HEPATITIS B- Part One

Hepatitis B: All You Must Know

Hepatitis B is a deadly viral infection, deadlier than the HIV/AIDS.
 Hepatitis B is a very infectious and chronic disease that affects the liver. It is caused by the Hepatitis B virus. It causes acute as well as chronic infections.

It causes scarring on the liver, liver failure and also cancer of the liver. It is a DNA virus, with small irregular features, and it is in no way related to Hepatitis A or hepatitis C virus. It is very infectious perhaps more infectious even than the HIV virus.

This virus has the ability to resist and persist in infected cells allowing it the ability to easily replicate thereby causing chronic conditions such as liver failure. Approximately over 2,000 people die of Hepatitis B every year.


This disease presents in two stages namely:

The ACUTE STAGE of Hepatitis B: This is the stage in which the infection is still in a new level or new stage. This means that in this stage, the individual may not even experience any symptom until about 4 months later. This disease has the ability to hide itself but in most cases of acute Hepatitis, the infection will resolve itself in weeks at most months.

But in some people although in a smaller number, this disease becomes a very severe and life-threatening form of acute hepatitis known as fulminant Hepatitis. This form won’t resolve itself and it has the ability to become chronic.

The CHRONIC STAGE of Hepatitis B: it is a more severe and more life-threatening stage of the Hepatitis B virus. At this stage, the virus has fully developed the ability to resist in its infected cells and therefore it never goes away completely. This occurs after 6 months of the individual having the infection.

Here are a few things that are very essential for you to know about this infection;

Hepatitis is a very common infection that is seen in Asia, Africa, China, the Philippines and the middle east. Almost 10% of the population usually develops the Chronic Hepatitis B.Hepatitis B is considered a leading cause of liver cancer deaths around the world and also the second leading cause of Generalcancer deaths across the globe.Symptoms don’t generally show and symptoms at the initial stage of this disease. This is because the disease can last for up to 6months in the body without giving off any symptoms.Symptoms usually begin with the general and usual non-specific ones such as General body weakness, tiredness and maybe fever. The person might also experience nausea, vomiting and loss of appetite.

Symptoms then gradually becomes very severe with presentations such as jaundice, dark or brown-colored urine, yellowing of the sclera, body itching and severe pain in the right upper abdominal region.

Hepatitis B is a leading cause of liver cirrhosis and also hepatocellular carcinoma globally. According to statistics, about 300-400 million people are suffering from Hepatitis B worldwide.Infants can get this virus from their mothers even from the womb and majority of these infants almost more than 90% of them proceed to chronic and long-term stage of Hepatitis B.This infection is transmitted via sexual intercourse(unprotected), intravenous (I.V) drugs, sharing of infected needles with one’s dug partner, homosexuality, blood transfusion, and perinatal transfusion (i.e. the blood transferred from the mothers to their babies).Most patients with Chronic Hepatitis B are advised to stay away from alcohol. Perhaps, you may be reading this and already diagnosed, please stay away from alcohol because alcohol will only make things worse and decline very fast. This will only increase your chances of getting liver cirrhosis and liver cancer.The type of liver cancer caused by Hepatitis B is very different from other type of liver cancers. Other liver cancers start from other cells of the other organs of the body and then it spreads to the liver, but this starts type of liver cancer starts in the liver due to a prolonged damage to the liver.Cirrhosis is a disease of the liver which occurs when a scar tissue starts to form on the liver. These scarring then becomes so severe so much so that it starts to cause the function of the liver to begin to decline causing the liver to stop functioning all together. This will affect all the internal body processes like blood flow, removal of toxins and poisons, and likewise digestion of essential body nutrients.Transmission of this infection can be between children too (between the ages of 5 and 7). It is usually common with this age bracket because they tend to share things that would have come in contact with the body fluid of an infected child to a child who is not infected hence this infection is spread easily.Another easy means of transmission of this virus is through sex. Having unprotected sex with an infected person puts you at a very high risk of contracting the disease. This occurs when body fluids of an infected person such as semen, body sweat, or vaginal secretions enter the body of an uninfected person. This accounts for majority of cases of acute hepatitis B.

For people with multiple sexual partners or men who have anal sex with other men likewise couples who engage in anal sex are more at risk of contracting this disease.

Health workers too who handle blood and other body secretions are prone to contracting this disease if they are not very careful and also if they lack personal hygiene.There is no specific and single treatment for Hepatitis B. Most times, antiviral drugs are usually prescribed so as to slow down the progress of the disease on the liver. This will limit the pain associated and also the risk of getting liver cancer (the main disease)According to World Health Organization, a vaccine mostly is in the use of preventing the possibility of getting this disease.It is important to know that anyone allergic to yeast must not take any anti Hepatitis B medicine. This is because yeast is used in the production of a Hepatitis B vaccine.Your diet is very important when trying to manage Hepatitis B symptoms. Eat enough of vegetables as this contains chlorophyll which is very essential for liver damage and it is highly beneficial in controlling and managing oxidative stores.Avoid foods and drinks that are spicy as this will cause an inflammatory effect. Sugary and carbonated drinks are prohibited. Try to eat natural foods and not refined foods.Avoid over the counter drugs as they have the tendency to worsen and increase liver damage. For people with Hepatitis B, your aim is to reduce liver damage and so taking over the counter drugs will increase your chances of liver damage which is the opposite of what you want,Always take in water. One of the basic symptoms of Hepatitis B is vomiting and diarrhea. Due to this, body fluid is lost and in order to replenish it, you are to stay hydrated by taking water. This will help you and sustain you ensuring you don’t get dehydrated.

HEAVY MENSTRUATION FLOW

Heavy menstrual flow medically referred to as menorrhagia is a form of bleeding that can make a woman feel uncomfortable during the menstrual cycle. It can be accompanied with dysmenorrhea.

Heavy bleeding doesn't necessarily mean there's anything seriously wrong, but it can affect a woman physically and emotionally, and disrupt everyday life.

SIGNS THAT SHOW YOU HAVE HEAVY MENSTRUAL FLOW

You have heavy or excessive menstrual bleeding if:

·         you change pads or tampons 3-5 times per day and it was not so before

·         blood leaks off the pad or tampon to stain your clothes or bedsheet or seat

·         you need to use tampons and towels together

What causes heavy periods?

Menorrhagia has no real cause most of the time but we do know that some conditions or medications do cause or increase the risk of menorrhagia.

Conditions that can cause heavy bleeding include:

·         pelvic inflammatory disease (PID) – UTI (the womb, fallopian tubes or ovaries) that can cause pelvic or abdominal pain and bleeding after sex or between periods

·         polycystic ovary syndrome (PCOS) – a common condition that affects how the ovaries work; it causes irregular periods, and periods can be heavy when they start again 

·         fibroids – non-cancerous growths that develop in or around the womb and can cause heavy or painful periods

·         adenomyosis – when tissue from the womb lining becomes embedded in the wall of the womb

·         endometriosis – when small pieces of the womb lining are found outside the womb, such as in the fallopian tubes, ovaries, bladder or vagina (although this is more likely to cause painful periods)

·         Hypothyroidism (underactive thyroid gland) – where the thyroid gland doesn't produce enough hormones, causing tiredness, weight gain and feelings of depression 

·         blood clotting disorders

·         cancer of the womb (although this is relatively rare)

·         an IUD (intrauterine contraceptive device, or "the coil") – this can make your periods heavier for the first three to six months after insertion

·         anticoagulant medication (drugs that prevent blood clots)

·         some medicines used for chemotherapy

Treating heavy periods

You may not need treatment if a serious cause isn't suspected, or the bleeding doesn't affect your everyday life.

Read more here for treatment options

Bleeding after childbirth

After having a baby, heavy vaginal bleeding, known as lochia, is very common and completely normal. It's your body's way of getting rid of the womb lining after you've given birth.

The bleeding can last from two to six weeks, and the blood may come out quickly, or slowly and evenly.

The amount of blood loss varies between women. If you've had a caesarean section, you'll also have some bleeding as the womb lining sheds, although it may be lighter than if you'd had a vaginal birth.

You'll need to use thick sanitary pads to start with while the bleeding is at its heaviest.

Once the flow settles down, you can switch to using normal sanitary pads. Always wash your hands before and after changing your pad.

Don't use tampons for the first six weeks after the birth as it increases the risk of your womb becoming infected.

The colour of the blood will also change in the days and weeks after childbirth. It'll be bright red for the first few days and may contain small clots.

As the bleeding becomes less heavy, the colour of the blood will lighten, becoming pinkish and more watery.

It's important to make sure you get plenty of rest and don't overdo it during this time. It could be a postpartum haemorrhage caused by a piece of placenta still inside your womb. You may need antibiotics or an operation to remove the piece of placenta.

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ALERT: WHY YOU MUST TREAT YOUR HYPERTENSION

Stroke

the remote control of all body parts

High blood pressure causes your arteries to damage or clog more easily, putting you at high risk for a stroke

When a blood vessel in the brain is blocked or damaged, that part of the brain does not get the blood and oxygen it needs. So brain cell or body cell dies as a result of oxygen deprivation if the partial pressure of oxygen falls below normal. This can cause partial paralysis or total paralysis depending on part of the brained involved. This results in loss of ability to control movement and body functions, speak, remember things, or think clearly. This means there is impairment of cognition.

Heart and artery damage

the life machine of every man

High blood pressure can cause microscopic tears in your artery walls. These tears turn into scar tissue. The scar tissue creates rough walls, collecting cholesterol, platelets, fats, and plaque. This narrows and hardens the arteries

Damaged and hardened arteries can limit the amount of blood your organs get, causing them to not work as well as they should

Pieces of the deposits left in the arteries due to scar tissue can break off, causing blood clots that flow through the bloodstream until they get stuck in a small space. This can block the blood supply to part of your heart or brain, causing a heart attack or stroke

The heart has to work harder to pump blood through damaged arteries. This can make it thicker and larger. The damaged heart works less effectively, so the rest of your organs may not get all the blood they need

When the heart doesn't get as much blood as it needs, you could develop angina—uncomfortable pressure, fullness, squeezing, or pain in the center of the chest. People with angina usually feel their symptoms when walking up a hill, climbing stairs, or doing other sorts of physical activity

Narrowing of the arteries to your legs, stomach, arms, and head, called peripheral artery disease (PAD), can cause cramping, pain, or tiredness mostly in the leg and hip muscles. People with PAD also have a much higher risk of heart attack or stroke

Kidney damage

the purifier of the body

Uncontrolled HTN can exert much pressure on the kidney capillaries which can lead to nephropathy. At initial time, HTN can results of hyperfilteration at the glomerulus. This can lead to essential blood electrolyte such as albumin and other proteins being lost in the urine. Damage to kidney is a double damage to the body because the kidney gradually loses it function of osmoregulation i.e regulation of water and salt balance, elimination of waste products of metablosim and secondly the body then loses another Blood pressure control mechanism as damaged kidneys are also unable to help your body regulate its own blood pressure which normal kidneys do.  So uncontrolled HBP can lead to kidney failure

Vision loss

the light of the body

High blood pressure causes much pressure to the delicate blood vessels (capillaries) in the eyes and damages them. This leads to retinopathy or impaired vision.

Glaucoma is an eye disease that is often associated with elevated intraocular pressure, in which damage to the eye (optic) nerve can lead to loss of vision and even blindness if the cause was not properly addressed.

So HBP is the chief risk factor for glaucoma which is the chief cause of permanent blindness in the world.  So lowering your blood pressure will do good in preventing damage to blood vessels in the eye so treating.

Also, brain damage caused by stroke can also lead to permanent vision loss. 

Hypertensive crisis

body organs

This is HBP at the extreme (SBP of 180 or higher /DBP of 110 or higher). The writer here have taken a BP of 216/140 mmHg. It may even be as high as 240/150. This is hypertensive emergency and the patient should be admitted right away because any further negligence may lead to comorbidities and synchronous organ failure within few days.

It may be accompanied by a severe headache, tachycardia, dyspnea or shortness of breath, nosebleed, and/or anxiety disorder.

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MANAGEMENT OF HYPERTENSION

The first step to managing hypertension is lifestyle modification. If the BP is not responding well to lifestyle modification, the drug therapy will be the next step. Below are classes of drugs used listed, your healthcare provider will choose the one appropriate for you.

Calcium channel blockers,  CCBs

Calcium channel blockers can also be grouped into several classes depending on their structural composition

Calcium channel blockers reduce blood pressure by widening your blood vessels.

Common examples are amlodipine, nicardipine, felodipine and nifedipine, diltiazem , verapamil. It should be noted that verapamil and diltiazem have more affinity for calcium channels in the heart.

Possible side effects include headaches, swollen ankles and constipation.

Beta-blockers

Beta-blockers can reduce blood pressure by reducing the contractility of the heart thereby making your heart beat more slowly and with less force.

They may have devastating effect in patient with left ventricular heart failure and should not be given in this case.

They are also contraindicated in hypertensive asthmatic patients because they worsen asthma by their induced bronchoconstriction via beta receptor in the respiratory pathway

Common examples are timolol, propanolol, atenolol , bisoprolol and metoprolol.

The beta-antagonists that are still very much in use are those ones that are selective.

Possible side effects include decreased libido, dizziness, headaches, tiredness, and cold hands and feet.

ACE inhibitors

Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure by dilating blood vessels especially the peripheral vasculatures. ACE inhibitors are very useful in patients with co-morbidity as well preventing end-organ damage which is mostly associated with HTN

Common examples are enalapril, lisinopril, perindopril and ramipril.

The most noticeable side effect is a persistent unproductive cough. Other possible side effects include headaches, dizziness and a rash.

Angiotensin-2 receptor blockers (ARBs)

ARBs work in a similar way to ACE inhibitors. They're often recommended if ACE inhibitors cause troublesome side effects.

ARBs have no or less effect on bradykinin level and so are not likely to dry cough associated with ACE inhibitors.

Common examples are candesartan, irbesartan, losartan, valsartan and olmesartan.

Possible side effects include dizziness, headaches, and cold or flu-like symptoms.

ACE inhibitors and ARBs can be grouped together as RAAS which means rennin-angiotensin-aldosterone system which highlights the mechanism of their action.

Diuretics

Diuretics work by removing excess salt and water from the body through urine. There exist different types of diuretics so your healthcare provider will prescribe the one appropriate for you after adequate assessment.

Common examples are ,hydrochlorthiazide HCT, moduretic, indapamide and bendroflumethiazide.

Possible side effects include postural hypotension, increased thirst, and frequent urination

 Hypokalaemia and hyponatraemia are common so electrolyte level must be monitored.

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Questions and Answers on Hypertension

What is Hypertension?

Hypertension is a sustained high blood pressure. It means if take your blood pressure on three or several occasions and it remains high, you might be having hypertension otherwise called High Blood Pressure.

You may have high blood pressure and may not have hypertension but if you keep on having high blood pressure repetitively, then you are likely hypertensive.

What is Blood Pressure BP?

Blood pressure (BP) is the pressure or force which the blood exerts on the blood vessels (‘the pipes that carries blood to and fro through the heart) as it flows through them.  An elementary Physics students will know that a liquid passing through a hollow pipe does exerts pressure on the inner surface of the pipe. Imagine the heart as a pumping machine. Any pumping machine will use a force or pressure to pump liquid. Blood pressure can also be defined as the force with which the heart pumps blood through the blood vessel. You have high blood pressure when the force of pumped blood is too high against the arteries.

How do I know if I have high Blood Pressure?

Visit a health professional and demand your blood pressure taken. He/she will use a blood pressure-taking instrument called sphygmomanometer to measure your BP.  You can take your BP by yourself if you have the instrument. Read about self blood pressure monitoring.

What is the normal BP value?

Blood pressure value exists as two readings known as systolic blood pressure SBP and diastolic blood pressure DBP. The blood pressure is written as SBP/DBP mmHg, e.g 97/72 mmHg simply read as “97 over 72”. The first number, called systolic blood pressure, measures the pressure in your blood vessels when your heart contracts or ‘beats’ to pump blood. The second number, called diastolic blood pressure, measures the pressure in your blood vessels when your heart relaxes between beats.

The normal value is 120/80mmHg or less but any BP from 140/90mmHg is too high and if the similar reading is obtained on three separate occasions, it will be deemed as hypertension.

If the systolic blood pressure (SBP) is less than or equal to 120mmHg and the diastolic blood pressure (DBP) is less than or equal to 80mmHg, it is still normal.

SBP greater than 140 and DBP greater than 90 is high.

SBP between 120-139 and DBP from 80-89 is prehypertensive stage; such person is at risk of hypertension.

Does blood pressure has to do with age?

Statistics shows that Systolic blood pressure (SBP) increases with age until the 80 or 90 years while diastolic blood pressure (DBP) rises only until middle age and then either remains steady or slightly decreases.

During those times when doctors had limited understanding about the risks of high blood pressure, people thought the value for pressure should be age plus 100.

How do I know if I have hypertension?

Hypertension or high blood pressure has no symptom and even individual may only be lucky to have symptoms such as headaches or stomach pain. This is why hypertension is often referred to as the ‘silent killer’ in that it may have no warning signs at all.

What will happen to me if I have hypertension?

Something will happen to you if you have HBP that is not controlled. We can sum what will happen to you into long-term and short-term complications. Uncontrolled HBP can will cause artery damage, brain damage, kidney damage, loss of vision, stroke, diabetes among others. It can cause sudden death by causing heart attack.

What is the real cause of hypertension?

Hypertension has no particular cause. Hypertension whose cause or origin is unknown is classed by doctors as primary or essential hypertension. However a pregnant woman with no history of hypertension, who then suddenly has hypertension during pregnancy may be said to have secondary hypertension. Secondary hypertension is the one that commences secondary to a particular condition or disease state. Also there are risk factors that have been known to contribute to or cause hypertension.

What are risk factors or lifestyles that can cause hypertension?

Certain factors some of which are modifiable and some non-modifiable increase the risk of developing hypertension.

Non-modifiable factors

 Age-risk of hypertension increases with age

Sex-overall, men are likely to have HBP than women

Family history

Modifiable factors

Alcohol drinking

Smoking

Excess salt intake

Obesity

Diabetes mellitus

Stress

Is hypertension preventable?

Yes, read the modifiable risk factors and try as much as possible to avoid them. Observe daily yoga. You can fix in physical exercise into your daily time-table.

Is hypertension curable?

There is no cure for hypertension. Cure in this context refers to a drug that will totally eliminate it in such a way that it won’t come back again. Once you become hypertensive, you have to manage it for the rest of your life. An individual may be hypertensive for fifty or more year without any crisis if it is managed and controlled properly over those years

How is hypertension managed?

Once you are diagnosed with hypertension, the first option of management should not be drugs but lifestyle modifications, that is, adjusting the modifiable risk factors such as reducing sodium intake and alcohol as well as creating time for exercise. It is after the HBP is not being controlled by these modifications that we start managing with drugs. Read more here on drug management of HTN.

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Self-monitoring of Blood Pressure SMBP

Individual can take their BP at home or office thanks to availability of automated BP monitors. Patients should be advised not to take their BP several time per week but rather two days per week to avoid paying much attention to their BP. Focusing much on one’s BP can also lead to anxiety that may raise the BP.

Most self monitoring devices are self activated, and misreporting of blood pressure readings is possible. Recently, the use of memory equipped devices has reduced such error, which can also be avoided by adopting telemedicine techniques, which lead to further improvement in controlling blood pressure. Although the technique is easy to learn, some patients may not be good candidates for self monitoring, which may result in anxiety or modification of treatment by the patient.

Step 1: Get a BP monitor

You can purchase a BP monitor from a nearby pharmacy or online pharmacy at an affordable cost. Always bear in mind that a higher price doesn't necessarily correlate to better quality. The digital BP monitor is the one suitable for home use because it requires less effort as the readings are displayed like whole numbers for you, everything is automated. The only thing you will have to learn will be how to fit the cuff round your arm. Your pharmacist or doctor will teach you this.

Step 2: visit a pharmacist or doctor with the BP monitor you purchase

Your healthcare provider will help you to justify your newly purchased device. A pharmacist or doctor will educate you on how to use the BP monitor to read your BP. He/she will probably use manual BP gauge with sphygmomanometer as a control to ensure your BP monitor is taking your correct approximate BP value. You can do that often for a re-evaluation.

Step 3: Take your blood pressure

Before you take your BP, avoid caffeine, alcohol, tobacco, and exercise for at least 30 minutes before measuring your blood pressure.

• Sit with your feet flat on the floor, rest your back against the chair, and place your arm on a table. Your arm and the BP monitor should be on the same level as your heart.
• After sitting quietly for five minutes, wrap the cuff fittingly around the upper part of your bare arm. The center of the cuff should sit over your artery (some blood pressure monitors have an arrow to help you with placement).
• An automatic monitor will inflate by itself when you press a button.
• Check the top and bottom readings on display window. The top number is your systolic pressure—the blood pressure when your heart beats. The bottom number is your diastolic pressure—the pressure in between heartbeats. Write down your blood pressure number each time you measure it so you can track it over time.

Step 4: interpret and utilize your BP reading

Based on the BP monitor reading, you can interpret the results according JNC 7 or 8 guidelines on hypertension.

According to JNC 7, patients with sustained hypertension are further divided into

Stage 1 hypertension (systolic BP 140-159 or diastolic BP 90-99 mmHg)

Stage 2 hypertension (systolic BP ≥160 or diastolic BP ≥100 mmHg) or severe HTN, and those with compelling indications that include diabetes, cardiovascular disease, and renal disease.

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Drug Abuse

Drug abuse is simply means illicit use of drug and/or drug substances. Drug abuse is often used in place of drug misuse. The two terms are different but related.

Drugs are beneficial and save lives when rightly  used. The term drug as applied to drug abuse means dangerous drugs.

Some drugs though may have beneficial effects, have been known to have serious harmful effects when used wrongly, and Governments are really concerned about the harmful effects of such drugs that they enact laws to regulate their consumption. Such drugs are called controlled drugs or dangerous drugs. In Nigeria and in US, there is a section of the law called the Dangerous Drugs Act.

Such laws state who can handle or give those drugs and the procedure or protocol for being a custodian of those drugs. In a nutshell, these drugs are being regulated by laws, handling such drugs with negligence or without regard to laws regulating them is termed drug abuse.

For instance, 'drink-driving' which causes drowsiness and hallucination, is an offence in various countries because it can lead fatal RTA.

Most drugs are banned from use in the general public except in medical use because they are habit-forming. It is drug abuse when any individual is found with any of the banned drugs. So to people who abuse drugs, it is to detriment of their health.

Before goverment can ban a drug, it means they do so to save the lives of citizens because they have weighed the risks of such drug and found it to have adverse effects either acute or long-term adverse effects in the future.

Some drugs are banned because they have the following attributes:

• Physical dependence- a tendency to continue taking a drug because stopping it will cause a reduction in your output or causes weakness in the mind and body. So such individual depends on the drug to carry on their daily life.
• Addiction- addiction simply means inability to stop doing something even if it is harmful. Such individual is liable to suffer from stopping it. One can be addicted to anything, for instance, you may be addicted to sex, gambling or gaming. Various addictions are far from good or normal, because you may become sick if you don't do them. According to  MediLexicon's Medical Dictionary , Addiction is Habitual psychological or physiologic dependence on a substance or practice that is beyond voluntary control . Addiction has to do with physiological brain changes. Stopping a drug to which you are addicted will lead to some symptoms called withdrawal symptoms.
• Tolerance-this is noticeable reduction in response to a drug upon repeated uses. Addiction to a drug result in tolerance such small dose or the usual effective dose is no longer working for the person. So there is always attempt to increase the dose to achieve the desired effects
• Habit-forming- some drugs have a tendency of causing addiction while some don't.

Below is a list of some substances that are often abused by people:

1. Cocaine-cocaine is a substance or hard drug obtained from the South-American plants Erythroxylum coca L. Cocaine or the plant is usually abused because of its stimulant effect giving a sense of euphoria. It highly habit-forming. Some students take it to increase their assimilation and reading time but when the effect of the drug wears off, there is gradual loss of concentration such that they need to take perpetually to improve concentration. It therefore means there will surely be cognitive decline over time. It is actually true based on experience, that cocaine abusers will definitely suffer cognitive impairment and mental disorder as time rolls by.
2. Morphine-morphine is a habit-forming drug obtained from opium poppy(Papaver somniferum). It is a strong analgesic which belong to the class called opioid or narcotic drug. It is reserved for medical purposes only. It causes great euphoria.
3. Codeine-belongs to same class as morphine. It is used for pain as well as antitussive ingredients. Most people looking to buy cough expectorant with codeine always do that because of the codeine in it.
4. Alcohol-alcohol in various concentration is nearly the most abused substance world-wide.

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Effects of Drug Abuse

Most drug addicts take drugs by smoking, sniffing, injection via skin or veins and the common effects are site-related. For instance, the adverse effects below are common in people taking injection.

• keloids or puncture marks.
• edema.
• Cellulitis.
• Abscesses.
• Tuberculosis.
• Endocarditis
• HIV or hepatitis virus contraction.
• 
  
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•  

About Keloids-The monstrous scars

 Keloids are fibrous lesions that form at a site of injury due to irregular production of type III and type I collagen. There is a difference between a keloid and a hypertrophic scar. Hypertrophic scars are confined to the extent of the wound or injury and may subside over a period of time. On the other hand, keloids may extend beyond the margin of the wound and may grow into neighbouring areas too.Unlike hypertrophic scars, keloids continue to grow outside of the original wound margins, fail to resolve over time, may itch and become painful. Keloids are generally associated with piercing on any part of the body.Although documented in all races, keloids are more prevalent in people of certain color (African American, Asian, Latinos) with a positive correlation to skin pigmentation. Most keloids appear in those with darker skin types while there are no reported incidents in Albinos. Keloids often mature into unsightly lesions affecting self-esteem and quality of life. Depending on the location and size of the keloid, range of motion may be impaired.

 Physical appearance of keloids

keloid scar on the ear

keloids may occur from head injury or razor bumps

 keloids develop most often on the chest, back, shoulders, and earlobes.Keloid typically starts to form within three months after the original skin damage although it can take up to a year Sometimes, a keloid can itch and even pain at touch causing a lot of discomfort. That is when you will need to seek a solution to remove the keloid and be at ease They are usually smooth, slightly shiny, firm skin growths. They can feel itch, and painful at touch. Once they have fully developed the pain usually disappears. 

 How Keloids form 

 In the formation of keloid, the first thing you will probably notice is that rubbery scar tissue starts growing beyond the borders of the original damage. It may become tender, itchy, and painful or produce a burning sensation. Sometimes keloid develops without any apparent skin injury, although most people can identify a cause. The common areas are the breastbone (sternum), shoulder, earlobe and cheek. Keloid growing over a joint can restrict movement. over time, the original red colour gradually changes to brown or becomes pale. Growth continues for a few weeks to a few months. The growth is usually slow but occasionally there is rapid enlargement over a few months. Once they stop growing most keloid scars remain the same size or shrink. Keloid scars are an overgrowth of skin after a cut or injury. Keloid scarring is an abnormal skin healing process , it bypasses normal replacement of worn out cell while the skin heals excessively. There may be a time lag of a month between the injury and the start of formation of keloid scar. Keloid scarring starts as a localised spot and forms progessively over months. Keloids can form in the following areas: Behind the ears after ear piercing. On the breastbone after chickenpox, acne, or an injury. On the side of the shoulder for example after a vaccine shots on deltoid. They can also occur after surgery, done by doctors - for example, after ear reduction surgery (where there is a scar behind the ears) or for removal of a suspicious skin growth. Anywhere on the body following injuries. 

 Causes of keloids 

There is limited knowledge regarding the causes of keloid scars. Science is still yet to be able to explain why some people go on to develop keloid scars after their skin is damaged, and others don't. However we do understand that keloid scars form because the normal process of scarring, that form normal healing process for everyone but goes overtly excessive: Normally when the skin is damaged, new skin comes up to replace the damaged ones which gradually wear out (this process is called 'involution'). In a keloid scar too much collagen is laid down in the skin after the damage has happened instead of the worn-out tissues scarring off and fading away, the scar tissue just stays where it is. Keloid scars are inexplicably common in people who have black skin and who originate from Africa or the Caribbean but probably due to higher melanin of their skin. It also happens to human being only;other animals do not get keloid scars. A skin tumour like a dermatofibroma or a soft tissue sarcoma can ocassionaly but rarely be mistaken for a keloid scar, or vice versa. 

 Preventing Keloid Formation 

For people with high risk of having keloids, it is beneficial they avoid piercings, tattoos and any unnecessary surgical procedures such as cosmetic surgery, especially in those areas of the body where keloid is prone to develop.If possible, such people should avoid surgery unless the benefits outweigh the risk. If you get acne, you should make sure it is treated effectively at an early stage so the spots do not scar. If you are identified as being at risk of keloid and need an operation, your surgeon may offer you dressings, steroid injections or other treatments to reduce the risk of keloid developing. 

Treatment Options for Keloids 

 Many patients often ask for their keloid scar to be 'cut out' or surgically removed. This is hardly ever successful and in fact can result in an even bigger keloid scar coming back. Keloids must never be cut out by a GP or by anyone who isn't medically qualified. They should only be treated by a specialist doctor such as a dermatologist or a plastic surgeon. Determining the most effective treatment for keloids has been challenging because how well a keloid scar responds to treatment can be unpredictable; many treatments are a matter of trial and error. There are several ways of treating keloid scars, without surgery:

 1. One of the most common methods is injecting steroids and local anaesthetic agent into the keloid scar itself. The injections are done with a tiny needle, but can be a bit sore. This method of drug administration is referred to as intralesional injection. The steroids and anaesthetic can help to stop the proliferation of the skin cells in the keloid scar. One such drug is Triamcinolone (Kenalog). Kenalog cream can applied externally to the keloid scar two times per day while the injection is administered intralesionally. Sometimes putting steroid ointment on, under a dressing, can dampen down a keloid scar. A tape that is impregnated with steroids is prescribed by dermatologists. They are helpful in children, who may not be able to tolerate steroid injections. 

Treatment Duration: Approximately one injection is given once a month, for 4-6 months. One of the side-effects of too many steroids in the skin can be that the skin gets thin and easily damaged. 

Some keloid scars are steroid resistant such that instead the steroid only causes serious side effects 

 2. silicone Treatment: Silicone is put on to the skin either as a gel or a flexible sheet. The efficacy of silicone in keloid treatment cannot be guaranteed but it has been claimed that it can reduce the thickness of the keloid scar and also makes the colour fade. The silicone gel is almost invisible once it's dry and is easy to apply. However, it can take a while to dry fully and you can't put any clothes on top until it's completely dry. 

 3. Laser therapy has been shown to be effective for keloid scars. These are specialised treatments used by specially trained dermatologists. You should not use a cosmetic skin clinic that does not have properly qualified doctors. 

 4. Superficial radiotherapy (SRT) treatment is another variant of options that is a making major advances in the treatment of keloids.It requires the work of a specialist. SRT treatment method targets those cells that overproduce scar tissue and result in the raised and expanded keloid scars that cause so much discomfort. The SRT–100 is an exciting new development and delivers superficial photon beam therapy to the healing scar. This controls the overproduction of collagen that leads to hypertrophic scarring. This is a superficial targeted treatment that does not penetrate beyond the fibroblasts responsible for wound healing. After excision the patient is given three consecutive doses of SRT over three days and the wound heals normally. 

 Below are some natural remedies to reduce keloid scars: 

 1. Lemon Juice – Extract the juice from a fresh lemon and apply it on the affected skin area. Leave it on the skin for about half an hour, and then wash the area with lukewarm water. Repeat the process at least once daily. 

 2. Baking Soda – Mix one part baking soda with three parts hydrogen peroxide to make a smooth paste. Apply the paste directly on the keloid scar to reduce inflammation and speed up the healing process. Do this three or four times a day depending upon the severity of the scar. 

 3. Aspirin – Crush three or four aspirin tablets and add a small amount of water to make a smooth, thick paste. Apply the paste on the scar, allow it to dry completely and then rinse it off by rubbing the area gently under water.Allow to dry and then apply some olive oil or tea tree oil. Repeat daily until the keloid is gone.

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