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Ichthyosis vulgaris | Idiopathic guttate hypomelanosis | Impetigo | Ingrown toenails | Intertrigo

ICHTHYOSIS VULGARIS

The term ichthyosis (Ichthyus is a Greek word meaning "fish") refers to a group of hereditary disorders characterised by dryness and scaling. The most common and mildest form is known as ichthyosis vulgaris and is described in greater detail below. More severe and rare forms include X-linked ichthyosis which is transmitted by the X-chromosome (hence, only males are affected and women are carriers), lamellar ichthyosis which is transmitted by an autosomal recessive gene (which means both parents of the affected person carry the defective gene) and epidermolytic ichthyosiform dermatosis (which is transmitted by an autosomal dominant gene). The latter two forms can appear at birth and involve the whole body causing an erythroderma.

    Cause

  • Ichthyosis vulgaris is inherited in an autosomal dominant manner which means about half the offsprings will be affected if one parent carries the gene for ichthyosis vulgaris.

    Symptoms

  • Ichthyosis vulgaris appears at or soon after birth, usually around 3 months of age and gets better with age.
  • Fish-like scales on the shins (most commonly), arms and back.
  • The rest of the skin may show fine powdery scaling or xerosis.
  • The creases on the palms are often accentuated.
  • Keratosis pilaris is frequently present.
      Ichthyosis vulgaris.
    Click on mage for larger view
    What you can do
  • You should consult a doctor.
  • Apply moisturisers as for xerosis.
  • Avoid drying soaps.

    What the doctor may do

  • Confirm the diagnosis.
  • Prescribe keratolytics (products that facilitate the removal of scales from the skin surface).

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IDIOPATHIC GUTTATE HYPOMELANOSIS

This condition causes depigmentation of the skin. It usually affects middle-aged.

    Cause

  • Sun-damage.

    Symptoms

  • 2 - 5mm porcelain white spots with clearly defined borders.
  • Affects the sun-exposed skin on the back of the hands and forearms, the shins and occasionally, the back.

    What you can do

  • You should consult a doctor as vitiligo needs to be excluded.
  • Protect your skin against sun-damage (see sun protection).

    What the doctor may do

  • Exclude vitiligo.

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IMPETIGO

Impetigo a superficial bacterial infection of the skin, seen most commonly in children. Ecthyma is a deep, ulcerative form of impetigo. Impetigo is contagious and may spread form one person to another or from one site to another. Any part of the body may be affected, especially exposed areas such as the face (commonly around the nose and mouth), buttocks and limbs. Impetigo may develop after minor skin trauma such as a scratch, a cut or an insect bite or in areas of skin affected by eczema and scabies (secondary impetigo). Bullous impetigo is a variety of impetigo that begins as large flaccid blisters.

    Cause

  • Streptococcal bacteria, staphylococcal bacteria or both.
  • Bullous impetigo is caused by the staphylococcal bacteria.

    Predisposing factors

  • Overcrowding.
  • Poor personal hygiene.
  • Family members harbouring the bacteria (healthy carriers).
  • Neglected skin trauma.
  • Itchy skin disorders which cause scratching such as eczema and scabies.

    Symptoms

  • Pustules (pusheads) or small blisters that rupture easily, releasing a yellow exudate that dries into golden-yellow crusts.
  • The crusts can be removed easily, leaving a raw weeping surface that rapidly becomes encrusted again.
  • Bullous impetigo begins as larger flaccid blisters. These rupture easily and leave a lacquer like base.
  • Itch may be present.
  • Lymph glands draining the area may become enlarged.

      Impetigo.
    Click on image for larger view

    Complications

  • Glomerulonephritis (kidney inflammation) may complicate impetigo caused by the streptococcal bacteria.

    What you can do

  • You should consult a doctor.
  • Cover the area with gauze.
  • Wash the area with soap and water three times a day and gently remove the crusts. Warm compresses for about 10 minutes will aid the removal of crusts.
  • Change soiled dressing frequently.
  • Change the sheets daily.
  • Observe careful hygiene. Do not share personal items such as towels and clothes.
  • Infected children should stay away from school for at least 48 hours after the start of antibiotics.
    Key points
  • Recurrent impetigo may be due to a carrier who may be carrying the bacteria in the nostrils. Family members may need to be screened for infection and treated accordingly.

    What the doctor may do

  • Take a swab for bacterial culture and sensitivity.
  • Treat with antibiotics.

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INGROWN TOENAILS

Ingrown toenails are caused by the one or both edges of the nail growing into the skin.

    Causes

  • Poor nail cutting technique.
  • Poor fitting shoes, especially high-heeled pointed women's shoes.

    Symptoms

  • Pain, swelling and inflammation of the nail folds.
  • Pus draining out from under the nail folds.

    Complications

  • Bleeds if traumatised.
  • Pyogenic granuloma.

    What you can do

  • You should consult a doctor.
  • Lift the corners of the nails with a wad of cotton.
  • In future, cut the nail straight across.

    What the doctor may do

  • Prescribe antibiotics.
  • Surgery to remove all or a strip of nail with the adjacent skin.

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INTERTRIGO

Intertrigo refers to an inflammation of the skin in body fold areas.

    Causes
    There are many causes:-

     
  • Physical causes (this form of intertrigo is referred to as simple intertrigo):
     
    • Prolonged heat.
    • Moisture.
    • Friction from adjacent skin surfaces rubbing together.
     
  • Skin disorders affecting the body folds:
     
     
  • Infections affecting the body folds:
     
     
    Symptoms
  • Redness and sogginess of the skin surfaces.
  • Itching may be present.
  • Other signs may be present depending on the skin disorder or infection.

    What you can do

  • You should consult a doctor.
  • Reduce weight if obese.
  • Apply cool compresses.
  • Air the area by taking short walks.
  • Wear cotton fabrics.
  • Use dusting powders.
  • Take antihistamine to reduce itching.

    What the doctor may do

  • Determine the cause.
  • Treat accordingly with mild topical steroids, topical antifungals or antibiotics.

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