Skin Disorders Lecture Notes PDF

Skin disorders  objectives By the end of this lecture the student should be able to Identify different skin diseases related to P.T Construct a proper PT program for each disease Identify risk factors for different skin disorders Match proper P.T modality for each skin dise...

Skin disorders  objectives By the end of this lecture the student should be able to Identify different skin diseases related to P.T Construct a proper PT program for each disease Identify risk factors for different skin disorders Match proper P.T modality for each skin disease.  Acne vulgaris Adult acne can have an enormous impact on our life. An estimated 20% of adult men and 30% of adult women between the ages of 20- 60 suffer from adult acne, and the numbers are growing.  Acne Vulgaris is a skin disease caused by changes in the pilosebaceous units(the hair follicles and sebaceous gland).It commonly occurs during adolescents affecting more than 85% of teenagers and frequently continues to adulthood.  Causes Of Acne 1)Family/Genetic history-Acne tends to run in family. 2)Hormonal activity-Such as menstrual cycle in puberty. During puberty androgen activity increases. 3)Inflammation, Skin irritation or scratching of any kind will activate the inflammation. 4)Stress-Some believe that increased output of hormones from adrenal glands during stress periods may activate acne formation. 5)Hyperactive sebaceous glands. 6)Accumulation of dead skin cells that block the pores. 7)Bacteria in pores. 8)Use of anabolic steroids. 9)use of certain medications containing barbiturates, androgen… 10)Diet-Acne is inflamed by dietary factors. People consuming high amount of chocolates may increase the chances of developing acne.  Acne Vulgaris Treatment 1)Oral antibiotics 2)Topical antibiotics 3)Hormonal treatment-In females acne can be improved by hormonal treatment. Common combined oestrogen/ progestogen methods of hormonal contraception has shown the effect.  Physiotherapy treatment of acne vulgaris GOALS 1)To obtain desquamation of skin. 2)Increase vascularity. 3)Reduce number of micro-organism. 4)Improve general health and hygiene.  -UV Laser. iontophoresis UVR-First the skin is washed with soap water and then gently dried with clean towel then irradiated by UVR. E 1 dose is given 2-3 times a week for about 3-4 weeks. This is given to improve the condition of the skin and this is repeated. E2 and E 3 doses are given for healing purpose. This will open the block causing the infected material to discharge rather than retain it in the skin.  LASER-He-Ne laser with wavelength 632.8nm to burn away the follicle sac from which the hair grows.  Alopecia Areata Alopecia Areata is defined as premature loss of hair. Some times leads to total loss of hair from the body.  Causes The condition is thought to be an autoimmune disorder in which the body attacks its own hair follicles and suppresses or stops hair growth. T cell lymphocytes cluster around the follicles, causing inflammation and subsequent hair loss.  Age: Generally affects under 30 years of age. Predisposing factors: a) Poor health b) Heredity plays an important role c) Anxiety and fatigue. Sex: It affects both the sexes equally.  Pathological Changes Hair becomes weak from root and comes out of follicle. Atrophy of hair follicle occurs. Sebaceous glands becomes inactive or less active.  Clinical Features Insidious onset. Hair starts falling in clumps. White skin appears after the patches of hair falls. Baldness appears.  Classification: Alopecia areata : Loss of hair from scalp in patches. Alopecia totalis : Scalp hair loss along with eye brows. 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 patient may not recover. The new hair which appears can be pigmented, different from normal hair.  Alopecia Cure by Physiotherapy: Aims: To improve general health To improve nutrition to hair follicles  Means: UVR Sub-erythema or doses of E1 are given for 5-8 minutes daily. Treatment should be continued for 2-3 months  Dermatomyositis A systemic connective tissue disease,, characterized by inflammatory and degenerative changes in the muscles and skin leading to symmetric weakness and some degree of muscle atrophy, in the limb girdles, neck and pharynx. This disease has also shown to effect the esophagus, lungs, and least commonly the heart.  May appear at any age but most commonly from age 40-60 in adulthood; in childhood 5- 15 The female to male ratio is 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 Typically found on the face resembling the butterfly rash associated with SLE, neck, shoulders, chest and back, forearms, lower legs, medial malleoli, and dorsum of the proximal interphalangeal and metacarpophalangeal joints.  Causes The etiology of this disease is unknown Potential autoimmune mechanism; T cells inappropriately recognize muscle fiber antigens as foreign and attack the muscle tissues causing muscle breakdown Potentially triggered by a virus Potentially drug induced  Systemic Involvement Systemic manifestations: Common: proximal muscle weakness, dysphonia Less common: respiratory muscle weakness, visual changes, abdominal pain -Aspiration pneumonia secondary to respiratory muscle weakness -Muscle atrophy -Muscle calcification -Ocular complications including iritis, nystagmus, optic atrophy  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 should include: 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 is a chronic disorder that causes depigmentation patches in skin.  Incidence of Vitiligo 1-2% of the population both males and females of all races. begin at any age more noticeable to people with darker skin color.  causes The cause of vitiligo disease is not known an autoimmune melanocytes destroy themselves.  symptoms - depigmented patches(milky white) on the skin, common in sun exposed areas like hands, feet, arms, face and lips. - Other common areas include armpits, groin, around the mouth, eyes, nostrils, - Rarely the patches show slight erythema, but as a rule they show only depigmentation and senstivity to light, - hair may be white or black patterns of Vitiligo : Focal Pattern : Depigmentation is limited to one or only 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 PUVA is a form of re-pigmentation therapy where a type of medication known as psoralen is used. It makes the skin very sensitive to light. psoralens are given in pill form. Treatment with PUVA has a 50 to 70% chance of returning color Usually at least a year of twice weekly treatments are required.  Narrow Band UVB (NBUVB)  Grafting Transfer of skin from normal to white areas is useful for only a small group of vitiligo patients.  Depigmentation Therapy For some patients with extensive involvement, the most practical treatment for vitiligo disease is to remove remaining pigment from normal skin and make the whole body an even white color. This therapy takes about a year to complete. The pigment removal is permanent.