Actinic keratosis is most effectively treated

Actinic keratosis—Overview

Actinic keratosis (AK), also called solar keratosis, is a precancerous skin condition caused by prolonged sun exposure. Untreated, rough, scaly patches on sun-exposed areas such as the face, head, ears, lips, forearms, and hands can develop into squamous cell carcinoma. The patches may appear pink, crimson, brown, or flesh-colored. Due to sun exposure, it usually develops in individuals over 40. AK is not contagious.

Actinic keratosis face, head

Possible Risks

Possible risks include outdoor work, tanning beds, and chronic sun exposure.
Light hair, eyes, and skin minimise melanin protection.
Over 40.
HIV and organ transplant recipients are immunosuppressed.

Location:

This condition is more common in sunny climates, such as in South Indian states like Tamil Nadu, where UV exposure is intense.

Possible Issues

If left untreated, 5–10% of AKs develop Squamous Cell Carcinoma (SCC)
Cosmetic issues: Face/scalp patches might impact appearance.
Field cancerization: Multiple AKs imply broad solar exposure.

Diagnosis

Clinical exam: Dermatologists examine patients visually and tactilely.
If the lesion suggests invasive cancer, biopsy.

Ways to prevent

For sun protection, use broad-spectrum sunscreen (SPF ≥30), protective clothes, and helmets.
Stay away from tanning beds.
Patients with AK who are at high risk or have multiple cases should have regular skin checks.
Early treatment can prevent skin cancer.

What causes actinic keratosis?

Main Actinic Keratosis Causes

Long-term UV exposure

Sunlight: The main reason. UV radiation damages keratinocyte DNA through the skin.
Tanning beds and lights emit UV.

Long-term damage

The cumulative effects of daily outdoor activities mount up over decades.
Years of exposure cause lesions, not one sunburn.

Increased Susceptibility Risks

Fair skin, light hair, and light eyes have less melanin.
Over-40s are the most common.
They typically reside in bright or high-UV areas such as South India and Australia.
Job: Outdoor workers (farmers, builders, fishers).
Chronic immunosuppression: Organ transplant recipients or immunosuppressive medication users.
UV exposure causes DNA mutations in skin cells.
Damaged epidermal cells provide rough, scaly areas.
Untreated lesions can become squamous cell cancer.

Can actinic keratosis become cancerous?

AK is a precancerous lesion that, in some cases, can progress to cancer.

Cancer Progression Risk

AKs can lead to Squamous Cell Carcinoma (SCC), a prevalent skin disease.
Studies predict that 5–10% of untreated AKs may develop SCC.
Multiple AKs (field cancerization), lip lesions (actinic cheilitis), or immunosuppression (transplant patients) increase risk.

BCC/Melanoma:

Although AKs don't cause these malignancies, their existence indicates significant UV damage, which raises skin cancer risk.

Malignant Transformation Warning Signs

A thicker, sensitive, or painful lesion is a warning sign of malignant transformation.
Rapid expansion or ulceration.
Unhealing bleeding or crusting.
The condition is compared to the firmness of the adjacent skin.

Monitoring & Prevention

Early AK therapy greatly decreases cancer risk.
If you have several lesions, see a dermatologist regularly.
Protection from the sun (SPF ≥30, hats, clothing) is the best strategy to avoid new AKs and lower progression risk.

Also, read https://dermnetnz.org/topics/actinic-keratosis.

Who is most at risk for actinic keratosis?

High-risk Actinic Keratosis groups

1. Genetics, Skin Type

Fair complexion, light hair, and light eyes result in reduced UV protection due to melanin.
Skin cancer risk increases with family history and genetic predisposition.

2. Age

Risk increases with accumulated sun exposure for individuals over 40.
AKs are rare in youngsters but widespread in middle-aged and elderly individuals.

3. Solar exposure

Outdoor workers such as farmers, builders, fishers, and athletes are susceptible to solar exposure.
Solar exposure also affects people who live in bright climates or near the equator, such as in South India or Australia.
People may have a history of sunburn or exposure to tanning beds.

4. Immune State

Individuals who are on immunosuppressants following an organ transplant are a prime example.
HIV-positive or immunocompromised people.
Reduced immune surveillance lets aberrant cells proliferate unrestrained.

5. Other Risks

Men are more harmed owing to outdoor work and less sunscreen application.
Bald or thinning hair: Increases UV exposure.
Unprotected sunbathing, gardening, sports, and leisure activities increase UV exposure.

Common Actinic Keratosis Symptoms • Texture:

The affected areas may be rough, dry, or scaly, exhibiting a harsh texture. • These regions may exhibit a crusty texture or feature a prominent bulge resembling horns. • Color: red, pink, tan, brown, silvery, or skin-colored. • The color can manifest as discoloured patches or blend in with the surrounding skin. • Size: • The size can vary from a small spot to a diameter of 1 inch (2.5 cm). • Shape and Surface: • Flat or slightly elevated. • Over time, the surface may harden and develop a wart-like appearance. • Location: • Chronic sun exposure areas: face, scalp, ears, lips, neck, shoulders, forearms, and backs of hands. • Progress: • Lesions develop gradually over months to years. • Progressing squamous cell carcinoma may cause thickening, tenderness, or bleeding.

Warning Signs of Medical Concern ·

The tumour may grow quickly or undergo a rapid size shift. • Pain, soreness, or itching. • Ongoing bleeding or ulceration. • The skin appears firmer in comparison to the surrounding skin.

Is the actinic keratosis resolved?

Untreated actinic keratosis (AK) often persists, recurs, or worsens.

Natural Actinic Keratosis Course
Persistence: AK lesions typically stay on the skin without treatment.
Spontaneous Regression: AKs may temporarily fade or disappear when sun exposure is minimised.
The sun damage keeps them from disappearing, so they regularly return.
Untreated AKs can progress to squamous cell carcinoma (SCC) at a rate of 5-10%.
No one can anticipate which lesions will become malignant.

Reasons to Treat

Dermatologists proactively treat precancerous AKs.
Removing them minimises SCC risk and enhances attractiveness.
Cold therapy, topical creams (5-FU, imiquimod, and diclofenac), photodynamic therapy, and laser therapy are used.

Long-term care and prevention

Provide consistent sun protection (SPF ≥30, caps, clothes).
Check skin for new lesions regularly.
Lifestyle changes: Stop using tanning beds and limit noon sun.

How to treat toddler keratosis?

Bathe warmly, not hotly. Use a gentle, soap-free body and face wash. Apply a light moisturizer multiple times a day.

Treating actinic keratosis

The Main Treatments

1. Freezing therapy

Liquid nitrogen is used to freeze and destroy abnormal cells.
Ideal for: Few lesions.
Quick, effective, and low-downtime.
Cons: Possible redness, blistering, or hypopigmentation.
Recurrence: 24% within 12 months if sun exposure continues.

2. Topically applied drugs

5-Fluorouracil (5-FU) cream destroys aberrant cells.
Imiquimod: Boosts the immune system attack on damaged cells.
Diclofenac gel: Milder, slower anti-inflammatory.
Ingenol mebutate: Fast but rarely used.
Best for: Multiple lesions or “field cancerization” (widespread UV damage).
Cons: Treatment may cause redness, inflammation, and peeling.

3. Photodynamic Therapy

A light-activated medication is applied to skin and exposed to specific light.
This treatment is specifically designed for larger areas that have multiple AKs.
Pros: Cosmetically effective, cures visible and unseen lesions.
Cons: Clinic visits, transient pain/redness.

4. Surgery Choices

Curettage and electrocautery: Lesion removal.
Abnormal cells vaporise under laser therapy.
This treatment is particularly effective for thick, resistant lesions.

5. Self-Care, Prevention

Use sunscreen (SPF ≥30) daily on exposed skin.
Protective gear, caps, and sunglasses.
Avoid tanning beds and the noon sun.
Regular dermatology exams should be conducted at least annually following therapy.

Brief Summary

Precancerous actinic keratosis demands active treatment. The most common first-line treatment is cryotherapy, whereas topical creams and photodynamic therapy treat extensive lesions. Sun protection is crucial to preventing recurrence.

Conclusion

Long-term sun exposure causes actinic keratosis (AK), a common precancerous skin disease. Sun-exposed areas develop rough, scaly patches that indicate skin injury. AKs can develop squamous cell carcinoma, so early identification and treatment are crucial.

Prevent, treat, and control actinic keratosis. Consistent sun protection and early medical care work best. AKs are a symptom of cumulative sun exposure, so patients may protect their skin and lower cancer risk.

Kaposi sarcoma cancer treatment guidelines

Kaposi's Sarcoma—Overview:

Kaposi's Sarcoma (KS), a rare malignancy caused by Human Herpesvirus 8 (HHV-8), usually appears as purple, red, or brown skin lesions but can also infect the lungs and gastrointestinal tract. Kaposi's Sarcoma is a type of cancer that affects the lining of blood and lymph vessels. It is strongly connected to reduced immunity, notably in HIV/AIDS and immunosuppressive therapy patients. HIV/AIDS (KS). Patients are often prescribed immunosuppressants following an organ transplant. Elderly males from the Mediterranean/Eastern Europe typically have HIV/AIDS (KS), while sub-Saharan Africans have endemic KS.

Kaposi sarcoma

Symptoms

Skin lesions: Painless purple, red, or brown spots, plaques, or nodules.
Mucosal lesions may appear on the mouth, nose, or anus.
Internal Involvement: Lung or digestive system lesions can cause respiratory problems, bloody coughs, and GI bleeding.

What causes Kaposi sarcoma?

Kaposi sarcoma (KS) is caused by infection with the Human Herpesvirus 8 (HHV-8, also known as KSHV), but not everyone infected with HHV-8 develops KS. The virus needs cofactors like immune suppression to transform cells into cancerous ones, affecting the skin, lymph nodes, and internal organs.

What are the four Kaposi sarcoma types?

Four forms of Kaposi's Sarcoma (KS) are associated with various populations and risk factors:
Traditional KS: Slow, skin-focused older males.
Aggressive African KS can affect children.
Epidemic KS: HIV/AIDS-related, widespread, and expanding.
Often reversible, immunosuppressive therapy causes KS.

How does Kaposi sarcoma spread?

Kaposi's Sarcoma (KS) spreads differently depending on the type and the patient's immunological condition. A breakdown:

Key spread factors

Low immunity (HIV/AIDS, immunosuppressive therapy) promotes spread.
Effective HIV antiretroviral therapy (ART) can stop or reverse KS development.
Internal organ involvement indicates a more aggressive illness; skin-only KS is slower.
Compared to younger, immunocompromised patients, older classic KS patients progress more slowly.

Classic KS: Slow, indolent.

AIDS-related KS: Rapid, life-threatening.
Adjustments to immunosuppressive therapy cause KS.
Kaposi's Sarcoma can range from indolent (developing over years) to aggressive (expanding within months), with HIV-related KS spreading fastest.

Also, read https://emedicine.medscape.com/article/279734-treatment?form=fpf.

Can Kaposi sarcoma be prevented?

Kaposi's Sarcoma (KS) is connected to Human Herpesvirus 8 (HHV-8); however, the best prevention methods focus on immune system health, specifically HIV control and immunosuppressive medication use.

Important Prevention Methods

1) HIV/AIDS Management

The most effective strategy to avoid epidemic (AIDS-related) KS is consistent ART use. ART improves immunity and greatly reduces KS risk.
HIV testing and early treatment: Early HIV detection and ART reduce KS risk.

2. Immunosuppression reduction

If KS develops, transplant doctors may alter or reduce immunosuppressive medicines.
Use immunosuppressive drugs under physician supervision to avoid unnecessary long-term use.

3. General Immune Health

Healthy lifestyle: Balanced food, exercise, sleep, and stress management boost immunity.
Avoiding co-infections like tuberculosis and hepatitis reduces immune strain.

4. Know HHV-8

Transmission: Saliva, sexual contact, and potentially blood spread HHV-8.
Safe practices: Protecting sexual activity and not sharing toothbrushes or razors can reduce risk.
Geographic risk: HHV-8 is more prevalent in sub-Saharan Africa and the Mediterranean; awareness is crucial.

Controllable Risks

Untreated HIV infection represents the highest risk for KS.
Long-term immunosuppression increases risk.
Weakened immunity from poor health or co-infections promotes KS development.

Who has the highest sarcoma risk?

Certain genetic disorders, past radiation therapy, chemical exposure, chronic lymphedema, and weakened immune systems increase sarcoma risk. Sarcoma risk is not highly connected to diet or smoking.

Major Sarcoma Risk Groups

1. Genes and heredity

TP53 mutations cause Li-Fraumeni syndrome.
Familial retinoblastoma (RB1 mutations)
Type 1 neurofibromatosis
Werner syndrome (early ageing)
These disorders enhance bone and soft tissue sarcoma risk.

2. Radiation/chemotherapy history

Radiation for other malignancies can increase sarcoma risk years later.
Secondary sarcomas are linked to alkylating chemotherapy medications.

3. Chemical Encounters

Vinyl chloride, dioxins, arsenic, and pesticides increase sarcoma risk.
In chemical industries, occupational exposure is a risk.

4. Chronic Lymphedema

Chronic limb swelling following breast cancer surgery or radiation can lead to lymphangiosarcoma, a rare sarcoma subtype.

5. Immunosuppression

Individuals who are taking immunosuppressants following an organ transplant are also at risk.
HIV/AIDS patients, particularly those suffering from Kaposi's Sarcoma, also face this risk.

Disconnected Groups

Lifestyle factors such as smoking, eating, and exercising do not increase the risk of developing sarcoma.
Sarcoma is not caused by trauma, but tumors may appear after an injury.

Practical Tip

People with genetic cancer syndromes, radiation/chemo, chemical exposure, chronic lymphedema, or immunological suppression are most at risk.
General population: Sarcoma is infrequent and usually risk-free.

How is sarcoma diagnosed?

Stepwise clinical evaluation, imaging, and biopsy are needed to diagnose sarcoma. Sarcomas are rare and can look like benign masses; thorough diagnosis is necessary.

Common Diagnostic Steps

1 Clinical Exam

Patients describe lumps, swelling, discomfort, or inexplicable symptoms.
Physical exam: Doctors evaluate mass size, position, depth, and growth rate.
Rapidly developing, deep-seated, or painful masses are suspicious.

2. Imaging Studies

MRI is the preferred method for diagnosing soft tissue sarcomas, as it provides information on the size, depth, and proximity to adjacent tissues.
CT scan: Used for lung metastases and bone sarcomas.
Ewing's and osteosarcomas benefit from X-rays.
PET Scan: Used to assess spread or therapy response.

3. Biopsy (final diagnosis)

Core needle biopsy: Preferred; minimally invasive but delivers pathologic tissue.
If needle biopsy fails, incisional biopsy is used.
Excisional biopsy: For tiny, readily removed lesions.
Pathology: Cell morphology and markers confirm sarcoma.

4. Laboratory/Molecular Tests

Immunohistochemistry classifies sarcoma subtypes using particular proteins.
Genetic testing: Finds Ewing's sarcoma's EWS-FLI1 chromosomal translocation.
Although not diagnostic, blood testing can assist measure health before therapy.

5. Staging

Upon diagnosis, clinicians stage sarcoma using:
Tumor depth and size
Spread to lymph nodes or distant organs (lungs)
Depends on how aggressive the cells are histologically

Treatment Choices

The video about causes and treatment for Kaposi sarcoma

Antiretroviral Therapy (ART): First-line HIV-related KS treatment; immune function recovery decreases lesions.
Local treatments: Surgery, cryotherapy, or radiation for lesions.
Systemic therapy: Liposomal doxorubicin, interferon-alpha, or immunotherapy for disease dissemination.
Manage bleeding and respiratory issues with supportive care.

The prognosis varies depending on the immunological status and the severity of the disease.

ART helps HIV-related KS; relapse is probable.
Classic KS: Slow-growing and controllable.
Endemic KS: Aggressive, especially in kids.

Conclusion

Sarcomas are rare, diverse malignancies that affect connective tissues such as bone, muscle, fat, and blood vessels. Kaposi's Sarcoma (KS) is distinct since it is caused by HHV-8 and is connected to immunological suppression.

Kaposi's Sarcoma demonstrates the importance of the immune system in cancer development. Stimulating immunity by HIV therapy, medical management, or a healthy lifestyle is key to prevention and control. Early detection and customized therapy improve outcomes.

Facts about postural orthostatic tachycardia syndrome

Facts about Postural Orthostatic Tachycardia Syndrome

POTS—Overview.

Postural Orthostatic Tachycardia Syndrome is a chronic autonomic nervous system condition that causes an abnormal increase in heart rate (≥30 bpm in adults, ≥40 bpm in adolescents) within 10 minutes of standing, without a significant reduction in blood pressure. It is becoming more common worldwide. Orthostatic intolerance is distinguished by increased heart rate, dizziness, fatigue, and palpitations when standing. The condition is characterized by a dysfunction in the autonomic control of blood flow and heart rate.

Criteria for diagnosis:

Within 10 minutes of standing or tilt-table testing, the heart rate increases by at least 30 bpm in adults and 40 bpm in adolescents.
There is no orthostatic hypotension (a decrease in systolic or diastolic blood pressure of ≥20 mmHg).
Measure heart rate and blood pressure with a tilt-table or active stand test.
Rule out other causes: Dehydration, blood loss, or orthostatic hypotension

Who is affected?

Demographics: Predominantly affects women aged 15-50.
Associated Conditions: Possible after viral infection, trauma, surgery, or pregnancy. This condition is often associated with autoimmune diseases, Ehlers-Danlos syndrome, and CFS.

Management and Treatment

Lifestyle changes:
Increased hydration and salt intake.
Utilize compression stockings for better circulation.
Implement gradual exercise programs such as recumbent cycling and swimming.
Beta-blockers (heart rate reduction).
Fludrocortisone is used to increase blood volume.
Midodrine improves vascular tone.
With no cure, care focuses on symptom control and everyday function.

Risks and Factors Misdiagnosis risk: POTS is commonly misdiagnosed as anxiety, persistent fatigue, or dehydration.

Long-term impact: Can drastically reduce quality of life, although not life-threatening.
Research gaps: The cause of POTS is uncertain, and ongoing investigations are exploring autoimmune and genetic factors.

Can POTS be cured?

There is no cure for POTS. Many people see significant improvement with lifestyle modifications, medications, and physical training, and some symptoms may disappear.

Can POTS Go Away?

No standard treatment eliminates POTS permanently.
Proper care can reduce symptoms and perhaps induce remission. Some individuals with POTS experience symptoms for a lifetime, while others may improve after months or years, particularly if their symptoms developed following a viral illness or surgery.

Medications:

Beta-blockers (lower heart rate).
Increase blood volume using fludrocortisone.
Midodrine promotes vascular tone.
Ivabradine (Corlanor) could reduce tachycardia without lowering blood pressure off-label.

POTS symptoms

Standing upright causes POTS symptoms, including rapid heartbeat, dizziness, fainting, weariness, and “brain fog.” These symptoms range in severity and may have an impact on daily life.

Key Symptoms of POTS:

Cardiovascular:
Rapid heartbeat within 10 minutes of standing
Palpitations or pounding heart, Chest discomfort, Neurological:
Dizziness or lightheadedness, Syncope or near-fainting episodes, Concentration issues (brain fog)
Headaches

General/Systemic:

Excessive weariness and exercise intolerance
Leg weakness • Nausea, bloating, or abdominal pain • Sweating irregularities
Other features:
Symptoms intensify in hot weather due to heat intolerance.
Acrocyanosis (bluish staining of feet/hands when standing) • Sleep disruptions

Symptom Causes

• Prolonged standing (queues, showers, cooking) • Heat exposure (summer weather, hot baths) • Dehydration • Stress or illness • Sudden postural changes

Causes

Autonomic nerve system failure causes Postural Orthostatic Tachycardia Syndrome (POTS), which affects heart rate and blood flow when standing. It commonly follows viral infections, autoimmune diseases, trauma, or genetic connective tissue problems.

The main causes and contributing factors are:

1. ANS dysfunction

The autonomic nervous system fails to regulate blood vessel constriction and heart rate adequately.
Excessive tachycardia occurs when standing, without the typical blood pressure decline of orthostatic hypotension.

2. Abnormal blood volume

Patients with hypovolemia may have lower circulating blood volume.
The legs and abdomen may experience blood pooling, resulting in decreased blood return to the heart and compensatory tachycardia.

3. Autoimmune Links

POTS is linked to autoimmune illnesses such as lupus, Sjögren's syndrome, and Hashimoto's thyroiditis.
Autoantibodies can disrupt autonomic nerve signals.

4. Genetic/Connective Tissue Disorders

Ehlers-Danlos syndrome (EDS): Weak connective tissue causes excessive blood pooling.
Familial predisposition: Possible hereditary influence.

5. Post-Viral or Post-Traumatic Onset

Patients often experience POTS symptoms after:
Viruses like Epstein-Barr and COVID-19 often cause POTS symptoms.
Surgery, trauma, or pregnancy.

6. Other Contributors

Prolonged bed rest or inactivity might increase signs of deconditioning.
Hormonal factors: Most prevalent in women, suggesting estrogen/progesterone involvement.
Neuropathy may cause POTS by damaging tiny nerve fibers that govern blood vessel constriction.

Key Notes

POTS is multifaceted, with no single etiology explaining all cases.
The cause is generally a combination of autonomic dysfunction, blood pooling, autoimmune activity, and hereditary predisposition.
Knowing the cause helps create personalised treatments, like increasing blood volume for low blood levels, using compression garments for blood pooling, and adjusting the immune system for autoimmune-related POTS

Treating POTS

The video about how PTOS is treated

Lifestyle adjustments, physical training, and drugs to minimize symptoms, including rapid heartbeat, dizziness, and exhaustion, are used to treat Postural Orthostatic Tachycardia Syndrome (POTS). A structured management plan is beneficial for most patients.

Also, read https://www.dysautonomiainternational.org/page.php?ID=30

Main Treatment Methods

1. Lifestyle changes

Hydrate and salt: Increase fluid intake (2-3 litres/day) and dietary sodium (3-10 g/day, under medical advice) to increase blood volume.
Compression Garments: Waist-high stockings or abdominal binders minimize leg blood pooling.
Exercise Therapy: Start with recumbent or semi-reclined exercises (e.g., rowing, swimming, cycling) and graduate to upright activities.
Posture Strategies: Reduce prolonged standing, rise slowly, and utilize physical counter-maneuvers (leg crossing, muscle tensing).

2. Symptom-based Heart Rate Control: • Beta-blockers (e.g., propranolol, metoprolol) are recommended.

Ivabradine (off-label, decreases heart rate without reducing blood pressure)
Support for blood pressure and circulation:
Fludrocortisone (blood volume increase)
Midodrine (increases blood vessel tightness and standing tolerance)
Autonomic Modulation:
SSRIs and SNRIs are used to treat anxiety and autonomic dysfunction.
Pyridostigmine (boosts parasympathetic activity)

3. Physiotherapist-supervised graded exercise regimens enhance cardiovascular fitness.

Begin with horizontal workouts and gradually graduate to upright training.

4. Helpful Things

Adjusted diet: Smaller, frequent meals to prevent postprandial symptoms.
Ensure temperature management by avoiding hot situations and showers.
Sleep hygiene: Restful sleep enhances autonomic stability.

Risks and Factors

Each patient responds differently to therapies, requiring individualized programs.
Side effects of medications: Beta-blockers may induce weariness, fludrocortisone may increase blood pressure, and midodrine may cause goosebumps or urinary retention.
POTS misdiagnosis: Commonly misdiagnosed as worry or persistent exhaustion, delaying treatment.
Long-term prognosis: Although treatment often results in improvement, relapses are possible.

Life expectancy with POTS

Chronic, non-fatal Postural Orthostatic Tachycardia Syndrome (POTS) rarely shortens life. Most patients have a favorable long-term outlook, even if it can produce severe symptoms like COPD or congestive heart failure.

Conclusion

Postural Orthostatic Tachycardia Syndrome, a complicated, multivariate autonomic nervous system illness, mostly affects young women but can impact anyone. It causes dizziness, weariness, palpitations, and cognitive issues due to an irregular heart rate spike when standing. POTS is controllable, not curable, and many individuals regain independence and stability with proper treatment.

Perioral Dermatitis: A Guide to Cure the Skin

Describe Perioral dermatitis.

Chronic inflammatory perioral dermatitis creates a red, bumpy rash around the lips, sometimes spreading to the nose and eyes. It manifests as clusters of tiny papules or pustules over redness and scaling and is often associated with topical steroid usage, cosmetics, or skin irritants.

Key Perioral Dermatitis Features

The condition is characterised by a scaly, flaky, red rash accompanied by pustules. It may involve the nose, eyes, and forehead. Particularly the lips. The skin may experience burning, itching, or tightness. Vermillion borders are frequently spared by the rash.

Causes and Risks

Most common trigger: topical corticosteroids.
Heavy cosmetics and moisturisers can clog pores.
Use fluoridated toothpaste or dental products.
Hormonal changes can occur due to the use of oral contraceptives, for example.
Environmental factors include UV exposure and stress.
Rare triggers, such as chewing gum, have been reported.

How does perioral dermatitis look?

Small red lumps, occasionally with pus, surrounded by inflammatory, flaky, or scaly skin around the mouth, nose, or eyes, are typical of perioral dermatitis. The vermillion border of the lips is generally spared, distinguishing the rash from other disorders.

Typical Look

Red papules or pustules: Small lumps that resemble acne but are not real pimples.
Background redness: Skin around pimples may appear irritated.
Dryness or scaling: Rashes may have flaky spots.
Distribution: • Mostly around the mouth.
The rash has the potential to affect the nose, chin, or eyes.
Lip sparing: The rash typically does not affect the lip surface.

What causes perioral dermatitis?

Usually induced by topical corticosteroids on the face, perioral dermatitis can also be caused by cosmetics, heavy moisturisers, fluoride toothpaste, hormonal changes, and environmental irritants, including UV exposure or wind. The key to controlling the illness is finding and eliminating these triggers.

Main causes and triggers

Topical corticosteroids
The most common cause. Even moderate OTC hydrocortisone creams can cause it.
Stopping steroids may exacerbate the rash before improving.
Heavy products like balms, oils, primers, and moisturizers can clog pores and cause irritation.
Common offenders include fragrance, essential oils, alcohol-based toners, and harsh scrubs.

Dental products

Use toothpaste that contains fluoride or tartar-control agents.
Strongly flavoured toothpastes (spicy or minty) may cause flares.
Environmental considerations
Sun exposure, wind, and inadequate photoprotection might aggravate symptoms.
Climate change and stress may contribute.
Hormonal factors: Oral contraceptives and hormonal variations might cause flare-ups.
Unusual triggers
Chewing gum is rarely cited as a cause.

Possible Risks

The condition is more common in women aged 20-45.
Skin type: Sensitive or reactive skin enhances sensitivity.
Medical history: History of topical steroids or chronic skin disorders.

Who suffers from perioral dermatitis?

Men and children can get perioral dermatitis, but women between 20 and 45 are most likely.

Standard Affected Groups

Adult women aged 20-45 years are more susceptible to the condition, likely due to their increased use of topical corticosteroids, cosmetics, and hormonal factors.
Children may develop perioral dermatitis if topical steroids are applied to the face.
Men: Rare but possible—often associated with shaving products, steroid creams, or dental irritants.

Possible Risks

Use of topical corticosteroids, even modest hydrocortisone, may pose a risk.
The use of cosmetics, such as moisturizers, makeup, and occlusives, can also pose potential risks.
Dental products such as fluoridated or tartar-control toothpaste are also commonly used.
Hormonal changes can occur due to the use of oral contraceptives and fluctuations in the menstrual cycle.
Environmental factors: UV exposure, wind, and stress.
Skin type: Sensitive or reactive skin enhances sensitivity.

Is perioral dermatitis contagious?

Perioral dermatitis will not spread.

Why Not Contagious

Inflammatory condition: Caused by irritation, steroid usage, or other triggers, not by contagious bacteria, viruses, or fungi.
No person-to-person transmission: It cannot be spread through touch, utensils, or close contact.
Each occurrence is linked to personal characteristics such as skincare products, toothpaste, or hormonal changes.

Important Note:

Although not contagious, it may resemble acne or rosacea, causing confusion. Avoid unneeded worry and improper treatment with proper diagnosis.

How is perioral dermatitis diagnosed?

Clinicians diagnose perioral dermatitis by inspecting the skin and asking about topical treatments, medications, and symptoms. No lab test exists.

Diagnosis steps

Medical history

The patient may have a history of long-term or recent use of topical corticosteroids on the face.
Use cosmetics, moisturizers, or fluoridated toothpaste.
Hormonal factors such as oral contraceptives and menstruation may also be present.

Physical examination

Rash around lips, nose, or eyes.
The examination reveals small red papules or pustules on a background of redness and scaling.
The vermillion border (lip edge) is reduced.
Exclusion of other conditions

The absence of comedones (blackheads/whiteheads) in perioral dermatitis rules out acne.

Rosacea causes generalized redness and flushing beyond the perioral area.
Seborrheic dermatitis: skin with oily scales, typically in scalp/nasolabial creases.
Allergic contact dermatitis leads to itching and is connected to certain allergens.
Additional tests are usually not required.
Skin swabs or scrapings can rule out bacterial, fungal, or parasitic infections.
Conduct patch testing for possible allergic contact dermatitis.

Treating perioral dermatitis

The video about how to treat Perioral Dermatitis

Stopping triggers (particularly topical steroids and irritating cosmetics) and employing gentle skin care and topical or oral antibiotics treat perioral dermatitis. Most cases improve within weeks after offending agents are removed.

Treatment Steps:

1. Eliminate Triggers

Stop using topical corticosteroids, including modest hydrocortisone.
Withdrawal may induce a brief flare before recovery.
Avoid heavy cosmetics and occlusive moisturizers (oily creams, thick balms).
Change toothpaste if fluoridated or tartar-control types worsen symptoms.
Reduce irritations: fragrance-heavy products, harsh scrubbing, and alcohol-based toners.

2. Topicals

Metronidazole cream/gel: Anti-inflammatory and antibacterial.
Erythromycin gel: Effective for mild instances.
Use pimecrolimus or tacrolimus as non-steroid options for inflammation.
Some use azelaic acid for its anti-inflammatory qualities.

3. Moderate to Severe Oral Treatments

Tetracycline antibiotics, specifically doxycycline, minocycline, and tetracycline, are commonly used.
These antibiotics are typically recommended for a period of 6–12 weeks.
Macrolides (erythromycin, azithromycin) are available for youngsters and pregnant patients.

4. Skin Support

Use mild, soap-free cleaners.
Apply gentle, non-comedogenic moisturizers as needed.
Avoid over-washing or scrubbing the affected region.
Ensure skin is protected from sun and wind exposure.

Also, read https://torontodermatologycentre.com/perioral-dermatitis/.

Prevention and Long-Term Management

Avoid reusing topical steroids on the face.
Streamline skincare with fewer products, fragrance-free, and hypoallergenic options.
Monitor hormonal effects (oral contraceptives may contribute).
Inform patients that POD is not communicable but may recur if triggers return.

Risks and Factors

Steroid withdrawal flare: Symptoms may temporarily intensify after stopping steroids.
Recurrence: High if triggers are reestablished.
Psychological impact: Visible rash might influence confidence and quality of life.

Overnight perioral dermatitis treatment?

Perioral dermatitis is a persistent inflammatory illness that takes weeks to months to heal, even with treatment. Trying to “get rid of it overnight” might frustrate and worsen the rash if harsh or incorrect therapies are employed.

Not Disappearing Overnight

Inflamed skin needs time to settle down after the removal of triggers.
Steroid withdrawal flare: Symptoms may worsen before lessening after stopping topical steroids.
Timeline for treatment:
Topical therapies: 2-4 weeks of improvement.
Oral antibiotics: 4-8 weeks of improvement.

Do It Now

It won't go away overnight, but you can start healing:

Stop topical steroids unless advised by a doctor.
Simplify skincare by using light cleansers and avoiding heavy creams, oils, and makeup.
Avoid fluoridated or tartar-control toothpaste if suspected as a cause.
Avoid irritants like scents, scrubs, and alcohol-based toners.
If outdoors, use light, non-comedogenic sunscreen to protect skin.

Conclusion

Patient and constant treatment are needed to treat perioral dermatitis, an inflammatory reaction. While avoiding triggers and commencing medical treatment is the fastest way to improve, outcomes take time.

Management relies on delicate skin care, avoiding steroids and irritants, and medical treatment as necessary. Preventing recurrence and reducing suffering requires patient education.

Lipoma: Clinical Overview and Management Strategies.

Defining lipoma

A lipoma is a slow-growing fat cell mass under the skin. If handled, it feels soft and springy and moves readily. Unless they hurt or look awful, lipomas are harmless and rarely need treatment. The overgrowth of fat cells results in the formation of lumps. Lipomas are soft, doughy, and movable under the skin. Lipomas typically appear on the back, shoulders, arms, neck, thighs, and trunk. Internal organs and muscles rarely develop them. Usually, lipomas measure 1-10 cm, but they have the potential to expand over time. The development of lipomas often occurs over a period of months or years. While benign lipomas are typically painless, they can cause discomfort in sensitive areas or nerve pressure.

What are lipoma symptoms?

Symptoms of Lipoma

Soft, doughy lump: Rubbery and easily movable under skin.
Slow growth: Develops gradually over months or years.
Size: Typically 1-3 cm, but can expand.
Location: Typically on the back, shoulders, arms, thighs, and neck.
Painless: Most lipomas are painless.
Occasionally, pushing on nerves, joints, or blood vessels may cause slight pain or tenderness.
Cosmetic concern: Lumpiness can be uncomfortable even without symptoms.

Less Common Signs

Rare pain or soreness may occur if the lipoma pushes on surrounding structures.
The presence of large lipomas near joints or muscles might limit mobility.
Multiple lumps: Multiple lipomas can be caused by a condition known as lipomatosis.
Rapid growth or hardness: Unusual traits that need medical investigation to rule out liposarcoma.

Important Note

Benign lipomas are not malignant. A lump that grows quickly, hurts, or feels sore needs medical evaluation to rule out liposarcoma, a rare malignant tumor.

When to See a Doctor

The lump rapidly expands.
Feels stiff or uneven.
Inflammation or soreness occurs.
Interferes with daily tasks.

"Lipomas are usually innocuous; monitoring size, texture, and symptoms is vital for safety."

What causes lipomas?

Main causes and risks

Genetic predisposition: Lipomas run in families, suggesting a hereditary component.
The condition is most common in individuals aged 40-60.
Men have a slightly higher prevalence.
Minor injuries: Lipomas may occur following trauma, but this is not conclusive.
Metabolic factors: Conditions influencing fat metabolism may contribute.
Multiple lipomas (lipomatosis): Commonly caused by hereditary disorders.

Affiliated Conditions

Familial multiple lipomatosis: Inherited predisposition to develop numerous lipomas.
Madelung's disease (benign symmetric lipomatosis) is a rare illness characterized by the presence of multiple lipomas on the neck and shoulders that are commonly associated with alcohol use.
Dercum's disease (adiposis dolorosa) is a rare disorder characterized by painful lipomas, typically in obese, postmenopausal women.

What are lipoma complications?

Most tiny lipomas are harmless. Large lipomas that compress adjacent structures and nerves can cause problems.

Surgery complications for lipoma removal include:

Signs of infection: bleeding, discomfort, and scars.
Return of lipoma
Diabetics and corticosteroid users may be more susceptible to infections.

Diagnosis

Physical Exam: Doctors generally detect lipomas through touch and appearance.
Imaging (Ultrasound/MRI): For deep or unusual lumps.
Biopsy: A rare procedure for suspected cancer.

What is the best lipoma treatment?

The video about the non-surgical removal of Lipoma

Important Considerations

Most lipomas are harmless and do not require treatment.
Surgical excision is the preferred treatment method, removing the lump and reducing the risk of recurrence.
Nonsurgical treatments like liposuction and steroid injections may reduce lipoma size but not eliminate it.
Medical evaluation is necessary to rule out liposarcoma, a rare malignant tumor, if the lump grows rapidly, feels firm, or is painful.
Monitoring is sufficient for small, painless lipomas.
Surgical removal is the most effective treatment for big, painful, or cosmetically unpleasant lesions.
If minimum scarring is desired, liposuction may be attempted, but recurrence risk is increased.
Consult a healthcare expert before making any decisions, especially if the lump changes in size or texture.

Is lipoma dangerous?

Lipomas rarely cause harm. These fat cell growths are usually innocuous.

Why Are Lipomas Generally Safe?

Benign in nature: Lipomas do not spread to other body parts.
Slow growth: They grow slowly and frequently remain small.
No cancer risk: Lipomas do not cause cancer.

Situations requiring medical attention

Rapid growth or enlargement may occur.
Choose a firm texture over soft and rubbery.
Nerve or blood vessel pressure may cause pain or soreness.
• The tumor may be located deep inside muscles or organs, potentially interfering with their function.
The tumor may have an unusual appearance due to its irregular form, which is rooted in deeper tissues.
A liposarcoma, a rare malignant tumor, may imitate a lipoma.

Lipoma removal without surgery?

Non-Surgical Options

Steroid injections:
Reduce lipoma by destroying fat cells.
Steroid injections typically decrease the size of the lipoma, but they rarely eliminate it completely.
Possible recurrence.
Minimally invasive liposuction:
A thin tube is used to remove fatty tissue.
The procedure results in less scarring when compared to excision.
The capsule retention increases the risk of recurrence.

What Doesn't Work

Home cures, herbal therapies, and topical creams lack scientific evidence of efficacy.
Diet and exercise do not reduce lipomas, which are localized fat cell growths unrelated to body fat.

Key Takeaway

Surgical excision is the only permanent solution. Nonsurgical techniques such as steroids and liposuction may reduce the lump's size but not eliminate it. When a lipoma is small, painless, and not irritating, observation is usually the best treatment.

Untreated lipomas—what happens?

A typical outcome of untreated lipomas

Stable: Lipomas may maintain their size for years without producing difficulties.
Slow growth: Some may not grow rapidly but may gradually enlarge.
Low risk of cancer: Lipomas seldom develop malignancy. They're not cancerous.
Cosmetic concerns: Even if medically innocuous, visible bumps can be irritating.

Possible Complications

Although rare, untreated lipomas can cause:

Tenderness or pain: When pressing on nerves, muscles, or blood vessels.
The presence of large lipomas near joints or muscles might limit mobility.
Multiple lipomas: Individuals may acquire multiple lumps (lipomatosis).
Confusion in diagnosis: A fast-growing or firm lump may be liposarcoma, a rare malignant tumor that needs medical attention.

Conclusion

When necessary, surgical removal is best, although liposuction and steroid injections may diminish but rarely remove them. Lipomas are harmless and do not cause cancer, but a lump that changes abruptly, feels solid, or hurts should be examined. Lipomas are normally harmless. Most can be left untreated, but monitoring changes and seeing a doctor when necessary ensures peace of mind and effective treatment.

New Therapies to Cure B-Cell Lymphoma

What is B-cell lymphoma?

B-cell lymphoma is a type of blood cancer that develops in B lymphocytes, a kind of white blood cell responsible for producing antibodies to fight infections. It belongs to the group of lymphomas, which are cancers of the lymphatic system, and most cases fall under non-Hodgkin lymphoma.

B-Cell Lymphoma

What Happens in B-Cell Lymphoma

Normal role of B-cells: They mature in the bone marrow and lymphatic system, then produce antibodies to defend against bacteria, viruses, and toxins.
Cancerous change: In lymphoma, these cells grow abnormally and multiply uncontrollably, forming tumors in lymph nodes or other organs.
Spread: Because the lymphatic system is widespread, B-cell lymphoma can appear in many parts of the body (lymph nodes, spleen, bone marrow, digestive tract, etc.).

Types and Classification

B-cell lymphomas are divided into:
Indolent (low-grade): Slow-growing, often manageable for many years but rarely cured.
Aggressive (high-grade): Fast-growing, requiring intensive treatment, but some types can be cured.
Examples include:
Diffuse large B-cell lymphoma (DLBCL)—the most common aggressive type.
Follicular lymphoma—a common indolent type.
Mantle cell lymphoma, Burkitt lymphoma, and others.

What Causes B-Cell Lymphoma?

B-cell lymphoma is caused by genetic mutations in B lymphocytes that make them grow uncontrollably, but the exact reasons why these mutations occur are not fully understood. Several risk factors—such as age, immune system problems, infections, and environmental exposures—can increase the likelihood of developing the disease.

Biological Causes

Genetic mutations: Changes in DNA within B cells disrupt normal growth and death cycles, leading to uncontrolled proliferation.
Chromosomal translocations: Certain changes in the arrangement of genes, like BCL2, MYC, or BCL6, often occur in specific types of lymphoma, such as
Immune system dysfunction: A weakened or overactive immune system can contribute to abnormal B-cell activity.

Risk Factors

Age: Most B-cell lymphomas occur in people over 60.
Gender: Slightly more common in men.
Family history: Having relatives with lymphoma may increase risk.
Immune suppression: Conditions like HIV/AIDS, organ transplant medications, or autoimmune diseases raise susceptibility.
Infections: Certain viruses (e.g., Epstein-Barr virus and hepatitis C) and bacteria (e.g., Helicobacter pylori) are associated with specific lymphoma subtypes.
Environmental exposures: Long-term contact with pesticides, solvents, or radiation may play a role.
Lifestyle factors: Obesity and chronic inflammation are being studied as possible contributors.

What are the symptoms of B-cell lymphoma?

The main symptoms of B-cell lymphoma include painless swollen lymph nodes, persistent fatigue, fevers, night sweats, and unexplained weight loss. These are often referred to as “B symptoms” and are important warning signs for doctors.

Common Symptoms

Swollen lymph nodes
Usually, these lymph nodes are painless and can be located in the neck, armpit, or groin.
Persistent fatigue and weakness
The patient experiences extreme fatigue, even when they are at rest.
Fever and night sweats
Drenching sweats at night, sometimes with recurrent fevers.
Unexplained weight loss
Losing more than 10% of body weight without trying.
Enlarged spleen or liver
Can cause abdominal fullness or discomfort.
Frequent infections
This can be attributed to a weakened immune system.

Other Possible Symptoms

Depending on where the lymphoma develops, additional signs may appear:
Chest pain, cough, or shortness of breath (if lymph nodes in the chest are affected).
Additional signs may include abdominal pain, bloating, or digestive issues, if the gastrointestinal tract is affected.
Rare cutaneous forms may present with skin lesions or rashes.
If the bone marrow or the nervous system is involved, patients may experience bone pain or neurological symptoms.

How is B-Cell Lymphoma Diagnosed?

Diagnosing B-cell lymphoma involves a combination of clinical evaluation, imaging, laboratory tests, and—most importantly—biopsy of affected tissue. Because symptoms can mimic other conditions, a precise diagnosis requires identifying abnormal B lymphocytes and classifying the lymphoma subtype.

Steps in Diagnosis

1. Medical History & Physical Exam

The doctor checks for swollen lymph nodes, spleen, or liver.
Reviews symptoms such as night sweats, fever, and weight loss.

2. Blood Tests

A complete blood count (CBC) is performed to evaluate the levels of white blood cells, red blood cells, and platelets.
Lactate dehydrogenase (LDH) levels are often elevated in aggressive lymphomas.
Tests for liver and kidney function are also conducted.

3. Imaging Studies

Imaging studies such as CT scan, PET scan, or MRI are utilized to identify enlarged lymph nodes or organ involvement.
PET scans are especially useful for staging and monitoring treatment.

4. Biopsy (Gold Standard)

An excisional or core needle biopsy is performed on a lymph node or affected tissue.
Pathologists examine cells under a microscope to confirm lymphoma.
Immunohistochemistry and flow cytometry help identify B-cell markers (e.g., CD19, CD20).

5. Bone Marrow Examination

Aspiration and biopsy to check if lymphoma has spread to the bone marrow.

6. Molecular & Genetic Testing

Detects chromosomal translocations (e.g., BCL2, MYC, BCL6).
Guides treatment decisions and prognosis.

Staging

Once diagnosed, doctors stage the lymphoma (I–IV) based on how far it has spread. Staging influences treatment planning and prognosis.

How is B-cell lymphoma treated?

Treatment for B-cell lymphoma depends on the specific subtype, stage, and whether it is indolent (slow-growing) or aggressive (fast-growing). The goal may be a cure (in aggressive types) or long-term control (in indolent types).

Main Treatment Options

1. Chemotherapy

The standard backbone of treatment is often given in cycles.
Common regimen: CHOP (Cyclophosphamide, Doxorubicin, Vincristine, Prednisone).

2. Immunotherapy

Monoclonal antibodies like rituximab target CD20 on B cells.
These antibodies are often combined with chemotherapy (R-CHOP).
Newer agents include obinutuzumab and ofatumumab.

3. Targeted Therapy

Drugs that block specific pathways cancer cells use to grow.
Examples: BTK inhibitors (ibrutinib, acalabrutinib), PI3K inhibitors, and BCL2 inhibitors (venetoclax).

4. Radiation Therapy

Used for localized disease or symptom relief.

5. Stem Cell Transplant

Autologous transplant: the patient’s own stem cells are used after high-dose chemotherapy.
Allogeneic transplant: donor stem cells are considered in relapsed or refractory cases.

6. CAR-T Cell Therapy

The patient’s T cells are engineered to attack lymphoma cells.
This treatment is utilized in cases of relapsed or refractory aggressive B-cell lymphomas.

7. Watchful Waiting (for indolent types)

In slow-growing lymphomas without symptoms, doctors may monitor without immediate treatment.

Factors Influencing Treatment Choice

Subtype (e.g., diffuse large B-cell lymphoma vs. follicular lymphoma).
Stage and spread of disease.
Patient’s age and overall health.
Presence of “B symptoms” (fever, night sweats, weight loss).
Genetic mutations (e.g., MYC, BCL2, BCL6).

Treatment Beyond Standard Therapies

The video about advanced treatment for large B-cell lymphoma

In addition to regular chemo-immunotherapy (like R-CHOP), B-cell lymphoma treatment now offers newer options like bispecific antibodies, antibody-drug conjugates, CAR-T These therapies are designed for relapsed, refractory, or high-risk patients who don’t respond well to conventional regimens.

Emerging & Advanced Therapies

1. Bispecific Antibodies (T-cell engagers)

Drugs like epcoritamab and glofitamab bind both CD20 on B cells and CD3 on T cells, redirecting T cells to kill lymphoma cells.
Diffuse large B-cell lymphoma (DLBCL) is a condition that is resistant to treatment.
Advantage: Off-the-shelf therapy (unlike CAR-T), easier to administer.

2. Antibody–Drug Conjugates (ADCs)

Antibodies linked to potent chemotherapy payloads.
Example: Polatuzumab vedotin (targets CD79b) used with bendamustine and rituximab.
Delivers cytotoxic drugs directly to lymphoma cells, sparing healthy tissue.

3. CAR-T Cell Therapy

The patient’s T cells are genetically engineered to attack CD19-positive lymphoma cells.
It is particularly effective in treating relapsed or refractory aggressive B-cell lymphomas.
Limitation: Complex manufacturing, risk of cytokine release syndrome.

4. Small-Molecule Inhibitors

BTK inhibitors (ibrutinib, acalabrutinib, and zanubrutinib) block the B-cell receptor.
BCL2 inhibitors (venetoclax) promote cancer cell death.
Often used in mantle cell lymphoma or chronic lymphocytic leukemia, but is being explored in other B-cell lymphomas.

5. Novel Immunotherapies

Checkpoint inhibitors (PD-1/PD-L1 blockers) are under investigation for certain subtypes.
Vaccines and engineered NK-cell therapies are in early clinical trials.

Risks & Considerations

The use of CAR-T and bispecifics may lead to immune-related side effects such as cytokine release syndrome and neurotoxicity.
Cost and accessibility: Advanced therapies are expensive and not widely available in all regions.
Resistance development: Cancer cells may adapt, requiring combination strategies.
Patient selection: Genetic testing and subtype classification are critical to match therapy.

What is the prognosis for B-cell lymphoma?

The prognosis for B-cell lymphoma varies widely depending on the subtype, stage, and patient factors. Some aggressive forms can be cured with intensive therapy, while indolent (slow-growing) types are often managed long-term but rarely eradicated.

Key Prognostic Factors

Subtype of lymphoma

Diffuse large B-cell lymphoma (DLBCL): Aggressive but potentially curable with R-CHOP; ~60–70% achieve long-term remission.
Follicular lymphoma: Indolent, median survival >15 years, but relapses are common.
Mantle cell lymphoma: More challenging, median survival is ~5–7 years, though newer therapies are improving outcomes.

Stage at diagnosis

Early-stage disease has better outcomes than advanced-stage.
Patient age and health
Younger, healthier patients tolerate intensive therapy better.
Presence of “B symptoms” (fever, night sweats, weight loss)
Often indicates a more aggressive disease.
Genetic mutations
Alterations in MYC, BCL2, or BCL6 genes can worsen prognosis.
Response to initial therapy

"Achieving complete remission after first-line treatment is strongly linked to long-term survival."

Survival Outlook

Aggressive B-cell lymphomas:

With modern chemo-immunotherapy, many patients achieve a cure.
Relapsed/refractory cases may benefit from CAR-T therapy or bispecific antibodies.

Indolent B-cell lymphomas:

Although indolent B-cell lymphomas are not usually curable, patients can often live for many years with treatment and monitoring.
Quality of life can remain excellent with targeted therapies.

Important Perspective

Prognosis is not one-size-fits-all—it depends on biology, treatment response, and patient resilience.
Advances in immunotherapy, CAR-T, and targeted drugs are significantly improving survival rates for patients who previously had poor outcomes.

Conclusion

B-cell lymphoma is a diverse group of blood cancers that arise from antibody-producing B lymphocytes. Its impact ranges from indolent forms that can be managed for many years to aggressive subtypes that demand urgent treatment but may be curable.

B-cell lymphoma is not a single disease but a spectrum, requiring personalised approaches for diagnosis, treatment, and long-term management. With modern therapies, many patients achieve remission or durable control, and ongoing research promises even better outcomes in the future.

Is sleepwalking a sign of mental illness?

Sleepwalking-Overview

Sleepwalking is a parasomnia. This sleep disorder involves nightmares and bedwetting. It typically occurs within a few hours of falling into a deep slumber. Sleepwalking, also known as somnambulism, is a sleep disorder characterised by a person getting out of bed and moving around while asleep. Most often, people roam around the house in deep sleep.

We switch between two kinds of sleep multiple times a night. Dreaming occurs during REM sleep. During this time, we usually paralyse our muscles to avoid acting on our dreams. Non-REM sleep has three phases: light to profound. Starting the night with three NREM stages is typical.

Sleepwalking occurs at the beginning of the sleep cycle, according to Sleepless in New Orleans. Sleepwalking most likely occurs in non-REM stage 3—before deep REM—because the muscles are not paralyzed, even though the person remains 'asleep.'

It's a partial arousal from stage 3 sleep. The person has glassy eyes and is barely responsive. They do unusual things and are confused if gently woken.

What Causes Sleepwalking?

Sleepwalking (somnambulism) is a disorder of arousal that occurs during deep non-REM sleep (usually in the first third of the night). Instead of transitioning smoothly between sleep stages, the brain gets “stuck” between sleep and wakefulness.

Key Triggers

Sleep deprivation increases the likelihood of incomplete arousal.
Stress or anxiety disrupts normal sleep cycles.
Illness or fever—especially in children—can provoke episodes.
Medications—sedatives, hypnotics, or stimulants may interfere with sleep regulation.
Sleep disorders include sleep apnea, restless leg syndrome, and periodic limb movement disorder.
Genetics—family history plays a role; sleepwalking often runs in families.
Neurological conditions—Parkinson’s disease and other disorders can sometimes be linked.

How It Works in the Brain

Sleepwalking occurs during slow-wave sleep (stage N3), when the body is deeply relaxed, but the brain is not fully “off.”
The frontal lobe (responsible for rational decision-making) remains mostly asleep, while motor areas are active enough to trigger walking or other behaviors.
This mismatch explains why sleepwalkers can perform complex actions but appear confused and have little to no memory of the event.

Risks and Considerations

Injury risk: Sleepwalkers may bump into objects, fall, or leave the house.
Daytime fatigue: Frequent episodes disrupt restorative sleep.
Underlying conditions: Persistent sleepwalking may signal a medical issue that needs evaluation.

Prevention Strategies

Maintain regular sleep schedules to reduce sleep deprivation.
Create a safe environment (lock doors, remove sharp objects).
Manage stress with relaxation techniques.
Seek medical evaluation if episodes are frequent, dangerous, or associated with other sleep problems.

Is sleepwalking a mental illness?

Sleepwalking is not classified as a mental illness. It is considered a type of sleep disorder called a parasomnia, which involves unusual behaviors during sleep.

What Sleepwalking Really Is

Parasomnia: Sleepwalking (somnambulism) falls under parasomnias, which are abnormal behaviors during sleep, such as talking, eating, or walking.
Sleep stage: It happens during deep non-REM sleep (slow-wave sleep), usually in the first third of the night.
Not psychiatric by default: Most cases are unrelated to mental illness. Instead, they are linked to sleep cycle disruptions, genetics, or environmental triggers.

Relationship to Mental Health

Stress and anxiety: Emotional stress can increase the likelihood of episodes.
Co-occurrence: Sleepwalking may sometimes appear alongside mental health conditions such as depression, anxiety, or dementia, but it is not itself a psychiatric disorder.
Children vs. adults: In children, sleepwalking is common and usually resolves with age. In adults, persistent sleepwalking may warrant evaluation for underlying medical or psychological issues.

Is sleepwalking dangerous?

Sleepwalking can be potentially dangerous, though the level of risk depends on the person, their environment, and the severity of episodes.

Why Sleepwalking Can Be Risky

Accidental injuries: Sleepwalkers may trip, fall down stairs, bump into furniture, or even leave the house.
Unsafe behaviors: Some may attempt cooking, driving, or using sharp objects while not fully conscious.
Environmental hazards: Open windows, balconies, pools, or traffic can pose serious risks.
Confusion on waking: If startled awake, a sleepwalker may feel disoriented or react aggressively without meaning to.

Children vs. Adults

Children: Episodes are usually harmless and often outgrown, but safety precautions (like gates near stairs) are important.
Adults: More concerning, since episodes may involve complex behaviors (e.g., leaving the house, driving). Persistent adult sleepwalking should be medically evaluated.

Safety Tips

Secure the environment: Lock doors/windows, remove sharp objects, block stairways.
Avoid waking suddenly: Gently guide the person back to bed instead of shaking them awake.
Improve sleep hygiene: Regular sleep schedules, stress management, and avoiding alcohol or sedatives can reduce episodes.
Seek medical help: If sleepwalking is frequent, dangerous, or linked to other sleep disorders (like sleep apnea)

Sleepwalking causes in children

Sleepwalking in children is usually caused by incomplete arousal from deep non-REM sleep, often triggered by factors like genetics, sleep deprivation, stress, fever, or certain medications. It is not a sign of mental illness, and most children outgrow it.

Common Causes of Sleepwalking in Children

Sleepwalking (somnambulism) is more common in kids than adults, typically between ages 4 and 12, with peak prevalence around 8–12 years. Episodes usually occur in the first few hours of sleep.

Key Triggers

Genetics: Family history plays a strong role; children with parents who sleepwalk are more likely to experience it.
Sleep deprivation: Lack of adequate rest increases the chance of incomplete arousal.
Stress or anxiety: Emotional stress can disrupt sleep cycles.
Fever or illness: High temperatures or infections can provoke episodes.
Medications: Some sedatives, antihistamines, or stimulants may interfere with sleep regulation.
Other sleep disorders, such as sleep apnea and restless leg syndrome, may also be involved.
Immature nervous system: Children’s brains are still developing, making transitions between sleep stages less stable.

What Happens During Sleepwalking

Occurs in deep non-REM sleep (stage N3).
The brain is partly asleep, but motor areas are active enough to trigger walking or other behaviors.
Children usually have open but glazed eyes, appear confused, and have no memory of the event afterwards.

Risks

Most episodes are harmless, but children may fall, bump into objects, or wander outside.
Complex behaviors (like opening doors) can occur sometimes, increasing the risk of injury.

Prevention & Safety Tips

Ensure regular sleep schedules to avoid sleep deprivation.
Reduce stress with calming bedtime routines.
Keep the environment safe: lock doors/windows, block stairways, and remove sharp objects.
Avoid waking the child suddenly; instead, gently guide them back to bed.
Seek medical advice if episodes are frequent, prolonged, or dangerous.

How to stop sleepwalking in children?

Practical Steps to Help Stop Sleepwalking in Children

Here are the most effective strategies recommended by pediatric sleep specialists:

1. Improve Sleep Hygiene

Consistent bedtime and wake time: Stick to a regular sleep schedule, even on weekends.
Adequate sleep: Make sure the child gets enough sleep for their age group.
Calm bedtime routine: Reading, soft music, or relaxation exercises can help.
Avoid stimulants: Limit caffeine (chocolate, sodas) and heavy meals before bed.

2. Reduce Stress and Anxiety

Relaxation techniques: Breathing exercises, gentle yoga, or mindfulness for kids.
Daytime activity: Encourage play and exercise to release energy.
Address worries: Talk through school or social stressors before bedtime.

3. Create a Safe Environment

Lock doors and windows to prevent wandering outside.
Block stairways with gates if needed.
Remove sharp or breakable objects from the child’s room.
Avoid bunk beds if sleepwalking is frequent.

4. Gentle Handling During Episodes

Do not wake suddenly: Instead, calmly guide the child back to bed.
Stay calm: Episodes are usually brief and harmless.

5. Medical Evaluation (if needed)

Frequent or dangerous episodes: Consult a paediatrician or sleep specialist.
Underlying conditions: Rule out sleep apnea, restless leg syndrome, or medication side effects.
Behavioral strategies: In rare cases, scheduled awakenings (waking the child 15–30 minutes before typical episodes) may help.

Risks and Considerations

Most children outgrow sleepwalking by adolescence.
The main danger is accidental injury, not the sleepwalking itself.
Persistent or severe cases may require professional evaluation.

Treatment Approaches for Sleepwalking

The video about the psychological approach to sleepwalking

1. Lifestyle & Behavioral Strategies (First-line)

Adequate sleep: Prevents sleep deprivation, a major trigger.
Stress management: Relaxation techniques, meditation, or calming bedtime routines.
Sleep hygiene: Consistent sleep schedule, quiet/dark bedroom, avoiding caffeine or heavy meals before bed.
Scheduled awakenings: Waking the person 15–30 minutes before typical episodes can sometimes break the cycle.
Environmental safety: Lock doors/windows, block stairways, remove sharp objects, and avoid bunk beds for children.

2. Medical Evaluation

Rule out underlying conditions: Sleep apnea, restless leg syndrome, seizures, or medication side effects.
Sleep study (polysomnography): May be recommended if episodes are frequent, dangerous, or complex.

3. Medications (for severe cases only)

Benzodiazepines (e.g., clonazepam): Sometimes prescribed to reduce episodes.
Antidepressants: May be used if sleepwalking is linked to mood disorders.
Melatonin: Occasionally considered to regulate sleep cycles.

4. Therapies

Cognitive-behavioral therapy (CBT): Helps manage stress and anxiety that may trigger episodes.
Relaxation training: Breathing exercises, mindfulness, or guided imagery before bed.
Biofeedback: Sometimes used to improve sleep regulation.

Risks & Considerations

Children: Most outgrow sleepwalking naturally; treatment is rarely needed beyond safety measures.
Adults: Persistent or dangerous episodes should be medically evaluated.

Conclusion

Sleepwalking is not a mental illness but a parasomnia—a sleep disorder that occurs when the brain is caught between deep sleep and wakefulness. It is most common in children due to their developing nervous systems and often resolves naturally with age. Sleepwalking is a manageable condition. With proper sleep routines, stress control, and a safe environment, most cases improve naturally.

How to Prevent Human Papillomavirus and Save Lives

What is the HPV virus?

HPV is a family of over 200 viruses. It mostly affects the skin and mucous membranes. Genital warts and cervical cancer can result from HPV, a common virus. The majority of infections resolve on their own, but those of high risk can cause serious health problems. Because HPV rarely causes symptoms, most people become infected without realising it.

How Does HPV Spread?

Experience intimate skin-to-skin touch, not just intercourse.
This can occur through vaginal, anal, or oral sex.
Sharing sex toys.
HPV can be transmitted accidentally, even though it rarely causes symptoms.

Risks, complications

Genital warts: painless bumps or growths.
Cancers: cervical, anal, penile, vaginal, vulvar, and oropharyngeal.
High-risk HPV can persist in the cervix or throat for years before developing into illness.

Prevention

The HPV vaccination is highly efficient in avoiding infection from the most harmful types.
Regular screening: Pap smears and HPV tests detect early malignant changes.
Safe practices: Condoms minimise risk but cannot eradicate HPV transmission through skin contact.

What are HPV symptoms?

Most HPV infections are symptomless. Symptoms mainly involve warts or, rarely, malignancy.

HPV Symptoms:

Genital warts
Small or raised pimples, possibly cauliflower-shaped, are present in the genital area.
While they are usually painless, they can also cause itching or discomfort.
Other types of warts
Common warts: rough lumps on hands, fingers, or elbows.
Plantar warts are painful growths on the bottom of the feet.
Flat warts are sores that are smoother or flatter on the face or legs.

Less Visible or Serious Signs

High-risk HPV infections may not present any symptoms until they progress to precancerous changes or malignancies.
Cervical changes: Only detected by Pap smears or HPV tests.
Symptoms of cancer (often late):
Cervical cancer may cause abnormal vaginal bleeding or discharge.
Symptoms of anal cancer include pain, bleeding, or lumps.
Oropharyngeal cancer can cause a persistent sore throat, earache, or difficulty swallowing.
Rare growths or sores can develop on the penis, vulva, or vagina.

Key Info

HPV infections typically resolve without symptoms after 1–2 years.
Low-risk HPV strains (e.g., types 6 and 11) contribute to visible warts.
High-risk HPV strains (e.g., types 16 and 18) can cause cancer but may not be detected until advanced stages.

Meaning for You

Don't rely solely on symptoms—HPV can be undetected.
Pap smears and HPV screenings are crucial for early diagnosis of precancerous alterations.
Vaccination prevents infection from the most harmful strains.

Will high-risk HPV cause cancer?

Not necessarily. High-risk HPV does not guarantee cancer, but it increases the risk if the infection persists.

How High-Risk HPV Works

Most infections resolve naturally within 1–2 years due to the immune system. • Viruses can persist and induce aberrant cell alterations in some individuals. Those alterations may lead to cancer over time if not discovered and addressed.

Cancer-prone factors

These factors include enduring infection with high-risk strains, such as HPV 16 and 18.
HIV and immunosuppressive therapy can weaken the immune system.
Smoking has been linked to the development of cervical and other cancers.
Other infections, such as chlamydia, can increase risk.
Insufficient screening, such as Pap smears and HPV testing, can also increase the risk.

High-Risk HPV Cancers

Cervical cancer (most prevalent).
Anal cancer.
Oropharyngeal carcinoma affects the throat, tonsils, and base of the tongue.
Rarer penile, vulvar, and vaginal malignancies.

Monitoring & Prevention

HPV vaccination: Prevents the most harmful strains.
Regular screenings: Pap smears and HPV tests detect precancerous alterations early.
Healthy lifestyle: No smoking, robust immunity.
Follow-up care: Doctors constantly monitor cell changes in high-risk HPV cases.

How can I avoid HPV?

HPV prevention requires vaccination, safe practices, and regular screening due to its prevalence. A clear breakdown:

To prevent HPV, be vaccinated against the most hazardous strains, including those that cause cancer and genital warts.

The vaccination should ideally be administered before engaging in sexual activity, but it may still be beneficial for adults up to 45 years old.
Practice safer sex. • Use condoms or dental dams to lower risk, but not eliminate it, as HPV transmits through skin-to-skin contact.
To lower the risk of exposure, limit the number of sexual partners.
Monogamous relationships significantly lower risk.
Boost the immune system. • Maintain a healthy lifestyle (no smoking, a balanced diet, and frequent exercise) for faster infection clearance.

Avoiding HPV Transmission in Existing Partners

Communicate openly with partners to inform their decisions.
Avoid sexual contact with warts: Warts spread easily.
Consistently use protection: Even healthy people can spread HPV.
Remain current on screenings: Pap smears and HPV tests detect abnormalities early, preventing cancer.

HPV vaccination: should I?

Immunising against HPV helps most people. It is indicated for children, adolescents, and young adults up to 45 and can be given occasionally. The vaccination prevents HPV-related malignancies and genital warts safely and effectively.

Key Advice

Routine vaccination: • The CDC advises HPV immunization for males and girls aged 11-12 (starting at age 9).
Vaccination is advised until age 26 if not done earlier.
Adults aged 27-45 may select catch-up immunization after discussing risks and benefits with a healthcare provider.
Effectiveness: • Long-term protection against cervical, anal, throat, penile, vulvar, and vaginal cancers.
The most popular vaccine, Gardasil 9, protects against nine high-risk HPV strains.

Risks and Considerations

Side effects: Mild (injection site pain, headache, low-grade temperature).
Timing: Provide protection before sexual activity for optimal results.
The HPV vaccine prevents new infections, but it does not treat existing ones.

The Bottom Line

HPV vaccination is recommended for those under 26. Discuss with your doctor if you're 27–45 and your health and risk factors warrant it.

HPV diagnosis: how?

Since HPV rarely causes symptoms, screening tests and clinical examinations are used to diagnose it. This is how doctors diagnose it:

Main HPV Diagnosis Methods

Pap smear (Pap test) • Examines cervical cells for HPV-related abnormalities.
This test is often the initial indicator of a high-risk HPV infection.
HPV DNA test: Directly detects high-risk HPV strains' genetic material.
This test can be conducted either concurrently with or after a Pap smear.
Visual examination: Doctors can identify genital warts via observation.
Warts typically do not require a lab test.
Colposcopy
If abnormal Pap or HPV tests are found, a doctor may employ a magnification instrument for a closer examination.
Biopsy: If abnormal tissue is discovered, a small sample is examined under a microscope for precancerous or cancerous changes.

Important Notes:

Routine screening is crucial. HPV often provides no symptoms until problems.
Men are not typically tested for HPV unless warts or worrisome areas arise.
HPV screenings may only discover high-risk strains associated with cancer.

HPV treatment?

The video about the awareness of HPV

HPV cannot be “cured” with medication; most infections resolve naturally in 1–2 years. Treatment targets HPV-related warts and precancerous alterations.

Management of HPV

No direct antiviral treatment: The immune system typically eliminates the infection.
Low-risk HPV types produce genital warts:
Treatment options include topical medicines such as imiquimod, podofilox, and trichloroacetic acid.
Treatment options include cryotherapy, surgery, and laser therapy.
High-risk HPV varieties can cause precancerous cervical alterations.
A Pap smear or HPV test can detect these alterations.
Treatments include LEEP, cryotherapy, and cone biopsy to eliminate aberrant cells.
Treat HPV-related cancers with regular treatments (surgery, radiotherapy, chemotherapy, and immunotherapy).

Strategies for Support and Prevention

The HPV immunisation prevents infection from the most harmful strains but does not treat existing HPV.

Regular screening: Pap smears and HPV testing detect abnormalities before they develop into cancer.
Healthy lifestyle: Strong immunity helps remove HPV faster (no smoking, proper eating, exercise).

Conclusion:

HPV (Human Papillomavirus) is a prevalent viral illness transmitted through close skin-to-skin contact. Most infections are innocuous and clear naturally, but high-risk strains can cause precancerous changes and malignancies, especially cervical cancer. Screening (Pap smears, HPV tests) is necessary for early detection because symptoms are often missing. Warts, aberrant cells, and malignancies are treated, not the virus. HPV vaccination, safer sexual behaviors, and regular checkups greatly lower risks. HPV can be managed, and its worst effects prevented through knowledge, vaccination, and screening.