Melasma is a condition in which areas of the skin become darker than the surrounding skin.

Definition

Melasma is a condition in which areas of the skin become darker than the surrounding skin. Doctors call this hyperpigmentation. It typically occurs on the face, particularly the forehead, cheeks and above the upper lip. The dark patches often appear on both sides of the face in a nearly identical pattern. The darker-colored patches of skin can be any shade, from tan to deep brown. Rarely, these dark patches may appear on other sun-exposed areas of the body.

It occurs much more often in women than in men, and usually is associated with hormonal changes. That is why the dark patches develop often during pregnancy, or if a woman is taking hormone replacement therapy (HRT) or oral contraceptives. Melasma during pregnancy is relatively common. Sometimes it is called the “mask of pregnancy” or “chloasma.” The dark patches typically last until the pregnancy ends.

The most important factor in the development of melasma is exposure to sunlight. Using medications that make you sensitive to the sun (photosensitizing) can increase your risk of developing melasma. These can include some cosmetics and medicines used to treat ovarian or thyroid problems. Protection from the sun is a necessary part of treatment of melasma. For example, women who are pregnant or who take a hormone medication and avoid the sun are less likely to develop melasma than are those who spend a lot of time in the sun.

Melasma

Pathophysiology

The most important factor is exposure to sunlight. UV radiation induces production of alpha-melanocyte–stimulating hormone and corticotropin as well as interleukin 1 and endothelin 1, which contributes to increased melanin production by intraepidermal melanocytes. Prolonged UV exposure-induced dermal inflammation and fibroblast activation upregulate stem cell factors in the melasma dermis, resulting in increased melanogenesis.

Types of Melasma

There are four types of pigmentation patterns include:

  • Epidermal melasma is identified by the presence of excess melanin in the superficial layers of skin.
  • Dermal melasma is distinguished by the presence of melanophages (cells that ingest melanin) throughout the dermis.
  • Mixed melasma includes both the epidermal and dermal type.
  • Excess melanocytes are present in the skin of dark-skinned individuals.

Risk factors

The below points are the risk factors:

  • Sunlight is the greatest risk factor, resulting from exposure to UVA, UVB, and Visible light.
  • Hormonal lead to the production of more melanin pigment, whether through pregnancy, menopause, oral contraceptives, or cosmetics containing hormones.
  • Genetics plays a role in about 50% of cases of people affected by melasma.
  • Malnutrition may be contributing factor because melasma is often found in people with abnormal liver function and vitamin B12 deficiency.
  • Cosmetics containing hydroquinone may cause dark patches.

Generally, shallow pigmentation can happen easily and locate the outer layer of skin so it is easier to treat than deep pigmentation. Try to avoid the risk factors to reduce the risk of developing the condition and reduce the risk of melasma reappearing after fading.

Causes of Melasma

Doctors don’t know the exact causes. It probably happens when the color-making cells in the skin produce too much color. Anyone can get it, but it is more common among young women. The condition is often associated with the female hormones estrogen and progesterone. You are at increased risk of developing melasma if you are a woman who:

  • Takes birth control pills.
  • Takes hormone replacement therapy.
  • It often appears during pregnancy, in the second or third trimesters. It is sometimes called the “mask of pregnancy.”

Being out in the sun for too long and too often also puts you at risk for this condition. It is common in people who live in tropical climates. People who have darker skin are also more likely to get it.

Symptoms

It causes light brown, dark brown, and/or bluish patches or freckle-like spots on your skin. Sometimes the patches can become red or inflamed. It appears in six locations or a combination of locations on your skin:

  • Brachial: The melasma appears on your shoulders and upper arms.
  • Centrofacial: The melasma appears on your forehead, cheeks, nose and upper lip.
  • Lateral cheek pattern: The melasma appears on both cheeks.
  • Malar: The melasma appears on your cheeks and nose.
  • Mandibular: It appears on the jawline.
  • Neck: In people age 50 or older, it can appear on all sides of the neck.

Your healthcare provider will decide for sure if you have melasma or another type of skin disorder.

Melasma complications

There are no known medical complications associated with melasma. It does not carry an increased risk of melanoma or nonmelanoma skin cancers.

  • It can have a severe impact on quality of life due to its visibility.
  • The psychosocial burden of melasma can be an important consideration for many patients. Patients are often quite displeased or distressed with the appearance of melasma and can become frustrated by the challenges of treatment and its tendency to recur if strict preventive measures are not used.
  • Self-image and self-esteem may suffer as a result of this condition.
  • Physicians should be cognizant of this component of evaluating and treating patients with melasma.
  • The Melasma Quality of Life Scale (MelasQOL) is a validated tool to provide quantification of melasma’s impact on a patient’s quality of life. The results do not correlate with the MASI score referenced earlier.

Diagnosis and test

Visual examination

Diagnosis begins with a simple inspection of the area. It can sometimes be apparent just by looking at it, but it can still be helpful to use some additional tools to recommend your best treatment options.

Wood’s lamp

A Wood’s lamp is a special light device that can detect pigmentation in the skin using ultraviolet light (or, black light). The pigmentation brought on by melasma will cause it to stand out under a Wood’s lamp.

Biopsy test

A biopsy usually involves removing a tiny bit of the affected skin so it can be more closely analyzed in a lab. This can sometimes be required because your melasma might look like another skin condition.

Treatment and medications

Melasma can fade on its own. This usually happens when a trigger, such as a pregnancy or birth control pills, causes the melasma. When a woman delivers her baby or stops taking the birth control pills, it can fade.

However, some people have for years, or even a lifetime. If the melasma does not go away or a woman wants to keep taking birth control pills, melasma treatments are available. These include:

Hydroquinone: This medication is a common first treatment for melasma. It is applied to the skin and works to even out your skin tone. Hydroquinone is no longer available without a prescription. If hydroquinone is a good fit for you, your dermatologist can prescribe it.

Tretinoin and corticosteroids: To enhance skin lightening, your dermatologist may prescribe a second medicine. This medicine may be tretinoin or a corticosteroid. Sometimes a medicine contains three medicines (hydroquinone, tretinoin, and a corticosteroid) in one cream. This is often called a triple cream.

Other topical (applied to the skin) medicines: Your dermatologist may prescribe azelaic acid or kojic acid to help reduce melasma.

Procedures: If medicine you apply to your skin does not get rid of your melasma, a procedure may succeed. Procedures for melasma include a chemical peel, microdermabrasion, dermabrasion, laser treatment, or a light-based procedure. Only a dermatologist should perform these procedures.

New skin problems can occur when the person who gives the treatment does not tailor it to the patient’s skin type.

Ask your dermatologist about possible side effects (health problems that can result from the treatment).

If you notice any of the following after getting treatment for melasma, be sure to call your dermatologist:

  • Skin irritation
  • Darkening of the skin
  • Other problems

Prevention of Melasma

The best way to lower your risk for melasma due to sun exposure is to protect your skin from the sun and ultraviolet (UV) light.

Things you can do to lower your exposure to sunlight include:

  • Wear clothing such as hats, long-sleeved shirts, long skirts, or pants.
  • Try to avoid being in the sun during midday, when ultraviolet light is most intense.
  • Use high-quality sunscreens, preferably with a sun protection factor (SPF) rating of at least 30. Pick a broad-spectrum sunscreen that blocks both UVA and UVB light.
  • Apply sunscreen before going out into the sun, and reapply often — at least every 2 hours while in the sun.
  • Use sunscreen year-round, including in the winter.
  • Avoid sun lamps, tanning beds, and tanning salons.

Other things to know about sun exposure:

  • Sun exposure is stronger in or near surfaces that reflect light, such as water, sand, concrete, and areas painted white.
  • Sunlight is more intense at the beginning of the summer.
  • Skin burns faster at higher altitudes.

Rubella is commonly known as German measles or 3-day measles.

Overview – Rubella

Rubella is commonly known as German measles or 3-day measles is an infection that mostly affects the skin and lymph nodes. It is caused by the rubella virus (not the same virus that causes measles).

German measles spreads when people breathe in virus-infected fluid, such as the droplets sprayed into the air when a person with german measles sneezes or coughs, or share food or drink with someone who’s infected. It also can pass through a pregnant woman’s bloodstream to infect her unborn child.

It’s a generally mild disease in children; the primary medical danger of german measles is the infection of pregnant women because it can cause congenital rubella syndrome in developing babies.

Before a vaccine against german measles became available in 1969, german measles epidemics happened every 6-9 years, usually among kids 5 to 9 years old, along with many cases of congenital rubella. Thanks to immunization, there are far fewer cases of rubella and congenital rubella.

Most german measles infections today appear in young, non-immunized adults rather than in kids. In fact, experts estimate that 10% of young adults are currently susceptible to german measles, which could pose a danger to any children they might have someday.

Pathophysiology of Rubella

Postnatal rubella

The usual portal of entry of the rubella virus is the respiratory epithelium of the nasopharynx. The virus is transmitted via the aerosolized particles from the respiratory tract secretions of infected individuals. The virus attaches to and invades the respiratory epithelium. It then spreads hematogenously (primary viremia) to regional and distant lymphatics and replicates in the reticuloendothelial system. This is followed by a secondary viremia that occurs 6-20 days after infection. During this viremic phase, the rubella virus can be recovered from different body sites including lymph nodes, urine, cerebrospinal fluid (CSF), conjunctival sac, breast milk, synovial fluid, and lungs. Viremia peaks just before the onset of rash and disappear shortly thereafter. An infected person begins to shed the virus from the nasopharynx 3-8 days after exposure for 6-14 days after onset of the rash.

Congenital rubella syndrome

Fetal infection occurs transplacentally during the maternal viremic phase, but the mechanisms by which the rubella virus causes fetal damage are poorly understood. The fetal defects observed in congenital rubella syndrome are likely secondary to vasculitis resulting in tissue necrosis without inflammation. Another possible mechanism is direct viral damage to infected cells. Studies have demonstrated that cells infected with german measles in the early fetal period have reduced mitotic activity. This may be the result of chromosomal breakage or due to the production of a protein that inhibits mitosis. Regardless of the mechanism, any injury affecting the fetus in the first trimester (during the phase of organogenesis) results in congenital organ defects.

Causes of Rubella

German measles is caused by a virus that is spread through the air or by close contact.

A person with german measles may spread the disease to others from 1 week before the rash begins, until 1 to 2 weeks after the rash disappears.

Because the measles-mumps-rubella (MMR) vaccine is given to most children, german measles is much less common now. Almost everyone who receives the vaccine has immunity to German measles. Immunity means that your body has built a defense against the rubella virus.

In some adults, the vaccine may wear off. This means they are not fully protected. Women who may become pregnant and other adults may receive a booster shot.

Children and adults who were never vaccinated against german measles may still get this infection.

Who is at risk for German measles?

Most cases of German measles occur in people who live in countries that don’t offer routine immunization against german measles.

The rubella vaccine is usually given to children when they’re between 12 and 15 months old, and then again when they’re between ages 4 and 6. This means that infants and young toddlers who haven’t yet received all vaccines have a greater risk of getting German measles.

To avoid complications during pregnancy, many women who become pregnant are given a blood test to confirm immunity to German measles. It’s important to contact your doctor immediately if you’ve never received the vaccine and think you might have been exposed to German measles.

Symptoms of Rubella

Rubella means “little red” and the disease features a red rash, “rubella” is Latin for “little red.”

Symptoms normally appear 14 to 21 days after infection.

The rash often starts on the face and moves to the trunk and limbs. After 3 to 5 days, it fades and disappears. It can be itchy.

Other symptoms include:

  • A stuffy or runny nose
  • Headache
  • A mild fever
  • Red, inflamed eyes
  • Nerve inflammation
  • Enlarged and tender lymph nodes
  • Aching joints

Though the infection can happen at any age, german measles rarely affects young infants or people over 40 years. A person who is infected with German measles at an older age will normally have more severe symptoms.

Complications

Up to 70% of women who get german measles may experience arthritis; this is rare in children and men. In rare cases, german measles can cause serious problems, including brain infections and bleeding problems.

The most serious complication from german measles infection is the harm it can cause a pregnant woman’s developing baby. If an unvaccinated pregnant woman gets infected with the rubella virus she can have a miscarriage, or her baby can die just after birth. Also, she can pass the virus to her developing baby who can develop serious birth defects such as:

  • Heart problems,
  • Loss of hearing and eyesight,
  • Intellectual disability, and
  • Liver or spleen damage.

Serious birth defects are more common if a woman is infected early in her pregnancy, especially in the first trimester. These severe birth defects are known as congenital rubella syndrome (CRS).

Complications are rare with german measles in healthy infants.  Complications can include:

  • Arthralgia or arthritis in adults
  • Thrombocytopenic purpura
  • Otitis media

Diagnosis and Test?

If a woman is pregnant and she may have come into contact with german measles, she should see a doctor at once.

It is best to call the doctor’s office first, as they may wish to schedule an appointment at a time when there is the least chance of passing the virus on.

If there are no symptoms, a diagnosis is made by testing a saliva or blood sample. If IgM antibodies are present, this may indicate a new german measles infection.

If IgG antibodies are present, they indicate that a german measles infection has either been present in the past or the individual has already been vaccinated.

If neither antibody is present, the individual does not carry the virus and has never been immunized.

Treatment

No treatment will shorten the course of rubella infection, and symptoms are often so mild that treatment usually isn’t necessary. However, doctors often recommend isolation from others — especially pregnant women — during the infectious period.

If you contract German measles while you’re pregnant, discuss the risks to your baby with your doctor. If you wish to continue your pregnancy, you may be given antibodies called hyperimmune globulin that can fight off the infection. This can reduce your symptoms, but doesn’t eliminate the possibility of your baby developing congenital rubella syndrome.

Support of an infant born with congenital rubella syndrome varies depending on the extent of the infant’s problems. Children with multiple complications may require early treatment from a team of specialists.

Lifestyle and home remedies

In rare instances when a child or adult is infected with German measles, simple self-care measures are required:

  • Rest in bed as necessary.
  • Take acetaminophen (Tylenol, others) to relieve discomfort from fever and aches.
  • Tell friends, family, and co-workers — especially pregnant women — about your diagnosis if they may have been exposed to the disease.
  • Avoid people who have conditions that cause deficient or suppressed immune systems.
  • Tell your child’s school or child care provider that your child has German measles.

Prevention

  • Exclude people with german measles from childcare, preschool, school, and work until fully recovered or for at least 4 days after the onset of the rash.
  • Rubella is best prevented by the measles, mumps and
  • Rubella (MMR) combination vaccine or the measles, mumps, German measles, and varicella (MMRV) combination vaccine. Most people who have two doses of a rubella-containing vaccine will be protected against German measles infection.
  • Vaccination after exposure will not prevent infection.
  • All health care and childcare staff (men and women) should be assessed for immunity to German measles and if not immune, should be immunized.
  • Anyone with suspected german measles should consult a doctor both to check that the diagnosis is correct and so that contacts (in particular, pregnant women) can be advised. A contact is any person who has been close enough to an infected person to be at risk of having acquired the infection from that person.

Pregnant women

In addition to the above prevention points, all pregnant women:

  • Should be tested for immunity to German measles prior to, or during early pregnancy. If found not to be immune, MMR vaccination is given after delivery of the baby but before discharge from the maternity unit. Rubella vaccine should not be given to a woman known to be pregnant and pregnancy should be avoided for one month after vaccination.
  • With suspected german measles or exposure to german measles should seek specialist obstetric advice, regardless of a history of german measles or rubella vaccination. german measles re-infection, often without symptoms, can occur in individuals who have had previous infection or vaccination, although fetal damage is very rare in these cases.

The vaccine to prevent german measles

Getting vaccinated is the best way to prevent german measles. And when enough people get vaccinated against German measles, the entire community is less likely to get it. So when you and your family get vaccinated, you help keep yourselves and your community healthy.

There are 2 vaccines that can prevent german measles:

  • The MMR vaccine protects children and adults from German measles and mumps
  • The MMRV vaccine protects children from german measles, measles, mumps, and chickenpox

Who needs to get the rubella vaccine?

All children need to get the vaccine — and some adults may need it, too.

Children: Children ages 1 through 6 years need to get the rubella vaccine as part of their routine vaccine schedule.

Children need 2 doses of the vaccine at the following ages:

  • 12 through 15 months for the first dose
  • 4 through 6 years for the second dose (or sooner as long as it’s 28 days after the first dose)

Children ages 1 through 12 years can get the MMRV vaccine, which is a combination vaccine. The MMRV vaccine protects against measles, mumps, rubella, and chickenpox. Your child’s doctor can recommend the vaccine that’s right for your child.

Adults: Adults may need to get the rubella vaccine if they didn’t get it as a child. In general, everyone age 18 and older born after 1956 who has not had rubella needs at least 1 dose of the rubella vaccine.

What are the side effects of the rubella vaccine?

Side effects are usually mild and go away in a few days. They may include:

  • Fever
  • Mild rash
  • Swollen glands in the cheeks or neck

Less common side effects of the vaccine include:

  • Pain or stiffness in the joints, usually in women (up to 1 person out of 4)
  • Seizures (sudden, unusual movements or behavior) from having a high fever (about 1 out of every 3,000 doses)
  • Temporary (short-term) low platelet count (about 1 out of every 30,000 doses)

Like any medicine, there’s a very small chance that the german measles vaccine could cause a serious reaction.

Alopecia areata, also known as spot baldness, is an autoimmune disease in which hair is lost from some or all areas of the body.

Definition

Alopecia areata, also known as spot baldness, is an autoimmune disease in which hair is lost from some or all areas of the body. Usually, the hair loss occurs from the scalp due to the body’s failure to recognize its own body cells and subsequent destruction of its own tissue as if it were an invader.

It usually causes small, coin-sized, round patches of baldness on the scalp, although hair elsewhere such as the beard, eyebrows, eyelashes, body, and limbs can be affected. Occasionally it can involve the whole scalp (alopecia totalis) or even the entire body and scalp (alopecia universalis). It is not possible to predict how much hair will be lost. Regrowth of hair in typical alopecia areata is usually over a period of months or sometimes years, but cannot be guaranteed. The hair sometimes regrows white, at least in the first instance. Further hair loss is not uncommon. In alopecia totalis and alopecia universalis, the likelihood of total regrowth is less.

Epidemiology

Androgenic alopecia is the most common cause of hair loss in males. The overall incidence in Caucasian men may be as high as 96% or more, but the exact prevalence is unknown. Estimates should include the ages for which the estimate has been generated and the degree of hair loss. Caucasian men aged 20 to 40 years have bitemporal recession in 62% of cases. In men aged 18 to 49 years, the incidence of hair loss measured as type III or greater on the well-accepted Hamilton-Norwood hair loss rating scale is estimated to be at least 42%. Within the ages 40 to 49 years, however, 53% are estimated to have moderate-to-extensive hair loss.

Types of alopecia areata

Alopecia areata (patchy)

Alopecia areata (patchy) is the form with one or more coin-sized (usually round or oval) patches on the scalp or other places on the body that grow hair. This type may convert into either alopecia totalis (hair loss across the entire scalp) or alopecia universalis (hair loss across the entire body), but most commonly it remains patchy.

Persistent patchy alopecia areata

Persistent patchy alopecia areata is characterized by patchy scalp hair loss that continues over a long period of time without ever developing into extensive alopecia areata such as totalis or universalis.

Alopecia totalis

Alopecia totalis results in hair loss across the entire scalp.

Alopecia universalis

Alopecia universalis is more advanced than alopecia totalis. This type results in hair loss across the entire scalp and face (including eyebrows and eyelashes), plus the rest of the body (including pubic hair).

Other forms of alopecia areata

Diffuse alopecia areata

Diffuse alopecia areata results in sudden and unexpected thinning of the hair all over the scalp. It can be hard to diagnose because it looks a lot like other forms of hair loss such as telogen effluvium or male or female pattern hair loss.

Ophiasis alopecia

Ophiasis alopecia areata has a unique pattern of hair loss, which includes the sides and lower back of the scalp (called the occipital region) in the shape of a band. Ophiasis alopecia areata can be more difficult to treat because it does not respond as quickly to medication.

Risk factors

Genetics: If your parents have the history of alopecia or any atopic disorder, you are at a high risk of suffering from Alopecia Areata. The family history of autoimmune disorders like SLE, RA, etc. also elevate the risk of developing Alopecia during your lifetime.

Hair care and styling: Use of the harsh chemical through shampoos, hair coloring products or hair styling habits like using hair dryers can also increase the likelihood of Alopecia since these are found to be stressful to your hair & scalp.

Stress: Any exposure to unusual stressful factors like extreme weather conditions, etc. Emotional stress leading to use of anti-depressants or other medication increase the probability of getting Alopecia disorder.

Vaccination: Sometimes, particularly in children Alopecia is seen to develop post vaccination.

Viral infections: Viral infections can trigger alopecia areata.

Vit D deficiency: A study confirms that individuals with low levels of Vit D are at high risk of developing alopecia.

Causes of alopecia areata

  • So tiny cells in the immune system, called T cells, gather around the base of a hair follicle and try to kill it. This causes the hair to fall out. But at some point, the immune attack must come to an end and the hair grows back.
  • Alopecia areata can be triggered by a recent illness, like a viral infection, or by taking certain medications for other medical conditions. Some people can link the onset of their alopecia to a stressful life event, but many can’t. Sometimes it seems to run in families and it has been known to come on in twins at the same time. More often than not, no cause is found at all.
  • If you have alopecia areata you also have a slightly higher-than-average chance of developing other autoimmune diseases such as thyroid disorders, pernicious anemia and vitiligo. Your doctor may wish to check for these if there are any signs of them along with the hair loss.

Symptoms

There are different Alopecia causes, but there are certain common signs and symptoms which can lead you to find an Alopecia Areata cure.

  • Sudden loss of hair is defined, usually small round patches in the beginning. Coin-sized patches of hair begin to fall.
  • Excessive hair-fall even on touch, or clumps of hair left on the pillow or in the shower.
  • Bald patches spread rapidly, and hair growth may be affected in other body areas including eyelashes and beard, for example.
  • A burning sensation or crawling sensation or itching on the scalp or the body area before hair loss.
  • Chronic or extensive alopecia sometimes can be associated with pitting of nails.

Complications of alopecia areata

  • Alopecia areata patients are at risk for psychosocial consequences of their disease, such as depression and anxiety.
  • They should be assessed for atopy, vitiligo, thyroid disease, and other autoimmune conditions.

Diagnosis and test

Generally, dermatologist treats alopecia areata. They are doctors who specialize in the diagnosis and treatment of problems related to skin, its structure, functions, and diseases, as well as its peripheral (nails, hair, sweat glands). Hair loss alone should not be considered to diagnose alopecia areata. There are other types of diseases as well that might cause hair to fall out similar to alopecia areata

The typical diagnosis procedure includes Hair analysis and Blood tests

Hair analysis

  • Doctors might examine a few hair samples using a microscope
  • Doctors might also perform a scalp biopsy to ensure that hair loss is not due to other conditions including fungal infections
  • As part of scalp biopsy, doctors might even remove a small piece of skin on the scalp for a more detailed analysis

Blood tests

  • If other autoimmune conditions are suspected for hair, then doctors might suggest blood tests to be done
  • Doctors would like to test for the presence of one or more abnormal antibodies because if these autoantibodies are found in the blood, it confirms that there is an autoimmune disorder in the body
  • There are other blood tests that can be of help to rule out hair loss due to other conditions like the antinuclear antibody test, testing the iron levels and thyroid hormones test

Treatment and medications

There is not yet any reliable cure for alopecia areata and other forms of autoimmune hair loss. Because spontaneous regrowth is common in alopecia areata, and research has often been of poor quality, the effectiveness of reported treatments is mostly unknown.

Topical treatments

Several topical treatments used for alopecia areata are reported to result in temporary improvement in some people. Their role and efficacy are unknown. The hair may fall out when they are stopped. These include:

  • Potent or ultrapotent topical steroids
  • Minoxidil solution or foam
  • Dithranol (anthralin) ointment

Intralesional corticosteroid injections

Injections of triamcinolone acetonide 2.5–10 mg/ml into patchy scalp, beard or eyebrow alopecia areata may speed up regrowth of hair. Its effect is temporary. If bald patches reappear, they can be reinjected.

Systemic corticosteroids

Oral and pulse intravenous steroids in high dose can lead to temporary regrowth of hair. Most physicians agree that long-term systemic steroid treatment is not justified because of potential and actual adverse effects.

Immunotherapy

The sensitizing agent’s diphenylcyclopropenone (diphencyprone) and dinitrochlorobenzene provoke contact allergic dermatitis in treated areas. These sensitizers can be reapplied once weekly to bald areas on the scalp. The resultant dermatitis is irritating and may be unsightly. It is often accompanied by a swollen lymph gland.

Other treatments

A combination of the lipid-lowering agent’s simvastatin and ezetimibe (which have immunomodulating effects) has been reported to be effective.

There is no convincing data to support the use of methotrexate, sulfasalazine, azathioprine, ciclosporin or phototherapy.

JAK inhibitors

Several patients with severe alopecia areata have had improvement when treated with oral tofacitinib or oral ruxolitinib, which are Janus kinase (JAK) inhibitors. It is thought they may act by blocking interleukin (IL)-15 signaling. Watch out for the results of clinical trials of these biologic medicines.

Prevention of alopecia areata

The condition cannot be prevented or avoided. The cause is unknown and varies by person. Alopecia areata is not tied to stress, as some people believe. Some people have a family history of alopecia areata. Having a family member with alopecia areata and another immune system disease can raise your risk of having it. Other immune system diseases include type 1 diabetes, rheumatoid arthritis, thyroid disease, lupus,  Addison’s disease, and atopic dermatitis. It is rare for a parent to pass the condition onto a child.

Capgras syndrome is a psychological condition that is characterized by a belief that a particular person has been replaced by an imposter.

Definition

Capgras syndrome is a psychological condition that is characterized by a belief that a particular person has been replaced by an imposter. This bizarre belief may lead one to acrimoniously accuse a friend or spouse of being “a fake” or an “imposter” of the actual person.

As you can imagine, capgras syndrome causes great discord and anxiety in the lives of not only the person suffering from it but also from the person being accused as well. This syndrome is sometimes called the “imposter syndrome” or “capgras delusion”.

There is really no limit to what someone with this syndrome will accuse as being an impostor. In fact, according to the health line, in some specific cases, someone who is experiencing capgras syndrome may actually believe that an inanimate object, an animal, or even a home is an imposter. It has been shown that this syndrome can affect anyone. However, it’s more common in women, and in rare cases, it can affect children also.

History

It is named after Joseph Capgras (1873-1950), a France|French psychiatrist who first described the disorder in a 1923 paper by Capgras and Reboul-Lachaux. They used the term  l’illusion des sosies (the illusion of doubles) to describe the case of a French woman who complained that various “doubles” had taken the place of people she knew. However, the term illusion has a subtly different meaning from delusion in psychiatry so “the Capgras delusion” is used as a more suitable name.

Epidemiology

Though more common in women than in men, this syndrome is most definitely possible in anyone and has even been known to affect children in some rare cases. Overall, however, the disorder is considered to be quite rare with approximately 1.3% of people suffering from it in any given year. In the general population, approximately 1.8% of females and 0.9% of males are believed to have the disorder, whether diagnosed or undiagnosed. Unfortunately, it’s a disorder with very poor treatment results and outcomes.

Causes of Capgras Syndrome

  • The exact cause of Capgras syndrome is not known, but there are a number of theories. Some researchers believe it is caused by problems within the brain such as atrophy, lesions, or cerebral dysfunction. Some others believe that it’s a combination of physical and cognitive changes.
  • However, it is commonly associated with Alzheimer’s disease or dementia, affecting memory and the sense of reality. Episodes of Capgras syndrome can also be experienced by people with schizophrenia.
  • In rare cases, the syndrome can also be caused due to a brain injury especially in the back of the right hemisphere of the brains that processes facial recognition. Also, people with epilepsy may experience the syndrome in rare cases.

Symptoms

  • Though Capgrass Syndrome has been linked to several different physiological disorders it has been seen most commonly in people who have Paranoid Schizophrenia or in individuals who have Dementia.
  • Those who have Capgras Syndrome are found to be in a delusional, almost neurotic state and are typically non-responsive to any caregiver.
  • They also tend to be very hyper active and very anxious, which can cause a great amount of stress on both the afflicted and those around them, as stated by PhychCentral.
  • Individuals that have Body Dementia are the ones who are most often the ones who develop this condition, Body Dementia is a common form of dementia that shares characteristics with both Alzheimer’s and Parkinson’s diseases.
  • Since Lewy Body Dementia (LBD) symptoms resemble other diseases, it can be especially challenging to diagnose correctly.

Diagnosis of Capgras Syndrome

Because it is a rare and poorly understood condition, there is no definitive way to diagnose the Capgras delusion. Diagnosis is primarily made on the psychological evaluation of the patient, who is most likely brought to a psychologist’s attention by a family member or friend believed to be an imposter by the person under the delusion.

Treatment and medications

Currently, there is no standard treatment for people affected by Capgras syndrome, and more research is needed to find the most effective way it can be treated.

In some cases, treating the underlying condition can reduce or cure someone’s symptoms. For example, controlling or treating Alzheimer’s disease may improve the symptoms of Capgras syndrome.

Treatments for underlying conditions vary widely, but may include:

  • Antipsychotics
  • Therapy
  • Surgery
  • Memory and recognition medications

In some cases, validation therapy may be useful. Validation therapy focuses on someone accepting the misidentification to help them relax and reduce anxiety.

In other cases, caregivers and facilities may actively attempt to ground the person in reality, as far as they can, by giving frequent reminders of the time and place.

Caregivers and family members can also assist by providing a safe and comfortable space free from external stressors, as much as possible.

Some general tips for caring for someone with Capgras syndrome include:

  • Being patient and sympathizing, as Capgras syndrome can cause real fear and anxiety.
  • Limiting exposure to the “imposter” when an episode is taking place.
  • Having the “imposter” speak before they are seen, as their voice may be recognized.
  • Acknowledging the feelings surrounding the identity confusion when they occur.
  • Not arguing with the person about the “imposter” they think they are seeing.

How to Take Care of Someone Who Has Capgras Syndrome

A caregiver who has to deal with a patient with Capgras Syndrome may feel frustrated, especially if they are the ones who are viewed as the impostor.  Aging Care gives some tips to be able to assist the individual who is suffering from it. These are ways in which a person can help a Capgras Syndrome patient:

Accept their feelings and concerns.

Instead of negating their view, the caregiver should show that they understand what the patient is feeling and that it is all right for them to feel that way. Instead of correcting their perception of reality, they should try to picture themselves in the same situation.

Create a secure and emotional attachment.

The caregiver should also remind them how much they and the ‘impostor” loves them. If the person suffering from Capgras Syndrome has the belief that the “impostor” is trying to hurt them or steal from them, they should be constantly reassured that the said “impostor” would not do those things.

Depend on sound interactions.

It is revealed that patients with Capgras Syndrome have a hard time visually connecting to their loved ones. A better alternative to having face-to-face visits with the patient is talking to them by telephone. The person who wishes to interact with the patient may also talk to the patient personally, as long as they are out of the patient’s line of sight. The person identified as an impostor can announce their arrival before the patient is able to see them. Doing this will aid in making an emotional bond and starting a conversation as the visitor appears gradually within their vision. This can also help the patient positively recognize their loved one.

Here are some more tips for caregivers

  • Acknowledge their feelings: Say things like “I know this is upsetting and am sorry this is happening to you.”
  • Stay emotionally connected: Say things like “I care about you and you are safe here.”
  • Send the imposter away: Once the “imposter” has left the room, continue to reiterate that you have sent them away and your loved one is safe. Keep engaging warmly and emotionally.
  • Connect through sound: The “imposter” can say things right outside the door, out of sight, like: “Hi honey, I’m home. What smells so great? I can’t wait to have dinner with you,” etc. This ensures a positive identification of the “real” person via an emotional connection.
  • Don’t argue and prove the person wrong. Accept that the person afflicted by this syndrome absolutely believes their spouse, friend or other caregiver is an imposter. Trying to prove them wrong is like trying to convince them the sky is not blue.
  • Your hospice care provider can work with you as the family member on a daily basis in reinforcing these approaches.

Prognosis of Capgras Syndrome

  • Some people with Capgras syndrome may never achieve a full recovery. However, caregivers and family members can help reduce their loved one’s symptoms, including anxiety and fear.
  • Anyone experiencing or witnessing the symptoms of Capgras syndrome should speak to a doctor as soon as possible.

Granuloma inguinale or Donovanosis is a genital ulcerative disease caused by the intracellular gram-negative bacterium Klebsiella granulomatis.

Description

Granuloma inguinale or Donovanosis is a genital ulcerative disease caused by the intracellular gram-negative bacterium Klebsiella granulomatis (formerly known as Calymmatobacterium granulomatis). The disease occurs rarely in the United States, although it is endemic in some tropical and developing areas, including India; Papua, New Guinea; the Caribbean; central Australia; and southern Africa.

Clinically, the disease is commonly characterized as painless, slowly progressive ulcerative lesions on the genitals or perineum without regional lymphadenopathy; subcutaneous granulomas (pseudobuboes) also might occur. The lesions are highly vascular (i.e., beefy red appearance) and bleed. Extragenital infection can occur with extension of infection to the pelvis, or it can disseminate to intra-abdominal organs, bones, or the mouth. The lesions also can develop secondary bacterial infection and can coexist with other sexually transmitted pathogens.

Pathophysiology of Granuloma Inguinale

The intracellular organism responsible for granuloma inguinale was initially described by Donovan over a century ago, and subsequently, the bacterium was classified in 1913 as Calymmatobacterium granulomatis. Although Anderson suggested that the organism be eponymously named Donovania granulomatosis, Carter et al discovered that the molecular structure of the causative organism was similar to Klebsiella species and reclassified the gram-negative pleomorphic bacillus as Klebsiella granulomatis.

The mode of transmission of granuloma inguinale primarily occurs through sexual contact; however, it is hypothesized to have low infectious capabilities because repeated exposure is necessary for clinical infection to occur. Additionally, granuloma inguinale may also be obtained through the fecal route or by passage through an infected birth canal.

Transmission

Granuloma Inguinale is generally considered to be transmitted via sexual contact, but not always and could be transmitted by close personal contact or faecal contamination. Infections that cause ulcers and sores around the genitals may increase the risk of HIV transmission. Other causes of ulcers or sores need to be considered, before a diagnosis is made.

Causes and risk factors

  • Granuloma inguinale (Donovanosis) is caused by the bacterium Klebsiella granulomatis.
  • The disease is commonly found in tropical and subtropical areas such as southeast India, Guyana, and New Guinea.
  • There are about 100 cases reported per year in the United States. Most of these cases occur in people who have traveled to or are from places where the disease is common.
  • The disease spreads mostly through vaginal or anal intercourse. Very rarely, it spreads during oral sex.
  • Most infections occur in people ages 20 to 40.

Symptoms of Granuloma Inguinale

Symptoms can occur 1 to 12 weeks after coming in contact with the disease causing bacteria.

These may include:

  • Sores in the anal area in about half of the cases.
  • Small, beefy-red bumps appear on the genitals or around the anus.
  • The skin gradually wears away, and the bumps turn into raised, beefy-red, velvety nodules called granulation tissue. They are often painless, but they bleed easily if injured.
  • The disease slowly spreads and destroys genital tissue.
  • Tissue damage may spread to the groin.
  • The genitals and the skin around them lose skin color.

In its early stages, it may be hard to tell the difference between donovanosis and chancroid.

In the later stages, donovanosis may look like advanced genital cancers, lymphogranuloma venereum, and anogenital cutaneous amebiasis.

Possible Complications

Health problems that may result from this disease include:

  • Genital damage and scarring
  • Loss of skin color in genital area
  • Permanent genital swelling due to scarring

Diagnosis of Granuloma Inguinale

Microscopic examination

Microscopic examination showing Donovan bodies in fluid from a lesion. Granuloma inguinale is suspected in patients from endemic areas with characteristic lesions. Diagnosis of granuloma inguinale is confirmed microscopically by the presence of Donovan bodies (numerous bacilli in the cytoplasm of macrophages shown by Giemsa or Wright stain) in smears of fluid from scrapings from the edge of lesions. These smears contain many plasma cells.

Biopsy

Biopsy specimens are taken if the diagnosis is unclear or if adequate tissue fluid cannot be obtained because lesions are dry, sclerotic, or necrotic. The bacteria do not grow on ordinary culture media.

Treatment Options for Granuloma Inguinale

Antibiotic choices are based on small series and clinical experience. Durations of therapy, as noted, should be taken as estimates and lesions should, in general, be treated until resolution.

  • Azithromycin, 1g orally per week for at least 3 weeks, or until healing is complete (Centers for Disease Control [CDC] guidelines)
  • Azithromycin, 1g initially, then 500mg daily until healing is complete (World Health Organization [WHO] guidelines)
  • Docycycline, 100 mg twice daily for at least 3 weeks, or until lesions have healed
  • Ciprofloxacin 750mg daily for at least 3 weeks, or until healing is complete
  • Trimethoprim-sulfamethoxazole (160mg/800mg), twice daily for at least 3 weeks, or until healing is complete
  • Erythromycin base, 500mg four times a day for at least 3 weeks, and until all lesions have healed

In the pregnant patient or those coinfected with HIV, adding a parenterally administered aminoglycoside such as gentamycin should be considered. Parenteral gentamycin should be considered in patients slow to respond to therapy. Surgical debridement may be needed in cases of extensive fibrotic or invasive lesions

Prevention of Granuloma Inguinale

The following general measures can help prevent granuloma inguinale (and other sexually transmitted diseases):

  • Regular and correct use of condoms
  • Avoidance of unsafe sex practices, such as frequently changing sex partners or having sexual intercourse with prostitutes or with partners who have other sex partners
  • Prompt diagnosis and treatment of the infection (to prevent spread to other people)
  • Identification of the sexual contacts of infected people, followed by counseling or treatment of these contacts
  • Not having sex (anal, vaginal, or oral) is the most reliable way to prevent sexually transmitted diseases but is often unrealistic.

Amazing armless woman who does everything with the support of her leg.

Life is full of surprises, meet this amazing pretty young woman without hand.

She does everything with the support of her leg.

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EFCC arraigned former bank PHB director for alleged fraud of N26.6 billion.

According to TVC news, it was gathered that the Economic and Financial Crime Commission(EFCC) have arraigned the former Bank PHB director.

Mr. Funmi Adenmosun before a federal high court sitting in Lagos state for alleged money laundering of N26.6 billion.

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HURIWA has charged IGP and DSS to investigate a secret gas chamber in Ebonyi state.

It was gathered that Human Rights Writers Association of Nigeria (HURIWA), has charged Inspector General of Police (IGP), Usman Alkali Baba and Director-General of the Department of State Services (DSS), Yusuf Magaji Bichi, to investigate a secret gas chamber in Ebonyi State.

It alleged that the five engineers, who were hired by the African Development Bank (AfDB) for a road Project in Ebonyi State disappeared three months ago without trace.

HURIWA the Ebonyi State Police Command of incompetence and complicity to conceal facts on the disappearance of the five engineers, but who were declared dead by the Ebonyi State government.

In a statement issued, yesterday, in Abuja by its National Coordinator, Emmanuel Onwubiko, HURIWA said the police in Abuja, especially in the office of the IGP should investigate the incident and reorganise the Ebonyi State Police Command working on the whims and caprices of the governor.

The rights group asked that the Ebonyi State Commissioner for Information, Orji Uchenna Orji, who issued a statement on the missing engineers, should be investigated.

It is so that the law enforcement agencies can have additional intelligence that may assist to determine what happened to the engineers, whose families and children do not know their whereabouts since they travelled for work in Ebonyi State for three months now, it stated.

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Ghana police arrest five man gang armed robbery led by a military man.

Homepage gathere that Five robbery gangs led by a military man at the Burma Camp in Accra are in the grips of the Northern regional police in Tamale for alleged armed robbery.

The suspects, Ibrahim Issah, 27, Contractor from Accra, Mohammed Mustapha, 23, a soldier attached to Burma Camp, and Vivor Christopher, 27, phones repairer.

The remaining suspects are Benjamin Agyei, 23, a mobile money vendor from Accra, and Seyram Addo, 29, a Plumber from Danfa near Madina in Accra.

The suspects were reportedly arrested by Buipe Highway Patrol Team for robbing a 2020 Toyota Camry vehicle and other properties from its owner at his residence and fled.

Per police sitrep sighted by DGN Online, the suspects on January 23, 2022, said police received information about the attack and robbery by the suspects who fled towards Buipe direction.

The Buipe Highway Patrol Team on duty at Sawaba Police checkpoint on Buipe Tamale highway was alerted who intercepted and arrested the suspects in two vehicles with registration numbers AS8445-19 and GX6923-20 in connection with the crime and sent them to the Buipe Police Station.

Police retrieved from the suspects 13 assorted mobile phones, one Falcon Foreign Pistol loaded with 9mm ammunition, a wallet containing a bunch of keys together with two handcuffs keys, two Voter’s ID Cards, Melcom card, Access Bankcard, and a cash sum of GHC21.20p.

Other items such as some Military uniforms, Police Ballistic helmets, and police uniforms were also found in the Toyota Camry Spider with registration number GX6923-20.

Police have therefore retained the items while the suspects have been detained after the victim had identified one of the vehicles the suspects were using as his, taken from him at gunpoint, and other items at his residence at Banvim-Jonshegu a suburb of Tamale.

Meanwhile, the Regional Police Headquarters, Tamale has taken over the investigation and prosecution of the case.

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