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    SKIN NOTES WITH THERAPEUTIC

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    26 views27 pages

    Skin Notes With Therapeutic

    Uploaded by

    Abhishek

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    © All Rights Reserved
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    of 27
    W SKIN ECZEMA Eczema is a non contagious inflammatory disease fo the skin in response to endogenous or exogenous stimuli, characterized by erythema, edema, vesiculation, oozing, weeping and crusting. Microscopically, characterized by intraepidermal vesiculation. It is due to an antigen-antibody reaction. Etiology There are two groups of eczema — exogenous (or contact) and endogenous (or constitutional) : Exogenous eczemas « Primary irritant dermatitis. * Allergic contact dermatitis. + Infective dermatitis. Endogenous eczemas + Atopic dermatitis. + Seborrhoeic dermatitis. + Neurodermatitis + Discoid * Gravitational. * Pompholyx. Exogenous eczemas Irritant contact dermatitis : Detergents, alkalis, acids, pec abrasive dusts are common causes. Irritant contact ¢memas account for the majority of industrial cases and work hf. + and is due to irritant loss. Napkin eczema in babies is common ammoniacal urine and feces. : It is due to a delayed Allergic contact eczem™ © ace with an antigen. hypersensitivity reaction following con Some common allergens shes Present In Nickel “Joweltery, Bra clips, Jean studs pews Cement, tetera Rubber cherleats Clothing, Shoas, Tyres Hair dye, Clothing Paraphenylee diamine Perfumes, Citrus fruits Balsam of Peru Neomycin Topical applications Parabens Preservatives in cosmetics Epoxy resin Resin adhesives Endogenous eczemas Atopic eczema : Atopy is a genetically determined disorder in which there is an increased liability to form IgE antibodes and increased susceptibility to cetain diseases like asthma, hay fever and dermatitis. Seborrheic dermatitis : [s a constitutional diathesis which affects ceratain areas of greatest sebacious activity. Sometimes becoming generalised. Pathology (eczema) The histological changes in eczema reflects the dynamic changes resulting from inflammation of the epidermis and dermis. Histology of the classical eczema passes through the following stages : Spongiosis : Epidermal edema, separation of malpigian cells stretching and rupture of prickles. Rupture of vesicles. Parakeratosis : In which horny cells retain their nuclei. Lichenification : Thickening and increased pigmentation of cells layers. -_ ALIST OF COMMON REGIONAL CONTACTANTS tose directly applied like a cosmetics — face powder, cream, bindi, varmilion (sindhur), eyebrow pave ume, $02, 0! (Brahmi, Lom: 1 ecto, Crest a ee tume, Loma Cr pert Ee ‘and Cantharadine etc.), shampoos, dyes (Inecta, Crest and Para pe actacle frames. ‘dS, The distibution is typical in all these contactants. ec] csovedst poets, fumes, paints. by the patient’ rose eee nen ee ‘almost any iritant or sensitizer may get on to the face, since it i oa face with fingers from time to time. Nail vamish is a common exe . Ups: Lipstick. toothpaste, cigarette holders, pipes and balloons. - ecart, dyed fur, collar, ing i i Neck! scarf, dyed fur, collar, buttons, marking ink, jewellery (particulatly chrone or nickel), hat strap, sume. , , pody: Clothing, buttons, marking ink (dhobi’s mark) . agiae : DeSS armpit pads, dyes, depilatories, deodorants, astringens. Genitals and a oe i Cortcentves (rubber, quinine and other chemicals), toilet paper, medicaments used DY louches , antiprurtus (particularly cocaine derivatives), feminine hygiene gprs. avlonsiplastic underwear, puttock : Tolet paper, lavatory seat (vamish), jute and straw mattresses, toy horses. + Occupational - primary irritants and sensitisers. Hobbies - gardening, photography, painting etc. onions, tomatoes, ladies fingers: drivers steering wheel, ignition key; Wrists : Waterand its strap, bracelet and bangles. Thighs : Clothing, things in pockets particularly matchboxes, ‘and suspenders (rubber or nickel). Feet : Footwear, shoes (chrome dyes and rubber). The dorsum and sides of the feet are selectively | scaces ate spared (comparison : tinea pec), Colored sacks (dyes and nyion), elastic shoe strap Symptems / signs Acute eczema Redness and swelling, usually with ill defined margins. + Papules, vesicles and more rarely big blisters. + Exudation and cracking. + Scaling. Chronic eczema * Many show all of above fe: vesicular and exudative. + Thickening : Lichenification, a dry leathery thickening with increased skin markings is secondary to rubbing dis most often seen in atopic eczema. atures though it is usually less and scratching an + Fissures and scratch marks. * Pigmentation. 662 extbook of practice of medicine seborrheic eczema sealp, ears, [c€ i presternal an P of axillae, umblicus: Fissure id eczema gq seen most often in elderly males, those of other type of eczema vesicular and crusted. Disco! common form ©) is This eejons are more di The lesion: and are usually mu Gravitational eczema Occurs on the lower leg an tig insufficiency ! d is often assosiated with signs of veno’ » Edema. ; «Red or bluish discoloration. OCCUPATIONAL DERMATITIS Occupation Causative Agents and Type of Dermatitis sw ngrcuturats and gadeners Plants, waeds, Pe rides, fertlizers and oils - mechanical injures a and contact dermaiis. Automobile workers is, poral, slvents, greases, paints, thinner —2cne ane demettis. Cement lime, insecticides, fungicides, wood, pains, Kerosene ol, © Building workers turer! Chemical and Phawraceuticel Different ay6 ils, disinfectants, als, pha s, explosives, solvents, ens eto. — contact dermatits industries © Coal miners Mechanical injures. « Dentists Engineering Industries Cutting oils, solvents, 4 © Housewives ‘and detergents, vegtanles and fruits, nickel, polishes, pare- pherlyene diamene, reys, Kerosene ol, wooden cutlery, lowes, adsed to foods !ke socium bisulphide tuber gloves, and sensit ser in salads, artifical favors, para! ageris in laundry products. fodine, streptomycin, chlorpromazine, s conaine denvatives contact dermatitis Turpentine, pains, detergents ~ contact dermatitis. Mel, bichromate ~ contact dermatitis Resins, hardeness, solvents, alues, cellulose, esters ete. — contact dermatiis, © Printers Dyes, acrylic plales and inks causing dermatitis and Rubber workers MB.EH., T.M.T., M.B.T,, dyes, glues, oll etc. ~ con and depiginentation Chromate, formaldehyde, dyes, arsenic, alkel derraitis and depigmertation, Dermatitis and tar acne. Formaldehyde, solvents, dyes, bleaches e _ dyes, fuorescent whitening iphonarnide, tinct, benzoin, 2 Nurses and Doctors e = Painters © Photographers Plastic factory tact detmatitis e Tanney workers ies, acids etc. e Tar workers: «Textile workers tc. — contact dermatitis. * Loss of hair. * — Induration. . Ulceration, Pompholyx (Dyshidro This type of eczema h, formation and affects th Investigations Patch testing to allergic contact eczema. Prick testing : 1 atopic eczema if food exacerbating factors, Hemosiderin pigmentation, tic eczema) ‘as bouts of recurrent vesicle or bulla ¢ palm, fingers and sole. allergen : Used in suspected cases of It is Used for few patients with stubborn or inhalant allergens are suspected as Culture : This is for bacterial yeast and fungal pathogens. DISTINGUISHING FEATURES OF TRUE INFANTILE AND SEBORRHEIC ECZMEA Seborrheic Infantile « Diseases develop af 3-6 months after birth, somatimes earlier. « Child is irritable and weak, Starts from cheeks and extends to forearms and legs. Oozing mare. Areas look clean « Family history of atopic disorders except in simple variety + lching is severe and spasmodic + Recurrences frequent and usually independent of season, ‘Cradile cap’ at the time of birth, seborthoeic dermatitis efterwerds. Child is usually healthy and happy olhernise. Stans from scalp, posterior auricular folds, and involves neck and trunk, On the trunk fiat macular erythematous or hypopigmented and scaly rash. in some cases, it manifests as diaper dermatitis. Crusting more and the areas hav 2 diny appearance. Family history of seborthoeic disorders. Itching, mild to moderate. Recurrences mostly seasonal ie. summer and monsoon; at times in winter also. Complications * Superinfection, with bacterias or yeasts and viruses. Reaction to local medicaments. Psychological affects - anxiety neuroses. cea _Textdook of practice of m pifferential diagnosis seborrheic dermatitis. . Contact dermatitis. Impetigo: Treatment Explanation, reassurance and encouragement Avoidance of contact with irritants. Protection of affected part Patient should be careful in their choice of soap; they shout not be drying after bathing; rinsing skin should be patie’ dry not rubbed. Homoeopathic medicines i , with great burni Arsenicum : Chronic forms of eczema, wi rning ang itching. The skin is thickened. Chronic dry eczema (Lyco, in dy scaly eczema.) / Baryta carb : Ecema on the back of hands, skin rough, dry ang chapped / Berberis aquifolium : Scaly, pustular eruptions on the face, : This remedy relieves the ithcing of eczema rapidly Croton ti, , and permanently; small blisters. Fluoric acid : A very valuable remedy in eczema with itching red vesicles having a tendency to scale off. Graphites : Moist, scabby eruptions on the scalp, sore to touch, The skin is very sensitive to touch and suppurates easily. It is also useful in eczema of the genital organs. Eczema capitis and moist eczemas, when chron Kali mur. : and obstinate in character. Mezereum : The best remedy when crusts form and there is great itching, worse when warm and wrapped-up. Secretion dries quickly producing crusts under which thick pus oozes. Rhus tox.: Eczema with vesicular eruptions, which are numerous with great itching. The skin is often swollen and edematous and these vesicles have a red circumference at the base. Symptoms worse at night, in damp weather and in winter, Sulphur : Eczema erythematosum. Ageravation from washing Scratching makes the part burn intensely; tendency to pustular eruptions; eruptions of yellow crusts. Rhus venenata : A single dose of this medicine in 30th poten will sometimes suffice in a simple case. In case it aggravates, 7 skin 665 ae a SI eo Medicine should not be repeated but the results should P watched for some time, until a higher dose becomes necessary. ° chive | Alumina : Chapped or dry eczmea; intolerable itching in warm bed. Urtica urens : Eczema with burning, itching and stinging. Mercurius cor. : Obstinate eczema including eczema capitis. Note = Tuberculinum and Syphilinum are the most important remedies in all skin affections. Other remedies : Ars. iod., Bar, m., Calc., Calc. sulph., Cic., Dule., Hep., Jug. c., Jug., Led., Olnd., Petr., Psor., Sulph-iod. (Beyond this regional involvement may be scen under relative sections. Constitutinal treatment is the basic approach). PSORIASIS It is a chronic, non infectious skin disease characterized by well defined, slightly, raised, dry erythematous macules with silvery scales and typical extensor distribution. The main abnormality in psoriasis is increased epidermal proliferation due to excessive division of cells in the basal layer and a shorter life cycle time The transit time of keratinocytes through the epidermis is shortened and the epidermal turnover time falls from 28 days to 5 to 6 days. Etiolegy +» The exact etiology is unknown. A genetic predisposition is evidenced by a positive family history in 25% patients and association of HLA B& and Al7. THE HISTOLOGY OF PSORIASIS Poiymorpnenuctear leucocyte mecro-abscesses Parshereioss Prortasis + Biochemcial. — { ee * Immunopathological : : Ss) Many immunological é abnormalities have been found but their role is uncertain. Ineguiar nekenng ol epwarma: Dlates ana tonuows capillary oops Upper tra Tine Dermal : The in- anne creased epidermal cell proliferation of Psoriasis is related to increased replication and meta ers eats olism edicine 686 Textbook of practice of re ups ~ Factors causing flare UPS sury or irriation of normal “ Koebne? penomenon) | the site. This is called «Trauma (Koel «of psoriasis . jon! skin induces }s!0 Koebner’s phenomenor ' «Infection : B-hae™ strep ese » Sunlight : 10% becomes me. Drugs ! Antimalarials, beta-t « Emotion - Anxiety. Pathology Histology . ratosis. igi Parakerato of the stratum malpigii Thinning of supra-paillary portion Elongation of rete-pegs- Edema and clubbing of papillae. Micro abscess of ‘Munro’. + Dilated and tortuous capillary in « Edema and round cell infilteration in upper dermis. Various variants Plaque pattern : Most common type; individual lesions are well demarcated; range from few mm. to several centimetres in diameter. The lesions are red with dry, silvery white scaling, which may be obvious only after scraping the surface, ‘The elbows, knee, lower back and scalp are most commonly affected. Guttate psoriasis : Usually seen in children and adolescents. A shower of small sized (3-5 mm) erythematous papules which are scaly initially; patient may develop the plaque pattern later. upper dermis. the papillae and Pustular psoriasis : Pustular lesions are sometimes localised to palms and soles; in severe cases of generalised pustular psoriasis, pustules of variable size appear all over the body. Arthropathie psoriasis : Limb joints are commonly involved. Distal arthritis, involving distal interphalangeal and other small joints, is the commonest presentation. pe rt cies psoriasis : It is a complication of psoriasis ally occuring as a result of injudicious treatment. Fi 5 vole psoriasis 3 Flexural areas are predominantly . Psoriasis involving the natal cleft, submaxillary ne <7 ano o&@ Skin 697 axillary folds ot scaly but req, » Blisten ny eB and n symmetrical. jasis : i and mucosal psor! # It is the genital m is which i 7 UCUS me; glans penis which is more often involved thay TMM" esp symptoms J signs ™Ucosa, typical distribution is extensor type. . Common areas affected are scalp, back of elt + sgnces, legs and lower part of the back, of the ae front of runk. t exhibitis itself as a dry, well defined mai + Sraque of erythema with layer upon layer or Papules and when a psoriatic lesion is scratched with the wales dissecting forceps, a candle greases like soa tt ofa repeatedly produced even from non scaling lesi fe can be called the ‘candle grease sign’ ions. This is The complete removal of scale produces pinpoi which is typical of psoriasis. Pinpoint bleeding Normally characterised by absence of itching, but in topi countries patient complain of slight or moderate praia The lesions are slightly raised above the surface of ski there is no induration. e of skin, but psoriatic lesion may develop along the scratch lines in the active phase; this is called Koebner’s phenomenon. Nail show three type of lesions. - Pitting. - Separation of the distal portion of the nail from nail-bed and wall. - Thickening of nail + On scalp : thick, scaly papules discretely distributed all over, with intervening areas of normal skin. The lesions are ary; there is no matting of hair, never causes loss of hair and baldness. Investigations ' History is typical ‘ Biopsy is rarely required. lifferential diagnosis * Atopic dermatitis. Impetigo. Reiter’s syndrome. jnstructions are vital ang ent’s intelligence. ~ e and t’s or par tient shou equent sun baths before Iphur springs all are usefu reassuranc he patien ld be maintained. A moderate warm climate. fr onset of winter and visits of SU bringing down the relapse rate. c¢ medicines Homoeopathi Hep., Lyco., Petrol. Im : Graph.. Psoriasis of pa puce, nails : Graph., Sep. Psoriasis of pre Psoriasis of tongue : Sep. Other remedies : Ars. iod., Kali. ars., Lyco., Mez., Pi yco., Mez., Petr., Pors., Sars., Sep. ACNE VULGARIS jis a common inflammatory disease of t! geen i adolescents characterised by ceoondarily infected, resulting in papules, qones, nodules and scars. In the preadolesce: rt gleosa and some comedones frequently epeen aa ners the disease in the twenties; it gradually decreases and is am 7 seen especially in women after the age of 28, or so (post adolescent gene). It occurs in both girls and boys; in the latter ma somewhat severer form. he pilosebaceous follicles comedones which are pustules, cysts, come. » ina Theories of causation « Increase in the | frdens| quantity of androgens secreted, or increased sensitivity of the sebaceous glands to _ | sebaceous on Occlusion of llosebaceous duct -Beciovel colerisaton of duct Increased stu androgens. comme ee toi Alteration in the com- ~_ psi ery Position of sebaceous 4} medias mio Gee, secretion (free fatty ‘THE PATHOGENESIS OF ACNE acids are increased and these are irritant to the skin). leading to formation of c icine 672 Textbook of practice of me: 8. Alteration in bacterial flora of the skin — acne bacillus pro- piohibacterium acnes. Acne is often familial. The inheritance pattern is probably polygenic. Pathology ; lidiyrot ecb ; ‘ is i ivity of sebaceous gland: yuberty there is increase in acti : g : eon Pow If the infundibulum of the follicles are plugged of Skin Collection of sebum inside the follicle. These is growth of a bacillus, which causes release of fatty acids. These fatty se egi y ction to sebum occurs, acids act as irritants and foregin body rea acids act a omedones, papules etc. If pus accumulates inside then pustules form. Symptoms / signs Onset and progress : Starting just after puberty the comedones prgoress to papules and may completely involve or progress to form pustules, and heal with resultant scars or pits. Sites :(Cheeks, chin, nose, forehead, chest, back, shoulder and buttocks usually associated with an oily scalp. — Types of acne « | Comedones : Comedones are only on an oily skin. White head : On the surface of skin, it appears as a slightly elevated white dot. Black head : Sulphur constituent of sebum soon get converted into sulphide turning the white head into black dot, called blackhead. Acne papulosa : Large number of inflammatory papules. Acne pustulosa : Papules often suppurate to from pustules, resutling from the action of secondary invading micro- organisms, chiefly staphylococci Acne indurata : Characterised by firm, perifollicular nodules of bluish rtd colour. Acne cystica : Many of indurata eventually become completely or partially absorbed, other transform into cysts, acne cystica. Acne atrophica : Where there are tiny residual atrophic pits and Scars. aoe ag qreatment | Skin 673 Must be treated oa,, +f ue sioid scarring. Early, condition be kept Under og —— — Ntrol to _-General : The ener, —— “ 1 and hypothyroidism ae should be checkeg Diet : Certain foods st , v “chocolate, Creams etc. - Cleansing : Wash thi -, le face fr j 3 flora and removes the Seas ci with soap. This reduces » Laser therapy can be used. improvement, > ANemia fe ould be avoided like Pasteries, pj, ’ Wed foods, nuts, eggs, butter anit pa Dermoabrasion helps in cosmetic Homoeopathic medicines Hydrocotyle : Great dryness and desquamation of epidermis, |-Nux vom. : From liquor drinks, Agaricus : With blueness and tendency to chilblains. Ars: iodide or Sulph iodide : Severe obstinate cases. Bellis p. : From cold drinks. Carbo. an. : For recent cases, but if they are full of blood, give Bell. and if they are pale, give Pulsatilla. Carbo veg. : From gastric derangements. Kali brom. : For eruption on face, chest and shoulders (Acne vulgaris). Antim sulph. 6x : (Acne with pus). A mixture of Silicia 200 + Carbo veg. 200 for acne. . jes 2 . crud., Aur., Calc. sili, Calc. s., Carbo. mite, Capen. ee. Psor., Sep., Thuja, Tub. (see distribution area also in repertory). layer of the eipiaermis, lives there for about two months. In these burrows, she lays her eggs which develop into larvae. They pierce the roofs of the burrows, find shelter in the pores of the skin, and develop into adult mites. The life cycle of the acarus, from the ovum to the adult Stage is from 13 to 21 days. Symptoms / signs * The lesions usually Spares head and neck History of exposure or multiple cases in the family, Nocturnal pruritus. Burrows; they tebresent the path Taversed by the aiasite in the horny oe of the skin. Their ths vary from a sasceri(5 SABO ANIMAL PARASITES, 688 Textbook of practice of medicine i ith quarter of an inch to one inch. If the roof is I ate Recdle, the mite can be demonstrated, The comune es Of burrows are the fingers, the interdigital webs, f Ee ae \srists, the points of elbows, the anterior axilaty 0 Manoa the nipples, the abdomen, the buttocks, 8¢! and the feet. * Fine, pin-head sized, follicular papules. . Excoriations and scratch markes. Laboratory diagnosis : ° : rganism) + Microscopic examination of specimen for org: . @urrow ink test Complications + _Impetigonization. : “Eczematization, * Secondary lymphadenitis. Differential diagnosis * Pediculosis, . Other causes of pruritus. Treatment * . Personal hygiene and daily bath; separate clothes, bed linen and towels; use of medicated scap containing 3 p.c. acid Salicylic and 10 p.c. sulphur (Tetmosol). Hot bath and thorough scrubbing followed by new clothes. Old clothes should be disinfected. ° Treat all contacts - conjugal, family members, school friends etc, whether they have symptoms or not. This is most important to prevent ping-ponging of the disease. It must be bered that pruritus may persist for a few weeks even the acari have been got rid of by the specific treatment. Half hearted, ineffective treatment of contacts and inadequate infection of clothing are responsible for failure to cure and eradicate scabies. Homoecpathic medicines Anthrok., Crot tig., Hep., Mez., Psor., Sep., Sul. Arsenicum : Inveterate cases; eruptions on the bends of knees; pustular eruptions; burning and itching : better from external warmth. Skin 689 ta : Baker’s and Grocer’s it erupti serie ch, as cruptions on the back of carbo Veg. ? Eruptions dry and fine; alm worse OP the extremities; itching worse afte symptoms, belching of wind and _passi: mercurial ointments. ‘ost on the whole body T undressing; dyspeptic ng of flatus; abuse of causticum : Abuse of mercury and sulphur; yellowish col the face; warts on the face; involuntary discharge of uri re wh mn coughing, sneezing or waking, sensitiveness to cold zie, “nen Hepar sulph. : Fat, pustulous and crusty itch, also aft mercurial ointments. sneeon Sulphur : It is the main remedy, voluptuous tingling and itching with burning and soreness after scratching. Sulphuric acid : Indicated when itchiness of the skin and single pustule appear every spring after a not perfectly cured itch. If all the above remedies fail (in IX potency), Dr. Hering’s recommendations be followed as laid down below :- Begin with one dose of Mercurius 30, and give after a few days Sulphur 30 in alternation for sometime. If improvement takes place, stop further dosing. If there is, however, no relief, try the following remedies :- Carbo veg. : Every other day, if the vesicles are small and dry, or ring and evening. But if the pustules are give Hepar suiph 30 moi then Sulphur and afterwards Causticum large, give Mercurius, night and morning in water. Lachesis : If the pustules are large and become repeat it whenever the pains get worse. i is: f the pustules, take Note. : On suppression or disappearance 0! t ; Sulphur or Arsenicum 200 (one dose) fortnightly, until the rash returns. yellow and blue, ee ““pusiled in the lymphatic vessels and gland. The male is about 4 cm by 0.1 mm and the female 6 cm by 0.2 mm. 1 hey copulate, the female becomes gravid, discharging microfilariae (livin lymphatics: these ente; lymphatics have become o the primary iriation and are found in the Stage of infection Mosqui hosts in w into infective larval filari beings through bites by enter the lymphatic nto blood stream unless the ccluded by inflammation due to Secondary infection, Microfilariae » sucked during bitings, mature ae. They are transferred to human infected Mosquitoes; larval filariae system, maturing in about 3 months. Symptoms / signs Stage of invasion, the symptoms are mainly allergic taking the form of painful swellings of the scrotum, arms and legs (like erythema nodosum), urticarial lesions, lymphadenitis, lymphangitis and filarial fever. q After the adult worms have lodged them- selves in lymphatic vessels and glands, the microfilariae are liberated. Only at this Stage can they be demonstrated in the peripheral blood. Filarial abscesses, lymph scrotum, lymph hydrocele an and hydrocoe! Wuchereria ba ZEND ee Epididymo-orchitis Microttar, =f ‘ae in blood us \d) Adu worm in Yrph vessel Lympanote ncrott| and Brugia malayi, Life eyele and pathogenesis of lymphatic filariasis, be » varicose groin glands, d chyluria, arthritis etc, are the usual symptoms at this stage. Inguinal and femoral glands are hard and fibrous; when microfilaria can be demonstrated lymphatics are also seen. In lymph enlarged, bulky and itchy. Surfac which on rupture keep on disch colored fluid The most common infestation elephantiasis of the legs and = scr obstruction of the lymphati There pl is tense solid ede accompanied by repeated eosinophilia, Elephantiasis js a very often cripples the patient. are often enlarged. Micro this stage. fil Investigations Eosinophilia, Treatment Pressure bandages and sg elephantiasis. urgery The lymp! Demonstration of microfilariae in thi unctured with a syringe, in the lymph. Indurated scrotum the scrorum is e shows lymph varices arging continously straw- one comes across is otum produced by the ic vessels and glands, lymphangitis, and distressing symptoms; it hatic glands in the groin ariae are absent from blood at € night blood. complement fixation and skin tests. help the bad case of ii mosqui Homo Arse e reme the fei Elephantiasis d skin, hardened and itching). Hydrocele is consists of mass treatment of all ‘an area and the eradication of ¢ prev" r The Pid indivduals in en ane f insecticides in the breeding places. nfecte toes by the usc eopathic medicines Mez., Staph.» Psor» Sulph- dies given under ‘Malaria’ apply in this disease also, at rbrile stage: Elaeis (thickene great thickening of epidermoid layer and Hydrocotyle ( exfoliation of scales). anacardium (skin sym Myristica sebifers (inflammation 0 (epithelioma of skin). ptoms similar to Rhus) . {'skin, cellular tissue). Arsenic alb. Silicea (elephantiasis of scrotum). Apis (serous inflammation of testes). Aurum (chronic inflammation of testicles). Cal. fluor. (induration of testes). Conium (testicles hard and enlarged). Fluoric acid (swollen scrotum). Graphites (testicles swollen and indurated). Rhododendron (induration and swelling of testicles after gonorrhoea). Spongia (swelling of spermatic cord and testicles with pain and tenderness). Inflammatory fever * Aconite + Bell. + Bry. Lymphangitis * Apis * Ars. iodide * Mere. sol. Lachesis adenitis - Apis . Bell « lodium . Phyt {LICHEN PLANUS nate. 2 hronic_disorde; «¢ an uncommon acute, subacute or chronic disorder of tp okin and raucous: ancs characterized by purplish < Golaccous, polyhedral, flat-topped, itchy, papules: occuring mostly cn the flexor surfaces and in the_mouth. The name lichen jg Sefived from the resemblance it has to the purplish lichens that grow on trees in the hills. ce main features of lichen planus are : . i itic skin lesion: oy ical pruritic skin lesions + Cmocosal lesions. ) ban tration 0 { melanophages and lymphocytes in Etiology «It’s cause is unknown. + (Psychogenic stress.’) «In tropical countries, a lichen-planus-like eruption is often brought about by chloroquine and insect bites. Pathology It is characteristic and, in a typical lesion, it consists of sis, a patchy increase in the stratum granulosum, shortening of the inter-papillary processes, basal cell degeneration, and a well-defined band of round-cell infiltration in the upper corium. Symptoms / signs Typically, lichen planus consists of polyhedral, firm, purplish or violaceous papules with shiny, {fat tops; very thin, firmly attached scales may be evident on the surface. Faint striations of grey streaks (Wickham’s stria) can be seen on the surface of the papules through a magnifying lens These are best demonstrated after applying oil to the lesion. The papule is about the size of a _Split_pea_{sometimes smaller) = The papules may become confluent to form plaques if the enlarge with cenira’ clearing; rin, - papules anus annularie). Each ring hag cfs 2 forme Leer with a reddish or purplish lichenoia Peripher emented cengastant, being more 90 in dark-skinned peorae tian tropical climates. ing in Itching produces_lichen_planus_papules along the lin ie of seratching "Koebner’s phenomenon’ similar to one. att a = 7 in 3 : psoriasis. : The (ash is bilateral and_symmetic the front of wrists, the flexor surface abdomen, the legs, genitalia and the Lesions also occur in the mouth, buccal Mucosa, |, commonly, on the lips, tongue and genitalias ~~” [°88 It is distributed alon, sof the forcarmens Sek orcas, the The disease is seldeom seen on the Scalp, the pal ms hands and the soles of the feet. The mucous tient? lesions are usually a symptomatic, but sometimes valtge little burning and irritation. It is usually a chronic disease lasting for several months or years. Nails are affected only in a minority of cases. Variations of lichen planus Annular lichen planus : Ringed lesions with central clearing and raised firm periphery. Acute generalized lichen planus : The onset is sudden, the course short, and the rash is generalised. In the early stages, the eruption may not be typical, but characteristic lesions soon become visible. It may merge into chronic lichen planus. Lichen planus verrucosus : It occurs as hyperkeratotic, verrucous, violaceous nodules and patches on the legs. It may occur as such, but is usually accompanied by typical lesions on the legs, wrists, forearms, etc. Itching is severe. Linear or herpes-zoster like lichen planus : The lincar form, common in children, is seen on the extremities or the face. The lesions rarely occur along the segmental distribution of nerves; when they do, the condition may be Confused with herpes-zoster or nervous unius lateralis. Lichen plano-pilaris : It is usually seen as acuminate, follicular papules with horny spines, accompanied by flat, lichenoid lesions on the chest, back and upper arms. Bullous and atrophic forms : These forms of lichen pl ae rare, anus Textbook of practice of medicine gations \ onst of typical lesion»): Polyhedral, firm, violaceou (may be difficult to detect in dark skinned people) flat, (imped papules with Wickham's stria and very thin adherent scales. (Di tribution on the flexors, genitalia and mouth.) 696 « Pruritus. e«

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