One can get scabies by coming in contact with a person who is already suffering from this skin disorder. Scabies is known for the severe itching it produces. The physical signs are all due to the excessive itching and scratching. Vesicles are commonly seen on skin which looks excoriated. If the skin becomes secondarily infected, one can also see oozing and crusting. The burrow which the mite makes on the skin can also be seen sometimes.

The scabies lesions are often seen on palms, flexural creases, interdigital area, lower abdomen, genitalia, buttock folds, aloes and ankles. Head and neck are usually spared except in infants. A person with a strong immune system is not likely to have many lesions. On the other hand, patients suffering from AIDS, who are severely immune compromised, will have a number of eruptions. This type of scabies is known as Norwegian scabies, which is a very severe and crusted form of scabies. It can also be seen in patients who are receiving immunosuppressive drugs for various reasons.

Scabies is usually diagnosed clinically. Severe itching with excoriation is often suggestive of this skin disorder. Not very often, the burrow can be seen on skin. These burrows created by the mite are grey-white in appearance. They are linear and raised. Skin scrapings from the affected site can show the mite or its eggs. Skin surface biopsy is used to confirm the diagnosis.

Scabies is a very infectious disease so once someone has been diagnosed with it, treatment should be started immediately. This is important to prevent its spread. All the family members of the affected individual should also be treated simultaneously. The medications used for treating scabies are- Permethrin, Malathion, Crotamiton and Monosulfiram.

The lotion needs to be applied all over the body except face and neck. One should always take bath with hot water before applying the lotion. Next bath can be taken only after 24 hours of applying the lotion. These are some general rules which one need to follow when undergoing treatment for scabies. Scabies is related to hygiene so if you keep yourself and your surroundings clean, there are very less chances that you are going to get it. Waste disposal at home should also be done properly. All such measures can definitely prevent the spread of Scabies.

Patients suffering from acne often become depressed and thus need moral support and counseling. There are few general rules that these patients must follow. They should always keep their skin clean. Face should be cleaned using a mild soap or face wash. Hair should be tied in a way that it does not touch the face and forehead. Pillows, bed sheets which come in contact with the face should be kept clean. Also, one should never touch the inflamed skin with fingers. It can lead to further infection. The use of cosmetics should be kept to minimal. Any oil based cosmetic should never be applied. One should reduce the consumption of nuts, chocolates, cocoa and fatty meat. Any form of stress should also be avoided.

After these general rules, let’s discuss the main drugs which are being used to treat acne. The preferred treatment is the topical treatment (local application). Systemic drugs are not used too often nowadays. The various topical preparations which are being used are creams, gels or lotions. The advent of retinoids revolutionized the acne therapy. These drugs encourage the shedding of the horny plugs which are responsible for obstruction of the hair follicles. The retinoids used commonly are- Tretinoin, Isotretinoin and Adapalene. They usually have very less side effects.

Few antibiotics are also used topically like Erythromycin (1-2 percent) and Clindamycin (2 percent). These drugs are quite effective especially in treating mild and moderate forms of acne. Tetracycline can also be used locally but is not as effective as the other antibiotics. Sulphur was once a popular drug for treating acne but is not being used much now.

Systemic treatment is required if the local treatment isn’t enough or acne is too severe. But these might be prescribed in the beginning of therapy also. Tetracyclines have long been used systemically for treating acne. The principal antibiotic is Oxytetracycline. Minocycline is used if the response to Oxytetracycline is not good enough. These drugs are usually given for a period of two to three months. However treatment might have to be maintained for several months or even longer. Diarrhoea and gastrointestinal upset can occur with long term consumption of tetracyclines. Erythromycin is also equally effective when used systemically. Both these antibiotics are usually started in a dose of 250mg and the dose is reduced after few weeks if the response is good.

If a patient does not respond to any of the topical and systemic drugs given above, then Isoretinoin is used systemically. It acts on the sebaceous glands and decrease the sebum production. It is usually given for a period of four months. The problem with this drug is that there are way too many side effects. It can harm the liver, bone and can also increase the lipid levels in the blood.

Last but not the least; anti-androgens are also used for treating acne. They inhibit sebum secretion. One of the anti-androgen which is being used is Dianette. Spironolactone which is actually a diuretic is also occasionally used for treatment of acne. However these drugs are not too popular and are used only as the last resort!

Acne is one of the commonest skin diseases which occur mostly in the late teenage years. It is more common in females and they can have it even till they are in their late thirties. In this disease, the hair follicles in the skin get obstructed which then leads to inflammation and finally destruction of the tissue.

Acne has been directly associated with levels of sebum. It is because of the increased sebum excretion in the teenagers that acne is so common in them. A bacterium named ‘Propionibacterium acnes’ has also been associated with this skin disorder. The face is affected the most, particularly skin of the nose, cheeks, forehead, lower jaw and chin. It is also frequently seen on the back of the neck, shoulders, the back and front of the chest. Buttocks and thighs are usually not affected but patients with severe acne can have lesions on these areas also.

Hot and humid conditions can worsen acne. The first thing which one gets with this disorder is that their skin starts looking greasy and oily. One can probably notice a number of blackheads on the affected areas. They are most common on the side of the nose. The face gets covered with small or big eruptions (papules) which look red and inflamed. They can also get quite painful especially when they get filled with pus. When they contain pus the eruptions are called as pustules and if they persist for a very long time, they are known as nodules. One gets really deep scars after these lesions heal and the scars can even remain their for a life time!

The good thing about this disorder is that it is self limiting. It can not be present all the time. However there are few who will have persistent acne with the disease being constantly present in an acute condition throughout the year. Most people do not get acne after the age of 25 years but then nothing is fixed or constant in medicine and acne is no exception!

One can also develop acne due to consumption of certain drugs like corticosteroids, anti-convulsants and oral contraceptive pills. But this form of acne is usually quite different from the regular variety and can be easily identified clinically. Workers who work at places where lubricating oils are used can develop what is known as ‘oil acne’. Exposures to a chemical ‘chloracne’ can also lead to this disorder. Women who suffer from polycystic ovarian syndrome are more likely to have severe acne.

The treatment of acne is a very wide topic and I shall be discussing about it in detail in another article. Till then keep your skin clean and healthy!