What is your diagnosis?
Anatomy
Human anatomy can be precisely defined as a complementary basic medical science, which deals with the scientific study of morphology of human body. In simpler words, human anatomy is the study of structure of human body.Learn about human physiology as you study anatomical charts and models of every system in the human body!
Saturday, December 31, 2011
Friday, December 30, 2011
Benefits of having Alzheimer's disease
3:17 AM
bolty
5. You never have to watch reruns on television.
4. You are always meeting new people.
3. You don't have to remember the whines and complaints of your spouse.
2. You can hide your own Easter eggs.
1. Mysteries are always interesting.
4. You are always meeting new people.
3. You don't have to remember the whines and complaints of your spouse.
2. You can hide your own Easter eggs.
1. Mysteries are always interesting.
Friday, November 4, 2011
Spot Diagnosis 021
1:19 PM
bolty
Saturday, September 17, 2011
Dermatomyositis
10:21 AM
gagen
The association between dermatomyositis (and possibly polymyositis) and malignancy has been recognized for a long time. Dermatomyositis is a systemic disorder that frequently affects the esophagus and lungs and, less commonly, the heart. Calcinosis is a complication of dermatomyositis that is observed most often in children and adolescents.
Case no.2
6:22 AM
gagen
A 56-year-old woman presented with complaints of an ulcerating lesion at the inner corner of right eye for the past 8 months. There had been an off and on history of yellowish discharge from the lesion; occasionally it is blood tinged. She had a history of trauma with a wooden stick at the affected site, 10 months earlier. Clinically, a firm mass could be palpated. Extraocular movements were full. Slit lamp and fundus examination were within normal limits in both eyes. CT scan showing coronal and axial view is shown above.
1. The most probable diagnosis is:
a. sebaceous gland carcinoma
b. canaliculitis (Actinomyces)
c. chronic dacryocystitis with fistula
d. basal cell carcinoma
2. The treatment would be:
a. curettage of canaliculi and Amphoteracin B
b. dacryo-cystorhinostomy with stent
c. incisional biopsy
d. wide excision of the lesion with margin control
Friday, September 16, 2011
Thursday, September 15, 2011
Staring At An Eclipse Can Blind You
7:53 AM
bolty
As sunlight enters the eye, it can damage the light-sensitive nerve endings in the back of the eye -- known as the retina -- causing vision loss.
Total and partial eclipses can lead to serious damage if precautions are not taken to prevent blindness. This is why there are only a few safe ways to view an eclipse, such as with a referred image. Regular sunglasses, exposed film, and even a welder's helmet are not safe.
Waardenburg syndrome
5:04 AM
bolty
Waardenburg syndrome (WS) is an inherited disorder often characterized by varying degrees of hearing loss and changes in skin and hair pigmentation. The syndrome got its name from a Dutch eye doctor named Petrus Johannes Waardenburg who first noticed that people with differently colored eyes often had a hearing impairment. He went on to study over a thousand individuals in deaf families and found that some of them had certain physical characteristics in common.One commonly observed characteristic of Waardenburg syndrome is two differently colored eyes. One eye is usually brown and the other blue. Sometimes, one eye has two different colors. Other individuals with Waardenburg syndrome may have unusually brilliant blue eyes.
People with WS may also have distinctive hair coloring, such as a patch of white hair or premature gray hair as early as age 12. Other possible physical features include a wide space between the inner corners of eyes called a broad nasal root. In addition persons with WS may have low frontal hairline and their eyebrows may connect. The levels of hearing loss associated with the syndrome can vary from moderate to profound.Individuals with Waardenburg syndrome may have some or all of the traits of the syndrome. For example, a person with WS may have a white forelock, a patch of white hair near the forehead, and no hearing impairment. Others may have white patches of skin and severe hearing impairment. The severity of the hearing impairment varies among individuals with WS as do changes in the skin and hair.
On rare occasions, WS has been associated with other conditions that are present at birth, such as intestinal disorders, elevation of the shoulder blade, and disorders of the spine. A facial abnormality, known as cleft lip and/or palate, also has been associated with WS.
Pancoast Tumor
4:32 AM
bolty
Pancoast tumors originate at the top margin of the lung. They form an abnormal patch of tissue over the lung apex and principally involve the chest wall structures rather than the underlying lung tissue. They invade the following structures:
- Lymphatics (small, thin vessels that carry lymph fluid through the body)
- Lower roots of the brachial plexus (a complex network of nerves that is formed chiefly by the lower 4 cervical [neck] nerves and the first thoracic [chest]nerve)
- Intercostal nerves (nerves that lie between a pair of adjacent ribs)
- Stellate ganglion (a mass of nerve tissue containing nerve cells that form an enlargement on a nerve or on 2 or more nerves at their point of junction or separation)
- Sympathetic chain (either of the pair of ganglionated lengthwise cords of the sympathetic nervous system that are situated on each side of the spinal column)
- Adjacent ribs
- Vertebrae
Carcinomas (cancerous tumors) in the superior pulmonary sulcus produce the Pancoast syndrome, which is characterized by pain in the shoulder and along the inner side of the arm and hand. Pancoast tumors tend to spread to the tissue surrounding them in the early stage of the disease. As long as the cancer has not metastasized (spread) and involved the regional lymph nodes (small, bean-shaped structures found throughout the body), these tumors can be successfully treated.
Wednesday, September 14, 2011
The Man Who Can Eat Everything
5:21 AM
bolty
This basically means the guy can eat and even digest metal, glass and even toxic and poisonous material. Michel Lotito's stomach lining is twice as thick as normal, a rare condition that most doctors agree developed in the womb, though nobody is sure how. Lotito does not often suffer from ill-effects due to his diet, even after the consumption of materials usually considered poisonous.
When performing he consumes around a kilogram of material daily, preceding it with mineral oil and drinking considerable quantities of water during the 'meal'. He apparently possesses a stomach and intestine with walls of twice the expected thickness, and his digestive acids are, allegedly, unusually powerful, allowing him to digest a certain portion of his metallic meals.
Lotito even entered the Guinness book of records when he ate an airplane. The airplane took roughly two years to be 'eaten' from 1978 to 1980
Lotito even entered the Guinness book of records when he ate an airplane. The airplane took roughly two years to be 'eaten' from 1978 to 1980
See the video:
Tuesday, September 13, 2011
Surprising things that give you headaches
11:54 AM
bolty
Some people say the roots of their hair hurt when they get a headache.
But sometimes the usual suspects don't explain that pain in your head. That's because some triggers are just plain weird -- like perfume, storms, earrings -- . Here's how to identify the source of your headache so you can send it packing.
Perfume
"Strong scents bother me instantly," says Bethany Hegedus, 35, a writer and receptionist from Brooklyn, New York. She can get a headache from a whiff of Lovely by Sarah Jessica Parker or a stroll past a Yankee Candle. Her sense of smell is so acute that she can sniff out whether a co-worker has changed laundry detergents or hand lotions, a degree of sensitivity common among scent-driven headache sufferers. The headaches can be fleeting if exposure is brief -- or they can last all day.
Why it hurts: Strong odors may activate the nose's nerve cells, which stimulate the nerve system associated with head pain. Ironically, the offending scents are often pleasant, says Vincent Martin, M.D., a headache specialist at the University of Cincinnati College of Medicine.
What to do: Avoid perfumes, strong household cleansers, fragranced soaps and shampoos, and air fresheners. That's a challenge when just about everything these days is "Clothesline Clean" or "Citrus Fresh," but Hegedus does her best with unscented laundry detergent and deodorant, and wears no fragrances. At the office, she politely asks colleagues not to wear heavy perfumes. And if all else fails? "I keep a bottle of Excedrin Extra Strength at my desk," she says. Health.com: A power punch against headaches
That remedy has aspirin, acetaminophen and caffeine, a combination endorsed by several medical organizations for migraine and tension headaches. However, you might want to try aspirin or acetaminophen individually rather than mixed together with caffeine, says Andrew Charles, M.D., director of the Headache Research and Treatment Center at the University of California, Los Angeles, School of Medicine. Frequent use of medicines with caffeine can lead to dependency and "rebound" headaches, the kind that come right back as soon as the meds wear off. Aspirin, ibuprofen, and naproxen treat pain and the inflammation often associated with headaches. Acetaminophen fights pain, but not inflammation. (Another caveat: If over-the-counter meds don't help, a trip to the neurologist may be needed, Martin says.)
Weather
Studies show that the headache-prone are especially attuned to changes in barometric pressure, rising temperatures, high humidity, lightning, and cloudy skies. Rebecca Kinney, a 31-year-old librarian from Newton, Massachusetts, calls herself a human barometer. Gray skies and rain on the way trigger excruciating pain. "The headache is usually on one side of my head, and it pulsates, as if someone is drilling into me," she says.
Why it hurts: The meteorological shifts are thought to trigger chemical and electrical changes in the brain that irritate nerves -- sometimes causing fairly dramatic pain. In fact, "50 to 60 percent of migraine patients will identify a weather change as the trigger for their headaches," Martin says.
What to do: On bad-weather days, Kinney puts an ice compress on her eyes in the morning. "Sometimes I can catch the headache before it gets worse," she says. Another trick: Record your symptoms and the weather to piece together patterns. Then check out the "Aches and Pains" forecast on Weather.com; it breaks down how the day is dawning in terms of temperature, barometric pressure, and wind patterns. Pretreat with 400 milligrams of ibuprofen a day or two before expected weather changes, says Mark W. Green, M.D., director of headache medicine at Columbia University. (Naproxen or aspirin may work, as well.) Health.com: Take that! for pain
Earrings, headbands, and ponytails
Some people say the roots of their hair hurt when they get a headache. Kinney describes it as a "hair cramp." Other women swear that their earrings can lead to head pain. And they're all correct!
Why it hurts: The muscle groups around your scalp don't have pain fibers, but their connective tissues do. "Ponytail headaches" result when tightly pulled hair irritates the muscle system. And your swingy updo isn't the only thing contributing to your pain: Tight-fitting hats, headbands, and heavy earrings are also culprits, says Stephen Silberstein, M.D., director of the Jefferson Headache Center at Thomas Jefferson University in Philadelphia, Pennsylvania. Why earrings? It's possible that earrings can pull on that same connective tissue. But some studies suggest that skin sensitivity around your scalp, face, and ears often accompanies a migraine. The earring supersensitivity could be a sign that a migraine's coming, but not the cause of the headache.
What to do: It probably didn't take a study in the journal Headache to tell you that loosening your ponytail relieves a ponytail ache. Researchers have found that this simple action decreased headache pain within 30 minutes, and, in some cases, instantly. Kinney makes a conscious effort to reposition her ponytail throughout the day. Typically, the thicker your hair or the heavier your headwear, the more likely you'll experience this type of headache. Best bet: Save tight updos and heavy earrings for nights out, when you won't be wearing them for long. Health.com: Best new pain cures for women
Hunger
There's a reason some nutrition gurus recommend that we eat several small meals a day: It keeps our blood sugar on an even keel. Dieting, fasting, skipping lunch -- they all can cause you to bottom out, which may trigger a headache.
Why it hurts: Experts believe low blood sugar may stimulate nerve pathways that bring on these common headaches, but the exact mechanism is murky.
What to do: Uh, eat? Exactly. But remember that what you grab may play a role in whether your headache returns. "Sugar headaches" may occur when we binge on sweets on an empty stomach. The spike in blood sugar ratchets insulin levels, which eventually cause blood sugar to sink even lower. Instead, balance a protein with a complex carbohydrate, such as fish and brown rice, or a snack of whole-wheat toast with almond butter. Martin adds that eating foods rich in magnesium (spinach, beans, nuts, and seeds) and riboflavin (dairy products, lean meats, leafy greens, enriched breads and cereals) may prevent and alleviate head pain. Riboflavin is a B vitamin; large doses are thought to help prevent migraines.
Bear in mind, too, that cheese, chocolate, lunch meats, caffeine, and additives such as monosodium glutamate (MSG) may trigger headaches. In general, if you suffer from moderate, severe, or frequent headaches (more than two a week), consult a headache specialist about your diet. You may need to keep a food diary to hunt for culprits. Health.com: Could painkillers be hurting your heart?
Monday, September 12, 2011
Saturday, September 10, 2011
Chimera
6:38 AM
bolty
Many more people are microchimeras and carry smaller numbers of foreign blood cells that may have passed from mother across the placenta, or persist from a blood transfusion. In vitro fertilization (IVF) is also contributing to the number of human chimeras. To improve success rates, two or more embryos are placed in the uterus so women who have IVF have more twin pregnancies than usual. More twins mean more chimeras.
In Greek mythology, the Chimera was an awesome fire-breathing monster with the head of a lion, the body of a goat, and the tail of a serpent. The Chimera was killed by the hero Bellerophon mounted, in most versions of the tale, on Pegasus, the winged horse.
Mysterie people
6:22 AM
bolty
 |
| Chimera |
Instead she received a hammer blow. The letter told her outright that two of her three sons could not be hers. What was going on?
It took Kruskall and her team two years to crack the riddle. In the end they discovered that Jane is a chimera, a mixture of two individuals - non-identical twin sisters - who fused in the womb and grew into a single body. Some parts of her are derived from one twin, others from the other. It seems bizarre that this can happen at all, but Jane's is not an isolated case. Around 30 similar instances of chimerism have been reported, and there are probably many more out there who will never discover their unusual origins.
Spot Diagnosis 005
1:29 AM
bolty
Neurological examination revealed a marked central and peripheral hypotonia and normal deep tendon reflexes in his arms and legs. His skin was dry and lax, and his hair was quite coarse and wiry.There were no abnormal birthmarks.
The complete blood count and levels of electrolytes, calcium, magnesium, phosphate, albumin, pre-albumin,total protein, liver enzymes, blood urea nitrogen and creatinine were all within normal limits. The serum copper level was 7.1 μmol/L, and the ceruloplasmin level was 120 mg/L.
Friday, September 9, 2011
The Girl Who Was "Born" Twice
1:26 PM
bolty
They brought the baby about 80% out of her mother’s womb, excised the tumor, and then tucked her back in. Ten weeks later, in May 2008, Macie Hope McCartney was born—again. And this time for good.
Source : http://www.cbsnews.com/stories/2008/06/06/eveningnews/main4161410.shtml
Spot Diagnosis 003
12:55 PM
bolty
The patient was diagnosed with multiple myeloma 3 years earlier.
What is the diagnosis of the eye lesions ?
Thursday, September 8, 2011
Spot Diagnosis 002
4:32 AM
bolty
What is your diagnosis?
Tuesday, September 6, 2011
Treatment And Prognosis for Stevens-Johnson Syndrome
12:55 PM
bolty
Systemic Corticosteroids. Systemic steroid therapy has been the accepted treatment for SJS-TEN for years. It is believed to suppress the intensity and the extension of the necrolytic process in the skin as well as in internal organs.
Conversely, the use of steroids has also almost become a contraindicated mode of therapy. They were regarded as being hazardous, owing to reports of iatrogenic decrease of host resistance, increase of morbidity and complications, prolonged recovery and reduced survival, following their use.
Parallel to the change in regard to steroid treatment in SJS-TEN, the management of this severe disease was shifted to specialized burn centers and was taken over by nondermatologists, mostly surgeons, who sometimes erroneously regarded SJS-TEN and burns as similar entities. However, in terms of etiology and pathogenesis, a burn is a one-time acute event that affects the skin from the outside, whereas SJS-TEN is a more complex, probably immune (T lymphocyte)-mediated process that reaches the skin from within. The disease process continues to progress over a period of several days after first appearance.
Today, in the absence of clinical control trials, most authors believe that systemic steroids are of unproven benefit in early forms of and are clearly harmful in advanced SJS-TEN.
Intravenous Immunoglobulin. As mentioned previously, the results of IVIg treatment are not uniform in all reports. It should be avoided in patients with renal failure, as increased mortality has been observed. Thus, currently intravenous immune globulin is not considered part of the standard of care for TEN.
In conclusion, optimal treatment for the SJS-TEN spectrum remains to be clarified. To date, no specific treatment has been proven to be beneficial for SJS-TEN. The best management is early recognition, prompt withdrawal of causative drugs and supportive care.
Prognosis
In order to rank severity and predict prognosis in TEN patients, the severity-of-illness score (SCORTEN), was developed. The score is a mathematical tool consisting of the sum of seven clinical variables (age, history of malignancy, heart rate, initial epidermal detachment, admission blood urea nitrogen, glucose levels and serum bicarbonate) as prognostic factors.
The SJS-TEN spectrum is an acute illness with potentially life-threatening complications. Reported mortality rates are 5% with SJS, 10-15% with overlap forms and 30-35% with TEN. Most deaths in patients with TEN are a result of sepsis-induced organ failure.
TEN might also result in late complications, such as transitory hyper- and/or hypopigmentation, scarring primarily due to pressure or secondary infections, alopecia, anonychia and sicca-like syndrome. Phimosis and vaginal synechiae may also be present. Ocular sequelae affecting up to 40% of the survivors may cause corneal lesions, which may result in severe impairment of vision. Therefore, intensive ophthalmologic follow-up and treatment is mandatory in patients with the SJS-TEN spectrum.
< Diagnosis
Diagnosis Of Stevens-Johnson Syndrome
12:44 PM
bolty
Doctors often can identify Stevens-Johnson syndrome based on your medical history, a physical exam and the disorder's distinctive signs and symptoms. To confirm the diagnosis, your doctor may take a tissue sample of your skin (biopsy) for examination under a microscope.
No specific laboratory studies (other than biopsy) exist that can definitively establish the diagnosis of Stevens-Johnson syndrome.
- A complete blood count (CBC) may reveal a normal white blood cell (WBC) count or a nonspecific leukocytosis. A severely elevated WBC count indicates the possibility of a superimposed bacterial infection.
- Skin and blood cultures have been advocated because the incidence of serious bacterial bloodstream infections and sepsis contribute to morbidity and mortality.
- Determine renal function and evaluate urine for blood.
- Electrolytes and other chemistries may be needed to help manage related problems.
- Cultures of blood, urine, and wounds are indicated when an infection is clinically suspected.
- Bronchoscopy, esophagogastroduodenoscopy (EGD), and colonoscopy may be indicated.
Skin biopsy is the definitive diagnostic study but is not an emergency department (ED) procedure.
- Skin biopsy specimens demonstrate that the bullae are subepidermal.
- Epidermal cell necrosis may be noted.
- Perivascular areas are infiltrated with lymphocytes.
< Causes Treatment >
Causes Of Stevens-Johnson Syndrome
12:22 PM
bolty
The most common medicines that may cause SJS are:
- Antibiotics (used to treat infection)
- Anti-seizure medicines (used to treat convulsions).
- Non-steroidal anti-inflammatory medicine (used to treat swelling or fever)
- Penicillins, which are used to treat infections
- Infections
- Drug Reactions
- Malignancies
- Unknown Causes.
Bacterial infections include diphtheria, Brucellosis, mycobacteriae, mycoplasma pneumonia and typhoid. Fungal infections previously associated with SJS include coccidioidomycosis, dermatophytosis and histoplasmosis. Certain types of protozoal infections, including malaria and trichomoniasis, have also been reported. Although Stevens Johnson Syndrome is relatively rare in children, it has been associated with Epstein-Barr virus.
< Symptoms Diagnosis >
Symptoms of Stevens-Johnson Syndrome
5:28 AM
bolty
A painful conjunctivitis may occur in the eye, frequently with a pus discharge, and can lead to corneal scarring and loss of vision. In addition to the mucous membrane lesions, fever and exhaustion are usual.
Approximately one-third of patients have pulmonary involvement with cough and patchy infiltrates (material that has permeated into the tissues) on chest x-ray. In fatal cases, renal failure and pneumonia may occur.
Signs and symptoms of Stevens-Johnson syndrome include:- Facial swelling
- Tongue swelling
- Hives
- Skin pain
- A red or purple skin rash that spreads within hours to days
- Blisters on your skin and mucous membranes, especially in your mouth, nose and eyes
- Shedding (sloughing) of your skin
Up to two weeks before SJS sores appear on your mouth and skin,
you may have the following symptoms:
- Cough
- Fatigue (sleepiness)
- Fever and chills
- Headache.
- Muscle and joint pain
- Sore throat
- Nausea, vomiting, constipation, or diarrhea
- Mild dizziness or drowsiness
- Tender or swollen glands
- Swollen or painful gums
- Headache
- Muscle twitches
- Increased facial hair
- Swelling of breasts
- Insomnia
When to see a doctor
Stevens-Johnson syndrome requires immediate medical attention. Seek emergency medical care if you experience any of the following signs or symptoms:
- Unexplained widespread skin pain
- Facial swelling
- Blisters on your skin and mucous membranes
- Hives
- Tongue swelling
- A red or purple skin rash that spreads
- Shedding of your skin
Stevens-Johnson syndrome
5:18 AM
bolty
Stevens-Johnson syndrome presents a medical emergency that usually requires hospitalization. Treatment focuses on eliminating the underlying cause, controlling symptoms and minimizing complications.
Recovery after Stevens-Johnson syndrome can take weeks to months, depending on the severity of your condition. If your doctor determines that your case of Stevens-Johnson syndrome was caused by medication, you'll need to permanently avoid the medication and all others related to it.
Wednesday, August 31, 2011
What Causes Acne?
12:12 PM
bolty
 |
| How Acne Develops |
Acne happens when sebaceous (oil) glands attached to the hair follicles are stimulated at the time of puberty by elevated levels of male hormones. Sebum (oil) is a natural substance which l
ubricates and protects the skin. Associated with increased oil production is a change in the manner in which the skin cells mature so that they are predisposed to clog the follicular openings or pores. The clogged hair follicle gradually enlarges, producing a bump. As the follicle enlarges, the wall may rupture, allowing irritating substances and normal skin bacteria access into the deeper layers of the skin, ultimately producing inflammation.
Inflammation near the skin's surface produces a pustule; deeper inflammation results in a papule (pimple); deeper still and it's a cyst. If the oil breaks though to the surface, the result is a "whitehead." If the oil accumulates melanin pigment or becomes oxidized, the oil changes from white to black, and the result is a "blackhead." Blackheads are therefore not dirt and do not reflect poor hygiene.
Here are some factors that don't usually play a role in acne:
- Heredity: With the exception of very severe acne, most people do not have the problem exactly as their parents did. Almost everyone has some acne at some point in their life.
- Food: Parents often tell teens to avoid pizza, chocolate, greasy and fried foods, and junk food. While these foods may not be good for overall health, they don't cause acne or make it worse. Although some recent studies have implicated milk and pure chocolate in aggravating acne, these findings are very far from established
- Dirt: As mentioned above, "blackheads" are oxidized oil, not dirt. Sweat does not cause acne, therefore, it is not necessary to shower instantly after exercise for fear that sweat will clog pores. On the other hand, excessive washing can dry and irritate the skin.
- Stress: Some people get so upset by their pimples that they pick at them and make them last longer. Stress, however, does not play much of a direct role in causing acne.
- Pressure: In some patients, pressure from helmets, chin straps, collars, suspenders, and the like can aggravate acne.
- Drugs: Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone [Deltasone, Orasone, Prednicen-M, Liquid Pred] or the steroids that bodybuilders or athletes take). Other drugs that can cause or aggravate acne are anticonvulsant medications and lithium (Eskalith, Lithobid), which is used to treat bipolar disorder. Most cases of acne, however, are not drug related.
- Occupations: In some jobs, exposure to industrial products like cutting oils may produce acne.
- Cosmetics: Some cosmetics and skin-care products are pore clogging ("comedogenic"). Of the many available brands of skin-care products, it is important to read the list of ingredients and choose those which have water listed first or second if you are concerned about acne. These "water-based" products are usually safe.
Treatment for Acna
12:09 PM
bolty
If you haven't been able to control your acne adequately, you may want to consult a primary-care physician or dermatologist. The goal of treatment should be the prevention of scarring (not a flawless complexion) so that after the condition spontaneously resolves there is no lasting sign of the affliction. Here are some of the options available:- Topical (externally applied) antibiotics and antibacterials: These include erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone),clindamycin (BenzaClin, Duac), sulfacetamide (Klaron), and azelaic acid(Azelex or Finacea).
- Retinoids: Retin-A (tretinoin) has been around for years, and preparations have become milder and gentler while still maintaining its effectiveness. Newer retinoids include adapalene (Differin) and tazarotene (Tazorac). These medications are especially helpful for unclogging pores. Side effects may include irritation and a mild increase in sensitivity to the sun. With proper sun protection, however, they can be used even during sunny periods. In December 2008, the U.S. FDA approved the combination medication known as Epiduo gel, which contains the retinoid adapalene along with the antibacterial cleanser benzoyl peroxide. This once-daily prescription treatment was approved for use in patients 12 years of age and older.
- Oral antibiotics: Doctors may start treatment with tetracycline(Sumycin) or one of the related "cyclines," such as doxycycline(Vibramycin, Oracea, Adoxa, Atridox and others) and minocycline(Dynacin, Minocin). Other oral antibiotics that are useful for treating acne are cefadroxil (Duricef), amoxicillin (Amoxil, DisperMox, Trimox), and the sulfa drugs.
- Problems with these drugs can include allergic reactions (especially sulfa), gastrointestinal upset, and increased sun sensitivity. Doxycycline, in particular, is generally safe but can sometime cause esophagitis (irritation of the esophagus, producing discomfort when swallowing) and an increased tendency to sunburn.
- Despite many people's concerns about using oral antibiotics for several months or longer, such use does not "weaken the immune system" and make them more susceptible to infections or unable to use other antibiotics when necessary.
- Recently published reports that long-term antibiotic use may increase the risk of breast cancer will require further study, but at present they are not substantiated. In general, doctors prescribe oral antibiotic therapy for acne only when necessary and for as short a time as possible.
- Oral contraceptives: Oral contraceptives, which are low in estrogen to promote safety, have little effect on acne one way or the other. Some contraceptive pills have been to shown to have modest effectiveness in treating acne. Those FDA approved for treating acne are Estrostep,Ortho Tri-Cyclen, and Yaz. Most dermatologists work together with primary physicians or gynecologists when recommending these medications.
- Spironolactone (Aldactone): This drug blocks androgen (hormone) receptors. It can cause breast tenderness, menstrual irregularities, and increased potassium levels in the bloodstream. It can help some women with resistant acne, however, and is generally well-tolerated in the young women who need it.
- Cortisone injections: To make large pimples and cysts flatten out fast, doctors inject them with a form of cortisone.
- Isotretinoin: (Accutane was the original brand name; there are now several generic versions in common use, including Sotret, Claravis, and Amnesteem.) Isotretinoin is an excellent treatment for severe, resistant acne and has been used on millions of patients since it was introduced in Europe in 1971 and in the U.S. in 1982. It should be used for people with severe acne, chiefly of the cystic variety, which has been unresponsive to conventional therapies like those listed above. The drug has many potential serious side effects and requires a number of unique controls before it is prescribed. This means that isotretinoin is not a good choice for people whose acne is not that bad but who are frustrated and want "something that will knock acne out once and for all."
- Used properly, isotretinoin is safe and produces few side effects beyond dry lips and occasional muscle aches. This drug is prescribed for five to six months. Fasting blood tests are monitored monthly to check liver function and the level of triglycerides, substances related to cholesterol, which often rise a bit during treatment, but rarely to the point where treatment has to be modified or stopped.
- Even though isotretinoin does not remain in the body after therapy is stopped, improvement is often long-lasting. It is safe to take two or three courses of the drug if unresponsive acne makes a comeback. It is, however, best to wait at least several months and to try other methods before using isotretinoin again.
- Isotretinoin has a high risk of inducing birth defects if taken by pregnant women. Women of childbearing age who take isotretinoin need two negative pregnancy tests (blood or urine) before starting the drug, monthly tests while they take it, and another after they are done. Those who are sexually active must use two forms of contraception, one of which is usually the oral contraceptive pill. Isotretinoin leaves the body completely when treatment is done; women must be sure to avoid pregnancy for one month after therapy is stopped. There is, however, no risk to childbearing after that time.
- Other concerns include inflammatory bowel disease and the risk of depression and suicide in patients taking isotretinoin. Government oversight has resulted in a highly publicized and very burdensome national registration system for those taking the drug. This has reinforced concerns in many patients and their families have that isotretinoin is dangerous. In fact, large-scale studies so far have shown no convincing evidence of increased risk for those taking isotretinoin compared with the general population. It is important for those taking this drug to report changes in mood or bowel habits (or any other symptoms) to their doctors. Even patients who are being treated for depression are not barred from taking isotretinoin, whose striking success often improves the mood and outlook of patients with severe disease.
- Laser treatments: Recent years have brought reports of success in treating acne using lasers and similar devices, alone or in conjunction with photosensitizing dyes. It appears that these treatments are safe and can be effective, but it is not clear that their success is lasting. At this point, laser treatment of acne is best thought of as an adjunct to conventional therapy, rather than as a substitute.
- Chemical peels: Whether the superficial peels (like glycolic acid) performed by aestheticians or deeper ones performed in the doctor's office, chemical peels are of modest, supportive benefit only, and in general, they do not substitute for regular therapy.
- Treatment of acne scars: For those patients whose acne has gone away but left them with permanent scarring, several options are available. These include surgical procedures to elevate deep, depressed acne scars and laser resurfacing to smooth out shallow acne scars. Newer forms of laser resurfacing ("fractional resurfacing") are less invasive and heal faster than older methods, although results are less complete and they may need to be repeated three or more times. These treatments can help, but they are never completely successful at eliminating acne scars.
What are other things you can do for acne?
- Cosmetics: Don't be afraid to hide blemishes with flesh-tinted coverups or even foundation, as long at it is water-based (which makes it noncomedogenic). There are many quality products available.
- Facials: While not absolutely essential, steaming and "deep-cleaning" pores is useful, both alone and in addition to medical treatment, especially for people with "whiteheads" or "blackheads."Having these pores unclogged by a professional also reduces the temptation to do it yourself.
- Pore strips: Pharmacies now carry, under a variety of brand names, strips which you put on your nose, forehead, chin, etc., to "pull out" oil from your pores. These are, in effect, a do-it-yourself facial. They are inexpensive, safe, and work reasonably well if used properly.
- Toothpaste? One popular home remedy is to put toothpaste on zits. There is no medical basis for this. Ditto for vinegar.
- Cleanse twice daily with a 5% benzoyl peroxide wash. An alternative for those who are allergic to benzoyl peroxide is 2% salicylic acid.
- Apply a gel or cream containing 5% benzoyl peroxide; an alternative is sulfur or resorcinol.
- At night, apply a spot cream containing sulfur to the affected areas.
- Use a light skin moisturizer and water-based oil-free makeup.
Diagnose Acne
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There is no medical test used to diagnose acne. A diagnosis is made only with a visual examination. Most people can recognize and diagnose acne themselves; however, there is a tendency to overreact. One zit or one pimple does not constitute a full-blown case of the disease.However, if you are unsure if what you are experiencing is acne, or if your acne seems severe, see your dermatologist.
Some skin conditions can look remarkably similar to acne, although their causes and treatments are different. Do you have acne or an acne look-alike condition? If you are unsure, it is always wise to consult with a doctor. Common skin conditions that can be mistaken for acne include:
- Rosacea - Causes red, flushed skin with papules and pustules, especially in the nose and cheek area.
- Folliculitis - Bumps or pustules caused by inflammation of the hair follicle.
- Keratosis pilaris - Small, rough, "goose-flesh" like bumps most often found on the upper arms, thighs and buttocks, and sometimes the face.
- Miliaria rubra - Small red bumps on the surface of the skin caused by excessive heat exposure. Also known as heat rash.
Signs And Types Of Acne
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Comedones (whiteheads and blackheads) are created when the openings of hair follicles become clogged and blocked with oil secretions, dead skin cells and sometimes bacteria. When comedones (kom-uh-DOE-neze) are open at the skin surface, they're called blackheads because of the dark appearance of the plugs in the hair follicles. When comedones are closed, they're called whiteheads — slightly raised, skin-colored bumps.
Papules are small raised bumps that signal inflammation or infection in the hair follicles. Papules may be red and tender.
Pustules are red, tender bumps with white pus at their tips.
Nodules are large, solid, painful lumps beneath the surface of the skin. They're formed by the buildup of secretions deep within hair follicles.
Cysts are painful, pus-filled lumps beneath the surface of the skin. These boil-like infections can cause scars.
When to see a doctor
Acne usually isn't a serious medical condition. But you may want to seek medical treatment from a dermatologist for persistent pimples or inflamed cysts to avoid scarring or other damage to your skin. If acne and the scars it may have left are affecting your social relationships or self-esteem, you may also want to ask a dermatologist if your acne can be controlled or if your scars can be diminished.
Acne
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Acne (acne vulgaris, common acne) is a disease of the hair follicles of the face, chest, and back that affects almost all males and females during puberty; the only exception being teenage members of a few primitive isolated tribes living in Neolithic societies. It is not caused by bacteria, although bacteria play a role in its development. It is not unusual for some women to develop acne in their mid- to late-20s.Acne can be distressing and annoyingly persistent. Acne lesions heal slowly, and when one begins to resolve, others seem to crop up.
Acne appears on the skin as:
- congested pores ("comedones"), also known as blackheads or whiteheads,
- tender red bumps also known as pimples or zits,
- pustules, and occasionally as
- cysts (deep pimples, boils).
