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Definition : It is a common inflammatory disease of pilosebaceous follicles in which the pilosebaceous follicles become oversensitive to a normal level of testosterone.  Cause : Androgens  Follicular keratinisation  Hereditary  Propionic bacterium acnes  Immunological factor Environmental factor  Exacerbating factor : Peak severity of acne is in the late teenage years but acne may persist into the 3rd decade  and beyond particularly in a female. Factors : Acne occurs with stress Premenstrual period  With aggressive acne or recalcitrant acne, the cause is virilising syndrome in female, acromegaly, Occupational exposure to an agent.  A drug like steroids, hormones, anti-epileptic drugs, Iodine.  Genetic & hormonal factor plays an important role.  Pathogenetic factor : Increase sebum excretion: Clear relation between severity of acne & sebum excretion.  Main determinants of sebum excretion are hormonal accounting for the onset of acne in t

Keloid is a vascular hypertrophic scar. It is actually a form of soft fibroma, prone to recurrence, and is different from a usual hypertrophic scar.  Diagnostic point : Scar raised above the surface and widened. Claw like processes spreading out from the margins. Red or pink coloured. A symptom of intense itching. Firm inconsistency. Margin may be tender in a growing keloid.  Predisposing causes : Site of scar: Example - Vertical scar in neck and ear. Nature: Vaccination scar and burns are prone to keloid formation.  Race: Negroes are common sufferers.  Common in T.B. patients. Pregnant state: Sometimes keloid formation is common after operation or wounds occurring during pregnancy.   Treatment : Preoperative deep therapy is followed by excision of the keloid and skin grafting, if skin edges can't be brought together without tension.  Postoperative deep X-ray should be started, when the skin graft has taken.  All these measures are

A scar is a result of abnormal healing of wound with a mass of devascularised fibrous tissue covered by a single layer of epithelium, which contains no skin appendages or no lymphatics. During the process of healing the blood vessels are constructed by the collagen fibre of the fibroblasts, hence the scar is relatively avascular.  Complications : 1. Contracture and deformity  Scar contracts to one-third of its original length.  Effects :  1. Deformity: Especially of flexor surface of joints.  2. Limitation of joint movement : False ankylosis  Predisposing cause : Infection  burns  Treatment : Preventive :  Splinting and early skin graft.  Curative :  Gradually stretching  Excision and followed by a skin graft. Pedicle graft can only prevent subsequent contracture and at times Thiersch graft is better avoided. Z plastic with rearrangement of scar lines.  2. Keloid  Keloid is a vascular hypertrophic scar. It is actually a form o

Mensuration  Definition :   It is a phenomenon of cyclical discharge of blood, mucus, cellular and usually a dead ovum from uterus per vagina of a sexually matured women during her reproductive life, usually at an interval of 28 days + or - 2 days. Cycle :  The average cycle lasts 28 days but may vary from 21 to 35 days. Duration : 3 to 5 days but anything between 2 to 7 days is normal. Cycle and duration are less regular into extremes of life. Example: in post-menarcheal girls and peri-menopausal women.  Flow : It begins as a pink discharge and becomes heavy on 2nd and 3rd day. It consists of blood, endometrial debris, cervical and endometrial secretion, bacteria, RBC, WBC, alkaline and acid phosphate, plasminogen, fibrinolysin and a degenerated ovum. It has got a characteristic odour. The menstrual blood differs from normal blood in that it lakes prothrombin and fibrinolysin and therefore does not clot. It clots appear it means bleeding has been excessive and

Definition :   Menorrhagia is a profusion  and to protected menstruation. Excessive discharge of blood occuring at the menstrual period. It is important to emphasise that the menstrual cycle is unaltered, bleeding associated with irregular cycle should not be regarded as menorrhagia. Menorrhagia common in premenopausal women. Aetiology : General disease- hypertension, chronic congestive failure, chronic nephrosis, nutrition vitaminosis, or defective nutrition, severe anaemia, leukemias. Worry, sorrow. Sexual excesses,  prolong eating of Aspirin. Endocrine disorder -  hypothyroidisum or hyperthyroidism. Dysfunctional uterine hemorrhage Pelvic cause - uterine malformation, double uterus. Pelvic endometriosis, chocolate cyst of the ovary, uterine fibroid. Pelvic inflammation, Adenomyosis, chronic endometritis, carcinoma of   endometrium. Hormonal distrubance. Clinical futures :  Menorrhagia is itself a symptoms. Symptoms : General due to blood loss - we

Definition : Dysmenorrhoea means painful menstruation. painful menstruation,abdominal cramps. Pain arise before or during the flow.it may also be  present after the flow has stop. Types : Primary or spasmodic dysmenorrhoea : Pain due to   menstruation and uterine region. Obstructive dysmenorrhoea - a type of spasmodic , a partial or complete obsruction of the genital canal. Membranous dysmenorrhoea - a type of spasmodic, a big pieces of endometriumis casted out. It runs families. Secondary or congestive dysmenorrhoea:   Pain with menstruation and it felt in lower abdomen and back 3 to 7 before the menstruation and better after menstruation.  The congestion increase beyond the physiological limit it also known as congestive dysmenorrhoea. Cause : Definite cause is unknown. Associated factors. primary or spasmodic dysmenorrhoea :  Ischemic condition if uterine muscles. Conical cervix, uterine malformation like rudimentory horn or septate uterus. Physiolo

Definition : Cryptomenorrhoea is also called hematocolpos. It is a condition where menstruation occurs but is not visible due to an obstruction of the genital tract. Concealed menses. In this menstruation is taking place but escape of blood. It prevented by an obstruction in the genital canal. The endometrium  is shed but congenital obstruction such as a vaginal septum  and  on part of the hymen  retains the menstrual flow. Causes : Congenital : Imperforate hymen. Closed cervix. Acquired : Stenosis of the cervix after amputation. Obstetric injury. Clinical feature: Symptoms : Amenorrhoea . Constipation. Retention of urine. Dysuria. Lower abdominal pain every month. Frequent micturition before retention. Swelling in the lower abdomen. Retention of urine. Signs: On palpation and speculum examination saw obstruction in the upper vagina and cervix. Cystic swelling per rectum. Usually seen above 15 to 18 years girl. Hypogastric cystic swelling per ab

Definition : Amenorrhoea is an absence of menstrual flow occurring at any time between puberty and the menopause, except during pregnancy and lactation. Aetiological classification : Physiological : During pregnancy. Sometime during adolescence. Before puberty. After menopause. Sometime during lactation. Pathological :  Primary amenorrhoea:  When menarche does not appear even when the girl is over 18 years. Cryptomenorrhoea .  Rudimentary or infantile uterus or ovaries.  Sex chromosomal defect.  Congenital absence of uterus or ovaries. Endocrinal cause - hypothyroidism, juvenile diabetes mellitus etc.  Injury or diseases of the midbrain. Turner's syndrome. Frohlick's syndrome. Tuberculosis, anaemia etc. Poor nutrition. Some drugs like androgens etc.     Secondary Amenorrhoea: Cessation of menses for 3 or more months following normal menstruation . Uterine injury, tuberculosis, hysterectomy, radiation D & C etc. Cervical stenosis or ampu