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Varicella | Varicose eczema | Vasculitis | Vitiligo

VARICELLA (CHICKENPOX)

Varicella or chickenpox is a viral infection that causes fever and blisters which crust over and heal after 2 to 3 weeks. It usually affects children but can also occur in adults who may develop a more severe and sometimes even fatal infection. The person becomes immune to further attacks of varicella but may develop herpes zoster (shingles) instead, later on in life.

    Cause

  • Varicella-zoster virus (VZV) which is transmitted by airborne droplets and skin to skin contact. The incubation period is 1 - 3 weeks. After infection, the varicella-zoster virus travels up a nerve and remains dormant (inactive) in the nerve ganglion (nerve relay station). If activated (usually in late adult life), the virus causes a more localised infection known as shingles (see herpes zoster).

    Symptoms

  • Preceding malaise (feeling of illness), headache, muscle ache and low-grade fever.
  • Pink to red spots which develop a blister in the centre giving rise to the appearance of a "dewdrop on a rose petal".
  • The vesicles become pustules (pusheads) and crust over a 8 to 12 -hour period.
  • The eruptions occur in crops over the trunk, face and scalp so that at any one time different evolutionary stages may be seen.
  • Crusts will loosen after another 1 - 2 weeks.
  • Itching.

      Varicella (chickenpox)
    Click on image for larger view

    Complications

  • Scarring.
  • Secondary bacterial infection which increases the risk of scars.
  • Secondary bacterial infection may get into the blood and cause septicaemia (blood poisoning).
  • Pneumonia (lung inflammation).
  • Encephalitis (brain inflammation).
  • Death which is more common in adults.
  • Congenital varicella may develop if infection occurs in the first 3 months of pregnancy, resulting in an underweight baby with eye and brain abnormalities, scarring of the skin and abnormal development of the limbs.

    What you can do

  • You should consult a doctor.
  • Take antihistamines to relieve itching.
  • Avoid scratching as it encourages secondary infection and scarring.
  • Apply cool compresses.
  • Apply calamine lotion to reduce itching.
  • Stay in isolation. Varicella is infectious 5 days before the onset of the rash until all the eruptions have crusted.
  • Take paracetemol for fever relief. Do not take aspirin as this has been associated with the development of Reye's syndrome, a life-threatening condition causing brain and liver inflammation.

    What the doctor may do

  • Confirm the diagnosis.
  • Prescribe topical or oral antibiotics.
  • Prescribe oral acyclovir which helps to reduce the severity of symptoms and hasten healing.

    Prevention

  • A vaccine is now available to prevent varicella.

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VARICOSE ECZEMA

Varicose eczema or stasis dermatitis is a form of eczema affecting the legs of people with varicose veins. Women are more likely to be affected because they have a higher risk of developing varicose veins.

    Cause

  • Poor return of blood from the leg veins to the heart, results in the pooling of blood in the veins, causing varicose veins as well as a diminished supply of oxygen to the tissues there. The latter is believed to cause varicose eczema.

    Symptoms

  • Redness and scaling, occasionally with weeping and crusting on the lower portion of the legs, especially on the inside of the ankles.
  • Brownish pigmentation of the skin.
  • Fibrosis or stiffening of the skin.
  • Varicose veins or thin threadlike blue veins around the ankles are usually (but not always) evident.

      Varicose (stasis) ulcer.
    Click on image for larger view

    Complications

  • Ulceration.
  • Secondary bacterial infection.
  • Allergies often develop to topical medications used on the area.

    What you can do

  • You should consult a doctor.
  • Avoid scratching as this may cause ulceration and secondary bacterial infection.
  • Apply saline compress if the area is weepy.
  • Take antihistamines to reduce itch.
  • Wear compression bandages or supportive stockings.
  • Raise the foot of the bed by about 10 inches to help return blood.
  • Lose weight if obese.
  • Exercise or stretch the legs regularly.
  • Put up the feet as often as possible.
  • Avoid constricting garments.
  • Avoid constipation by taking high fibre diet.

    What the doctor may do

  • Prescribe topical steroids.
  • Prescribe antibiotics for secondary bacterial infection.
  • Conduct patch tests to determine the cause of allergy, if necessary.
  • Sclerotherapy (injections to force closure of the varicose veins) or surgery to remove the varicose veins.
  • Pinch grafts to help ulcers heal.

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VASCULITIS

Vasculitis is an inflammation of the blood vessel walls due to an immunological reaction. It can be divided into cutaneous vasculitis which affects the blood vessels of the skin and systemic vasculitis which affects the blood vessels supplying internal organs such as heart, kidneys, intestines, muscles and nervous system. There are many forms of vasculitis, some involving only the blood vessels in the skin primarily and are painful but otherwise harmless. Others like polyateritis nodosa and Wegener's granulomatosis involve blood vessels supplying the heart, kidneys, intestines, muscles and nervous system are potentially serious.

    Causes

  • Drugs and injected serum.
  • Infections such as streptococcal sorethroat (Henoch Schonlein purpura) and hepatitis B (polyarteritis nodosa).
  • Collagen vascular disease such as lupus erythematosus and rheumatoid arthritis.
  • Lymphoma (cancer of the lymph glands).
  • Blood disorders.
  • Idiopathic (of unknown cause).

    Symptoms

  • Purpura (haemorrhagic spots or patches) which is slightly raised. Purpura does not disappear when pessed.
  • Blisters, painful nodules (swellings) and ulcers may occur in more severe cases.
  • Urticarial vasculitis which is different from ordinary urticaria in that it lasts more than 24 hours and heals with a dark stain.
  • Livedo reticularis which is a mottled or net-like bluish or purplish discolouration of the skin. It may be a sign of polyarteritis nodosa which may affect the skin alone (cutaneous polyarteritis nodosa) or the skin and internal organs (systemic polyarteritis nodosa).
  • Henoch-Schonlein purpura (HSP) is a type of vasculitis that is associated with joint pains, abdominal pains (sometimes constipation or diarrhoea) and haematuria (blood in the urine). It represents a hypersensitivity reaction caused by streptococcal throat infections.

      Vasculitis.
    Click on image for larger view
    Complications
    Complications are usually caused by vasculitis affecting internal organs, for example,
  • Systemic polyarteritis nodosa may cause fever, joint and muscle pains, nausea, vomiting, abdominal pain, heart failure, high blood pressure, kidney problems, strokes and nerve damage.
  • Wegener's granulomatosis may also affect the larger blood vessels, mouth, ear nose and throat (ulcers and destruction of the nasal cartilage leading to a saddle nose deformity), lungs (coughing of blood and breathlessness), eye, kidney and nerve inflammation.

    What you can do

  • You should consult a doctor.

    What the doctor may do

  • Perform a skin biopsy.
  • Conduct tests to exclude involvement of internal organs.
  • Treat with systemic steroids, anti-inflammatory and immunosuppressive drugs.
  • Treat the underlying cause, if any.

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VITILIGO

Vitiligo or leucoderma occurs when the skin pigment, melanin is not produced. It affects about 1% of the population and is a serious cosmetic problem in dark-skinned individuals. A familial tendency has been observed.

    Cause

  • Autoimmune disease (self-allergy) in which the body's defence system mistakenly attacks the melanocytes (melanin-producing cells) as though they were foreign.

    Symptoms

  • Well-defined milky white patches.
  • Occurs most commonly on the face, neck, hands, elbows, knees, the body folds such as the armpits and groin, nipples, genital areas, around orifices (mouth, eyes, anus, umbilicus) and on areas of trauma (eg., along scratch lines).
  • May have evidence or a history of other autoimmune diseases such as premature greying of the hair (see canities), alopecia areata, diabetes, pernicious anaemia, Addison's disease and thyroid disease.
      Vitiligo.
    Click on image for larger view
  • Complications
  • Very occasionally, vitiligo may spread to involve very extensive areas of skin.

    What you can do

  • You should consult a doctor.
  • Use cosmetic camouflage.

    What the doctor may do

  • Exclude other autoimmune diseases or check for antibodies to thyroglobulin and parietal cells (which are increased in autoimmune disorders).
  • Prescribe topical steroids.
  • Treat with topical or oral PUVA - natural or artificial sunlight in association with psoralens (a photosensitising medicine that may be applied to the skin or taken by mouth).
  • Minigrafting which involves removing circular areas of depigmented skin with a biopsy punch and replacing them with grafts taken with the same instrument from other sites such as the buttocks.
  • Bleach the remaining skin to a uniform white colour if vitiligo is very extensive.
    Keypoints
  • The treatment of vitiligo is not very satisfactory.
  • Repigmentation is slow and may not be complete, especially over the fingers and bony prominences.
  • Repigmentation is unlikely if the area involved has no hair follicles or the hairs there are white.

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