Scalds are the damage caused by contact with hot fluids.

The cause of a burn may be:

Direct heat – flames, hot surfaces, hot liquids or gases

Electrical – faulty wiring, old plugs, lightning

Chemical – strong acids or alkalis, cleaning fluids, old batteries

What Are The Symptoms?

There may be obvious and immediate damage to the skin, which can be very painful.

With partial thickness burns, the skin may be pink, red or mottled. Blistering may also be seen.

With full thickness burns, the top layer of skin is destroyed and may look white or black, and charred. Full thickness burns are painless, as the nerves carrying pain signals have been destroyed.

Burns are common among young children. Scalds are particularly common among toddlers, who are energetic explorers with little sense of potential danger – knocking over hot cups of tea, grabbing at pans on the cooker or getting into hot baths.

Cool small burns immediately under cold running water for at least ten minutes. Rinse chemical burns for 20 minutes.

Briefly rinse larger burns, avoiding excessive cooling.

Remove clothes in the area of the burn where possible, without causing further damage to the skin. Then either wrap the burned area in a clean clear plastic bag or place a clean smooth material, such as cling film, over the burn to prevent infection.

Minor burns can be treated at home with painkillers and sterile dressings (don’t pop blisters). Deep or extensive burns, or burns to the face, hands or across joints, need to be assessed and treated in hospital.

The extent of burns can be estimated using special charts. More than ten per cent burns need hospital treatment (including intravenous fluids). Burns to more than 50 per cent of the body’s surface carry a poor chance of survival.

Severe burns need specialised long-term management, which may include skin grafts or treatments to prevent contractures, as well as psychological support to deal with scarring.

Prevent burns from happening by making your home safe. For example, install smoke detectors, check wiring and remove chemicals.

Author. Medical Advice By Vivienne Balonwu, Free Medical Advice Online.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

This condition (also called atopic eczema or infantile eczema) affects people with dry and rough skin (keratosis pilaris) and may be caused by a variety of allergens. It often starts in early childhood, around three months of age, and tends to run in ‘atopic’ families.

Possible causes include:

This condition affects mainly adults. It occurs on skin contact with a chemical substance and takes 24 hours to develop.

There are two types of contact dermatitis:

Allergic contact dermatitis – the skin becomes sensitised to something over a period of time and an allergic reaction occurs on re-exposure.

Irritant contact dermatitis – occurs when the skin comes in contact with something that strips away its natural oils and makes the skin red, dry, cracked and itchy Irritant contact dermatitis is not an allergy.

An estimated one in 12 adults and one in five school-age children have eczema. According to the Health and Safety Executive, occupational dermatitis (irritant contact dermatitis caused by sensitivity to substances at work) accounts for up to a third of all working days lost by British industry.

The most common causes of allergic contact dermatitis are:

The most common causes of irritant contact dermatitis include:

In mild cases, eczema is nothing more than a slightly irritating patch of sore skin, but in severe cases extensive areas of skin may become inflamed and unbearably itchy.

Some people with these symptoms develop problems such as depression with low self-esteem, and have difficulty coping at school or work.

People with eczema are also more prone to herpes, skin fungal and wart infections.

Up to half of all babies with widespread atopic eczema will later develop asthma and rhinitis as the eczema improves. This phenomenon is referred to as the ‘allergic march’.

If you have contact dermatitis, you must try to identify the cause so you can avoid it. Patch testing with various chemicals can help in this.

If you have atopic eczema, you may be able to find out what you’re allergic to by having special skin-prick tests for environmental and food allergens. Once an allergen has been identified, practical steps can be taken to avoid it.

Completely avoid the substance that triggers the eczematous rash and treat any existing rash with medium potency steroid ointments and moisturising emollients.

Atopic eczema is usually a little more difficult to treat and you may need to try a number of different treatments, or a combination of treatments, before finding which one works best for you.

People with atopic eczema should bath regularly using liberal amounts of emollients (moisturising creams, ointments, lotions and bath oils) to soften and hydrate the skin. Ointments work much better than creams on dry eczematous skin, but are greasy.

Avoid perfumed moisturisers and those with added lanolin.

Outbreaks of eczema should be treated with adequate amounts of steroid ointments to reduce skin inflammation. These will only make the eczema better if used continuously for five to seven days.

Don’t be afraid to use steroid ointments – they’ll clear the eczema so moisturiser can continue to protect the skin. Moisturisers and creams alone won’t settle active eczema.

You may be given antihistamine medication to make your skin less itchy. This should also help you to sleep better at night by reducing itching. In severe atopic eczema, you may be given a short course of oral steroid tablets to get the inflammation under control.

Antibiotics may occasionally be needed to treat impetigo and eczema flare-ups caused by staphylococcus and streptococcus bacteria.

‘Wet wrapping’ is sometimes used overnight, particularly on children, if emollients and steroid creams alone are not effective. The treatment involves applying wet tubular bandages over emollients and steroid creams to aid their absorption. It also helps to relieve itching and prevent scratching.

Evening primrose oil (or gamolenic acid) has been used to treat atopic eczema, but with disappointing results.

Some results from trials using Chinese herbal medicine to treat eczema have been encouraging, but it’s important to remember that just because a treatment is ‘herbal’ or ‘natural’ doesn’t mean it’s safe for everyone.

Reducing intake of histamine-containing foods, such as tomato, berries, strong cheese, chocolate, Marmite and dark-meat fish, may reduce itching and redness.

Newer non-steroidal eczema creams, called tacrolimus and pimecrolimus, seem to be effective for clearing eczema on sensitive skin such as the face, and have no steroid side-effects.

There’s mounting evidence that supplementing probiotic ‘good bacteria’ in a child’s early diet will reduce the risks of developing eczema. Adding omega-3 essential oils to the diet may also be beneficial.

If you have atopic eczema you may find the following useful:

For more information on treating and controlling eczema, contact the National Eczema Society.

Author. Medical Advice By Vivienne Balonwu, Free Medical Advice Online.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Head Lice

Head lice are tiny insects – no bigger than the head of a pin – that live on human hair, and feed by sucking blood from the scalp. Their egg cases are called ‘nits’ and these are always hatched or empty egg shells so their presence does not necessarily indicate active infestation. Once hatched, these shells are harmless. Head lice most commonly affect children, but adults in infected families can also get them. Lice cannot survive out of the hair, and cannot be transferred to animals or pets. They are spread only by relatively prolonged head to head contact, not by brief or fleeting contact, and they walk – not jump – from one person to another.

Any lice which are seen on someone’s clothes or back are incapable of transferring to another person and it is impossible to pick them up from towels, bedding or clothing. It is a fallacy that lice only live in dirty hair – they are found just as frequently in scrupulously clean households. They are seen most frequently in children between the ages of 4 and 11, with girls showing a slightly greater infection rate, possibly due to the length of their hair.

What Are The Signs And Symptoms Of Head Lice?

The main symptom is one of scalp itching, and this can be intense with considerable associated scratching. It can take several weeks for this itching to develop.This scratching can break the scalp skin, and so there may be an associated secondary skin infection which is often painful and may bleed.

Will I Have Any Tests Or Investigations For Head Lice?

Not as such, but it is always best to confirm the presence of active lice by using a special lice detector comb. This is the most effective way to spot them. The hair should be dampened and then combed carefully from the roots to the tips onto a clean sheet of paper. If lice are present they will be seen on the paper or the comb.

What Is The Treatment For Head Lice?

The treatment consists of insecticide lotions or shampoos applied regularly to kill both any live lice and eggs. The current practice in the UK is to use one insecticide for a course of treatment (two applications spaced one week apart) and if this treatment fails, to use another product whose active ingredient is in a different insecticide class. The current insecticides in use in the UK are malathion, the pyrethroids permethrin and phenothrin (all available over the counter from chemists without prescription) and carbaryl (prescription only).

In general, carbaryl is kept in reserve if all else fails. Another method of treating head lice is sometimes followed in the UK called ‘bug busting’. Here, the hair is wet combed intensely, using a special fine toothed comb and conditioner for at least 30 minutes every third day for a week. It remains unclear as to whether this method is any more or less effective than insecticide treatments and is time consuming for parents and children.

What Course Will Infestation With Head Lice Follow?

If treated effectively and correctly, head lice can be readily cleared. If they are left however, they will not disappear by themselves so treatment is the only option.

Can I Do Anything To Help Myself?

It can be impossible to prevent schoolchildren from catching head lice but prompt treatment and regular checking using a lice detector comb will mean their inconvenience is kept to a minimum.

Tell Your Doctor

1. Have you seen any lice or nits on your child or yourself?
2. Have you used a nit detector comb?
3. Do any of your child’s friends have head lice?
4. Has your child been scratching their head?
5. Have you used any treatments yourself?

Ask Your Doctor

1. Will ordinary shampoo remove lice?
2. Is there resistance to any of the treatments?
3. Are there any side effects?
4. Do I need to tell anyone about getting lice?
5. Does my whole family need treatment?

By Dr Roger Henderson, MB BS Lond., LMSSA Lond. Medical advice on head lice is published by Dr Vivienne Balonwu.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Psoriasis On Skin

Psoriasis is a common, long-term, slow progressing skin condition that affects up to one and a half million people in the UK. Psoriasis makes the skin of a person inflamed (becoming red, swollen and painful) and can make it look like fish scales (scaling). Psoriasis can affect any part of the body.
There are a number of different types of psoriasis and they are explained in the section ‘Will I have any tests or investigations?’.

What Causes Psoriasis?

The cause of psoriasis is unknown. But certain types of the condition might be inherited: about three in ten people with psoriasis have a relative who also has the condition. However, a definite genetic link has yet to be proved.
It is thought that the underlying problem is that new skin cells are produced too quickly and rise to the surface before the old skin cells have had time to die off and be scrubbed away. The result of this overproduction of skin cells is red and raised patches on the skin.
The overproduction of skin cells may be due to a problem with the immune system. In psoriasis sufferers, their bodies’ immune systems may cause too many white blood cells (known as T cells) to be produced in the skin. These T cells cause the skin to become inflamed by releasing chemicals that cause the body to react as if it was being attacked by an infection – this is known as the inflammatory cycle. This inflammatory cycle causes the excess production of skin cells and this produces psoriasis.

Symptoms Of Psoriasis And Signs

On the skin, psoriasis appears as patches of thick, red skin that have a silvery scaly appearance. These skin patches are known as plaques. The plaques usually appear on the elbows, knees, scalp (skin under the hair of the head) and on the lower back. However, plaques can appear on any part of the body. Plaques may itch intensely, or ‘burn’ and the skin may crack around the joints (such as the elbow or knuckles).

No matter which type of psoriasis a person has, they will find that their nails become thickened, crumbly and pitted.

Psoriasis tends to appear and disappear and there may be wide differences in its severity on the same person over time. Most sufferers only have a few isolated patches but, in its worst form, the psoriasis may affect the whole body and 6 people with psoriasis in every 100 develop a form of arthritis in the joints. This rare form of arthritis usually occurs at the tips of the fingers, in the toes and in the lower back of those who develop it. And, just like the skin plaques, this form of arthritis can disappear completely.

Will I Have Any Tests Or Investigations?

Most forms of psoriasis can be diagnosed by a doctor carrying out an examination and asking the sufferer a number of questions (known as ftaking the history’). But diagnosing psoriasis can sometimes be tricky as psoriasis can look like other skin conditions so, if there is any doubt in the doctor’s mind, a small sample of skin is taken and sent to a specialist for confirmation.

The most common type of psoriasis – plaques of reddened skin with a silvery covering – is called plaque psoriasis, but other forms include:
 
¤ Guttate psoriasis. This form of psoriasis often appears several days after infection by a virus or a certain type of bacteria known as streptococcus. It looks like drop-like patches on the torso, scalp or limbs and is often milder than plaque psoriasis.

¤ Pustular psoriasis. With this form of psoriasis, painful bumps of pus (known as pustules) or blisters appear on the palms of the hand or soles of the feet. These pustules and blisters then turn brown and scaly. It is common in middle age and more painful than plaque psoriasis although not usually more severe.

¤ Flexural psoriasis. The skin is red but not scaly. Flexural psoriasis appear in the armpits, groin or under the breasts, and is often as severe as plaque psoriasis.

¤ Erythrodermic psoriasis. A rare condition where much of the body’s skin has become red and scaly. The body’s ability to control its temperature and fluid balance have been badly affected. People with this erythrodermic psoriasis often need to be treated in hospital.

What Psoriasis Treatments Might I Need?

Doctors normally follow the ’1-2-3′ treatment system for psoriasis.

Step 1. Using treatments that are applied directly to the skin in the affected area. Such localised treatment of a condition is known as topical treatment. Topical treatments for psoriasis include skin softeners (known as emollients), coal tar and salicylic acid preparations, steroids applied to the skin (if used carefully), Vitamin D ointments and dithranol – a synthetic chemical used effectively in plaque psoriasis. Your doctor will probably try a number of different treatments as not every treatment works for every patient, so that he or she can find the one that suits you best.

Step 2. Treating the condition with light (known as phototherapy). The majority of sufferers benefit from sunlight, and this type of treatment developed from this observation. It is called PUVA treatment, where the patient takes a drug called psoralens before being exposed to ultraviolet A light in a solarium ‘box’ for half an hour two to three times a week. This is effective, especially in the more severe types of psoriasis.

Step 3. Treating with oral tablets. The usual one given is called methotrexate, which works by slowing down the excessive production of the skin cells and so reducing the psoriasis. This can be dramatically effective, but these drugs are generally avoided unless all else has failed and your psoriasis is severe, because of the potential side-effects of the drugs such as severe nausea, vomiting and toxic effects on red and white blood cells. Any treatment with such drugs requires regular blood tests to monitor the body’s reaction to it.

What Course Will The Illness Follow?

Psoriasis follows a fluctuating pattern, so many people will need little or no treatment for a while and then more active therapy as the condition becomes worse, before the condition gets better again and so on. Each person’s psoriasis is different and will respond differently to different types of treatment, so often trials of treatment are needed. At least one third of people with psoriasis will find that their problem disappears for long periods of time or, for some people, for ever. However, a permanent cure for all people has not been found yet.

Can I Do Anything To Help Myself?

Definitely. There are at least three easy steps you can take.

Stress. Stress makes psoriasis worse, so one of the most beneficial things you can do is to try to develop a positive attitude to the condition.

Diet. Although no specific diet has been shown to be of benefit, if you find your psoriasis seems to be worse after eating certain foods, avoid them and see what happens.

Sunlight. Moderate sunlight helps many people, although a small number find that their psoriasis worsens after exposure to the sun.

Tell Your Doctor

1. Does anyone else in the family have this problem?
2. Have you noticed any problems with your joints?
3. Is it worse when you are stressed?
4. Does your skin seem to be flaking off more than usual?
5. Are the patches very itchy?

Ask Your Doctor

1. Is it infectious?
2. Can it be linked to my hormones?
3. Can my children inherit it?
4. Should I shower or bathe, or does it make no difference?
5. Are there any alternative treatments which may help my skin?

by Dr Roger Henderson, MB BS Lond., LMSSA Lond.

This free Medical Advice Online is published by Vivienne Balonwu.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Acne is a common condition that affects most people at some point in their lives. Although acne can be nothing more than a few embarrassing spots, it can be very widespread, causing scars on the skin. Acne is a disease that can be treated, and because it can cause scarring and physical damage to the skin, as well as significant emotional distress and loss of self-esteem, it should always be taken seriously.

The Cause Of Acne

Acne is caused by a blockage of the sebaceous (oil-producing) glands. It is common in teenagers because rising levels of sex hormones stimulate the flow of sebum (oil), which becomes trapped in the glands. Acne can also be aggravated by skin products, such as sunscreens and some other creams which block the pores.

 Common Questions On Acne

Acne is not primarily due to an infection, although there may be an overgrowth of normal skin germs in association with acne. It is not contagious.

No.

Although certain hormonal conditions can make acne worse, or even cause it, acne is a skin disease. Some women notice that their acne varies through the menstrual cycle and is usually worse just before a period.

Changing your diet probably won’t help. Foods such as chocolate, dairy products, citrus fruits and cola have been named as possible causes of acne over the years, but the evidence has shown that diet generally plays no role in acne.

No, in fact, excessive cleaning can make your acne worse. It’s best to cleanse twice a day – in the morning and at night. Strong antiseptic lotions can irritate the skin without helping the acne.

For some people, sunshine or ultraviolet light can help to treat acne, but generally the health risks associated with sun exposure, including skin damage and skin cancers, outweigh the benefits. In some patients acne may flare up in the summer (‘summer acne’).

Although drinking water is good for your health, there is no evidence that it will help to treat your acne.

Sweating can, in some cases, contribute to acne, particularly on the back, shoulders and chest. You should be able to decide if this is the case with you.

Unfortunately not! A significant number of people in their 20s, 30s and 40s continue to be troubled by acne and need medical treatment.

Psychological Effects

Acne is a very visible problem and it can have psychological effects, especially for teenagers. Acne on the face can reduce self-confidence and self-esteem, and interfere with forming relationships. These problems are not always understood by parents and friends. Unfortunately, people do still judge a book by its cover, so if you have acne you need understanding, support and above all else, appropriate treatment. It’s important to realise that acne can be helped substantially by the good treatments available. It may take a little time for those treatments to work, and there may be some side effects, but progress can certainly be made.

It’s a big help if your family and friends understand the psychological effects which can accompany acne. Talk to them about it and give them this sheet to read.

If you’re feeling depressed about your acne, psychiatric and psychological support is available. Talk to your GP if you feel you need that support.

 Treatment – How To Get Rid Of Acne

Acne comes in different forms, ranging from very mild to very severe. If you have acne, you need to be carefully assessed by a doctor and the nature and causes of your condition identified. In cases of severe acne, your GP may refer you to a dermatologist (a specialist in skin diseases) for assessment and treatment.

The milder forms of acne can be treated by simple measures, such as creams and lotions containing benzoyl peroxide that are available over the counter at your pharmacist. These products are usually used once or twice a day and may cause skin dryness and peeling when you first start using them. This will improve with time.

For moderate acne, prescribed medication such as antibiotic solutions, tretinoin cream, other vitamin A derivatives or azelaic acid cream, can be applied to the skin. These acne products can be a little irritating but generally this shouldn’t worry you. If these products are not helping your acne, your doctor may suggest taking antibiotic tablets for several months. The contraceptive pill may help women with acne.

For severe acne you will need to take antibiotic tablets for several months, but if this is not successful, there is another treatment available called isotretinoin. This is a vitamin A tablet which you take for four to six months. It can have some unpleasant side-effects and can only be prescribed by hospital specialists, but it can cure people with severe acne, particularly if it is causing scarring.

Remember, always rely on your GP’s advice for the right treatment for your acne.

By Dr Carol Blow, MB BS, MRCP, MRCGP, DRCOG.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.