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Rheumatoid Arthritis and Exercise

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If you have arthritis there’s a lot you can do to help yourself, starting with the right sort of exercise. The Arthritis Foundation has prepared this feature to help you start today.

Exercise can help to

  • decrease pain
  • strengthen muscles
  • strengthen bones and minimise osteoporosis (thin bones)
  • maintain and increase joint movement
  • increase heart and lung fitness
  • improve posture
  • control weight and reduce body fat
  • relieve muscle tension
  • decrease stress levels
  • enhance body shape
  • improve sleep patterns
  • create a feeling of well-being
  • develop a positive attitude and healthier lifestyle

Why Exercise With Arthritis

To relieve and prevent the problems associated with arthritis: such as stiffness, muscle weakness, joint deformity, dependence on others, stress and depression. Weight-bearing exercise help to minimise the effects of osteoporosis.

Rest-Exercise Balance

If you have arthritis you must fine right balance between exercise and: Careful attention to rest, exercise and way we hold our joints is an important part of pain management. Rest is needed to settle an inflamed joint or general flare-up, but too much rest will weaken muscles and increase stiffness. So use these principles as a guide:

  1. When joints are inflamed, rest is needed. The amount and type will depend on how inflamed your joint is.
  2. If joints ache only on certain movements, have a rest from those movements.

Types of Exercise

There are three main types of exercise: Mobility—designed to maintain or increase the range of motion of a joint. It is a good idea to take all your joints through r full range of motion each day. Remember that being busy (for example, doing housework) is not exercising. Pay vial attention to joints that are stiff, as need more exercise. However, never force a stiff joint to move more than it is able. (See exercise nos. 1, 2, 7, 8, 9, 10.)

  1. Strengthening—designed to increase the power of muscles. This will help joints to bear weight, to move objects, and to maintain strong, stable joints. isometrics are good strengthening exercises for joints with arthritis, because they involve tightening muscles without moving joints. (See exercise nos. 3, 4, 5, 6.)
  2. Fitness—has a beneficial effect on the heart and lung system and increases general body fitness. Good examples for people with arthritis are swimming, walking, cycling and dancing. Always progress slowly with these exercises. All of the above exercises need to be included in your weekly exercise routine for arthritis.

Exercise Guidelines

  1. Try to perform your exercise program three or four times each week.
  2. Concentrate on quality rather than quantity—better to do less properly, than many poorly.
  3. Move your joints slowly and smoothly—do not jerk them.
  4. Be aware of pain and swelling and exercise gently if either is present.
  5. If pain after exercise lasts more than two hours, it means you’ve overdone it—so do less next time. Perhaps you need to change your program?
  6. Muscles and joints are exercised more effectively when they’re warmed up— after a bath or shower may be a good time.
  7. Exercising in warm water is a good way to exercise your whole body, because the buoyancy of the water supports the joints so they can move easily and freely. It also helps tight muscles to relax.
  8. Do not continue with an exercise that causes severe pain.
  9. If you have a joint replacement, check with your surgeon or physiotherapist about what movements to avoid.


  • Exercise when you are
  • Least stiff
  • Have least pain
  • Are least tired
  • And when your medications are working most effectively
  • Posture Guidelines
  • Correct posture should become a way of life.
  • Have a short rest period daily—lie as fiat as possible with all your joints au: straight.
  • Avoid sitting in low, soft chairs. Ensure there is an adequate backrest, with you: hips at right angles and your feet resting comfortably on the floor or stool.
  • Stand as tall as possible, but be comfortable.
  • Avoid sitting or standing for Ion,: periods
  • How to Be Successful in Your Exercise Program
  • Start slowly—then progress gradually.
  • Set weekly goals—be realistic. make a contract with yourself—write down.
  • Exercise with a friend.
  • Keep a diary.
  • Exercise regularly to maintain a good general fitness level.
  • Try to develop a balanced program of :nobility, strengthening, and fitness exercises
  • Have the right equipment—wear supportive shock-absorbing footwear
  • Sec a physiotherapist for expert advice :: an exercise program, and for individual attention.
  • Find the correct balance between exercise and rest.
  • Check with your doctor before starting a new exercise program if you have any medical problems, such as: asthma, diabetes, epilepsy, a heart condition, high blood pressure, obesity, or if you are or have been a smoker.

Some Exercise Examples

  • Exercise should be fun, so find a way of exercising your body that you enjoy.
  • Here are some suggestions:
  • General fitness activities—swimming, walking, jogging, cycling, dancing.
  • Classes—fitness, stretch, hydrotherapy (water exercises), aquarobics,
  • Sports—tennis, table tennis, bowls, golf, badminton, croquet and others.

Individual exercise routine to perform at home. If you have arthritis you need to exercise your joints daily. Remember to consult a physiotherapist for your personal exercise program, for specific treatment on joints and posture advice.

Outdoor Safety

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Before allowing your mobile child to explore the great outdoors around your home, take a child’s-level survey of any area she might reach. If she’s a skilled crawler, keep in mind how fast she can move while your attention is diverted.
If you have a swimming pool, make sure that a childproof fence surrounds it. (Some states require this safety barrier by law.) If your yard contains a spa, it should be securely covered when not in use.
Check the lawn for mushrooms—if you are not absolutely certain that they are nontoxic, get rid of them because anything a young child finds will likely go straight into her mouth.
Make sure that potentially hazardous items such as garden tools, insecticides, or fertilizer are not accessible to children.
Older children should not use garden, hand, or power tools until you teach them to use them correctly and safely. Give them detailed instructions (including demonstrations, if appropriate) and safety precautions; they should repeat back to you both directions and cautions before they are allowed to handle any potentially hazardous equipment.
Protective eye wear must be used if the any tools will produce flying debris. In addition, ear protection should be used when using loud power tools.
Don’t forget to apply sunscreen with a sun protection factor (SPF) rating of 15 or more if a child is going to be outdoors for any length of time, especially between the hours of 10 A.M. and 3 P.M.—even on a hazy or overcast day. This is particularly important at higher altitudes or around lakes and seashores where the sun’s ultraviolet light (which provokes the burn) can reflect off of water and sand. Special caution is needed for infants, because a baby’s skin can become sunburned after as little as 15 minutes of direct exposure. Sunscreens containing PABA shouldn’t be used on a baby’s skin before six months of age. If you take your baby outdoors for any length of time, keep her in the shade or use an umbrella, and make sure that her skin is covered with appropriate clothing (including a hat or bonnet) if some sun exposure is unavoidable.

Weather Safety

  • Dress your child appropriately for the outing, allowing for adjustments if the weather changes.
  • Carry rain gear in your car.
  • Apply sun block (SPF 15 to 45, depending on skin type) before you or your child go outside.
  • Take and use hats and sunglasses.

Bicycle Safety

  • Make sure your child takes a bike-safety class or teach him the rules of the road yourself
  • Stick to bicycle paths whenever possible.
  • Children under age six should not ride on the street.
  • Make sure that the bicycle is the right size (take the child along when you buy it). When sitting on the seat with hands on the handlebars, the child should be able to touch the ground with the balls of his feet. When straddling the center bar with both feet flat on the ground, there should be at least one inch of clearance between the bar and the child’s crotch.
  • Do not buy a bicycle with hand brakes until the child is able to grasp with sufficient pressure to use them effectively.
  • Keep the bicycle in good repair and teach your child how to fix and maintain it.
  • Insist that your child wear a bicycle helmet and always wear one yourself.
  • Discourage your child from riding at night. If it is necessary for him to do so, be sure that the bicycle is properly equipped with lights and reflectors and that your child wears reflective (or at least bright) clothing.

Safety Gear

  • Provide the protective equipment appropriate for any sport in which your child participates. Make sure it is worn at practices as well as at games.
  • Your child must wear a properly fitting helmet that meets the standards of the American National Standards Institute (ANSI) or the Snell Memorial Foundation when riding a bike or when sitting in a carrier seat on your bicycle. Wear your own helmet as well, both for self-protection and to set a good example. Critical injuries to the skull and brain can occur during a bicycle accident, and a helmet can reduce the severity of damage by as much as 90 percent. As your child grows, the helmet will need to be sized upward accordingly.
  • Make sure that your child uses wrist guards, elbow and knee pads, and a helmet for roller blading and skateboarding.

Pedestrian Safety

  • Fence off and/or supervise any outside play area.
  • Provide a play area that prevents balls and riding toys front rolling into the street. Prohibit riding of Big Wheels, tricycles, and bicycles in or near traffic or on driveways. Hold a young child’s hand when stalking around traffic.
  • When crossing the street, teach and model safety measures: Stop at the curb, then look—left, right, then left again—before entering the street.
  • Plan walking routes that minimize crossing heavy traffic.

Motor Vehicles Safety

Seat Belts and Car Seats

Over the last 20 years, widespread use of seat belts has led to a steady reduction in traffic fatalities. Proper use of seat belts and car seats decreases the risk of serious injury or death by as much as 50 percent. But in the United States, the leading cause of death in people underage thirty-five continues to be motor-vehicle-related injuries. Most of these individuals were not properly restrained by seat belts or car seats.

Safety on the Road

  • Parents and children should wear their seat belts. Do not start the car until everyone is secured in an infant or child seat or properly belted.
  • Never hold a child in your lap when you are riding in a car.
  • A child under twelve should never be placed in the front seat of an automobile with a passenger-side air bag because deployment of the bag can cause fatal injuries in a young passenger—even during a minor accident.
  • For children under 40 pounds (18 kg), use a car safety seat approved for your child’s age and weight in accordance with the manufacturer’s directions. (Make sure you have a safety seat for your infant’s first important ride home from the hospital.) The seat should be secured in the rear seat of the vehicle. For an infant who weighs less than 20 pounds (9 kg), the seat should face backwards. Buy or rent the next size up as your child grows larger.
  • Toddlers 40 to 60 pounds should be properly secured in a booster seat.
  • When the child reaches 60 pounds, lap and shoulder belts should be used. The lap belt should be low and tight across the pelvis, not the abdomen. The shoulder harness should be placed snugly over the collarbone and breastbone, not the shoulder.
  • If your child takes off his seat belt or gets out of the car seat while you are driving, pull over safely and stop the car. Do not attempt to deal with this (or any other) problem while driving.
  • Insist that your child wear a seat belt, no matter whose car he rides in.
  • Never leave your child unattended in a car.
  • Never transport a child in a cargo area that is not properly equipped to carry passengers (specifically, the back of a station wagon, van, or pickup truck).
  • Do not allow your child under age twelve to operate a motor vehicle, including a motorcycle, motorbike, trail bike, or other off-road vehicles. An adolescent should operate one of these vehicles only if he is licensed and properly trained, and has demonstrated appropriate responsibility.
  • Be very cautious about allowing your child to ride as a passenger on a motorcycle, motor bike, trail bike, or off-road vehicle. Insist on a proper helmet, slow speed, and a mature, sober driver.

Irregular Menstrual Bleeding

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What is Irregular Menstrual Bleeding?

The volume and frequency of menstrual bleeding can be as capricious as it is varied. A dazzling array of technical definitions is used to describe the possible variations. Here are the main ones, and you may find yourself among the number.

  • Polymenorrhea. This means that bleeding lasts for the normal number of days (four, five, or six or whatever is usual for a particular woman), but that it occurs more often. For instance, the total cycle is less than 24 days – it may mean a period comes on each 22 days or even less. It is caused by a variation in the regular rhythmic release of hormones that initiate the egg-release mechanism.
  • Menorrhagia. Here the cycle is normal, but the duration and volume of bleeding is increased. Instead of lasting for the usual four to five days, it may persist for eight days or more. It usually means there is some hormonal imbalance present.
  • Polymenorrhagia. In these cases, the bleeding is excessive, and the length of the cycle is reduced. Often this occurs when there is chronic inflammation occurring in the pelvic organs. But it is also often present in people suffering from emotional disorders, anxiety states and similar psychosomatic disorders.
  • Metrorrhagia. This means bleeding is quite irregular, both in volume and duration. It is usually excessive, and is often associated with disease of the uterus.
  • Dysfunctional uterine bleeding. When investigation fails to indicate any disease, this name tag is often applied. Frequently it is related to psychological or psychosomatic causes.

Irregular Menstrual Bleeding Causes

The Greeks held the view that the womb (hysteros in their language) controlled female emotions, and that any disorder of the uterus could produce hysterical and other abnormal mental states. Of’ course, this is not true, but rather the reverse is nearer the mark.

Emotional problems can often be transmitted through the higher cerebral centers to produce uterine abnormalities.

It is well documented that emotional upsets, tensions, anxieties, sexual frustrations, marital disharmony, work pressures, family disputes, submerged fears, can all lead to either complete failure of menstruation, or to uterine bleeding abnormalities.

These are capable of working on the part of the brain called the hypothalamus, and in turn the cyclical release of hormones that stimulates ovulation is prevented, or disturbed. In turn this leads to menstrual irregularities. However, there are many other causes of menstrual irregularities. Each part of’ the pelvic system can play a possible role. Disorders of the ovary itself can occur from tumors and cysts of this organ. Or the uterus itself’ may be at fault. Noncancerous growths called fibroids are notorious for producing heavy bleeding. But more important, cancer of the womb can also produce irregularities.

Heavy bleeding is common with the IUD (intra-uterine contraceptive device), although it is rarely used today. Pregnancy is the most common cause of abnormal bleeding, and its presence denotes a disturbance of the normal progress. It usually indicates an impending abortion (or miscarriage).

Irregular Menstrual Bleeding Treatment

It is essential that any sudden deviation from a person’s normal menstrual habits be investigated promptly by the doctor or gynecologist.

A full pelvic examination usually takes place at once after a thorough history has been taken.

It is imperative that the cause be discovered. Once this has occurred, then therapy can be instituted if this is warranted. In many cases, the cause is quite apparent.

Injuries (an increasingly common situation, especially with female participation in many erstwhile male sports, such as waterskiing) are usually obvious.

The bleeding of a pregnant woman is often (but not always) fairly self-evident. But often a diagnostic D and C (short for dilatation of the cervical canal and curettage of the walls of the uterus) is ordered promptly. This can be accompanied by a request for blood tests or pregnancy tests. Certain blood disorders may be present. Prolonged bleeding, even though it may not have been heavy but persistent, can produce anemia in women, and this is quite common. Tests will quickly indicate any of these abnormalities.

The operation is preceded by a general anesthetic. Then the gynecologist manually examines the patient’s pelvic organs to determine any obvious abnormalities.

When the patient is at complete rest and fully relaxed, a better examination may be carried out.

After this, the walls of the uterus are curetted or scraped clean. The “scrapings” are examined, and then sent to the pathologist for examination under the microscope.

This total exercise will often produce an answer it’ a physical cause exists. Blood tests may indicate a correctable abnormality. The physical examination may indicate the presence of cysts or solid tumors in the ovary or uterine wall. If a miscarriage is imminent, this may also be treated and the diagnostic routine then has become the therapy at the same time. Any abnormality in the uterine wall (such as meaty growths called polyps, a well-known troublemaker) will be swept away to be examined by the pathologist. Serious lesions such as cancer, if present, will show up in the microscopic study.

This is often carried out in conjunction with a laparoscopy. here, a thin, stainless steel tube with a light and magnifying lens at one end is inserted through a small incision (about 1 cm long) just below the navel, and directed downward to the pelvic cavity. At the free end, the gynecologist peers into a specially magnified eyepiece, and is able to obtain a complete bird’s eye visualization of the pelvic cavity and its contents. The doctor can therefore see if there is any obvious pathology present.

Today, a computer-chip camera may be attached to the tip of the laparoscope. A picture is transmitted electronically to a large VDU screen. This gives a full color, real-time enlarged picture of the parts under examination. The doctor watches the screen while manipulating the instruments. Whereas the D and C gives information of the internal part of the womb, this is an outside appraisal. What is more, it is often possible to actually treat any obvious disorder, such as piercing small cysts, cutting through adhesions, and caring for other anomalies that may be playing a part in the symptoms.

The laparoscope has revolutionized gynecological diagnosis and treatment and is now extensively used worldwide.

From this point on, treatment will depend on what eventuated at the operation and subsequent investigations. Whatever is amiss must then be corrected, if this has not automatically occurred with the D and C.

If no abnormality is detected, the patient may be subsequently placed on oral hormonal therapy.

Indeed, this has revolutionized the lot of the hapless bleeding woman. In old time (and that is not so very long ago), removal of the uterus was a common subsequent operation for cases in which persistent, heavy blood loss was taking place. There was no other simple remedy. But removal of the entire organ of course automatically solved the problem.

But today, with the universal availability of the contraceptive pill, which is really a combination of normally occurring estrogens and progestogens, a check to ovulation, and hence to uterine blood. This is of even greater importance in younger women, particularly those under the age of 35 years who may still wish to reproduce.

Once the uterus is removed, it is entirely impossible to reproduce ever again. However, in women over the age of 40, the full family complement has usually been acquired. These days, further pregnancies over this age are certainly discouraged, and the removal of the uterus for medical reasons is no great loss. Many women would prefer to take oral medication, rather than suffer the thoughts of a surgical operation, for it is a major one and there is always a slight risk factor. (However, crossing the busy highway in front of your home is probably a far riskier event than a straightforward hysterectomy carried out by experts today.)

Hysterectomy, surgical removal of the uterus, is probably the most common female operation next to the diagnostic D and C procedure. There is often criticism that too many are carried out, and that surgeons sometimes perform it unnecessarily and without giving other routines a fair trial.

In the long run, it is often up to the patient and doctor to fully discuss the alternatives. In any discussion of this nature, it is better to have a three-way talk, with the husband being present at the same time. He often likes to know the reasons for procedures of this magnitude (it is always a once-only event in any woman’s life. and is quite important to her and her partner).

Before the operation is the time to ask all the questions. It is not much use leaving these until afterwards. The surgeon usually will be happy to point out the pros and the cons for the recommended line of action. Take advantage of this, and listen and ask questions.

Abnormal or irregular uterine bleeding may indicate the presence of cancer, not only of the uterus itself, but possibly of other pelvic organs.

This is most likely in women who have passed the change of life, or the so-called menopause.

Post-menopausal bleeding is usually defined as bleeding that occurs six months or more after the menopause – that means when normal periods appear to have finished.

“One-fifth of these cases are due to malignancy,” the British Medical Journal recently stated. Under no circumstances should this be neglected. You must see the doctor promptly, even if you are scared stiff of what might be found. Only early diagnosis and prompt treatment offer hope of survival from cancers in this region. Do not put it off until tomorrow. Then it may be too late – forever. Whether the flow is frank blood, a watery fluid or a smelly, offensive material, the same rule applies. Get along to the doctor.

If you are in this age group and you are trying to retain your good looks and youthful appearance by taking hormonal tablets, irregular vaginal bleeding can occur. This is often of no serious consequence. But the same rule applies, for it is impossible to tell the difference until adequate investigation takes place. This usually means that a diagnostic D and C, preceded by a full pelvic examination, is essential.

But never put it off until tomorrow (or next week, next month or next year – unfortunately it is happening all the time). The life in peril could be yours, and you have total control over what you do.

Disorders of the Skin

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The skin is the outer covering of one body. Doctors consider it to be a separate “organ” of the body, and it covers a large area. Fortunately, because any disorder of the skin is usually quickly seen, it receives attention more promptly than diseases occurring within the body that generally cannot be seen by the naked eye. People merely rely on symptoms – subjective sensations that tell them something is wrong.

However, although symptoms often arise with skin disorders, such as itch or irritation, the mere sight of an abnormality is frequently enough to bring a patient along to the doctor in search of a cure.

The skin of the face in particular carries major social implications. A clear, pimple-free, smooth skin is equated with beauty and good looks. Much has been made of this in the world. Not only does everybody desire to look attractive, but in the younger age groups, particularly with young women, its importance is major.

Disorders of the Skin Causes

Cancer, a word that conjures up horrible forebodings, is very common on the skin. Skin cancers are among the most common form of carcinoma. Fortunately, once again because they are readily obvious at an early stage, diagnosis tends to be made earlier. At this stage, successful treatment is generally possible. But, like any type of cancer, if left, it may bring serious consequences, and even death.

There are a great many skin disorders. In fact, many books have been written for doctors. In this section, it will be possible (and, I suggest, desirable) to deal with only the more common skin disorders, those that affect most people most often. So if you cannot locate some bizarre, rare skin problem here, it is for this reason.

An extremely large number of disorders can occur with the skin. Because they are obvious from an early stage, treatment can often be commenced promptly, as the skin is the most accessible organ of the entire body.

Skin grows continuously. The outermost layer is called the epidermis, which has an outer layer of dead cells called the Stratum corneum. This is continually shed as new skin cells grow up from active cells underneath. This is why skin lesions, cuts etc soon “heal.” The old cells are completely replaced by new ones. Below this is the dermis. This contains the blood vessels, sweat glands, oil glands (sebaceous glands) and the hair follicles from which the hairs grow. Blood vessels and nerves arc present in this layer.

Deeper than this is the subcutaneous tissue, which contains greater masses of structures, fat, blood vessels, nerves and muscle.

Hair and nails are part of the skin structure. They, too, come from growing cells beneath, and are merely dead objects in themselves.

Many words have been coined to describe the multitude of lesions occurring on the skin. They are merely descriptive, and are used by doctors. They are really unimportant to the treatment of the disorders, although some common expressions are used in this book.

Skin Terminology

These are some of the terms used to describe disorders of the skin:


This is a flat, non-raised circumscribed area of skin pigmentation such as a freckle or flat mole.


This is a pimple. It is a raised, small, well-demarcated area and color may vary such as in warts, acne pimples and raised parts of psoriasis.


This is an accumulation of papules, and may be quite extensive. In fact, any raised area 2-3 cm or more in diameter is called a plaque. Extensive areas as in psoriasis are often seen. They may be scaly.


This is a lump, and it may be below or above the skin surface. It does not necessarily indicate a malignancy (cancer), although lay persons frequently believe the terms synonymous. The Greater bulk of tumors are noncancerous (“benign”).


This is a raised area of skin. It is usually pinkish, and there may be surrounding redness of the skin, but not necessarily. Hives and allergic reactions, and bites are typical of weals.


These are blisters. Usually small, they are typified by cold-sore Larger sores are called bullae. Sun friction, contact dermatitis and eruptions are common causes.


If pus fills the blister (vesicle), then referred to as a pustule. Infection has often occurred, producing the pus.


Many skin disorders result in scaling of the skin. It is common following sunburn where large sheets come ay rather than fine scales. Dermatitis, particularly seborrhoeic dermatitis the form of dandruff, and psoriasis over scales are typical.


Ulcers break in the skin surface; they are common in skin disorders. It means some serious form of infection or underlying disorder and need careful diagnosis.


Any lesion that discharges will ultimately dry out and form a coating or crust. Although these may appear to be satisfactory on inspection, frequently activity is occurring underneath, and this is the important aspect. It must be treated until cured.


Any skin disorder where inflammation or injury has taken place will be awed ultimately by scarring. These new skin cells have grown into the body. Sometimes these may be very excessive and “keloid” scarring occurs commonly after burning etc.

Some skin disorders tend to occur in specific parts. This often makes diagnosis much easier, although with so many skin diseases having similar characteristics, it can be difficult.


This describes an itch. Many skin troubles are characterized by itch, indeed, it can often be intense. Some have special “antipruritic” (anti-itch) properties, and these are used freely when this symptom is proving troublesome.


This means the part is red. Often, particularly if infection is present also, it may be warm or hot.

The list of skin disorders continues. They seem to come in a never-ending profusion. Modern therapy has made a huge difference in treatment. Cancers are among 7:1 or more, important disorders, and prompt therapy is vital. Leave black moles well alone and seek immediate medical advice, for they can be fatal. Birthmarks often disappear without any treatment; freckles and bruises may be status symbols, and at last a cure has been claimed for the troublesome complaint called psoriasis.

Fungus Infections Ringworm (Tinea)

Ringworm, also known as tinea, is a common infection of the skin. Unlike many infections due to bacteria and viruses, ringworm is a “fungus” infection and is really a microscopic “plant.” Infections can be small, localized and barely noticeable. But others are extensive and produce major symptoms. Children are often infected from pet animals. Almost any part of the skin of the body may be affected. The lesions produced vary, depending on the locality.

Diagnosis is often difficult as the sores may simulate other skin disorders. Doctors often rely on special tests. A frequently used one is to take some “scrapings” from the infection and examine these under a microscope. This shows a typical picture of the fungus.

Another method is the use of special ultraviolet light called “Wood’s light.” Under this, certain forms of ringworm give a translucent hue.

Until the advent of the antibiotic called griseofulvin, taken orally, treatment of ringworm consisted of local applications. This often gave poor results. But griseofulvin has revolutionized therapy and brings prompt relief in most cases; here are some of the chief areas affected and the points to check:

Ringworm of the Scalp (Tinea Capitis)

Circular areas of baldness occur on the scalp. Often the lesion is red and scaling. It is found almost exclusively in children, and there is a history of contacting other children with the same complaint or contacting infected animals, usually household pets. Diagnosis is confirmed by the physician from scrapings or by use of Wood’s light.

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