Dermatology

Dermatomyositis

Dermatomyositis is one of a group of muscle diseases known as the inflammatory myopathies, which are characterized by chronic muscle inflammation accompanied by muscle weakness.

Dermatomyositis’ cardinal symptom is a skin rash that precedes, accompanies, or follows progressive muscle weakness. The rash looks patchy, with purple or red discolorations, and characteristically develops on the eyelids and on muscles used to extend or straighten joints, including knuckles, elbows, knees, and toes.

Red rashes may also occur on the face, neck, shoulders, upper chest, back, and other locations, and there may be swelling in the affected areas. The rash sometimes occurs without obvious muscle involvement.

Adults with dermatomyositis may experience:

  • Weight loss
  • A low-grade fever
  • Inflamed lungs
  • Sensitivity to light

Children and adults with dermatomyositis may develop calcium deposits, which appear as hard bumps under the skin or in the muscle (called calcinosis). Calcinosis most often occurs 1-3 years after the disease begins. These deposits are seen more often in children with dermatomyositis than in adults.

In some cases of dermatomyositis, distal muscles (muscles located away from the trunk of the body, such as those in the forearms and around the ankles and wrists) may be affected as the disease progresses.

Dermatomyositis may be associated with collagen-vascular or autoimmune diseases, such as lupus.

There is no cure for dermatomyositis, but the symptoms can be treated. Options include:

  • Medication
  • Physical therapy
  • Exercise
  • Heat therapy (including microwave and ultrasound)
  • Orthotics and assistive devices
  • Rest

The standard treatment for dermatomyositis is a corticosteroid drug, given either in pill form or intravenously. Immunosuppressant drugs, such as azathioprine and methotrexate, may reduce inflammation in people who do not respond well to prednisone. Periodic treatment using intravenous immunoglobulin can also improve recovery. Other immunosuppressive agents used to treat the inflammation associated with dermatomyositis include cyclosporine A, cyclophosphamide, and tacrolimus.

Physical therapy is usually recommended to prevent muscle atrophy and to regain muscle strength and range of motion.

Many individuals with dermatomyositis may need a topical ointment, such as topical corticosteroids, for their skin disorder. They should wear a high-protection sunscreen and protective clothing.
Surgery may be required to remove calcium deposits that cause nerve pain and recurrent infections.

Most cases of dermatomyositis respond to therapy. The disease is usually more severe and resistant to therapy in individuals with cardiac or pulmonary problems.

Warts

Warts (verruca vulgaris) are hard, rough bumps that grow on the skin. They typically appear on the feet and hands.

Warts are caused by a common skin virus. Most people are exposed to the virus at one time or another.

Warts may disappear by themselves over several months or years. However, because the warts may spread, it is a good idea to see a physician. The doctor can accurately diagnose the warts, and together, you can choose a plan for treatment.

There are several methods for treating warts. One common method of treatment is freezing of the warts (cryotherapy) to remove them. A very cold substance called liquid nitrogen is used with this treatment.

After this treatment your child may develop a blister which may contain clear fluid or blood. If this occurs, drain the blister with a sterile needle. To make the needle sterile, hold the tip of the needle into a flame (from a match, lighter, or the flame of a gas-stove burner). After the needle cools, gently “pop” the blister leaving the top intact, releasing the blood or fluid. This process should not hurt because the skin on top of the blister is dead.

After the blister is drained, clean the area gently with warm soapy water and gently dry. Keep the area covered with an adhesive bandage (Band-Aid) and a small amount of antibiotic ointment until the area is healed. It is preferred that you use Polysporin or Triple Antibiotic Bacitracin instead of Neosporin.

The doctor may ask you to treat the warts at home between freezings with an over-the-counter wart medication containing salicylic acid in a liquid, patch or stick form.

Tuberous Sclerosis

Tuberous sclerosis (TSC) is a rare genetic disease that causes benign tumors to grow in the brain and on other vital organs such as the kidneys, heart, eyes, lungs, and skin. It commonly affects the central nervous system.

TSC may be present at birth, but signs of the disorder can be subtle and full symptoms may take some time to develop.

In addition to the benign tumors that frequently occur in TSC, other common symptoms include:

  • Seizures
  • Mental retardation
  • Behavior problems
  • Skin abnormalities

Three types of brain tumors are associated with TSC:

  • Cortical tubers – which generally form on the surface of the brain
  • Subependymal nodules – which form in the walls of the ventricles (the fluid-filled cavities of the brain)
  • Giant-cell astrocytomas – a type of tumor that can block the flow of fluids within the brain

The prognosis for individuals with TSC depends on the severity of symptoms. Individuals with mild symptoms generally do well and live long productive lives, while individuals with the more severe form may have serious disabilities. In rare cases, seizures, infections, or tumors in vital organs such as the kidneys and brain can lead to severe complications and even death. However, with appropriate medical care, most individuals with the disorder can look forward to normal life expectancy.

There is no cure for TSC, although treatment is available for a number of the symptoms. The generic drug everolimus is approved to treat benign tumors called subependymal giant cell astrocytomas (SEGA) in individuals with tuberous sclerosis who require treatment but are not candidates for surgery. Antiepileptic drugs may be used to control seizures and medications may be prescribed for behavior problems. Intervention programs, including special schooling and occupational therapy, may benefit individuals with special needs and developmental issues. Surgery, including dermabrasion and laser treatment, may be useful for treatment of skin lesions. Because TSC is a lifelong condition, individuals need to be regularly monitored by a doctor. Due to the many varied symptoms of TSC, care by a clinician experienced with the disorder is recommended.

Sturge-Weber Syndrome

Sturge-Weber syndrome, sometimes referred to as encephalotrigeminal angiomatosis, is a rare congenital neurological and skin disorder.

Sturge-Weber is an embryonal developmental anomaly resulting from errors in fetal development. Unlike other neurocutaneous disorders (phakomatoses), Sturge-Weber occurs sporadically and is not hereditary.

It is indicated at birth by seizures accompanied by a large port-wine stain birthmark on the forehead and upper eyelid of one side of the face. The birthmark can vary in color from light pink to deep purple and is caused by an overabundance of capillaries around the trigeminal nerve just beneath the surface of the face.

Sturge-Weber syndrome is also accompanied by the loss of nerve cells and calcification of tissue in the cerebral cortex of the brain on the same side of the body as the birthmark.

Neurological symptoms include:

  • Seizures that begin in infancy and may worsen with age
  • Convulsions usually happen on the side of the body opposite the birthmark and vary in severity
  • There may be muscle weakness on the same side
  • Developmental delays and mental retardation
  • Glaucoma – increased pressure within the eye (at birth or developing later)

The increased pressure within the eye can cause the eyeball to enlarge and bulge out of its socket (buphthalmos). Sturge-Weber syndrome rarely affects other body organs.

Although it is possible for the birthmark and atrophy in the cerebral cortex to be present without symptoms, most infants will develop convulsive seizures during their first year of life. There is a greater likelihood of intellectual impairment when seizures start before the age of 2 and are resistant to treatment.

Treatment for Sturge-Weber syndrome is symptomatic. Laser treatment may be used to lighten or remove the birthmark. Anticonvulsant medications may be used to control seizures. Doctors recommend yearly monitoring for glaucoma. Surgery may be performed on more serious cases of glaucoma. Physical therapy should be considered for infants and children with muscle weakness. Educational therapy is often prescribed for those with mental retardation or developmental delays.

Skin Color Changes in Newborns

The color of a baby’s skin can often help identify possible problems in another area of the body. It is important for you to detect and notify your baby’s physician if the following skin color changes should occur:

Increasing Yellow Color – Jaundice

Over half of all newborns develop some amount of jaundice, a yellow coloring in their skin, during the first week. This is usually a temporary condition, but may be a more serious sign of another illness.

Jaundice is caused by the breakdown of red blood cells. As the old cells are broken down, hemoglobin is changed into bilirubin and removed by the liver. The build-up of bilirubin in the blood is called hyperbilirubinemia. Because bilirubin has a pigment, or coloring, it causes a yellowing of the baby’s skin and tissues. As liver function matures, the jaundice goes away. A premature infant is more likely to develop jaundice. The yellow tint to the skin can often be seen by gently pressing on the baby’s forehead or chest and watching the color return.

Types of jaundice include:

  • Physiologic jaundice occurs as a “normal” response to the baby’s limited ability to excrete bilirubin in the first days of life.
  • Breast milk jaundice occurs in about 2 percent of breastfed babies after the first week. Some develop breast milk jaundice in the first week due to low calorie intake or dehydration.
  • Jaundice from hemolysis, the breakdown of red blood cells, can occur due to hemolytic disease of the newborn (Rh disease), having too many red blood cells, or bleeding.

Jaundice related to inadequate liver function can occur due to infection or other factors.

Treatment for jaundice depends on many factors, including the cause and the severity of the jaundice. Treatment often includes using special lights called phototherapy. Babies with severe jaundice may need hospitalization and blood transfusions.

Babies with jaundice may have feeding problems and be irritable or listless. Call your baby’s physician if your baby has any of these signs.

Blue Color That Does Not Go Away

When a baby is first born, the skin is a dark red to purple color. As the baby begins to breathe air, the color changes to red. This redness normally begins to fade in the first day. A baby’s hands and feet may stay bluish in color for several days. This is a normal response to a newborn’s immature blood circulation.

Blue coloring of other parts of the body is not normal. Occasionally, a baby’s face or lips and mouth may turn purplish with very intense crying. However, this should turn back pink when the baby stops crying. If the baby’s color does not turn pink again, or there is an overall blue tinge to the baby, this may signal a problem. The blue coloring is called cyanosis and is often seen in babies with a heart defect, because the heart cannot pump the oxygenated blood to the rest of the body. Breathing difficulties may also cause cyanosis.

Consult your baby’s pediatrician immediately if your baby has any blue coloring.

Scalp Ringworm

Scalp ringworm, also known as tinea capitis, is an infection caused by a fungus.

Ringworm of the scalp is most common in toddlers and school-age children.

Scalp ringworm is infectious and easy to catch. Therefore, it is very important that any of your child’s siblings, close friends and relatives be carefully screened to see if they have any signs of infection. Ringworm can be spread by:

  • Human to human contact
  • Object to human contact
  • Animal to human contact

The infection affects the scalp and hair deep into its roots and may produce flaking, small infected bumps, and loss of hair. It can also produce small, scaly, red to brown patches on the skin which should be treated.

Because the scalp ringworm infection is deep down in the hair roots, your child must take medicine by mouth in order to cure it. Your doctor will prescribe an oral medicine to be taken daily with fatty foods such as milk, yogurt or ice cream. A special shampoo will also be prescribed also to get rid of the infection on the scalp.

Once your child is on treatment and using the shampoo regularly, he/she should be allowed to return to school. The medication must be taken for at least 6 weeks. It should not be stopped until the doctor has decided the infection is cured.

Scabies

Scabies is a skin condition caused by infestation with mites. A mite is a spider-like insect so small that it can only be seen under a microscope. The female mite burrows under the skin and lays eggs. The path where the mite burrows looks like a tiny scratch mark.

The mites cause severe itching. If the skin is scratched open, it can become infected.

Scabies is “caught” by having skin-to-skin contact with a person who has it, or much less commonly, by wearing clothes that have scabies mites living in them. It is not caused by poor hygiene. All family members who have had direct contact with an affected person should be treated at the same time.

To treat scabies:

  • Buy the cream prescribed by your doctor. The most common treatment is 5% Permethrin cream. This has been proven safe in infants as young as 2 months of age.
  • Apply the cream or lotion to the child and all persons being treated on the same night.
  • Massage the cream into the scalp of all children under 2 years of age and for any child with an itching scalp.
  • Apply a thin coat of the prescribed cream or lotion to the entire surface of the child’s skin, from the neck down. If your child is less than 1 year old, you should also treat the head and neck. The mites like to live in warm, moist areas between fingers and toes, in the belly button, armpits, under fingernails and in the skin around the waist and genital area. Make very sure the cream or lotion is applied to these areas.
  • Leave the cream on for 8-12 hours. (Overnight is convenient)
  • Then have your child take a bath or shower and wash thoroughly, all treated persons should be treated in the same manner.
  • Itching may continue for several more days, and may not completely go away for 6 weeks. If itching hasn’t improved in a week, call your doctor.
  • In some cases, a second application one week later may be recommended by the physician.

Store the cream out of children’s reach. If any of the cream happens to get into the eyes, wash the eyes with cool water.

The mite that causes scabies can live in clothing and bed linens for up to a week. The morning after the lotion is applied it is suggested that you complete the following cleaning:

  • You can treat linen and clothing in one of three ways:
    • Using hot water, wash all clothing, bed linens, towels, and washcloths that have been used or worn within the week before your child was treated.
    • Clothes can be put in the dryer at highest heat for 15 minutes. Wipe dryer when done.
    • Put all clothes and linens used away in garbage bags tied tightly for 1 week. Shake out items after removing them from the bag.
  • Clean clothes should be worn after each treatment.
  • Bed linens should be changed after each treatment.
  • Mites may live in carpets and furniture. Vacuum all carpets, upholstered furniture, floor length cutains and wipe all flat surfaces.
  • Remember to clean coats, highchair covers and stroller seats/covers.

To prevent scabies from spreading, all family and household members with skin contact should be treated whether or not they are itching or have a rash. Scabies may not show any signs until 1 month after exposure.

If you know the person from whom your child got scabies, avoid skin-to-skin contact with that person until he/she is treated.

Psoriasis

Psoriasis is a chronic skin problem that causes skin cells to grow too quickly, resulting in thick, white, silvery, or red patches of skin. Normally, skin cells grow gradually and flake off about every 4 weeks. New skin cells grow to replace the outer layers of the skin as they shed. But in psoriasis, new skin cells move rapidly to the surface of the skin in days rather than weeks. They build up and form thick patches called plaques. The patches range in size from small to large. They most often appear on the:

  • Knees
  • Elbows
  • Scalp
  • Hands
  • Feet
  • Lower back

Psoriasis is most common in adults. But children and teens can get it too. In some cases, psoriasis runs in families. Researchers are studying large families affected by psoriasis to find out how it is passed from parents to their children and what might trigger the condition.

Experts believe that psoriasis occurs when the immune system overreacts, causing inflammation and flaking of skin.

People with psoriasis often notice times when their skin gets worse. Things that can cause psoriasis symptoms to flare up or make the condition worse include:

  • A cold and dry climate.
  • Skin injury. An injury to the skin can cause psoriasis patches to form anywhere on the body, including the site of the injury. This includes injuries to your nails or nearby skin while trimming your nails.
  • Stress and anxiety. Stress can cause psoriasis to flare or can make symptoms worse.
  • Infection. Infections such as strep throat can cause psoriasis to appear suddenly, especially in children.
  • Certain medicines. Some medicines, such as NSAIDs, beta-blockers, and lithium, have been found to make psoriasis symptoms worse.
  • Overexposure to sunlight. Short periods of sun exposure reduce psoriasis in most people, but too much sun can damage the skin and cause skin cancer. And sunburns can trigger flares of psoriasis.
  • Alcohol. Alcohol use can cause symptoms to flare up.
  • Smoking. If you smoke, try to quit. Smoking, especially in women, makes you more likely to get psoriasis and can make it worse if you already have it.

Things that cause psoriasis to flare up should be avoided whenever possible.

Psoriasis is not contagious. It cannot be spread by touch from person to person.

Symptoms of psoriasis appear in different ways. Psoriasis can be mild, with small areas of rash. When psoriasis is moderate or severe, the skin gets inflamed with raised red areas topped with loose, silvery, scaling skin. If psoriasis is severe, the skin becomes itchy and tender. And sometimes large patches form and may be uncomfortable. The patches can join together and cover large areas of skin, such as the entire back.

In some people, psoriasis causes joints to become swollen, tender, and painful. This is called psoriatic arthritis. This arthritis can also affect the fingernails and toenails, causing the nails to pit, change colour, and separate from the nail bed. Dead skin may build up under the nails.

Symptoms often disappear (go into remission), even without treatment, and then return (flare up).

Having psoriasis can be embarrassing, and many people, especially teens, avoid swimming and other situations where patches can show. But there are many types of treatment that can help keep psoriasis under control.

Most cases of psoriasis are mild, and treatment begins with skin care. This includes keeping your skin moist with creams and lotions. These are often used with other treatments including shampoos, ultraviolet light, and medicines your doctor prescribes.

Skin care at home can help control psoriasis. Follow these tips to care for psoriasis:

  • Use creams or lotions, baths, or soaks to keep your skin moist.
  • Try short exposure to sunlight or ultraviolet (UV) light.
  • Gently soften and remove psoriasis crusts by putting cream on the crusts and then peeling the loose crusts off. Removing crusts may help your skin to absorb creams and lotions. Remove them carefully, though, so you don’t irritate the skin.
  • Follow instructions for skin products and prescribed medicines. It may take a period of trial and error until you know which skin products or methods work best for you. For mild symptoms of psoriasis, some over-the-counter medicines, such as aloe vera, may be soothing.

Studies have not found that specific diets can cure or improve the condition, even though some advertisements claim to. For some people, not eating certain foods helps their psoriasis. Most doctors recommend that you eat a balanced diet to be healthy and stay at a healthy weight.

In some cases, psoriasis can be hard to treat. You may need to try different combinations of treatments to find what works for you. Treatment for psoriasis may continue for a lifetime.