Lupus

What Is Lupus?

Lupus is a lifelong disorder of the immune system. Immune cells attack the body’s own healthy tissues, leading to inflammation and tissue damage. Symptoms may be limited to the skin, but more often lupus also causes internal problems such as joint pain. In severe cases, it can damage the heart, kidneys, and other vital organs. Although there’s no cure, there are treatments that can minimize the damage.


Lupus Symptom: Joint Pain

Joint and muscle pain is often the first sign of lupus. This pain tends to occur on both sides of the body at the same time, particularly in the joints of the wrists, hands, elbows, knees, or ankles. The joints may look inflamed and feel warm to the touch. But unlike rheumatoid arthritis, lupus usually does not cause permanent joint damage.


Lupus Symptom: Butterfly Rash

A tell-tale sign of lupus is a butterfly-shaped rash across the cheeks and bridge of the nose. Other common skin problems include sensitivity to the sun with flaky, red spots or a scaly, purple rash on various parts of the body, including the face, neck, and arms. Some people also develop mouth or lip sores.

Lupus Symptom: Nail Changes

Lupus can cause the nails to crack or fall off. They may be discolored with blue or reddish spots at the base. These spots are actually in the nail bed, the result of inflamed small blood vessels. Swelling may also make the skin around the base of the nail look red and puffy.

Lupus Symptoms: Fever and Fatigue

Most people with lupus experience some degree of fatigue. In many cases, it is severe enough to interfere with exercise and other daily activities. Most patients also run a low-grade fever from time to time. This unexplained fever may be the only warning sign in some people.

Lupus Symptom: Light Sensitivity

Many people with lupus are unusually sensitive to the sun and other forms of ultraviolet light (such as tanning beds.) A day at the beach may trigger a skin rash in areas exposed to sunlight and may worsen other lupus symptoms. Certain medications can make people with lupus even more sensitive to UV light.

Lupus Symptom: Hair Loss

The symptoms of lupus tend to come and go, and this includes hair loss. Patients may go through periods where their hair falls out in patches or becomes thinner all across the scalp. Once the flare-up is over, new hair is likely to grow in evenly.

Lupus Symptom: Raynaud's

Some people with lupus develop a condition called Raynaud’s phenomenon. Their fingers and toes become painful, numb, and tingly in response to cold temperatures or emotional stress. This happens when small blood vessels spasm and restrict blood flow to the area. During an attack, the fingers and toes may turn white or blue. People can also have Raynaud's without having lupus or any serious health complications.

Lupus or Something Else?

When lupus begins, it can look a lot like rheumatoid arthritis, which causes joint pain and swelling, or fibromyalgia, which causes fatigue and pain. One aspect that sets lupus apart is the combination of skin rashes with joint pain and fatigue. There are also lab tests that can help distinguish lupus from other diseases.

Diagnosing Lupus

Diagnosing lupus can be tricky. The disease can mimic other conditions, and it often takes a different course in different people. Many people have it for years before developing tell-tale symptoms. Although there is no one test for lupus, certain proteins usually show up in a patient’s blood. A blood test for antinuclear antibodies (ANAs) can provide a critical clue. Other lab tests may check cell counts, kidney function, and clotting time. A tissue biopsy sometimes helps with diagnosis.

Who Gets Lupus?

Anyone can get lupus. But more than 90% of people with lupus are women. Aside from being female, your odds of getting the disease are higher if you are:

• African-American, Latino, or Asian
• Aged 15 to 45
• Related to someone with lup

Types of Lupus

When people say “lupus,” they usually mean systemic lupus erythematosus (SLE), the most common and serious type. But there are other types. Cutaneous lupus erythematosus – also called discoid lupus -- is limited to the skin and doesn’t cause the organ damage that sometimes occurs with SLE. The most common symptom is a circular rash. Drug-induced systemic lupus causes temporary lupus symptoms in people who take certain medications.

Medical Treatments for Lupus

There are ways to control the symptoms of lupus. These include corticosteroid creams for rashes and nonsteroidal anti-inflammatory drugs (NSAIDs) for joint pain and fever. Antimalarial medications can help fight joint pain, ulcers, and rashes. Higher dose of corticosteroids may be given as pills or injections. People with severe lupus may benefit from drugs that suppress the immune system.

Self-Care for Lupus

Making some changes to your routine can also help reduce lupus flare-ups:

• Cover up when you’re in the sun.
• Don’t smoke.
• Exercise regularly.
• Improve your stress management skills.

Also be sure to get plenty of rest. Some people with lupus need up to 12 hours of sleep a night.

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Alzheimer's Disease

Reviewed by Brunilda Nazario, MD on January 21, 2010
Source: 2010 WebMD

Could It Be Alzheimer's?

It's normal for our loved ones to become a bit forgetful as they age. So how can we separate a harmless "senior moment" from a more serious problem like Alzheimer's disease? One in eight people 65 and older have this devastating form of dementia. In its first stages, Alzheimer's may not be obvious to friends and family. But there are some early warning signs to watch for.

Warning Signs: Memory and Speech

In early Alzheimer's, long-term memories usually remain intact while short-term memories become sketchy. Your loved one may forget conversations you had. He or she may repeat questions that were already answered. The disease also disrupts speech, so patients may struggle to remember common words.

Warning Signs: Behavior

In addition to memory loss, Alzheimer's can cause confusion and behavior changes. Your loved one may get lost in familiar places. Mood swings and poor judgment are also common, as is poor hygiene. People who once dressed with style may resort to wearing stained clothes and unwashed hair.

Don't Ignore the Signs

While it's difficult to face the possibility that a loved one could have Alzheimer's, it's better to consult a doctor sooner rather than later. First, the diagnosis might not be Alzheimer's after all. The symptoms could be caused by a highly treatable problem, such as a thyroid imbalance. And if it is Alzheimer's, today's treatments work best when they are used early in the course of the disease.

Diagnosing Alzheimer's

There is no simple test for Alzheimer's, so the doctor will rely on you to describe the changes in your loved one. A mental status test, sometimes called a "mini-cog," or other screening tests can help evaluate the patient's mental function and short-term memory. In addition, neurological exams and brain scans may be used to rule out other problems, such as a stroke or tumor — and they can help provide other information about the brain.

Alzheimer's and the Brain

Alzheimer's disease leads to nerve cell death and tissue loss throughout the brain. As the disease progresses, brain tissue shrinks and the ventricles (chambers within the brain that contain cerebrospinal fluid) become larger. The damage disrupts communication between brain cells, crippling memory, speech, and comprehension.

Alzheimer's Progression: What to Expect

Alzheimer's disease takes a different path in every patient. In some people the symptoms worsen quickly, leading to severe memory loss and confusion within a few years. In others, the changes may be more gradual with the disease taking 20 years to run its course. The average length of survival after a diagnosis of Alzheimer's is three to nine years.

How Alzheimer's Affects Daily Life

Because Alzheimer's affects concentration, patients may lose the ability to manage ordinary tasks like cooking or paying the bills. A study suggests difficulty balancing a checkbook is often one of the first effects of Alzheimer's. As the symptoms worsen, your loved one may not recognize familiar people or places. He or she may get lost easily, or use utensils improperly, such as combing hair with a fork. Incontinence, balance problems, and loss of language are common in the advanced stages.

Alzheimer's and Driving

Poor coordination, memory loss, and confusion make for a dangerous combination behind the wheel. If you feel your loved one should not be driving, explain why. If he or she won't listen, ask the doctor to step in. If the patient still insists on driving, contact the Department of Motor Vehicles for an assessment. Then make an alternate plan for your loved one's transportation need.

Alzheimer's and Exercise

Exercise can help people with Alzheimer's maintain some muscle strength and coordination. It also improves mood and may reduce anxiety. Check with your loved one's doctor to learn which types of exercise are appropriate. Repetitive activities, such as walking, weeding, or even folding laundry may be the most effective at promoting a sense of calm.

Alzheimer's Medications

There is no cure for Alzheimer's disease, and no known way to slow the nerve damage within the brain. But there are a variety of medications that appear to help maintain mental function and slow the disease progression. If these treatments are given during the early stages of Alzheimer's, your loved one may be able to remain independent and carry out daily tasks for a longer period of time.

The Caregiver's Role

As the caregiver of someone with Alzheimer's, you will probably wear many hats — cook, chauffeur, accountant. While you may have to handle the meal planning and finances, encourage the patient to do some activities independently. It may help to label cabinets with their contents and put up sticky notes with reminders of daily tasks. Be sure to buy a weekly pill box for medications.

Challenges in Caregiving

In the early stages of Alzheimer's, patients often understand what is happening and may be ashamed or anxious. Watch for signs of depression because this can often be managed with medication. In the more advanced stages, your loved one may become paranoid or violent and could even turn on you. Remember that the disease is responsible for this change. Alert the doctor about violent behavior promptly.

Sundown Syndrome

Some people with Alzheimer's become distressed when the sun goes down. This agitation tends to last through the evening and sometimes all through the night. The cause is not known, but there are some strategies to ease the tension. Keep the house well lit and close the drapes before sunset. Try distracting your loved one with a favorite activity or TV show. And restrict caffeine after breakfast.

When Your Loved One Doesn't Know You

Many people with Alzheimer's have trouble remembering names — even those of close family members. A temporary fix is to put up pictures of friends and relatives with names printed underneath. Eventually, the patient may no longer recognize faces and may react to loved ones as if they are strangers. This can be a distressing time for family members, especially the primary caregiver.

Warning Signs of Caregiver Stress

Caring for someone with Alzheimer's can be physically and mentally taxing. Signs of caregiver stress include:

• Anger, sadness, and mood swings.
• Headaches or back pain.
• Difficulty concentrating.
• Difficulty sleeping.

Taking Care of the Caregiver

To avoid caregiver burnout, make sure you take at least a few minutes to do something you enjoy every day. Stay in touch with friends and keep up with hobbies whenever possible. Find a friend or relative to be your support person. You can also join an online or local caregiver support group through the Alzheimer's Association.

Essential Documents

While your loved one is still able to make important decisions, contact an attorney about drafting advance directives. These are legal documents that spell out the patient's preferences for medical treatments and end-of-life care. The patient should designate someone to make health care decisions and manage finances on his or her behalf. This can avoid confusion when your loved one is no longer able to state his or her wishes.

Home Health Care

Many patients express a desire to stay in their own homes as long as possible. Unfortunately, they may have trouble getting dressed or using the bathroom on their own as the disease advances. A home health aide can assist with personal hygiene and other daily tasks. You can also look into local services that deliver meals or provide transportation to the elderly. Most communities have an Area Agency on Aging that provides such services.

Assisted Living Facilities

There may come a day when your loved one can no longer be cared for at home. If he or she does not need 24-hour nursing care, an assisted-living facility may be an appropriate choice. ALFs provide housing, meals, and activities, but are much less expensive than nursing homes. Look for a facility with an Alzheimer's special care unit, which delivers 24-hour supervision and personal care to meet the needs of people with dementia.

End-Stage Alzheimer's

People with advanced Alzheimer's may lose the ability to walk, talk, or respond to others. Eventually, the disease can hinder vital functions, such as the ability to swallow. Patients in this stage may benefit from hospice care, which provides pain relief and comfort for the terminally ill.

Helping Children Cope

Children may feel confused, afraid, or even resentful when a family member is affected by Alzheimer's. Let the child know these feelings are normal and answer his or her questions about the illness honestly. Help the child celebrate happy memories of the patient — for example, by creating a scrapbook.

Reducing Your Risk of Alzheimer's

If you're caring for a relative with Alzheimer's, you might be wondering if there's anything you can do to reduce your own risk. Research in this area is ongoing, but diet and exercise appear key. Studies indicate a lower risk among people who eat a Mediterranean diet rich in vegetables, fish, and nuts. Research also suggests those who are the most physically active are the least likely to get Alzheimer's.

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Skin Problems

Reviewed by: Louise Chang, MD on May 20, 2010
Source: WebMD  2010

Got Skin Problems?
Is your skin itching, breaking out, covered in a rash, or playing host to strange spots? Skin inflammation, changes in texture or color, and spots may be the result of infection, a chronic skin condition, or contact with an allergen or irritant. You can learn to recognize common adult skin problems. Yet, while many are minor, they may signal something more serious, so always consult a doctor for proper diagnosis.

Shingles (Herpes Zoster)

Shingles starts with burning, tingling, or very sensitive skin. A rash of raised dots develops into painful blisters that last about two weeks. Shingles often occurs on the trunk and buttocks, but can appear anywhere. Most people recover, but pain, numbness, and itching linger for many -- and may last for months, years, or the rest of their lives. Treatment with antiviral drugs, steroids, antidepressants, and topical agents can help.

Hives (Urticaria)

A common allergic reaction that looks like welts, hives are often itchy, stinging, or burning. Hives vary in size and may join together to form larger areas. They may appear anywhere and last minutes or days. Medications, foods, food additives, temperature extremes, and infections like strep throat are some causes of hives. Antihistamines can provide relief.

Psoriasis

A non-contagious rash of thick red plaques covered with white or silvery scales, psoriasis usually affects the scalp, elbows, knees, and lower back. The rash can heal and recur throughout life. The cause of psoriasis is unknown, but the immune system triggers new skin cells to develop too quickly. Treatments include medications applied to the skin, light therapy, and medications taken by mouth, injection or infusion.

Eczema

Eczema describes several non-contagious conditions where skin is inflamed, red, dry, and itchy. Stress, irritants (like soaps), allergens, and climate can trigger flare-ups though they're not eczema's cause, which is unknown. In adults, eczema often occurs on the elbows and hands, and in "bending" areas, such as inside the elbows. Treatments include topical or oral medications and shots.

Rosacea

Often beginning as a tendency to flush easily, rosacea causes redness on the nose, chin, cheeks, forehead, even the eyes. The redness may intensify over time, taking on a ruddy appearance with visible blood vessels. In some cases, thickened skin, bumps and pus-filled pimples can develop. Rosacea treatment includes medications as well as surgical procedures such as laser therapy, dermabrasion, and electrocautery to reshape affected areas.

Cold Sores (Fever Blisters)

Small, painful, fluid-filled blisters on the mouth or nose, cold sores are caused by the herpes simplex virus. Lasting about 10-14 days, cold sores are very contagious. Triggers can include fever, too much sun, stress, or hormonal changes such as menstruation. Antiviral pills or creams can be used as treatment, but call your doctor if sores contain pus, you have a fever greater than 100.5 degrees, or if your eyes become irritated.

Rash From Plants

Contact with the oily coating from poison ivy, oak, and sumac causes a rash in many people. It begins with redness and swelling at the contact site, then becomes intensely itchy with the development of blisters usually 12 to 72 hours after exposure. The typical rash is arranged as a red line on an exposed area, caused by the plant dragging across the skin. The rash usually lasts up to two weeks.

Soothe Itchy Plant Rashes

Prescription or over-the-counter medication may soothe the itching of mild rashes. Cool compresses and oatmeal baths may help with symptoms. For a severe rash, oral corticosteroid may be given. If the skin becomes infected, antibiotics may be necessary. Avoiding direct contact with the plants can prevent the rash, so learn to recognize poisonous plants. In general, poison oak grows west of the Rockies; poison ivy to the east.

Razor Bumps

Razor bumps are tiny, irritated bumps that develop after shaving. People with curly hair are most affected by them. The sharp edge of closely shaven hair can curl back and grow into the skin, causing irritation and pimples, and even scarring. To minimize razor bumps, take a hot shower before shaving, shave in the direction of hair growth, and don't stretch the skin while shaving. Rinse with cold water, then apply moisturizer.

Skin Tags

A skin tag is a small flap of flesh-colored or slightly darker tissue that hangs off the skin by a connecting stalk. They're usually found on the neck, chest, back, armpits, under the breasts, or in the groin area. Skin tags appear most often in women and elderly people. They are not dangerous and usually don't cause pain unless they become irritated by clothing or nearby skin rubbing against them. A doctor can remove a skin tag by cutting, freezing, or burning it off.

Acne

At the heart of acne lies a clogged pore from oil and dead skin cells that can become inflamed. When open, it is called a blackhead or open comedo; closed, a whitehead or closed comedo. Often seen on the face, chest, and back, acne can be triggered hormones and bacteria. To help control it, keep oily areas clean and don't squeeze pimples (it may cause infection and scars).

Athlete's Foot

A fungal skin infection that can cause peeling, redness, itching, burning, and sometimes blisters and sores, athlete's foot is contagious, passed by direct contact, sharing shoes worn by an infected person, or by walking barefoot in areas such as locker rooms or near pools. It's usually treated with topical antifungal lotions or oral medications for more severe cases. Keeping feet and the inside of shoes clean and dry is important in treatment.

Moles

Usually brown or black, moles can be anywhere on the body, alone or in groups, and generally appear before age 20. Some moles (not all) change slowly over the years, becoming raised, developing hair, and/or changing color. While most are non-cancerous, some moles have a higher risk of becoming cancerous. Have a dermatologist evaluate moles that change, have irregular borders, unusual or uneven color, bleed, or itch.

Age or Liver Spots

These pesky brown or gray spots are not really caused by aging, though they do become more common as people age. They're the result of sun exposure, which is why they tend to appear on areas that get a lot of sun, such as the face, hands, and arms. Bleaching creams, acid peels, and light-based treatments may lessen their appearance. To rule out serious skin conditions such as melanoma, see a dermatologist for proper identification.

Pityriasis Rosea

A harmless rash, pityriasis rosea usually begins with a single, scaly pink patch with a raised border. Days to weeks later, a scaly rash appears on the arms, legs, back, chest, and abdomen, and sometimes the neck. The rash may appear "Christmas tree" shaped across the body. The rash, whose cause is unknown, isn't believed to be contagious and can be itchy. It often goes away in 6-8 weeks without treatment. Pityriasis rosea is most often seen between the ages of 10 and 35.

Melasma ('Pregnancy Mask')

Melasma (chloasma) is characterized by tan or brown patches on the cheeks, nose, forehead, and chin. Although usually called the "pregnancy mask," men can also develop it. Melasma occurs in half of all women during pregnancy. It may go away after pregnancy but, if it persists, can be treated with prescription creams and over-the-counter products. Use a sunscreen at all times if you have melasma, as sunlight worsens the condition.

Warts

In most cases, common warts appear on the fingers or hands. Caused by contact with the contagious human papillomavirus, warts can spread from person to person or via contact with something used by a person with the virus. You can prevent spreading warts by not picking them, covering them with bandages, and keeping them dry. In most cases, warts are harmless, painless, and go away on their own. If they persist, treatments include freezing, surgery, lasers, and chemicals.

Seborrheic Keratoses

Noncancerous growths that may develop with age, seborrheic keratoses can appear on many areas of the skin either alone or in groups. They may be dark or multicolored, and they usually have a grainy surface, though they can be smooth and waxy. No treatment is necessary unless irritation develops or their appearance is a concern. Because seborrheic keratoses may be mistaken for moles or skin cancer, see a dermatologist for proper diagnosis.

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