11.06.2015

Cupping therapy usa 94

Learn the basic theories of Traditional Chinese Medicine and the proper skills and applications of cupping massage. On a deeper level, the cups are strategically placed over certain acupoints based on Traditional Chinese Medicine (TCM) theory, thereby stimulating specific organ function.
In the past, diaper contact dermatitis was usually localized to moist peri-genital and peri-anal skin locations. Presentation of pityriasis that shows the typical "Christmas tree" dermatone distribution on the back but more extensive rash on the arms and legs. Post treatment with antibiotics for MRSA and antifungal for tinea capitus, this child's inflammation has markedly improved but the child will likely still have patches of permanent alopecia due to severe damage to the hair follicles.
Palmoplantar keratoderma is a chronic condition manifesting in early childhood with marked thickening of the skin of the palms and soles and areas of rash on body pressure points and sites of recurrent friction. Acanthosis and circular lesions of superficial fungal infection complicate atopic dermatitis with hyperpigmented patches on his shoulders in this overweight youth with insulin resistance.
Superficial inflammatory conditions such as diaper dermatitis, seborrhea, tinea versicolor, and pityriasis alba are common conditions which frequently result in hypopigmentation that resolves over a period of a few months.
Contact Dermatitis:Contact dermatitis to a metal fastener on a pair of jeans that has produced hyperpigmented papules coalescing to a plaque on this child's abdomen. Chicken Pox (Varicella) This child has hyperpigmented macules scattered over her body from chicken pox. Superficial LacerationA superficial laceration has produced hypopigmentationwith surrounding hyperpigmentation in this patient. Atopic DermatitisThis teen has severe pigmentary changes from inadequately treated atopic dermatitis. This child has a patch of nummular eczema, with coalescing papules around the pilar opparatus (located just below the nipple on the chest).
Lichenification:This child with severe atopic dermatitis illustrates the tendency of children with dark skin to develop very unsightly lichenification where they have a chronic dermatosis and puritis.
Although they are often seen in the lumbosacral and gluteal areas they are not limited to those regions. Transient Neonatal Pustular MelanosisThe hyperpigmented macules and vesicles seen on the face and neck of this newborn infant are characteristic of transient neonatal pustular melanosis (TNPM). They can often be confused with herpes simplex, but usually can be distinguished on clinical grounds.
Timea corporis - Classic Presentation:Tinea corporis is extremely common in children of all ethnic backgrounds, but sometimes may have a different appearance in children with dark skin.
Tinea Corporis without Erythema:Tinea corporis often presents without any erythema in children with dark skin as is illustrated in this photo. Tinea Corporis at HarilineTinea corporis at the hairline, which goes into the scalp, needs to be treated systemically with oral anti-fungal agent such as griseofulvin.
Herald Patch of Pityriasis RoseaThis lesion looks very similar to tinea corporis but actually is a herald patch seen at the onset of pityriasis rosea.
Pityriasis Rosea - Classic PresentationThe oval shaped plaques of confluent scaling papules, distributed along the dermatomes, are characteristic of pityriasis rosea in children.
Pityriasis Rosea - inverse distribution on armsChildren with dark skin often present with an inverse distribution of lesions in pityriasis rosea. The large patches on the right leg appeared first and were initially thought to be tinea corporis. Lichen Nitidus vs Lichen StriatusThis child has a line of skin colored papules stretching from the upper thigh to the ankle. Pityriasis AlbaThe hypopigmented patches on this child's left cheek is characteristic of pityriasis alba. For unknown reasons, tinea capitis is much more prevalent in the United States in African American children than in children of other races. The current epidemic of this illness often presents with a seborrheic-like scaling in the absence of alopecia. The lesions are less erythematous on the background of darker skin but typical "burrows" can be seen from the mite under the skin and secondary infection causes impetigo lesions where the child scratches their skin.
Tinea Versicolor - hyperpigmentedThese lesions are examples of the hyperpigmented variation of tinea versicolor.


Tinea Versicolor - HypopigmentedThe name tinea versicolor refers to the variable coloration of lesions. Pseudofolliculiltis BarbaePseudofolliculitis barbae is a foreign body reaction that occurs when arcuate hairs curve upon themselves and re-penetrate the skin. Hypopigmentation from Tretinoin (Retin A) UseThis teen's acne improved with Retin A, but hypopigmentation developed on the cheeks where it was applied more densely. Henna and contact DermatitisThis East African girl developed a severe contact dermatitis with itching at the site of an elaborate skin decoration with henna. Coining in a ChildCoining is a common healing practice used among Asian patients within the United States. Coining TechniqueThe lesions seen in coining are produced by rubbing a warm oil or Tiger Balm on the skin and firmly abrading the skin with a coin or special instrument as is illustrated in this photo. Circular Burns from Traditional HealingPatterned circular scars around the umbilicus in this East African child were produced by traditional treatments for illness.
Circular Burns on ScalpThese circular lesions were produced by traditional burning treatments in an East African boy. ScarringThese diagonal scars at the top of the buttocks were from cuts made in the skin by the grandmother of this East African child "to help her walk" when she was about 9 months of age. Cupping creates a vacuum with the soft tissues which helps lift, separate and remove fascial restrictions. This course offers fire cupping - the most beneficial, but also the most difficult form of cupping to master.
The papules will resolve with corticoid steroid treatment and removal of contact with metal, but the hyperpigmentation will last for months. These lesions can be prevented by appropriate vaccination of children 12 months and over with the varicella vaccine. This superficial inflammation usually resolves with temporary hypopigmentation at the site of lesions over 6 to 8 weeks.
This lichenification and hyperpigmentation is very slow to resolve even with regular treatment with topical steroids. Intrauterinely acquired herpes infection can present with vesicles and pustules at birth, but most of these infants have intrauterine growth retardation and microcephaly. This is a typical lesion of tinea corporis: an annular shaped lesion with raised margins, clearing in the center and some erythema.
The lesions may be more difficult to see in children with darker skin pigmentation and as noted earlier, often have a more papulofollicular appearance.
Rather than appearing on the trunk, as in the prior photo, they primarily are distributed on the arms and legs as is illustrated in this photo. It usually does not respond to topical steroids and resolves without treatment over a period of months, but the duration of lesions is variable. Fifteen percent of African Americans who visited an outpatient clinic for non-dermatological reasons were found to be infected in a recent study. This non-inflammed presentation leads to delayed diagnosis and spread within the household. The plaques and patches are slightly raised, usually circular, often on the neck and upper face, but commonly on the chest, back, and under the breasts in adolescent girls.
This creates pustules and papules as illustrated on the back of the head of this young man who has shaved his scalp. The hypopigmentation resolved with shortening the duration of Retin A application to 2 hours and adding an oral antibiotic to prevent the inflammatory lesions.
This is commonly seen with tight hair braids or tuffs and is found in individuals from many different ethnic backgrounds. Initially they were confused with alopecia from tinea capitis but the history indicated that they had been produced by a traditional treatment for chronic ear infection. Scars are also common on the face as cosmetic and religious decoration in many African groups. Like coining, cupping is done to release wind from the body and thereby restore balance and health. It is a very common practice in many ethnic groups to do ear piercing in early infancy which may help to avoid keloid formation.


Compared to a bruise they are more uniform in skin color, their borders are better defined, there is no induration or tenderness and they are stable over time. They are more common in term infants and are almost always seen at birth or soon after birth. Perinatally acquired herpes infection usually does not present with vesicles until day of life 5 - 17. The lesions of lichen striatus appear similar to those of lichen nitidus, but have a linear distribution.
Early treatment of acne, when it is mild, is important to prevent the long lasting hyperpigmentation and scars.
The alopecia can be permanent if there are large areas that are not recognized and treated appropriately by loosening the traction on the hairs.
When applied to the fingertips, black henna has been found to interfere with measurement of oxygen saturation from a fingertip. It is also used with a wide variety of febrile illnesses as well as stress related symptoms in adults such as headaches, muscle aches and pain, low energy. The child complained that this cupping, done by a grandmother hurt, but that it did not hurt when done by mother. The instructors are doctors of TCM with years of clinical experience including internships in Chinese hospitals where cupping is a primary treatment for pain conditions. Adequate topical corticosteroids, oral antihistamines and moisturizing agents to prevent itching, and early recognition and treatment of secondary bacterial skin infection can help prevent this cosmetically disfiguiring change in pigment. Although pustules are present and a culture may show bacteria, it is not necessary to treat with antibiotics. Treatment consists of avoiding a close shave, shaving with an electric razor and applying a depilatory chemical cream. Benzoyl peroxide which is commonly used in over the counter acne preparations, is a bleaching agent and produces lightened skin color with overuse.
However, some patints with contact dermatitis who have subsequently had patch tests with lawsone, the active ingredient in henna, have not shown a reaction. The practice produces linear petechiae and ecchymosis on the chest and back which resolve over several days. Excoriated acne, impetigo, varicella, lupus, infected atopic dermatitis, contact dermatitis, and scars from burns, lacerations and abrasions are common conditions which cause long-lasting hyperpigmentation. This child developed many other skin colored papules over the trunk during the next few months. The patches tend to be more prominent in the summer and fall as the child's normal skin tans and gets darker with the sunlight exposure whereas the affected areas remain paler. In newborn infants there is enough transcutaneous absorption of the active agent in henna, lawsone (a potent oxidizing agent), to produce hemolysis of red blood cells and indirect hyperbilirubinemia. This suggests that there are other unetermined ingredients in henna powders which are allergens. When they were biopsied the histopathology of the lesions was found to be characteristic of lichen nitidus.
The presence of the lesions usually indicate that the child was very sick at one time and western medical treatment was not available or had not been effective. Informing the parents to anticipate hypo-pigmentation as a part of the natural healing process helps to improve compliance with topical treatment.
However, it may produce intense inflammation which can result in hyperpigmented patches on the face that are very slow to resolve or hypopigmentation as in the case above. It is useful for the provider to ask about how the child was ill at the time they received the treatment.
Stronger forms of tretinoin (0.1% cream) have been used to successfully lighten post inflammatory hyperpigmentation from acne in adults with 40 weeks of nightly treatment.



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