DOCSLIB.ORG

Medical and Environmental Risk Factors for the Development of Central Centrifugal Cicatricial Alopecia a Population Study

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Medical and Environmental Risk Factors for the Development of Central Centrifugal Cicatricial Alopecia a Population Study STUDY ONLINE FIRST Medical and Environmental Risk Factors for the Development of Central Centrifugal Cicatricial Alopecia A Population Study Angela Kyei, MD, MPH; Wilma Fowler Bergfeld, MD; Melissa Piliang, MD; Pamela Summers, MD Objective: To investigate medical and environmental lished central scalp alopecia photographic scale, a score risk factors for central centrifugal cicatricial alopecia consistent with clinically evident central hair loss. Ad- (CCCA), the most common type of scarring alopecia in vanced central hair loss with clinical signs of scarring African American women. (grade Ն3) was seen in 59% of these respondents and was interpreted as clinically consistent with CCCA. Dia- Design: A population study involving a quantitative betes mellitus type 2 was significantly higher in those with cross-sectional survey of risk factors for CCCA. Survey CCCA (P=.01), as were bacterial scalp infections (P=.045) results are then correlated with a clinical evaluation for CCCA using a standardized, previously published cen- and hair styles associated with traction (eg, from braids tral scalp alopecia photographic scale. and weaves) (P=.02). Conclusions: Our survey results suggest that there is a Setting: Two African American churches and a health high prevalence of central hair loss among African Ameri- fair for African American women in Cleveland, Ohio. can women. Hair styles causing traction as well as in- Participants: A total of 326 African American women flammation in the form of bacterial infection may be con- who participated in the hair study. tributing to the development of CCCA. The increase in diabetes mellitus type 2 among those with CCCA is in Main Outcome Measures: Prevalence of CCCA in the line with the recent theory that cicatricial alopecia may general African American population and risk factors as- be a manifestation of metabolic dysregulation. sociated with CCCA. Arch Dermatol. Results: Of the 326 responders, 28% received a grade Published online April 11, 2011. of 2 or higher using a standardized, previously pub- doi:10.1001/archdermatol.2011.66 ENTRAL CENTRIFUGAL CICA- Most of the prevalence data on this en- tricial alopecia (CCCA) is tity come from Khumalo et al,6,7 who have a term coined by the conducted population studies in Africa North American Hair Re- looking at hairdressing and the preva- search Society (NAHRS) lence of scalp diseases commonly seen in Cto describe a scarring hair loss, centered black children and adults. They found a on the vertex of the scalp, that spreads pe- surprisingly low prevalence of CCCA ripherally. It is almost exclusively used to (1.9%) in adults, most of whom were older describe this type of hair loss in African than 50 years, and no CCCA in children, American women and replaces previ- a surprising finding given that the com- ously used terms such as hot comb alope- mon hair grooming practices, such as cia, coined by Lopresti et al1 in 1968 and chemical relaxer use and braids linked to follicular degeneration syndrome, coined CCCA in African American women, are by Sperling and Sau2 in 1992. It is thought also used in this African population. In to be the most common pattern of scar- contrast, African American women in the ring hair loss seen in African American United States commonly present with this women, yet so little is known about its true entity, but true prevalence data in this Author Affiliations: Institute of prevalence among them. Moreover, the eti- population are lacking. 1 Dermatology and Plastic ology and risk factors, including environ- Lopresti et al were the first to pro- Surgery, Cleveland Clinic, mental, medical, and genetic risk factors, pose an environmental risk factor, namely, Cleveland, Ohio. remain to be elucidated.1-5 the use of hot combs in combination with ARCH DERMATOL PUBLISHED ONLINE APRIL 11, 2011 WWW.ARCHDERMATOL.COM E1 ©2011 American Medical Association. All rights reserved. autoimmune conditions, such as thyroid disease and DM; and Table 1. Central Hair Loss Grades (CHLGs) at Examinationa questions about hormonally driven conditions, such as unwanted and excessive hair growth, acne, and difficulty con- Respondents, ceiving (eTable, http://www.archdermatol.com) Finally, data Physician-assigned No. (%) of Total about methods of hair grooming, such as the age at which chemi- CHLGs Population Mean Age, y cal relaxers were first used and use of braids and weaves, were 0-1 224 (72) 40 compiled and analyzed to determine if there was any associa- 4,5 2-5 86 (28) 53 tion with CCCA. 3-5 52 (17) 58 The questionnaire was followed by a scalp examination using the standardized central scalp alopecia photographic scale to a Grades: 0, no central scalp hair loss; 1, minimal central scalp loss; grade hair loss (previously published by Olsen et al4). Using 2, clinically evident central scalp hair loss; 3-5, advanced central scalp hair this scale, Olsen et al4 interpreted a central hair loss grade loss. (CHLG) of 0 as normal hair; a CHLG of 1 to 2 as possibly early CCCA, androgenetic alopecia, or telogen effluvium; and a CHLG of 3 to 5 as probable CCCA given the usual characteristics of scalp oil to straighten the naturally curly African hair in scarring such as a shiny scalp and loss of follicular ostia found order to increase manageability. Since then, most other in this group. The scalp examination was conducted by der- forms of hair grooming methods used by African Ameri- matologists well trained in the area of hair loss, assessing for cans, including the use of braids, weaves, and chemical the characteristics of scarring. Standardized photographs of par- relaxers, have been linked to the development of CCCA. ticipants’ central scalp and anterotemporal scalp were ob- Gathers and Lim8 found an association between CCCA tained using professional photography. Validation of the CHLGs and hair weaves and braids but not relaxers. Khumalo assigned by each evaluator was ensured through a follow-up 6,7 group review of the scalp photographs. Answers to the ques- et al, however, reported 5 cases of acute chemical re- tionnaire were compared with the CHLG to determine if there laxer–associated scarring hair loss in African women. Bu- was a relationship between the development of CCCA and these 9 lengo-Ransby and Bergfeld also reported a case of chemi- various risk factors. The data were analyzed using frequencies cal relaxer–associated scarring hair loss. There are other and percentages. Spearman correlation was used for associa- reports of relaxers causing clinically significant chemi- tions; t tests, ␹2 tests, and Fisher exact test were used when cal burns and hair loss, but it is unclear if those affected appropriate. went on to develop CCCA. Thus, it is still uncertain 6-10 whether hair grooming practices are a risk factor. RESULTS While several studies have addressed environmental risk factors by examining hair grooming practices, few DEMOGRAPHIC DATA AND CLINICAL FINDINGS have addressed medical and genetic risk factors for this disorder. Given that CCCA has a distinct clinical pre- There were 326 African American responders, with a mean sentation and seems to predominantly affect African age of 50 years (Table 1). From the 326 responders, 16 Americans, it is important to ask whether risk factors were excluded from analysis because of a history of alo- unique to this population might contribute to the patho- pecia areata, lupus, and/or other hair loss pattern that was genesis of this disorder. Could CCCA be linked to other consistent with either of these types of hair loss. The common medical conditions found in African Ameri- NAHRS central hair loss scale was used to grade central cans, such as diabetes mellitus (DM), and other autoim- hair loss in all responders. A CHLG of 0 was interpreted mune conditions, such as lupus? Could it be linked to as normal central hair density without obvious hair loss. common skin conditions found in this population, such A CHLG of 1 was interpreted as minimal central hair loss as hypertrophic scars and keloids, fungal and bacterial and thus unlikely to have CCCA; a CHLG of 2 was in- scalp infections, and seborrheic dermatitis? Is there a fam- terpreted as clinically evident central hair loss and pos- ily history of this type of hair loss in patients with CCCA? sibly early evolving CCCA, although a diagnosis of an- These are important questions that remain unanswered. drogenetic alopecia must be entertained. A CHLG of 3 Given the lack of epidemiologic data, the main goal of to 5 was interpreted to be consistent with clinically evi- this study was to elucidate environmental as well as medi- dent CCCA (Figure 1 and Figure 2). A total of 86 of cal risk factors that may be associated with CCCA as well 310 respondents (28%) received a CHLG of 2 or higher as to estimate the prevalence of this disorder in African using this scale, a score consistent with clinically evi- Americans. dent central hair loss. Central centrifugal cicatricial alo- pecia (CHLGs 3-5) was seen in 59% of these respon- METHODS dents (Table 1). This study, which was approved by the Cleveland Clinic’s SYSTEMIC METABOLIC DISEASE (Cleveland, Ohio) institutional review board, involved the administration of a questionnaire about risk factors for CCCA There was a low prevalence of type 2 DM in this popu- to 326 African American women at 2 churches and a health lation (8%) but a statistically significant increase (P =.01) fair for African American women at the Cleveland Clinic. The questionnaire consisted of questions about demographic data, in the prevalence of type 2 DM was observed in those such as age and participants’ level of education; questions with CCCA (CHLGs 3-5) when comparing those with about genetic susceptibility, such as family history of male- no CCCA (CHLGs 0-1).
Load more

Recommended publications
  • Cutaneous Manifestations of HIV Infection Carrie L
    Chapter Title Cutaneous Manifestations of HIV Infection Carrie L. Kovarik, MD Addy Kekitiinwa, MB, ChB Heidi Schwarzwald, MD, MPH Objectives Table 1. Cutaneous manifestations of HIV 1. Review the most common cutaneous Cause Manifestations manifestations of human immunodeficiency Neoplasia Kaposi sarcoma virus (HIV) infection. Lymphoma 2. Describe the methods of diagnosis and treatment Squamous cell carcinoma for each cutaneous disease. Infectious Herpes zoster Herpes simplex virus infections Superficial fungal infections Key Points Angular cheilitis 1. Cutaneous lesions are often the first Chancroid manifestation of HIV noted by patients and Cryptococcus Histoplasmosis health professionals. Human papillomavirus (verruca vulgaris, 2. Cutaneous lesions occur frequently in both adults verruca plana, condyloma) and children infected with HIV. Impetigo 3. Diagnosis of several mucocutaneous diseases Lymphogranuloma venereum in the setting of HIV will allow appropriate Molluscum contagiosum treatment and prevention of complications. Syphilis Furunculosis 4. Prompt diagnosis and treatment of cutaneous Folliculitis manifestations can prevent complications and Pyomyositis improve quality of life for HIV-infected persons. Other Pruritic papular eruption Seborrheic dermatitis Overview Drug eruption Vasculitis Many people with human immunodeficiency virus Psoriasis (HIV) infection develop cutaneous lesions. The risk of Hyperpigmentation developing cutaneous manifestations increases with Photodermatitis disease progression. As immunosuppression increases, Atopic Dermatitis patients may develop multiple skin diseases at once, Hair changes atypical-appearing skin lesions, or diseases that are refractory to standard treatment. Skin conditions that have been associated with HIV infection are listed in Clinical staging is useful in the initial assessment of a Table 1. patient, at the time the patient enters into long-term HIV care, and for monitoring a patient’s disease progression.
    [Show full text]
  • Cutaneous Manifestations of Newborns in Omdurman Maternity Hospital
    ﺑﺴﻢ اﷲ اﻟﺮﺣﻤﻦ اﻟﺮﺣﻴﻢ Cutaneous Manifestations of Newborns in Omdurman Maternity Hospital A thesis submitted in the partial fulfillment of the degree of clinical MD in pediatrics and child health University of Khartoum By DR. AMNA ABDEL KHALIG MOHAMED ATTAR MBBS University of Khartoum Supervisor PROF. SALAH AHMED IBRAHIM MD, FRCP, FRCPCH Department of Pediatrics and Child Health University of Khartoum University of Khartoum The Graduate College Medical and Health Studies Board 2008 Dedication I dedicate my study to the Department of Pediatrics University of Khartoum hoping to be a true addition to neonatal care practice in Sudan. i Acknowledgment I would like to express my gratitude to my supervisor Prof. Salah Ahmed Ibrahim, Professor of Peadiatric and Child Health, who encouraged me throughout the study and provided me with advice and support. I am also grateful to Dr. Osman Suleiman Al-Khalifa, the Dermatologist for his support at the start of the study. Special thanks to the staff at Omdurman Maternity Hospital for their support. I am also grateful to all mothers and newborns without their participation and cooperation this study could not be possible. Love and appreciation to my family for their support, drive and kindness. ii Table of contents Dedication i Acknowledgement ii Table of contents iii English Abstract vii Arabic abstract ix List of abbreviations xi List of tables xiii List of figures xiv Chapter One: Introduction & Literature Review 1.1 The skin of NB 1 1.2 Traumatic lesions 5 1.3 Desquamation 8 1.4 Lanugo hair 9 1.5
    [Show full text]
  • STD Glossary of Terms
    STD 101 In A Box- STD Glossary of Terms Abstinence Not having sexual intercourse Acquired A disease of the human immune system caused by the Human Immunodeficiency Virus (HIV). HIV/AIDS represents the entire range of Immunodeficiency disease caused by the HIV virus from early infection to late stage Syndrome (AIDS) symptoms. Anal Intercourse Sexual contact in which the penis enters the anus. Antibiotic A medication that either kills or inhibits the growth of a bacteria. Antiviral A medication that either kills or inhibits the growth of a virus. A thinning of tissue modified by the location. In epidermal atrophy, the epidermis becomes transparent with a loss of skin texture and cigarette Atrophic paper-like wrinkling. In dermal atrophy, there is a loss of connective tissue and the lesion is depressed. A polymicrobial clinical syndrome resulting from replacement of the Bacterial Vaginosis normal hydrogen peroxide producing Lactobacillus sp. in the vagina with (BV) high concentrations of anaerobic bacteria. The common symptom of BV is abnormal homogeneous, off-white, fishy smelling vaginal discharge. Cervical Motion A sign found on pelvic examination suggestive of pelvic pathology; when Tenderness (CMT) movement of the cervix during the bimanual exam elicits pain. The lower, cylindrical end of the uterus that forms a narrow canal Cervix connecting the upper (uterus) and lower (vagina) parts of a woman's reproductive tract. The most common sexually transmitted bacterial infection in the U.S., caused by the bacteria Chlamydia trachomatis. Often no symptoms are present, especially in women. Untreated chlamydia can cause sterility, Chlamydia Pelvic Inflammatory Disease (PID), and increase the chances for life- threatening tubal pregnancies.
    [Show full text]
  • Survey of Skin Disorders in Newborns: Clinical Observation in an Egyptian Medical Centre Nursery A.A
    املجلة الصحية لرشق املتوسط املجلد الثامن عرش العدد اﻷول Survey of skin disorders in newborns: clinical observation in an Egyptian medical centre nursery A.A. El-Moneim 1 and R.E. El-Dawela 2 مسح لﻻضطرابات اجللدية لدى الولدان: مﻻحظة رسيرية يف حضانة يف مركز طبي يف مرص عبري أمحد عبد املنعم، رهيام عز الدولة الرشقاوي اخلﻻصة:مل َ ْت َظ اﻻضطرابات اجللدية لدى الولدان بدراسات جيدة يف مرص. وقد هدفت الباحثتان إىل دراسة أنامط التغريات اجللدية يف عينة من ِ الولدان املرصيني، وهي دراسة وصفية استباقية أترابية شملت ستة مئة وليد يف َّحضانة يف مستشفى جامعة سوهاج، َّوتضمنت الفحص اجللدي خﻻل اﻷيام اخلمسة اﻷوىل بعد الوﻻدة. وقد تم كشف اﻻضطرابات اجللدية لدى 240 ًوليدا )40%( ولوحظت الومحات لدى 100 وليد )%16.7(، ومعظمها من النمط ذي اخلﻻيا امليﻻنية )لطخات منغولية لدى 11.7% مع ومحات وﻻدية ذات ميﻻنية اخلﻻيا لدى 2.7%(. كام ُك ِش َف ْت العداوى الفطرية اجللدية، ومنها داء َّاملبيضات الفموية، وعدوى الفطريات يف مناطق احلفاظات أو َالـم َذح الناجم عن عدوى َّاملبيضات يف اﻷرفاغ )أصل الفخذ(، وذلك لدى 13.3%، ُوكشفت بعض العداوى اجلرثومية يف 1.3%من الولدان. وتشري املقارنات مع الدراسات اﻷخرى يف أرجاء العامل إىل معدل مرتفع للعدوى بالفطريات مع معدل منخفض للومحات الوﻻدية يف دراستنا للولدان، وتويص الباحثتان بإجراء تقييم روتيني جلدي للولدان، ّوﻻسيام يف ضوء املعدﻻت املرتفعة للعدوى اجللدية بالفطريات. ABSTRACT The frequency of neonatal skin disorders has not been well studied in Egypt. Our aim was to address patterns of dermatological changes in a sample of Egyptian newborns. In a descriptive prospective cohort study 600 newborns in Sohag University hospital nursery were dermatologically examined within the first 5 days of birth.
    [Show full text]
  • Non-Dermatomal Varicella-Zoster Skin Infection: Disseminated Cutaneous Herpes Zoster Without Dermatome in an Immunosuppressed Woman
    Volume 23 Number 10 | October 2017 Dermatology Online Journal || Case Report DOJ 23 (10): 4 Non-dermatomal varicella-zoster skin infection: disseminated cutaneous herpes zoster without dermatome in an immunosuppressed woman Lindsay P Osborn1 BA,, Philip R Cohen2 MD Affiliations: 1Medical College of Georgia, Augusta, Georgia, 2University of California, San Diego, California Corresponding Author: Lindsay P. Osborn, 1 Seventh Street, Suite 1403, Augusta, GA 30901, Email: [email protected] Introduction Abstract Herpes viral infection in humans includes both Disseminated herpes zoster is defined as the presence herpes simplex (HSV) and herpes zoster. The varicella of more than 20 lesions outside the dermatome. zoster virus (VZV) is the etiology of both primary This unusual presentation is more common in varicella and herpes zoster (commonly known as immunosuppressed patients. Complications such chicken pox and shingles, respectively), with herpes as hepatitis, encephalitis, and pneumonitis are more zoster being the re-activated form of the virus. The likely in individuals with disseminated varicella zoster classical presentation of herpes zoster is a unilateral virus infection. distribution of vesicles along a single or adjacent dermatome [1]. Disseminated herpes zoster is A 63-year-old woman being treated for breast cancer defined as having more than 20 lesions outside the developed multiple pustules and vesicles days primary or adjacent dermatome [2]. after starting doxorubicin and cyclophosphamide chemotherapy. Ten individual lesions appeared on Although uncommon among all herpes zoster her chest, abdomen, back, and leg. Non-dermatomal infections, the prevalence of disseminated VZV in disseminated herpes zoster was suspected. She was a setting of immunosuppression is thought to be treated with oral antiviral therapy, as well as with oral anywhere from 10 to 40% [3, 4].
    [Show full text]
  • Skin of Color
    Dermatology Patient Education Skin of Color There are a variety of skin, hair and nail conditions that are common in people with skin of color such as African Americans, Asians, Latinos and Native Americans. Your dermatologist can help diagnose and treat these skin conditions. SKIN CONDITIONS Postinflammatory hyperpigmentation (PIH) This condition results in patches of darker skin as your skin heals after a cut or scrape, or when acne, eczema or other rashes clear. PIH often fades, but the darker the PIH, the longer fading can take. Your dermatologist can help restore your skin’s color more quickly. Prescription medicines containing retinoids or hydroquinone (a bleaching ingredient), and procedures such as chemical peels and microdermabrasion may help. Your dermatologist will also encourage you to wear sunscreen to avoid further darkening of the skin due to ultraviolet (UV) light exposure and prevent further PIH from developing. Treatment products available over-the-counter rarely help and can make PIH more noticeable. Melasma This common condition causes brown to gray-brown patches, usually on the face. It occurs most often in women who have Latina, African, or Asian ancestry. Men can get melasma, too. Melasma can also appear on other parts of the body that get lots of sun exposure, such as the forearms and neck. Melasma may be associated with pregnancy, birth control pills or estrogen replacement therapy. It may also be hereditary. Melasma can fade on its own, but it often recurs. Your dermatologist can provide prescription topical treatment to help the condition fade. Procedures including chemical peels and microdermabrasion can also help.
    [Show full text]
  • Cellulitis: a Review of 62
    Clinical Review & Education Review Cellulitis A Review Adam B. Raff, MD, PhD; Daniela Kroshinsky, MD, MPH CME Quiz at IMPORTANCE Cellulitis is an infection of the deep dermis and subcutaneous tissue, presenting jamanetworkcme.com with expanding erythema, warmth, tenderness, and swelling. Cellulitis is a common global health burden, with more than 650 000 admissions per year in the United States alone. OBSERVATIONS In the United States, an estimated 14.5 million cases annually of cellulitis account for $3.7 billion in ambulatory care costs alone. The majority of cases of cellulitis are nonculturable and therefore the causative bacteria are unknown. In the 15% of cellulitis cases in which organisms are identified, most are due to β-hemolytic Streptococcus and Staphylococcus aureus. There are no effective diagnostic modalities, and many clinical conditions appear similar. Treatment of primary and recurrent cellulitis should initially cover Streptococcus and methicillin-sensitive S aureus, with expansion for methicillin-resistant S aureus (MRSA) in cases of cellulitis associated with specific risk factors, such as athletes, children, men who have sex with men, prisoners, military recruits, residents of long-term care facilities, those with prior MRSA exposure, and intravenous drug users. Five days of treatment is sufficient with extension if symptoms are not improved. Addressing predisposing factors can minimize risk of recurrence. CONCLUSIONS AND RELEVANCE The diagnosis of cellulitis is based primarily on history and Author Affiliations: Harvard Medical physical examination. Treatment of uncomplicated cellulitis should be directed against School, Massachusetts General Streptococcus and methicillin-sensitive S aureus. Failure to improve with appropriate first-line Hospital, Boston. antibiotics should prompt consideration for resistant organisms, secondary conditions that Corresponding Author: Daniela mimic cellulitis, or underlying complicating conditions such as immunosuppression, chronic Kroshinsky, MD, MPH, liver disease, or chronic kidney disease.
    [Show full text]
  • Bacterial Skin and Soft Tissue Infections
    VOLUME 39 : NUMBER 5 : OCTOBER 2016 ARTICLE Bacterial skin and soft tissue infections Vichitra Sukumaran SUMMARY Advanced trainee1 Sanjaya Senanayake Bacterial skin infections are common presentations to both general practice and the Senior specialist1 emergency department. Associate professor of 2 The optimal treatment for purulent infections such as boils and carbuncles is incision and medicine drainage. Antibiotic therapy is not usually required. 1 Infectious Diseases Most uncomplicated bacterial skin infections that require antibiotics need 5–10 days of treatment. Canberra Hospital 2 Australian National There is a high prevalence of purulent skin infections caused by community-acquired University Medical School (non‑multiresistant) methicillin-resistant Staphylococcus aureus. It is therefore important to Canberra provide adequate antimicrobial coverage for these infections in empiric antibiotic regimens. Keywords antibiotics, cellulitis, Introduction Cellulitis and erysipelas impetigo, soft tissue It is important to have a good understanding of Both cellulitis and erysipelas manifest as spreading infection the common clinical manifestations and pathogens areas of skin erythema and warmth. Localised involved in bacterial skin infections to be able to infections are often accompanied by lymphangitis and Aust Prescr 2016;39:159–63 manage them appropriately. The type of skin infection lymphadenopathy. Not infrequently, groin pain and http://dx.doi.org/10.18773/ depends on the depth and the skin compartment tenderness due to inguinal lymphadenitis will precede austprescr.2016.058 involved. The classification and management of these the cellulitis. Some patients can be quite unwell with infections are outlined in Table 1. fevers and features of systemic toxicity. Bacteraemia, although uncommon (less than 5%), still occurs. Impetigo Erysipelas involves the upper dermis and superficial Impetigo is a superficial bacterial infection that can lymphatics.
    [Show full text]
  • Cellulitis: Current Insights Into Pathophysiology and Clinical Management
    The Netherlands Journal of Medicine REVIEW Cellulitis: current insights into pathophysiology and clinical management D.R. Cranendonk1,2*, A.P.M. Lavrijsen3, J.M. Prins1, W.J. Wiersinga1,2 1Department of Medicine, Academic Medical Center, Amsterdam, the Netherlands, 2Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center, Amsterdam, the Netherlands, 3Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands, *corresponding author: email: [email protected] A B S T R A C T frequent infections requiring hospitalisation.1 The historical distinction between cellulitis and erysipelas, Cellulitis is a bacterial skin and soft tissue infection which based on different bacterial aetiologies and thus treatment occurs when the physical skin barrier, the immune system options, is becoming obsolete as increasing evidence and/or the circulatory system are impaired. Diabetes, suggests a large overlap between these two entities obesity and old age are associated with defects in all of (textbox 1). In the Netherlands, the annual incidence is these areas and as a result are major predisposing factors estimated to be 22 per 1000 inhabitants. Approximately for cellulitis. In this review, we summarise current insights 7% of all patients with cellulitis are hospitalised.5,6 The into the pathophysiology of cellulitis and place the Dutch mortality rate of hospitalised patients has been reported guidelines on the clinical management of cellulitis of to be around 2.5%.7 Recent epidemiology data on cellulitis the lower extremities in perspective. Recent evidence in the Netherlands are lacking, but given the rise in the on diagnostic strategies is discussed, the importance of incidence of important risk factors (namely diabetes, which is underscored by findings that venous insufficiency, obesity and old age), an increase in the incidence of eczema, deep vein thrombosis and gout are frequently cellulitis is expected.8-10 Dutch guidelines on the clinical mistaken for cellulitis.
    [Show full text]
  • Common Conditions
    Common Conditions Alopecia • Alopecia (hair loss) can occur when hair fails to grow • Pyoderma (a bacterial skin infection in which at a normal rate or when hair is lost more quickly skin debris, bacteria, and inflammatory cells than it can grow back. clog and damage the hair follicle) • Alopecia can result from a variety of medical conditions, • Seborrhea (a skin condition in which excessive including skin infections, hormonal diseases, and flaking of skin cells causes clogging of the hair infestations with fleas or mites. follicle) • Many causes of alopecia are treatable. If the hair follicle • Glandular or hormonal diseases (such as has not been permanently damaged or destroyed, the thyroid disease and adrenal gland disease, hair will grow back over time. in which the hair growth cycle is disrupted because of hormonal changes; secondary skin What Is Alopecia? infections or seborrhea can also occur) Alopecia is the medical term used to describe hair loss. Alopecia can occur when hair fails to grow at a Alopecia can result when a pet damages its skin or normal rate, or when hair is lost more quickly than pulls out its hair. Fleas, for example, can cause itchy it can grow back. Alopecia should not be confused pets to pull out their hair and create bald patches. with increased shedding. Shedding (even year-round Pets that are allergic to fleas experience even more shedding in some pets) is a normal process and is intense itching and can remove their hair, create not an illness. Shedding should only be a cause wounds on their skin, and develop secondary bacterial for concern if it is heavy enough to create areas of infections from repetitive scratching and biting.
    [Show full text]
  • Shingles (Herpes Zoster) Brown Health Services Patient Education Series
    Shingles (Herpes Zoster) Brown Health Services Patient Education Series What is shingles? What are the symptoms? Shingles, also known as herpes zoster, is a painful Before a rash presents, many people first rash caused by the varicella zoster virus. This is the experience: same virus that causes chickenpox, also known as ● burning, sharp pain, tingling, or numbness varicella. Shingles is a reactivation of the virus, so sensation to one side of the body or face you can get it if you had the chickenpox, or received ○ back and/or abdomen are most the chickenpox vaccine, as a child. The classic common shingles rash consists of painful, blister-like lesions ● severe itching or aching rather than pain appearing in a band or stripe pattern across one ● fatigue, fever, chills, headache, and upset side of the body. In fact, the name “shingles” comes stomach from the Latin word for belt or girdle. After a few days of the burning, pain, and/or How often does it occur? tingling, a rash will likely begin to develop. After you recover from chickenpox or receive the A typical progression of the rash: chickenpox vaccine, the varicella zoster virus remains inactive and dormant in the body. The virus ● starts out as groups of red bumps that turn is usually dormant in the roots of the nerve cells. into small, clear, fluid-filled blisters on Shingles is the result of the varicella zoster virus reddened skin reactivating years later. ● blisters can look similar to chickenpox ● over the next several days, the blisters tend It is unclear what causes the reactivation of the to drain and (within 7-10 days) then crust virus, though a weakened immune system is a over before eventually beginning to common culprit.
    [Show full text]
  • WOODS, STEPHANIE J, MFA Weaving Weave
    WOODS, STEPHANIE J, M.F.A. Weaving Weave (2015) Directed by Mariam Aziza Stephan 29 pp. As an artist I frequently disclose memories shared with my mother, aunts and friends to explore the identities of African American women; specifically their relationship to their hair and skin complexion post slavery. My videos, sculptures, and photography explore multilayered issues, such as-what are ways African American women use hair manipulation as a mask to hide their true identities? And, what are the effects of colorism in present day society? WEAVING WEAVE by Stephanie J. Woods A Thesis Submitted to the Faculty of The Graduate School at The University of North Carolina at Greensboro in Partial Fulfillment of the Requirements for the Degree Master of Fine Arts Greensboro 2015 Approved by ________________ Committee Chair APPROVAL PAGE This thesis has been approved by the following committee of the Faculty of The Graduate School at the University of North Carolina at Greensboro. Committee Chair _____________________________________ Mariam Aziza Stephan Committee Members _____________________________________ Nikki Blair _____________________________________ Elizabeth Perrill _____________________________________ Amy Purcell ___________________________ Date of Acceptance by Committee _________________________ Date of Final Oral Examination ii ACKNOWLEDGEMENTS I would like to acknowledge Sharon Blassingame and Johannes Barfield for their artist support, and assistance throughout graduate school. iii TABLE OF CONTENTS Page WEAVING WEAVE………………………….…..………………………………………1
    [Show full text]