When your skin lesion tells more than a simple skin disease

Almost everyone cares about their skin. We spend average 2000$ per year on skin care and personal hygiene products. But not many of us seem to worry about what diseases are hidden behind an underlying skin problem. There is an infinite number of diseases that can have skin manifestations.

tsc lesions

Have you seen these before? They are called “shagreen patches”, “Ash-leaf spots” and “sebaceous adenoma”, respectively (pictures 1,2 and 3); often seen is tuberous sclerosis (TSC). This is a genetic disorder resulting in a variety of lesions that may affect virtually every organ system of the body. Most physicians are only dimly, if at all, aware of TSC. The sebaceous adenoma is often confused with acne.  Cardiac involvement is maximal in prenatal life or infancy. TSC can also present with Seizures, autism, and developmental delays and learning difficulties in infancy or childhood. Many will have been told that they had febrile convulsions or an age-related epilepsy syndrome. Hypertension and renal failure in the case of polycystic kidney disease, in infancy or early childhood may also present. Dental involvement may include sealed or bonded teeth, multiple randomly distributed pits in dental enamel or a gingival fibroma.

 

Clubbing

clubbing

Clubbing represents a localized drumstick-like swelling of the fingers and toes, it is seen in persons with cyanotic congenital heart diseases (eg, tetralogy of Fallot, Eisenmenger syndrome). It is also seen in persons with infective endocarditis. The acquired causes include pulmonary conditions such as lung cancer, lung abscess, cystic fibrosis etc., or gastrointestinal diseases. If your nails are like this, you should definitely see a doctor.

 

 

 

xanthelasma

This yellowish deposit of fat underneath the skin, usually on or around the eyelids are called xanthelasma. It may indicate high blood levels of cholesterol or high risk for atherosclerosis. Atherosclerosis is the hardening and narrowing of the arteries  and the is the leading cause of heart attacks, strokes, and peripheral vascular disease, what together are called “cardiovascular disease.”

In conclusion, you should take care of your skin, but don’t do it alone. Skin lesions or features that might be insignificant for you might not be really so. Consult a physician.

Could it be Borderline Personality Disorder?

Fear of abandonment, unstable or changing relationships, self-image issues or lack of self-esteem, anxiety disorders…. Do you suffer from Borderline Personality disorder (BPD)? Learn more about this often undiagnosed but serious mental disorder.

 

What is BPD and how serious is it?

 

Borderline personality disorder (BPD) is a serious mental illness that causes unstable moods, behavior, and relationships. It usually begins during adolescence or early adulthood. This marked instability in functioning, affect, mood, interpersonal relationships, and, at times, reality testing is associated with major depression, psychoactive substance abuse, and psychotic disorders. In many instances, the comorbid disorder is diagnosed accurately, but the clinician misses the borderline diagnosis.

Women with BPD are more likely to have co-occurring disorders such as major depression, anxiety disorders including panic disorder, substance abuse or eating disorders. In men, BPD is more likely to accompany disorders such as substance abuse or antisocial personality disorder. Nearly 75% or more of those living with BPD also qualify for an anxiety disorder. 70-75% of patients with BPD have a history of at least one deliberate act of self-harm, and the mean estimated rate of completed suicides is 9%.

How is it diagnosed?

 

There are 9 criteria to diagnose BPD but in order to make the diagnosis, one doesn’t need to meet all of them. BPD is diagnosed on the basis of (1) a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and (2) marked impulsivity beginning by early adulthood and present in a variety of contexts, as followed:

  Criterion 1:  Frantic efforts to avoid real or imagined abandonment including panic, depression, rage, (this does not include suicidal or self-mutilating behavior mentioned in criterion 5). Examples of that are:

  1. I am going to live my life the way I want. People with BPD think rebellion help them escape from pain.
  2. I’m so freaked out by the idea of being alone or being left that I will do whatever it takes to stay in a relationship that is not working. Upon separation or fear of rejection, people with BPD react in desperate ways when it isn’t even warranted.
  3. When a person suffering from BPD feels loss of control over people’s relationship, they tend to divide people. It can even happen in a healthcare environment where they might for example lie about the nurses to the doctor so the nurses can fight one another. This is call splitting mechanism.

    Criterion 2: A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. In other words, intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love to extreme dislike or anger and are subject to change without notice or predicating event. People with BPD may also seem overly reliant or dependent upon friends, lovers, or family members.

    Criterion 3 : Markedly and persistently unstable self-image or sense of self,  which can result in sudden changes in feelings, opinions, values, or plans and goals for the future (such as school, career choices, religion etc.)

    Criterion 4: Impulsivity in at least two areas that are potentially self-damaging Impulsive or risky behavior often includes sex, substance abuse, binges (for example eating at inappropriate hours of the day, drinking excessively or simply eating too much), or charging a lot of money on credit cards. These behaviors are often considered to be dangerously impulsive and can put oneself or others at risk ; this does not include suicidal or self-mutilating behavior covered in criterion 5.

   Criterion 5:  Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. Self-injurious behavior includes suicide and suicide attempts. Self-harming behaviors linked with BPD include cutting, burning, hitting, head banging, hair pulling, and other harmful acts.

    Criterion 6: Affective instability due to a marked reactivity of mood. Examples are:

  1. Intense episodic dysphoria (profound state of unease or dissatisfaction)
  2. Irritability or anxiety usually lasting a few hours and only rarely more than a few days.

   Criterion 7:  Chronic feelings of emptiness and/or boredom

    Criterion 8: Inappropriate, intense anger or difficulty controlling anger. Example:

  1. Yelling at a friend for being late at a lunch date
  2. Frequent displays of temper, constant anger
  3. Recurrent physical fights
  4. Holding grudges

 Criterion 9:   Transient, stress-related paranoid ideation or severe dissociative symptoms such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality.

 

Treatment

 

BPD is often viewed as difficult to treat. However, recent research shows that BPD can be treated effectively, and that many people with this illness improve over time.

Dialectic behavior therapy (DBT) is the mainstay of treatment. Medication may be necessary for impulsivity, anxiety, affective instability and psychosis. Hospitalization may be necessary because of suicidal or other self-injurious behavior.

If you think you might meet the criterion for BPD, talk to a mental health professional.

When excessive hair is a problem

In many cases, excessive hair can be a serious problem. Sufferers often describe it as a “‘mental trauma”, “an emotional anguish”, “a serious cosmetic problem”, “a nightmare” and when women are affected, they even call it a “loss of feminity”. Truth is, while abundant scalp hair is viewed as a blessing or as being healthy, excessive body hair can be a serious concern. Read what underlying problem can be hidden behind excessive body hair, and how to get rid of it.

Hirsutism

Even though hirsutism is broadly defined as excessive hairiness, the term is most commonly used to talk about women with excess growth of terminal hair in a male pattern. In this case the hairiness implies the presence of abnormal hormonal action. Hirsutism can also occur in men. However, it is more difficult to recognize because of the wide variability of healthy male terminal hair growth. Dihydrotestosterone is the androgen that acts on the hair follicle to produce terminal hair. This hormone is derived from both the bloodstream and conversion of testosterone.

Many things can cause hirsutism, and the age of appearance can raise suspicions on a specific diagnosis. It can develop after weight gain and after a young woman stops using oral contraceptives. Most cases are due to polycystic ovary syndrome (PCOS); these women will likely have irregular menses. The outcomes of hirsutism depend on whether it is benign or malignant. But if in an older woman it worsens rapidly, it should raise the suspicion of an androgen-secreting tumor. It is also important to remember that none of the drugs used to treat hirsutism has FDA approval for such use.

Women with hirsutism are usually obese, and are thought to be at an increased risk for atherosclerosis, diabetes and coronary heart disease. If you believe you might have hirsutism, talk to your doctor to find out if it is true and to discuss the best therapeutic options for you.

Hypertrichosis

Hypertrichosis is excessive hair growth over and above the normal for the age, sex and race of an individual. The excess hair growth from hypertrichosis differs from hirsutism in which terminal hair is coarse, curly, and pigmented. By contrast, in hypertrichosis it is usually vellus hair, which is fine, soft and lightly pigmented. In the past, persons with congenital hypertrichosis have been so dramatized and romanticized that individuals with rare hypertrichosis syndromes became crowd-drawing money-making phenomena in many 19th century sideshow acts. They were referred to as dog-men, hair-men, human Skye terriers, ape-men, werewolves, and Homo sylvestris.

Hypertrichosis may be associated with metabolic disorders (eg, hyperthyroidism, anorexia nervosa, porphyria) and with some medications (eg, phenytoin, diazoxide, minoxidil, glucocorticoids, cyclosporine, hexachlorobenzene). Medication-induced hair changes are often reversible.

As mentioned in the introduction, excessive hair may cause cosmetic embarrassment, resulting in a significant emotional burden, particularly if extensive. Sometimes it is just a family tendency, and it doesn’t mean they have hirsutism or hypertrichosis. The currently available treatment methods include cosmetic procedures (bleaching, trimming, shaving, plucking, waxing, chemical depilatories, and electrosurgical epilation), and hair removal using light sources and lasers. Laser-assisted hair removal is the most efficient method of long-term hair removal currently available.

Learn more about laser and light-based hair removal

Light Based Hair Removal

Excessive body hair may cause cosmetic embarrassment, resulting in a significant emotional burden, particularly if extensive. Sometimes it is just a family tendency, and it doesn’t mean they have hirsutism or hypertrichosis. The currently available treatment methods include cosmetic procedures (bleaching, trimming, shaving, plucking, waxing, chemical depilatories, and electrosurgical epilation), and hair removal using light sources and lasers. Laser-assisted hair removal is the most efficient method of long-term hair removal currently available.

The process of laser and light-based hair removal is well known and established. It has been proven in clinical use around the world for over 15 years as a safe and effective way to achieve permanent results.

Light-based hair removal is based on the theory of selective photothermolysis in which optical energy is used to disable hair growth. In order to achieve such thermal effect, the hair shaft needs to selectively absorb light energy and transform it into heat. This selectivity is achieved when high optical energy that is delivered to the tissue is mostly absorbed by hair shaft pigment, while the epidermis and the surrounding tissue is actively cooled (by a cooling mechanism). Melanin is the pigment in the hair shaft that is responsible for the absorption of the light, which generates the heat that eventually disables hair growth. When hair growth is disabled, hair removal is achieved.

The time it takes to complete a full hair growth cycle varies from person to person and the location of the hair on the body, and for some individuals it may take 18-24 months. At any given moment the majority of the hair follicles in any skin area are in the resting stages. These resting hairs cannot be affected by laser or light hair removal treatment, however hairs in the growing Anagen phase will respond. It is therefore important to understand that it may take a full hair growth cycle to achieve complete results when doing any energy based hair removal.

Most people start to see noticeable results after four treatments, and great results after six treatments. Maintenance treatments are common after eight treatments to treat stray hairs that may have been in Telogen or Catagen phase or to treat patches of hairs that were missed in initial treatment.

By using an FDA cleared technology. SensEpil is an affordable hair removal device compared to professional clinics  or other at home lasers. It is ideal for individuals who want to say goodbye to unwanted hair, those who desire a treatment for sensitive areas (bikini line) or smaller, targeted zones, a silky smooth skin without ingrown hairs and razor burn. 

Thumb sucking habit: How to make your child stop?

Thumb sucking is a repetitive habit behavior and when it causes impairment, it can be stereotypic movement disorder. Till age 3-4 sucking a thumb or another digit is mostly benign and normal. Many children find it appeasing and comforting. After this age, it is important to make them stop before the social and health problems show up. If continued beyond age 4-5 years, thumb and digit sucking may cause dental problems, deformities of the fingers and thumbs, increased risk of accidental ingestions, pica (persistent eating of substances with no nutrition, such as dirt or paint), thumb callus, skin breakdown, paronychia (a bacterial or fungal infection of the hand or foot where the nail and skin meet), dental malocclusion and social stigmatization.

Identify the causes

The underlying social problems of a thumb sucker can be many: obsessive compulsive disorder, neglect, anxiety, abuse etc. Most children who suck their thumb do it at some precise moments such as, after being disciplined, when they are sleepy, or when they feel rejected. Knowing what triggers the thumb sucking help you act as a team to avoid it.

Relocation, separation, school changes, and any other stressful moment can cause anxiety in children and can make them want to find comfort in the digit sucking.

Hide the digit or find a substitute

If the desire to have something in their mouth is really strong even after you have tried to talk to them not to, some children stop after the digit is replaced or hidden. Gloves or a Band-Aid of their favorite character are useful options. You can also try replacing it by a pacifier, a Mr. Freeze ice pop or just by giving them some water. It is important that the pop be homemade; colorful fruits give them a better look and make them more attractive. Try not to replace the digit by a candy as the excess of sugar can itself provoke dangerous health issues to your child. If your child often sucks the thumb when he needs comfort in bed, you can buy him a teddy bear.

Engaging in two hands activities and rewards

Jump rope, modeling compound, video games, soap bubbles and crafts require the use of both hands. While your child will participate, he cannot really book a hand to put in his mouth. You can procure yourself a calendar and stickers to mark the days in which he doesn’t suck a digit, you can congratulate and reward him when he succeeds. Remember that if they don’t, you should avoid blaming them, as the blame can be a trigger.

Appeal the feelings

For some parents, the bitter products to be applied twice daily to the nails do wonders. These products, found in pharmacies, give a funny taste to the thumb and is often enough to deter the child to taste it again. However, be sure to use recommended products and NOT products of the house as Tabasco, Aloe Vera plant and vinegar. Other parents draw a sad face on the thumb and let the child know that the thumb is sad whenever he puts it in his mouth. Tell them Mr. Thumb (or Mr. ‘the digit he sucks’) would rather be beside them while they are sleeping.

Know the red flags

Sometimes the thumb sucking is accompanied by other repetitive behaviors, such as body rocking (the act of rocking back and forth) head-rolling or head-banging, nail biting and trichotillomania.  Body rocking is usually seen just before sleeping or after waking. Head banging often occurs during teething, ear infections, and temper tantrums. It may cause abrasions and callus formation and rarely, lead to fractures or more serious injury.

Trichotillomania is the repeated plucking of scalp or body hair, leading to clinically significant hair loss. Most sufferers have no other comorbidities, but the condition is related to body dysmorphic disorders, personality disorders, and eating disorders.

These behaviors are a sign that consultation with a developmental-behavioral pediatrician, a child psychologist, or a child psychiatrist is indicated.

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Dear patient with Diabetes Mellitus- Advice from a nurse to you

Diabetes is a common disease that affect the majority of people living in the world. According to research in 2014, an estimated of 387 million people have diabetes worldwide. There are two types of diabetes: DM1(when the pancreas fails to produce enough insulin, those people usually requires insulin to manage blood sugars), DM2(when the cells of the body fail to produce insulin or resist it, this type can be managed by a good lifestyle). During pregnancy, a woman can also develop gestational diabetes. Managing diabetes means a change in lifestyle.

Here are five tips for people affected by this disease:

  • Educate yourself about the disease process. Know the complications associated with the disease. Know the signs and symptoms of hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar). Because a low blood sugar can be more dangerous, know the signs and symptoms associated with it, know how to check blood sugar, and what to do if it occurs. Also learn about the different insulin types and how to self-administer if you have been prescribed insulin for your treatment.

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  • Eat healthy. A well balanced meal is a great way to manage your diabetes. It is not about the quantity; it is more about a well portioned with the different food categories. Limit fats because it is full of calories, but use mono and polyunsaturated sources like vegetable, nuts, seeds oil.

Diet for Diabetics

  • Be active. Regular physical activities are very important in managing diabetes; it helps lower blood sugar. When you move your muscles either by running, walking, or swimming, you burn the calories and use insulin.
  • Lose the extra. Being overweight can cause insulin resistance. If you are overweight, losing weight can be a good way to help prevent and manage diabetes.

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  • Be aware. Diabetes can lead to many complications. One way to prevent the progression of this disease and to manage it well is to be aware of what our body is telling us. Pay attention to every inch of your body and take precautions to avoid any kind of infection. Keep every crease clean and dry.

Diabetes is a lifelong disease. Don’t let it control, be the boss and take control of your health. By doing so, you will live a happy, healthy, and long life.