Dermatology is the branch of medicine dealing with the skin . It is a speciality with both medical and surgical aspects. A dermatologist is a specialist medical doctor who manages diseases related to skin, hair, nails, and some cosmetic problems.
93-581: Attested in English in 1819, the word "dermatology" derives from the Greek δέρματος ( dermatos ), genitive of δέρμα ( derma ), "skin" (itself from δέρω dero , "to flay") and -λογία -logia . Neo-Latin dermatologia was coined in 1630, an anatomical term with various French and German uses attested from the 1730s. In 1708, the first great school of dermatology became a reality at the famous Hôpital Saint-Louis in Paris, and
186-537: A pitch accent . In Modern Greek, all vowels and consonants are short. Many vowels and diphthongs once pronounced distinctly are pronounced as /i/ ( iotacism ). Some of the stops and glides in diphthongs have become fricatives , and the pitch accent has changed to a stress accent . Many of the changes took place in the Koine Greek period. The writing system of Modern Greek, however, does not reflect all pronunciation changes. The examples below represent Attic Greek in
279-470: A buildup of apoptotic debris can be observed in GC because of an ineffective clearance of apoptotic cells. Close to TBM, follicular dendritic cells (FDC) are localised in GC, which attach antigen material to their surface and, in contrast to bone marrow -derived DC, neither take it up nor present it via MHC molecules. Autoreactive B cells can accidentally emerge during somatic hypermutation and migrate into
372-546: A cSLE-like disorders. )(Note that mutations in the UNC93B1 gene may cause either cSLE or the chilblain lupus erythematosus form of cSLE. ) Mutations in a wide range of other genes do not by themselves cause SLE but two or more of them may act together, act in concert with environmental factors, or act in some but not other populations (e.g., cause SLE in Chinese but not Europeans) to cause SLE or an SLE-like syndrome but do so in only
465-587: A decade. A study published by the Journal of the American Medical Association reported fewer than 3.4 dermatologists for every 100,000 people. In the UK, a dermatologist is a medically qualified practitioner who has gone on to specialize in medicine and then subspecialize in dermatology. This involves: Upon successful completion of the four-year training period, the doctor becomes an accredited dermatologist and
558-457: A definitive diagnosis is reached. Common initial and chronic complaints include fever , malaise , joint pains , muscle pains , and fatigue . Because these symptoms are so often seen in association with other diseases, these signs and symptoms are not part of the diagnostic criteria for SLE. When occurring in conjunction with other signs and symptoms, however, they are considered suggestive. While SLE can occur in both males and females, it
651-433: A fellowship. This technique requires the integration of the same doctor in two different capacities - surgeon and pathologist. In case either of the two responsibilities is assigned to another doctor or qualified health-care professional, it is not considered to be Mohs surgery. Physicians can qualify for this specialization by completing both a pediatric residency and a dermatology residency. Or they might elect to complete
744-468: A fifth major dialect group, or it is Mycenaean Greek overlaid by Doric, with a non-Greek native influence. Regarding the speech of the ancient Macedonians diverse theories have been put forward, but the epigraphic activity and the archaeological discoveries in the Greek region of Macedonia during the last decades has brought to light documents, among which the first texts written in Macedonian , such as
837-473: A low serum level of vitamin D ) often occurs in patients with SLE and that its level is particularly low in patients with more active SLE. Furthermore, 5 studies reported that SLE patients treated with vitamin D had significant reductions in the activity of their disease. However, other studies have found that the levels of vitamin D in SLE are not low, that vitamin D does not reduce their SLE's activity, and/or that
930-432: A more severe form of SLE termed childhood-onset systemic lupus erythematosus . The cause of SLE is not clear. It is thought to involve a combination of genetics and environmental factors . Among identical twins , if one is affected there is a 24% chance the other one will also develop the disease. Female sex hormones , sunlight, smoking, vitamin D deficiency , and certain infections are also believed to increase
1023-463: A person's risk. The mechanism involves an immune response by autoantibodies against a person's own tissues. These are most commonly anti-nuclear antibodies and they result in inflammation . Diagnosis can be difficult and is based on a combination of symptoms and laboratory tests. There are a number of other kinds of lupus erythematosus including discoid lupus erythematosus , neonatal lupus , and subacute cutaneous lupus erythematosus . There
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#17328409753651116-607: A population shift towards immature B cells. Memory B cells with increased CD27 +/ IgD —are less susceptible to immunosuppression. CD27-/IgD- memory B cells are associated with increased disease activity and renal lupus. T cells, which regulate B-cell responses and infiltrate target tissues, have defects in signaling, adhesion, co-stimulation, gene transcription, and alternative splicing. The cytokines B-lymphocyte stimulator (BLyS), also known as B-cell activating factor (BAFF), interleukin 6, interleukin 17, interleukin 18, type I interferons, and tumor necrosis factor α (TNFα) are involved in
1209-437: A positive test for antiphospholipid antibodies; the combination of such findings have earned the term " lupus anticoagulant -positive". Another autoantibody finding in SLE is the anti-cardiolipin antibody , which can cause a false positive test for syphilis . SLE may cause pericarditis (inflammation of the outer lining surrounding the heart), myocarditis (inflammation of the heart muscle), or endocarditis (inflammation of
1302-428: A post-residency fellowship. This field encompasses the complex diseases of the neonates , hereditary skin diseases or genodermatoses , and the many difficulties of working with the pediatric population. Another area pediatric dermatologists may focus on is treating acne. Acne is formed when follicles under the skin become clogged. This can be caused by sebum, an oil that keeps the skin moist, or dead skin cells clogging
1395-543: A prefix /e-/, called the augment . This was probably originally a separate word, meaning something like "then", added because tenses in PIE had primarily aspectual meaning. The augment is added to the indicative of the aorist, imperfect, and pluperfect, but not to any of the other forms of the aorist (no other forms of the imperfect and pluperfect exist). The two kinds of augment in Greek are syllabic and quantitative. The syllabic augment
1488-411: A pro-inflammatory form of cell death, is increased in T lymphocytes, due to mitochondrial dysfunction, oxidative stress, and depletion of ATP. Impaired clearance of dying cells is a potential pathway for the development of this systemic autoimmune disease . This includes deficient phagocytic activity, impaired lysosomal degradation, and scant serum components in addition to increased apoptosis . SLE
1581-560: A residency in dermatology and one in pathology. Trichology specializes in diseases, which manifest with hair loss, hair abnormalities, hypertrichosis and scalp changes. Trichoscopy is a medical diagnostic method that is used by dermatologists with a special interest in trichology. This field specializes in the treatment of immune-mediated skin diseases such as lupus , bullous pemphigoid , pemphigus vulgaris , and other immune-mediated skin disorders. Specialists in this field often run their own immunopathology labs. Immunodermatology testing
1674-653: A result have impaired degradation of internalized apoptotic debris, which results in chronic activation of Toll-like receptors and permeabilization of the phagolysosomal membrane, allowing activation of cytosolic sensors. In addition, intact apoptotic debris recycles back to the cell membrane and accumulate on the surface of the cell. Recent research has found an association between certain people with lupus (especially those with lupus nephritis ) and an impairment in degrading neutrophil extracellular traps (NETs). These were due to DNAse1 inhibiting factors, or NET protecting factors in people's serum, rather than abnormalities in
1767-761: A result of treating the disease. It can rarely present with intracranial hypertension syndrome , characterized by an elevated intracranial pressure , papilledema , and headache with occasional abducens nerve paresis , absence of a space-occupying lesion or ventricular enlargement, and normal cerebrospinal fluid chemical and hematological constituents. More rare manifestations are acute confusional state , Guillain–Barré syndrome , aseptic meningitis , autonomic disorder , demyelinating syndrome , mononeuropathy (which might manifest as mononeuritis multiplex ), movement disorder (more specifically, chorea ), myasthenia gravis , myelopathy , cranial neuropathy and plexopathy . Neurological disorders contribute to
1860-704: A significant percentage of morbidity and mortality in people with lupus. As a result, the neural side of lupus is being studied in hopes of reducing morbidity and mortality rates. One aspect of this disease is severe damage to the epithelial cells of the blood–brain barrier . In certain regions, depression affects up to 60% of women with SLE. Up to one-third of patients report that their eyes are affected. The most common diseases are dry eye syndrome and secondary Sjögren's syndrome , but episcleritis , scleritis , retinopathy (more often affecting both eyes than one), ischemic optic neuropathy , retinal detachment , and secondary angle-closure glaucoma may occur. In addition,
1953-447: A small percentage of cases. The development of a genetically-regulated trait or disorder that is dependent on the inheritance of two or more genes is termed oligogenic inheritance or polygenic inheritance . SLE is regarded as a prototype disease due to the significant overlap in its symptoms with other autoimmune diseases. Patients with SLE have higher levels of DNA damage than normal subjects, and several proteins involved in
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#17328409753652046-533: A strong Northwest Greek influence, and can in some respects be considered a transitional dialect, as exemplified in the poems of the Boeotian poet Pindar who wrote in Doric with a small Aeolic admixture. Thessalian likewise had come under Northwest Greek influence, though to a lesser degree. Pamphylian Greek , spoken in a small area on the southwestern coast of Anatolia and little preserved in inscriptions, may be either
2139-435: A threat to the tolerization of B cells and T cells. Dendritic cells in the germinal center may endocytose such antigenic material and present it to T cells, activating them. Also, apoptotic chromatin and nuclei may attach to the surfaces of follicular dendritic cells and make this material available for activating other B cells that may have randomly acquired self-protein specificity through somatic hypermutation. Necrosis,
2232-510: A vowel or /n s r/ ; final stops were lost, as in γάλα "milk", compared with γάλακτος "of milk" (genitive). Ancient Greek of the classical period also differed in both the inventory and distribution of original PIE phonemes due to numerous sound changes, notably the following: The pronunciation of Ancient Greek was very different from that of Modern Greek . Ancient Greek had long and short vowels ; many diphthongs ; double and single consonants; voiced, voiceless, and aspirated stops ; and
2325-548: Is able to apply for a consultant hospital post as a consultant dermatologist. Dermatologists have been leaders in the field of cosmetic surgery. Some dermatologists complete fellowships in surgical dermatology. Many are trained in their residency on the use of botulinum toxin , fillers, and laser surgery. Some dermatologists perform cosmetic procedures including liposuction , blepharoplasty , and face lifts . Most dermatologists limit their cosmetic practice to minimally invasive procedures. Despite an absence of formal guidelines from
2418-418: Is added to stems beginning with consonants, and simply prefixes e (stems beginning with r , however, add er ). The quantitative augment is added to stems beginning with vowels, and involves lengthening the vowel: Some verbs augment irregularly; the most common variation is e → ei . The irregularity can be explained diachronically by the loss of s between vowels, or that of the letter w , which affected
2511-470: Is associated with defects in apoptotic clearance, and the damaging effects caused by apoptotic debris. Early apoptotic cells express "eat-me" signals, of cell-surface proteins such as phosphatidylserine, that prompt immune cells to engulf them. Apoptotic cells also express find-me signals to attract macrophages and dendritic cells. When apoptotic material is not removed correctly by phagocytes, they are captured instead by antigen-presenting cells, which leads to
2604-448: Is considered by some linguists to have been closely related to Greek . Among Indo-European branches with living descendants, Greek is often argued to have the closest genetic ties with Armenian (see also Graeco-Armenian ) and Indo-Iranian languages (see Graeco-Aryan ). Ancient Greek differs from Proto-Indo-European (PIE) and other Indo-European languages in certain ways. In phonotactics , ancient Greek words could end only in
2697-409: Is essential for the correct diagnosis and treatment of many diseases affecting epithelial organs including skin, mucous membranes, gastrointestinal and respiratory tracts. The various diseases often overlap in clinical and histological presentation and, although the diseases themselves are not common, may present with features of common skin disorders such as urticaria, eczema and chronic itch. Therefore,
2790-438: Is estimated to expand at a compound annual growth rate (CAGR) of 11.4% from 2022 to 2030. This usually includes six months of general pathology and six months of dermatopathology. Alumni of both specialties can qualify as dermatopathologists. At the completion of a standard residency in dermatology, many dermatologists are also competent at dermatopathology. Some dermatopathologists qualify to sit for their examinations by completing
2883-449: Is for joint pain , with the small joints of the hand and wrist usually affected, although all joints are at risk. More than 90 percent of those affected will experience joint or muscle pain at some time during the course of their illness. Unlike rheumatoid arthritis , lupus arthritis is less disabling and usually does not cause severe destruction of the joints. Fewer than ten percent of people with lupus arthritis will develop deformities of
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2976-669: Is found far more often in women, and the symptoms associated with each sex are different. Females tend to have a greater number of relapses , a low white blood cell count , more arthritis , Raynaud syndrome , and psychiatric symptoms . Males tend to have more seizures , kidney disease , serositis (inflammation of tissues lining the lungs and heart), skin problems , and peripheral neuropathy . As many as 70% of people with lupus have some skin symptoms. The three main categories of lesions are chronic cutaneous (discoid) lupus, subacute cutaneous lupus, and acute cutaneous lupus. People with discoid lupus may exhibit thick, red scaly patches on
3069-571: Is four years. This training consists of an initial medical, transitional, surgical, or pediatric intern year followed by a three-year dermatology residency. Following this training, one- or two-year post-residency fellowships are available in immunodermatology , phototherapy , laser medicine , Mohs micrographic surgery , cosmetic surgery , dermatopathology , or pediatric dermatology. While these dermatology fellowships offer additional subspecialty training, many dermatologists proficiently provide these services without subspecialty fellowship training. For
3162-403: Is no cure for SLE, but there are experimental and symptomatic treatments. Treatments may include NSAIDs , corticosteroids , immunosuppressants , hydroxychloroquine , and methotrexate . Although corticosteroids are rapidly effective, long-term use results in side effects. Alternative medicine has not been shown to affect the disease. Men have higher mortality. SLE significantly increases
3255-683: Is one of the most difficult challenges in medicine, because it can involve so many different patterns of symptoms, some of which may be mistaken for signs of infectious disease or stroke. A common neurological disorder people with SLE have is headache , although the existence of a specific lupus headache and the optimal approach to headache in SLE cases remains controversial. Other common neuropsychiatric manifestations of SLE include cognitive disorder , mood disorder , cerebrovascular disease , seizures , polyneuropathy , anxiety disorder , psychosis , depression , and in some extreme cases, personality disorders. Steroid psychosis can also occur as
3348-527: Is the occurrence of SLE symptoms in an infant born from a mother with SLE, most commonly presenting with a rash resembling discoid lupus erythematosus , and sometimes with systemic abnormalities such as heart block or enlargement of the liver and spleen . Neonatal lupus is usually benign and self-limited. Medications for treatment of SLE can carry severe risks for female and male reproduction. Cyclophosphamide (also known as Cytoxan), can lead to infertility by causing premature ovarian insufficiency (POI),
3441-530: Is the study of skin disease at the population level. One of its aspects is the determination of the global burden of skin diseases. From 1990 to 2013, skin disease constituted about 2% of total global disease disability as measured in disability-adjusted life-years. Therapies provided by dermatologists include: Most dermatologic pharmacology can be categorized based on the Anatomical Therapeutic Chemical (ATC) classification system , specifically
3534-549: The ATC code D . Ancient Greek Ancient Greek ( Ἑλληνῐκή , Hellēnikḗ ; [hellɛːnikɛ́ː] ) includes the forms of the Greek language used in ancient Greece and the ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek ( c. 1400–1200 BC ), Dark Ages ( c. 1200–800 BC ), the Archaic or Epic period ( c. 800–500 BC ), and
3627-460: The American Board of Dermatology , many cosmetic fellowships are offered in both surgery and laser medicine. A dermatopathologist is a pathologist or dermatologist who specializes in the pathology of the skin. This field is shared by dermatologists and pathologists. Usually, a dermatologist or pathologist completes one year of dermatopathology fellowship and according to market projections, it
3720-627: The Classical period ( c. 500–300 BC ). Ancient Greek was the language of Homer and of fifth-century Athenian historians, playwrights, and philosophers . It has contributed many words to English vocabulary and has been a standard subject of study in educational institutions of the Western world since the Renaissance . This article primarily contains information about the Epic and Classical periods of
3813-497: The Pella curse tablet , as Hatzopoulos and other scholars note. Based on the conclusions drawn by several studies and findings such as Pella curse tablet , Emilio Crespo and other scholars suggest that ancient Macedonian was a Northwest Doric dialect , which shares isoglosses with its neighboring Thessalian dialects spoken in northeastern Thessaly . Some have also suggested an Aeolic Greek classification. The Lesbian dialect
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3906-589: The epic poems , the Iliad and the Odyssey , and in later poems by other authors. Homeric Greek had significant differences in grammar and pronunciation from Classical Attic and other Classical-era dialects. The origins, early form and development of the Hellenic language family are not well understood because of a lack of contemporaneous evidence. Several theories exist about what Hellenic dialect groups may have existed between
3999-720: The macrophage activation syndrome . Mutations in about 40 genes have been reported to cause cSLE and/or a cSLE-like disease. These genes include 5 which as of February, 2024 were classified as inborn errors of immunity genes, i.e., DNASE1L3 , TREX1 , IFIH1 , Tartrate-resistant acid phosphatase and PRKCD and 28 other genes, i.e., NEIL3 , TMEM173 , ADAR1 , NRAS , SAMHD1 , SOS1 , FASLG , FAS receptor gene , RAG1 , RAG2 , DNASE1 , SHOC2 , KRAS , PTPN11 , PTEN , BLK , RNASEH2A , RNASEH2B , RNASEH2C , Complement component 1qA , Complement component 1qB , Complement component 1r , Complement component 1s , Complement component 2 , Complement component 3 , UNC93B1 , and
4092-510: The mantle zone , autoreactive B cells require further survival signals from autoreactive helper T cells, which promote the maturation of autoantibody-producing plasma cells and B memory cells. In the presence of autoreactive T cells , a chronic autoimmune disease may be the consequence. Anti-nRNP autoantibodies to nRNP A and nRNP C initially targeted restricted, proline -rich motifs . Antibody binding subsequently spread to other epitopes . The similarity and cross-reactivity between
4185-705: The pleurae known as pleurisy , which can rarely give rise to shrinking lung syndrome involving a reduced lung volume. Other associated lung conditions include pneumonitis , chronic diffuse interstitial lung disease , pulmonary hypertension , pulmonary emboli , and pulmonary hemorrhage . Painless passage of blood or protein in the urine may often be the only presenting sign of kidney involvement. Acute or chronic renal impairment may develop with lupus nephritis , leading to acute or end-stage kidney failure . Because of early recognition and management of SLE with immunosuppressive drugs or corticosteroids, end-stage renal failure occurs in less than 5% of cases; except in
4278-501: The present , future , and imperfect are imperfective in aspect; the aorist , present perfect , pluperfect and future perfect are perfective in aspect. Most tenses display all four moods and three voices, although there is no future subjunctive or imperative. Also, there is no imperfect subjunctive, optative or imperative. The infinitives and participles correspond to the finite combinations of tense, aspect, and voice. The indicative of past tenses adds (conceptually, at least)
4371-474: The 1930s by Frederic E. Mohs , the procedure is defined as a type of CCPDMA processing. Physicians trained in this technique must be comfortable with both pathology and surgery, and dermatologists receive extensive training in both during their residency. Physicians who perform Mohs surgery can receive training in this specialized technique during their dermatology residency, but many seek additional training either through formal preceptorships to become fellows of
4464-1031: The 5th century BC. Ancient pronunciation cannot be reconstructed with certainty, but Greek from the period is well documented, and there is little disagreement among linguists as to the general nature of the sounds that the letters represent. /oː/ raised to [uː] , probably by the 4th century BC. Greek, like all of the older Indo-European languages , is highly inflected. It is highly archaic in its preservation of Proto-Indo-European forms. In ancient Greek, nouns (including proper nouns) have five cases ( nominative , genitive , dative , accusative , and vocative ), three genders ( masculine , feminine , and neuter ), and three numbers (singular, dual , and plural ). Verbs have four moods ( indicative , imperative , subjunctive , and optative ) and three voices (active, middle, and passive ), as well as three persons (first, second, and third) and various other forms. Verbs are conjugated through seven combinations of tenses and aspect (generally simply called "tenses"):
4557-813: The American Society for Mohs Surgery or through one-year Mohs surgery fellowship training programs administered by the American College of Mohs Surgery. In 2020, the American Board of Dermatology (ABD) received approval from the American Board of Medical Specialties (ABMS) to establish a board-certification exam in the subspecialty of Micrographic Dermatologic Surgery (Mohs Surgery). The exam was first offered in October 2021 to any US board-certified dermatologist who practices Mohs surgery, regardless of whether they received their training in dermatology residency or as part of
4650-490: The Archaic period of ancient Greek (see Homeric Greek for more details): Μῆνιν ἄειδε, θεά, Πηληϊάδεω Ἀχιλῆος οὐλομένην, ἣ μυρί' Ἀχαιοῖς ἄλγε' ἔθηκε, πολλὰς δ' ἰφθίμους ψυχὰς Ἄϊδι προΐαψεν ἡρώων, αὐτοὺς δὲ ἑλώρια τεῦχε κύνεσσιν οἰωνοῖσί τε πᾶσι· Διὸς δ' ἐτελείετο βουλή· ἐξ οὗ δὴ τὰ πρῶτα διαστήτην ἐρίσαντε Ἀτρεΐδης τε ἄναξ ἀνδρῶν καὶ δῖος Ἀχιλλεύς. The beginning of Apology by Plato exemplifies Attic Greek from
4743-652: The Classical period of ancient Greek. (The second line is the IPA , the third is transliterated into the Latin alphabet using a modern version of the Erasmian scheme .) Ὅτι [hóti Hóti μὲν men mèn ὑμεῖς, hyːmêːs hūmeîs, Lupus Lupus , formally called systemic lupus erythematosus ( SLE ), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of
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#17328409753654836-668: The DNAse1 itself. DNAse1 mutations in lupus have so far only been found in some Japanese cohorts. The clearance of early apoptotic cells is an important function in multicellular organisms. It leads to a progression of the apoptosis process and finally to secondary necrosis of the cells if this ability is disturbed. Necrotic cells release nuclear fragments as potential autoantigens , as well as internal danger signals, inducing maturation of dendritic cells (DCs) since they have lost their membranes' integrity. Increased appearance of apoptotic cells also stimulates inefficient clearance. That leads to
4929-540: The Dorians. The Greeks of this period believed there were three major divisions of all Greek people – Dorians, Aeolians, and Ionians (including Athenians), each with their own defining and distinctive dialects. Allowing for their oversight of Arcadian, an obscure mountain dialect, and Cypriot, far from the center of Greek scholarship, this division of people and language is quite similar to the results of modern archaeological-linguistic investigation. One standard formulation for
5022-550: The aorist. Following Homer 's practice, the augment is sometimes not made in poetry , especially epic poetry. The augment sometimes substitutes for reduplication; see below. Almost all forms of the perfect, pluperfect, and future perfect reduplicate the initial syllable of the verb stem. (A few irregular forms of perfect do not reduplicate, whereas a handful of irregular aorists reduplicate.) The three types of reduplication are: Irregular duplication can be understood diachronically. For example, lambanō (root lab ) has
5115-419: The augment when it was word-initial. In verbs with a preposition as a prefix, the augment is placed not at the start of the word, but between the preposition and the original verb. For example, προσ(-)βάλλω (I attack) goes to προσ έ βαλoν in the aorist. However compound verbs consisting of a prefix that is not a preposition retain the augment at the start of the word: αὐτο(-)μολῶ goes to ηὐ τομόλησα in
5208-629: The black population, where the risk is many times higher. The histological hallmark of SLE is membranous glomerulonephritis with "wire loop" abnormalities. This finding is due to immune complex deposition along the glomerular basement membrane , leading to a typical granular appearance in immunofluorescence testing. Neuropsychiatric syndromes can result when SLE affects the central or peripheral nervous system . The American College of Rheumatology defines 19 neuropsychiatric syndromes in systemic lupus erythematosus. The diagnosis of neuropsychiatric syndromes concurrent with SLE (now termed as NPSLE),
5301-419: The body. Symptoms vary among people and may be mild to severe. Common symptoms include painful and swollen joints , fever , chest pain , hair loss , mouth ulcers , swollen lymph nodes , feeling tired , and a red rash which is most commonly on the face. Often there are periods of illness, called flares , and periods of remission during which there are few symptoms. Children up to 18 years old develop
5394-455: The cell nucleus . These antibody attacks are the immediate cause of SLE. SLE is a chronic inflammatory disease believed to be a type III hypersensitivity response with potential type II involvement. Reticulate and stellate acral pigmentation should be considered a possible manifestation of SLE and high titers of anti-cardiolipin antibodies , or a consequence of therapy. People with SLE have intense polyclonal B-cell activation, with
5487-505: The developing world are unclear. Lupus is Latin for 'wolf': the disease was so-named in the 13th century as the rash was thought to appear like a wolf's bite. SLE is one of several diseases known as " the great imitator " because it often mimics or is mistaken for other illnesses. SLE is a classical item in differential diagnosis , because SLE symptoms vary widely and come and go unpredictably. Diagnosis can thus be elusive, with some people having unexplained symptoms of SLE for years before
5580-706: The development of antinuclear antibodies. Monocytes isolated from whole blood of people with SLE show reduced expression of CD44 surface molecules involved in the uptake of apoptotic cells. Most of the monocytes and tingible body macrophages (TBMs), which are found in the germinal centres of lymph nodes , even show a definitely different morphology; they are smaller or scarce and die earlier. Serum components like complement factors, CRP , and some glycoproteins are, furthermore, decisively important for an efficiently operating phagocytosis. With SLE, these components are often missing, diminished, or inefficient. Macrophages during SLE fail to mature their lysosomes and as
5673-487: The diagnosis of an immunodermatological disease is often delayed. Tests are performed on blood and tissues that are sent to various laboratories from medical facilities and referring physicians across the United States. The dermatologic subspecialty called Mohs surgery focuses on the excision of skin cancers using a technique that allows intraoperative assessment of most of the peripheral and deep tumor margins. Developed in
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#17328409753655766-611: The dialect of Sparta ), and Northern Peloponnesus Doric (including Corinthian ). All the groups were represented by colonies beyond Greece proper as well, and these colonies generally developed local characteristics, often under the influence of settlers or neighbors speaking different Greek dialects. After the conquests of Alexander the Great in the late 4th century BC, a new international dialect known as Koine or Common Greek developed, largely based on Attic Greek , but with influence from other dialects. This dialect slowly replaced most of
5859-517: The dialects is: West vs. non-West Greek is the strongest-marked and earliest division, with non-West in subsets of Ionic-Attic (or Attic-Ionic) and Aeolic vs. Arcadocypriot, or Aeolic and Arcado-Cypriot vs. Ionic-Attic. Often non-West is called 'East Greek'. Arcadocypriot apparently descended more closely from the Mycenaean Greek of the Bronze Age. Boeotian Greek had come under
5952-413: The disease or a side effect of pharmacological treatment. People with SLE may have an association with antiphospholipid antibody syndrome (a thrombotic disorder), wherein autoantibodies to phospholipids are present in their serum. Abnormalities associated with antiphospholipid antibody syndrome include a paradoxical prolonged partial thromboplastin time (which usually occurs in hemorrhagic disorders) and
6045-510: The divergence of early Greek-like speech from the common Proto-Indo-European language and the Classical period. They have the same general outline but differ in some of the detail. The only attested dialect from this period is Mycenaean Greek , but its relationship to the historical dialects and the historical circumstances of the times imply that the overall groups already existed in some form. Scholars assume that major Ancient Greek period dialect groups developed not later than 1120 BC, at
6138-503: The drug. The VigiBase drug safety data repositor diagnosed 12,166 cases of drug-induced SLE recorded between 1968 and 2017. Among the 118 agents causing SLE, five main classes were most often associated with drug-induced SLE. These drugs were antiarrhythmic agents such as procainamide or quinidine ; antihypertensive agents such as hydralazine , captopril , or acebutolol ; antimicrobial agents such as minocycline , isoniazid , carbamazepine , or phenytoin ; and agents that inhibit
6231-461: The first textbooks (Willan's, 1798–1808) and atlases ( Alibert's , 1806–1816) appeared in print around the same time. After earning a medical degree ( M.D. or D.O. ), the length of training in the United States for a general dermatologist to be eligible for board certification by the American Academy of Dermatology , American Board of Dermatology , or American Osteopathic Board of Dermatology
6324-419: The germinal center light zone. Autoreactive B cells, maturated coincidentally, normally do not receive survival signals by antigen planted on follicular dendritic cells and perish by apoptosis. In the case of clearance deficiency, apoptotic nuclear debris accumulates in the light zone of GC and gets attached to FDC. This serves as a germinal centre survival signal for autoreactive B-cells. After migration into
6417-467: The hands and feet. People with SLE are at particular risk of developing osteoarticular tuberculosis . A possible association between rheumatoid arthritis and SLE has been suggested, and SLE may be associated with an increased risk of bone fractures in relatively young women. Anemia is common in children with SLE and develops in about 50% of cases. Low platelet count ( thrombocytopenia ) and low white blood cell count ( leukopenia ) may be due to
6510-430: The inflammation-inducing actions of interferon or tumor necrosis factor . Discoid (cutaneous) lupus is limited to skin symptoms and is diagnosed by biopsy of rash on the face, neck, scalp or arms. Approximately 5% of people with DLE progress to SLE. SLE is triggered by environmental factors that are unknown. In SLE, the body's immune system produces antibodies against self-protein , particularly against proteins in
6603-604: The inflammatory process and are potential therapeutic targets. SLE is associated with low C3 levels in the complement system . Tingible body macrophages (TBMs) – large phagocytic cells in the germinal centers of secondary lymph nodes – express CD68 protein. These cells normally engulf B cells that have undergone apoptosis after somatic hypermutation . In some people with SLE, significantly fewer TBMs can be found, and these cells rarely contain material from apoptotic B cells. Also, uningested apoptotic nuclei can be found outside of TBMs. This material may present
6696-523: The inner lining of the heart). The endocarditis of SLE is non-infectious, and is also called Libman–Sacks endocarditis . It involves either the mitral valve or the tricuspid valve . Atherosclerosis also occurs more often and advances more rapidly than in the general population. Steroids are sometimes prescribed as an anti-inflammatory treatment for lupus; however, they can increase one's risk for heart disease, high cholesterol, and atherosclerosis. SLE can cause pleuritic pain as well as inflammation of
6789-514: The language, which are the best-attested periods and considered most typical of Ancient Greek. From the Hellenistic period ( c. 300 BC ), Ancient Greek was followed by Koine Greek , which is regarded as a separate historical stage, though its earliest form closely resembles Attic Greek , and its latest form approaches Medieval Greek . There were several regional dialects of Ancient Greek; Attic Greek developed into Koine. Ancient Greek
6882-612: The loss of normal function of one's ovaries prior to age forty. Methotrexate can cause termination or deformity in fetuses and is a common abortifacient , and for men taking a high dose and planning to father, a discontinuation period of 6 months is recommended before insemination. Fatigue in SLE is probably multifactorial and has been related to not only disease activity or complications such as anemia or hypothyroidism , but also to pain , depression , poor sleep quality, poor physical fitness and lack of social support . Some studies have found that vitamin D deficiency (i.e.,
6975-441: The maturation of DCs and also to the presentation of intracellular antigens of late apoptotic or secondary necrotic cells, via MHC molecules. Autoimmunity possibly results from the extended exposure to nuclear and intracellular autoantigens derived from late apoptotic and secondary necrotic cells. B and T cell tolerance for apoptotic cells is abrogated, and the lymphocytes get activated by these autoantigens; inflammation and
7068-430: The medication that triggered the episode is stopped. While there are no established criteria for diagnosing drug-induced SLE, most authors have agreed on the following definition: the afflicted patient had a sufficient and continuing exposure to the drug, at least one symptom compatible with SLE, no history suggestive of SLE before starting the drug, and resolution of symptoms within weeks or months after stopping intake of
7161-653: The medications used to treat SLE can cause eye disease: long-term glucocorticoid use can cause cataracts and secondary open-angle glaucoma, and long-term hydroxychloroquine treatment can cause vortex keratopathy and maculopathy . While most pregnancies have positive outcomes, there is a greater risk of adverse events occurring during pregnancy. SLE causes an increased rate of fetal death in utero and spontaneous abortion (miscarriage). The overall live-birth rate in people with SLE has been estimated to be 72%. Pregnancy outcome appears to be worse in people with SLE whose disease flares up during pregnancy. Neonatal lupus
7254-499: The older dialects, although the Doric dialect has survived in the Tsakonian language , which is spoken in the region of modern Sparta. Doric has also passed down its aorist terminations into most verbs of Demotic Greek . By about the 6th century AD, the Koine had slowly metamorphosed into Medieval Greek . Phrygian is an extinct Indo-European language of West and Central Anatolia , which
7347-477: The past several years, dermatology residency positions in the United States have been one of the most competitive to obtain. According to the American Academy of Dermatology, dermatologists are trained to diagnose and manage over 3,000 distinct skin, hair, and nail conditions across patients spanning various age groups. The United States has been experiencing a national shortage of dermatologists for more than
7440-487: The perfect stem eilēpha (not * lelēpha ) because it was originally slambanō , with perfect seslēpha , becoming eilēpha through compensatory lengthening. Reduplication is also visible in the present tense stems of certain verbs. These stems add a syllable consisting of the root's initial consonant followed by i . A nasal stop appears after the reduplication in some verbs. The earliest extant examples of ancient Greek writing ( c. 1450 BC ) are in
7533-511: The pores. This is very common in teens and young adults, and can be treated by prescription from a dermatologist. Teledermatology is a form of dermatological practice in which telecommunication technologies are used to exchange medical information and treatment through audio, visual, and data communication, including photos of dermatologic conditions, between dermatologists and nondermatologists who are evaluating patients, along with dermatologists directly with patients via distance. In India, during
7626-432: The preservation of genomic stability show polymorphisms , some of which increase the risk for SLE development. Defective DNA repair is a likely mechanism underlying lupus development. Drug-induced lupus erythematosus is a (generally) reversible condition that usually occurs in people being treated for a long-term illness. Drug-induced lupus mimics SLE. However, symptoms of drug-induced lupus generally disappear once
7719-453: The production of autoantibodies by plasma cells is initiated. A clearance deficiency in the skin for apoptotic cells has also been observed in people with cutaneous lupus erythematosus (CLE). In healthy conditions, apoptotic lymphocytes are removed in germinal centers (GC) by specialized phagocytes, the tingible body macrophages (TBM), which is why no free apoptotic and potential autoantigenic material can be seen. In some people with SLE,
7812-537: The risk of cardiovascular disease , with this being the most common cause of death. While women with lupus have higher risk pregnancies, most are successful. Rate of SLE varies between countries from 20 to 70 per 100,000. Women of childbearing age are affected about nine times more often than men. While it most commonly begins between the ages of 15 and 45, a wide range of ages can be affected. Those of African , Caribbean , and Chinese descent are at higher risk than those of European descent . Rates of disease in
7905-517: The same fertilized egg ) and genome-wide association studies have identified numerous genes that by themselves promote the development of SLE, particularly childhood-onset SLE, i.e., cSLE, in rare cases of SLE/cSLE. The single-gene (also termed monogenic) causes of cSLE (or a cSLE-like disorder) develop in individuals before they reach 18 years of age. cSLE typically is more severe and potentially lethal than adult-onset SLE because it often involves SLE-induced neurologic disease, renal failure, and/or
7998-701: The severe coronavirus situations, some dermatologists have initiated online consultation with their patients using some of popular apps, such as Practo, Apollo Pharmacy, Skin Beauty Pal, Lybrate, etc. This subspecialty deals with options to view skin conditions over a large distance to provide knowledge exchange , to establish second-opinion services for experts, or to use this for follow-up of individuals with chronic skin conditions. Teledermatology can reduce wait times by allowing dermatologists to treat minor conditions online while serious conditions requiring immediate care are given priority for appointments. Dermatoepidemiology
8091-453: The skin. Similarly, subacute cutaneous lupus manifests as red, scaly patches of skin but with distinct edges. Acute cutaneous lupus manifests as a rash. Some have the classic malar rash (commonly known as the butterfly rash ) associated with the disease. This rash occurs in 30–60% of people with SLE. Hair loss , mouth and nasal ulcers, and lesions on the skin are other possible manifestations. The most commonly sought medical attention
8184-517: The syllabic script Linear B . Beginning in the 8th century BC, however, the Greek alphabet became standard, albeit with some variation among dialects. Early texts are written in boustrophedon style, but left-to-right became standard during the classic period. Modern editions of ancient Greek texts are usually written with accents and breathing marks , interword spacing , modern punctuation , and sometimes mixed case , but these were all introduced later. The beginning of Homer 's Iliad exemplifies
8277-463: The time of the Dorian invasions —and that their first appearances as precise alphabetic writing began in the 8th century BC. The invasion would not be "Dorian" unless the invaders had some cultural relationship to the historical Dorians . The invasion is known to have displaced population to the later Attic-Ionic regions, who regarded themselves as descendants of the population displaced by or contending with
8370-586: The two complement component 4 genes , C4A and C4B . (The C4A and C4B genes code respectively for complement component A and complement component B proteins. These two proteins combine to form the complement component 4 protein which plays various roles in regulating immune function. Individuals normally have multiple copies of the C4A and C4B gene but if they have reduced levels of one and/or both of these genes make low levels of complement component 4 protein and thereby are at risk for developing cSLE or
8463-1086: The vitamin D levels and responses to vitamin D treatment varied in different patient populations (i.e., varied based on whether the study was conducted on individuals living in Africa or Europe). Because of these conflicting findings, the following middle ground has been proposed for using vitamin D to treat SLE: a) patients with SLE that have 25-hydroxyvitamin D 2 plus 25-hydroxyvitamin D 3 serum levels less than 30 ng/ml should be treated with vitamin D to keep these levels at or above 30 ng/ml or, in patients having major SLE-related organ involvement, at 36 to 40 ng/ml and b) patients with 25-hydroxyvitamin D 2 plus 25-hydroxyvitamin D 3 levels at or above 30 ng/ml should not be treated with vitamin D unless they have major SLE-related organ involvement in which case they should be treated with 25-hydroxyvitamin D 2 plus 25-hydroxyvitamin D 3 to maintain their serum vitamin D levels between 36 and 40 ng/ml. Studies of identical twins (i.e., twins that develop from
8556-475: Was Aeolic. For example, fragments of the works of the poet Sappho from the island of Lesbos are in Aeolian. Most of the dialect sub-groups listed above had further subdivisions, generally equivalent to a city-state and its surrounding territory, or to an island. Doric notably had several intermediate divisions as well, into Island Doric (including Cretan Doric ), Southern Peloponnesus Doric (including Laconian ,
8649-452: Was a pluricentric language , divided into many dialects. The main dialect groups are Attic and Ionic , Aeolic , Arcadocypriot , and Doric , many of them with several subdivisions. Some dialects are found in standardized literary forms in literature , while others are attested only in inscriptions. There are also several historical forms. Homeric Greek is a literary form of Archaic Greek (derived primarily from Ionic and Aeolic) used in
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