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Occlusive Therapy For Chronic Skin Disorders

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Although occlusive therapy have great potential in the management of some skin conditions like lichen simplex chronicus, psoriasis vulgaris,  hand eczema, atopic dermatitis,  lupus erythematosus and many other chronic skin lesions, the therapeutic mechanism of this therapy is not completely understood. But occlusion artificially restores and corrects the defective barrier between the skin.

Prolonged and continuous occlusion and hydration of affected skin areas with a suitable barrier increases the efficacy. This therapy is useful for treating many chronic skin disorder as faciliates the penetration of topical medicines easily. But you should be aware that occlusive therapy with class one corticosteriods are not recommended. These preparations includes  – Betamethasone dipropionate creams,ointment 0.05% ( Diprolene ),  Clobetasol propionate cream, ointment 0.05% ( Clobex,Temovate ),  Diflorasone diacetate ointment 0.05%  ( Apexicon, Psorcon ),  Halobetasol propionate cream, ointment 0.05% ( Ultravate).

Instructions for Occlusive Therapy

  • Soak the area in water for around 15-20 minutes
  • After soaking the area apply the medication into the lesion while the skin is still moist.
  • Cover the area with a plastic wrap,plastic gloves for hands,plastic bags for feet, bathing cap for scalp and vinyl exercise suit for large body areas.
  • Seal the edges with tape or cover plastic with an ace bandage, a long stocking or any dressing that will ensure close adherence to skin. Paper tapes are better and less irritating.
  • Use for atleast 6 hours. Overnight application is usually sufficient to induce clinical remission. But this can also be done at day time. Occlusion for even few hours may be beneficial.

The Risk Of Side Effects From Topical Corticosteroids

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Corticosteroids are the most potent and effective local anti-inflammatory medications available and have a striking ability to inhibit cell division. They are the therapy of choice in most inflammatory condition  like eczema, dermatitis and psoriasis. You should remember that topical steroids are used for supression or relieve signs and symptoms of most skin conditions, and they are not curative therapy for skin conditions.

There are many topical steroids available, and they differ in potency and formulation. The risk of side effects from topical corticosteroids is directly  related to its potency , duration of therapy, frequency of application and anatomical area. Low potent corticosteroids have less side effects than Ultra potent  topical corticosteroids. To minimise the side effects of  Ultra potent topical corticosteroids limiting its use to maximum of 50 gm per week and maximum of 2 weeks is recommended. After 2 weeks or after an acute condition is on controlled,dosing can be reduced and with a tapering maintenance therapy and major side effects can be reduced.

Multiple potential adverse effect  are associated with use of topical corticosteroids.The most common are discussed below.

Skin atrophy and maceration: Skin atrophy and maceration are frequent findings if potent corticosteroids are used for longer time, especially when used with occlusive technique. This is reversible after discontinuation of therapy within 2-6 months.
Striae: They are Most common around the groin, axillae, and inner thigh.They are usually not reversible, but it may fade over period of time.
Telangiectasia: They are small visible distended blood vessels seen in skin surface . They are commonly seen on the face, neck, chest and sometimes on upper thigh and below knee. They are often reversible, but sometimes can be permanent. For permanent telangiectasia , Sclerotherapy  is the first line of therapy.
Abnormal hair growth: Sometime longterm use of topical corticosteriods might result in fine hair growth around the areas but it is reversible.
Hypopigmentation: Sometime hypopigmentation can occur with the use of potent therapy, most common in dark skinned people. This hypopigmentation is a reversible one.
Supression of Infections: Corticosteroids have ability to supress the infection. So, sometime symptoms and signs of bacterial,fungal or any viral infection may be masked which might further results in worsening of the conditions without being recognized.
Rebound dermatitis: When sudden discontinuation of corticosteriods, rebound dermatitis might occur. So the therapy must be taper for few weeks before discontinuation.
Systemic side effects: High potent topical corticosteroids used for a longer duration of time may induce mild hypercortisolism, hyperglycemia, Hypothalamic-pituitary axis suppression, and rarely cusing’s syndrome and growth retardation in children. Children and elderly are at higher risk of side effects.

Tachyphylaxis: Tachyphylaxis or Tolerance might occur after a few weeks of therapy. If an inflammatory skin condition gets worsens after initial good response, tolerance to the anti-inflammatory effects of topical corticosteroids should always be suspected. This can be prevented by limiting the frequency of application per day. This is a reversible condition and can be managed by stopping therapy for a few days ( 4 days ), and then resuming with the same treatment or any other  alternate agent.

Other common side effects might be: Purpura ( Bruising with with minimal trauma), and Acneform/Rosacea like eruptions ( common on face).

Topical corticosteroids treatment  are being used for more than 50 years in skin therapy and they bear minimal risk if used properly with a proper prescription of a dermatologist and a regular supervision. They are safe if used with appropriate potency and strength for appropriate skin condition.

If you have any questions regarding  topical corticosteroids you can ask us at DermaTalk Skin Care Forums

Intertrigo Treatment And Prevention

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Intertrigo is a nonspecific inflammatory lesion of the skin folds. It is most common in obese peoples and during hot weather. It is most commonly aggravated by moisture, perspiration, heat, friction, and lack of air circulation. Intertrigo is worsened  by infection with yeast  like Candida albican, bacterial, fungal and viral also plays role in infection.

Intertrigo uaually affects inner thighs, armpits, and underside of the breasts and belly and sometimes behind the ears, and the web spaces between the toes and fingers. The appearance of intertrigo is dependent on the area of skin involved. They are usually raw-looking, sometimes itchy, macerated and red rash with scaling on the edges with foul smelling odor.

Intertrigo can occur in any skin folds that rub together and trap moisture. We see diaper rash in infants is also an intertrigo.

Intertrigo usually appear:
In the crease of your neck
On the underside of the breasts or belly
In the armpit
In the groin and at the scrotum
Between the buttocks
Between toes and fingers

Prevention and Treatment of Intertrigo

Environment changes to promote drying and prevent skin to skin friction are essential steps in preventing further infection. So correcting the causative factors is critical in management. Take these steps in correcting and management of Intertrigo :

  • Your living and working area should be kept dry. Air conditioners, absorbent powders and fan would help.
  • The clothes you wear should be light, nonconstricting and adsorbent. Avoid wool, nylon and synthetic clothes. Bras for female and underwear for male should be light.
  • You should wash, rinse and dry the areas atleast twice daily. Mild antibactrial or low PH ( PH 5.5-7 ) cleanser can be used. Absorbent powders can be used to make it dry.
  • Oily  ointments or cosmetics might more harm than good so it should be avoided. If there is much incontinence, lotions, spray and powder creams may be used.
  • Weight loss in incouraged to reduce the size of fat folds.
  • Applying  cooling water, burow solution, dilute vinegar, or wet tea bags often are effective.
  • Initially some mild  topical OTC  (over the counter) corticosteroids might be used, but prolonged therapy with corticosteroids is not recommended as it might lead to skin atrophy.
  • For itching, soothing lotions like calamine can be used.
  • For relief of rash,burns and  superficial wounds, Zinc oxide, cod liver oil, and talc can be used.
  • Antifungal preparation like clotrimazole and miconazole creams  are helpful. For better results combination with mild steroid is recommended.

Self Skin Examination For Early Detection of Melanoma

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Melanoma is the fastest growing cancer and its incidence is doubling every 10 years. Currently 1 in 60 individual will develop melanoma as per US data. With the changes in ozone layer, some predict this incidence will increase sharply in near future. The survival rate of melanomas is directly related to early detection.  So it is critically important for peoples to have a good understanding of early detection and prompt prevention and treatment of  melanoma.

As melanoma is a type of skin cancer so it usually start with lesion on your skin. It can be easily detected at an early stage by yourself with a self skin examination. By checking the skin regularly for any suspected lesions on your skin increases the chance of finding melanoma early. People who have risk of melanomas could do a routine monthly Skin self-examination. Skin self-examination from head to toe for any  signs of melanoma, including changes in existing moles and the development of new moles is the most effective way for early detection of melanoma. Follow the ABCD of melanoma while examination.

Here is how to perform a Skin self-examination:

  • With your clothes off, stand in front of a full-length mirror in a well-lighted room. Use a hand mirror to see your back, arms, underarms, buttocks, legs and other hard too see areas.
  • Start with the scalp and face  and go downward, checking your head, neck, shoulders, chest,back, and so on. Use a comb or a hair dryer to help move hair so you can see the scalp and neck better.
  • Don’t forget to check for your nose and lips, cause  these areas have righ risk of squamous cell carcinomas and basal cell carcinomas.
  • Don’t forget to check your front, back, and sides of the arms and legs.
  • Check your finger nails and palm and also  foot soles and toes and toe nails.
  • If you have moles, be sure where your moles are and how they look. If you check your skin regularly, you will be familiar with how your moles look like.
  • Look for any signs of change in moles , you can take a picture of your moles and compare over time. Look for a change in outline of a mole, its shape and size or color (especially a new black area). Also, look for any new and  unusual or suspicion lesion.

If you suspect any abnormal changes in moles or any spots that doesn’t heal over time immediately consult your doctor or a dermatologist.

If you have any questions regarding melanoma ask us at our Skin Care Forums Here

Any Doubtful Non Itchy Painless Mass Could Be Skin Cancer

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When cells of the skin multiply in a haphazard manner,they form small masses on the skin, and these are known as skin cancer.

There are mainly three types of skin cancer. The most common are squamous cell carcinoma and basal cell carcinoma. Squamous cell carcinoma present ulcerated masses on the lower half of the face, while basal cell carcinoma are skin coloured, pearly white or coloured masses on the upper half of the face. Both can be cured by surgical method.

Melanoma, on the other hand, is the most lethal cancers. They are like coloured moles, which grow repidly,can bleed,are itchy or change colour. They have to be excised very early. Any doubtful lesion or mass on the skin which doesn’t itch, painless has to be checked to rule out skin cancer.

Skin cancer is diagnosed clinically and confirmed by histopathological examination. If you have doubt or if you suspect of skin cancer it is better to consult a dermatologist as soon as possible for quick management and treatment.

Treatment Of Acne In a Spa

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Spas primarily offers different types of specialties treatment ranging from massage,  facials, exfoliation and medical treatments of skin disorders with a supervision of licensed health care professional. A medical spa provides comprehensive therapeutic and restorative care that promises to restore beauty and health.

Various new treatment options to treat acne have been introduced which can be done in a spa with a supervision of licenced medical professionals. The most common treatments will be discussed here:

Microdermabrasion: Microdermabrasion is usually performed using aluminum crystals or other abrasive substance and is useful therapy for acne and acne scars treatment. Treatment usually takes around 30-45 minutes depending on the area . Cost of a single session might take around $100, but for effective results several sessions might required.

Laser and light therapy: Light treatment can be performed alone or with prior application of 20% aminolevulinic acid for around 10 minutes to 2 hours. For better result treatment in every 3 weeks for atleast 3 months is suggested. This therapy can be performed in conjunction with other acne therapies.

Nonablative lasers: It uses a selective photothermolysis to target the follicle.  With the transient thermal effects, P.acne is reduced and sebaceous glands are heated and decrease in size. These treatment are usually performed monthly for 4-6 months.

Other therapies that might be performed in spas are  pulsed dye lasers, chemical peels and laser skin resurfacing. Spas also offers treatment with Alfa-hydroxy acids ( glycolic,citric,lactic and pyruvic acids) and beta-hydroxy acids ( salicyclic acids) .These agents can be  topical creams or as peeling agents .

The Most Efective Combined Therapy For Acne

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With many research and study, combined therapy with retinoids, Benzoyl peroxide gels and topical antibiotics are found to be most effective in treating most of the acne infections.

With this type of therapy, the retinoids prevents or removes comedones, whereas benzoyl peroxide or any other topical antibiotics eradicates P.Acnes. The retinoids also enhances absorption of the other medications. Sometimes irritation reactions limit the use of this combination therapy. So before you apply the combination therapy for your acne, there are few things you should know.

Always use retinoids creams or solution in the evening or bedtime as a single agent .

Apply benzoyl perixide gel or any other topical antibiotics prescribed in the morning.

If you acne have decreased then you must decrease the frequency of therapy and the concentration of the medications.

If you are using tretioin, apply the agent at different times, not simultaneously. Mixing highly saturated tretinoin with reactive oxidants like benzoyl perixide  might destroy both chemicals.

If you have any questions regarding use of combination therapy ask us at DermaTalk Skin Care Forum

Acne Treatment With Benzoyl Peroxide

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Benzoyl peroxide (BPO)  is a commonly used topical treatment for mild acne which was introduced in 1934. It is  safe preparation for all adults and children, and it can  be used in pregnancy too. Despite the fact that there are only few randomized trials that have been published, BPO is considered the standard topical treatment  in mild acne.

Benzoyl peroxide has a potent bacteriostatic effect with a reduction of p.Acne within 2 days and a reduction in lesion count after 4 days of application. Benzoyl peroxide will also reduce the size and number of comedones present and may inhibit sebum secretion.

Benzoyl peroxide prescription and many other over-the-counter preparation can be obtained in various strength from 2.5% to 10%. It comes in alcohol-based gels or water based gels. The water-based preparation are less drying than the alcohol-based preparations. Benzoyl peroxide gels is normally applied once or twice daily.

The effect of Benzoyl peroxide is dose-dependent, The higher the dose the more it might be irritation. Normally 5 % BPO is enough to control mild acne. Skin irritation is the most common side effects so before you apply Benzoyl peroxide for the first time,  it is adviced to skin-allergy test by applying small amount on antecubital area. As it has strong oxidative potential, So be aware that it might bleach colored and dark clothing or even hair.

If you have any questions regarding  Benzoyl Peroxide, Ask us at DermaTalk Skin Care Forums

Topical Antibiotics Used for Acne Treatment

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Acne is common skin disease that affect almost 90% of the people at some time in their life. Acne is caused by abnormal desquamation of follicular epithelium which results in obstruction of the pilosebaceous canal. The  obstruction of the pilosebaceous canal further  leads to the formation of comedones. These comedones becomes inflamed due to overgrowth of Propionibacterium acnes.

Topical Preparations like Benzoyl peroxide, Salicylic Acid, Azelaic Acid, Retinoids, Sulfur Preparations and many topical antibiotics are mainly used in the treatment of acne. These topical preparations are either used a single line regimen or with combination therapy.

Topical antibiotics are safer and accurate to use as compared to other oral antibiotics . Topical antibiotics are mainly used for their role to kill  P acnes. They may also have anti-inflammatory properties, Thus killing the bacteria and keeps the glands unblocked. The most commonly used topical antibiotics are Tetracycline, Erythromycin and Clindamycin. Study shows that Clindamycin is more effective than topical tetracycline in treating acne. They are most effective in combination with benzoyl peroxide. These preparation can be used once or twice a day depending upon the nature of acne. Gels and solutions may be more irritating than creams or lotions.

Clindamycin: Clindamycin  is one of the most commonly used topical antibiotics. It is available in 1% concentration in a hydro-alcoholic vehicle as a gel or lotion. This can be Applied once or twice daily. Some common side effects might be Skin dryness and another which is rare ( only 2-3 cases ) might be  pseudomembranous colitis. Patients suffering from inflammatory bowel disease should not use this antibiotics. The therapy must be stopped if any gastrointestinal symptoms occurs. It can be used in combination with benzoyl peroxide prepration for better outcome.

Erythromycin : Erythromycin is another popular antibiotics used as topical treatment. It is available as 1.5 %  solution, 2% solution or a combination 3%  Erythromycin and 5%  benzoyl peroxide gel. It can be applied once or twice daily. It doesn’t have much more side effects and can be used in pregnancy too.

Tetracycline: Tetracycline is another topical antibiotic used in acne treatment. It comes in 2.2 %  solution. It may be applied once or twice daily. Special precautions should be taken before applying it as it might stain skin and clothes. Sometimes  it may cause severe allergic reactions to skins.

It is important to know that acne is not a disease of hygiene. so you should not try to scrub the lesions away, and  should not use alcohol-based astringents which might dry and irritate your skin.

If you have any questions that are not answered here you can ask us at DermaTalk Skin Care Forum

 

Study Finds No Association Between Streptococcus Pharyngitis And Pityriasis Rosea

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A study at Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, India suggests that there is no association between streptococcus pharyngitis and pityriasis rosea.

Pityriasis rosea is self limited skin condition of uncertain etiology. The exact cause of pityriasis rosea is not known but various hypotheses have been postulated incriminating infective agents such as viruses, bacteria, spirochete and noninfective etiologies such as atopy and autoimmune causes have also been investigated.

They undertook a study to investigate the role of Streptococcus haemolyticus in the causation of pityriasis rosea and study the levels of C-reactive protein (CRP) and ASLO titer in patients with pityriasis rosea.

The study included 20 patients with pityriasis rosea attending the outpatient dermatology department at JIPMER hospital during the period from June to December 2004. Corresponding number of age- and sex-matched controls were chosen from amongst healthy individuals and patients attending skin OPD with dermatological disorders other than pityriasis rosea.

On analyzing the data collected from 20 cases of pityriasis rosea, the average age was found to be 15.3 years and ranged from 5 years to 30 years. The male to female ratio was found to be 1.5:1. The average duration of illness was 14.5 days (median) and 29.3 days (mean). CRP was negative in all the cases as well as the controls. ASLO titer was found to be raised in 2 (10%) cases, while it remained below the critical value in all the controls. On comparing the cases and controls, the raised ASLO titer in the cases was found to be not statistically significant (p = 0.147). From the throat swab culture, Streptococcus haemolyticus was isolated from only one case and none of the controls. This finding was not statistically significant (p = 0.310).

As per the findings of the present study, They arrived at conclusion that there is no association between streptococcus pharyngitis and pityriasis rosea.

Source:

Parija M, Thappa DM. Study of role of streptococcal throat infection in pityriasis rosea. Indian J Dermatol [serial online] 2008 [cited 2009 Jan 3];53:171-3. Available from: http://www.e-ijd.org/text.asp?2008/53/4/171/44787