KSHUDRA KHUSTAS

IT IS BASED ON MINOR SKIN LESIONS .
REF: CHARAKA SAMHITHA

1. A CORRELATIVE STUDY OF CHARAKOKTA KSHUDRA KHUSTAS WITH MODERN SKIN DISEASES Presented by Dr . N.PADMA PRIYA, PG Scholar Guide: Dr.Praveen Kumar Madikonda, MD(BHU) , Associate Professor HOD: Dr. B. Johar, MD Dept. Of Panchakarma, Dr. B.R.K.R.Govt. Ayurvedic Medical College , Hyderabad, Telangana

2. Definition of Kushta 1. “kushnati angam” : one which causes despicable situation 2. “kushnati vapu iti kushtam”: the disease which causes discolouration of skin is termed as kushta 3. “kalenopekshitam yasmath sarvam kushnati tadvapuhu”: by the course of time, it makes entire body to look ugly or if timely intervention is not done, it causes disgraceful situation .

3. Pathogenesis:- The three vitiated doshas i.e vata, pitta and kapha in turn vitiates twak, rakta, mamsa and ambu. These taken together constitute seven fold pathogenic substances of kushta. In all types of kushta tridoshas involvement will be there but according to the predominance of dosha symptoms are visible. There are total 18 kushtas, out of which 7 are maha kushtas and the remaining 11 are kshudra kushtas . The details of kshudra kushtas are as shown below.

4. 1 Eka kushta : Dosa predominance – Vata kapha Signs and Symptoms: Aswedam – absence of sweating around the lesion Mahavasthu – the lesion is spread over an extended area of the skin or large lesions. Matsya shakala upamam – resemble the skin of fish This disease can be compared with following modern skin diseases:

5. Ichthyosis vulgaris - it is also called fish scale disease or fish skin disease - it is an inherited skin disorder in which dead cells accumulate keratin tissue in the form of thick, dry scales on the surface of the skin. - it can be present at birth but usually first appear during early childhood. Symptoms : Dry, scaly skin The colour of the scales can be white, dirty grey or brown Painful cracks present on the skin Acquired ichthyosis generally associated with other diseases like Cancer, Thyroid and Aids.

6. ICHTHYOSIS VULGARIS

7. B. Plaque psoriasis: - it is also called psoriasis vulgaris - it is a chronic auto-immune skin disease - plague psoriasis is a common type of psoriasis Symptoms : Raised, inflamed skin areas Lesions are irregular and oval in shape Well defined and sharply demarcated boundaries Dry, thin, silvery white scales Symmetric distribution of lesions Burning and itching sensation will be present Most of the times, it is associated with arthritis

8. PLAQUE PSORIASIS

9. C . Other diseases which forms plaques are Lichen simplex chronic – shows dirty, itchy oval flakes Differentiating symptom : plaques are in violate colour but not in silver colour. Pityriasis alba – shows a white plaque without erythema Differentiating symptom : these plaques appear only on the face. Syphilis – secondary syphilis scales resemble psoriasis and it also called ‘psoriasis form plaques ’. Differentiating symptom : Serological test only Teniapedis – sometimes resemble psoriasis but plaques are infiltrated, erythematous, hyper keratotic Differentiating symptom : shows central healing of plaques .

10. Allergic contact dermatitis – in chronic conditions it resembles psoriasis but plaques are dry, itchy, erythematous Differentiating symptom : scales appear in yellow/orange in colour Sub acute SLE – resembles psoriasis but plaques are less scaly, firmly adherent in nature Differentiating symptom : scales appear in bright red in colour

11. 2. CHARMAKYAM Dosa predominance – Vata kapha Signs and Symptoms: - Bahalam – the afflicted part of skin in charma kushta is thick - Hasti charmavat – skin resembles the skin of an elephant This disease can be compared with following modern skin diseases: (A) SCLERODERMA : - refers to a range of disorders in which the skin and connective tissues become harden and tighten. - it is a long term progressive disease

12. - it is also taught to be an auto immune condition in which bodies own immune system attacks the body tissue - this results in over production of collagen, the protein that forms the basis of connective tissue, the result is thickening, fibrosis and scarring of tissues - it is of two types.. Systemic and local. Systemic scleroderma : it is sometimes known as CREST syndrome C – calcinosis – calcium deposits in tissues and under the skin R – Raynaud’s phenomenon E – esophageal dysfunction S – sclerodactyly – thick skin on the finger T – Telangiectasia – enlarged blood vessels with red spots

13. Circumscript scleroderma : - it is a disease limited to skin - it consists one or more circumscribed oval plaques - Borders of the plaques presenting inflammatory signs i.e white colour inside and red colour outside called ‘lilac ring’ or ‘morphea’ - in the course of disease, sclerotic patch ends into hypo or hyper pigmented atrophy and lesions are asymmetric in nature usually located more on trunk less on extremeties. - scleroderma en coup de sabre – unilateral linear involvement of head and face Other associated symptoms: - intra cerebral inflammation - epilepsy, other neurological abnormalities

14. SCLERODERMA

15. ( B) PACHYDERMA The main symptom is thickening of skin In this disease skin of patient resemble skin of elephant, rhinoceros, hippopotamus . This is caused by congenital enlargement of lymph vessel or lymph vessel obstruction. (C) ELEPHANTIASIS NOSTRUM VERRUCOSA It is a cutaneous condition, a final hypertrophic fibrosis followed by a long standing lymphangitis. In this disease skin looks rough nodular or wart like plaques like elephant skin. commonly effected areas are lower limbs and scrotum

16. PACHY DERMA ELEPHANTIASIS NOSTRAS VERRUCOA

17. ( D) ELEPHANTIASIS OR FILARIASIS A human disease caused by parasitic worm known as Wuchereria Brancrofti , Symptom: marked swelling in lower limbs and genitalia , ears and mucous membrane. Skin becomes thicker like elephant skin. This was first diagnosed mosquito born disease. Elephantiasis leads to marked swelling of the lower half of the body and thickening of skin due to inflammation and blockage of lymphatic vessels. Diagnosis : Nocturnal peripheral blood smear

18. 3 Kitibha kushta Dosa predominance – Vata kapha signs and symptoms- shyavam-blackish brown discolouration of the skin. kina kara sparsham-rough on touch, give a feel of the scar of a wound. parusham-hard This disease can be compared with following modern skin diseases: (a) Guttate psoriasis - is a form of psoriasis that often starts in childhood and young adulthood. This is second most common type of psoriasis after plaque psoriasis. The name guttate psoriasis comes from the latin word guttate which means “Drop” . The condition has been given this name because of the small, red scaly patches, which are rough to touch and it looks like rain drops on the skin.

19. Even though it is an auto immune disorder, it is triggered by other factors. They include: URTI Streptococcal infection Tonsillitis Stress Injury to skin Hormonal disorders Genetic factors Environmental factors like pollution, etc

20. GUTTATE PSORIASIS

21. ( b) Actinic keratosis : It is also known as Solar Keratosis. Skin develops rough , scaly brown patches on the skin due long term exposure to the sun. Symptoms : Rough dry or scaly patches on the skin, usually less than one inch. Because of small size they are palpated more easily than visualised and have roughened quality on palpation. slightly raised patch or bump on the top layer of the skin. colour varies from pink. Red or brown. Itching and burning sensations are common signs in the effected areas. Common sites are : face, lips, ears, on the back of the hand, fore head, scalp and neck.

22. ACTINIC KERATOSIS

23. 4 Vipadika Dosa predominance – Vata kapha Signs and symptoms: Pani pada sputanam- cracks in the palms and soles. Teevra vedanam- severe pain This disease can be compared with following modern skin diseases: Plantar palmar psoriasis: It is an auto immune condition. It can occur as a part of more like general plaque psoriasis. simultaneously effects both hands and feet or alone

24. Symptoms : well defined areas of raised, thickened skin. redness and scaling. cracking and bleeding. Itching and burning sensation. some times pustules may also present. Risk/Triggering factors : House hold work farm work manual labour exposure to chemicals and physical irritants like detergents etc

25. PLANTAR PALMAR PSORIASIS

26. Associated diseases or High chances of getting plantar palmar psoriasis are: Thyroid disease Arthritis Type -1 diabetes Gluten sensitivity Streptococcal tonsillitis (b) Palmo plantar pustulosis: It is an auto immune disorder It causes blisters like sores on palms and soles It can also cause cracked skin or red colour scaly patches with severe pain

27. PLANTAR PALMAR PUSTULOSIS

28. ( c) Palmo plantar eczema or Dry hidrotic eczema: Symptoms- Deep seated blisters on the edges of the fingers and toes when blisters dry they turn into cracks Other symptoms include; scaly cracked skin Itching Redness Flaking severe pain most common in women associated with seasonal allergies, mostly in spring season

29. PALMO PLANTAR ECZEMA

30. Triggering factors: Pollen grains stress Excessive sweating Prolonged contact with water Nickel contact like contact with jewellery, cell phones etc Cobalt contact like contact with dish wash bar, paints , varnishes etc (d) Plantar palmar keratoderma/ Keratosis palmaris et plantaris: Kerato derma is a term that means marked thickening of the skin on the palms and soles. This is mainly of 4 types:

31. Diffuse keratosis – effects mostly palm and soles. Focal keratosis – mainly effect pressure areas Punctate type of keratoderma - tiny bumps on the palms and soles. Inflammatory keratoderma - an inflammatory skin condition like eczema or psoriasis etc . 5. ALASAKA : Dosha predominance – vata kapha Signs and Symptoms: Gandaihi – boils Raga – reddish colour Kandu -itching sensation

32. This can be compared with tenia infection: Tenia is the name of group of diseases caused by a fungus, tenia is often called ‘ring worm’ infection because of its circular ring like appearance Common symptoms – - scaly, crusted rash mostly appear as round and red patches on the skin - itching - blister like lesions - hair loss and scaling on the scalp Different type of tenia effect different areas of the body Type of tinea – affected area Tinea pedis – foot

33. Tinea unguium – nails Tinea manuum – hand Tinea cruris – groin Tinea corporis – body Tinea capitis – scalp Tinea facici – face Tinea barbae- beard Tinea inbricata – overlapping pattern Tinea nigra –uppermost layers of the skin in black colour Tinea versicolor – chest , neck, upper arm in various colours Tinea incognito – produced from previous tropical application of cortico steroid

34. 6 . DADRU MANDALA Dosha predominance – pitta kapha Signs and Symptoms: Sa kandu – intense itching sensation over and around the patches Raga – redness Pidaka – eruptions or boils or nodules This disease can be compared with following modern diseases a. Purigo nodularis :- Purigo nodularis is a skin disease that causes_ Hard itchy lump or nodules on the skin Pruritis or itching can be intense

35. Scratching leads to pain, bleeding and formation of secondary skin lesion. Itching worsened by heat, sweating or irritation from clothing Usually appear on the arms or legs Some times it may be associated with Atopic dermatitis Lymphoma HIV infection Severe anaemia Kidney disease

36. PURIGO NODULARIS

37. 2. Lichen planus :- A chronic inflammatory and auto immune skin disease which resembles plant lichen. Lichen is a simple slow growing plant that typically forms low crusty, leaf like growth on rocks, walls and trees. Lichen planus a skin disease in which small, hard, round lesions occur close together, which effects the skin, nails, hair and mucous membrane Symptoms :- it is characterised by polygonal, flat topped violaceous papules Pruritis of varying severity Common sites :- inner fore arm Wrist ankle and sometimes genitalia

38. Triggering factors : Hepatitis-C Flu vaccine Certain chemicals and medicines etc. 7. CHARMADALA Dosha predominance – pitta kapha Signs and Symptoms : Raktam – redness around the boils Kandu – itching Rujaa – pain Dalati – erosion or cracks in the skin - Sphota - boils

39. Samsparsha asaha – tenderness, the person does not allow the afflicted part of the skin to be touched This disease can be compared with following modern skin diseases: Herpes simplex - It is an infectious disease caused by herpes simplex virus HSV-I causes oral herpes HSV-II causes genital herpes Symptoms:- Blisters Redness Pain and itching Tenderness Enlarged lymph nodes

40. Blisters and ulceration on genitalia Cold sores around the mouth (b) Herpangia it is a viral infection caused by entero virus-71 and echo virus Commonly effected age group 3-10 years Season – summer Symptoms:- Blisters appear in the mouth, usually in the back of throat and roof of the mouth Second common type Is hand-mouth foot disease which effects childrens hand and feet also Associated with pain and tenderness Fever, headache and loss of appetite.

41. HERPANGIA

42. (c) Herpes zoster It is also called as Shingle It is an inflammatory condition especially affecting and spreading along a nerve route Commonly effected nerve is trigeminal nerve commonly effected areas are thorax, head and neck Causative organism – varicella zoster virus Symptoms :- Blister formation Severe pain Itching Burning sensation Tenderness

43. Main diagnostic features are - rash develops on one side of midline of the body as a clear vesicles These small vesicles contains clear fluid and turns into pustules These pustules turns into ulcers finally they crust up as sores Complications :- Post herpetic neuralgia Herpes zoster opthalmicus myelitis Deafness, tinnitus Encephalitis Pneumonitis Hepatitis etc .

44. HERPES ZOSTER

45. ( d) IMPETIGO Impetigo is a bacterial skin infection caused by Staphylococcus and Strepto coccus bacteria It is more common in children than adults It is of two types: (1) Non Bullous type (2) Bullous type Common Symptoms : Small red coloured blisters or papules Dark or honey coloured crusts will form 0n bursting the pustules. Non Bullous type : This is more common type , caused by both strepto cocci a nd Staphylo cocci bacteria Initially forms small red papules similar to insect bites

46. These lesions rapidly evolve to small blisters and pustules Then finally scab over with a honey coloured crust Mainly seen around the nose and on the face less frequently effects arms and legs Bullous type: This form of impetigo is caused by Staphylo cocci bacteria These bacteria produce a toxin that reduces cell to cell stick ness causing separation between the two layers of skin i.e epidermis and dermis This leads to formation of blisters or bullae This blisters mainly appear on buttocks and trunk region. This bullae are fragile and contain clear yellow fluid

47. IMPETIGO NON-BULLOUS TYPE BULLOUS TYPE

48. The bullae are delicate and often break with the overlapping roof of the skin is lost leaving red raw skin with ragged edge A dark crust will develop during the final stages of disease. This crust will resolve with healing . 8. PAMA Dosha predominance – pitta kapha Signs and Symptoms :- Sweta, aruna, shyaava pidaka – eruptions or boils which are white, yellowish red, blackish brown in colour Kandu – itching This disease can be correlated with following modern diseases. Scabies :- It is a dermatologic condition caused by sarcoptes scabiei an eight legged microscopic mite

49. Scabies is a contagious disease can spread very easily from person to person through close physical contact. Effects almost all age groups especially low socio economic status people Symptoms : - Itching It is one of the most important symptoms of scabies It is often worse at night and can be most severe and intense Rash when the mite burrows into the skin it forms burrow tracks which are most commonly found in skin folds and resembles hives, bites, knots, pimples and patches with different colours which vary from silvery grey to brown. Most common colour of scales is grey .

50. SCABIES

51. These occur when infected areas are scratched by the person These open sores leads to impetigo. b) Atopic dermatitis (eczema) It is a condition which makes the skin dry and itchy It is a long lasting disease which may be associated with asthma and with hey fever It is common in children but can occur at any age Symptoms :- Dry skin Itching which is severe at night times Red, brown, greyish patches on the skin Small raised bumps which may leak fluids

52. ATOPIC DERMATITIS

53. Thick, cracked and scaly skin Sensitive and swollen skin formed by scratching 9. SPHOTA Dosha predominance - pitta and kapha Signs and Symptoms :- Spotaha – boils or eruptions Swetam – white colour skin around lesion Arunam – golden yellow or red colour skin around the boils Tanu twacha - skin over the lesion will be thin This disease can be compared with following modern skin diseases :

54. Chickenpox : It is an infectious disease caused by Vericella – Zoster virus It is highly contagious disease, it is airborne disease which spreads easily with cough and sneezes of infected person to others and also through contact Prodromal symptoms : Fever , Malaise Loss of appetite Headache , Tiredness Actual symptoms : Itchy rash with small fluid filled blisters for first few days. Blisters then turns into red papules which break out over several days. Finally forms crust and scabs

55. CHICKEN POX

56. Other symptoms : when it is associated with secondary bacterial infections, patient develops pain, warmth and tenderness Complications of Chickenpox : Pneumonia Inflammation of the brain Bacterial skin infections b) Pemphigus : It is a rare form of blistering auto immune disorder It causes blisters and sores on the skin and mucous membrane especially in the mouth and genitalia The blisters rupture easily, leaving open sores which may ooze and become infected It is of two types viz. Pemphigus Vulgaris and Pemphigus foliaceus.

57. Pemphigus Vulgaris : It usually begins with blisters in the mouth then on to the skin or genital mucosa These blisters are typically painful but do not itch It causes mouth ulcers Pemphigus foliaceus : Usually blisters begin on the chest, back and shoulders These blisters are more itchy than pain They do not cause mouth ulcers Complications: Secondary skin infections Sepsis , Malnutrition due to mouth ulcers

58. PEMPHIGUS VULGARIS FOLIACEUS

59. All types of Blisters can be compared with the condition sphota which is one of the “Kshudra Kushta” . Blister or bulla , when small it is called vesicle. It is a bubble of fluid which formed beneath a thin layer of dead skin. It contains fluid, a mixture of water and protein, that oozes from injured tissue. Usually involves top most layers of the skin , which peels quickly without forming a scar. Some external causes for blister formation: 1 friction- After a long walk , running , tight shoe , etc. 2 cold (frost bite)- when we are exposed to temperatures below freezing point , our blood vessels contract push blood away from extremities and forms a blister with extra cellular fluid.

60. 3 Heat- Burns and scalds form blisters on the skin ,even sun burns can cause blisters on the skin. 4 Chemicals- which on contact cause blisters .Eg strong acids, etc. (d) Some diseases which cause blisters: Herpes simplex Impetigo Herpes zoster Chicken pox Pemphigus Erysipelas Folliculitis Cellulitis, Dermatitis , etc. *Acute condition of all these blister forming diseases can be compared with the sphota , when these diseases are affected by secondary infections , they may turn into the condition like “ Charmadala ”.

61. 10. SHATARU Dosha predominance - pitta and kapha Signs and Symptoms :- Raktam – Redness around the skin Shyavam- Blackish brown or bluish black colouration around the lesion. Bhahu vrana – Multiple lesions Daha- Burning sensation Arati- Severe pain This disease can be compared with following modern skin diseases : Pyoderma Gangrenosum : It is an auto inflammatory disorder which spreads rapidly with painful ulcers. This is also known as neutrophilic dermatosis. Most of the time it is associated with IBS / Crohn’s disease , Rheumatoid arthritis, Hepatitis , Leukaemia , etc.

62. PYODERMA GANGRENOSUM

63. This disease usually starts suddenly at the site of minor injury. It may start as a small pustule, red bump or a blood blister. When skin of the blister breaks down , resulting in an ulcer. The edge of the ulcer is purple in colour and undermine. Several ulcers may develop at the same time. b) Poly arthritis nodosa: It consists of focal inflammatory nodules throughout the arterial wall It is more common in men and also in patients with active Hepatitis-B It is a multi system disease ,mainly causes a systemic necrotizing inflammation of blood vessels, typically involving the arteries of the kidneys which may also involves nerve and skin

64. Nerve – peripheral neuropathy includes tingling, numbness and pain in hands, arms, feet and leg Skin – purpura - Nodular formation - ulcers - gangrene mostly occur on leg with severe pain - fever, weight loss, joint pains - increased ESR - increased BP and proteinuria are main diagnostic features

65. POLY ARTHRITIS NODOSA

66. C) Leg ulcers: Leg ulcers are of mainly four types: Venous ulcers Arterial ulcers Neuropathic Diabetic ulcers Pressure ulcers Out of these four types “Venous ulcers” and “Arterial ulcers” can be compared with “Shataru”. Venous ulcers Arterial ulcers Other names: -Venous insufficiency ulceration. -Stasis ulcers -Stasis dermatitis Other names: -Ischemic ulcers -Ischemic wounds

67. Venous ulcer Arterial ulcer Varicose ulcers Ulcus cruris *Mostly associated with DVT and varicose veins. PAIN: Moderate pain , throbbing , aching and heavy feeling in the legs. Improves with the elevation and rest. ULCER: Shallow with flat margins Venous ulcers are typically wet with moderate to heavy exudate. *Mostly associated with PAD. PAIN: Severe pain , intermittent claudication Can be worse at night and rest. Improves with dependency. ULCER: Deep , punched out appearance Irregular in shape Presence of necrotic tissue which unhealthy appearance to the wound. Arterial ulcers are typically dry and scabbed with low exudate.

68. Venous ulcer Arterial ulcer The skin surrounding venous ulcers may be oedematous and there may be evidence of varicose veins. OTHER SYMPTOMS: Due to death of RBC’s red colour staining to the wound (Hemosiderin staining) Thickening and fibrosis of the skin. Dilated veins at the ankle. Crusty , dry hyper-keratotic , itchy skin. Eczematous skin . Pedal pulses present. Normal capillary refill , less than three seconds. The skin surrounding the arterial ulcers may be pale , cold , shiny and hairless. OTHER SYMPTOMS: Thin , shiny , dry skin Reduced or no hair on the lower leg. Skin feels cooler to touch. Pallor on leg elevation. Absence or weak pedal pulses . Delayed capillary refill greater than three seconds. Development of gangrene.

69. Venous ulcer Arterial ulcer LOCATION: Occurs on medial aspect of the leg , especially medial malleolus area . Gaiter area of the leg. COMMON CAUSES: Previous H/O DVT. Varicose veins. Obesity Pregnancy Reduced mobility. Previous vein surgery. LOCATION: Occurs on the lateral aspect of the leg , especially lateral malleolus , toes and feet. Over bony prominences. COMMON CAUSES: Diabetes Hypertension Smoking Obesity Reducing mobility Previous history of vascular disease.

70. 11. VICHARCHIKA Dosha predominance – kapha dosha Signs and symptoms: Pidaka – eruptions (boils or blisters) Shyava – blackish brown or bluish black colouration of skin around the lesion Bahu srava – excessive discharges or oozing Kandu – severe itching sensation This disease can be compared with following modern skin diseases: Eczema - It is not a single health condition but a recognisable reaction pattern seen in a number of skin diseases - It is a condition where patches of skin become inflamed, red, itchy, cracked and rough

71. Atopic dermatitis is a common type of eczema Symptoms :- Acute condition:- Tiny blisters containing fluid Blisters are red in colour Eventually produce crusted, thick plaques on the skin It is moderate itchy Chronic condition:- Blisters burst and ooze Blisters after burst turns into thick skin The thickened skin consists elevated crusts and scales

72. Chronic eczema is very itchy Atopic dermatitis when causes blisters that ooze, or weepy sores .weepy areas leak fluid, which is usually clear, when it presents with weepy sores, it may be called as wet eczema, weepy eczema, or weeping eczema , weepy sores can also be a sign of infection , which is more relevant condition to correlate with charakokta bahu srave vicharcika. There are 12 types of skin conditions that produce eczema Atopic dermatitis: This health condition has genetic basis, and produce common type of eczema. It is a condition which makes the skin dry and itchy It is a long lasting disease may be associated with asthma and hey fever It is common in children but can occur at any age Symptoms:- Dry skin Itching which is severe at night times Red, brown, greyish patches on the skin Small raised bumps which may leak fluids

73. WET ECZEMA

74. ii. Irritant dermatitis: It occurs when the skin is repeatedly exposed to excessive washing and toxic substances iii. Allergic contact dermatitis: It is a form of contact dermatitis that is the manifestation of an allergic response caused by contact with allergic substance . IV. Stasis dermatitis: It commonly occurs on the swollen lower legs of people who have poor circulation in the veins of the legs. v. Fungal infection: This can produce a pattern identical to many other types of eczema Fungus is visible on microscopic examination and in culture

75. DERMATITIS IRRITANT TYPE CONTACT TYPE FUNGAL TYPE STASIS TYPE

76. vi. Scabies : It is caused by an infestation by 8 legged microscopic itch mite and may produce rash very similar to other forms of eczema. vii. Pomphylox (Dys-hidrotic eczema): It is common but poorly understood health condition which classically effects the hand and occasionally the feet It produces an itchy rash with tiny blisters mainly on the sides of the fingers and toes and rarely on the palms and soles viii. Lichen simplex chronicus : It produces thick end plaques on the skin commonly found on shin and neck

77. SCABIES POMPHYLOX LICHEN SIMPLEX

78. ix. Nummular eczema : This is a non specific term for coin shaped plaques of skin. It is commonly noticed on the lower legs of older individuals. x. Zerotic eczema (dry skin): In this, the skin will crack and ooze due to excess dryness and appear as crazy paving It is seen usually on lower legs of elderly people More common in winter season It is extremely itchy xi. Seborrhic dermatitis : In adults rash appears on the scalp, face, ears and mid chest In infants it can produce weepy-oozy rash behind the ears and can be quite extensive involving entire body.

79. DERMATITIS NUMMULAR TYPE XEROTIC TYPE SEBORRHEIC TYPE

80. xii. Vericose eczema : It occurs on the lower limbs secondary to varicose veins Usually around the medial malleoli It presents with leakage of blood, activation of inflammatory cells and fibro blasts It also shows lipodermato sclerosis and more pigmentation often seen