“Disorders, Conditions, and Diseases”
Mr. Mahesh Chand
Mr. Pravin Dani
Introduction of the Integumentary system.
Anatomy and physiology of the skin.
Causes of the skin disorders.
Common disorders with their signs and
Disease- an abnormal condition of the body or
the mind that causes dysfunction or
Disorder- a functional abnormality, or
Condition- a state of being, in health, a
disease, such as a heart condition.
The prevalence of skin disease in India is 10 to
12 percent of the total population with Eczema
and Psoriasis being the major contributors. Due
to pollution, ultraviolet light, and global
warming, photosensitive skin disorders like
pigment darkening, sunburn, skin cancers, and
infectious diseases are increasing at a faster
pace. A one percent reduction in ozone leads to
a two to four percent increase in the incidence
According to Ankit Goyal, Program Manager, Healthcare
Practice, Frost & Sullivan, "The ecosystem for skin
care treatment is witnessing a great change in
demand patterns. Gone are the days, when skin care
was limited to treatment of common skin diseases.
The emergence of cosmetic and anti-aging treatments
has changed the face of the skin care industry. The
number of these cosmetic procedures is expected
reach 18 to 20 lakh by 2015 in India.
In 2013, with prevalence rate of 10 percent, the
population affected across India from skin disease is
estimated at nearly 15.1 crore. It is estimated that at a
CAGR of 12 percent about 18.8 crore people is likely
to suffer from skin disease by 2015".
At present, there are about 6,000 dermatologists
catering to a population of over 121 crore. This means
that for every 100,000 people, only 0.49
dermatologists are available in India as compared to
3.2 in many states of the US."
Integumentary system is composed of the
skin and accessory structures
Copyright 2003 by Mosby, Inc. All
The largest organ of the body
Varies in thickness from 1/50 inch (0.5 mm) in the
eyelids to 1/4 inch (6.3 mm) in the soles of the feet
Changes in the skin often indicate the presence of
other body system disorders including anemia,
respiratory disorders, liver disorders, cancer, and
Copyright 2003 by Mosby, Inc. All
Copyright 2003 by Mosby, Inc. All
Outermost layer of the skin that is composed of a
surface of dead cells with an underlying layer of
Called the “true” skin; the dermis contains the
blood vessels and nerves
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Skin has hair in all areas except the soles of the
feet and palms of the hands
Hair serves to block foreign particles from entering
the body through structures such as the nose and
The visible portion is called the shaft
The hair follicle is the root with its covering
Copyright 2003 by Mosby, Inc. All
Three types of glands in the skin
Sebaceous glands (oil)
Sudoriferous glands (sweat)
Function is to help regulate the body
temperature and excrete body wastes
Copyright 2003 by Mosby, Inc. All
Functions of the SKIN
Protects the other body systems from injury and
Vitamin Production (D)
Conditions, andConditions, and
Psoriasis is a long-lasting autoimmune disease characterized by
patches of abnormal skin.
These skin patches are typically red, itchy, and scaly. They may
vary in severity from small and localized to complete body
Psoriasis is estimated to affect 2–4% of the population of the
Microbes eg. Candida albicans
Medications eg. beta blockers,, NSAIDS
Psoriatic arthritis eg. Hips, knees, spine (spondylitis), and sacroiliac joint
Pustular psoriasis appears as raised bumps filled with noninfectious pus.
Other skin lesion
Skin biopsy or scraping may be performed to rule out other disorders and to
confirm the diagnosis.
Topical agents eg. mineral oil, petroleum jelly, calcipotriol
Surgery: removal of the tonsils may benefit people with chronic plaque
psoriasis, guttate psoriasis, and palmoplantar pustulosis
Acne vulgaris (or simply acne) is a long-term skin disease that occurs
when hair follicles become clogged with dead skin cells andoil from the
skin. Acne vulgaris is a common skin disease that affects 85-100% of
people at some time during their lives.
Acne is characterized by areas of blackheads, whiteheads, pimples,
and greasy skin, and may result in scarring. The resulting appearance can
lead to anxiety, reduced self-esteem and, in extreme
cases, depression or thoughts of suicide
Signs And symptoms
Typical features of acne include seborrhea (increased oil
secretion), microcomedones, comedones, papules, pustules,
nodules (large papules), and in many cases scarring.The
appearance of acne varies with skin color. It may result in
psychological and social problems.
Medications eg.Benzoyl peroxide, retinoids,antibiotics
Dermatitis, also known as eczema, is inflammation of the skin. It is
characterized by itchy, erythematous, vesicular, weeping, and
crusting patches. The term eczema is also commonly used to
describe atopic dermatitis also known as atopic eczema.
Causes: Are unclear
Signs and symptoms:
Dermatitis symptoms include itching, stinging and a burning
sensation. Papules and vesicles are commonly present. The small red
bumps experienced in this type of dermatitis are usually about 1 cm in size,
red in color and may be found symmetrically grouped or distributed on the
upper or lower back, buttocks, elbows, knees, neck, shoulders, and scalp.
History and physical examination.
skin biopsy may be useful
There is no known cure for eczema, with treatment aiming to control
symptoms by reducing inflammation and relieving itching.
Medications eg. Carticosteroids
The word "dermatitis" means inflammation of the
skin. It results from exposure to allergens (allergic
contact dermatitis) or irritants (irritant contact
dermatitis). Phototoxic dermatitis occurs when the
allergen or irritant is activated by sunlight.
Irritant contact dermatitis
Signs and symptoms:
Red rash, blisters, Itchy, burning skin
patch tests one of various methods
commonly known as allergy testing.
Medications eg-histamine, corticosteroids
Athlete's foot (also known as ringworm of the foot, tinea
pedum, and moccasin foot) is a common and contagious skin
disease that causes itching, scaling, flaking, and sometimes blistering of
the affected areas. Its medical name is tinea pedis,a member of the
group of diseases or conditions known as tinea, most of which
are dermatophytoses (fungal infections of the skin, hair, or nails).
It can caused by fungi Trichophyton rubrum or T. mentagrophytes,but may
also be caused by Epidermophyton floccosum.
(direct or indirect)
Athlete's foot can usually be diagnosed by visual inspection of the skin
and by identifying less obvious symptoms such as itching of the
If the diagnosis is uncertain, direct microscopy of a potassium
hydroxide preparation of a skin scraping (known as a KOH test) can
confirm the diagnosis of athlete's foot and help rule out other
possible causes, such as candidiasis, pitted
keratolysis, erythrasma, contact dermatitis, eczema, or psoriasis.
A Wood's lamp (black light), although useful in diagnosing fungal
infections of the scalp.
Topical eg. miconazole nitrate, clotrimazole, tolnaftate
Oral eg. Terbinafine, Fluconazole or itraconazole
Urticaria (from the Latin urtica, "nettle" from urere, "to
burn"), commonly referred to as hives, is a kind of skin
rash notable for pale red, raised, itchy bumps. Hives may cause a
burning or stinging sensation.
Drug induced: Due to codeine, dextroamphetamine,
aspirin, ibuprofen, penicillin,
Infection or environmental agent
The mainstay of therapy for both acute and chronic urticaria is patient
education, avoiding triggers, and antihistamines.
Rosacea is a chronic skin condition characterized by
facial redness, small and superficial dilated blood
vessels on facial skin, papules, pustules,
and swelling. Rosacea affects all ages and has four
subtypes, three affecting the skin and the fourth affecting
the eyes (ocular type).
Causes: The exact cause of rosacea is unknown
Signs and symptoms:
The main symptoms of this facial
condition include red or pink patches, visible broken
blood vessels, small red bumps, red cysts, and pink
or irritated eyes.
Most people with rosacea have only mild redness and are never
formally diagnosed or treated. No single, specific test for
rosacea is known.
Medications: eg. ivermectin and azelaic acid creams
and brimonidine, doxycycline, and isotretinoin by mouth.
Laser: Dermatological vascular laser (single wavelength)
or intense pulsed light (broad spectrum) machines offer one
of the best treatments for rosacea.
CO2 lasers can be used to remove excess tissue caused by
Vitiligo (vit-ill-EYE-go) is a chronic skin condition characterized by
portions of the skin losing their pigment. It occurs when skin pigment
cells die or are unable to function. the cause of vitiligo is unknown.
Research suggests vitiligo may arise from autoimmune, genetic, oxidative
stress, neural, or viral causes.
Signs and symptoms:
White patches appear on the skin in different parts of the body.
The only sign of vitiligo is the presence of pale patchy areas of depigmented
skin which tend to occur on the extremities. The patches are initially small,
but often grow and change shape
An ultraviolet light can be used in the early phase of this disease for
identification and to determine effectiveness of treatment. Skin with vitiligo,
when exposed to a black light, will glow blue. In contrast, healthy skin will
have no reaction.
Immune mediators: Topical preparations including glucocorticoids (such as 0.05%
clobetasol or 0.10% betamethasone) and calcineurin inhibitors (such
as tacrolimus or pimecrolimus) are considered to be first-line vitiligo treatments.
Phototherapy: Phototherapy is considered to be a second-line treatment for
vitiligo. Exposing the skin to UVB light from UVB lamps is the most common
treatment for vitiligo.
Skin camouflage: In mild cases, vitiligo patches can be hidden with makeup or
other cosmetic camouflage solutions.
Impetigo is a contagious bacterial skin infection most
common among preschool children.People who play
close contact sports, such as wrestling are also
susceptible, regardless of age. It is also known as
It is primarily caused by Staphylococcus aureus, and
sometimes by Streptococcus pyogenes
The infection is spread by direct contact with lesions or
with nasal carriers.
The incubation period is 1–3 days after exposure
toStreptococcus and 4–10 days for Staphylococcus.
Impetigo is usually diagnosed based on its appearance. It generally appears
as honey-colored scabs formed from dried serum, and is often found on
the arms, legs, or face.
The disease was treated with an application of the antiseptic gentian violet.
Today, topical or oral antibiotics are usually prescribed.
Mild cases may be treated with bactericidal ointment, such as mupirocin.
Severe cases require oral antibiotics, such as dicloxacillin, flucloxacillin,
or erythromycin. Alternatively, amoxicillin combined with clavulanate
potassium, cephalosporins (first-generation) and many others may also be
used as an antibiotic treatment.
A boil, also referred to as a skin abscess, is a localized
infection deep in the skin.
A boil, also called a furuncle, is a deep folliculitis, infection of
the hair follicle. It is most commonly caused by infection by the
bacterium Staphylococcus aureus, resulting in a painful swollen
area on the skin caused by an accumulation of pus and dead
Bacteria eg. staphylococci
Poor immune system eg. Hiv/dm/malnutrition
Signs and symptoms:
Boils are bumpy, red, pus-filled lumps around a hair follicle that
are tender, warm, and very painful. A yellow or white point at the
center of the lump can be seen when the boil is ready to drain or
A boil may clear up on its own without bursting, but more often it will need
to open and drain. This will usually happen spontaneously within two weeks.
Regular application of a warm moist compress, both before and after a boil
opens, can help speed healing.
Antibiotic therapy may be recommended for large or recurrent boils
A skin abscess, a collection of pus that forms inside the
body. It is usually caused by bacterial infection, most commonly
with Staphylococcus aureus or Streptococcus pyogenes, which can
The initial cause of a carbuncle can often not be determined. Triggers
that make carbuncle infections more likely include rashes such
as folliculitis; friction from clothing or shaving; having hair pulled
out, such as sites where clothing or furniture grab at hairs;
generally poor hygiene; poor nutrition; or weakening of immunity.
Poor nutrition may be an important factor – for example, persons
with diabetes and immune system diseases are more likely to
The carbuncle may be the size of a pea or as large as a golf ball. It may be red
and irritated, and might hurt when touched. It may also grow very fast and have a
white or yellow center. It may crust or spread to other skin areas. Sometimes other
symptoms may occur, such as fatigue, fever and a general discomfort or sick
feeling. Itching may occur before the carbuncle develops.
Antibiotics is useful.
Ringworm is not, as its name suggests, caused by a worm.
Characterized by round lesions (rings) and early belief that
the infection was caused by a parasite (worm), the term
ringworm was born.
Fungi thrive in moist, warm areas, such as locker rooms, tanning
beds, swimming pools, and skin folds.
Red, scaly, itchy or raised patches
Patches may be redder on outside edges or resembles a ring
Patches that begins to ooze or develop blister
Bald patches may develop, when the scalp is affected
On nail it may be thicker discolored or begin to crac
Antifungal treatments include topical agents such
as miconazole, terbinafine, clotrimazole, ketoconazole, or tolnaftate applied
twice daily until symptoms resolve — usually within one or two weeks.
Topical treatments should then be continued for a further 7 days after
resolution of visible symptoms to prevent recurrence.
In severe cases or scalp ringworm, systemic treatment with oral medications
may be given.
A wart is a small, rough growth resembling a cauliflower or a
solid blister.caused by human papillomavirus(HPV) infection.
Causes: Warts are caused by the human papilloma virus (HPV). There
are about 130 known types of human papilloma viruses.
Common warts – HPV types 2 and 4 (most common); also types 1, 3,
26, 29, and 57 and others.
It typically occurs on humans' hands or feet but often in other
Medication:eg. Salicylic acid, Bleomycin
Keratolysis, of dead surface skin cells usually using salicylic
acid, blistering agents, immune system modifiers
("immunomodulators"), or formaldehyde.
Surgical curettage of the wart;
A keloid is the formation of a type of scar which, depending on its
maturity, is composed mainly of either type III (early) or type I
(late) collagen. It is a result of an overgrowth of granulation tissue
at the site of a healed skin injury which is then slowly replaced by
collagen type 1. Keloids are firm, rubbery lesions or shiny,
fibrous nodules, and can vary from pink to the colour of the
patient's flesh or red to dark brown in color.
Most skin injury types can contribute to scarring. This includes acne
scars, burns, chickenpox scars, ear piercing, scratches, surgical
cuts or vaccination sites.
Keloids expand in claw-like growths over normal skin.They can occur as a result
of severe acne or chickenpox scarring, infection at a wound site, repeated
trauma to an area, excessive skin tension during wound closure or a foreign
body in a wound.
The best treatment is prevention in patients with a known predisposition. This
includes preventing unnecessary trauma or surgery.
Cryotherapy or Cryosurgery is an application of extreme cold to treat keloids.
MRSA (methicillin resistant staphylococcus aureus) is a type
of staphylococcus bacteria (staph) that is resistant to beta-lactam
antibiotics. MRSA is contagious and can cause life-threatening
MRSA is spread by coming in contact with an infected person.
hospitalization (current or within the past year)
weakened immune system
Generalized feeling of ill health (malaise),rash, headaches, muscle aches,
chills, fever, Fatigue, Cough, shortness of breath, chest pain.
Culture of skin infection
Treatment: MRSA can be sensitive to other antibiotics. Intravenous antibiotics are
used to treat severe infections. Not all CA-MRSA infections are treated with
antibiotics. The doctor may choose to drain an abscess, rather than treat with
Gangrene (or gangrenous necrosis) is a type
of necrosis caused by a critically insufficient blood
supply. This potentially life-threatening condition may occur
after an injury or infection, or in people suffering from any
chronic health problem affecting blood circulation. The
primary cause of gangrene is reduced blood supply to the
affected tissues, which results in cell death. Diabetes and
long-term smoking increase the risk of suffering from
Gangrene is caused by a critically insufficient blood supply
(e.g., peripheral vascular disease) or infection.
It is associated with diabetes and long-term tobacco smoking.
This condition most commonly occurs in the lower
extremities (legs and feet).
The method of treatment is generally
determined by the location of affected tissue
and extent of tissue loss. The best treatment
for gangrene is revascularization (i.e.,
restoration of blood flow) of the afflicted organ,
which can reverse some of the effects of
necrosis and allow healing.
Other treatments include antibiotic therapy,
wound care, debridement and
Harlequin-type ichthyosis is a severe genetic skin
disease, which causes thickening of the stratum corneum of
the epidermis. It is the most severe form of congenital
ichthyosis, characterized by a thickening of the keratin
layer in fetal human skin.
The harlequin-type designation comes from the diamond
shape of the scales at birth caused by severe hyperkeratosis.
The disease can be diagnosed in the uterus by way of fetal
skin biopsy or by morphologic analysis of amniotic fluid cells
obtained by amniocentesis.
Sufferers feature severe cranial and facial deformities. The ears may be very
poorly developed or absent entirely, as may the nose. The eyelids may be
everted (ectropion), The lips are pulled back by the dry skin (eclabium).
Joints are sometimes lacking in movement, and may be below the normal
Hypoplasia is sometimes found in the fingers.
Polydactyly has also been found on occasion.
Constant care is required to moisturise and protect the skin
Scleroderma, also known as systemic
sclerosis, is a chronic systemic autoimmune
disease characterised by hardening (sclero) of
the skin (derma). In the more severe form, it
also affects internal
Causes: Scleroderma is caused by genetic and
Cardiovascular: Raynaud's phenomenon palpitations, irregular heart
rate.hypertension and congestive heart failure
Digestive: GERD,indigestion, loss of appetite, diarrhoea alternating with constipation,
Pulmonary: progressive worsening of shortness of breath, chest pain
Musculoskeletal: joint, muscle aches, loss of joint range of motion.
Genitourinary: erectile dysfunction, dyspareunia, scleroderma renal crises and kidney failure.
Treatment:There is no cure for scleroderma, although relief of symptoms is
often achieved. These include-
Raynaud's phenomenon with vasodilators such as calcium channel blockers, alpha
Digital ulcers with phosphodiesterase 5 inhibitors
Pulmonary arterial hypertension with endothelin receptor antagonists.
Gastrooesophageal reflux disease with antacids
Alopecia areata (AA), also known as spot
baldness, is an autoimmune disease in which hair is
lost from some or all areas of the body, usually from
the scalp due to the body's failure to recognize its own
body cells and destroys.
Alopecia areata affects both males and females.
This type of hair loss is different than male-
pattern baldness, an inherited condition.
The area of hair loss may tingle or be painful.
The hair tends to fall out over a short period of time, with the loss commonly
occurring more on one side of the scalp than the other.
Nails may have pitting.
The underlying skin is unscarred and looks superficially normal.
These patches can take many shapes, but are most usually round or oval.
If the affected region is small, it is reasonable to only observe the progression
of the illness, as the problem often spontaneously regresses and the hair
may grow back
In cases of severe hair loss, limited success has been shown from treating AA
with the corticosteroids clobetasol or fluocinonide, corticosteroid injections,
Caused by radiation, sun, boiling water,
chemicals, fire or electricity
RULE OF NINES –RULE OF NINES –
Measures percent of body burned.
Body divided into 11 area,
each is 9% of body
Burns are categorized by severity as first, second,
or third degree.
First degree burns are similar to a painful sunburn,
causing redness and swelling to the tissues.
The damage is more severe with second degree
burns, leading to blistering and more intense pain.
Damage is found in deeper tissues.
The skin turns white and loses sensation with third
degree burns. The entire depth of tissue is affected.
Scarring is permanent, and depending on the extent
of the burning, may be fatal.
Burn treatment depends upon the location, total
burn area, and intensity of the burn.
FIRST DEGREEFIRST DEGREE
Skin red and dry
Rx – cold water
Healing within one
SECOND DEGREESECOND DEGREE
Skin may be exposed
Rx – pain medication,
dry sterile dressing
Healing within 2
THIRD DEGREETHIRD DEGREE
Symptoms – loss
of skin, blackened
May be life
In its most
of skin and,
Skin cancer is the most common form of cancer in the
More than one million skin cancers are diagnosed
annually.Each year there are more new cases of skin
cancer than the combined incidence of cancers of the
breast, prostate, lung and colon.
One in five Americans will develop skin cancer in the
course of a lifetime.
Basal cell carcinoma (BCC) is the most common form of
skin cancer; about one million of the cases diagnosed
annually are basal cell carcinomas. basal cell
carcinomas are rarely fatal, but can be highly disfiguring
Squamous cell carcinoma (SCC) is the second most common
form of skin cancer. More than 250,000 cases are diagnosed
each year, resulting in approximately 2,500 deaths.
Basal cell carcinoma and squamous cell carcinoma are the two
major forms of non-melanoma skin cancer. Between 40 and 50
percent of Americans who live to age 65 will have either skin
cancer at least once.
About 90 percent of non-melanoma skin cancers are
associated with exposure to ultraviolet (UV) radiation from the
Up to 90 percent of the visible changes commonly attributed to
aging are caused by the sun.
Basal cell cancer most often appears on sun-exposed
areas such as the face, scalp, ears, chest, back, and
The most common appearance of basal cell cancer is
that of a small dome-shaped bump that has a pearly
Blood vessels may be seen on the surface.
Basal cell cancer can also appear as a pimple-like
growth that heals, only to come back again and again.
A very common sign of basal cell cancer is a sore
that bleeds, heals up, only to recur again.
A firm, red nodule on your face,
lower lip, ears, neck, hands or arms.
A flat lesion with a scaly crust on
your face, ears, neck, hands or arms.
A new ulceration or raised area on a
pre-existing scar or ulcer.
An ulcer or flat, white patch inside
A red, raised patch or ulcerated sore
in the anus or on your genitals.
A highly malignant type of skin cancer that arises in
melanocytes, the cells that produce pigment.
Melanoma usually begins in a mole.
A popular method for remembering the signs and
symptoms of melanoma is the mnemonic "ABCD":
Asymmetrical skin lesion.
Border of the lesion is irregular.
Color: melanomas usually have multiple colors.
Diameter: moles greater than 6mm are more likely to be
melanomas than smaller moles.
Rx – surgical removal of melanoma and
surrounding area and chemotherapy
Impaired skin integrity
Risk for infection
Risk for imbalanced nutrition less than body
Topical pharmacological therapy such as
Benzoyl peroxide wash, gel , Benzulfoid cream,
salicylic acid, differen.
Systemic Therapy such as oral antibiotics
(erythromycin, penicillin, minocin), Harmones,
Antiandrogens, oral contraceptives,
SURGICAL: Extraction of comedo contents,
drainage of pustules and cysts, excision of
sinus tracts and cysts, cryothrapy, Laser
resurfacing of scars.
Moh’s microscopic surgery
Mohs surgery, also known as chemosurgery, developed in
1938 by a general surgeon, Frederic E. Mohs, is
microscopically controlled surgery used to treat common types
of skin cancer. During the surgery, after each removal of tissue
and while the patient waits, the tissue is examined for cancer
cells. That examination informs the decision for additional
tissue removal. Mohs surgery is one of the many methods of
obtaining complete margin control during removal of a skin
Electrosurgery is the application of a high-frequency electric
current to biological tissue as a means to cut, coagulate,
desiccate, or fulgurate tissue.
Cryosurgery (cryotherapy) is the use of extreme cold in
surgery to destroy abnormal or diseased tissue.The term comes
from the Greek words cryo ("icy cold") and surgery meaning
"hand work" or "handiwork". Cryosurgery has been historically
used to treat a number of diseases and disorders, especially a
variety of benign and malignant skin conditions.
Radiation is the emission or transmission of energy in the
form of waves or particles through space or through a material
Use antiseptic solutions to cleanse the skin and
reduce bacterial content and prevent spread.
Wear gloves when giving care to patients with
Instruct patient and family to breath at least once daily
with bacteria soap.
Encourage cleanliness and good hygiene practices to
prevent spread of lesion from one skin to another and
from one person to another person.
Instruct patient and family not to share bath
towels and washcloths and to avoid physical
contact between the infected person and other
person until lesion heal.
Monitoring and managing potential complications
Promoting Home and community based care.
The aim of the present study was to explore the
effect of the topical application of calcipotriol
on the expression levels of zinc finger protein
A20 and nuclear factor-κB (NF-κB) in the skin
lesions of patients with psoriasis vulgaris.
The calcipotriol ointment was topically applied twice a day for 6
weeks by 26 patients with psoriasis vulgaris. At the end of
weeks 2, 4 and 6 after the first application of calcipotriol
ointment, the clinical efficacy and Psoriasis Area and Severity
Index (PASI) score were compared with those prior to
The expression of zinc finger protein A20 and NF-κB in the skin
lesions prior to and following treatment with calcipotriol was
measured by immunohistochemical staining and western
blotting. At the end of week 6, the clinical effectiveness rate of
calcipotriol was higher compared with that at the end of weeks
2 and 4 (χ2
=8.12 and 9.06, respectively; P<0.05).
The PASI score declined significantly at the end of weeks 2, 4
and 6 (t=9.37, 10.54 and 12.43; P<0.05, 0.05 and 0.001,
respectively). At the end of week 6, the expression levels of zinc
finger protein A20 and NF-κB were significantly lower compared
with those prior to treatment (χ2
=3.65 and 4.17, respectively;
P<0.01). The expression levels of the two proteins were higher
in the skin lesions of patients with psoriasis vulgaris prior to the
initiation of treatment than in the skin of a normal control
Following the 6-week treatment with calcipotriol, the
expression levels of the two proteins in the
psoriasis skin lesions were significantly lower than
they were prior to treatment (P<0.01). Thus, the
present study found that in addition to the typical
pathway of NF-κB being targeted in the treatment
of psoriasis with calcipotriol, the zinc finger protein
A20 may also modulate the inflammatory response
Text book of medical surgical Nursing
Brunner & Siddarth’s 11th
edition Walter Kluwer Publication
Lewis’s Medical Surgical Nursing assessment and
management of clinical problems, Elesvier publication
Page No. 446-504
Textbook of Anatomy Ross and willson