treatments have serious side effects. So your health care provider might suggest that you first try changing the appearance of your skin by applying a self-tanning product or makeup.

Even if treatment is successful for a while, the results may not last or new patches may appear. Your health care provider might recommend a medication applied to the skin as maintenance therapy to help prevent relapse.

Removing the remaining color (depigmentation). This therapy may be an option if your vitiligo is widespread and other treatments haven't worked. A depigmenting agent is applied to unaffected areas of skin. This gradually lightens the skin so that it blends with the discolored areas. The therapy is done once or twice a day for nine months or longer.

You might have vitiligo. You could also have another condition like tinea versicolor. The white spots may also be caused by a skin injury. A board-certified dermatologist can give you an accurate diagnosis.

After giving you the diagnosis, your dermatologist will also ask whether you want to treat the vitiligo. Some people choose not to. Model Winnie Harlow, who has vitiligo, lets the world see her skin as it is.

Treatment cannot cure vitiligo. While researchers are looking for a cure, treatment cannot currently cure this disease. Treatment can help restore lost skin color, but results may fade over time. Many patients return for maintenance treatment to keep their results.

Light therapy exposes your skin to a type of ultraviolet (UV) light that can restore your natural skin color. If a large area of your body needs treatment, your dermatologist may prescribe a treatment called phototherapy.

Treatment of atopic dermatitis may start with regular moisturizing and other self-care habits. If these don't help, your health care provider might suggest medicated creams that control itching and help repair skin. These are sometimes combined with other treatments.

Leprosy is an age-old disease and is described in the literature of ancient civilizations. It is a chronic infectious disease which is caused by a type of bacteria called Mycobacterium leprae. The disease affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and the eyes. Leprosy is curable and treatment in the early stages can prevent disability. Apart from the physical deformity, persons affected by leprosy also face stigmatization and discrimination.

Leprosy is a curable disease. The currently recommended treatment regimen consists of three drugs: dapsone, rifampicin and clofazimine. The combination is referred to as multi-drug therapy (MDT). The duration of treatment is six months for PB and 12 months for MB cases. MDT kills the pathogen and cures the patient. Early diagnosis and prompt treatment can help to prevent disabilities. WHO has been providing MDT free of cost. Free MDT was initially funded by The Nippon Foundation and since 2000 it is being donated through an agreement with Novartis.

WHO has developed e-learning modules that aim to enhance knowledge and skills of health workers at all levels on topics related to diagnosis, treatment of leprosy and management of disabilities. These can be accessed the OpenWHO platform.

Allergy testing, which includes serologic evaluation of allergen-specific IgE and intradermal skin testing, should not be used for the diagnosis of CAD.6 Many healthy dogs are sensitized to environmental allergens and consequently have positive test results. Furthermore, many dogs with clinical signs of CAD have negative results on these tests; the term atopic-like dermatitis describes this group of dogs.1,9 Allergy testing should be carried out only to identify allergens to be used for allergen-specific immunotherapy and desensitization (see Allergen Immunotherapy).

CAD is a multifactorial chronic disease that requires a multimodal treatment approach to decrease pruritus and inflammation below the threshold of clinical signs. Guidelines from the International Task Force on Canine Atopic Dermatitis1,3 recommend therapeutic interventions based on identifying and managing the flare factors (FIGURE 3), as well as whether the patient is experiencing an acute flare or has chronic skin lesions.

Adjunctive treatments for severe skin inflammation, pruritus, ear infections, and superficial pyoderma should be initiated immediately at the start of a diet trial. The treatment should resolve all concurrent clinical signs of pruritus and infection (ears, skin) within 6 to 10 weeks of the diet trial, at which time the symptomatic medications are discontinued, and the patient can be maintained only on the novel food for the following 2 to 3 weeks. The patients are carefully observed during these 2 to 3 weeks; if the clinical signs or pruritus and skin/ear infections do not recur, the patient should be rechallenged with the old diet. A relapse of clinical signs within 14 days of rechallenge is expected in dogs with food allergy, although in most cases, untrained client/ owner observation is used to determine relapse.1,3 59ce067264

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