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Alopecia Areata
Atopic Dermatitis
Eczema
Hand Eczema
Scabies
Urticaria
Fungal infections
Psoriasis

Alopecia Areata

What is alopecia areata?


Alopecia areata (or AA) is a common type of hair loss affecting both men and women of all ages, and most often in children and young adults. It usually starts as sudden falling out of hair as one or more small round patches on any part of the body. There is no pain or itch associated with the hair loss, and a person may not be aware of it until someone else notices it.

It is most noticeable on the scalp. The hair follicles become very small. Hair growth slows down and may not grow beyond the scalp surface for months. The scalp is most commonly affected. Some lose a few bald spots that regrow hair in few months. In others, extensive patches occur. In a few people all the hair is lost (known as alopecia totalis and alopecia universalis) and may be permanent. Normally, the hair follicles retain the ability to regrow later with or without treatment and even after many years.
What causes it?


The cells of the body immune system called lymphocytes attack the hair roots leading to weakened hairs and falling out of hairs. Attack on a body tissue by our own immune system is called autoimmune process. It is not entirely understood why autoimmunity develops. There is probably a genetic predisposition and a family history is reported by some affected individuals. Diet and nutritional deficiencies do not cause AA. There is also no conclusive evidence that stress causes it though it may aggravate the hair loss.
Will AA recur?


The natural course of AA is difficult to predict. The hair may grow back completely. In many patients AA may recur after a variable period of time at the same or different sites. In some cases, especially those having extensive hair loss, partial hair regrowth occurs. Sometimes, it can take years to regrow hair. There are no known effective methods to prevent recurrences.

ATOPIC Dermatitis

What is Atopic Dermatitis?

Atopic dermatitis (AD) or atopic eczema is the most common type of eczema, affecting more than 9.6 million children and about 16.5 million adults in the United States. It’s a chronic condition that can come and go for years or throughout life, and can overlap with other types of eczema.
What are the causes of Atopic Eczema?

The cause of atopic eczema is not completely understood. Genetic factors may appear to play a strong role. The oily barrier of the skin tends to be reduced in people with atopic eczema. This leads to an increase in water loss and tendency towards dry skin. The epidermis is the first line of defence between the body and the environment. An intact epidermis keeps the environmental irritant from entering the body.

What makes Atopic Eczema itch?

Many substances have been identified as triggers for patients with atopic eczema. These triggers may not be the same for everyone. It may be difficult to identify the exact 'triggers'.

How can Atopic Eczema be prevented?

Eliminate aggravating factors:
  • Heat, perspiration and dry environment
  • Emotional stress and/or anxiety
  • Rapid and extreme temperature changes
How can Atopic Eczema be treated?
1) Avoid irritants to the skin and other 'triggers' whenever possible
  • Avoid soap and bubble baths. They can dry the skin and make it more prone to irritation. Use a soap substitute instead.
  • Avoid scratching the eczema. Keep nails short
  • Wear cotton clothes rather than fabrics such as wool.
  • Avoid getting too hot or too cold. Extreme temperatures can irritate the skin.
  • Keep household clean by regular cleaning, paying attention to your bedroom and mattress.
2) Moisturise, moisturise, moisturise
  • Use a moisturiser regularly as people with eczema tend to have dry skin.
  • Apply the moisturiser all over the areas of skin liberally.
  • Use a moisturiser at least 3 - 4 times a day and after a bath or shower.
  • Moisturise everyday. Do not stop moisturising even when the skin appears good.
  • Pat your skin dry rather than rubbing it dry after each shower or bath.]
3) Medications
  • Corticosteroids reduce inflammation of the skin.
  • Strong topical steroids may be needed to control severe flares of eczema - only for a short period of time.
  • Creams are best for moist or weepy skin.
  • Ointments are ideal for skin that is dry and thickened.
  • Oral steroids are occasionally used to treat a severe episode of eczema though this is usually not recommended on a regular basis because of potential side effects.
  • Oral antihistamines help to relieve the itch of eczema. However, they may cause drowsiness as well and may affect your daily activities.
Note: Do not stop applying moisturiser as well when you are on a course of topical steroids.
What are the causes of Atopic Dermatitis?
The cause of atopic eczema is not completely understood. Genetic factors may appear to play a strong role. The oily barrier of the skin tends to be reduced in people with atopic eczema. This leads to an increase in water loss and tendency towards dry skin. The epidermis is the first line of defence between the body and the environment. An intact epidermis keeps the environmental irritant from entering the body.
Symptoms of Atopic Eczema
  • Itching of the skin (may be more intense and noticeable at night)
  • Redness
  • Small bumps
  • Big patches
  • Skin flaking
Features of atopic eczema vary from one individual to another, and can change over time.
Features include:
  • Dry scales
  • Clogged hair follicles causing small bumps to develop, usually on the face, upper arms and thighs, known as keratosis pilaris
  • Inflammation around the lips
  • Increased skin creases on the palms and/or extra fold of skin under the eye
  • Darkening of the skin around the eye
  • In adults, it commonly affects the neck, the elbow creases, and the back of the knees
What makes Atopic Dermatitis itch?
Many substances have been identified as triggers for patients with atopic eczema. These triggers may not be the same for everyone. It may be difficult to identify the exact 'triggers'.
It may be:
  • Rough or coarse material that comes in contact with the skin
  • Extremes of temperature - too hot/too cold
  • Excessive sweating
  • Exposure to certain detergents, soaps, disinfectants
  • House dust mites
  • Upper respiratory tract infection
  • Stress
Asking for your consent
If you decide to go ahead with this surgery, you will be asked to sign a consent form. This confirms that you agree to have the procedure and understand what it involves.
What happens during Mohs’ surgery?
There are several stages to Mohs’ surgery. First, your doctor will inject the area where your tumour is, with a local anaesthetic. This numbs the area, so you will not feel any pain during surgery. It will not put you to sleep, so you will remain awake throughout the surgery. If you are particularly anxious, we can give you a mild sedative to help you relax. Please discuss this with the doctor.

We may also use anaesthetic eye drops if your tumour is near your eye.

Once the anaesthetic has taken effect, the visible (also called the clinically evident) part of the tumour is removed, along with a small margin of normal skin tissue. This tissue is taken to a laboratory where your doctor will be able to look at it under a microscope to check for cancer cells. This takes about 40-60 minutes, so a temporary dressing is applied to your wound and you are asked to sit in the waiting area.

If cancer cells are present in this tissue, you will be brought back into theatre and more tissue will be taken away and examined under the microscope. This will be repeated until all the tumour cells have been removed.

The local anaesthetic lasts for about 2 hours, and can be ‘topped up’ if needed. Because of the nature of this surgery, we are unable to tell you exactly how long your surgery will last.

How can Atopic Dermatitis be prevented?
Eliminate aggravating factors:
  • Heat, perspiration and dry environment
  • Emotional stress and/or anxiety
  • Rapid and extreme temperature changes
How can Atopic Dermatitis be treated?
1) Avoid irritants to the skin and other 'triggers' whenever possible
  • Avoid soap and bubble baths. They can dry the skin and make it more prone to irritation. Use a soap substitute instead.
  • Avoid scratching the eczema. Keep nails short
  • Wear cotton clothes rather than fabrics such as wool.
  • Avoid getting too hot or too cold. Extreme temperatures can irritate the skin.
  • Keep household clean by regular cleaning, paying attention to your bedroom and mattress.
2) Moisturise, moisturise, moisturise
  • Use a moisturiser regularly as people with eczema tend to have dry skin.
  • Apply the moisturiser all over the areas of skin liberally.
  • Use a moisturiser at least 3 - 4 times a day and after a bath or shower.
  • Moisturise everyday. Do not stop moisturising even when the skin appears good.
  • Pat your skin dry rather than rubbing it dry after each shower or bath.
3) Medications
  • Corticosteroids reduce inflammation of the skin.
  • Strong topical steroids may be needed to control severe flares of eczema - only for a short period of time.
  • Creams are best for moist or weepy skin.
  • Ointments are ideal for skin that is dry and thickened.
  • Oral steroids are occasionally used to treat a severe episode of eczema though this is usually not recommended on a regular basis because of potential side effects.
  • Oral antihistamines help to relieve the itch of eczema. However, they may cause drowsiness as well and may affect your daily activities.
Note: Do not stop applying moisturiser as well when you are on a course of topical steroids.

ECZEMA

What is eczema?

Eczema is one of the commonest rashes affecting more than 10% of the population. It is a medical term used to define a specific type of skin inflammation (spongiosis). It is often but not always itchy though the presentation can vary from simply dry, rough patches to red spots and patches to blistering to painful cracks.
There are different types of eczema:
1. Atopic eczema
  • This often starts in infancy though it can present at any age. People with atopic eczema has genetic predisposition of atopy (hyper-reactive immune system to environmental stimuli). Asthma and allergic rhinitis are often present. They often have dry skin
2. Seborrhoiec eczema
  • This is seen during first six month of life and after puberty. It is eczema presents on oily skin (scalp, face, chest, back, genitalia). It often presents as dry, peeling skin and often not as itchy as other form of eczema.
3. Contact eczema
  • This is eczema resulted from skin irritation or allergic reaction to a substance. Hand eczema seen in a housewife is often due to irritation by prolonged water and detergent contact. A person with nickel allergy may present as eczema patches on neck due to necklace containing nickel or on earlobe due to nickel containing earring.
4. Asteatotic eczema
  • This is eczema due to excessive dryness of skin. This is often seen in elderly, or people who have been overseas and exposed to climates with low humidity.
5. Endogenous eczema
  • This is a term used to describe eczema without any identifiable external factors (presumably from an unknown internal factor).
What causes eczema?
This is not entirely understood. There is likely an underlying genetic predisposition and an environmental trigger. Researchers are only beginning to identify some of these eczema genes and while the environmental factor is clear as in contact eczema, it is often not known in most cases.

Many external factors while not causing eczema can aggravate it. Such factors include dry climate, heat & sweating, dusty environment, food allergy, viral infection, vaccination, stress.
How is eczema treated?
While there is no cure for eczema, it can be treated or controlled so well that the patients can have long term remission with occasional flare only. Treatment aims to control the skin inflammation and to improve the skin barrier function.

Topical moisturiser not only hydrates the skin but improve the skin barrier function. It is particularly useful in prevention of eczema flare and thus reducing the needs for the topical corticosteroid.

Topical cortico-steroid is a very effective treatment for eczema, Used judiciously, it is very safe with negligible absorption into the body and negligible side effect on the skin itself. It comes in various strength and preparation for skin on different part of body, eczema of different severity and ease of use.

Topical calcineurine Inhibitor (tacrolimus and pimecrolimus) is a good supplementary treatment to topical cortico-steroid. It is particularly useful for eczema on face and around the eyes, and eczema needing a long period of treatment.

Oral antihistamine is often dispensed as anti-itch. Sedative anti-histamines work better than non-sedative anti-histamines. It is particularly useful if there is co-existing urticaria with the eczema. It may be given long term in the more difficult eczema.

Oral antibiotic is useful in eczema with secondary bacteria infection.

Phototherapy is a reasonable option in patients needing more intensive regimen of treatment. The need for frequent visit to a phototherapy centre (1-3 times a week) and the relatively slow onset of action make it less attractive.

Cortico-steroids, cyclosporine, azathioprine taken orally are very effective treatment but only used in the most severe cases of eczema due to potential risk of side effects.
Asking for your consent
If you decide to go ahead with this surgery, you will be asked to sign a consent form. This confirms that you agree to have the procedure and understand what it involves.
How is eczema diagnosed?
The diagnosis of eczema is often based on history and appearance of the rashes or clinical features of the rashes only.

There is no blood test which can diagnose eczema. Total IgE or eosinophil count is often raised but it is not diagnostic of eczema. Blood test (RAST test) may also be done in selected cases to evaluate for the role of allergy.

Skin prick tests and patch tests may be done in some cases to evaluate for the role of allergy in aggravating the eczema.

Occasionally, a skin biopsy is done in clinically difficult cases.

Will I have a follow-up appointment?
You will have a follow up appointment with the team that repaired your wound.

If your follow up is with us, we will usually see you one week after your surgery to check that your skin is healing well and to remove any stitches you may have. If there are any changes to this, we will advise you on the day of your surgery.

We usually see you again approximately 1 and 3 months after your wound has healed.

HAND ECZEMA

What is Eczema?

It is an inflammatory reaction to several factors, including irritating or allergic substances.
Your hand eczema may be caused by:
  • Constitutional factors inherited sensitive skin
  • Irritation from too much wet work, detergents, solvents, acids, etc
  • Allergy to a specific substance (e.g. cement, perfume, etc)
  • A combination of all of the above factors
Your doctor will:
  • Help you uncover any allergy and/or irritant that is causing or aggravating your hand eczema
  • Prescribe wet dressing, medicated creams, ointments or tablets to suppress the eczema
You on your part should:
  • Assist your doctor by telling him the substances which you come into contact with at home or at work, and in your hobby.
  • You must inform your doctor of the medication or skin care products you have applied.
  • You should also protect yourself from irritants.
When doing housework:
  • When doing wet work like washing clothes and dishes, wear rubber or PVC gloves. Do not wear the gloves for more than 30 minutes at one time. Do not wet the interior of the gloves.
  • Avoid handling fruits, vegetables, shellfish and raw meat with bare hands. Use gloves when preparing these foods.
  • Avoid handling dirty diapers with bare hands. Use gloves.
  • Never squeeze floor mops with bare hands. Change the gloves if they are wet inside.
When working with water, solvents, coolants, oils, greases, etc:
  • Try to protect your hands with gloves when it is safe to do so. Use rubber or plastic gloves. Cotton gloves are not recommended. They soak up the irritants and worsen the problem.
  • Do not use strong, medicated soap or detergent powder to wash your hands. Use gentle soap instead.
  • Do not wash your hands too often.
  • Never use solvents to clean your hands.
  • Once an allergy is detected, avoid the allergen completely.
What causes eczema?

This is not entirely understood. There is likely an underlying genetic predisposition and an environmental trigger. Researchers are only beginning to identify some of these eczema genes and while the environmental factor is clear as in contact eczema, it is often not known in most cases.

Many external factors while not causing eczema can aggravate it. Such factors include dry climate, heat & sweating, dusty environment, food allergy, viral infection, vaccination, stress.

How is eczema diagnosed?

The diagnosis of eczema is often based on history and appearance of the rashes or clinical features of the rashes only.

There is no blood test which can diagnose eczema. Total IgE or eosinophil count is often raised but it is not diagnostic of eczema. Blood test (RAST test) may also be done in selected cases to evaluate for the role of allergy.

Skin prick tests and patch tests may be done in some cases to evaluate for the role of allergy in aggravating the eczema.

Occasionally, a skin biopsy is done in clinically difficult cases.

Are there any other alternatives?
Your doctor has recommended that this is the most appropriate treatment for you. Any alternatives will have been discussed at your consultation. If you have further questions please see the contact details below/overleaf.

If your skin cancer is not treated, it will continue to grow and may require more aggressive treatment in the future.
How can I prepare for my surgery?
The letter accompanying this leaflet contains information about how to prepare for your surgery. Please make sure you read this carefully.

Please do not wear any make up or jewellery on or near the site of your surgery.
Asking for your consent
If you decide to go ahead with this surgery, you will be asked to sign a consent form. This confirms that you agree to have the procedure and understand what it involves.
What happens during Mohs’ surgery?
There are several stages to Mohs’ surgery. First, your doctor will inject the area where your tumour is, with a local anaesthetic. This numbs the area, so you will not feel any pain during surgery. It will not put you to sleep, so you will remain awake throughout the surgery. If you are particularly anxious, we can give you a mild sedative to help you relax. Please discuss this with the doctor.

We may also use anaesthetic eye drops if your tumour is near your eye.

Once the anaesthetic has taken effect, the visible (also called the clinically evident) part of the tumour is removed, along with a small margin of normal skin tissue. This tissue is taken to a laboratory where your doctor will be able to look at it under a microscope to check for cancer cells. This takes about 40-60 minutes, so a temporary dressing is applied to your wound and you are asked to sit in the waiting area.

If cancer cells are present in this tissue, you will be brought back into theatre and more tissue will be taken away and examined under the microscope. This will be repeated until all the tumour cells have been removed.

The local anaesthetic lasts for about 2 hours, and can be ‘topped up’ if needed. Because of the nature of this surgery, we are unable to tell you exactly how long your surgery will last.

What happens after the procedure?
Once all the tumour cells have been removed, there are several options for repairing your resulting wound. These will be discussed with you in more detail before your surgery. Your wound may be:
  • closed by the team who performed the micrographic surgery immediately after the tumour has been removed;
  • dressed and then repaired by a plastic surgeon at a hospital chosen by our surgeon;
  • left to heal normally; or
  • repaired at another hospital. In this case we will renew your dressing before you travel to your referring hospital. We will also give you a letter from our doctors to hand to your surgeon when you arrive at your referring hospital. You will be told how to look after your wound by the team that repairs your wound.
What are the risks?
Your doctor will explain the potential risks for this type of surgery with you in more detail, but complications include:
  • Bleeding at the site of the tumour.
  • Pain. The local anaesthetic should last until you return home. Aspirin free pain relief (such as Paracetamol) should relieve any discomfort. The doctor or nurse caring for you can give you more advice.
  • Nerve damage. Although your surgeon will try to avoid this, nerves can occasionally be damaged during surgery, leading to a numb area of skin. This is usually temporary.
  • Infection at the wound site. You will be given instructions on how to care for your wound to minimise this risk.
  • Scarring. You will have a scar after the surgery. The doctors use closure techniques to minimise the effect of this. Scars will fade over time.
What do I need to do after I go home?
Before you leave the hospital, please make sure you have been given information about how to look after your wound at home.

You will probably need to rest after the surgery for about 48 hours. If you work, we recommend that you take at least 2 days off after the surgery. We will give you more advice on the day of your surgery.
Will I have a follow-up appointment?
You will have a follow up appointment with the team that repaired your wound.

If your follow up is with us, we will usually see you one week after your surgery to check that your skin is healing well and to remove any stitches you may have. If there are any changes to this, we will advise you on the day of your surgery.

We usually see you again approximately 1 and 3 months after your wound has healed.

SCABIES

What is Scabies?

Scabies is a skin infection that is caused by a type of microscopic mite known as Sarcoptes scabiei.

Scabies is very contagious, affecting people of all races and social classes. Scabies causes pimple-like irritations known as the scabies rash. These mites burrow under the skin and lay eggs. The mites are about the size of a pinhead, are nearly transparent, and usually cannot be seen.
How does scabies spread?

Scabies is transmitted by direct, prolonged, skin-to-skin contact. A very common way to get scabies is to shake hands with an infected person. Household members and sexual partners are likely to become infected. Transmission may also occur by sharing clothings, towels and beddings.

You cannot get scabies from pets. Scabies mites only infect humans. Scabies mites can only survive for three or four days if they are away from the human body.

Scabies is contagious and can spread scabies until all the mites and eggs are killed by treatment.

Symptoms of scabies
Scabies symptoms include:
  • Itching – often severe and usually worse at night
  • Thin, irregular burrow tracks (often in zigzag or '5' pattern) made up of tiny blisters or bumps on your skin
The burrows or tracks typically appear in folds of your skin. Though almost any part of your body may be involved, in adults scabies is most often found:
  • Between fingers
  • In armpits
  • Along the inside of wrists
  • On the soles of the feet
  • Around breasts
  • Around the male genital area
  • On buttocks

Scabies treatment

It is important to start treatment immediately. The longer you wait, the more the mites will spread.

The mite can be killed rapidly by the use of effective medication e.g. benzyl benzoate emulsion, malathion or permethrin. Attention should be paid to the specific instructions on how the medication should be applied.

You may still itch for 4 to 6 weeks after treatment and this is because the body develops a reaction to the dead mite. Your doctor will prescribe antihistamine tablets and steroid creams to control the itch. DO NOT APPLY the anti-scabetic medication repeatedly and excessively.

You should also wash your clothings, bed sheets and towels after treatment since the bugs can live in them.

People who are prone to scabies
  • People who have multiple sex partners
  • Anyone who lives in crowded conditions
  • Patients and healthcare workers in hospitals and nursing homes
  • Students, teachers, and other caregivers in day-care centres
  • People who live or work in institutions or prisons
  • Patients whose immune systems are weakened by illness (e.g. HIV, organ transplant, cancers) or immune-suppressing medications
  • Elderly
Precautions to prevent other people in the household from becoming infected
  • Close contact should be avoided. All close contacts, caregivers and spouse may need to get treated if avoidance is impossible.
  • All clothes, beddings and towels used by the infected person during the three days before treatment, should be washed in hot water and preferably dried in a hot dryer.
  • Caregivers who touch an infected person should wear gloves and long sleeves to prevent mites from getting onto their hands and forearms.
Who should be treated for scabies?
  • Anyone diagnosed with scabies
  • His or her sexual partners
  • Prolonged contact to infected person
To prevent reinfection, treatment should be started at the same time should everyone in the family requires.

How soon after treatment will the patient feel better?

Itch may continue for 4 to 6 weeks. This does not mean that the infection is still active. If the itch becomes intolerable, you can inform your doctor and additional antihistamine medication may be prescribed.

How does scabies spread?
Scabies is transmitted by direct, prolonged, skin-to-skin contact. A very common way to get scabies is to shake hands with an infected person. Household members and sexual partners are likely to become infected. Transmission may also occur by sharing clothings, towels and beddings.

You cannot get scabies from pets. Scabies mites only infect humans. Scabies mites can only survive for three or four days if they are away from the human body.

Scabies is contagious and can spread scabies until all the mites and eggs are killed by treatment.

Symptoms of scabies Scabies symptoms include:
  • Itching – often severe and usually worse at night
  • Thin, irregular burrow tracks (often in zigzag or '5' pattern) made up of tiny blisters or bumps on your skin
The burrows or tracks typically appear in folds of your skin. Though almost any part of your body may be involved, in adults scabies is most often found:
  • Between fingers
  • In armpits
  • Along the inside of wrists
  • On the soles of the feet
  • Around breasts
  • Around the male genital area
  • On buttocks
Scabies treatment

It is important to start treatment immediately. The longer you wait, the more the mites will spread.

The mite can be killed rapidly by the use of effective medication e.g. benzyl benzoate emulsion, malathion or permethrin. Attention should be paid to the specific instructions on how the medication should be applied.

You may still itch for 4 to 6 weeks after treatment and this is because the body develops a reaction to the dead mite. Your doctor will prescribe antihistamine tablets and steroid creams to control the itch. DO NOT APPLY the anti-scabetic medication repeatedly and excessively.

You should also wash your clothings, bed sheets and towels after treatment since the bugs can live in them.

People who are prone to scabies
  • People who have multiple sex partners
  • Anyone who lives in crowded conditions
  • Patients and healthcare workers in hospitals and nursing homes
  • Students, teachers, and other caregivers in day-care centres
  • People who live or work in institutions or prisons
  • Patients whose immune systems are weakened by illness (e.g. HIV, organ transplant, cancers) or immune-suppressing medications
  • Elderly
Precautions to prevent other people in the household from becoming infected
  • Close contact should be avoided. All close contacts, caregivers and spouse may need to get treated if avoidance is impossible.
  • All clothes, beddings and towels used by the infected person during the three days before treatment, should be washed in hot water and preferably dried in a hot dryer.
  • Caregivers who touch an infected person should wear gloves and long sleeves to prevent mites from getting onto their hands and forearms.
How soon after treatment will the patient feel better?
Itch may continue for 4 to 6 weeks. This does not mean that the infection is still active. If the itch becomes intolerable, you can inform your doctor and additional antihistamine medication may be prescribed.

How can I prepare for my surgery?
The letter accompanying this leaflet contains information about how to prepare for your surgery. Please make sure you read this carefully.

Please do not wear any make up or jewellery on or near the site of your surgery.
Who should be treated for scabies?
  • Anyone diagnosed with scabies
  • His or her sexual partners
  • Prolonged contact to infected person
To prevent reinfection, treatment should be started at the same time should everyone in the family requires.

URTICARIA

What is Urticaria (Hives)

Urticaria, also commonly known as hives, is an itchy rash caused by tiny amount of fluid that leaks from blood vessels just under the skin surface. The rash may be triggered by an allergy, or by another factor such as heat or exercise. In most cases, the rash lasts 24-48 hours and is not serious.
Urticaria is classified as:

1. Acute urticaria
  • It develops suddenly and last less than 6 weeks. Most cases last about 24 to 48 hours. It can affect anyone at any age. Some people have recurring bouts of acute urticarial.
2. Chronic urticaria
  • It persists longer, more than 6 weeks. This is not uncommon.
What happens to the skin in urticaria?

The redness and swelling are due to changes in the small blood vessels of the skin. This leads to increased blood flow to the affected skin, and excessive fluid moves into the surrounding tissues. Histamine is the predominant chemical mediator for these changes and it causes the sensation of itch. Histamine is released by the mast cell, a special type of immune cell in the skin. Mast cells release histamine when stimulated by mast cell stimulators or activators.

What is the appearance of urticaria?

The rash usually appears suddenly and can affect any area of the skin. Small raised areas known as 'wheals' develop on the skin. These wheals appear like "mosquito bite reaction and they are extremely itchy. Each wheal is white or red and is usually surrounded by a small red area of skin called a flare.

These wheals vary in size and they make the affected area of the skin appear blotchy and red.

The rash can also appear quite dramatic if many areas of skin are suddenly affected.

Is urticaria serious?


This is usually not serious. The rash is itchy but normally fades within a day or so and causes no harm. Most people with acute urticaria do not feel unwell unless they have a cold or 'flu' that is triggering the rash. The cause of the rash is not known in more than half of the cases and it is commonly a 'one-off' event.

However, complicated cases may arise in the following situations:
  • Food allergy
  • If a food allergy is the cause then the rash is likely to return each time you eat the particular food. This is more often a 'nuisance' than serious.
  • Severe allergyp
  • People who have severe allergic reaction to peanuts, insect stings, etc often have an urticarial rash as one of the symptoms. This is in addition to other symptoms such as severe angioedema breathing difficulties, etc.
  • Chronic urticariapp
  • This means that the rash keeps coming and going on most days for 6 weeks or longer. This is not uncommon.
If you are experiencing mild hives, you can help reduce the discomfort by:
  • Taking cool showers
  • Applying cool compress
  • Wearing loose-fitting clothes
  • Avoiding strenuous activity
  • Taking an antihistamine
Meanwhile, try to find out what is triggering your hives and avoid whatever the trigger is.
What causes urticaria?
The cause of acute urticaria is frequently not found. Known triggers include:
  • Allergies
    1. Food such as nuts, strawberries, citrus fruits, egg, food additives, shellfish.
      It can occur even if you have eaten it many times before without any problem.
    2. Insect bites and stings.
    3. Medications like penicillin, aspirin, and pain killers.
  • Viral infections such as cold or 'flu' can trigger an urticarial rash in some people.
    A mild viral infection, which causes few other symptoms, probably triggers an urticarial rash that develops without an apparent cause.
  • Skin contact with 'sensitisers' can cause urticaria in some people, e.g. latex, plants, etc.
Like acute urticaria, there is usually no readily identifiable cause for chronic urticaria. It has been found that some cases of chronic urticaria may be autoimmune in nature. These patients have immune cells targeting the mast cells leading to the release of histamine.

Signs and symptoms
The most common locations for hives include:
  • Trunk
  • Limbs like arms, forearms, thighs and legs though it can affect many other areas
  • Swelling of the eyes, lips, hands, feet or genitals can sometimes occur.

    This swelling is called angioedema and it usually goes away within 24 to 48 hours. People who have severe allergic reaction to peanuts, insect stings, etc often have an urticarial rash as one of the symptoms. This is in addition to other symptoms such as severe angioedema breathing difficulties, etc. This means that the rash keeps coming and going on most days for 6 weeks or longer. This is not uncommon.
When to seek medical attention?

Before visiting your doctor, try to notice what might be triggering your hives and whether it worsens with exposure to heat, cold, pressure, vibration, etc. Try to recall any recent illnesses you may have had since some illnesses can trigger hives.

What happens to the skin in urticaria?
The redness and swelling are due to changes in the small blood vessels of the skin. This leads to increased blood flow to the affected skin, and excessive fluid moves into the surrounding tissues. Histamine is the predominant chemical mediator for these changes and it causes the sensation of itch. Histamine is released by the mast cell, a special type of immune cell in the skin. Mast cells release histamine when stimulated by mast cell stimulators or activators.
What is the appearance of urticaria?
The rash usually appears suddenly and can affect any area of the skin. Small raised areas known as 'wheals' develop on the skin. These wheals appear like "mosquito bite reaction and they are extremely itchy. Each wheal is white or red and is usually surrounded by a small red area of skin called a flare.

These wheals vary in size and they make the affected area of the skin appear blotchy and red.

The rash can also appear quite dramatic if many areas of skin are suddenly affected.
Is urticaria serious?
This is usually not serious. The rash is itchy but normally fades within a day or so and causes no harm. Most people with acute urticaria do not feel unwell unless they have a cold or 'flu' that is triggering the rash. The cause of the rash is not known in more than half of the cases and it is commonly a 'one-off' event.

However, complicated cases may arise in the following situations:
  • Food allergy
  • If a food allergy is the cause then the rash is likely to return each time you eat the particular food. This is more often a 'nuisance' than serious.
  • Severe allergyp
  • People who have severe allergic reaction to peanuts, insect stings, etc often have an urticarial rash as one of the symptoms. This is in addition to other symptoms such as severe angioedema breathing difficulties, etc.
  • Chronic urticariapp
  • This means that the rash keeps coming and going on most days for 6 weeks or longer. This is not uncommon.
If you are experiencing mild hives, you can help reduce the discomfort by:
  • Taking cool showers
  • Applying cool compress
  • Wearing loose-fitting clothes
  • Avoiding strenuous activity
  • Taking an antihistamine
Meanwhile, try to find out what is triggering your hives and avoid whatever the trigger is.

What causes urticaria?
The cause of acute urticaria is frequently not found. Known triggers include:
  • Allergies
    1. Food such as nuts, strawberries, citrus fruits, egg, food additives, shellfish.
      It can occur even if you have eaten it many times before without any problem.
    2. Insect bites and stings.
    3. Medications like penicillin, aspirin, and pain killers.
  • Viral infections such as cold or 'flu' can trigger an urticarial rash in some people.
    A mild viral infection, which causes few other symptoms, probably triggers an urticarial rash that develops without an apparent cause.
  • Skin contact with 'sensitisers' can cause urticaria in some people, e.g. latex, plants, etc.
Like acute urticaria, there is usually no readily identifiable cause for chronic urticaria. It has been found that some cases of chronic urticaria may be autoimmune in nature. These patients have immune cells targeting the mast cells leading to the release of histamine.

Signs and symptoms
The most common locations for hives include:
  • Trunk
  • Limbs like arms, forearms, thighs and legs though it can affect many other areas
  • Swelling of the eyes, lips, hands, feet or genitals can sometimes occur.

    This swelling is called angioedema and it usually goes away within 24 to 48 hours. People who have severe allergic reaction to peanuts, insect stings, etc often have an urticarial rash as one of the symptoms. This is in addition to other symptoms such as severe angioedema breathing difficulties, etc. This means that the rash keeps coming and going on most days for 6 weeks or longer. This is not uncommon.
When to seek medical attention?
Before visiting your doctor, try to notice what might be triggering your hives and whether it worsens with exposure to heat, cold, pressure, vibration, etc. Try to recall any recent illnesses you may have had since some illnesses can trigger hives.

FUNGAL INFECTIONS

Fungal infections of the skin are quite common and generally mild skin diseases. Thay are also known as ‘mycoses’ and can however become severe in very sick or otherwise immune suppressed people.

Fungal infections are caused by fungi which are parasites or saprophytes that live off organic matter.

Yeasts are a subtype of fungus that naturally lives on the skin and is harmless unless it grows out of control and leads to an infection. Areas of the skin that are moist, like folds in the skin or between the toes tend to get fungal infections as yeast easily multiplies in such conditions. Fungal infections typically live on the top layer of skin and can be prevented by keeping skin clean and dry.

If your fungal infection cannot be controlled, it is advised to seek help from a dermatologist. A dermatologist can diagnose a fungal skin infection with a simple skin exam or by scraping a small amount of skin from the affected area and examining it under a microscope.

Most fungal infections are effectively treated with medicated antifungal topical applications. These medications may also be combined with oral antifungal medications and prescription-strength corticosteroids in some cases.

Common types of fungal infections:
- Athlete’s Foot
- Ringworm
- Yeast infection

Psoriasis

Psoriasis typically appears as dry, scaly flakes on the skin. The skin cells shed and collect on the skin’s surface, causing red, flaky, crusty patches covered in silvery scales. These scales shed easily, and you may also experience intense itching and burning. It mostly occurs on the elbows, knees, lower back and scalp, though psoriasis patches can appear anywhere on the skin.

Psoriasis is a chronic autoimmune inflammatory condition that occurs when the immune system mistakes skin cells for a virus or other infection and responds by producing more skin cell growth in the area.

The condition affects both men and women equally and it tends to affect those with cardiovascular disease and metabolic syndrome. Psoriasis is mostly an inherited skin condition so if you suspect you might have psoriasis, you should check your family’s history with the condition before visiting your dermatologist. Individuals who have a parent with psoriasis are 15 percent more likely to develop it.

Psoriasis goes through cycles of improving and worsening, which is called a “flare.”
Some common triggers of outbreaks of psoriasis may include:
  • Stress
  • Infection (such as strep throat or staph)
  • Medications (lithium, beta-blockers, anti-malarial drugs)
  • Skin injuries (bruises, shaving, chafing, tattoos or sunburn)
  • Other skin conditions (scabies, blisters, dermatitis)
  • Cold weather, indoor-heating
  • Hormones
  • Smoking and excessive drinking

Treatment Of Psoriasis

There are several ways to treat psoriasis depending on the severity of the condition.

Common modes of treatment include topical applications that aim to soothe inflammation and slow down the growth of skin cells. Phototherapy, also known as light therapy, uses ultraviolet light to penetrate the skin and slow the growth of cells.

Psoriasis treatment usually starts with a mild topical cream and progresses to more powerful treatments if necessary.

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