Symptoms and treatment of Psoriasis

Definition
Chronic skin disease, benign, characterized by an erythematous, scaly rash, which evolves in spurts, predominantly on the elbows, knees, scalp.
Psoriasis is characterized by an abnormal proliferation and differentiation of keratinocytes associated with infiltration of the dermis and epidermis by T cells and neutrophils forming microabscesses in the stratum corneum.

Prevalence
Psoriasis is a chronic skin disease which affects around 2% of the population.

Etiology
The etiopathogenesis is still unknown:
- Existence of hereditary factors in particular admitted with an attack family (inconstant connection to certain HLA groups),
- Role of psychological trauma (hormonal changes, stress ..) and infections in the determination of relapses (streptococcal infections),
- Some research suggests that psoriasis results from immune abnormalities.

Symptoms and signs
Psoriasis manifests itself in several ways, most often by the appearance of red or pink skin patches covered with dry scales and whitish more or less thick material that detach discovering a red skin and saignottante.
The plates, especially those present on the scalp, crumble and lamellae white, similar to dandruff, become detached from the epidermis.
Psoriasis is sometimes accompanied by itching and fissures (particularly on the hands and feet).
Particularly serious forms exist:
- Because of the localization: face, folds, genitals, scalp, with palmoplantar or nail,
- Pustular in character: it is localized amicrobiennes pustules on the hands and feet and diffuse or generalized,
- By their extension: generalized forms bearing the clinical features of psoriasis (psoriasis universalis) or taking on the appearance of erythroderma,
- Because of inflammatory joint diseases: psoriatic arthritis, psoriatic spondylitis, inflammatory joint flare accompanying forms generalis

Location

Psoriasis affects certain specific areas of the body:
- The most frequently: The scalp, elbows, knees, back
- The less frequently: the groin, armpits, the palms, soles, nails (which have multiple punctate depressions giving a corner "in thimble"), buttocks, around the navel The inside of the cheeks, the external genitalia.

Diagnosis
The diagnostic elements:
- Location at the extensor surface of the members
- Raised red, scaly plates
- The scales removed with a curette, which gives a whitish spot "in the task of candle"
- Itching is variable and inconstant

In most cases, the diagnosis does not pose a problem. However, some atypical forms and certain locations are more difficult to diagnose:
- Folds psoriasis (inverse psoriasis) that realizes an aspect of chronic intertrigo resistant to usual treatment,
- Nail psoriasis may be mistaken for onychomycosis (in half the cases the two are related),
- Psoriasis of the scalp and face that is very similar to seborrheic dermatitis,
- Guttate psoriasis, eruptive child and adolescent who may be mistaken for a viral rash or pityriasis rosea.
In these particular forms, the biopsy provides only rarely a definitive diagnosis. This is essentially the presence of typical lesions remote, and especially the evolution of chronic lesions that are useful for diagnosis.

Evolution
The age of onset is highly variable, the evolution is undefined, unpredictable, made outbreaks and remissions of varying length and more or less complete (persistence of lesions of the elbows and knees) in which the lesions disappear without scars, hyperpigmentation at best or a stain amelanotic transient.
Some medications worsen psoriasis (blockers, inhibitors of angiotensin converting enzyme - ACE inhibitors, lithium).

Treatments
In the current state of knowledge, there is no treatment that can cure psoriasis and all treatments can only claim a suspensive action. The hopes of radical treatment are related to the discovery of genes responsible for disease.
First look for triggers: infections, drugs.
The treatment of psoriasis limited to a few spots, called first-line derivatives of vitamin D that can be associated with local corticosteroid.
There are also topical retinoid (Tazarotene)
In the most extensive psoriasis, phototherapy is the treatment of choice, whether ultraviolet B (usually narrow spectrum - 311 nm) or PUVA introduces these ultraviolet A decision of psoralen (Méladinine most often).
Finally in severe (generalized psoriasis, erythrodermic or pustular) should be called to Methotrexate, retinoids (Soriatane) or cyclosporin.
These therapies are not without major side effects and require a complete pre-therapeutic and regular monitoring in specialized settings.

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Eczema: Diagnosis and treatment

pic from Wikipedia 

Diagnosis
In most cases the diagnosis of AD is clinical and requires no further exploration. In atypical forms can be used in certain laboratory tests (specific IgE, Phadiatop, etc..) And allergy.
Prick tests to aeroallergens (mites, pollens, etc..) And food allergens (food).
Lower cost, they have almost the same sensitivity and same specificity as the measurement of specific IgE.
An exploration allergy will be decided when the lesions persist despite treatment well followed, or when lesions appear on atypical locations of atopic dermatitis. It may include depending on the etiology suspected, the installation of patch tests in search of contact sensitization. Tests to foods, supplemented if positive tests for reintroduction are considered mainly in children and severe forms of eczema.
The allergens most frequently found in atopic dermatitis of the child in order of frequency are: egg white, peanut, mustard, cow's milk and fish.
Photobiological exploration will be considered in case of worsening during sun exposure.

Complications
Superinfection of lesions and exudative excoriated.
Bacterial and fungal favored by itching, scratching and corticosteroids.

Viral.
Kaposi's sarcoma-Juliusberg varioliform or pustulosis. This is a serious complication caused by a skin-tropic virus, usually herpes (primary infection mainly), rarely coxsackie and influenza. The eruption highly febrile with altered general condition, occurs in a exacerbation of atopic dermatitis. It begins quite suddenly on the face and then spreads in the form of vesiculo-pustules varioliform umbilicated, necrotic and hemorrhagic.
The evolution is favorable in antiviral. Complications from visceral dissemination are now rare (herpes encephalitis).
Prevention in atopic thrust should be the removal of all about the environment herpes.

Warts, multiple and chronic molluscum contagiosum frequent and profuse.

Erythroderma: sometimes secondary to an abrupt withdrawal of corticosteroids or local extent of corticosteroids (cons-indicated).
Relationship problems. Possible complications secondary to psycho chronic itching in erythematous skin or oozing lichenified must be taken into account in the treatment of atopic dermatitis.


Treatment
The treatment consists of several points: the treatment of pressure that will appeal mainly to topical corticosteroids, and treatment of etiology when possible (foreclosure of a contact allergen, elimination of aggravating factors). This treatment is not always easy to explain and must therefore be assured that it was well understood by the patient.

Treatment of eczema flare: antisepsis, topical steroids and antihistamines.
Antisepsis and potentially draining lesions. Be used antiseptics colorless and low awareness such as chlorhexidine, silver nitrate 0.5% in water (weeping forms), etc.. The mercury derivatives, hexamidine potentially allergenic will be avoided. Topical antibiotics are not necessary in uncomplicated forms.
1. Local corticosteroid.
Corticosteroid therapy is generally essential for the treatment of eczema flare, and it must be short to avoid the complications and habituation. Creams are preferred for areas hairless and child, ointments for very dry forms, and lotions for hairy areas. The application method can be done according to several schemes: one twice daily for 5-7 days with gradual reduction over a week, or morning and evening for five days, in the evening for 5 days, 1 night of 2 for 8 days.

2. Tacrolimus (Protopic)
This new treatment can be an alternative when there is a failure of topical corticosteroids. It does not cause skin atrophy and can be used on the eyelids without risk to the eye. However, it induces side effects, the most important thing is irritation sometimes requiring discontinuation.
It can be prescribed by dermatologists and pediatricians on special orders.
3. Antihistamines.
They are often very effective, but may be associated with the start of treatment in cases of pruritus bothersome.
[ source ]

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skin cancer

Description

The skin cancer is the cancer most common in Canada. It is estimated that each year about 75,000 people in Canada are diagnosed with skin cancer in non-melanoma, and this number continues to rise.

The skin cancers are classified into three types: basal cell carcinoma, squamous cell carcinoma, and melanoma. This article focuses on the first two forms of skin cancer, known both as the "cancer of the skin non-melanoma". Unlike melanoma, the mortality rate for cancer of the skin of non-melanoma is low and is often treated very easily. For information on melanoma, please see our Melanoma article.

Basal cell carcinoma (BCC) is the only skin cancer the most common, but also the most common form of cancer. It grows from the basal (deepest) of the epidermis (the outer layer of skin). Cancer cells almost always appears on sun-exposed skin areas like the forehead, hands, lips, or the top of the pinna. BCC makes up about 75% of all skin cancers non-melanoma. There are three main types of BCC:

superficial basal cell carcinoma (CBS): This type of cancer often appears on the chest and upper body (torso) and possibly in the face. In most cases, it is a well-circumscribed scaly patch that looks like eczema. It is often surrounded by a raised edge of pearly color.
Nodular basal cell carcinoma: This type of CB appears on areas exposed to sunlight, including the head and neck. It has the form of a lump usually pink or pearly.
morpheaform basal cell carcinoma: This type of CB appears as ivory scar in areas that have never undergone surgery or injury. The tumor is slightly raised and waxy, often white or yellowish. The outline of the tumor is not accurate.
There are also two more unusual types of BCC: pigmented (tattoo) (similar to nodular BCC, but with white and brown pigmentation) and cystic BCC (bluish-gray with liquid center).

Squamous cell carcinoma is less common than basal cell carcinoma, but still represents the second form of skin cancer the most common. It grows from the top layers of the skin, and it occurs most often on sun-exposed surfaces.

Other cancers such as Merkel cell carcinoma, Kaposi's sarcoma or cutaneous T-cell lymphoma are cancers of the skin very rare, representing approximately 1% of cancers of non-melanoma.


Causes

Like melanoma, basal and squamous cell carcinomas are associated with a significant exposure to sunlight. Most people accumulate the majority of their total exposure to sunlight during childhood, and studies have shown that even a single sunburn in childhood increases the risk of skin cancer later in of life. But there is no need to catch a sunburn to suffer skin lesions. A tan is a sign of skin damage caused by ultraviolet (UV).

In Canada, skin cancer is rare in people under 40. Sunbathing at the origin of skin tumors were taken mostly 30, 40 or 50 years ago. In Australia, where people are much more exposed to ultraviolet radiation from an early age, skin cancer strikes people in their twenties and thirties.

People with fair skin, blond or red hair, blue eyes or green, who have freckles, or who tan easily are at higher risk of cancer of the skin because their skin is less pigmented and they are less well protected from the sun.

In general, tumors are formed when the DNA of a healthy cell undergoes a mutation that causes deregulated cell proliferation. Scientists now believe that in basal cell carcinoma, a gene called PTC is damaged by UV radiation. Under normal conditions, this gene induces the production by the cell of a protein that prevents reproduction of adjustment. A similar scenario may be at work in the case of squamous cell carcinoma.

Other causes of skin cancer, stress X-rays, skin contact with arsenic or radium, or simply bad luck. Even if a person is poorly exposed to sunlight, an error can occur spontaneously in cell division. We also know that a sexually transmitted cancer-causing virus, human papillomavirus (HPV) can cause a rare form of squamous cell carcinoma.


Symptoms and Complications

Basal cell carcinoma (BC) generally appears to skin sites exposed to sunlight. It first appears as a small blister pink and round, but that depends on the type of CB (eg. Superficial, nodular or morpheaform). Over time, the tumor can continue to grow and after a few months or years, it is sometimes surrounded by tiny blood vessels, but visible. The lesion often forms crusts repeatedly, and then cured, forming new crust. The crust formation is sometimes accompanied by bleeding.

If the lesion is not treated, its appearance can be very different, because cancer cells destroy the skin. The lesion takes the appearance of a bite, in which case, the tumor is called a rodent ulcer.

The CB is the type of superficial basal cell carcinoma the least aggressive, whereas the CB morpheaform is the most aggressive and most dangerous of these cancers. The CB surface develops outside its border (edge) and damage over time, the surrounding tissue. Since the CB surface develops slowly, people do not always consult their doctor immediately. Detection and early treatment are often the best way to increase its chances of survival in many types of cancer. The CB nodules have irregular contours and often remain flat. This type of cancer often causes bleeding followed by crusting or flaking. The CB morpheaform develop rapidly and are more difficult to treat.

Squamous cell carcinoma usually begins with a small hard mass. In most cases it develops from actinic keratosis (AK), a rough, scaly lesions of the skin that appears on the surface of the skin exposed to sunlight. It can be the same color as the surrounding skin, but it can also be brown, pink or red. The KA is simply an alteration of the size, shape and organization of skin cells. Because they can cause skin cancer, we recommend screening and treatment of KA as soon as possible.

Squamous cell carcinoma is characterized by redness, scaling, crusting or ulcers. In addition, it can cause itching and be slow to heal. Gradually, as the tumor of squamous cell carcinoma grows, the skin tends to degenerate and becomes scarred tissue. The tumor bleed easily if scratched, without it being painful so far. Squamous cell carcinoma is more likely to develop in the form of metastases (spread to other parts of the body) that the CB. Fortunately, early treatment increases survival and healing.

Complications arise when the tumor invades the tissues that have other functions, such as tissues of the mouth, anus or eye. In general, cancers of the mucous membranes (eg. The lips) are more likely to develop into metastases (spread of the disease to other organs). Similarly, cancerous tumors that sit between your fingers or between the index finger and thumb or the first phalanx (before the first joint of a finger) may also be further developed in the form of metastases. Metastases are unlikely in these cancers.

Although basal cell carcinoma or squamous cell carcinomas rarely cause death, these tumors can disfigure the patient. Untreated, cancer can develop and cause disfigurement. Treatment can sometimes disfiguring the patient if a large amount of skin tissue to be excised.

diagnosis

The skin cancer is diagnosed by microscopic analysis of a sample of skin taken from the bump or spot suspicious. This is called a biopsy. Under normal conditions, it is not necessary to perform complex tests to determine if the cancer has spread to other parts of the body as it rarely happens.

There are three types of biopsies to confirm the diagnosis of cancer of the skin non-melanoma. They include:

biopsy surface

biopsy punch,

excision.

Depending on the biopsy, removing a portion or all of the tumor. All of these biopsies require local anesthesia.

Treatment and Prevention

Is usually treated skin cancer by surgery. However, the doctor never told the patient that the cancer is completely cured, because there is always a risk that the cancer will return if cancer cells have invaded parts and tissues adjacent to the tumor. Surgeons typically cut an extra margin around skin tumors to reduce the risk of recurrence.

Tumors at high risk, such as tumors of the hand or lip, is often excised by Mohs micrographic surgery, which allows a surgeon to remove skin layer by using a microscope to accurately follow the contour the cancer. This technique reduces the risk of recurrence.

Sometimes the tumors are destroyed by the application of liquid nitrogen (cryogenic) or using a laser that burns the tumor. In addition to surgery, radiotherapy and chemotherapy are suitable for the treatment of cancer has recurred or in the case of metastatic potential.

Topical medications (applied to the skin) are sometimes used to treat basal cell carcinoma (BC). Topical medications include 5-fluorouracil (also known as fluorouracil) and imiquimod. 5-fluorouracil (5-FU) belongs to the group of medicines known as topical antineoplastics. It works by inhibiting the growth of cancer cells. Imiquimod belongs to a new group of topical medications called biological response modifiers. This type of drug works by stimulating the immune system to produce substances that fight cancer.

In cases where the cancer has spread to other parts of the body, chemotherapy may be used in combination with other treatments such as radiotherapy and surgery. The doctor decides on the appropriate mix for each individual based on their medical history.

To prevent skin cancer, protect your skin against the sun by wearing long clothing and using sunscreen with an SPF of at least 15 (SPF 15) that filters out UVA and UVB rays. Apply a generous amount of sunscreen on your body at least half an hour before going outside. Check your skin every month to detect changes, growths or sores that do not heal. If necessary, consult a doctor as soon as possible.

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