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Pityriasis Lichenoides - This is an uncommon condition that occurs in two forms. The acute form consists of red bumps on the skin that persist for a few weeks or months and heal leaving a scar. Usually, there is a countable number of lesions. The chronic form consists of small, pink, scaly bumps, often as hundreds of lesions that are itchy and persist for long periods. This form does not scar. The cause of this disease is unknown and therefore there is no specific treatment. Ultraviolet light treatment, either phototherapy or PUVA therapy, is very effective in clearing both forms of the condition. After a successful course of treatment most patients have a long-term remission. Pityriasis Rosea - Pityriasis rosea is a common condition thought to be caused by a virus. It starts suddenly and spreads as a widespread scaly, pink to red rash. Usually it runs a brief course lasting about a month and clears spontaneously but it can persist for months. Treatment usually consists of applying a cortisone-type ointment or cream and use of antihistamines for itch. In some patients the rash is very marked with a lot of inflammation of the skin so that normal activities are compromised. A more effective treatment in these patients is a course of ultraviolet light therapy such as phototherapy or PUVA therapy. This treatment usually clears pityriasis rosea in a few weeks. Photosensitivity - Sensitivity to light, or photosensitivity, refers to a number of disorders in which people have an abnormal reaction when exposed to natural sunlight or artificial light indoors. These conditions are common and affect about 10% of the population regardless of skin color. The most common condition, so-called polymorphous light eruption, appears as numerous small red bumps on the exposed skin several hours after exposure to sunlight and lasts days or a week or more. It usually starts in early adult life and persists with a recurrence each spring or summer. Other forms of photosensitivity can be more persistent and last all year. Confirmation of a diagnosis of photosensitivity rests on reproducing the rash, often by specialized testing to various wavelengths of light. Treatment ranges from simple avoidance of sunlight, protection as with sunscreens or, in severely affected people, desensitization to eliminate the photosensitivity. This latter treatment involves deliberate exposure to light as a course of treatment. One or more of these measures are successful in controlling photosensitivity in most people. Pruritus - Itch - Pruritus or itchiness of the skin is a very common symptom of many skin disorders but it may also occur by itself when the skin appears to be otherwise normal. Pruritus of this type requires thorough investigation because it can indicate an internal disease is present interfering with function of the kidneys, liver, bone marrow or other organ. If all investigations are negative it is usually labeled as idiopathic pruritus - cause unknown. The first line of treatment of pruritus is use of antihistamines, moisturizing creams and sedatives. If these treatments are unsuccessful an alternative approach is the use ultraviolet light treatment, either PUVA therapy or UVB phototherapy. These treatments suppress itch in most patients regardless of whether it is idiopathic pruritus or a symptom of an internal disease. Urticaria - Hives - Hives or urticaria is a common skin disorder and is most commonly caused by allergy to a medication or a food. This type of urticaria is of sudden onset and lasts only a few days. There is another type of urticaria called chronic urticaria that lasts for weeks to months or years. The cause of chronic urticaria is unknown; it is probably not due to an allergy since a trigger substance is rarely found. Chronic urticaria is usually treated with various antihistamines and these medications give some relief until a spontaneous recovery occurs. Ultraviolet light therapy can suppress chronic urticaria and maintain suppression for long periods. It is mainly used in patients who have had an inadequate response to antihistamines. Alopecia Areata - Alopecia areata is an autoimmune disease in which hair is lost from the scalp and less commonly from other areas of the skin. The cause is unknown but it is known that the body’s own immune system causes inflammation around the hair follicle resulting in premature loss of hair. The disorder can occur at any age but is most common in young adults. The natural course of the condition is variable and ranges from spontaneous recovery that is common to gradual progression. Three main types of treatment are used. Cortisone-type medications are injected into the areas of hair loss, applied topically as lotions or given orally as tablets. A poison-ivy type dermatitis can be induced at the site of hair loss by application of various chemicals. Ultraviolet light treatment has also been used. This treatment is mainly used after failure of response to cortisone. The response to any treatment is very variable and treatment is unsuccessful in many patients with progressive disease. Mycosis Fungoides - Mycosis fungoides or cutaneous T cell lymphoma (CTCL) as it is sometimes called is a lymphoma, a type of cancer and is mainly confined to the skin. The cause of this condition is unknown and while it is most common in middle life, it can appear at any age. Most cases of mycosis fungoides are slow in developing and slow in progression. Frequently a diagnosis of eczema will be made and then after examination of repeated biopsies of skin, the diagnosis of mycosis fungoides will be established. In a few patients, the disease appears more suddenly and progression is more rapid. There are a number of treatments for mycosis fungoides and the choice of the best therapy for a patient largely depends on the type and stage of the disease. Ultraviolet light treatment in the form of PUVA therapy is most effective in patients with early disease in whom it can produce a long-term remission with return of the skin to normal appearance. Long-term maintenance treatment is required to maintain the remission. Lichen Planus Lichen planus is an itchy, purplish rash on the skin of unknown cause. It usually begins in adult life and runs a chronic course lasting two years on average but it can be shorter or last many years. Usually it involves all areas of the body plus it often appears inside the mouth and this can give rise to the most symptoms. The main approach to treatment is topical application of cortisone-type preparations as creams and ointments. These reduce the pruritus or itch and also reduce the severity of the lesions. Prednisone or some other systemic form of cortisone is required in patients with extensive disease. Patients who do not respond to a course of prednisone or who have an immediate relapse when it is stopped, can be treated with ultraviolet light in the form of PUVA therapy. This treatment clears about 80% of patients and most remain clear after a brief period of maintenance treatment. Granuloma Annulare - Granuloma annulare is most common in children in whom it appears as one or a few round lesions often with a clear center. A much less common form occurs in adults with usually flat and sometimes itchy lesions widely distributed over many areas of the skin. This so-called disseminated granuloma annulare is usually difficult to treat and, as a consequence, many treatments have been used. Several studies have shown that it responds to an ultraviolet light treatment called PUVA therapy and this treatment can produce long-term remissions. Usually about 30 to 50 treatments are required to clear all lesions but maintenance treatment is usually brief and relapse is uncommon. [return to top of page] [return to diseases & disorders] |
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