SKIN
DISEASES
DERMATITIS-ECZEMA
Dermatitis is a general term describing the inflammation of the skin. It has many causes, and the condition can manifest in different forms. Findings are generally rash and itching.
The skin affected by dermatitis can present with pustules full of liquid or purulence on the skin, discharge, crusting and the drying, flaking off and eruption of these crusts.
Types of eczema include eczema resulting from contact (contact dermatitis) from substances such chemicals, metals, plants etc., atopic dermatitis (eczema), seborrheic eczema seen on the scalp and the face.
Dermatitis is a non-infectious prevalent disease and is usually not life-threatening. However, it does cause discomfort in the patient. Particularly atopic dermatitis seen in children may affect the child's and the parent's sleep patterns and may have a negative impact on their daily focus. Failure at school and various negative situations may stem from this. Therefore, the main objective of treatment is the curbing of the itching symptom and preventing symptoms from repeating.
What are the symptoms and findings?
Different types of dermatitis may manifest on different regions of the body in different appearances.
The most prevalent types of dermatitis are as follows:
Atopic Dermatitis (Eczema): These are red, itchy rashes frequently starting in infancy. They are usually seen in regions such as the inner elbow, back of knee and the front part of the neck (throat) where the skin is sinuate. If the red area is itched, liquid may leak, and the area may later become flakey. Atopic dermatitis may decrease, heal or recur over time.
Contact Dermatitis: It is a condition characterized with redness manifesting in the region where the skin contacts substances that may irritate or cause allergic reactions. These regions may develop burning, stinging and vesiculation.
Seborrheic Dermatitis: This condition causes patch-like flakey red rashes on affected regions and persistent dandruff. This type of dermatitis is usually active on oily regions of theskin (face, upper chest or back). In this profile, recovery and recurrence periods are usually consecutive.
When should you see a doctor?
If those symptoms affect the patient's daily life and make them uncomfortable, a doctor should be consulted.
What are the causes of dermatitis?
Different disease, allergic conditions, genetic factors or exposure to corrosive substances may cause different types of dermatitis.
Atopic dermatitis: This condition may appear with the combination of many factors such as dry skin, genetic predisposition, a possible defect of the immune system, bacteria on the skin and environmental conditions.
Contact dermatitis: This condition manifests following contact with numerous allergen substances (different plants, cosmetic products, jewelry, perfumes, preservatives).
Seborrheic dermatitis: This condition may be caused by more than one factor. One of these is a type of fungus naturally found on the skin. Individuals with seborrheic dermatitis may notice that their symptoms change according to seasons.
What are the risk factors?
A series of factors may increase the risk of contracting dermatitis:
- Age: Although dermatitis appears at all ages, atopic dermatitis is more prevalent during infancy. Patients with atopic dermatitis may witness that the condition disappears with age.
- Allergies and asthma: Likelihood of atopic dermatitis is higher in people having a history of allergy or asthma.
- Profession:Coming into contact with specific metals, solvents, cleaning products while working increases the risk of contact dermatitis. Healthcare professionals have a higher risk of developing contact dermatitis on the hands.
Itching the redness caused by dermatitis may cause open wounds and their infection. These infections may spread on other regions of the body and may, albeit rarely, be life-threatening.
Preparing the answers to the questions that may be asked by the doctor may help you.
- What are the symptoms and when did they start?
- Is there a reason that causes the manifesting of these symptoms?
- What medications are you currently taking?
- Is there anyone in the family with a history of allergy or asthma?
- Have you undergone any previous treatment for this condition? Did they work?
How is dermatitis diagnosed?
After listening to you and examining you, your doctor may conduct some tests, including skin biopsy and patch tests.
PSORIASIS
Psoriasis is a chronic inflammatory disease seen at a 1,5% rate in society. Although the root cause of the disease is not entirely known, genetic and environmental factors play a role in its formation. Psoriasis presents with redness on the skin topped with nacre-like white flakes causing thickening of the skin erupting with the flakes. Psoriasis has an extremely negative impact on the patient's quality of life. Bleeding can occur if lesions are itched.
Psoriasis may be accompanied by cardiac diseases, inflammatory bowel diseases and joint defects. That is why, when psoriasis patients experience rheumatic symptoms such as joint pain and stiffness, they should consult a doctor and describe their symptoms by indicating thay they suffer from psoriasis.
Psoriasis is a lifelong disease. Periods qualified by a significant relief of symptoms are followed by severe ones. These episodes may last several weeks or several months. The following healing period may last years. Aside from the skin, the disease may cause changes in nails and loss of nails.
The most prevalent type of psoriasis is plaque psoriasis. Although it can be seen in any region of the body, it is most frequent on the back of the knees and elbows, scalp and face. Furthermore, psoriasis may cause loss of nails due to a spreading on them.
Causes of episodes in psoriasis:
- Stress
- Smoking and alcohol consumption
- Infections
- Traumas such as blows, frictions, etc.
- Cold weather
- Some medications (When you are going to use medications for other conditions, do not forget to indicate to your doctor that you are suffering from psoriasis as well.)
Individuals with psoriasis may suffer from the following conditions more frequently:
- Joint disease (psoriatic arthritis)
- Eye infections
- Obesity
- Type 2 diabetes
- High blood pressure
- Cardiovascular diseases
- Metabolic syndrome
- Other diseases caused by a defect of the immune system
- Renal diseases
Diagnosis
In psoriasis, lesions on the skin are typical. These have a typical appearance with white nacre-like flakes on the redness on the skin. Special diagnostic methods and other methods such as biopsy can be used in cases where an exact diagnosis cannot be made.
Treatment
Treatment of psoriasis is fundamentally divided into 3 groups:
- Topical treatments (creams, ointments, lotions applied on the skin)
- Ultraviolet treatment
- Systemic treatments (oral medications or intravenous medications)
The most preferred drug class in topical treatments are as follows:
Patients who do not get any benefit from topical treatments are recommended systemic treatments. Treatment is specifically planned based on the situation of the patient and of lesions. Patients sometimes recommend their own therapies to others, but the planning of the treatment must be done exclusively by the doctor to the patient. Aside from these treatments, it is important for patients to take warm baths daily and to keep their skin moisturized for the treatment to be successful.
References.
Gürer, M.A. Turkey Psoriasis Treatment Guide-2016. Turkderm, 50,2.
Turkish Association of Dermatological and Venereal Diseases, Psoriasis Disease and Treatment Patient Information click here (son erişim: 03.09.2020)
Aydemir EH, Skin Diseases and Wound Care Symposium, 2001: 77-80
ACNE VULGARIS
Acne Vulgaris is a chronic and inflammatory disease of the skin resulting from the combination of follicles and sebaceous glands called acne vulgaris pilosebaceous unit. It is known as pimples or blackheads in society. It is most prevalent during pubescence and its severity decreases in adulthood. While it is more prevalent among women, it manifests more severely in men. Although acne vulgaris is not a life-threatening disease, it is an important one since it affects patients' quality of life.
A bacteria called Propionibacterium acnes also plays a role in the occurrence of acne, but this bacteria is already present in our skin's natural flora. Acne vulgaris is not a contagious disease.
Patients should not squeeze acne lesions. Squeezing them may cause the infection of the lesion and subsequent permanent scars. Dermatology specialists may clean and drain blackheads and acnes for treatment purposes.
Patients should avoid rubbing their faces because this may cause the inflammation of blackheads.
Symptoms and findings
The disease is characterized by typical lesions known as blackheads and pimples. These lesions are called comedone lesions and primarily occur with the clogging of hair follicles and the filling of these follicles by an oil secreted by the skin and called sebum. When melanin pigments accumulate in the comedones, these appear as blackheads. If these comedones develop bacterial reproduction and inflammation, structures known as pimples form. Although these lesions are mostly seen on the face, they can also be seen on other parts of the body such as the back and the shoulders.
Causes and risk factors
Different factors may cause the development of acne vulgaris:
- It is known that nutrition-related factors may trigger acne. Foods high in sugar such as chocolate, candies etc. cause a quick increase of blood sugar and may indirectly trigger acne. Therefore, the consumption of these foods in high amounts is not recommended.
- It is known that stress causes an increase of acne lesions and that patients who take trainings for the management of stress experience a reduction in the severity of the disease.
- The presence of acne vulgaris in the family is a risk factor in the development of the disease.
- Some medications and cosmetics can cause the developing of the disease. Usually, cosmetics are produced so as to not cause any acne formation.
Diagnosis
Diagnosis of acne vulgaris is made by a doctor following examination. Sometimes laboratory tests are necessary for determining the cause of acne and other underlying diseases.
Treatment
Aside from drugs such as creams and gels directly spread on lesions and based on patients and the type of lesions, oral tablets and capsules too may be opted for.
In order for the treatment to succeed, medications prescribed by the doctor should be used properly and regularly, and their recommendations should be followed.
References:
1- Turkish Society of Dermatology Acne Patient Information Guide click here
(last access: 03.09.2020)
2- Kutlubay Z, Turkish Acne Diagnosis and Treatment Guide, 2018
FUNGAL INFECTIONS ON THE SKIN
Fungal infections of the skin
Fungi are beings that we come across frequently in our surroundings. A small part of these beings cause skin infections in humans. These infections are usually caused by fungi called dermatophytes. Limited with the skin, these infections are mostly seen on the feet and are called tinea pedis. These are mostly seen on the abdomen in children. In adults, they are mostly seen on the feet and inguinal region after adolescence.
Since fungal infections of the skin are not life-threatening, they may sometimes not be taken seriously. However, they are known to harm the quality of life. Especially in elderly people, thickening of the toenails and change of color may result from infections on toenails. This treatable condition (fungal infection of the toenail) may be seen and accepted by patients as a natural sign of aging.
When fungal infections of the skin are left untreated, they may spread to the hand of the patient and from there on, to other areas of the body or to other people via itching and contact. In some cases, even if the patient has received treatment, if the personal belongings they used when they had the infection have not been properly cleaned, these may cause a renewed fungal infection.
Symptoms and Findings
In fungal infections of the skin, the most frequent reason for consulting a doctor is itching. In some rare cases, infection may not be accompanied by itching. The skin may present redness, flaking, discharge and crusting.
Risk factors
There are some factors that facilitate the occurrence of fungal infections. Some of these are as follows:
- Excessive perspiration
- Wearing synthetic clothes
- Not drying wet parts of the body properly, leaving them moist
- Sharing flip-flops, socks and towels with others
- Conditions such as diabetes, deficiency of the immune system
- Using immunosuppressant medications such as chemotherapy and corticosteroids
Diagnosis
Fungal infections usually have a very typical appearance. Doctors can diagnose them by simply examining the skin. In some cases, they may feel the need to conduct some tests. When looked under a special light called Wood's lamp, regions affected by fungal infection appear yellow and green. Another method used for exact diagnosis is sampling scrapings from the area and then examining them under a microscope. When fungi are directly seen under the microscope, exact diagnosis can be made. Again, scrapings can be placed on the feed area and the fungus can be made to reproduce (culture).
Treatments
Aside from medications used in treatment, lifestyle changes also play a very important role. Patients may have fungal infections in other areas of their bodies that they are not aware of. They might have transmitted the disease to people they are living with or they may have contracted it from them. Therefore, the examination of the partners of the patient is particularly important. Sharing common belongings such as towels, socks, slippers / flip-flops (in the bathroom etc. included) and underwear should be avoided. The patient should not reuse belongings such as flip-flops, socks, shoes, underwear before sanitizing them, otherwise, recontamination may occur. Since humidity is very important for fungi to live and reproduce, the patient should wear cotton clothing, antiperspirant shoes, and they should dry the areas between their toes after washing their feet and make sure their body is entirely dried. Otherwise, treatment may be unsuccessful.
Medications used in the treatment of fungal infections are called antifungal. Local applications in the form of creams and sprays are usually effective. For the treatment to be fully successful, once symptoms such as itching have passed, the medications should be used for another two weeks. Since fungal infections can spread, spreading of medication on the skin should include 2 cm of the healthy skin too. If infections are on the nails or on the scalp or they do not heal with local applications, then systemic antifungal medications could be needed. Toenail fungi may take more than 6 months to heal.
References:
Gül Ü, Ankara Med J, 2014, 14(3): 107 – 113
Üstünsoy M, METU Health and Counseling Center, Superficial Fungal Diseases of the Skin
BACTERIAL SKIN INFECTIONS
The skin is the organ that has a protective task against external factors and is constantly exposed to external microorganisms. Although it is constantly exposed to the external environment, it prevents these microorganisms from infecting our skin thanks to its protective factors. Some of the protective factors of our skin are as follows:
- The skin's barrier structure
- Acid and lipid coats on the skin that form with the skin's secretions
- The upper layer of the skin renewing itself every 28 days
- Microorganisms that are naturally present on the flora of the skin
If those protective factors weaken, external microorganisms may cause infections on the skin and in the subcutaneous tissues.
Some bacterial infections seen on the skin and the soft tissues are as follows:
Impetigo: It is usually characterized by a yellowish crusting and discharge around the mouth of children. It is contagious.
Erysipelas: It is usually characterized by redness, oedema and pain in the face and legs.
Cellulite: It is usually seen on the legs and is characterized by redness, increase of heat, pain and swelling.
Follicullitis: It is the infection of hair follicles. It usually presents as vesicles full of purulence similar to pimples.
Furuncle: Also known as inflamed sores, it is the severe infection of hair follicles and of their surroundings.
Carbuncle: It is a follicle infection where more than one hair follicles is affected. They are more severe than furuncles.
Paronychia: It is the infection of nail folds and of their surroundings and is also known as whitlow.
Risk factors:
Risk factors of skin and soft tissue infections are as follows:
- Damage of skin integrity due to blows, frictions and burns
- Insect and animal bites, scratches
- Diabetes
- Obesity
- Immunosuppressant diseases
- Incorrect skin cleaning
- Incorrect eating habits
- Loss of skin integrity following itching caused by skin diseases
Symptoms
Different symptoms may present in bacterial skin infections. Usually these may be redness, increase of heat, itching, pain, discharge.
Diagnosis
Diagnosis is usually made with examination. Bacteria can be seen when examined with a special dye under the microscope. In some rare instances, the bacteria may be identified by planting culture on the feeding area.
Treatment
Different infections require different treatments. Bacterial infections of the skin and of the soft tissue can be cured with antibiotics. While medications in the form of creams or ointments applied directly on the skin are usually sufficient, some severe cases may require the use of systemic antibiotics, in other words, medications administered orally or intravenously.
References:
Gül Ü, Ankara Med J, 2016;16(1):98‐114
Bozkurt B, Clinical Medicine Family Practice, 2019; 11;1: 18-22
WOUND HEALING
Wound: Deterioration of structural or functional characteristics of tissues or organs due to internal or external causes. Wound formation may be caused by different factors. Our body is able to heal wounds thanks to cell division. There are some factors to take into consideration during wound healing. One of these is preventing a permanent scar while the wound heals. If the contours of the wound close fully, no infection develops, no foreign body enters the wound, then the likeliness of a scar is lessened. However, scars are also dependent on personal factors.
Wounds are analyzed in 3 main categories:
- Mechanical wound: scratches, tears, fissions, wounds caused by perforation, bites/stings, surgical wounds.
- Burns and chemical wounds: Wounds caused by heat, chemical substances, electrical energy, radiation.
- Chronic wounds: These wounds form as a result of a lack of blood supply to the tissue.
The healing of chronic wounds caused by long-term diseases may be more difficult compared to acute wounds. Some of the chronic wounds are as follows:
- Bedsores: These are wounds resulting from a lack of proper blood circulation due to bedridden patient not being able to switch positions for a long time.
- Diabetic wounds: These wounds usually form on the feet as a result of an impaired blood circulation caused by diabetes. Their treatment may take a long time and can be challenging.
- Varicose ulcers: These wounds form as a result of an impairment of the circulation due to the thrombus of veins of the legs.
Burns
Temperatures of 44 degrees or above can cause burns on the skin. In children, burns are seen in home accidents. Paying attention to home accidents and taking the necessary measures to prevent them from occurring may prevent many potential injuries. Burns are grouped into three as follows:
1st degree burns where the upper layer of the skin (epidermis) is affected
2nd degree burns where the middle layer of the skin (dermis) is affected
3rd degree burns where the bottom layer of the skin (subcutaneous fat) is affected.
Burn injury treatment is planned based on the ratio of the affected regions of the body and the degree of the burn.
Wound healing:
Wound healing is constituted in 4 main phases. These are: coagulation, inflammation, propagation and maturation. These phases are intertwined, and the maturation phase may take a very long time. The latter is the phase where the wound is fully recovered. If the best conditions are ensured throughout all of these phases, a scarless healing may be ensured.
Wound treatment:
Factors to be taken into consideration in wound treatment are as follows:
When the wound first occurs, it must be washed and cleansed with clean water. Necrotic tissues and foreign objects must be removed from the region of the wound. Any discharges coming from the wound must be removed from the wound area. The latter must be kept moist to a certain degree. Keeping it excessively damp or dry may delay healing. In order to prevent any infection developing on the wound region, the zone should be kept sterile and be protected from uncontrolled contacts from the exterior. If deemed appropriate by doctors, antibiotics can be applied locally or systemically as preventive measures. Similarly, in order to ensure the patient's comfort and to relieve their pain, painkillers can be administered. Advanced technical devices, various treatments and surgical options can be agreed upon by doctors and applied.
References:
Çetinkale O, Wound Care and Treatment, İ.Ü. Cerrahpaşa Faculty of Medicine, Continuing Medical Training Activities Symposium Series, No: 67
