A chronic inflammatory disorder of the connective tissues, lupus erythematosus appears in two forms: discoid lupus erythematosus, which affects only the skin, and systemic lupus erythematosus, which affects multiple organ systems (as well as the skin) and can be fatal.

Like rheumatoid arthritis, systemic lupus is characterized by recurring remissions and flare-ups, especially common during the spring and summer. The annual incidence of this disorder averages about 27 cases in 1 million whites and 75 cases in 1 million blacks. Systemic lupus strikes women 8 times as often as men, increasing to 15 times as often during childbearing years. Systemic lupus occurs worldwide but is most prevalent among Asians and blacks.

The prognosis improves with early diagnosis and treatment but remains poor for people who develop heart and blood vessel, kidney; or nervous system complications or severe bacterial infections.

What Causes it?

The exact cause of systemic lupus remains a mystery, but available evidence points to interrelated immunologic, environmental, hormonal, and genetic factors. An immune dysfunction, such as autoimmunity, is considered the prime causative mechanism. In autoimmunity, the body produces antibodies (such as the antinuclear antibody) against its own cells. The formed antigen-antibody complexes can suppress the body’s normal immunity and damage tissues. One significant feature in people with this disorder is their ability to produce antibodies against many different tissue components, such as red blood cells, neutrophils, platelets, lymphocytes, or almost any organ or tissue in the body .

Certain predisposing factors may make a person susceptible to systemic lupus. Physical or mental stress, streptococcal or viral infections, exposure to sunlight or ultraviolet light, immunization, pregnancy, and abnormal estrogen metabolism all may affect the disease’s development.

Systemic lupus also may be triggered or aggravated by treatment with certain drugs – for example, Procan SR, Apresoline, antiseizure drugs and, less frequently; penicillins, sulfa drugs, and oral contraceptives.

What are its Symptoms?

The onset of systemic lupus may be acute or insidious and produces no characteristic clinical pattern. However, its symptoms commonly include fever, weight loss, malaise and fatigue, as well as rashes and pain in multiple joints.

Systemic lupus may involve every organ system. In 90% of cases, joint involvement is similar to that in rheumatoid arthritis. Skin lesions are most commonly a red rash in areas exposed to light. The classic butterfly rash over the nose and cheeks occurs in fewer than 50% of people with systemic lupus. Ultraviolet rays often provoke or aggravate skin eruptions. Vasculitis can develop (especially in the fingers and toes), possibly leading to infarctive lesions, necrotic leg ulcers, or gangrene of the fingers or toes. Raynaud’s phenomenon (decreased blood flow to the fingers and toes, causing numbness and pain) appears in about 20% of cases. Patchy hair loss and painless ulcers of the mucous membranes are common.

Constitutional symptoms of systemic lupus include aching, malaise, fatigue, low-grade or spiking fever, chills, loss of appetite, and weight loss. Lymph node enlargement (diffuse or local, and nontender), abdominal pain, nausea, vomiting, diarrhea, and constipation may occur. Women may experience absent or irregular menstrual periods during the active phase of systemic lupus erythematosus.

About 50% of people with systemic lupus develop signs of cardiopulmonary abnormalities, such as pleuritis, pericarditis, and shortness of breath. Myocarditis, endocarditis, rapid heartbeat, parenchymal infiltrates, and pneumonitis may occur. Kidney effects may include blood, protein, sediment, and cellular casts in the urine and may progress to total kidney failure. Urinary tract infections may be caused by heightened susceptibility to infection. Seizure disorders and mental dysfunction may indicate neurologic damage. Central nervous system involvement may produce emotional instability, psychosis, and organic brain syndrome. Headaches, irritability, and depression also are common.

How is it Diagnosed?

Diagnostic tests for people with systemic lupus include a complete blood count with differential, platelet count, erythrocyte sedimentation rate, and serum electrophoresis.

Specific tests include antinuclear antibody, anti-DNA, and lupus erythematosus cell tests, urine studies, blood complement studies, chest X-ray, electrocardiography, and kidney biopsy.

Some people show a positive lupus anticoagulant test and a positive anticardiolipin test. These people are prone to antiphospholipid syndrome (blood clot formation, miscarriage, and low platelet count).

How is it Treated?

People with mild systemic lupus require little or no medication. Nonsteroidal anti-inflammatory compounds, including aspirin, control arthritis symptoms in many cases. Skin lesions need topical treatment. Corticosteroid creams, such as Cordran, are recommended for acute lesions.

Refractory skin lesions are treated with intralesional corticoste­roids or antimalarials, such as Plaquenil and Ara1en. Because these drugs can cause retinal damage, such treatment requires eye exams every 6 months.

Corticosteroids remain the treatment of choice for systemic symptoms of systemic lupus, for acute generalized flare-ups, or for serious disease related to vital organ systems, such as pleuritis, pericarditis. lupus nephritis, vasculitis, and central nervous system involvement. Initial doses equivalent to 60 milligrams or more of Orasone often bring noticeable improvement within 48 hours. As soon as symptoms are under control, corticosteroid dosage is tapered down slowly.

Diffuse proliferative glomerulonephritis, a major complication of this disorder, requires treatment with large doses of corticosteroids. If kidney failure occurs, dialysis or kidney transplant may be necessary. In some people, cytotoxic drugs such as Imuran and Cytoxan may delay or prevent deteriorating kidney status. Antihypertensive drugs and dietary changes may also be warranted in kidney disease.

The light-sensitive person should wear protective clothing (hat, sunglasses, long sleeves, slacks) and use a sunscreen containing para-aminobenzoic acid when outside. Because systemic lupus usually strikes women of childbearing age, questions associated with pregnancy often arise. The best evidence available indicates that a woman with this disorder can have a safe, successful pregnancy if she has no serious kidney or nervous system impairment.

What can a person with lupus do?

• Watch for symptoms, such as joint pain or stiffness, weakness, fever, fatigue, and chills. Stay alert for shortness of breath, chest pain, and arm or leg swelling. Check for blood in your urine, scalp hair loss, and bleeding, ulcers, pallor, and bruised skin and mucous membranes.

• Eat a balanced diet. Foods high in protein, vitamins, and iron help maintain optimum nutrition and prevent anemia. However, if you have kidney problems, the doctor will recommend a low-sodium, low-protein diet.

• Get plenty of rest.

• Apply heat packs to relieve joint pain and stiffness. Get regular exercise to maintain a full range of motion and prevent contractures. Perform range-of-motion exercises, as well as body alignment and postural techniques.

• Take prescribed drugs exactly as directed, and watch for side effects, especially if you’re taking high doses of corticosteroids.

• If you’re receiving Cytoxan, be sure to drink plenty of fluids.

• Use hypoallergenic makeup, if needed, and consult a hairdresser who specializes in scalp disorders.

• Buy drugs in quantity, if possible. Be skeptical about “miracle’ drugs for relief of arthritis symptoms.

• Contact the Lupus Foundation of America and the Arthritis Foundation for more information.

This chronic skin disorder is characterized by superficial skin inflammation and intense itching. Although atopic dermatitis may appear at any age, it typically begins during infancy or early childhood. It may then disappear spontaneously, followed by flare-ups in late childhood, adolescence, or early adulthood. Atopic dermatitis affects approximately 0.7% of the population.

What Causes it?

The cause of atopic dermatitis is still unknown. However, several theories attempt to explain its cause. One theory suggests an underlying metabolic- or biochemical-induced skin disorder genetically linked to elevated serum immunoglobulin E levels; another suggests defective T-cell function.

Exacerbating factors of atopic dermatitis include irritants, infections (commonly caused by Staphylococcus aureus), and some allergens. Although no reliable link exists between atopic dermatitis and exposure to inhaled allergens (such as household dust and animal dander), exposure to food allergens (such as soybeans, fish, or nuts) may coincide with Hare-ups of atopic dermatitis.

What are its Symptoms?

Scratching the skin intensifies itching, resulting in red, weeping lesions. Eventually, the lesions become scaly. Usually, they’re found on the neck, inside the elbows, and behind the knees and ears. People with atopic dermatitis are prone to unusually severe viral infections, bacterial and fungal skin infections, eye complications, and allergic contact dermatitis.

How is it Diagnosed?

Typically, the person has a history of allergies, such as asthma, hay fever, or hives; family members may have a similar history. Lab tests show an increase in the white blood cells active in hypersensitivity responses and elevated serum immunoglobulin E.

How is it Treated?

Measures to ease this chronic disorder include meticulous skin care, environmental control of offending allergens, and drug therapy. Because dry skin aggravates itching, frequent application of nonirritating skin lubricants is important, especially after bathing or showering. Minimizing exposure to allergens and irritants, such as wools and harsh detergents, also helps control symptoms.

Drug therapy involves corticosteroids and antipruritics. Active dermatitis responds well to topical corticosteroids such as Synalar and Cordran. These drugs should be applied immediately after bathing for the best penetration. Oral antihistamines, especially the phenothiazine derivatives such as Tacaryl and Temaril, help control itching. A bedtime dose of antihistamines may reduce involuntary scratching during sleep. If secondary infection develops, antibiotics are necessary.

Because this disorder may frustrate the person and strain family ties, counseling may playa role in treatment .

What can a person with atopic dermatitis do?

• Avoid factors that trigger this condition.

• Maintain good personal hygiene.

• Be alert for signs and symptoms of secondary infection.

To reduce the risk of contracting AIDS, public health advocates recommend following safe sex practices, such as condom use.

What Causes it?

AIDS is caused by a retrovirus called human immunodeficiency virus (HIV). The retrovirus strikes cells bearing a substance called the CD4 antigen. This antigen serves as a receptor for HIV and lets it enter the cell. HIV prefers to infect CD4+ cells, which are white blood cells that are sometimes called helper cells. But it may also infect other cells. including certain digestive tract cells, uterine cervical cells, and neuroglial cells, a type of nerve cell.

After HIV invades a cell, it reproduces. Recent research shows that in the first weeks after infection, HIV is extremely active. It eventually causes profound illness by hindering the immune system’s ability to fight disease.

The infection process takes three forms:

• immunodeficiency – opportunistic infections and unusual cancers

• autoimmunity – the body’s reaction against its own tissues

•neurologic problems – AIDS dementia, a brain condition known as HIV encephalopathy, and peripheral nerve disorders.

Transmission Modes

HIV is transmitted by intimate sexual contact, especially during rectal intercourse that injures the mucous membranes; by transfusion of contaminated blood or blood products (this risk has diminished thanks to routine testing of all blood products); by sharing of contaminated needles; and by transmission from an infected mother to her fetus (by cervical or blood contact at delivery and in breast milk). Mounting evidence suggests that HIV is not transmitted by casual household or social contact.

What are its Symptoms?

Some people with AIDS lack symptoms until they suddenly develop an opportunistic infection or the purple skin lesions of Kaposi’s sarcoma, one of the cancers associated with AIDS.

But more often, they have nonspecific signs and symptoms, such as fatigue, afternoon fevers, night sweats, weight loss, diarrhea, or cough. Soon after these appear, they typically develop several infections at the same time.

In children with AIDS, the time between exposure to HIV and appearance of symptoms seems to be shorter (an average of 8 months). Signs and symptoms resemble those of adults with AIDS, except for those related to sexually transmitted disease. Finally, in children, the most common manifestation and cause of death isn’t Pneumocystis carinii pneumonia, as in adults, but diffuse interstitial pneumonitis.

How is it Diagnosed?

According to the Centers for Disease Control and Prevention, a diagnosis of AIDS is confirmed by the presence of an opportunistic infection with lab evidence of HIV infection and a CD4+ T-cell count of less than 200 cells per microliter.

How is it Treated?

Currently, no cure exists for AIDS. However, the drug Retrovir (known as AZT) is used alone or along with other drugs, such as Hivid, to inhibit HIV reproduction. Videx may be used if a person can’t tolerate AZT or no longer responds to it.

Supportive measures aim to reduce the person’s risk of infection, treat existing infections and cancers, maintain adequate nutrition, and provide emotional support.

Additional Drug Treatment

Although drugs can eliminate many of the organisms that cause opportunistic infections, these infections tend to recur once drug treatment stops. The drug of choice for P. carinii pneumonia is oral or intravenous Bactrim or Septra. If this treatment fails or if toxicity occurs, the person may be given NebuPent or Pentam 300. However, this drug may cause liver problems, a rapid pulse, low blood pressure, low blood sugar, and rashes.

To treat Kaposi’s sarcoma, the person may receive chemotherapy drugs, such as Oncovin and VePesid. Unfortunately, aggressive treatment of this cancer makes infection more likely. An interferon alfa drug is also being used to treat Kaposi’s sarcoma. Radiation and laser therapy can relieve, but not cure, local Kaposi’s lesions.

To treat retinitis, the person may receive Foscavir or Cytovene.

To reduce the risk of contracting AIDS, public health advocates recommend following safe sex practices, such as condom use.

What Causes it?

AIDS is caused by a retrovirus called human immunodeficiency virus (HIV). The retrovirus strikes cells bearing a substance called the CD4 antigen. This antigen serves as a receptor for HIV and lets it enter the cell. HIV prefers to infect CD4+ cells, which are white blood cells that are sometimes called helper cells. But it may also infect other cells. including certain digestive tract cells, uterine cervical cells, and neuroglial cells, a type of nerve cell.

After HIV invades a cell, it reproduces. Recent research shows that in the first weeks after infection, HIV is extremely active. It eventually causes profound illness by hindering the immune system’s ability to fight disease.

The infection process takes three forms:

immunodeficiency – opportunistic infections and unusual cancers

autoimmunity – the body’s reaction against its own tissues

neurologic problems – AIDS dementia, a brain condition known as HIV encephalopathy, and peripheral nerve disorders.

Transmission modes

HIV is transmitted by intimate sexual contact, especially during rectal intercourse that injures the mucous membranes; by transfusion of contaminated blood or blood products (this risk has diminished thanks to routine testing of all blood products); by sharing of contaminated needles; and by transmission from an infected mother to her fetus (by cervical or blood contact at delivery and in breast milk). Mounting evidence suggests that HIV is not transmitted by casual household or social contact.

What are its symptoms?

Some people with AIDS lack symptoms until they suddenly develop an opportunistic infection or the purple skin lesions of Kaposi’s sarcoma, one of the cancers associated with AIDS.

But more often, they have nonspecific signs and symptoms, such as fatigue, afternoon fevers, night sweats, weight loss, diarrhea, or cough. Soon after these appear, they typically develop several infections at the same time.

In children with AIDS, the time between exposure to HIV and appearance of symptoms seems to be shorter (an average of 8 months). Signs and symptoms resemble those of adults with AIDS, except for those related to sexually transmitted disease. Finally, in children, the most common manifestation and cause of death isn’t Pneumocystis carinii pneumonia, as in adults, but diffuse interstitial pneumonitis.

How is it diagnosed?

According to the Centers for Disease Control and Prevention, a diagnosis of AIDS is confirmed by the presence of an opportunistic infection with lab evidence of HIV infection and a CD4+ T-cell count of less than 200 cells per microliter.

How is it treated?

Currently, no cure exists for AIDS. However, the drug Retrovir (known as AZT) is used alone or along with other drugs, such as Hivid, to inhibit HIV reproduction. Videx may be used if a person can’t tolerate AZT or no longer responds to it.

Supportive measures aim to reduce the person’s risk of infection, treat existing infections and cancers, maintain adequate nutrition, and provide emotional support.

Additional drug treatment

Although drugs can eliminate many of the organisms that cause opportunistic infections, these infections tend to recur once drug treatment stops. The drug of choice for P. carinii pneumonia is oral or intravenous Bactrim or Septra. If this treatment fails or if toxicity occurs, the person may be given NebuPent or Pentam 300. However, this drug may cause liver problems, a rapid pulse, low blood pressure, low blood sugar, and rashes.

To treat Kaposi’s sarcoma, the person may receive chemotherapy drugs, such as Oncovin and VePesid. Unfortunately, aggressive treatment of this cancer makes infection more likely. An interferon alfa drug is also being used to treat Kaposi’s sarcoma. Radiation and laser therapy can relieve, but not cure, local Kaposi’s lesions.

To treat retinitis, the person may receive Foscavir or Cytovene.

What are these conditions?

Allergies are reactions to airborne (inhaled) allergens – substance, that can produce hypersensitivity reactions such as a runny nose and eye inflammation. Some allergies, such as hay fever, are seasonal Others occur year-round (perennial allergies).

Allergies affect over 20 million Americans. They’re most prevalent in young children and adolescents but occur in people of all ages.

What causes them?

Hay fever is a hypersensitivity response brought about by antibodies, called immunoglobulin E. In most cases, hay fever is induced by wind­borne pollens: in the spring, by tree pollens; in the summer, by grass pollens; and in the fall, by weed pollens. Occasionally, allergy to fungal spores induces hay fever.

In year-round allergies, the allergens provoke responses year ­round. Major year-round allergens and irritants include dust mites. feather pillows, mold, cigarette smoke, upholstery, and animal danders. A seasonal pollen allergy may worsen the symptoms of year­round allergies.

What are their symptoms?

In seasonal allergies, the main signs and symptoms are sneezing spells, a runny nose with profuse watery discharge, nasal congestion. and itching of the nose and eyes. The person usually has swollen nasal passages, reddened eyes with swollen eyelids, excessive tearing, and headache or sinus pain. Some allergy sufferers also complain of an itchy throat and a general ill feeling called malaise.

Year-round allergies usually cause only a runny nose and nasal congestion. But they can cause chronic nasal blockage, which then blocks the auditory tube that extends from the middle ear to the throat (called the eustachian tube). Blocked eustachian tubes are especially common in children with year-round allergies.

In both seasonal and year-round allergies, “allergic shiners” (dark circles) may appear under the eyes. The severity of signs and symptoms may vary from season to season and from year to year.

How are they diagnosed?

\With allergies, the person’s sputum and nasal discharge usually contain large amounts of a type of white blood cell active in hypersensitivity responses called eosinophils. Blood tests show normal or elevated immunoglobulin E antibody levels.

For a firm diagnosis, the doctor takes a personal and family history of allergies and considers physical exam findings. To pinpoint the responsible allergens, he or she may order skin testing and assess the person’s responses to environmental stimuli.

To rule out a common cold, which mimics an allergy, the doctor checks for typical cold symptoms, such as fever, sore throat, beet-red nasal mucous membranes, and nasal discharge without eosinophils. In a child, the doctor checks for a foreign body in the nose, such as a bean or a button, which can cause allergy-like symptoms.

How are they treated?

Treatment aims to control allergy symptoms by eliminating environmental allergens, if possible, and by drug therapy and a special treatment called immunotherapy.

Drug therapy

Antihistamines may be given, although these commonly cause sedation, dry mouth, nausea, dizziness, blurred vision, and nervousness. Newer antihistamines, such as Seldane, have fewer side effects and are less likely to cause sedation. However, an overdose of these drugs may cause irregular heartbeats.

Some people get relief from inhaled intranasal steroids, which reduce inflammation without causing the systemic side effects of antihistamines. The most commonly used intranasal corticosteroids are Nasalide, Beconase, and Vancenase. Unfortunately, during acute allergy attacks, these drugs rarely give relief. Nasal decongestants and oral antihistamines may be needed instead.

Immunotherapy

For long-term allergy management, the doctor may recommend immunotherapy. In this treatment, the person receives increasingly large doses of the offending allergens to gradually develop immunity. The doses are administered before or during allergy season or year ­round

What can a person with allergies do?

• If the doctor has prescribed intranasal corticosteroids, use them regularly, as directed, for optimal effectiveness.

• If you’re taking Nasalcrom, be aware that although this drug can help prevent allergies, it may take up to 4 weeks to work. Also, you must take it regularly during allergy season.

• Call the doctor if you have a delayed reaction to immunotherapy .

• To reduce your exposure to airborne allergens, sleep with the windows closed, and use air conditioning to filter allergens.

• If you have severe and resistant allergies, you may have to consider drastic lifestyle changes, such as moving to a pollen-free area, either seasonally or year-round.