PSA in Dermatology

PSA is commonly used in medicine to refer to Prostate Specific Antigen which is a protein produced by the prostate gland that is measured as a marker of prostate enlargement, prostate cancer and prostatitis.

However in a paper published by Dr Mercola who is a dermatologist and rheumatologists as well as an assistant professor at Harvard Medical School, PSA has become a mnemonic for:

P Pain in joints which are often swollen

S Stiffness for more than 30 minutes after rest AND/OR Swollen, sausage-shaped fingers or toes

A Axial spine involvement characterized by symptoms like a stiff back

This PSA represents symptoms of inflammatory arthritis and psoriatic arthritis.
It is an important mnemonic for dermatologists because many skin conditions also have rheumatological symptoms. Common examples of such conditions include psoriasis, dermatomyositis and lupus erythematosus.  

This mnemonic will serve as a reminder for dermatologists seeing patients who mention any of the  PSA symptoms. It will remind them to inquire about other systemic symptoms of these dermato-rheumatological diseases. It these are present, it will lead to a more extensive physical examination, ordering of serologic and radiologic tests and referral to a rheumatologist for co-management.

PsA, with a small s, is also used in dermatology to stand for Psoriatic arthritis. In addition to the above PSA  symptoms, patients with PsA can also present with:
1. Nail pitting which can be associated with thickening and discoloration.
2. Enthesitis or pain in areas where tendons attach to bones like the heel (Achilles tendinitis), sole (plantar fasciitis), knees and hips.
3. Fatigue

Another important point to remember when examining a patient with PsA and PSA is that there are 5 types of PsA:
1. Symmetric psoriatic arthritis which affects similar joints on both sides of the body is often confused with rheumatoid arthritis.
2. Asymmetric psoriatic arthritis which affects both small and large joints like the hip and knee and can be confused with osteoarthritis.
3. Distal interphalangeal predominant (DIP) which affects the small joints of the fingers and toes and can be confused with osteoarthritis.
4. Spondylitis which affects the vertebrae and sacroiliac region and can be confused with osteoarthritis.
5. Arthritis mutilans which is the severe and destrictive form that usually destroys the small joints of the fingers and toes.    

References:

Dark Skin Dermatology Color Atlas

Dark Skin Dermatology Color Atlas contains over 100 color photos of skin diseases, hair diseases, and nail diseases affecting people with skin of color or Fitzpatrick skin types IV, V, and VI.

Click here to buy Dark Skin Dermatology Color Atlas
 

Chemical Peels and Lasers for Acne Scar Treatment

The latest development in the treatment of acne scars in persons with Fitzpatrick skin types III, IV and V is from Dr. Shehnaz Arsiwala.
This dermatologist uses chemical peels in addition to sun care and the standard topical priming to prepare her patient’s skin for laser resurfacing.
In a study which she presented at the 23rd World Congress of Dermatology in June 2015, Dr. Arsiwala gave her patients 3 to 5 sessions of salicylic, glycolic, retinol and combinations peels every 15 days. These sessions were followed by 3 to 4 sessions of laser ablation with fractional erbium or fractional carbon dioxide lasers.
Results noted from her pre-laser chemical peel priming included better outcomes for acne scar treatment and improvement of the underlying acne. Other effects noted included improvement of photodamaged skin and better skin texture in general.
This combination of chemical peels and laser therapy is great since both work the same way by removing the top layer of the skin to make the acne scar less apparent. 
Lasers however go the extra mile since in additional to the ablational component, they also have the fractional component in which cavities are created to help the skin shrink.
Beginning with a chemical peel is also good because laser outcomes are more predictable and one can therefore fine tune the results of the chemical peel.  

Since many acne scars require at least two modalities of treatment to get good results, other treatments that can be combined for optimal results include surgical excision, punch grafting, light electrosurgery resurfacing and even the use of fillers like liquid injectable silicone. Dermabrasion can also be done as a first step and followed by laser therapy.

References:
1. Arsiwala S. FC28-05: Interventional Priming With Peels Before Ablative Fractional Laser Resurfacing for Acne Scars. Presented at: 23rd World Congress of Dermatology; June 8-13, 2015; Vancouver, British Columbia. http://www.healio.com/dermatology/skin-care/news/online/%7B180d4ad9-fed5-4d63-9fa7-5542070bbf0c%7D/peels-prime-darker-skin-types-prior-to-laser-treatment-for-acne-scars

This is a Guest Post by Dr. Marian K who is a freelance medical writer. To submit your Dermatology related guest post please use our Contact Us page.

Psoriasis Linked to Obesity in Children


The possibility of a link between obesity and psoriasis in children has been revealed by a study done by Dr Amy Paller from the Northwestern University Feinberg School of Medicine and published in the Archives of Dermatology.

This study was done on more than 600 children aged between 5 and 17 years of which approximately 200 had severe psoriasis, 200 mild psoriasis and the rest served as the control group.

Dr Paller's study revealed that:
1. On average, children with psoriasis were four times more likely to be obese when compared to those without pediatric psoriasis. 

2. This tendency was noted to rise with the severity of the psoriasis since children with severe psoriasis were seven times more likely to be obese.

Dr Paller speculated that the link between these two conditions could be inflammatory mediators which contribute to both their development.
  
Holistic Dermatology
This study suggested that applying the principles of holistic dermatology is the best approach when managing children with psoriasis since the weight issues have to be addressed in concert with the skin problem.

This holistic approach is also backed by the fact that some studies imply that psoriasis goes into remission in adults with a high body mass index (BMI) who lose weight.

Therefore parents as well as children with psoriasis should be given lifestyle modifications tips like exercise and diet plans and referred to specialists to help them lose the excess weight when they are being issued with conventional medicine prescriptions for psoriasis.

To learn more about this study, click here

Why Patients Discontinue Treatment of Psoriasis


The reasons why patients discontinue their treatment of psoriasis have been revealed by a study done by Howa Yeung from the University of Pennsylvania Perelman School of Medicine in Philadelphia and published in the Journal of the American Academy of Dermatology.

This study, which was done on patients with plaque psoriasis of moderate to severe severity, revealed the following reasons for stopping psoriasis treatment:
1. Medications loosing their effectiveness was given as the reason by more patients who had been prescribed etanercept and adalimumab for psoriasis treatment than those who had been taking methotrexate.

2. Side effects of the medications were cited as the reason for cessation by more patients who had been put on acitretin compared to those who had been on etanercept, adalimumab, methotrexate and ultraviolet B phototherapy.

3. The cost of the treatment was given as the reason for discontinuing treatment by more patients who have been put on ultraviolet B phototherapy.

To learn more on why patients discontinue their treatment of psoriasis, click here.


Pellagra



Pellagra uses color pictures and clear explanations to teach you about this nutritional disease which affects the skin.

Table of contents:
Chapter 1. What causes Pellagra?
Chapter 2. What are the symptoms and signs of Pellagra?
Chapter 3. What investigations are done for Pellagra?
Chapter 4. What are the differential diagnosis for Pellagra?
Chapter 5. What is the treatment for Pellagra?
Chapter 6. What are the complications of Pellagra?
Chapter 7. How can Pellagra be prevented?

BOOK EXCERPT
Chapter 1
WHAT CAUSES PELLAGRA?
Pellagra is a nutritional disease that is caused by deficiency of vitamin B3 or niacin which is a water soluble vitamin.

Pellagra can be classified in the following way:
1. Primary pellagra
Primary pellagra develops as a result of inadequate dietary niacin intake. Primary pellagra can also develop as a result of inadequate dietary tryptophan intake since this amino acid is converted to niacin in the body. The causes of primary pellagra include poverty related malnutrition, maize (corn) based diet, anorexia nervosa, chronic parenteral nutrition, fad diets and severe elimination diets.  

2. Secondary pellagra
Secondary pellagra develops despite adequate dietary niacin due to poor niacin intake, absorption, and processing by the body. Causes of secondary pellagra include:
a. Gastrointestinal diseases such as chronic diarrhea, Crohn’s disease, ulcerative colitis, regional enteritis, gastrointestinal tuberculosis, and liver cirrhosis.
b. Chronic alcoholism and chronic drug addiction
c. Anorexia nervosa
d. Chronic dialysis
e. Malignant carcinoid tumors since the tryptophan is used to form the serotonin.
f. Hartnup syndrome which is an inherited disorder of amino acid transport which results in defective absorption of tryptophan by the gastrointestinal tract and kidneys.
g. Medications such as isoniazid which competes with niacin, pyrazinamide, 5-fluorouracil, 6-mercaptopurine, azathioprine, chloramphenicol, and phenytoin.

Click here to buy the PDF eBook Pellagra.


Poikiloderma

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Poikiloderma uses color pictures and clear explanations to teach you about this skin condition.
Table of contents:
Chapter 1. What is Poikiloderma?
Chapter 2. What causes Poikiloderma?
Chapter 3. What are the symptoms and signs of Poikiloderma?
Chapter 4. What investigations are done for Poikiloderma?
Chapter 5. What is the treatment for Poikiloderma?
Chapter 6. Poikilodermatous Mycosis Fungoides or Poikiloderma vasculare atrophicans
Chapter 7. Poikiloderma of Civatte

BOOK EXCERPT

WHAT IS POIKILODERMA?
Poikiloderma is a skin condition characterized by patches of hyperpigmentation, hypopigmentation and atrophy (thinning skin) with telangiectases (dilated capillaries).

WHAT CAUSES POIKILODERMA?
Conditions associated with prominent poikiloderma include:
1. Poikilodermatous mycosis fungoides
2. Poikiloderma of Civatte
3. Large plaque parapsoriasis
4. Connective tissue disease such as lupus erythematosus and dermatomyositis
5. Overuse of topical glucocorticoids
6. Radiation dermatitis
7. Graft versus host disease
8. Genodermatoses such as Rothmund-Thompson syndrome, Bloom syndrome, and dyskeratosis congenita.

Click here to buy the PDF eBook Poikiloderma.


Urticaria

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Urticaria uses color pictures and clear explanations to teach about this common skin disorder which can progress to life threatening angioedema and anaphylaxis.

Table of contents:
Chapter 1. What is Urticaria?
Chapter 2. What are the different types of Urticaria?
Chapter 3. What causes Urticaria?
Chapter 4. What is the pathophysiology of Urticaria?
Chapter 5. What are the symptoms and signs of Urticaria?
Chapter 6. What investigations are done for Urticaria?
Chapter 7. How is a diagnosis of Urticaria made?
Chapter 8. What are the differential diagnosis for Urticaria?
Chapter 9. What is the treatment for Urticaria?
Chapter 10. What are the complications of Urticaria?
Chapter 11. How can Urticaria be prevented?

BOOK EXCERPT

WHAT IS URTICARIA?
Urticaria, which is also known as hives or wheals, occurs in all races and affects approximately 15-20% of the general population at one time. It is the most commonly seen skin disorder in the emergency department and one that should be attended to emergently since it can progress to life threatening angioedema and anaphylaxis.


WHAT ARE THE DIFFERENT TYPES OF URTICARIA?
Urticaria can either be classified acute urticaria or chronic urticaria depending on the duration of the lesions.
1. Acute urticaria
Acute urticaria is usually a self-limiting illness since the transient lesions usually resolve within 24 hours though they may recur for up to 6 weeks. It can occur in all age groups and its incidence is equal in both men and women. 

Acute urticaria can develop because of physical contact with allergens such as latex, inhalation of allergens in molds, ingestion of allergens in shellfish and intravenous administration of allergens in radio-contrast dye.  

The cause of acute urticaria are usually identified in around 50% of patients. Most cases of acute urticaria respond well to treatment with histamine receptor blockers and patients have complete resolution of symptoms within a week.

Click here to buy the PDF eBook Urticaria.


Lamellar Ichthyosis


Lamellar Ichthyosis uses color pictures and clear explanations to teach about this inherited skin disorder. It also suggests specific products that are beneficial for moisturizing and softening the dry, scaly skin of lamellar ichthyosis.  

Table of contents:
Chapter 1. What causes Lamellar Ichthyosis?
Chapter 2. What are the symptoms of Lamellar Ichthyosis?
Chapter 3. What are the investigations for Lamellar Ichthyosis?
Chapter 4. What is the treatment for Lamellar Ichthyosis?
Chapter 5. What are the complications of Lamellar Ichthyosis?
Chapter 6. How can Lamellar Ichthyosis be prevented?

Book Excerpt
What Causes Lamellar Ichthyosis?

Lamellar ichthyosis is a keratinization disorder which is usually inherited in an autosomal recessive fashion. This means that both parents have to be carriers of the abnormal gene to pass it on to their children.

Patients with lamellar ichthyosis have a proliferative hyperkeratosis which means that the rate of production of new skin cells is faster than the rate at which the body can shed them.

What are the Symptoms of Lamellar Ichthyosis?
1. The baby is born covered with a thick collodion membrane which is a shiny, yellow film that covers the baby. This tough film later dries up and is shed in 10 to 14 days to reveal erythematous (red) skin covered with scales. 

2. 2. These scales of lamellar ichthyosis can be fine and white or large and dark. They are arranged in a mosaic pattern resembling the scales of a fish (ichthys is a Greek word which means fish). 

Click here to buy the PDF eBook Lamellar Ichthyosis.

Ichthyosis

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Ichthyosis uses color pictures and clear explanations to teach about this skin disorder. It also gives specific products that are beneficial for moisturizing and softening the dry, scaly skin of both acquired and inherited ichthyosis.   

Table of contents:
Chapter 1. What is Ichthyosis?
Chapter 2. What causes Ichthyosis?
Chapter 3. What are the symptoms of Ichthyosis?
Chapter 4. What is the treatment for Ichthyosis?
Chapter 5. What are the complications of Ichthyosis?
Chapter 6. Ichthyosis Vulgaris
Chapter 7. Congenital Ichthyosiform Erythroderma or Non-Bullous Ichthyosiform Erythroderma
Chapter 8. Epidermolytic Hyperkeratosis Ichthyosis or Bullous Ichthyosiform Erythroderma
Chapter 9. Lamellar Ichthyosis
Chapter 10. X-Linked Ichthyosis
Chapter 11. Acquired Ichthyosis

Book Excerpt
What is Ichthyosis?
Ichthyosis is derived from the Greek word ichthys which means fish. It consists of a group of around 20 disorders of keratinization which are characterized by persistently dry skin with a fish-like scale. These disorders affect all races and occur all over the world.
The widespread dry scaling of ichthyosis can develop either as a result of:
1. The production of new skin cells at a rate that is faster than the body can shed (proliferative hyperkeratosis)
2. The production of new skin cells at a normal rate but coupled with a slower than normal rate of shedding the old skin cells (retention hyperkeratosis)   

What are the Causes of Ichthyosis?
Ichthyosis can be inherited or acquired.

The inherited ichthyosis are due to genetic mutations (changes in the genes) and include:
1. Ichthyosis vulgaris
2. Lamellar ichthyosis
3. Epidermolytic hyperkeratosis
4. Congenital ichthyosiform erythroderma
5. X-linked ichthyosis

The acquired ichthyosis develop later on in life and are associated with diseases such as of the kidney and thyroid or the use of medications such as nicotinic acid.

Click here to buy the PDF eBook Ichthyosis.