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E
Ecthyma | Eczema
or dermatitis | Elastosis perforans
| Ephelides | Epidermal
naevi | Epidermolysis bullosa
| Erythema multiforme | Erythema nodosum | Erythrasma
| Erythroderma
and exfoliative dermatitis | Eye bags
ECTHYMA
Ecthyma is a deep ulcerative
bacterial skin infection most commonly seen in children and the
elderly. It usually affects the buttocks and lower limbs.
Cause
- Ecthyma is a deep
ulcerative type of impetigo caused
by the staphylococcal bacteria. Infection may follow an insect
bite or some minor skin trauma.
- Poor hygiene and malnutrition
may play a role.
Symptoms
- A pustule (pushead)
or blister that rapidly enlarges and ulcerates.
- The ulcer may be covered
by a thick crust.
- Removal of the crust
leaves a deep ulcer with a raised border.
- There may be associated
lymphangitis (red lines spreading upwards).
- Pain..
- Heal within 6 - 8
weeks, leaving scars.
Complications
- Depressed oval or
coin-shaped scars often remain after ecthyma heals.
What you can do
- You should consult
a doctor.
- Apply warm compresses
followed by removal of crusts.
- Clean with an antiseptic
lotion and apply a thin layer of the topical antibiotic prescribed
by the doctor.
- Observe careful personal
hygiene.
- Do not share personal
items such as towels, shaving brushes and blades.
- Separate bed linens,
towels, etc., and boil separately.
- Keep fingernails short.
What the doctor
may do
- Prescribe oral and
topical antibiotics.
- Take a culture to
help chose the best antibiotic to use.
TOP
ECZEMA OR DERMATITIS
Eczema or dermatitis
refers to an inflammation of the skin characterised by redness,
swelling, weeping and scaling. It is usually itchy and constant
scratching leads to lichenification (leathery thickening of the
skin). Doctors divide eczemas into two broad groups:
Exogenous (exo
means external and gen means production in Greek) eczemas
are caused by external factors such as allergy to cement and plaster
or irritation from chemicals, soaps and detergents (see contact
dermatitis). Endogenous (endo means internal) eczemas,
on the other hand has to do with the skin's make-up or constitution.
Hence, they are also called constitutional eczemas. Endogenous
or constitutional eczemas cannot be cured whereas exogenous eczemas
can be if the causal substance can be avoided.
Symptoms
- The symptoms are similar
regardless of the type of eczema.
- Acute
eczema, subacute eczema or chronic eczema (see below).
- Itching is common
to all stages of eczema.
|
Stages |
Characteristics |
|
Acute |
Blisters, weeping, papules
(pimply bumps), pustules (pusheads) |
|
Subacute |
Redness, scaling, glistening
serum and crusting. |
|
Chronic |
Dryness, redness, scaling,
lichenification (leathery thickening of the skin with accentuation
of the skin markings) and fissuring (cracking) |
Complications
- Spread of eczema to
other areas of skin or the entire body (see erythroderma).
- Secondary bacterial
infection.
-
- Treatment
- See under specific
types of eczema.
TOP
ELASTOSIS PERFORANS
This is a rare disorder
in which abnormal elastic tissue is being pushed out of the skin.
Cause
- Part and parcel of
other disorders such as Ehler-Danlos syndrome, Marfan's syndrome,
Down's syndrome, acrogeria and Rothmund-Thomson syndrome.
- Drug induced, eg.,
due to penicillamine, a drug used in the treatment of Wilson's
disease ( a disorder of copper metabolism) and scleroderma.
Penicillamine interferes with the normal cross linking of elastic
tissue. The elastic tissue is therefore abnormal and the skin
tries to push it out of the skin.
- Unknown because some
cases occur for no apparent reason.
Symptoms
- Ringed-shaped waxy
lesion with a slightly depressed centre.
- Usually appears on
the back of the neck or arms.
What you can do
- You should consult
a doctor.
What the doctor
may do
- Determine the cause
and eliminate it (e.g. penicillamine)
- Treatment is not needed.
TOP
EPHELIDES
Ephelides or freckles
are most commonly seen in children with fair skins, especially
those of Celtic origin.
Cause
- Inherited tendency.
Symptoms
- Light brown or tan
spots on the sun-exposed skin, especially the cheeks, nose, shoulders
and the upper back.
- Small (2 - 4 mm in
size) irregular in shape.
- Freckles become darker
with sun exposure for example, during the summer and lighten
during the winter months.
 |
Ephelides.
Click
on image for larger view |
What you can
do
- Protect against the
sun (see sun protection).
- Consult a doctor for
treatment if the freckles bother you.
What the doctor
may do
- Lighten with chemical
peels or liquid nitrogen
aplications.
- Prescribe hydroquinone
containing lightening creams.
TOP
EPIDERMAL
NAEVI
This is a relatively
uncommon development abnormality appearing at or soon after birth.
Cause
- Non-cancerous growth
of the epidermis.
Symptoms
- Raised brown area
with a rough warty surface.
- Tendency to occur
in lines along the length of a limb.
What you can do
- You should consult
a doctor.
What the doctor
may do
- Destroy the area using
electrosurgery or
the carbon dioxide laser.
- Excise the area with
or without grafting.
TOP
EPIDERMOLYSIS BULLOSA
This is a group of rare
inherited disorders which result in blistering after minor trauma.
There several types of epidermolysis bullosa and they can divided
into two groups depending on the mode of inheritance.
- Autosomal dominant
where only one parent need be affected and the offspring has
a 50% chance of inheriting the defect.
- Autosomal recessive
where both parents have to be carriers and the offspring has
a 25% chance of inheriting the defect.
Cause
- Inheritance.
Symptoms
- Usually occurs in
children as blisters on the feet and hands and on places likely
to be traumatised such as the knees and elbows.
- Generally, the disease
is more severe in the autosomal recessive types where blisters
may occur in the oesophagus and cause difficulty feeding. In
some cases, babies are born with raw skin because the blistered
areas have been shed in the womb.
Complications
- Infection.
- Scarring.
- The digits (fingers
and toes) may fuse together as the raw areas heal resulting in
severe disability.
- What you can do
- You should consult
a doctor.
- Protect the skin against
trauma.
- What the doctor
may do
- Give genetic counseling.
- Treat the complications.
TOP
ERYTHEMA MULTIFORME
This is an inflammatory
condition of the skin characterised by rashes that look like a
target ("target lesions) or bull's eye ("bull's eye
lesions)".
Causes
- Allergic reaction
to drugs such as penicillin, sulphonamides and barbiturates.
- Hypersensitivity reaction
to bacteria (eg., mycoplasma chest infection), virus (especially
the herpes simplex
virus or cold sore virus).
- Internal disease.
- Pregnancy.
- Unknown.
Symptoms
- "Target"
or "bull's eye" lesions comprising of a pale or dusky
red centre (sometimes, a blister) and surrounding rings of different
shades of red. Usually occur on the back of the hands, palms,
soles, limbs and face.
- May be preceded by
a cough, fever, sorethroat, malaise (feeling of illness) or headache.
- In
severe cases, the mucous membranes (eyes, mouth, nasal passages
and genitals) may be ulcerated. This form is called Steven's
Johnson's syndrome. Another more severe form is called toxic
epidermal necrolysis. In this form the, the rashes progress
rapidly to become blisters that slough off leaving raw areas
like a scald.
 |
Erythema multiforme.
Click
of image for larger view |
Complications
- Secondary infection
of damaged skin.
- Eye damage from Steven's
Johnson's syndrome.
- Fluid and electrolyte
imbalance, organ failure and shock from toxic epidermal necrolysis.
May be fatal.
-
- What you can do
- You should consult
a doctor.
-
- What the doctor
may do.
- Prescribe topical
steroids for mild
cases.
- Prescribe systemic
steroids (oral
or intravenous) for severe cases.
- Hospitalise severe
cases of erythema multiforme, Steven's Johnson's syndrome and
toxic epidermal necrolysis for management.
- Treat the underlying
cause.
- TOP
An inflammatory condition
of the skin characterised by painful inflamed nodules (large swellings)
on the lower legs.
- Cause
- Hypersensitivity to
bacterial infection, eg., streptococcal sorethroat and tuberculosis.
- Hypersensitivity reaction
to deep fungal infections such as histoplasmosis and coccidiomycosis.
- Drug eruption, eg.,
due to sulphur drugs, iodides, penicillin and the birth control
pill.
- Sarcoidosis, a disease
that causes a purplish facial rash, enlarged lymph glands in
the mediastinum (middle of the chest), fever and joint pains.
It may affect the eyes, heart, lung and kidneys (as a result
from high calcium levels). It is more common in Blacks. Sarcoidosis
responds to oral steroids.
Methotrexate, an immunosuppressive
drugs, may sometimes be used.
- Inflammatory bowel
disease such as Crohn's disease and ulcerative colitis.
Behcet's
disease.
- Collagen vascular
disease.
-
- Symptoms
- Inflamed, red painful
swellings.
- Usually occur on the
lower legs. Sometimes on the arms.
- May be associated
with fever, malaise (feeling of illness), headache, muscle and
joint pains.
-
- Complications
- Depends on the underlying
cause.
-
- What you can do
- You should consult
a doctor.
-
- What the doctor
may do
- Determine and treat
the underlying cause.
- Prescribe painkillers
or nonsteroidal antiinflammatory drugs (NSAIDs), potassium iodide
or oral steroids.
- TOP
ERYTHRASMA
Erythrasma is a superficial
bacterial infection of the body folds such as the toe webs, groin
and armpits. It is more common in warm climates and usually affects
young adults.
- Cause
- Infection with a bacteria
called Corynebacterium minutissimum.
Aggravating factors
- Diabetes
- A warm, humid climate.
Symptoms
- Well-defined pink
or brown dry patches in the armpits and groins.
- Scaling and maceration
of the toe webs.
-
- What you can do
- You should consult
a doctor.
- Wear loose clothes.
-
- What the doctor
may do
- Confirm the diagnosis.
- The affected areas
fluoresce a coral red colour when illuminated with a Wood's lamp.
- Treat with an oral
antibiotics such as erythromycin or antibiotic or antifungal
creams. Relapses are common.
- TOP
ERYTHRODERMA AND EXFOLIATIVE
DERMATITIS
Erythroderma refers
to a diffuse reddening of the skin whereas exfoliative dermatitis
refers to reddened skin that is also exfoliating or shedding.
They have different causes.
- Causes
- Spread of a pre-existing
skin disease such as atopic
dermatitis, seborrhoeic
dermatitis, varicose eczema,
contact dermatitis,
psoriasis, lichen
planus, pityriasis rubra pilaris
and pemphigus
foliaceus.
- Norwegian crusted
scabies.
- Congenital ichthyosiform
erythroderma (see ichthyosis).
- Diffuse mastocytosis.
- Severe photosensitivity.
- Drug allergy (see
drug eruption) - especially
antimalarials, allopurinol (gout medicine), non-steroidal anti-inflammatory
drugs, phenytoin (used to treat epilepsy), gold (used to treat
rheumatoid arthritis) and penicillin and sulphonamide antibiotics.
- Underlying cancers
such as lymphomas and leukaemias.
- Unknown.
Symptoms
- Diffuse redness of
the skin.
- Shedding of scales
as the condition progresses.
- Itching.
- Fatigue.
- Fever.
- Shivering from excessive
heat loss.
 |
Erythroderma.
Click
on image for larger view |
Complications
- Hypothermia (low body
temperature) due to increased heat loss from the dilated blood
vessels in the skin.
- Cardiac failure due
to increased blood flow through the skin putting a strain on
the heart.
- Hypoproteinaemia (low
serum protein) due to loss of skin cells.
- Iron deficiency anaemia.
- Weight loss.
-
- What you can do
- You should consult
a doctor.
-
- What the doctor
may do
- Hospitalise for management.
- Determine and treat
the underlying cause.
- Prescribe oral and
or topical steroids.
- Prescribe antihistamines
to reduce itching.
- Treat the complications.
- TOP
EYE
BAGS
Eye bags are a common
cause of concern because they make a person look old and less
alert.
- Cause
- Herniation of fat
through a weakening in the orbicularis oculi muscle.
- Loss of skin elasticity
due to ageing.
- Swelling due to fluid
accumulating as a result of lack of sleep, stress, allergy or
illness.
- Inherited condition
known as blepharochalasia.
Symptoms
- Loose skin under the
eyes.
- Swelling under the
eyes.
What you can do
- The swelling, if due
to fluid aculating, can be reduced by using a cool compress
or cucumber slices.
What the doctor can do
- Exclude allergies
and other illnesses.
- Perform blepharoplasty
(eyelid lift).
-
- TOP
