Thrush is a fungal infection occurring in the mouth. It is also called as yeast thrush. It leads to the formation of white patches on the inner side of the cheeks. It is caused by a fungus called candida albicans. It can be the primary source of infection and lead to diaper rashes in babies and vaginal infections in females.

Thrush is seen most commonly in toddlers, newborn infants and individuals with a weakened immune system.

Causes of Thrush

The abnormal and excessive growth of candida albicans is responsible for causing thrush. In normal conditions there is some amount of fungus present on the skin and within the gastrointestinal tract. The good organisms within the body keep a check on all such bacteria and fungi. But at the time of an illness or stress, this balance is disrupted and excessive proliferation of the fungus occurs resulting in clinical infection called thrush.

Any condition that makes the immune system weak can also invite fungal infections. These include cancer treatments like chemotherapy and radiotherapy, HIV/AIDS, leukemia etc.

Diabetics who tend to have a higher amount of glucose in their blood are also more susceptible to getting fungal infections because the fungus proliferates in the presence of sugar.

Thrush pregnancy: If a pregnant lady has yeast infections then the infection can pass to the baby via the vaginal fluids at the time of delivery. This is the commonest cause of the infection in newborn babies. It makes feeding difficult and painful.

Risk Factors For Getting Thrush

Small babies and toddlers are the most prone to getting thrush. People who have a weakened immune system may get the fungal infection more easily as compared to others. Here are some risk factors that make you susceptible to the fungal infection

• HIV/AIDS
• Cancer treatment like chemotherapy and radiotherapy
• Use of dentures
• Cigarette smoking
• Organ transplant patients who are on immuno-suppressive drugs
• Antibiotics and cortico-steroids

Symptoms of Thrush

1. In Adults: In the early few days there may be no symptoms, but within a week the patches will increase in size and give rise to discomfort. The signs and symptoms of thrush are:
   • Whitish raised patches on the tongue,cheeks and palate
   • Bleeding is the patch is scrapped
   • Pain
   • Difficulty in eating and swallowing
   • Dryness and cracks on the corners of mouth
2. In Infants: The oral thrush in infants leads to difficulty in breast feeding and so the child tends to refuse feeds. Irritability and crying are the symptoms seen in newborns.
3. In Mothers: The yeast infection tends to pass from the mouth of the baby to the mother through the nipples during breast feeding. So the breast may get infected and the mother may have sharp severe pain in the breast during feeding, increased sensitivity of the nipples. The skin around the nipples also gets affected.The infection in the mother can pass on to the baby and vice versa so in all such cases, both the mother and the baby need to treated with anti fungal medication simultaneously to completely eradicate the fungus.

Diagnosis of Thrush

The diagnosis is done on the basis of symptoms of the patient and clinical examination. The mouth and the tongue will have white patches on them that are irregular in shape. Eating food may be difficult and painful especially in smaller kids and toddlers. If the infection is severe, a swab may be taken from the oral thrush patch and sent to the laboratory for analysis and detection of candida albicans.

If the infection spreads to the throat, then the confirmation of the diagnosis can be done by a throat swab or an endoscopy. An endoscope is a flexible instrument with a camera attached to its tip and it gives the image of the mucosa of the throat and esophagus to pinpoint the exact pathology.

Treatment of Thrush

The treatment for thrush is divided into two parts- home based and medical. The medical treatment includes-

Oral thrush medications include anti-fungal medicines like fluconazole and clotrimazole. Nystatin is a mouth wash that is specifically used fort fungal infections. You are supposed to hold the liquid in your mouth and then throw it away. In patients with HIV/AIDS, antifungal medicine called itraconazole is used.

At home you can try the following measures to relive the discomfort caused by the thrush.

• Using mouthwash oral thrush or mouth sprays can aggravate the lesions.
• Use a new tooth brush with soft bristles so that the mucosa does not get injured.
• Change your toothbrush once the infection is cured.
• Use a medicated gargle or salt water to rinse the mouth.
• Keep a check on the diabetes as fungi tend to proliferate in excess sugar environments.
• Have lots of yogurt without sugar to increase the number of good bacteria in the body.

For newborns, thrush treatment is slightly different. The mother and the child have to be treated simultaneously. The baby has to be given an antifungal medicine and the mother has to apply an anti-fungal cream on the nipples. The mother should use nursing pads to avoid the fungus from spreading to the other parts of the body from the nipple. All instruments like breast pumps, pacifiers for the baby etc must be properly sterilized to prevent spreading of the infection.

The treatment for oral thrush may take a few weeks as fungal infections are stubborn and take time to go away. In many cases it may resolve and crop up again. So a good immune system and proper medication is essential to completely eradicate the infection.

Complications of Thrush

The complications of thrush are not very severe in normal persons. But if the immune system is weakened, the infection may flare up greatly and the fungus may enter the blood stream and cause infections in other parts of the body.

Thrush in newborns can cause more trouble. The fungus tends to give rise to a diaper rash in most of the cases. So when a child has a severe diaper rash, the doctor will always look for a fungal infection in the mouth.

Prevention of Thrush

The best way to prevent fungal infections is by maintaining good oral hygiene and keeping your immunity at the highest by following a healthy life style.

Pregnant ladies should take extra care to treat any fungal infections promptly so that it does not get passed on to the baby.

The use of yogurt which has a lot of good bacteria and other probiotic properties should be done daily in your diet. It is the best treatment for thrush.

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The presence of rashes in the diaper area of the baby that is around the genitals and buttocks are called as diaper rashes. These are generally reddish in color and can range from simple red prickly heat spots to a wide spread patch. The affected area is generally warm to touch and leads to irritation and crying when you change the diaper or clean the area. These rashes are very common in the first year of the baby’s life.

Common Causes of Diaper Rashes

1. Wetness of the diaper: The commonest reason why a baby rash diaper occurs is that the skin is exposed for longer hours to the wetness of a soiled diaper. If you do not change the diaper for a long time, the wet environment within the diaper irritates the skin and causes the rash. Even the most absorbent diaper can lead to a rash.
2. Diarrhea: Frequent bowel movements or diarrhea can also lead to diaper rashes especially if the child is left in the soiled diaper for a long time.
3. Chemicals: The chemicals and fragrances in the diapers and wet wipes that are used to clean the baby are often responsible for causing the rashes as the baby’s skin is very sensitive. If you are using a cloth diaper, then the detergents used to wash the cloth could be too strong and irritate the skin of the baby.
4. Weaning: When you start your baby on solid foods, the ph and consistency of the stool changes and this is the commonest cause of diaper rashes in babies above six months of age. A new food ingredient also may cause diarrhea in the baby. If you have taken some food that has caused an allergy, the baby can get a rash if he is breast feeding.
5. Bacterial and yeast infections: The diaper area tends to remain moist most of the time and so the yeast thrive and flourish there and cause a rash. This happens commonly in the cracks and folds of the skin. Thrush is an oral yeast infection. Many times if the baby has an oral infection, he may also have an associated diaper rash. This confirms the aetiology to be fungal in origin (yeast infection).
6. Antibiotics: If the baby is on antibiotics or if the mother is taking antibiotics and the baby is breastfeeding, yeast infections come up because the antibiotics kill the healthy flora that keep the yeast in check. Antibiotics can also cause diarrhea which again contribute to nappy rash.

Severe Diaper Rash

What causes bad diaper rash? Most of the cases of diaper rashes are mild to moderate but if they are neglected, then they can get severe and you should seek immediate medical help in such cases. The following are some of the warning symptoms:

• Rash along with blisters
• Pus filled eruptions
• Oozing patches with yellow spots
• Open diaper rash sores
• Fever indicating an infection

Treatment of Diaper Rash

1. The best way to treat a rash is to keep the child open and free from a diaper for a few days or if the rash is mild, then you can put the diaper but change it frequently before it gets fully wet.
2. During each diaper change, clean the area with warm soapy water and dry the area completely. Apply a nappy rash cream or powder and then put on the fresh diaper. If you do not dry the area properly, the moisture can get trapped inside the diaper and aggravate the rash.
3. Never rub the rash dry with a cloth, instead pat it dry and the best method is to let it air dry completely.
4. Use a good quality diaper rash cream. The cream will act as a barrier and prevent worsening of the rash when it comes in contact with the urine and stool. Apply a thick layer of the cream so that it lasts for a few diaper changes. OTC diaper rash creams are barrier creams and the best ones are those containing zinc oxide or petroleum jelly.
5. Try changing the diaper brand if you suspect that to be the cause of the rash or switch to cloth diapers. You must ensure that the new diapers that you buy should be one size bigger so as to allow the skin to breathe and heal faster.
6. If the climate is hot and humid, avoid the diaper as much as possible and leave the baby in cloth pants. Apply the cream and use cotton nappies or underwear. This will help the rash to heal very fast. Use a plastic sheet to prevent the sheets from getting soiled.
7. If the rash is caused due to diarrhea, then treating the bowel disturbance is best remedy for diaper rash caused by diarrhea.

How to Help a Diaper Rash?

The best way to prevent a rash is to change the diapers frequently. Do not allow the baby to remain in a soiled diaper, change it as soon as possible. Avoid using scented baby products as they can irritate the sensitive skin. Do not wear the diapers very tightly and get a bigger size before they become uncomfortable and tight. All these above tips will help you to prevent unnecessary rashes in your baby.

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Your little baby will wake up each day with a small new change. One fine day you may wake up and see little red bumps on baby face, particularly his cheeks. This baby rash is commonly called baby acne and they are commonly seen on the cheeks. There is no fixed known cause behind this acne breakout. Baby acne should be differentiated from milia. Milia are small white spots seen on the face immediately after birth. Milia are not related to the acne and both these conditions tend to resolve on their own.

Characteristics of the Eruptions

Baby face pimples or acne are little red bumps seen on the face, mostly the checks. They can occur on the back due to an allergy to the detergents in the clothes or itchy clothing. The bumps can be present from birth and they go away on their own after two to four weeks. If the eruptions linger on for more than three weeks, then you should consult your doctor. The location of the eruptions decides the diagnosis. If multiple such eruptions are seen on the scalp and are associated with itching and scaling then it is most likely to be skin problems called cradle cap which is very common in small babies. You can find infantile acne pictures on the web and see how the eruptions look.

Causes of Baby Acne

The exact causes of acne are not known but as in case of adolescent acne, the baby acne also have some relation to the maternal hormones. The surge in the hormones of the mother at the end of the pregnancy, are the most likely cause of newborn rash. At times, certain medications that the mother takes are also responsible for causing the acne. If you feel that any baby product that you are using could be causing the acne or rash, you must discontinue it immediately and use only safe and certified baby products.

Treatment of Baby Acne

Usually the acne tend to resolve on their own but if they last for more than a few weeks, then you need to consult your doctor. The treatment of baby pimples is very different from that of adult acne treatment. He may prescribe a cream or lotion for the same. Medicated creams need to be used here. Never use over the counter washes or creams for your baby as their skin is very delicate and sensitive. A strong skin product may lead to a skin reaction of adverse nature.

Home Remedies for Baby Acne

There are some useful home remedies that you can try for baby acne and keep your baby’s skin as healthy as possible. The most important is baby skin care.

1. Cleaning the face: Always clean your baby’s face twice a day. Do so by using warm water and a mild baby soap or moisturizer. If your baby’s skin is sensitive, you could use a medicated soap as suggested by your pediatrician. Always take care that you do not use any other soap or skin treatment creams, as they can lead to burning in the eyes. Baby soaps and products are made especially with a no tear formula so that even if the soap goes into the eyes, the baby does not have any burning or pain.
2. Scrubbing: Always remember that you should never scrub your baby’s skin as it is very delicate and soft. Whenever you clean the skin, it should be with gentle circular motions with moderate pressure. Scrubbing can damage the superficial layers of the skin and lead to bruising.
3. Creams and Lotions: If your baby keeps getting acne and bumps, he could be having an oily skin. Using any sort or cream or lotion will only aggravate the condition further and increase the number of acne. You should never use over the counter medications for your baby. This is a very important tip for infant acne treatment.
4. Never squeeze: You should never try to squeeze the acne or try to puncture it in an attempt to clear it out. By doing so you will cause unnecessary pain to the baby and also irritate the skin making it more vulnerable to infections.
5. Wait and Watch: You need to be patient as a parent and understand that newborn acne are not a serious medical illness. It is a skin breakout and will resolve on its own. More importantly the acne are not causing any trouble to the baby and so you also should be rest assured and just wait for it to clear up on its own.

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Acne which is also known as pimple can occur at any age group but there are certain times when you are more prone to getting it. The last time you were bothered with acne could have been your puberty years. Is it common to breakout during pregnancy? Yes! It is one of the common skin affections apart from pigmentation which occurs due to the pregnancy hormones. During pregnancy, the hormone progesterone causes an increase in the secretion of sebaceous glands (sebum). The increased quantity of sebum and shedding of the cells of hair follicles together cause the blockage of the sebaceous gland opening. The sebum collects inside and bacterial action begins. This leads to inflammation and this is how the pregnancy acne crops up. Depending on your skin type, you could get lots of acne during pregnancy. The common sites of the acne are the face, neck and back and less commonly the arms, thighs and even buttocks. They can be mild, moderate or severe in intensity. Severe acne present with pus formation can cause pain with inflammation of the surrounding skin.

How to Help Pregnancy Acne?

There are certain skin care tips that can help to prevent or control the pregnancy acne and help you get the pre-pregnancy clear skin. During pregnancy you need to take utmost care of what you apply on the skin as not all products are safe during pregnancy. Here are some useful tips for you:

• Clean your skin regularly. Wash your face with a mild soap or cleaner twice a day. Use acne soap if required. Regular washing will prevent the dust from clogging the skin pores and thus control the flare up of acne. In case you have oily skin, you are more prone to getting acne as your skin has a tendency to secrete more amount of sebum than normal. In such cases wash your hair regularly. If the pillow or towel is oil stained, wash them too.
• Moisturizers and skin creams may make your skin oilier so you need to choose an oil free moisturizer during pregnancy. It will prevent the over drying of the skin. During pregnancy the skin tends to stretch and become itchy, this will be taken care of very well by a moisturizer.

• Do not try to scrub the pimples away. It can break the zits and the sebum can give you a disfigured look. The acne that are broken or squeezed also tend to dry up leaving behind scars. These acne scars do not go away easily.
• Many skin treatments and medications for acne lead to peeling off of the superficial layer of the skin. Going out in the sun can make your skin prone to sunburns and even skin cancer as the skin’s deeper layers get exposed to the sun. So, be careful to cover up adequately when going out in the sun. You could also use a sunscreen with SPF 15 (sun protection factor) to protect the skin.
• During pregnancy, be very careful of the skin care products you choose as not all are safe or recommended during this time. Pick up oil free preparations to prevent acne.
• Diet plays a very important role in the way you look and also the condition of your skin. Eating oily and rich foods, junk foods etc can make you more prone to getting zits. Have a balanced diet and lots of fruits and vegetables.
• Drinking at least 10-12 glasses of water per day will help to keep your skin supple and fresh as all the impurities are flushed out of the body.
• Always consult your doctor before using any acne medications or topical applications. Severe cases of acne may need to be medically treated with antibiotics to prevent the infection from getting severe.

Acne Treatment

The latest and most effective treatment for acne is the use of medications called retinoids. These are the best acne treatment but they are not safe during pregnancy as they can get absorbed into the skin and the breast milk. Severe acne treatment may require antibiotics. Erythromycin is the safest to use during pregnancy. Acne cream and acne cleanser are topical methods of controlling the acne.

If the acne scars are very severe, then acne laser treatment is the best suggested acne scar removal procedure that you may choose to undergo, but only once the pregnancy is over.

Although you may have many skin troubles during pregnancy, it is also this time that the active blood circulation and pregnancy hormones gift you with that beautiful pregnancy glow! So do not lose sleep over the zits as they will settle down once your hormones go back to normal.

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Melasma, which is also commonly known as chloasma is a skin condition that is characterized by an increased pigmentation on face. This is seen most commonly on the face. The typical distribution of the hyperpigmentation on face helps to establish the diagnosis. The color of the patches could be a slight tan to dark brown. It is seen less commonly on other sun exposed areas of the body. It generally has a symmetrical distribution on the face.

Causes of Melasma

There are some identified causes and risk factors for melasma but the exact cause is still not known. It is seen more commonly in dark skinned individuals as compared to fair skinned persons. There is also a known link with the estrogen and progesterone levels in the body. Women are at a greater risk of developing this face pigmentation. Pregnancy and hormone changes occurring in the body as in HRT – Hormone Replacement Therapy or taking oral contraceptive pills are the major causes of melasma. Sun exposure is known to increase the pigmentation troubles. Overuse of cosmetics and some thyroid medications make your skin more sensitive to the rays of the sun. So, using a sun block becomes an important part of the treatment for melasma.

Symptoms of Melasma

Melasma causes patches of skin discoloration on forehead and face which can range from a tan to dark brown color depending on your skin type. These brown patches on face are symmetrically distributed and are seen more on the sun exposed areas of the body. It is common in pregnant women due to the hormonal changes and is also called as the mask of pregnancy. The typical distribution of the brown patches is over the forehead, bridge of the nose, both cheeks and the chin. The pregnancy mask causes the face looks like it has a butterfly shaped brown patch so it is also called as butterfly pigmentation.

It can also occur on the arms and neck region. These patches are harmless and have no serious implications except for cosmetic problems.

The pigmentation normally resolves or lightens on its own once the pregnancy is over or the hormone therapy is stopped within few months. In a very small percentage of women, the patches never completely fade away.

Diagnosis of Melasma

The diagnosis is mainly done by looking at the distribution of the skin patches and the presence of one or more of the risk factors like pregnancy, hormone therapy etc.

The confirmation of the diagnosis is done by Woods Lamp Examination. This testing is done by exposing the skin to a special type of light which helps to determine how many layers of skin are affected. If the doctor suspects another serious skin disorder, he may take a small biopsy from the patch and send it for testing. The cells identified under the microscope will help to establish the diagnosis more accurately.

Treatment of Melasma

Women who are on hormone replacement therapy see a regression in the dark patches once the medication stops. The patches resolve on their own in pregnant women once the pregnancy ends and the baby is born. Some other modes of treatment available are:

• Hydroquinone cream helps to take the pigment out of the skin by blocking the process that leads to the formation of skin pigment melanin.
• Chemical peels are used to treat the dark patches on face. The cream causes an artificial chemical burn just like sunburn. With passing weeks the burnt skin wears off and gives way to fresh skin which is free from the patches. This treatment is used only if the skin condition does not respond to the primary treatments.
• Laser melasma treatment is the most recent advancement in this field. It uses certain wave lengths of light and laser rays to treat the pigmentation on the face.

Prevention of Melasma

The best way of preventing pigmentation is to cover the face adequately when going out in the sun by wearing a mask, shades and a hat. Sun blocks or Sunscreens are very effective in such cases. The sunscreen should have an SPF (Sun Protection Factor) of at least 30. Cosmetics can be used to cover up the patches. Ladies diagnosed with this skin condition should avoid waxing as it can worsen the condition. This is not a serious skin disease and is self limiting in most cases.

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Cherry angiomas are quite common types of vascular lesions that appear on the skin. They are usually dilated capillaries or the excessive clumping of blood vessels. They may appear as cherry-red papules or purplish in color. Cherry angiomas are also known as Campbell De Morgan spots after the British surgeon who first took notice of these clusters of lesions. Senile angioma is another name given as its proliferation increases over age.[1]

Cherry angiomas are known to increase with age, specifically after 40 years old. The exact cause is still unknown but it can appear to any areas of the skin. Most often they appear on the torso.[2] These are non-cancerous growths made of blood vessels.[5]

What are the Characteristics of Cherry Angioma?

• Cherry angiomas usually appear like bright cherry-red papules or are purplish in nature.
• They would occur in any surface area of the skin but is most common on the trunk or the torso. The face, scalp, neck, arms and legs are also probable sites for the development of cherry angiomas. The papules seldom appear on the hands and feet.
• The papules may be flat topped and may start as small dots or pinheads.
• They are usually quite smooth or they can be elevated and stick out from the skin.
• Cherry angiomas may increase in size and diameter. They would also tend to expand in thickness as it continues to grow larger.
• Some cherry angiomas may adapt a mushroom or dome shape as it becomes larger.
• Polypoid angioma is the name given to several adjoining angiomas.[5]
• Cherry angiomas are usually painless and not harmful. However, large cherry angiomas may bleed excessively if injured because of the proximity of the blood vessels of the angiomas to the skin. [5]

Causes of Cherry Angioma

• The cause of the development of cherry angiomas is idiopathic in nature though they have been linked with genetic tendencies. This lack of information is probably due to the disinterest regarding the subject as these lesions are usually benign and rarely indicate malignancy.

• Cherry angiomas usually occur after 40 years of age though they may start appearing as early as 30 years old. However, there may also be incidences when they start to appear spontaneously in younger people.

• There are two mechanisms involved that may lead to the possibility of cherry angiomas:

• Angiogenesis refers to the growth and formation of new blood vessels from current and existing blood vessels.
• Vasculogenesis, on the other hand, refers to the formation of new blood vessels as they are and without any pre-existing blood vessels.

• Certain chemicals and compounds have also been linked with the development of cherry angiomas. These include but are not limited to bromides, butoxyethanol, cyclosporine and mustard gas.

• An increase in mast cells, which are cells usually rich in histamine and heparin, has also been associated with the proliferation of cherry angiomas.

Exams and Tests for Diagnosis

Diagnosis for cherry angiomas is usually made on the basis of the physical appearance of the lesion growth. A skin biopsy may be indicated to confirm the diagnosis. Usually there are no other laboratory studies that may be required unless histopathologic confirmation is necessary to rule out malignancies.[2]

Treatment and Removal

Cherry angiomas may or may not be treated as they are usually harmless or painless. The main reasons, however, for their removal is for aesthetic purposes as well as if the lesions tend to bleed frequently.

There are several treatment options for the removal of cherry angioma:

Cryosurgery

This is the use of extremely cold temperature to eradicate abnormal tissue. Ice crystals would form around the cells until such time that the cells would tear apart. The blood vessels of the abnormal tissue are also damaged when they become frozen. Argon, carbon dioxide, liquid nitrogen, dimethyl ether – propane are the most common chemical compounds that are used for this procedure.

It is not as invasive as other procedures and causes minimal pain and scarring. Localized pain and redness may be managed with analgesics like acetaminophen, aspirin and ibuprofen. In addition, it is a cost effective therapy. The risks associated with cryosurgery are damage to the nerve tissues and scarring.

Electrosurgery

This procedure utilizes the application of an electric current to the abnormal tissue to destroy it. Electrosurgical devices are used and alternating current is used in directly heating the tissue. The risk of scarring may be avoided if done by a skilled professional.

Electrocautery

This procedure uses heat conduction by an electric current through a heated metal probe. This procedure is different from electrosurgery due to the differences in the electric current used. However, the use of electrocautery has been controversial because of the toxicity of the surgical smoke emitted during the procedure.

Pulsed Dye Laser

This procedure makes use of an organic dye as the active laser medium. The dye would usually come in a liquid preparation but can also come in solid or gas state.

Intensed Pulse Light (IPL)

This procedure utilizes various wavelengths in targeting various skin treatments including removal of vascular lesions. It is much more commonly used as a form of hair removal technique. However, there may be contraindications for the application of this treatment, which include seizures, sunburn, hypertrophic scarring and moles.

Shave Excision

This is done by removing the lesion through the use of a blade. Bleeding may be stopped through the use of aluminum chloride or electrocautery.

Natural Remedies for Cherry Angiomas

There are also natural remedies, which may be used in treating cherry angiomas. These remedies utilize natural ingredients provided by nature.

1. Sandalwood powder may be mixed with fresh basil leaves to make a paste.
2. Crushed leaves of strawberry may also be used.
3. Witch hazel is also helpful in eliminating bacteria after a shower.

Although cherry angiomas are usually not dangerous and need not necessarily be treated, it is important to have them checked by a dermatologist if multiple angiomas are noted in a short span of time. This is important to rule out internal malignancies. In addition, it is important to remember that the cherry angiomas should not be punctured because of their risk to bleed profusely.

Cherry Angioma Pictures

Picture 1 : Cherry Angioma photo

Picture 2 : Cherry Angioma

Picture 3 : Cherry Angioma image

Picture 4 : Cherry Angioma on shoulder

References

1. http://en.wikipedia.org/wiki/Cherry_angioma
2. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002413/
3. http://www.nlm.nih.gov/medlineplus/ency/article/001441.htm
4. http://www.healthcentral.com/encyclopedia/408/18.html
5. http://www.primehealthchannel.com/cherry-angioma.html

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HIV rash is a symptom of Human Immunodeficiency Virus or HIV that commonly appears at the 2^nd or 3^rd week of the course of the disease. HIV rash may be considered as a warning sign that an infection is already present in the body. It is usually located in the central part of the body, anterior and posterior trunk and around the face and the neck up to the limbs and hands. In addition, an estimate of 85% of HIV infected patients will develop HIV rash.

However, not all presentations of a skin rash translate to an HIV rash. Due to some similarities of an HIV rash to those rashes that occur in other skin conditions and allergic reactions, it is important to consult a physician before assuming anything to prevent confusion and unnecessary hassle.

Pathophysiology of HIV Rash

Since HIV rash is a symptom of an infectious disease called Human Immunodeficiency Virus or HIV,  understanding  how HIV rash occurs includes knowing the pathophysiology of HIV.

Infection Stage

HIV is an infectious disease. The ability of the body to resist infection, or immunity, is the first line of defense. HIV is an intracellular parasite called retrovirus. Instead of the common phenomenon of the genetic material being carried off in an organism’s deoxyribonucleic acid or DNA, the genetic material in a retrovirus is contained in its ribonucleic acid or RNA.

These viral RNA is encased, and this case comes with a glycoprotein that is usually sticking out of the envelope. This glycoprotein is the one mainly responsible for enabling the HIV to enter its goal cell. For the “invasion” to be successful, the viral envelope should be able to fuse to the goal cell’s plasma membrane.

Primary Infection stage

The primary infection stage is usually when HIV rash appears. It is the stage or period from the time infection occurs up to the time where antibodies are developed to fight off HIV. This is the period where intense proliferation of the virus occurs, as well as its widespread dissemination throughout the body. At this early part of the primary infection stage, the person may experience no symptoms at all or severe flu-like symptoms.

However, in the 3^rd week, the person starts to manifest signs and symptoms, especially HIV rash. Most of these symptoms resemble those of mononucleosis’ symptoms. Aside from HIV rash, the person may also have:

• Muscle aches,
• Headaches
• Enlarged lymph nodes
• Fever
• Joint pain
• Diarrhea
• Sore throat
• Mouth or genital ulcers and/or
• Night sweats. [3]

Viral Set Point

This is the stage where the antibodies that fight off HIV (immune response) are roughly the same amount as those of the number of HIV in the body. This means that the individual is, at this time, in a steady state of infection. This viral set point may last for a few years.

HIV Rash Causes

HIV rash may have its origins as a viral, or bacterial or fungal infection, or as a drug reaction. That is why it is essential to seek medical attention promptly for proper diagnosis and treatment. [4]

HIV rash can occur at any stage throughout the course of HIV infection. In the acute or initial stage of infection, the HIV rash appears as a generalized condition,  which means it looks like a  “common” rash. Consequently,  it is usually mistaken as something else, such as an allergic infection. This occurs at around 2^nd to 3^rd week of the disease.

In the chronic stage of the disease however, the HIV rash may appear as a symptom of various integumentary infections. One of these associated integumentary infections is seborrheic dermatitis. Seborrheic dermatitis is one of the most common integumentary manifestations of the HIV disease. The HIV rash in seborrheic dermatitis is usually scaly or flaky in nature, indurated and diffused throughout the face, scalp, chest and even the groin area.

Another integumentary infection in the chronic stage which appears as an HIV rash is the herpes virus infection. The HIV rash from herpes infection is reddish in color and typified with blisters that are characteristically fluid-filled. In addition, there is also an HIV rash,  caused by an HIV complication called Drug Rash with Eosinophilia and System Symptoms or DRESS. This HIV complication appears as a characteristic HIV rash of its own and usually requires immediate medical attention.

Another cause of HIV rash is drug-related. This usually happens when there is an adjustment of dosage of the current medication or if the HIV physician has decided to switch to another medication. In these cases, there is a high possibility of resulting skin irritations. This resulting HIV rash usually resolves as the patient gets used to the adjustment of dosage or to the new medication. However, if the HIV rash does not go away naturally, consult the HIV physician about it.

More than half of the individuals treated with trimethoprim-sulfamethoxazole (TMP-SMZ) develop this drug-related HIV rash. This HIV rash is itchy or pruritic in nature and is accompanied by the presence of pinkish-red macules and papules.

All of these HIV rashes are all sources of discomfort to the patient.  In addition these rashes result in a higher rate of infection because the integrity of the skin has been compromised.

Characteristics of HIV Rash

Different opportunistic infections may present different HIV rash appearances. The shape and size of HIV rash may vary.  Some may present as only little dots while others may appear in large clusters throughout the body.  The most common characteristic of an HIV rash is that one of purplish to blackish in color for dark-skinned individuals, and reddish to brownish in color for light-skinned individuals. Also, it is usually similar to an eczema, because it may present as a reddish to brownish razor skin bump.

The HIV rash may also be pruritic in nature. Also, HIV rash may be accompanied by fever, fatigue, white patches in the mouth or oral thrush, loss of appetite, loose bowel movement and resulting loss in weight. Blisters may also appear in the body’s mucous membranes such as the mouth, eyes or the genital area. Peeling of the skin may also occur. Extreme complications of HIV rash may include problems involving vision and loss of memory.

HIV Rash Pictures

Picture 1 : HIV Rashes on hands and fingers

Picture 2  : HIV Rashes on all over body

Picture 3 : HIV rashes (red) on back

Picture 4  : HIV Rashes on chest and trunk

Picture 5  : HIV Rashes on shoulders

Medical Management of HIV Rash

If a person develops an HIV rash, it is very important not to self medicate. Self-medication may only worsen things. Consult with an HIV physician. This HIV physician will determine the cause and nature of the HIV rash, as these rashes occur with various underlying conditions. When the correct cause is determined, then the appropriate treatment will then be employed.

Pharmacologic Therapy

To control pruritus or itching and the swelling of the HIV rash, over the counter drugs are usually administered to control it. Example of these over the counter drugs is Benadryl, a hydrocortisone cream. Moreover, if the underlying condition related to the HIV rash is already severe in nature and the resulting pain is already debilitating to the patient, then the HIV physician may administer analgesics as needed or at regular intervals, around the clock.

Alternative Treatment Regimen

Exposure to extreme temperatures, whether be it extreme heat or extreme cold may aggravate the HIV rash. Therefore, the HIV physician may advise the patient to avoid hot bath and showers, direct sunlight and extremely cold environments. [5]

Also, be vigilant about the food and medicine intakes, and even soaps and other skin products that have come in contact with the skin prior to the appearance of HIV rashes, as these HIV rashes may be caused by an allergic reaction to these things.

Some nutritional supplements may be helpful to minimize specific symptoms, such as fish oil or whey protein. Others can be detrimental such as St. John’s Wort or garlic supplements. [3]

Furthermore, if a patient is advised to stop taking a certain medication due to the appearance of an HIV rash, do not restart it when the rash symptoms are relieved.  Never do things in your own way. Always consult the HIV physician before taking any action regarding treatment regimen.

Practice proper hygiene. Rashes can occur due to irritation from dusts and even unwashed, dirty clothes. By practicing proper hygiene, the patient can avoid HIV rashes which are associated with personal sanitation.

Avoid unprotected sexual activity. Tight fitting clothing and harsh chemical soaps can also irritate the skin and make it more vulnerable to HIV rash.[6]

Supportive Therapy for HIV Rash

Severe skin breakdown may be very debilitating to the patient. Hence, supportive care is necessary to be provided to the patient. Supportive care includes assisting the patient in meticulous and thorough skin care. Moreover, the patient should be turned regularly (preferably every two hours) to prevent bedsores and further damage to the weight bearing skin affected by the HIV rash. Assistance with applying topical medications and dressing should also be provided if necessary.

Pain associated with HIV rash may also be relieved or alleviated with the use of relaxation techniques such as deep breathing exercises (if the patient is able to do so), as well as guided imagery.

References:

1. http://www.livestrong.com/article/154733-early-symptoms-of-the-hiv-virus/
2. http://www.health.com/health/gallery/0,,20539037_6,00.html
3. http://www.mayoclinic.com/health/hiv-aids/DS00005/METHOD=print
4. http://symptomstreatment.org/hiv-rash/
5. HIV rash
6. http://www.hivsymptomsonline.com/hiv-rashes.html
7. http://emedicalhub.com/hiv-rash-symptoms-pics-treatment/

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Dyshidrotic dermatitis is a medical skin condition that primarily affects our hands and feet with small blisters. This condition is also referred as pompholyx, dyshidrotic eczema or vesicular eczema. The term dyshidrotic is used in relation to the sweat glands, which signifies the connection to sweat glands affectation while the term pompholyx is taken from the Greek language, meaning bubble.

About 5% to 20% of patients who suffer from eczema are suffering from dyshidrotic dermatitis. According to research, the commonly affected populations are those people who reside in a place with a warm climate. In addition, this frequently appears during the summer season. There is no specific gender affected from this skin problem. However, middle-aged individuals are usually victims of dyshidrotic dermatitis with 38 years as the mean age target. This condition is rare in children, but they do become susceptible when they have a history of atopic dermatitis.

Dyshidrotic dermatitis can be easily diagnosed through a physical examination. Simple examination of the skin blisters can support for the final diagnosis. A family history of dyshidrotic dermatitis can also help conclude for the diagnosis. In order to rule out other conditions, a skin biopsy is performed. Potassium hydroxide test is also performed to rule out fungal infection and contact dermatitis, a very different skin condition that is characterized by a local rash or skin irritation. In KOH test, skin scrapings mixed with KOH solution are viewed with a use of microscope. Another test is called the patch test, which can detect if the cause is from hypersensitivity/allergic reaction.

Dyshidrotic Dermatitis Symptoms

Discomfort and physical alteration are the main manifestations of dyshidrotic dermatitis. The areas of affectation are the hands and feet, more specifically the sides of our fingers and soles of feet. It has been recorded that most of the patients manifest hand dyshidrotic dermatitis, where 80% is the allocated population. The rest of the cases are patients who manifest symptoms most prominently on their feet. The following are the enumerated symptoms of dyshidrotic dermatitis:

1. Pruritus which is accompanied by with onset of vesicles.
2. Intense burning sensation frequently appears before the emergence of vesicles.
3. Blistering is noted which are noted as small but deep and more in number on the sides of the palms, fingers and on the soles of feet. This is only possible when infection has developed.
4. Palms of the hand and soles of the feet become reddish (inflamed) and are warm to touch.
5. The areas affected are prominent to sweating which can lead to skin cracking and peeling when dried.
6. There is a big chance of nail changes most especially when the condition persists and not properly managed. Ridges on the nails and indentations are noted. Nail thickening and discoloration may also develop.

Dyshidrotic Dermatitis Pictures

Picture 1 : Dyshidrotic Dermatitis on feet

Picture 2 : Dyshidrotic Dermatitis on fingers

Picture 3 : Dyshidrotic Dermatitis on Palm

Causes for Dyshidrotic dermatitis

Dyshidrotic dermatitis is an idiopathic condition or from an unknown etiology. There are potential factors and contributing factors for such skin condition. The following are the said precipitating factors for dyshidrotic dermatitis:

Genetics

According to study, monozygotic twins are found susceptible from dyshidrotic dermatitis. Even though explanation from its contribution is not clear, relation is found from a believed genetic mutation of the filaggrin gene that leads to its loss and dyskeratinization.

Sweat glands problem

The more sweaty a person’s hand and feet are, the more they become at risk for the development of this skin condition. There have been disputes for its association, sweat ducts may or may not be the contributing factor for its development.

Skin sensitivities

People sensitive to nickel may develop dyshidrotic dermatitis when exposed to such element. While those who ingest cobalt accidentally and are known to be sensitive to it are also at risk for the skin disease’ development.

Atopy

According to research, a number of atopic diathesis conditions can lead to dyshidrotic dermatitis. These familial conditions such as eczema, hay fever, asthma and sinusitis are the considered triggering conditions.

Underlying conditions

Those who suffer from fungal infection become susceptible from another skin condition. Others with a weak immune system, such as those who had contracted HIV-AIDS, are evidently susceptible from dyshidrotic dermatitis.

Stress

This is considered as one of the most common risk factor for dyshidrotic dermatitis. A lot of dyshidrotic dermatitis patients suffer from its flare-ups when distressed.

Treatment for Dyshidrotic dermatitis

The main aim in the treatment plan for dyshidrotic dermatitis is to provide comfort and alleviate, control the presenting symptoms. There is no direct cure for dyshidrotic dermatitis which is the usual inquiry of patients. The following are the said interventions for dyshidrotic dermatitis:

• In order to relieve the pruritus, taking of oral antihistamines can do the trick. Anti-pruritics are also dispensed for patients. The drugs may include Benadryl (diphenhydramine) or loratadine.
• Ointments or creams. Corticosteroid creams that can help reduce the blister and the accompanying discomfort are provided to patients. This can also facilitate improvement from the redness and cracks from dyshidrotic dermatitis. There are cases where oral steroids are provided which present good and favorable results from severe cases. Ointments which contain immune-suppressing action such as tacrolimus and pimecrolimus are very helpful in treating unresponsive cases. This can help suppress the process of the immune process, which reduces the inflammation from the skin blisters and pruritus. However, skin infection may be a complication from taking such type of drug.
• Phototherapy. This has been noted to provide great results and is very effective in the end. This shall use light therapy (psoralen plus ultraviolet A) which is provides less irritation.
• Botox injections. This treatment may sound odd but has considerable good results that treat the severe cases of dyshidrotic dermatitis. On the other hand, not all physicians practice this form of intervention.
• Cold compress. This can variably alleviate the itchiness. It is much recommended to provide such compress when one is using topical creams with it.
• Continue home care. One should avoid scratching the rashes, especially the blisters. Do not keep the hands or feet too dry, by applying some moisturizing cream after wash. If the case presents that skin sensitivities caused the skin problem, one should avoid it and all other forms of skin irritants such as detergent soaps and the like.

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Jock itch or Tinea cruris is  easily recognized. It is an infection of the skin caused by ringworm (Tinea) which is actually a fungus, not a worm. Usually the skin in the area of  inner thighs, buttocks, genitals and scrotum are affected. This is because the fungus grows well in warm and most areas of the body.  Jock itch looks like a rash shaped like a ring. The skin is usually red and irritated.  Sometimes women can get ringworm too, but it is not as common.  Obese people who have areas of skin rubbing against other skin and who sweat a lot are also likely to get this infection. Often athletes or people involved in sports are the ones who get this infection. That is how the name “Jock itch” came about.

Types of Ringworms on Humans

• Jock itch (Tinea cruris) this is a skin infection at or near the groin.

• Nail ringworm (Tinea unguium) Onychomycosis affects your nails and makes them stiff, brittle and opaque. The most common people to have this condition are those with peripheral vascular disease and women who use artificial nails.

• Scalp ringworm (Tinea capitis) is usually found in children because of  poor hygiene. Sores called keroins on the scalp are cause by a fungus,Tricophyton tonsurans.

• Athlete’s foot (Tinea pedis) painful rashes, scaling or peeling on toes and fingers and the space between each of them, caused by Trycophyton. Often transmitted in public showers or bathrooms or similar wet areas.

• Beard ringworm (Tinea barbae) “Barber’s itch”  occurs in the beards of adolescent and adult males. The cause is Zoophilic and Antro-pophilic fungi. In children or on females it is called Tinea faciei. [3]
  

Is Jock Itch Contagious?

The primary way these infections are spread is through sex.  In addition, sharing towels, clothing, swimsuits or not washing your hands after contact with the infected area will spread this fungus.   If you go to a public pool or gym often, get a shower before and after you go there.

Jock Itch Causes

• Warm and moist areas of inner thighs and the groin are perfect for the fungus that causes jock itch.
• Wearing tight-fitting underwear that keep the area bathed in sweat for long time periods of  time contributes to rashes and irritation from growth of fungi.
• People who perspire profusely and obese people are especially likely to develop these infections.
• Use of public swimming pools, locker rooms and showers or sharing the clothing from an infected person will quickly spread the infection. Trychophytin and Epidermophyton floccosum thrive in these areas.
• People with inadequate immune systems, perhaps because of diabetes, chemotherapy, AIDS/HIV or hepatitis are very vulnerable.  Also if you are taking medication which is an immunosuppressant you are at risk.
• Diverse food allergies or intolerance can contribute to the growth of the offending fungus, for instance, yeast, gluten or lactose or fructose sensitivity.
• Humidity, friction and heat may also be causes of jock itch. Some women will get it beneath their breasts.
• Poor blood circulation and low blood oxygen also contribute to fungus growth.
• Patients with diabetes may also develop yeast infections. Candida albicans may cause abscesses on the tip of penis.

Jock Itch Pictures

Jock Itch :

Jock Itch :

: Photo 3

(Jock Itch images – source : http://atlasdermatologico.com.br)

Jock Itch Symptoms

• The initial simple symptoms of jock itch is mild recurrent irritations in the groin and the skin nearby, including the inner thighs. This is followed by burning sensations.
• Rashes are ring-shaped about an inch in size, light red or pink color at first. Later the rash may become dry or bumpy or possibly have pus that seeps out.
• Discoloration of the skin such as lighter or darker than normal skin color may result. This can be either hypopigmentation or hyperpigmentation.
• Signs of jock itch can include blisters or keroins.
• Tenia pedis results in skin flaking in toes and is extremely itchy.

Jock Itch Treatment & Cure

Jock itch can be treated and cured with anti-fungal medications and jock itch remedies which inhibit the growth of the fungus. Most ointments contain terbinafine, lotrimin, oxiconazole, ciclopirox, naftifine, micatin, econazole nitrate or tolnaftate (Tinactin). These formulas prevent the fungi from making  works to ergosterol, thus the cell membrane cannot be secure and its growth is inhibited or terminated.

To soothe itching, sometimes glucocorticoid steroids are used. They will also prevent secondary infections.

You can learn how to treat jock itch with self-care tips such as these:

• Antibacterial soaps will  not help because it is caused by a fungus, not a bacteria.
• Use soap containing  coconut oil essentials.
• Wash with water.
• Apply petroleum based jelly as lubricant to suppress itchy feeling and burning sensation.
• To restore a natural acidic layer on your skin and to minimize the smell, use  warm water mixed with apple cider vinegar or lemon juice.
• Avoid tight clothing.
• Wear loose fitting cotton clothing. Boxers or shorts are good.
• Allow the infected area access to more air if you sleep in the nude.
• Bathe well after physical activity with plain water to get rid of the dirt and sweat on your body.
• Mix coconut oil with 5 drops of tea tree oil or olive oil or tea tree oil and use it twice daily on the infected area. This helps kill the fungus.
• Commercial, over the counter, Jock itch cream, can relieve the burning and itching. The spray or jock itch  powder can also help.

Though jock itch can be a distressing condition for the one who suffers from it, it is not permanent or lethal. This common condition has an excellent prognosis. Once it is diagnosed,  it can be  treated with over-the-counter medications or home remedies.  An extreme case can lead to chronic disfiguring or scarring and can be embarrassing. Therefore you should pay attention and take proper precautions at the first sign of infection.

References:

1. http://www.mayoclinic.com/health/jock-itch/DS00490/DSECTION=symptoms
2. http://www.medicinenet.com/jock_itch/page6.htm#medication
3. http://en.wikipedia.org/wiki/Tinea_barbae
4. http://www.emedicinehealth.com/jock_itch/page2_em.htm
5. http://dermatology.about.com/cs/fungalinfections/a/jockitch.htm

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