Archives March 2023

Atopic Dermatitis (eczema)

Eczema is a condition that makes your skin red and itchy. It’s common in children but can occur at any age. Atopic dermatitis is long lasting (chronic) and tends to flare periodically and then subside. It may be accompanied by asthma or hay fever.

No cure has been found for atopic dermatitis. But treatments and self-care measures can relieve itching and prevent new outbreaks. For example, it helps to avoid harsh soaps and other irritants, apply medicated creams or ointments, and moisturize your skin.

Symptoms Of Dermatitis

Atopic dermatitis (eczema) signs and symptoms vary widely from person to person and include:

Itching, which may be severe, especially at night

Red to brownish-gray patches, especially on the hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the bend of the elbows and knees, and, in infants, the face and scalp

Small, raised bumps, which may leak fluid and crust over when scratched

Thickened, cracked, dry, scaly skin

Raw, sensitive, swollen skin from scratching

Atopic dermatitis most often begins before age 5 and may persist into adolescence and adulthood. For some people, it flares periodically and then clears up for a time, even for several years.

Factors that worsen atopic dermatitis

Most people with atopic dermatitis also have Staphylococcus aureus bacteria on their skin. The staph bacteria multiply rapidly when the skin barrier is broken and fluid is present on the skin. This in turn may worsen symptoms, particularly in young children.

Factors that can worsen atopic dermatitis signs and symptoms include:

Dry skin, which can result from long, hot baths or showers

Scratching, which causes further skin damage

Bacteria and viruses

Stress

Sweat

Changes in heat and humidity

Solvents, cleaners, soaps and detergents

Wool in clothing, blankets and carpets

Dust and pollen

Tobacco smoke and air pollution

Eggs, milk, peanuts, soybeans, fish and wheat, in infants and children

Atopic dermatitis is related to allergies. But eliminating allergens is rarely helpful in clearing the condition. Occasionally, items that trap dust — such as feather pillows, down comforters, mattresses, carpeting and drapes — can worsen the condition.

Causes of Dermatitis

The exact cause of atopic dermatitis (eczema) is unknown. Healthy skin helps retain moisture and protects you from bacteria, irritants and allergens. Eczema is likely related to a mix of factors:

Dry, irritable skin, which reduces the skin’s ability to be an effective barrier

A gene variation that affects the skin’s barrier function

Immune system dysfunction

Bacteria, such as Staphylococcus aureus, on the skin that creates a film that blocks sweat glands

Environmental conditions

Treatment and Drugs

Atopic dermatitis can be persistent. You may need to try various treatments over months or years to control it. And even if you respond to treatment, your signs and symptoms may return (flare).

It’s important to recognize the condition early so you can start treatment. If regular moisturizing and other self-care steps don’t help, your doctor may suggest the following treatments and drugs:

Medications

Creams that control itching and inflammation. Your doctor may prescribe a corticosteroid cream or ointment. Talk with your doctor before using any topical corticosteroid. Overuse of this drug may cause skin irritation or discoloration, thinning of the skin, infections, and stretch marks.

Creams that help repair the skin. Drugs called calcineurin inhibitors — such as tacrolimus (Protopic) and pimecrolimus (Elidel) — affect your immune system. Applied to the skin, they help maintain normal skin, control itching and reduce flares of atopic dermatitis. Due to possible side effects, these prescription-only drugs are used only when other treatments have failed or if someone can’t tolerate other treatments. They are approved for children older than 2 and for adults.

Drugs to fight infection. You may need antibiotics if you have a bacterial skin infection or an open sore or cracked skin caused by scratching. Your doctor may recommend taking oral antibiotics for a short time to treat an infection. Or he or she may suggest you take it for a longer time to reduce bacteria on your skin and to prevent another infection.

Oral anti-itch drugs. If itching is severe, oral antihistamines may help. Diphenhydramine (Benadryl, others) can make you sleepy and may be especially helpful at bedtime.

Oral or injected drugs that control inflammation. For more-severe cases, your doctor may prescribe oral corticosteroids — such as prednisone — or an injected corticosteroid. These drugs are effective but can’t be used long term because of potential serious side effects. Continue moisturizing and using other self-care remedies to prevent a flare-up after you stop taking the corticosteroids.

Acute Liver Failure

Acute liver failure is loss of liver function that occurs rapidly — in days or weeks —usually in a person who has no pre-existing liver disease. Acute liver failure is less common than chronic liver failure, which develops more slowly.

Acute liver failure, also known as fulminant hepatic failure, can cause serious complications, including excessive bleeding and increasing pressure in the brain. It’s a medical emergency that requires hospitalization.

Depending on the cause, acute liver failure can sometimes be reversed with treatment. In many situations, though, a liver transplant may be the only cure.

Symptoms of Acute Liver Failure

Signs and symptoms of acute liver failure may include:

Yellowing of your skin and eyeballs (jaundice)

Pain in your upper right abdomen

Abdominal swelling

Nausea

Vomiting

A general sense of feeling unwell (malaise)

Disorientation or confusion

Sleepiness

Causes of Acute Liver Failure

Acute liver failure occurs when liver cells are damaged significantly and are no longer able to function. Potential causes include:

Acetaminophen overdose. Taking too much acetaminophen (Tylenol, others) is the most common cause of acute liver failure in the United States. Acute liver failure can occur after one very large dose of acetaminophen, or after higher than recommended doses every day for several days.

Prescription medications. Some prescription medications, including antibiotics, nonsteroidal anti-inflammatory drugs and anticonvulsants, can cause acute liver failure.

Herbal supplements. Herbal drugs and supplements, including kava, ephedra, skullcap and pennyroyal, have been linked to acute liver failure.

Hepatitis and other viruses. Hepatitis A, hepatitis B and hepatitis E can cause acute liver failure. Other viruses that can cause acute liver failure include Epstein-Barr virus, cytomegalovirus and herpes simplex virus.

Toxins. Toxins that can cause acute liver failure include the poisonous wild mushroom Amanita phalloides, which is sometimes mistaken for edible species.

Autoimmune disease. Liver failure can be caused by autoimmune hepatitis — a disease in which your immune system attacks liver cells, causing inflammation and injury.

Diseases of the veins in the liver. Vascular diseases, such as Budd-Chiari syndrome, can cause blockages in the veins of the liver, leading to acute liver failure.

Metabolic disease. Rare metabolic diseases, such as Wilson’s disease and acute fatty liver of pregnancy, infrequently cause acute liver failure.

Cancer. Cancer that either begins in or spreads to your liver can cause your liver to fail.

Many cases of acute liver failure have no apparent cause.

Tests and Diagnosis

Tests and procedures used to diagnose acute liver failure include:

Blood tests. Blood tests to determine how well your liver is functioning may include the prothrombin time test, which measures how long it takes your blood to clot. With acute liver failure, blood won’t clot as quickly as it should.

Imaging tests. Your doctor may recommend imaging tests, such as ultrasound, to evaluate your liver. Imaging tests may show liver damage and may help your doctor determine the cause of your liver problems.

Examination of liver tissue. Your doctor may recommend a procedure to remove a small piece of liver tissue (liver biopsy). Tests of the liver tissue may help your doctor understand why your liver is failing.

Because people with acute liver failure are at risk of bleeding during biopsy, the doctor may perform a transjugular liver biopsy. Through a tiny incision on the right side of your neck, your doctor passes a thin tube (catheter) into a large vein in your neck, through your heart and into a vein exiting your liver. Your doctor then inserts a needle down through the catheter and retrieves a sample of liver tissue.

Medications

People with acute liver failure are often treated in the intensive care unit of a hospital —and when possible, in a facility that can perform a liver transplant if necessary. Your doctor may try to treat the liver damage itself, but in many cases, treatment involves controlling complications and giving your liver time to heal.

Treatments for acute liver failure

Acute liver failure treatments may include:

Medications to reverse poisoning. Acute liver failure caused by acetaminophen overdose or mushroom poisoning is treated with drugs that can reverse the effects of the toxin and may reduce liver damage.

Liver transplant. When acute liver failure can’t be reversed, the only treatment may be a liver transplant. During a liver transplant, a surgeon removes your damaged liver and replaces it with a healthy liver from a donor.

Treatments for complications

Your doctor will work to control signs and symptoms you’re experiencing and try to prevent complications caused by acute liver failure. This care may include:

Relieving pressure caused by excess fluid in the brain. Cerebral edema caused by acute liver failure can increase pressure on your brain. Medications can help reduce the fluid buildup in your brain.

Screening for infections. Your medical team will take periodic samples of your blood and urine to be tested for infection. If your doctor suspects that you have an infection, you’ll receive medications to treat the infection.

Preventing severe bleeding. Your doctor can give you medications to reduce the risk of bleeding. If you lose a lot of blood, your doctor may perform tests to find the source of the blood loss, and you may require blood transfusions.

Acute Kidney Failure

Acute kidney failure occurs when your kidneys suddenly become unable to filter waste products from your blood. When your kidneys lose their filtering ability, dangerous levels of wastes may accumulate, and your blood’s chemical makeup may get out of balance.

Acute kidney failure — also called acute renal failure or acute kidney injury — develops rapidly over a few hours or a few days. Acute kidney failure is most common in people who are already hospitalized, particularly in critically ill people who need intensive care.

Acute kidney failure can be fatal and requires intensive treatment. However, acute kidney failure may be reversible. If you’re otherwise in good health, you may recover normal or nearly normal kidney function.

Symptoms of Acute kidney failure

Signs and symptoms of acute kidney failure may include:

Decreased urine output, although occasionally urine output remains normal

Fluid retention, causing swelling in your legs, ankles or feet

Drowsiness

Shortness of breath

Fatigue

Confusion

Nausea

Seizures or coma in severe cases

Chest pain or pressure

Sometimes acute kidney failure causes no signs or symptoms and is detected through lab tests done for another reason.

Causes of Acute kidney failure

Acute kidney failure can occur when:

You have a condition that slows blood flow to your kidneys

You experience direct damage to your kidneys

Your kidneys’ urine drainage tubes (ureters) become blocked and wastes can’t leave your body through your urine

Impaired blood flow to the kidneys

Diseases and conditions that may slow blood flow to the kidneys and lead to kidney failure include:

Blood or fluid loss

Blood pressure medications

Heart attack and  Heart disease

Infection

Liver failure

Use of aspirin, ibuprofen (Advil, Motrin IB, others), naproxen (Aleve, others) or related drugs

Severe allergic reaction (anaphylaxis)

Severe burns

Severe dehydration

Damage to the kidneys

These diseases, conditions and agents may damage the kidneys and lead to acute kidney failure:

Blood clots in the veins and arteries in and around the kidneys

Cholesterol deposits that block blood flow in the kidneys

Glomerulonephritis  inflammation of the tiny filters in the kidneys (glomeruli)

Hemolytic uremic syndrome, a condition that results from premature destruction of red blood cells

Infection

Lupus, an immune system disorder causing glomerulonephritis

Medications, such as certain chemotherapy drugs, antibiotics, dyes used during imaging tests and zoledronic acid (Reclast, Zometa), used to treat osteoporosis and high blood calcium levels (hypercalcemia)

Multiple myeloma, a cancer of the plasma cells

Scleroderma, a group of rare diseases affecting the skin and connective tissues

Thrombotic thrombocytopenic purpura, a rare blood disorder

Toxins, such as alcohol, heavy metals and cocaine

Vasculitis, an inflammation of blood vessels

Urine blockage in the kidneys

Diseases and conditions that block the passage of urine out of the body (urinary obstructions) and can lead to acute kidney failure include:

Bladder cancer

Blood clots in the urinary tract

Cervical cancer

Colon cancer

Enlarged prostate

Kidney stones

Nerve damage involving the nerves that control the bladder

Prostate cancer

Risk Factors of Acute kidney failure

Acute kidney failure almost always occurs in connection with another medical condition or event. Conditions that can increase your risk of acute kidney failure include:

Being hospitalized, especially for a serious condition that requires intensive care

Advanced age

Blockages in the blood vessels in your arms or legs (peripheral artery disease)

Diabetes

High blood pressure

Heart failure

Kidney diseases

Liver diseases

Tests and Diagnosis

If your signs and symptoms suggest that you have acute kidney failure, your doctor may recommend certain tests and procedures to verify your diagnosis. These may include:

Urine output measurements. The amount of urine you excrete in a day may help your doctor determine the cause of your kidney failure.

Urine tests. Analyzing a sample of your urine, a procedure called urinalysis, may reveal abnormalities that suggest kidney failure.

Blood tests. A sample of your blood may reveal rapidly rising levels of urea and creatinine — two substances used to measure kidney function.

Imaging tests. Imaging tests such as ultrasound and computerized tomography may be used to help your doctor see your kidneys.

Removing a sample of kidney tissue for testing. In some situations, your doctor may recommend a kidney biopsy to remove a small sample of kidney tissue for lab testing. Your doctor inserts a needle through your skin and into your kidney to remove the sample.

Treatment and Drugs

Treatment for acute kidney failure typically requires a hospital stay. Most people with acute kidney failure are already hospitalized. How long you’ll stay in the hospital depends on the reason for your acute kidney failure and how quickly your kidneys recover.

Your doctor will also work to prevent complications and allow your kidneys time to heal. Treatments that help prevent complications include:

Treatments to balance the amount of fluids in your blood. If your acute kidney failure is caused by a lack of fluids in your blood, your doctor may recommend intravenous (IV) fluids. In other cases, acute kidney failure may cause you to have too much fluid, leading to swelling in your arms and legs. In these cases, your doctor may recommend medications (diuretics) to cause your body to expel extra fluids.

Medications to control blood potassium. If your kidneys aren’t properly filtering potassium from your blood, your doctor may prescribe calcium, glucose or sodium polystyrene sulfonate (Kayexalate, Kionex) to prevent the accumulation of high levels of potassium in your blood. Too much potassium in the blood can cause dangerous irregular heartbeats (arrhythmias) and muscle weakness.

Medications to restore blood calcium levels. If the levels of calcium in your blood drop too low, your doctor may recommend an infusion of calcium.

Dialysis to remove toxins from your blood. If toxins build up in your blood, you may need temporary hemodialysis — often referred to simply as dialysis — to help remove toxins and excess fluids from your body while your kidneys heal. Dialysis may also help remove excess potassium from your body. During dialysis, a machine pumps blood out of your body through an artificial kidney (dialyzer) that filters out waste. The blood is then returned to your body.

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