Pigmentation

Melanin is responsible for imparting color to the skin, hair and iris of the eyes. Levels of melanin depend on race and amount of sunlight exposure. Melanin production increases with exposure to the skin so as to protect the skin against harmful ultraviolet rays. Skin pigmentation disorders occur as a result of the body producing either too much or too little melanin. Skin pigmentation creates a darker or lighter skin tone that may be blotchy and uneven. Sun damage is probably the leading cause of skin pigmentation problems. Other factors include drug reactions, hormonal changes, genetic factors and medications.

Hormonal therapy, childbirth or birth control pills can cause skin pigmentation changes. Many people suffer from skin pigmentation problems as a result of locally increased skin pigment production. They appear as age spots, moles, liver spots or hyper pigmentation after local skin damage. Freckles are another variation in pigmentation of the skin. They are caused but by uneven release of the pigment.

Hypopigmentation or loss of skin pigmentation is a condition where the body does not produce sufficient melanin. Sometimes after an ulcer, blister, burn, or infection heals, the skin loses some of its pigment in that area. Albino is one who suffers total hypopigmentation at birth.

Vitiligo: Vitiligo is another form of hypo pigmentation caused by the loss of pigment-producing cells in the skin (melanocytes). These white patches are very sensitive to the sun. This skin pigmentation disorder affects nearly 2% of the population and is more evident in those with darker skin. Some scientists believe vitiligo may be caused by an autoimmune disorder. It is also linked to hyperthyroidism and Addison's Disease that affects the adrenal glands.

Hyper Pigmentation is a condition where the body produces too much melanin thereby causing it to become darker than usual. Hyper pigmentation can occur due to excessive sun bathing or drug reactions. Many a time wounds and scars leave a darker patch of skin. Birthmarks, moles, and aging spots are also indications of hyper pigmentation. It is important to keep on the alert for any change in size, color or texture for indications of skin cancer.

Lichen Simplex Chronicus: This skin pigmentation disorder is characterized by dark patches of skin accompanied with severe itching. This can lead to permanent scarring and infection if untreated.

Melasma: This hyper pigmentation condition is a fallout of pregnancy hormones. A dark mask appears over the cheeks, bridge of the nose and the neck. This skin pigmentation condition is also known as chloasma and can be treated with prescription creams and over-the-counter products.

Birthmarks: This type of skin pigmentation appears at birth or in the few weeks following birth. These birthmarks do not generally pose any health risks.

Port-wine Stains: These skin pigmentation spots are caused by abnormal development of capillaries and appear as a red or purple mark on the body.

Wood's Lamp Examination

A wood's lamp examination helps the doctor confirm a fungal infection or bacterial infection. The doctor is able to determine the cause of any light or dark colored spot on the skin using this examination. This is a test using Ultraviolet or UV light to look more closely at the skin.

In case of fair skinned individuals, Wood's lamp can detect Vitiligo or any other depigmentation even when it is not visible to the eye under normal conditions. In case of detection, Vitiligo can be treated at an early stage even before it is visible to the normal eye, thereby minimizing treatment and preventing further expansion of the disorder.

What is Wood's lamp?

Also known as Black Light Test, or Ultraviolet Light Test, this is based on the use of ultraviolet light which is shined on the area being examined, when performed in a dark room. It emits ultraviolet light in the 365 nanometer range and when the light is shined directly on the area in darkness, the dermatologist looks for any change in color or fluorescence. While normal skin does not fluoresce under the light of the Wood's lamp, affected skin 'glows' in dark. if any fungal or bacterial infection or pigment is present, the Wood's lamp can strengthen or lessen the suspicion of a particular diagnosis based on the color of florescence of the affected skin being illuminated. Even subtle color changes can be detected very well using Wood's lamp.

Procedure

You will be seated in a dark room usually in the dermatologist's office. The doctor turns on the Wood's lamp and holds it approximately 5 inches from the skin to look for color changes. It will reveal skin color changes not visible to the mere eye examination. The patient is advised not to look directly into the light when being examined. This portion of the examination usually lasts for less than a minute and the patient feels no discomfort from the examination.

Pre and post procedure

Before the Wood's lamp examination do not wash the area or apply any cream to the skin to avoid inaccurate results. Following the procedure, the dermatologist may decide to treat the skin condition based on the results of the Wood's lamp examination. Additional tests are sometimes done to arrive at the correct diagnosis. No aftercare is recommended specific to the examination and depending on the result of the examination the physician may recommend treatment of a skin disorder.

Why is Wood's lamp examination done?

Certain skin problems including bacterial and fungal infections, Porphyria, skin coloring changes in Vitiligo, head lice and nits, Erythrasma and other pigmentary disorders can be performed using this test.

The test also reveals different colors according to the type of the skin disease which includes:

• Golden Yellow: Tinea Versicolor
• Pale Green: Trichophyton Schoenleini
• Bright Yellow green: Microsporum Audouini or M. Canis
• Aquagreen To Blue: Pseudomonas Aeruginosa
• Pink To Pink orange: Porphyria Cutanea Tarda
• Ash-Leaf-Shaped Spot: Tuberous Sclerosis
• Blue white: Leprosy
• Pale White: Hypopigmentation
• Purple brown: Hyperpigmentation
• Bright White, Or Blue white: Depigmentation, Vitiligo
• Bright White: Albinism If it is a normal result, the skin will not shine under the ultraviolet light.

Risks

Exposure to Ultra violet Light for prolonged duration can result in skin damage and cancer of the skin. But this test hardly lasts for a minute and the intensity of the light is minimal. Patients should avoid looking directly into the UV light and since the time for the procedure is very minimal - less than a minute - the procedure is well tolerated as there is no associated pain and no side effects as a result. Beware that the presence of other materials like certain kind of makeup, deodorants, perfume, body lotion or soap can also fluoresce leading to difficulty in arriving at a conclusive diagnosis. Equally if the room is not dark enough, it may present difficulty for proper examination. Not all bacteria or fungi show up under the UV light.

Angelman syndrome

Angelman syndrome is a neurological disorder predominantly caused in children. It was first discovered by Harry Angelman in 1965. This disorder is also popularly known as the happy puppet syndrome. Angelman syndrome is associated with genetics of the affected person and the symptoms that proceed as a result of it are developmental in origin. Children who are affected by this disorder show delayed developmental characteristics and sometimes impaired functionalities associated with it. Although Angelman syndrome is a rare disorder, studies indicate that one among every forty thousand children born is affected by it. The children are normal at birth but exhibit the symptoms of this disorder gradually.

Clinical Manifestations of Angelman syndrome

The clinical manifestations of the Angelman syndrome are associated with the developing stages of the child after birth. The initial sign are seizures indicating the probability of Angelman syndrome. The first appearance of seizures happens around the age of two. The head size is usually below the average. Mental retardation associated with speech difficulty or total speech impairment along with jerky and quick movements are classical symptoms of the Angelman syndrome.

This disorder is also remarkably noticed by visual facial disorientation such as reduced lip size, wide and constant smiling expression and protruding or prominent chin. Children affected by Angelman syndrome have poor motor skills and also face difficulties in sitting, standing and also walking. Apart from these symptoms, children who are affected by this disorder have strong affinity towards water. Behavior abnormalities such as frequent laughter, hyperactive nature and lack of consistent attention are predominant. Anatomical observations for Angelman syndrome include hypopigmentation, wide mouth with distantly spaced teeth and prominent jaw. People suffering from this disorder also experience heat sensitivity and difficulty in swallowing food.

Diagnosis of Angelman syndrome

The initial diagnosis of the Angelman syndrome is difficult because the symptoms begin to surface around the age of three. Many disorders such as autism have cohesive symptoms like the Angelman syndrome and hence careful analysis of the clinical symptoms and genetic parameters are done to avoid misinterpretation. Genetic testing can be done along with the detection of birth defects in the babies by keeping a track of developmental stages and behavioral patterns. Diagnostic genetic tests such as methylation tests are administered to confirm the Angelman syndrome.

Treatment of Angelman syndrome

Angelman therapy management is predominantly done by effective counseling. Top priority is given to patients who are prone to seizures. Clinical management techniques such as speech therapy, physiotherapy and occupational therapy are done to improve the motor skills. Monitoring and treating epileptic attacks and controlling hyperactive behavior are effective methodologies to treat and manage Angelman syndrome. Consistent monitoring of the general motor skills of the child followed by skills such as learning abilities, self-help and communication can aid in the identification of the disorder at an early stage.

Since sleep disturbance is also a common factor in the Angelman syndrome, consistently monitoring the sleep patterns can help evaluate the condition. Use of hypnotics such as benzodiazepines is recommended only for a short duration as they become addictive after a certain stage. Monitoring young children during the onset of puberty is of much significance as it helps in the effective counseling process involving sexual health and other related issues. Other therapies such as reflexology, hydrotherapy and also music help in the healing process.