THREADING Skin Diseases & Disorders

Skin diseases and disorders

Dermatology Study of skin, its nature, structure, functions, diseases and treatment

Dermatologist Skin specialist

Pathology Study of disease

Trichology Study of hair and it’s diseases

Etiology Study of cause of disease

Diagnosis Recognition of a disease from its symptoms

Prognosis Foretelling of probable course of disease

Symptoms subjective objective

Signs of disease refers to symptoms that can be felt as itching, burning or pains refers to symptoms that can be seen as pimples, pustules or inflammation

Disease Implies an illness. Requires medical or surgical intervention, and should preferably not be touched by a therapist

Disorder Implies some abnormality, which is not an illness, eg. hyperpigmentation of the skin, or post acne scarring

Acute disease Manifested by symptoms of a more or less violent character and of short duration. Disease is severe

Chronic disease

Long duration, usually mild but recurring

Infectious disease

Due to pathogenic germs taken into body as a result of contact with contaminated object or lesion

Contagious disease

Communicable by contact. Caused by pathogenic organisms that invade body through contact with an infected person or contaminated object. Organism could invade body through skin, mucous membrane, digestive system or respiration system

Communicable disease

Transmitted through contact with an infected person or animal

Congenital disease

Present in infant at birth

Seasonal disease

Influenced by weather, such as prickly heat in summer, and forms of eczema, which are more prevalent in cold weather

Occupational disease

Contracted while engaging in certain kinds of employment, and is caused by coming in contact with cosmetics, chemicals or tints

Parasitic disease

Caused by vegetable or animal parasites, such as pediculosis or ringworm

Disease-producing bacteria

Such as staphylococcus and streptococcus, cause pus forming bacteria pathogenic disease

Systemic disease

Due to under or over functioning of internal glands. May be caused by an inadequate diet

Venereal disease

Contagious disease commonly acquired by contact with a infected person during sexual intercourse

Epidemic Manifestation of a disease that attacks simultaneously a large number of persons living in a particular locality

Allergy Sensitivity, which certain persons develop to normally harmless substances. Skin allergies are quite common. Contact with certain types of cosmetics, medicines, and tints or eating foods, may all bring about an itching eruption, accompanied by redness, swelling, blisters, oozing and or scaling

Inflammation Sign of skin disorder characterized by redness, pain, swelling and heat

Infection Invasion of body by pathogenic organisms

Infestation Invasion by animal parasites

Benign Mild, non cancerous

Malignant Very virulent, cancerous

Primary lesions – refers to first sign of skin disorder/disease

Papule

Clearly marked superficial elevated solid lesion, less than 5mm in diameter eg mole and blind pimple

Pustule

Commences as a papule, then accumulates puss in center ad appears as an elevated inflamed red area

Nodule

Larger papule – solid or oedematous raised lesion. Larger than 5mm in diameter

Macule

Clearly marked flat area of pigmented skin which cannot be felt eg ephelides (freckles) and some birthmarks which darken on sun exposure

Plague

Superficial, elevated, palpable flat topped patch – 5mm in diameter, primarily epidermal in nature

Vesicle

Fluid-filled elevated bladder – 5mm in diameter. Small blister with clear fluid. Appear below or within epidermis

Bulla

Fluid filled lesion – 1cm in diameter eg large blister, classified as sub-epidermal or sub-corneal

Cyst

Nodule consisting of an epithelial lined cavity containing thick smelly mucus or fluid

Wheal

Red/white lesion which is raised above the skin. Some oedema in dermis and slight urticaria. Associated with contact irritation such as poison iv or certain food or lashes of a whip

Comedo/comedones

Blackheads, dried plug or sebum and keratin blocking entrance of a sebaceous gland. Black colour is due to development of sulphide in keratinized cells at surface and melanin pigment

Erythema

Superficial redness of skin

Secondary lesions

Atrophy

Wasting away of epidermal or dermal cells due to degeneration from disuse or ageing (skin thin, translucent and wrinkled)

Crust

Scab of dry excretion, which may have been blood, serum, pus or thick keratin cells

Erosion

Superficial break in epidermal tissue caused by ulceration. Does not bleed or scar

Excoriation

Shallow excavation/abrasion in epidermis due to scratching or scraping eg carpet burn

Fissure

Painful linear crack in skin. May extend down to entire epidermis eg cracked heels, or chapped lips

Keloid

Hard, whitish, raised scar. Occurs in a healed wound. Due to overgrowth of fibrous connective/scar tissue

Lichenification

Thickening of prickle cell and horny layer of epidermis with underlying inflammation giving skin a dry leather-like appearance

Scales/flakes

Abnormal accumulation of loose keratin layers on epidermis. Silvery/white or grey in colour

Scar

Mark left by connective tissue formation at site of healed injury

Telangiectasia

A group of dilated blood vessels

Ulcer

Erosion of epidermis and some dermal tissue due to lack of nutrient supply. Bleeds and leaves scars

Descriptive terms

Keratosis

Rough thickening of horny layer on sun exposed skin

Hyperkeratosis

Refers to hypertrophy in horny layer

Parakeratosis

Nuclei of cells in horny layer persist instead of disappearing

Acanthosis

Increase in depth of prickle cell layer

Spongiosis

Oedema between cellular regions

Pruritus

Skin inflammation that causes itching

Milia

White keratin containing cysts in upper dermis

Necrosis

Death of cells in tissue/an organ due to lack of blood supply

Oedema

Excess amount fluid in body tissue

Haemangioma

Benign blood vessel tumour

Hirsute

Excessive hair growth in men

Hypertrichosis

Excess hairiness in areas not usually bearing prominent hair

Papiloma

Simple tumour arising from non grandular epithelial surface

Purpura

Purple spots, occur when red blood cells leak into skin from dermal blood vessels

Scleroderma

Extra deposition of collagen hardening, atrophy and ulceration of skin

Seborrhoea

Disease of sebaceous glands

Skin tags

Fibro-epithelial polyp mostly found on neck and in body folds

Stria

Band of skin (white, pink/purple) as result of connective tissue changes.

Urticaria

Hives, itchy rash due to food/nettle stings

Diseases caused by bacteria

Furuncle

Localised red lump, occurs around hair follicle

Impetigo

Skin appears red and itchy, small blisters appear

Abscess

Acute bacterial infection, localised collection of pus

Cellulites

Acute inflammation of connective tissue, skin appear dark red, swollen and feels hot

Folliculitis

Large number of hair follicles in a region becomes infected with staphylococci

Hordeola/styes

Infection of sebaceous gland of eyelash hair follicle

Conjunctivitis/ pink eyes

Inflammation of mucous membrane that covers eye and lines eyelids

Diseases caused by viruses

Herpes simplex

Blisters commencing as itchy patch of erythema

Herpes zoster

Shingles, acute infection of nerve root, producing groups of vesicles along section of skin served by infected nerve

Warts/verrucae

Localised growths of epidermis

Verruca vulgaris

Hands, firm papule with rough horny surface

Verruca plana

Flat topped, occurs on face and back of hands, pearly elevation

Verruca plantaris

Soles of feet, yellowish-white

Diseases caused by fungi

Ringworm/ tinea

Tinea pedis (feet)

Occurs on soles between toes in presence of excess sweating

Tinea unguim (nails)

Appears on toe nails

Tinea cruris (groin)

Occurs on males, spread by sharing bath towels

Tinea corporis (body)

Superficial rash with slight inflammation

Tinea barbae (beard)

Deep infection of hair follicles forming small pustules and abscesses on skin

Tinea capitis (scalp)

Scaly patches of different sizes containing broken hairs

Candida

Yeast fungi, infect skin, nails and mucous membranes of mouth and vagina

Pityriosis versicolor

Chronic, asymptomatic superficial fungal infection

Infestation caused by animal parasites

Pediculosis

Infestation by lice that live on human blood that’s obtained from biting skin

Pediculosis capitis

Head lice

Pediculosis corporus

Body lice

Pediculosis pubis

Pubic lice

Scabies

Contagious disease, caused by scabies itch mite

Insects

Can also damage skin

Skin diseases and disorders caused by allergic phenomena

Dermatitis

Inflammatory skin disorder, skin becomes red, itchy and swollen. Blisters may appear. Primary dermatitis = skin is irritated by action of a substance upon skin, leads to skin inflammation. Allergic contact dermatitis = problem is caused by intolerance of skin to a particular substance/group of substances. On exposure to substance skin quickly becomes irritated and an allergic reaction occurs.

Eczema

Inflammation of skin cased b contact, internally/externally with an irritant

Urticaria/nettle rash/hives

Sudden eruption of wheals of varying sizes. Rash occurs rapidly. Burning and itching is intense.

Drug rashes

Allergic in origin, start as a sudden, widespread, itchy rash which affects body symmetrically. Rash usually clears up a short time after stopping drug.

Skin disorders of keratinazation/abnormal growth

Psoriasis

Well-defined papules/plagues of various sizes. Lesions are red, covered with silvery scales

Itchyoisis

Group of inherited skin disorders of keratinisation characterized by dryness and a fish scale appearance of skin

Keratosis pilaris

Multiple small horny follicular plugs found mainly on upper arms and thighs

Calluses and corns

Hyperkeratosis plagues which develop at friction/pressure points. Corns are more deeply situated

Disorders of connective tissue

Solar elastosis

Damage to collagen fibres, thickened, wrinkle, furrowed skin on sun exposed parts

Stretch marks/stria

Dermal tearing by extreme stretching of skin

Keloid

Hard, raised, whitish scar formed due to an over growth of fibrous tissue in a healed scar

Generalised pruritus (itching)

Modified form of pain, common skin complaint Causes: dry skin, pressure, chafing in obese persons, iron deficiency, liver disease, renal failure

Xanthelasma/ xanthomas

Deposits of lipids in skin

Skin disorder due to disturbances of pigmentation

Hyper pigmentation

Melanocytic naevi/moles

Benign tumours of melanocyte cells

Intradermal naevus

Dome shaped, papillomatous/pedunculated, vary from skin tone to shades of brown

Junctional naevus

Hairless, flat, slightly raised, light brown to black, often speckled

Compound neavus

More raised than papillomatous, coarse dark hairs

Freckless/ ephelides

Small to light brown macules. Darken in sun exposure

Lentigines/ lentigo

Evenly pigmented black/brown macules. Do not darken with sun exposure

Chloasma/ melasma

Result of taking contraceptive pills

Café-au-lait spots

Multiple light brown macular patches varying in size

Ochronosis

Due to skin lightening creams

Berloque dermatitis/ perfume dermatitis

Caused by perfume

Mongolian spots

Bluish patches, result from disfunctional melanocytes deep in dermis

Hypo pigmentation

Vitiligo

Patches of completely white skin which lost their pigment

Tinea versicolal/ pityriosis versicolor (depigmentation)

Depigmented macules with/without fine scales

Albinism (lack of pigmentation)

Skin unable to produce melanin pigment and skin, hair and eyes lack colour

Disorders of pigmentation caused by blood vessels

Port-wine stain

Localised, red-purple macule, found on face since birth

Strawberry naevus

Pin-red compressible vascular swelling, develops during first 6 months of life

Spider naevus

Small superficial arteriole giving rise to localised telangiectasia angioma

Compbell de morgan spots

Benign capillary growths, bright red papules

Skin disorders of pilo-sebaceous unit

Acne vulgaris

Chronic inflammatory disease of pilo-sebaceous unit

Acne lesions

A comedo, or basic acne lesion, is a hair follicle that has become clogged with oil and dead skin cells. Comedones (the plural of comedo) can develop into bumps called whiteheads and blackheads.

Micro comedone

Smallest for of black head

Closed comedone

Impaction in hair follicle, hardened over cap of stratum corneum cells

Hard closed comedones

Found around eye area

Soft closed comedones

Due to comedogenic ingredients in products/make-up

Open comedone

Non-inflamed impartion of dead skin cells, sebum, bacteria, exposed to air

Papule

High break of follicle wall, empties impaction into dermis, white blood cells attack and a sore red lesion is felt

Pustule

Papule develops and white blood cells attack, pus is produced, yellow cap of pus visible on surface of skin

Nodule

Deep break in follicle wall, empties impaction into lower dermis, thus infects adjoining follicles

Cysts

Membrane forms around lesions in dermis, traps it as a soft, fluid-filled lump, has to be incised and treated by a doctor/dermatologist

Rosacea (acne rocacea)

Chronic inflammatory facial dermatosis characterised by an erythematous eruption of papules and pustules, dilated blood vessels and a flushed appearance on forehead, nose, cheeks and chin

The development of a pustule:

“SAPI”

S: Excessive sebum production:

• Acne is a genetic condition –clients with the condition has larger and more sebaceous glands which produce more sebum than normal.

• Androgens are the main hormonal drive of the sebaceous follicles = causing sebum production (puberty – when the sebaceous gland matures),

• Hyper response of the sebaceous follicles to normal levels of circulating androgens occur.

• Emotional stress may aggravate acne (pituitary-adrenal hormones)

A: Abnormal keratinization

• Increase in the production of keratinocytes lining in the follicle

• Retention of these cells within the follicle

• Excess sebum build up within the follicle and form a microcomedone.

• The micrcomedo enlarges and forms a closed comedo or open comedo.

P: Multiplication of propionibacterium acnes

• Anaerobic conditions in the follicle causes the p-acne in the follicular flora to become active.

• P-acne produce many enzymes (lipase, phosphatases, proteases, and hyaluronate lyase)

I: Inflammation

• The enzymes that are produced by the p-acne causes inflammation. Lipase liberate free fatty acids which may in turn lead to marked inflammation.

• White blood cells invade the area causing inflammation.

• A Papule is formed proceeding into a pustule.

• This cause follicular damage and inflammation

Isotretinoin (Roaccutane) Drug derived from VitaminA. Acne medication that was launched in South Africa in 1984. (Used for 20 years now) Dermatologist have vast experience of its use but still has managed to remain controversial. Indications Chronic acne conditions, nodulocystic acne, adult acne, seborrhea, gram folliculitis, rosacea and scarring from any degree of acne(does not treat scars but prevent scars-relative indication). Failure to respond either to antibiotics or hormonal treatment.( 4 months) Contra-Indications: Pregnancy, Hypovitamine A treatments, and hypersensitivity to the drug. Sometimes people with depression, and psychological problems. Dosage: Optimal dose: 120 to 150 mg/kg body weight at a dose as close as possible to 1mg and not below 0,75 mg/kg body weight/day.

• Dayly dose: 0,75 -1 mg per kg body weight per day

• Acumative dose 120mg x body weight

e.g. 60 kg will take 60 mg per day (1200 days – 4 months)

Length of course: 4-5 months Despite this, some GPs still use small doses: The patient cannot expect a optimal outcome! ( it is expensive) Used correctly clients can anticipate a 75 – 80% rate of not having to use acne treatment again. For maximal absorption it needs to be taken at or just after a meal as it is absorbed best in the presence of fat. Blood tests: Monthly lipid studies and liver function tests seems to have dropped away. If there is a specific problem such as diabetes or a history of familial hypercholesterolaemia, many dermatologists no longer insist on blood tests. Levels usually return to the baseline level within one month after the end of the course. Side-effects: Side-effects tend to be at their worst during the first 6-8 weeks of treatment. Usually the side-effects do not require lowering the dose.

• Dryness of the lips, skin and eyes (Duratears for the eyes)

• Nose bleeding

• Eczema on the hands

• Headaches

• Joint pains

• Photosensitivity

• Skin fragility and erithema (red appearance)

• Hair loss

• The connection between Roaccutane and either depression or suicide has not been proved.

* The taking of vit A supplements concurrently with Roaccutane will increase the severity of side-effects. * Tetracycline drugs should not be taken during the therapy owing to a theoretical increase in the likelihood of the development of hypertension. Precautions a therapist can take when performing a facial treatment on a Roaccutane user:

• No harsh products should be uses.

• No exfoliation

• No AHA products

• Aim to rehydrate the skin

• Avoid overstimulation (massage, frimator)

Advice that can be given to the client that is using Roaccutane:

• Adhere to dr’s advice

• Use sunblock/ stay out of the sun

• Drink 8 glasses of water a day/ prevent further dehydration by drinking too much coffee/alcohol

• Use a good water based moisturizer

• Use moisturizing lip balm and eyedrops

• Use green base for vascular appearance.

Extra interesting facts: Roaccutane is not stored in the body – after 2 weeks all the traces will be out of the body, and women can become pregnant 1 month after stopping the drug. But rather proceed with a wax treatment 3 months after use – to be save!

Disorders of sweat glands

Anidrosis

Absence of sweat, due to break down of sweat glands and congenital factors

Hyperhidrosis

Secretion of excessive amount of sweat, which may have an offensive odour

Bromidrosis

Condition in which sweat has a particularly offensive odour

Miliara rubra/prickly heat

Caused by sweat-duct blockage induced by temperature change