Combinations of oral and topical medicines for acne skin care are advised by the doctor for acute cases. Topical medicines include acne treatment creams, lotions, solutions, or gels.. Wash the affected area twice a day carefully with mild soap. Do not use rough materials to wipe your face. Wash and clean your face as often as possible.

•    The facial cleanser which you select for acne skin care should be oil based. They should be mild and non-irritating.
•    Excess washing can cause irritation. Wash your face twice a day, both in the morning and evening.
•    Use your hands to wash your face. A washcloth may cause irritation to your skin. The act of washing must be considered as simply prepping your skin for medication, nothing more. There is absolutely no need to scrub during washing because washing itself does not clear breakouts since dirt does not cause acne.
•    Do not vigorously rub your skin to dry it.  Rubbing the skin can cause irritation, and excess irritation can lead to more breakouts. So gently the pat dry your face.
•    Use shampoo on your hair regularly.
•    Keep hair off the shoulders and face and wash it regularly.
•    Avoid shaving as far as possible. While shaving, take care to avoid nicking pimples. Use fresh, clean blades to avoid infection.
•    Avoid using makeup or cosmetics in acne prone areas. If you have to, use hypoallergenic cosmetics that are fragrance free.
•    Don’t pick, pop, scratch or squeeze your pimples. This may lead to scarring and infections.
•    When using over-the-counter treatment for acne, start with the lowest strength and apply once a day after washing. It may take several weeks and never use more than 5% strength without consulting a dermatologist.

Oil called “sebum” is secreted normally from hair follicles which travels up the tiny hair follicles to the skins pores where it lubricates and protects the skin. Sometimes, there are overworked oil glands which enlarge and produce too much sebum which can get trapped in the hair follicle. Thus the pores get clogged which are then either called blackheads or whiteheads. This will allow bacterial overgrowth of Propionibacterium acnes. In the surrounding skin, acne will be formed when these bacteria inflames the hair follicle.

Acne manifests in many different ways. Though they all look like cysts, they have distinct characteristics.

Whiteheads: These are formed when a pore is completely blocked trapping bacteria, sebum and dead skin cells and forming a white protuberance on the surface. Some of them appear bulbous, but care should be taken not to pop these cysts as it may lead to bacterial infections.

Blackheads: These happen when a pore is partially blocked allowing some of the dead skin cells and sebum to flow out. The black colour is not an accumulation of dirt or grit but formed as a result of a reaction of melanin, a pigment in the skin, with oxygen. Blackheads do not clear as easily as whiteheads.

Papules: They are small, tender red bumps without a head. Don’t ever try to squeeze a papule because it will cause scarring.

Pustules: They are similar to whiteheads but are more inflamed and appear as a red circle with a white or yellow center.

Nodules: Nodular acne consists of cysts which are much larger and more painful and long lasting. Nodules are hard, large bumps forming under the surface of the skin. Acne scars are very common with nodules and you should not attempt to squeeze a nodule. It may cause trauma to the skin and the lesions may last longer.

Most of the acne, even if it disappears, will leave a scar. The treatment for this scar removal is quite difficult. Proper treatment of acne will go a long way in reducing scarring. Before you treat for acne scars, your dermatologist will take your age, overall health and medical history. The following dermatological procedures may help minimize problems caused by acne.

Chemical peels:
Chemical peels are used for irregular pigmentation, superficial scars and sun-damaged skin. The upper layer of the skin is removed with a chemical application and by doing so, the skin is regenerated. This helps to clear the scar.

Dermabrasion:
This treatment is used to help in acne scar removal, minimize skin surface irregularities, and surgical scars. It involves the removal of top layers if skin with an electric machine. When the skin heals, the surface will appear smoother and fresher.
Collagen injections:
Purified collagen, derived from a cow is injected beneath the skin to replace lost collagen. It is commonly used to treat facial lines, wrinkles and scars.

Laser resurfacing:
This process uses high energy light to burn away damaged skin. It is used to minimize fine scars and wrinkles.
Punch grafts:
Punch grafts are skin grafts used to replace scarred skin and assist in acne scar removal. After a hole is punched in the skin to remove the scar, it is replaced with unscarred fresh skin, usually from behind the earlobe. Punch grafts are helpful in treating deep acne scars.
Autologous fat transfer:
This is yet another procedure which hastens the process of acne scar removal. It involves the transfer of fat from another site of your body which is then injected and placed just below the skin. The replaced fat causes the skin over the depressed scar to elevate. This is used to correct deep contour defects caused by nodulocystic acne. Because fat gets absorbed by the skin, this procedure may have to be repeated.

Diagnosis

If you suspect you have spinal arthritis, you should see a doctor. Your doctor will do a detailed examination. You may have to do a few simple exercises so your doctor can see if your range of motion is affected. These exercises will include bending forward, side-to-side or backwards. You may also be asked to lie down and raise your legs. The symptoms of spinal arthritis are similar to other spinal conditions. It is therefore important for your doctor to rule out more serious problems. You have to undergo a variety of tests such as:
•    Blood tests
•    X-rays
•    MRI
•    Computerized axial tomography scan
•    Bone scan
•    Myelogram

After your doctor determines you have arthritis in your spine, there are a number of treatment options. Spinal arthritis is no death sentence. Many who have arthritis continue to lead active and productive lives. An awareness of your condition and managing your symptoms are the keys to living with spinal arthritis.

The chronic pain associated with arthritis can very seriously affect your quality of life. If left untreated, it can also lead to physiological problems such as muscle breakdown or weakness as well as psychological difficulties such as anxiety and depression. There are a wide variety of treatments that can help relieve the pain and discomfort of arthritis

In addition to medications, many people with arthritis can find relief from physical therapy and exercise. Physical therapy is a treatment method that focuses on pain relief, healing, restoring function and movement, improving body mechanics, as well as overall fitness and wellness.

Osteoarthritis is a degenerative condition that destroys the smooth outer covering of bone. It normally affects people over fifty years of age and is more common in the AC joint than in the glenohumeral shoulder joint.

Rheumatoid arthritis is a systemic inflammatory condition of the joint lining. It can affect people of all ages and usually affects multiple joints on both sides of the body.

Post-traumatic arthritis is a form of osteoarthritis that develops after an injury such as a dislocation or fracture of the shoulder. Arthritis can also develop after a rotator cuff tear.

Symptoms

The most common symptom of arthritis of the shoulder is pain, which is heightened by activity and worsens progressively. If the glenohumeral shoulder joint is affected, the pain is situated in the back of the shoulder and may intensify with changes in the weather. The pain of arthritis of the shoulder in the AC joint is focused on the front of the shoulder. Patients with rheumatoid arthritis may have pain in all these areas if both shoulder joints are affected.

Limited motion of the shoulder joints is another symptom. You may hear a clicking or snapping sound (crepitus) as you move your shoulder. It may become more difficult to comb your hair, to lift your arm or reach up to a shelf. As the disease furthers, any movement of the shoulder causes pain. Night pain is common and sleeping may be difficult.

Diagnosis

A physical examination and X-rays are needed to properly diagnose arthritis of the shoulder. During the physical examination, your physician will look for:

•    Weakness in the muscles
•    Tenderness and sensitivity to touch
•    Extent of assisted and self-directed range of motion
•    Any signs of injury to the tendons, muscles and ligaments surrounding the joint
•    Involvement of other joints
•    Creaking with movement
•    Pain occurring when pressure is placed on the joint

Arthritis of the shoulder can be confirmed if X-rays of an arthritic shoulder show a narrowing of the joint space, changes in the bone and the formation of bone spurs. If an injection of a local anaesthetic into the joint relieves the pain temporarily, the diagnosis can be confirmed.

Treatment

As with other arthritic conditions, initial treatment of arthritis of the shoulder is quite conservative: Rest or change of activities is suggested to avoid provoking pain - you may need to alter the way you move your arm to do things with your hand.

Taking of non-steroidal anti-inflammatory medications such as aspirin or ibuprofen to reduce inflammation is recommended.

Apply ice on the shoulder for 20 to 30 minutes two or three times a day to reduce inflammation and ease pain.  If you have rheumatoid arthritis, your doctor may recommend a series of corticosteroid injections or prescribe a disease-modifying drug such as methotrexate. The taking of dietary supplements such as glucosamine and chondroitin sulfate may also be helpful.

Most patients require aggressive second-line drugs, such, as methotrexate in addition to anti-inflammatory agents. Sometimes these are used in combination. In some patients with severe joint deformity, surgery may be required.

First-line Drugs

Acetylsalicylate, ibuprofen, naproxen, etodolacare are examples of non-steroid anti-inflammatory drug. NSAIDs can reduce pain, swelling and tissue inflammation. Aspirin is an effective anti-inflammatory medication for rheumatoid arthritis. It has been used as rheumatoid arthritis medication since ancient times.

The most common side effects of aspirin and other NSAIDs include ulcers, abdominal pain, stomach upset, and sometimes even gastrointestinal bleeding. To reduce side effects on the stomach, NSAIDs are usually taken with food. Some additional medications are often recommended to protect the stomach from the ulcer effects of NSAIDs. These include antacids, proton-pump inhibitors, misoprotosol, and sucralfate.

Rheumatoid arthritis medications like cortisteroids can be injected directly into tissues and joints or be given orally. They are more potent than NSAIDs in reducing inflammation and in restoring joint mobility and function. They are useful for short periods during severe flares of disease activity, or when the disease is not responding to NSAIDs. Their side effects include facial puffiness, weight gain, thinning of the skin and bone, cataracts, risk of infection, muscle wasting, easy bruising and destruction of large joints such as the hips.

Second-line or slow-action Drugs

Rheumatoid arthritis requires medications other than NSAIDs and corticosteroids to stop increasing damage to cartilage, bone, and adjacent soft tissues. The rheumatoid arthritis medications are also referred to as Disease-modifying Anti-rheumatic Drugs or DMARDs. They come in many forms and are listed below.

Hydroxychloroquinine is used over extended periods as rheumatoid arthritis medication. Side effects include skin rashes, muscle weakness, upset stomach and vision changes. Though vision changes are rare, patients taking hydroxychloroquine should consult an ophthalmologist.

For the treatment of mild to severe inflammatory bowel diseases, like Crohn’s colitus and ulcerative colitus, sulfasalazine is a widely used oral medication. Azulfidine is used to treat rheumatoid arthritis in combination with anti-inflammatory medications. Azulfidine is generally well tolerated and side effects include rash and upset stomach. Azulfidine is made up of sulfa and salicylate compounds and it should be avoided by patients with known sulfa allergies.

Methotrexate has gained popularity among doctors as an initial second-line drug because of both its infrequent side effects and effectiveness. It also has dose flexibility. Methotrexate is an immune suppression rheumatoid arthritis medication. It affects the bone marrow and the liver, even rarely causing cirrhosis. Persons taking methotrexate require blood test monitoring regularly of blood counts and liver function blood tests.

Gold salts are a popular rheumatoid arthritis medication throughout most of the past century. Gold thiomalate and gold thioglucose are given by injection, initially on a weekly basis for long durations. Side effects of gold – both oral and injectable, include mouth sores, skin rash, kidney damage with seepage of protein in the urine, and bone marrow damage with anaemia and low white cell count. Patients receiving gold treatment are routinely monitored with urine and blood tests.

D-penicillamine can be a helpful rheumatoid arthritis medication in some patients with progressive forms of the disease. Side effects include fever, chills, mouth sores, a metallic taste in the mouth, skin rash, stomach upset, kidney and bone marrow damage, and easy bruising. Patients on this rheumatoid arthritis medication require routine blood and urine tests. D-penicillamine rarely causes symptoms of other autoimmune diseases.

A number of immunosuppressive drugs are used as rheumatoid arthritis medication. They include methotrexate as described above along with, chlorambucil, azathioprine, cyclophosphamide and cyclosporine. Because of rather serious side effects, immunosuppressive medicines are generally kept aside for patients with very aggressive forms of the disease, or those with serious complications. The exception is methotrexate, which is not frequently associated with serious side effects and can be carefully monitored with blood testing.

Rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease. It is a chronic illness which can last for years and patients may experience long periods without symptoms. Rheumatoid arthritis is a progressive illness that has the potential to cause functional disability and joint destruction.

Causes of rheumatoid arthritis

The real cause of rheumatoid arthritis is not known and it is a very active area of worldwide research. Scientists believe the tendency to develop rheumatoid arthritis may be genetically inherited. Suspicions are that certain infections or factors in the environment might trigger the immune system to attack the body’s own tissues, resulting in inflammation in various organs of the body like the lungs or eyes.

Immune cells, called lymphocytes, are activated and chemical messengers, such as tumour necrosis factor are expressed in the inflamed areas. Environmental factors also play some role in the cause of rheumatoid arthritis. Recently, scientists have reported that smoking increases the risk of developing the disease.

Symptoms of rheumatoid arthritis

The symptoms of rheumatoid arthritis depend on the degree of tissue inflammation. When body tissues are inflamed, the disease becomes active. When the inflammation subsides, the disease goes into a remission. Remissions occur spontaneously or with treatment, and can last weeks, months, or years.

During remissions, symptoms of the disease go away, and patients normally feel well. When it becomes active again, the symptoms return. The return of disease symptoms and activity is called a flare or relapse. The course of a flare varies from patient to patient, and periods of flares and remissions are typical.

When the disease is active, symptoms include lack of appetite, low grade fever, fatigue, muscle and joint aches, and stiffness. Joint and muscle stiffness are usually most notable in the morning and/or after periods of inactivity. During flares, joints frequently become tender, swollen, red, and painful. This occurs because the lining tissue of the joint becomes inflamed, resulting in the production of excessive joint fluid. The synovium also thickens with inflammation.

Most people with psoriatic arthritis also have psoriasis. In very rare cases, a person can have psoriatic arthritis without having psoriasis.

Symptoms of psoriatic arthritis:
• Reduced motion range
• Pain and redness of the eye, similar to conjunctivitis
• Swelling, pain, stiffness and tenderness of the joints and surrounding soft tissue
• Nail changes, including lifting of the nail or pitting
• Morning tiredness and stiffness

Psoriatic arthritis can develop at any time. On a normal average, it appears about ten years after the first signs of psoriasis. It appears between the ages of 30 and 50 and affects men and women equally. Arthritis symptoms normally occur before any skin lesions, in about one of seven people with psoriatic arthritis. Psoriatic arthritis is thought to be caused by a malfunctioning immune system. It is usually milder than rheumatoid arthritis, but some patients have as severe a disease as patients with rheumatoid arthritis.

Psoriatic arthritis may start gradually with mild symptoms, or it can arise quickly. It is important to have an early and accurate diagnosis, as far as possible. If left without proper treatment, psoriatic arthritis can be a progressively disabling disease. As a matter of fact, one half of those with psoriatic arthritis already have bone loss by the time the disease is diagnosed.

There are no definitive tests for psoriatic arthritis but the onset of joint swelling and pain in persons with psoriasis should be a warning signal. Treatment involves disease-modifying and anti-inflammatory medications. Methotrexate is probably a good starting point. Additionally, drugs like etanercept, adalimumab, and infliximab are usually commenced soon after methotrexate.

After fifty five years, it occurs more frequently in females. This type of arthritis commonly affects the feet, hands, large weight-bearing joints, such as the hips and knees and the spine. Osteoarthritis, which has no known cause, is normally referred to as primary osteoarthritis. When the cause is known, the condition is referred to as secondary osteoarthritis.

Primary osteoarthritis is normally related to aging. When we age, the water content of the cartilage increases and the protein makeup of cartilage degenerates. Continued use of the joints over the years inflames the cartilage, causing joint pain and swelling. Slowly, cartilage begins to degenerate by flaking or forming tiny crevasses. In later stages, there is a total loss of the cartilage cushion between the bones of the joints. Inflammation of the cartilage may also stimulate new bone growths to form around the joints. Osteoarthritis occasionally can be found in many members of the same family, implying a genetic basis for this condition.

Unlike other forms of arthritis osteoarthritis does not affect other organs of the body. The most common symptom of osteoarthritis is pain in the affected joints after prolonged repetitive use. Joint pain usually worsens later in the day. This can cause swelling, warmth, and creaking of the affected joints. Stiffness and pain of the joints can also occur after long periods of inactivity, for example, sitting in a movie hall. In severe cases, complete loss of cartilage cushion causes friction between bones, causing pain at rest or pain with limited motion.

Symptoms of osteoarthritis differ a great deal from patient to patient. Some persons can be debilitated by their symptoms. Others may have remarkably few symptoms in spite of dramatic degeneration of the joints apparent on x-rays. Symptoms may also be intermittent. Patients with osteoarthritis of the hands and knees may also have years of pain-free intervals between symptoms.

Though the reasons leading to knee osteoarthritis is not known, there seems to be a genetic component. Obesity, trauma and even a fracture can lead to this form of arthritis.

Osteoarthritis affects each person differently. In some people, it progresses quickly; in others, the symptoms are more serious. Scientists do not know yet what causes the disease, but there can be a combination of factors, including being overweight, the aging process, joint injury, and stresses on the joints from certain jobs and sports activities

Even though osteoarthritis does not produce many initial symptoms, morning stiffness, pain with activity and mild swellings may occur over a period of time. A dull toothache like pain, especially with weather changes is common in the intermediate stages. No single test can diagnose osteoarthritis. Most doctors use a combination of the following methods to diagnose the disease and rule out other conditions:

A combination of tests, both physical and clinical are carried out before the doctor actually determines the nature of the condition and the subsequent treatment processes for knee osteoarthritis. The patient’s general health, including his reflexes, muscle strength and joints of the patient will be examined. The ability of the patient to walk, bend, and carry out activities of daily living will also be considered.

The main objectives of the treatment are to maintain normal physical function and reduce symptoms. This can be done with anti-inflammatory medications, carefully planned exercise programs, weight control and occasional steroid injections.  Injections of some of the precursors of cartilage and oral supplements such as glucosamine sulfate and chondrotin sulfate are other nonoperative therapies that have shown promise in the treatment of knee osteoarthritis.

Most people with knee osteoarthritis exercise best when their pain is least severe. Start with an adequate warmup and begin exercising slowly. Resting frequently ensures a good workout. It also reduces the risk of injury. A physical therapist can evaluate how a patient’s muscles are working. This information helps the therapist develop a safe, personalized exercise program to increase strength and flexibility