Understanding Acne

There are many myths about what causes acne. Some people blame foods for their outbreaks. Some think that dirty skin causes it. But there’s little evidence that either has much effect on most people’s acne. People of all races and ages get acne. About 4 of every 5 people between the ages of 11 and 30 have outbreaks at some point. It’s most common in adolescents and young adults. Although acne is usually not a serious health threat, it can be upsetting, and severe acne can lead to permanent scarring. Fortunately, for most people, acne tends to go away by the time they reach their 30s. Acne begins in the skin’s oil glands. The oils travel up a canal called a follicle, which also contains a hair. The oils empty onto the skin surface through the follicle’s opening, or pore. The hair, oil and cells that line the narrow follicle can form a plug and block the pore, preventing oil from reaching the skin’s surface. This mix of oil and cells allows bacteria that normally live on the skin to grow in plugged follicles. Your body’s defense system then moves to attack the bacteria and the area gets inflamed. If the plugged follicle stays beneath the skin, you get a white bump called a whitehead. If it reaches the surface of the skin and opens up, you get a blackhead. It’s not because of dirt; the oil becomes black on the skin’s surface when it’s exposed to air. Both whiteheads and blackheads may stay in the skin for a long time. Eventually, the wall of the plugged follicle can break down, leading to pimples, or zits. One important factor in acne is an increase in certain hormones during puberty. These hormones cause the oil glands to enlarge and make more oil. Hormone changes related to pregnancy or starting or stopping birth control pills can also cause acne. Studies suggest that you can inherit a tendency to develop acne from your parents, so genes likely play some role. Stress doesn’t cause acne, but research has found that for people who have acne, stress can make it worse. Certain drugs are also known to cause acne. Greasy cosmetics, for example, can alter the cells of the follicles and make them stick together, producing a plug. If you have acne, try oil-free cosmetics. Choose products labeled noncomedogenic (meaning they don’t promote the formation of closed pores). If you have acne, don’t rub or touch your pimples. Squeezing, pinching or picking at them can lead to scars or dark blotches. Gently wash your face with a mild cleanser twice a day—and after heavy exercise. Don’t use strong soaps or rough scrub pads; they may make the problem worse. It’s also important to shampoo your hair regularly. If you have oily hair, you may want to wash it every day. Several over-the-counter medicines can treat mild acne. It may take up to 8 weeks before you notice an improvement. For more severe acne, talk to your doctor about the options. Researchers continue to work on developing new drugs to treat acne. They’re also trying to better understand the causes of acne so they can explore new remedies. In the meantime, there are several available treatments that may help. NIH

Melanoma

Melanoma is a disease in which malignant (cancer) cells form in the skin cells called melanocytes (cells that color the skin).

Melanocytes are found throughout the lower part of the epidermis. They make melanin, the pigment that gives skin its natural color. When skin is exposed to the sun, melanocytes make more pigment, causing the skin to tan, or darken.

The skin is the body’s largest organ. It protects against heat, sunlight, injury, and infection. The skin has 2 main layers: the epidermis (upper or outer layer) and the dermis (lower or inner layer).

When melanoma starts in the skin, the disease is called cutaneous melanoma.Melanoma may also occur in the eye and is called intraocular or ocular melanoma.

There are 3 types of skin cancer:

• Melanoma.

• Basal cell skin cancer.
• Squamous cell skin cancer.

Melanoma is more aggressive than basal cell skin cancer or squamous cell skin cancer.

Melanoma can occur anywhere on the body.

In men, melanoma is often found on the trunk (the area from the shoulders to the hips) or the head and neck. In women, melanoma often develops on the arms and legs. Melanoma usually occurs in adults, but it is sometimes found in children and adolescents.

Unusual moles, exposure to sunlight, and health history can affect the risk of developing melanoma.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for melanoma include the following:

• Unusual moles.
• Exposure to natural sunlight.
• Exposure to artificial ultraviolet light (tanning booth).
• Family or personal history of melanoma.
• Being white and older than 20 years.
• Red or blond hair.
• White or light-colored skin and freckles.
• Blue eyes.

Possible signs of melanoma include a change in the appearance of a mole or pigmented area.

These and other symptoms may be caused by melanoma. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

• A mole that:

• • changes in size, shape, or color.
  • has irregular edges or borders.
  • is more than 1 color.
  • is asymmetrical (if the mole is divided in half, the 2 halves are different in size or shape).
  • itches.
  • oozes, bleeds, or is ulcerated (a hole forms in the skin when the top layer of cells breaks down and the underlying tissue shows through).

• Change in pigmented (colored) skin.
• Satellite moles (new moles that grow near an existing mole).

Tests that examine the skin are used to detect (find) and diagnose melanoma.

If a mole or pigmented area of the skin changes or looks abnormal, the following tests and procedures can help detect and diagnose melanoma:

• Skin examination: A doctor or nurse examines the skin to look for moles, birthmarks, or other pigmented areas that look abnormal in color, size, shape, or texture.
• Biopsy: A local excision is done to remove as much of the suspicious mole or lesion as possible. A pathologist then looks at the tissue under a microscope to check for cancer cells. Because melanoma can be hard to diagnose, patients should consider having their biopsy sample checked by a second pathologist.

Suspicious areas should not be shaved off or cauterized (destroyed with a hot instrument, an electrical current, or a caustic substance).

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

• The stage of melanoma (whether cancer is found in the outer layer of skin only, or has spread to the lymph nodes, or to other places in the body.
• Whether there was bleeding or ulceration at the primary site.
• The location and size of the tumor.
• The patient’s general health.

Although many people are successfully treated, melanoma can recur (come back).

National Cancer Institute

Frost Bite and Hypothermia

LOW TEMPERATURE + WIND SPEED + WETNESS = INJURIES & ILLNESS

FROST BITE

What Happens to the Body:

• FREEZING IN DEEP LAYERS OF SKIN AND TISSUE
• PALE, WAXY-WHITE SKIN COLOR
• SKIN BECOMES HARD and NUMB
• USUALLY AFFECTS THE FINGERS, HANDS, TOES, FEET, EARS, and NOSE.

What Should Be Done: (land temperatures)

• Move the person to a warm dry area. Don’t leave the person alone.
• Remove any wet or tight clothing that may cut off blood flow to the affected area.
• DO NOT rub the affected area, because rubbing causes damage to the skin and tissue.
• Gently place the affected area in a warm (105°F) water bath and monitor the water temperature to slowly warm the tissue. Don’t pour warm water directly on the affected area because it will warm the tissue too fast causing tissue damage. Warming takes about 25-40 minutes.
• After the affected area has been warmed, it may become puffy and blister. The affected area may have a burning feeling or numbness. When normal feeling, movement, and skin color have returned, the affected area should be dried and wrapped to keep it warm. NOTE: If there is a chance the affected area may get cold again, do not warm the skin. If the skin is warmed and then becomes cold again, it will cause severe tissue damage.
• Seek medical attention as soon as possible.

HYPOTHERMIA – (Medical Emergency)

What Happens to the Body:

• NORMAL BODY TEMPERATURE (98.6° F/37°C ) DROPS TO OR BELOW 95°F (350 C)
• FATIGUE OR DROWSINESS
• UNCONTROLLED SHIVERING
• COOL BLUISH SKIN
• SLURRED SPEECH
• CLUMSY MOVEMENTS
• IRRITABLE, IRRATIONAL OR CONFUSED BEHAVIOR.

What Should Be Done: (land temperatures)

• Call for emergency help (i.e., Ambulance or Call 911).
• Move the person to a warm, dry area. Don’t leave the person alone. Remove any wet clothing and replace with warm, dry clothing or wrap the person in blankets.
• Have the person drink warm, sweet drinks (sugar water or sports-type drinks) if they are alert. Avoid drinks with caffeine (coffee, tea, or hot chocolate) or alcohol.
• Have the person move their arms and legs to create muscle heat. If they are unable to do this, place warm bottles or hot packs in the arm pits, groin, neck, and head areas. DO NOT rub the person’s body or place them in warm water bath. This may stop their heart.

What Should Be Done: (water temperatures)

• Call for emergency help (Ambulance or Call 911). Body heat is lost up to 25 times faster in water.
• DO NOT remove any clothing. Button, buckle, zip, and tighten any collars, cuffs, shoes, and hoods because the layer of trapped water closest to the body provides a layer of insulation that slows the loss of heat. Keep the head out of the water and put on a hat or hood.
• Get out of the water as quickly as possible or climb on anything floating. DO NOT attempt to swim unless a floating object or another person can be reached because swimming or other physical activity uses the body’s heat and reduces survival time by about 50 percent.
• If getting out of the water is not possible, wait quietly and conserve body heat by folding arms across the chest, keeping thighs together, bending knees, and crossing ankles. If another person is in the water, huddle together with chests held closely.

How to Protect Workers

• Recognize the environmental and workplace conditions that lead to potential cold-induced illnesses and injuries.
• Learn the signs and symptoms of cold-induced illnesses/injuries and what to do to help the worker.
• Train the workforce about cold-induced illnesses and injuries.
• Select proper clothing for cold, wet, and windy conditions. Layer clothing to adjust to changing environmental temperatures. Wear a hat and gloves, in addition to underwear that will keep water away from the skin (polypropylene).
• Take frequent short breaks in warm dry shelters to allow the body to warm up.
• Perform work during the warmest part of the day.
• Avoid exhaustion or fatigue because energy is needed to keep muscles warm.
• Use the buddy system (work in pairs).
• Drink warm, sweet beverages (sugar water, sports-type drinks). Avoid drinks with caffeine (coffee, tea, or hot chocolate) or alcohol.
• Eat warm, high-calorie foods like hot pasta dishes.

Workers Are at Increased Risk When…

• They have predisposing health conditions such as cardiovascular disease, diabetes, and hypertension.
• They take certain medication (check with your doctor, nurse, or pharmacy and ask if any medicines you are taking affect you while working in cold environments).
• They are in poor physical condition, have a poor diet, or are older.

Osha

Dermatomyositis

What is Dermatomyositis?

Dermatomyositis is one of a group of muscle diseases known as the inflammatory myopathies, which are characterized by chronic muscle inflammation accompanied by muscle weakness. Dermatomyositis’ cardinal symptom is a skin rash that precedes or accompanies progressive muscle weakness. The rash looks patchy, with bluish-purple or red discolorations, and characteristically develops on the eyelids and on muscles used to extend or straighten joints, including knuckles, elbows, heels, and toes. Red rashes may also occur on the face, neck, shoulders, upper chest, back, and other locations, and there may be swelling in the affected areas. The rash sometimes occurs without obvious muscle involvement. Adults with dermatomyositis may experience weight loss or a low-grade fever, have inflamed lungs, and be sensitive to light. Children and adults with dermatomyositis may develop calcium deposits, which appear as hard bumps under the skin or in the muscle (called calcinosis). Calcinosis most often occurs 1-3 years after the disease begins.  These deposits are seen more often in children with dermatomyositis than in adults.  In some cases of dermatomyositis, distal muscles (muscles located away from the trunk of the body, such as those in the forearms and around the ankles and wrists) may be affected as the disease progresses.  Dermatomyositis may be associated with collagen-vascular or autoimmune diseases, such as lupus.

Is there any treatment?

There is no cure for dermatomyositis, but the symptoms can be treated. Options include medication, physical therapy, exercise, heat therapy (including microwave and ultrasound), orthotics and assistive devices, and rest. The standard treatment for dermatomyositis is a corticosteroid drug, given either in pill form or intravenously. Immunosuppressant drugs, such as azathioprine and methotrexate, may reduce inflammation in people who do not respond well to prednisone. Periodic treatment using intravenous immunoglobulin can also improve recovery. Other immunosuppressive agents used to treat the inflammation associated with dermatomyositis include cyclosporine A, cyclophosphamide, and tacrolimus. Physical therapy is usually recommended to prevent muscle atrophy and to regain muscle strength and range of motion.  Many individuals with dermatomyositis may need a topical ointment, such as topical corticosteroids, for their skin disorder. They should wear a high-protection sunscreen and protective clothing. Surgery may be required to remove calcium deposits that cause nerve pain and recurrent infections.

What is the prognosis?

Most cases of dermatomyositis respond to therapy. The disease is usually more severe and resistant to therapy in individuals with cardiac or pulmonary problems.

NINDS

Incontinentia Pigmenti (IP)

Synonym(s): Bloch-Sulzberger Syndrome

What is Incontinentia Pigmenti (IP)?

Incontinentia pigmenti (IP) is an inherited disorder of skin pigmentation that is also associated with abnormalities of the teeth, skeletal system, eyes, and central nervous system. It is one of a group of gene-linked diseases known as neurocutaneous disorders. In most cases, IP is caused by mutations in a gene called NEMO (NF-kappaB essential modulator). Males are more severely affected than females. Discolored skin is caused by excessive deposits of melanin (normal skin pigment). Most newborns with IP will develop discolored skin within the first two weeks. The pigmentation involves the trunk and extremities, is slate-grey, blue or brown, and is distributed in irregular marbled or wavy lines. The discoloration fades with age. Neurological problems include loss of brain tissue (known as cerebral atrophy), the formation of small cavities in the central white matter of the brain, and the loss of neurons in the cerebellar cortex. About 20% of children with IP will have slow motor development, muscle weakness in one or both sides of the body, mental retardation, and seizures. They are also likely to have visual problems, including crossed eyes, cataracts, and severe visual loss. Dental problems are also common, including missing or peg-shaped teeth. A related disorder, incontinentia pigmenti achromians, features skin patterns of light, unpigmented swirls and streaks that are the reverse of IP. Associated neurological problems are similar.

Is there any treatment?

The skin abnormalities of IP usually disappear by adolescence or adulthood without treatment. Diminished vision may be treated with corrective lenses, medication, or, in severe cases, surgery. A specialist may treat dental problems. Neurological symptoms such as seizures, muscle spasms, or mild paralysis may be controlled with medication and/or medical devices and with the advice of a neurologist.

What is the prognosis?

Although the skin abnormalities usually regress, and sometimes disappear completely, there may be residual neurological difficulties.

NINDS

Risk Factors for Skin Cancer

Risk Factors

People with certain risk factors are more likely than others to develop skin cancer. Risk factors vary for different types of skin cancer, but some general risk factors are having—

• A lighter natural skin color.
• Family history of skin cancer.
• A personal history of skin cancer.
• Exposure to the sun through work and play.
• A history of sunburns early in life.
• Skin that burns, freckles, reddens easily, or becomes painful in the sun.
• Blue or green eyes.
• Blond or red hair.
• Certain types and a large number of moles.

Tanning and Burning

When ultraviolet (UV) rays reach the skin’s inner layer, the skin makes more melanin. Melanin is the pigment that colors the skin. It moves toward the outer layers of the skin and becomes visible as a tan.

A tan does not indicate good health. Some doctors consider a tan a response to injury, because it appears after the sun’s UV rays have killed some skin cells and damaged others.

People burn or tan depending on their skin type, the time of year, and the amount of time they have spent in the sun. The six types of skin, based on how likely it is to tan or burn, are—

• I: Always burns, never tans, sensitive to sun exposure.
• II: Burns easily, tans minimally.
• III: Burns moderately, tans gradually to light brown.
• IV: Burns minimally, always tans well to moderately brown.
• V: Rarely burns, tans profusely to dark.
• VI: Never burns, deeply pigmented, least sensitive.

Although everyone’s skin can be damaged by too much sunlight, people with skin types I and II are at the highest risk.

CDC

Mastocytosis

Mastocytosis is a disorder that may occur in both children and adults. It is caused by the presence of too many mast cells in your body. You can find mast cells in skin, lymph nodes, internal organs (such as the liver and spleen) and the linings of the lung, stomach, and intestine. Mast cells play an important role in helping your immune system defend these tissues from disease. Mast cells attract other key players of the immune defense system to areas of your body where they are needed by releasing chemical “alarms” such as histamine and cytokines.

Mast cells seem to have other roles as well. Found to gather around wounds, they may play a part in wound healing. For example, the typical itching you feel around a healing scab may be caused by histamine released by mast cells. Researchers also think mast cells may have a role in the growth of blood vessels. No one with too few or no mast cells has ever been found. This fact indicates to some scientists that having too few mast cells may be incompatible with life.

The presence of too many mast cells, or mastocytosis, can occur in two forms—cutaneous and systemic. The most common cutaneous (skin) form is also called urticaria pigmentosa, which occurs when mast cells infiltrate the skin. Systemic mastocytosis is caused by mast cells accumulating in the tissues and can affect organs such as the liver, spleen, bone marrow, and small intestine.

Researchers first described urticaria pigmentosa in 1869. Systemic mastocytosis was first reported in the scientific literature in 1949. The true number of cases of either type of mastocytosis remains unknown, but mastocytosis generally is considered to be an “orphan disease.” (Orphan diseases affect approximately 200,000 or fewer people in the United States.)

Symptoms
Chemicals released by mast cells cause changes in your body’s functioning that lead to typical allergic responses such as flushing, itching, abdominal cramping, and even shock. When too many mast cells are in your body, the additional chemicals can cause:

• Musculoskeletal pain
• Abdominal discomfort
• Nausea and vomiting
• Ulcers
• Diarrhea
• Skin lesions

It can also cause episodes of hypotension (very low blood pressure and faintness) or anaphylaxis (shock).

Diagnosis
Your doctor can diagnose cutaneous mastocytosis by the appearance of your skin and confirm it by finding an abnormally high number of mast cells on a skin biopsy. The diagnosis of systemic mastocytosis is made when an increased number of abnormal mast cells is found during an examination of your bone marrow.

Other tests that are important in evaluating a suspected case of mastocytosis include measurement of a protein (tryptase) from mast cells in your blood and a search for specific genetic mutations that health experts associate with this disease.Doctors use several medicines to treat mastocytosis symptoms, including antihistamines (to prevent the effect of mast cell histamine) and anticholinergics (to relieve intestinal cramping). A number of medicines treat specific symptoms of mastocytosis.

Antihistamines frequently treat itching and other skin complaints. Certain antihistamines work specifically against ulcers; proton pump inhibitors also relieve ulcer-like symptoms.

Two types of antihistamines treat severe flushing and low blood pressure before symptoms appear; epinephrine can treat these symptoms after they begin.

Topical steroids temporarily reduce skin lesions that are cosmetically disturbing
Steroids treat malabsorption, or impaired ability to take in nutrients.

In cases in which mastocytosis is malignant, cancerous, or associated with a blood disorder, steroids and/or chemotherapy may be necessary.

NIH

What is Pemphigus?

What Is Pemphigus?

Pemphigus is a group of rare autoimmune diseases that cause blistering of the skin and mucous membranes (mouth, nose, throat, eyes, and genitals). Some forms of the disease, including the most common form, may be fatal if left untreated.

What Causes Pemphigus?

Normally, our immune system produces antibodies that attack viruses and harmful bacteria to keep us healthy. In people with pemphigus, however, the immune system mistakenly attacks the cells in the epidermis, or top layer of the skin, and the mucous membranes. The immune system produces antibodies against proteins in the skin known as desmogleins. These proteins form the glue that keeps skin cells attached to keep the skin intact. When desmogleins are attacked, skin cells separate from each other and fluid can collect between the layers of skin, forming blisters that do not heal. In some cases, these blisters can cover a large area of skin.

It is unclear what triggers the disease, although it appears that some people have a genetic susceptibility. Environmental agents may trigger the development of pemphigus in people who are likely to be affected by the disease because of their genes. In rare cases, it may be triggered by certain medications. In those cases, the disease usually goes away when the medication is stopped.

Is Pemphigus Contagious?

Pemphigus is not contagious. It does not spread from person to person.

Is Pemphigus Hereditary?

Though there can be a genetic predisposition to develop pemphigus, there is no indication the disease is hereditary.

Who Gets Pemphigus?

Pemphigus affects people across racial and cultural lines. Research has shown that certain ethnic groups (such as the eastern European Jewish community and people of Mediterranean descent) are more susceptible to pemphigus. A particular type of pemphigus occurs more frequently in people who live in the rain forests of Brazil.

Men and women are equally affected. Research studies suggest a genetic predisposition to the disease. Although the onset usually occurs in middle-aged and older adults, all forms of the disease may occur in young adults and children.

What Are the Different Types of Pemphigus?

There are several types of pemphigus and other similar blistering disorders. The type of disease depends on what level in the skin the blisters form and where they are located on the body. Blisters always occur on or near the surface of the skin, which is called the epidermis. People with pemphigus vulgaris, for example, have blisters that occur within the lower layer of the epidermis, while people with pemphigus foliaceus have blisters that form in the topmost layer. The type of antibody that is attacking the skin cells may also define the type of disease present.

• Pemphigus vulgaris is the most common type of pemphigus in the United States. Soft and limp blisters appear on healthy-looking skin and mucous membranes. The sores almost always start in the mouth. The blisters of pemphigus vulgaris form within the deep layer of the epidermis, and are often painful. Blistered skin becomes so fragile that it may peel off by rubbing a finger on it. The blisters normally heal without scarring, but pigmented spots may remain for a number of months.
• Pemphigus vegetans is a form of pemphigus with thick sores in the groin and under the arms.
• Pemphigus foliaceus involves crusted sores or fragile blisters that often appear first on the face and scalp and later on the chest and other parts of the body. Unlike pemphigus vulgaris, blisters do not form in the mouth. The sores are superficial and often itchy, and are rarely as painful as pemphigus vulgaris blisters. There may also be loose, moist scales on the skin.
• IgA pemphigus is a blistering disorder in which a different type of antibody binds to the cell surface of epidermal cells. This disease is different from other forms of pemphigus because it involves a different type of antibody (called IgA) than other types. The disease may result in blisters similar to those seen in pemphigus foliaceus, or it may involve many small bumps containing pus. This is the most benign, or least harmful, form of pemphigus.
• Paraneoplastic pemphigus is a rare disease that is distinct from pemphigus, but shares some features of it. It occurs in people with certain types of cancer, including some lymphomas and leukemias. It often involves severe ulcers of the mouth and lips, cuts and scarring of the lining of the eye and eyelids, and skin blisters. Because the antibodies also bind the airways, patients may develop life-threatening problems in the lungs. This disease is different from pemphigus, and the antibodies in the blood are different. Special tests may be needed to identify paraneoplastic pemphigus.

What Is Pemphigoid, and How Is It Different From Pemphigus?

Pemphigoid is also a blistering disorder caused by autoimmune problems that result in an attack on the skin cells by a person’s own antibodies. Pemphigoid produces a split in the cells where the epidermis and dermis, the layer below the epidermis, meet, causing deep, tense blisters that do not break easily. Pemphigus, on the other hand, causes a separation within the epidermis, and the blisters are soft, limp, and easily broken. Pemphigoid is seen most often in the elderly and may be fatal. Usually, both pemphigus and pemphigoid are treated with similar medications. Severe cases may require different treatment.

How Is Pemphigus Diagnosed?

A diagnosis of pemphigus has several parts:

• A visual examination by a dermatologist. The doctor will take a complete history and physical exam, noting the appearance and location of the blisters.
• A blister biopsy. A sample of a blister is removed and examined under the microscope. The doctor will look for cell separation that is characteristic of pemphigus, and will also determine the layer of skin in which the cells are separated.
• Direct immunofluorescence. A biopsy of a skin sample is treated in the laboratory with a chemical compound to find the abnormal desmoglein antibodies that attack the skin. The specific type of antibodies that form may indicate what type of pemphigus exists.
• Indirect immunofluorescence. Sometimes called an antibody titre test, a sample of blood is tested to measure pemphigus antibody levels in the blood and help determine the severity of the disease. Once treatment begins, this blood test may also be used to find out if treatment is working.

Pemphigus is a serious disease, and it is important to do all of these tests to confirm a diagnosis. No single test is right all of the time.

Because it is rare, pemphigus is often the last disease considered during diagnosis. Early diagnosis may permit successful treatment with only low levels of medication, so consult a doctor if you have persistent blisters on the skin or in the mouth. In the most common form of pemphigus (pemphigus vulgaris), the mouth is often the first place that blisters or sores appear.

What Type of Doctor Treats Pemphigus?

Pemphigus is a rare disease of the skin; therefore, dermatologists are the doctors best equipped to diagnose and treat people with pemphigus. If you have blisters in the mouth, a dentist can provide guidance for maintaining good oral health. This is important for preventing gum disease and tooth loss.

How Is Pemphigus Treated?

Treatment for pemphigus vulgaris involves using one or more drugs. High-dose oral corticosteroids, such as prednisone or prednisolone, are the main treatment for pemphigus. These are anti-inflammatory medicines that suppress the immune system. High doses are often required to bring pemphigus under control. To minimize the side effects patients may experience, once the disease begins to subside the corticosteroid levels are reduced slowly to the lowest level required to prevent new blisters or sores from appearing. Many patients will go into complete remission with treatment, although this may take a number of years. Other patients will need to continue to take small doses of medication to keep the disease under control. Prednisone is usually taken by mouth, but can also be injected into a vein, muscle, or directly into a blister. The route depends on the type and severity of disease. Usually, a corticosteroid cream will be used directly on the blisters.

To keep the levels of corticosteroid use to a minimum, immunosuppressive drugs are often added to a patient’s treatment. These are drugs that stop or slow down the immune system’s response to what it sees as an attack on the body. They include:

• Myco-phenolate mofetil (CellCept^*)
• Azathioprine (Imuran)
• Cyclophosphamide (Cytoxan)
• Methotrexate.

Other drugs that may be used include:

• Dapsone (DDS)
• Antibiotics such as tetracycline.

^* Brand names included in this booklet are provided as examples only and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

All of these medications can cause serious side effects. You should see your doctor regularly for blood and urine tests. Be sure to report any problems or side effects you experience to the doctor. With prolonged high-dose corticosteroid therapy, common side effects include susceptibility to life-threatening infections, delayed wound healing, osteoporosis, cataracts, glaucoma, type 2 diabetes, loss of muscle mass, peptic ulcers, swelling of the face and upper back, and salt and water retention. To reduce the risk of osteoporosis, bone density measurements are taken, and patients with low bone density are prescribed medications such as alendronate (Fosamax) or risedronate (Actonel). Extra calcium and vitamin D intake, exercise, and stopping smoking are also recommended. For diabetes caused by steroid use, patients must be on a low sugar diet and may need to take antidiabetic medications.

The immunosuppressive drugs that are used to treat pemphigus can also increase the chances of developing an infection and may cause anemia, a decrease in the white blood cells in the blood, inflammation of the liver, nausea, vomiting, or allergic reactions.

People with severe pemphigus that cannot be controlled with corticosteroids may undergo plasmapheresis, a treatment in which the blood containing the damaging antibodies is removed and replaced with blood that is free of antibodies. Such patients can also be treated with IVIg, or intravenous immunoglobulin, which is given daily for 3 to 5 days, every 2 to 4 weeks for 1 to several months. Plasmapheresis and IVIg are both very expensive treatments, since they require large amounts of donated and specially processed blood. Scientists have reported success in treating difficult cases of pemphigus vulgaris with a combination of IVIg and rituximab, a cancer medication.

The treatment prescribed will depend on the type of pemphigus and the severity of the disease. Work closely with your doctor to devise the treatment regimen that works best for you. Because the medications used to treat pemphigus are strong medications with potentially serious side effects, every doctor that you see should be made aware of the type and amount of medications you are taking.

It may take several months to years for the ulcers and blisters of pemphigus vulgaris to disappear after treatment has begun because circulating antibodies remain in the blood for a long time. Lesions in the mouth are particularly slow to heal. Blisters in the mouth can make brushing the teeth painful, leaving you prone to gum disease and tooth loss. A dentist can offer approaches that enable you to maintain healthy teeth and gums. Avoiding spicy, hard, and acidic foods will help, since those foods can irritate or trigger the blisters. If you are taking corticosteroids, you should receive advice for maintaining a diet low in calories, fat, and sodium, and high in potassium and calcium.

What Is the Prognosis for People Who Have Pemphigus?

The outlook for people with pemphigus has changed dramatically in the past 40 years. A person diagnosed with pemphigus vulgaris in the 1960s faced the reality that they had a disease that was rare, usually fatal, poorly understood, with no good treatment options. Today, through medical research supported by the National Institutes of Health (NIH), the picture is dramatically better. The disease is now rarely fatal, and the majority of deaths occur from infections. For most people with pemphigus, the disease can be controlled with corticosteroids and other medications, and these medications can eventually be completely discontinued. However, as described earlier, these medications can cause side effects that can sometimes be serious. Pemphigus and its treatments can be debilitating and cause lost time at work, weight loss, loss of sleep, and emotional distress. The International Pemphigus Foundation provides patient support services to help people with the disease cope with its effects.

NIAMS

Impetigo

Impetigo is an infection of the top layers of the skin and is most common among children ages 2 to 6 years. It usually starts when bacteria get into a cut, scratch, or insect bite.

Impetigo is usually caused by staphylococcus (staph) bacteria, but it also can be caused by group A streptococcus bacteria. Skin infections are usually caused by different types (strains) of strep bacteria than those that cause strep throat. Therefore, the types of strep germs that cause impetigo are usually different from those that cause strep throat.

The infection is spread by direct contact with lesions (wounds or sores) or nasal discharge from an infected person. Scratching may spread the lesions. It usually takes 1 to 3 days from the time of infection until you show symptoms. If your skin doesn’t have breaks in it, you can’t be infected by dried strep bacteria in the air.

Symptoms start with red or pimple-like lesions surrounded by reddened skin. These sores can be anywhere on your body, but mostly on your face, arms, and legs. The sores fill with pus, then break open after a few days and form a thick crust. Itching is common.

Your healthcare provider can diagnose the infection by looking at the skin lesions.

If your impetigo is caused by strep bacteria, your healthcare provider will prescribe oral antibiotics, as with strep throat. This treatment may also include an antibiotic ointment to be used on your skin.

NIH

Latex Allergies

Latex gloves have proved effective in preventing transmission of many infectious diseases to health care workers. But for some workers, exposures to latex may result in allergic reactions. Reports of such reactions have increased in recent years–especially among health care workers.

CDC

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