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Pityriasis Alba

Definition

Dermatitis characterized by hypopigmentation. Erythema and scaling usuall yprecede hypopigmentation.

Age

Pityriasis alba usually occurs in children between 3 to 16 years of age. Pityriasis alba is often common in atopic individuals but notconfined to them.

Clinical features

The patch is round, oval, or irregular hypopigmented and usually not well marginated. Initially lesions are often slightly erythematous and may have fine scaling. When the erythema subsides completely persistent fine scaling and hypopigmentation is left behind. Patches range in size from 0.5 to 2 cm, may be larger on the trunk. In children are most common on the cheeks, around the mouth and chin.

Disease course

Hypopigmentation may persist formonths.

Management

  • Emollient/moisturizer
  • Mild topical corticosteroids
  • Topical tacrolimus or pimecrolimus
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Dermatitis and eczema of the eyelids

Eyelid involvement is a common feature of a topic dermatitis. Seborrheic dermatitis and contact allergy to various components of eye makeup, nail polish, fragrances, or ophthalmic medicaments maybe responsible in some cases. Cause remains obscure in some cases.

Management

  • Avoid allergens/irritants
  • Use moisturizer
  • Hydrocortisone 1% cream is often effective.
  • Tacrolimus ointment or pimecrolimus 1% cream are preferred when prolonged use is required.
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Palmoplantar hyperhidrosis

Palmoplantar hyperhidrosis

Palmoplantar hyperhidrosis commonly begins in childhood or around puberty. The sweating of the palms and soles is either continuous or phasic. When continuous, it is worse in the summer and not so clearly related to mentalstatus. When phasic, it is usually associated with minor emotionalor mental activity, and not markedly different in any season.

Complications and co-morbidities

Palmoplantar hyperhidrosis predisposes to vesicular eczema (pompholyx) and allergy to footwear constituents. Maceration of the skin in between toes maylead to both fungal and bacterial infection.

Disease course

Axillary and palmer hyperhidrosis may persist for few years, but usually spontaneously improve after the age of 25 years.

Investigations

Thyroid function is seldom contributory.

Management of hyperhidrosis

Topical anticholinergics. Topical 0.5% glycopyrronium bromide cream is useful in gustatory hyperhidrosis and at0.5–2.0% for axillary hyperhidrosis

Eccrine (Sweat) duct-blocking agents. These drugs block thedelivery of sweat to the skin surface. Formalin 1% soaks and Glutaraldehyde 10% swabbed onto the feet helps some patients, but skin staining is a concernso is suitable just for the feet. Aluminium chlorhydrates –20% aluminum chloride in absolute ethanol can be tried for axillary hyperhidrosis.

Iontophoresis. Tap water iontophoresis is a satisfactory option for palmo-planter hyperhidrosis.

Botulinum toxin A injection. Intradermal injection of BOTOX produces a marked reduction of sweating in hyperhidrotic areas. Benefit normally lasts for up to 8 months in axillary and 6 months in palmar hyperhidrosis.

Reference

Rook’s Textbook of Dermatology, Ninth Edition

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Seborrhoeic Dermatitis

Synonyms

Dandruff

Pityriasis capitisor Seborrhoeic dermatitis (SD) is a common, chronic, relapsing condition characterized by reddish scaly patches and variable itching. It affects the scalp, face and central chest-areas with a high density of sebaceous(oil) glands. On scalp without inflammation it isreferred to as dandruff or pityriasis capitis.

Malassezia (Pityrosprum) yeasts are associated with SD and cause dandruff through indirect and possibly immunological mechanisms.

Prevalence

Dandruff affects up to half of the world’s population post puberty.

Environmental factors

Dandruff (SD) occurs more commonly in winter and usually improves with sun exposure.

Clinical features

SD (dandruff) onsets in early adult life with localized inflammation and superficial flaking of the skin. It runs a chronic relapsing course. Facial involvement with fine flaking of skin with mild redness is seen around nasolabial folds,ear creases, eyelids, medial eyebrows, and in the external ear canals. Scalp involvement ranges from mild flaking to inflammatory dermatitis with thicker, yellowish, greasy scales and crusts. Involvement of the anterior eyelid margin may occur in SD and presents with flaky debris on the eyelashes.

Disease course

SD is generally considered to be a chronic complaint, with flares and requires long term treatment.

Management

There is no definitive cure for SD (dandruff). Long term maintenance treatment is required but some patients only use treatment intermittently for acute, symptomatic flares. Topical antifungals shampoos are the mainstay of therapy due to their safety in all ages.

Reference

Rook’s Textbook of Dermatology, Ninth Edition

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Xanthelasma palbebrum

Definition

Xanthelasmas are plane xanthomas that develop around the eyes.

Associated diseases

Xanthelasmas are seen in Familial Hypercholesterolemia, type III hyperlipoproteinaemia and chronic cholestasis, but are also seen in people with normal circulating lipid levels.

Clinical features

Upper eyelids and medial canthus are the most commonly affected areas. They are relatively soft and color range from pale yellow to yellow orange.

Complications and comorbidities

Xanthelasmaisan independent predictor of coronary heart disease.

Investigations

Full lipid profile and liver function test.

Management

Xanthelasmasarea cosmetic problem. Treatments options include surgical excision, topical trichloracetic acid, electrocauteryor CO2 lasers. They may often recur after treatment.

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Zoster (Herpes zoster, Shingles)

Definition

Zoster is a unilateral eruption due to reactivation of latent VZV (Varicella zoster virus).

Synonyms

  • Herpes zoster
  • Shingles

Causative organisms

Reactivation of latent VZV.

General Description

Zoster is affliction of people who have previouslyhad varicella(chickenpox). Zoster patients are infectious and in susceptible contacts of zoster, chickenpox can occur.

Age

The mean age of zoster patients is about 60 years.

Predisposing factors

An earlier infection with chickenpox(varicella) is essential before zoster. Chickenpox occurs commonly in childhood and zoster in middle to older age.

Clinical features

The first manifestation of zoster is usually varying degree of pain. Closely grouped red fluid filled lesions develop in a dermatome with a striking cut off at the midline.

Post herpetic neuralgia

The commonest sequel of zoster is postherpetic neuralgia, defined as persistence of pain more than a month after the onset of zoster. PHN increases in incidence and severity with age. It is more likely to develop if there is prolonged and severe pain associated with the eruption. The pain may be a continuous burning sensation with hyperesthesia, or a sudden shooting type, but aitchy ‘crawling’ sensation may also occur.

Disease course

The pain and symptoms subside gradually as the eruption disappears. In uncomplicated cases recovery may take 2–3 weeks in young, and 3–4 weeks inolder patients.

Management

Shingles is a self limiting infection, but it is painful, and post herpetic neuralgia may occur.

Measures to counteract the infection, provide analgesia and facilitate healing are required.

Rest and analgesia may be sufficient for mild attacks of zoster in the young. Soothing topical preparations relieve discomfort. An antiviral is required for painful zoster infections, in facial zoster and in the immunocompromised. Treatment should start as early as possible, preferably within the first 24-48 hours. Antiviral treatment prevents progression of eruption, reduces the systemic complications of zoster, and lessens the pain during treatment.

Reference

Rook’s Textbook of Dermatology Ninth Edition

17-11-2020 https://www.dermastation.com/blog/wp-content/uploads/2020/11/zoster.jpg Herpes zoster, Zoster,