Professor Mustafa Arici
Although children do get arthritis arthritis disease order etoricoxib in india, children in Lyme were developing joint disease at a rate 100 times greater than normal arthritis diet in ayurveda order etoricoxib master card. Although cases have been reported in almost every state arthritis weather buy etoricoxib, a significant number of cases remain high in three main areas: the Northeast arthritis of the neck buy cheap etoricoxib line, upper Midwest and northern California. Even in common areas, not all deer ticks are infected with the bacteria that cause Lyme disease and only a small percentage of people or pets bitten by a deer tick actually become sick. Most people treated with antibiotics in the early stages of the disease recover completely, a few may have returning or a persistent symptom long after the infection has cleared. Symptoms Lyme disease can affect various parts of the body, producing a wide range of signs and symptoms. Not everyone with the disease will have all of the signs and symptoms, and the signs and symptoms of infection in the United States may be different from those in other countries. Many times the rash was reported to start in the groin, belt area or behind the knee. Over the next few days, the redness expands, forming a rash that may be as small as a dime or as large as 12 inches across. The rash is called erythema migrans, is one of the hallmarks of Lyme disease, affecting about 80 percent of infected people. If you are allergic to tick saliva, redness may develop at the site of a tick bite. This is not the same as erythema migrans, which tends to expand and get redder over time. Your knees are especially likely to be affected, but the pain can shift from one joint to another. Memory loss, difficulty concentrating, and changes in mood or sleep habits also can be symptoms of late-stage Lyme disease. Causes In the United States, Lyme disease is caused by the bacterium Borrelia burgdorferi, which is carried primarily by deer ticks. The ticks are brown and often no bigger than the head of the pin, which can make them nearly impossible to spot. Like vampires, ticks thrive on blood, latching onto a host and feeding for four or five days until they are swollen to many times their normal size. During feeding, ticks that carry disease producing bacteria can transmit the bacteria to a healthy host. In areas where Lyme disease is common, as many as 50 percent of deer ticks may carry Borrelia burgdorferi. Deer ticks prefer the blood of mice, small birds and deer, but are not averse to dining on humans, cats, dogs and horses. They live in low bushes and tall grasses of wooded areas, waiting for warm-blooded animals to pass by and are most active in the spring, summer and fall. The bacteria enter your skin through the bite and eventually make their way into your bloodstream. However, because the bacteria are not transmitted for about 48 hours after the bite, removing the tick as soon as possible can help prevent infection. Risk factors Where you live or vacation can affect your chances of getting Lyme disease. In these regions, children who spend a lot of time outdoors are especially at risk. If you are in an area where ticks are common, protect yourself and your children by wearing long sleeves and long pants. Its variable signs and symptoms mimic other conditions, including viral infections, various joint disorders, muscle pain (fibromyalgia) and chronic fatigue syndrome. If you do not have the characteristic Lyme disease rash, your doctor will ask detailed questions about your medical history and do a physical exam. Lab tests to identify antibodies to the bacteria may be used to help confirm the diagnosis. These tests are most reliable a few weeks after an infection because it takes your body some time to develop antibodies. However, because it can sometimes provide false-positive results, it is not used as the sole basis for diagnosis. It may also be used to detect persistent infection in the cerebrospinal fluid of people who have nervous system symptoms. A 14 to 21-day course of antibiotics is usually recommended, but some studies suggest that courses lasting 10 to 14 days are equally effective. If the disease has progressed, your doctor may recommend treatment with an intravenous antibiotic for 14 to 28 days. Intravenous antibiotics can cause various side effects, including a lower white blood cell count, gallstones and mild to severe diarrhea. Although bismuth is safely used in some oral medications for stomach ulcers, it is not approved for use in injectable form or as a treatment for Lyme disease. Bismacine can cause bismuth poisoning, which may lead to heart and kidney failure. About 10 percent concentration is effective for about two hours, while higher concentrations last longer. Keep in mind that chemical repellents can be toxic, and use only the amount needed for the time you will be outdoors. Other natural repellents, such as citronella and oil of geranium, also offer some protection. Deer ticks are often no bigger than the head of a pin, so you may not discover them unless you search carefully. But for unknown reasons, in people with type 1 diabetes, the immune system attacks various cells in the body. The Causes for Type 1 Diabetes Doctors do not know all the factors that lead to type 1 diabetes. Doctors have identified that an environmental trigger plays a role in causing the disease. Markers of this destruction - called autoantibodies - can be seen in most people with type 1 diabetes. In fact, they are present in 85% to 90% of people with the condition when the blood sugars are high. Symptoms Increased thirst Increased hunger (especially after eating) Dry mouth Nausea and occasionally vomiting Abdominal pain Frequent urination Unexplained weight loss (even though you are eating and feel hungry) Fatigue (weak, tired feeling) Blurred vision Heavy, labored breathing (Kussmaul respiration) Frequent infections of the skin, urinary tract or vagina Signs of an emergency with type 1 diabetes include: Shaking and confusion Rapid breathing Fruity smell to the breath Abdominal pain Loss of consciousness (rare) Type 2 Diabetes Type 2 diabetes, often called non-insulin dependent diabetes, is the most common form of diabetes, affecting 90% 95% of the 18. Unlike people with type 1 diabetes, people with type 2 diabetes produce insulin; however, the insulin their pancreas secretes is either not enough or the body is unable to recognize the insulin and use it properly. Other problems associated with the buildup of glucose in the blood include: Dehydration: the buildup of sugar in the blood can cause an increase in urination (to try to clear the sugar from the body). When the kidneys lose the glucose through the urine, a large amount of water is also lost, causing dehydration. Hyperosmolar nonketotic diabetic coma: When a person with type 2 diabetes becomes severely dehydrated and is not able to drink enough fluids to make up for the fluid losses, they may develop this life-threatening complication. Damage to the body: Over time, the high glucose levels in the blood may damage the nerves and small blood vessels of the eyes, kidneys, and heart and predispose a person to atherosclerosis (hardening) of the large arteries that can cause heart attack and stroke. In addition, older people are more susceptible to developing the disease since aging makes the body less tolerant of sugars. Causes Although it is more common than type 1 diabetes, type 2 diabetes is less well understood. Extra urethral Incontinence Endoscopy can be an invaluable tool in the diagnosis and treatment of extra urethral incontinence due to vesico vaginal fistula and ectopic ureter patellofemoral arthritis definition cheap etoricoxib 120mg online. Cystourethros copy can precisely localize a fistula site in the bladder and help plan surgical correction arthritis pain relief gel generic etoricoxib 60mg on-line. Specifically rheumatoid arthritis espanol cheap etoricoxib 60mg line, when detrimental effects on the upper urinary tract or anatomical abnormalities of the upper and lower urinary tract are suspected arthritis pain quality buy online etoricoxib, such studies can be useful. We will limit our discussion to imaging of the upper and lower urinary tract; however, there are cases where a urologic work up of voiding dysfunction may prompt radiographic investigation of the nervous system or spine. Renal Ultrasound; Ultrasonography is a noninvasive study using sound waves passed into the body through a transducer to detect abnormalities. This can be determined by allowing a patient to void (voluntarily or involuntarily) during bladder pressure monitoring. In fact, detrusor pressure during voiding is actually determined by the amount of outlet resistance. Sphincteractivitycanbemeasuredduringurodynamict esting either by surface electrodes (similar to those used for electrocar diogram) or by inserting needle electrodes directly into the sphincter muscle. Video urodynamics refers to the simultaneous measurement and display of urodynamic parameters with radiographic visualization of the lower urinary tract. In these cases, the bladder is filled with radiographic contrast filling during urodynamics. Because all urodynamic parameters previously mentioned are visualized simultaneously with the radiographic appearance of the lower urinary tract, the clinician can better appreciate their interrelationships and recognize artifacts. Assess the patient for signs and symptoms of anxiety evidenced by verbalization, tenseness, tachycardia, elevated blood pressure, facial pallor, and self-focused behaviors. Anxiety may be manifested by increases in vital signs, pallor, or self-focused behaviors. Orient patient to the environment, equipment, and routines this decreases anxiety. Involve family members or significant others in orientation and teaching sessions to encourage their support of the patient. Encourage family members or significant others to provide support to patient without obvious anxiousness as anxious family members will convey those feelings to the patient. Identify allergies the patient may have to contrast agents, or drugs prior to diagnostic testing. Provide information about injections or invasive procedures that may be done to the patient to reduce anxiety. Maintain a calm, supportive, and confident manner when interacting with the patient. The purpose of urine formation is the removal of potentially toxic waste products from the blood. Urine production and elimination are one of the most important mechanisms of body homeostasis all body systems are directly or indirectly affected by kidney function eg. Regulates erythropoiesis; the kidneys produce hormone erythropoietin that regulates erythropoiesis. Hypoxic conditions secretes more erythropoietin excessive Oxygen inhibits hormone production. It also aids in calcium absorption; affects the absorption of Calcium from intestine by helping to activate Vitamin D circulating in blood. The upper portions of both kidneys rest on the lower surface of the diaphragm and are enclosed and protected by the lower rib cage. On the medial side of each kidney is an indentation called the hilus, where the renal artery enters and the renal vein and ureter emerge. The renal artery is a branch of the abdominal aorta, and the renal vein returns blood to the inferior vena cava. Internal Structure of the Kidney A frontal section of the kidney shows three distinct areas; the outermost area is the renal cortex, which contains the parts of the nephrons called renal corpuscles and convoluted tubules. The middle area is the renal medulla, which contains loops of Henle and collecting tubules. The renal medulla consists of wedge-shaped pieces called renal pyramids; the apex, or papilla, of each pyramid points medially. The third area is a cavity called the renal pelvis; it is formed by the expansion of the ureter within the kidney at the hilus. Funnel-shaped extensions of the renal pelvis, called calyces, enclose the papillae of the renal pyramids. Urine flows from the pyramids into the calyces, then to the renal pelvis, and finally into the ureter. There are extensions of the cortex into renal columns which divides the medulla into 6-10 renal pyramids, the papilla of each pyramid nestled in cup shaped calyces the calyces converge to form renal pelvis. The glomerulus is a capillary network that arises from an afferent arteriole and empties into an efferent arteriole. The diameter of the efferent arteriole is smaller than that of the afferent arteriole, which helps maintain a fairly high blood pressure in the glomerulus. The space between the inner and outer layers contains renal filtrate, the fluid that is formed from the blood in the glomerulus and that will eventually become urine. The distal convoluted tubules from several nephrons empty into a collecting tubule. Several collecting tubules then unite to form a papillary duct that empties urine into a calyx of the renal pelvis. All the parts of the renal tubule are surrounded by the peritubular capillaries, which arise from the efferent arterioleand receive the materials reabsorbed by the renal tubules. The renal pelvis funnels urine to paired ureters tubular extensions of renal pelvis peristalsis moves urine along to bladder 4. Bladder; its is small in size about the size of a walnut when empty, it can hold up to 800 ml, voluntarily up to 2000 ml when obstructed. The mucosa -innermost layer, secretes mucous for protection from corrosive effects of urine;submucosa -fibrous connective tissue; muscularis -several smooth muscle layers; serosa -visceral peritoneum. It has involuntary internal & voluntary external urethral sphincters, as bladder expands to hold urine, activates stretch receptors in wall that monitor volume when volume exceeds 200 ml the receptor signals enter our conscious perception causing a desire to urinate 5. Urethra; in the male it has dual function (rid body of urine & release of seminal fluid during orgasm) In the female it has a single function (rids body of urine). The pathway of blood flow through the kidney is an essential part of the process of urine formation. Blood from the abdominal aorta enters the renal artery, which branches extensively within the kidney into smaller arteries. From the afferent arterioles, blood flows into the glomeruli (capillaries), to efferent arterioles, to peritubular capillaries, to veins in the kidney, to the renal vein, and finally to the inferior vena cava. In this pathway are two sets of capillaries; that is, two sites of exchanges between the blood and the surrounding tissues (in this case, the parts of the nephrons). The exchanges that take place in the capillaries of the kidneys form urine from blood plasma. The Renal Artery brings blood to kidney and it branches eventually into afferent arterioles. Buy 90mg etoricoxib mastercard. Thai Massage Therapy: Carpal Tunnel & Arthritis Pain Techniques Jen Hilman Austin.
Give a strong tea rheumatoid arthritis or gout buy etoricoxib with paypal, of Lobelia per enema and follow with a strong infusion per oram arthritis in back icd 9 discount etoricoxib express. The enema may also be used in order to produce emesis in cases of malarial fever if required tylenol arthritis pain label purchase etoricoxib without a prescription. In dislocation give small doses regularly and frequently and apply also locally rheumatoid arthritis medscape order discount etoricoxib on line, and it will be of great value in relaxing the parts so that the dislocation may be the more readily and easily reduced. The oil of Lobelia has less of the stimulating property and is not so likely to produce emesis. Then water can be added to the percolater and a strong preparation results, to which some glycerin may be added. In giving Lobelia there will be less relaxation if Capsicum or Hydrastis be added. This will allay irritation, prevent emesis, arrest spasmodic conditions and allay sympathetic vomiting. In spasmodic and membranous croup, whooping cough, asthma, occlusion of the gall ducts, strangulated hernia, rigid os uteri, hour-glass contractions and tetanus, Lobelia has no equal. Emesis is a powerful arrestor of hemorrhages, whether from lungs, uterus or bowels. Lobelia is best suited where and when arterial action is strong and when given in asthenic and more or less putrescent, conditions, its continuance usually should be brief, only sufficient to cleanse and then use a more stimulating treatment. Small doses given at regular intervals and continued for some time will bring on that state known as the alarm, in which condition we examine our patient and find him with a good, full, soft, steady pulse; breathing full and gentle; the secretions of the skin increased; the secernents are all relaxed, and the whole system is in a state of relaxation and rest. As a result of such condition the skin will be relaxed, there will be a free discharge of urine, of bile and of faeces. The nerves are quieted, the mucous membrane is freed of much mucous, and in every way the whole system and all of its several parts are more completely under the control of the vital force than they had previously been. Give in large doses and give until relaxation occurs, then sustain by appropriate stimulation. It quiets the nerves and prevents the vital force from putting forth as much inflammatory effort. In sluggish cases it arouses the system to dislodge semi-putrescent material, and quickly stimulates and equalizes the circulation. It is a most valuable preparation for sick-headache, some forms of dyspepsia and in the incipiency of some forms of apoplexy. Three-fourths teaspoonful in warm water every five minutes in a strong infusion of Cimicifuga. This preparation is best administered in the form of Acetous Syrup, which is pleasant and very efficient. To make the Syrup fill the bottle two-thirds full of the Tincture and add sugar to fill the bottle. The oil is best administered by being triturated with 16 times its own weight of sugar or lactin, or the two may be combined in equal parts. The Doctor says:-This is a most excellent preparation where profound relaxation is desired without emesis. It is excellent in peritonitis, lung and bronchial troubles, especially for bronchial cough and painful conditions in any part of the body. Seed and Tannin in equal parts in Vaseline makes an excellent suppository or may be introduced in rectal capsules for hemorrhoids. Triturate enough Lobelia lnflata in Bicarbonate Soda to form a thin paste and this rubbed well into a sore made by a rusty nail or into other inflamed or poisoned sores has been very successful in the hands of Dr. At first put on a paste of this and then keep the surface moist with Lobelia, Tincture. You will be surprised to see how quickly it will cause pain to cease and cure the wound. I have twice restored my own dying and falling hair with six ounces of this, writes Dr. Its alterative influence is felt by the lymphatics when they are swollen and hard and when scrofula is present. It assists in the relief of dyspepsia, constipation, catarrh hemorrhoids, leucorrhoea, spongy gums, decaying teeth. The tomato is a germicide and a cleanser of the mucous membrane, and may be a means of preventing typhoid fever and diarrhoea. I have noticed one thing peculiar with the use of the tomato by those who have recently used some form of mercury. There may follow some semblance to salivation, but usually a little Hydrastia Phosphate and Glycerin will quickly relieve this. The capsules of this moss contain a very fine powder called Lycopodium which consists of the seeds or spores of the plant. It is exceedingly fine, very light and of a delicate yellow colour, tasteless and inodorous. Lycopodium Clava turn has come into prominence as an internal remedy for use in urinary disorders. It has rendered good service in the treatment of spasmodic retention of urine in children, catarrhal cystitis, and in chronic kidney diseases causing pain in kidneys, ureters, and bladder, and associated with rheumatic symptoms. As a gastric sedative in indigestion, dyspepsia and catarrhal gastritis it will be found efficient. The properties are similar to Aduga Chamaepitys (European Ground Pine) Both are stimulant, diuretic, emmenagogue. The herb is a powerful antiperiodic and seems to influence the secernents more and the brain centres less than does quinine. If it could be properly covered by some vehicle it would be a more valuable agent than quinine. The herb is an aromatic, soothing, stimulating, astringent tonic, influencing the mucous membrane. It is valuable in dysentery, diarrhoea, cholera infantum, in typhoid fever, in hemorrhages of the lungs, gums, bowels, kidneys, uterus. In hot infusion it influences the capillaries, soothes arterial excitement, strengthens the venous circulation, relieves gastric, alvine and urethral irritation, equalizes the circulation and soothes the nerves. In combination with Inula, Symphytum or Prunus it forms a good tonic cough syrup where expectoration is quite free. Cold preparations influence the kidneys and give valuable assistance in enuresis, cystitis, nephritis and spermatorrhoea. The bark of the root and trunk of all these species is a mild aromatic, diffusive, stimulating tonic, influencing the mucous membrane of the alvine and renal tracts. In convalescence it is a gentle tonic, improving digestion, and is of value in convalescence from fevers and rheumatism. It is useful in urethral irritation; is quite soothing to the nervous system and is very sustaining. The glands and hair of the capsules come to us in the form of a deep red powder, having but little taste, and insoluble in water. The berries are gathered and rubbed together so as to divest them of this powder, which is a pleasant anthelmintic. It causes no colic and needs to be followed by no physic as do other anthelmintics. An ounce or more of the powder may be given in capsules, in fluid extract or in infusion. It is of much importance in dysentery, diarrhoea, nephritis, cystitis, and urethritis. In poultice it is excellent upon inflamed surfaces, and with such agents as Aralia, Comfrey or Inula it gives valuable assistance to the lungs, over which it may also be applied as a poultice. In hot infusion it is somewhat diaphoretic, promotes a good outward flow of the circulation and relieves hypneraemic conditions of the lungs, congestions and hoarseness. Its best influence upon the lungs is in combination with Aralia, Inula and Prunus. Marrubium decreases the mucous discharge and gives good results in wet catarrh and where expectoration is too free. The bark of this climbing vine is a stimulating, toning alterative, valuable in atonic conditions of the gastric membrane; gastric ulceration and chronic catarrhal gastritis. It increases the urinary flow, cleanses the mucous mem brane and soothes and tones the urinary passages. It can regulate the activity that low glycaemic load diets may infiuence of xenobiotics and is actively involved in the sebum production based on the beneficial endo wound healing process [6] arthritis fat fingers discount 60mg etoricoxib amex. In the last years rheumatoid arthritis gene order generic etoricoxib pills, acne research has made a On the other hand arthritis frozen fingers buy cheap etoricoxib 90 mg on line, extreme caloric restriction remarkable progress in understanding the mecha dramatically decreases the sebum excretion rate nisms involved in the pathogenesis of the disease and these changes can be reversed when a normal by using cell culture models and new molecular diet is resumed [15 arthritis diet foods to eat discount etoricoxib american express, 16]. Typical cultures as models to study specific functions Western diet, comprised of milk and hypergly involved in development, growth and differentia caemic foods, may have potentiating effects on tion of sebaceous gland cells. Another hallmark of sebum in acne patients is the presence of lipoperoxides, mainly due to the 10. The cell proliferation, differentiation, lipogenesis, composition of the produced lipids is also of hormone metabolism and cytokine and chemo great importance. Moreover, receptor superfamily and play a critical role in low levels of linoleic acid have been observed in cholesterol homeostasis and lipid metabolism 80 C. These data cell cycle regulation, lipid content and interleu were further verified by the identification of his kin-6/interleukin-8 secretion in vitro [28]. All three compounds on Sebocytes all-trans retinoic acid, 13-cis retinoic acid and 9-cis retinoic acid exhibit anti-proliferative 10. The association between local overproduction of 10 the Role of the Sebaceous Gland 81 active androgens and acne. This contradiction has led to the assump thinner skin with less collagen and increase of tion that cofactors may be required for the induc subcutaneous adipose tissue and also to small tion of the entire so-called androgenic infiuence sized sebaceous glands [51 ]. A dis localised to the peripheral cells of sebaceous turbed function of this cascade has been also glands in the rat [55], while in human skin the associated with tumourigenesis, i. These data demonstrate that uniform and intense in all regions of the gland hormones interact in a complex fashion, and [56]. These findings suggest the strong Other neuropeptides such as substance P or involvement of neurogenic factors and sebocytes vasointestinal peptide may also be involved in the in the disease process of acne. Substance P, which can be elicited by stress, may promote the devel opment of cytoplasmic organelles in sebaceous 10. It also increases the size of indi Infiammation is being regarded as a key compo vidual sebaceous cells and the number of sebum nent of the pathogenesis of acne [77]. In the last vacuoles for each differentiated sebaceous cell, all few years, there has been a debate as to whether of which suggest that substance P promotes both hyperkeratinisation of the follicular duct precedes 84 C. No differences function and skin infiammation, can regulate the were noted between normal skin from acne expression of infiammatory mediators. Keratinocytes and sebocytes may act as therapeutic strategies to deal with the disease immune cells capable of pathogen recognition and [86]. In a stressed environment, Recent evidence has indicated that human seba the amounts of released cytokines increase sig ceous glands may contribute to the skin immune nificantly. Psoriasin has been suggested to be involved sion levels are up-regulated in the presence of P. Characterization of bipo tential epidermal progenitors derived from human cytes to enhance their innate immune defence sebaceous gland: contrasting roles of c-Myc and beta ability. Human skin is a ste roidogenic tissue: steroidogenic enzymes and cofac cantly up-regulates the expression of proinfiam tors are expressed in epidermis, normal sebocytes, matory cytokines [93]. The effect one of the most common skin disorders, acne, of a low glycemic load diet on acne vulgaris and the and critically revisit conventional concepts of fatty acid composition of skin surface triglycerides. Changes in skin surface lipid composition induced by severe caloric drug development. Sebaceous gland far very useful tools to provide new chances response in man to prolonged total caloric depriva tion. Changes in the fatty acid composition of sebum associated with high carbohydrate diets. Role of insulin, insulin-like References growth factor-1, hyperglycaemic food and milk con sumption in the pathogenesis of acne vulgaris. The sebocyte studies of sterol and squalene secretion by human culture: a model to study the pathophysiology of the skin. Pelle E, McCarthy J, Seltmann H, Huang X, otides into human epithelial skin cells. Control Expression of retinoid-X receptors (fialpha,-beta, of human sebocyte proliferation in vitro by testos gamma) and retinoic acid receptors (fialpha,-beta, terone and 5-alpha-dihydrotestosterone is dependent gamma) in normal human skin: an immunohistological on the localization of the sebaceous glands. What is the the proliferation, lipid synthesis and keratin expres pathogenesis of acnefi Limited cooperation between per sebaceous lipids is regulated by the peroxisome prolif oxisome proliferator-activated receptors and retinoid erator-activated receptor ligand linoleic acid in human X receptor agonists in sebocyte growth and develop sebocytes. Characterization of the vitamin biosynthesis of leukotriene B(4) and prostaglandin D endocrine system in human sebocytes in vitro. Minghetti P, Cilurzo F, Casiraghi A, Montanari L, tion/administration on hair growth and skin sebum Santoro A. Development of patches for the controlled production in transsexual males and females. Growth hormone and mone: an autocrine hormone that promotes lipogen insulin-like growth factors have different effects esis in human sebocytes. Involvement of the corticotropin-releasing hor N, Nakayama H, Takahashi S, Doi K. Increased in situ expression of melanocortin-1 recep Immunohistochemical localization of insulin-like tor in sebaceous glands of lesional skin of patients with growth factor I in the adult rat. Human dermal microvascu for insulin-like growth factor-1 receptor and epi lar endothelial cells express the melanocortin recep dermal growth factor receptor. Activation of toll-like receptor 2 in acne trig reveals marked upregulation of genes involved gers infiammatory cytokine responses. Ito A, Sakiguchi T, Kitamura K, Akamatsu H, and proinfiammatory cytokines/chemokines in human Horio T. A toll-like receptor 2-responsive lipid effec Delta12,14-prostaglandin J2 in hamster sebaceous tor pathway protects mammals against skin infec glands: identification of cytochrome P-450-mediated tions with gram-positive bacteria. Human beta defensin-1 and fi2 dermis in transgenic mice constitutively expressing expression in human pilosebaceous units: upregu cyclooxygenase-2 in skin. Nagy I, Pivarcsi A, Koreck A, Szell M, Urban E, sebaceous glands and cultured sebocytes. However, it is important teria with the pathogenesis of acne goes back to note that there remains the possibility that over 100 years. In 1896 the German dermatolo other cutaneous microorganisms, for example gist Paul Gerson Unna published histological staphylococci and Malassezia spp. Microbial numbers are controlled by physical factors, such as pH, oxygen, nutrient availabil ity and humidity, and through interactions with 11. Of greater sig Human Skin nificance was the observation that lack of clinical improvement in acne patients treated with eryth the most prevalent and numerous resident romycin was associated with the development of skin microorganisms belong to the genera erythromycin resistance in propionibacteria [4]. Propionibacterium, Staphylococcus, Coryne It is still unclear what role bacteria and in par bacterium and Malassezia. Less prevalent and There is no simple cause-and-effect relationship, probably considered transients rather than true 11 the Role of Bacteria 93 commensals are species of Streptococcus and increases leading to a reduction in desquamation Peptostreptococcus. Therefore there may be a diversity of human skin may have been underes role for P. This study present than previously determined through cul also provided a hypothesis for why in acne, only ture alone. One note of caution is that these stud a proportion of follicles are affected at any one ies used samples taken at only one single time time. Therefore it is extremely difficult to deter different growth phases with those in stationary mine if those microorganisms identified are true phase inducing the highest levels of cytokines. Differences in follicle microenvironments may Nevertheless, such studies are important in our result in different P. One study used lesion mapping to accurately determine the age of infiammatory lesions. An immu occur during comedogenesis: (1) keratinocytes nohistochemical comparison of biopsies of unin lining the follicle wall hyperproliferate as shown volved skin from acne patients and non-acne by an increase in the cell proliferation marker controls showed that in acne patients normal fol Ki-67 and (2) cohesion between keratinocytes licles were surrounded by large numbers of 94 M. It is important to consider other extracellular enzymes and biologically active molecules pro duced by P. Some of these act as chemoattrac these molecules may have a role in promoting tants to cells of the immune system. These mol rupture of the follicle wall and further tissue ecules can also stimulate cells involved in damage following rupture. |
