Ichthyosis Vulgaris

What is ichthyosis vulgaris?

Ichthyosis vulgaris is an inherited or acquired skin condition that occurs when the skin doesn’t shed its dead skin cells. This causes dry, dead skin cells to accumulate in patches on the surface of the skin. It’s also known as “fish scale disease” because the dead skin accumulates in a similar pattern to a fish’s scales.

The majority of cases are mild and confined to specific areas of the body. However, some cases are severe and cover large areas of the body, including the abdomen, back, arms, and legs.

SYMPTOMS

Symptoms of ichthyosis vulgaris

Symptoms of ichthyosis vulgaris include:

• flaky scalp
• itchy skin
• polygon-shaped scales on the skin
• scales that are brown, gray, or white
• severely dry skin
• thickened skin

Symptoms of ichthyosis vulgaris are typically worse in winter, when the air is colder and drier. The patches of dry skin typically appear on the elbows and lower legs. It most often affects the shins in thick, dark segments. In severe cases, ichthyosis vulgaris may also cause deep, painful cracks to develop on the soles of the feet or palms of the hands.

CAUSES

What causes ichthyosis vulgaris?

Ichthyosis vulgaris may be present at birth or appear in the first few years of a child’s life. It typically disappears during early childhood. Some people may never have symptoms again. But for others, it can return during adulthood.

As with many other skin conditions, genetics play a role in the transmission of ichthyosis vulgaris. The condition follows an autosomal dominant pattern. This means that only one parent needs to possess the mutated gene in order to pass it onto his or her child. It’s one of the most common of all inherited skin disorders.

In rare cases, adults can develop ichthyosis vulgaris even if they don’t carry the defective gene. Though this is rare, it’s most often associated with other conditions, including cancer, kidney failure, or thyroid disease. It can also be associated with taking certain types of medications.

Ichthyosis vulgaris may also occur along with other skin disorders, such as atopic dermatitis or keratosis pilaris. Atopic dermatitis, more commonly known as severe eczema, is known for causing extremely itchy skin rashes.

The affected skin may also be thick and covered in scales. The white or red skin bumps caused by keratosis pilaris can look similar to acne, but they usually appear on the arms, thighs, or buttocks. This condition can also cause rough patches of skin.

DIAGNOSIS

How is ichthyosis vulgaris diagnosed?

A doctor specializing in skin disorders, called a dermatologist, can typically diagnose ichthyosis vulgaris by sight.

Your doctor will ask you about any family history of skin diseases, the age you first experienced symptoms, and whether you have any other skin disorders.

Your doctor will also record where the patches of dry skin appear. This will help your doctor track the effectiveness of your treatment.

Your doctor may also perform other tests, such as a blood test or skin biopsy. This will rule out other skin conditions, such as psoriasis, that cause similar symptoms. A skin biopsy involves removing a small section of the affected skin for examination under a microscope.

TREATMENT

Treating ichthyosis vulgaris

There’s currently no cure for ichthyosis vulgaris. However, treatment can help you manage your symptoms.

Home treatments

Exfoliating your skin with a loofa or a pumice stone after you bathe can help remove the excess skin.

Regularly apply moisturizers that have urea or propylene glycol in them. These chemicals will help your skin stay moist. Using products with urea, lactic, or salicylic acid can also help your skin shed dead cells. Using a humidifier in your home will add moisture into the air and keep your skin from drying out.

Prescription treatments

Your doctor may also prescribe specialized creams or ointments to help moisturize the skin, get rid of dead skin, and control inflammation and itching. These may include topical treatments containing the following ingredients:

• Lactic acid or other alpha hydroxy acids. These compounds, also used in anti-aging cosmetics, help the skin retain moisture and reduce scaling.
• Retinoids. Retinoids may be used in difficult cases to slow your body’s production of skin cells. These substances are derived from vitamin A, so they may have some adverse side effects. Side effects may include lip swelling or hair loss. Birth defects may occur if taken during pregnancy.

Telangiectasia (Spider Veins)

Understanding telangiectasia

Telangiectasia is a condition in which widened venules (tiny blood vessels) cause threadlike red lines or patterns on the skin. These patterns, or telangiectases, form gradually and often in clusters. They’re sometimes known as “spider veins” because of their fine and weblike appearance.

Telangiectases are common in areas that are easily seen (such as the lips, nose, eyes, fingers, and cheeks). They can cause discomfort, and some people find them unattractive. Many people choose to have them removed. Removal is done by causing damage to the vessel and forcing it to collapse or scar. This reduces the appearance of the red marks or patterns on the skin.

While telangiectases are usually benign, they can be a sign of serious illness. For example, hereditary hemorrhagic telangiectasia (HHT) is a rare genetic condition that causes telangiectases that can be life-threatening. Instead of forming on the skin, telangiectases caused by HHT appear in vital organs, such as the liver. They may burst, causing massive bleeding (hemorrhages).

SYMPTOMS

Recognizing the symptoms of telangiectasia

Telangiectases can be uncomfortable. They are generally not life-threatening, but some people may not like how they look. They develop gradually, but can be worsened by health and beauty products that cause skin irritation, such as abrasive soaps and sponges.

Symptoms include:

• pain (related to pressure on venules)
• itching
• threadlike red marks or patterns on the skin

The symptoms of HHT include:

• frequent nosebleeds
• red or dark black blood in stools
• shortness of breath
• seizures
• small strokes
• port-wine stain birthmark

CAUSES

What are the causes of telangiectasia?

The exact cause of telangiectasia is unknown. Researchers believe several causes may contribute to the development of telangiectases. These causes may be genetic, environmental, or a combination of both. It’s believed that most cases of telangiectasia are caused by chronic exposure to the sun or extreme temperatures. This is because they usually appear on the body where skin is often exposed to sunlight and air.

Other possible causes include:

• alcoholism: can affect the flow of blood in vessels and can cause liver disease
• pregnancy: often applies large amounts of pressure on venules
• aging: aging blood vessels can begin to weaken
• rosacea: enlarges venules in the face, creating a flushed appearance in cheeks and nose
• habitual corticosteroid use: thins and weakens the skin
• scleroderma: hardens and contracts the skin
• dermatomyositis: inflames skin and underlying muscle tissue
• systemic lupus erythematosus: can increase skin sensitivity to sunlight and extreme temperatures

The causes of hereditary hemorrhagic telangiectasia are genetic. People with HHT inherit the disease from at least one parent. Five genes are suspected to cause HHT, and three are known. People with HHT receive either one normal gene and one mutated gene or two mutated genes (it only takes one mutated gene to cause HHT).

RISK FACTORS

Who is at risk of contracting telangiectasia?

Telangiectasia is a common skin disorder, even among healthy people. However, certain people are more at risk of developing telangiectases than others. This includes those who:

• work outdoors
• sit or stand all day
• misuse alcohol
• are pregnant
• are older or elderly (telangiectases are more likely to form as skin ages)
• have rosacea, scleroderma, dermatomyositis, or systemic lupus erythematosus (SLE)
• use corticosteroids

DIAGNOSIS

How do doctors diagnose telangiectasia?

Doctors may rely on the clinical signs of the disease. Telangiectasia is easily visible from the threadlike red lines or patterns it creates on the skin. In some cases, doctors may want to make sure that there is no underlying disorder. Diseases associated with telangiectasia include:

• HHT (also called Osler-Weber-Rendu syndrome): an inherited disorder of the blood vessels in skin and internal organs that can cause excessive bleeding
• Sturge-Weber disease: a rare disorder that causes a port-wine stain birthmark and nervous system problems
• spider angiomas: an abnormal collection of blood vessels near the surface of the skin
• xeroderma pigmentosum: a rare condition in which the skin and eyes are extremely sensitive to ultraviolet light

HHT may cause the formation of abnormal blood vessels called arteriovenous malformations (AVMs). These may occur in several areas of the body. These AVMs allow direct connection between arteries and veins without intervening capillaries. This may result in hemorrhage (severe bleeding). This bleeding can be deadly if it occurs in the brain, liver, or lungs.

To diagnose HHT, doctors may perform an MRI or a CT scan to look for bleeding or abnormalities inside the body.

TREATMENT

Treatment of telangiectasia

Treatment focuses on improving the appearance of the skin. Different methods include:

• laser therapy: laser targets the widened vessel and seals it (this usually involves little pain and has a short recovery period)
• surgery: widened vessels can be removed (this can be very painful and may lead to a long recovery)
• sclerotherapy: focuses on causing damage to the inner lining of the blood vessel by injecting it with a chemical solution that causes a blood clot that collapses, thickens, or scars the venule (there’s usually no recovery needed, although there may be some temporary exercise restrictions)

Treatment for HHT may include:

• embolization to block or close a blood vessel
• laser therapy to stop bleeding
• surgery

Athlete's Foot

Athlete's foot facts

• Athlete's foot is a common disorder of the feet characterized by scaling and/or blistering of the soles, fissures of the toe webs, and itching.
• When caused by a fungus, athlete's foot may spread to the palms, groin, and body.
• Fungal infections of the feet are contagious and can be spread person to person or by walking on contaminated floors.
• Other causes of athlete's foot include contact allergy, erythrasma, bacterial infection, pompholyx, intertrigo, and occasionally psoriasis.
• When athlete's foot is caused by a fungus, it can be treated with antifungal medications, many of which are available without a prescription.
• Keeping the feet dry by using cotton socks and breathable shoes can help prevent athlete's foot.

 What is athlete's foot? What are causes and risk factors of athlete's foot ?

Athlete's foot is a term given to almost any inflammatory skin disease that affects the sole of the foot and the skin between the toes. It is usually a scaly, red, raw-appearing eruption and occasionally may be weepy and oozing with small blisters. It affects the feet of athletes and non-athletes alike. Although it is frequently caused by a fungal infection, other causes may be indistinguishable without proper testing.

The medical name for fungal athlete's foot is tinea pedis. There are a variety of fungi that cause athlete's foot, and these can be contracted in many locations, including gyms, locker rooms, swimming pools, communal showers, nail salons, and from contaminated socks and clothing. The fungi can also be spread directly from person to person by contact. Most people acquire fungus on the feet from walking barefoot in areas where someone else with athlete's foot has recently walked. Some people are simply more prone to this condition while others seem relatively resistant to it. Another colorful name for this condition is "jungle rot," often used by members of the armed services serving in tropical climates.

Fungal infections are promoted by warmth and moisture. There is some speculation that before enclosed shoes became common, tinea pedis was less prevalent. Up to 70% of the population may develop athlete's foot at some time. An infection by athlete's foot fungi does not confer any resistance to subsequent infections.

What are the symptoms and signs of athlete's foot ?

Many individuals with athlete's foot have no symptoms at all and do not even know they have an infection. Many may think they simply have dry skin on the soles of their feet. Common symptoms of athlete's foot typically include various degrees of itching, stinging, and burning. The skin may frequently peel, and in particularly severe cases, there may be some cracking, fissuring, pain, and itching in the toe webs. Occasionally, athlete's foot can blister.

What are risk factors for athlete's foot?

Walking barefoot in wet, dark areas frequented by many other individuals like indoor swimming pool decks, communal showers, and locker rooms result in frequent exposure to pathogenic fungi (dermatophytes) that cause athlete’s foot. Wearing occlusive footwear is thought to play a significant role in the increased frequency of tinea pedis. Exposure to moisture either from excessive sweating or from an external source is a risk factor. Wearing the same shoes and socks for an extended period may damage the skin. Patients with diabetes are predisposed to develop tinea pedis. Some believe that eczema (atopic dermatitis) can predispose one to tinea pedis. It appears that many more men have tinea pedis than women. Pedicure performed in contaminated environments can spread disease.

What is the treatment for athlete's foot?

Since there is no single cause for athlete’s foot there is no single treatment. Nevertheless, all causes of this condition benefit by promoting a dry, clean, and friction-free environment for the feet.

Occlusive shoe materials, such as vinyl, which cause the feet to remain moist, provide an excellent area for the fungus to proliferate. Likewise, absorbent socks like cotton that wick water away from your feet may help. Some individuals who sweat excessively benefit from the application of antiperspirants like 20% aluminum chloride (Drysol). Powders can help keep your feet dry. Although counterintuitive, if your feet can be soaked in a solution of aluminum acetate (Burow's solution or Domeboro solution) and then air dried with a fan, this can be very helpful if performed three or four times within 30 minutes. A home remedy of dilute white vinegar soaks, using one part vinegar and roughly four parts water, once or twice a day (as 10-minute foot soaks) may aid in treatment followed by evaporation can be helpful.

For fungus infection, there are plenty of options. Many medications are available, including miconazole (Micatin, Zeasorb powder), econazole (Spectazole), clotrimazole(Lotrimin), terbinafine (Lamisil), naftifine (Naftin), butenafine (Mentax), ciclopirox (Loprox), ketoconazole (Nizoral), efinaconazole (Jublia), luliconazole (Luzu), sertaconazole (Ertaczo), sulconazole (Exelderm), and tolnaftate (Tinactin). Ask your health care professional or pharmacist for a recommendation. It is difficult to know which of these drugs is most effective since they have not been tested against each other. Cost is probably the most significant differentiating factor, and many are available without a prescription. Treatment for athlete's foot should generally be continued for four weeks or at least one week after all of the skin symptoms have cleared.

More advanced or resistant cases of athlete's foot may require a course of an oral (pill) antifungal like terbinafine (Lamisil), itraconazole (Sporanox), or fluconazole(Diflucan). Laboratory blood tests to make sure there is no liver disease may be required before taking these pills.

Topical corticosteroid creams can act as a fertilizer for fungus and may actually worsen fungal skin infections by suppressing the body's immune defenses. These topical steroid medications have no role in treating fungal foot infections but can be quite effective in treating noninfectious causes of athlete’s foot.

If the fungal infection has spread to the toenails, the nails must also be treated to avoid reinfection of the feet. Often, the nails are initially ignored only to find the athlete's foot keeps recurring. It is important to treat all of the visible fungus at the same time. Effective nail fungus treatment may be more intensive and require prolonged courses (three to four months) of oral antifungal medications.

Alopecia Areata

Alopecia Areata facts

• Alopecia areata is peculiar form of hair loss that usually affects the scalp but can occur on any hair-bearing skin.
• Alopecia areata produces one or more patches of balding without any obvious change in the texture of the affected skin, a non-scarring alopecia.
• Alopecia areata affects males and females.
• It is thought to be an autoimmune disorder, in which hair follicles, are damaged by a misguided immune system.
• For most patients, the condition resolves without treatment within a year, but hair loss is sometimes permanent.
• Many treatments are known to aid in hair regrowth. Multiple treatments may be necessary, and none consistently work for all patients.

 What is alopecia areata?

Alopecia areata is an acquired skin disease that can affect all hair-bearing skin and is characterized by localized areas of non-scarring alopecia (hair loss). Alopecia areata is occasionally associated with other medical problems. Most often these bald areas regrow their hair spontaneously.

Alopecia areata is rare before 3 years of age. There seems to be a significant inherited predisposition for the development of alopecia areata.

What causes alopecia areata?

Current evidence suggests that alopecia areata is caused by an abnormality in the immune system that damages hair follicles. This particular abnormality leads to autoimmunity, a misguided immune system that tends to attack its own body. As a result, the immune system attacks particular tissues of the body. In alopecia areata, for unknown reasons, the body's own immune system attacks the hair follicles and disrupts normal hair formation. Biopsies of affected skin show immune lymphocytes penetrating into the hair bulb of the hair follicles. Alopecia areata is occasionally associated with other autoimmune conditions such as thyroid disease, vitiligo, lupus, rheumatoid arthritis, and ulcerative colitis. The diagnosis or treatment of these diseases is unlikely to affect the course of alopecia areata. Sometimes, alopecia areata occurs within family members, suggesting a role of genes.

What are the signs and symptoms of the different patterns of alopecia areata?

The most common pattern is one or more well-defined spots of hair loss on the scalp. If alopecia occurs in an ophiasis pattern (hair loss involving the temporal and posterior scalp) or if large areas of the scalp are involved for long periods of time, the prognosis is worse. A more generalized form of hair loss is referred to as diffuse alopecia areata where there is widespread dramatic thinning of the scalp hair. Occasionally, all of the scalp hair is entirely lost, a condition referred to as alopecia totalis. Less frequently, the loss of all of the hairs on the entire body, called alopecia universalis, occurs.

Who is affected by alopecia areata?

Alopecia areata tends to occur most often in adults 30 to 60 years of age. However, it can also affect older individuals and, rarely, young children. Alopecia areata is not contagious. It should be distinguished from hair shedding that may occur following the discontinuation of hormonal estrogen and progesterone therapies for birth control or the hair shedding associated with the end of pregnancy. There are a number of treatable conditions that could be confused with alopecia areata.

What is the treatment for alopecia areata?

The course of typical alopecia areata is not predictable with a high likelihood of spontaneous remission. The longer the period of time of hair loss and the larger the area involved, the less likely the hair will regrow spontaneously. Therefore, there are a variety of treatments, but none of these can confidently be predicted to impact the course of this disease. Local steroid injections intracutaneously may be very helpful in restarting the hair growth cycle in treated areas. Steroid creams, lotions, and shampoos have been used for many years but are of limited benefit at best. Although oral systemic steroids are known to induce hair growth in affected patients, their long-term use is contraindicated because of the likelihood of undesirable side effects.

The topical sensitizers, diphencyprone or squaric acid dibutylester, have been used in those suffering from recalcitrant alopecia areata or those with more than 50% hair loss. The goal of treatment is to create an allergic contact dermatitis of the scalp. This alteration in the immune response occasionally is accompanied by hair regrowth. The efficacy of the topical sensitizers has been demonstrated in both young children and adults, but it probably works less than half the time. Recent success using oral janus kinase inhibitors, including tofacitinib, ruxolitinib, and baricitinib, have been shown to be efficacious in severe, extensive alopecia areata in adults, but long-term therapy has potential side effects. The durability of response to these medications is variable, and most patients experience recurrence of hair loss after discontinuation. Perhaps topical therapy with these types of drugs may be available in the near future.

There is no known effective method of prevention, although the elimination of emotional stress is felt to be helpful. No drugs or hair care products have been associated with the onset of alopecia areata.

Although not precisely a treatment, the cosmetic camouflage of alopecia areata is certainly an important consideration in patient management. The damaging emotional effect of significant hair loss for both women and men can be considerable.

Lichen Planus

What is lichen planus?

Lichen planus is a skin rash triggered by the immune system. It’s not known why the immune response occurs. There may be several contributing factors, and each case is different. Potential causes include:

• viral infections
• allergens
• stress
• genetics

Sometimes lichen planus occurs along with autoimmune disorders. While it may be uncomfortable, in most cases lichen planus is not a serious condition. It’s also not contagious.

However, there are some rare variations of the condition that may be serious and painful. These conditions can be treated with topical and oral medications to reduce symptoms, or by using drugs that suppress the immune system.

SYMPTOMS

Symptoms of lichen planus

Some of the most common symptoms of lichen planus include the following:

• purplish-colored lesions or bumps with flat tops on your skin or genitals
• lesions that develop and spread over the body over the course of several weeks or a few months
• itching at the site of the rash
• lacy-white lesions in the mouth, which may be painful or cause a burning sensation
• blisters, which burst and become scabby
• thin white lines over the rash

The most common type of lichen planus affects the skin. Over the course of several weeks, lesions appear and spread. The condition usually clears up within 6 to 16 months.

Less commonly, the lesions can occur in areas besides the skin or genitals. These may include:

• mucous membranes
• nails
• the scalp

There are also variations of the condition more common in the Middle East, Asia, Africa, and Latin America.

CAUSES AND RISK FACTORS

What are the causes and risk factors?

Lichen planus develops when your body attacks your skin or mucous membrane cells by mistake. Doctors are not sure why this happens.

Lichen planus can occur in anyone at any age, but there are certain factors that make some people more likely to develop the condition. The skin form of lichen planus occurs in men and women equally, but women are twice as likely to get the oral form. It’s very rare in children and older adults. It’s most common in middle-aged people.

Other risk factors include having family members who’ve had lichen planus, having a viral disease like hepatitis C, or being exposed to certain chemicals that act as allergens. These allergens may include:

• antibiotics
• arsenic
• gold
• iodide compounds
• diuretics
• certain kinds of dyes
• Other medications

DIAGNOSIS

Diagnosis of lichen planus

Anytime you see or feel a rash on your skin or lesions in your mouth or on your genitals, you should see your doctor as soon as possible. Your primary care doctor may send you to a dermatologist if a diagnosis of lichen planus is not obvious, or if your symptoms are making you very uncomfortable.

Your primary care doctor or dermatologist may be able to tell that you have lichen planus simply by looking at your rash. To confirm the diagnosis, you may need further tests.

Tests could include a biopsy, which means taking a small sample of your skin cells to view under a microscope, or an allergy test to find out if you’re having an allergic reaction. If your doctor suspects the underlying cause is an infection, you may need to have a test for hepatitis C.

TREATMENT

Treating lichen planus

For mild cases of lichen planus, which usually clear up in weeks or months, you may not need any treatment. If the symptoms are uncomfortable or severe, your doctor can prescribe medication.

There is no cure for lichen planus, but medications that treat the symptoms are helpful and some may even be able to target a possible underlying cause. Medications often prescribed include:

• retinoids, which are related to vitamin A and are taken topically or orally
• corticosteroids reduce inflammation and can be topical, oral, or given as an injection
• antihistamines reduce inflammation and may be particularly helpful if your rash is triggered by an allergen
• nonsteroidal creams are applied topically and can suppress your immune system and help clear up the rash
• light therapy treats lichen planus with ultraviolet light

Home treatments

There are other things you can try at home to complement your prescription treatments. These include:

• soaking in an oatmeal bath
• avoiding scratching
• applying cool compresses to the rash
• using OTC anti-itch creams

Talk to your doctor before adding OTC products to your treatment plan. This way you’ll be certain that nothing you might take will interact with prescription medications you’re taking.

COMPLICATIONS

What are the complications of lichen planus?

Lichen planus can be difficult to treat if it develops on your vagina or vulva. This can lead to pain, scarring, and discomfort during sex.

Developing lichen planus can also increase your risk of squamous cell carcinoma. The increase in risk is small, but you should see your doctor for routine skin cancer examinations.

OUTLOOK

What’s the outlook?

Lichen planus can be uncomfortable, but is not dangerous. With time, and a combination of home and prescription treatments, your rash will clear up.