Melasma: Symptoms and Causes

What is that melasma? Chloasma or melasma is a skin disorder in the form of patches with the formation of the dye bark excessively, colored black and brown, are generally symmetrical, uneven, such as discoloration of the skin, often found on the face, the cheeks, forehead, chin, upper lip , and can extend up to the neck.

Generally occurs in pregnant women or users of oral contraceptives (eg, birth control pills). Melasma is excessive melanin formation caused by exposure to ultraviolet and sunlight.

The cause of melasma, Trends genetics, hormonal influences, and ultraviolet radiation is the most important cause of melasma. More than 30% had a family history of melasma patients who also suffer from melasma. Oral contraceptive pills that contain estrogen-progesterone therapy for prostate cancer can also cause melasma. Medical therapy of allergies and certain cosmetics reported cause melasma, though rarely.
Melasma is rare before the age of puberty. Commonly experienced by adults aged 30-44 years (productive age) and is more common in women. In Indonesia, a comparison of this case to the women and men is 24: 1.

Clinical symptoms of melasma disease begins with patches of black and brown on the cheek, and then extended to the entire face. Skin disorders melasma, hyperpigmentation Plaques with no firm boundaries. Injuries and disorders are usually symmetrical, especially when on the cheek, spread to resemble a mask.
Location disease melasma may occur on the entire face, but mostly on the cheeks, forehead, chin, under the nose, below the lower jaw.

Melasma examination, to determine the type of melasma, Wood lamp examination (with a wavelength of 340-400 nm). There is thickening of the outermost layer of skin; the formation of excessive keratin, but relatively mild. In the basal cells and suprabasal found to deposit melanin. Sometimes melanin is found in all layers of keratinocytes in the epidermis. Melasma Area and Severity Index (MASI) commonly used doctors to assess the condition of patients with melasma. Consider the results of tests to evaluate thyroid function. Not required laboratory tests.

Handling melasma, medications antipigmentasi (depigmenting agents), adjusted for the skin condition of each patient. Hydrogen peroxide and topical corticosteroids. Vitamin C high dose. Vitamin C is thought to inhibit the oxidation dopakuinon. Glutathione. Glutathione is a tripeptide which has a -SH group, may join the cupric ions (Cu) and the enzyme tyrosinase that disrupted melanin formation. The use of bleach (bleaching), which is able to inhibit the activity of the enzyme tyrosinase in the melanocytes, resulting in the formation of melanin is reduced. Retinoids, serves to regulate cell growth and proliferation. For example: topical tretinoin. The use of retinoic acid would affect the pigments in the keratinocytes, also interfere transferpigmen. The use of tretinoin efektifsebagai single therapy. Improvements achieved in a minimum of 6 months.
Laser surgery, using a Q-switched ruby ​​laser and argon laser. Chemical exfoliation, performed by a dermatologist or beautician. Antibiotics, Mass lnya: azelaic acid cream (20%).

Topical therapy approved by the US Food and Drug Administration (FDA) for the treatment of melasma is Triple Combination Cream, containing hydroquinone (4%), tretinoin (0.05%), and fluocinolone acetonide (0.01%). Triple Combination cream is safe and effective when used alternately or continuously for 24 weeks.
Combination treatment with the triple combination cream followed by a laser (1064-nm Q-switched Nd: YAG) proved to be effective, not followed by serious side effects. Topical therapy should be initiated at least eight weeks prior to laser therapy to achieve optimal results.
In topical therapy with a concentration of 4% or less, only a few patients experienced severe side effects.
Generally, the longer the treatment of melasma about 4-6 weeks. Although many treatment products in the form of creams, ointments, capsules, extracts, and others that aims to overcome melasma, be sure to use it with a doctor's supervision. This is to avoid complications or irritations that actually worsen the situation. Better to come immediately to the doctor or dermatologist to get treatment and good handling and measurable.

Melasma can be prevented by: Avoiding the sun, wearing a hat, umbrella, sunscreen and Stopping the use of contraceptives.
The hormone estrogen, progesterone, and MSH (melanocyte-stimulating hormone) can stimulate the occurrence of melasma. Ultraviolet light can stimulate pigment formation process. Melanin (melanogenesis).

Systemic drugs such as chloroquine, chlorpromazine, cytostatic, and minocycline can stimulate melanogenesis. Melasma can occur in men and women who are not pregnant and not using the contraceptive pill.

Gangrene : Causes, Symptoms, and Treatments

What is gangrene? Gangrene is a term to define the decay of body tissues or organs or tissue death caused by lack of blood supply. And the process occurs as a complication of inflammation or infection, injury, or degenerative changes associated with chronic diseases, such as diabetes mellitus. There are 3 main types of gangrene, which is dry, wet or damp, and gas gangrene. Gangrene many called by the term Gangrehe, gangrenosum ulcers. Gas gangrene or also called myonecrosis

Gangrene Causes, generally by a bacterial infection, such as Clostridium welchii, Clostridium per frin ges, Clostridium septicum, Clostridium novyi, Clostridium histolyticum, Clostridium sporogenes, or other species that can survive with little oxygen. Once located in the network, these bacteria will produce gas and toxins.

In wet gangrene, the causative organism is different strains of bacteria, including Streptococcus sp and Staphylococcus sp. Forms are rare but serious infection, Streptococcus group A, can interfere with blood flow. If not treated, it can progress to skin infections and tissue directly under the skin.
Chronic diseases such as diabetes mellitus, or diseases that affect blood vessels (Buerger's disease, Raynaud's disease) can also lead to gangrene.

Symptoms of gangrene is damage to the skin on the feet, tip toes irregular, swollen, with fluid, dead tissue is black and fetid. If the toxin the bacteria spread to the bloodstream, then the patient will complain of fever, rapid heart rate, rapid breathing, changes in mental status, loss of appetite, diarrhea, vomiting, and broken blood vessels.

Treatments for gangrene, for people to do with therapies such as povidone iodine solution compresses 5-10%. If no improvement in a short time, see your doctor to get proper care and handling more perfect. If the causative organism has been detected, wet gangrene can be given broad-spectrum antibiotics. Infected tissue to be operated on, and amputation may be considered. Analgesic required to control discomfort. Intravenous fluids and blood transfusion is indicated in case of shock, adds red blood cells, and electrolytes. Hydration and good nutrition are also required for wound healing. Although still controversial, some cases gangrene still given hyperbaric oxygen.

Prevention of gangrene, severe diabetes mellitus patients should do hand and foot care are routinely and regularly, as directed by a physician. Education about foot care important. Skin infections should be addressed so that the bacteria are not spread.

Gangrene usually occur in people with diabetes mellitus, malnutrition (lack of nutrition, not perfect), and in patients with leprosy.

Preventing the Spread of Infectious Diseases

An area there is a disease depends on the presence of people who are sensitive and appropriate environmental conditions for the life of disease-causing microorganisms. Microorganisms which have a simple life cycle, distribution will be broader than that cycle is very complex, for example, non-human animals also need to continue his life.

Socio-economic factors affecting the spread of the disease population. Agricultural areas, farms, to review the habit of using fertilizer, environmental hygiene and sanitation and poor personal hygiene and poverty are all factors that can increase the spread of disease. Migration of people from one area to another, religions and beliefs of people with special religious rituals that can also affect the spread of certain diseases.

Tropical regions wet with warm temperature are ideal habitat for the breeding of disease-causing organisms, in both humans and animals. Subtropical areas short summers, and cold climates as well as areas that are very hot climates inhibit the development, life and the spread of disease-causing organisms.

Various kinds of organisms that cause disease in humans and animals are found in some countries, because of the environment in the region allowing disease-causing organisms can live and breed perfectly.

Epidemiological studies done several countries showed that infectious diseases are still an important cause of death. Malaria and Dengue fever is an infectious disease that is not only difficult to eradicate in some countries, but it still is an infectious disease that became a global health problem.

National health reporting in certain countries shows that parasitic diseases are related closely related to the life of an environmental, still show a very high frequency in various regions. One of them is a worm diseases transmitted through the soil (soil-transmitted Helminths) such as helminth infection (ascariasis), whip worm infections (trichuriasis) and hookworm infection.

Studies in some developing countries, for example by screening feces on the population, in rural areas or in urban areas, some areas show figures helminth infections are still high. Likewise, diarrheal diseases, whether caused by bacteria, parasites and viruses are also always been a major health problem in many regions. Lack of clean water, the narrowness of the land where the family lives, the habit of eating with unwashed hands first, reuse the leaves and wrappers of food that has been thrown into the trash, vegetables are eaten raw, use of river water for various necessities of life (shower, wash your food, wash clothes, rinse, brush your teeth, which is also used as a toilet), and the use of feces for fertilizer vegetables, increase the spread of infectious diseases that attack the digestive system.

In addition to the factors mentioned above, occupational factors can also influence the frequency of parasitic diseases. Plantation workers which means his latrines are inadequate in number, the field worker worker watering and irrigation, mining and forestry workers, farmers and ranchers are included in a group at high risk of infection of infectious diseases.

Infectious diseases transmitted by insects that require long-term handling of voices including filariasis is elephantiasis disease caused by filarial worms, malaria caused by plasmodium, dengue fever caused by dengue virus, and diarrhea caused by viruses and bacteria. This disease transmission capabilities are various types of insects, for example, flies and cockroaches transmit diarrhea and mosquitoes that transmit malaria, filariasis and dengue fever which has a kind of habit and a different life.

The species of mosquitoes have biological properties that the way of life and a place to live and breed very varied. Adan mosquitoes that require clear water for breeding sites, there is a need brackish water, marsh, nest sheltered from the sun or vice versa there that actually require warmth of the sun. Besides mosquitoes are nothing like human blood as a source of life (anthropophilic), or just like the blood of animals (zoophilic), but no one can live by sucking the blood of humans and animals (antropozoofilik).

Besides filariasis and soil-transmitted Helminths, parasites sikius life is strongly associated with the environment is the pork tapeworm (Taenia solium) and the beef tapeworm (Taenia saginata), protozoausus for example Entamoeba histolytica, Giardia lamblia and Balantidiumcoil and blood protozoan diseases, namely malaria.

Some areas are the focus of schistosomiasis is endemic, blood flukes that can cause severe clinical manifestations that can lead to death of the patient. Causes schistosomiasis is a worm that lives in human blood vessels that japonicum.Cacing parasite Schistosoma is a zoonosis that can be transmitted from animals to humans and vice versa, in need of fresh water as effective as the development stage.

The life cycle of the organism, parasite adaptation, bacteria, viruses and fungi to the environment are included in the body of the host in which they live, causing differences in the life cycle of the various types of parasites.
Humans can act as a host of single definitive (definitive host, the final host) which is the only source of disease transmission of parasites, bacteria, virus or fungus) or one of the hosts must be separated from the other animals who also acts as the host of the definitive , or simply to host and disease-causing organisms incidental that naturally live in Animals. Animals that can act as the definitive host for disease-causing organisms that live in humans called backup host (host reservoir).

To complete the life cycle, sometimes parasites requires another animal that acts as an intermediate host (intermediate host) where the development of young stages of the parasite, such as shape larvae. Some types of worms trematodes and cestodes require two intermediate host, namely primary and secondary intermediate host. Instead humans can act as an intermediate host for the parasite that is the definitive host animals. Consequences caused by the larvae of the pork tapeworm (Taenia solium) or dog tapeworm (Echinococcus granulosus), for example, can cause health problems that endanger human life patients.

The spread of infectious diseases, Transmission many causes, in general, namely the existence of sources of infection, ways of transmission of the parasite and the host sensitive or sensitive. The spread of disease-causing organisms from one individual to the possible direct or indirect transmission.

Clinical symptoms of infectious diseases are influenced by many things, the number of disease-causing organisms into the patient's body, changes pathological arising in the tissues and organs, mechanical damage to the body's tissues and due to irritation of disease-causing organisms, toxins or materials toxic or cause allergic produced parasites or other organisms and negative reactions organs and tissue disorders.

If there is a balance between disease-causing organisms in which they live with the host, then the host's career shows no clinical symptoms are noticeable, but still always remove disease-causing organisms that can be transmitted to others.
Body resistance or immunity of host innate immunity may be appropriate to the species, race, or individual immunity against disease-causing organisms in general or a particular species or strains of organisms. Immunity can be absolute, but more often partial. For example immunity related to race, the black (negro) is more resistant to hookworm and malaria vivax than whites.

Groups of children and the elderly are most often suffer from infections transmitted disease, can first occur at a very young age. Akariasis eg infection have been reported in infants aged 4 months while on trichuriasis youngest age is 5 months. At hookworm can occur at the age of 6 months and this can happen when a child is placed just on the ground without a pedestal, so the infective larvae of hookworms can infect through the skin. Whereas in viral infections, bacterial or toxoplasmosis, an infection can occur since the fetus in the womb of his mother.

Diagnosis of infectious diseases. Clinical manifestations are often common parasitic disease because it causes the symptoms and complaints are similar to each other, so that only the clinical symptoms alone is difficult to hold on to determine what type of parasites which cause parasitic diseases. For example, a variety of intestinal worm infections shows symptoms are vague and not typical so difficult to identify. In laboratory tests it is necessary to establish a definite diagnosis of infection-causing parasite species such parasitit.

Parasitic infections are generally chronic nature and rarely cause sudden death, so it is often overlooked and neglected as a result. Malnutrition and anemia is the result most often experienced by the population, especially in areas that have been previously malnutrition, causing manifestations of malnutrition in varying degrees from mild to severe.

This situation will be even tougher because many parasitic diseases can also cause diarrhea. Parasitic infections hookworm weight can cause health problems in adults and adolescents productive lowered work productivity, while at the pregnant woman will experience a variety of disorders in the process of pregnancy and birth to her son in the form of abortion that is recurrent, poisoning pregnancy and fetal death before old enough content. Can also premature babies born with weight below the normal size. In children, there will be physical and mental development disorder that will eventually grow into adults who are low-power performance.

Disease viruses and bacteria, many viruses and bacterial illness that lasted acute, with clinical symptoms that clear so that it can be determined diagnosis. In the infectious diseases that include chronic or unclear symptoms, laboratory tests or other examinations using diagnostic tools (for example, examination using Rontgen rays, CT Scan, Ultrasound, Electrocardiograph) can help confirm the diagnosis of infectious diseases.

Treatment of infectious diseases, infectious disease should be treated with either through action quickly and accurately, whether the provision of medicines in accordance with the cause, the operative action if necessary, and nutrition that meets the needs of the patient to improve the patient endurance.

Drugs against infectious diseases in general can cause side effects for patients. Because of the dosage given should be the right size so that as little as possible side effects on the patient's body tissue, but it gives a lethal effect against the parasite in question. Less amount of the drug and the dose that kills disease-causing organisms may lead to infectious organism resistance to the drugs used, thus hindering the eradication of infectious diseases in a wider scale in a region or country. Malaria in many countries has been widely reported resistant to chloroquine, as well as tuberculosis that are resistant to various types of drugs that had previously been used widely.

Prevention of infectious diseases, in principle, to prevent the spread of infectious diseases carried by breaking the chain of disease-causing organism's life cycle, namely through: 1. treat the patient as a source of infection, 2. health education to prevent the spread of disease and avoid contact with the source of infectious diseases, 3. keep clean water, food, environment and work environment, as well as the disposal limbahyang good, 4. eradicate and control the backup host (reservoir host) and vector-borne diseases, and 5. increase the body's resistance to parasite infection.

For example, a worm that is transmitted through the soil always requires a soil medium for the development of infective stage that can infect other humans. Ascaris lumbricoides and Trichuristrichiura can be transmitted through food or drink contaminated by worm eggs found in soil contaminated with feces of patients. While infective hookworm larvae that infect human skin contact with soil contaminated with feces of patients hookworm infection. Soil contamination by fecal patients will only happen if the patient defecate on the ground and not in the latrines that meet the correct requirements. Therefore, the procurement of a good toilet is absolutely necessary to combat intestinal worm diseases, with a record of latrines must be used properly.

In general, preventive measures carried out in several ways together in order to achieve a satisfactory result, better prevention in the short term and in the long term. It also should be noted that the precautionary measures do not have a negative impact on the environment and the health of the environment in general.

Herpes: Treatment and Prevention

What is the disease Herpes? herpes discussion on the topic will be focused on two types of diseases are herpes simplex and herpes zoster or shingles

Herpes simplex is caused by herpes simplex virus (VHS) are included in the family Herpetoviridae Herpetovirus. Virus virion size of 110 nm. There are 2 types of VHS, namely VHS type 1 that attacks the nerve sheath or the trigeminal nerve ganglion, and VHS type 2 which causes damage to the vulvovaginal area.

Transmission of herpes simplex, humans are the only source of transmission of herpes simpieks. Primary infections occur in children under five years (toddlers), especially those from poor families in densely populated population.

The primary transmission occurs melalul point droplet of saliva and oral fluids, through conjunctival secretions and by direct contact in the genital meialui birth canal during delivery process takes place.

Secondary transmission occurs as a result of provocation or stimulation febrile diseases, allergies, mechanical or psychological trauma and excessive sun exposure.

Clinical symptoms of herpes simplex
VHS type .1 cause clinical symptoms include:
Pharyngitis
Gingivostomatitis
Labiales herpes, or herpes facial herpesfebralis
Herpetic keratoconjunctivitis
VHS type 2 show the clinical picture:
Genital herpes or
Herpes vulvovaginitis.

Half of the infants born prematurely VHS infection. Skin and mouth herpes can spread to organs viserai or to the brain. for that this disease should not be taken lightly.

To determine the cause of the virus, cytologic examination on the organ tissue damage. Serology with serological test to determine the presence of neutralizing antibodies (IgG and 1gm) or determination of the type of antigen using monoclonal antibodies.

Treatment of herpes simplex, Human gamma globulin is given as a general treatment of herpes simplex. To reduce infant mortality due to infection VHS can be administered by intravenous Adenine arabinoside.
Herpetic meningoencephalitis treated with intravenous acyclovir, its cytarabin or another antimetabolite. Keratoconjunctivitis patients can be treated with local asikiovir or 5-iodo-deoxyuridine. To reduce patient complaints given palliative medicine.

Prevention of transmission of herpes, pregnant women who have had genital herpes in the genital organs should be examined virological and cytological. Examination carried out in the last trimester of pregnancy. Cesarean section can be done to prevent the transmission of herpes from mother to infant birth.

Herpes zoster or shingles is an infectious disease that infects adult sporadic. The cause is the Varicella Zoster virus (VVZ) that attacks the roots of the posterior segment of unilateral nerve ganglion or kraniai.
VVZ including DNA viruses and family Herpetoviridae benselubung virions which have a diameter of 110 nm.

The spread of disease zoster, shingles infectious diseases are sporadic, not depending on the season. Clinical symptoms arise due to reactivation of latent form of the virus that had previously been located in the sensory ganglion, after the patient recovered and vanisela disease. Zoster occurs only in adults. Penulanan VVZ in children, will cause varicella disease in children.

Clinical symptoms of shingles, a common symptom of infection tenjadi the VVZ is fever and malaise. Patients will then complain of severe pain in the area of ​​distribution of nerve roots mainly contained in the ribs, accompanied by the emergence of groups of vesicles in the nerve distribution area the same.

Diagnosis zoster, shingles clinical symptoms for diagnosis confirmed by inspecting laboratonium. Vesicles smear examination will find multicore giant cells (multinuclear giant cell) and inclusion bodies (nuclear inclusion body)
The examination of fluid senebrospinal shows the pressure increase, the microscopic examination showed monocytes.
Serologic tests with complement fixation or ELISA test showed an increase in IgG antibody titers and specific 1gm.

Treatment and prevention of herpes zoster, shingles sufferers can be given the treatment with serum hiperimun (Human Serum hyperimmune, Varicella-Zoster Immune Globulin-VZIG). If no complications occur zoster can heal by itself. To reduce pain given pain medication. When the lesions occur in the eye, the patient is given atropine and cortisone. Secondary infection with bacteria can be treated with appropriate antibiotics.
In the event of severe zoster in adults may be given antiviral drugs Vidarabin, whereas progressive zoster overcome with intravenous acyclovir. Antiviral drugs should be given immediately, no later than 3 days after the onset of skin disorders.

To prevent transmission VVZ in infants whose mothers have varicella, given Hyperimun Human Serum (VZIG) as many as 125 units, because until now there is no vaccine to prevent shingles infection.

How is the spread of infectious diseases?

How is the spread of infectious diseases? Transmission of the disease parasites, bacteria, viruses and fungi is influenced by three factors, namely the source of infection, ways of transmission of the parasite and the host sensitive or sensitive.

The combination of these factors determine the spread and the high prevalence of parasites in an area at a particular time and place. Besides the natural adaptation of the parasite to humans as hosts, habits and relationships in the human population and the high durability of the individual human body, affecting the rapid occurrence of parasitic disease transmission.

Contagious disease which infects patients in early infection is generally asymptomatic. After that there will be a clear clinical picture that in the course of the disease can then develop into acute and severe disease that causes the death of the patient. In patients with a high body resistance, disease will heal or will develop into a chronic disease or chronic symptoms or minor complaints. In this case even though the patient is still suffering from a particular disease-causing microorganisms, but have no symptoms or complaints (called the carrier), so this career is a potential source of transmission of infectious disease to other healthy people.

Career occurred between host and parasite because there is a balance in the life of each. Career example found in malaria transmission, amubiasis, filaniasis and diseases caused by viral or bacterial infection of the intestine.

The spread of disease-causing organisms and one individual patients to susceptible individuals may occur directly (direct contact) or through indirect transmission. In the indirect transmission, to be able to infect a susceptible host parasite must pass through the stages of developmental stages before they become infective stage.

Infective stage transmission can occur by direct contact or indirectly, with food, drink, soil, vertebrate animals and vector insects, or from mother to baby through the placenta during childbirth.