Skin diseases & Corticosteroids

Skin diseases:

Adults & Pediatric

Eczema
Urticaria
Drug Eruption
Angioedema
Erythema multiform
Psoriasis

Pediatric

Miliaria 'Miliaria crystallina or sudamina is caused by obstruction of the sweat ducts close to the surface of the skin and appears as tiny superficial clear blisters that break easily.'

Infantile Atopic dermatitis
Seborrhic dermatitis
Pityriasis Rosea
Diaper rash
Candida dermatitis
Irritant dermatitis

Skin tests:

Intradermal test

Similar to a tuberculosis test.During this test, a small amount of the allergen solution is injected into the skin.
An intradermal allergy test may be done when a substance does not cause a reaction in the skin prick test but is still suspected as an allergen for that person.
The intradermal test is more sensitive than the skin prick test but is more often positive in people who do not have symptoms to that allergen (false-positive test results).
Intradermal Test

Patch test

For a skin patch test, the allergen solution is placed on a pad that is taped to the skin for 24 to 72 hours.
This test is used to detect a skin allergy called contact dermatitis.
Patch test

Scratch test

Also known as a puncture or prick test. 
This test is done by placing a drop of a solution containing a possible allergen on the skin, and a series of scratches or needle pricks allows the solution to enter the skin.
If the skin develops a red, raised itchy area (called a wheal), it usually means that the person is allergic to that allergen.
This is called a positive reaction.
Scratch Test

SCORAD index (Severity Scoring of Atopic Dermatitis)
Extent criteria (A)
Intensity criteria (B)
Subjective symptoms (C)
SCORAD index :A/5 + 7 x B/2 + C =

Extent criteria:
The rule of 9  Grading in practice : It is advisable to draw lesion spread directly on the evaluation sheet and then perform the calculation.

Intensity criteria:

Subjective symptoms:
The two most representative items concerning the quality of life of patients are : Pruritus and Insomnia .

Corticosteroids

What is Cortisol?
Cortisol is a steroid hormone, in the glucocorticoid class of hormones, and is produced in humans by the zona fasciculata of the adrenal cortex within the adrenal gland. It is released in response to stress and low blood-glucose concentration

Pharmacological action:

Direct (Intended) Actions

Anti-inflammatory
Anti-allergy
Anti-immunity

Permissive Actions

Lipolytic effects
Effect on blood pressure Effect on bronchial muscles (e.g.,sympathomimetic amine)

Cortisol secretion:

The synthesis of cortisol in the adrenal gland is stimulated by the anterior lobe of the pituitary gland with adrenocorticotropic hormone (ACTH); ACTH production is in turn stimulated by corticotropin-releasing hormone (CRH), which is released by the hypothalamus.

Cortisol increase side effect:

Elevated cortisol level is found in many diseases, including infectious, aging-related, depression and depression -associated conditions; even in some with no known origin.
While it was initially thought that a high level is the result of these diseases, there is mounting evidence to the contrary, namely, that high cortisol actually plays a major role in inducing them, opening the possibility that anti cortisol drugs might represent a new beneficial therapy.
High levels for prolonged periods leads to fat deposition and often belly fat.
Hair analysis can reveal if seniors have elevated stress hormone levels that may put them at increased risk for heart disease and stroke.
Unlike a blood test that provides information about stress hormone levels at a single point in time, analysis of a strand of hair can reveal trends in levels of the stress hormone cortisol over several months, higher long-term levels are more likely to cause heart disease.

Addison Syndrome

Addison's disease is a disorder that occurs when your body produces insufficient amounts of certain hormones produced by your adrenal glands. In Addison's disease, your adrenal glands produce too little cortisol and often insufficient levels of aldosterone as well.
The image taken from the "Nursing Eduction Consultant Inc."

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