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Haemangiomas |Hailey Hailey disease | Hairloss (go to alopecia) | Hand eczema or hand dermatitis | Hand Foot and Mouth disease | Hang nails or torn cuticles | Herpes simplex virus infection | Herpes zoster (go to zoster) | Hidradenitis suppurativa | Hirsutism | Histiocytoma (go to dermatofibroma) | Hives (go to urticaria) | Hyperhidrosis

HAEMANGIOMAS

Haemangiomas are harmless overgrowths of the blood vessels in the skin. Most develop at or soon after birth (see below):-

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HAILEY HAILEY DISEASE

Hailey-Hailey disease or familial benign chronic pemphigus, is rare genetic skin disorder characterised by blistering and crusting of the neck, armpits, groin, and scalp.

    Cause

  • Inherited as an autosomal dominant trait which means that only one parent need be infected and the offsprings have a 50% chance of inheriting the disorder.
  • In a small number of cases, there does not appear to be a family history and these are thought to be cause by spontaneous mutation in the gene.

    Symptoms

  • Redness, blistering and crusting on the neck, armpits, groin and sometimes on the scalp.
  • Itching and soreness.
  • Malodour.
  • Hailey-Hailey disease usually runs for years with alternating periods of activity and relative inactivity.
      Hailey hailey disease.
    Click on image for larger view
    Complications
  • Secondary infection by bacteria or Candida albicans.

    What you can do

  • You should consult a doctor.
  • Avoid heat, sweating and friction which makes the condition worse.
  • Use cold water compresses.

    What the doctor may do

  • Prescribe steroid creams to relieve symptoms.
  • Prescribe oral and topical antibiotics for secondary bacterial infection.
  • Prescribe antifungal creams for candidiasis.
  • Surgical removal followed by skin grafting may be considered in some patients.

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HAND ECZEMA OR HAND DERMATITIS

Hand eczema refers to an eczema that primarily affects the hands.

    Causes

  • Irritant contact dermatitis which may develop after brief contact with highly irritating substances such as acids, alkalis and solvents or after repeated exposure to mild irritants such as soaps, detergents, solvents, abrasive dusts and water. The latter variety is known as cumulative insult dermatitis and is best exemplified by "housewife's dermatitis" and "bartender's hands". Persons with a history of atopy, that is, asthma, allergic rhinitis and atopic dermatitis are more susceptible to this type of hand dermatitis.
  • Allergic contact dermatitis which is due to allergy to substances handled such as metals, cement, epoxy resins and soldering flux.
  • Endogenous hand eczema which is believed to be due to inborn sensitivity. It may represent atopic dermatitis affecting the hands or pompholyx.
     
    Symptoms
  • During the acute stage, there may be redness, swelling, small blisters and pusheads and weeping.
  • As the eczema becomes chronic, the skin becomes scaly and cracked.
  • Very often, there is a combination of the two, for example, dryness and scaling accompanied by small blisters. This stage is sometimes referred to as subacute eczema.
  • Itching.
      Hand eczema.
    Click on image for larger view

    Key points
  • Psoriasis confined to the hands is sometimes difficult to distinguish from hand eczema and the diagnosis may not be apparent until symptoms of psoriasis appear on other parts of the body. However, distinguishing them on the hands is not crucial because the treatment is similar.
  • Pompholyx is a special variety of endogenous eczema that affects the hands. It is characterised by deep seated blisters that look like sago-grains or frog spawn.

    Complications

  • Secondary bacterial infection.

    What you can do

  • You should consult a doctor to determine the cause, if any and for treatment.
  • Minimise contact with water.
  • Wear gloves whenever you perform wet chores, especially when it involves exposure to known irritants such as soaps, detergents and household cleansers. Gloves with cotton liners are ideal as they help to absorb sweat. Alternatively, cotton gloves may be worn inside impervious gloves. All gloves should be changed if their insides get wet through water seepage or sweating.
  • Use a mild non-drying soap for bathing and washing the hands.
  • Wear gloves to shampoo the hair.
  • Apply moisturisers regularly.
  • Take antihistamines to relieve itching.

    What the doctor may do

  • Determine the cause, using patch tests if necessary.
  • Prescribe antihistamines.
  • Prescribe topical steroids or tar preparations.
  • Treat severe acute cases with a short course of systemic steroids.
  • Treat very chronic and resistant cases with PUVA.

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HAND, FOOT AND MOUTH DISEASE

This is a contagious viral infection of the skin in young children. It is spread by droplet infection and tends to occur in small epidemics, especially in the summer. The incubation period is 3 - 5 days.

    Cause

  • Coxsackie A16.
  • Enterovirus 71.

    Symptoms

  • Small slightly oval shaped blisters surrounded by a red border on the palms and soles.
  • Painful ulcers inside the mouth.
  • Mild fever may be present.

    What you can do

  • You should consult a doctor.
  • Use antiseptic mouth gargles.
  • Take simple painkillers such as paracetemol.

    What the doctor may do

  • Prescribe anaesthetic gels to reduce discomfort during meals.
  • Specific treatment is not necessary because the blisters and sores heal after about one week.

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HANGNAILS OR TORN CUTICLES

These are splits in the skin along the sides and base of the nails.

    Causes

  • Dryness.
  • Paper cuts.
  • Picking of the skin and cuticle around the nails.
  • Improper manicuring.

    Symptoms

  • Pain and bleeding if the slivers of skin are pulled.

    Complications

  • Secondary bacterial infection, leading to acute paronychia.

    What you can do

  • Cut off the slivers of skin with a sharp pair of scissors. Do not pull the skin as this causes bleeding and pain.
  • Moisturise the skin.
  • Minimise contact with water and known irritants (see hand eczema).

    What the doctor may do

  • Prescribe antibiotics if there is infection.

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HERPES SIMPLEX VIRUS INFECTION

Herpes simplex virus (HSV) infections are classified into primary or recurrent infections. After a primary infection, the virus remains dormant in the cells. The virus may become active from time to time and cause a recurrent infection. There are a number of triggers that can provoke a recurrence. HSV infection on or around the lips is known as herpes labialis and that on the genitals is known as herpes genitalis.

    Cause

  • Herpes simplex virus (HSV) infections of the skin may be caused by two types of viruses:
     
    • Herpes simplex virus type 1 (HSV-1) and
    • Herpes simplex virus type 2 (HSV-2).

    Although there are exceptions, herpes labialis and herpes infections above the waist tend to be due to HSV-1 whereas herpes genitalis and infections below the waist are usually due to HSV-2.
     
    Symptoms
    The incubation period is 2 - 20 days (average of 6 days). HSV-1 and HSV-2 infections are indistinguishable on examination. After the first infection (primary herpes), the virus retreats up a nerve fibre and remains inactive until reactivated. When reactivated, a recurrence occurs. Primary infections are more severe and heal after 2 - 3 weeks compared to recurrent infections which produce milder symptoms and heal after 5 - 10 days. The two most commonly affected areas include the lips and genitals but herpes may affect any part of the skin.
     
  • Primary herpes stomatogingivitis (primary herpes infection of the mouth)
    Primary herpetic infection of the mouth usually affects the gums, tongue, palate (roof of the mouth), insides of the cheeks and the throat. It usually affects young children and is spread through droplets just like the common cold.
     
    • High fever and malaise (feeling of illness).
    • Swollen, bleeding or ulcerated gums.
    • Blisters and ulcers on the tongue, palate, insides of the cheeks and the throat.
    • Drinking and eating is painful and the breath is foul.
    • Lymph glands in the neck are swollen.
    • Sometimes the infection may be mild or subclinical (ie., shows no signs).
    • The infection resolves after 2 weeks even without treatment but recurrences may occur. Recurrences are usually less severe and affect the skin around the mouth rather than inside ("cold sores"). They are less severe may be preceded by premonitory symptoms such as itching, tingling or burning.
     
  • Primary herpes genitalis (primary herpes infection of the genitalia).
    Primary genital herpes is sexually transmitted. It usually affects the head or shaft of the penis, under the foreskin or the perianal (around the anus) skin in homosexual males. In women, they may occur on the lips of the vagina, the mucosa around the vaginal opening and inside the vagina and on the cervix (neck of the womb).
     
    • A group of painful or itchy blisters.
    • The blisters rupture to form ulcers.
    • The ulcers crust over and heal after 2 - 3 weeks.
    • Lymph glands in the groin may be enlarged and tender.
    • There may be fever and malaise (feeling of illness).
    • Women may experience pain and difficulty passing urine.
    • Recurrent attacks occur when the virus is reactivated. The symptoms are generally less severe and may be preceded by premonitory symptoms such as itching, tingling or burning.

      Herpes simplex virus infection of the skin.
    Click on image for larger view 

    Complications

  • Recurrences are the most common complication and are more common after HSV- 2 infections.
  • Secondary bacterial infection.
  • HSV infection around the eyes may cause conjunctivitis, ulceration and scarring of the cornea (transparent covering of the eye), resulting in serious impairment of vision.
  • HSV can cause a severe and widespread infection known as eczema herpeticum in people with atopic dermatitis and Kaposi's varicelliform eruption in those with Darier's disease..
  • Herpes genitalis was previously reported to be associated with a greater risk of developing cancer of the cervix. Although this view has been challenged recently, it is still the routine for doctors to do a Pap smear (cancer smear of the cervix) every year in women with a past history of herpes genitalis.
  • Erythema multiforme may follow HSV infection in some individuals.
  • Herpes genitalis occuring for the first time during the first 3 months of pregnancy may result in a miscarriage.
  • Herpes genitalis at the time of delivery may lead to neonatal herpes (herpes of the newborn) which may result in permanent brain and eye damage or death.

    What you can do

  • You should consult a doctor.
  • Keep the area clean and aid natural healing by bathing the area with saline two or more times a day. Saline can be prepared by dissolving a teaspoonful of salt in a pint of water.
  • Take simple painkillers.
  • Take antihistamines.
  • Do not scratch the area.
  • Wash the hands on waking each morning and after contact with the area to avoid transmitting infection to other parts of the body.
  • Avoid sex during attacks of herpes genitalis.
  • If recurrences are frequent, obtain a tube of acyclovir cream form your doctor so that you can begin treatment as soon as possible. If that does not work, discuss the use of suppressive treatment with your doctor.
  • Inform your doctor about your history of genital herpes when you are pregnant. A Caesarean section (abdominal delivery) is usually recommended if a person has positive HSV culture near term or evidence of genital herpes at the time of delivery.
  • As a precaution, see your doctor for a Pap smear (cancer smear of the cervix) annually if you have a history of herpes genitalis.
  • Adopt measures to minimise the risk of recurrences (see below):

    Factors known to trigger recurrent infections

  • Fever.
  • Other infections, such as colds.
  • Excessive exposure to sunlight (herpes labialis).
  • Menstruation (herpes genitalis).
  • Dermabrasion and laser resurfacing.
  • Trauma during sex (herpes genitalis).
  • Stress.

    What the doctor may do

  • Confirm the diagnosis by examination with or without a culture for HSV.
  • Counsel you about HSV infections.
  • Prescribe antibiotics for bacterial infection.
  • Prescribe the anti-herpes drug, acyclovir which helps to relieve pain and speed up the healing process.
  • Prescribe acyclovir cream to reduce discomfort and hasten healing. If recurrences are very frequent or severe, suppressive therapy with daily oral acyclovir can be used.
  • Do a Pap smear annually on women with a past history of herpes genitalis.

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HIDRADENITIS SUPPURATIVA

Hidradenitis suppurativa is a chronic inflammation of the hair follicles in the armpits, pubic area and around the nipples and anus.

    Cause

  • Inflammation of the upper part of the hair follicle into which the apocrine glands (the special sweat glands found in the armpits, pubic area and around the nipples and anus) open, leading to obstruction and rupture.

    Symptoms

  • Inflamed swellings and abscesses.
  • Pus discharging through openings of the abscess or through sinuses (blind tracts).
  • Bridge-like scars develop as old abscesses heal.
  • Pain.
  • Fever.
  • Often associated with obesity and severe cystic acne (aee acne vulgaris).

      Hidradenitis suppurative.
    Click on image for larger view 

    Complications

  • Scarring.
  • Recurrent attacks of pain, inflammation and discharging pus.

    What you can do

  • Early treatment is necessary and more effective. You should consult a doctor.
  • Wash the affected areas with an antiseptic soap to reduce the number of bacteria in the area.
  • Consider reducing friction by wearing loose clothing.
  • Reduce the weight if obese.

    What the doctor may do

  • Take swabs for culture and sensitivity to determine which is the best antibiotics to use.
  • Prescribe longterm oral antibiotics.
  • Give intralesional steroids injections.
  • Prescribe oral isotretinoin.
  • Prescribe oral contraceptive pills such as Diane 35 with or without cyproterone acetate in female patients.
  • Drain abscesses that are very painful.
  • Excise persistent swellings.
  • Remove the entire hair-bearing area and replace with a skin graft.

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HIRSUTISM

Hirsutism refers to excessive growth of coarse dark hair of a male pattern in females.

    Causes

  • Genetic or racial hirsutism may be observed in some families and among certain races, especially among Mediterranean, Middle Eastern and Semitic people. Their hair follicles are, for some reason, more sensitive to normal levels of male hormones.
  • Hormonal hirsutism is due to increased levels of circulating androgens for example, in polycystic ovary syndrome, adrenogenital syndrome and Cushing's syndrome.
  • Menopause due to an increased influence of androgens as a result of lower levels of oestrogens (female hormones).
  • Drugs such as androgens (which may be abused by athlete's), steroids and minoxidil and cyclosporin (an immunosuppressive drugs).
  • Porphyria cutanea tarda.

    Symptoms

  • Dark coarse hair in a male sexual distribution such as on the upper lip, chin, sideburns, chest, abdomen, arms and legs.
  • In hormonal hirsutism, these changes are accompanied by signs of virilisation such as deepening of the voice, increased muscle bulk, severe acne vulgaris, androgenetic alopecia, sterility and menstrual disturbances.

      Hirsutism.
    Click on image for larger view 

    What you can do

  • You should consult a doctor to determine the cause.
  • Consider cosmetic measures (see below).
     
    Cosmetic procedures
  • Shaving, plucking and waxing. However, these treatments do not permanently remove hair and folliculitis is a common complication.
  • Bleaching to make the hairs less visible. However, irritation may occur.
  • Use depilatory creams to chemically remove the unwanted hairs. Care as these products can irritate the skin.
  • Electrolysis can permanently remove hair. However, the procedure is slow as it involves inserting an electrode into each hair follicle and is painful. Multiple treatments are necessary and scarring may occur if electrolysis is not done by properly electrologists.

    What the doctor may do

  • Order blood tests to detect abnormal levels of male hormones.
  • Perform ultrasound examinations to detect polycystic ovaries.
  • Prescribe drugs to suppress androgen production. The drug treatments used include a combination of spironolactone (a drug used to treat water retention) and a birth control pill or the birth control pill Diane-35 with or without cyproterone acetate (an anti-androgen).
  • Surgery to remove androgen producing tumours, if any.
  • Remove the hairs with lasers.This method, known as laser hair removal is fast and relatively painless. However, two or more treatments are usually necessary and treatment reduces hair rather than completetely remove hair. Preliminary results show that this treatment has some promise.

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HYPERHIDROSIS

Hyperhidrosis refers to inappropriate and excessive sweating. It may affect the palms (palmar hyperhidrosis), soles (plantar hyperhidrosis) or the armpits (axillary hyperhidrosis). The problem usually occurs after puberty and is worse under stress.

    Causes

  • Idiopathic (of unknown cause).
  • Overactive thyroid gland.

    Symptoms

  • Excessive sweating usually of the palms, feet and armpits.

    Complications

  • Socially embarrassing.
  • Interferes with ability to grip.
  • Causes writing to smudge.
  • May give an unpleasant odour when there is bactarial decomposition of the sweat, especially when it affects the armpits and feet.
  • Damages shoes.
  • Predisposes to pitted keratolysis.

    What you can do

  • Nothing as it improves with age.
  • Use antiperspirants for axillary hyperhidrosis.
  • Wear lightweight cotton clothes.
  • Wear shoes made of natural materials.
  • You should consult a doctor if it is distressing.

    What the doctor may do

  • Prescribe formaldehyde, glutaraldehyde soaks for hyperhidrosis affecting the palms and soles. Prescribe aluminium chloride solution for hyperhidrosis affecting the armpits.
  • Iontophoresis which involves soaking the palms or soles in a solution of tap water or isoprotium bromide and passing a small direct current through the solution. A modification of this method has also been used to treat axillary hyperhidrosis. A battery powered iontophoresis machine is also available.
  • Surgery - Excision of the sweat glands in the armpits in cases of axillary hyperhidrosis and thoracic sympathectomy (cutting the nerves that control sweating) in severe cases of hyperhidrosis of the palms.
  • Prescribe drugs to reduce sweating. These drugs may cause some unpleasant side effects such as dry mouths and blurred vision.
  • Prescribe transquilisers before stressful events.

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