Text C. Localized Scratch Dermatitis

Localized scratch dermatitis (lichen simplex chronicus, neurodermatitis) is a chronic, itchy inflammation of the top layer of the skin. It causes dryness, scaling, and dark, thickened patches that have oval, irregular, or angular shapes.

The cause is unknown, but psychologic factors may play a role. The condition doesn’t seem to be allergic. More women than men have localized scratch dermatitis, and it’s common among Asians and Native Americans. It usually develops between ages 20 and 50.

Symptoms and diagnosis

Localized scratch dermatitis can occur anywhere on the body, including the anus (pruritus ani) and the vagina (pruritus vulvae). In the early stage the skin looks normal, but it itches. Later, dryness, scaling, and dark patches develop as a result of the scratching and rubbing.

Doctor try to discover the possible psychologic stress or underlying allergies or diseases that may be causing the initial itching. When the condition occurs around the anus or vagina, the doctor may investigate the possibility of pin-worms, trichomoniasis, hemorrhoids, local dis­charges, fungal infections, warts, contact derma­titis, or psoriasis as the cause.

Treatment

For the condition to clear up, the person must stop the scratching and rubbing that's irritating the skin. To help control the itching, doctors pre­scribe antihistamines to be taken by mouth and corticosteroid creams to be rubbed gently on the affected area. Surgical tape saturated with a corticosteroid provides a therapeutic drug and prevents the person from scratching. The doctor may inject longer-acting corticosteroids under the skin to control the itching. Other medications to control itching, such as hydroxyzine or doxepin, may also help some people.

When this condition develops around the anus or vagina, the best treatment is corticosteroid cream. Zinc oxide paste may be applied over the cream to protect the area; the paste can be removed with mineral oil. Hard rubbing with toilet paper after a bowel movement can aggravate the condition.

Notes:

scratch экскориация, ссадина

patch пятно, бляшка

 

Skin Inflammation

 

The skin can break out in a variety of rashes, sores, and blisters (skin eruptions). Sometimes the skin quickly returns to normal, but some skin eruptions are long lasting and even life threaten­ing. Many times the cause is never discovered. Commonly, drugs taken internally cause various skin reactions.

Text A. Drug Rashes

 

Drug rashes are side effects of medications.

Drugs cause rashes in several ways. Most drug rashes are allergic reactions to medications. After taking the first (or any subsequent) dose of a par­ticular drug, a person may become sensitized to the drug. Later exposure to the drug may trigger an allergic reaction. Usually within minutes, though sometimes hours or days later, the skin breaks out in a rash. Other allergic symptoms - including a runny nose, watery eyes, or an asthma attack - may occur along with the rash.

Drugs also produce rashes directly without in­volving an allergic reaction. For example, corti­costeroids (cortisone-like drugs) may produce acne and cause skin to become thin, and anticoagulants (blood thinners) may cause bruising when blood leaks under the skin.

Certain drugs make the skin particularly sensitive to the effects of sunlight (photosensitivity). These drugs include certain antipsychotic medications, tetracycline, antibiotics that contain sulfa, chlorothiazide, and some artificial sweeteners. No rash appears when the drug is taken but later exposure to the sun produces an area of red, sometimes itchy, skin or gray-blue discoloration.

Drugs can cause almost any type of rash, but among the most important rashes that may result from drugs are hives (urticaria), toxic epidermal necrolysis, erythema multiforme, Stevens-Johnson syndrome, and erythema nodosum.

Symptoms

Drug rashes vary in severity from mild redness with pimples over a small area to peeling of the entire skin. Rashes may appear suddenly after a person takes a drug (for example, hives may erupt after taking penicillin), or they may be delayed for hours or days. Rarely, drug rashes show up years later; for example, arsenic may cause the skin to flake, change color, and even become cancerous years after ingestion.

Diagnosis

Rashes have many possible causes, and cur­rently no laboratory tests confirm that a rash results from a drug. Figuring out whether a drug is responsible may be difficult because a rash can result from only a minute amount of a drug, it can erupt long after a person has taken a drug, and it can persist for weeks or months after a person has stopped taking a drug. Every drug a person has taken is suspect, including those bought without a prescription; even eye drops, nose drops, and suppositories are possible causes. Sometimes the only way to determine which drug is causing a rash is to have the person stop taking all but life-sustaining drugs. Whenever possible, chemically unrelated drugs are substituted. If there are no such substitutes, the person starts taking the drugs again one at a time to see which one causes the reaction. However, this method can be hazardous if the person had a severe aller­gic reaction to the drug.

Treatment

Most drug reactions disappear when the re­sponsible drug is stopped. When the skin rash is dry or itchy, a corticosteroid ointment may help relieve symptoms. Although most cases of hives clear up quickly without treatment, oral antihistamines or oral corticosteroids may be needed; very serious eruptions are treated with an injec­tion of epinephrine or a corticosteroid.

Notes:

break out внезапно начинать(ся), появляться

pimple папула, прыщ, угорь

peeling отслаивание

hazardous опасный, рискованный