Physical Therapy for Skin Disorders

Skin Disorders

Acne Vulgaris

• A skin disease caused by changes in the pilosebaceous units (hair follicles and sebaceous gland)
• Commonly occurs during adolescence, affecting more than 85% of teenagers, and frequently continues into adulthood
• Causes:
  • Family/genetic history
  • Hormonal activity (menstrual cycle, puberty)
  • Inflammation, skin irritation, or scratching
  • Stress
  • Hyperactive sebaceous glands
  • Accumulation of dead skin cells blocking pores
  • Bacteria in pores
  • Use of anabolic steroids
  • Certain medications (barbiturates, androgen)
  • Diet (high consumption of chocolates)
• Treatment:
  • Oral antibiotics
  • Topical antibiotics
  • Hormonal treatment (for females)
  • Physiotherapy:
    • Goals:
      • Obtain desquamation of skin
      • Increase vascularity
      • Reduce number of micro-organisms
      • Improve general health and hygiene
    • Methods:
      • UVR
      • Laser (He-Ne laser, 632.8nm wavelength)

Alopecia Areata

• Defined as premature loss of hair, sometimes leading to total loss of hair from the body
• Causes:
  • Autoimmune disorder (body attacks its own hair follicles and suppresses hair growth)
  • Age: generally affects individuals under 30 years old
  • Predisposing factors:
    • Poor health
    • Heredity
    • Anxiety and fatigue
• Pathological Changes:
  • Hair becomes weak from the root and comes out of follicle
  • Atrophy of hair follicle occurs
  • Sebaceous glands become inactive or less active
• Clinical Features:
  • Insidious onset
  • Hair starts falling in clumps
  • White skin appears after patches of hair fall
  • Baldness appears
• Classification:
  • Alopecia areata: loss of hair from scalp in patches
  • Alopecia totalis: scalp hair loss along with eyebrows
  • Alopecia universalis: loss of hair all over the body
• Prognosis:
  • Growth of fine hair may be seen within two months
  • Majority of patients recover within a year
  • Sometimes patients may not recover
• Physiotherapy treatment:
  • Aims:
    • Improve general health
    • Improve nutrition to hair follicles
  • Means:
    • UVR (sub-erythema or E1 doses) for 5-8 minutes daily, continued for 2-3 months

Dermatomyositis

• A systemic connective tissue disease characterized by inflammatory and degenerative changes in muscles and skin
• Leading to symmetric weakness and some degree of muscle atrophy in limb girdles, neck, and pharynx
• May affect the esophagus, lungs, and heart
• Typically appears between ages 40-60, with a female to male ratio of 2:1
• Characteristics/Clinical Presentation:
  • Onset may be acute or insidious
  • Progressive symmetric muscle weakness primarily in muscles of proximal joints and neck and pharynx
  • Erythematous skin rash, elevated on the face, neck, shoulders, chest, and back
• Causes:
  • Unknown etiology
  • Potential autoimmune mechanism
  • Potentially triggered by a virus
  • Potentially drug-induced
• Physical Therapy Management:
  • Goals:
    • Reduce impaired joint mobility
    • Restore motor function
    • Improve muscle performance
    • Regain range of motion associated with connective tissue dysfunction
    • Reduce complications of skin involvement into fascia, muscle, or bone and scar formation
  • Treatment:
    • Patient education on joint preservation
    • Strengthening to prevent atrophy once inflammation is controlled
    • Range of motion exercises to prevent contractures
    • Passive stretching and splinting

Vitiligo

• A chronic disorder that causes depigmentation patches in skin
• Incidence: 1-2% of the population, affecting both males and females of all races, at any age
• Causes:
  • Unknown etiology
  • Autoimmune disorder (melanocytes destroy themselves)
• Symptoms:
  • Depigmented patches (milky white) on the skin, common in sun-exposed areas
  • Rarely, patches show slight erythema, but typically only depigmentation and sensitivity to light
  • Hair may be white or black
• Patterns of Vitiligo:
  • Focal Pattern: depigmentation limited to one or few areas
  • Segmental Pattern: depigmentation develops on only one side of the body
  • Generalized Pattern: depigmentation develops on different parts of the body
• Treatment:
  • Repigmentation Therapy
  • Topical Corticosteroids
  • PUVA (psoralen and UVA light therapy)
  • Narrow Band UVB (NBUVB)
  • Grafting (transfer of skin from normal to white areas, useful for a small group of vitiligo patients)