By Paul K. Buxton
(BMJ Books) Royal Infirmary, united kingdom. bargains a concise assessment of all the necessities of dermatology, written for non-dermatologists and first care physicians. Discusses numerous universal stipulations resembling psoriasis, eczema, pimples and rosacea, bacterial an infection, viral an infection, tropical dermatology, and extra. considerable colour photographs. past variation: c1998. Softcover.
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Antimalarial drugs, such as hydroxychloroquine, are more effective in the subacute type. In discoid lupus erythematosus there are well defined lesions with a combination of atrophy and hyperkeratosis of the hair follicles giving a “nutmeg grater” appearance. They occur predominantly on the cheeks, nose, and forehead. It is about three times as common in women as men, which is a lower ratio than in the systemic variety. There is a tendency for the skin lesions to gradually progress and to flare up on sun exposure.
Camphor-containing preparations and crotamiton (Eurax) are also helpful. Topical steroid ointments and occlusive dressings may help to prevent scratching and may help to break the itch–scratch–itch cycle. Emollients should be used for dry skin. Topical local anaesthetics may give relief but intolerance develops and they can cause allergic reactions. Sedative antihistamines at night may be helpful. In liver failure cholestyramine powder may help to relieve the intense pruritus, as this is thought to be due to bile salts in the skin.
Chronic irritant dermatitis can be harder to assess as it develops insidiously in many cases. Often it starts with episodes of transient inflammation that clear up, but with each successive episode the damage becomes worse with an escalation of inflammatory changes that eventually become chronic and fixed. Once chronic damage has occurred the skin is vulnerable to any further irritation, so the condition may flare up in the future even after removal of the causative factors. Individuals with atopic eczema are particularly liable to develop chronic irritant dermatitis and secondary infection is an additional factor.
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