27 yr lady came with lesion.as shown in images.itching and swelling present.gradually it increasing in size.diagnosis and treatment plz??

A 35 yr female pt with Nodular swellings over both hands , feets and face since 5-6 months with B/L foot swelling, no itching , no burning sensation

A 55 year old male presented to OPD with complaints of lesions as shown in picture, with lesions in legs being itchy and sclaes come out too *History* Known case of T2DM/HTN well controlled on Gliclazide, Linagliptin, Losartan/Amlodipine Current HBA1C is 8.2 *Investigations* His reports of complete panel is normal, except TLC being 13000, but no complaints of fever etc *Diagnosis* Please guide are these any lesions due to any medication too In legs I am suspecting Ichthyosis Vulgaris Please guide about the discoloured lesions in back, elbow and elsewhere too *Management* Also discuss the management of Ichthyosis Vulgaris So far I have started him on following - Vildagliptin/Metformin 50/500 BD Moisturex Soft Cream BD Coconut Oil at bedtime Tab Fexofenadine 180 in mning Telmisartan/Amlodipine 40/5 in mning

ABC OF : NAIL DISORDERS. ( I ). MAY BE USEFUL. *** ANONYCHIA is the absence of nails, an anomaly, which may be the result of a congenital ectodermal defect, ichthyosis, severe infection, severe allergic contact dermatitis, self-inflicted trauma, Raynaud phenomenon, lichen planus, epidermolysis bullosa, or severe exfoliative diseases....... *** PSORIASIS can also affect the fingernails and toenails, leading to thick fingernails with pitting, ridges in the nails, nail lifting away from the nail bed, and irregular contour of the nail....... *** LICHEN PLANUS of the nails can cause brittle or split nails, and the affected nails may have ridges running lengthwise....... *** FUNGAL nail infections are common infections of the fingernails or toenails that can cause the nail to become discolored, thick, and more likely to crack and break. Infections are more common in toenails than fingernails.....by some dermatophytes, Candida (Monilia) species, etc....... The technical name for a fungal nail infection is “ONYCHOMYCOSIS.”....... *** SPOON-SHAPED or spooning fingernails refers to a concavity in the fingernail itself, resulting in a depression in the nail that gives an appearance of a spoon shape to the entire nail. This growth disturbance in the nail is known as KOILONYCHIA....... In particular, koilonychias is associated with IRON DEFICIENCY. *** Fingernails are made by living skin cells....... So a skin condition such as eczema may lead to fingernail ridges. Skin dryness can also cause these ridges. If the body is low in protein, calcium, zinc.......or vitamin A, a deficiency can sometimes be revealed by ridges in the fingernails. ** HORIZONTAL RIDGES run from side to side on nails and are often referred to as BEAU'S LINES may be a sign of previous injury, underlying health conditions, or in rare cases, arsenic poisoning....... Horizontal ridges can be caused by trauma to the nail and may be deep or discolored. The can also indicate malnutrition, psoriasis or a thyroid problem....... ** VERTICAL RIDGES are usually harmless and a consequence of ageing.......nail injury, or trauma, or underlying medical conditions....... *** The ECTODERMAL DYSPLASIAS (EDs) are genetic disorders affecting the development or function of the teeth, hair, nails and sweat glands....... ** ED is not a single disorder, but a group of closely related conditions of which more than 150 different syndromes have been identified....... *** Nail CLUBBING, also known as digital clubbing, is a deformity of the finger or toe nails associated with a number of diseases, mostly of the heart and lungs. ... Hippocrates was probably the first to document clubbing as a sign of disease, and the phenomenon is therefore occasionally called "Hippocratic fingers"..... ** Lung cancer is the most common cause of clubbing. Clubbing often occurs in heart and lung diseases that reduce the amount of oxygen in the blood. ... Heart defects that are present at birth (congenital) Chronic lung infections that occur in people with bronchiectasis, cystic fibrosis, or lung abscess....... *** While the NAIL BITING and picking seems to be such a common problem, the psychological and medical research does not agree on the exact motivation for the action. However, it suggests that nail biting can be the result of STRESS, VARIOUS MEDICAL DISORDERS, LEARNED BEHAVIORS, OR JUST PLAIN HABIT....... *** SPLINTER HEMORRHAGES : They run in the direction of nail growth. They are named splinter hemorrhages because they look like a splinter under the fingernail. The hemorrhages may be caused by tiny clots that damage the small capillaries under the nails. Splinter hemorrhages can occur with infection of the heart valves (endocarditis)....... *** YELLOW TOENAILS in an infection by a fungus that attacks the nails..... or, in some cases, they may be a sign of skin cancer. The fungal infection is caused most often by dermatophytes, which eat keratin to grow....... One of the MOST COMMON CAUSES of YELLOW NAILS is a FUNGAL INFECTION. As the infection worsens, the nail bed may retract, and nails may thicken and crumble. In rare cases, yellow nails can indicate a more serious condition such as SEVERE THYROID DISEASE, LUNG DISEASE, DIABETES or PSORIASIS....... *** WHILE NAILS ( LEUKONYCHIA ) : CAUSES : Iron deficiency anemia. Cirrhosis of liver. Kidney disease. Heart failure. Diabetes. Problems with the digestion of proteins. An excessive loss of proteins in the intestines. zinc deficiency........etc....... *** RED NAILS :- CAUSES : LUPUS patients get quirky, angular blood vessels in their nail folds. PSORIASIS starts in the nails up to 10 percent of the time and CAUSES SPLITTING and PITTING of the nail bed. HEART DISEASE can turn the nail beds red....... ** If the NAIL BED is RED, it could be caused by a high content of fatty acids and cholesterol, due to an excess of dairy products, sugar and salt in the diet. This can lead to an underactive liver and blocked arteries....... To keep the system healthy by replacing refined foods with wholegrain rice and bread, and flush out the system with plenty of fresh vegetables and at least five glasses of water a day....... *** HALF PINK and HALF WHITE nails can be a sign of kidney disease....... *** BRITTLE NAILS :- CAUSES : AGING. CHEMICAL/TOXIN EXPOSURE. LONG-TERM USE OF NAIL POLISH AND POLISH REMOVE. LOW HUMIDITY ENVIRONMENT. MALNUTRITION. NAIL-PATELLA SYNDROME. PROLONGED EXPOSURE TO WATER. TRAUMA. ** B complex vitamins (especially biotin), calcium, and zinc have all been implicated. There are other medical conditions which can cause brittle nails such as ANEMIA (low blood count), THYROID DISORDERS, and skin disorders such as LICHEN PLANUS and PSORIASIS. ** ONYCHOSCHIZIA includes splitting, brittle, soft or thin nails. Onychoschizia is MORE COMMON IN WOMEN. Only VERY RARELY are INTERNAL DISEASE or VITAMIN DEFICIENCIES the reason (IRON DEFICIENCY is the MOST COMMON).......

#HolisticMedicine #CCAUpdates All you need to know about Alopecia (hairloss) Most people normally shed 50 to 100 hairs a day. This usually doesn't cause noticeable thinning of scalp hair because new hair is growing in at the same time. Hair loss, baldness or alopecia occurs when this cycle of hair growth and shedding is disrupted or when the hair follicle is destroyed and replaced with scar tissue. The exact cause of hair loss may not be fully understood, but it's usually related to one or more of the following factors: Family history (heredity), especially for male-pattern baldness Hormonal changes (e.g. pregnancy, childbirth or the onset of menopause) Certain medical conditions (e.g. thyroid disorders, diabetes, anemia, Systemic Lupus Erythematosus (SLE), sarcoidosis with skin involvement, and some local conditions such as tinea infection of scalp, lichen planus, and Trichotillomania (a disorder causes people to repeatedly pull out their own hair)) Certain treatment (e.g. cancer treatment (chemotherapy and radiation therapy), blood thinners, high dose vitamin A, drug for arthritis, depression, heart problems and high blood pressure, birth control pills and anabolic steroids (steroids taken to build muscle and improve athletic performance)) Severe emotional and physical stress Nutritional deficiencies (not enough protein or iron, eating disorder such as anorexia and bulimia, and weigh lost) Androgenetic alopecia: Androgenetic alopecia is the most common type of progressive hair loss. It is also known as male-pattern baldness, female-pattern baldness, or just common baldness. Androgenetic alopecia is caused by a combination of genetic and hormonal factors. Dihydrotestosterone (DHT) is the main hormone responsible for androgenetic alopecia in genetically susceptible individuals. DHT causes scalp hair loss by inducing a change in the hair follicles on the scalp. The hairs produced by the affected follicles become progressively smaller in diameter, shorter in length and lighter in colour until eventually the follicles shrink completely and stop producing hair. Male-pattern baldness can begin as early as puberty, and affects around half of all men by 50 years of age. It generally follows a pattern of a receding hairline, followed by thinning of the hair on the crown and temples, resulting in partial or complete baldness. In female-pattern baldness, hair usually only thins on top of the head. It tends to be more noticeable in women who have been through the menopause. Besides Androgenetic alopecia, there are other forms of hair loss such as Alopecia Areata (AA), Telogen Effluvium (TE). Alopecia areata: Alopecia areata most frequently presents as a single round patch (about the size of a large coin) or multiple patches of hair loss that may coalesce into larger areas of alopecia. They usually appear on the scalp but can occur anywhere on the body. It can occur at any age, but mostly affects teenagers and young adults. In alopecia areata, hair is lost because it is affected by inflammation. The cause of this inflammation is unknown but it is thought that the immune system, the natural defence which normally protects the body from infections and other diseases, may attack the growing hair. Why this might happen is not fully understood, nor is it known why only localised areas are affected and why the hair usually regrows again. Telogen effluvium In telogen effluvium (TE), hair density decreases resulting in reduced volume of hair. The decrease of hair density is due to marked increase in hairs shed each day, an increased proportion of hairs shift from the growing phase (anagen) to the shedding phase (telogen). Normally only 10% of the scalp hair is in the telogen phase, but in telogen effluvium this increases to 30% or more. The cause of TE is due to a disturbance of the normal hair cycle. Common triggers of telogen effluvium include childbirth, severe trauma or illness, a stressful or major life event (such as losing a loved one), marked weight loss and extreme dieting, a severe skin problem affecting the scalp, a new medication or withdrawal of a hormone treatment Many cases of hair loss are temporary; while some hair loss is permanent. Some are natural part of ageing and do not need treatment; some are part of the process of medical conditions which will resolve as the medical conditions are treated; whereas for some conditions, treatment are available. Hair loss can have an emotional impact, so you may want to look at treatment if you're uncomfortable with your appearance. The goals of treatment are to promote hair growth, slow hair loss or hide hair loss. Drug treatments for some types of hair loss are available. For telogen effluvium it usually resolves completely without any intervention, as the normal length of telogen is approximately 100 days (3 to 6 months) after which period the hair starts growing again (anagen phase). For alopecia areata hair may regrow without treatment within a year. There is drug for treating alopecia areata e.g. corticosteroid, it is used for reducing inflammation and suppress immune system. For androgenic alopecia, drugs treatments are available. In addition to drug treatment there are other available treatments such as surgery, laser therapy, and wigs. Your doctor may suggest a combination of these approaches in order to get the best results. *Drugs for Androgenetic Alopecia: Two medicines, namely finasteride and minoxidil, are used in the treatment of male-pattern baldness. Minoxidil is currently the only medicine available to treat female-pattern baldness. Finasteride is available as oral tablets which are only used for men. It works by preventing the hormone testosterone being converted to the hormone dihydrotestosterone (DHT). DHT causes the hair follicles to shrink, so blocking its production allows the hair follicles to regain their normal size. It usually takes three to six months of continuously using finasteride before any effect is seen. The balding process usually resumes within six to twelve months if treatment is stopped. Minoxidil is available as topical preparations (e.g. topical solution/lotion, and foam) which may be used for men and women. It is applied directly to the scalp. It's not clear how minoxidil works. It usually needs to be used for several months before any effect is seen. The balding process will usually resume if treatment with minoxidil is stopped. The re-grown hair may fall out three to four months after treatment is stopped. Finasteride tablets are prescription only medicines, whereas topical preparations containing not more than 5% of minoxidil are pharmacy only medicines. It is important to seek dermatologist's opinion or medical advice to identify any underlying causes before starting any treatment. *Drugs for Alopecia Areata: Although there is neither a cure for alopecia areata nor drugs approved for its treatment, some people find that medications approved for other purposes can help hair grow back, at least temporarily. Intralesional corticosteroids stimulate hair regrowth at the site of injection and may be of benefit for limited patchy hair loss. Side effect of intralesional corticosteroid injection includes increased risk of infection, headache, joint pain and injection site reaction. Oral pulsed or continuous corticosteroids may be used in severe progressive cases. Both intralesional and oral corticosteroid are prescription only medicines. *Drugs for Alopecia, common side effects and precautions 1. Finasteride (oral) side effects: impotence decreased libido ejaculation disorders breast tenderness and enlargement testicular pain Precautions: Use with caution in hepatic impairment. Patients should be evaluated for prostatic carcinoma before and during therapy. Contra-indicated in women who are or may become pregnant. Women who are or may become pregnant should avoid handling crushed or broken tablets of finasteride. Use of a condom is recommended if sexual partner is pregnant or likely to become pregnant. Cases of male breast cancer have been reported. May increase the risk of high-grade prostate cancer. 2. Minoxidil (topical) side effects: contact dermatitis itching local burning flushing changes in hair colour or texture headache Precautions: Should be restricted to the scalp. Do not apply on other parts of the body. Avoid contact with eyes, mouth and mucous membranes, broken, infected, shaved, or inflamed skin. Avoid inhalation of spray mist when spray applicator is used. Avoid occlusive dressings and topical drugs which enhance absorption. Discontinue if increased hair loss persists for more than 2 weeks. Users should discontinue treatment if there is no improvement after one year. Avoid in pregnancy and lactation. Contraindicated in user with treated or untreated hypertension. General advice: * Eat a nutritionally balanced diet. If you are otherwise well-nourished, taking nutritional supplements has not been shown to be helpful. * Avoid tight hairstyles, such as braids, buns or ponytails. * Avoid compulsively twisting, rubbing or pulling your hair. * Treat your hair gently when washing and brushing. A wide-toothed comb may help prevent pulling out hair. * Avoid harsh treatments such as hot rollers, curling irons, hot oil treatments and permanents.