Lupus

 Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease in which the immune system attacks healthy tissue, causing inflammation and damage to various organs and tissues. Lupus affects the skin, joints, kidneys, heart, lungs, brain, and blood cells. It is a complex condition with varying severity, and its cause is not fully understood. 

Types of Lupus

1. Systemic Lupus Erythematosus (SLE): -

•  The most common and severe form of the disease. 
•  It affects multiple organ systems, including the skin, kidneys, and central nervous system. 

2. Cutaneous lupus erythematosus: - 

• Primarily affects the skin

         Types include: 

•      Discoid lupus erythematosus (DLE):  may cause scarring.

•    Subacute cutaneous lupus erythematosus: red, scaly  lesions, sensitive to sunlight; 

3. Drug-induced lupus: 

       

•  caused by certain drugs (hydralazine, procainamide, isoniazid, etc.).
•  Symptoms resolve when the drug is discontinued.

 4. Neonatal lupus: - 

• Rare disease that affects newborns of mothers with lupus. 
•  May cause skin rash, liver damage, congenital heart block.

 Causes: - 

 The exact cause of lupus is unknown, but is thought to be the result of a combination of genetic, environmental, and hormonal factors. 

• Risk Factors - Gender More common in females (90% of cases). 
• Age: 15-45 years most common. 
• Ethnicity: More common in African Americans
• Heredity: Family history of lupus and other autoimmune diseases. 
• Environmental factors: 

1. sunlight (u.v light)
2. Infections (e.g., Epstein-Barr virus).  
3. Certain medications. 

•  Hormones: estrogen may be involved. 

 Symptoms:

 Symptoms of lupus are variable, with flare-ups and remissions.

 Common symptoms include:

 1. General Symptoms - 

• Fatigue. 
• Fever. 
• Weight loss or gain;

 2. Skin and hair -

• Erythema Butterfly red rash across cheeks and nose;
• Photosensitivity (photosensitivity). 
• Discoid (round, scaly) rash. 
• Hair thinning or alopecia.

 3.Joints and muscles: -

•  Joint pain, swelling (arthritis), especially morning stiffness. 

4. Kidneys: - 

• Lupus nephritis: inflammation of the kidneys that causes protein in the urine, swelling, and high blood pressure. 

5. Heart and lungs: -

•  Pleurisy (chest pain when breathing).
•  Pericarditis (inflammation around the heart).

 6. Nervous System: -

• Headaches, confusion, memory loss. 
•  Seizures or strokes

 7. Hematologic and Immune System: - 

• Anemia. 
• Low platelet or white blood cell counts.
• Increased risk of blood clots. 

 Diagnosis:

 Lupus can be difficult to diagnose because the symptoms are similar to those of other diseases. Diagnosis is based on a combination of the following: 

1. History and physical examination; 

2. Clinical examination: - 

• Antinuclear antibody (ANA) test: detects autoantibodies. 
•  Anti-dsDNA and anti-Smith's antibodies: specific by lupus. 
•  Complement levels (C3, C4): often low during disease activity.
•   Urinalysis: detects renal involvement; 

3. Imaging: - chest x-ray or echocardiography to look for heart or lung involvement;

4. Biopsy: - renal biopsy to evaluate for lupus nephritis;

 Treatment :

There is no cure for lupus, but treatment is aimed at controlling symptoms, preventing flare-ups, and reducing organ damage.

1. Medication - 

• Nonsteroidal anti-inflammatory drugs (NSAIDs): for joint pain and inflammation.
• Antimalarial drugs (e.g., hydroxychloroquine): reduce skin and joint symptoms and prevent flare-ups. 
• Corticosteroids(e.g., prednisone): Used for severe inflammation.
• Immunosuppressants(e.g., methotrexate, azathioprine): suppress the immune system. 
• Biologic therapies (e.g., belimumab, rituximab): target specific immune pathways 

2. Improve lifestyle habits: - 

•   Avoid sun exposure and use sunscreen and protective clothing. 
•  Exercise regularly to reduce joint pain and fatigue. 
•  Manage stress to prevent flare-ups. -
•  Maintain a healthy diet to maintain general health.

 3.Treatment of Organ Complications: - 

• Dialysis or kidney transplantation for severe lupus nephritis. 
•  Use blood thinners for blood clotting disorders.

Complications:

1. Organ damage: - permanent damage to kidneys, heart, lungs, or brain

2. Infections: - due to compromised immune system or immunosuppressive therapy

3. Cardiovascular disease: - increased risk of heart attack or stroke 

4.Pregnancy complications: - increased risk of miscarriage, preeclampsia, or premature delivery.

 Prognosis - 

• Mild to moderate: Most people can manage lupus effectively with treatment and lifestyle adjustments. 
• Severe cases: Aggressive treatment and regular follow-up are necessary if organ involvement is present.  
• Advances in treatment have improved lupus survival and quality of life.

    Living with lupus:

•   Establish a strong support system, including health care providers, family members, and support groups. 
• Identify symptoms and triggers and address flare-ups. 
• Stay informed about the latest research and treatments.

Psoriasis

Psoriasis is a chronic autoimmune skin disease that causes rapid accumulation of skin cells, scaling, redness, and inflammation. Psoriasis is not contagious and often has a genetic component. Psoriasis can occur on any part of the body and varies in severity. 

 Types of Psoriasis:

1. Psoriasis Vulgaris: - 

• Most common form. 
• It is characterized by raised red patches covered with silvery-white scales.
• Typically seen on the scalp, elbows, knees, and lower back

2. Guttate Psoriasis: - 

• appears as small, drop-like sores on the trunk, arms, legs, or scalp. 
• Often provoked by bacterial infections such as streptococci.

3. Psoriasis Inversa: - 

• occurs in folds of skin (e.g., under the breasts, around the groin area). 
• Smooth, shiny red patches without scaling;

 4. Pustular psoriasis: -

• characterized by white pustules (pus-filled blisters) surrounded by red skin. 
• It may be localized to the hands and feet or spread over the entire body.

5. Erythrodermic Psoriasis: - 

• Rare and severe form, causing extensive redness, scaling, and desquamation. 
• It can be life-threatening and requires immediate treatment.

6. Nail Psoriasis: -

• Fingernails and toenails are affected, causing depression, discoloration, thickening or peeling of the nail bed.

7. Psoriatic Arthritis: -

•  Joint pain, stiffness and swelling, often with skin symptoms. 

General Skin Symptoms: - 

• Red inflamed patches on the skin.
• Silvery-white scales or plaques.
• Dry, cracked skin may bleed. 
• Itching, burning, and pain in affected areas. 

 Nail changes: -

• Pitted, raised or thickened nails. 
• Nail detachment from nail bed. 

 Joint Symptoms(in psoriatic arthritis): - 

• Joint pain, swelling, stiffness. 
• Decreased range of joint motion. 
• Morning stiffness lasting several hours. 

Causes and Triggers :

 Causes: Psoriasis is an autoimmune disease, which causes rapid cell turnover (3-7 days instead of the usual 28 days) as the immune system mistakenly attacks healthy skin cells. The result is an accumulation of skin cells and characteristic scaling.

 

Triggers :

• Stress: Stress exacerbates symptoms. 
• Infections: e.g., streptococcal or respiratory infections. 
• Weather: Cold, dry weather can aggravate symptoms. 
• Injuries: wounds, cuts, sunburn (Kevner's phenomenon). 
• Medications: beta-blockers, lithium, antimalarials. 
• Lifestyle: smoking, alcohol consumption, obesity. 

 Diagnosis : 

Physical Examination: - 

• Based on the appearance of the skin, scalp, or nails.

Skin biopsy: - 

• Rarely, a small sample of skin may be examined under a microscope to confirm the diagnosis and rule out other conditions. 

Treatment:

 There is no cure for psoriasis, but there are a variety of treatments aimed at reducing symptoms, reducing flare-ups, and improving quality of life. 

Topical Treatments: 

1.Corticosteroids: -

•  Reduce inflammation and itching.
• Examples: hydrocortisone, betamethasone; 

2. Vitamin D analogues: -

•  slow skin cell growth. 
•  Examples: calcipotriol, calcitriol.

3. Cole tar: -

• reduces scaling, itching and inflammation.

4. Salicylic acid: -

•  removes scaling and promotes the effects of other treatments.

5. Hydrating agents and emollients: - 

• moisturizes skin and reduces scaling.

  Phototherapy:

1. Ultraviolet Phototherapy: - 

• irradiate skin with controlled amounts of ultraviolet B.

 2. PVA Therapy: - 

• use UVA light in combination with a photosensitizer (psoralen).

 Systemic Therapy (moderate to severe): 

1. Medications: - 

• Methotrexate: methotrexate: reduces inflammation and suppresses the immune system.
• Cyclosporine: suppresses the immune system. 
• Acitretin: retinoid that normalizes skin cell growth.

 2. Biologic Therapy: - 

• Targets specific immune pathways involved in psoriasis.
• Examples: adalimumab, infliximab, etanercept, secukinumab, ustekinumab. 

Complications - 

Psoriatic arthritis: - 

•  may cause permanent joint damage if untreated.

Increased risk of other diseases: -

•  Cardiovascular disease, type 2 diabetes, metabolic syndrome.
•  Anxiety, depression, low self-esteem. 

 Infections: - 

• Open or cracked skin can become infected.

 

Prevention and Management - 

Avoid Triggers: - 

• Identify and minimize stress, injuries, and irritants that aggravate symptoms. 

 Maintain a healthy lifestyle: - 

• Eat a balanced diet, exercise, avoid smoking and alcohol. 

 Skin Care - 

• Use gentle cleansers, moisturize frequently, and avoid harsh chemicals.

 - Regular checkups: - 

• Monitor symptoms and consult a health care professional to adjust treatment as needed. 

Prognosis :

Psoriasis is a lifelong disease with periods of remission and flare-ups. With effective management, most individuals can control symptoms and maintain a good quality of life. Newer therapies, especially biologic agents, have significantly improved the prognosis of patients with moderate to severe psoriasis.

Eczema

 Eczema, also known as atopic dermatitis, is a chronic inflammatory skin disease characterized by itching, redness, dryness, and cracking. Eczema can occur in people of all ages, but is most common in children. Eczema often occurs in cycles, with flare-ups and remissions. 

Types of Eczema :

1. Atopic Dermatitis: 

• most common eczema, associated with allergies, asthma or hay fever.

2. Contact Dermatitis: -

• Irritant Contact Dermatitis: caused by direct skin contact with an irritant (soap, chemical, etc.).
• Allergic contact dermatitis: caused by allergic reactions to substances such as nickel, perfumes, poison ivy, etc.

3. Dyshidrotic eczema: small itchy blisters on the hands and feet.

4.Coinoid eczema: mostly on legs, arms, or torso, 

5. Seborrheic dermatitis: scaly, greasy patches on the scalp, face, or chest;

 6. Stasis dermatitis: stasis dermatitis: occurs on the lower extremities due to poor circulation and fluid buildup; 

causes :

 The exact cause of eczema is unknown, but a combination of genetic, environmental, and immune factors are involved. Common triggers include:

• Irritants Irritants: soaps, detergents, fragrances, or certain fabrics.
• Allergens Allergens: pollen, dust mites, pet dander, or certain foods. 
• Environmental factors: cold, heat, humidity. 
• Stress: Can aggravate symptoms.
• Heredity: Family history of eczema, asthma, or hay fever increases risk.
• Immune system dysfunction: overreaction to external stimuli. 

Symptoms - 

Itching: often intense, especially at night. 

Red or brownish-gray spots: often on hands, feet, ankles, wrists, neck, upper chest, eyelids, elbows, or inner knees.

Dry, cracked skin: may bleed or fester.

Thickened skin: from prolonged scratching or friction.

Liquid-filled blisters: may ooze and crust over. 

Diagnosis:

• Eczema is usually diagnosed by: Based on the appearance of the skin. 
• Medical history: includes allergies, asthma, family history of eczema. 
• Patch test: identifies specific allergens if contact dermatitis is suspected. 
• Skin biopsy: In rare cases, to rule out other conditions. 

 Treatment:

There is no cure for eczema, but treatment is aimed at managing symptoms and preventing flare-ups:

 1. Topical treatment: 

• Moisturizers (emollients): keep skin moist and protect barrier function. 
•  Corticosteroid creams or ointments: reduce inflammation and itching. 
• Calcineurin inhibitors(e.g., tacrolimus, pimecrolimus): for sensitive areas such as the face.

2. Oral medications: - 

• Antihistamines: for nighttime itching;
• Systemic corticosteroids:Used for severe flare-ups. 
• Immunosuppressants(e.g., cyclosporine, methotrexate): for severe, refractory eczema.

3 Biological therapies: -

 

• Dupilumab (Dupixent): monoclonal antibody for moderate to severe atopic dermatitis.

4 Lifestyle and home therapy: -

 

• Warm bath: after warm bath, Apply moisturizer immediately after warm bath. 
• Wet wrap therapy: After applying the medication, wrap the skin with a wet bandage. -
•  Avoid triggers: Identify and eliminate allergens and irritants. 

5. Phototherapy: - 

•  Controlled exposure to ultraviolet light. 

 Complications :

•  Infections: - Scratching and skin breakage can lead to bacterial, viral,   and fungal infections. 
• Chronic itching and scratching: can lead to lichenification (thickened, leathery skin). 
• Sleep disturbances: Severe itching may affect sleep. 
• Psychological effects: stress, anxiety, depression. 

Prevention :

• 1. Regular moisturizing: use a thick cream or ointment after bathing;
• 2. Avoid harsh soaps and detergents: use fragrance-free, non-irritating products; 
• 3. Wear soft, breathable fabrics: cotton, etc.; 
• 4. Stress management: practice relaxation techniques such as yoga and meditation;
• 5. Allergy management: avoid allergens and keep living conditions free of dust mites and pet dander; 

prognosis:

• Many children will outgrow eczema by puberty, but others will experience periodic recurrences throughout their lives.  
• With proper treatment and prevention strategies, most can effectively manage their symptoms and lead comfortable lives.