Bowen's Disease is characterized by a precancerous, slow growing skin malignancy. The major symptom is a red-brown, scaly or crusted patch on the skin which resembles psoriasis or dermatitis. It may occur on any part of the skin or in the mucous membranes.
Bowen's disease typically presents as a gradually enlarging, well demarcated erythematous plaque with an irregular border and surface crusting or scaling. BD may occur at any age in adults but is rare before the age of 30 years - most patients are aged over 60. Any site may be affected, although involvement of palms or soles is uncommon. BD occurs predominantly in women (70-85% of cases); about three-quarters of patients have lesions on the lower leg (60-85%), usually in previously or presently sun-exposed areas of skin.
Bowen's Disease is also defined as Bowen's among dermatologists. Bowen disease is a squamous cell carcinoma (SCC) in situ with the latent for significant lateral spread. Pre-invasive means that there are cancer cells there. But they are enclosed to the outermost layer of skin, the epidermis. Most doctors and authorities regard Bowen's as a type of squamous cell carcinoma; although some regard it as a precancer.
Causes
The exact cause of Bowen's disease is unknown. Like many forms of cancer, long-term sun exposure may be a cause. The skin usually indicates sun damage, such as wrinkling, changes in pigmentation, and loss of elasticity. Ingestion of arsenic has been associated with cases of Bowen's disease found in skin areas unexposed to light or mucous membranes.
Bowen's disease may turn cancerous
In most cases, Bowen's disease remains confined to the upper layer of the skin (epidermis). However, there is a small risk that the affected cells may migrate deeper into the skin layers. Once Bowen's disease escapes the epidermis, it can become a more aggressive form of skin cancer. If a patch of Bowen's disease becomes raised, tender or bleeding then it may have turned cancerous and will need medical attention.
Treatment
Surgical excision is the common treatment for small SCC in situ which involves the removal of approximately one quarter of an inch past the edge of the cancer. With larger cancers Mohs surgery has the highest rate of all known treatment methods and may be necessary although they can also have surgical excision.
Several treatments are available for Bowen's disease, such as freezing it, scraping it off the skin (curettage), and surgical removal. In some cases a cream known as 5-fluorouracil (Efudix cream) or an alternative cream called imiquimod (Aldara) may be used. Photodynamic therapy is available in some clinics now (see below). Radiotherapy (X-ray treatment) is being used less often.
Curettage ? the lesion is scraped off the skin. It may also be used with cauterisation, where the skin is lightly burnt with and electric current. Recurrence is slightly more likely than with surgery.
Addison's disease (chronic adrenal insufficiency) is a rare and progressive disorder that affects between one and six in every 100,000 people. It occurs in all age groups and afflicts men and women equally. Addison's disease is caused by the inability of the adrenal glands to make sufficient amounts of regulating hormones. The adrenal cortex (the outer part) also produces important hormones, the corticosteroids. Classical Addison's disease results from a loss of both cortisol and aldosterone secretion due to the near total or total destruction of both adrenal glands. These glands form part of the endocrine system, which works with the nervous system and the immune system to help the body cope with different events and stresses. It helps maintain blood pressure and water and salt balance in the body by helping the kidney retain sodium and excrete potassium. When aldosterone production falls too low, the kidneys are not able to regulate salt and water balance, causing blood volume and blood pressure to drop. If ACTH is deficient, there will not be enough cortisol produced, although aldosterone may remain adequate. This is secondary adrenal insufficiency, which is distinctly different, but similar to Addison's disease, since both include a loss of cortisol secretion.
Causes of Addison's Disease
The common Causes of Addison's Disease :
The immune system mistakenly attacking the gland (autoimmune disease)
Use of blood-thinning drugs (anticoagulants) .
Infections such as tuberculosis , HIV, or fungal infections.
Invasion of the adrenal glands by cancer cells from another part of the body.
Tumors.
Chronic infections, such as fungal infections.
Hemorrhage, blood loss.
The symptoms of Addison's disease are caused by the failure of the adrenal glands, seated above the kidneys , to produce enough of the hormone cortisol and, in some cases, the hormone aldosterone .
Symptoms of Addison's Disease
Some Symptoms of Addison's Disease :
Muscle weakness.
Depression .
Irritability .
Chronic fatigue that gradually worsens.
Weight loss and loss of appetite .
Nausea , diarrhea , or vomiting .
Dehydration.
Dysphagia (difficulty swallowing) .
Polyuria .
Increased number of eosinophils.
Restlessness .
Treatment of Addison's Disease
Medications to replace the hormones cortisol and aldosterone. Hydrocortisone is often used because it can function like both of these hormones. If another medication is used instead of hydrocortisone (such as prednisolone, methylprednisolone, or dexamethasone), you also will need a medication that can function like aldosterone (usually fludrocortisone). You will need a higher dose of medication during childbirth; when you have an injury, surgery, or a serious infection; or during severe stress, such as the death of a loved one.
Increasing salt in the diet. Because people with adrenal failure tend to lose sodium , you will need extra salt (sodium chloride) in your diet, especially during hot and humid weather and vigorous exercise. However, because people with Addison's disease retain potassium , you need to avoid salt substitutes, which usually contain potassium chloride salts.
Regular medical checkups to monitor symptoms and blood pressure. Your health professional also may need to do lab tests to evaluate and monitor blood levels of potassium, sodium, and cortisol.
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