Skin Disorders

Rash in Corner of Mouth: Angular Cheilitis and its Treatment

June 6, 2020 by Dr.Deepak Leave a Comment

Rash in Corner of mouth can be bothersome for most individuals. This painful condition called as angular cheilitis. Although not serious issue, this can cause difficulties in day to day activities like eating or talking. Good news is that it is highly preventable. Unlike chapped lips, which generally occurs due to lack of moisture, angular cheilitis is cause by excess moisture in the corner of the mouth or infection.

What is Angular Cheilitis?

Angular cheilitis is also called as angular stomatitis. Angular cheilitis is an inflammatory condition that causes red, swollen, scales, crusting and fissuring in the corner of the mouth. This may affect one corner of the mouth or both. It is usually confined to the corners and does not spread. Depending on the underlying cause it can go quickly or persist for long.

What causes Angular Cheilitis?

Because it is a multi-factorial disease, so the cause of Angular cheilitis varies from individual to individual. It can be due to infection or other non-infectious cause like repetitive licking or irritation, nutritional vitamin deficiency or other skin causes.

Common causes of angular cheilitis are:

Irritant contact dermatitis due to repetitive licking or contact with saliva.
Dry chapped lips
Yeast or fungal infection in the corner of the mouth
Viral infections like herpes (cold sores).

Who are at risk of angular cheilitis?

Children and adults with poor health condition or weak immunity are mostly affected. Because, licking of the lips can further worsen the disease, it must a avoided. Risk factors include:

Infants and old age
Individuals with wrinkling or increased folding of skin at the corners of the mouth
People with diabetes, coeliac disease or inflammatory bowel disease like Crohn disease and uncreative colitis.
Long term antibiotics or corticosteroids use
Atopic skin sensitive to toothpaste, makeup, and other food
Poor fitting dentures
Poor nutrition, vitamin deficiency like riboflavin or iron deficiency.
People with Down syndrome
People on Oral retinoid medication like isotretinoin or acitretin.
Chronic Smokers

Sign and Symptoms of Angular Cheilitis

Common signs and symptoms of Angular cheilitis include:

Swollen, thickened and red rash in the corner of the mouth.
Dry, scaly, crusted and fissured lesion at the angle of the mouth.
Burning, pain and soreness in the area affected.
Irritation and itching at the corner of the mouth

Symptoms may be either in one side of the mouth or both. It is usually confined to the corners only and does not spread. But in rare cases it can spread to adjacent area due to bacteria (impetigo) or fungus ( candidiais) infection.

Treatment of Angular Cheilitis

Most of the healthy individuals need no treatment, it resolves by itself. When not improved following treatment can be initiated depending on the specific cause:

Individual with uncontrolled diabetes need diet and lifestyle changes and anti-diabetes medications.
People with poor nutrition and vitamins deficiency need vitamin supplements.
If it is due to yeast or fungus oral or topical antifungal medications is used.
When there is a bacterial infection oral or topical antibiotic is given.
Topical steroids cream used for short period help heal the lesion quick
Use thick moisturizer, vaseline or lip balm frequently.
Individuals with wrinkling or increased folding of skin at the corners of the mouth can benefit from Botox or Filler injection.

Heat rash in Babies: Best ways to Treat and Prevent

June 3, 2020 by Dr.Deepak Leave a Comment

Heat rash is a skin condition that often affects babies and children in hot and humid weather conditions. These rashes also called as prickly heat rash can feel itchy, uncomfortable, and prickly. Summer night can be difficult for babies as heat rash can keep your baby up all night, scratching those itchy, red bumps.

Babies are mostly affected because they tend to have warmer body temperature than adults. Because their sweat glands are less developed, their skin is not effective at regulating body temperature. Babies tend to have more skin folds, which can trap more heat and sweat. Although heat rash is not usually dangerous, but it indicated that baby is risk of overheating that can cause several other serious issues. So it’s very important to keep the baby cool and comfortable which can quickly clear up the rash.

What causes heat rash in Babies?

Heat rash in babies develops when sweat ducts in the skin are blocked due to excessive sweating creating small fluid filled red bumps or blisters on the skin. It is most common during summer months, when weather is hot and humid. Tight fitting clothes and repetitive friction or rubbing in the skin make it worse.

Most affected areas on babies are:

Neck folds
Armpit
Elbow and knee creases
Inner thighs

Types of heat rash

There are 3 types of heat rash or miliaria

Miliria rubra: This is the common type of rash which happens when there is blockage in the sweat glands near the outer superficial surface of the skin. It usually doesn’t need treatment as it goes away when body is cooled.

Miliaria crystalline: This is least severe form of heat rash. It happens when there is a blockage in the sweat glands deeper in the epidermis. This type of heat rash can cause tiny clear or white blisters. Usually topical treatment is all needed.

Miliaria profunda: This is severe type of heat rash and need immediate attention. This is the result of sweat leaking into the middle layer of skin (dermis). Besides itching, babies may also experience with intense flushing and burning sensation.

What are the symptoms of heat rash in babies?

Baby heat rash appears as clusters of tiny red bumps or clear vesicles commonly see on face and in the skin folds of neck, upper chest, arm, legs and groin. The skin tends to be hot and flushy with itching, tingling and prickling sensation. Your child can’t tell you how he feels but it can keep your baby up all night, scratching those itchy, red bumps.

Treatment of Heat rash in Babies

In most cases, the rash will go away on its own fairly quickly without any treatment. But in rear case, if the child starts having fever or you see pustules and swelling over the rash visit the doctor immediately. Don’t use thick creams, lotions or prickly heat powder as they further clog the pores and worsen the rash. Follow the below mentioned suggestions for management of prickly heat.

Shift the baby in cooler and well ventilated area, keep the skin cool and dry.
Apply cool compress in affected area.
Wash away oil and sweat with mild soap and cool water, then gently pat the skin dry.
Clean the skin folds regularly to avoid sweat and dirt trap in the skin.
You can use air conditioning or fans to help keep the skin cool but don’t put your child in direct fan or A/C.
Breast feed your baby regularly, give adequate water to help maintain hydration.
Use loose fitting light clothes to you baby, let the skin breathe.

Minocycline Topical Foam 1.5% Approved by FDA for Rosacea

June 3, 2020 by Dr.Deepak Leave a Comment

FDA approves first topical minocycline Foam 1.5% ZILXI for the treatment of inflammatory rosacea. Minocyclin is a tetracycline-class drug that was originally approved as an oral formulation for the treatment of acne vulgaris but now being developed into topical formulation to treat both acne vulgaris and rosacea. Previously on Oct 2019 same formulation in the name of Amzeeq 4% topical foam was approved for the treatment of acne.

ZILXI, developed as FMX103 by Menlo’s wholly-owned subsidiary Foamix Pharmaceuticals Ltd. (“Foamix”), is the first minocycline product of any kind to be approved by the FDA for use in rosacea.

“This approval is welcome news for clinicians and patients who seek novel options for this difficult to treat skin disorder,” said David Domzalski, Chief Executive Officer of Menlo. “ Minocycline Foam ZILXI 1.5% is a potential turning point in rosacea treatment, providing millions of people with a new treatment option that is well-tolerated and effective.”

Rosacea is a diverse skin condition that most commonly presents with symptoms such as deep facial redness, spider veins (telangiectasia) and acne-like inflammatory lesions (papules and pustules).

Minocycline is one of several broad-spectrum antibiotics known as tetracyclines with anti-inflammatory properties; their use in some patients is limited due to systemic side effects when taken orally. In ZILXI, Menlo has once more leveraged its proprietary Molecule Stabilizing Technology (MST™) platform to effectively deliver minocycline in a foam-based vehicle.

“This is the only product containing minocycline approved by the FDA for rosacea,” said Iain Stuart, PhD, Chief Scientific Officer of Menlo. “The availability of a novel topical formulation of this molecule underscores our efforts to provide innovative treatment options for patients who suffer from difficult to treat skin conditions.”

The FDA approval of ZILXI is primarily supported by data from two clinical trials in 1,522 patients 18 years of age and older. In each 12-week multicenter, randomized, double-blind, vehicle-controlled trial, subjects with inflammatory lesions of rosacea were treated once daily with ZILXI or vehicle. No other topical or systemic medication affecting the course of inflammatory lesions of rosacea was permitted for use during these trials.

The co-primary efficacy endpoints were (a) the absolute change from baseline in inflammatory lesion counts at Week 12 and (b) the proportion of subjects with treatment success at Week 12 defined as an IGA score of 0 (“clear”) or 1 (“almost clear”), and at least a two-grade improvement (decrease) from baseline at Week 12. ZILXI met both co-primary endpoints in each clinical trial, demonstrating statistically significant improvements in inflammatory lesion count and Investigator Global Assessment (IGA) treatment success.

No treatment-related serious adverse events were reported. The most common adverse reaction reported by ?1% of subjects treated with ZILXI and more frequently than in subjects treated with vehicle was diarrhea (1% vs. 0%), respectively.

Menlo anticipates having ZILXI available for prescribing by 4th quarter of this year.

News Source: Menlo Therapeutics

What is Maskne (Mask Acne): Its Treatment and Prevention

June 2, 2020 by Dr.Deepak Leave a Comment

Have you been experiencing acne break out during this month or those who hadn’t had acne in the pasts experiencing few extra pimples around the mouth nose and cheeks? Well, it might be because you are wearing your face mask for long time. Today many people are experiencing this problem called Maskne or Mascne. As you are being encouraged to wear face masks in public to help reduce the spread of coronavirus, maskne is something that will likely to become more common in near future.

What exactly is maskne and why does it happen?

The term Mascne or Maskne is a type of acne around your peri-oral areas that is cause by wearing mask for long period. Dermatologist call this as Acne Mechanica. Maskne is a type of acne formed in areas due to repetitive friction, pressure, stretching, rubbing or occlusion.

How can mask cause Acne?

Mascne is caused by the combination of friction from the mask, which irritates the skin barrier, as well as the hot moisture trapped inside, which dilates the pores and allows bacteria and oil to clog them up. When the follicles get clogged, they become inflamed leading to nasty acne breakouts.

How does maskne or mask acne look like?

Maskne look like tiny little whiteheads or sometime blackheads that pop up after wearing your medical mask for longer period of time to prevent corona spread. Although most cases are limited to mask areas, but when severe, it may spread beyond mask area. Usually, here you won’t see any deep and painful large pimples which are caused by hormones.

How to treat Masacne?

Treating Masacne or acne mechanica needs to be done gently. Lot of people with acne uses aggressive acne treatment in the firstline. This isn’t a right thing; it can further damage skin barrier function leading to more irritation. For people experiencing red and extra dryness of skin or breakouts you may apply hydrocortisone cream for short period of time which will help calm irritation and inflammation.

It is necessary to wear mask in the public when social distancing is difficult to maintain, but you can always take off the mask and let the skin breathe whenever you are away from people.

10 Tips to Prevent masacne when wearing masks

If you are wearing a cloth mask, wash it every day. If a disposable one, discard it when it becomes damp or at least air it out. Apply silicone gel strip in the pressure point if you are wearing N95 mask for long.
Don’t touch your protective mask often; always wash your hands after you touch on something.
Wear well fitting mask, do not use tight masks.
Cleanse and moisturize your skin immediately after you remove your mask. Be gentle, use gel or water based moisturizers that can help with clogged pores. Moisturizers also hydrate the skin, rebuild the barrier and give it a chance to heal quickly.
Wash your face at least twice daily with gentle cleanser. For acne skin you can use mild medicated cleanser containing salicylic acid or benzyl peroxide to effectively remove oil and to provide an antibacterial and anti-inflammatory effect.
Remember not to over wash your face, when you are over washing you are stripping natural oils off your skin and making it more irritated.
Avoid the use of makeup, foundations and concealers which leads to clogged pores resulting in acne breakouts.
When frequents washing is impossible you can use oil-free wipes to freshen up the skin.
If you have active acne, treat it as quick possible to avoid further complications. Your doctor will suggest you anti-acne medications that best suits your skin. Don’t try to treat it yourself with strong medications like adapalene which can make skin more irritating.
If doctor are unreachable, over the counter acne products that help resolve the clogged pores are also beneficial.

Lump on Neck: Could it be Cancer?

August 5, 2013 by Dr.Deepak 5 Comments

It is obvious to get concerned when you discover any new lump on neck. Good news is that, most of the cases of lumps on the neck are acute and harmless. However, sometimes lumps on the neck may be the presentation of more serious condition that may need immediate medical attentions.

Your body has many lymph nodes that plays key role in fighting off the virus, bacteria and other illnesses. Among all the areas, most common areas that you may notice swollen lymph nodes are neck, underarms and groin. Most of the lymph nodes in our body can’t be felt; they can only be felt during illness. In normal healthy person they are non-tender or painless. During illness they may be tender and swollen. In this article we’ll focus on lumps that arises in different location of the neck and their possible causes.

Lump below the jaw
Any lump below the jaw on either side may be due to swelling of the submandibular lymph node. Swelling occurs when there is infection of the head, neck, pharynx, ears, eyes, and scalp.

Lump below Chin
Any lump below the chin may be due to swelling of submental lymph node. Swelling occurs due to various conditions and disease like infectious mononucleosis, cytomegalovirus, Epstein-Barr virus, toxoplasmosis, dental pathology such as periodontitis.

Lump on side of neck
When you find any lumps on side of neck, they may be due to infection in the tonsils, tongue, pinna or parotid gland. Most common causes of lump on side of neck is pharyngitis

Lump behind the ears
Any lump behind the ears may be due to swelling of post-auricular lymph node. Most common cause for its swelling is local infection on the ear and sometime the scalp.

Lump in front of the ears
Swelling of pre-auricular lymph node results as lump in front of the ear. This may be due to infection in the external auditory canal of the ear.

Lump above the right clavicle
When there is any lump above the right clavicle, there may be something wrong with the lungs or the esophagus. When there is swollen right supraclavicular lymph node, it may suggest cancer of the lung or the stomach.

Lump above the left clavicle
Lump above the left clavicle may suggest lymphoma or thoracic cancer, while sometime it just may be due to fungal or bacterial infection.

Lump on back of neck
Lump on back of neck may just be due to local infection in the head or neck region. However, if the lumps are either side of the back of neck, they might also be due to lymphoma, tuberculosis or any head and neck cancer.

The most common causes of painful lump in the neck are due to infection and usually are self-limited and can resolve quickly after infection is controlled. However, some lumps can lasts longer for several months and can create confusion with the cancer. Experts agree that the lumps above the clavicle (supraclavicular) should be immediately investigated for cancer.

Risk factors for malignancy include the followings:

Old age
Firm, fixed and hard lump on neck
Painless
Duration more than 2 weeks
Supraclavicular location

Visit your doctor (especially ENT doctor) if you have any unexplained lumps on the neck. He/she will perform a though examination and when there are no any specific signs and symptoms of any serious disease or malignancy, your doctor may keep you on observation for a month. If the lesion still persists, he/she may perform biopsy or other specific tests.

If you are experiencing persistent enlargement of lymph nodes that lasts more than 2 weeks or if they feel hard and painless, you should get it checked immediately. Don’t rely on what you have learned and seen on the internet and try to diagnose yourself. Get it checked and confirm its benign nature so you don’t have to regret later.

Lumps Under Skin – Most Possible Causes

July 21, 2013 by Dr.Deepak Leave a Comment

The moment you discover bumps or lumps under skin, first thing that comes on your mind is: what the hell is this, could it be cancer? Well, it is common to experience scary feelings but the truth is most lumps under the skin are benign harmless and can be treated easily or even left alone. There might be nothing to worry about but it is wise to confirm the diagnosis with the doctor so you don’t have to regret later. Never diagnose yourself by just looking at the pictures you find online.

What are the possible causes of lumps under the skin?

There are several causes of lumps under the skin; most of the cases are harmless while few may be harmful. The lump may be any of the following:

Lipoma
Lipoma is one of the most common causes of lumps under skin. Lipomas are small, fatty masses that are harmless to your health. Your lump may be a lipoma if it feels soft and rolls easily under your skin.

Cyst
Cysts are closed sac that can be found in or under the skin containing fluid or semisolid material. The inner contents may be yellow in color and can be removed easily with minor surgical extraction. Most of these cysts are harmless and may require no treatment.

Enlarged lymph nodes
Enlarged lymph nodes are often seen in the neck armpit and the groin. Enlarged lymph nodes can be caused by simple infections like cold and flu or acute injury and bacterial infection. In rare cases it can also be caused due to chronic diseases like cancer and HIV. They usually disappear once the infection subsides. However, if the swelling persists or gets worse, it may suggest something more serious like lymphoma.

Abscess

Abscess is generally painful swelling resulting from collection of fluid or pus that is trapped inside a closed space. It is generally due to acute injury, bacteria or parasites. One may experience raised, red, hot and pain in the affected area and sometime associated with yellowish tip.

Malignant tumor

Although the possibilities for malignant tumor are less, one must still rule out the possibility of its malignancy. Fortunately, lumps under skin are rarely cancerous but one must always keep in mind of the following possibilities:

Soft tissue sarcoma
Soft tissue sarcoma is the cancer of the tissues underneath the skin, and may cause a lump almost anywhere on the body.

Lymphoma
Lymphoma (not to confuse with harmless lipoma) this is cancer of the lymph glands, and causes a painless swelling in the neck, armpit or groin.

Ganglion
Ganglion is cysts that are commonly seen around the joints and tendons. Most commonly seen on the back of the wrist, the cyst is smooth and soft lump under the skin. Inside the cyst is a thick jelly-like fluid. The ganglion can be removed if its causing you discomfort, otherwise it can be left alone.

Hernias
Hernias are small soft swelling that can be seen around the groin or the lower abdomen. It results in bulging of the abdominal content due to weak muscle wall of the affected area. Generally hernia is not that serious, but medical consultation is very important to avoid complications like strangulation.

Interesting facts about the lumps

Lumps that are movable are less likely to be dangerous than the fixed ones.
Soft lumps are less likely to be dangerous than the hard ones.
Painful lumps are less dangerous than the painless ones.
Smooth lumps are less dangerous than the rough ones.
Lumps that appear suddenly are less likely to be dangerous.
Lumps that grow rapidly are less likely to be dangerous.

Warning: These guidelines in most cases are true, but don’t apply in all the cases. If you are worried visit your doctor immediately.

In general lumps and swelling under skin may be classified according to the area affected

Lumps on facial areas

Mumps
Angioedema
Dental abscess
Salivary gland stone

Lump in the neck or throat

Swollen lymph nodes
Cysts
Skin tags
Goitre

Lump in the armpits

Swollen lymph nodes
Lymphoma

Lump on the shoulder, back, chest and arms

Lipomas
Epidermal or pilar cysts

Lump in the breast

Enlarged milk ducts
Fibroadenomas
Mastitis
Cysts
Skin Tags
Lipomas

Lump on the hand, wrist or finger

Ganglion
Warts

Lump around the groin area

Swollen lymph nodes
Cysts
Hernia
Saphena varix
Genital warts

Lump or swelling in the testicle

Varicocele
Hydrocele
Epididymal cyst

Lump around the anus

Abscess
Haemorroids
Rectal prolapse
Skin tags
Genital warts

Cradle Cap in Babies – Causes and Remedies

July 19, 2013 by Dr.Deepak Leave a Comment

If you are first time mother, you may be worried about your baby’s thick, greasy scalp. But it usually is nothing to worry about. Most likely, it is due to a common but harmless and temporary condition that many babies develop called cradle cap. Although it might look worrisome, it rarely causes any discomfort to the child and is totally harmless that resolves on its own after few months.

What is Cradle Cap?

Cradle cap is relatively common harmless condition of the scalp presenting in the first 3 months of the baby’s life. Cradle cap appears as patches of thick, greasy, yellowish, crusty, scaly rash over the soft scalp. The vertex and the frontal area are commonly involved. However, cradle cap is not limited to the scalp, it can occur on face and other parts of the body too. Cradle cap is basically the infant form of seborrheic dermatitis, so called as “Infantile seborrhoeic dermatitis” that is limited to the scalp.

Other names given to cradle cap

Infantile seborrhoeic dermatitis
Honeycomb disease
Pityriasis capitis
Milk crust
Crusta lacteal

What Causes Cradle Cap?

The exact cause of cradle cap is not clear, but it is clear that it is not due to any allergies, infections or lack of hygiene. Experts agree that it is probably due to overactive sebaceous glands that produce excess sebum, which prevent the old skin cells from drying and falling off, as a result they stick to the scalp giving a thick greasy look. It is believed that babies have high level of mother’s hormones in their body even after several weeks or months following birth that is responsible for excess sebum production. Another factor like yeast infection (commonly malassezia) may also play role in the development of cradle cap.

Symptoms of Cradle Cap

Not all cases of cradle looks the same, it may look different on every baby. However, there are some common signs and symptoms that are usually present with the cradle cap, some of which are listed below:

No itching
Greasiness
Thick, scaly and flakey scalp
White, discolored or yellow crusts
Reddening of the affected skin
Temporary hair loss

Cradle Cap Pictures

Cradle Cap Treatment

Cradle cap usually doesn’t require any medical treatments which may disappear on its own after few weeks or months. It can sometime take more than a year for cradle cap to go. In the meantime, there are several remedies that can help loosen the scales and prevent scale buildups. Some of which are discussed below:

Cradle Cap Remedies

Home remedies of cradle cap

Gently massage your baby’s scalp with the mineral oil (baby oil will do) and leave it overnight, then wash your baby’s scalp with mild baby shampoo next morning.
Gently rub your baby’s scalp with finger to loosen the crusts and scales. You may also use soft brush to loosen the crusts.
Repeat this process every day until you see improvement and continue using every few days to help prevent scale buildups.
You may use mild anti-dandruff shampoo if above option is not working but these dandruff shampoo can irritate the baby skin and eyes. To be on the safe side, you may go to the nearest pharmacy and ask for cradle cap shampoo.

Maintenance therapy with mild shampoo every few days is a must as baby’s skin will continue to produce sebum several months after birth.
If frequent shampooing is not helping, it’s time to visit your doctor. He/she may prescribe stronger shampoo containing antifungal medications or hydrocortisone cream.
If your baby’s cradle cap looks red, inflamed or swollen, this could be suggestive of infection. Visit your doctor immediately; he/she will manage accordingly with antifungal and antibiotics.

Things you should avoid

Never pick cradle cap off your baby scalp; you may end up with the infected scalp.
Be sure not to use adult strength prescription dandruff shampoos.
Never use over the counter steroids and antifungal creams without talking to your doctor, as some products can harm your baby.
Avoid shampoo containing salicylic acid that can be absorbed through skin and irritate the baby.

Remember, most of the babies might looks funny in the beginning as they have been through 9 months journey. They need some time to adjust to the new world. Some might have oddly shaped head as a result of narrow vaginal canal; some might have cradle cap that might look scary. The good thing is, these initial imperfections are temporary and you know your baby is always beautiful.

Medications that can Cause Skin Pigmentation

June 7, 2013 by Dr.Deepak 1 Comment

Skin pigmentation due to drugs is quite common and accounts for 10 to 20% of all cases of acquired hyperpigmentation. Skin pigmentation can be due to variety of drugs that can arise due to direct effects of the drugs as in combination with triggering factors like sun exposure. Out of several drugs some of the most common drugs that cause skin pigmentation are antimalarials drugs, tetracyclines, nonsteroidal anti-inflammatory drugs, cytotoxic drugs, amiodarone, heavy metals and psychotropic drugs.

Treatment of drug induced pigmentation is usually withdrawal from the offending medicine and avoiding sun exposure. It may be accompanied by fading creams for several weeks to help improve the pigmentation.

Tetracyclines Groups

Hyperpigmentation is common in individuals taking tetracycline, especially minocycline. Tetracycline and minocycline may also cause brown discoloration of teeth, so is not recommended in children. Some of the drugs in these groups are:

Doxycycline
Demeclocycline
Minocycline
Oxytetracycline
Tetracycline

Heavymetals

The heavy metals are also considered to be causative factors for pigmentation disorders. Presentation may differ from metals to metals but are usually slate-gray or blue-gray in appearance. Some of the heavy metals that may cause pigmentation are below:

Arsenic
Bismuth
Gold (compounds)
Iron
Lead
Mercury
Silver

Antiretroviral drugs

Antiretroviral drugs can also cause skin and nail pigmentation that may resolve gradually when the drug is withdrawn. These drugs include:

Indinavir
Emtricitabine
Saquinavir
Zidovudine

Topical medications

There are several topical medications that might cause skin pigmentation, some of which are listed below:

Aminolevulinic acid
Carmustine (BCNU)
Bergamot
Bimatoprost
Carteolol
Chlorhexidine
Imiquimod
Latanoprost
Nitrogen mustard
Tretinoin
Verteporfin

Antihypertensive drugs

Sometimes antihypertensive drugs can also cause pigmentary changes in the skin. Some of the drugs that might cause pigmentation are: that might causes pigmentation on skin are

Acebutolol
Betaxolol
Bisoprolol
Captopril
Clonidine
Diltiazem
Esmolol
Indapamide
Labetalol
Methyldopa
Metoprolol
Minoxidil
Nisoldipine
Propranolol
Spironolactone
Timolol

Antimalarial drugs that can cause pigmentary changes are

Amodiaquine
Chloroquine
Hydroxychloroquine
Pyrimethamine
Quinacrine
Quinine

Anti-fungal agents that can cause pigmentation disorders are

Amphotericin B
Griseofulvin
Ketoconazole
Sertaconazole
Terbinafine
Voriconazole

Chemotherapeutics agents that can cause pigmentation on skin are

Bleomycin
Busulfan
Doxorubicin
Daunorubicin
fluorouracil
cyclophosphamide
carmustine
docetaxel
Bevacizumab
Capecitabine
Carboplatin
Cisplatin
Dactinomycin
Epirubicin
Estramustine
Etoposide
Floxuridine
Fluorouracil
Hydroxyurea
Ifosfamide
Irinotecan
Mechlorethamine
Mercaptopurine
Methotrexate
Mitomycin
Mitotane
Mitoxantrone
Paclitaxel
Pentostatin
Procarbazine
Thiotepa
Vinblastine
Vincristine
Vinorelbine

Immunosuppressive drug
Azathioprine
Cyclosporine

Antiviral Drugs

Ganciclovir
Cidofovir
Foscarnet
Ribavirin

Antidepressants, Antipsychotic and anxiety disorders medications

Phenothiazines
Imipramine
Desipramine
Chlorpromazine
Amitriptyline
Citalopram
Clomipramine
Clonazepam
Diazepam
Fluoxetine
Promazine
Fluvoxamine
Fluphenazine
Haloperidol
Promazine
Perphenazine
Thiothixene
Loxapine
Mesoridazine
Molindone
Olanzapine
Paroxetine
Pimozide
Risperidone
Thioridazine

Antiepilectic
Phenytoin
Carbamazepine
Mephenytoin
Tiagabine
Topiramate

Other drugs acting on Central nervous system
Methamphetamine
Tolcapone
Eletriptan
Donepezil

Anaesthetic drugs, pain reliever and muscle relaxant drugs

Levobupivacaine
Lidocaine
Orphenadrine
Cyclobenzaprine
Leflunomide
Etodolac
Phenazopyridine
Methysergide
Ketoprofen
Pentazocine

Antibiotics that may sometime cause pigmentation are
Ceftriaxone
Enoxacin
Grepafloxacin
Linezolid
Lomefloxacin
Ofloxacin
Sparfloxacin
Sulfadiazine

Anti-tuberculosis and Antileprosy drugs
Rifabutin
Rifapentine
Clofazimine
Dapsone

Hormones
Chlorotrianisene
Corticosteroids
Diethylstilbestrol

Thyroid Hormone to treat hyperthyroidism
Propylthiouracil
Methimazole

Anti-allergic drugs
Promethazine
Cetirizine

Anti-nausea/vomiting,
Metoclopramide
Prochlorperazine

Antiulcer drug
Rabeprazole
Pantoprazole

Retinoids
Isotretinoin
Alitretinoin

Other Miscellaneous Drugs
Amiodarone
Cevimeline
Deferoxamine
Dicumarol
Dinoprostone
Glatiramer
Heroin
Interferon
Methoxsalen
Nicotine
Phenolphthalein
Psoralens
Riluzole
Sulfasalazine
Niacin
Smallpox vaccine
Quinidine

Tripe palms: Almost Always a Sign of Internal Cancer

May 23, 2013 by Dr.Deepak 1 Comment

Tripe palms are very rare skin condition associated with internal cancer. It is estimated that more than 90% of the cases with tripe palms have underlying malignancy. In most of the cases, it usually occurs before cancer is diagnosed, but can arise at any point during the course of the cancer.

Tripe palms are characterized by velvety, rugose thickening of the palms that resembles tripe, the villous stomach lining of pork, beef, or sheep. Many experts consider this to be a form of palmar acanthosis nigricans, because of its clinical similarities and frequency of co-occurrence. Some also called it as “acanthosis palmaris” and “acanthosis nigricans of the palms”. One may sometime experience tenderness around periungual region.

What Causes Tripe Palms?

The exact cause of tripe palm is unclear but some suggest that it might be due to some substances from the associated cancer that might stimulate the palm skin cells to proliferate. Tripe palms are frequently seen in associated with acanthosis nigricans. In patient with both acanthosis nigricans and tripe palms, stomach cancer is common findings while in patient with tripe palms alone, lung cancer is most common. Other cancers associated with tripe palms are tumors of head and neck and tumors of genitourinary tract. In few cases they are also associated with psoriasis, bullous pemphigoid and exfoliative dermatitis.

If one has tripe palm, a detail cancer checkup should be done because in almost 50% of the cases, they are the initial signs of internal cancer.

How is tripe palm diagnosed?

Your doctor can diagnose the condition just by its characteristics appearance. If there is confusion your doctor may perform biopsy to confirm the case.

Treatment of Tripe Palm

There is no specific treatment for tripe palms. Treatment modalities are targeted in treating the underlying cause for tripe palms. Removal of the underlying tumor may allow improvement in around 30% of the cases. Few papers have suggested that retionids alone or in combination with metformin might help in improving the lesion.

There is no way to prevent the development of tripe palms. Patients should be up to date with standard cancer screenings.

Erythema Nodosum

April 2, 2013 by Dr.Deepak Leave a Comment

Erythema nodosum is an inflammation of the subcutaneous fat. It is not a disease but a reaction pattern to various immunological reactions caused by different viral, bacterial, fungal infections, drugs, malignant disorders and other causes.

Erythema nodosum is commonly seen in women of age 20 to 40 but may occur at any age. Erythema nodosum starts with a sudden onset of symmetric, tender and erythematous nodules or raised plaque on the legs or forearm, most often seen on shin of the legs. After few days the nodules turn purple or red color than to green or yellowish color. One may have fever, headache, joint pain, abdominal pain, vomiting and diarrhea. The nodules may be so tender that walking may be difficult. Lesions usually resolve without scarring within 5-6 weeks. There is no ulceration seen and the lesion heals without scarring or atrophy. These lesions usually last 3-6 weeks and resolves, however, EN may recur frequently if the causative agent is not removed or treated.

Although erythema nodosum results from wide variety of etiologic agents, streptococcal infections are considered as most frequent causative factor in children. In contrast, adult erythema nodosum is most commonly associated with drugs, sarcoidosis, and inflammatory bowel disease to a large number of inciting factors. Below are several etiological factors for Erythema Nodosum

Infections

Bacterial Infections

Streptococcal infections
Tuberculosis
Yersinia infections
Salmonella infections
Syphilis
Campylobacter infections
Brucellosis
Q fever
Tularemia
Atypical mycobacterial infections
Chancroid
Meningococcemia
Corynebacterium diphtheriae infections
Cat-scratch disease
Propionibacterium acnes
Shigella infections
Gonorrhea
Leptospirosis
Lymphogranuloma venereum
Chlamydia
psittaci infections
Mycoplasma pneumoniae infections

Viral Infections

Herpes simplex
Infectious mononucleosis
Hepatitis B
Milker’s nodules
Orf
Measles
Cytomegalovirus infections

Fungal Infections

Histoplasmosis
Dermatophytes
Blastomycosis
Coccidioidomycosis
Sporotrichosis
Aspergillosis

Protozoal Infections

Giardiasis
Ancylostomiasis
Toxoplasmosis
Amebiasis
Ascariasis

Erythema Nodosum Pictures

Drugs

Oral contraceptives
Sulfonamides
Bromides
Iodides
Minocycline
Aminopyrine
Gold salts
Penicillin
Salicylates
Isotretinoin
Chlorothiazides
Phenytoin
Arsphenamine
Hepatitis B vaccine
Nitrofurantoin
Pyritinol
D-penicillamine
Thalidomide
Interleukin

Malignant Diseases

Leukemia
Renal carcinoma
Hodgkin disease
Non-Hodgkin
Lymphoma
Sarcoma
Post-radiotherapy for pelvic carcinoma

Miscellaneous Conditions

Ulcerative colitis
Pregnancy
Chronic active hepatitis
Sweet syndrome
Sarcoidosis
Colon diverticulosis
Crohn disease
Behçet disease
Reiter syndrome
Takayasu arteritis
Immunoglobulin A nephropathy
Granulomatous mastitis
Vogt-Koyanagi disease
Sjögren syndrome

Treatment of Erythema Nodosum

As several agents may cause erythema nodosum, eliminating these causative factors is the main aim of the treatment. Besides treating causative factors, bed rest is also very important part of treatment. Pain killers like aspirin, indomethacin or ibuprofen are helpful for those experiencing pain. In severe cases systemic corticosteroids may be given by your doctor or are not generally required for mild cases.

References
Fitzpatrick’s Dermatology in General Medicine, 7th Edition