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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
Maceration is defined as the softening and breaking down of skin resulting from prolonged exposure to moisture. It was first described by Jean-Martin Charcot in 1877. Maceration is caused by excessive amounts of fluid remaining in contact with the skin or the surface of a wound for extended periods.
Maceration often occurs when one applies a bandage to everything from a paper cut on the finger to much larger wounds that require professional treatment. One may also notice maceration after wearing non-breathable plastic or latex rubber gloves, which trap moisture against the skin.
Maceration also occurs during treatment of wounds because the skin under the bandage becomes wet due to perspiration, urine or other bodily fluids. The excess moisture is sometimes called hyperhydration.
Wrinkles are the first sign that the skin is over-hydrated. In addition, macerated skin becomes extremely soft and takes on a whitish appearance. However, this white skin should not be confused with the pale, whitish appearance of the new epithelial tissue in a healing wound.
Although most maceration clears up quickly once the skin is exposed to fresh air and allowed to dry, sometimes skin that experiences long periods of maceration is vulnerable to fungal and bacterial infection. As opportunistic organisms affect the area, it may become itchy or develop a foul odour.
Intense rubbing can cause a blister, as can any friction on the skin if continued long enough. This kind of blister is most common after walking long distances or by wearing old or poorly fitting shoes. Blisters are most common on the hands and feet, as these extremities are susceptible while walking, running, or performing repetitive motions, such as joystick manipulation whilst playing certain video games, digging with a shovel, playing guitar, etc. Blisters form more easily on moist skin than on dry or soaked skin, and are more common in warm conditions. Less-aggressive rubbing over long periods of time may cause calluses to form rather than a blister. Both blisters and calluses can lead to more serious complications, such as foot ulceration and infection, particularly when sensation or circulation is impaired, as in the case of diabetes, neuropathy or peripheral artery disease (PAD).
There are also a number of medical conditions that cause blisters. The most common are chickenpox, herpes, impetigo, and a form of eczema called dyshidrosis. Other, much rarer conditions that cause blisters include:
- Bullous pemphigoid: a skin disease that causes large, tightly filled blisters to develop, usually affecting people over the age of 60.
- Pemphigus: a serious skin disease in which blisters develop if pressure is applied to the skin; the blisters burst easily, leaving raw areas that can become infected.
- Dermatitis herpetiformis: a skin disease that causes intensely itchy blisters, usually on the elbows, knees, back and buttocks. The blisters usually develop in patches of the same shape and size on both sides of the body.
- Chronic bullous dermatosis: a disease that causes clusters of blisters on the face, mouth or genitals.
- Cutaneous radiation syndrome
- Epidermolysis bullosa
Athlete's foot is divided into four categories or presentations: chronic interdigital athlete's foot, plantar (chronic scaly) athlete's foot (aka "moccasin foot"), acute ulcerative tinea pedis, and vesiculobullous athlete's foot. "Interdigital" means between the toes. "Plantar" here refers to the sole of the foot. The ulcerative condition includes macerated lesions with scaly borders. Maceration is the softening and breaking down of skin due to extensive exposure to moisture. A vesiculobullous disease is a type of mucocutaneous disease characterized by vesicles and bullae (blisters). Both vesicles and bullae are fluid-filled lesions, and they are distinguished by size (vesicles being less than 5–10 mm and bulla being larger than 5–10 mm, depending upon what definition is used).
Athlete's foot occurs most often between the toes (interdigital), with the space between the fourth and fifth digits most commonly afflicted. Cases of interdigital athlete's foot caused by "Trichophyton rubrum" may be symptomless, it may itch, or the skin between the toes may appear red or ulcerative (scaly, flaky, with soft and white if skin has been kept wet), with or without itching. An acute ulcerative variant of interdigital athlete's foot caused by "T. mentagrophytes" is characterized by pain, maceration of the skin, erosions and fissuring of the skin, crusting, and an odor due to secondary bacterial infection.
Plantar athlete's foot (moccasin foot) is also caused by "T. rubrum" which typically causes asymptomatic, slightly erythematous plaques (areas of redness of the skin) to form on the plantar surface (sole) of the foot that are often covered by fine, powdery hyperkeratotic scales.
The vesiculobullous type of athlete's foot is less common and is usually caused by "T. mentagrophytes" and is characterized by a sudden outbreak of itchy blisters and vesicles on an erythematous base, usually appearing on the sole of the foot. This subtype of athlete's foot is often complicated by secondary bacterial infection by "Streptococcus pyogenes" or "Staphylococcus aureus".
"Trench foot " is a medical condition caused by prolonged exposure of the feet to damp, unsanitary, and cold conditions. The use of the word "trench" in the name of this condition is a reference to trench warfare, mainly associated with World War I. Affected feet may become numb, affected by erythrosis (turning red) or cyanosis (turning blue) as a result of poor vascular supply, and feet may begin to have a decaying odour due to the possibility of the early stages of necrosis setting in. As the condition worsens, feet may also begin to swell. Advanced trench foot often involves blisters and open sores, which lead to fungal infections; this is sometimes called tropical ulcer (jungle rot).
If left untreated, trench foot usually results in gangrene, which can cause the need for amputation. If trench foot is treated properly, complete recovery is normal, though it is marked by severe short-term pain when feeling returns. As with other cold-related injuries, trench foot leaves sufferers more susceptible to it in the future.
It may have a variety of appearances; most easily identifiable are the enlarging raised red rings with a central area of clearing (ringworm). The same appearances of ringworm may also occur on the scalp (tinea capitis), beard area (tinea barbae) or the groin (tinea cruris, known as jock itch or dhobi itch).
Other classic features of tinea corporis include:
- The edge of the rash appears elevated and is scaly to touch.
- Sometimes the skin surrounding the rash may be dry and flaky.
- Almost invariably, there will be hair loss in areas of the infection.
"Tropical immersion foot" (also known as "Paddy foot", and "Paddy-field foot") is a skin condition of the feet seen after continuous immersion of the feet in water or mud of temperature above 22 degrees Celsius (roughly 72 degrees Fahrenheit ) for two to ten days.
Other rashes that occur in the diaper area include seborrhoeic dermatitis and atopic dermatitis. Both Seborrheic and Atopic dermatitis require individualized treatment; they are not the subject of this article.
- Seborrheic dermatitis, typified by oily, thick yellowish scales, is most commonly seen on the scalp (cradle cap) but can also appear in the inguinal folds.
- Atopic dermatitis, or eczema, is associated with allergic reaction, often hereditary. This class of rashes may appear anywhere on the body and is characterized by intense itchiness.
The diagnosis of IDD is made clinically, by observing the limitation of an erythematous eruption to the convex surfaces of the genital area and buttocks. If the diaper dermatitis occurs for greater than 3 days it may be colonized with "Candida albicans", giving it the beefy red, sharply marginated, appearance of diaper candidiasis.
Athlete's foot, known medically as tinea pedis, is a common skin infection of the feet caused by fungus. Signs and symptoms often include itching, scaling, and redness. In severe cases the skin may blister. Athlete's foot fungus may infect any part of the foot, but most often grows between the toes. The next most common area is the bottom of the foot. The same fungus may also affect the nails or the hands. It is a member of the group of diseases known as tinea.
Athlete's foot is caused by a number of different fungi. These include species of "Trichophyton", "Epidermophyton", and "Microsporum". The condition is typically acquired by coming into contact with infected skin, or fungus in the environment. Common places where the fungi can survive are around swimming pools and in locker rooms. They may also be spread from other animals. Usually diagnosis is made based on signs and symptoms; however, it can be confirmed either by culture or seeing hyphae using a microscope.
Some methods of prevention include avoiding walking barefoot in public showers, keeping the toenails short, wearing big enough shoes, and changing socks daily. When infected, the feet should be kept dry and clean and wearing sandals may help. Treatment can be either with antifungal medication applied to the skin such as clotrimazole or for persistent infections antifungal medication that are taken by mouth such as terbinafine. The use of the cream is typically recommended for four weeks.
Athlete's foot was first medically described in 1908. Globally, athlete's foot affects about 15% of the population. Males are more often affected than females. It occurs most frequently in older children or younger adults. Historically it is believed to have been a rare condition, that became more frequent in the 1900s due to the great use of shoes, health clubs, war, and travel.
Intertrigo refers to a type of inflammatory rash (dermatitis) of the superficial skin that occurs within a person's body folds. These areas are more susceptible to irritation and subsequent infection due to factors that promote skin breakdown such as moisture, friction, and exposure to bodily secretions such as sweat, urine or feces. Areas of the body which are more likely to be affected by intertrigo include the inframammary fold, intergluteal cleft, armpits, and spaces between the fingers or toes. Skin affected by intertrigo is more prone to infection than intact skin.
The term "intertrigo" commonly refers to a secondary infection with bacteria (such as "Corynebacterium minutissimum"), fungi (such as "Candida albicans"), or viruses. A frequent manifestation is candidal intertrigo.
Intertrigo occurs more often in warm and humid conditions. Generally, intertrigo is more common in people with a weakened immune system including children, the elderly, and immunocompromised people. The condition is also more common in people who experience urinary incontinence and decreased ability to move.
Their color is typically similar to that of the skin. Small black dots may occur on the surface. One or more may occur in an area. They may result in pain with pressure such that walking may be difficult.
Bacterial intertrigo can be caused by "Streptococci" and "Corynebacterium minutissimum".
Xeroderma or xerodermia (also known as xerosis cutis), derived from the Greek words for "dry skin", is a condition involving the integumentary system, which in most cases can safely be treated with emollients or moisturizers. Xeroderma occurs most commonly on the scalp, lower legs, arms, hands, the knuckles, the sides of the abdomen, and thighs. Symptoms most associated with xeroderma are scaling (the visible peeling of the outer skin layer), itching, and skin cracking.
The intense contact between a musical instrument and skin may exaggerate existing skin conditions or cause new skin skin conditions. Skin conditions like hyperhidrosis, lichen planus, psoriasis, eczema, and urticaria may be caused in instrumental musicians due to occupational exposure and stress. Allergic contact dermatitis and irritant contact dermatitis are the most common skin conditions seen in string musicians.
The symptoms of this condition include:
- Occasional fine scaling of the skin producing a very superficial ash-like scale
- Pale, dark tan, or pink in color, with a reddish undertone that can darken when the patient is overheated, such as in a hot shower or during/after exercise. Tanning typically makes the affected areas contrast more starkly with the surrounding skin.
- Sharp border
Pityriasis versicolor is more common in hot, humid climates or in those who sweat heavily, so it may recur each summer.
The yeasts can often be seen under the microscope within the lesions and typically have a so-called "spaghetti and meatball appearance" as the round yeasts produce filaments.
In people with dark skin tones, pigmentary changes such as hypopigmentation (loss of color) are common, while in those with lighter skin color, hyperpigmentation (increase in skin color) is more common. These discolorations have led to the term "sun fungus".
Tinea corporis (also known as ringworm, tinea circinata, and tinea glabrosa) is a superficial fungal infection (dermatophytosis) of the arms and legs, especially on glabrous skin; however, it may occur on any part of the body. It is similar to other forms of tinea.
Plantar warts are benign epithelial tumors generally caused by infection by human papillomavirus types 1, 2, 4, 60, or 63, but have also been caused by types 57, 65, 66, and 156. These types are classified as clinical (visible symptoms). The virus attacks compromised skin through direct contact, entering through possibly tiny cuts and abrasions in the stratum corneum (outermost layer of skin). After infection, warts may not become visible for several weeks or months. Because of pressure on the sole of the foot or finger, the wart is pushed inward and a layer of hard skin may form over the wart. A plantar wart can be painful if left untreated.
Warts may spread through autoinoculation, by infecting nearby skin or by infected walking surfaces. They may fuse or develop into clusters called mosaic warts.
Keratosis pilaris results in small bumps on the skin that feel like rough sandpaper. They are skin-colored bumps the size of a grain of sand, many of which are surrounded by a slight pink color in light skinned people and dark spots in dark skinned people. Most people with keratosis pilaris do not have symptoms but the bumps in the skin can occasionally be itchy.
Though people with keratosis pilaris experience the condition year-round, the problem can become exacerbated and the bumps are likely to look and feel more pronounced in color and texture during the colder months when moisture levels in the air are lower. The symptoms may also worsen during pregnancy or after childbirth.
Defatting is the chemical dissolving of dermal lipids, from the skin, on contact with defatting agents. This can result in water loss from the affected area and cause the whitening and drying of the skin which may result in cracking, secondary infection and chemical irritant contact dermatitis.
The signs and symptoms of dandruff are an itchy scalp and flakiness. Red and greasy patches of skin and a tingly feeling on the skin are also symptoms.
Rosin, the material commonly used to wax string instruments is known to cause allergic contact dermatitis in musicians. Nickel, a metal found in musical instruments causes allergic contact dermatitis on the fingers and hands of string instrumentalists and in the lip and neck of wind instrumentalists. Wind instrumentalists with lip and neck infection should switch to gold or plastic mouthpieces if allergic dermatitis occurs. (R)-4-methoxydalbergione present in rosewood may cause allergic contact dermatitis in violinists. Cane reed (causing chelitis in saxophone players), propolis (a wax used to close structural gaps in musical instruments), paraphenylenediamine (used to polish musical instruments) and potassium dichromate (tanning agent to the skin of the harp) also cause allergic contact dermatitis in musicians.
Tinea versicolor is a condition characterized by a skin eruption on the trunk and proximal extremities. The majority of tinea versicolor is caused by the fungus "Malassezia globosa", although "Malassezia furfur" is responsible for a small number of cases. These yeasts are normally found on the human skin and become troublesome only under certain circumstances, such as a warm and humid environment, although the exact conditions that cause initiation of the disease process are poorly understood.
The condition pityriasis versicolor was first identified in 1846. Versicolor comes from the Latin, from "" to turn + color. It is also commonly referred to as Peter Elam's disease in many parts of South Asia.
A corn (or "clavus", plural "clavi") is a specially shaped callus of dead skin that usually occurs on thin or glabrous (hairless and smooth) skin surfaces, especially on the dorsal surface of toes or fingers. They can sometimes occur on the thicker palmar or plantar skin surfaces. Corns form when the pressure point against the skin traces an elliptical or semi-elliptical path during the rubbing motion, the center of which is at the point of pressure, gradually widening. If there is constant stimulation of the tissue producing the corns, even after the corn is surgically removed, the skin may continue to grow as a corn.
The hard part at the center of the corn resembles a funnel with a broad raised top and a pointed bottom. Because of their shape, corns intensify the pressure at the tip and can cause deep tissue damage and ulceration. The scientific name for a corn is "heloma" (plural "helomata"). A hard corn is called a "heloma durum", while a soft corn is called a "heloma molle".
The location of the soft corns tends to differ from that of hard corns. Hard corns occur on dry, flat surfaces of skin. Soft corns (frequently found between adjacent toes) stay moist, keeping the surrounding skin soft. The corn's center is not soft however, but indurated.
The specific diagnostic workup and treatments for corns may differ substantially from other forms of calluses.
Keratosis pilaris (KP) (also follicular keratosis, lichen pilaris, or colloquially "chicken skin") is a common, autosomal dominant, genetic condition of the skin's hair follicles characterized by the appearance of rough, slightly red bumps on light skin and brown bumps on darker skin. It most often appears on the back, outer sides of the upper arm (though the forearm can also be affected), face, thighs, and buttocks; KP can also occur on the hands, and tops of legs, sides, or any body part except glabrous skin (like the palms or soles of feet). Often the lesions will appear on the face, which may be mistaken for acne.