Dermatitis

Dermatitis is a general term that describes an inflammation of the skin. There are different types of dermatitis, including seborrheic dermatitis and atopic dermatitis (eczema). Though the disorder can have many causes and occur in many forms, it usually involves swollen, reddened and itchy skin.

Dermatitis is a common condition that isn't life-threatening or contagious. But, it can make you feel uncomfortable and self-conscious. A combination of self-care steps and medications can help you treat dermatitis.

Causes:

A number of health conditions, allergies, genetic factors, physical and mental stressors, and irritants can cause dermatitis:
Contact dermatitis results from direct contact with one of many irritants or allergens. Common irritants include laundry soap, skin soaps or detergents, and cleaning products. Possible allergens include rubber; metals, such as nickel; jewelry; perfume; cosmetics; weeds, such as poison ivy; and neomycin, a common ingredient in topical antibiotic creams.
It takes a greater amount of contact with an irritant over a longer time to cause dermatitis than it takes for an allergen. If you're sensitized to an allergen, just brief exposure to a small amount of it can cause dermatitis. Once you develop sensitivity to an allergen, you typically have it for life.

Neurodermatitis typically develops when something has created an itchy sensation in a specific area of your skin. This irritation may lead you to rub or scratch your skin repeatedly in that area. Common locations include ankles, wrist, outer forearm or arm, and the back of your neck. Neurodermatitis may also be associated with other skin conditions, such as dry skin, eczema or psoriasis. Contact dermatitis caused by allergens doesn't seem to be a factor, though.
Seborrheic dermatitis causes a red rash with yellowish and somewhat "oily" scales, usually on the scalp. It's common in people with oily skin or hair, and it may come and go depending on the season of the year. It may occur during times of physical stress, travel or in people who have neurological conditions, such as Parkinson's disease. In infants, this disorder is known as cradle cap.
Stasis dermatitis can occur when fluid accumulates in the tissues just beneath your skin, and typically involves the lower leg. The extra fluid interferes with your blood's ability to nourish your skin and places extra pressure against your skin from underneath. Varicose veins and other chronic conditions that affect circulation in your legs often cause this fluid buildup.
Atopic dermatitis often occurs with allergies and frequently runs in families in which members have asthma or hay fever. It usually begins in infancy and may vary in severity during childhood and adolescence. It tends to become less of a problem in adulthood, unless you're exposed to allergens or irritants in the workplace. The exact cause of this disorder is unknown, but is likely due to a combination of dry, irritable skin together with a malfunction in the body's immune system. Stress can exacerbate atopic dermatitis, but it doesn't cause it.
Perioral dermatitis may be a form of the skin disorder rosacea, adult acne or seborrheic dermatitis, involving the skin around the mouth or nose. The exact cause is unknown, but makeup, moisturizers, topical corticosteroids or some dental products containing fluoride may play a role.

Symptoms:

There are several types of dermatitis, including:
* Contact dermatitis, a rash that results from either repeated contact with irritants or contact with allergy-producing substances, such as poison ivy.
* Neurodermatitis, a chronic itchy skin condition localized to certain areas of the skin.
* Seborrheic dermatitis, a common scalp condition that often causes dandruff.
* Stasis dermatitis, a skin condition that's caused by a buildup of fluid under the skin of the legs.
* Atopic dermatitis, more commonly known as eczema or atopic eczema, a chronic itchy rash that tends to come and go.
* Perioral dermatitis, a bumpy rash around the mouth.

Each has distinct signs and symptoms. Common signs and symptoms include:
Redness, Swelling, Itching, Skin lesions, etc.

Diagnosis:
Your doctor may diagnose dermatitis after talking to you about your signs and symptoms and examining your skin.

Patch testing
In the case of contact dermatitis, your doctor may conduct patch testing on your skin to see which substances inflame your skin. In this test, your doctor applies small amounts of various substances to your skin under an adhesive covering. During return visits, your doctor examines your skin to see if you've had a reaction to any of the substances.

Treatment:
Dermatitis treatment varies, depending on the cause:

Contact dermatitis- Treatment consists primarily of identifying the cause of the rash and then avoiding it. Sometimes, creams containing hydrocortisone or other stronger steroidal creams with or without wet dressings may help relieve redness and itching. It can take as long as two to four weeks for this type of dermatitis to clear up.
Neurodermatitis- Getting you to stop scratching and to avoid further aggravating your skin are the treatment objectives. Accomplishing this may mean covering the affected area to prevent you from scratching it. Hydrocortisone and similar lotions and creams may help soothe your skin. You also may find that wet compresses provide relief. Antidepressants or anti-anxiety medications are helpful for some people. Also, counseling can help you learn how your emotions and behaviors can fuel — or prevent — itching and scratching.
Seborrheic dermatitis- Medicated shampoos are usually the first treatment choice. Commonly used shampoos contain tar, pyrithione zinc, salicylic acid or ketoconazole as the active ingredient. Hydrocortisone creams and lotions may soothe nonscalp seborrheic dermatitis. If you develop a secondary infection, you may need treatment for this, too.
Stasis dermatitis- Treatment consists of correcting the condition that causes fluid to accumulate in your legs or ankles for extended periods. This may mean wearing elastic support hose or even having varicose vein surgery. You may also use wet dressings to soften the thickened yet fragile skin and to control infection.
Atopic dermatitis- Treatment typically consists of applying hydrocortisone-containing lotions to ease signs and symptoms. If your skin cracks open, your doctor may prescribe wet dressings with mildly astringent properties to contract your skin, reduce secretions and prevent infection. If itching is severe, your doctor may suggest you take antihistamines. Light therapy, which involves exposing your skin to controlled amounts of natural or artificial light, also may help prevent recurrences.
Perioral dermatitis- Treatment for this condition is usually with the oral antibiotic tetracycline. You may need to continue this treatment for several months to prevent a recurrence. Your doctor may prescribe a very mild corticosteroid cream in the initial phase of treatment to reduce signs and symptoms of perioral dermatitis. When stronger corticosteroids are used, the condition may return temporarily and even worsen when the medication is stopped.

For all types of dermatitis, occasional use of over-the-counter antihistamines can reduce itching.

Immunomodulators
A class of nonsteroidal medications called immunomodulators, such as tacrolimus (Protopic) and pimecrolimus (Elidel), may help treat seborrheic dermatitis and atopic dermatitis. These medications affect the immune system and have anti-inflammatory and mild antifungal properties.

Due to possible concerns about the effect of prolonged use of these medications on the immune system, the Food and Drug Administration recommends that Elidel and Protopic be used only when other treatments have failed, or if someone can't tolerate other treatments.

Depression

Depression is one of the most common health conditions in the world. Depression isn't a weakness, nor is it something that you can simply "snap out of." Depression, formally called major depression, major depressive disorder or clinical depression, is a medical illness that involves the mind and body. It affects how you think and behave and can cause a variety of emotional and physical problems. You may not be able to go about your usual daily activities, and depression may make you feel as if life just isn't worth living anymore.

Most health professionals today consider depression a chronic illness that requires long-term treatment, much like diabetes or high blood pressure. Although some people experience only one episode of depression, most have repeated episodes of depression symptoms throughout their life.

Effective diagnosis and treatment can help reduce even severe depression symptoms. And with effective treatment, most people with depression feel better, often within weeks, and can return to the daily activities they previously enjoyed.

Causes:
It's not known specifically what causes depression. As with many mental illnesses, it's thought that a variety of biochemical, genetic and environmental factors may cause depression:

Biochemical- Some evidence from high-tech imaging studies indicates that people with depression have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes. The naturally occurring brain chemicals called neurotransmitters, which are linked to mood, also may play a role in depression. Hormonal imbalances also could be a culprit.
Genes- Some studies show that depression is more common in people whose biological family members also have the condition. Researchers are trying to find genes that may be involved in causing depression.
Environment- Environment is also thought to play a causal role in some way. Environmental causes are situations in your life that are difficult to cope with, such as the loss of a loved one, financial problems and high stress.

Symptoms:
Symptoms of depression include:
Loss of interest in normal daily activities, Feeling sad or down, Feeling hopeless, Crying spells for no apparent reason, Problems sleeping, Trouble focusing or concentrating, Difficulty making decisions, Unintentional weight gain or loss, Irritability, Restlessness, Being easily annoyed, Feeling fatigued or weak, Feeling worthless, Loss of interest in sex, Thoughts of suicide or suicidal behavior, Unexplained physical problems, such as back pain or headaches, etc.

Diagnosis:
When doctors suspect someone has depression, they typically run a battery of medical and psychological tests and exams. These can help rule out other problems that could be causing your symptoms, pinpoint a diagnosis and also check for any related complications. These exams and tests generally include:

Physical exam- This may include measuring height and weight; checking vital signs, such as heart rate, blood pressure and temperature; listening to the heart and lungs; and examining the abdomen.
Laboratory tests- These may include a complete blood count (CBC), screening for alcohol and drugs, and a check of your thyroid function.
Psychological evaluation- A doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns. He or she will ask about your symptoms, including when they started, how severe they are, how they affect your daily life and whether you've had similar episodes in the past. You'll also discuss any thoughts you may have of suicide or self-harm.

There are several other conditions whose symptoms may include depression. It's important to get an accurate diagnosis so you can get the appropriate treatment. Your doctor or mental health provider's evaluation will help determine if you have major depression or one of these other conditions that can sometimes resemble major depression:

Adjustment disorder- An adjustment disorder is a severe emotional reaction to a difficult event in your life. It's a type of stress-related mental illness that may affect your feelings, thoughts and behavior.
Bipolar disorder- This type of depression is characterized by mood swings that range from highs to lows. It's sometimes difficult to distinguish between bipolar disorder and depression, but it's very important to get the right diagnosis so that you can get the proper treatment and medications.
Cyclothymia- Cyclothymia, or cyclothymic disorder, is a milder form of bipolar disorder.
Dysthymia- Dysthymia is a less severe but more chronic form of depression. While it's usually not disabling, dysthymia can prevent you from functioning normally in your daily routine and from living life to its fullest.
Postpartum depression- This is depression that occurs in a new mother usually within a month of having a baby.
Psychotic depression- This is severe depression accompanied by psychosis, such as delusions or hallucinations.
Schizoaffective disorder- Schizoaffective disorder is a condition in which a person meets the criteria for both schizophrenia and a mood disorder.
Seasonal affective disorder- This type of depression is related to changes in seasons and a lack of exposure to sunlight.

Treatment:
Numerous treatments for depression are available. Standard depression treatment options include:
Medications-
Dozens of medications are available to treat depression. Most people find the best relief of depression symptoms by combining medications and psychotherapy. Some medications for depression are antidepressants that have been specifically approved by the Food and Drug Administration (FDA) to treat depression. Doctors also can use their medical judgment to prescribe other medications that haven't been FDA approved to treat depression but that may be effective anyway — a common and perfectly legal practice called off-label use.

There are several different types of antidepressants. Antidepressants are generally categorized by how they affect the naturally occurring biochemicals in your brain to change your mood. To determine which antidepressant may be best for you, doctors typically follow general practice guidelines. They may also ask you to take a blood test called the cytochrome P450 test, which can help identify genetic factors that influence your response to certain antidepressants (as well as some other medications).

SSRIs (selective serotonin reuptake inhibitors) include fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro).

Other common first choices for antidepressants include serotonin and norepinephrine reuptake inhibitors (SNRIs), norepinephrine and dopamine reuptake inhibitors (NDRIs), combined reuptake inhibitors and receptor blockers, and tetracyclic antidepressants.

Monoamine oxidase inhibitors (MAOIs) is often prescribed as a last resort, when other medications haven't worked. That's because MAOIs, while generally effective, can have serious harmful side effects. They also require strict dietary restrictions because of rare but potentially fatal interactions with certain foods. Newer versions of MAOIs that you stick on your skin as a skin patch rather than swallowing may have fewer side effects.

Psychotherapy
Psychotherapy is another key depression treatment. It's often used along with medication treatment. Psychotherapy is a general term for a way of treating depression by talking about your condition and related issues with a mental health provider. Psychotherapy is also known as therapy, talk therapy, counseling or psychosocial therapy.

Through these talk sessions, you learn about the causes of depression so that you can better understand it. You also learn how to identify and make changes in unhealthy behavior or thoughts, explore relationships and experiences, find better ways to cope and solve problems, and set realistic goals for your life. Psychotherapy can help you regain a sense of happiness and control in your life and help alleviate depression symptoms, such as hopelessness and anger. It also may help you adjust to a crisis or other current difficulty.

Electroconvulsive therapy
In electroconvulsive therapy (ECT), electrical currents are passed through the brain to trigger a seizure. Although many people are leery of ECT and its side effects, it typically offers fast, effective relief of depression symptoms. Experts aren't sure how this therapy relieves the signs and symptoms of depression. The procedure may affect levels of neurotransmitters in your brain. The most common side effect is confusion, which can last from a few minutes to several hours. Some people also experience partial memory loss, but memory often returns.

ECT is usually used for people who don't get better with medications and for those at high risk of suicide. It may be the only treatment available for older adults with severe depression who can't take medications because of heart disease.

Dengue

Dengue fever and dengue hemorrhagic fever (DHF) are acute febrile diseases, found in the tropics and Africa, and caused by four closely related virus serotypes of the genus Flavivirus, family Flaviviridae. The geographical spread is similar to malaria, but unlike malaria, dengue is often found in urban areas of developed tropical nations, including Singapore, Taiwan, Indonesia, India and Brazil. Each serotype is sufficiently different that there is no cross-protection and epidemics caused by multiple serotypes (hyperendemicity) can occur. Dengue is transmitted to humans by the Aedes aegypti (rarely Aedes albopictus) mosquito, which feeds during the day.

Causes:
Dengue fever is caused by any one of four dengue viruses spread by the Aedes aegypti mosquito. These mosquitoes thrive in and near human habitations where they breed in even the cleanest water.

Mosquitoes transmit the virus back and forth between humans. When a mosquito bites a person infected with a dengue virus, the virus enters the mosquito's bloodstream. It then circulates before settling in the salivary glands. When the infected mosquito then bites another person, the virus enters that person's bloodstream, where it may cause the serious illness.

You can become infected with dengue fever more than once. This happens when you're exposed to a different one of the four dengue viruses than one to which you were previously exposed. Infection a second time is typically what causes the more severe form of the disease — dengue hemorrhagic fever.

Symptoms:
Signs and symptoms of dengue fever usually begin four to seven days after you've been bitten by a mosquito carrying a dengue virus. These signs and symptoms can vary, depending on the form of the disease. More severe forms of the disease usually begin the same way as the mild form (dengue fever), then become worse after several days.

Dengue fever signs and symptoms typically include:
High fever, up to 105 F, A rash over most of your body, which may subside after a couple of days and then reappear, Severe headache, backache or both, Pain behind your eyes, Severe joint and muscle pain, Nausea and vomiting, etc.

Dengue fever rarely causes death, and symptoms usually get better after five to seven days.

Dengue hemorrhagic fever — a more severe form of the disease — can also cause:

* Significant damage to your blood and lymph vessels.
* A decrease in the number blood cells that help your blood clot (platelets).
* Bleeding from the nose, mouth and under the skin, creating the appearance of bruising.
* Death.

Dengue shock syndrome — the most severe form of the disease — may also cause:

* Blood vessel fluid (plasma) leakage.
* Heavy bleeding.
* A sudden drop in blood pressure (shock).
* Death.

Diagnosis:
Diagnosing dengue fever can be difficult. That's because its signs and symptoms can be easily confused with those of other diseases, such as malaria, leptospirosis and typhoid fever. Still, diagnosis of dengue fever is typically done by evaluating your signs and symptoms along with your medical and travel history. To diagnose your condition, your doctor will likely ask about these. In addition, your blood may be tested for evidence of a dengue virus.

Medical history
Your doctor will likely ask about your medical and travel history and any exposure to mosquitoes. Be sure to describe international trips in detail, including the countries you visited and the dates, as well as any contact you may have had with mosquitoes.

Blood tests
Laboratory tests, usually using a sample of your blood, are needed to confirm a diagnosis of dengue fever. If you have dengue fever, your blood may reveal the virus itself. If not, blood tests known as hemagglutination inhibition (HI) assay, enzyme-linked immunosorbent assay (ELISA) and reverse transcriptase-polymerase chain reaction (RT-PCR) also can detect antigens, antibodies or nucleic acids specific to the viruses. These tests may take several days.

Treatment:
No specific treatment for dengue fever exists.

If you have a mild form of the disease, your doctor will recommend making sure to drink enough fluids to avoid dehydration from vomiting and high fever. You can also take acetaminophen (Tylenol, others) for pain and fever. Avoid aspirin or other nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve). These can increase the risk of bleeding complications.

If you have a more severe form of the disease, treatment consists of supportive care in a hospital. Such care includes intravenous fluids and electrolyte replacement, maintaining adequate blood pressure and replacing blood loss.


If you have any form of dengue fever, you may also be kept away from mosquitoes, to avoid transmitting the disease to others.

Dementia

Dementia is the progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging. Although dementia is far more common in the geriatric population, it may occur in any stage of adulthood. This age cutoff is defining, as similar sets of symptoms due to organic brain dysfunction are given different names in populations younger than adulthood.

In dementia, affected areas in cognition may be memory, attention, language, and problem solving. Higher mental functions are affected first in the process. Especially in the later stages of the condition, affected persons may be disoriented in time (not knowing what day of the week, day of the month, month, or even what year it is), in place (not knowing where they are), and in person (not knowing who they are).

Symptoms of dementia can be classified as either reversible or irreversible depending upon the etiology of the disease. Less than 10 percent of cases of dementia are due to causes which may presently be reversed with treatment. Of these cases almost 100% are elderly people. Dementia is a term for a non-specific illness syndrome (set of symptoms) which is caused by many different specific disease processes, in the same way that symptoms of organ dysfunction such as shortness of breath, jaundice, or pain are attributable to many etiologies.

Without careful assessment of history, the short-term syndrome of delirium can easily be confused with dementia, because many of the symptoms of these are also present in dementia. Some mental illnesses including depression and psychosis may also produce symptoms which must be differentiated from both delirium and dementia.

Types:
Cortical dementias-
1) Alzheimer's disease.
2) Vascular dementia (also known as multi-infarct dementia), including Binswanger's disease.
3) Dementia with Lewy bodies (DLB).
4) Alcohol-Induced Persisting Dementia.
Korsakoff's syndrome
Wernicke's encephalopathy
5) Frontotemporal lobar degenerations (FTLD), including Pick's disease.
Frontotemporal dementia (or frontal variant FTLD)
Semantic dementia (or temporal variant FTLD)
Progressive non-fluent aphasia
6) Creutzfeldt-Jakob disease.
7) Dementia pugilistica.
8) Moyamoya disease.

Subcortical dementias-
* Dementia due to Huntington's disease.
* Dementia due to Hypothyroidism.
* Dementia due to Parkinson's disease.
* Dementia due to Vitamin B1 deficiency.
* Dementia due to Vitamin B12 deficiency.
* Dementia due to Folate deficiency.
* Dementia due to Syphilis.
* Dementia due to Subdural hematoma.
* Dementia due to Hypercalcaemia.
* Dementia due to Hypoglycemia.
* AIDS dementia complex.
* Pseudodementia (associated with clinical depression and bipolar disorder).
* Substance-induced persisting dementia (related to psychoactive use and formerly Absinthism).
* Dementia due to multiple etiologies.

Causes:
The slowly progressing destruction of nerve cells in the brain leads to the previously mentioned symptoms of Alzheimer's disease. It is a natural phenomenon to loose a certain number of nerve cells during ageing but this loss occurs much more rapidly in people suffering from Alzheimer's disease. As a result the brain of the patient does not function normally any longer.

In rare cases, the disease is caused by genetic changes (mutations) in the family. In these cases symptoms usually occur before the age of 60 and progress rapidly. All currently known mutations result in an overproduction of a protein which destroys the nerve cells. In most cases the exact cause remains largely unexplained; interaction of several factors probably leads to the onset. Everybody is at risk of developing this disease. Several genetic factors are known to increase the risk, without themselves being the cause. These include a (normal) variant of the gene apolipoprotein E which encourages the deposition of the harmful protein.

The probability of developing Alzheimer's disease increases with advancing age. The probability is higher for women and for people having a lower standard of education.

Symptoms:
Alzheimer's disease was first described in 1907 by the physician Alois Alzheimer. The most commonly known symptom of Alzheimer's disease is confusion. This behaviour in particular causes us to become 'estranged' from others and to be unpredictable in our interactions. Confusion can also occur 'acutly' i.e. suddenly and limited in time - for example triggered by a hospital stay, directly after heart surgery etc. It is difficult to understand this estrangement and it cannot be explained away - on the other hand everybody also experiences similar situations from time to time: we forget, misplace, can not remember names, cannot find our car in the car park and similar lapses. So both aspects are present: dementia is not familiar but also not entirely alien to us.

People with Alzheimer suffer mainly from impaired memory and orientation, limitations of concentration, planning and judgement, personality changes and later also perceptual, speech and walking disorders; in the final stage, various other body functions such as swallowing and the excretion process are also affected. During the course of Alzheimer's disease, patients lose their independence in managing everyday life. There are effects on perception and social relationships; people become more and more dependent on care.

Diagnosis:
Proper differential diagnosis between the types of dementia will require, at the least, referral to a specialist,
e.g. geriatric internist, geriatric psychiatrist, neurologist, neuropsychologist or geropsychologist. However, there exist some brief tests (5-15 minutes) that have reasonable reliability and can be used in the office or other setting to screen cognitive status for deficits which are considered pathological. Examples of such tests include the abbreviated mental test score (AMTS), the mini mental state examination (MMSE), Modified Mini-Mental State Examination (3MS), the Cognitive Abilities Screening Instrument (CASI), and the clock drawing test. An AMTS score of less than six (out of a possible score of ten) and an MMSE score under 24 (out of a possible score of 30) suggests a need for further evaluation. Scores must be interpreted in the context of the person's educational and other background, and the particular circumstances; for example, a person highly depressed or in great pain will not be expected to do well on many tests of mental ability.

Laboratory tests:
Routine blood tests are also usually performed to rule out treatable causes. These tests include vitamin B12, folic acid, thyroid-stimulating hormone (TSH), C-reactive protein, full blood count, electrolytes, calcium, renal function, and liver enzymes. Abnormalities may suggest vitamin deficiency, infection or other problems that commonly cause confusion or disorientation in the elderly. The problem is complicated by the fact that these cause confusion more often in persons who have early dementia, so that "reversal" of such problems may ultimately only be temporary.
Chronic use of substances such as alcohol can also predispose the patient to cognitive changes suggestive of dementia.

Imaging:
A CT scan or magnetic resonance imaging (MRI scan) is commonly performed, although these modalities do not have optimal sensitivity for the diffuse metabolic changes associated with dementia in a patient who shows no gross neurological problems (such as paralysis or weakness) on neurological exam. CT or MRI may suggest normal pressure hydrocephalus, a potentially reversible cause of dementia, and can yield information relevant to other types of dementia, such as infarction (stroke) that would point at a vascular type of dementia. However, the functional neuroimaging modalities of SPECT and PET have shown similar ability to diagnose dementia as clinical exam. The ability of SPECT to differentiate the vascular cause from the Alzheimer disease cause of dementias, appears to be superior to differentiation by clinical exam.

Treatment:
Except for the treatable types listed above, there is no cure to this illness, although scientists are progressing in making a type of medication that will slow down the process. Cholinesterase inhibitors are often used early in the disease course. Cognitive and behavioral interventions may also be appropriate. Educating and providing emotional support to the caregiver (or carer) is of importance as well.

A Canadian study found that a lifetime of bilingualism has a marked influence on delaying the onset of dementia by an average of four years when compared to monolingual patients. The researchers determined that the onset of dementia symptoms in the monolingual group occurred at the mean age of 71.4, while the bilingual group was 75.5 years. The difference remained even after considering the possible effect of cultural differences, immigration, formal education, employment and even gender as influences in the results.

Medications:
Tacrine (Cognex), donepezil (Aricept), galantamine (Reminyl), and rivastigmine (Exelon) are approved by the United States Food and Drug Administration (FDA) for treatment of dementia induced by Alzheimer disease. They may be useful for other similar diseases causing dementia such as Parkinsons or vascular dementia.

N-methyl-D-aspartate Blockers like Memantine (Namenda) is a drug representative of this class. It can be used in combination with acetylcholinesterase inhibitors.

Haloperidol (Haldol), risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel) are frequently prescribed to help manage psychosis and agitation. Treatment of dementia-associated psychosis or agitation is intended to decrease psychotic symptoms (for example, paranoia, delusions, hallucinations), screaming, combativeness, and/or violence.

Dehydration

Dehydration occurs when you lose more fluid than you take in and your body doesn't have enough water and other fluids to carry out its normal functions. If lost fluid remains unreplenished, you may suffer serious consequences.

Common causes of dehydration include intense bouts of diarrhea, vomiting, fever or excessive sweating. Inadequate intake of water during hot weather or exercise also may deplete your body's water stores. Anyone may become dehydrated, but young children, older adults and people with chronic illnesses are most at risk. Mild dehydration can cause symptoms such as weakness, dizziness and fatigue. Severe dehydration is a life-threatening medical emergency.

You can usually reverse mild to moderate dehydration by increasing your intake of fluids, but severe cases need immediate medical treatment. The safest approach is not to become dehydrated in the first place. You can do that by monitoring your fluid loss during hot weather, illness or exercise, and drinking enough liquids to replace what you lose.

Causes:
If you're an average adult, every day you lose more than 10 cups (close to 2.5 liters) of water simply by sweating, breathing and eliminating waste. You also lose electrolytes — minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body. Normally, you can replenish what you've lost through the foods and liquids you consume, even when you're active.

But when you eliminate more water and salts than you replace, dehydration results — your system literally dries out. Sometimes dehydration occurs for simple reasons: You don't drink enough because you're sick or busy, or because you lack access to potable water when you're traveling, hiking or camping.

* Diarrhea, vomiting- Severe, acute diarrhea, that is, diarrhea that comes on suddenly and violently — can cause a tremendous loss of water and electrolytes in a short amount of time. If you have vomiting along with diarrhea, you lose even more fluids and minerals. Children and infants are especially at risk. Worldwide, more than 1.5 million infants and children die of dehydration resulting from diarrhea every year — 300 to 500 of them in the United States. Most of these deaths occur in the first year of life.
* Fever- In general, the higher your fever, the more dehydrated you may become. If you have a fever in addition to diarrhea and vomiting, you lose even more fluids.
* Excessive sweating- You lose water when you sweat. If you engage in vigorous activity and don't replace fluids as you go along, you can become dehydrated. Hot, humid weather increases the amount you sweat and the amount of fluid you lose. But you can also become dehydrated in winter if you don't replace lost fluids. Preteens and teens who participate in sports may be especially susceptible, both because of their body weight, which is generally lower than that of adults, and because they may not be experienced enough to know the warning signs of dehydration.
* Increased urination- This is most often the result of undiagnosed or uncontrolled diabetes mellitus, a disease that affects the way your body uses blood sugar and that often causes increased thirst and more frequent urination. Another type of diabetes, diabetes insipidus, is also characterized by excessive thirst and urination, but in this case the cause is a hormonal disorder that makes your kidneys unable to conserve water. Certain medications — diuretics, antihistamines, blood pressure medications and some psychiatric drugs — as well as alcohol also can lead to dehydration, generally because they cause you to urinate or perspire more than normal.
* Burns- Doctors classify burns according to the depth of the injury and the extent of tissue damage. Third-degree burns are the most severe, penetrating all three layers of skin, and often destroying sweat glands, hair follicles and nerve endings. People with third-degree burns or extensive first- or second-degree burns experience profound fluid loss, and the resulting dehydration can be life-threatening.

Symptoms:
Mild to moderate dehydration is likely to cause:
Dry, sticky mouth, Sleepiness or tiredness — children are likely to be less active than usual, Thirst, Decreased urine output — fewer than six wet diapers a day for infants and eight hours or more without urination for older children and teens, Few or no tears when crying, Muscle weakness, Headache, Dizziness or lightheadedness.

Severe dehydration, a medical emergency, can cause:
Extreme thirst, Extreme fussiness or sleepiness in infants and children; irritability and confusion in adults, Very dry mouth, skin and mucous membranes, Lack of sweating, Little or no urination — any urine that is produced will be dark yellow or amber, Sunken eyes, Shriveled and dry skin that lacks elasticity and doesn't "bounce back" when pinched into a fold, In infants, sunken fontanels — the soft spots on the top of a baby's head, Low blood pressure, Rapid heartbeat, Fever, In the most serious cases, delirium or unconsciousness.

Diagnosis:
Your doctor can often diagnose dehydration on the basis of physical signs and symptoms such as little or no urination, sunken eyes, and skin that lacks its normal elasticity and resilience when pinched. If you're dehydrated, you're also likely to have low blood pressure, especially when moving from a prone to a standing position, a faster than normal heart rate and reduced blood flow to your extremities.

To help confirm the diagnosis and pinpoint the degree of dehydration, you may have other tests, such as:
* Blood tests- These may be used to check your electrolytes, especially sodium and potassium; to look for signs of concentrated blood; and to evaluate how well your kidneys are working.
* Urinalysis- The color and clarity of your urine, the presence of carbon compounds (ketones) and your urine's specific gravity — that is, the mass of the urine as compared with equal amounts of distilled water — all help show whether you're dehydrated and to what degree. A high specific gravity, for example, indicates significant dehydration.

If it's not obvious why you're dehydrated, your doctor may order additional tests to check for diabetes and for liver or kidney problems.

Treatment:
The only effective treatment for dehydration is to replace lost fluids. The best approach to dehydration treatment depends on your age, the severity of your dehydration and its cause.

Treating dehydration in sick children
Your doctor can offer specific suggestions for treating dehydration in your child, but some general guidelines include the following:
Use an oral rehydration solution. Unless your doctor advises otherwise, use an oral rehydration solution such as Pedialyte for infants and children who have diarrhea, vomiting or fever. These solutions contain water and salts in specific proportions to replenish both fluids and electrolytes. They also contain glucose or another carbohydrate such as rice powder to enhance absorption in the intestinal tract. Oral rehydration products are readily available in most drugstores, and many pharmacies carry their own brands. Begin giving fluids early in the course of an illness instead of waiting until the situation becomes urgent.

In most developing countries, you can buy packets of a powdered oral rehydration solution, WHO-ORS, originally developed by the World Health Organization to treat diarrhea and dehydration in infants with cholera. Reconstitute the powder in water according to the directions on the package. Always boil the water first, remeasure the water, then add the powdered oral rehydration material.

Treating dehydration in sick adults
Most adults with mild to moderate dehydration from diarrhea, vomiting or fever can improve their condition by drinking more water. Avoid coffee, tea and other beverages that contain caffeine, as they may temporarily increase dehydration. Fruit juices and sodas can make diarrhea worse.

Treating dehydration in athletes of all ages
For exercise-related dehydration, cool water is your best bet. Sports drinks containing electrolytes and a carbohydrate solution also may be helpful. There's no need for salt tablets — too much salt can lead to hypernatremic dehydration, a condition in which your body not only is short of water but also carries an excess of sodium.

Treating severe dehydration
Children and adults who are severely dehydrated should be treated by emergency personnel arriving in an ambulance or in a hospital emergency room, where they can receive salts and fluids through a vein (intravenously) rather than by mouth. Intravenous hydration provides the body with water and essential nutrients much more quickly than oral solutions do — something that's essential in life-threatening situations.

de Quervain syndrome

de Quervain syndrome (also known as washerwoman's sprain, Radial styloid tenosynovitis, de Quervain disease, de Quervain's tenosynovitis, de Quervain's stenosing tenosynovitis or mother's wrist), is an inflammation or a tendinosis of the sheath or tunnel that surrounds two tendons that control movement of the thumb.
It is name for named for Swiss surgeon Fritz de Quervain who first identified it in 1895. It should not be confused with "de Quervain's thyroiditis", another condition named for the same person.
Working in the garden, playing music, knitting, cooking and walking your pet can all be enjoyable activities, but if these activities cause pain in your wrist and hand, you may have a condition known as de Quervain's tenosynovitis.
In de Quervain's tenosynovitis, the sheath of the tendons on the thumb side of your wrist becomes inflamed or swollen, restricting the tendons' movement. The result with de Quervain's tenosynovitis is discomfort and pain every time you turn your wrist, grasp anything or make a fist.

Treatment for de Quervain's tenosynovitis may range from immobilizing your wrist and taking medications to surgery in more serious cases. If you start treatment early on, your symptoms of de Quervain's tenosynovitis should generally improve within four to six weeks.

Causes:

When you grip, grasp, clench, pinch or wring anything in your hand, you use two major tendons in your wrist and lower thumb. These tendons run side by side from your forearm through the thumb side of your wrist. They normally glide unhampered through the small tunnel that connects them to the base of the thumb. In de Quervain's tenosynovitis, the tendons' slippery covering becomes inflamed, restricting movement of the tendons.

A common cause is chronic overuse of your wrist. For example, peeling carrots involves a repetitive motion, a bent wrist and the gripping of the peeler. If you peel carrots or potatoes day after day, hour after hour, this combination may be enough to irritate the sheath around the two tendons.

Other causes of de Quervain's tenosynovitis include:
* Direct injury to your wrist or tendon; scar tissue can restrict movement of the tendons.
* Inflammatory arthritis, such as rheumatoid arthritis.

Symptoms:

The main signs and symptoms of de Quervain's tenosynovitis are pain and swelling near the base of your thumb. The pain may appear suddenly or may increase over time. If the condition goes too long without treatment, the pain may spread farther into your thumb, back into your forearm or both.
Pinching, grasping and other movements of your thumb and wrist aggravate the pain.

Symptoms of de Quervain's tenosynovitis include:
* Pain near the base of your thumb.
* Swelling near the base of your thumb.
* Numbness in the back of your thumb and index finger, caused by the swollen tendon rubbing on a nerve.
* A fluid-filled cyst in the same region as the swelling and pain.
* Difficulty moving your thumb and wrist when you're doing activities that involve grasping or pinching.
* A "sticking" or "stop-and-go" sensation in your thumb when trying to move it.
* A squeaking sound as the tendons try to move back and forth through the inflamed sheaths.

Diagnosis:

Your doctor may confirm a diagnosis of de Quervain's tenosynovitis by doing a Finkelstein test. In this simple test, you bend your thumb across the palm of your hand and bend your fingers down over your thumb. Then you bend your wrist toward your little finger. If this causes pain on the thumb side of your wrist, the test is considered positive.

If you feel pain about three inches up your forearm, you may have a condition called intersection syndrome. This is similar to de Quervain's tenosynovitis, but affects a different area of your wrist and requires different treatment.

Treatment:

To reduce pain and swelling, initial treatment of de Quervain's tenosynovitis may include:

* Immobilizing your thumb and wrist, keeping them straight with a splint or brace to help rest your tendons.
* Avoiding repetitive thumb movements whenever possible.
* Avoiding pinching with your thumb when moving your wrist from side to side.
* Applying heat to or icing the affected area.
* Using nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve).

Your doctor may also recommend injections of corticosteroid medications into the tendon sheath to reduce swelling. Treatment is generally successful if begun early on, though overuse injuries often recur if you have difficulty discontinuing the repetitive motions that caused the condition in the first place.

Making adjustments

Your medical team may include a physical therapist or occupational therapist who may monitor your habits and give suggestions on how to make necessary adjustments to relieve stress on your wrists. Your therapist can also teach you exercises focused on your wrist, hand and arm to strengthen your muscles, reduce pain and limit the irritation of the tendons.

In more serious cases

If your case is more serious, your doctor may recommend outpatient surgery. Surgery involves a procedure in which your doctor inspects the sheath surrounding the involved tendon or tendons, and then opens the sheath to release pressure.

Dandruff

Dandruff (also called scurf and historically termed Pityriasis capitis) is due to the excessive shedding of dead skin cells from the scalp. As it is normal for skin cells to die and flake off, a small amount of flaking is normal and in fact quite common. Some people, however, either chronically or as a result of certain triggers, experience an unusually large amount of flaking, which can also be accompanied by redness and irritation. Most cases of dandruff can be easily treated with specialized shampoos. Dandruff is not an organism like lice; it is just dead skin that accumulates in the scalp.
Dandruff is unlikely to be the cause of hair loss. Excessive flaking can also be a symptom of seborrhoeic dermatitis, psoriasis, fungal infection or excoriation associated with infestation of head lice.
If dandruff is the only thing standing between you and a closet full of basic black, you're not alone. Many people have this chronic scalp disorder, which is marked by itching and excessive flaking of the scalp. Although dandruff isn't contagious and is rarely serious, it can be embarrassing and surprisingly persistent.
The good news is that dandruff can usually be controlled. Mild cases of dandruff may need nothing more than daily shampooing with a gentle cleanser. And stubborn flakes often respond to medicated shampoos. What's more, researchers have identified a yeast-like fungus that may cause or aggravate dandruff, a discovery that may lead to better treatments.

Causes:

At one time or another, dandruff causes have been attributed to dry skin, oily skin, shampooing too often or not often enough, a poor diet, stress, and the use of too many fancy styling products. Although some of these factors may exacerbate or contribute to scalp flaking, the real culprit may be a fat-eating, yeast-like fungus called malassezia, formerly known as pityrosporum.

Malassezia lives on the scalps of most healthy adults without causing problems. But sometimes it grows out of control, feeding on the oils secreted by your hair follicles and causing irritation that leads to increased cell turnover. The result is a large number of dead skin cells. As the cells fall off, they tend to clump together with oil from your hair and scalp, making them appear white, flaky and all too visible.

Exactly what causes an overgrowth of these organisms isn't known, although increased oil production; hormonal fluctuations; stress; illness; neurological disorders, such as Parkinson's disease; a suppressed immune system; infrequent shampooing and extra sensitivity to the malassezia fungus may contribute to the development of dandruff.

Seborrheic dermatitis

Flaking is a symptom of seborrheic dermatitis. Joseph Bark notes that "Redness and itching is actually seborrheic dermatitis, and it frequently occurs around the folds of the nose and the eyebrow areas, not just the scalp." Dry, thick, well-defined lesions consisting of large, silvery scales may be traced to the less common psoriasis of the scalp. Seasonal changes, stress, and immuno-suppression seem to affect seborrheic dermatitis.

Symptoms:

For most people, the signs and symptoms of dandruff are unmistakable: white, oily looking flakes of dead skin that dot your hair and shoulders and an itchy,
scaling scalp. But it's not quite that simple — many conditions cause excessive skin scaling, including:
* Dry skin- the kind you get in winter when the air is cold and rooms are overheated — is by far the most common cause of itchy, flaking skin. But flakes from dry skin are generally smaller and less oily than those caused by dandruff.
* Seborrheic dermatitis- This condition, a frequent cause of dandruff, is marked by red, greasy skin covered with flaky white or yellow scales. Seborrheic dermatitis affects not only your scalp but also other areas rich in oil glands, such as your eyebrows, the sides of your nose and the backs of your ears, your breastbone, your groin area, and sometimes your armpits.
* Psoriasis- This skin disorder causes an accumulation of dead skin cells that form thick silvery scales. Psoriasis commonly occurs on your knees, elbows and trunk, but it can also affect your scalp.
* Cradle cap- (seborrheic dermatitis of the scalp). This disorder, which causes a scaling, crusty scalp, is most common in newborns, but it can occur anytime during infancy. Although it can be alarming for parents, cradle cap isn't dangerous and usually clears up on its own by the time a baby is a year old.
* Contact dermatitis- Sometimes sensitivities to certain hair-care products or hair dyes can cause a red, itchy, scaling scalp.

Self-Care:

You can't prevent dandruff, but you can take steps to reduce your risk:
* Learn to manage stress- Stress affects your overall health, making you susceptible to a number of conditions and diseases. It can even help trigger dandruff or exacerbate existing symptoms.
* Shampoo often- If you tend to have an oily scalp, daily shampooing to remove the excess oil may help prevent dandruff.
* Cut back on styling products- Hair sprays, styling gels, mousses and hair waxes can all build up on your hair and scalp, making them oilier.
* Eat a healthy diet- A diet that provides enough zinc, B vitamins and essential fatty acid may help prevent dandruff.
* Get a little sun- Sunlight may be good for dandruff. But because exposure to ultraviolet light damages your skin and increases your risk of skin cancer, don't sunbathe. Instead, just spend a little time outdoors. And be sure to wear sunscreen on your face and body.

Treatment:

Dandruff is a chronic condition that can almost always be controlled, but dandruff treatment may take a little patience and persistence. In general, mild scaling can often be helped by daily cleansing with a gentle shampoo to reduce oiliness and cell buildup.

When regular shampoos fail, OTC dandruff shampoos may succeed. But dandruff shampoos aren't all alike, and you may need to experiment until you find one that works best for you. Dandruff shampoos are classified according to their active ingredient:

Zinc pyrithione shampoos (Selsun Salon, Head & Shoulders). These contain the antibacterial and antifungal agent zinc pyrithione, which has been shown to reduce the fungus that causes dandruff and seborrheic dermatitis.
Tar-based shampoos (Neutrogena T/Gel). Coal tar, a byproduct of the coal manufacturing process, helps conditions such as dandruff, seborrheic dermatitis and psoriasis by slowing cell turnover.
Shampoos containing salicylic acid (Ionil T). These "scalp scrubs" help eliminate scale, but they may leave your scalp dry, leading to more flaking. Using a conditioner after shampooing can help counter dryness.
Selenium sulfide shampoos (Selsun Blue). These shampoos help prevent cell turnover and may also reduce the number of malassezia. Because they can discolor blonde, gray or chemically colored hair, be sure to use them only as directed and to rinse well after shampooing.
Ketoconazole shampoos (Nizoral). The newest addition to the dandruff armamentarium, ketoconazole is a broad-spectrum antifungal agent that may work when other shampoos fail. It's available over-the-counter as well as by prescription.