Skin Disorders

Vaginal Itching in Children

March 25, 2013 by Dr.Deepak Leave a Comment

Vaginal itching in children is relatively common issue and may be associated with redness, inflammation, and discharge or even bleeding. Most of the cases are harmless and can be effectively managed and prevented by removing the irritating cause or with some home remedies and over the counter medications.

Vaginal itching is quite common in children and young girls. In girls between 2-4 years, bacterial vaginitis due to bacteria entering the vagina as a result of poor toilet hygiene is quite common. So it is important for mother to educate about proper washing and wiping after urination and bowel moments. Lazy to wash/wipe or excessive washing and wiping can both cause irritation.

As your child reaches eight or nine, vaginal itching may be due to vaginal yeast infections. Although yeast normally lives in the vagina without harming, they can be symptomatic when they overgrow. This can lead to severe itching, burning, redness and inflammation and may also be associated with thick white discharge. Overgrowth of the yeast can be due to antibiotics that are usually given for ear and throat infection in children or any other condition that weakens the immune system.

In rare cases, vaginal itching can also be due to pinworm that causes itching around anal areas. They can migrate out of the anal areas and reach towards lower vagina. Itching due to pinworm is severe during nights.

Vagina can be very sensitive before puberty and easily irritated by several substances. Experts agree that most of the cases of genital itching and redness are caused by local irritants like bubble bath, scented soap and shampoos. Strong detergents and bleach used to clean the under garments can also cause irritation and itching, as can tight fitting nylon panties. Several other nonspecific vulvo-vaginitis can cause itching in children and young girls before puberty. However, once puberty begins, the vagina tends to be more acidic, that can fight and help prevent infections.

Psoriasis, lichen sclerosus et atrophicus, childhood eczema, and seborrhea are some of the other conditions that can cause vaginal itching in children.

It is very important for parents to educate their child (between age 10-13 years), about the vaginal parts and commonly encountered issues, so she can be aware of the changes and manage accordingly. Also when there is unexplained recurrent infection that is resistant to treatment, one should suspect sexual abuse in a child. As this matter is very sensitive, you should talk to your child about it and try to help and support her in every way.

Home Remedies for vaginal itching in children

There are several remedies that can get rid of vaginal itching, few are listed below:

Maintain good toilet hygiene.
Avoid bubble bath, scented soap and shampoo.
Avoid tight fitting nylon underwear; always wear loose fitting cotton underwear.
Baking soda soaks is preferred in children with yeast infection and thought to work better than vinegar soaks.
If there is inflammation low strength steroid (1% hydrocortisone) for 2-3 days might help.

If the symptom doesn’t subside within a week or if your child has vaginal discharge, bleeding, painful urination or any other symptoms contact your health care provider immediately.

Erythema ab Igne: Warning for Laptop Users

March 19, 2013 by Dr.Deepak 1 Comment

I’m sure many of us use Laptops, and as the name suggest they are supposed to be placed on your laps. But have you ever thought that long term placement of laptops on your laps can cost you much. Yes, placing laptops on your laps without any cooling device or barrier can cause a skin condition called erythema ab igne, commonly known as toasted skin syndrome, fire stains or laptop thigh. Since the development of laptop computers, it has been a major risk factor for erythema ab igne and is increasing dramatically among the individuals who are prolonged laptop users.

Who Gets Erythema ab Igne?

Previously it was a common condition of elderly individuals and women, who are more prone to heat exposure. It was commonly seen on sins among the house-wife who were frequently involved in cooking on wood-burning stoves or close to fires. Other risk factors were those people who use electric heater, hot water bags or heating pads for joint pain or lower back pain. It can also be seen on the arms of chefs and bakers who are often exposed to the heat and radiation from ovens, as well as in glassmakers and jewelers. People with underlying conditions like hypothyroidism and poor microcirculation are more prone to this condition.

With the development of laptops computers it has been a major concern since heat and infrared radiation can directly affect the thighs. The underside of a laptop can be above 50 celcius, which is much warmer than you might have imagine and is enough to cause erythema ab igne when exposed for prolonged time. The heat and radiation source can be the fan, the battery or the optical drive.

How does it look like?

Initially, there may be mild and transient redness on the affected area. After prolonged repetitive exposure, the characteristics rash of erythema ab igne develops. The rash of erythema ab igne looks like reticular (net-like), red to brown pigmented patch on the area that has been affected by prolonged heat or radiation. In some cases there may be mild itching and burning sensation but most often it may be asymptomatic and go unnoticed until one see it.

Erythema ab Igne and Cancer

Although most experts agree on the fact that erythema ab igne due to laptops may not cause any long-term side effects or lead to severe complications, there is still a small chance of malignant transformation. Few papers have suggested that, on rare occasions, squamous cell carcinoma and Merkel cell carcinoma may arise in the lesions of erythema ab igne, but it may take more than 30 years of chronic exposure.[1-4] So, individuals with a history of long-standing erythema ab igne should consult dermatologist for detail examination and if needed the area should be biopsied.

Treatment of Erythema ab Igne

The treatment of erythema ab igne is to avoid exposure to heat and radiation source. You may need to add something in between your laptop and the leg to prevent further damage to the skin. The rash will ultimately fade and return to normal several months after discontinuation of direct heat or radiation. However in dark skinned individuals there may be pigmentation abnormalities that might take longer than normal or even permanent. So, the earlier you start preventing the more chances of complete recovery.

Hyperpigmentation can be improved with the use of topical agents like hydroquinone or tretinoin. If there is itching and inflammation mild corticosteroids may be applied.

Prevention of to

Avoid using laptops on naked thighs.
Add some cooling fan or any other barrier in between your laptop and the leg.
If possible try to avoid further heat exposure by placing the laptop on the desk.

References

Cross F. On a turf (peat) fire cancer: malignant change superimposed on erythema ab igne. Proc R Soc Med 1967;60:1307-8.
Peterkin GA. Malignant change in erythema ab igne. BMJ 1955;2:1599-600.
Jones, CS, Tyring SK, Lee PC, Fine JD. Development of neuroendocrine (Merkel cell) carcinoma mixed with squamous cell carcinoma in erythema ab igne. Arch Dermatol 1988;124:110-3.
Hewitt JB, Sherif A, Kerr KM, Stankler L. Merkel cell and squamous cell carcinomas arising in erythema ab igne [letter]. Br J Dermatol 1993;128:591-2.

Tinea Cruris: Bothersome Ringworm of the Groin

March 1, 2013 by Dr.Deepak Leave a Comment

Tinea cruris, jock itch, ringworm of groin or whatever you name it, is the most common superficial fungal infection of the groin area and adjacent skin. Although can be seen throughout the year tinea cruris is most common during summer months. Male are at risk higher than females. Tinea cruris is not that serious problem and can be managed effectively by keeping the area clean, dry and applications of anti-fungal medications. However, recurrence is very common and this creates problem for most of the people.

Who is at Risk?

Tinea cruris is commonly seen in adolescent boys and adult men. Person having tinea cruris may also be having fungal infection on the foot and body (athlete’s foot and ringworm). It is common among the people who are obese and who sweats a lot, but can occur to anyone. It can be aggravated by repetitive friction in the groin area. It is contagious and can be spread through skin-skin contact or through unwashed clothing.

How is Tinea Cruris diagnosed?

Your doctor can diagnose the lesion based on direct examination and symptoms of the lesion. No other tests are generally necessary. If it creates confusion with other disease, your doctor may perform a quick KOH test to confirm or culture and biopsy as needed to exclude other diseases.

Other condition that can be confused with tinea cruris are:

Candida infection/Candidial intertrigo: Generally acute onset, usually bright red rash with satellite pustules surrounding the rash.

Inverse psoriasis: Chronic red scaly rash,Mild or no itch,often associated with rash elsewhere on body (scalp, knee,elbow,nails)

Erythrasma: Usually asymptomatic patches with dry, red to brown color.

Dermatitis: Several other dermatitis like seborrhoeic dermatitis, irritant contact dermatitis, allergic contact dermatitis

Symptoms of Tinea Cruris

Red, itchy, ring shaped rash in the groin area and adjacent skin is the most common presentation. The red patch is often associated with scales, small blisters and redness around the periphery while normal skin tone in the center. Both groins are commonly affected. The rash usually spreads few cm down inside to the thighs.

Treatment of Tinea Cruris

Several treatment options are available both over the counter and prescription medications. You can buy over the counter antifungal cream containing Butenafine, terbinafine, Tolnaftate, ketoconazole, clotrimazole, miconazole, econazole and apply on regular basis. Application of antifungal 2-3 times a day and maintaining the area clean and dry is usually sufficient in most cases. Terbinafine in compared to other azoles is expensive but is the most effective medication, also requiring shorter treatment duration. If it doesn’t work you may need prescription antifungal creams.

How to apply antifungal for maximum result and to avoid recurrence

Apply the cream to the affected area including surrounding 2-3 cm of normal skin.
Apply for longer duration and continue applying even if the lesion has healed (you may adjust maintenance dose to once daily or alternate days for few weeks after lesion heals).
Application may differ according to medication; see the leaflet for more detail on each medication.
If there is inflammation, you doctor may also provide with mild steroids to subside the inflammation. Steroids will also soothe the itching and redness. Never use steroids for more than a week.

Oral antifungal may also be prescribed by your doctor if the infection is severe. Oral antifungals like terbinafine, fluconazole or itraconazole may be given by your doctor.

How can I prevent Tinea Cruris from recurring?

Although tinea cruris can be treated effectively by both over the counter and prescription medications, recurrence is very common. So, in order to prevent from recurring there are several things you have to keep in mind. Few are listed below:

Wash your groin area daily with mild soap and dry thoroughly. It is very necessary to keep the area dry; fungi can grow faster and multiply in wet and moist environment.
Change your underwear on daily basis; don’t give any change for fungus to multiply.
Don’t wear underwear or any clothing that irritates the area. Avoid tight-fitting and rough-textured clothing.
People often ignore and put on the underwear while the skin is still wet, never repeat such mistake.
Check for fungal infection on other areas like foot (athlete’s foot) and treat it accordingly, if left untreated it can spread to the groin and other areas too.
Never share private clothing and towels with other people. Always wash towel frequently and dry it in the sun daily after you use it.

Final Words

Tinea cruris usually responds well to treatment and complications are rare. However, if left untreated, secondary bacterial infection or even permanent darkening of the skin color may occur. So don’t wait and keep scratching, consult a dermatologist and get it treated.

Another condition called erythrasma can also occur on the same area and sometimes misdiagnosed. Erythrasma is caused by bacterial infection so applying anti-fungal won’t work.

Bier spots: Small White Spots on Skin

February 28, 2013 by Dr.Deepak 3 Comments

Bier spots, also called physiologic anemic macules, are small white irregular spots on the skin usually seen on arms and legs of young adults that are thought to be due to vascular anomaly. In few cases they may also be seen on the trunk making the diagnosis more confusing. They are usually harmless and require no treatment.

Bier spots are usually seen in individuals between 20-40 years and are more common in women than men. They are characterized by numerous irregular white spots (macules) with red erythematous surrounding that blanch on pressure. These white macules often disappear when affected limb is raised. These spots are thought to arise due to physiologic response of small blood vessels of the skin to venous hypertension and constriction of small blood vessels leading to tissue hypoxia. So, there is dilation of vessels in red area and constriction of vessels in pale areas.

Although Bier spots are considered as harmless physiologic response, they sometimes may represent systemic disease like scleroderma renal crisis, lymphoma and mixed cryoglobulinemia. So never underestimated the disease, always seek professional help before confirming the disease. Your doctor may order some tests to confirm that they are not due to some underlying systemic disease. When your doctor confirm they are totally harmless, it can be ignored or treated for cosmetic reason. If it was due to underlying disease, treating the cause will resolve the spots. Sometimes, they are also associated with pregnancy in women.

Other possibilities that may mimic Bier spots

Vitiligo
Post-inflammatory hypopigmentation
Pityriasis versicolor
Pityriasis alba
Nevus anemicus

Treatment options for Bier spots

In normal physiologic cases no treatment is required because the lesion is harmless, asymptomatic and resolve spontaneously. If it was due to underlying systemic illness, treating the cause will resolve the lesions. As early intervention can increase the chances of positive outcomes, always seek professional help as early as possible, don’t try to diagnose your-self just by looking few images online.

Salmon patch: Common Birthmarks on Babies

February 26, 2013 by Dr.Deepak 1 Comment

Salmon patch is one of the most common birthmarks seen on babies. These birthmarks are caused by capillary vascular malformation, where small blood vessels (capillaries) get stretched (dilated). Salmon patch is thought to occur in about 40% of all newborns. It is called as angel‘s kiss when it occurs on forehead and called stroke bite when it occurs on back of the neck. Medically termed as nevus simplex, salmon patch is often temporary and no treatment is needed.

Signs and Symptoms of Salmon Patch

Salmon patch are usually small flat pink or red skin with unclear border commonly seen on the forehead, between eyebrows, eyelids, nose, upper lip and back of the neck. They may be seen during birth or during the first months of life. They can be very noticeable when the child is crying or during temperature change. When you push the lesion, it may fade. Most lesions will spontaneously disappear within the first year of life. However, few may persists into adult life, which may cause major cosmetic problem.

How is salmon patch diagnosed?

Your doctor can diagnose salmon patch simply by direct examination of the lesion. No any other tests are needed.

How is salmon patch treated?

Usually no treatment is needed, as the lesion fades within first year of life. However, if there is darkening of the area, cracking, bleeding or any other problems, contact your doctor immediately. In most cases there is nothing to worry and it fades over time. If the patch is on the glabella (between eyebrows) or back of the neck then it might take several years to fade. If salmon patch lasts longer or persists into adulthood, it can be effectively treated with laser therapy.

Eight Signs of Malignant Melanoma: The ABCDE Rule

February 9, 2013 by Dr.Deepak 1 Comment

Early detection of melanoma is the key to prognosis of melanoma. The earlier it can be detected the more chances of easy treatment. However, there are such circumstances where it can be misdiagnosed. So there are no any specific characteristics that can confirm the diagnosis of melanoma. The well-known rule of ABCDE of melanoma detection continues to be a useful tool for both doctors and the public. In this article we’ll brief the most common eight signs of malignant melanoma. Do remember that self-diagnosis may sometimes put you in trouble, so always seek expert advice if you suspect any abnormal moles in your skin.

Eight Signs of Malignant Melanoma

A Asymmetry in shape, which means that one half is not identical to other half. Although not included in ABCDE rule, age can also be another factor. The development of a new pigmented lesion with characteristics of either any of ABCD rule, in an individual above 40-50 years can also be highly suspected for melanoma.

B Border is irregular, notched, scalloped, ragged, or poorly defined as opposed to smooth and straight edges.

C Color is not uniform, varying shades from one area to another, different colors ranging from brown, black, gray, red and white.

D Diameter is usually large, greater than 6mm, approximately the tip of pencil eraser. Some suggest D for difference that denotes difference from other lesion. Experts think that a pigmented mole should globally share a common appearance or family resemblance. Even in an individual with multiple atypical moles, the mole should be morphologically similar. So, the mole that is different from other pigmented moles on a particular individual should always be suspected for melanoma.

E Evolution of moles, if the mole has gone through recent changes in size, shape and color. Some use E for enlargement, which signify an increase in size of lesion. Another is Elevation which is always present and is irregular with surface distortion.

Lesion having above characteristic may potentially be harmful melanoma. In addition to increase in size and change in colors that are two early signs of melanoma, persistent itching is also an earlier symptom. Inflammation, tenderness, ulcer and bleeding denote that the lesion has advanced. If you suspect any of the above changes seek medical advice immediately.

Nevoid melanoma is a rare melanoma that resembles harmless moles and doesn’t follow the ABCDE rule. Early nevoid melanoma usually has smooth borders, small (less than 6mm) and even color lesion, which can be mistaken for harmless lesion according to ABCD rule.

Lets summarize the 8 signs of melanoma

Asymmetry in shape
Border is irregular
Color is not uniform
Diameter is usually large
Difference from other lesions
Evolution of moles
Enlargement of mole
Elevation above the surface

Others

Persistent itching
Inflammation
Tenderness
Ulcer
Bleeding

Common Causes of White Spots on Penis

February 5, 2013 by Dr.Deepak 4 Comments

White spots on penis could be very embarrassing for every man. These white spots could be due to several conditions and are usually not due to sexually transmitted infection. These spots could sometime be just a harmless spot, but if you are worried please consult your doctor. This article is limited to white spots on penis that are usually flat and not raised. Please refer to raised bumps on penis for other conditions.

Mucosal Vitiligo

Vitiligo which involves oral and genital mucosa is classified as mucosal vitiligo. Mucosal vitiligo can be seen in any areas like lips, glans penis, prepuce, and anal. In most cases vitiligo may also be present in any other parts of the body but sometimes it can also be isolated to these genital areas. Mucosal vitiligo is often difficult to treat and is resistance to medications.

Lichen Sclerosus

Lichen sclerosus involving penis is commonly a presentation of uncircumcised men although it can occur in circumcised individuals.The classic presentation of genital lichen sclerosus is atrophic white patches or plague but it may also manifests as scaly patches with telangiectasia and sparse purpura. Early genital lichen sclerosus may be confused with vitiligo. If there is clinical confusion biopsy is helpful. Patients with genital Lichen sclerosus may carry risk of developing squamous cell carcinoma of penis.

Scar

Scarring is also one of the common causes of white spots on penis. Injuries and infection of the penis usually heals with scarring that are either temporary or permanent depending on the type of injuries or infection. These injuries may leave hypopigmented or hyperpigmented scar on the penis.

Post-inflammatory Hypopigmentation

Post-inflammatory hypopigmentation (PIH) is also common cause of white spots on penis. Any infection or inflammation on penis may result in post inflammatory hypopigmentation.

Pityriasis versicolor

Pityriasis versicolor is another cause of hypopigmentation on penis. PV is caused by yeast and usually involves other parts of the body in addition to genital areas. Topical antifungal medications applied over 4-6 weeks may resolve the condition while it may take over 6 months to 1 year or more for hypopigmentation to return to its normal color.

Bier spots

Bier spots are small, irregular, hypopigmented spots that are usually found on the arms and legs of young adults. It can sometime develop on genital areas like penis. They are thought to be caused by vasoconstriction in small vessels which may be due to anatomical and functional damage to the small vessels of the skin. Some papers have associated biers spots with systemic disease such as scleroderma renal crisis, lymphoma and mixed cryoglobulinemia.[1,2]

Other condition that may present as white spots on penis are listed below:

Viral warts
Striae
Cicatricial pemphigoid
Squamous hyperplasia
Extramammary Paget disease
Mycosis fungoides

References

Peyrot I, Boulinguez S, Sparsa A, et al. Bier’s white spots associated with scleroderma renal crisis. Clin Exp Dermatol 2007;32: 165-7.
Binois R, Galliot C, Audia S, et al. Multiple anaemic macules and diffuse erythrocyanosis revealing mixed cryoglobulinaemia. Eur J Dermatol 2011;21:269-70. Fan YM, Yang YP, Li W, et al. Bier spots: six case reports. J Am Acad Dermatol 2009;61:e11-2.

Itchy Skin no Rash: Pruritus Sine Materia

February 3, 2013 by Dr.Deepak Leave a Comment

Itchy skin with no rash can cause significant discomfort to a person and also may create confusion for general physician. Every individual can experience itchy skin without rash when he/she is suffering from stress and anxiety or excess dryness of the skin. But there are several other conditions that should be focused when it comes to itchy skin no rash. Underlying acute and chronic medical conditions should always be ruled-out when no other definitive cause of itchy skin can be found. This article review few causes of itchy skin with no rash. There might be several other causes of itchy skin without rash that might have not been discussed here, but we have tried our best to include most common.

Chronic Kidney Disease

It is estimated that up to 50% of the patients with chronic renal failure experience generalized itching. Individual may develop secondary skin lesion as a result of intense scratching like prurigo nodularis, nummular eczema etc.

Cholestasis

Cholestasis is not a disease; it’s a symptom of several hepato-billary conditions. Itching associated with cholestasis starts with the hands and legs and becomes generalized. The itching may be due to bile salts in the skin as a result of biliary obstruction and raised level of opioid peptides.

Endocrine Disease

Several endocrine disorders are associated with itching without rash. Disease like hypothyroidism where skin is excess dry and thyrotoxicosis are associated with generalized itching. Itching can also be the manifestation of diabetes neuropathy.

Hematologic Disease

Itching is associated with several blood disorders. Around 50% of patients with polycythemia vera manifests generalized itching especially after contact with water (often termed as “bath itch”). Itchy skin without rash is often presenting symptoms in Hodgkin disease. Other diseases that can have itchy skin with rash are leukemias, cutaneous mastocytosis.

HIV Infection

Itching can also occur in primary infection of HIV which may or may not be associated with skin rash and infection. Itching in HIV may be associated with internal cause like, renal disease, hepatic disease, drug reaction or lymphoma.

Senile Pruritus

Itchy skin in elderly people especially over 70 years is always a common finding. Although exact cause can’t be found, excessive dryness may be one reason. Sometimes itching may also be provoked when contact with water. Itching is usually worsen during night and aggravated by hot water.

Aquagenic Pruritus

Itchy skin without rash can also occur due to contact with water, either cold or hot. This itching may last for an hour or so and may not be associated with skin rash. The exact cause for this condition is unknown.

Notalgia Paresthetica

Notalgia paresthetica is a common localized itch of mid-back skin especially in infrascapular region. Itching may be associated with tingling, pricking or numbness of the area affected. Notalgia paresthetica is thought to be cutaneous sign of an underlying degenerative cervical spine disease. The itching may be due to the entrapment of spinal nerves that supply sensation to upper-back. Although topical therapy might help decrease the sensation, systemic or detail spinal examination may be required for further management of notalgia paresthetica.

Brachioradial Pruritus

Commonly seen in middle aged individual, brachioradial pruritus is localized itching on the outer surface of the upper arm, elbow, and forearm. It has been suggested that brachioradial pruritus is cause by nerve damage due to cervical spine abnormalities. Prolonged long-term exposure to sun has also been suggested in the etiology of brachioradial pruritus.

Below are the summary lists of disease that can be associated with “itchy skin no rash”

Metabolic, endocrine conditions
Hyperthyroidism
Hypothyroidism
Pregnancy related

Malignant neoplasms
Lymphoma, myeloid and lymphatic leukemia,
myelodysplasia
Multiple myeloma
Hodgkin disease
Other cancer (rare)

Infestations
Scabies
Pediculosis
Hookworm
Onchocerciasis
Ascariasis

Renal disease
Renal failure

Hepatic disease
Obstructive biliary disease
Intrahepatic cholestasis

Hematologic disease
Polycythemia vera
Paraproteinemia, iron deficiency

Psychogenic states
Acute
Periods of emotional stress
Chronic
Delusions of parasitosis
Psychogenic pruritus
Neurotic excoriations
Anorexia nervosa

Other miscellaneous conditions
Senile pruritus
Xerosis
Fiber glass exposure
Factitious urticaria
Brachioradial pruritus
Notalgia paresthetica
Aquagenic pruritus

Drugs
Asymptomatic drug sensitivities
Aspirin, alcohol, dextran, polymyxin B, morphine, codeine, scopolamine, tubocurarine etc..

References
Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology, sixth Ed

Itchy Arms No Rash: Brachioradial Pruritus

February 1, 2013 by Dr.Deepak 35 Comments

Brachioradial pruritus (itchy arms) is a localized intense itching on the outer aspect of the upper arm, elbow, and forearm. This is commonly seen in fair-skinned individuals who are often exposed to sun. The itching may gradually be more widespread and intense but may still look normal without any rash. The itching may be so intense that may result in bleeding due to scratching.

Although there are several other conditions that are associated with itchy arms, most of them are associated with rash on the arms and probably on other areas of the body too. Most common cause of severe itching with rash is atopic dermatitis, which is characterized by severe itching, redness, scaling and lichenification of the skin. Other common conditions include dry skin, neurodermatitis, allergic contact dermatitis, eczema, psoriasis etc.

Brachioradial prurituis is commonly seen in middle aged individual, however, it may start during adulthood and increase its intensity as individual in exposed to chronic sun. The most common area of itchy arm is the outer aspect of forearm but can be experienced on elbow, upper arms, neck and back. Itching can be intense associated with prickling, burning or stinging sensation. The involve area may be hypersensitive to touch.

Unlike other parts, arms can be easily access in anytime anywhere either private or public so patients will be habitual due to frequent itching. This chronic itching may result in secondary skin changes like scarring and hypo or hyper-pigmentations.

Itchy arms often involve one arm that is frequently exposed to sun but can be experienced on both arms too. In case of bilateral itching it may be suggestive of spinal tumour, so prompt investigation may be needed.

What Causes Brachioradial Prutitus?

It has been suggested that brachioradial pruritus is cause by nerve damage due to cervical spine abnormalities. Prolonged long-term exposure to sun has also been suggested in the etiology of brachioradial pruritus. Minor injuries and abnormalities of cervical spine like calcium deposit, disc prolapse or bulging, and degenerative changes of spine and skin that occurs due to normal aging or disease and excessive sun exposure can also cause the problem.

Treatment for Brachioradial Pruritus

There is no cure for such itchy arms but ice pack and cooling lotions may be beneficial. Beside symptomatic relief, it is very important to find out the case and treat any underlying systemic cause especially spinal origin. Other therapy like topical capsaicin cream, anesthetic creams, anticonvulsant medications (gabapentine) and antidepressants have also been used with success. Avoiding chronic sun exposure may also help relief the symptoms.

Dark Spots on Skin Influenced by Genetic Factors

January 30, 2013 by Dr.Deepak Leave a Comment

Dark spots on skin, especially on the face can be very embarrassing. It is important to know what really causes it. Most of the cases of dark pigmentation are acquired either by excess sun exposure, some diseases, drugs, or hormonal changes. There are few diseases that are caused by defects in the genes and may pass through families. In this article we will only focus on few of those diseases that are influenced by genetic factors. There may also be several other diseases of pigmentation caused by genetic defects that have not be discussed here.

Freckles

Freckles are small light brown spots seen in sun-exposed areas. They are more common in fair skinned people and more prominent during summer while fading during winter. Freckles are harmless and rarely develop into skin cancer. But if you see any change in freckle color, size and shape contact doctor immediately.

Lentigines

Lentigines are tiny light brown to jet black in color usually seen in sun exposed or artificial source of ultra violet radiation as in the case of tanning beds and photo-chemotherapy. Unlike freckles they usually do not fade during winter months.

Xeroderma Pigmentosum

Xeroderma Pigmentosum is characterized by sun sensitivity, photophobia, early freckling, and neoplastic changes on sun-exposed areas. One may develop several small freckles-like hyperpigmented spots on sun-exposed areas. XP may start as early as first 1-2 years of life. It is estimated that those who develops XP early in their life have greater risk of squamous cell carcinoma, basal cell carcinoma, or melanoma.

Cafe Au Lait Spots

Café au lait spots are light to dark brown birthmarks with smooth or irregular border. They are usually associated with neurofibromatosis type 1, a multisystem genetic disorder characterized by the growth of tumors along nerves in the skin, brain, and other parts of the body.

Peutz–Jeghers Syndrome

Peutz-Jeghers syndrome is genetic disorder characterized by the development of small, flat, brown or dark blue spots on lips, inside and around the mouth, near eyes, nostrils and fingers with multiple polyps on stomach and intestines. These pigmentations usually appear during early childhood (not at birth). Lips spots may fade with time. Multiple polyps can cause severe problems like abdominal pain, bowel obstruction and chronic bleeding. People with Peutz-Jeghers syndrome have very high risk of developing intestinal cancer, stomach cancer, colorectal cancer and pancreas cancer during their lifetime than general population.

Albright’s Syndrome

Albright’s syndrome is a genetic disorder associated with fibrous dysplasia of bones, hormonal problems, skin pigmentation (café-au-lait spots) and premature puberty.

LEOPARD Syndrome

LEOPARD syndrome is a complex genetic disorder characterized by Lentigines, Electrocardiographic conduction abnormalities, Ocular hypertelorism, Pulmonary stenosis, abnormalities of genitalia, Retardation of growth and Deafness. The characteristic lentigines can be seen early during first few months of life and occurs in high numbers. Clinical diagnosis of LEOPARD syndrome is done by facial features along with other cardiac abnormalities as stated above.