Skin Diseases

Skin diseases have a high prevalence anywhere in the world including our country. They can be due to infections like leprosy, inflammatory like eczema and pimples, can be inherited or an external manifestation of internal serious disease.

Infections
Impetigo, is highly infectious, common skin disease seen more in children. It presents as weeping, exudative areas with typical honey coloured crust on the surface. It spreads by direct contact. They are treated with antibiotic skin creams and if many are present with an antibiotic by mouth too. A bullous variety presents with watery bubble like appearance commonly seen in babies.

Cellulitis
Presents as hot, sometimes tender red areas due to a bacteria. Often seen in the legs. Patients are unwell with fever. Commonly seen in diabetics. Treatment with antibiotic is needed.

Folliculitis
Is the inflammation of hair follicles presenting with itchy pustules. It is common in humid conditions and wearing occlusive clothing. Boils are more deep seated infections of the skin producing red painful swellings. They are common in teenagers and often recur. Washing the limbs with light pink Condy's solution is a preventive measure.

Herpes Simplex
Caused by a virus. Type 1, is spread by direct contact or by droplets, seen in early childhood. Present as a painful vesicle or an ulcer. In the lips the virus lying dormant can get activated during a stress period, trauma, fever or those on strong drugs. Type 2, virus stay dormant in the nerves of lower spinal cord. Gets activated and by affection of the nerves will produce pain in the groin, buttocks or thighs. Anorectal herpes is common in men having sex with men. It can present as growths on the external genital opening of a woman, whose baby can infected during the vaginal delivery. Hence, an indication for a Caesaration section delivery. It is a very common sexually transmitted diseases seen in the young from 18 to 24 years. Painful shallow ulcers develop in the external genitalia which may coalesce. Then it becomes dry and crusted. Neurological complications can occur.

Human Pappiloma Virus infection
Is a common sexually transmitted infection and some types causing a cancer of the cervix. Warts develop in the external genitalia and the perianal region. The latter is more common in men who practice anorectal sex. There is an effective vaccine now given to women to prevent it.

Trichomoniasis
Is again sexually transmitted. Can infect the vagina and the urethral passage. The common complain is a vaginal discharge. Men are usually asymptomatic and present as partners of an affected woman.

Candidiasis
Candidiasis is the commonest fungal infection in the human. Vulvovaginal infection in women and infection of the penis in males. In women intense itching of the external genitalia is the dominant feature. In men infection of the male organ. This organism can also have manifestations in the mucous membrane of the mouth in new born babies and infants. Also known a "thrush" there are white specks like "coconut dust" on the mucous membrane of the mouth. This infection can occur following antibiotic theraphy. Can and should be treated.

Molluscum contiogisum
"Water blisters" is a common childhood virus skin infection. The lesions are multiple small (1 to 3 mm) translucent swellings which look like fluid filled bubbles but in fact solid individual lesions may have a central depression. The can be found anywhere. It is transmitted by direct contact. They usually continue to occur in crops over 6 to 12 months and rarely require treatment and often spontaneously resolve. Any stratching or trauma will speed up healing.

Ring Worm Infections
The commonest is in the groin, in the foot it is called 'the athlete's foot', and also in the body. In the body usually presents with slightly itchy asymmetrical scaly patches which shows central clear area and an advancing raised edge. Ring worm in the face appears after the use steroid skin creams. The commonest ring worm is in the groins. Seen as well demarcated red swellings, with an arc like border extending down to the upper thigh. Athlete's foot may be confined to the toe clefts where the skin looks like macerated and fissured. Tinea capitis is the infection of scalp. It is spread by close contact in schools and households especially and may also be spread by hairdressers. Increase of air travel has allowed it to spread to newer places. Overcrowding and poor social conditions promote the spread. The appearance of hair ring worm is highly variable from mild diffuse scaling with no hair loss (similar to dandruff) to the more typical circular patches with associated balding and broken hairs. Ring worm of the nails is increasingly common with age. It is seen as an assymmetrical whitening or yellowish black discoloration of one or more nails. Discoloration starting at a border and spreading to the entire nail. The nail appears thickened. Crumbly white material appears under the nail plate.

Pityriasis versicolor
Commonly known as (aluhung). In dark skinned persons it appears as areas of hypo pigmentation (lack of skin pigment). There is scaliness on scraping. Inappropriate use of steroid skin creams leads to this condition. These are easily treatable by your family doctor and cause no serious sequale.

Scabies

It is an intensely itchy rash caused by a mite. It can affect all races and people of any social class. It is most common in children and young adults but can affect any age. There are 300 million cases of scabies in the world each year. It is commoner in poorer areas with overcrowding. Scabies is spread by prolonged close contact such as within households or institutions or sexual contact. It presents with red itchy tiny swellings or occasionally as bubbles or pus containing elevated swellings (pustules). It can occur anywhere in the body but very rare to affect the face except in new born-babies. Sites of predilection are between the web spaces of fingers and toes, which is very characteristic, on the palms and soles around the wrists and arm pits, on the male genitalia and around the nipples in females and the navel. These mites form burrows which are linear or curved. The scratching is worse in the night. Excoriations and secondary bacterial infection may complicate the rash. Secondary bacterial infection with the streptococcus is common cause of acute nephritis (important and serious disease of the kidney in young children).

Lice Infection

Head lice is a common infectiom worldwide predominantly affecting children and commoner in females. Spread is by direct contact and encouraged by overcrowding. It usually presents with itching or scalp excoriations. Diagnosis is confirmed by the presence of eggs (Nits) seen tightly bound to the hair shaft. Adult lice may be seen in heavy infestation. Eradication is difficult because of non compliance as well as resistance patterns.

Body Lice

Infestation with body lice is a disease of poverty and neglect. It is spread by direct contact or sharing infected clothing. The lice and the eggs are rarely seen on the patient but are commonly found on the clothing. It presents with itching, excoriations and sometimes post inflammatory dark pigmentation. 

Pubic Lice (Crabs)

The pubic lice is a blood sucking insect which attaches tightly to the pubic hair. They may also get attached to eyebrows or eye lashes. The most common complaint is itching. Lice may be seen at the base of the hair. They resemble small scabs or freckles. Blue patches may be seen at the feeding sites.

Insect Bites or Papular Urticaria

These depend on contact with an animal (cats, dogs, birds) infested with fleas. Or after bites from flying insects like mosquitoes. The fleas can be seen in soft furnishings, carpets and bedding. Bites present as itchy elevated lesions which are often grouped in clusters. The legs are the most common site of bites. Anti flea treatment of the animal and furnishings is required. Insect repellants and appropriate clothing will help lessen bites from flying insects.

Infestation with Bed Bugs

They are brown/black lentil sized insects at night time as they are attracted to warmth and carbon dioxide of sleeping humans.