Dermatology PDF

# Dermatology ## Definition Diagnosis and treatment of skin diseases ## Layers of Skin 1. Epidermis 2. Dermis 3. Hypodermis ## Epidermis Has 3/4 types of cells: ### Keratinocytes - About 90% present - Have keratin (dense protein) - Have protective role against environment and pathogens ### Me...

# Dermatology ## Definition Diagnosis and treatment of skin diseases ## Layers of Skin 1. Epidermis 2. Dermis 3. Hypodermis ## Epidermis Has 3/4 types of cells: ### Keratinocytes - About 90% present - Have keratin (dense protein) - Have protective role against environment and pathogens ### Melanocytes - About 8% present - Important in melanin formation that protects from sun rays - Melanin production depends upon aggregating factors like sun exposure and stress - Alpha-MSH release in response to stress ### Langerhans Cells - These are immune cells that originate from hematopoietic stem cells. - They are macrophages that present in skin that kills pathogens in the epidermis. ### Merkel's Cells - These are limited in number - They are present deeper inside the skin - They are sensory cells. ## Layers of Epidermis 1. Stratum Corneum - Granular type - It has maximum keratin - Provides physical barrier - Prevents harms of weather 2. Stratum Lucidum - It is only present in fingerprints, palms, and ridges of soles. - It is not present in the whole body surface - It increases the thickness of the skin - It gives a glossy appearance 3. Stratum Granulosum - It is the second layer in the whole body and third in the palms and soles - It is granular dispersed - It has small size cells 4. Stratum Spinosum - It has small cells that have spines - Maximum thickness is 4 millimeters (thicker most in the soles) - Minimum thickness is 0.5 millimeters (skin of eyelids) 5. Stratum Basalae - It is the basal layer - It is present deeper most - Its cells are capable to divide ## Layers of Dermis Dermis is connective tissue, fibrous aerolar tissue. ### Outer Layer - Makes up 1/5th of the total thickness - Elastic in nature, has finger-like projections that increase surface area so the skin stretches - Papillary region - Nails protect finger tips and skin around nails - Hair gives protection and temperature regulation. Hair follicles surround by micro muscles called erectal pilli (erects in winter) - When it divides, the skin moves upwards, the corneum slugs off, and the lucidum becomes corneum basalae. Then, the corneum basalae becomes spinosum, the spinosum becomes granulosum, and the granulosum when the basalae divides further. ### Reticular Layer - Makes up 4/5ths of the dermis thickness - Major structures like hair and glands are present. It protects and regulates temperature. - Appendages present like nails and hairs. - Oily skin has high secretions - Glands are also present here. Sebaceous glands present in surrounding to hair follicles, which have the same opening as hair follicles. These glands secrete fatty secretions to prevent dryness of the skin. Glands are not present in palms and soles. If infection of the duct occurs, then pimples form, also called folliculitis. - If glands secretions trap in skin, it is called a white head. If these secretions come out and make contact with the environment, then it becomes black head. ## Sweat Glands Present all over the body. ### Acrine - Present all over the body - It has no connection to hair follicle. ### Apocrine - Present in specific regions like armpit or pubic region. - Water plus fatty material in secretion causes smell/odour. ## Eczema - It is a type of dermatitis - Characterized by dry and itchy patches on the skin. Vesicles present along with inflammation, erythema, itchiness, and exudation. ## Causes of Eczema - Overactivity of immune response causes eczema - Genetic predisposition - Environmental factors (pollutants, smoke, soaps, cosmetics, low humidity) - Mental health effects skin - High stress levels - Anxiety - Depression - Foods (peanuts, dairy products) - Skin barrier damage due to scratching in eczema ## Appearance of Eczema - Purple color discoloration in dark skin - Red or pink color discoloration in fair skin ## Incidence of Eczema Common in children and resolves in adults. ## Risk Factors of Eczema - Dermatitis - A-fever - Asthama - Co-exist with intestinal worms (give deworming in treatment) ## Location of Eczema Most commonly - Hands - Feet - Knees - Ankles - Neck - Elbow, face - Cheeks, lips, around ears ## Signs and Symptoms of Eczema - Dry scaling of the skin - Itchiness - Rashes. - Bumps on the skin - Thick leathery patches on skin (chronic, not in acute) - Flaky/crusty/scaly skin - Swelling of the skin ## Types of Eczema - Contact dermatitis - Atopic dermatitis - Distropic dermatitis - Neurodermatitis - Seboric dermatitis - They may exist single or co-exist with each other ## Diagnosis of Eczema - Physical examination - Do allergy test (inject allergic antigen) - IGE test (non-specific test). Antibodies level increases - Skin biopsy (to differentiate between different types of dermatitis) ## Treatment of Eczema ### Urtecaria - Jal neem 50 grams - Chaksu 50 grams - Narkachor 25 grams - Asoont 50 grams - Barhami dandi 50 grams - Fulfil siyah 50 grams - Sarphoka 50 grams - Dose: 500 milligrams (1 + 1) cap form ### Warmi (For Deworming) - Barg e neem 2 grams - Magz Kadu 2 grams - AFSanteen Ignored - Zeera siyah Ignored - Bao barang 3 grams - wirch Ignored - Long Ignored - Amla Ignored - Dose: Children: 250 milligrams; Adults: 500 milligrams (1 + 1) given after some sweet for two weeks ### Allergix - Barg e mehndi 1 gram - Tukh e mehndi 1 gram - Shahtra 1 gram - Gul e nelofer 1 gram - Gul e banafsha 0.25 gram - Dose: 500 milligram capsule. Give in all types of allergy. ### Special Eczema Treatment - Zafran .5 gram (1/2 gram) - Jand baid satr 3 grams - Mustagi 3 grams - Dose: 500 milligrams ### Medications for Application on skin: - Murdar sang 20 grams - Ral safaid 20 grams - Kafoor 10 grams - Neela thotha 5 grams (4 injections powder form) - Penicillin Ignored - Shab e zamani 20 grams - Vaseline 100 grams - Dose: Mix/grind and then apply locally. ### Ready-Made Medication - Humdard (sulfur ointment) - Marham kafoori - Piles x oil ## Acne Vulgaris - It is the cutaneous infection of pilocebacious units. - As a result papules or comedons form. - The duct is inflamed, and the exudate stores. ### Close Comedons - They are white heads. - If the inflammatory exudate stuck inside the skin, then it is called a white head. ### Open Comedons - They are black heads. - If the inflammatory exudate comes out and makes contacts with the environment, so wastes or pollution make it black, these are called black heads. ## Acne Vulgaris: If It Stays For Prolonged Time - If it stays for a prolonged time, then inflammation of the duct starts, which forms pustules or nodules. ## Acne Vulgaris: Incidence - Common in the 30's - Occurs in pubertal to prepubertal age - In both sexes - If males are insensitive to androgens, then no acne occurs. ## Acne Vulgaris: Location - Shoulder blades - Upper in the thoracic cavity - Back - Chin - Cheeks - Forehead ## Acne Vulgaris: If More Skin Involves - If more skin is involves, then a hard mass forms called a nodule. - If pus is present, then it is called a pustule. ## Causes of Acne Vulgaris - Cutibacterium acne - Propionibacterium Invade by the duct and cause infection - Androgens (hyper sensitivity to normal levels of androgens) - The follicle present in surrounding of sebaceous glands reacts with the duct. - Pre-menstrual chances are high due to edema of the duct - Coexist with PCOS (because they have a high androgenic factor) - Stress - Chemicals (oily in nature) - Genetic cause - Vigorously rub the skin - Exposure to sunlight - Oil-based cosmetics - Use of medications (anti-convulsant therapy) - Oily diet. - Nodules have multiple postures - Androgens increase sebum production ## Pathogenesis of Acne Vulgaris - Abnormal keratinization occurs - The corneum cells block the duct, so keratinization occurs - Hair follicles also contain keratin excess. Keratinization causes acne formation - If it exceeds, then multiple lesions are present in the skin - If re-injury occurs, hyper keratinization occurs, so scars form - Healing occurs if pus removes ## Color of Acne Vulgaris - Reddish or dark brown color ## History of Acne Vulgaris - Divide it into grades: ### Grade 1 - If only comedon occurs (due to sebum accumulation). No pustule present and no inflammation. ### Grade 2 - If inflammation present and red pimples form, pain occurs. ### Grade 3 - Pus formation occurs ### Grade 4 - If large surface area is involved. ## Treatment of Acne Vulgaris ### Topical Therapies - Benzyl peroxide (4%, 5%, 10%) - It is hygroscopic in action, so it reduces the edema and lessens the pain, so the pustule subsides. It is marketed as Bravoxyl. - Topical Isotrex (0.05%) - Benzyl peroxide (1%) + Clindamycin (DUAC name) - Tetracycline - Arthriocine (250-500 milligrams) ### Hormonal Therapy - If all above treatments fail, then give steroids (estrogen + anti-androgen) (estrogen + prednisolone) ## Management of Acne Vulgaris - Treat the cause like remove dietary factors - Avoid C+D/D+H food ## Herbal Remedies for Acne Vulgaris - Raskpoor Ignored - Dar chakna Ignored - Hartal 2 grams - Babchi 4 grams - Rayi 8 grams - Do not give this to a patient with a high temperature. Instead, give asgand + stawar + malathi (1000 milligrams). ## Psoriasis - It is a chronic disease in which the immune system becomes more active, causing skin cells to divide too quickly. ## Characteristics of Psoriasis - Patches of skin become scaly and inflamed ## Types of Psoriasis - Most common type ### Plaque Psoriasis - Appears as raised red patches of skin that are covered by silvery scales. - Develops in a symmetrical pattern in the body ### Guttate Psoriasis - Usually appears in children and young adults. - Small dots like, usually on the limbs ### Pustular Psoriasis - This type has pus-filled bumps called pustules, surrounded by red skin that appears. - Usually appears on the hands and feet. ### Inverse Psoriasis - This form appears as smooth red patches in folds of the skin, such as beneath the breast, groins, or armpits. ## Symptoms of Psoriasis - Poor sleep quality - Chronic disease, so anxiety and depression - Depends upon types - Patches of thick red skin with silvery white scales that are itchy or burning - Dry, cracked skin that itches or bleeds - Thick, rigid, pitted nails ## Aggrevating Factors of Psoriasis - Infected by staphylococcal or HIV - Certain medications, especially to treat heart, mental disorders, malaria - Smoking - Obesity ## Management of Psoriasis - Bed rest - Balanced diet - Avoid stress - Remove aggravating factors - Remove anxiety stress in present ## Psoriasis: Differential Diagnosis - White scales and thickness, bumps ## Causes of Psoriasis - Autoimmune causes predisposed with genetic factors - The actual cause is unknown - Psoriatic flare period---in which symptoms appear ## Psoriasis: Treatment - Prescribe anxolactic medications - Polytar (liquid/bar) that is the combo of coal tar and pin tar - Psoralei (for local application) - Methotrexate (10-15 milligrams) once a week (IM, IV) - Cyclosporins (2.5-5 milligrams/kilogram) in divided doses (2, 3) in severe cases. - Prednisolone (5-15 milligrams) 3-4 times. - Tapering course ## Psoriasis: Herbal Treatments - Babchi Ignored - Gandak Ignored - Sat podina Ignored - Grind the first two and the third one in a pestle and mortar, then fill capsules; use equal quantity. - Slica gel capsules to prevent liquidfication - Give barhami boti (grind in powder form) - Give immunomodulators 500 milligrams twice a day, like aloe vera or syrup (barisal, alocare) - Give utrecaria - If burning sensation then give sat podina. - M2 + M3 = Set 2 (mix them in equal quantity, fill capsules called set 2. - HR: - Ajwain Ignored - Babchi Ignored - Rayi Ignored - Gandak Ignored, 3 times of the above ones ## Alopecia Areata - It is an autoimmune disorder. - Here loss of hair occurs in specific areas (round, patches) ## Causes of Alopecia Areata - Hormonal - Fungal (here chances high) - Allergic conditions (Asthama) - Can coexist with seboric dermatitis or dandruff ## Location of Alopecia Areata - Scalp or other body parts where hair is present ## Types of Alopecia Areata - Here all scalp hair loss occurs ### Alopecia Areata Totalis - Here all scalp hair loss occurs ### Alopecia Areata Universalis - Here all body hair loss ### Ophiasis Alopecia Areata - Here no hair is present in sides or back, but hair is present in the center. ## Symptoms of Alopecia Areata - Patchy hair loss - No facial hairs - No eyelashes/eyebrows - Pitted nails - Itching not present - Tingling sensation in patches during hair fall - Area may be plane, soft, and have plane dots due to presence of the hair follicles. - Margins of the hair are weak, so it can easily pick. ## Diagnosis of Alopecia Areata - Physical examination - Culture if seboric then greasy/oily dandruff, then culture it. ## Treatment of Alopecia Areata - Corticosteroids to suppress the immune system - Immunomodulators (aloe vera ki bani hue) for the autoimmune - Hydro (Barisal) Ignored - Antimony sulfide (for hormonal and fungal cause) use it topically (5 grams/100 grams) 5 grams of powder in wet field, like vaseline, jelly or oil. - If only fungal, then combine benzoic acid (10 grams) + salicylic acid (5 grams) (100 grams/wet field) - Fungal then use copper sulfate (1 gram) in 100 millimeters of vinegar, mix it and add in the bottle and use 5-10 drops in water after bath. - Use selenium-based shampoo ## Alopecia Areata: Herbal Remedies - Methi dana - Amla - Barhami - Malathi - Bicho boti - In equal quantity. ## Another - Amla (Antioxidant). 1 gram - Asgand (has starch/protein). 2 grams - Give in 1 gram dose. - It is used for hair fall and sleep. May also be used in lactating females. ## Icthyosis - It is a skin disorder, which causes the formation of dry fish-like scales on the skin surface. - It is characterized by dry, thickened, rough, scaly skin. - 20 types of icthyosis are present, including hereditary and acquired. ### Icthyosis Vulgaris - Most of the cases belong to one common cause, icthyosis vulgaris. - Icthyosis vulgaris is an autosomal dominant condition characterized by dry, scaly skin. ## Pathogenesis of Icthyosis - Skin cells form a high amount of keratin, which in turn causes dry scales. ## Symptoms of Icthyosis - Dry scaly patches - Itching - High chances of skin infection due to itching - Dryness - High keratinization ## Diagnosis of Icthyosis - It does not develop in children - It develops to maximum from 3-5 months to 5 years. - Symptoms become less as the age progresses. - High chances in the old age. - No symptom in adolescence. ## Location of Icthyosis - Commonly dry scales are present in the dorsal surface where skin is stretched. - Symptoms maximum - Less common in areas where folds are. - High scales in the elbow joint - Palmer or planter surface is thickened due to hyper keratinization ## Treatment of Icthyosis - Symptoms can reduce with more care. - Use moisturizer. - Oilatum cream (makes the skin soft and smooth). - Lacticare cream (steroid + ointment present) ## Active Components in Icthyosis Products - Urea (10%-20%) - It increases flexibility of the skin and maintains high humidity. - Propylene glycol (10%-20%) - It has a hygroscopic effect and absorbs water and causes shedding of scales. - These 2 can be mixed separately in any vet field and used locally. ## Freckles and Lentigo - Freckles are dark color spots, whereas the size increases in the case of a lentigo. ## Causes of Freckles and Lentigo - Freckles are produced as a result of overproduction of melanin by melanocytes (hyperpigmentation). - Lentigo is also known as liver spots. ## Location of Freckles and Lentigo - Facial region - Dorsal surface of the body - More sun exposure body parts - High in pregnancy - Freckles are commonly present in fair-skinned people. - Mostly dupsy ## In Case of Melanoma - These are large in size and are seen as a bump on the skin ## Treatment of Melanoma - Less stress - Less sun exposure - Less hyperpigmentation method - Cosmetics are used ## Melanoma: Wars - There two types of wars present ### Yaman - Pink and yellow color; more effective ### Sodan - Black color - Boil in olive oil until its color turns pink; then, massage it on the effective area. It will increase the blood supply, which leads to more waste removed from that area. ## Melanoma: Recent Theory - When black bile increases in the body, it causes black discoloration in the body. - Here heat-producing organs get damaged - H+D -------> C+D - Accumulation of waste also increases because of C+D ## Melanoma: Orally - Qus + t + Shereen. 1 gram - Haldi. 1/2 gram - Wirch Ignored - Arjan. 1 gram - Make a paste in olive oil and massage on the skin. ## Root Causes of Melanoma - Give H+M in last trimester. - Calcium and iron to C+D temperature. ## Atopic Dermatitis - A type of eczema. - Chronic, autoimmune ## Incidence of Atopic Dermatitis - Children: 20%; Adults: 10% ## Location of Atopic Dermatitis - Affects flexion area, especially: - Creases - Under the eyes - Neck - Cheeks - Elbow - Back of the knee ## Pathogenesis of Atopic Dermatitis - Here the immune system dysregulation - Dendritic cells get damaged. - Interleukin 4 activates IGE. - Genetic (FLG fillagrin gene) produces fillagrin protein that acts as a barrier, but due to mutation protein is not produced ## Causes of Atopic Dermatitis - Skin barrier - Due to dehydration as the water molecules act as a barrier. - Water molecules diffuse: It is a trans-epidermal water loss. Water is less, so the pH of the body is less. - The tight junction: As barriers disrupt so the antigen enters. ## Risk Factors of Atopic Dermatitis - Family history is present in 70% of the cases. - Genetic - Dehydration/water loss - Allergies - Hot and dry climate - Smoking - Stress ## Symptoms of Atopic Dermatitis - Dry, scaly, cracked skin. - Inflammation - Redness - Burning sensation - Leisons ## Diagnosis of Atopic Dermatitis - Clinical examination - Medical history (family history, antigen exposure) - Physical examination: Hanfin and Pajka criteria. - 3 things necessary to confirm: - Pruritis - Eczematous lesions - Dry Skin - Check IGE levels, which are raised (non-specific test). - Complete blood count (CBC) ## Management of Atopic Dermatitis - Avoid risk factors - Use moisturizer. - Prevent water loss - Antibiotics - Immuno modulators ## Atopic Dermatitis: Herbal Treatments - Hab e sabar (1 + 1) 500 milligrams - Hydro (500 milligrams) - Allergix (500 milligrams) ## Leprosy - It is a chronic skin infection. - Caused by Mycobacterium leprae. - The involvement of the nervous system occurs. ## Incidence of Leprosy - High risk in 5-15 years or over 30 years. ## Pathophysiology of Leprosy - The Mycobacterium leprae (ML) invade and target Schwann cells (protective cells of the peripheral nervous system) - The ML reacts against them and destroys them. - It causes parasthesia of those cells - Due to this sensory and motor function loss. ## Leprosy: Location - Most commonly in the extremities, specifically: - Extremities - Upper limb - Facial region - Feet and legs. ## Leprosy: Most Commonly Found In - Asia and Africa ## Leprosy: Mode of Transmission - Droplet infection - Direct contact - Handshaking ## Leprosy: Complications - Due to motor and sensory loss, paralysis may occur ## Leprosy: Types - There are different types: ### Tuberculoid Leprosy - It is the same as the in to inf - It is the same type of granuloma, and the nodules form as in the case of tuberculosis. - These are most common, occurring in the periphery, anular shaped, parasthetic, dry patches. - Complications include palsy of peripheral nerves, foot drop, and hand drop. - Initially only sensory loss occurs, but motor function also is lost in advanced stages ### Lepromatous Leprosy - Here, nasal discharge, epistaxis occurs. - Small, symmetrical hypopigmented macules form. - Mostly affects the legs, arms, buttock, and face. ## Leprosy: Shape - Anular shaped, may be small, or large. ##Leprosy: Characteristics - Hypopigmented patches are produced, which may be a macule, nodule, or pustule. - The lesions are dry and anaesthetic (no sensation) ## Borderline Leprosy - In borderline leprosy, skin lesions are numerous, but they remain asymmetrical. - The lesions are usually plaques rather than macules and exhibit satellite lesions. - Nerve involvement in borderline leprosy is manifested as thickening or tenderness of local nerves, but the skin lesions retain sensation. ## Intermediate Leprosy - Indeterminate leprosy is characterized by hypopigmented maculae with ill-defined borders; - If untreated, it may progress to tuberculoid, borderline or lepromatous disease. ## Leprosy: Treatment - Give multi-therapy drugs for 1-2 years. - After treatment, patients should be under observation for 5 years. - Drugs that should be used: - Dapsone: 100 milligrams per day. - Refempicine: 600 milligrams per month - Clofazimine: 300 milligrams per month - Give antibiotic minocycline (100 milligrams per day) for the first 3 months ## Vitiligo - It is an acquired autoimmune disease. - Here hypopigmentation or discoloration of the skin occurs. ## Pathogenesis of Vitiligo - Here, auto-immune destruction of melanocytes occurs, which causes no melanin production so patchy areas are produced on the body. ## Vitiligo: Location - Patchy areas may be found on hands, and feet. These patches remain prolonged for years. - These patches become larger in size with passage of time. ## Vitiligo: Shape and Size - If the size is 1 centimeter, then it is called a macule. - If the size is less than 1 centimeter, then it is called a papule. - Papules fuse with each other and become larger in size. ## Vitiligo: Characteristics - Patches have demarcated convex edges. - These patches are localized and multiple in number ## Causes of Vitiligo - It's only a cause of autoimmunity. ## Vitiligo: Incidence - Only 1% of the population have this ## Vitiligo: Management - Give immunomodulators or immunosuppresors because of an autoimmune disease. - Use sun blocks, because the reaction of the skin increases in the sun. - Can give corticosteroids, which lessen the process but its an immunosuppressor, so the chances of other diseases become high - Clobivat (inhibits the immune system, prevents spreading) ## Vitiligo: Skin Type - The skin will be white if no hairs are present. - If hairs are present, then hairs will also become white. ## Vitiligo: Risk Factors - If any other autoimmune disorder, like Addison's disease, SLE, or sarcoidosis are present, then chances will be high. ## Vitiligo: Herbal Treatments - If C+M increases in the body, then vitiligo forms, so give C+D medication. - Loung Ignored - Dar cheni Ignored - Jal vatri Ignored ## Warts - These are noncancerous outgrowths on the skin. - Normally they are non-dangerous, but sometimes they are painful. - These are contagious. ## Causative Agent of Warts - Caused by the human papilloma virus. - This virus has over 100 strains. - Some strains cause warts. Some cause cancer - 10-15 types cause warts or moles depending on which body part is involved. ## Warts: Location - They may be on the skin, mucosa, like the buccal, cervical, or anal mucosa ## Warts: Incidence - 20% chances in school-going - High chances in immunocompromised people ## Warts: Shape - These are flat, round, rough, brown, gray, black, or cauliflower-like. ## Types of Warts - Here are some common types: ### Common Warts - Caused by 2,4 strains of the virus - Commonly on hands. - Rough bumps and black dots are present. - It is black due to dead capillaries. So, the heme removes oxidation of the blood, which causes discoloration. ### Planter Warts - Caused by 1,2,4,27,57 stains of the virus - Commonly present beneath the soles. - These are flat, develop deep inside (seem smaller outside and larger inside). - Common in the school-going (10%-20%): ### Mosaic Warts - Caused by the 2nd strain of the virus - Commonly on the ball-like region of a thumb, between the toes of the planter region. - It can spread and cover a major area of the planter region. - These are painless; they don't disturb walking. - These are flatter. ### Filiform Warts - Caused by 1,2,4,27,29 strains of the virus - Most commonly in the face, around the eyes, nose (inside the nose). - These are like hanging over the skin. - They are finger or thread-like. ### Flat Warts - Caused by 3,10,28 strains of the virus. - It does not have any specific region. - It can be anywhere. - These are smooth and soft - May vary in number from 10-100 ### Genital Warts - Caused by 6,11 strains of the virus. - Present on the mucosa lining, cervix, anal canal. - It spreads through direct contact. - These are hard, noodle-like, rough. ### Butcher's Warts - A butcher's wart is a wart on the hands of butchers - They tend to occur in multiple numbers. - They are generally larger than common warts. - It is typically associated with 2,4,7 strains of the virus and up to 50% by HPV7. - It occurs when hands have prolonged contract with moist meat. ### Focal Epithelial Hyperplasia - Heck's disease, also known as Focal Epithelial Hyperplasia, is an asymptomatic, benign neoplastic condition, characterized by multiple white to pinkish papules that occur diffusely in the oral cavity. - Can present with slightly pale, smooth or roughened surface morphology - It is caused by the human papilloma virus (HPV) types 13 or 32 ## Treatment of Warts - Cut from the base, and use the silver nitrate solution to remove the bleeding. - Apply acetic acid directly; it will remove in 2-3 days. - Use 1 gram of caustic soda + lime water, make a paste and apply this gel-like material drop by drop locally. It will remove in 2-3 days. It causes the removal of blood supply and inflammation. - Remove a single layer daily. This is a long-term process where size reduces (50%-70%), which has a high success rate. Use salicylic acid topically if multiple. - Give specific anti-virals. ## Warts: Herbal Treatments - Orally use hydro, HS, Set 2. - Taramera - Babchi - Rayi - These 3 can be given separately in 250-500 milligrams in powder form. ## Candidiasis - Fungal infection caused by any species of candida. - Our body contains normal flora, which maintains a balance to prevent overgrowth. - When normal flora imbalanced, there is a high chance of candida albicans. ## Treatment of Candidiasis ### Local - Use the hydrazol for chronic. - Vinegar + copper sulfate (5% concentration) and apply with cotton buds. Don't touch anything after the application (apply at night). - Salicylic acid + benzoic acid. ### Systemic - Use fluconzol (150 milligrams per week) systemically. ## Onychomycosis - Onychomycosis, which is also known as tinea unguium, is a fungal infection of the nail. - Symptoms may include white or yellow nail discoloration, thickening of the nail, and separation of the nail from the nail bed. - Fingernails may be affected but are more common with toenails. ## Pityriasis - Small patches or discoloration of the skin - Whitish patches are produced - Present in arms and back. - It is caused by hot or humid climate as sweating is high in the body. - If it remains prolonged, then it fuses to form large. - It is caused by the imbalance of normal flora of Malassezia specie. - If it remains prolonged, then the surrounding becomes pink. - When patches enlarge, they seem like pink spots on the body, otherwise, they seem as white. ## Pityriasis: Treatment - Use topical antifungals. ## Intertrigo - It is a type of Candida. - Caused due to overgrowth of Candida in the skin folds. - If hygiene is not good, it happens. - Caused by hot and humid climate. - It is present in the webs in fingers, toes, beneath the breast, nappy rashes in the child, buttock (napkin dermatitis), groin, in toes of athletes. - Caused by moisture. It spreads externally and starts from deeper folds. ## Intertrigo: Treatment - Use local treatment as above. - Maintain hygiene. - Improve the environment. - Reduce sweating. - Use the powder form. ## Vulvo-Vaginal Candidiasis - It is commonly present. - Itching, redness or inflammation of the vulvo-vagina due to Candida. - If the swelling is prolonged, then it causes urinary tract infection (UTI). - It's chances are high in poor hygiene, pregnancy, advance age, diabetes, immuno-suppressant people, low iron level, or anemic patients. ## Vulvo-Vaginal Candidiasis: Treatment: - Use local anti-fungal. - If prolonged then use systemic antifungal. - Use medication to suppress the symptoms like immunomodulators. - Use M2+M3, hydro, HS, MSlif dryness, because the itching is high. - Use anti-inflammatory. ## Carbuncles - A carbuncle is a cluster of boils caused by bacterial infection. - The presence of a carbuncle is a sign that the immune system is active and fighting the infection. - The infection is contagious and may spread to other areas of the body. ## Carbuncle: Location - Commonly present in the eyes, nose, face, spinal cord, and other body parts. ## Causative Agent of Carbuncles - They are caused by staphylococcus aureus or staphylococcus pyogenes ## Characteristics of Carbuncles - Advance form of boils - Large boils join to form carbuncles. - Some carbuncles have one opening, while if multiple follicles are involved, then they have multiple openings, which are more in size. - Every follicle has a different pocket. - Sudden, acute, severe immune response in which the normal cells also die. - Tenderness, hardness or lump present beneath the skin in the starting, and at the end, pus-filled cavities form. - Swollen, painful ## Pathogenesis of Carbuncles - The skin barrier, which is part of your innate immune system (IS), gets disrupted due to scratching. So, bacteria invade the skin, which leads to the inflammation and reaction against the bacteria, the pus forms. - After this resolution phase starts where the tip form and pus drain (lump------>pus) in 1-2 days. - Initially, pus with blood present when immature, but once it matures, only yellow pus is present. ## Symptoms of Carbuncles - Redness - Swelling - Tenderness - Pain - Itching - Systemic effects of inflammation, like malaise. - Fever due to inflammatory mediators. - Anorexia ## Healing of Carbuncles - If the pus is present, then there is no healing -