Category Archives: Skin in Systemic Diseases

Signs & Symptoms of Psoriasis

By Dr Hanish Babu, MD, Dermatologist & Venereologist, City Medical Centre Ajman and Cosmolaser Medical Centre, Sharjah, UAE.

COMMON PRESENTATIONS OF PSORIASIS

clinical types of psoriasis
Clinical Types of Psoriasis

 Psoriasis signs and symptoms vary according to the morphology, stage and anatomical site of involvement of the psoriasis rashes, which are typically scaly plaques on a red base of skin.

Psoriasis is characterised by the development of erythematous (reddish), well defined, dry, scaly, papules and plaques of sizes ranging from a pin head to palm sized or larger. Lesions have a full rich red (salmon) color in the skin of Caucasians. Rarely, lesions on the legs or trunk may show a violaceous or bluish hue.

Psoriasis usually begins as small, erythematous, scaly papules that gradually enlarge to form well demarcated, raised, erythematous plaque with a scaly surface.

The scales in psoriasis are typically silvery white, dry, brittle and arranged in a lamellated fashion. This silvery white color is due to refraction of light through the air trapped in between the scales. The upper scales fall off in large quantities, while the lower layers of scales are firmly fixed.

Grattage Test

Auspitz sign in Psoriasis

Gentle scrapping of the surface of a psoriasis plaque with a glass slide will remove the loosely attached scales and reveal a shiny surface peppered with fine bleeding points. These bleeding points represent the dilated and tortuous capillary blood vessels in the papillary dermis, one of the characteristic pathological events taking place in psoriasis affected skin. This sign is known as Auspitz sign, which is a diagnostic sign of psoriasis.

The number of lesions in psoriasis may be a few or numerous. When multiple, they are arranged in a symmetrical fashion on the body.

The commonest sites for psoriasis are the extensor surfaces of the elbows and knees, low back (sacrum), and the scalp, but any part of the body may be involved.

Nail and joints may also be involved in psoriasis. Progressive painful joint swelling is seen in 10-30% of psoriasis patients.

Another characteristic of psoriasis is the Koebner phenomenon, whereby, new psoriasis lesions appear on areas of skin injury. The injury should reach the level of dermis for the Koebner phenomenon to appear. Superficial scratches involving the epidermis alone will not produce new psoriatic rashes.

Psoriasis derived its name from Sora (Gr), meaning itching. Itching is a prominent symptom in most cases, but varies greatly in intensity from case to case. Some patients do not experience itching at all. In the eruptive stage, when new lesions appear and the present ones progressively enlarge, a warm, burning sensation may be felt by the patient.

Clinical Types of Psoriasis

Depending upon distinct morphological and anatomical characteristics, psoriasis may be divided into different clinical types.

Depending upon the sites of involvement, psoriasis may be classified as scalp psoriasis, trunk psoriasis, flexural psoriasis, palmo-plantar psoriasis, psoriasis glans and nail psoriasis.

Common morphological clinical types of psoriasis are: guttate psoriasis, common plaque psoriasis, inverse or flexural psoriasis, pustular psoriasis and erythrodermic psoriasis.

Guttate Psoriasis

guttate psoriasis
Guttate Psoriasis

Guttate Psoriasis is a special variant which primarily occurs in children and young people following a streptococcal throat infection. Drop-like, scaly patches appear on the entire body. In many cases, the condition disappears by itself after a few weeks or months. This type of psoriasis responds very well to systemic antibiotics.

Common Plaque Psoriasis

Psoriasis Vulgaris
Plaque Psoriasis

Plaque psoriasis is the commonest type of psoriasis, also known as psoriasis vulgaris, occurring in about 80% of psoriasis patients. Common plaque psoriasis usually begins as small, erythematous, scaly papules that gradually enlarge to form well demarcated, raised, erythematous plaque with a scaly surface.

 Inverse or Flexural Psoriasis

This type of psoriasis occurs in skin folds (flexures). Red, itchy plaques appear in the armpits, under the breasts, on the stomach, in the groin or on the buttocks. The plaques are often infected by the yeast-like fungus candida albicans. Scales are usually absent in inverse psoriasis.

Psoriasis Nails

Psoriasis of the nail often manifests itself as small indentures in the nails. These are known as nail pits. Nail pits , though, is not a feature of psoriasis alone, many other skin conditions like alopecia areata can be associated with nail pits.

Psoriasis Nail with Pits

When the nail involvement is severe, the  nail thickens and crumbles away. Nail involvement is most common when psoriatic joint (psoriatic arthritis) involvement is present.

Psoriasis of the Scalp

Scalp Psoriasis

Psoriasis of the scalp can be difficult to distinguish from a severe case of dandruff or seborrheic dermatitis, and sometimes the two occur simultaneously. Thick scaly plaques localised to certain areas are typical of psoriasis scalp.

Pustular Psoriasis

Pustular Psoriasis

Pustular psoriasis is a rare variant where the inflammation is so severe that, in addition to the usual lesions, blisters or pustules containing fluid appear on the skin. This can be localised to the palms and soles or generalised, spreading all over the body

Erythrodermic Psoriasis

Erythrodermic Psoriasis

Erythrodermic psoriasis is the most severe form of psoriasis, which resembles a bad case of severe sunburn with redness, scaling and swelling of the skin all over the body.

Psoriatic Arthritis

Psoriatic Arthritis

In around  10 to 30% psoriasis patients, a debilitating joint disease, known as Psoriatic Arthritis may develop. It causes inflammation in and around the joints and affects an estimated 28 million psoriasis patients. People with psoriatic arthritis experience progressive joint pain and swelling, which is often coupled with scaly, red skin lesions on other areas of the body.

Clinical Types of Psoriasis According to Activity

Acute eruptive: This is the guttate variety which suddenly appears all over the body

Chronic progressive: The common plaque psoriasis, also known as psoriasis vulgaris. This gradually progress in size and number.

Chronic stationary :When the psoriasis lesions remain stationary without increasing in size and with a dull red colour and minimal scaling, this is a stationary stage. This stage usually precedes the regressive stage.

Chronic regressive: With or (sometimes)without treatment, psoriasis lesions gradually become thin, scaling reduces, the red color changes from dull red to violaceous and gradually fade. In those who have used steroids or ultraviolet radiation, a hypopigmented (whitish) ring known as Woronoff’s ring may be seen surrounding the lesion.

Choice of treatment differs  for each of these types of psoriasis.

Read more about Psoriasis:

Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available for diagnosis and treatment of common skin, hair and nail diseases. No diagnosis should be made or treatment undertaken without first consulting your dermatologist. If you do so, the author will not be responsible for any consequences. The images provided are for illustration purpose only and should not be reproduced without the consent of the author.

About the Author of Skin Care Tips from Dermatologist: Dr Hanish Babu, MD
Dr Hanish Babu, MD, Dermatologist, Sharjah and Ajman, UAE
Dr Hanish Babu, MD

Dr Hanish Babu, MD is a dermatologist with more than 3 decades of experience in treating skin and sexually transmitted diseases in UAE and India. He has been practicing in UAE since last 22 years. He is a respected speaker during the Continuing Medical education Programmes for doctors, medical students and paramedical staff and is also a Stress Management Trainer. He organises group therapy sessions for patients with psoriasis, eczema and vitiligo.

He is available for consultation at Cosmolaser Medical Centre in Samnan, Sharjah (06 5678 200) from 10 am – 2 pm and at City Medical Centre, Al Bustan, Ajman (06-7 441 882) from 4.30 pm – 9.30 pm.

Visit his personal website  dr-hanishbabu.com for more details and for educational articles on Skin, hair, nail and sexually transmitted diseases. Click here to Book an Appointment with dermatologist Dr Hanish Babu, MD

Topical Corticosteroids: Double Edged Swords!

Topical corticosteroids have revolutionised the treatment of inflammatory skin diseases, since they were introduced in 1952. They are very effective treatment options for many skin diseases and have revolutionised the management of eczema, allergies and other inflammatory skin diseases like psoriasis. Their effectiveness is prompt and most acute allergies can be cured within a few days. For chronic illnesses, like Atopic Eczema in children and psoriasis, they have to be used for a longer duration.

But, If not used with proper titre of dose and strength, they can cause damage to the skin, sometimes permanent. There are many unscientific formulations masquerading as anti-fungal creams and whitening or bleaching creams in the market, where one of the ingredient is potent or super potent steroid. Thus topical steroid creams are double edged swords, the use of which should be carefully titred according to their potency, stage of disease, age of the patient and site of application.

A knowledge of different classes of topical steroids according to their potency is important for everyone prescribing or using these effective and useful medications.

Classes of Steroids and Precautions
Classes of Steroids and Precautions

From the above it is clear that  topical corticosteroids  should be carefully chosen according to their potency, stage of disease, age of the patient and site of application. This is of paramount importance and all those who use these wonderful medications, including patients, pharmacists and doctors should be aware of their strengths and indications of use.

Topical corticosteroids come in several forms, including creams, lotions and ointments. Creams and solutions are a class below in potency than ointments. Ointments are greasy and preferred in chronic dermatitis and scaly diseases like psoriasis. Creams can be used in acute and subacute skin inflammation. Gels and lotions are preferred in hairy areas and scalp.

Side Effects of Topical Corticosteroids

Topical steroids have both topical (limited to skin) and systemic side effects.

Topical Side Effects of Topical Steroids Limited to Skin
  • Topical application of steroids causes thinning of the skin by causing atrophy of the skin layers.
  • Dilation of capillaries that are shown through the thinned skin, known as telengiectasia.
  • Stretching and splitting of the skin causing stretch marks or striae dystensiae.
  • Pimple like eruptions on the treated area, especially on the face, chest, back and limbs, called steroid acne.
  • The main problem with topical (and systemic steroids) is the rebound phenomenon or exacerbation of the lesions that occur if the steroids are suddenly stopped or withdrawn. A localized form of psoriasis can become generalized or a generalized form can get precipitated as pustular or erythrodermic forms when steroids are withdrawn.
  • Higher strength steroids should be avoided on the face, especially near eyes, on the body folds and near the genital organs. Steroids used near eyes for prolonged duration have been shown to cause cataract formation in the eyes and glaucoma.
  • Steroids are best avoided in the presence of infection as these can exacerbate infections.
  • Other topical side effects of topical steroids include easy bruising, purpura, skin ulceration, non healing of ulcers, exacerbation of infections, perioral dermatitis, rosacea, hypo pigmentation, hyper pigmentation, and excessive hair growth. Mistaken application of steroids on ring worms cause changes in morphology and spread of the fungal infection, known as tinea incognito.
Systemic Side Effects of Topical Steroids
  • Adrenal Suppression. Because of the absorption of potent steroids into the blood stream, the adrenal glands could become suppressed and their production of normal steroids will suffer as a result. This can have far reaching effects on the body. If prolonged, this can produce a cushingoid (moon like) face in patients and cause other systemic effects.
  • Tachyphylaxis.The body develops resistance to the topical application after some time.
How to Avoid Topical Steroid Side Effects
Unscientific Steroid Combinations
Unscientific Steroid Combinations are better avoided
  1. Topical Steroids are wonder drugs for many skin diseases like eczema and skin allergies but should be used only under supervision of a skin specialist or a modern medicine doctor who is trained to use it.
  2. Never buy steroid containing creams directly from pharmacy
  3. Avoid using fairness, whitening or bleaching creams from saloons, parlours and unlabelled sources. These may contain very strong steroids and cause serious damage to your skin.
  4. Avoid using so called anti-fungal creams containing steroids. When in doubt, consult a skin specialist before using such creams.
  5. Potent and super-potent steroid creams should only be used under the supervision of a skin specialist.
  6. Never use steroid containing creams in the presence of infection or if diagnosis is not sure.
  7. Use appropriate graded strength according to severity, age, site of involvement.
  8. Gradual withdrawal and replacement with safer creams should be resorted to.
  9. Superpotentà Potent à Moderate à Least Potent.  Shift down as the condition improves.
  10. Application free interval: 5-7 days after every two weeks of application helps avoid side effects.
  11. Never use higher strength topical steroids in infants and children.
  12. Avoid moderate to superpotent classes of topical steroids in sensitive areas like face and body folds.
  13. Once acute phase is under control, shift to steroid sparing calcineurin inhibitors like Tacrolimus, Pimecrolimus.
Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available for diagnosis and treatment of common skin, hair and nail diseases. No diagnosis should be made or treatment undertaken without first consulting your dermatologist. If you do so, the author will not be responsible for any consequences. The images provided are for illustration purpose only and should not be reproduced without the consent of the author.

About the Author of Skin Care Tips from Dermatologist: Dr Hanish Babu, MD
Dr Hanish Babu, MD, Dermatologist, Sharjah and Ajman, UAE
Dr Hanish Babu, MD

Dr Hanish Babu, MD is a dermatologist with more than 3 decades of experience in treating skin and sexually transmitted diseases in UAE and India. He has been practicing in UAE since last 22 years. He is a respected speaker during the Continuing Medical education Programmes for doctors, medical students and paramedical staff and is also a Stress Management Trainer. He organises group therapy sessions for patients with psoriasis, eczema and vitiligo.

He is available for consultation at Cosmolaser Medical Centre in Samnan, Sharjah (06 5678 200) from 10 am – 2 pm and at City Medical Centre, Al Bustan, Ajman (06-7 441 882) from 4.30 pm – 9.30 pm.

Visit his personal website  dr-hanishbabu.com for more details and for educational articles on Skin, hair, nail and sexually transmitted diseases. Click here to Book an Appointment with dermatologist Dr Hanish Babu, MD

Tips on How to Treat Scalp Psoriasis

These tips on how to treat scalp psoriasis deals with the causes of itchy scaly scalp caused by psoriasis and the most effective remedies to control it.

Scalp is commonly involved in psoriasis. Many a times psoriasis starts on the scalp and remains localized to the scalp for many years. The lesions usually spread to other parts of body following application of superpotent class of topical corticosteroids like clobetasole propionate.

Treatment with systemic steroids followed by sudden stoppage of the medication can also cause the flares in other parts of the body.

Psoriasis scalp may be associated with scattered, isolated psoriasis plaques else where on the body or generalized psoriasis.

The area behind the ears is the most common site affected in scalp psoriasis. Occiput ( back of head) is another common site of involvement.

The lesions on the scalp may be either red, raised, scaly plaques scattered at different areas of the scalp or diffusely scaly to involve the whole scalp. Itchy and scaly scalp is the usual presenting symptom of scalp psoriasis. Surprisingly, even with generalized scalp involvement, psoriasis of scalp does not usually cause hair loss.

Psoriasis of the scalp has to be differentiated from severe dandruff or seborrhoeic dermatitis. A singular feature is that psoriasis is most often localized to a few areas on the scalp while the seborrhoeic dermatitis is present throughout the scalp. The scaling in severe dandruff is also not very thick as in psoriasis and the bleeding points on scrapping (Auspitz sign) are absent in dandruff and seborrheic dermatitis.

Itchy Scalp Psoriasis: Auspitz Sign
Auspitz Sign in Psoriasis: Bleeding points on scrapping off the scales.

Harsh scrapping or vigorous rubbing can cause psoriasis plaque to appear in uninvolved areas of the scalp. This is the well known koebner phenomenon in psoriasis. Hence this should be avoided.

What are the Other Causes of Itchy and Scaly Scalp?

Psoriasis of the scalp has to be differentiated from severe dandruff or seborrheic dermatitis. Seborrheic dermatitis is generalised on the scalp while psoriasis is localised to certain areas.

The other causes of itchy scaly scalp are tinea amiantacea, tinea capitis (ring worm of scalp), contact allergy to hair lotions, creams or shampoos, dry scalp, lichen planus of the scalp, folliculitis etc.

Read more about other causes of itchy scalp conditions and their management.

How to Treat Scalp Psoriasis
Itchy scalp: Treatment of Scalp Psoriasis involves removal of scales with medications and shampoo.
Psoriasis Scalp can be controlled with proper treatment

Remedies for the itchy, scaly scalp depend upon the severity of the scalp psoriasis and extend of involvement.

Treatment of the Mild Scalp Psoriasis.

In mild type of scalp psoriasis, these is only superficial scaling, the thick scaly plaques are absent. The first line of treatment is tar or ketaconazole shampoos followed by betamethasone valerate scalp solution. In the absence of inflammation, calcipotriene solution can replace or alternate with the steroid topical application.

Treatment of Severe Scalp Psoriasis.

In severe psoriasis of the scalp, there are thick adherent scaly plaques on the scalp. Unless the scales are removed, the antipsoriatic medication will not be able to act on the skin. Hence the first step is to remove the scales.

Removal of Thick Scales of Scalp Psoriasis. The following steps will help remove the scales: Wet the scalp thoroughly, cover the involved area of the scalp with either a 10% salicylic acid in mineral oil or a coconut oil based tar and salicylic acid pomade. This is covered with a plastic wrap overnight. 20% urea cream is an alternative. A tar and salicylic acid containing shampoo is used in the morning to remove the scales.

Tar Shampoo is good in getting rid of Itchy Scalp Psoriasis
Tar Containing Shampoo helps control Scalp Psoriasis

Topical Applications in Scalp Psoriasis. Once the scales are removed, a combination of calcipotriene and betamethasone dipropionate gives best results in controlling the scalp psoriasis. Other alternatives are tar solutions, steroid-salicylic acid combinations, anthraline, and steroid lotions like clobetasole propionate. This is combined with moisturizing lotions like the liquid paraffin when the thickness is reduced.

Along with the above measures, life style management is also important for effective control of psoriasis. We will discuss this in a subsequent article later.

Read more about Psoriasis and other causes of Itchy Scalp:
Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available for diagnosis and treatment of common skin, hair and nail diseases. No diagnosis should be made or treatment undertaken without first consulting your dermatologist. If you do so, the author will not be responsible for any consequences. The images provided are for illustration purpose only and should not be reproduced without the consent of the author.

About the Author of Skin Care Tips from Dermatologist: Dr Hanish Babu, MD
Dr Hanish Babu, MD, Dermatologist, Sharjah and Ajman, UAE
Dr Hanish Babu, MD

Dr Hanish Babu, MD is a dermatologist with more than 3 decades of experience in treating skin and sexually transmitted diseases in UAE and India. He has been practicing in UAE since last 22 years. He is a respected speaker during the Continuing Medical education Programmes for doctors, medical students and paramedical staff and is also a Stress Management Trainer. He organises group therapy sessions for patients with psoriasis, eczema and vitiligo.

He is available for consultation at Cosmolaser Medical Centre in Samnan, Sharjah (06 5678 200) from 9 am – 1 pm and at City Medical Centre, Al Bustan, Ajman (06-7 441 882) from 4.30 pm – 9.30 pm.

Visit his personal website  dr-hanishbabu.com for more details and for educational articles on Skin, hair, nail and sexually transmitted diseases. Click here to Book an Appointment with dermatologist Dr Hanish Babu, MD

What is Seborrheic Dermatitis?

The cause, triggers and complications of the dermatitis of the sebaceous areas

Seborrheic dermatitis, the dermatitis of the sebaceous areas, is a common disease. It may be considered part of a clinical spectrum which include dandruff and psoriasis..

The Clinical Spectrum of Seborrheic Dermatitis

Seborrheic dermatitis is a common skin disease associated with increased and altered sebum production and yeast colonization.  Seborrheic dermatitis presents as a chronic dermatitis in sebum rich areas of the body like scalp, face and upper trunk. Its milder, non-inflammatory form is known as dandruff.  Seborrheic Dermatitis affects 1-3% general population, though dandruff is a very common occurrence. More than 36% of HIV positive patients have Seborrheic Dermatitis.

What is the cause for Seborrheic Dermatitis?

Seborrheic dermatitis appears in genetically pre-disposed individuals with the so called seborrheic diathesis, meaning increased sebum secretion  in the sebaceous gland rich areas of the body-  the scalp, face, front of chest, and in between the shoulder blades.  Certain triggering agents plus the greasiness of the skin in these areas is a flourishing ground for the yeasts known as malassezia. These yeasts breakdown and alter the composition of the sebum which further sets in motion an inflammatory response in the skin. This again increases the sebum secretion and the cycle continues.

Seborrheic dermatitis in the nasal fold.
Seborrheic dermatitis in the nasal fold.

The skin becomes red, irritated and scaly. Itching is prominent in acute, active state. In addition to the classical sites, seborrheic dermatitis can also affect the eyelids, armpits, groin and gluteal fold.

Seborrheic Dermatitis can cause an intensely itchy scalp.
Seborrheic dermatitis is a cause for severe itchy scalp.

Malassezia species M.restricta and M.globosa have been isolated from the seborrheic dermatitis skin.

Seborrheic dermatitis is seen in the first  few months of life when maternal androgens are present in the blood. Then, the disease re appears in susceptible individuals after the sebaceous glands become active during puberty.

Seborrheic dermatitis can be considered a part of the clinical spectrum between dandruff and psoriasis. (See the Figure above)

What are the triggers for Seborrheic Dermatitis?

  1. Stress & Fatigue. Both lowered immunity and hormonal stimulation are the reasons for increased seborrheic dermatitis in stressed and fatigued conditions.
  2. Hormonal  Triggers . Androgen hormones control the sebaceous activity in humans. Probably these are under the control of a sebotrophic hormone secreted from the hypothalamus. Body builders using anabolic steroids get severe attacks of seborrheic dermatitis.
  3. Environmental Triggers. Seborrheic dermatitis is precipitated in low humid conditions and in winter.
  4. Low Immune states. Either due to medications, or diseases like HIV and malignancies trigger seborrheic dermatitis.
  5. Food. Sugar consumption, fast foods, Vit B including B12 malutilization, biotin deficiency, niacin deficiency, pyridoxine deficiency, zinc deficiency and excess alcohol consumption have all been found to increase the incidence of seborrheic dermatitis .
  6. Drugs. Broad spectrum Antibiotics, OCP, Systemic Steroids, buspirone, chlorpromazine, cimetidine, ethionamide, griseofulvin, haloperidol, interferon alfa, lithium, methoxsalen, methyldopa, phenothiazines, psoralens, stanozolol are some of the medications that have been found to increase seborrheic dermatitis. The list is not complete.
  7. Diseases. Seborrheic dermatitis may be the presenting feature of Parkinsonism and  HIV infection. Incidence of seborrheic dermatitis is high in epilepsy, idiopathic post encephalitis,  diabetes mellitus, paralytic states etc.

What are the other causes for Itchy Scalp?

Seborrheic dermatitis has to be differentiated from other causes of itchy scalp, like scalp  dryness, contact allergy and psoriasis, all of which cause itchy and scaly scalp. For details see Causes of Itchy Scalp.

What are the types of Seborrheic Dermatitis?

  1. Infantile Seborrheic Dermatitis
    1. Cradle cap
    2. Trunk: Flexural, napkin area
    3. Leiner’s disease
  2. Adult Seborrheic Dermatitis
    1. Scalp: Dandruff and inflammatory types.
    2. Face: Inflammatory and non inflammatory, with blepharitis(eye lid)
    3. Trunk: Petaloid, pityriasiform, follicular, follicular, eczematous type
    4. Generalized exfoliative erythroderma
Seborrheic Dermatitis Chest. Image Courtesy: Galderma
Seborrheic Dermatitis Chest

What are the complications of Seborrheic Dermatitis?

  • Psychosocial impact: Chronic visible disease may affect a person’s self esteem.
  • Secondary bacterial infection with Staphylococcus aureus may occur, with typical impetigo with increased redness, oozing, and crusting.

What is Leiner’s Disease?

Leiner’s disease is a complication of seborrheic dermatitis in infants with C5 complement deficiency. There is usually a sudden confluence of lesions leading to a generalised scaling and redness of the skin. The child is severely ill with anemia, diarrhea, and vomiting. Secondary bacterial infection is common.

Because of the varied internal causes, it is quite difficult to get rid of seborrheic dermatitis. But, with some life style changes and appropriate treatment,  it is possible to get rid of Seborrheic Dermatitis.

Read more:

Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available for diagnosis and treatment of common skin, hair and nail diseases. No diagnosis should be made or treatment undertaken without first consulting your dermatologist. If you do so, the author will not be responsible for any consequences. The images provided are for illustration purpose only and should not be reproduced without the consent of the author.

About the Author of Skin Care Tips from Dermatologist: Dr Hanish Babu, MD
Dr Hanish Babu, MD, Dermatologist, Sharjah and Ajman, UAE
Dr Hanish Babu, MD

Dr Hanish Babu, MD is a dermatologist with more than 3 decades of experience in treating skin and sexually transmitted diseases in UAE and India. He has been practicing in UAE since last 22 years. He is a respected speaker during the Continuing Medical education Programmes for doctors, medical students and paramedical staff and is also a Stress Management Trainer. He organises group therapy sessions for patients with psoriasis, eczema and vitiligo.

He is available for consultation at Cosmolaser Medical Centre in Samnan, Sharjah (06 5678 200) from 9 am – 1 pm and at City Medical Centre, Al Bustan, Ajman (06-7 441 882) from 4.30 pm – 9.30 pm.

Visit his personal website  dr-hanishbabu.com for more details and for educational articles on Skin, hair, nail and sexually transmitted diseases. Click here to Book an Appointment with dermatologist Dr Hanish Babu, MD

Itchy Scalp Remedies

Itchy Scalp Remedies

Itchy Scalp Remedies
Proper Itchy Scalp Remedies Depend upon Finding the Exact Cause of the Scalp Itching

How to Get Rid of Scalp Itching

Itchy scalp remedies depend upon the diagnosis and management of specific causes of the scalp itching.

Causes of itchy scalp include dry scalp, dandruff, seborrheic dermatitis, scalp psoriasis, contact dermatitis, head lice infestation, ring worm of the scalp, tinea amiantacea, lichen planus, hair follicle inflammation, neurogenic excoriation and pyogenic infection of scalp. It is evident that no single shot remedy can effectively get rid of the scalp itching.

Itchy scalp remedies include diagnosis of the specific underlying disease and general and specific measures of treatment according to the causes of itchy scalp.

Diagnosis of Itchy Scalp

Diagnosing the causes of itchy scalp involves both clinical and laboratory diagnosis.

Clinical Diagnosis of Itchy Scalp

Most diseases causing itchy scalp like psoriasis and lichen planus have characteristic appearance. Dry scalp is a diagnosis reached after excluding other causes of itchy scalp. Only when confusion arises as to the cause of the itchy scalp, is there any need for the laboratory investigations.

Laboratory Diagnosis of Itchy Scalp

If there is any doubt about the cause of the scalp itching, your doctor will take a scrapping from the scales and examine it under microscope to confirm or rule out fungal infections.

A skin biopsy will differentiate lichen planus and discoid lupus erythematosus, both of which cause scarring, hair loss and itching on the scalp. In treatment resistant folliculitis of scalp, the doctor may call for a gram’s stain of the pus or even a culture study.

Itchy Scalp Remedies

General Measures to Get Rid of Scalp Itching

  • Keep the scalp scale free with regular shampooing.
  • Too much harsh shampooing should be avoided.
  • Avoid drying hair lotions, tinctures etc
  • Take a well balanced diet, have sufficient sleep and do regular exercise.
  • For moderate to severe itchy scalp, an antihistamine will help reduce the itching

Specific Measures to Get Rid of Scalp Itching

Dry Scalp Remedies

Treatment of dry scalp involves avoidance of drying shampoos and application of moisturizing lotions and creams. 5-10% urea lotion will help keep the scalp moist.

How to Get Rid of Dandruff

Regular cleansing with anti-dandruff shampoos and application of anti-yeast medications will help clear dandruff.

Read more on How to Get Rid of Dandruff

Seborrheic Dermatitis Remedies

Mild steroid-antifungal combinations and tar shampoos will keep the seborrheic dermatitis in check, along with life style changes.

More about How to Get Rid of Seborrheic Dermatitis

How to Treat Scalp Psoriasis

Removal of the thick scales followed by application of a combination of calcipotriene with potent topical steroids gives best results for scalp psoriasis. Regular use of tar containing shampoos will help prevent recurrences.

Tips on How to Treat Scalp Psoriasis Most Effectively

Contact Dermatitis Remedies

Avoidance of the culprit for the contact allergy, application of steroid creams, and antihistamine medications will control mild to moderate contact dermatitis of the scalp. Severe reactions may require oral steroids.

Head Lice Infestation (Pediculosis Capitis) Remedies

Pediculosis capitis or head lice infestation responds well to anti-louse medications and shampoos used weekly ones.

Ring Worm of the Scalp (Tinea Capitis) Remedies

Antifungal medications, both oral and topical, is required to treat tinea capitis. Shampoos containing selenium sulphide, ketoconazole or zinc pyrithione can be used on alternate days.  Treatment may have to be continued for a period of up to 3 months to avoid recurrence.

Pityriasis Amiantacea (Tinea Amiantacea) Remedies

Treatment of the underlying cause like psoriasis, lichen simplex or seborrheic dermatitis will cure P.amiantacea.

Scalp Lichen Planus Remedy

Scalp lichen planus requires treatment with intralesional steroids or topical super potent steroids. Itching will disappear early, but treatment cannot prevent scarring most of the time, unless treated early.

Hair Follicle Inflammation Treatment

Folliculitis of the scalp is usually either a pityrosporum folliculitis due to yeast or a staph infection. Treatment depends upon the outcome of the gram’s stain or culture studies.

Neurogenic Excoriation Treatment

This is a neurodermatitis. Treatment involves stress management, anxiolytics, and super potent steroids or intralesional steroids.

Pyogenic Infection of Scalp Remedies

Topical and systemic antibiotics will clear the infection most of the time. Regular cleansing with povidone iodine cleanser will help in avoiding recurrences.

Also read Causes of Itchy Scalp

Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available for diagnosis and treatment of common skin, hair and nail diseases. No diagnosis should be made or treatment undertaken without first consulting your dermatologist. If you do so, the author will not be responsible for any consequences. The images provided are for illustration purpose only and should not be reproduced without the consent of the author.

About the Author of Skin Care Tips from Dermatologist: Dr Hanish Babu, MD
Dr Hanish Babu, MD, Dermatologist, Sharjah and Ajman, UAE
Dr Hanish Babu, MD

Dr Hanish Babu, MD is a dermatologist with more than 3 decades of experience in treating skin and sexually transmitted diseases in UAE and India. He has been practicing in UAE since last 22 years. He is a respected speaker during the Continuing Medical education Programmes for doctors, medical students and paramedical staff and is also a Stress Management Trainer. He organises group therapy sessions for patients with psoriasis, eczema and vitiligo.

He is available for consultation at Cosmolaser Medical Centre in Samnan, Sharjah (06 5678 200) from 9 am – 1 pm and at City Medical Centre, Al Bustan, Ajman (06-7 441 882) from 4.30 pm – 9.30 pm.

Visit his personal website  dr-hanishbabu.com for more details and for educational articles on Skin, hair, nail and sexually transmitted diseases. Click here to Book an Appointment with dermatologist Dr Hanish Babu, MD

Itchy Scalp: Causes

Itchy Scalp may be caused by many diseases, including Psoriasis
Itchy Scalp may be caused by many diseases, including Psoriasis

Itchy scalp is a common problem in general population. It can be caused by many skin diseases affecting the scalp and hair.

Itchy scalp can be caused by a number of diseases.  A proper diagnosis is important to effectively treat the scalp itching.

Causes of Itchy Scalp

The commonest causes of itchy scalp are dry scalp, dandruff, seborrheic dermatitis, scalp psoriasis, contact dermatitis, head lice infestation, ring worm of the Scalp, pityriasis amiantacea, lichen planus, hair follicle inflammation, neurogenic excoriation and pyogenic infection of scalp. Needless to say, a definite diagnosis is necessary to effectively get rid of the itchy scalp.

Dry Scalp

Dry scalp is one of the overlooked causes of itching of the scalp. Dryness of the scalp may be caused by harsh shampoos, hair lotions or tinctures (with alcohol as base) or following frequent washing.

Dandruff

Dandruff is a common physiological problem
Dandruff is a common problem

While mild dandruff may not cause much itching on the scalp, superadded yeast infection will cause itching of mild to moderate severity.  The scaling of dandruff is generalized over the scalp.

Seborrheic Dermatitis

Seborrhiec Dermatitis is an important cause for scalp itching
Seborrheic Dermatitis: An important cause for Scalp Itching

Seborrheic dermatitis shows greasy scales throughout the scalp. The underlying skin may be reddish. In severe cases, red scaly rashes may be present on the sides of the nose, chest and back. The scalp itching in seborrheic dermatitis can be moderate to severe.

Scalp Psoriasis

Scalp Psoriasis causes varying degree of itchy scalp
Scalp Psoriasis can cause varying degree of itchy scalp

Scalp psoriasis, in contrast to seborrheic dermatitis, has thick scales with scattered plaques at different places of the scalp. Scrapping off the scales reveals bleeding points, what is known as the Auspitz’ sign. Itching is variable in scalp psoriasis.

Contact Dermatitis

Allergic Contact Dermatitis from hair colors can cause an intensely itchy scalp
Dye and coloured Henna are common causes of  itchy scalp

Allergy to some scalp and hair applications (creams, lotions, gels, shampoos, hair dye etc) can present as severely itchy scalp with oozing and crusting and scaling. A history of topical applications prior to the clinical manifestations of scalp itching and dermatitis clinches the diagnosis in most cases.

Head Lice Infestation (Pediculosis capitis)

Head lice infestation can cause severe scalp pruritus and infection
Pediculosis capitis or head lice can cause severe scalp itching and infection

Pediculosis capitis or head lice infestation is a common cause of itchy scalp in girls and young woman who tie their hair before it is dry and create a perfect environment for the lice to flourish. Severe lice infestation can cause secondary bacterial infection, oozing, crusting and dermatitis changes on the scalp neck and forehead. At times a generalized itchy dermatitis, an ide eruption may appear all over the body if the lice infestation is very severe. Finding the louse and/or its nits confirms the diagnosis.

Ring Worm of the Scalp (Tinea capitis)

Tinea capitis is a common itchy scalp fungal infection in children
Tinea capitis is a common itchy scalp fungal infection in children.

Ring worm of the scalp is usually seen in children, and rarely in adults. There is circumscribed and patchy scaling and itching with broken hairs or hair fall in the area.

Pityriasis amiantacea (Tinea amiantacea)

Pityriasis amiantacea can cause severe scalp irritation and itching
Pityriasis Amiantacea: Another Itchy Scalp cause

Pityriasis amiantacea is thought to be hypersensitivity response to a number of scalp diseases, like scalp psoriasis, seborrheic dermatitis or lichen simplex. Tinea amiantacea is a misnomer as fungal infection is rarely a cause for P.amiantacea. There is a thick yellow crusty flaking of the scalp along with matting of the hairs in the affected areas.  Scaling is more prominent than itching in P.amiantacea.

Lichen Planus

Lichen Planus of scalp and hair (Lichen planopilaris) can be the cause of intense itchy scalp and scarring hair loss
Lichen Planus can cause intense Scalp itching and scarring hair loss

Lichen planus can affect the scalp at times, and is known as lichen plano pilaris. Redness, itching, hair loss and scarring are the features of lichen planus.

Hair Follicle Inflammation

Hair follicles inflammation or infection, known as folliculitis can occur on the scalp due to yeast or bacteria.  Itchy scalp and painful, scattered and infected bumps are the features.

Neurogenic Excoriation

Neurogenic excoriation or lichen simplex is another cause for itchy scalp and is related to stress and anxiety. Habitual scratching leads to thickening and hair loss to a localised area of the scalp, usually on the sides.

Pyogenic Infection of Scalp

Bacterial infection of the scalp is common in malnourished children. Itchy, flaky crusts with yellowish discharge mat the hairs together.

Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available for diagnosis and treatment of common skin, hair and nail diseases. No diagnosis should be made or treatment undertaken without first consulting your dermatologist. If you do so, the author will not be responsible for any consequences. The images provided are for illustration purpose only and should not be reproduced without the consent of the author.

About the Author of Skin Care Tips from Dermatologist: Dr Hanish Babu, MD
Dr Hanish Babu, MD, Dermatologist, Sharjah and Ajman, UAE
Dr Hanish Babu, MD

Dr Hanish Babu, MD is a dermatologist with more than 3 decades of experience in treating skin and sexually transmitted diseases in UAE and India. He has been practicing in UAE since last 22 years. He is a respected speaker during the Continuing Medical education Programmes for doctors, medical students and paramedical staff and is also a Stress Management Trainer. He organises group therapy sessions for patients with psoriasis, eczema and vitiligo.

He is available for consultation at Cosmolaser Medical Centre in Samnan, Sharjah (06 5678 200) from 9 am – 1 pm and at City Medical Centre, Al Bustan, Ajman (06-7 441 882) from 4.30 pm – 9.30 pm.

Visit his personal website  dr-hanishbabu.com for more details and for educational articles on Skin, hair, nail and sexually transmitted diseases. Click here to Book an Appointment with dermatologist Dr Hanish Babu, MD

Acanthosis Nigricans: How to Manage

 

Treatment of acanthosis nigricans involves topical treatment and removal of the offending cause of the skin thickening and pigmentation.

Treatment of Acanthosis Nigricans: Treating the Cause
Treatment of Acanthosis nigricans involves treating the Cause

Tips on Dealing with Acanthosis Nigricans

There are certain do’s and don’ts in dealing with acanthosis nigricans. These are important in limiting the spread of the disease and finding the underlying causes.

Do’s in dealing with acanthosis nigricans:

  • The first course open to a patient is of course differentiating the benign and malignant varieties of acanthosis nigricans, preferably with the help of a dermatologist.
  • Diet control and regular exercise to reduce weight is essential in controlling acanthosis nigricans
  • Diabetes, if present, should be brought under strict control through dietary restriction, exercises and effective medications
  • In case of suspected malignant acanthosis nigricans, full panel of laboratory investigations should be carried out without much delay. Tumor markers, hormonal assays, endoscopy, Ultrasound and CT scans and whole body MRI are mandatory in such cases. The appearance of acanthosis nigricans can precede the full expression of cancer even by 5 years.
  • Consultations with a general physician and a gastro-enterologist once in six months is advisable in suspected acanthosis nigricans where no primary focus could be found in previous check ups. The frequency should be increased in cases where the skin changes are rapidly progressing.
  • Any sudden progression of the skin condition, appearance of skin tags or seborrheic keratosis (Leser Trelat sign) calls for urgent medical consultation.

 

Acanthosis nigricans treatments depends upon finding and treating the basic cause

Don’ts in Dealing with Acanthosis Nigricans

There are certain things to be avoided in the presence of acanthosis nigricans:

Most people think that the dirty appearance of the skin in acanthosis nigricans is due to dirt deposition on the skin. This results in constant vigorous scrubbing of the involved skin. This should be avoided at all cost.

So, Don’t

  • Scrub too much, as frequent rubbing will only increase skin thickening and pigmentation
  • Use strong abrasives: tend to irritate the skin more.

Treatment Guidelines for  Acanthosis Nigricans

  1. Correction of underlying cause
  • Removal of tumor
  • Correction of endocrine disorder: In case of Insulin Resistance, Metformin could be useful in treating Acanthosis Nigricans, alone or in combination with Rosiglitazone.
  • Reduction of weight: Low carb diets and exercise will help.
  • Removal of causative drug
  • Dietary supplimentation with fish oil containing omega 3 fatty acids have been reported to be beneficial
  • Cyproheptadine has been found useful in some cases

 2. Management of Skin Lesions:

  • Topical Retin A
  • Salicylic acid application alone or in combination with steroids, alternating with emollient applications to minimize irritation.
  • Calcipotriol
  • In severe unresponsive cases, systemic retinoids are useful.
  • TCA Peels, laser ablation all have been tried with varying results

Read also:


Published by Dr Hanish Babu, MD on 29th May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

 

Acanthosis Nigricans: How to Differentiate Malignant from Benign

 

We have already seen the main causes and different types of Acanthosis Nigricans.

As acanthosis nigricans is, at times, a fore-runner of internal cancer, it is important to differentiate between the harmless benign acanthosis nigricans from the malignant variety of acanthosis nigricans, as early diagnosis of cancer could be life saving. It is reported that the appearance of acanthosis nigricans precedes the appearance of internal cancer even before a couple of years!

Malignant Acanthosis Nigricans has to be Differentiated from Benign

Even after treatment of the causative cancer, acanthosis nigricans plays an important role as a followup indicator as well. Usually when the cancer is surgically excised and treated with radiation or chemotherapy, acanthosis nigricans disappears. Any recurrence of acanthosis nigricans later may thus point to recurrence of the cancer.

Curth HO (Archives of Dermatology, Vol 102, 1970) reports a remarkable case of acanthosis nigricans persisting for years even after excising  a leiomyoma of stomach, squamous cell carcinoma of bladder and nephrectomy of one kidney for transitional cell carcinoma in a 84 year old man.Then one lesion of adenocarcinoma was found in his colon and removed. Surprise! His long standing acanthosis nigricans disappeared within a few days without any treatment!

Moral: To achieve cure you must excise the responsible hormone secreting tumor, not just any tumor!

How to Differentiate Benign from Malignant Acanthosis Nigricans?

If any of the following features are present in a patient with acanthosis nigricans, presence of internal cancer may be suspected:

  1. Age of onset: Benign acanthosis nigricans appear soon after birth, childhood or in puberty. Early age of onset should arouse suspicion.
  2. Speed of Progression: If the typical features of acanthosis nigricans appear and progress rapidly, it is indicative of a malignant origin.
  3. Severity of Skin Changes: In malignant acanthosis nigricans, the skin changes are more pronounced compared to the benign types of acanthosis nigricans. The dark color (pigmentation) is present beyond the area of thickening in the malignant acanthosis nigricans.
  4. Distribution of Skin Lesions: In malignant acanthosis nigricans, there is extensive involvement of the skin, almost all folds and palms and soles and face are involved.
  5. Mucous membrane involvement: In contrast to the benign acanthosis nigricans, mucous membrane involvement is prominent in about 50% of malignant type of acanthosis nigricans.
  6. Skin Tags: Sudden appearance of skin tags in a case of acanthosis nigricans is indicative of serious underlying illness.
  7. Symptoms: Most benign acanthosis nigricans are asymptomatic. Usually there is irritation and itching in the skin lesions of malignant acanthosis. 

Also Read:


Published by Dr Hanish Babu, MD on 29th May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

Acanthosis Nigricans, a Marker of Cancer: Types, Causes and Diagnosis

 

Acanthosis Nigricans
Acanthosis Nigricans can be a marker of Internal Cancer

Acanthosis nigricans is a dark and velvety thickening of the skin in the armpits, neck and other body folds. It is considered as a marker for certain internal malignancies and endocrinal disturbances.

Acanthosis nigricans may occur due to a hereditary predisposition or associated with many diseases and medications.  People with acanthosis nigricans are known for their resistance to insulin in diabetics. The importance of acanthosis nigricans lies in the fact that at times it could be associated with certain cancers. Infact, sudden appearance of  acanthosis nigricans at any age calls for a thorough investigation of body systems to rule out any underlying cancers.

What is the Cause for Acanthosis Nigricans?

As mentioned above, there are many causes for acanthosis nigricans. According to the underlying cause, acanthosis nigricans is divided into 5 different types.

  1. Hereditary Benign Acanthosis Nigricans. This type runs in families and there is usually no associated endocrine disorders. This type of acanthosis nigricans appears in childhood and increases at puberty though many regress with age.
  2. Benign Syndromic Acanthosis Nigricans. This is associated with certain endocrine diseases. Insulin resistance is an underlying pathology in benign acanthosis nigricans. Most patients will have any of the following hormonal problems: diabetes, increased androgen secreting tumors, acromegaly or gigantism, Cushing’s syndrome, Addison’s disease , hypothyroidism etc. Course depends upon the management of underlying disturbance.
  3. Pseudo Acanthosis Nigricans  associated with Obesity. Starts at puberty. Common among dark skinned. Obesity—insulin resistance. Regression seen with significant weight loss.
  4. Drug induced Acanthosis Nigricans. High dose nicotinic acid, stilbesterol in young males, systemic steroid therapy, certain OCPs, growth hormone therapy, insulin, pituitary extract, protease inhibitors are some of the medications that can cause acanthosis nigricans
  5. Malignant Acanthosis Nigricans. Associated with adenocarcinoma of GIT and GUT tracts, less commonly with lymphomas. Even as early as 5 years of onset of other signs and symptoms of certain malignancies. Usually regress after successful treatment.

The typical skin features of thickening and dark pigmentations in acanthosis nigricans are caused by  certain chemicals secreted by the tumors or the effect of hormones, including insulin on the skin fibroblasts and melanocytes.

How Can Acanthosis Nigricans be Diagnosed?

Acanthosis nigricans has to be differentiated from diseases like Confluent and Reticulated papillomatosis, pigmented pityriasis versicolor, X-linked Icthyosis, retention hyperkeratosis and excessive nicotinic acid ingestion. Diagnosis of acanthosis nigricans is mainly from the history and clinical presentations. A complete workout including a hormonal profile, blood sugar,  biopsy of the skin and histopathological study, and, in case of suspected malignant acanthosis nigricans, a full body imaging and endoscopy is called for.

Clinical Features

Irrespective of the cause, all varieties of acanthosis nigricans show a  dark pigmentation and thickening of the skin, usually in a symmetrical manner, on the neck, axillae, groins, elbows, behind the knees, around umbilicus and in the perianal region. Skin looks dirty and the surface is wavy and rugose with a velvety appearance. Skin lines show up prominently. In acanthosis associated with obesity, the dark, thickened and velvety patches are more pronounced on the apposed surfaces of the folds, especially the thighs. Skin tags appear in large numbers in these patients.

In the severe malignant variety, all features of acanthosis nigricans are accentuated: the skin is  more thickened, dark and velvety and there is often involvement of the palms, soles, oral cavity and the edges of the lips.

Also Read:

Book an Appointment with Dermatologist Dr Hanish Babu, MD


Published by Dr Hanish Babu, MD on 29th May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD