Autoimmune disorders are those that occur as a result of a hypersensitive immune system. The immune system attacks and destroys healthy body tissue. Typically autoimmune disorders affect the working of RBC, endocrine glands such as thyroid, muscles and joints. Examples of autoimmune disorders include Type I diabetes, Rheumatoid arthritis, pernicious anemia, Grave's disease and Multiple sclerosis.
Pruritus is a skin disease associated with conditions pertaining to autoimmune disorders and other advanced complications like liver cirrhosis. Pruritus cases vary from mild to complex as the symptoms associated with the condition generally aggravate with age. Untreated pruritus can be a big hindrance to an individual's normal life as it interferes with sleep patterns leading to irritability and stress. In some cases the causative agent for this disease is the Hepatitis C virus which accounts in 20% of the population.
Pruritus occurs mostly in the wrist and ankles as a scratch. The intensity of the itch facilitates other factors such as eczema, impetigo and induced urticaria. The immune response releases histamines causing allergic reactions. The association of pruritus with allergic reactions is identified by the presence of serotonin. The serotonin release caused because of pruritus occurs in case of preexisting medical conditions such as polycythemia, lymphoma and cholestasis.
The identification and diagnosis of pruritus is closely associated with the evaluation of dermatological condition of the patient. Progressive pruritus is noticed with contact dermatitis, urticaria, scabies, pediculous infections of the genital region, folliculitis and xerotic eczema.The factors associated with the respective causes along with pruritus are fomites, dust, bites, chemicals and photosensitivity. Atopic dermatitis induces aggressive form of pruritus. The intense forms of atopic dermatitis associated pruritus usually occur in pregnant women, infants and veterans. Systemic causes of pruritus involve preexisting conditions such as Hodgkin's lymphoma, HIV, scleroderma, multiple myeloma, chronic renal failure and many other conditions.
Pruritus diagnosis involves meticulous procedures in examining the exact history of the patient to rule out other forms of allergic reactions. The information pertaining to the patient history includes several factors such as travel zones, food and occupation. Differentiation of non-septic and septic forms is done to identify systemic involvement of the disease. Secondary infections and malignancies associated have to be identified. Specific sites are identified on the skin reaction to respective drug therapy is carefully monitored.
Avoid stress which delays the healing process. Topical creams are prescribed for allergic forms of pruritus. Skin cleansing is an important step. It is predominantly done to prevent secondary infections and conditions such as psoriasis. Patients who have history of sunburn and sensitivity to extreme temperatures need to relieve the stress upon immune system that reacts immediately to such conditions. Hydration of the skin helps in the restoration of the skin cells to facilitate the process of healing. Change of diet and lifestyle is prescribed to patients who are sensitive foods such as nuts, seafood etc. Patients with a history of contact dermatitis are advised to use skin safe deodorants, shampoos and bubble bath solutions. Oral antihistamines are recommended to ease the immune system's reactivity. Hot water bath and tight clothing are to be avoided in case of pruritus as it may aggravate the condition. Topical creams containing corticosteroids are recommended during the onset of a pruritic reaction. In case of secondary infections associated with pruritus, antibiotics are given.
Sjogren syndrome is an autoimmune disorder causing conditions such as xerostomia and Xerophthalmia. It was first discovered by Henrick Sjogren. The symptoms associated with this disorder are often chronic and occur due to damage or impairment of the exocrine glands caused due to the lymphocytic infiltrates and hypersensitivity reactions. The onset of Sjogren syndrome predominantly occurs in the region of salivary glands and lacrimal glands. The primary form of Sjogren syndrome is generally associated with external glandular symptoms such as dry eyes and dry mouth without any connective tissue damage. The secondary form of the Sjogren syndrome usually occurs because of preexisting autoimmune disorders.
Clinical manifestations of Sjogren syndrome
Sjogren syndrome usually occurs in the older age group; however exceptions have been reported on it affecting younger persons. The factors causing Sjogren syndrome are predominantly genetical or environmental. Neuro-endocrine impairment plays a significant role in the onset of the Sjogren syndrome. HLA-DR genotype is the predominant factor in the genetic propagation of the disease.
Sjogren syndrome is associated with a cascade of symptoms related to many organ systems and their functions. The affected regions are ocular, oral, ontological, laryngeal, vascular, neurologic and endocrine systems respectively. The effect of the Sjogren syndrome is mainly on the head and neck region and hence the sense organs are affected to a larger extent. Other clinical conditions include loss of hearing, arthralgia, myalgia and also frequent epistaxis. Sjogren syndrome if not treated, can lead to serious conditions such as lymphoma and renal failure.
Diagnosis and treatment of Sjogren syndrome
Sjogren syndrome is diagnosed by using radiological, pathological and serological analysis. Schirmer's test is used in the diagnosis of Xerophthalmia. It is used to estimate the tear secretion level of patients suffering with dry eye conditions. The decreased levels or absence of tear secretion indicates probability of Sjogren syndrome. Salivary biopsy is advised for patients suffering xerostomia. The pathological analysis of the salivary glands also reveals underlying infiltration and damage caused to the exocrine glands. Serological analysis of the Sjogren syndrome are generally associated with low WBC counts, increased erythrocyte sedimentation rates, elevated levels of protein and hyper-gammaglobulinemia of IgM. Careful clinical study of the diagnostic parameters along with symptoms is necessary to rule out false positive results.
The treatment of Sjogren syndrome is generally a slow process because it is an autoimmune disorder. Immunosuppressive drugs and salivary substitutions are some of the methods administered to manage Sjogren syndrome. Pilocarpine an FDA approved tear stimulating drug is widely used for the treatment of dry eyes.
Bibliography / Reference
Collection of Pages - Last revised Date: December 15, 2018