Sunday, October 08, 2006

merdeka celebrations with more dermatology FYIs

Come, come allow me to yabber ‘bout a couple of skin diseases in conjunction with “tanggal tiga puluh satu bulan lapan lima puluh tujuh”…

Erysipelas (and cellulitis) is an acute spreading of infection within the dermal and subcutaneous layer of the skin. It is characterized by a red, hot, painful area of the skin near the site of bacterial entry. This old man came in with an infected foot. Prior to this he had an allergic reaction to chicken which made his legs itch. Scratching fast forward and now his lower right leg hurts like f*cks. All the scratching could be a form of trauma to the skin that caused microabrasions (micro cuts in skin) to happen allowing infection entry into tissue spaces. It takes afew days for the infection to happen and the patient may suffer from fever, chills, fatigue and anorexia. If the patient does not show signs of sepsis (heavy systemic infection), NaCl (sodium chloride; saline) compresses can be administer to the wound + immobilization / rest + elevation + antibiotics. Without proper management the tissues will necrotize (rot).

Tinea cruris is a dermatophytic (dermatophytes being a unique fungal group capable of infecting nonviable keratinized tissue) infection of the groin, pubic region and thighs also known as the ‘jock itch’. Usually infecting men, warm and humid environment + tight clothing + obesity also contribute to the development of this disease. It can last from months to years and it’s the intense itch that drives patients to get help. An old man came with Tinea cruris all over his groin and ass. It was scaling and slightly dark in shade. After eradication of Tinea Cruris with antifungal agents, reinfection can be prevented by wearing less layers of clothing and immediately wash all clothes worn.
Pityriasis versicolor a type of yeast (usually Malassezia furfur) infection and causes white hypopigmented or red / dark hyperpigmented patches on the skin. Your grandmother probably calls it panau. She probably said you got it ‘cos you immediately showered after sweating. It is not true-lah. You will find it itches more severely after a good sweat or in warm, humid temperature. After treatment, the patches may take a longer while to get eliminated. Patients should avoid layers, tight clothes or materials which can restrict sweat absorption. Symptoms may recur.

Leprosy is a chronic disease of the Mycobacterium family (the family that turut brings you Tuberculosis) that affects major sites of involvement: the skin, peripheral nervous system, upper respiratory tract, eyes and testes. Your grandmother probably calls it kusta and it’s also known as Hansen’s disease / Morbus Hansen. You can contract this disease through skin contact, respiratory system, gastrointestinal system and animal hosts like armadillos and monkeys as well as from flora: the Sphagnum moss. The cardinal signs of leprosy are anaesthetic patches on the skin, history of contact with leprosy patients / living in endemic leprosy areas and positive active Tuberculoid bacillus. There are many classifications of the disease which can be explored by your doctor. If you just came from a leprosy endemic area or had contact with a leprosy patient, been swimming in a lake covered with Sphagnum moss, have armadillos as pets or came from petting monkeys in the wild… lookout for pale patch(es) on the skin that has no sensation, clawing of your fingers/toes and transfiguration into what they call banana fingers, your features turning into Simba’s (fasies leoninas: lion face), glove and stocking syndrome: numbness in your hands and feet and thickening of nerves (you feel you can pluck your nerves on your elbows / behind your knees / side of neck like a guitar). I know I know you’re thinking, “HAHH kusta-ah?? I thought WHO declare eradication of leprosy last time” Yea… but unfortunately for us due to poverty and unhygienic sanitation, leprosy makes its second debut as a re-emerging disease in Indon. After the first few years of hardcore antibiotic multi-drug therapy, the most difficult problem is managing the changes secondary to neurologic deficits. A lot of rehabilitation and physiotherapy would be involved in improving functions of fingers and toes.

Psoriasis is said to be ‘one of the miseries that beset mankind’. What are the others-ah?? Dunno-lah… bankruptcy?? Early incidence of psoriasis peaks at the age of 22.5 years while the late incidence of psoriasis peaks at the age of about 55. an early onset of psoriasis usually predicts a more severe and long-lasting disease with positive family history. This hereditary disease manifests as sharply marginated reddish lesions with silvery white scales. It may occur anywhere in the body but there are classic predilection sites such as the scalp, behind ears, elbows, knees, feet soles, palms, groin and the small of the back. It can occur in dual forms: eruptive inflammatory types with multiple droplet / coin lesions which has a greater tendency towards resolution or chronic stable plaques which present for months and years. Trigger factors which precipitate psoriasis are physical trauma (Koebner’s phenomenon), infection, stress, drugs and alcohol as a putative trigger factor. Psoriasis happens ‘cos of alteration of cell kinetics of keratinocytes with a shortening of the cell cycle resulting in 28 times the normal production of epidermal cells meaning cell death and shedding in an extreme rate in comparison to normal skin cells. Psoriasis is managed through corticosteroid therapy: topical and systemic, UVA / UVB phototherapy, oral retinoids or methotrexate (used in miscarriage or cancer patients).

Scabies is a horrid infestation by the mite Sarcoptes scabiei.
(to be continued)
P.S. (disclaimer): info courtesy of Fitzpatrick Dermatology

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