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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
Dryness is a medical condition in which there is local or more generalized decrease in normal lubrication of the skin or mucous membranes.
Examples of local dryness include dry mouth, dry eyes, dry skin and vaginal dryness. These often have specific causes and treatments. It is possible to have dry eyes without any other signs or symptoms, but this usually causes a syndrome of eye symptoms called keratoconjunctivitis sicca.
More generalized dryness can be caused by e.g. dehydration (that is, more general loss of body fluids), anticholinergic drugs and Sjögren syndrome.
A study conducted in November of 2017, conveyed a correlation between blepharitis and early onset metabolic syndrome (MetS). To investigate the relationship between blepharitis and MetS, researchers used the Longitudinal Health Insurance Database in Taiwan. Results indicated that hyperlipidaemia and coronary artery disease were significantly correlated with the prior development of blepharitis. Therefore, blepharitis was shown to be significantly related to MetS and can serve as an early indication of the condition.
In another recent study, the presence of Demodex has been unveiled as a common cause of blepharitis. However, the pathogenesis of demodicosis is still unclear. In this study, researchers provide a diagnosis of the disease and propose diagnostic criteria of Demodex blepharitis.
The mechanism by which the bacteria causes symptoms of blepharitis is not fully understood and may include direct irritation of bacterial toxins and/or enhanced cell-mediated immunity to S. aureus.
Staphylococcal blepharitis is caused by an infection of the anterior portion of the eyelid by Staphylococcal bacteria. In a study of ocular flora, 46% to 51% of those diagnosed with staphylococcal blepharitis had cultures positive for Staphylococcus aureus in comparison to 8% of normal patients. Staphylococcal blepharitis may start in childhood and continue into adulthood. It is commonly recurrent and it requires special medical care. The prevalence of Staphylococcus aureus in the conjunctival sac and on the lid margin varies among countries, likely due to differences in climate and environment. Seborrheic blepharitis is characterized by less inflammation than Staphylococcal blepharitis; however, it causes more excess oil or greasy scaling. Meibomian Gland Dysfunction is a result of abnormalities of the meibomian glands and altered secretion meibum, which plays an imperative role in lagging the evaporation of tear films and smoothing of the tear film to produce an even optical surface. Posterior blepharitis is an inflammation of the eyelids, secondary to dysfunction of the meibomian glands. Like anterior blepharitis, it is a bilateral chronic condition and may be associated with skin rosacea. There is growing evidence that, in some cases, it is caused by Demodex mites.
Aside from physiologic causes of xerostomia, iatrogenic effects of medications are the most common cause. A medication which is known to cause xerostomia may be termed "xerogenic". Over 500 medications produce xerostomia as a side effect (see table). Sixty-three percent of the top 200 most commonly prescribed drugs in the United States are xerogenic. The likelihood of xerostomia increases in relation to the total number of medications taken, whether the individual medications are xerogenic or not. The sensation of dryness usually starts shortly after starting the offending medication or after increasing the dose. Anticholinergic, sympathomimetic, or diuretic drugs are usually responsible.
Keratoconjunctivitis is inflammation ("-itis") of the cornea and conjunctiva.
When only the cornea is inflamed, it is called "keratitis"; when only the conjunctiva is inflamed, it is called "conjunctivitis".
There are several potential causes of the inflammation:
- Keratoconjunctivitis sicca is used when the inflammation is due to dryness. ("Sicca" means "dryness" in medical contexts.) It occurs with 20% of rheumatoid arthritis patients.
- The term "Vernal keratoconjunctivitis" (VKC) is used to refer to keratoconjunctivitis occurring in spring, and is usually considered to be due to allergens.
- "Atopic keratoconjunctivitis" is one manifestation of atopy.
- "Epidemic keratoconjunctivitis" is caused by an adenovirus infection.
- "Infectious bovine keratoconjunctivitis" (IBK) is a disease affecting cattle caused by the bacteria "Moraxella bovis".
- "Pink eye in sheep and goat" is another infectious keratoconjunctivitis of veterinary concern, mostly caused by "Chlamydophila pecorum"
- "Superior limbic keratoconjunctivitis" is thought to be caused by mechanical trauma.
- "Keratoconjunctivitis photoelectrica" (arc eye) means inflammation caused by photoelectric UV light. It is a type of ultraviolet keratitis. Such UV exposure can be caused by arc welding without wearing protective eye glass, or by high altitude exposure from sunlight reflected from snow ("snow blindness"). The inflammation will only appear after about 6 to 12 hours. It can be treated by rest, as the inflammation usually heals after 24–48 hours. Proper eye protection should be worn to prevent keratoconjunctivitis photoelectrica.
Xerostomia may be caused by autoimmune damage to the salivary glands. Sjögren's syndrome is one such disease, and it causes other symptoms, including xerophthalmia (dry eyes), dry vagina, fatigue, myalgia (muscle pain), and arthralgia (joint pain). Females are more likely to suffer from autoimmune disease, and 90% of people with Sjögren's syndrome are women. Primary Sjögren's syndrome is the combination of dry eyes and xerostomia. Secondary Sjögren's syndrome is identical to primary form but with the addition of a combination of other connective tissue disorders such as systemic lupus erythematosus or rheumatoid arthritis.
One of the most common areas of the body associated with irritation is the vagina. Many women complain of an itch, dryness, or discharge in the perineum at some point in their lives. There are several causes of vaginal irritation including fungal vaginitis (like candida) or trichomoniasis. Often, herpes simplex infection of the mouth or genitalia can be recurrent and prove to be extremely irritating.
Sometimes, the irritation can be of the chronic type and it can be so intense that it also causes painful intercourse. Aside from infections, chronic irritation of the vagina may be related to the use of contraceptives and condoms made from latex. The majority of contraceptives are made of synthetic chemicals which can induce allergies, rash and itching. Sometimes the lubricant used for intercourse may cause irritation.
Another cause of irritation in women is post menopausal vaginitis. The decline in the female sex hormones leads to development of dryness and itching in the vagina. This is often accompanied by painful sexual intercourse. Cracks and tears often develop on outer aspects of the labia which becomes red from chronic scratching. Post menopausal vaginitis can be treated with short term use of vaginal estrogen pessary and use of a moisturizer.
Phlyctenular keratoconjunctivitis, also known as phlyctenulosis, is an inflammatory syndrome caused by a delayed (aka type-IV) hypersensitivity reaction to one or more antigens. The triggering antigen is usually a bacterial protein (particularly from "Staphylococcus aureus"), but may also be a virus, fungus (particularly "Candida albicans"), or nematode.
The symptoms of phlyctenular keratoconjunctivitis are primarily treated with application of an appropriate corticosteroid eye drop, such as prednisolone acetate (Pred Forte) or loteprednol (Lotemax). Loteprednol is increasingly preferred due to its lower risk of elevating intraocular pressure. The corticosteroid suppresses the immune response, reducing inflammation and improving most symptoms.
The causative agent (i.e. the source of the antigen that triggered the hypersensitive immune response) should also be identified. "Staphylococcus aureus" is usually the primary suspect, along with "Mycobacterium tuberculosis" in areas where TB is endemic, followed by "Chlamydia trachomatis". Active bacterial infections may be treated with a topical antibiotic or a combination antibiotic-steroid eye drop, such as tobramycin/dexamethasone (Tobradex). An oral tetracycline antibiotic (such as doxycycline) may be used in systemic or particularly severe/intractable infections. Erythromycin may be an effective alternative, especially in pediatric cases where the side effects of tetracyclines are unacceptable.
Artificial tears can reduce dryness and discomfort from corneal lesions. Photophobic discomfort can be mitigated with dark sunglasses.
Individuals who smoke or are exposed to smog or other airborne pollutants can develop a condition known as COPD. In this disorder, there is constant irritation of the breathing tubes (trachea) and the small airways. The constant irritation results in excess production of mucus which makes breathing difficult. Frequently, these individuals wake up in the morning with copious amounts of foul smelling mucus and a cough which lasts all day. Wheeze and heavy phlegm are common findings. COPD is a lifelong disorder and there is no cure. Eventually most people develop recurrent pneumonia, lack any type of endurance, and are unable to work productively. One of the ways to avoid chronic bronchitis is to stop or not smoke.
Normally, exfoliation is restricted to a particular area and normal skin will replace the exfoliated parts, so no treatment is needed. Since keratolysis exfoliativa is caused by friction, detergents, and solvents, these factors should be avoided. Creams, especially those with silicone and lactic acid are also helpful. In severe cases, photochemotherapy is an option.
Keratolysis exfoliativa normally appears during warm weather. Due to excessive sweating and friction, in for example athletic shoes, the skin can start to exfoliate. Other factors that can cause exfoliation are detergents and solvents.
Another very common cause has been reported from salt water fishermen, who often suffer from these symptoms. It is not sure whether it is from the salt water or whether it is from some bacteria from fish.
Repeated licking resulting in a cycle of wetting and drying causes the redness, fissuring and scale. IIt can also occur with lip chewing, thumb sucking or excessive drooling.
Wind instrument players may also experience lip licker's dermatitis.
Compulsive licking of lips causing lick lip dermatitis is also seen as psychological disorder.
Persistent and continuous breathing from the mouth can cause dry lips and result in temptation to repeated lick lips.
Conjunctivitis may also be caused by allergens such as pollen, perfumes, cosmetics, smoke, dust mites, Balsam of Peru, and eye drops.
Lip lickers dermatitis, popularly known as perioral dermatitis, is an Irritant contact dermatitis on and around the lips due to saliva from repetitive lip licking. Involving children more than adults, the resulting papules, scaling, erythema and occasional fissures and crusting make a well-defined ring around the lips. The rash extends as far as the tongue can reach and frequently spares the angle of the mouth. Unlike periorificial dermatitis, the vermillion border of the lip is often involved and the treatment is simple moisturisers.
Conjunctivitis, when caused by an infection, is most commonly caused by a viral infection. Bacterial infections, allergies, other irritants, and dryness are also common causes. Both bacterial and viral infections are contagious and passed from person to person, but can also spread through contaminated objects or water.
This is a rare inflammatory condition of the minor salivary glands, usually in the lower lip, which appears swollen and everted. There may also be ulceration, crusting, abscesses, and sinus tracts. It is an acquired disorder, but the cause is uncertain. Suspected causes include sunlight, tobacco, syphilis, poor oral hygiene and genetic factors. The openings of the minor salivary gland ducts become inflamed and dilated, and there may be mucopurulent discharge from the ducts. A previous classification suggested dividing cheilitis into 3 types based on severity, with the later stages involving secondary infection with bacteria, and increased ulceration, suppuration and swelling: Type 1, Simple; Type 2, Superficial suppurative ("Baelz's disease"); and Type 3, Deep suppurative ("cheilitis glandularis epostemetosa"). Cheilitis glandularis usually occurs in middle-aged and elderly males, and it carries a risk of malignant transformation to squamous cell carcinoma (18% to 35%). Preventative treatment such as vermilionectomy ("lip shave") is therefore the treatment of choice.
Keratoconjunctivitis sicca is relatively common within the United States, especially so in older patients. Specifically, the persons most likely to be affected by dry eyes are those aged 40 or older. 10-20% of adults experience Keratoconjunctivitis sicca. Approximately 1 to 4 million adults (age 65-84) in the USA are effected.
While persons with autoimmune diseases have a high likelihood of having dry eyes, most persons with dry eyes do not have an autoimmune disease. Instances of Sjögren syndrome and keratoconjunctivitis sicca associated with it are present much more commonly in women, with a ratio of 9:1. In addition, milder forms of keratoconjunctivitis sicca also are more common in women. This is partly because hormonal changes, such as those that occur in pregnancy, menstruation, and menopause, can decrease tear production.
In areas of the world where malnutrition is common, vitamin A deficiency is a common cause. This is rare in the United States.
Racial predilections do not exist for this disease.
There is no good evidence that a mother's diet during pregnancy, the formula used, or breastfeeding changes the risk. There is tentative evidence that probiotics in infancy may reduce rates but it is insufficient to recommend its use.
People with eczema should not get the smallpox vaccination due to risk of developing eczema vaccinatum, a potentially severe and sometimes fatal complication.
Xerophthalmia usually affects children under nine years old and "accounts for 20,000-100,000 new cases of childhood blindness each year in the developing countries." The disease is largely found in developing countries like many of those in Africa and Southern Asia. The condition is not congenital and develops over the course of a few months as the lacrimal glands fail to produce tears. Other conditions involved in the progression already stated include the appearance of Bitot's spots, which are clumps of keratin debris that build up inside the conjunctiva and night blindness, which precedes corneal ulceration and total blindness.
Also termed "lip dermatitis", eczematous cheilitis is a diverse group of disorders which often have an unknown cause. Chronic eczematous reactions account for the majority of chronic cheilitis cases.
It is divided into endogenous (due to an inherent characteristic of the individual), and exogenous (where it is caused by an external agent). The main cause of endogenous eczematous cheilitis is atopic cheilitis (atopic dermatitis), and the main causes of exogenous eczematous cheilitis is irritant contact cheilitis ("e.g.", caused by a lip-licking habit) and allergic contact cheilitis. The latter is characterized by a dryness, fissuring, edema, and crusting. It affects females more commonly than males, in a ratio of about 9:1.
The most common causes of allergic contact cheilitis is lip cosmetics, including lipsticks and lip balm, followed by toothpastes. A lipstick allergy can be difficult to diagnose in some cases as it is possible that cheilitis can develop without the person even wearing lipstick. Instead, small exposure such as kissing someone who is wearing lipstick is enough to cause the condition.
Allergy to Balsam of Peru can manifest as cheilitis. Allergies to metal, wood, or other components can cause cheilitis reactions in musicians, especially players of woodwind and brass instruments, "e.g.", the so-called "clarinetist's cheilitis", or "flutist's cheilitis". "Pigmented contact cheilitis" is one type of allergic cheilitis in which a brown-black discoloration of the lips develops. Patch testing is used to identify the substance triggering allergic contact cheilitis.
Keratoconjunctivitis sicca is uncommon in cats. Most cases seem to be caused by chronic conjunctivitis, especially secondary to feline herpesvirus. Diagnosis, symptoms, and treatment are similar to those for dogs.
Risk factors for the development of acne, other than genetics, have not been conclusively identified. Possible secondary contributors include hormones, infections, diet and stress. Studies investigating the impact of smoking on the incidence and severity of acne have been inconclusive. Sunlight and cleanliness are not associated with acne.
In a survey in New York city 35% of nursing mothers stopped breastfeeding after one week due to the pain of cracked nipples. Thirty percent stopped breastfeeding between weeks one and three. Another survey of breastfeeding mothers in Brazil reported that there was 25% higher risk of interruption of exclusive breastfeeding when the women had cracked nipples. Mothers with higher education levels are more likely to continue breastfeeding despite the pain of cracked nipples.
The overall prevalence of PR in the United States has been estimated to be 0.13% in men and 0.14% in women. It most commonly occurs between the ages of 10 and 35. It is more common in spring.
PR is not viewed as contagious, though there have been reports of small epidemics in fraternity houses and military bases, schools and gyms.