SKIN CONDITIONS
المؤلف:
FRANK GARVEY AND JACKY VINCENT
المصدر:
Caring for People with Learning Disabilities
الجزء والصفحة:
P128-C8
2025-10-21
289
SKIN CONDITIONS
Atopic dermatitis is the presence of red, scaly, itchy skin. It is most likely to appear on the cheeks, behind the ears, behind the knees and in the elbow creases. Treatment is with steroid creams and oral antihistamines. This is an irritating condition, which needs to be managed by carers to prevent pain and discomfort for those individuals affected.
Seborrhea is a similar condition, but usually greasy and scaly, and appearing on the scalp and eyebrows. Dandruff shampoos or shampoos with either tar compounds or salicylates are used to treat seborrhea of the scalp. Occasionally, antifungal preparations may be useful. This condition can affect an individual’s sense of worth and self-esteem, so needs to be treated seriously.
Hyperkeratosis is very thick skin and, in adults with Down’s syndrome, occurs on the palms and soles of the feet. Treatment is only tried if the hyper-keratosis appears to bother the person with it, and consists of creams with salicyclic acid or a pumice stone. Hyperkeratosis of the feet can be decreased by wearing comfortable shoes.
Syringomas are benign skin tumours that arise from sweat ducts. They look like very small multiple raised nodules on the skin, with varying degrees of yellowish color. They are most often seen on the eyelids, neck and chest. Syringomas occur twice as often in females as in males. These do not require treatment, but they can be removed by lasers, shaving or scooping out with a curette.
Elastosis perforans serpiginosa is a disorder of the elastic tissue of the skin, causing deep-red raised lesions to appear in a linear or a circular pattern. These tend to occur on the back and sides of the neck, but may also be seen on the chin, cheeks, arms and knees. These occur in males four times as often as in females. These may last for well over 10 years before going away on their own. Liquid nitrogen is the best current treatment, but this condition has a high rate of recurrence.
Vitiligo is a loss of pigmentation of the skin in well-defined areas. It may occur anywhere on the body and at any age. Vitiligo is not a common problem in adults with Down’s syndrome, but is still more common than in the general population. The cause is unknown, but it may be caused by auto-antibodies destroying melanocytes, which are cells in the skin that produce pigment.
Acanthosis nigrans is an increase in pigmentation. The darker skin is also slightly elevated and scaly, often with the appearance of dirt that won’t wash off. One large study in Spain reported that out of 51 adults with Down’s syndrome, 26 had acanthosis nigrans. This condition most often appears on the back of the neck, the hands and the groin. While acanthosis nigrans has been associated with type II diabetes mellitus, none of the affected adults with Down’s syndrome with acanthosis nigrans in the Spanish study had evidence of diabetes.
Chelitis is the presence of fissures and red, scaly skin at the corners of the mouth and lips. This is usually due to moisture collecting at the corners of the mouth, but can also be complicated by infection from bacteria or the yeast Candida. The application of a mild steroid cream is useful, along with treating infection when present.
Scabies is an infection of the skin caused by a microscopic mite. For reasons unknown, this infection is a common problem in adults with Down’s syndrome and tends to be a worse infection than in the general population. The mite is transmitted by skin-to-skin contact. The rash is extremely itchy and typically appears as small, raised red dots. These dots can appear in lines (the mites burrowing under the skin), but are more often seen in the webs between fingers, around the waist, on the buttocks and around the bra line in females. If the affected person scratches the rash a lot, it can develop a secondary bacterial infection. Scabies usually responds to permethrin cream with a onetime application.
Alopecia (hair loss) is common in both men and women with Down’s syndrome. Alopecia areata is the term used to describe patchy hair loss, which is not due to infection or drugs. The bald patches have distinct borders, with no hair thinning in other areas of the scalp. Alopecia totalis can also occur. Rarely, hair loss can occur all over the body; this is known as alopecia universalis. Once again, an autoimmune process is thought to be responsible for these conditions, with antibodies being specifically manufactured against hair follicles. Alopecia areata is more common in adults with Down’s syndrome, occurring in 5–9 per cent of this population (compared with 1–2 per cent of the general population). A gene implicated in the cause of alopecia areata has been found on the 21st chromosome. There is no cure at present for alopecia; treatment is currently aimed at helping hair re-growth, but it cannot stop the spread of hair loss. The first line of treatment for adults is injection of corticosteroids into the bald spots, with the goal of suppressing the immune reaction causing hair loss. Re-growth can be seen in 4–8 weeks, and treatment is repeated every 4–6 weeks up to a maximum of 6 months. The application of steroid creams is ineffective. There has been some success with hair re-growth with topical applications of minoxidil and anthralin. There are newer agents being tried in clinical studies, such as diphenyl-cyclopropenone and dinitrochlorobenzene, but are not yet commercially available.
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