vitiligo,psoriasis,alopecia andhyperhydrosis -physiotherapy

1. Physiotherapy in Skin
conditions
A.THANGAMANI RAMALINGAM
PT, MSc(PSY),PGDRM, ACspss, MIAP

2. Functions
of the skin
Protection from external injury
Covering the organs
Used in fluid balance excretory function
Sensory function
Controls temperature
Absorption
Metabolizes vitamin D
Gateway for drug delivery
Cosmetic function

3. Skin conditions
 Acne vulgaris is a common chronic skin disease
involving blockage and/or inflammation of hair follicles
 Alopecia - It is a type of hair loss that occurs when the
immune system mistakenly attacks hair follicles
 Psoriasis -It is a papulo-squamous disorder of skin.
Characterized by erythemato-squamous lesions, vary in
size from pinpoint to large plaques. May be localized or
generalized with pustular eruptions. It may affect the
joints/nails.
 Leucoderma / Vitiligo-These are white patches of the
skin.
 Hyperhidrosis is a condition characterized by
abnormally increased sweating

4. Acne vulgaris
 Open comedones
(black heads)
 Closed comedones
(white heads)
 Papules
 Enlarged pores of hair
follicles
 Cysts
 Pustules
 Scars (occassionally)
 Comedolytics
 Chemotherapy
 Exfoliants
 Cryotherapy

5. Alopecia
 Types
 Alopecia areata – local
patches
 Alopecia totalis –
whole scalp
 Alopecia universalis –
scalp and body
 Topical steroids
 PUVA therapy

6. Hyperhidrosis
 primary hyperhidrosis or
focal hyperhidrosis.
 generalized
hyperhidrosis or
secondary hyperhidrosis
 palmoplantar
hyperhidrosis
 Gustatory
hyperhidrosis

7.  overactivity of the
sympathetic nervous
system
 inherited as an
autosomal dominant
genetic trait
 certain types of
cancer, disturbances
of the endocrine
system, infections, and
medications

8. Psoriasis - papulosquamous disorder
Five main types of psoriasis:
plaque, guttate, inverse,
pustular, and erythrodermic.
nonpustular and pustular types
Psoriatic plaque - a silvery center
surrounded by a reddened border.
 Genetic disease
 Defect in regulatory T cells, and
cytokine interleukin-10
 Skin cells are replaced every 3–5
days(normal 28-30 days)
 scaly, erythematous plaques,
papules, or patches of skin that may
be painful and itchy.
 Psoriatic arthritis
 Treatments may include steroid
creams, vitamin D3 cream, ultraviolet
light, and immune system
suppressing medications such as
methotrexate

9.  Mild psoriasis has been
defined as a percentage
of body surface area
(BSA)≤10, a Psoriasis
Area Severity Index
(PASI) score ≤10, and a
dermatology life quality
index (DLQI) score ≤10.
 Moderate to severe
psoriasis was defined by
the same group as BSA
>10 or PASI score >10
and a DLQI score >10.

10. Five forms of Psoriatic Arthritis
 Asymmetric oligo-articular arthritis (70% of cases)
Joints involved  - DIP, PIP, MCP mostly
-Tenosynovitis
-Hip/Knee occasionally
 Symmetric rheumatoid like arthritis (15% of cases)
 Classical psoriatic arthritis (5% of cases)
DIP mostly involved
 Arthritis multilans (5% of cases)
Osteolysis with severe destruction/deformation of bones
Even dissolution of the phalanges
 Ankylosing spondylitis with or without peripheral
joint involvement (5% of cases)

12. Vitiligo
Tissue biopsy
cytokine interleukin-1β.
Immune suppressing medications
including glucocorticoids (such as
0.05% clobetasol or 0.10%
betamethasone) and calcineurin
inhibitors (such as tacrolimus or
pimecrolimus) are considered to be first-
line vitiligo treatments
Steroid
Phototherapy(Narrowband ultraviolet B
(NBUVB) phototherapy/PUVA)
Counselling
Skin camouflage
Depigmentation (An alternative approach is
to eliminate the skin colour from the normal
areas using monobenzone cream)
 Characterized by patches of the
skin losing their pigment
 Genetic susceptibility
 Auto immune disorder
Two main types: segmental and non-
segmental
Non segmental-
 Generalized Vitiligo: the most
common pattern, wide and
randomly distributed areas of
depigmentation
 Universal Vitiligo: depigmentation
encompasses most of the body
 Focal Vitiligo: one or a few
scattered macules in one area,
most common in children
 Acrofacial Vitiligo: fingers and
periorificial areas
 Mucosal Vitiligo: depigmentation of
only the mucous membranes[

13. Physiotherapy
 UVR therapy/phototherapy
 Joint and muscle integrity
 Care of the bony prominences
 Increase the mobility and
activity
 Exercise to improve circulation
 Reduce shear friction force
 Don’t expose to extreme hot/
cold
 Lubricate the skin ‘ adequate
fluid intake’
 Use appropriate infection
control techniques
 Maintain hygiene
PT assessment
 Inspection under good light
 General appearance of the skin
 Temperature
 Moisture , dryness, skin texture
 Colour size of lesion
 Palpate the lymph nodes
 Look for cyanosis
 Check the pulses

14. Advanced PT asssessment

15.  The evaluation is based on six indicators:
sensory perception, moisture, activity,
mobility, nutrition, and friction or shear.

16. UVR in skin conditions
 Ultraviolet radiation therapy is used to obtain one or
more of the following effects: increased vitamin D
production, stimulation of the skin, sterilization, tanning,
hyperplasia, and exfoliation (peeling).
 The use of UVR is indicated for treatment of infectious
and noninfectious skin diseases and for the excitation of
calcium metabolism.
 The development of antibiotics and other medications
has greatly reduced the clinical use of UVR.
 Today the most common use of UVR is in the treatment
of dermatologic conditions such as psoriasis and acne
and hard to cure infectious skin conditions such as
pressure sores.

17. UV treatments
Goeckerman’s regimen :
Apply coal tar for
24 hrs  Remove it with
mineral or vegetable oil 
Exposure to UV Rays to
induce mild erythema  A
bath with soap and water
to wash of scales  Tar is
reapplied after bath.
Ingram’s regimen:
Coal tar application and
dry it  After drying, UVB radiation
to sub erythema dosage  Cover
up the lesions with Dithranol (0.4%
paste)  Powder is applied and
the lesion covered with Stockinette
 Patient comes after 24 hrs for
treatment. (A short regimen is
also available for 30minutes to
2hrs)