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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)
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Razor burn is a less serious condition caused by shaving, characterized by mild to moderate redness and irritation on the surface of the skin. Unlike PFB, it is usually transient and there is no infection involved.
There is also a condition called "folliculitis barbae". The difference between the two is the cause of the inflammation in the hair follicles. Folliculitis barbae is caused by viral or bacterial infections, where pseudofolliculitis is caused by irritation from shaving and ingrown hairs.
A related condition, pseudofolliculitis nuchae, occurs on the back of the neck, often along the posterior hairline, when curved hairs are cut short and allowed to grow back into the skin. Left untreated, this can develop into acne keloidalis nuchae, a condition where hard, dark keloid-like bumps form on the neck. Both occur frequently in black men in the military, where it is so common that services often have widely known protocols for management
Worldwide, KP affects an estimated 30-50% of the adult population and approximately 50-80% of all adolescents. It is more common in women than in men, and is often present in otherwise healthy individuals. The skin condition is prevalent in persons of all ethnicities. No particular ethnicity is at higher risk for developing keratosis pilaris. Although keratosis pilaris may manifest in persons of any age, it usually appears within the first decade of life and is more common in young children. In most cases, the condition gradually improves before age 30, however it can persist longer.
The best form of prevention is to determine whether shaving or waxing irritates the skin and hair worse.When shaving, there are a few precautions that can be taken to prevent ingrown hairs including proper shaving techniques and preparation of the skin before shaving. When shaving, applying the proper amount of lubrication (in the form of shaving cream, gel, or soap) is important to prevent the hair from being forced underneath the surface of the skin. Also the application of too much force with a razor can contribute to hair that is cut shorter than the surrounding dermis. Using a beard trimmer at the lowest setting (1 mm or 0.5 mm) instead of shaving is an effective alternative.
Alternatively, ingrown hair can be prevented by removing the hair permanently, e.g. by laser hair removal or hair removal through electrolysis.
The most effective prevention is to grow a beard. For men who are required to; or simply prefer to shave, studies show the optimal length to be about 0.5 mm to 1 mm to prevent their hair growing back into the skin. Using a beard trimmer at the lowest setting (0.5mm or 1mm) instead of shaving is an effective alternative. The resulting faint stubble can be shaped using a standard electric razor on non-problematic areas (cheeks, lower neck).
For most cases, completely avoiding shaving for three to four weeks allows all lesions to subside, and most extrafollicular hairs will resolve themselves in about ten days.
Permanent removal of the hair follicle is the only definitive treatment for PFB. Electrolysis is effective but limited by its slow pace, pain and expense. Laser-assisted hair removal is effective. There is a risk of skin discoloration and a very small risk of scarring.
Exfoliation with various tools such as brushes and loofahs also helps prevent bumps.
Some men use electric razors to control PFB. Those who use a razor, should use a single blade or special wire-wrapped blade to avoid shaving too closely, with a new blade each shave. Shaving in the direction of hair growth every other day, rather than daily, may improve pseudofolliculitis barbae. If one must use a blade, softening the beard first with a hot, wet washcloth for five minutes or shave while showering in hot water can be helpful. Some use shaving powders (a kind of chemical depilatory) to avoid the irritation of using a blade. Barium sulfide-based depilatories are most effective, but produce an unpleasant smell.
The bacteria staphylococci are present in the majority of cases. Treatment with systemic antibiotics and coal tar shampoo can completely clear the condition when Staphylococcus aureus bacteria are found. Fungal infections such as tinea capitis are known to mimic the symptoms of the condition and can be cleared with antifungal treatment.
Ingrown hair is a condition where hair curls back or grows sideways into the skin. The condition is most prevalent among people who have coarse or curly hair. It may or may not be accompanied by an infection of the hair follicle (folliculitis) or "razor bumps" (pseudofolliculitis barbae), which vary in size. While ingrown hair most commonly appears in areas where the skin is shaved or waxed (beard, legs, pubic region), it can appear anywhere. Anything which causes the hair to be broken off unevenly with a sharp tip can cause ingrown hairs. Ingrown hairs are also caused because of lack of natural exfoliation in the skin.
Research is looking into connections between hair loss and other health issues. While there has been speculation about a connection between early-onset male pattern hair loss and heart disease, a review of articles from 1954 to 1999 found no conclusive connection between baldness and coronary artery disease. The dermatologists who conducted the review suggested further study was needed.
Environmental factors are under review. A 2007 study indicated that smoking may be a factor associated with age-related hair loss among Asian men. The study controlled for age and family history, and found statistically significant positive associations between moderate or severe male pattern hairloss and smoking status.
Vertex baldness is associated with an increased risk of coronary heart disease (CHD) and the relationship depends upon the severity of baldness, while frontal baldness is not. Thus, vertex baldness might be a marker of CHD and is more closely associated with atherosclerosis than frontal baldness.
Tinea capitis caused by species of "Microsporum" and "Trichophyton" is a contagious disease that is endemic in many countries. Affecting primarily pre-pubertal children between 6 and 10 years, it is more common in males than females; rarely does the disease persist past age sixteen. Because spread is thought to occur through direct contact with afflicted individuals, large outbreaks have been known to occur in schools and other places where children are in close quarters; however, indirect spread through contamination with infected objects ("fomites") may also be a factor in the spread of infection. In the USA, tinea capitis is thought to occur in 3-8% of the pediatric population; up to one-third of households with contact with an infected person may harbor the disease without showing any symptoms.
The fungal species responsible for causing tinea capitis vary according to the geographical region, and may also change over time. For example, "Microsporum audouinii" was the predominant etiological agent in North America and Europe until the 1950s, but now "Trichophyton tonsurans" is more common in the USA, and becoming more common in Europe and the United Kingdom. This shift is thought to be due to the widespread use of griseofulvin, which is more effective against "M. audounii" than "T. tonsurans"; also, changes in immigration patterns and increases in international travel have likely spread "T. tonsurans" to new areas. Another fungal species that has increased in prevalence is "Trichophyton violaceum", especially in urban populations of the United Kingdom and Europe.
Keratosis pilaris occurs when the human body produces excess amounts of the skin protein keratin, resulting in the formation of small, raised bumps in the skin often with surrounding redness. The excess keratin, which is the color of the person's natural skin tone, surrounds and entraps the hair follicles in the pore. This causes the formation of hard plugs (process known as hyperkeratinization). Many KP bumps contain an ingrown hair that has coiled. This is a result of the keratinized skin's "capping off" the hair follicle, preventing the hair from exiting. The hair grows encapsulated inside the follicle. KP is more common in patients affected by atopic diseases such as allergic rhinitis and atopic dermatitis.
The condition affects 0.1%–0.2% of the population, and occurs equally in both males and females. Alopecia areata occurs in people who are otherwise healthy and have no other skin disorders. Initial presentation most commonly occurs in the late teenage years, early childhood, or young adulthood, but can happen at any ages. Patients also tend to have a slightly higher incidence of conditions related to the immune system, such as asthma, allergies, atopic dermatitis, and hypothyroidism.
Other causes of hair loss include:
- Alopecia mucinosa
- Biotinidase deficiency
- Chronic inflammation
- Diabetes
- Lupus erythematosus
- Pseudopelade of Brocq
- Telogen effluvium
- Tufted folliculitis
Pityriasis amiantacea (also known as "Tinea amiantacea") is an eczematous condition of the scalp in which thick tenaciously adherent scale infiltrates and surrounds the base of a group of scalp hairs. It does not result in scarring or alopecia.
Pityriasis amiantacea was first described by Alibert in 1832. Pityriasis amiantacea affects the scalp as shiny asbestos-like (amiantaceus) thick scales attached in layers to the hair shaft. The scales surround and bind down tufts of hair. The condition can be localised or covering over the entire scalp. Temporary alopecia and scarring alopecia may occur due to repeated removal of hairs attached to the scale. It is a rare disease with a female predilection.
Pityriasis amiantacea can easily be misdiagnosed due its close resemblance to other scalp diseases such as psoriasis, seborrhoeic dermatitis or lichen planus. However in pityriasis amiantacea the scales are attached to both the hair shaft and the scalp. Pityriasis amiantacea may be present with other inflammatory conditions such as atopic dermatitis or seborrhoeic dermatitis and sebaceous scales and alopecia can occur. According to the dermatology text Bolognia this condition is most often seen in psoriasis, but may also be seen in secondarily infected atopic dermatitis, seborrheic dermatitis, and tinea capitis.
The cause of the various cicatricial alopecias is poorly understood. However, all cicatricial alopecias involve inflammation directed at the upper part of the hair follicle where the stem cells and sebaceous gland (oil gland) are located. If the stem cells and sebaceous gland are destroyed, there is then no possibility for regeneration of the hair follicle, and permanent hair loss results.
Cicatricial alopecias are not contagious. In general, cicatricial alopecias are not associated with other illnesses, and usually occur in otherwise healthy men and women.
Cicatricial alopecias affect both men and women, most commonly adults, although all ages may be affected. Epidemiologic studies have not been performed to determine the incidence of cicatricial alopecias. In general, they are not common.
The majority of patients with cicatricial alopecia have no family history of a similar condition. The one exception is Central centrifugal cicatricial alopecia, which primarily affects women of African ancestry and may occur in several women in the same family. While it is possible to have more than one type of hair loss condition, non-scarring forms of hair loss do not turn into scarring forms of hair loss.
Certain hair shampoos and ointments visually thicken existing hair, without affecting the growth cycle. There have also been developments in the fashion industry with wig design. The fashion accessory has also been shown to be a source of psychological support for women undergoing chemotherapy, with cancer survivors in one study describing their wig as a "constant companion". Other studies in women have demonstrated a more mixed psychosocial impact of hairpiece use.
Specialized scalp tattoos can mimic the appearance of a short buzzed haircut.
Advice often given includes:
- Avoid sharing clothing, sports equipment, towels, or sheets.
- Wash clothes in hot water with fungicidal soap after suspected exposure to ringworm.
- Avoid walking barefoot; instead wear appropriate protective shoes in locker rooms and sandals at the beach.
- Avoid touching pets with bald spots, as they are often carriers of the fungus.
In most cases which begin with a small number of patches of hair loss, hair grows back after a few months to a year. In cases with a greater number of patches, hair can either grow back or progress to alopecia areata totalis or, in rare cases, alopecia areata universalis.
There is no loss of body function, and effects of alopecial areata are mainly psychological (loss of self-image due to hair loss), although these can be severe. Loss of hair also means the scalp burns more easily in the sun. Patients may also have aberrant nail formation because keratin forms both hair and nails.
Hair may grow back and then fall out again later. This may not indicate a recurrence of the condition, but rather a natural cycle of growth-and-shedding from a relatively synchronised start; such a pattern will fade over time. Episodes of alopecia areata before puberty predispose to chronic recurrence of the condition.
Alopecia can be the cause of psychological stress. Because hair loss can lead to significant changes in appearance, individuals with it may experience social phobia, anxiety, and depression.
It may appear as thickened, scaly, and sometimes boggy swellings, or as expanding raised red rings (ringworm). Common symptoms are severe itching of the scalp, dandruff, and bald patches where the fungus has rooted itself in the skin. It often presents identically to dandruff or seborrheic dermatitis. The highest incidence in the United States of America is in American boys of school age.
There are three type of tinea capitis, microsporosis, trichophytosis, and favus; these are based on the causative microorganism, and the nature of the symptoms. In "microsporosis", the lesion is a small red papule around a hair shaft that later becomes scaly; eventually the hairs break off 1–3 mm above the scalp. This disease used to be caused primarily by "Microsporum audouinii", but in Europe, "M. canis" is more frequently the causative fungus. The source of this fungus is typically sick cats and kittens; it may be spread through person to person contact, or by sharing contaminated brushes and combs. In the United States, "Trichophytosis" is usually caused by "Trichophyton tonsurans", while "T. violaceum" is more common in Eastern Europe, Africa, and India. This fungus causes dry, non-inflammatory patches that tend to be angular in shape. When the hairs break off at the opening of the follicle, black dots remain. "Favus" is caused by "T. schoenleinii", and is endemic in South Africa and the Middle East. It is characterized by a number of yellowish, circular, cup-shaped crusts (scutula) grouped in patches like a piece of honeycomb, each about the size of a split pea, with a hair projecting in the center. These increase in size and become crusted over, so that the characteristic lesion can only be seen around the edge of the scab.
Radiation induces hair loss through damage to hair follicle stem cell progenitors and alteration of keratin expression. Radiation therapy has been associated with increased mucin production in hair follicles.
Studies have suggested electromagnetic radiation as a therapeutic growth stimulant in alopecia.
Frontal Fibrosing Alopecia has been most often reported in post-menopausal women with higher levels of affluence and a negative smoking history. Autoimmune disease is found in 30% of patients.
It is important to continue to watch for symptoms and signs of active disease during and after treatment to ensure that the disease is responding adequately and has not re-activated after therapy has been discontinued. Response to therapy may be indicated by the resolution of scalp symptoms such as itching, pain, tenderness, or burning, by improvement in the signs of scalp inflammation such as decreased redness, scaling or pustules, and by halting or slowing the progression of hair loss. A dermatologist can follow your cicatricial alopecia using these guidelines, and with the pull test. Photographs of the scalp may be useful in monitoring the course of the disease and response to treatment.
Improvement or stabilization of the condition has been reported with topical and intralesional corticosteroids, antibiotics, hydroxychloroquine, topical and oral immunomodulators, tacrolimus, and most recently, 5-alpha-reductase inhibitors. In one study, the use of anti-androgens (finasteride or dutasteride) was associated with improvement in 47% and stabilization in 53% of patients
The most common digit to become ingrown is the big toe, but ingrowth can occur on any nail. Ingrown nails can be avoided by cutting nails straight across; not along a curve, not too short and no shorter than the flesh around it. Footwear that is too small or too narrow, or with too shallow of a "toe box", will exacerbate any underlying problem with a toenail. Sharp square corners may be uncomfortable and cause snagging on socks. Proper cutting leaves the leading edge of the nail free of the flesh, precluding it from growing into the toe. Filing of the corner is reasonable. Some nails require cutting of the corners far back to remove edges that dig into the flesh; this is often done as a partial wedge resection by a podiatrist. Ingrown toe nails can be caused by injury, commonly blunt trauma in which the flesh is pressed against the nail causing a small cut that swells. Injury to the nail can cause it to grow abnormally, making it wider or thicker than normal, or even bulged or crooked.
A number of different species of fungi are involved in dermatophytosis. Dermatophytes of the genera "Trichophyton" and "Microsporum" are the most common causative agents. These fungi attack various parts of the body and lead to the conditions listed below. The Latin names are for the conditions (disease patterns), not the agents that cause them. The disease patterns below identify the type of fungus that causes them only in the cases listed:
- Dermatophytosis
- Tinea pedis (athlete's foot) – fungal infection of the feet
- Tinea unguium – fungal infection of the fingernails and toenails, and the nail bed
- Tinea corporis – fungal infection of the arms, legs, and trunk
- Tinea cruris (jock itch) – fungal infection of the groin area
- Tinea manuum – fungal infection of the hands and palm area
- Tinea capitis – fungal infection of the scalp and hair
- Tinea barbae – fungal infestation of facial hair
- Tinea faciei (face fungus) – fungal infection of the face
- Other superficial mycoses (not classic ringworm, since not caused by dermatophytes)
- Tinea versicolor – caused by "Malassezia furfur"
- Tinea nigra – caused by "Hortaea werneckii"
The main contributor to onychocryptosis is footwear, particularly ill-fitting shoes with inadequate toe-box room and tight stockings that apply pressure to the top or side of the foot. Other factors may include the damp atmosphere of enclosed shoes, which soften the nail-plate and cause swelling on the epidermal keratin (eventually increasing the convex arch permanently), genetics, trauma and disease. Improper cutting of the nail may cause the nail to cut into the side-fold skin from growth and impact, whether or not the nail is truly "ingrown". The nail bends inwards or upwards depending on the angle of its cut. If the cutting tool, such as scissors, is at an attitude in which the lower blade is closer to the toe than the upper blade, the toenail will tend to grow upwards from its base, and vice versa. The process is visible along the nail as it grows, appearing as a warp advancing to the end of the nail. The upper corners turn more easily than the center of the nail tip. Holding the tool at the same angle for all nails may induce these conditions; as the nail turns closer to the skin, it becomes harder to fit the lower blade in the right attitude under the nail. When cutting a nail, it is not just the correct angle that is important, but also how short it is cut. A shorter cut will bend the nail more, unless the cut is even on both top and bottom of the nail.
Causes may include:
- Shoes causing a bunching of the toes in the developmental stages of the foot (frequently in people under 21), which can cause the nail to curl and dig into the skin. This is particularly the case in ill-fitting shoes that are too narrow or too short, but any toed shoes may cause an ingrown nail.
- Poor nail care, including cutting the nail too short, rounded off at the tip or peeled off at the edges instead of being cut straight across.
- Broken toenails.
- Trauma to the nail plate or toe, which can occur by dropping objects on or stubbing the toenail, or by the nail protruding through the shoe (as during sports or other vigorous activity), can cause the flesh to become injured and the nail to grow irregularly and press into the flesh.
- Predisposition, such as abnormally shaped nail beds, nail deformities caused by diseases or a genetic susceptibility, increases the chance of an ingrown nail, but the ingrowth cannot occur without pressure from a shoe.
- A bacterial infection, treatable with antibiotics.
One study compared patients with ingrown toenails to healthy controls and found no difference in the shape of toenails between those of patients and of the control group. The study suggested that treatment should not be based on the correction of a non-existent nail deformity. Ingrown toenails are caused by weight-bearing (activities such as walking, running, etc.) in patients that have too much soft skin tissue on the sides of their nail. Weight bearing causes this excessive amount of skin to bulge up along the sides of the nail. The pressure on the skin around the nail results in the tissue being damaged, resulting in swelling, redness and infection. Many treatments are directed at the nail itself and often include partial or full removal of the healthy nail. However, failure to treat the cutaneous condition can result in a return of the ingrowth and a deformity or mutilation of the nail.
The transmission of Tinea Barbae to humans occurs through contact of an infected animal to the skin of a human. Infection can occasionally be transmitted through contact of infected animal hair on human skin. Tinea Barbae is very rarely transmitted through human to human contact but is not completely impossible.