Clinical Presentation-Skin Disorders

Tinea capitis, or “ringworm” of the scalp, presents as one or more sharply marginated plaques of partial alopecia. Inflammation and scale are present, but often these two changes are quite minimal. The recognition of broken hairs (stubble and black dots at the follicular orifices) is the best clue to correct diagnosis. Nearly all cases occur in children, but the diagnosis should be considered in any adult presenting with evidence of localized alopecia . Kerion formation is a complication that occurs in about 10% of cases. This represents a sensitization phenomenon whereby the fungi induce a remarkably brisk inflammatory reaction with resulting pustulation, crusting, and edema formation. Wood’s lamp examination does not reveal fluorescence in the most common forms of tinea capitis or in kerion formation. Unfortunately, KOH preparations are difficult for the inexperienced to interpret. For this reason, any suspected diagnosis requires the plucking of infected hairs for fungal culture. Course and PrognosisTinea capitis and zoophilic tinea corporis usually resolve spontaneously after 6 to 12 months of activity. Tinea pedis, tinea cruris, and anthropophilic tinea corporis continue indefinitely. There are, however, periods of relative quiescence and exacerbation. All of these fungal diseases respond well to treatment, but with the exception of tinea capitis and zoophilic tinea corporis infections, recurrence following treatment is rather likely. PathogenesisTinea pedis, tinea cruris, and anthropophilic tinea corporis are most commonly caused by Trichophyton rulnum. Trichophyton interdigitate and Epidermophhyton floccoswn infections are also seen. Generally, one cannot predict the causative organism on the basis of clinical appearance. Zoophilic tinea corporis can be caused by Microsporum canis, Trichophyton mentagrophytes, and Trichophyton verrucosum. Tinea capitis is caused by Trichophyton tonsurans in 90% of cases. The likelihood of inoculation with any of these fungi is enhanced if cuts and scratches are present on the skin. Clinical evidence of infection following inoculation is enhanced by the presence of warmth and moisture, such as occurs in the groin and under footwear. Depression of cell-mediated immune responsiveness, as in atopic patients, is a major predisposing factor for the development of T. rubrum infection. TherapyTinea cruris and those cases of tinea pedis that involve only the web spaces can be treated with any of the topical antifungal agents. Other forms of tinea pedis usually require the use of griseofulvin. Mild cases of tinea corporis also respond well to topical agents. Extensive disease and those cases with a component of follicular involvement are best treated with griseofulvin. Tinea capitis requires the use of griseofulvin. Orally administered ketoconazole therapy is rarely appropriate for either tinea corporis or capitis. Kerion on nation, if present, can be treated with intralesional steroid injections or with a short burst of systemically administered steroids.

Medicines and Drugs Used in Amoebiasis

Amoebiasis is a worldwide disease, particularly common in tropical countries and places where public hygiene and sanitation are poor. Amoebic infection is caused by an organism, Entamoeba histolytica (EH) which usually spreads through contaminated food and water. Since the causative organism of amoebiasis derives its nutrition from the normal bacterial flora of the large intestine, the latter is the chief site of infection. However, in some cases it may spread to other organs of the body, liver being the most susceptible to infection. Based on the site of the infection, the disease has been divided into intestinal and extra-intestinal amoebiasis.Intestinal Amoebic Infection: During the acute phase of intestinal amoebiasis the patient may have loose motions, with or without mucus and blood, besides griping pain in the abdomen which may be severe at the time of evacuation. In chronic amoebiasis, a patient may complain of a dull pain in the lower abdomen, alternate constipation and diarrhoea, foul smell in the stools, formation of gases, and loss of appetite. Some people with amoebic infection may remain symptom-free or experience little discomfort but they may pass cysts in their stools (free cyst passers) and are potential carriers of the disease which spread it to others.Extra-intestinal Infection: This amoebiasis infection is usually associated with a previous history of intestinal amoebiasis. When the liver is involved, the patient ‘may have pain in the right upper abdomen, fever, sweating, loss of weight, and anaemia. Importance of Diet: Successful treatment of amoebiasis depends both on drugs and on proper diet and good hygiene. For quick recovery it is best to eat a protein-rich, low-roughage and low­carbohydrate diet. Use of clean drinking water and avoidance of contamination are important. Drugs for Intestinal Amoebiasis The drugs used in treating amoebiasis can be divided into three categories according to their effectiveness.Metronidazole (Flagyl, Metrogyl, Unimezol) This is a drug of choice in all forms of amoebiasis except in asymptomatic cyst carriers. Since most of it is absorbed in the intestines, another drug which acts in intestinal amoebiasis should be used along with it to avoid relapse and to eradicate the disease. It is given in a dose of 400 to 800 mg, 3 times a day, for 10 days. Adverse Effects: The incidence of adverse effects is low and include nausea, an unpleasant metallic taste in the mouth, a furry tongue, ulcers in the mouth, loss of appetite, distress, and pain in the abdomen. Sometimes it may affect nerves and may, in rare cases, cause convulsions. Depression of the bone marrow may lead to a short lasting fall in white blood cell count. A relapse can occur if the full course is not taken. Precautions Alcohol consumption should be avoided with this drug as it causes a severe reaction leading to vomiting and flushing. Also avoid its use during initial months of pregnancy.Those suffering from epilepsy or any other nervous system disorder should avoid it. It depresses the bone marrow. White blood cell count must be monitored by those taking the drug repeatedly.

Do you absolutely need to know about AIDS 101?

IntroductionDue both to the stigma and the awareness program attached with it, now AIDS has become a common household term. There are very less people who actually know that the exact word is Acquired Immune Deficiency Syndrome, AIDS in short. Because of the morbidity and mortality attached and also because of the ignorance about it there are lots and lots of myths against this deadly disease. This alone shows the anxiety and concern of the general mass.HistoryThe virus for this disease is thought to have transmitted from simian monkeys in the forests of Africa to humans and from there it traveled to USA and different countries. It was brewing in the bodies till in 1981 in USA the Center for Disease Control and prevention (CDC) recognized it for the first time and reported that there was an unexplained occurrence of an unusual pneumonia in a few homosexuals. Soon the disease was to be found in intravenous drug users. But it was only in 1983 that the causative virus was isolated from a patient and then further classified. Obviously because of the ignorance initially the information was confined to only certain specific institutions in the early 1980s. Then as the disease became more prevalent and showed its mortality patterns more and more people became aware of this disease. Today it’s a topic of concern for every type of doctor be it a family physician, obstetrician, dentist, dermatologist or any other field.HIV and AIDSAIDS is a disease, as the name suggests, in which the person over a period of time loses his power of immunity to fight infections and hence he is a prey to a host of infections which otherwise wont have occurred. The causative organism is a virus called the Human Immunodeficiency Virus. On gaining entry into the body of a subject through another patient’s body fluids such as blood, blood products, semen, etc. the virus remains in the lymphatic system and gets replicated. Then over a period of years it reduces the body’s immune system.Current problemThe problem is so severe that according to CDC, till 2003 the number of AIDS cases in USA are 1.2 million and the number are still increasing and 40,000 new cases get infected each year in whole of USA.Diseases associated with aidsThere are many different diseases associated with this disease ranging from all types of bacterial infections to viral infections and other protozoa and helminthes infections. ManagementThe disease is managed by a whole lot of drugs because of the inability of the scientists to develop a vaccine against it. The drugs against it are basically divided into two types. One type prevents against the possible development of the potential bacterial, viral and helminthes infections and the other group helps in the killing and preventing replication of HIV. The first group has drugs such as trimethoprim sulfamethoxazole, clarithromycin, amphotericin, fluconazole, etc. The latter group has antiviral drugs such as zidovudine, diagnosing, saquinavir, endeavor, enfuvirtide, etc. PreventionTill there are no effective vaccines available prevention is the best cost effective treatment available. Adherence to universal precautions meaning that every body fluid from a patient is considered to be infected from HIV until proven otherwise should be practiced. Also there are various institutions and organizations both governmental and non-governmental involved in creating awareness throughout the world.

Tinea capitis, or “ringworm” of the scalp, presents as one or more sharply marginated plaques of partial alopecia. Inflammation and scale are present, but often these two changes are quite minimal. The recognition of broken hairs (stubble and black dots at the follicular orifices) is the best clue to correct diagnosis. Nearly all cases occur in children, but the diagnosis should be considered in any adult presenting with evidence of localized alopecia . Kerion formation is a complication that occurs in about 10% of cases. This represents a sensitization phenomenon whereby the fungi induce a remarkably brisk inflammatory reaction with resulting pustulation, crusting, and edema formation. Wood’s lamp examination does not reveal fluorescence in the most common forms of tinea capitis or in kerion formation. Unfortunately, KOH preparations are difficult for the inexperienced to interpret. For this reason, any suspected diagnosis requires the plucking of infected hairs for fungal culture.
Course and Prognosis

Tinea capitis and zoophilic tinea corporis usually resolve spontaneously after 6 to 12 months of activity. Tinea pedis, tinea cruris, and anthropophilic tinea corporis continue indefinitely. There are, however, periods of relative quiescence and exacerbation. All of these fungal diseases respond well to treatment, but with the exception of tinea capitis and zoophilic tinea corporis infections, recurrence following treatment is rather likely.
Pathogenesis

Tinea pedis, tinea cruris, and anthropophilic tinea corporis are most commonly caused by Trichophyton rulnum. Trichophyton interdigitate and Epidermophhyton floccoswn infections are also seen. Generally, one cannot predict the causative organism on the basis of clinical appearance. Zoophilic tinea corporis can be caused by Microsporum canis, Trichophyton mentagrophytes, and Trichophyton verrucosum. Tinea capitis is caused by Trichophyton tonsurans in 90% of cases.

The likelihood of inoculation with any of these fungi is enhanced if cuts and scratches are present on the skin. Clinical evidence of infection following inoculation is enhanced by the presence of warmth and moisture, such as occurs in the groin and under footwear. Depression of cell-mediated immune responsiveness, as in atopic patients, is a major predisposing factor for the development of T. rubrum infection.
Therapy

Tinea cruris and those cases of tinea pedis that involve only the web spaces can be treated with any of the topical antifungal agents. Other forms of tinea pedis usually require the use of griseofulvin. Mild cases of tinea corporis also respond well to topical agents. Extensive disease and those cases with a component of follicular involvement are best treated with griseofulvin. Tinea capitis requires the use of griseofulvin. Orally administered ketoconazole therapy is rarely appropriate for either tinea corporis or capitis. Kerion on nation, if present, can be treated with intralesional steroid injections or with a short burst of systemically administered steroids.

For more info about clinial dermatology and skin care advice have a look at authors site.