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Skintervention Guide: Purely Paleo Skincare

The Skintervention Guide contains more than 200 pages of downloadable, Fully Digital information that will radically change the way you think about skincare, body care, and everything in-between. For just $37 the key to natural skincare and a beautifully radiant body is at your fingertips. Heal Acne, Eczema, Scarring, Skin, Hair, And Nail Problems Naturally! Great Skin And A Beautiful Body Starts From The Inside. A Guide To Paleo And Primal Nutrition, Digestion, And The Right Routine For Gorgeous Skin And Body. As an added bonus, youll receive two Extra downloads: Skintervention Guide Easy Recipes to kickstart your journey, and Skintervention Guide Resources where I share all my fave goodies (North America-based) to pamper your skin naturally. Not only that, but you receive lifetime updates to the guide And access to my password-protected Online resource guide! Thats over 200 pages of in-depth, quality content; Bonus Guides, online support, and a lifetime of updates! Heres what I will share with you: The nutrients you need for beautiful skin, lovely hair and a radiant bodyand where to find them. Unexpected super-foods that are critical for skin wellness (conventional wisdom not welcome!) Why almost everyone needs digestive helpand how to get it. How to get nutrients where they need to go. The best products on the planet for cleansing and nourishing the skin (hint: there are NO unpronounceable ingredients or unnecessary chemicals!) Alternatives to conventional makeup, hair dyes and hair care products. Strategies for improving cellulite and tips for smart intimate and feminine care. How to ditch toxins in food, in your body, and in your body care routine! More here...

Skintervention Guide Purely Paleo Skincare Overview


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Author: Liz Wolfe
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My Skintervention Guide Purely Paleo Skincare Review

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I started using this book straight away after buying it. This is a guide like no other; it is friendly, direct and full of proven practical tips to develop your skills.

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Printed In The United States Of America

There is little commonality in the scientific methods, processes, and formulations required for the wide variety of cosmetics and toiletries in the market. Products range from preparations for hair, oral, and skin care to lipsticks, nail polishes and extenders, deodorants, body powders and aerosols, to quasi-pharmaceutical over-the-counter products such as antiperspirants, dandruff shampoos, antimicrobial soaps, and acne and sun screen products.

The International Scene

There are three main trading blocks, the United States, Europe, and Japan. Obviously globalization as an integrated free-trade network cannot work if each block classifies and regulates skin care products differently. Unfortunately, no international consensus currently exists, inevitably sparking disputes and trade practices that may place some producers at a grave disadvantage. Japanese authorities have created their own laws in response to the problem that many skin care products are neither pure drugs nor pure cosmetics in the traditional sense, but mixtures of the two. The category we call cosmeceuticals they call quasidrugs (5). They allow cosmetics to include pharmacologically active ingredients, provided that the medicinal effects are mild and the products have been demonstrated to be safe. The legal wording leaves a lot of room for ambiguities and ad hoc interpretations that some perceive as a trade restraint.

Conditions That May Simulate Verruca Vulgaris

The distinction between warts and plantar calluses is sometimes difficult and is important because the latter can be treated with keratolytics and debridement alone and do not require the more destructive therapies used on verrucae. The difference can be determined by paring the lesion down with a scalpel blade. Warts will show a single or sometimes multiple cores that interrupt normal skin lines. They also exhibit dark red or black speckles, which are the thrombosed ends of the feeder vessels. Calloses show neither of these changes.

Evaluation of Eyelid Lesions

Fluid Filled Cyst Eyelid

The epidermis responds to chronic trauma with increased cell proliferation and increased keratin production (Fig. 9). The characteristic morphologic features of lichenification include palpable thickness of the skin compared to nearby normal skin accentuation of the normal cross-hatched skin markings and the presence of lichen-type scale. Lichenification is especially characteristic in the chronic lesions of atopic dermatitis and neuro-dermatitis. It is particularly marked in the variant of these two diseases known as lichen simplex chronicus. Color is surprisingly hard to describe accurately. This is partly due to the lack of absolute color standards and partly due to the confounding effect that the patient's normal skin color has on lesional color. One must also discount the color contributed by secondary characteristics such as scale or crust. This can usually be accomplished by looking at the peripheral edge of a lesion, since both scale and crust are often less prominent in this...

Gender Ethnicracial And Life Span Considerations

Elicit a history of skin problems, the length of time skin disorders have existed, daily routine skin care, and current medications. Ask the patient about exposure to sunlight in particular, establish long-term patterns of exposure to sunlight, either at work or in recreational activities, and determine what form of sun protection the patient has customarily used. Record the patient's history of scars, vaccination sites, and burns. Establish a patient history of exposure to radiation or arsenic be sure to ask about the patient's occupational history to discover if he or she has been at risk of ingesting arsenic at an industrial site. PHYSICAL EXAMINATION. Observe the color, texture, turgor, and pigmentation of the patient's skin for deviations from normal skin parameters. Note in detail any lesions, nodules, or plaques.

Epithelialization Contraction

Close to 20 different collagen molecules have been identified and characterized. Type I collagen makes up over 90 of the collagen in the body and is the dominant type in mature wounds. Type III collagen is also a key in early wound healing, composing up to a third of all wound collagen during the granulation tissue of the fibroblastic phase, before being replaced during the remodeling phase to restore the normal 4 1 ratio between types I and III collagen that exist in normal skin and mature wounds.

Biochemical Abnormalities

Abnormalities Shapes Lipids

A reduction of the effective intercellular lipid barrier properties can lead to deficiencies ranging from dry skin (depletion of lipids owing to excessive use of detergents), to hyperproliferation and abnormal scaling. Causes include essential fatty acid deficiency, abnormal intercellular deposition of various lipids, accumulation of

Bullous Lesions in Lupus Erythematosus

Lupus Tumidus

(2) On unusual occasions,bullous eruptions or vesiculobullous lesions, unassociated with LE skin lesions, occur in patients with SLE (Bacman et al. 2004, Camisa and Sharma 1983, Gammon et al. 1985, Hall et al. 1982, Olansky et al. 1982, Penneys and Wiley 1979). These lesions predominantly involve flexural or extensor skin (Fig. 6.19), the upper trunk, and the supraclavicular regions, but the face and the mucosal membranes are also predilection sites. The bullae arise on erythematous or normal skin, tend to be tense, and may approach the size of blisters in

Moisturizers In Relation To Skin Structure And Water Content

Roughness and scaling are visible features of clinically dry skin in patients with atopic dermatitis (3). Closer examination of these areas by scanning electron microscopy shows that the surface morphology is changed from a regular pattern to a coarser one, with broad, irregularly running furrows and loss of minor furrows (3). Likewise, in xerosis, increasing derangement of minor furrows and later also of major furrows can be observed (23). A more coarse and irregular skin surface pattern with larger squares is also found in recessive X-linked ichthyosis (24). Using instrumental evaluation of the skin topography the influence of moisturizers on the skin structure has been addressed (25,28-33). The roughness parameters and the distance between furrows peaks can describe changes in the hydration status (28-35). Dry skin tends to have a larger number of high peaks and a larger distance between the peaks than normal skin (33,34). Hydration of normal skin has been reported both to decrease...

Moisturizers In Relation To The Barrier Function

Content and organization of these intercellular barrier lipids have broad implications for the permeability barrier function (36,83-85,125,126). The lipid compo- < sition of the SC is highly variable among individuals, depending on a number of factors (Table 4). In dry skin and in skin exposed to organic solvents, the lipid

Discussion And Conclusion

A lack of water may be too simple an explanation for all types of problems covered by the term dry skin, such as redness, scaling, roughness, itching, and a feeling of discomfort. Rather than just aiming at a general increase in the water content, the abnormal epidermis should probably be treated according to the underlying pathogenesis. The possibilities to correct or prevent abnormalities in the skin by different treatments may also help to explain the differences in preference for different moisturizers among individuals. This opens up new possibilities for further improvement in the treatment of different dry skin disorders.

Postpeeling Care and Complications

Bland cleansers and moisturizers are continued for 48 h or until all post-peel irritation subsides. Patients are then able to resume the use of their topical skin care regimen including topical bleaching agents, acne medications, and or retinoids. Post-peel adverse reactions such as excessive desquamation and irritation are treated with low to high potency topical steroids. Topical steroids are extremely effective in resolving post-peel inflammation and mitigating the complication of post-inflammatory hy-perpigmentation. In the author's experience, any residual post-inflammatory hyperpigmen-tation resolves with use of topical hydro qui-none formulations following salicylic acid peeling.

Discoid Lupus Erythematosus Classic Appearance

Lesions evolve according to a characteristic time course. Fresh lesions first present as small, round, well-defined, slightly raised erythemas with dull surfaces that soon become rough to the touch and scaly. Scales are adherent and are often attached to the hair follicles (carpet tack phenomenon). Follicular orifices are first widened with keratotic plugs and may then disappear completely there is a gradual loss of hair in the lesions, leading to irreversible scarring alopecia. Lesions spread slowly and regress at the centers, which become smooth and sunken. Intermediate lesions become elevated and indurated at variable degrees and develop atrophy and loss of normal skin texture in their centers. At the periphery, rests of the active lesion remain as ring-like, arcuate, or polycyclic scaly erythemas that continue to spread. Old (burnt-out) lesions may be disfiguring they are large, with irregular borders, sharply demarcated, depigmented (porcelain white in dark skin), hairless, flat,...

Discharge And Home Healthcare Guidelines

Stress the importance of close attention to even minor skin injuries. Emphasize foot care, including the importance of properly fitting shoes with clean, nonconstricting socks daily washing and thorough drying of the feet and inspection of the toes, with special attention paid to the areas between the toes. Encourage the patient to contact a podiatrist as needed. Because of sensory loss in the lower extremities, teach the patient to test the bath water to prevent skin trauma from water that is too hot and to avoid using heating pads.

Primary Nursing Diagnosis

Always take into account patient safety, and weigh it against the possibility of the patient's further increase in intracranial pressure. Implement measures to limit the effects of immobility, such as skin care, range-of-motion exercises, and a turning and positioning schedule. Note the effect of position changes on intracranial pressure, and space activities as necessary.

Effects of UV Irradiation on CAMs

PA Norris and coworkers reported in vivo sequential expression of CAMs in UVB-induced erythema compared with intracutaneous injection of purified protein derivative (PPD). E-selectin expression on endothelial cells was seen after 6h in both reactions, with a prolonged expression (1 week) in the PPD reaction. PPD but not UVB induced basal keratinocyte ICAM-1 expression and VCAM-1 expression on stellate-shaped cells in the upper dermis, first seen at 24 h (Norris et al. 1991). In PLE, similar findings regarding CAM expression were found as after PPD injection, but keratinocyte ICAM-1 expression was strong already after 5 h, and VCAM-1 was expressed on perivascular cells (Norris et al. 1992). UVA irradiation in vivo on healthy skin increased endothelial ICAM-1 after 24 h, whereas ICAM-1 expression on cultured keratinocytes decreased after UVA but increased on cultured fibroblasts 6-48 h after irradiation. These authors also reported constitutive keratinocyte ICAM-1 expression (Treina et...

Pharmacologic Highlights

The patient with myxedema is generally weak and therefore progressively immobile. Hypothyroidism exposes the patient to the risk of skin breakdown. One goal is to increase the patient's mobility while accommodating her or his extreme weakness with frequent rest periods. Provide meticulous skin care.

Clinical Manifestations Of Dengue Infection

Skin eruptions may be more common in primary infections (6). The rash may be present in different ways, including flushing of the face, neck, or chest during the febrile period an erythematous or maculopapular rash after the third or fourth day a confluent petechial rash with round pale areas of normal skin or a combination of these. Less frequent than rash but not rare are mild hemorrhagic manifestations, such as petechiae, epistaxis, gingival hemorrhage, gastrointestinal hemorrhage, and microscopic hematuria. Hemorrhage is more commonly associated with a platelet count below 50,000 mm3, although hemorrhage does not necessarily occur with a low platelet count (7). The tourniquet test, a method for the assessment of capillary fragility or platelet function, may be positive in more than one-third of patients with dengue fever. To perform the tourniquet test, the blood pressure cuff is inflated to a point midway between the systolic and diastolic blood pressures and maintained for 5...

Transappendageal Transport

Vehicle penetrates normal skin 50-fold faster than follicle-free skin. Retention also 20 to 30-fold higher in normal skin Particle size dependency of follicular penetration, optimum 5 im Greater concentrations of hydrocortisone and testosterone observed in epidermis and dermis of normal skin, particularly at the depth of sebaceous glands, compared with follicle-free skin. In vivo effect less pronounced than in vitro Flux and absorption of caffeine, niflumic acid, and p-aminobenzoate threefold slower in follicle-free skin Particle size dependency of follicular

Dermatologic Physical Exam

Nonsolar lentigines These are macules of medium to dark-brown pigmentation that retain normal skin markings over their surface. Even when confluent, their size rarely exceeds 5 mm. They may be clinically indistinguishable from a junctional nevus. They are generally darker, sharper, and more regular than ephelides (see Photo 5). Solar lentigines These are macules of light- to medium-brown pigmentation tht retain normal skin markings over their surface. Color is often uneven, and the margins are irregular and fuzzy. Size varies from 0.5 to 1 cm or more (see Photo 6).

Risk For Deficient Fluid Volume

Defining Characteristics (Specify vomiting, diarrhea, excessive renal excretion, dry skin and mucous membranes, weight loss, decreased urinary output, altered intake, sunken fontanels in infant, decrease of tears and saliva, sunken soft eyeballs, nasogastric suction, fistula.)

Arch Derm Res 1996 288 103-107

Basal transepidermal water loss, skin thickness, skin blood flow and skin colour in relation to sodium-lauryl-sulphate-induced irritation in normal skin. Contact Derm 1991 25 108-114. 162. Loden M. Urea-containing moisturizers influence barrier properties of normal skin. Arch Dermatol Res 1996 288 103-107.

Clinical manifestation

Skin lesions fragile, flaccid vesicle or bulla filled with clear fluid, arising on normal skin or on an erythematous base large erosions with lateral spread of blisters Vegetating (vegetans) variant lesions in skin folds form vegetating plaques with excessive granulation tissue and crusting occur more frequently in intertriginous areas and on scalp and face

Classification Vitamin B complex

Side Effects GI N& V, diarrhea, peptic ulcer activation, abdominal pain. Dermatologic Flushing, warm feeling, skin rash, pruritus, dry skin, itching and tingling feeling, keratosis nigricans. Other Hypotension, headache, macular cystoid edema, amblyopia. NOTE Megadoses are accompanied by serious toxicity including the symptoms listed in the preceding as well as liver damage, hyperglycemia, hyperuricemia, arrhythmias, tachycardia, and dermatoses.

Dermatologie Physical Exam

The histology of a keratoacanthoma is very similar to that of a well-differentiated squamous cell carcinoma of the skin. KAs commonly contain squamous cells with atypical mitosis, individual cell keratinization, and other histologic signs of malignancy. The microscopic differentiation is dependent on both the cellular detail and the low-power configuration of the lesion. At each margin, a narrow spur of dermal connective tissue separates the normal epidermis from the lesion at the transitional junction between the normal and proliferating cells. For this reason, marginal punch biopsy is not adequate to distinguish between the two. Excisional biopsy or an incisional biopsy that contains a cross-section of the lesion into the adjacent normal skin is needed.

Sodium Hypochlorite

Frequent use causes a yellow discoloration to skin, catheter, and clothes Soaking for 5 min with the disinfectant is required during transfer set replacement May cause skin irritation and reaction Very dry skin results from exposure to povidone-iodine Growth of Pseudomonas sp. was observed in an opened multi-dispensed bottle of povidone-iodine 31 Povidone-iodine does not kill viruses such as HIV or Hepatitis May cause sclerosing encapsulating peritonitis 28 More costly

Immunological Factors

Two basic functional types of T helper (Th) cells can be distinguished. Th1 clones secrete mainly IL-2 and IFN-gamma. They are involved in cell-mediated inflammatory functions, e.g., the induction of delayed type hypersensitivity. Th2 clones produce IL-4, IL-5, IL-6, IL-10, and IL-13 (51,52) and stimulate IgE antibody by IL-4 and IL-13, activate eosinophils by IL-5 (53). In addition, they inhibit macrophages, antigen presenting cells, and T helper 1 (Th1) T-cells by IL-10 (54). The phenotype of the malignant T-cell clone patients with Sezary syndrome is consistent with peripheral T memory cells. Their cytokine transcription and secretion is comparable to human T helper 2 (Th2) cells with IL-5, IL-10, and IL-13. Attempts to reveal Th1 and 2 profiles in skin biopsies of CTCL patients revealed conflicting results. Saed et al. (55) demonstrated the presence of IL-2 and IFN-gamma, but no IL-4, IL-5, or IL-10 in the epidermis of MF by RT-PCR and concluded that MF exhibits a Th1 cytokine...

During Tolerizing Apoptosis

Apoptosis Lupus

Although many autoantigens targeted in SLE are redistributed in cells dying by apop-tosis, only ribonucleoprotein complexes containing La SSB, Ro SSA, Sm, and U1-70 kDa have been implicated in the pathogenesis of experimental photo-induced epidermal damage. It has been proposed that a pathologic immune response develops in patients with lupus against one or more of the photoproducts found in normal skin after UV irradiation, raising the possibility that these ribonucleoprotein complexes themselves (unlike other autoantigens) might be lupus chromophores. It is also possible that photoproducts that present in normal skin after UV irradiation might be metabolized abnormally in patients with lupus owing to genetic polymorphisms, predisposing to an exaggerated autoimmune response against these photo-products. The resulting immune response is directed against the UVB-induced complexes and subsequently spreads to individual component molecules (RNA and protein), generating an autoamplifying...

Michael D West Introduction to Aging

The aging of skin provides an important model for biological gerontology. The connective tissue of the dermis is readily accessible for studies from individuals of all ages. Generally a small punch biopsy is sufficient to supply cultures of fibroblasts, keratinocytes, or sections for histology. Such studies demonstrate pronounced changes in histology with age, alterations that share many features with similar changes occurring in other tissues in the body.2 These observations suggest that the study of aging skin could yield important clues to the pathogenesis of other age-related connective tissue disorders, and perhaps, aging in general. Skin, however, is unique it its exposure to relatively high levels of ultraviolet radiation. Therefore, a distinction is usually drawn between those changes in the skin attributed to long-term exposure to solar radiation (actinic skin damage) and those independent of such extrinsic causes (intrinsic skin aging). Much of this discussion will focus on...

Clinical Evolution of Melanoma

Malignant melanomas may arise de novo, that is, in apparently normal skin or in association with a pre-existing melanocytic nevus. When malignant melanomas arise de novo, they begin as a small, lightly pigmented macule that in time is characterized by asymmetry, scalloped borders, poor circumscription, and variations in color of predominantly tan to brown (Fig. 1A). Some such macular lesions become patches that are increasingly asymmetrical, poorly circumscribed, and varied in color (Fig. 1B). Other macular lesions of melanoma eventually become papular or nodular. Some other macular lesions may simply enlarge to become patches, others plaques, and still others combinations of papules or nodules upon patches or plaques (Figs. 2A-C 3A and B). Some nodules and tumors ulcerate. Some melanomas may undergo partial or complete regression (Fig. 4). The clinical features of malignant melanomas just described apply to malignant melanomas at all anatomic sites of the skin and mucous membranes.

Hypothyroidism in Infancy Childhood and Adolescence

Deceleration of linear growth is an important sign that is helpful in the early recognition of this disease. Affected children are relatively overweight for their height, although they are rarely obese. If hypothyroidism is severe and longstanding, immature facies and immature body proportion (increased upper lower body ratio) may be noted with delay in dental and skeletal maturation. The children have cold intolerance, dry skin and dry hair texture. In patients with severe long-standing hypothyroidism, muscular pseudohypertrophy gives a Herculean appearance called Kocher-Debre-Semelaign syndrome 23 .

Aging Effects by Disease Process

Eczemas Asteatotic dry skin, contact, seborrheic Infections Candidiasis, herpes zoster, onychomycosis, scabies Photodamage Actinic elastosis, colloid milium, Favre-Racouchot syndrome, freckling, photoaging (wrinkling, solar lentigo), poikiloderma of Civatte Premalignant Actinic keratosis, Bowen disease Malignancies BCC, lentigo maligna melanoma, MF, SCC Ulcerations leg, pressure decubitus Other Cutaneous horn, pruritus


Dry Skin and Moisturizers Chemistry and Function, edited by Marie Loden and Howard I. Maibach 27. Dry Skin and Moisturizers Chemistry and Function, Second Edition, edited by Marie Loden and Howard I. Maibach 29. Sensitive Skin Syndrome, edited by Enzo Berardesca, Joachim W. Fluhr, and Howard I. Maibach

New Category

Whether one is pro or con, the term cosmeceutical has permanently entered the vocabulary of skin care science. For some, the term has been transformed into a marketing tool, touting the benefits of skin care products. Others see it as a provocation for unwanted, costly, regulatory actions. The most benign view is that the category is superfluous and has no raison d'etre. Cosmeceuticals seem to have a certain semantic resonance, as witnessed by similar sounding neologisms for example, neutraceuticals (foods with health benefits) and neoceuticals (over-the-counter drugs with cosmetic effects).


Assess the patient for signs of dehydration such as tachycardia, altered level of consciousness, dry skin with poor turgor, dry mucous membranes, weight loss, and weak peripheral pulses. Check for postural hypotension that is, a drop in systolic blood pressure greater than 15 mm Hg when the patient is moved from a lying to a sitting or standing position.


New insights about the function of the skin, as well as the development of new products for skin care, make it necessary to question or redefine the definitions of cosmetics and drugs. Moreover, in the United States, Europe, and Japan, different definitions of cosmetics are used. The definition of a drug is more or less equivocal on these countries. According to the Food, Drug, and Cosmetic (FDC) Act, a drug is defined as an article intended for use in the diagnosis, mitigation, treatment, or prevention of disease or intended to affect the structure or any function of the body.

Specific History

Establish accurately the time of onset of the problem. If it is a chronic disorder, document the frequency and duration of individual attacks, exacerbations, or recurrent episodes. Many skin problems have a fairly characteristic age of onset, gender preference, and duration. Recurrences may follow recognizable fixed patterns, which will aid in diagnosis.


Among the wide-ranging environmental factors affecting human life, ultraviolet (UV) irradiation can be regarded as one of the most significant. Although UV light has an essential impact on terrestrial and aquatic ecology and is a fundamental necessity for the life of humans, animals, and plants, mid-wavelength UVB (290-320 nm) in particular can also exert hazardous effects on health. UV radiation not only plays an instrumental role in the development of skin cancer but also has profound effects on local and systemic inflammatory responses. While studying the biological effects of UVB irradiation, it has become evident that UV exposure can significantly compromise the immune system. The implications of the immunosuppres-sive properties of UV irradiation are manifold because UVB-induced immunosup-pression not only is responsible for the inhibition of protective cell-mediated immunity but also contributes to the initiation, development, and perpetuation of several skin disorders (Fisher...


Used as superficial chemical peeling agents, the pH of these solutions ranges from 0.08 to 2.75. Peeling solutions with a pH below 2 have dem-2 onstrated the potential to induce crusting and necrosis, which has not been seen with the partially neutralized solutions with a pH above 2 4 . The higher concentration acid (70 ) created more tissue damage than the lower concentration (50 ) compared to solutions with free acid. An increase of transmembrane permeability coefficient is observed with a decrease in pH, providing a possible explanation for the effectiveness of glycolic acid in skin treatment.


Glycolic acid has been recognized as an important adjunctive therapy in a variety of conditions including photodamage, acne, rosacea, striae albae pseudofolliculitis barbae, hyper-pigmentation disorders, actinic keratoses, fine wrinkles, lentigines, melasma and seborrheic keratoses 5 . Moreover, it can reduce UV-in-duced skin tumor development and it has been proposed as a therapeutic modality against skin exfoliative conditions such as ichthyosis, xeroderma and psoriasis. In post-menopausal women a cream containing 0.01 estradiol and 15 glycolic acid, applied to one side of the face for 6 months, induces a significant improvement in reversing markers (rete peg pattern, epidermal thickness) of skin aging 6 .

Postpeel Care

Use of bland cleansers and moisturizers is essential. Recommended moisturizing agents include Cetaphil, SBR-Lipocream, or Aquaphor. Peeling related to Jessner's usually resolves in 2-7 days. Patients can resume the use of general skin care products after peeling subsides. Makeup can be worn to camouflage peeling. Excessive peeling, erythema, or irritation postpeel can be treated with low or mid- to high-potency steroids for 5-7 days. Use of such agents should be based on the extent of irritation and inflammation.


Dry skin is characteristic of relatively severe kidney failure, but is not particularly distressing as a symptom. Itching, however, is a common and sometimes very distressing symptom. It doesn't usually appear until loss of kidney function is severe (about 80 percent). Its cause is also unknown. Our study, summarized at the end of the chapter, suggests that both


Ness, drowsiness, fatigue, hallucinations, insomnia, lethargy, mental changes, memory loss, strange dreams. GI Diarrhea, ischemic colitis, nausea, mesenteric arterial thrombosis, vomiting. Hematologic Agranulocytosis, thrombocytopenia. Allergic Fever, sore throat, respiratory distress, rash, pharyngitis, laryngos-pasm, anaphylaxis. Skin Pruritus, rash, increased skin pigmentation, sweating, dry skin, alopecia, skin irritation, psoriasis. Ophthalmic Dry, burning eyes. GU Dysuria, impotence, nocturia. Other Hypoglycemia or hyperglycemia. Respiratory Bronchospasm, dyspnea, wheezing. Drug Interactions See also Drug Interactions for Beta-Adrenergic Blocking Agents and Antihypertensive Agents.

Kava Kava

Most drugs that decrease anxiety also produce sedation. Surprisingly, kava kava itself does not appear to have this effect. However, kava kava may increase the sedating effects of alcohol and several medications that are frequently used in MS, including lioresal (Baclofen), tizanidine (Zanaflex), and diazepam (Valium). The effects of kava kava on MS fatigue are not known. Heavy use of kava kava over months may produce skin problems, red eyes, itching, and other difficulties.

Pigmentary Changes

Reactive hyperpigmentation can occur after any depth of chemical peels. Usually lighter complexions have a lower risk for hyperpig-mentation, but genetic factors play an important role, and sometimes light patients with dark genes will hyperpigment unexpectedly. Therefore, we recommend introducing bleaching preparation 2-3 weeks after the peel in all patients and continuing until erythema fades. Demarcation lines can be avoided if the boundaries of the peeling area are hidden under the mandibular line and feathered gradually to the normal skin (Fig. 8.16). Medium-depth neck peel is required in patients with blotchy pigmentation of the neck and in those with no clear mandibular line. Accentuation of the pigment in previously existing intradermal nevi is common and should be recognized when it occurs to avoid any unnecessary alarm of a changing mole.


Another more detailed study showed that normal skin contains at least three separate populations of DDCs by immunophenotypic analysis using a broad panel of 45 different antibodies based on the expression of blood clotting enzyme factor XIIIa that have distinctive phenotypic markers and immunologic capabilities (Nestle et al. 1993). By triple color staining, the relative distribution of factor XIIIa+ DDCs is as follows subset 1 (65 -70 of total DDCs) expresses neither CD1a nor CD14 subset 2 (15 -20 of total DDCs) expresses CD1a but not CD14, and subset 3 (10 -15 of total DDCs) expresses CD14 but not CD1a.

Atopic Dermatitis

Parakeratosis And Atopic Dermatitis

Pruritis aggravated by heat, sweat, or wool often leads to chronic rubbing and as a result, the eyelid skin becomes violaceous early on and hyperpigmented with time. Coalescent papules, fissures, and fine scaling may occur. If the condition becomes chronic, thickening and accentuation of normal skin lines (lichenification) can occur on the periocular skin, and scaling plaques occur predominantly on the upper eyelids. With time eversion or stenosis of the lacrimal puncta may occur and frank ectropion may be seen in severe cases. Loss of eyelashes can occur. Darkening of periorbital skin suggests the diagnosis of atopy and is frequently of cosmetic concern to patients. Secondary staphylococcal infection or colonization of the eczematous skin is common leading to chronic anterior blepharitis. Associated ocular changes include keratoconjunctivitis, chemosis, sympblepharon, corneal pannus, Tranta's dots, anterior and posterior subcapsular cataracts, and keratoconus.


Histopath Keloid Picture

INTRODUCTION Keloids represent exuberant scar formation resulting from proliferation of dermal tissue following skin injury. Mechanisms for keloid formation represent abnormal wound healing and include alterations in growth factors, collagen turnover, tension alignment, and genetic and immunologic contributions. Keloids differ from hypertrophic scars in that they spread beyond the initial site of injury. Because they tend to be invasive into the surrounding normal skin both clinically and histologically, with prolongation of the proliferative phase of wound repair they have been described as incomplete tumors. Although any body area can be affected, keloids commonly develop on the face, neck, chest, shoulders, and back. Keloids on the eyelid skin are relatively rare, even in patients who are prone to keloid formation. These scars tend to occur with greater frequency in patients with darker skin tones, but patients of any skin type can develop this exuberant clinical response.

Laser Resurfacing

Hyperpigmentation Although postinflammatory hyperpig-mentation may occur in any patient undergoing skin resurfacing procedures, the risk may be lessened by pretreating the skin with a bleaching agent. We pretreat our patients, especially those with type III skin or greater, with a combination of 8 hydro-quinone, 1 hydrocortisone, and 0.05 retinoic acid for up to 4 weeks before they undergo laser resurfacing. By following this preoperative protocol, patients with Fitzpatrick type III or IV skin can undergo laser resurfacing with a reduced risk of postoperative hyperpigmentation. We have also treated patients with type V and VI skin with some success. These patients, however, usually develop transient hyperpigmentation and require prolonged skin care with bleaching agents. Rarely, hyperpigmentation may persist for longer than 6 months. Superficial TCA peels will correct this condition.

Peeling Techniques

The author has observed cases of postin-flammatory hyperpigmentation even with low concentrations of superficial peeling agents. Hence, cautious titration is appropriate in darker skin types. Glycolic acid peels are titrated from 20-35 , 50 , and finally 70 . Similar titration methods are used for salicylic acid and TCA. Salicylic acid peels should be titrated from 20 to 30 . Despite the use of higher concentrations of TCA in some studies 12,13 , it is best to initiate TCA peeling in dark skin with low concentrations (i.e., 10-15 ). Post-peel care includes the use of bland cleansers and emollients until irritation and peeling subsides. The patient then resumes the use of topical skin care products and bleaching agents. Post-peel reactions such as excessive erythema, desquamation, and irritation are treated with low- to


Sunscreens have been developed to prevent the short- and long-term damaging effects of UV irradiation. However, the sun protective factor (SPF), which is defined as the ratio of the minimal erythema dose (MED) of sun-protected skin divided by the MED erythema of non-sun-protected skin, gives only a quantitative level of protection against sunburn and edema. Therefore, there is an ongoing debate on the potency of sunscreens to protect against many other deleterious biological UV effects such as photoimmunosuppression, skin aging, or skin cancer. Recent efforts have been directed toward determining the end points of sunscreen efficacy, such as immune protection factor (IPF), mutation protection factor (MPF), and protection against photocarcinogenesis (Gil and Kim 2000). Although standardized phototest procedures are available and can be used as tools to evaluate the protective effects of sunscreens toward UV induction of LE lesions, studies addressing this important topic are lacking....

Ecthyma Gangrenosum

Erythematous Papules With Eschar

May closely resemble ecthyma gangrenosum. As in bacterial ecthyma gangrenosum, cutaneous lesions due to opportunistic fungi may be a manifestation of hematogenous dissemination with secondary seeding of the skin. Alternatively, they may represent primary invasive infection, which may then disseminate. Gastrointestinal and respiratory tracts and skin are common portals of entry for disseminated infections. Invasive infections of the skin may occur in previously normal skin, but are more likely to occur in areas that have had a disrupted barrier, such as sites of vascular access, venipuncture, burns, or surgical procedures.


Special Concerns Use with caution, if at all, during lactation. Give a lower initial dose in liver impairment. Safety and efficacy have not been determined in children less than 2 years of age. Side Effects Most commonly, headache, somnolence, fatigue, and dry mouth. GI Altered salivation, gastritis, dyspepsia, stomatitis, tooth ache, thirst, altered taste, flatulence. CNS Hypoesthesia, hyperkinesia, migraine, anxiety, depression, agitation, paroniria, amnesia, impaired concentration. Ophthalmologic Altered lacrimation, conjunctivitis, blurred vision, eye pain, blepharo-spasm. Respiratory Upper respiratory infection, epistaxis, pharyngitis, dyspnea, coughing, rhinitis, sinusitis, sneezing, bronchitis, bronchospasm, hemoptysis, laryngitis. Body as a whole Asthenia, increased sweating, flushing, malaise, rigors, fever, dry skin, aggravated allergy, pruritus, purpura. Musculoskeletal Back chest pain, leg cramps, arthralgia, myalgia. GU Breast pain, menorrha-gia, dysmenorrhea, vaginitis....


The number of LCs is decreased in lesional skin of patients with LE compared with their nonlesional or perilesional skin, other inflammatory skin diseases, or normal skin (Bos et al. 1986, Shiohara et al. 1988, Sontheimer and Bergstresser 1982, Wollenberg et al. 2002). In another study, LCs were found to be reduced only in atrophic areas of the lesions (Mori et al. 1994). In perilesional epidermis, the numbers of CD1a+ and HLA-DR+ DCs are similar or identical to those in normal skin of healthy individuals (Mori et al. 1994).

Glycolic Acid

Glycolic acid peels are well tolerated in darker skinned racial-ethnic groups (Figs. 13.3a, b and 13.4a, b). Side effects are substantially minimized when concentrations are gradually titrated from the lower concentrations of 20-35 to the full-strength 70 peel. Glycolic acid peels are most advantageous when treating darker skin types with sensitive skin.


SCF has been shown to be expressed on stromal cells as a membrane-bound protein, and its expression can be induced by fibrogenic growth factors such as PDGF (Hiragun et al., 1998). It has also been shown to be expressed on keratinocytes as a membrane-bound protein in normal skin. However, in the skin of patients with mastocytosis, an increased amount of soluble SCF


Four signs of infection erythema, pain, swelling, and warmth imprecise margins of infection areas of edema and erythema blending into the surrounding normal skin systemic symptoms (e.g. fever, malaise) signs of lymphangitis with red lines extending proximal from the area of inflammation regional lymphadenopathy crepitus with anaerobic organisms


Resorcinol is used in hairdressing as a modifier (or a coupler) of the PPD group of dyes. It is the least frequent sensitizer in hairdressers. It is also used in resins, in skin treatment mixtures, and for tanning. Severe cases of dermatitis due to resorcinol contained in wart preparations have been reported.

Chemical Peels

No quantitative differences in melanocytes are seen in various ethnic groups, melanocytes of darker-skinned individuals produce greater quantities of melanin and demonstrate exaggerated responses to cutaneous injury. This translates clinically to an increased susceptibility to irritation and to a greater risk of further pigment alteration in darker-skinned individuals. To decrease the potential risk of exacerbation of hyperpigmentation, the authors' protocol in darker skin types include pre-treatment for 2-4 weeks with bleaching agents such as hy-droquinone 4 cream. If indicated, higher concentrations of hydroquinone (5-10 ) can be compounded. In addition, tretinoin is discontinued 1-2 weeks prior to the series of chemical peels performed at 2- to 4-week intervals 18 . In addition, retinoids can be eliminated from the topical skin care regimen used between peeling procedures.

Atopic Eczema

Most people have dry skin at some point, but people with atopic eczema have periodic eruptions of red, scaly patches of skin. In adolescents and young adults the patches usually appear inside the elbows and behind the knees and at the ankles and wrists in children they appear on the face and neck. But the eruptions can occur anywhere on the body and may not follow a pattern. The itching produced by the eruptions can be severe and prolonged.

Photodynamic Therapy

Photodynamic therapy is based on the photo-oxidative effects (i.e., generation of oxygen radicals) creating by illuminating porphyrins and their derivates that have accumulated in tumor cells after topical application. The tumor-selective effect of PDT is due to the preferential uptake of aminolevulinic acid (ALA) into tumor cells. The ratio of uptake of ALA between tumor and normal skin in CTCL is 5 1 (11). The most widely used photosensitizer for topical PDT is delta-ALA. Its uptake results in accumulation of protoporphyrin IX (PpIX) that exerts in vitro toxic effects on both, T- and B-lymphocytes during PDT (12). Photodynamic therapy is capable of inhibiting proliferation of transformed T-cells, in a manner similar to PUVA (13).


Erythema, worsening of psoriasis, skin pain, irritation, rash, desquamation, contact dermatitis, skin inflammation, fissuring, bleeding, dry skin, localized edema, skin discoloration. Drug Interactions T Risk of photo-sensitivity when used with fluoro-quinolones, phenothiazines, sulfon-amides, tetracyclines, thiazides.

Outcome Criteria

Reveals presence of secretions and excretions that lead to skin impairment especially in infants and young children who have thinner, more sensitive skin. ability to maintain healthy skin and mucous membranes with proper nutrition and circulation to tissues and the preservation of muscle mass and strength needed to pad bony prominences and allow movement and position change.

Mycosis Fungoides

Dry Eyes Lupus

CLINICAL PRESENTATION The disease begins as a chronic, pruritic, scaling dermatitis. This premycotic stage is represented by an erythematous, eczematous, or psoriasiform dermatitis that slowly progresses into the second, or plaque, stage. In this stage discrete plaques with bizarre configurations and a variable degree of scaling arise on a background of otherwise normal skin. Pruritius and excoriation are common. The third, or tumor, stage is characterized by eyelid tumors and plaques that are indistinguishable from lesions that occur on other body areas. Full-thickness eyelid ulceration with cicatricial ectropion is the most common sequel affecting 40 of patients with ophthalmic involvement. In addition conjunctival and lacrimal tumors, keratitis, corneal ulceration, uveitis, secondary glaucoma, optic atrophy, and papilledema have been reported. Nonspecific findings include cataracts, dry eyes, glaucoma, and ectropion.

Jock Itch

If you think that you may have jock itch, see your doctor. The condition may be hard to distinguish from other skin problems that have different causes and treatments. The doctor may scrape off a small sample of affected skin and examine it under a microscope to confirm the diagnosis. Jock itch is treated by applying an antifungal cream to the groin area daily for at least a month. Other tinea infections may be more difficult to clear up and may require treatment with an oral antifungal medication. You will need to use all of the antifungal medication prescribed even if your skin looks and feels better to be sure the infection has been completely eliminated.

Beauty for Newbies

Beauty for Newbies

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