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Pyogenic Granuloma

Pyogenic granulomas are common skin lesions that appear as tiny red bumps. These lesions have moist, shiny and smooth surface and are prone to bleeding quite often. They tend to bleed frequently as they contain large number of blood vessels at the site. These bumps are usually attached to the skin with stalk. The diameter of the stalk always measures lesser compared to the tumor. Pyogenic granulomas most often occur in children and young adults. It is also common in pregnant women and hormonal changes that take place during pregnancy is said to be the reason for developing Pyogenic granulomas during such period.


Causes and Symptoms

The exact cause for pyogenic granuloma is not known. However it normally occurs at the site of injured or damaged skin. This condition is neither hereditary nor is it contagious.


  • A small red raised bump on the skin that bleeds frequently.
  • They are benign and tend to erupt and grow at a rapid pace.
  • Usually occurs on hands, arms, and face. In rare cases, they can grow on the cornea of the eye. However pregnant women often develop them on the oral mucosa.
  • The lesion can measure from few millimeters to several centimeters and there could be single lesion or tiny multiple bumps clustered around the same area.

Pyogenic granulomas is normally diagnosed on mere observation during the clinical examination. A biopsy may be performed to confirm the diagnosis.


Treatment

Pyogenic granulomas may shrink, dry up and fall off on their own over a period of time. Yet the condition most often requires medical attention and treatment much before that; as the wait may be painful and distressing. Pregnant women need not opt for any treatment as the lesions disappear after delivery. In normal cases the following methods are usually followed to treat Pyogenic granulomas.

Curettage: Curettage is always known to be the first line treatment for Pyogenic granulomas. Curettage involves scraping of the lesion with a curette, a spoon like instrument with sharp edges. Once the lesion is removed, Electro cauterization is performed to avoid regrowth and prevent infection.

Cryotherapy: Cryotherapy involves freezing the lesion using liquid nitrogen. This method is effective in treating small lesions. Cryotherapy does not leave a deep scar. However it may change the color of the skin at the site.

Silver nitrate: Cauterization using silver nitrate is also a commonly followed method in treating Pyogenic granulomas.

Laser surgery: Laser treatment has been gaining popularity in treating Pyogenic granulomas. It is an outpatient procedure and results in better cosmetic appearance with little or no scarring.

Excision: There are high chances of recurrence even after timely treatment in Pyogenic granuloma. In such cases, the most effective method of treatment is to completely remove affected area through surgical excision and then close it with sutures.


Dermatoses

Dermatoses are conditions affecting the skin, nails, hair or glands. Dermatoses may be acute or chronic; acute conditions last from days to weeks and chronic conditions last from months to years. Treatment for dermatoses depends on whether the condition is acute or chronic. Most dermatoses respond to treatment with topical corticosteroids.


Dermatosis types and symptoms

Acute dermatoses: Occur suddenly and symptoms include redness, itching and swelling which may further progress to blisters, oozing, scratch marks etc. But usually the symptoms subside in a few days.

Chronic dermatoses: There are small oozing blisters and crusts that may appear thickened discolored and scaly. The skin is cracked and painful.

Subacute dermatoses: Symptoms include scaliness, scratch marks, redness and may peel off. The affected areas do not ooze and do not have blisters.


Dermatosis classification

Dermatosis may be described through the following terms

Lichenification: Thickening and discoloration of skin like the lichen on a tree.

Lesion: Abnormal area of the skin.

Macule: Change in color or consistency of the skin.

Nodule: a bump in the skin that may measure larger than a centimeter in diameter.

Papule: a bump in the skin that may measure smaller than a centimeter in diameter.

Plaque: A large area of affected skin that may flake or peel, it generally has defined edges.

Pustules: A bump that is filled with pus and may have resulted due to an infection.

Rash: A variety of conditions that may show up as red raised up area from the skin and involves inflammation.

Vesicles and bullae: Raised bumps that are filled with fluid.


Various Dermatosis conditions

Acute febrile neutrophilic dermatosis (Sweet's syndrome): Sweet's syndrome is characterized by skin lesions, sore eyes, ache in joints and fever. Red, swollen rashes and papules that are tender. Neutrophilic dermatosis can be caused due to many infections such as IBD, rheumatoid arthritis or upper respiratory tract infections. Rarely it can be a sign of an underlying blood disorder or cancer.

Contagious pustular dermatosis: Also called Contagious pustular dermatitis, it can be contracted from sheep affected with sheep pox, it shows up as papules.

Digitate dermatosis: Finger shaped psoriatic rash at the side of waist.

Dermatosis cinecienta: Symmetrical patches of thickened skin that are ash colored and is generally common in individuals under 40 years.

Dermatosis neglecta: Appears like warts, is a type of plaque caused due to inadequate washing of skin in a particular area. Dermatosis neglecta surfaces in the form of localized scaling and hyperpigmentation.

Dermatosis papulosa nigra: Often seen in dark skin toned people, many small, benign, dark skin lesions are seen on the face.

Linear lichenoid dermatosis: Small and scaly papule, often seen in children.

Transient acantholytic dermatosis or Grover's disease: Chronic, itchy blistering that is usually triggered by heat or sweating. It appears suddenly as itchy red spots on the trunk. It lasts for weeks to months, but resolves spontaneously.

Juvenile plantar dermatosis: Cracking and peeling of the weight-bearing soles of the juvenile plantar dermatosis: cracking and peeling of the weight-bearing soles of the feet in children.

Rheumatoid neutrophilic dermatosis: Skin manifestation of . It manifests as reddish palms and brittle split nails. The skin on the hands might become translucent and wrinkled.



Behcet's Syndrome

Turkish dermatologist, Hulusi Behcet (1889-1948) recognized and reported in 1937 symptoms of Behcet's syndrome. A dental infection is attributed as the etiology of the disease. The American Behcet's Disease Foundation (ABDA) was founded in 1978 with the objective to provide support to patients and family as well the caregivers. In the absence of a cure or a single test to definitely determine Behcet's syndrome or Behcet's disease, educate about the syndrome to seek prompt medical attention for treatment.


Morbus Behcet or Silk Road disease is the other name for Behcet Syndrome or disease. Month of May is Behcet's Awareness month and May 20th is Behcet's awareness day. The focus is on spreading awareness and stress the importance of self-help.


Behcet's syndrome facts


  • Non-contagious
  • Exact cause is unknown
  • Genetic predisposition is high.
  • Symptoms are similar to other disease of the digestive tract, Ulcerative Colitis and Crohn's Disease
  • No single test to confirm diagnosis.
  • No cure available.
  • Disease affects different parts of the body.
  • Men and women are equally prone but more severe in men.
  • In the US, affects more women.
  • More prevalent in Middle East, Mediterranean and Eastern Asia.
  • Turkey has the highest prevalence.
  • Leading cause of blindness in Japan.
  • Most common among age group 20-30.
  • Treatment requires more than one specialist.
  • Continued, extensive research to explore possible genetic, bacterial and viral cause.
  • Research is on to identify medicines to better treat Behcet's disease.

Behcet's syndrome – Autoimmune disease

There are over 14, 000 auto-immune diseases and 7000 plus are rare. Behcet's syndrome is rare. Autoimmune disease occurs when the body's immune system mistakenly attacks its own healthy tissues. Though the clinical feature of auto immunity is absent, Behcet's syndrome is classified as an autoimmune disease as it has various aspects related to autoimmune disease. Enhanced inflammatory response (inflammation of blood vessels) is one such aspect. Significant number of women as compared to men are more likely to be affected by autoimmune disease. Estrogen predisposes women to autoimmune disease.


Behcet's syndrome symptoms

The inflammation of blood vessels, particularly veins causes symptoms in many parts of the body. Swelling, redness, heat and pain are select features of an inflammation. Though Behcet's disease can affect any part of the body, involvement of the neurological system is known as neuro-Behcet's disease and is rated the most disabling complication of the disease. Not that common, neuro-Behcet's disease affects about 10 per cent of people with Behcet's disease.


The most common symptom of Behcet's syndrome is the regular occurrence of ulcers in the mouth and genitals. The symptoms are an off-shoot of inflammation of the eyes, skin, arteries, veins, joints, nervous and digestive systems and heart. Symptoms can be mild or severe. Symptoms can be noticed between ages 20-30 years.

Mouth ulcers: May look like normal mouth ulcers but are more painful and numerous in number. Ulcers develop in the tongue, lips, and gums and inside of the cheeks. Even if the ulcers heal within a couple of weeks, they recur.


Genital ulcers: In men, though genital ulcers can appear anywhere in the groin area, including the penis, it is more common on the scrotum. In women, the ulcers appear on the cervix (neck of the womb), vulva or vagina. The ulcers are usually painful and scars appear around the area.

Skin lesions: Resembling acne, pustular skin lesions can appear anywhere on the body. Erythema nodosum results in red, painful, tender lumps that can measure one to five centimeters. It is the result of inflammation in the fatty layer of the skin. It can appear on the legs and ankles but can also appear on the face, neck or arms. Erythema nodosum related to other disease heal without scars but if related to Behcet's disease, leaves the skin totally discolored.


Inflammation of the eyes: Sudden inflammation of the eyes is a common symptom of Behcet's syndrome. A group of connected tissues, uveal tract is inside the eye. This uveal tract gets inflamed. Uveitis as it is named can cause symptoms such as, painful red eyes, blurred vision and floaters (dots that move across the field of vision). With a possibility of permanent visual impairment, it is best to seek medical attention for appropriate treatment without any delay.

Skin sensitivity: Pathergy is a condition signifying sensitivity of the skin, particularly injury or irritation. Even a needle prick can lead to developing a large red lump in a day or two.


Gastrointestinal symptoms: Inflammation of the stomach and intestines causes symptoms such as loss of appetite, stomach pain, indigestion, diarrhea, feeling sick and vomiting. There is a possibility of damage to the bowel resulting in bleeding. Blood in stools suggests inflammation of the internal lining of the bowel.


Blood clots: Inflammation of the veins can lead to formation of blood clots or thrombosis.

Joint pain: Joint pain in ankles, wrists, knees, elbows and hips is common. Inflammation in the joint can cause swelling, redness and tenderness.

Brain: Meninges is the coverage of the brain. Inflammation of the brain or tissue that covers the brain (meninges) causes symptoms like headache, neck stiffness along with high body temperature. In severe cases, it can damage the nervous tissue and lead to extreme weakness or impaired function of the body.

Aneurysms: Aneurysms are outpouchings of blood vessel walls due to inflammation of arteries in the lungs. This can lead to massive lung hemorrhage. Symptoms include pain in the limbs, severe headache, feeling dizzy, and breathlessness, coughing up blood, confusion and loss of consciousness.

Inflammation of the nervous system: Inflammation of the central nervous system occurs in 5%-10% of reported cases. This is regarded as the most serious symptom. Typical symptoms include headache, double vision, loss of balance, seizures, partial paralysis on one side of the body, personality changes. Any of these are noticeable within the first five years of recognizing initial symptoms.

General symptoms: Experiencing extreme fatigue to the extent that it interrupts with everyday routine is a general symptom of Behcet's syndrome.


Behcet's Syndrome Causes

The exact cause remains unclear. Though regarded as an autoimmune disorder, it is unclear what triggers the autoimmune disorder. Other possible association is genetics. Certain ethnic groups or a family member with the disease increases chances of developing Behcet's syndrome. People with gene HLA B51, variations in other genes like IL10, IL23R-IL2RB2 increases the risk of developing the disease considerably. However, the condition does not have a clear pattern of incidence.


Risk factors identified include:

Age: Children and older adults can develop the condition. But men and women in the age group of 20-3 are more likely to be affected.

Location: People from countries in the Middle East and Far East, including Turkey, Iran, Japan and China are more likely to develop Behcet's syndrome.

Sex: The disease is more severe in men.

Genes: Having certain genes increases the risk of developing the syndrome.


Behcet's Syndrome Diagnosis

In the absence of a single test to diagnose Behcet's syndrome, doctors look out for symptoms. Blood tests or other laboratory tests are recommended to rule out other disease or illness. The criteria include:

Mouth sores: Mouth sores are very common. Many disorders are related to mouth sores. If the mouth sores recur every three months in 12 months, it is regarded as criteria for evaluating the disease.

Doctors look for two additional signs.



Behcet's Syndrome - time to seek help

Recognizing symptoms and relating the symptoms to Behcet's disease is essential. Note down symptoms being experienced and add related information that affects normal routine. Seek appointment with a doctor. If medical attention is delayed, the condition can worsen and lead to losing eye sight or a stroke. At the meeting, divulge family history and inform about medications for any other health issue or supplements being taken.


You are most likely to seek specialist help. Rheumatologist for arthritis, joint pain etc, Ophthalmologist for eye problems, gynecologist or an urologist for genital sores, dermatologist for skin issues, Gastroenterologist for digestive difficulties or neurologist for symptoms related to CNS (central nervous system).


Behcet's Syndrome Treatment

There is no cure for Behcet's syndrome. The treatment is aimed at alleviating the symptoms, reducing the frequency and intensity, put the disease into remission and prevent serious complications. Medicines for controlling the individual symptoms are prescribed. Some medicines are prescribed with other medicines to suppress the activity of immune system. Some medicines can have side effects too.

For the skin: gels, creams and ointment that contain a Corticosteroid to reduce the inflammation.


For mouth sores: Special mouth washes with Corticosteroid to reduce the pain and associated discomfort.

For the eyes: Eye drops with Corticosteroid to relieve pain and redness in the eye.


Coping with Behcet's syndrome


  • Take ample rest in between flares.
  • Pay attention to diet and exercise.
  • Find support groups and connect.
  • Login to American Behcet's Disease Association.
  • Read message boards and engage in chat sessions.

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Bibliography / Reference

Collection of Pages - Last revised Date: December 10, 2019