Psoriasis & Skin Clinic: Skin Conditions

Acne

Wed, 12 Mar 2008 00:00:00 +1300

Acne is common in adolescents and young adults. It usually occurs in early adolescence and decreases after the age of 25. However, some people, particularly women, develop acne for the first time in their late twenties or thirties. Severe acne tends to run in families and is presents more often in males.

Acne may also develop in people who suffer from any of several endocrine disorders. In particular, acne may develop in people who have abnormalities in circulating androgens. Some drugs can also cause or make acne worse.

Acne is a chronic inflammatory disease of the sebaceous (oil) glands and hair follicles.The scattered lesions caused by acne can manifest as single or multiple bumps generally called nodules or papules. Acne generally appears on the face (especially the chin, cheeks, forehead and around the nose), the chest, back, buttocks, nape, and scalp. Involvement is often symmetrical. Increased sebaceous activity on the face and scalp also leads to an oily complexion and greasy hair.

Acne is most likely caused by a combination of factors. First, there is an increase in sebum production and a blockage of the hair follicle. With the follicle blocked the population of normal bacteria in the follicle increases dramatically. The bacteria produce inflammatory chemicals, which leak into the surrounding dermis (skin).

Where the pore opening is large, the semisolid mass of debris creates a “plug” and appears at the skin surface as a blackhead. Whiteheads occur where the pore opening is small and the follicle walls then distend. Eventually this breaks allowing the mass of sebum, lipids, fatty acids and keratin to enter the dermis (skin layers). This then provokes a “foreign body” response and the formation of papules, pustules and nodules occurs. It is the rupturing of these that leads to intense inflammation of the skin. Continual occurrences in the same area will lead to scarring.

Although acne usually disappears once adolescence and growth are over, it can persist into adulthood. Women often present with acne during their menstrual cycle. It can also reappear in later years, especially in women who have received hormone treatment for other conditions.

In some cases, mostly males, papules can develop into red or dark red nodules or cysts which are located deeper within the skin than the normal presentation of papules. The surface area of the cysts are larger and malleable upon palpitation with the fingers. This form of acne usually leads to deep pitted scarring.

Source: Acne

Eczema & Dermatitis

Tue, 11 Mar 2008 00:00:00 +1300

Eczema originates from the Greek word “Ekzein”, which means “to boil”. Eczema is a common, non-infectious skin disease, that is exacerbated by internal or external factors.

Dermatitis (derm-, derma-, dermo-, dermat(o)- Prefix denoting the skin)- is a much broader term used to describe “inflammation of the skin”, in general.

The terms eczema & dermatitis are used interchangeably. Demarcation between the conditions is difficult at times, however similar treatment protocols are used for both conditions. In the interest of the reader or patient, it has been considered best to address them both in the same section.

There are many forms or subtypes of dermatitis/eczema. These include atopic eczema/dermatitis, seborrheic dermatitis/eczema and contact dermatitis/ eczema.

The different types occur in pattern according to age (notice the overlap of certain types over varying age groups): PLEASE CLICK ON THE TYPE OF DERMATITIS / ECZEMA FOR MORE INFORMATION

Source: Eczema & Dermatitis

Fungal Infections

Mon, 10 Mar 2008 00:00:00 +1300

Fungi are basically "simple" plants. Although widespread in nature, there are only a few that can affect the human body.

These fall into two groups:-

Dermatophytes

and
Yeasts

Dermatophytes are responsible for the majority of fungal infections that affect the body. They survive on dead keratin (a protein found in the nails, hair and the outermost layer of skin). When immunosuppression is involved the dermatophyte infection can penetrate into deeper layers of skin and in extremely severe cases can affect the body systemically.

There are three types of dermatophytes:

Trichophyton – infecting the hair, nails & skin
Microsporum – infecting the hair and skin
Epidermophyton – infecting the skin & nails

Yeast infections are more commonly caused by Candida albicans. Over 100 species of the yeast genus have been identified – most of which do not affect the human body. Candida albicans and other human pathogenic species usually colonize the human gastrointestinal tract. Bowel colonization affects between 40-60% of the population and this increases after any antibacterial/antibiotic medications. Throat and oral colonization affects approx. 20% of healthy individuals, while 13% of women are affected vaginally due to antibiotic treatment, pregnancy and oral contraception.

DERMATOPHYTES

TINEA CAPITIS (Ringworm of the scalp)

Tines capitis most often presents in pre-adolescent children. It is highly infectious and can be spread by direct contact, clothing, hairdressing implements or contact with infected animals.

If infected by the fungi from animal contact, the resulting lesions are more intensly inflamed than those caused by the fungi that has been transmitted person to person.

Most cases of tinea capitis begins with one or several patches of scaling and/or hair loss (alopecia).

“Gray Patch Ringworm” – presents as round or irregular scaly lesions of greyish-white patches. The hair breaks off at about 3-4mm above the skin surface. The hair roots are often covered in a “sheath” of white debris. Normal healing rarely results in any scaring.

“Kerion” – an extremely painful swollen and purulent inflamed nodule with multiple dark red, round or oval abscesses in various stages of formation. Pus is often draining from one or more ruptured abscesses which gives a “honeycomb” appearance to the skin surface. The hair falls out rather than breaking off. In extremely severe cases the entire scalp can be infected.

“Favus” – rare in Western countries, this form of Tinea capitis is caused by Trichophyton schoenleinii. Accompanied by extensive hair loss, which can become permanent. Scaring and thick yellowish brown crusts (scutula) develop, giving off a putrid odour.

TINEA MANUUM (Ringworm of the Hand)

A chronic dermatophytosis of the hands caused by Trichophyton rubrum, involving the palm and the webbing between the fingers.

It occasionally can also infect the back of the hands and can be accompanied by Tinea pedis (Athlete’s Foot). In its initial presentation small transparent pinpoint vesicles appear. These quickly rupture and as they dry up the hands become covered in layers of fine, white scales. If left untreated the affected skin becomes extremely dry, thickened and rough. Fissures or cracking will result, often causing pain and difficulty in bending or stretching of the fingers. The nails may also become infected.

TINEA PEDIS (Athlete’s Foot)

This condition is most commonly caused by Trichophyton rubrumm. It affects the webbing between the toes and the soles of the feet. The top of the feet and occasionally the ankles may also be involved.

A streptococcus bacteria can also invade the infected site causing localized infection. In more severe cases, cellulites (inflammation of the subcutaneous tissue) and lymphangitis (redness & inflammation of the lymphatic vessels, seen as red streaks in a streptococcal infection) can also occur.

Tinea pedis is quite common in adults, especially in young males. Highly infectious, it can be spread easily in communal areas such as changing rooms, showers or swimming pools. The condition is aggravated by hot “sweaty” weather and further inflamed by wearing tight-fitting shoes or sports runners.

There are three basic presentations of this condition:-

INTERDIGITAL

Lesions are commonly between the toes and between the sole border with the toes. The fourth and fifth toe spaces are more frequently infected.
Small vesicles are the first indication. They easily rupture when rubbed and the resulting “oozing” fluid gives off a distinctive “fishy” smell. The skin softens and turns white and after peeling develops a bright red appearance.
Some cases it presents as dry, rough skin which may be itchy and cracked.
Subsequent infection by other bacteria is common.
It is often worse in winter, tending to improve in warmer weather (probably due to the fact open or no shoes are worn and the feet can “breath”).
Reoccurences are possible.

MOCCASIN

Presents with a “shoe” like appearance over the entire foot and sometimes the ankle. The skin is dry and scaly and the sole may appear as a red or even whitish colour.
Frequently seen in patients who also have Tinea manuum.
Can be accompanied by infected nails.
Treatment is more difficult, however, good results can be achieved.

VESICULAR

Vesicles evolve rapidly either on the sole or top part of the foot. On the sole they often “collect” as groups, underneath the thickened skin.
May also present as large bullae (blisters). The vesicles eventually rupture. Upon drying, peeling occurs leaving a reddened base. This presentation resembles an allergic contact dermatitis.
Can also be accompanied by infected nails and secondary bacterial infections.

TINEA UNGUIUM (Ringworm of the nails)

Infection of the nail plates of the fingers or toes is commonly caused by Trichophyton metagrophytes or Trichophyton rubrum.

The infection can be primary or secondary. Primary infections often develop following external injury to the nail. Secondary infections result from a “spread” of the infective organism from pre-existing skin infections of the hands/feet.

As one gets older, the likelihood of nail infections increases.
The toe nails more likely infected than the fingernails. The nail of the big toe is the most common site of infection.
The nail becomes progressively opaque, yellow and thickened. Eventually the whole nail plate becomes infected and the nail starts to separate from the bed.
In severe cases the nail has difficulty in re-growing as it is deformed and weakened and breaks or fragments easily.

TINEA BARBAE (Ringworm of the beard)

This conditions affects mainly men and involves the beard and moustache regions of the face. It is due to the invasion of the hair follicle by dermatophyte Trichomychosis.

It presents as pustular folliculitis with red, inflamed and painful papules, nodules or pustules. The hairs are “loose” and can be easily removed. Commonly found on the upper lip, it can in extreme cases, spread to the cheeks, eyelids, eyebrows and even the forehead. If these areas are involved, the presentation is completely different, usually showing a sharply marginated redness with fine scaling over the affected area.

TINEA FACIALIS (Ringworm of the face)

More common in children, the condition is often misdiagnosed because of its presentation. It usually affects the cheeks, chin, nose and upper lip and is characterized by a well defined red patch. It can be extremely itchy and often results in a scoured, bloody ruptured appearance. It can be accompanied by white/yellowish scaling. It normally starts in one or two small areas that centrally progress outwards. It can also be light (photo) sensitive.

TINEA CORPORIS (Ringworm of the body)

A superficial dermatophyte infection of the “smooth” skin of the body – trunk, neck and limbs - but excluding the feet, hands and groin. The main fungi responsible are Microsporum and Trichophyton.

Lesions start with “grouped” papules of papulovesicles, which gradually increase in number and size. Singular or multiple, sharply defined circular, semicircular or concentric “edges” occur, forming “rings”. These “rings” are usually very red. As the centre heals, the elevated surrounding edge continues to erupt in clusters of papules or papulovesicles. It continues to spread out and a concentric pattern forms.

Fine scaling and mild to severe itching that accompanies the condition, is often worse in the summer. Cooler weather breaks the cycle only to reoccur the following summer.

TINEA CRURIS (Jock Itch)

A condition that almost exclusively affects adult men in the groin and genital area. It is worse in Summer due to sweating. It can still occur in Winter if heavy, multi-layered clothing is worn. It can also be transmitted through sexual contact.

In the initial stages the condition presents as a red scaly patch within a flexural fold, i.e. groin. This spreads gradually from the flexural fold to the thigh and buttocks. The patch is marked by a narrow, raised, well-defined inflamed edge. Small vesicles or pustules may form within the area. As the “centre” heals, hyperpigmentation, which is temporary, develops. The spread of the circular, semicircular or concentric patches is even.

It can spread to the scrotum with severe localized itching.

Although Epidermophyton floccosum is the main cause of this condition, Trichophyton rubrum can also be responsible.

If Trichophyton rubrum is the cause the onset is usually considerably slower. The lesions associated with this type of infection can spread as far as the abdomen and the lower back. This form is extremely painful.

Seconday bacterial infections can also increase the severity of the condition.

CANDIDIASIS

It is commonly caused by the yeast, Candida albicans and less often by other yeast strains.

Candida albicans is a normal inhabitant of the gut, vaginal tract and the mouth. Certain predisposing factors such as obesity, pregnancy, diabetes, the taking of oral contraception, antibiotics or the application of topical steroids, heat or immune dysfunction, cause the yeast to colonize out of control.

The yeast usually only infects the outer layers of the skin, spreading under the outer layer and causing it to lift and peel. Accompanied generally by intense redness which leaves a bare, glistening surface. It colonizes in the body folds affecting the skin under the breasts, the genitals, nail plate, mouth, face and scalp, and between the toes or fingers.

In people who are immune compromised the condition can become systemic. Invasion of the blood vessels can occur with widespread infection of the gastro-intestinal tract, trunk and extremities. May also present as a secondary infection in conditions such as eczema.

Source: Fungal Infections

Granuloma Annulare

Sun, 09 Mar 2008 00:00:00 +1300

This condition normally affects the back of the hands, the top of the foot, elbows and knees. It can also spread out along the arms and up the legs and even to the buttocks.

Twice as many women are affected and it usually presents in childhood or in young adults.

This condition is a benign, uncommon, slow progressing skin condition of unknown causes. It initially presents as small red or purple papule or papules that slowly develop into an irregular “ring” of firm papules that can be 0.5 to 5 cm in diameter.

Granuloma annulare is often misdiagnosed as tinea (ring worm) because of the round pattern. It is important to note that unlike tinea, where the border usually presents with scaling, the border of granuloma annulare does not present with a scale and is usually a raised, smooth leading edge.

It can last for months or years, however, in 75% of patients it will resolve within 2 years. Recurrences are common.

Source: Granuloma Annulare

Miliaria - Prickly Heat or Heat Rash

Sat, 08 Mar 2008 00:00:00 +1300

This condition presents as a direct result of profuse sweating from exposure to hot and humid weather conditions, especially in the tropics.

Blockage of the sweat glands causes the ducts to rupture and a superficial inflammatory reaction around the sweat glands occurs.

It is more likely to occur during scorching hot or extremely humid, summer conditions.

It usually affects children or obese people.
Rarely affecting the palms or soles, it is more likely to occur in the areas of the body that are covered by clothing and the areas that are prone to sweating.
The lesions present as papules or small, thin-walled superficial pinpoint vesicles often surrounded by a red “halo”. The lesions are slightly shiny and erupt easily when scratched. Upon drying there is an associated fine scaling of the affected area. Pinpoint sterile pustules may also be present.
It is often accompanied by a slight burning sensation and a “prickly” itchy feeling.
In extreme cases where the lesions are extensive, the condition may lead to heat exhaustion accompanied by systemic symptoms such as weakness, loss of appetite, fatigue, sleeping, headaches and dizziness.
Miliaria alba presents as white vesicles, unlike Miliaria rubra which has a "reddish" presentation. All other symptoms are the same.

Source: Miliaria - Prickly Heat or Heat Rash

Herpes Simplex Virus (Cold Sores)

Fri, 07 Mar 2008 00:00:00 +1300

The Herpes Simplex Virus (HSV) is a highly contagious infection.

Upon infection the person will develop an initial site infection – vesicle formation and local inflammation. The virus invades the sensory nerve cells where it will remain dormant. Upon reactivation, recurrences of the HSV will result.

When HSV is reactivated its presence is indicated by a burning, itching and tingling sensation prior to any vesicle formation. These vesicles may evolve into pustules. As they evolve erosion occurs and the skin layer is shed. The erosions often develop into ulcerations, either crusted or moist. The lesions may take between 2-4 weeks to fully heal and often result in post-inflammatory hypo or hyper pigmentation. The areas most likely to be affected are around the mouth, inner lips, throat, nose, fingers.

Reactivation can be caused by either:

physical skin trauma such as sunburn, windburn or an abrasion

or
systemic triggers such as fatigue, menstruation, stress or respiratory tract infections.

Human Pappiloma Virus (Warts)

Thu, 06 Mar 2008 00:00:00 +1300

PAPILLOMARVIRUS INFECTIONS - HPV (Verruca/Warts)

These are benign growths on the skin.

VERRUCA VULGARIS – Common warts account for 70% of all cutaneous warts. Approximately 20% of all school-aged children will present with an infection of warts.

They usually occur of the hands, fingers and knees. They can be as small as 1mm and up to 10mm, but rarely larger.

VERRUCA PLANTARIS (Plantar/Palmar Warts)

Affecting normally the soles but can also appear on the palms, this form is more common in older children and adults.

In the early stages a wart presents as a small, shiny, clearly defined papule. It progresses to a thickened surface studded with brownish black spots. Tenderness can be experienced. When on the feet, warts can be extremely painful when walking.

The warts can be solitary or in “groups”, often forming a mosaic like pattern.

VERRUCA PLANA (Flat Warts)

Sharply defined flat papules that are pinkish or light brown in colour. They can occur on the face, beard area, shins and back of the hands.

Butchers, meat packers and fish handlers seem to be exposed to a virulent strain that presents in large to very large “cauliflower” clusters on their hands.

FILOFORM WARTS (Skin Tags)

These can occur on any part of the body, in singular or cluster patterns. They start as a small papule and become progressively elongated.

Source: Human Pappiloma Virus (Warts)

Ichthyosis

Wed, 05 Mar 2008 00:00:00 +1300

From the Greek root “Ichthy” for fish. We know that the family of “Ichthyoses” are a group of genetic skin diseases that are characterized by dry, thickened and “scaling” skin.

In an Ichthyosis sufferer, the normal shedding process is inhibited or “slowed down” and in extreme cases the production of the skin cells can also be at a more rapid rate than normal. In some cases the condition is very mild to mild. However, at its worst it can be an extremely cosmetically disfiguring condition. Sufferers in this category also have to cope with many systemic infections due to the constant splitting of the skin and fissures that are often difficult to heal. The sufferer's immune system is impaired and they find it hard to fight off infections.

There are several different varieties of Ichthyosis. One of the most common forms is “Lamellar” Ichthyosis, which is believed to occur in ?1:300,000 births. Lamellar Ichthyosis usually is noticeable at birth due to the fact that the baby is encased in a "collodion – like" membrane. This membrane initially heals and may appear normal for a period of time.

Slowly as the child grows parchment like scales develop over the entire body. As the skin condition progresses, the scales become very thick and darken to black/brown in colour. Hands and feet (palmar/plantar) are also affected with deep creasing evident coupled with painful skin fissures. Hair growth is impaired due to the large crusted scales covering the head and scaring often leads to alopecia.

Ectropion (droopy eyelids) is another symptom of Lamellar ichthyosis.

In other forms of Ichthyosis e.g. X-linked, skin abnormalities are not apparent at birth. Onset of the symptoms may be delayed to between 2-6 weeks of age. The scales are finer with an erythema (reddened) background. Hand and feet also show the same deep creasing and skin fissures as seen in people who have Lamellar ichthyosis.

It is believed that around one million people in America alone, are afflicted with some form of Ichthyosis.

Evidence of very dry skin on the body, palms and feet already with peeling in scale formation beginning to occur, in a baby 8 weeks of age.

In the above examples, wrinkling of the skin increases and the face shows shiny tautness of the cheeks, around the lips and forehead.

This girl, aged 2, shows erythema (reddening) of the skin with progressive spread of small patches that eventually will join.

Fissures and cracked skin of the feet and hands can be painful and debilitating to walk or grasp objects.

The left photograph above shows the progression of the condition in a 7 year old boy. The photograph on the right shows widespread erythema with finer, smaller flaky scales in a 3 year old girl.

In this young male adult, below, the scales are thick and crusted. Flaking of the skin reveals reddened skin that has coarsened over the years. This, of course, is a very severe case.

Ichthyosis cannot be cured and at best treatments are currently aimed at managing or controlling the condition.

It is not an easy condition to treat and much of the treatment is based on trialling various strengths of ointments in order to find the one that the patient best responds to. The ointment mix would also change from time to time, depending on the response and the health of the patient.

Over the years, Dr Tirant has treated a number of Ichthyosis patients, who have responded with considerable improvements. His interest in this condition has grown considerably since visiting Hungary in 2002, where Dr Tirant became, involved in the treatment two children who have Icthyosis. Andras has had 2, intensive, 8 week treatments in Australia and Kristina who has had 1, intensive, 8 week treatment program in Australia.

Both have shown significant and marked improvement and are receiving ongoing treatment from Dr Tirant.

Dr. Tirant is the first to admit that he is not an Ichthyosis expert, his background being in the treatment of skin conditions such as Psoriasis, Eczema, Dermatitis, Rosacea and Acne. He is, however, encouraged enough, by the response of Andras and Kristina to his Treatment Protocols to feel confident in presenting the photographic evidence of their response to date.

Dr Tirant provides his Treatment Protocols to overseas Ichthyosis patients in conjunction with their dermatologist. Both Andras and Kristina are under dermatologist care back in Hungary and each year, when Dr. Tirant is in Hungary, Dr Tirant has a review with the children and their dermatologists. Patient's own dermatologists are able to provide observation of the skin condition, patient's health and the progress of treatment back to Dr Tirant in Australia via email etc..

For overseas patients, an Online Consultation, supported by a dermatologist's referral with a thorough & detailed medical history, supported by photographic jpegs would be the minimum basis required to establish a treatment regime. Photographs should be of general and close up shots of body areas focusing on hands (palms and back of) feet (soles and uppers) knees, elbows, armpits, neck, scalp, chest and back.

In severe cases, as with both Andras and Kristina, it may be advisable for some cases, in order to achieve the best results, that an intensive eight (8) week program is at some stage undertaken in Australia. This is where the fine tuning of the medications (both oral and topical) can take place on a weekly basis with results being observed and recorded first hand by Dr Tirant.

Dr. Tirant has spent the last 20 years researching the effects of and benefits of natural essential oils and herb extracts on the healing of and the improving of the skin. He has also experimented on various combinations of herb extracts, vitamins and minerals that are taken orally and how they interplay with and support his treatment protocols.

Unlike over the counter products and other prescribed products, Dr Tirant has the advantage of being able to tailor both his ointments, gels, skin conditioner & orals , as well as if required, to supplement these with additional herbal tonics especially formulated for the patient.

Source: Ichthyosis

Itching/Pruritis

Tue, 04 Mar 2008 00:00:00 +1300

Generalized Itching/Pruritis/Prurigo

Often the cause of itchy skin is not known or is unclear as itching is characterisitc of many skin conditions and systemic diseases.

Pruritis

Pruritis may be generalized (that may involve large areas of the body) or localized (restricted to a specific area).

Generalized pruritis also indicates "itching" that cannot be readily associated with a detectable primary skin condition such as eczema. Secondary features often involve severe excoriation (bloody scratches) that affect all sites except for the mid-back as this area cannot be reached by the patient. This pattern is called the "butterfly" sign. Most patients generally appear to have fine, dry and scaly skin and the itching usually responds well to the application of emollients.

Approximately half of the patients who suffer from pruritis may have some underlying systemic disease e.g. uremia, lymphomas, leukemias, iron deficiency and pregnancy etc. Other causes may be due to parasitic or fungal infestations, takingor cessation of drugs and psychological factors.

Localized pruritis is usually caused by skin friction either against close fitting clothing or skin to skin. Other causes may be fungal or parasitic infestations.

Pruritis is:-

PRURIGO

Source: Itching/Pruritis

Melasma/Chloasma

Mon, 03 Mar 2008 00:00:00 +1300

CONDITIONS EFFECTING PIGMENTATION OF THE SKIN

VITILIGO

A skin condition of unknown causes resulting in the progressive loss of pigmentation (melanocytes) from the skin. Onset may be at any age but is more common in adolescence and young adulthood.

A genetic predisposition to the condition is likely. Approximately 30% of patients have a family history with either a parent, sibling or child having the condition. An auto-immune link also plays a role in Vitiligo development and an association has been observed with auto-immune disorders including diabetes mellitus and thyroid conditions.

It is a chronic condition with a rapid onset, which is then followed by a relative period of stability or a slowed progression.

The lesions are usually symmetrically distributed “white” patches of varying size and number. The borders are sharply demarcated and there may be some heat or burning sensation, especially after exposure to the sun. The hairs that grow in these patches may also turn white.

MELASMA (Chloasma)

It is derived from the Greek language meaning “black spot”.

Melasma is yellow or brown hyperpigmentation of the skin which. It is more common in brown skin coloured persons and in women.

It is usually related to hormonal triggers such as pregnancy, the taking of oral contraceptives and hormonal replacement therapies as well as hormone imbalances. Exposure to sunlight and stress may also be triggers.

The pigmentation is symmetrical, usually involving the chin, cheeks, forehead, perioral (eye) and perinasal (nose) areas

HYPERPIGMENTATION

This condition is usually a post inflammatory over production of the epidermal melanin following a drug eruption, psoriasis, acne, dermatitis, eczema, lichen planus or after any type of trauma.

The lesions are usually limited to the area of preceding inflammation. They present as indistinct, “feathery” edged patches. The condition can persist for weeks or even months.

HYPOPIGMENTATION

Also a post-inflammatory condition, but with the loss of epidermal melanin. Unlike in Vitiligo where the lesions are “chalk” white, in this condition they are “off” white. Edges may be sharply marginated or even indistinct depending on the cause of the condition. Fine scaling may also accompany this condition. It can develop after pityriasis alba, dermatitis, psoriasis, guttate parapsoriasis or dermabrasions and chemical peels or even after glucocorticoid injections.

It can persist for months after the initial condition/inflammation has been resolved.

Source: Melasma/Chloasma

Nail Infections

Sun, 02 Mar 2008 00:00:00 +1300

ONYCHOLYSIS

The detachment of the nail plate from its bed, is often associated with psoriasis, fungal infections, lichen planus, trauma, chemical exposure and other systemic disorders.

As the nail plate lifts, the space between the plate and the bed collects dirt and keratinous debris. The colour of the affected nails may vary from greyish-white, yellow, brown, greenish or even black.

ACUTE PARONYCHIA

This condition is an inflammation of the nail fold, resulting in redness, swelling and throbbing pain. In severe cases pus will drain from the area surrounding the nail.

ONYCHOMYCOSIS

A chronic, progressive infection of the nail, that is caused by dermatophytes, candida and some moulds. It is often the result of a secondary or “spread” colonization.

Approximately 80% of onychomycosis occurs in the nails of the feet, especially in the big and little toe nails.

Source: Nail Infections

Para Psoriasis en Plaques

Sat, 01 Mar 2008 00:00:00 +1300

PARAPSORIASIS EN PLAQUES or Chronic Superficial Dermatitis

There are two types:-

Small Plaque ( Digitative Dermatosis)

Lesions < 5cm in diameter. Yellowish or light tan in colour. The patches or plaques are clearly defined and covered with a fine layer of scale. The lesions are small and finger shaped.

Large Plaque

Lesions > 10cm in diameter. Salmon pink or light red-brown in colour. They are large and tend to be round or oval in shape. Unlike plaque psoriasis or psoriasis annularis there is little or no flaking or thickening of the skin. The lesion is also flatter.

The condition is most commonly referred to as chronic superficial dermatitis.

It affects more males than females and usually presents in middle aged patients:-

It involves the trunk – abdomen, buttocks and may also involve the thighs and upper arms.
Itching is only slight.
The condition worsens in winter with a remission in summer.

Psoriatic Arthritis

Fri, 29 Feb 2008 00:00:00 +1300

It can affect between 10%-30% of psoriatics and is more frequent in patients with psoriatic nails or pustular psoriasis.

Characteristic symptoms include joint pain with or without swelling, stiffness, throbbing, redness of joints and heat within the joints, swelling with "sausage-like" appearance of the fingers and toes, tenderness of joints and the surrounding tissue, morning stiffness, reduced movement and functioning. Eye pain and redness, similar to those symptoms of conjuctiveitis, may also be present.

In 85% of patients who suffer from psoriatic arthritis, their skin symptoms preceded the joint disease on average by about 10 years. Most patients typically develop psoriatic arthritis between the ages of 30-50 years.

Although, as yet, there is no definitive medical test to determine psoriatic arthritis, other forms of arthritis, e.g. rheumatoid arthritis, have to be tested for in a process of elimination. Blood tests, MRI's and X-rays of the joints are typical diagnostic tests conducted to determine the type of arthritis involved.

There are five different types of psoriatic arthritis:

Distal arthritis - involving the small joints of the hands and feet, especially of the toes and fingers.
Oligoathritis - involving less than five larger joints.
Polyathritis - where more than five joints are involved and often presents with a similar appearance to rheumatoid arthritis.
Arthritis mutilans - a very destructive form of the disease that may cause permanent damage to the joints.
Spondylarthropathy - involving inflammation of the spine and hip joints.

Not all patients present with all of the symptoms, however it is vital to seek diagnosis and treatment if you are experiencing:

morning stiffness that lasts for two hours or more,
swelling accompanied by heat within the joints and redness of the joints,
persistent pain even after taking asprin.

Source: Psoriatic Arthritis

Psoriasis

Thu, 28 Feb 2008 00:00:00 +1300

Psoriasis is a skin condition that affects about 3.8% of the population and is the cause of great discomfort. For some, it may even result in hospitalization.

The cause of psoriasis is unknown, although it is well accepted that there is an underlying genetic component which, when triggered, causes the immune system to produce an excessive number of skin cells. As such it has been termed an auto-immune skin disorder. At present there is no cure.

There are four Primary triggers that start or activate the condition. They include:

Koebner Phenomenon - injury or trauma to the skin i.e. operations, Bites, cuts, abrasions etc;

Systemic Infections - Tonsilitis, Shingles and some viral and bacterial infections;

Drug Interaction - taking or cessation of certain drugs such as steroids, lithium, anti malarials, anti-inflamatories, some blood pressure medications (Beta Blockers) and antibiotics; and

Stress - Anxiety and worry.

Secondary triggers play a role in the continued exacerbation of the condition and Dr Tirant discovered that such factors were were often related to lifestyle, dietary and chemical exposure.

Types of Psoriasis

There are many types of psoriasis.

Plaque (Chronic)
Guttate
Flexural (Inverse)
Psoriasis Annularis
Pustular
Palmo-Plantar
Erythrodermic EEC
Scalp
Nail Involvement
Psoriatic Arthritis

Source: Psoriasis

Porphyrias

Wed, 27 Feb 2008 00:00:00 +1300

The porphyrias are a group of genetic disorders that result from an inherited abnormal *heme biosynthesis pathway. Patients with porphyria have a reduced level of porphyrin synthesizing enzymes. This causes a reduction of normal enzyme activity and an accumulation of toxic metabolites in the system. This accumulation is responsible for many of the symptoms experienced by people who have porphyria.

The malfunction in enzyme activity that occurs in porphyria is exacerbated by ingestion of certain drugs – both pharmaceutical and recreational. These include alcohol, sulfonamides, barbiturates, phenytoin, estrogens and chloroquine. Exposure to chemicals such as hexachlorobenzene (a fungicide) can also affect porphyria and may be responsible for triggering the condition in some cases. Avoiding drugs, alcohol and chemical exposure is an important component of treatment.

There are 5 types of porphyria and these are classified into two different groups – the erythropoietic porphyrias (caused by accumulation of *hemoglobin) and the hepatic porphyrias (caused by accumulation of the P450 cytochrome, a liver enzyme).

At the Psoriasis & Skin Clinic we treat only two of the 5 types of porphyria: porphyria cutanea tarda and variegate porphyria. These both fall within the classification of hepatic porphyries. Please see your doctor for treatment of other types of porphyria.

Porphyria Cutanea Tarda

This is the most common form of porphyria. It is characterized by symptoms of blistering, scarring and erosion especially on the back of the hands. Hypopigmented and hyperpigmented macules are common and dark brown or black hairs develop on the temples, cheeks, trunk and extremities. The symptoms are a response to increased skin photosensitivity. Patients often complain of having “fragile skin” and symptoms frequently occur following minor trauma of the skin.

Variegate Porphyria

Variegate porphyria is characterized by both cutaneous (skin) symptoms and neurological symptoms. In areas exposed to sunlight, there is increased skin fragility with blisters, scarring and the growth of black or brown hairs. These symptoms are similar to those seen in porphyria cutanea tarda.

The neurological symptoms can affect any portion of the nervous system. Possible symptoms include delirium, personality changes, seizures, muscle weakness, confusion, depression, sensory loss and peripheral neuropathy. Neurological changes can also affect the digestive system with acute attacks of abdominal pain, constipation, nausea and vomiting possible.

Glossary :

Heme: The iron holding constituent of hemoglobin. Gives hemoglobin its deep red colour.
Hemoglobin: The substance in red blood cells that enables them to carry oxygen.

Source: Porphyrias