Darier Disease

Darier disease is a stubborn rash which usually runs in families. The rash often starts when one is a teenager or older. It most commonly affects the chest, neck, back, ears, forehead, and groin, but may involve other body areas. At times the rash will cause a bad odor. This disease can also cause the fingernails to be fragile at the tips causing V-shaped notches at the end of the nails as pictured below.

The cause is thought to be due to a defective gene. The gene that causes Darier disease is often inherited from one's parents.
Darier disease is not contagious; that is, it does not spread from person to person.
The rash is often worse in the summer, due to the heat and humidity, and is aggravated by sunlight.

Cleansing the skin with a mild antibacterial soap such as Lever 2000 sometimes helps control the odor.
The doctor may give you a prescription for a gel or lotion to use on your skin.
There is no medical cure for Darier disease. A strong drug called Accutane sometimes helps this condition. Your doctor will discuss the possible use of this medication with you.
Vaseline Intensive Care Dry Skin Lotion with Vitamins A and E applied to the rash twice a day can often clear the lesions in 2-3 weeks.

Seborrheic Keratosis

Seborrheic keratoses are harmless, common skin growths that first appear during adult life. As time goes by, more growths appear. Seborrheic keratoses appear on both covered and uncovered parts of the body. These growths are sometimes referred to as barnacles of aging.

The tendency to develop seborrheic keratoses is inherited.
Seborrheic keratoses are harmless and almost never become malignant.
Seborrheic keratoses begin as slightly raised, light brown spots. Gradually they thicken and take on a rough, wartlike surface. They slowly darken and may turn black. These color changes are harmless.
Seborrheic keratoses are superficial and look as if they were stuck on the skin.

There is no need to treat seborrheic keratoses. The only reason to treat them is because they are ugly or getting caught on your clothing.
Seborrheic keratoses can be frozen with liquid nitrogen, cut, or burned off with an electric needle. Your doctor will suggest the method that he thinks will best remove your lesion.

Dennie Morgan Fold: Atopic Eczema Pleat

Some people with atopic dermatitis develop an extra fold of skin under their eyes, called an atopic pleat or Dennie-Morgan fold. Other people may have hyperpigmented eyelids, meaning that the skin on their eyelids darkens from inflammation or hay fever (allergic shiners). Patchy eyebrows and eyelashes may also result from scratching or rubbing.

FACIAL ECZEMA

Eczema of the face can be particularly distressing because it is exposed for all to see.
Therefore, apart from troublesome itching, sufferers must also cope with the appearance.
This can affect confidence and interfere significantly with daily life, especially if the
problem is long-standing.
Eczema of the face may have a similar appearance to eczema involving other areas of the
body, with redness, dryness and sometimes cracking, weeping and scabbing. There are
several different types of eczema that may affect the face. It may be part of a more
generalised condition, or localised just to the face.

Types of Facial Eczema: Allergic Contact Eczema

The face is a common site for allergic contact dermatitis. In allergic contact dermatitis the
immune system reacts to a specific chemical in the environment, producing a specific
allergic reaction. This usually occurs in people who have been exposed to the chemical
substance before and become ‘sensitised’ to it. Unlike irritant contact dermatitis, a
reaction may then occur following subsequent exposure to small amounts of the chemical,
causing allergic contact dermatitis.

Allergic contact dermatitis of the face can be caused by obvious direct contact with a
sensitising chemical such as a cosmetic, by contact with airborne substances such as
perfumed sprays and plant products, or by transfer of a sensitising chemical to the face by
the hands (e.g. nail varnish). Certain sensitising chemicals may affect characteristic areas
of the face, but the eczema may often be indistinguishable in appearance from atopic
eczema. Cosmetics are the usual culprits in allergic contact dermatitis affecting the face.
They contain fragrances, wool alcohols (lanolins), preservatives and dyes that can all
cause sensitisation. Allergy to ingredients of hair dyes may also cause severe allergic
contact dermatitis of the face. Nickel allergy is very common, affecting about 5% of
women. It usually causes earlobe dermatitis in allergic people who have been sensitised
(by ear piercing) and who then wear non-gold or silver jewellery. Less commonly, nickel
allergy may cause reactions to metal spectacle frames.

If allergic contact dermatitis is suspected patch tests may need to be carried out by the
dermatologist. Small quantities of potentially sensitising chemicals that are thought to be
relevant are applied to patches of normal skin on the back and held in place by adhesive
tape. This is removed after two days to look for an allergic reaction. The back is usually
examined again after a further two days to detect any delayed reaction. More details on
patch testing are available in a National Eczema Society fact sheet ‘Patch Testing’. If a
relevant sensitising chemical is identified, this should be rigorously avoided. In the case of
allergy to sensitising chemicals found in cosmetics, it is often necessary to obtain a list of
safe cosmetics from manufacturers. Your Pharmacist should also be able to help you
check the ingredients of a particular product. If in doubt, apply a small quantity of your
chosen cosmetic repeatedly to a small area on your forearm - significant allergy should
cause a localised itching rash.

Types of Facial Eczema: Irritant Contact Eczema

The skin can be irritated non-specifically by substances such as soaps and detergents,
causing irritant contact dermatitis. This will happen to anyone if the irritant is harsh
enough or exposure happens often enough and in large amounts. Irritant contact
dermatitis tends to affect other areas, particularly the hands, although eczema around the
lips, due to a persistent habit of lip-licking usually in children, may be considered as a form
of irritant contact dermatitis.

Types of Facial Eczema: Seborrheic Eczema

Seborrheic Eczema is another common cause of facial eczema and may affect adults and children. In the adult form the creases at the sides of the nose, the inner eyebrows and scalp are the main areas involved. The eyelids may also be affected (blepharitis). Other areas of the body
including the chest, armpits and back (between the shoulder blades) are sometimes
involved. Usually the affected skin is red with yellowish flakes, and there may be dandruff
of the scalp. It is thought that seborrhoeic eczema is a result of allergy towards a yeast
that occurs normally on the skin, especially in the more greasy (‘seborrhoeic’) areas such
as the face and scalp. The condition tends to be very persistent, being controlled with
treatment but occurring again when treatment is stopped.

Types of Facial Eczema: Atopic Eczema

Atopic Eczema is the most common cause of facial eczema, both in adults and children. It usually
begins in childhood, most often in the first year of life between two and six months, but as
with atopic eczema affecting other parts of the body, it may continue for many years into
adulthood. The cheeks and forehead are frequently involved first, but the whole face may
be affected along with other areas of the body. Itching, dryness and redness are the main
symptoms, but burning and stinging can also occur. Scratching may cause thickening of
the skin and it may darken in colour particularly in dark-skinned individuals. In the
thickened skin the normal markings often become more visible, leading to an appearance
termed ‘lichenification’. The eyelids may be involved (blepharitis) with thickening of the
lower eyelids being a particularly persistent problem. As with all forms of atopic eczema,
the exact cause isn’t clearly understood. Both inbuilt genetic factors and the influence of
the environment are important.

Eczema in the Eyes

Atopic keratoconjunctivitis although rare is the most severe manifestation of allergic eye disease occurring predominantly in adult males. It is the eye equivalent of severe eczema. This persistent condition results in constant itching, dry eyes, blurred vision and is associated with corneal swelling and scarring. Eyelid eczema and infection are common and lens cataracts may develop over time.

What is Eczema Herpeticum?

Eczema herpeticum represents widespread cutaneous HSV in patients with pre-existing skin disorders. Eczema herpeticum is also known as Kaposi's Varicelliform Eruption. Atopic Dermatitis is by far the most common underlying skin condition. Other skin conditions that predispose patients to this primary HSV infection include:

Darier's Disease
Pemphigus foliaceous
Icthyosis vulgaris

The patient often presents with clusters of umbilicated vesicles appearing on abnormal or even apparently normal skin. The eruption then spreads over the following 7 to 10 days, and the umbilicated vesicles evolve into classic discrete "punched-out" small erosions. Typically, the patient experiences fever, malaise, and generalized lymphadenopathy. The vesicles may break down and coalesce into large erosions that have a tendency to be complicated by secondary infection. The course of this condition is usually 2 to 6 weeks. Recurrent episodes may occur, but the clinical presentation is typically milder.

The differential diagnosis may include widespread impetigo (and, indeed, some cases may become secondarily impetiginized). Kaposi's varicelliform eruption secondary to vaccinia virus is far less likely.

The diagnosis is made by history and the clinical presentation. Tzanck preparation is a useful confirmatory test, and viral culture may be helpful in more subtle cases.

Therapy of eczema herpeticum is with oral acyclovir 200 mg 5 times daily. Burow's soaks 2 or 3 times daily may be useful for vesicular areas. Early and aggressive therapy of secondary infection is necessary, typically with oral antibiotics offering staphylococcal and streptococcal coverage. Inpatient management with intravenous acyclovir or antibiotic coverage may be required, especially in infants with high fever, poor oral intake, and evidence of secondary infection.

For to view pictures of Eczema herepticum, visit:
http://www.bu.edu/cme/modules/2002/herpes02/content/4-phsi-e.htm

An Overview of The Many Causes of Eczema

Many things cause eczema. The commonest is a general allergic over sensitivity (atopy). This sort of eczema is known as atopic eczema, and it is linked with asthma and hayfever. That is, these conditions often run together in a family.
The other possible causes include:
Infantile eczema which often affects young babies. This may lead to a patch below their chins, which gets wettest from dribbling, and may be associated with cradle cap.
Contact with substances which irritate the skin chemically. This is caused by direct contact between the skin and the substance, which might be such things as detergents, soaps, diesel or engine oils, strong chemicals, cleaners etc.
Contact with substances which the body has become allergic to. Commonly this involves nickel, rubbers etc. If a woman was sensitive to nickel in the past it would cause a reaction where the bra hooks and suspenders came near her skin, as these typically contained nickel. Plastics have helped to overcome this risk, but jewellery and watches are still a common cause. Suddenly people need to spend a bit more on their presents to you!
Varicose veins can lead to a form of eczema affecting the lower legs. This is known as varicose or gravitational eczema. As well as treatment of the skin, it is important to improve the blood circulation in the legs, and for most people this includes wearing support stockings and staying active on your feet. Your doctor will discuss the options.