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Ecthyma | Eczema or dermatitis | Elastosis perforans | Ephelides | Epidermal naevi | Epidermolysis bullosa | Erythema multiforme | Erythema nodosum | Erythrasma | Erythroderma and exfoliative dermatitis | Eye bags

ECTHYMA

Ecthyma is a deep ulcerative bacterial skin infection most commonly seen in children and the elderly. It usually affects the buttocks and lower limbs.

    Cause

  • Ecthyma is a deep ulcerative type of impetigo caused by the staphylococcal bacteria. Infection may follow an insect bite or some minor skin trauma.
  • Poor hygiene and malnutrition may play a role.

    Symptoms

  • A pustule (pushead) or blister that rapidly enlarges and ulcerates.
  • The ulcer may be covered by a thick crust.
  • Removal of the crust leaves a deep ulcer with a raised border.
  • There may be associated lymphangitis (red lines spreading upwards).
  • Pain..
  • Heal within 6 - 8 weeks, leaving scars.

      Ecthyma.
    Click on image for larger view

    Complications

  • Depressed oval or coin-shaped scars often remain after ecthyma heals.

    What you can do

  • You should consult a doctor.
  • Apply warm compresses followed by removal of crusts.
  • Clean with an antiseptic lotion and apply a thin layer of the topical antibiotic prescribed by the doctor.
  • Observe careful personal hygiene.
  • Do not share personal items such as towels, shaving brushes and blades.
  • Separate bed linens, towels, etc., and boil separately.
  • Keep fingernails short.

    What the doctor may do

  • Prescribe oral and topical antibiotics.
  • Take a culture to help chose the best antibiotic to use.

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ECZEMA OR DERMATITIS

Eczema or dermatitis refers to an inflammation of the skin characterised by redness, swelling, weeping and scaling. It is usually itchy and constant scratching leads to lichenification (leathery thickening of the skin). Doctors divide eczemas into two broad groups:

Exogenous (exo means external and gen means production in Greek) eczemas are caused by external factors such as allergy to cement and plaster or irritation from chemicals, soaps and detergents (see contact dermatitis). Endogenous (endo means internal) eczemas, on the other hand has to do with the skin's make-up or constitution. Hence, they are also called constitutional eczemas. Endogenous or constitutional eczemas cannot be cured whereas exogenous eczemas can be if the causal substance can be avoided.

    Symptoms

    The symptoms are similar regardless of the type of eczema.
  • Acute eczema, subacute eczema or chronic eczema (see below).
  • Itching is common to all stages of eczema.

     Stages Characteristics
    Acute Blisters, weeping, papules (pimply bumps), pustules (pusheads)
    Subacute Redness, scaling, glistening serum and crusting.
    Chronic Dryness, redness, scaling, lichenification (leathery thickening of the skin with accentuation of the skin markings) and fissuring (cracking)


      Acute eczema.
    Click on image for larger view
  • Complications
  • Spread of eczema to other areas of skin or the entire body (see erythroderma).
  • Secondary bacterial infection.
     
    Treatment
  • See under specific types of eczema.

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ELASTOSIS PERFORANS

This is a rare disorder in which abnormal elastic tissue is being pushed out of the skin.

    Cause

  • Part and parcel of other disorders such as Ehler-Danlos syndrome, Marfan's syndrome, Down's syndrome, acrogeria and Rothmund-Thomson syndrome.
  • Drug induced, eg., due to penicillamine, a drug used in the treatment of Wilson's disease ( a disorder of copper metabolism) and scleroderma. Penicillamine interferes with the normal cross linking of elastic tissue. The elastic tissue is therefore abnormal and the skin tries to push it out of the skin.
  • Unknown because some cases occur for no apparent reason.

    Symptoms

  • Ringed-shaped waxy lesion with a slightly depressed centre.
  • Usually appears on the back of the neck or arms.

    What you can do

  • You should consult a doctor.

    What the doctor may do

  • Determine the cause and eliminate it (e.g. penicillamine)
  • Treatment is not needed.

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EPHELIDES

Ephelides or freckles are most commonly seen in children with fair skins, especially those of Celtic origin.

    Cause

  • Inherited tendency.

    Symptoms

  • Light brown or tan spots on the sun-exposed skin, especially the cheeks, nose, shoulders and the upper back.
  • Small (2 - 4 mm in size) irregular in shape.
  • Freckles become darker with sun exposure for example, during the summer and lighten during the winter months.
      Ephelides.
    Click on image for larger view
    What you can do
  • Protect against the sun (see sun protection).
  • Consult a doctor for treatment if the freckles bother you.

    What the doctor may do

  • Lighten with chemical peels or liquid nitrogen aplications.
  • Prescribe hydroquinone containing lightening creams.

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EPIDERMAL NAEVI

This is a relatively uncommon development abnormality appearing at or soon after birth.

    Cause

  • Non-cancerous growth of the epidermis.

    Symptoms

  • Raised brown area with a rough warty surface.
  • Tendency to occur in lines along the length of a limb.

    What you can do

  • You should consult a doctor.

    What the doctor may do

  • Destroy the area using electrosurgery or the carbon dioxide laser.
  • Excise the area with or without grafting.

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EPIDERMOLYSIS BULLOSA

This is a group of rare inherited disorders which result in blistering after minor trauma. There several types of epidermolysis bullosa and they can divided into two groups depending on the mode of inheritance.

  • Autosomal dominant where only one parent need be affected and the offspring has a 50% chance of inheriting the defect.
  • Autosomal recessive where both parents have to be carriers and the offspring has a 25% chance of inheriting the defect.

    Cause

  • Inheritance.

    Symptoms

  • Usually occurs in children as blisters on the feet and hands and on places likely to be traumatised such as the knees and elbows.
  • Generally, the disease is more severe in the autosomal recessive types where blisters may occur in the oesophagus and cause difficulty feeding. In some cases, babies are born with raw skin because the blistered areas have been shed in the womb.

    Complications

  • Infection.
  • Scarring.
  • The digits (fingers and toes) may fuse together as the raw areas heal resulting in severe disability.
    What you can do
  • You should consult a doctor.
  • Protect the skin against trauma.
    What the doctor may do
  • Give genetic counseling.
  • Treat the complications.

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ERYTHEMA MULTIFORME

This is an inflammatory condition of the skin characterised by rashes that look like a target ("target lesions) or bull's eye ("bull's eye lesions)".

    Causes

  • Allergic reaction to drugs such as penicillin, sulphonamides and barbiturates.
  • Hypersensitivity reaction to bacteria (eg., mycoplasma chest infection), virus (especially the herpes simplex virus or cold sore virus).
  • Internal disease.
  • Pregnancy.
  • Unknown.

    Symptoms

  • "Target" or "bull's eye" lesions comprising of a pale or dusky red centre (sometimes, a blister) and surrounding rings of different shades of red. Usually occur on the back of the hands, palms, soles, limbs and face.
  • May be preceded by a cough, fever, sorethroat, malaise (feeling of illness) or headache.
  • In severe cases, the mucous membranes (eyes, mouth, nasal passages and genitals) may be ulcerated. This form is called Steven's Johnson's syndrome. Another more severe form is called toxic epidermal necrolysis. In this form the, the rashes progress rapidly to become blisters that slough off leaving raw areas like a scald.
      Erythema multiforme.
    Click of image for larger view
    Complications
  • Secondary infection of damaged skin.
  • Eye damage from Steven's Johnson's syndrome.
  • Fluid and electrolyte imbalance, organ failure and shock from toxic epidermal necrolysis. May be fatal.
     
    What you can do
  • You should consult a doctor.
     
    What the doctor may do.
  • Prescribe topical steroids for mild cases.
  • Prescribe systemic steroids (oral or intravenous) for severe cases.
  • Hospitalise severe cases of erythema multiforme, Steven's Johnson's syndrome and toxic epidermal necrolysis for management.
  • Treat the underlying cause.
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    ERYTHEMA NODOSUM

An inflammatory condition of the skin characterised by painful inflamed nodules (large swellings) on the lower legs.

    Cause
  • Hypersensitivity to bacterial infection, eg., streptococcal sorethroat and tuberculosis.
  • Hypersensitivity reaction to deep fungal infections such as histoplasmosis and coccidiomycosis.
  • Drug eruption, eg., due to sulphur drugs, iodides, penicillin and the birth control pill.
  • Sarcoidosis, a disease that causes a purplish facial rash, enlarged lymph glands in the mediastinum (middle of the chest), fever and joint pains. It may affect the eyes, heart, lung and kidneys (as a result from high calcium levels). It is more common in Blacks. Sarcoidosis responds to oral steroids. Methotrexate, an immunosuppressive drugs, may sometimes be used.
  • Inflammatory bowel disease such as Crohn's disease and ulcerative colitis. Behcet's disease.
  • Collagen vascular disease.
     
    Symptoms
  • Inflamed, red painful swellings.
  • Usually occur on the lower legs. Sometimes on the arms.
  • May be associated with fever, malaise (feeling of illness), headache, muscle and joint pains.
     
    Complications
  • Depends on the underlying cause.
     
    What you can do
  • You should consult a doctor.
     
    What the doctor may do
  • Determine and treat the underlying cause.
  • Prescribe painkillers or nonsteroidal antiinflammatory drugs (NSAIDs), potassium iodide or oral steroids.
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ERYTHRASMA

Erythrasma is a superficial bacterial infection of the body folds such as the toe webs, groin and armpits. It is more common in warm climates and usually affects young adults.

    Cause
  • Infection with a bacteria called Corynebacterium minutissimum.

    Aggravating factors
  • Diabetes
  • A warm, humid climate.

    Symptoms
  • Well-defined pink or brown dry patches in the armpits, groins and buttock cleft.
  • Scaling and maceration of the toe webs.
     
      Erythrasma
    Click on image for larger view 
    What you can do
  • You should consult a doctor.
  • Wear loose clothes.
     
    What the doctor may do
  • Confirm the diagnosis.
  • The affected areas fluoresce a coral red colour when illuminated with a Wood's lamp.
  • Treat with an oral antibiotics such as erythromycin or antibiotic or antifungal creams. Relapses are common.
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ERYTHRODERMA AND EXFOLIATIVE DERMATITIS

Erythroderma refers to a diffuse reddening of the skin whereas exfoliative dermatitis refers to reddened skin that is also exfoliating or shedding. They have different causes.

    Causes
  • Spread of a pre-existing skin disease such as atopic dermatitis, seborrhoeic dermatitis, varicose eczema, contact dermatitis, psoriasis, lichen planus, pityriasis rubra pilaris and pemphigus foliaceus.
  • Norwegian crusted scabies.
  • Congenital ichthyosiform erythroderma (see ichthyosis).
  • Diffuse mastocytosis.
  • Severe photosensitivity.
  • Drug allergy (see drug eruption) - especially antimalarials, allopurinol (gout medicine), non-steroidal anti-inflammatory drugs, phenytoin (used to treat epilepsy), gold (used to treat rheumatoid arthritis) and penicillin and sulphonamide antibiotics.
  • Underlying cancers such as lymphomas and leukaemias.
  • Unknown.

    Symptoms
  • Diffuse redness of the skin.
  • Shedding of scales as the condition progresses.
  • Itching.
  • Fatigue.
  • Fever.
  • Shivering from excessive heat loss.
      Erythroderma.
    Click on image for larger view
    Complications
  • Hypothermia (low body temperature) due to increased heat loss from the dilated blood vessels in the skin.
  • Cardiac failure due to increased blood flow through the skin putting a strain on the heart.
  • Hypoproteinaemia (low serum protein) due to loss of skin cells.
  • Iron deficiency anaemia.
  • Weight loss.
     
    What you can do
  • You should consult a doctor.
     
    What the doctor may do
  • Hospitalise for management.
  • Determine and treat the underlying cause.
  • Prescribe oral and or topical steroids.
  • Prescribe antihistamines to reduce itching.
  • Treat the complications.
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EYE BAGS

Eye bags are a common cause of concern because they make a person look old and less alert.

    Cause
  • Herniation of fat through a weakening in the orbicularis oculi muscle.
  • Loss of skin elasticity due to ageing.
  • Swelling due to fluid accumulating as a result of lack of sleep, stress, allergy or illness.
  • Inherited condition known as blepharochalasia.

    Symptoms
  • Loose skin under the eyes.
  • Swelling under the eyes.

    What you can do
  • The swelling, if due to fluid aculating, can be reduced by using a cool compress or cucumber slices.

    What the doctor can do
  • Exclude allergies and other illnesses.
  • Perform blepharoplasty (eyelid lift).
 
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