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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:

Macule

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

Papule

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.

Plaque

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.

Tumor

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”).

Weal

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.

Vesicles

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.

Pustules

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

Scales

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

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.

Crusts

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.

Scars

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.

Pruritus

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.

Erythema

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.

Ringworm

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A common and easily treated skin infection caused by a fungus called a dermatophyte (literally, “skin plant”), which invades in the outermost layer of skin.

Ringworm is mildly contagious through direct contact. Poor hygiene increases the likelihood of infection to anyone who comes in contact with the fungus can become infected. House pets such as cats and dogs can pass dermatophytes to children via direct contact with

Ringworm usually begins as one or more small, und, somewhat itchy, scaly, reddish spots that gradually increase in size. As each spot grows, its center usually begins to clear while the outer rim becomes raised. (The circular shape of the eruption and the wormlike appear-cc of the outer rim are the inspiration for its name.)Your child’s doctor can often diagnose ringworm simply by its appearance. He or she may scan the skin with an ultraviolet light, since areas infected by some dermatophytes may glow slightly, or gently take scrap from the front the affected skin and look for signs of the fungus under a microscope.

Once the diagnosis is made, ringworm can usually be treated with over-the-counter or prescription antifungal medication (creams). Depending upon the type used, the cream should be applied for two to three weeks to be effective. In severe cases oral medications may be pre-‘scribed. Skin-to-skin contact with infected individuals and pets should be minimized to avoid spreading the infection.

What To Do In An Emergency

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To a person with a reasonable knowledge of the simple basics of first aid, there is usually a clear-cut course to follow. There is no need to panic. This helps nobody, least of all the victim. Here in this section you will find the basic needs that may help in coping with the general run-of-the-mill accidents that commonly occur. It is not a complete manual, but it should serve as a guide in emergencies. However, this does not replace first aid training.

Read it through and get to know the requirements of how to act in an emergency. Who knows, but the next time it is needed you may be able to save someone very close to you – one of your children, relatives or friends. First aid knowledge will never go amiss, even if you use it only a few times in your lifetime. If it saves one life or more, then it will have been all worthwhile. It is possible to take courses in first aid in most countries.

To start this section, a few of the essential ingredients of first aid care will be outlined. It is not an exhaustive list, but covers the more important and more pressing needs.

Remain Calm

It is essential that the person offering first aid remain calm throughout the entire procedure. In major accidents, fear will no doubt strike the heart of any amateur not regularly geared for the unpleasant sights that may occur. Seeing humans in pain and distress is never easy, and a sense of empathy is inevitable. However, do not be overcome with anxiety, for this will reduce your efficiency. It is preferable for the adrenaline produced by your system to convert you into a more efficient unit. When you are calm, you can think clearly, act with precision, with dignity and authority.

Others will tend to listen to you, and are more likely to be helpful. Most important, your patient will appreciate kind, authoritative words, filled with good cheer, confidence and hope. Do not tell stories about the last person you saw with similar injuries who died two days later. Right now the patient wants good cheer, hope, confidence, life, more than anything else. Use this to its full effect, no matter how you might feel, and how poor the outlook appears. It is a major factor, and is repeated often in the following headings of guidance.

Breathing and Heartbeat When attending a person who has sustained an injury, or some type of medical emergency, there are several steps to follow. These may be summarised as follows:

1. First, make sure that both you and your patient are in a safe position. This is especially true of roadside accidents, where passing traffic may cause further serious injury to you both. Or with electrical emergencies, make certain that the power has been turned off, so that further danger cannot occur.

2. It is essential to check the patient’s level of consciousness.

3. Next, check that the airways are open and clear. When this has been done,

4. Check for breathing, and

5. Check the pulse in the neck (the carotid artery pulse). This may be felt by the fingers just below the jawbone on the side of the throat.

If the patient is not breathing automatically, it is necessary to take steps to force air into the lung system. This is called expired air resuscitation, or EAR for short. It used to be called mouth-to mouth breathing or resuscitation.

If the heart is not beating, indicated by an absence of the carotid pulse in the neck, it is essential that this be started again. This is carried out by external cardiac compression (ECC for short. formerly known as external cardiac massage). More likely both procedures will be carried out together, and this collectively is called cardiopulmonary resuscitation, or CPR for short. In summary, EAR + ECC = CPR.

It is essential to get the blood flowing again as urgently as possible, for it is well-established that irreversible brain damage may occur after three minutes, although this is a variable time. Sec the section on Resuscitation and learn by heart the methods to be used. The methods have various names, but names are unimportant; the basic steps are what matter. Any first aider must be aware of the system and be able to put it into immediate action at any moment. It is frequently life-sustaining.

These measures must be continued until normal heart and breathing action resume, or the patient is handed over to professional personnel geared with other methods of sustaining life.

Stop Bleeding

Once the heart and lung action have been re-established, the next most pressing emergency action is to check any abnormal bleeding. Blood loss is crucial, and it must be stopped as a matter of urgency The more forceful the loss (and the greater the volume being lost), the more urgent the measure.

If this does not happen, fluids are lost from the body, and very quickly the patient may submerge into various states of shock. This may lead to unconsciousness, and death may quickly result.

Blood loss, irrespective of where it is coming from, must be checked. External loss can usually be stopped or greatly reduced by direct pressure using some form of clean padding. It doesn’t matter what this is during an emergency. Be as sterile in your actions as possible, but stemming the flow comes before sterility with haemorrhaging.

Other Injuries

After these first essentials have been attended to, it is then possible to reassess the patient and attend to other injuries. These may include such features as broken bones (fractures), dislocations, soft tissue injuries such as lacerations, sprains and contusions (bruises). It may affect burns, foreign missiles and any number of items.

If the patient is unconscious, it may be impossible to decide what has happened. In any case, the patient is then best placed in a stable side position (see instructions and pictures), and medical help obtained.

Medical Help

Many accidents need urgent help from doctors and ambulance officers. Do what you can on the spot, and then summon assistance. Ideally, if living in the city or in areas where ambulance services are available, call them urgently, or have an assistant do this.

You will need to state clearly your address. and often the nearest cross-street, for this can help quicker access. State how many are injured and need help, and briefly the nature of the accident. Great details are unnecessary. Simply state: “There has been a motor-car accident and three persons are badly injured and two are unconscious.” That is adequate. Usually the ambulance depot gives you a reference number that is worth remembering in case there is some subsequent delay, or something goes wrong. If this is not available, get the help of a doctor.

If this is not forthcoming, then getting the patient to the emergency ward of a large hospital is the next best thing. The sooner this can be carried out the better. This is particularly difficult with serious accident cases, and unconscious victims or persons with a probable spinal or other serious fractures. However, in an emergency when there is no help available, you can only do your best.

First Aid Kit

Often many minor accidents can be helped a great deal if you happen to own a simple first aid kit. It is wise to have it ready for all occasions, and use it as need be. But after use, make certain you replenish the items used so that once more it will he readily available.

It is worth while having a photocopy of the methods of resuscitation and the stable side position glued to the inside of this kit, and also glued to the inside of your home medicine cabinet. Also, have the emergency phone numbers of likely persons you may need to contact similarly listed in these two places. It can make it so much easier when an emergency arises. How often have you seen people trying to fumble through the small print of the telephone book in an emergency. desperately trying to locate a much-needed number? Often they will miss it many times over because their nervous system is trying just too hard, and they are too overwrought to know what they are seeking. This even applies to such vital services as the ambulance, doctor, police and fire brigade. if these are clearly written in an obvious place, then you will have less worry, and you will be able to act in a more calm, positive and beneficial manner.

Summon Help

Often accidents require the assistance of many persons. Often you will need a neighbour or friends. Often there will be plenty of people around. But even though the crowd rapidly gathers when an accident occurs (especially spectacular events such as fires and road smashes), often there is hardly a soul who will willingly come forward to offer help. Far better to be able to call a friend or neighbour to lend a hand, and ideally someone who also has a little knowledge of first aid.

As a Last Resort

If, as a last resort, even though you are unfamiliar with first aid, and do not know too much about general principles, at least try to remain calm and do your best. Fortunately, commonsense often comes to the rescue, and will suggest to you what to do next. Be guided by your inner directives, and frequently this will help – at least until somebody with some more direction and knowledge turns up. Good wishes and success in your first aiding.

Primary Dysmenorrhoea

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What is Primary Dysmenorrhoea?

Primary Dysmenorrhoea is also known as spasmodic or true dysmenorrhoea. This is the most common form of severe period pain. It usually starts a year or two after the commencement of periods. It nearly always disappears spontaneously after 25 – 30 years of age and is usually at its peak between the ages of 15 and 20 years.

The pain always starts with the actual menstrual flow, never before. It may last for a few hours or even a day or more. It may be of considerable severity while it lasts. The pain is felt chiefly in the lower part of the abdomen. It often spreads to the inner parts of the thighs; there may be some low backache also. The patient may look drawn and pale, sweat profusely and feel very uncomfortable. Nausea and vomiting are fairly common, and sometimes the patient may faint. There is often discomfort with passing urine and with bowel actions; sometimes there is diarrhoea.

All sorts of medical explanations have been put forward over the years as to why this should suddenly put in an appearance in otherwise normal, healthy young women. Some claim the sudden alteration from an active, exercise-filled routine such as experienced in school or college to a more sedentary way of life is of particular importance and a causative factor. It strikes suddenly and without any obvious cause at an age when these variations are occurring, suggesting that physical activity (or the lack of it) may play a part.

Thousands of young women have been checked very carefully to discover if there is some underlying pathology. In most cases none can be found. The pelvic organs are perfectly normal and healthy. In some rare cases, heavy menstrual bleeding may produce clots, and in turn this can produce pain with the commencement of the flow, particularly if clots become jammed in the cervical canal.

Some women have an abnormally shaped uterus, and these seem more prone to producing menstrual problems, but these are in the minority. The most plausible explanation and the most recent one is wrapped up with the discovery of a new hormone called prostaglandin that is produced by the body. This is manufactured in women in the uterus, and it has a powerful effect in causing the muscle fibres of the uterine wall to contract rhythmically. It is also known that prostaglandin production is greatly stimulated by the female hormone progesterone, produced in increasing amounts during the second half of the menstrual cycle.

So it seems that with the build up of progesterone, prostaglandin is produced in maximum amounts just at the time when menstruation would be occurring. The violent cramp like pain and discomfort represents the uterine muscles actively contracting, and the other symptoms are a flow on from this. This is a very logical explanation, and further research will probably make the picture even clearer. On the other hand however, it may go down in history as just another theory as to its cause. There have been very many of them to date, and many doctors shrug their shoulders and wonder if any is true, including this most recent one.

Primary Dysmenorrhoea Treatment

The important aspect from the suffering woman’s point of view is what to do. She is not as concerned with the cause as with the remedy. Today, there are many different lines of attack. Here are some of them:

Pain-killers

Medication collectively referred to as analgesia will usually bring prompt, efficient relief from pain and discomfort. Many different lines are available, either on prescription from your physician, or over the counter from your pharmacist. Most contain the well known medications aspirin (acetyl salicylic acid), paracetamol and codeine in varying doses.

A simple remedy is paracetamol, 2 x 500 mg tablets three to four hourly. Alternatively, aspirin (soluble is often quicker in effect and may be dissolved in water), 2 x 300 mg tablets. Take this after food, as it may provoke nausea, being a gastric irritant. Some proprietary lines contain caffeine and codeine, which may assist; and some analgesics obtained by scripts from the doctor may have varying amounts of these ingredients. Most work quite successfully. Their use for half to one day is often adequate. Patients with the problem on a recurring basis should carry tablets with them when trouble is anticipated.

Antispasmodics

Doctors sometimes prescribe medications claimed to relieve spasm of the uterine muscle. These are usually a prescription-only line, and must be doctor-ordered and taken under correct medical supervision.

Anti-inflammatory Medication

For many years doctors have known that simple aspirin brings quick relief. It is also recognised that the anti-inflammatory drugs such as indomethacin, naproxen, ibuprofen and ketoprofen bring relief, even though these are generally used in arthritis! It seems that all three are powerful “prostaglandin antagonists”— in short, they destroy the prostaglandin in the uterus, and so stop its action and reduce the symptoms. These must also be given under proper medical supervision, for they are potent drugs, and must be treated with respect.

Hormone Therapy

The contraceptive pill has had a dramatic and major beneficial effect in reducing dysmenorrhoea. Once more, the hormones in the pill effectively prevent ovulation from taking place. In turn, this prevents progesterone from being formed, and stops prostaglandin from being manufactured. So, presto! There is no pain. Today, many young women in the dysmenorrhoea age bracket regularly take the pill for contraceptive reasons. Many notice that their period pains suddenly vanish.

In 1994 medroxyprogesterone (Depo Provera C150) was approved as an injectable contraceptive in Australia (much earlier in New Zealand). A single injection three-monthly prevents ovulation, which should inhibit periods and lessen dysmenorrhoea. Often, use of the pill or injection will solve the problem. Frequently, when the pill is discontinued, the period problem ceases also. But if not, medication may be continued. The pill is a potent combination of hormones, and in most Western countries it must be ordered by a doctor on a prescription and given under medical supervision. Its beneficial effect can be invaluable.

General care

There is little doubt that attention to general matters of physical activity, personal hygiene and commonsense living can also play a valuable part in ridding the system of dysmenorrhoea. Outdoor activity, participation in physical sports, commonsense attitudes to eating high-quality food, bowel regularity, adequate rest at night, can only help in a general sort of way. At least it equips the body to function more normally, and anything that will do this is north a trial—a long-term trial.


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