The document discusses various types of skin conditions including urticaria (hives), skin cracks, burns, and their causes, symptoms, classifications, complications, treatments, and prevention methods. It defines urticaria as raised, itchy bumps on the skin caused by allergens or unknown reasons. Skin cracks are caused by dry, damaged skin that can become infected. Burns are classified by degree of damage (first to fourth) and treated based on severity. The document provides details on diagnosing and managing different skin diseases and injuries.

1. Skin diseases
By
Dr. Laraib Jamil Rph
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2. Urticaria
• Definition: Urticaria is an outbreak of swollen,
pale red bumps or plaques (wheals) on
the skin that appear suddenly either as a result
of the body's reaction to certain allergens, or for
unknown reasons.
• Synonym: Hives
welts (raised mark on body)
wheals (raised swelling on skin)
nettle rash (stinging plant-rash)

4. Hives usually cause itching, but may also burn or
sting.
• They can appear anywhere on the body,
including the face, lips, tongue, throat, or ears.
• Hives vary in size (from a pencil eraser to a
dinner plate), and may join together to form
larger areas known as plaques.
• They can last for hours, or up to one day before
fading. and the skin returns to normal without
leaving any marks or bruising.

5. • Mechanism: When an allergic reaction occurs,
the body releases a protein called histamine.
When histamine is released, the tiny blood
vessels known as capillaries leak fluid. The fluid
accumulates in the skin and causes a rash.

6. Classification
Acute urticaria chronic urticaria
• It is spontanous (self
generated) hives or
angioedema or both
• less than 6 weeks
• Cause:Often due to:
Viral infection
Food / drug allergy
Adverse drug reaction
(opioids/NSAIDs)
• spontaneous hives, angioedema or both
• For more than 6 weeks
• Classification:
1-chronic spontanous urticaria
Cause: Autoimmune
2-chronic inducible urticaria
(very common)
Cause: Physical Urticaria (non-allergic hives
from environmental triggers)
EXAMPLE: Scratching/rubbing (dermatagraphic
urticaria)
Pressure/tight clothes (pressure urticaria)
Sweating/increased temperature (cholinergic
urticaria)
Cold exposure, ice (cold urticaria)
Swelling from vibration (vibration induced
angioedema)
Sunlight (solar urticaria)
Water (aquagenic urticaria)

7. • Angioedema: Angioedema is similar to hives,
but the swelling occurs beneath the skin instead
of on the surface. Angioedema is characterized
by deep swelling around the eyes and lips and
sometimes of the genitals, hands, and feet.
• It generally lasts longer than hives, but the
swelling usually goes away in less than 24 hours.
• This can be life threatening (ex- if on throat, air
ways etc)

8. • Causes:
• medications, including
some antibiotics and non-steroidal anti-
inflammatory drugs(NSAIDs), such
as aspirin and ACE inhibitors, used for high
blood pressure
• foods, such nuts, shellfish, food additives, eggs,
strawberries, and wheat products
• infections, including influenza

9. Symptoms:
• Patches of red or skin-colored welts (wheals), which
can appear anywhere on the body
• Welts that vary in size, change shape, and appear
and fade repeatedly as the reaction runs its course
• Itching, which may be severe
• Painful swelling (angioedema) of the lips, eyelids
and inside the throat
• A tendency for signs and symptoms to flare with
triggers such as heat, exercise and stress

10. Complications: serious allergic reaction (anaphylaxis).
• Signs and symptoms of anaphylaxis include dizziness,
trouble breathing, and swelling of your lips, eyelids and
tongue.
• Definition: Anaphylaxis is a serious, life-threatening
allergic reaction. The most
common anaphylactic reactions are to foods, insect
stings, medications and latex. If you are allergic to a
substance, your immune system overreacts to this
allergen by releasing chemicals that cause allergy
symptoms.
• Epinephrine is an injection-based medication used to
treat life-threatening allergic reactions called
anaphylaxis

11. Urticria
Treatment: medication to treat your hives. Sometimes, a combination
of several antihistamines or an increased dose of one antihistamine
may be recommended.
• Older antihistamines (sedating antihistamines) may cause you to get
sleepy, cause dryness and only last for several hours. Newer non-
sedating antihistamines are less likely to make you sleepy. They
have fewer side effects and last much longer. Non-sedating
antihistamines (Cetirizine, fexofenadine)
• For those who do not improve on antihistamines, 65% respond to
omalizumab. Omalizumab is monoclonal antibody against human
IgE- which is released in response to allergen. Omalizumab is an
FDA approved treatment of chronic urticaria. This medication is
injected under the skin once a month.
• Corticosteroids, such as prednisone or prednisolone may help hives.
These are not an ideal treatment for long-term use but may have a
role to relieve severe symptoms for a few days.

12. Skin Cracks
Definition: When the skin dries, it can become
rough and flaky, with small tears that can lead to
deeper cracks called fissures, which can extend
into the deeper layers of the skin.
Synonym: Skin fissure

14. Cracks of skin
• Mechanism: Cracked skin is often accompanied by
other symptoms of dry skin, with one symptom
often leading to another. For instance, dryness can
lead to scaling, scaling can cause itchiness, itching
can lead to scratching, scratching can cause
inflammation and small tears that can develop into
fissures (cracks), and these can lead to further
irritation. Treating dry, injured or cracked skin
promptly and diligently can help break this cycle.
• Dryness—Scaling—Itchiness—Scratches—
inflammation--Cracks

15. Causes:
• diet, dry or cold weather,
• Heat. Central heating, wood-burning stoves, space heaters
and fireplaces all reduce humidity and dry your skin.
• dermatitis,
• hormonal imbalance (TH=maintains epidermal homeostasis)
• allergic reactions
Other causes of cracked skin variety of skin disorders such as
• eczema (a term for several different types of skin swelling),
• psoriasis (a skin disease that causes itchy or sore patches of
thick, red skin with silvery scales),
• fungal infections (melassezia)
• ichthyosis (dry, scaly skin present from birth

16. Complications: if infection due to cracks left
untreated it can lead to sepsis
• Sepsis: Sepsis is a potentially life-threatening
condition caused by the body's response to an
infection. The body normally releases
chemicals into the bloodstream to fight an
infection. Sepsis occurs when the body's response
to these chemicals is out of balance, triggering
changes that can damage multiple organ systems
• Deep cracks that may bleed

17. Skin Cracks
Preventions:
• Moisturize. Moisturizer seals skin to keep water from
escaping.
• Limit water exposure. Keep bath and shower time to 10
minutes or less. Turn the dial to warm, not hot. Try to bathe
no more than once a day.
• Skip the drying soap. Try cleansing creams, gentle skin
cleansers and shower gels with added moisturizers.
• Cover as much skin as possible in cold
weather. Winter can be especially drying to skin, so be sure
to wear a scarf, hat and gloves when you go out.
• Wear rubber gloves. If you have to immerse your hands in
water or are using harsh cleansers, wearing gloves can help
protect your skin.

18. Burn
• Definition: A burn is a type of injury to skin,
or other tissues, caused by heat, cold, electricity,
chemicals or radiation. Most burns are due to
heat from hot liquids, solids, or fire.
• Classification: it can be classified as major
burns & minor burns.

19. Burns are caused by:
• Fire
• Hot liquid or steam
• Hot metal, glass or other objects
• Electrical currents
• Radiation, such as that from X-rays
• Sunlight or other sources of ultraviolet radiation, such as
a tanning bed
• Chemicals such as strong acids, lye(alkaline liquid ex-
caustic soda), paint thinner or gasoline (motor fuel or
petroleum)
• Abuse

20. Classification of burn
Major burn Minor burn
• Are deep
• Cause the skin to be dry and
leathery
• May appear charred (burnt)or
have patches of white, brown
or black
• Are larger than 3 inches (about
8 centimeters) in diameter or
cover the hands, feet, face,
groin, buttocks or a major
joint
• Superficial redness similar to a
sunburn
• Pain
• Appearance: Blisters
• Diameter: An area no larger
than 3 inches (about 8
centimeters) in diameter

21. Types/Levels of burns
• There are three primary types/levels of
burns: first-, second-, and third-degree. Each
degree is based on the severity of damage to the
skin, with first-degree being the most minor and
third-degree being the most severe.
• The type of burn is not based on the cause of it.
Scalding, for example, can cause all three burns,
depending on how hot the liquid is and how long it
stays in contact with the skin.
• Chemical and electrical burns warrant immediate
medical attention because they can affect the inside
of the body, even if skin damage is minor.

22. Burns
First degree burn:
• First-degree burns cause minimal skin damage. They are also called “superficial burns”
because they affect the outermost layer of skin (epidermis). Signs of a first-degree burn
include:
• redness
• minor inflammation, or swelling
• pain
• dry, peeling skin occurs as the burn heals
• Since this burn affects the top layer of skin, the signs and symptoms disappear once the
skin cells shed.
Healing time: First-degree burns usually heal within 7 to 10 days without scarring.
Treatment:
• soaking the wound in cool water for five minutes or longer
• taking acetaminophen or ibuprofen for pain relief
• applying lidocaine (an anesthetic) with aloe vera gel or cream to soothe the skin
• using an antibiotic ointment and loose gauze to protect the affected area
Precautions:
Make sure you don’t use ice, as this may make the damage worse.
Never apply cotton balls to a burn because the small fibers can stick to the injury and increase
the risk of infection

23. • Second degree burn: This type of burn affects both the epidermis and the second layer
of skin (dermis). So second-degree burns are more serious because the damage extends
beyond the top layer of skin.
• Sign: This type burn causes the skin to blister and become extremely red and sore(pain).
• Some blisters pop open, giving the burn a wet or weeping appearance. Over time, thick,
soft, scab-like tissue called fibrinous exudate may develop over the wound.
• Healing time: some second-degree burns take longer than three weeks to heal, but most
heal within two to three weeks without scarring, but often with pigment changes to the
skin.
• Treatment:
• running the skin under cool water for 15 minutes or longer
• taking over-the-counter pain medication (acetaminophen or ibuprofen)
• applying antibiotic cream to blisters
• The worse the blisters are, the longer the burn will take to heal. In some severe cases, skin
grafting is required to fix the damage. Skin grafting takes healthy skin from another area of
the body and moves it to the site of the burned skin.

24. • Third degree burns:
• They cause the most damage, extending through every layer of skin and
then reaches to the fat layer beneath the skin. Burned areas may be black,
brown or white. The skin may look leathery. Third-degree burns can destroy
nerves, causing numbness. There is a misconception that third-degree
burns are the most painful. However, with this type of burn the damage is
so extensive that there may not be any pain because of nerve damage.
• Symptoms:
• waxy and white color
• Char (to burn)
• dark brown color
• raised and leathery texture
• blisters that do not develop
Healing time: Without surgery, these wounds heal with severe scarring and
contracture. There is no set timeline for complete spontaneous healing for
third-degree burns.

25. Fourth degree burn:
• There are also fourth-degree burns. This type of
burn includes all of the symptoms of a third-degree
burn and also extends beyond the skin into tendons
and bones.
• Note: Burns are not static and may mature.
Over a few hours a first degree burn may involve
deeper structures and become second degree. Think
of a sunburn that blisters the next day. Similarly,
second degree burns may evolve into third degree
burns.

26. • Complications:
• Compared with first- and second-degree burns,
third-degree burns carry the most risk for
complications, such as infections ( such as first layer
is damaged, now it is open to bacteria so it can
cause infections).
• shock (more than15%-20% of the body is involved
in a burn, significant fluid may be lost. Shock may
occur if inadequate fluid is not provided
intravenously., which is often what could lead to
death.

27. • Sepsis: Bacterial infection, which may lead to a
bloodstream infection (sepsis)
• Tetanus: is another possible complication with burns of
all levels. Like sepsis, tetanus (infection of open wound
with anaerobic bacterium)is a bacterial infection. It
affects the nervous system, eventually leading to
problems with muscle contractions.
• hypothermia: due to loss & degradation of skin
which act as thermoregulator of body Dangerously low
body temperatures characterize hypothermia. While this
may seem like an unexpected complication of a burn, the
condition is actually prompted by excessive loss of body
heat from an injury.

28. • Breathing problems from the intake of hot air or
smoke
• Scars or ridged areas caused
by an overgrowth of scar tissue
(keloids)
• Bone and joint problems,
such as when scar tissue
causes the shortening
and tightening of skin, muscles or tendons
(contractures)

29. Treatment:
• Treating major burns
• Until emergency help arrives:
• Protect the burned person from further harm. If you can do so safely, make sure
the person you're helping is not in contact with the source of the burn. For electrical burns,
make sure the power source is off before you approach the burned person.
• Make certain that the person burned is breathing. If needed, begin rescue
breathing if you know how.
• Remove jewelry, belts and other restrictive items, especially from around burned
areas and the neck. Burned areas swell rapidly.
• Cover the area of the burn. Use a cool, moist bandage or a clean cloth.
• Don't immerse large severe burns in water. Doing so could cause a serious loss of
body heat (hypothermia).
• Elevate the burned area. Raise the wound above heart level, if possible.(reduce swelling
& discomfort ex-airways damage)
• Watch for signs of shock. Signs and symptoms include fainting, pale complexion or
breathing in a notably shallow fashion.

30. • Treating minor burns
• For minor burns:
• Cool the burn. Hold the burned area under cool (not cold) running water
or apply a cool, wet compress until the pain eases.
• Remove rings or other tight items from the burned area.Try to do
this quickly and gently, before the area swells.
• Don't break blisters. Fluid-filled blisters protect against infection. If a
blister breaks, clean the area with water (mild soap is optional). Apply an
antibiotic ointment. But if a rash appears, stop using the ointment.
• Apply lotion. Once a burn is completely cooled, apply a lotion, such as one
that contains aloe vera or a moisturizer. This helps prevent drying and
provides relief.
• Bandage the burn. Cover the burn with a sterile gauze bandage (not
fluffy cotton). Wrap it loosely to avoid putting pressure on burned skin.
Bandaging keeps air off the area, reduces pain and protects blistered skin.
• If needed, take an over-the-counter pain reliever, such as ibuprofen
(Advil, Motrin IB, others), naproxen sodium (Aleve) or acetaminophen
(Tylenol, others).

31. How to measure a burn

32. • The rule of nines assesses the percentage
of burn and is used to help guide treatment
decisions including fluid resuscitation and becomes
part of the guidelines to determine transfer to a
burn unit.
• You can estimate the body surface area on an adult
that has been burned by using multiples of 9.
• An adult who has been burned, the percent of the
body involved can be calculated as follows:
• As an example, if both legs (18% x 2 = 36%), the
groin (1%) and the front chest and abdomen were
burned, this would involve 55% of the body.

33. Scald• is a form of thermal burn
resulted from heated fluids
such as boiling water or steam
Most scalds are considered
first or second degree burns,
but third degree burns can result,
especially with prolonged contact.

34. • Causes:
• Most scalds result from exposure to high-temperature water such as tap water in baths and
showers
• cooking water boiled for the preparation of foods
• from the spilling of hot drinks, such as coffee.
• Scalds can be more severe when steam impinges on the naked skin, because steam
can reach higher temperatures than water and transfers latent heat (liquid-vapours by
condensation)
• On the other hand when clothes are soaked with hot water the heat transfer is often of a
longer duration since the body part can not be removed from the heat source as quickly.
• It is recommended for the temperature of tap water not to exceed 38 — 45 °C to avoid
discomfort and scalding.
• Water hotter than 60 °C can induce scalding injuries within seconds, while it takes
approximately 2 minutes to achieve an injury in 50 °C hot water.
• Scalds are generally more common in children, especially from the accidental spilling of hot
liquids.

35. Scald
Treatment:
• Applying first aid for scalds is the same as for burns. First, the site of
the injury should be removed from the source of heat, to prevent
further scalding.
• Cool the scald for about 20 minutes with cool or lukewarm (not
cold) water, such as water from a tap.
• With second-degree burns, blisters will form, but should never be
popped, as it only increases chances of infection.
• With third-degree burns, it is best to wrap the injury very loosely to
keep it clean, and seek expert medical attention.
• Treatments to avoid:
• Ice should be avoided, as it can do further damage to area around
the injury, as should butter, toothpaste, and specialized creams.
• Toothpaste: it contains calcium & pepermint it increase the chances
of muscle contraction and infections & also effect the tissue of skin)

36. Prickly heat
• Definition: is a rash that causes the skin to
turn red, along with a warm, stinging, or prickly
sensation. The feeling is usually accompanied by
small red dots in the affected area. The rash may
also have small, raised bumps and blisters.
• Synonyms: Heat rash, Miliaria

38. Prickly heat/Heat rash
• Patho mechanism: Prickly heat is caused by
trapped sweat. When the body is hot, it activates the
sweat glands to create sweat on the skin. The sweat
then cools the skin as it evaporates.
• When the body is kept in this warm state, the
constant sweat production can overload the sweat
glands. This can cause the sweat ducts to become
clogged, trapping sweat in the deep layers of the
skin. This causes the sweat to leak into the
surrounding tissue, which leads to irritation and
redness. You may feel the prickly, or stinging,
sensation that gives this condition its name
which responds by producing a rash.

39. Prickly heat
• Appearance: It looks like tiny bumps
surrounded by red skin. It usually happens on
clothed parts of the body, such as your
back, abdomen, neck, upper chest, groin, or
armpits. And it usually gets better once your skin
cools off.
• Heat rash happens most often in hot, humid
conditions. It's most common in infants. Active
people, newborns in incubators, and people on
bed rest with fever also are more likely to get it.

40. Prickly heat
Symptoms:
• small red spots
• an itchy, prickly feeling
• redness and mild swelling
• The symptoms are often the same in adults and
children.
• It can appear anywhere on the body and spread,
but it's not infectious to other people.

41. Prickly heat
• Causes:
• The most common trigger for prickly heat is exposure to heat for a long
time. This may be especially true in very humid areas where the sweat has a
harder time evaporating off the skin.
• Prickly heat is common in people from cooler climates who travel to
warmer climates. But it may also happen to a person in their usual climate
when they experience more heat and sweat than normal.
• Certain medications can also trigger prickly heat. Any drugs that raise the
body temperature or alter the function of the sweat glands can increase the
risk of prickly heat.
• Some medications for Parkinson's disease block the sweat, and tranquilizers
(sedative, for anxiety) and diuretics can change the fluid balance in the
body, which can trigger symptoms of prickly heat as well.
• A study in JAMA Dermatology noted that prickly heat developed where the
bacteria Staphylococcus were found. These bacteria are normal, but the
biofilm they produce can block sweat ducts and contribute to skin
conditions. This would suggest that people with Staphylococcus on their
skin may be more prone to prickly heat than others.

42. • Overheating. Overheating in general —
dressing too warmly or sleeping under an
electric blanket — can lead to heat rash.
• Prolonged bed rest. Heat rash can also occur
in people who are confined to bed for long
periods, especially if they have a fever.

43. Prickly heat/Heat rash
Treatment:
• Heat rash usually clears on its own. Severe forms of
the condition may need medical care, but the best
way to relieve symptoms is to cool your skin and
prevent sweating.
• Calamine lotion or topical steroid creams can help
treat the symptoms of redness, irritation, and
swelling.
• Camphor and menthol may also have a cooling
effect on the skin and help reduce the itchiness.
• In some cases, antihistamine medications can help
reduce itching.

44. Preventions:
• cooling off quickly to avoid additional sweat. Sitting in front of
a fan or in an air-conditioned room can help.
• Cold showers or baths can reduce body temperature and help
prickly heat clear up faster.
• People who are prone to prickly heat may find relief from
regularly washing the body with mild soap after sweating.
This can reduce the amount of sweat and the number of
bacteria on the skin.
• Don’t scratch your skin, or it could become infected.
• Keep the affected area dry.
• Don’t use ointments or creams that keep your skin moist.
• You can put powder on the rash to feel more comfortable

45. Prickly Heat
Types:
• The types of miliaria are classified according to
how deep the blocked sweat ducts are. Signs and
symptoms for each type vary.

46. 1- (miliaria crystallina)
The mildest form of
heat rash affects the sweat
ducts in
the top layer of skin.
This form is marked by clear,
fluid-filled blisters and bumps
(papules-pimples but not containing pus) that
break easily.

47. 2- (miliaria rubra)
A type that occurs deeper
in the skin, is sometimes
called prickly heat.
Signs and symptoms
include red bumps and itching or prickling in the
affected area

48. 3- miliaria pustulosa.
When fluid-containing
sacs (vesicles) of
miliaria rubra become
inflamed and pus-filled
(pustular). This form is called miliaria pustulosa.

49. 4- (miliaria profunda)
• A less common form of
heat rash affects the dermis,
a deeper layer of skin.
Retained sweat leaks out of
the sweat gland into the skin,
causing firm, flesh-colored lesions that resemble
goose bumps. (raised skin, such as involuntary
erection of hairs on neck & arms cause by cold)

50. Scabies
Definition:
• Scabies is one of several
skin conditions that can
cause itching and rashes.
It is a dermatologic
condition caused by
sarcoptes scabiei, an eight-legged microscopic mite
Scabies which causes not an infection, but an
infestation (presence of pests). Tiny mites
called Sarcoptes scabiei set up shop in the outer layers
of human skin.

51. Scabies
• Some key points about scabies:
• While the scabies mite needs skin to feed and survive, it can
live without a human host for 48 to 72 hours.
• The rash and itching experienced by those with scabies is a
result of the body's allergic reaction to the mites, their eggs,
and their waste.
• The average person infested with scabies will have 15 to 20
mites present.
• Those at highest risk of developing crusted scabies include the
immunocompromised, the elderly, and those housed in
institutional settings.
• Spread: It is highly contagious, being easily spread through
close physical contact and by sharing bedding, clothing, and
furniture infested with mites.

52. • Mechanism:
• The eight-legged mite that causes scabies in humans
is microscopic. The female mite burrows (tunnel or
hole) just beneath your skin and makes a tunnel
where it deposits eggs.
• The eggs hatch, and the mite larvae work their way
to the surface of your skin, where they mature and
can spread to other areas of your skin or to the skin
of other people. The itching of scabies results from
your body's allergic reaction to the mites, their eggs
and their waste.

53. Symptoms:
• The onset of symptoms of scabies varies depending
on whether or not a person has previously been
exposed to mites. The first time a person is exposed
to the scabies mite, it can take upwards of 2 to 6
weeks for symptoms to develop(as its first exposure
so it takes time to develop the immune response)
• This timeframe is significantly shorter in subsequent
infestations as the body's immune system is quicker
to react, typically within 1 to 4 days. (after first
exposure the immune system stays allert and react
sooner)

54. • Itching: This is often worse at night and can be severe and
intense. Itching is one of the most common scabies
symptoms.
• Rash: When the mite burrows into the skin, it forms burrow
tracks, or lines, which are most commonly found in skin folds
• Sores: These occur in infested areas where a person has
scratched at the skin.
• Open sores can lead to impetigo, commonly caused by
secondary infection with Staphylococcus aureus.
• Thick crusts: Crusted scabies, also known as Norwegian
scabies, is a form of severe scabies in which hundreds to
thousands of mites and mite eggs are harbored (sheltered)
within skin crusts, causing severe skin symptoms.

55. • Common sites of infestation:
• The burrows or tracks typically appear in folds of skin.
Though almost any part of the body may be involved, in adults
and older children scabies is most often found:
• Between the fingers
• In the armpits
• Around the waist
• Along the insides of the wrists
• On the inner elbows
• On the soles of the feet
• Around the breasts
• Around the male genital area
• On the buttocks
• On the knees

56. • Complications:
• Impetigo: Vigorous scratching can break your skin and allow a
secondary bacterial infection, such as impetigo, to occur.
Impetigo is a superficial infection of the skin that's caused
most often by staph (staphylococci) bacteria or occasionally
by strep (streptococci) bacteria.
• Crusted scabies: A more severe form of scabies, called crusted
scabies, tends to make skin crusty and scaly, and affects large
areas of the body may affect certain high-risk groups,
including:
• People with chronic health conditions that weaken the
immune system, such as HIV or chronic leukemia
• People who are very ill, such as people in hospitals or nursing
facilities

58. Scabies
• Diagnosis:
• To diagnose scabies, your doctor examines your
skin, looking for signs of mites, including the
characteristic burrows. When your doctor
locates a mite burrow, he or she may take a
scraping from that area of your skin to examine
under a microscope. The microscopic
examination can determine the presence of
mites or their eggs.

59. Scabies
• Preventions:
• To prevent re-infestation and to prevent the mites
from spreading to other people, take these steps:
• Clean all clothes and linen. Use hot, soapy water
to wash all clothing, towels and bedding used within
three days before beginning treatment. Dry with
high heat. Dry-clean items you can't wash at home.
• Starve the mites. Consider placing items you can't
wash in a sealed plastic bag and leaving it in an out-
of-the-way place, such as in your garage, for a
couple of weeks. Mites die after a few days without
food.

60. Treatment:
• Scabies is highly contagious, so anyone living
with a patient diagnosed with the condition, or
who has had close contact with the patient, will
most likely be recommended to receive
treatment for scabies even if they do not have
any symptoms. This includes any person with
whom the patient has had recent intimate
contact.

61. Scabies
• Medications commonly prescribed for scabies include:
• Permethrin cream (Elimite). Permethrin is a topical cream that
contains chemicals that kill scabies mites and their eggs. It is generally
considered safe for adults, pregnant women, and children ages 2 months
and older.
• Lindane lotion. This medication — also a chemical treatment — is
recommended only for people who can't tolerate other approved treatments
or for whom other treatments didn't work. This medication isn't safe for
children younger than age 10 years, women who are pregnant or nursing, or
anyone who weighs less than 110 pounds (50 kilograms).
• Ivermectin: (to treat many types of parasite infections) medication for
people with altered immune systems, for people who have crusted scabies,
or for people who don't respond to the prescription lotions and creams.
Ivermectin isn't recommended for women who are pregnant or nursing, or
for children who weigh less than 33 pounds (15 kilograms).

62. Pruritis
• Definition: It is sensation that provokes the
desire to scratch. Pruritus simply means itching.
• It can be associated with a number of disorders,
including dry skin, skin disease, pregnancy, and
rarely cancer

63. • Symptoms:
• You may have itchy skin over certain small areas, such as
on an arm or leg, or over your whole body. Itchy skin can
occur without any other noticeable changes on the skin.
Or it may be associated with:
• Redness
• Bumps, spots or blisters
• Dry, cracked skin
• Leathery or scaly skin
• Sometimes itchiness lasts a long time and can be intense.
As you rub or scratch the area, it gets itchier. And the
more it itches, the more you scratch. Breaking this itch-
scratch cycle can be difficult.

64. • Causes:
Skin conditions. Many skin conditions itch, including dry skin
(xerosis), eczema (dermatitis), psoriasis, scabies, burns, scars(mark
due to healing of wound), insect bites and hives (swollen skin due to
allergen).
Internal diseases. Itchy skin can be a symptom of an underlying
illness.
• These include liver disease:
Blood as a result of liver disease itch because some sabstances in liver
disease accumulate in blood like bile acids which causes itching
• kidney failure:
Build up of waste in your blood can cause severe itching, patient also
accumulate phosphorus in blood which contributes for itching.
.

65. • iron deficiency anemia
(anemia=abnormal, low amount of RBCs in blood)
rash is symptom of anemia so these rash causes itching
• thyroid problems :
Mostly occur in hyperthyroidism. As TH is responsible
for metabolism & heat production. When this TH over
reacts it will produce more heat that is prickly
sensation which causes itching.
• Cancer:
In pancreatic cancer when tumors block the bile duct
in this situation bile can leak into skin & cause itching.

66. • Nerve disorders. Conditions that affect the
nervous system — such as multiple sclerosis
MS=CNS disease that disrupts the flow of
information within a brain & b/w the brain & body.
So the reason of itching is MS effects the nerves
that control the area where the itch is.
Psychiatric diseases. Anxiety
Anxiety can cause increase in sweat secretion & if u
have rash which were safe but due to increase
sweating these rash causes itching.

67. • Irritation and allergic reactions. Wool,
chemicals, soaps and other substances can
irritate the skin and cause itching. Sometimes
the substance, such as poison parasites or
cosmetics, causes an allergic reaction. Also,
reactions to certain drugs, such as narcotic pain
medications (opioids) can cause itchy skin. As
itching is side effect of opioids.

68. Treatment:
• Reduce the cause of the itch
• If the itch is from a skin disease such as hives or eczema, treatment
of the skin disease itself generally relieves the itch.
• If the itch is from an internal disease, patients may require
medication to be taken orally,
• Although there are many causes for pruritis, there are some basics
that apply to most treatments.
• First of all, hot bathing or showering should be avoided. Only bathe
in lukewarm water. Wearing light clothing, and a cool work or
domestic environment all help to reduce the severity of itching.
Soaps often dry out the skin. Use mild soaps only in odour bearing
regions. After bathing, be sure to completely rinse off the soap film,
pat the skin lightly,
• and immediately apply a moisturising lotion or cream.

69. Acne
• Definition:
Acne is a skin condition that occurs when your
hair follicles become plugged (blocked) with oil
and dead skin cells. It often causes whiteheads,
blackheads or pimples, and usually appears on the
face, forehead, chest, upper back and shoulders.
Acne is most common among teenagers
(adolescence age), though it affects people of all
ages.

70. Pathophysiology:
• Human skin has pores that connect to oil glands (which produce
oily liquid, sebum) under the skin. Follicles connect the glands to
the pores. Follicles are small sacs that produce and secrete liquid.
• Sebum Role: It carries dead skin cells through the follicles to the
surface of the skin. A small hair grows through the follicle out of the
skin.
• Pimples grow when these follicles get blocked, and oil builds up
under the skin.
• Skin cells, sebum, and hair can clump together into a plug. This plug
gets infected with bacteria, and swelling results. A pimple starts to
develop when the plug begins to break down.
• Propionibacterium acnes (P. acnes) is the name of the bacteria
that live on the skin and contributes to the infection of pimples.

72. Causes:
1- Hair follicles clogged by oil and dead skin cells
2- Bacteria (P-acne)
3- Hormonal factors
• A range of factors triggers acne, but the main cause is
thought to be a rise in androgen levels.
• Androgen is a type of hormone, the levels of which rise
when adolescence begins. In women, it gets converted
into estrogen.
• Rising androgen levels cause the oil glands under the
skin to grow. The enlarged gland produces more sebum.
Excessive sebum can break down cellular walls in the
pores, causing bacteria to grow.

73. Acne
• Genes: Severe acne may be associated with XYY
syndrome : is rare chromosomal disorder that
effects male, (as XY is male sex chromosome)
caused by presence of an extra Copy of Y-
chromosome in each of male cells, this is not
inherited but due to random event during sperm
cell development) so symptoms include being
taller then average, acne & increased risks of
learning problems

74. • Factors which worsens the acne:
• Stress (cells that produce sebum they have receptors for
stress hormones)
• Few high-quality studies have been performed which demonstrate
that stress causes or worsens acne. While the connection between
acne and stress has been debated, some research indicates that
increased severity is associated with high stress levels in certain
contexts such as hormonal changes seen in premenstrual syndrome.
• Environmental factors
• Mechanical obstruction of skin follicles with helmets or chinstraps
can worsen pre-existing acne.
• Medications
• Several medications can worsen pre-existing acne, with examples
being lithium, hydantoin, isoniazid, glucocorticoids, iodides, bromid
es, and testosterone

75. Acne Myth (traditional story):
• some factors have little effect on acne:
• Greasy foods. Eating greasy food has little to no effect on
acne. Though working in a greasy area, such as a kitchen with
fry vats, does because the oil can stick to the skin and block
the hair follicles. This further irritates the skin or promotes
acne.
• Hygiene. Acne isn't caused by dirty skin. In fact, scrubbing
the skin too hard or cleansing with harsh soaps or chemicals
irritates the skin and can make acne worse.
• Cosmetics. Cosmetics don't necessarily worsen acne,
especially if you use oil-free makeup that doesn't clog pores
(noncomedogenics) and remove makeup regularly.

76. Symptoms:
Its signs and symptoms vary depending on the severity of your
condition:
• Whiteheads (closed plugged pores)
• Blackheads (open plugged pores)
• Small red, tender bumps (papules)
• Pimples (pustules), which are papules with pus at their tips
• Large, solid, painful lumps beneath the surface of the skin
(nodules)
• Painful, pus-filled lumps beneath the surface of the skin
(cystic lesions)
• Acne scars : are caused by inflammation within the dermal
layer of skin and are estimated to affect 95% of people with
acne

77. • Pigmentation (color from pigment called melanin)
• Post inflammatory hyperpigmentation (PIH) is
usually the result of nodular acne lesions. These
lesions often leave behind an inflamed darkened
mark after the original acne lesion has resolved. This
inflammation stimulates specialized pigment-
producing skin cells (known as melanocytes) to
produce more melanin pigment which leads to the
skin's darkened appearance

80. Types of acne pimples:
Acne pimples vary in size, color, and level of pain.
The following types are possible:
• Whiteheads: These remain under the skin and are small
• Blackheads: Clearly visible, they are black and appear on the surface
of the skin
• Papules: Small, usually pink bumps, these are visible on the surface
of the skin
• Pustules: Clearly visible on the surface of the skin. They are red at
their base and have pus at the top
• Nodules: Clearly visible on the surface of the skin. They are large,
solid, painful pimples that are embedded deep in the skin
• Cysts: Clearly visible on the surface of the skin. They are painful and
filled with pus. Cysts can cause scars.

81. • Classification:
• this CLASSIFICATION helps to determine an appropriate
treatment regimen. It can be classified as
• mild: Mild acne is classically defined by the presence
of clogged skin follicles (known as comedones) limited to the
face with occasional inflammatory lesions
• moderate: Moderate severity acne is said to occur when a
higher number of inflammatory papules and pustules occur
on the face compared to mild cases of acne and are found on
the trunk of the body
• severe : Severe acne is said to occur when nodules (the painful
'bumps' lying under the skin) are the characteristic facial
lesions and involvement of the trunk is extensive

82. Diagnosis:
1- sign & symptoms
2- Age is one factor which may help to distinguish
(19-24 years, in some cases 30 years)
adolesence

83. • Treatment for mild acne:
• Mild acne can be treated with over-the-counter (OTC) medications, such as
gels, soaps, pads, creams, and lotions, that are applied to the skin.
• Creams and lotions are best for sensitive skin. Alcohol-based gels dry the
skin and are better for oily skin.
• OTC acne remedies may contain the following active ingredients:
• Resorcinol: (obtained from resin) helps break down blackheads and
whiteheads
• Benzoyl peroxide: kills bacteria, accelerates the replacement of skin, and
slows the production of sebum
• Salicylic acid: assists the breakdown of blackheads and whiteheads and
helps reduce inflammation and swelling
• Retin-A: (retinoic acid) helps unblock pores through cell turnover
• Azelaic acid: (found in wheat, rye, barley) strengthens cells that line the
follicles, stops sebum eruptions, and reduces bacterial growth.

84. • Treating moderate to severe acne
• A skin specialist, or dermatologist, can treat more severe cases.
• They may prescribe a gel or cream similar to OTC medications but stronger,
or an oral or topical antibiotic : to reduce the bacterial population mostly
clarithromycin & tetracycline are used.
• Topical retinoids are a derivative of vitamin A. They unclog the pores
and prevent whiteheads and blackheads from developing.
• Isotretinoin :This is a strong, oral retinoid, used for the treatment of
severe cystic acne and severe acne that has not responded to other
medications and treatments.
• It is a strictly controlled medication with potentially serious side
effects. The patient must sign a consent form to say that they
understand the risks.
• Adverse effects include dry skin, dry lips, nosebleeds, fetal abnormalities if
used during pregnancy, and mood swings.
• Patients who take isotretinoin must avoid vitamin A supplements, as these
could lead to vitamin A toxicity.

85. Preventions:
• Wash your face no more than twice each day with warm water
and mild soap made especially for acne.
• Do not scrub the skin or burst the pimples, as this may push
the infection further down, causing more blocking, swelling,
and redness.
• Avoid popping pimples, as this makes scarring likelier.
• A specialist can treat a pimple that requires rapid removal for
cosmetic reasons.
• Refrain from touching the face.
• Hold the telephone away from the face when talking, as it is
likely to contain sebum and skin residue.
• Wash hands frequently, especially before applying lotions,
creams, or makeup.

86. • If acne is on the back, shoulders, or chest, try wearing loose clothing
to let the skin breathe. Avoid tight garments, such as headbands,
caps, and scarves, or wash them regularly if used.
• Choose makeup for sensitive skin and avoid oil-based products.
Remove makeup before sleeping.
• Use an electric shaver or sharp safety razors when shaving. Soften
the skin and beard with warm soapy water before applying shaving
cream.
• Keep hair clean, as it collects sebum and skin residue. Avoid greasy
hair products, such as those containing cocoa butter.
• Avoid excessive sun exposure, as it can cause the skin to produce
more sebum. Several acne medications increase the risk of sunburn.
• Avoid anxiety and stress, as it can increase production of cortisol
and adrenaline, which exacerbate acne.
• Try to keep cool and dry in hot and humid climates, to prevent
sweating.

87. Warts
• Definition: A (viral disease)wart is a small growth
with a rough texture that can appear anywhere on
the body. It can look like a solid blister or a small
cauliflower.
• Synonym: verrucae
• The appearance of a wart depends on its location
on the body and the thickness of the skin.
• Palmar warts appear on the hand. Plantar warts
affect the feet.
• People with a weakened immune system are more
likely to have warts.

88. Warts
• Key points about warts:
• A wart is a small growth on the skin that may look
like a solid blister or a small cauliflower.
• Types of wart include common warts, flat warts,
pigmented warts, and plantar warts.
• Black dots in the wart are blood vessels that can lead
to bleeding.
• Most warts disappear in 1 to 5 years without medical
treatment, but treatment is available for warts that
are large, numerous, or in sensitive areas.

90. Types of Warts:
• Common warts, or verruca vulgaris:
• Appearance: common warts have a firm, raised,
rough surface and may appear cauliflower-like.
• Location: They can occur anywhere, but they are
most common on the knuckles, fingers, elbows,
knees, and any area with broken skin.
• Clotted blood vessels are often visible in common
warts as small, darkened spots. These are known as
seed warts.

92. 2-Plantar warts
• These warts got their name
because "plantar" means
"of the sole" in Latin.
Unlike other warts, the pressure
from walking and standing makes
them grow into your skin.
• Painful verrucae appear
on the soles of the feet,
heels, and toes.
• They normally have a small central black dot surrounded by
hard, white tissue. Plantar warts are often difficult to clear.

93. 3- Plane warts, or verruca plana
• Plane warts are round,
flat, and smooth. They can
be yellowish, brownish, or
skin colored.
The upside of these warts is that
they're smaller (maybe 1/8 inch wide,
the thickness of the cord that charges
your phone) and smoother than other types.
• Also known as flat warts,
they grow most often on sun-exposed areas.
• They tend to grow in larger numbers, possibly between 20 and 100.
However, of all wart types, they are most likely to disappear without
treatment.

94. 4- Filiform warts, or verruca filiformis
• Filiform warts are
long and thin in shape.
and spiky, sometimes
like tiny brushes.
• They can grow rapidly
on the eyelids, neck, around your mouth and nose
and armpits.

95. 5- Mosaic warts
• Mosaic warts are
multiple plantar warts
in a large cluster.
• Unlike moles, warts are
often the same color as the person's skin.
Warts do not contain pus unless they become
infected.

96. 6- Genital wart Verruca acuminata):
• a wart that occurs on the genitalia.
• you get these by having sex with someone who has
them. They may look like small, scattered, skin-
colored bumps or like a cluster of bumps similar to a
little bit of cauliflower on your genitals. And they
can spread, even if you can't see them. Don't try to
get rid of genital warts yourself; they can be hard to
treat.
7- Periungual wart, a cauliflower-like cluster of warts
that occurs around the nails.

97. Warts
Causes:
• Warts are caused by the human papilloma virus (HPV).
There are about 130 known types of human papilloma
viruses.
• HPV infects the squamous epithelium, usually of the skin
or genitals through the excessive and rapid growth of
keratin, which is a hard protein on the top layer of the
skin.
• each HPV type is typically only able to infect a few
specific areas on the body.
• here's no cure for HPV, so some of the virus might stay
in your skin after the wart is gone and reappear later.

98. Spread:
• The virus can spread to other parts of the body through:
• scratching or biting a wart
• sucking fingers
• biting fingernails, if there are warts around the nails
• shaving the face or legs
• Having wet or damaged skin, and coming into contact with rough
surfaces increase the risk of infection.
• For example, a person with scratches or cuts on the soles of their
feet is more likely to develop a verruca in and around public
swimming pools.
• Each person's immune system responds to the HPV virus
differently, so not everyone who comes in contact with HPV
develops warts.
• Ex- HIV patients

99. Symptoms:
• Common warts usually occur on your fingers or
hands and may be:
• Small, fleshy, grainy bumps
• Flesh-colored, white, pink or tan
• Rough to the touch
• Sprinkled with black pinpoints, which are small,
clotted blood vessels

100. Warts
Diagnosis:
In most cases, your doctor can diagnose a common
wart with one or more of these techniques:
• Examining the wart
• Scraping off the top layer of the wart to check for
signs of dark, pinpoint dots — clotted blood vessels
— which are common with warts
• Removing a small section of the wart (shave biopsy)
and sending it to a laboratory for analysis to rule out
other types of skin growths

101. Warts
• Treatment:
• Most warts clear up without treatment. It can
take from a few weeks to several years,
depending on the location and number of warts.
They usually disappear faster in children.

102. 1- Salicylic acid: (stronger peeling medicine)
salicylic acid work by removing layers of a wart a little bit at a time.
• Most over-the-counter creams, gels, paints, and medicated Band-Aids contain salicylic
acid.
• It is important to protect the skin around the wart before applying this treatment because
salicylic acid may destroy healthy skin. Do not apply to the face.
• Applying petroleum jelly or a corn plaster to the skin around the wart can protect it from
damage.
• Some tips can enhance the effectiveness of this treatment.
• Soften the wart by rubbing dead tissue from the surface of the wart weekly using a pumice
stone or emery board. Make sure that the pumice stone or emery board is not used on
any other part of the body or by another person.
• Before applying the medication, soak the wart in water for about 5 minutes.
• Treatment is normally applied daily for about 3 months. If the skin becomes sore,
treatment should be stopped.

103. 2- Cryotherapy: it is freezing the wart by using
cold substance
• Freezing liquid, often nitrogen, is sprayed onto the
wart, destroying the cells. A blister develops, which
eventually scabs (breaks like crust) and falls off a
week or so later.
• This treatment must be carried out by a healthcare
professional. If the wart is large, this may require a
local anesthetic and several sessions.

104. 3- Surgery
• Sometimes a doctor may recommend surgery if
other treatments have not worked.
• Most warts can be shaved off with a surgical razor
under local anesthesia.
• Doctors may recommend applying a topical cream to
the site even after the wart's removal, to improve the
chances of it clearing.
• Laser treatment uses a precise laser beam to destroy
the wart.

105. 4- Cantharidin
• A doctor may apply a substance containing an
extract from an insect called a blister beetle and
other chemicals to the warts. The area is then
covered with a bandage.
• This is painless, but it creates a blister that may
be uncomfortable. The blister lifts the wart from
the skin, and the doctor removes the dead part
of the wart.

106. • Blister beetles are
beetles of the family Meloidae,
so called for their defensive
secretion of a blistering agent,
cantharidin

107. 5- other treatments may include:
• Bleomycin (anti-cancer drug), or Blenoxane, can be injected
into the wart to kill the virus. Bleomycin is also used for
treating some types of cancer.
• Note: genital warts can turn into cancer
• Retinoids, derived from vitamin A, disrupt the wart's skin cell
growth.
• Antibiotics are only effective in the case of infection.
• Common warts, especially around the fingernails and toenails,
may be difficult to eliminate completely or permanently.
• If the wart is gone but the virus remains, warts may recur.

108. Home remedies:
• Garlic: Compounds found in garlic may have antiviral activity and
help stop viral cells from growing. Chloroform garlic extracts
applied to warts are reported to have clear the growths in 3 to 4
months. Whether rubbing garlic on a wart will have the same effect
is not confirmed.
• Duct tape: In one study, a piece of duct tape the same size as the
wart was placed directly onto the wart, covering warts with duct
tape may peel away layers of skin and irritate it to kick-start your
immune system. Soak, sand, and put duct tape on the area (use
silver stuff because it's stickier). and removed after 6 days. Next, the
participants soaked the wart in water, before rubbing it with an
emery board or pumice stone. They then left the open until the next
day. This is not an evidence-based treatment, but it may be useful
for children, as it is painless and safe.

109. Preventions:
• To reduce the risk of catching or spreading warts:
• Do not touch other people's warts.
• Do not use other people's towels, washcloths, or other personal items.
• Do not share shoes and socks with other people.
• Do not scratch warts or verrucae, as this can cause them to spread.
• Wear sandals when entering and exiting communal showers and pools.
• Cover warts or verrucae with a waterproof covering when swimming, and
socks or gloves elsewhere, for example at the gym.
• Do not brush, comb, shave, or clip hair in areas that have warts.
• When filing or cutting nails do not use the same utensil on the infected nail
and the healthy nails.
• Do not bite fingernails if warts are near them.
• Keep hands as dry as possible.
• Wash hands thoroughly after touching a wart.