L
Larva
migrans | Leprosy | Leukoderma (go to vitiligo)
| Leukoplakia, oral | Lice (go to
pediculosis) | Lichen
amyloidosis | Lichen planus |
Lichen sclerosus et
atrophicus | Lichen simplex chronicus
| Lipoma | Lupus
erythematosus
LARVA
MIGRANS
Larva migrans also
known as creeping eruption is a larval infestation of the superficial
skin. It occurs most commonly in the tropics and subtropics and
usually affects travelers to and from these areas.
Cause
- Larva migrans is caused
by the larvae of the cat or dog hookworm. The larvae enter by
biting the bare skin of people walking or sitting on warm, humid
sand. Children may be infested while playing in sandboxes. The
larvae cannot complete its life-cycle in the skin and spends
its whole life wandering within the superficial layers of the
skin until it dies some 4 - 6 weeks later.
Symptoms
- Slightly raised red
serpentine tracts caused by the wandering larvae.
- Itching.
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Larva migrans.
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on image for larger view |
Complications
- Secondary bacterial
infection.
What you can do
- You should consult
a doctor.
What the doctor
may do
- Prescribe oral thiabendazole
or albendazole or apply liquid
nitrogen to the advancing end of the serpentine tracts.
- Treat secondary bacterial
infections with antibiotics.
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LEPROSY
Leprosy or Hansen's
disease is chronic contagious skin disease that damages the nerves
supplying the skin and muscles, causing loss of sensation, muscle
wasting, blindness and deformities. It is seen mainly in the
tropics and subtropics.
Cause
- Leprosy is caused
by the Mycobacterium leprae bacteria which attacks the
skin, mucous membranes and nerves. Infection is acquired through
inhalation or ingestion of infected droplets and the symptoms
may take 2 - 6 years to develop.
-
- Predisposing factors
- Living in an endemic
areas (areas known to have large numbers of leprosy cases).
- Family history of
leprosy.
- Malnutrition.
- Over-crowding.
-
- Symptoms
The symptoms depend on the stage and degree of immunity of the
person. Leprosy is divided into the following stages:
-
- Indeterminate leprosy
-
- This is the earliest
stage of leprosy.
- It causes reddish
or hypopigmented (lightened) patches.
- There may be some
alteration of sensation.
- This stage is often
overlooked or neglected until leprosy progresses into the more
advanced forms below.
-
- Tuberculoid leprosy
-
- This occurs in people
with higher immunity.
- It causes pinkish
or hypopigmented (lightened) patches with red, slightly raised
borders.
- Tendency to occur
in rings.
- Usually one to a few
patches are present.
- Loss of sensation.
- Affected nerves become
thickened (usually best seen on the neck and felt around the
elbows and knees) or damaged, leading to paralysis (claw hand,
wrist drop., etc).
-
- Lepromatous leprosy
-
- This form occurs in
people with low immunity.
- Causes shiny hypopigmented
(lightened) patches or dull red papules (bumps), nodules (larger
swellings) or plagues (raised patches).
- Multiple (unlike tuberculoid
leprosy) and symmetrically distributed on the body.
- Diffuse infiltration
of the skin on the face with loss of eyebrows and eyelashes (causing
leonine facies) and swelling of the legs and feet.
- Destruction of the
nasal cartilage, causing saddle-shaped deformity, destruction
of the larynx (voice-box), causing hoarseness.
- Eye problems (iritis,
keratitis, episcleritis).
- Nerve damage causing
paresthesia (pins and needles) and paralysis.
-
- Borderline leprosy
-
- This is an intermediate
form between tuberculoid and lepromatous leprosy. It is called
borderline tuberculoid leprosy when it resembles tuberculoid
leprosy more and borderline lepromatous leprosy when it resembles
lepromatous leprosy more.
- Pins and needles or
numbness of the hands and feet as the disease progresses.
-
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Lepromatous leprosy.
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on image for larger view |
- Complications
- Ulcers and severe
burns occur because the withdrawal response to pain that protects
the body against injury is lost.
- Muscle weakness, clawing
deformity of the hands and foot drop develop when the nerves
supplying the muscles are damaged.
- Nerve damage affects
corneal sensation and the ability of the eyelids to close, resulting
in corneal ulceration and blindness.
- Destruction and collapse
of the cartilage of the nose, causing a saddle-shaped deformity.
- Destruction of the
larynx, causing hoarseness.
- Destruction of bones,
leading to deformity and shortening of the digits.
- Squamous
cell cancer
may develop in chronic skin ulcers.
What you can do
- You should consult
a doctor. Early treatment prevents complications and transmission
to other family members.
What the doctor
may do
- Confirm the diagnosis
with split skin smears and skin biopsies.
- Determine the type
of leprosy because the type and duration of treatment is different.
- Treat with a combination
of antibiotics for several months to years.
- Screen and follow-up
family contacts.
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LEUKOPLAKIA,
ORAL
Oral leukoplakia refers
to a whitish thickening on the lips, tongue and inside of the
mouth.
Cause
- Chronic irritation
caused by smoking, tobacco and betel nut chewing, spicy foods,
alcohol, biting of the lips and poorly fitting dentures.
- Infection by certain
types of the wart or human papilloma virus (HPV 11 and 16).
- Infection by the Epstein
Barr virus which causes a special form of leukoplakia known as
oral hairy leukoplakia.
-
- Symptoms
- White patch which
cannot be scraped off (contrast with oral
candidiasis).
- Oral hairy leukoplakia
is usually seen in homosexual HIV infected patients.
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Oral leukoplakia.
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on image for larger view |
Complications
- May transform into
a squamous cell cancer.
- Secondary infection
by candida is common (see candidiasis).
What you can do
- You should consult
a doctor.
- Cut down on smoking,
alcohol consumption and spicy foods.
- See a dentist to have
the dentures remade.
What the doctor
may do
- Examine scrapings
for the presence of candidiasis.
- Perform a biopsy to
confirm the diagnosis.
- Remove the affected
area surgically.
- Treat with electrosurgery,
carbon dioxide laser
or liquid nitrogen.
- Treat or eliminate
the underlying cause.
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LICHEN
AMYLOIDOSIS
This is an extremely
itchy condition caused by the deposition of an abnormal protein
called amyloid in the skin. It is more common in middle-aged
oriental women.
Cause
- Degenerative process
affecting the basal cells of the epidermis in which keratin filaments
are converted to a substance known as amyloid. Why this happens
is not known.
Symptoms
- Extremely itchy reddish
brown papules (bumps) on the shins.
- Macular amyloidosis
is another form in which the skin has a grey rippled appearance.
It usually affects the upper back and is usually not itchy.
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Lichen amyloidosis.
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on image for larger view |
- What you can do
- You should consult
a doctor.
- Take antihistamines
to relieve itching.
- Avoid scratching or
rubbing the skin with rough objects as it usually worsens the
condition in the long run.
-
- What the doctor
may do
- Perform a skin biopsy
to confirm the diagnosis.
- Prescribe topical
steroids.
- Prescribe oral retinoids or systemic steroids in resistant
cases.
- Treat with phototherapy
(light treatment).
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LICHEN
PLANUS
Lichen planus is an
extremely itchy skin condition of unknown cause. It occurs at
any age and may last for months to years.
Cause
- Unknown, may be autoimmune
in which the immune system attacks the skin cells as though they
were foreign.
- Allergy - Drugs such
as chloroquine (antimalarial drug), gold (sometimes used in the
treatment of rheumatoid arthritis), captopril (used in the treatment
of high blood pressure), streptomycin (anti-tuberculosis drug),
lithium (used in the treatment of manic-depressive states) and
contact with colour developers may cause a lichen planus-like
eruption.
Symptoms
- Shiny, flat-topped
pink or purplish papules (bumps) which often have white lines
known as Wickham's striae crisscrossing their surface.
- The rash usually occurs
on the front of the wrists, on the forearms, the lower legs,
the ankles, the lower back, the genital area, around the umbilicus
(navel) and in a line along scratch marks.
- The rash is usually
extremely itchy.
- The rash usually clears
by 18 months but can persist for years in some patients.
- Dark patches often
remain after the rash has cleared and these may take several
months to clear.
- In some individuals
the rash becomes very thick and scaly. This form of lichen planus
is called hypertrophic lichen planus and is more persistent.
This form usually occurs on the shins.
- White lace-like patterns
can be seen on the inside of the cheeks and the tongue in 50%
of cases. Sometimes ulcers develop.
- Lichen planus may
occasionally affect the nail causing minor surface changes or
in some cases, destruction or shedding of the entire nail.
- Lichen planopilaris is a form of lichen planus
that affects the hair. It may cause scarring
alopecia.
- Lichen nitidus is a form of lichen planus
that causes tiny pink or skin coloured papules on the penis and
extremities. Unlike lichen planus, lichen nitidus is not itchy.
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Lichen planus.
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on image for larger view |
What you can
do
- You should consult
a doctor.
- Take antihistamines
to relieve itching.
What the doctor
may do
- Perform a skin
biopsy to confirm the diagnosis.
- Prescribe a strong
topical steroid
or in very severe cases, even systemic steroids.
- Prescribe antihistamines.
- Eliminate the cause.
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LICHEN SCLEROSUS ET ATROPHICUS
Lichen sclerosus et
atrophicus is an uncommon skin condition that may affect children
and middle-aged adults. It is slightly more common in women.
It occurs in two forms:
- Genital form
- Non-genital form
Cause
- Unknown.
Symptoms
- Genital form
-
- Ivory white atrophic
(thinned), shrunken skin affecting the vulva (vaginal lips) and
the skin around the anus, causing a narrowing of the vaginal
opening and anus, respectively. Telangiectasias
(broken capillaries) and purpura
(haemorrhagic spots) are often present.
- Similar changes may
affect the inner foreskin and glans penis (penile head), causing
phimosis (difficulty retracting the foreskin) and narrowing of
the urethral opening in males.
- Itching, burning,
dyspareunia (painful intercourse) and difficulty urinating due
to the narrowing of the urethral opening in males.
-
- Non-genital form
-
- Clusters of ivory
white spots which are often surrounded by a red halo. The individual
spots are flat topped and may be level with the skin, slightly
elevated or depressed. The skin pores are often dilated and filled
by keratin plugs.
- They usually occur
on the trunk, neck, armpits and front of the wrists.
Complications
- Superimposed candidiasis
(yeast infection).
- Squamous
cell cancer
may develop in long-standing cases of lichen sclerosus et atrophicus
affecting the vulva.
What you can do
- You should consult
a doctor.
- Take antihistamines
to relieve itching. Do not scratch.
What the doctor
may do
- Perform a skin
biopsy to confirm the diagnosis.
- Prescribe topical
steroids.
- Treat the complications.
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LICHEN
SIMPLEX CHRONICUS
Lichen simplex chronicus
refers to a thickening of the skin caused by repeated scratching.
It is also known as neurodermatitis because scratching
is more prominent under stress.
Cause
- An area of skin that
is hypersensitive and gratifying to scratch. The increased sensitivity
of the skin may be partly explained by the finding of enlarged
sensory nerve endings in the skin.
Symptoms
- Thickened patch usually
on areas within reach of itchy fingers such as the back and sides
of the neck, the scalp, the limbs, ankles and genitals.
- Severe itching which
comes on suddenly, causing the person to scratch. The heel is
often used to rub itchy areas on the feet.
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Lichen simplex chronicus
on the side of the ankle.
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on image for larger view |
What you can
do
- You should consult
a doctor.
- Stop scratching or
rubbing as this perpetuates the problem. Unfortunately, scratching
is so satisfying that stopping becomes difficult.
- Apply moisturisers
to soothe the skin.
- Take antihistamines
to reduce itching.
What the doctor
may do
- Prescribe strong topical
steroids with or
without occlusion.
- Give intralesional
steroids.
- Prescribe tranquilisers
in tense individuals.
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LIPOMA
Lipomas are harmless
rubbery skin swellings occuring anywhere on the body, particularly
on the neck, shoulders, back and abdomen.
Cause
- Non-cancerous overgrowth
of fatty tissue in the skin.
Symptoms
- Soft, lobulated, rubbery
swellings 1 - 2 cm in size or larger under a normal looking skin.
- The swellings can
be moved within the skin.
- Painless.
- May be solitary or
multiple.
What you can do
- You should consult
a doctor to confirm the diagnosis.
What the doctor
may do
- Excise or remove by
liposuction (suction removal of fat).
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LUPUS ERYTHEMATOSUS
Lupus erythematosus
(LE) is a disorder of the connective tissues. The term, cutaneous
lupus erythematosus (cutaneous LE) is used when LE affects the
skin alone and systemic lupus erythematosus (SLE) when other
parts of the body such as the joints, muscle, kidneys, lungs,
the nervous system and other internal organs are affected. Women
are more commonly affected. Discoid lupus erythematosus (DLE)
and subacute cutaneous lupus erythematosus (SCLE) are the most
common varieties of cutaneous LE.
Causes
- Autoimmune disorder
(self-allergy) caused by the immune system attacking the body
tissue as though it was foreign.
- Drug induced LE due
to drugs such as hydralazine, procaineamide and isoniazid.
Symptoms
- Discoid
lupus erythematosus (DLE)
-
- Well-defined red,
scaly, scarred patches with telangiectasias
(threadlike veins). Usually occur on the sun-exposed areas, especially
the face, upper back, "v" of the neck, backs of the
hands and occasionally on the scalp where it may cause a scarring
alopecia.
- About 5% DLE cases
go on to develop SLE.
-
- Subacute cutaneous
lupus erythematosus (SCLE)
-
- Red scaly psoriasis-like
patches.
- Tendency to occur
in rings.
- There may be mild
fever and malaise of feeling of illness).
-
- Systemic
lupus erythematosus (SLE)
-
- Red butterfly rash
on the cheeks and across the bridge of the nose.
- Rashes are characteristically
worsened or precipitated by exposure to sunlight.
- Telangiectasias (broken blood vessels) on
the palms, fingers and nailfolds.
- Vasculitis, urticarial vasculitis and
Raynaud's phenomenon (blanching of the fingers and toes in cold
weather, followed by numbness, a bluish colour, then redness
on rewarming.
- Telogen
effluvium (diffuse
hairloss).
- Arthritis.
- SLE may also affect
the kidneys, lungs, liver, blood and the nervous system.
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Discoid lupus erythematosus.
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on image for larger view |
Complications
- In SLE, death may
result from involvement of other vital organs, especially the
kidneys and central nervous system.
- Squamous cell cancers
may develop in areas of DLE.
What you can do
- You should consult
a doctor.
- Protect yourself against
sunlight because it makes LE worse (see sun
protection).
What the doctor
may do
- Perform a skin biopsy
to confirm the diagnosis.
- Test the blood for
the presence of antinuclear and anti-DNA antibodies.
- Treat with topical
steroids, intralesional
steroids, dapsone (a drug used to treat leprosy) and antimalarial
medicines (chloroquine and hydroxychloroquine). SLE may require
treatment with oral steroids
and immunosuppressive
drugs such as azathioprine and cyclophosphamide.
- Reinforce the importance
of sun protection.
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