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Corns and callosities are produced if an area of the skin is subjected to repeated friction as with ill-fitting/tight shoes or with specific occupational activity.A corn/ callosity consists of an area of thickening of the stratum corneum (the most superficial layer of the skin) which is subjected to repeated friction. If the area of thickening is small, it is called a ‘com’, and if the thickening occurs over a larger area it is called a ‘callosity’. Corns on the soles of the feetare commonly caused by the projecting end of a nail in the footwear, while corns on the toes are produced if the front of the shoe is narrow and tight-fitting and causes friction on the toes. Callosities are frequently located on the skin over the bony prominences, especially around the ankle or other joints, and are related to a specificposture. Callosities are also common on the hands, especially the palms of manual labourers.

A com/callosity in fact is a protective reaction of the skin which is subjected to friction from outside. If the friction is severe, it leads to the production of a blister but if the friction is not severe but recurrent, the skin tends to become progressively thicker and thicker. The thickening involves mainly the stratum corneum which leads to the formation of a keratinous plug. With continued pressure, the keratin plug starts pressing upon the underlying skin and causes pain, whenever the area is subjected to pressure. The corn/callosities are always located on areas which are subjected to repeated friction.

Treatment

For treatment, most people try to slice off the thickened keratin mass as this helps to reduce the pressure on the nerve endings and relieve the pain for some time, but since the cause of friction is generally not taken care of, the skin becomes thickened again and the com/callosities recur. For effective treatment therefore, the most important thing to do is to identify the cause of friction and take appropriate measures to prevent it. For corns on the feet one may advise the patient to interpose a layer of soft foam on the instep, especially at the areas where the corn/ callosities are located. One should also look for the projecting ends of the shoenails or areas where the sale of the shoe is hard and is likely to produce friction on the sale of the foot. If the corns are located on the toes, the person should be advised to wear shoes with a broad front or interpose a pad of cotton or foam between the skin and the shoe. Callosities located over the bony projections around the ankle are usually caused by squatting on the floor. A change in the posture or avoiding to squat on hard floor helps to prevent further friction. For the callosities located on the hand, interposition of a soft pad between the hand and the hard object responsible for the friction should help.

Once the cause of friction has been removed the process will reverse itself and the com/callosity would tend to disappear on its own, without any treatment, but this can take several months. To hasten the disappearance of the corn/ callosity one can use certain medicines which help to disintegrate the thickened stratum corneum (keratin plug). Such medicines are preferably applied under an occlusive pad/ dressing. The pad should be applied immediately after the bath and removed only the next day, before the next bath. During bathing the area should be cleaned thoroughly with a soap and the softened portion of the corm/callosity should be rubbed off from the com as much as possible. Continued daily applications of these pads would help in progressive reduction of the thickness of the keratin plug and this can be continued till the skin has attained normal texture. The process of removal of the keratin plug can however, be expedited by surgical removal of the keratin plug. In all such cases however, if the cause of the friction is not removed, the com/callosity will reappear. Therefore, identification of the cause of friction and taking measures to prevent further friction are more important than removal of the keratin plug.

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Chicken Pox Information manifests with an eruption of well-formed tense vesicles, which on the first day may be only a few but increase in number within the next few days to become generalised. Each vesicle is characteristically surrounded by a small zone of redness and there is a tendency for the vesicles to be concentrated on the trunk, rather than the face or the extremities. The fever on the first day is usually mild and is often ignored by the patient. The vesicles as a rule remain small and discrete and do not merge with each other. The eruption generally subsides within seven to 10days, even without any treatment; the lesions get crusted and the crusts fall off without leaving any permanent marks. In some patients however, the lesions leave behind hyperpigmented areas which too disappear in due course. Sometimes, the lesions get super-infected with pyogenic organisms which leave behind circular pitted scars.

Treatment

For treabnent, as a rule nothing is required because the disease is self-limiting and the lesions disappear within a week or so. One attack of chicken-pox usually leaves behind lifelong immunity. It is however, important that no such medicine should be administered during this period which can interfere with the development of lifelong immunity. Corticosteroids and immunosuppressive/ anti-cancer drugs are totally prohibited. The only drugs which can be given
during this period are those necessary to prevent high fever (mild fever should be left alone) or anti-histamines to control the itching, if it is severe. Oral antibiotics may be used during the later period if there is any evidence or risk of superinfection. This is especially useful for preventing permanent
scars.

If the patient has any indication of immune deficiency or if there is a risk of the chicken-pox becoming extensive, a course of the anti-viral drug (Acyclovir) is necessary.

There are no other special precautions required except that there is risk of the infection spreading to other persons who are in close proximity to the patient. Individuals who have suffered from chicken-pox in the past and acquired sufficient immunity against this virus do not need any protection but those who have not yet suffered from chickenpox, especially the children, or those who have not acquired adequate immunity during the previous infection, are likely to acquire the infection from the patient. These individuals therefore, should preferably keep away from the patient. Selective isolation of the patient therefore, is mandatory. The isolation has to be continued till all the crusts from the skin fall off. In a hospital situation, the other patients who are being treated with corticosteroids or immunosuppressive drugs must be kept away from the chicken-pox patient.

Bathing may be avoided if the patient has high fever and the use of topical applications may be limited to soothing applications (calamine lotion), if there is itching. An antiinfective lotion/ ointment may be applied for superadded infection; sponging of the patient may be undertaken in place of bathing and bathing may be permitted if the patient feels like having a bath.

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Normally the hairs are firmly attached to the skin by means of the hair roots. It is therefore not easy to pull a hair out of the skin without applying an adequate amount of force. Pulling a strand of hair out of the skin causes pain. The amount of force required to pull a hair out of the skin can be judged from the fact that some strong-willed individuals have at public demonstrations pulled a truck or some other similar heavy vehicle with their hair, although in such instances it is the collective strength of the hair roots which comes into action. A hair which comes out of the skin easily and without pain is most likely to be the hair which is in the resting phase and would have fallen off even otherwise within the next few days.

Under certain circumstances however, if the hairs are kept under constant and prolonged traction, the hairs can loosen out of the skin. This is called traction alopecia.This is commonly seen on the front or the sides of the scalp in ‘women who tie their hair into a very tight knot or a ponytail. Women who have a heavy growth of hair and tie their hair into a large bun which loosely hangs on their back can also produce sufficient traction on the hair roots, leading to traction alopecia in the corresponding areas. Sikh boys and some adults, who tie their hair into a tight knot on the top of their head or tie their beard in a manner which causes excessive tension, can suffer from the same type of alopecia. It is usually seen on the front and the sides of the scalp or the beard respectively. 

Since the hairs in this disease are not abnormal and the alopecia is caused merely by the traction, for treatment it is sufficient to prevent further traction to curb further loss of hair. The hairs start regrowing in due course, even without any medicinal treatment, but take due time to regrow.

Some people are likely to develop a psychiatric disease called trichotillomania, in which the patient develops a tendency to pull the hairs out from the scalp (and occasionally from the eyebrows, the moustache or the beard), whenever under psychological stress. The scalp and the hair in all such cases are completely normal and the hairs in these areas start regrowing almost immediately, but the process is often repeated in other areas. Thus, the areas of the loss of hair usually keep shifting from one region to the other. For treatment, it is advisable to assure the patient that the hairs on the scalp are normal and explain the mechanism of the hair loss. Psychiatric help may be obtained, if necessary, to bring out the cause of the psychological stress.

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This type of baldness is dependent on the male sex hormones and heredity. It is inherited from the parents and most people who manifest male-type baldness inherit this tendency from the father or the mother. Sometimes the father may not manifest the baldness but other male members in the father’s family may have this type of baldness. The member manifesting the male-type baldness may be the father, the father’s brothers or the paternal grandfather. On the other hand, the tendency may have been inherited from the mother but since females do not manifest this type of baldness, the affected members in the mother’s family are likely to be the mother’s brothers and the maternal grandfather. The other members having the baldness may be the patient’s brothers. Thus, the presence of male members having baldness among the family members on the paternal and/or the maternal side is enough indication that the person may have inherited the tendency for this type of baldness.

This type of baldness does not however, manifest itself before the age of puberty because it is dependent on the male sex hormones, which are produced only after puberty. Under the influence of these hormones the coarse and long hairs on the scalp are progressively replaced by finer and shorter hairs. With time, the person tends to have less and less coarse hairs. It is interesting to know that the same male sex hormones are responsible for the growth and maintenance of coarse hairs on the moustache and the beard, and all over the body, but on the scalp they become responsible for the loss of hair.

The maximum effect of these hormones is on a specified area of the scalp-the frontal and the parietal regions. This leads to a backward recession of the frontal hair-line with widening of the forehead and a decrease in the number of hairs on the central part of the top of the head. A circular area on the upper part of the back of the head also starts becoming bald and both these areas ultimately merge with each other. In its severest form, the central part of the head, from the frontal region to the back of the head may become completely devoid of hair but still, the person maintains a rim of hair along the sides and the back of the head. This type of baldness does not lead to loss of all the hairs on the entire scalp.

Treatment

A variety of shampoos and hair oils are being marketed for preventing baldness and many of them are based on ayurvedic formulations, but, most of these products have never been subjected to unbiased scientific evaluation. Claims of success on their usage are based on misconcepts and ignorance. The truth is that no shampoo can lead to baldness (hair loss) or to growth of hair. There is only one medical product, which has been confirmed to lead to growth of hair and to interfere with the progression of the male type of baldness. This preparation is based on minoxidil, which is used for treating hypertension and was found to lead to growth of hairs in patients under treatment with this drug. It is now available in the form of a 2 per cent solution for topical use. It has to be used in a proper quantity and in a proper manner to obtain the maximum benefit-l ml of the solution is to be applied and massaged into the skin twice a day.

The hair should be shampooed daily or as frequently as possible. The medicine is a pplied after the shampoo in the morning, and again at night without shampooing the hair. The use of hair oils has to be strictly prohibited. In addition, one has to remember that a hair which falls today was ordained to do so some three months previously. Thus, the number of hairs which have to fall off during the next three months has already been decided when the treatment is initiated. Thus, it would be futile to expect any results within the first three months. And since the medicine cannot be effective on the very first day of the treatment, it is advisable to assess the first results only after a minimum period of six months. After six months the rate of loss of hair should decrease to the normal level so that the baldness does not increase further.

Regrowth of the hairs or rather the conversion of fine hairs into coarse hairs can take a year or two. This will however, depend upon whether the root of the hair is still preserved or it has already been destroyed. In areas where the hair roots have been de stroyed, the hair cannot be expected to regrow. We usually recommend patients to get close-up photographs of the scalp hair and compare the degree of baldness at one-yearly intervals when the new hairs may become visible in the areas of baldness. Needless to say that success of the treatment depends on the regularity of the use of the medicine. The medicine has to be continued routinely throughout the rest of his life or as long as the hair are important to him because whenever the treatment is interrupted, the process of balding will start all over again.

There are by and large, no oral medicines available so far, which can control or reverse the process of baldness. Recently, an anti-androgen medicine, by the name of Finasteride, has been developed which can counter the effect of excess male hormones. The drug however, has to be used under medical supervision only.

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Alcohol withdrawal syndrome is a cluster of symptoms that occurs in alcohol-dependent people after cessation or reduction in alcohol use. Some people have mild shakiness and sweats. The worst form of withdrawal is called “DTs. Alcohol withdrawal refers to a group of symptoms that may occur from suddenly stopping the use of alcohol after chronic or prolonged ingestion. Alcohol withdrawal usually occurs in adults, but it may happen in teenagers or children as well. It can occur when a person who uses alcohol excessively suddenly stops drinking alcohol. The withdrawal usually occurs within 5 - 10 hours after the last drink, but it may occur up to 7 - 10 days later. Alcohol enhances the effect of GABA on GABA-A neuroreceptors, resulting in decreased overall brain excitability. Hallucinations occur in 3%–10%  of patients and are usually visual; their onset and duration  are variable but typically begin after several days of  abstinence.  Convulsions, which are usually 1 or 2 grand  mal seizures, occur in 5%–15% of patients during acute  alcohol withdrawal and typically occur within 6 to 48  hours after alcohol cessation.

Alcohol inhibits NMDA neuroreceptors, and chronic alcohol exposure results in up-regulation of these receptors. Alcohol withdrawal differs significantly from withdrawal from other drugs in that it can be directly fatal. While it is possible for heroin addicts, for instance, to die from other health problems made worse by the strain of withdrawal, an otherwise healthy alcoholic can die from the direct effects of withdrawal if it is not properly managed.  Acute alcohol withdrawal can produce some of the  more serious morbidity related to alcohol consumption. Clinical features of alcohol withdrawal follow the cessation  of regular high-dose alcohol ingestion as soon as  the blood alcohol level decreases significantly.21Within 6  to 24 hours after stopping drinking, tremors, nausea and  vomiting, anxiety, mild agitation, tachycardia, hypertension,  insomnia and diaphoresis may occur. The risk of seizures increases with the duration of alcohol abuse. The alcoholic could suffer from loss of respect from others who may see the problem as self-inflicted and easily avoided.

Alcohol  consumption is more strongly associated with seizures  than is alcohol withdrawal. Treatment may require maintenance of a moderately sedated state for a week or more until withdrawal is complete. Medication can be administered using fixed-schedule or symptom-triggered regimens. Multivitamins and thiamine (100 mg per day) should be provided during treatment for alcohol withdrawal. Rehabilitation for alcoholism is often recommended. This may include social support such as Alcoholics Anonymous, medications, and behavior therapy. Pharmacologic treatment of alcohol withdrawal syndrome involves the use of medications that are cross-tolerant with alcohol. Benzodiazepines have been shown to be safe and effective, particularly for preventing or treating seizures and delirium. Detoxification treats the physical effects of prolonged use of alcohol, but does not actually treat alcoholism. Haloperidol (Haldol) can be used to treat agitation and hallucinations, although it can lower the seizure threshold.

Alcohol Withdrawal Treatment Tips

1.Detoxification treats the physical effects of prolonged use of alcohol, but does not actually treat alcoholism.

2.Group therapy or psychotherapy can be used to deal with underlying psychological issues that are related to alcohol addiction.

3.Rationing and moderation programs such as Moderation Management do not mandate complete abstinence.

4.Sodium oxybate is the sodium salt of gamma-hydroxybutyric acid (GHB).

5..Pharmacologic treatment of alcohol withdrawal syndrome involves the use of medications that are cross-tolerant with alcohol.

6. Benzodiazepines have been shown to be safe and effective, particularly for preventing or treating seizures and delirium.

7.Adjunctive treatment with a beta blocker should be considered in patients with coronary artery disease.

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Raynaud’s disease is a rare disorder of the blood vessels, usually in the fingers and toes. Raynaud’s phenomenon can be associated with diseases of the arteries such as Buerger’s disease and atherosclerosis, rheumatoid arthritis, scleroderma and systemic Lupus erythematosus. Cold hands and feet are uncomfortable but are usually only a problem in winter. But for people who suffer from Raynaud’s disease they can be a year-round problem, sometimes with serious consequences. Raynaud’s disease affects a small percentage of Americans. Women are more likely than men are to have the disorder. It’s more common in people who live in colder climates. People with this disorder have attacks that cause the blood vessels to narrow. Raynaud’s disease is more than simply having cold hands and cold feet, and it’s not the same as frostbite. Signs and symptoms of Raynaud’s depend on the frequency, duration and severity of the blood vessel spasms that underlie the disorder. Raynaud’s disease occurs more frequently in women than in men.

Raynaud’s disease  can occur at any age it usually begins between the ages of 15 and 40. It is estimated that 4 - 5% of the United States population is affected. Primary Raynaud’s occurs spontaneously, without any underlying condition being present. It can be hereditary, in which case it is usually fairly mild. Women are affected nine times more than men.Secondary Raynaud’s is less common and is associated with underlying diseases such as Scleroderma, systemic lupus erythematosus, Sjögrens syndrome and rheumatoid arthritis. This is more serious and early and accurate diagnosis is essential. Medications that can be causes include beta-blockers and ergotamine. Self-care and preventive treatment usually are effective in alleviating mild symptoms of Raynaud’s. Alpha blockers-Some people find relief with drugs called alpha blockers, which counteract the actions of norepinephrine, a hormone that constricts blood vessels.  Calcium channel blockers  drugs relax and open up small blood vessels in your hands and feet.

Minimising emotional stress has a significant beneficial effect too. Hand warmers may be used on the wrists to warm the blood flowing to the hands. More serious cases require medical intervention due to the risks of gangrene and possible digital amputation. Microvascular surgery of the affected areas is a possible therapy.   Take precautions indoors. Wear socks. When taking food out of the refrigerator or freezer, wear gloves, mittens or oven mitts. Some people find it helpful to wear 0mittens and socks to bed during winter. Consider moving to a location with a milder climate. Moving to a warmer climate may help people with severe Raynaud’s. The medications that are used are calcium channel blockers e.g. nifedipine, alpha blockers e.g. Prazosin, and other drugs like fluoxetine and losartan.  Hypnosis, relaxation techniques, and visualization are also useful methods to help control emotions.

Treatment of Raynaude’s Disease Tips

1.Calcium channel blockers  drugs relax and open up small blood vessels in your hands and feet. 

2.Alpha blockers, which counteract the actions of norepinephrine, a hormone that constricts blood vessels.

3. Minimising emotional stress has a significant beneficial effect too.

4.Hand warmers may be used on the wrists to warm the blood flowing to the hands.

5. Microvascular surgery of the affected areas is a possible therapy.

6. Hypnosis, relaxation techniques, and visualization are also useful methods to help control emotions.

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Alzheimer’s disease is a brain disorder and neurodegenerative disease that in its most common form is found in people over age 65. Three genes have been discovered that cause early onset (familial) AD. Other genetic mutations that cause excessive accumulation of amyloid protein are associated with age-related (sporadic) AD. More than 5 million Americans now have Alzheimer’s.The early symptoms of AD, which include forgetfulness and loss of concentration, are often missed because they resemble natural signs of aging.  Symptoms of the disease include memory loss, confusion, impaired judgment, personality changes, disorientation, and loss of language skills. People who have had severe head or whiplash injuries appear to be at increased risk of developing dementia. Boxers who receive continual blows to the head are also at risk. People in the middle stages of AD may forget how to do simple tasks like brushing their teeth or combing their hair. 

Alzheimer’s disease has a long history, although the disease wasn’t given a name until the collection of symptoms was first described during the early part of the 20th century. Alzheimer’s disease has been identified as a protein misfolding disease, or proteopathy, due to the accumulation of abnormally folded amyloid beta protein and tau protein in the brains of AD patients. Alzheimer’s disease may also include behavioral changes, such as outbursts of violence or excessive passivity in people who have no previous history of such behavior. In the later stages, deterioration of musculature and mobility, leading to bedfastness, inability to feed oneself, and incontinence, will be seen if death from some external cause (e.g. heart attack or pneumonia) does not intervene. Alzheimer’s disease causes changes or deterioration in certain areas of the brain that control thinking, communication, and behavior. 

Scientists believe that genetics may play a role in many Alzheimer’s disease cases. Genetic factors are suspected, and dominant mutations in three different genes have been identified that account for a much smaller number of cases of familial. Mutationson chromosomes 1, 14, 21 increase risk as do possibly chromosomes 10, 12.  One risk factor for this type of Alzheimer’s disease is a protein called apolipoprotein E (apoE). Family history is another risk factor. As has head trauma following vascular damage from such diseases as stroke, high blood pressure, diabetes mellitis and atherosclerotic disease.  Smaller brains and head size leading to fewer connections within the brain have also been suggested in causation of Alzheimer’s disease. Attempts have been made to associate environmental causes, such as high levels of aluminium with Alzheimer’s.

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There are many types of treatment available to treat the acne. Wash their baby’s face daily with water or at times a mild, baby soap to help clear things up. Oils or creams are not recommended by the health care providers to reduce the acne from the surface of the skin. Ionic colloidal silver, the safest acne treatment - reduces swelling - treats infection - removes itching and sores - and promotes healthy skin growth. The 101 E Acne Getaway is recommended by the doctors to remove the baby acne in skin. There is no possible side effect of it. Parents should make sure about ingredients such as Fructus kochiae, Herba drymaria cordata, Radix Angelicae dahuricae, Cortex mori radicis, Herba Speranskia tuberculata, Cortex dictamni radicis, Radix gentianea, Rhizoma dryopteris crassirhizomae and Radix Ledebouriellae. It can give the best result after using regularly. Application of this treatment based on the affected portion of the baby’s skin. Clean affected portion of the skin with mild soap and clean water or cleanser like Aquanil Cleansing Lotion daily. Benzoyl Peroxide 5% lotion is very effective to remove acne from the skin. This lotion may be used in babies over 3 months old.

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Aromatherapy is a form of alternative medicine. Aromatherapy means “treatment using scents”. Aromatherapy refers to the use of essential oils extracted from herbs, trees and plants for therapeutic purposes. Essential oils are complex, highly fragrant and volatile substances, with varying degrees of complexity, fragrance, and volatility.Essential oils which are the pure “essence” of a plant, have been found to provide both psychological and physical benefits when used correctly and safely. Aromatherapy is a generic term that refers to any of the various traditions that make use of essential oils sometimes in combination with other alternative medical practices and spiritual beliefs. There are about 150 essential oils. Most of these oils have antiseptic properties; some are antiviral, anti-inflammatory, pain-relieving, antidepressant and expectorant. Other properties of the essential oils which are taken advantage of in aromatherapy are their stimulation, relaxation, digestion improvement, and diuretic properties. To get the maximum benefit from essential oils, it should be made from natural, pure raw materials. Synthetically made oils do not work. Medical aromatherapy uses the knowledge of the effect of essential oils on health when treating clinically diagnosed medical conditions.

Essential oils that are inhaled into the lungs are believed to offer both psychological and physical benefits. Aromatherapy is believed to be suitable for people of all ages, even babies. Fragrant oils extracted from plants chiefly through distillation (e.g. eucalyptus oil) or expression (grapefruit oil). Aromatherapy is one of the fastest growing fields in alternative medicine. It is widely used at home, clinics and hospitals for a variety of applications such as pain relief for women in labor pain, relieving pain caused by the side effects of the chemotherapy undergone by the cancer patients, and rehabilitation of cardiac patients. Essential Oils can supply other benefits as well. Some oils, for instance, act as a natural repellent and pesticide.  Citronella essential oil is the ingredient in the candles that provides this benefit. Oils vary in price based on the amount of the harvest, the country of origin, the type of extraction used (steam distillation, CO2 extract, enfleurage), and how desirable the oil is. Indian Sandalwood (Santalum album) is considered more desirable than Australian Sandalwood (Santalum spicatum), based upon the aroma, and is twice as costly, mainly because the species that yields Indian Sandalwood essential oils is endangered. Organic and wild harvested essential oils also tend to be more expensive.

Aromatherapy has roots in antiquity with the use of aromatic oils. However, as currently defined, aromatherapy involves the use of distilled plant volatiles, a twentieth century innovation. Essential oil” is used somewhat loosely as it is often applied to all aromatic products such as essence oils, absolutes, resinoids, and concretes. Oils that are applied to the skin are believed to be absorbed into the bloodstream. The components of the various oils are believed to aid in a variety of health, beauty and hygiene conditions. In Aromatherapy it is held that once extracted, the chemical constituents of a particular essential oil will determine its primary action. Generally, essential oils consist of chemical compounds which have hydrogen, carbon and oxygen in their building blocks. Cosmetic aromatherapy refers to the use of essential oils in hair and skin creams. Psycho-aromatherapy uses essential oils to bring about certain emotional states and moods, whether the desired feeling be relaxation, invigoration or a pleasant memory. Aromatherapy massage is the most common method utilized by aromatherapists. The aim in combining aromatherapy with massage is relaxation. A practitioner of this particular specialization must be well versed in massage and understand the varied properties of oils. In Aromatherapy it is held that when essential oils are applied in a body massage, they are carried by the to specific organs and systems of the body where they enhance the natural functions of these organs.

Essential oils can be used in making homemade lotions, facial toners, shampoos, perfumes, soaps, shower gels, and other natural products. Yarrow oil is used to reduce joint inflammation and relieve cold and influenza symptoms. Basil is used in perfumery for its clear, sweet and mildly spicy aroma. In aromatherapy, it is used for sharpening concentration, for its uplifting effect on depression, and to relieve headaches and migraines. Basil oil has many chemotypes and some are known to be emmenagogues and should be avoided during pregnancy.

Additionally, essential oils are often blended for their therapeutic synergistic abilities. Tea tree oil and many other essential oils have topical (external) antimicrobial (i.e. antibacterial, antifungal, antiviral, or antiparasitic) activity and are used as antiseptics and disinfectants. Essential oils and fatty/vegetable oils are two completely different types of oils.  Essential oils as implied by the term “Aromatherapy”, have a powerful effect through our sense of smell. In the field of Aromatherapy it is held that in skin care essential oils regulate the activity of capillaries and restore vitality to the tissues.

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Nail Patella Syndrome (NPS) also known Fong Disease. Nail-Patella syndrome (NPS) is a rare genetic disorder and those affected may have small or absent patellae (kneecaps), underdeveloped nails and an inability to fully straighten the elbows.  It has been recognized as a hereditary condition for over 100 years and is inherited in an autosomal dominant manner. Less common medical findings include defects of the upper lip, the roof of the mouth, and unusual skeletal abnormalities. Skeletal abnormalities may include poorly developed scapulae (shoulder blades), sideways bent fingers (clinodactyly), clubfoot, scoliosis, and unusual neck bones. There are also other effects, such as thickening of the basement membrane in the skin and of the tiny clusters of capillaries (glomeruli) in the kidney. Scientists have recognized an association between nail-patella syndrome and colon cancer. Nail changes are seen in 98% of patients with NPS but they may be subtle. Nails may be missing, small or abnormal, ridged, pitted, discoloured, separated into two halves by a ridge of skin, thin or less often, thickened. Nail changes may be noticeable at birth and are most often on both hands and are usually symmetrical.

Nail-patella syndrome is associated with open-angle glaucoma, which, if untreated, may lead to blindness. The gene for NPS, which was just recently discovered, is located on Chromosome 9q34 and is called LMX1B. Patients may also have cataracts, drooping eyelids (ptosis), or corneal problems such as glaucoma. People with nail-patella syndrome may display only a few or many of the recognized signs of this disease. Symptoms vary widely from person to person. Signs even vary within a single family with multiple affected members. The incidence of nail-patella syndrome is approximately one in 50,000 births. This disorder affects males and females equally. It is found throughout the world and occurs in all ethnic groups. The strongest risk factor for nail-patella syndrome is a family history of the disease. The LMX1B gene codes for a protein that is important in organizing embryonic limb development. Mutations in this gene have been detected in many unrelated people with nail-patella syndrome. Scientists have also been able to interrupt this gene in mice to produce defects similar to those seen in human nail-patella syndrome.

Kidney problems are sometimes worsened by pregnancy, and women with no history of renal problems can also experience pregnancy-related kidney problems like toxemia and pre-eclampsia. Kidney problems (see entry, Kidney disease) can occur in people with NPS at any age. Absence or hypoplasia (underdevelopment) of the kneecaps (patella) and deformities of the knee joint itself often give them a “squarish” look. Ankle edema and recurrent urinary tract infections can also be manifestations of renal involvement. Other problems seen more frequently in NPS include Irritable Bowel syndrome, constipation and poor circulation in the hands and feet with occasional numbness and tingling. NPS does not affect intelligence but there may be a link with Attention Deficit.The most obvious sign associated with nail-patella syndrome is absent, poorly developed, or unusual fingernails. Fingernail abnormalities are found in over 80% of patients with this disorder. Abnormalities may be found in one or more fingernails. Only rarely are all fingernails affected. This disease most commonly affects the fingernails of the thumbs and index fingers. 

Nail Patella Syndrome Treatment and Prevention Tips

1. Treatment, when required, depends on each patient’s specific symptoms. Severe kidney disease is treated with dialysis or a kidney transplant. Patients receiving kidney transplants do not develop nail-patella type renal complications in their new kidney.

2. Although more than 90% of patients with NPS have patellar involvement, most patients are asymptomatic and rarely require surgical treatment.

3. Associated abnormalities require appropriate care from specialists.

4. Eye drops, pills, laser procedures, and surgical operations are used to prevent or slow further damage from occurring.

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