45 y/o female with Sjögren's has 3 months of burning tongue, dryness, scrapping and KOH negative for fungi elements. Improves when steroids are given. Any ideas?

Autoimmune Diseases: Types, Symptoms, Causes and More........Check it Out...! ---------------------------------------------------------------------- ---------------------------------------------------------------------- What is an autoimmune disease? An autoimmune disease is a condition in which your immune system mistakenly attacks your body. The immune system normally guards against germs like bacteria and viruses. When it senses these foreign invaders, it sends out an army of fighter cells to attack them. Normally, the immune system can tell the difference between foreign cells and your own cells. In an autoimmune disease, the immune system mistakes part of your body — like your joints or skin — as foreign. It releases proteins called autoantibodies that attack healthy cells. Some autoimmune diseases target only one organ. Type 1 diabetes damages the pancreas. Other diseases, like lupus, affect the whole body. CAUSES Why does the immune system attack the body? Doctors don’t know what causes the immune system misfire. Yet some people are more likely to get an autoimmune disease than others. Women get autoimmune diseases at a rate of about 2 to 1 compared to men — 6.4 percent of women vs. 2.7 percent of men . Often the disease starts during a woman’s childbearing years (ages 14 to 44). Some autoimmune diseases are more common in certain ethnic groups. For example, lupus affects more African-American and Hispanic people than Caucasians. Certain autoimmune diseases, like multiple sclerosis and lupus, run in families. Not every family member will necessarily have the same disease, but they inherit a susceptibility to an autoimmune condition. Because the incidence of autoimmune diseases is rising, researchers suspect environmental factors like infections and exposures to chemicals or solvents might also be involved . A “Western” diet is another suspected trigger. Eating high-fat, high-sugar, and highly processed foods is linked to inflammation, which might set off an immune response. However, this hasn’t been proven . Another theory is called the hygiene hypothesis. Because of vaccines and antiseptics, children today aren’t exposed to as many germs as they were in the past. The lack of exposure could make their immune system overreact to harmless substances . BOTTOM LINE: Researchers don’t know exactly what causes autoimmune diseases. Diet, infections, and exposure to chemicals might be involved. COMMON AUTOIMMUNE DISEASES 14 common autoimmune diseases There are more than 80 different autoimmune diseases . Here are 14 of the most common ones. 1. Type 1 diabetes The pancreas produces the hormone insulin, which helps regulate blood sugar levels. In type 1 diabetes, the immune system attacks and destroys insulin-producing cells in the pancreas. High blood sugar can damage blood vessels, as well as organs like the heart, kidneys, eyes, and nerves. 2. Rheumatoid arthritis (RA) In rheumatoid arthritis (RA), the immune system attacks the joints. This attack causes redness, warmth, soreness, and stiffness in the joints. Unlike osteoarthritis, which affects people as they get older, RA can start as early as your 30s . 3. Psoriasis/psoriatic arthritis Skin cells normally grow and then shed when they’re no longer needed. Psoriasis causes skin cells to multiply too quickly. The extra cells build up and form red, scaly patches called scales or plaques on the skin. About 30 percent of people with psoriasis also develop swelling, stiffness, and pain in their joints . This form of the disease is called psoriatic arthritis. 4. Multiple sclerosis Multiple sclerosis (MS) damages the myelin sheath — the protective coating that surrounds nerve cells. Damage to the myelin sheath affects the transmission of messages between your brain and body. This damage can lead to symptoms like numbness, weakness, balance issues, and trouble walking. The disease comes in several forms, which progress at different rates. About 50 percent of people with MS need help walking within 15 years after getting the disease. 5. Systemic lupus erythematosus (lupus) Although doctors in the 1800s first described lupus as a skin disease because of the rash it produces, it actually affects many organs, including the joints, kidneys, brain, and heart . Joint pain, fatigue, and rashes are among the most common symptoms. 6. Inflammatory bowel disease Inflammatory bowel disease (IBD) is a term used to describe conditions that cause inflammation in the lining of the intestines. Each type of IBD affects a different part of the GI tract. Crohn’s disease can inflame any part of the GI tract, from the mouth to the anus. Ulcerative colitis affects only the lining of the large intestine (colon) and rectum. 7. Addison’s disease Addison’s disease affects the adrenal glands, which produce the hormones cortisol and aldosterone. Having too little of these hormones can affect the way the body uses and stores carbohydrates and sugar. Symptoms include weakness, fatigue, weight loss, and low blood sugar. 8. Graves’ disease Graves’ disease attacks the thyroid gland in the neck, causing it to produce too much of its hormones. Thyroid hormones control the body’s energy usage, or metabolism. Having too much of these hormones revs up your body’s activities, causing symptoms like nervousness, a fast heartbeat, heat intolerance, and weight loss. One common symptom of this disease is bulging eyes, called exophthalmos. It affects up to 50 percent of people with Graves’ disease . 9. Sjögren’s syndrome This condition attacks the joints, as well as glands that provide lubrication to the eyes and mouth. The hallmark symptoms of Sjögren’s syndrome are joint pain, dry eyes, and dry mouth. 10. Hashimoto’s thyroiditis In Hashimoto’s thyroiditis, thyroid hormone production slows. Symptoms include weight gain, sensitivity to cold, fatigue, hair loss, and swelling of the thyroid (goiter). 11. Myasthenia gravis Myasthenia gravis affects nerves that help the brain control the muscles. When these nerves are impaired, signals can’t direct the muscles to move. The most common symptom is muscle weakness that gets worse with activity and improves with rest. Often muscles that control swallowing and facial movements are involved. 12. Vasculitis Vasculitis happens when the immune system attacks blood vessels. The inflammation that results narrows the arteries and veins, allowing less blood to flow through them. 13. Pernicious anemia This condition affects a protein called intrinsic factor that helps the intestines absorb vitamin B-12 from food. Without this vitamin, the body can’t make enough red blood cells. Pernicious anemia is more common in older adults. It affects 0.1 percent of people in general, but nearly 2 percent of people over age 60 . 14. Celiac disease People with celiac disease can’t eat foods containing gluten — a protein found in wheat, rye, and other grain products. When gluten is in the intestine, the immune system attacks it and causes inflammation. Celiac disease affects about 1 percent of people in the United States . A larger number of people have gluten sensitivity, which isn’t an autoimmune disease, but can have similar symptoms like diarrhea and abdominal pain. SYMPTOMS Autoimmune disease symptoms The early symptoms of many autoimmune diseases are very similar, such as: fatigue achy muscles swelling and redness low-grade fever trouble concentrating numbness and tingling in the hands and feet hair loss skin rashes Individual diseases can also have their own unique symptoms. For example, type 1 diabetes causes extreme thirst, weight loss, and fatigue. IBD causes belly pain, bloating, and diarrhea. With autoimmune diseases like psoriasis or RA, symptoms come and go. Periods of symptoms are called flare-ups. Periods when the symptoms go away are called remissions. BOTTOM LINE: Symptoms like fatigue, muscle aches, swelling, and redness could be signs of an autoimmune disease. Often symptoms come and go over time. SEE A DOCTOR When to see a doctor See a doctor if you have symptoms of an autoimmune disease. You might need to visit a specialist, depending on the type of disease you have. Rheumatologists treat joint diseases like rheumatoid arthritis and Sjögren’s syndrome. Gastroenterologists treat diseases of the GI tract, such as celiac and Crohn’s disease. Endocrinologists treat conditions of the glands, including Graves’ and Addison’s disease. Dermatologists treat skin conditions such as psoriasis. DIAGNOSIS Tests that diagnose autoimmune diseases No single test can diagnose most autoimmune diseases. Your doctor will use a combination of tests and an assessment of your symptoms to diagnose you. The antinuclear antibody test (ANA) is often the first test that doctors use when symptoms suggest an autoimmune disease. A positive test means you likely have one of these diseases, but it won’t confirm exactly which one you have. Other tests look for specific autoantibodies produced in certain autoimmune diseases. Your doctor might also do tests to check for the inflammation these diseases produce in the body. BOTTOM LINE: A positive ANA blood test can show that you have an autoimmune disease. Your doctor can use your symptoms and other tests to confirm the diagnosis. TREATMENT How are autoimmune diseases treated? Treatments can’t cure autoimmune diseases, but they can control the overactive immune response and bring down inflammation. Drugs used to treat these conditions include: nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil) and naproxen (Naprosyn) immune-suppressing drugs Treatments are also available to relieve symptoms like pain, swelling, fatigue, and skin rashes. Eating a well-balanced diet and getting regular exercise can also help you feel better. BOTTOM LINE: The main treatment for autoimmune diseases is with medications that bring down inflammation and calm the overactive immune response. Treatments can also help relieve symptoms. BOTTOM LINE The bottom line More than 80 different autoimmune diseases exist. Often their symptoms overlap, making them hard to diagnose. Autoimmune diseases are more common in women, and they often run in families. Blood tests that look for autoantibodies can help doctors diagnose these conditions. Treatments include medicines to calm the overactive immune response and bring down inflammation in the body.

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47 years old female presented with dryness of mouth (figures 1-3) with occasional slurring of speech and occasional dysphasia since last 4-5 years with dry eyes. Which syndrome is flashing on your mind? �

Friends today I am discussing about a problem known as Alopecia Areata. What is alopecia areata? Alopecia areata is a disease that causes hair to fall out in small patches, which can remain unnoticeable. These patches may eventually connect and then become noticeable, however. This disease develops when the immune system attacks the hair follicles, resulting in hair loss. Sudden hair loss may occur on the scalp, and in some cases the eyebrows, eyelashes, and face, as well as other parts of the body. It can also develop slowly, and recur after years between instances. The condition can result in total hair loss, called alopecia universalis, and it can prevent hair from growing back. When hair does grow back, it’s possible for the hair to fall out again. The extent of hair loss and regrowth varies from person to person. There’s currently no cure for alopecia areata. However, there are treatments that may help hair grow back more quickly and that can prevent future hair loss, as well as unique ways to cover up the hair loss. Resources are also available to help people cope with the stress of the disease. What are the symptoms of alopecia areata? The main symptom of alopecia areata is hair loss. Hair usually falls out in small patches on the scalp. These patches are often several centimeters or less. Hair loss might also occur on other parts of the face, like the eyebrows, eyelashes, and beard, as well as other parts of the body. Some people lose hair in a few places. Others lose it in a lot of spots. You may first notice clumps of hair on your pillow or in the shower. If the spots are on the back of your head, someone may bring it to your attention. However, other types of diseases can also cause hair to fall out in a similar pattern. Hair loss alone isn’t used to diagnose alopecia areata. In rare cases, some people may experience more extensive hair loss. This is usually an indication of another type of alopecia, such as: alopecia totalis, which is the loss of all hair on the scalp alopecia universalis, which is the loss of all hair on the entire body Doctors might avoid using the terms “totalis” and “universalis” because some people may experience something between the two. It’s possible to lose all hair on the arms, legs and scalp, but not the chest, for example. The hair loss associated with alopecia areata is unpredictable and, as far as doctors and researchers can tell, appears to be spontaneous. The hair may grow back at any time and then may fall out again. The extent of hair loss and regrowth varies greatly from person to person. What causes alopecia areata? Alopecia areata is an autoimmune disease. An autoimmune disease develops when the immune system mistakes healthy cells for foreign substances. Normally, the immune system defends your body against foreign invaders, such as viruses and bacteria. If you have alopecia areata, however, your immune system mistakenly attacks your hair follicles. Hair follicles are the structures from which hairs grow. The follicles become smaller and stop producing hair, leading to hair loss. Researchers don’t know what triggers the immune system to attack hair follicles, so the exact cause of this condition isn’t known. However, it most often occurs in people who have a family history of other autoimmune diseases, such as type 1 diabetes or rheumatoid arthritis. This is why some scientists suspect that genetics may contribute to the development of alopecia areata. They also believe that certain factors in the environment are needed to trigger alopecia areata in people who are genetically predisposed to the disease. Alopecia alongside other skin conditions People with an autoimmune disease, like alopecia areata, are also more prone to having another autoimmune disease, including those that also affect the skin and hair. If you’ve been diagnosed with alopecia areata and another skin condition, you may find that treating one helps the other. In other cases, however, treating one may make the other worse. Psoriasis Psoriasis causes a rapid buildup of skin cells. It happens when the immune system mistakenly attacks the skin cells and causes the skin cell production process to go into overdrive. This results in thick patches of skin called plaques, as well as red, inflamed areas of skin. Treating psoriasis with alopecia can be tricky. The scaling associated with psoriasis can make the skin itchy, and scratching can make hair loss worse. In addition, biologic treatments often used for psoriasis, called TNF inhibiters, have been associated with hair loss in some people. For others, treating the psoriasis may help regrow hair. In one small study, over two-thirds of participants with alopecia areata who took a common psoriasis treatment called methotrexate had hair regrowth greater than 50 percent. Another case study found that a new psoriasis treatment called apremilast (Otezla) helped one woman with both psoriasis and alopecia regrow the hair on her scalp in 12 weeks. Atopic dermatitis (eczema) Researchers have established a link between alopecia and atopic dermatitis, a condition in which inflammation on the skin causes itchy, red rashes. Atopic dermatitis is more commonly known as eczema. Many treatment options for atopic dermatitis, like steroid creams and phototherapy, overlap with alopecia treatments, so it’s possible that treating one condition will help treat the other. One area of interest for treating both atopic dermatitis and alopecia is a class of drugs called JAK inhibitors. They’re currently used to treat rheumatoid arthritis and other conditions. One oral JAK inhibitor known as tofacinitib has already shown promise in small clinical trials for both atopic dermatitis and alopecia areata. Another biologic treatment called dupilumab (Dupixent), which has recently been approved by the FDA to treat atopic dermatitis, is also a drug of interest for treating alopecia. A clinical study evaluating dupliumab in people with alopecia — both with and without atopic dermatitis — is currently underway. How is alopecia areata diagnosed? A doctor will review your symptoms to determine if you have alopecia areata. They may be able to diagnose alopecia areata simply by looking at the extent of your hair loss and by examining a few hair samples under a microscope. Your doctor may also perform a scalp biopsy to rule out other conditions that cause hair loss, including fungal infections like tinea capitis. During a scalp biopsy, your doctor will remove a small piece of skin on your scalp for analysis. Blood tests might be done if other autoimmune conditions are suspected. The specific blood test performed depends on the particular disorder the doctor suspects. However, a doctor will likely test for the presence of one or more abnormal antibodies. If these antibodies are found in your blood, it usually means that you have an autoimmune disorder. Other blood tests that can help rule out other conditions include the following: C-reactive protein and erythrocyte sedimentation rate iron levels antinuclear antibody test thyroid hormones free and total testosterone follicle stimulating and luteinizing hormone How is alopecia areata treated? There’s no known cure for alopecia areata, but there are treatments that you can try that might be able to slow down future hair loss or help hair grow back more quickly. The condition is difficult to predict, which means it may require a large amount of trial and error until you find something that works for you. For some people, hair loss may still worsen despite treatment. Medical treatments Topical agents You can rub medications into your scalp to help stimulate hair growth. A number of medications are available, both over-the-counter (OTC) and by prescription: Minoxidil (Rogaine) is available OTC and applied twice daily to the scalp, eyebrows, and beard. It’s relatively safe, but it can take a year to see results. Anthralin (Dritho-Scalp) is a drug that irritates the skin in order to spur hair regrowth. Corticosteroid creams such as clobetasol (Impoyz), foams, lotions, and ointments are thought to work by decreasing inflammation in the hair follicle. Topical immunotherapy is a technique in which a chemical like diphencyprone is applied to the skin to spark an allergic rash. The rash, which resembles poison oak, may induce new hair growth within six months, but you’ll have to continue the treatment to maintain the regrowth. Injections Steroid injections are a common option for mild, patchy alopecia to help hair grow back on bald spots. Tiny needles inject the steroid into the bare skin of the affected areas. The treatment has to be repeated once every one to two months to regrow hair. It doesn’t prevent new hair loss from occurring. Oral treatments Cortisone tablets are sometimes used for extensive alopecia, but due to the possibility of side effects, this option should be discussed with a doctor. Oral immunosuppressants, like methotrexate and cyclosporine, are another option you can try. They work by blocking the immune system’s response, but they can’t be used for a long period of time due to the risk of side effects, such as high blood pressure, liver and kidney damage, and an increased risk of serious infections and a type of cancer called lymphoma. Light therapy Light therapy is also called photochemotherapy or just phototherapy. It’s a type of radiation treatment that uses a combination of an oral medication called psoralens and UV light. Alternative therapies Some people with alopecia areata choose alternative therapies to treat the condition. These may include: aromatherapy acupuncture microneedling probiotics low-level laser therapy (LLLT) vitamins, like zinc and biotin aloe vera drinks and topical gels onion juice rubbed onto the scalp essential oils like tea tree, rosemary, lavender, and peppermint other oils, like coconut, castor, olive, and jojoba an “anti-inflammatory” diet, also called the “autoimmune protocol,” which is a restrictive diet that mainly includes meats and vegetables scalp massage herbal supplements, such as ginseng, green tea, Chinese hibiscus, and saw palmetto Most alternative therapies haven’t been tested in clinical trials, so their effectiveness in treating hair loss isn’t known. The effectiveness of each treatment will vary from person to person. Some people don’t even need treatment since their hair grows back on its own. In other cases, however, people never see improvement despite trying every treatment option. You might need to try more than one treatment to see a difference. Keep in mind that hair regrowth may only be temporary. It’s possible for the hair to grow back and then fall out again. Homeopathic Medicines for Alopecia Areata 1. Arsenic Album – Homeopathic Medicine for Alopecia Areata Accompanied by Itching and Burning on the Scalp Arsenic Album is a recommended homeopathic treatment for alopecia areata which appears as circular bald patches along with itching and burning on the scalp. These symptoms aggravate at night. In some cases, the scalp is also sensitive. 2. Vinca Minor – Another Useful Homeopathic Medicine for Alopecia Areata Vinca Minor is another useful homeopathic medicine for alopecia areata. It works well in cases where there is a tendency for hair to fall in spots which are then replaced by white hair. Along with this, itching and violent scratching over the scalp may also be present. 3. Baryta Carb, Lycopodium, and Silicea – Homeopathic Medicines for Alopecia Areata in Young People The most prominently indicated homeopathic medicines for alopecia areata in young people are Baryta Carb, Lycopodium, and Silicea. Baryta Carb helps in recovering from bald patches that occur on the top of the scalp. Lycopodium works well for bald patches on the temples. Silicea is a good homeopathic treatment for alopecia areata occuring on the back of the scalp. 4. Fluoric Acid – Excellent Homeopathic Medicine for Alopecia Areata Fluoric Acid is among the top grade homeopathic remedies for alopecia areata. Fluoric Acid helps in the regrowth of hair in the bald patches. Fluoric Acid is also a highly suitable homeopathic medicine for hair fall after fever. 5. Phosphorus – A Wonderful Homeopathic Medicine for Alopecia Areata Another homeopathic medicine that has shown its effectiveness in alopecia areata cases is Phosphorus. Phosphorus works well in cases where a person suffers from the loss of hair in patches. Along with hair loss, dandruff on the scalp is also present. In some cases, there is itching on the scalp along with hair fall. Phosphorus also seems to help cases of traction alopecia. In such situations, there is a receding hair line. Hair fall from the forehead is prominent. A person needing Phosphorus may crave cold drinks and ice creams.