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           Pityriasis    

Definition

Pityriasis is one of any of a number of skin diseases that have in common lesions that resemble dandruff-like scales without obvious signs of inflammation. Types of pityriasis include: pityriasis alba (also called pityriasis streptogenes, pityriasis simplex, erythema streptogenes); pityriasis rosea; pityriasis rubra pilaris; and pityriasis versicolor (tinea versicolor).

Description

Pityriasis alba This is characterized by hypopigmented, round to oval, scaling patches on the face, upper arms, neck, or shoulders. The patches vary in size, usually being a few centimeters in diameter. The color is white or light pink. The scales are fine and adherent. Usually, the patches are sharply demarcated; the edges may be erythematous and slightly elevated. As a rule, pityriasis is asymptomatic. However, there may be mild pruritis. The disease occurs chiefly in children and teenagers. The cause is unknown. Excessively dry skin following exposure to strong sunlight appears to be contributory. Efforts to find an infectious agent - either bacterial, viral, or fungal - have been unsuccessful. Pityriasis rosea This is a mild, inflammatory exanthem of unknown origin, characterized by salmon-colored papular and macular lesions that are at first discrete but may become confluent. The individual patches are oval or circinate and covered with finely crinkled, dry epidermis, which often desquamates, leaving collaterate scaling. The disease usually begins with a single herald or mother patch, usually larger than succeeding lesions, which may persist a week or more before others appear. By that time involution of the herald patch has begun. The efflorescence of new lesions spreads rapidly, and after three to eight weeks they usually disappear spontaneously. The incidence is highest between the ages of 15 and 40 years, and the disease is most prevalent in the spring and autumn. Women are more frequently affected. The eruption is usually generalized, affecting chiefly the trunk, and sparing sun-exposed surfaces. At times it is localized to a certain area, such as the neck, thighs, groins, or axillae. Moderate pruritis may be present, particularly during the outbreak, and there may be mild constitutional symptoms prior to the onset. The cause is unknown. Pityriasis rubra pilaris This is a chronic skin disease characterized by small follicular papules, disseminated yellowish pink scaling patches, and often, solid confluent palmoplantar hyperkeratosis. The papules are the most important diagnostic feature, being more or less acuminate, reddish brown, about pinhead size, and topped by a central horny plug. In the horn center a hair, or part of one, is usually embedded. The disease generally manifests itself first by scaliness and erythema of the scalp. The eruption is limited in the beginning, having a predilection for the sides of the neck and trunk and the extensor surfaces of the extremities. Then, as new lesions occur, extensive areas are converted into sharply marginated patches of various sizes, which look like exaggerated goose-flesh and feel like a nutmeg grater. The involvement is generally symmetric and diffuse with, however, characteristic small islands of normal skin within the affected areas. Pityriasis Versicolor (tinea versicolor) On the upper trunk and extending onto the upper arms, finely scaling, guttate or nummular patches appear, particularly on young adults who perspire freely. The individual patches are yellowish or brownish macules in pale skin, or hypopigmented macules in dark skin, with delicate scaling. Mild itching and inflammation about the patches may be present. This common fungal disease is most prevalent in the tropics where there are high humidity and high temperatures and frequent exposure to sunlight.

Treatment

Pityriasis alba Highly useful are 0.5% hydrocortisone and 1% crude coal tar in a cream base (Zetone cream), half-strength Pragmatar ointment, Lac-Hydrin, 2% Zetar in Cordran cream, or 1% Vioform cream. The prognosis is good and there is usually spontaneous healing within several months to a few years. Pityriasis rosea Treatment is symptomatic. The duration may be notably reduced by appropriate treatment. Ultraviolet B in erythema exposures should be used to expedite the involution of lesions after the acute inflammatory stage has passed. Pruritis may uncommonly be intense and corticosteroid lotions, creams or sprays give immediate relief. Antihistamines by mouth are also beneficial. Pityriasis rubra pilaris Topical applications of bland emollients are recommended. Lac-Hydrin is particularly helpful. Accutane is the treatment of choice in adult-onset pityriasis rubra pilaris. Etretinate has also been reported to be effective. Vitamin A with the possible addition of vitamin E is often effective. Pityriasis versicolor Successful treatment has been reported with clotrimazole cream or lotion, with selenium sulfide lotion shampoo. The best treatment appears to be 400 mg of ketoconazole in a single oral dose. Some doctors recommend the use of Selsun.

                                                Pickwickian Syndrome

Definition
Pickwickian syndrome is a disorder that was named after Joe, the fat, red faced boy in Charles Dickens' The Pickwick Papers. This syndrome is a combination of obstructive apnea in moderately to severely obese people, most of whom attempt to sleep face up.

Description

About 2.5 million people in the U.S. suffer from sleep apnea (episodes of cessation of breathing during sleep) with men outnumbering women. The several conditions often associated with obstructive sleep apnea include obesity and a short thick neck, and reduction in muscle tone of the soft palate, the uvula (the small, conical, fleshy tissue hanging from the center of the soft palate), and the pharynx. The upper airway may be narrowed by enlarged tonsils or adenoids, a deviated nasal septum, nasal polyps, or congenital abnormalities. Even at high altitudes sleep disruption may occur because of low oxygen concentration. The Pickwickian syndrome consists of moderate to extreme obesity, alveolar (a hollow sac or cavity) hypoventilation, prolonged drowsiness, twitching, cyanosis (a dark bluish to purplish coloration of the skin), periodic breathing, secondary polycythemia (excessive red blood cells caused by low oxygen), and right sided heart failure. Details of the origin and development of this obesity hypoventilation syndrome are unknown, as is its true incidence. Studies show that the syndrome can exist in non-obese patients as well. Complications associated with untreated sleep apnea include hypertension, arrhythmias, abnormal blood levels of oxygen and carbon dioxide, and peripheral edema. Other complications include sleepwalking, blackouts, automatic robot-like behavior, intellectual deterioration, hallucinations, anxiety, irritability, aggressiveness, jealousy, suspiciousness, and irrational behavior. Loss of interest in sex, morning headaches, and bedwetting may also occur with time.
 

Treatment

Therapy consists mainly of weight loss, which reduces episodes of sleep apnea and improves the blood gases and the daytime drowsiness. Nocturnal positive pressure air flow can be dramatically effective. A few patients may require an opening in the windpipe (tracheostomy). The syndrome is reversible if treated.