Introduction

Huntington’s disease, also known as HD, is a rare degenerative disorder that greatly effects the central nervous system of the individual. It is often characterized by surplus and unwanted choreatic movements, unusual behavioral patterns, disturbances in the mental level and dementia. (Sheth 2013) As far as the Caucasian population is concerned, the Huntington’s disease is prevalent in one out of ten thousand persons. In a few cases, adolescents start to show symptoms of HD (known as JHD or Juvenile Huntington’s disease) before the age of twenty by demonstrating behavioral disorders and learning difficulties at school. However, chorea is the major indicator of the beginning of HD that spreads to all muscles with the passage of time. He/she, who affected from the disease, becomes severely retarded as the psychomotor processes are affected gradually also suffers decline of cognitive skills and starts experiencing mental disorder symptoms (Roos 2010).

If described in medical language, Huntington’s Disease is “an autosomal dominant inherited disease caused by an elongated CAG repeat (36 repeats or more) on the short arm of chromosome 4p16.3 in the Huntingtin gene” (Roos 2010). In adolescents that suffer from Juvenile Huntington’s disease, the repeat frequently goes beyond 55. The signs and clinical symptoms lay the basis for diagnosis, especially for individuals who have a parent with confirmed Huntington’s disease. The diagnosis is confirmed with the determination of DNA. Although, there is still no cure for the Huntington’s disease, the quality of life of the patients can be improved with the help of care and other available treatments. The individual with Huntington’s disease becomes completely dependent as the disease progresses and is not able to carry out even the day-to-day tasks. Death is most commonly caused by pneumonia seconded by successful suicidal attempts (Roos 2010).

The above chromosome map clearly shows there is a mutation in the Huntington’s disease.

Causes and Risks

All Huntington’s disease cases are found to be caused by the defective gene that was identified by the medical scientists in the year 1993. The huntingtin gene limitation is consisted of an added particular chemical code repeat in a minute part of chromosome 4. Normally, the huntingtin gene has a total of more or less twenty reappearances of this specific chemical code among the total codes that number three thousand around. The Huntington’s disease is caused by the chromosomal defect in which there are more than forty reappearances. For the genetic tests of the Huntington’s disease, these number of chemical codes repetitions that are present in the huntingtin protein gene of the patients are measured (Knowles 2007).

The actual function of the hungtin protein/gene is still a mystery to the scientists. They still don’t know about the process due to which dozens of surplus repeats in its genetic design cause the destructive indicators of Huntington’s disease. Any advancement and solution would be beneficial for the getting understandings of psychological disorders for instance Alzheimer’s, Parkinson’s disease etc. (Knowles 2007).

Symptoms

The symptoms of this disease may vary from person to person. There are cases when within the same family the symptoms do not match from the other family member.  In some cases, emotional and behavioral symptoms are more prominent and for others, the symptoms of involuntary movements (Lemiere 2004).  Following are some of the most common symptoms of Huntington’s disease.

Emotional/Behavioral Symptoms

Some of the symptoms which are usually encountered in the Huntington’s disease are anxiety, irritability, depression and apathy. Some people suffer from depression for a longer period before its recognition to be a symptom of HD. Social withdrawal, several occurrences of mood swings and impulsiveness with aggression are the behavioral changes that may show up. There are less chances of schizophrenia and other psychiatric problems in Huntington’s disease (Lemiere 2004).

Cognitive/Intellectual Symptoms

The very first signs of cognitive disturbance often are the slight changes in intellectual capacity. These signs are lack of ability to handle new situations and the organization of the routine matters as well. Long term memory stays well but short-term memory loss is a symptom too. The daily routine work/tasks become extremely difficult to perform (Lemiere 2004).

Motor Symptoms

Excessive restlessness, fidgeting, twitching are the nervous activities that are initial physical symptoms. There may be a change in the hand writing of the person. Routine activities like driving and cooking, which involve concentration and coordination, become difficult. Facial grimaces can appear as well and some involuntary movements of head and limbs. As a result, walking problem and balance maintenance can appear. During rest and taking sleep, movements decrease and the movement in stress or excitement may increase during voluntary effort (Lemiere 2004).

Being at Risk for Huntington’s disease

Huntington’s disease has different effects on different people so there is no particular condition/situation that makes a person defenseless to get affected by Huntington’s disease. Some people get so allergic of the topic that they even turn away from their family members as they do not wish to have discussions for their risk to have HD. On the other hand, there are a number of people who do nothing but constantly get afraid and think about being at risk to. (Weiner & Lipton 2003).

This is important to note here that being susceptible to Huntington’s disease is rather influential for people as it has a major effect on the choices in life including marriage, family planning and job opportunities. An occurrence of awkward situation, shuddering or absentmindedness/lack of memory may be regarded as an onset of the Huntington’s disease that may have terrifying consequences for the individual and his/her family.            A good number of at-risk people show enough bravery to acknowledge the risk for Huntington’s disease. This is significantly observable when there is no accessibility of an effective treatment. Without a doubt, people choose to continue living and do not opt for taking tests as there is no cure (Weiner & Lipton 2003). Currently, there is one in every ten thousand individuals in United States of America is suffering from HD. Those who are at risk to have inherited HD from a parent number more than 2.5 million. It is important to mention here that both genders are equally affected by this mental impairment disease. According to the worldwide statistics, estimations reveal that 5-10 people out of every 100,000 people will suffer from HD. Children who have a parent with HD have a 50/50 chance to be at risk of inheriting it. The occurrence of the Huntington’s disease has been observed all over the world. However, there are a number of territorial groups in which Huntington’s disease is uncommonly found.

Diagnosis

Only a comprehensive and detailed examination of Huntington’s disease can make sure the completion of an accurate clinical diagnosis. Family history is also checked in detail. In some cases, diagnosis also involves MRI (magnetic response imaging)/CT scans (computerized tomography). However, the findings from such processes are nor sufficient to provide enough information with the help of which a proper diagnosis may be formed. In the similar manner, Huntington’s disease may also be diagnosed by conducting the genetic test of the individual, the results of which may help in the confirmation, ruling out or identification of Huntington’s disease development (DiMaio, Fox & Mahoney 2010).

It is extremely important to mention here that if the HD gene is identified after a positive test result, this finding may not be helpful for the confirmation of HD diagnosis without a neurological examination. This is the reason why it is excessively significant to get checked up by a neurologist who is well-known with the Huntington’s disease. The efficiency of the neurologist counts a lot as HD symptoms are similar to symptoms of Parkinson’s disease, alcoholism etc. Therefore, it is really essential “to confirm that at least one affected member of the family has had the clinical diagnosis confirmed by molecular testing to provide the most accurate genetic counseling, especially if the husband would be considering molecular testing of his own Huntington disease genes” (DiMaio, Fox & Mahoney 2010).

The HD diagnosis may prove to be a relief for some people. They consider it a blessing to know that their lack of memory is a problem and the mystery of why they keep forgetting things is finally resolved. For others, the news regarding HD diagnosis comes as an upsetting shock. A majority of people tend to deny that they have HD even after positive results as it is rather disturbing for them to accept that they have such a rare disease. For such people, the best way to cope up with the reality is to engage in discussions regarding their emotional status. They may share their feelings with a closed one, support group member or therapist.

Genetic Testing

A test was developed soon after the discovery of the Huntington’s disease gene in the year 1993. This test made it possible for people to get confirmed whether they carry the HD-causing gene or not. In the initial phases, the linkage analysis process was used to test people and this needed the family members to get their blood samples tested. However, with the passage of time, new tests were introduced out of which the “direct gene test” is regarded as the most appropriate and authentic. This genetic test only requires the individual who takes the test for the detection of HD gene to give his/her blood sample (Knowles 2007).

Thus, the tests findings revealed that the Huntington disease gene consists of a particular expanded section only found in people who have HD. On the other hand, others who do not suffer from HD have a “tri-nucleotide repeats” section in their DNA. DNA is composed of building blocks i.e. nucleotides which are represented by the alphabets C, A, G and T. As already mentioned, the CAG pattern is repeated forty times or more in people who have Huntington’s disease. The genetic test is used for the analysis of an individual’s DNA whereby the CAG numbers in his/her DNA is counted. The results of the genetic test then make it possible to tell whether there are chances of HD development or not. However, the onset of HD cannot be predicted by genetic testing. It is surprising to know that the genetic disease for Huntington’s disease offer results that are more or less ninety-nine percent accurate all the time (Kirby 1998).

It is an entirely personal matter to decide about undergoing genetic testing, a decision that must not be taken with a light heart. It is required of the family members to not enforce an at-risk individual to go for genetic testing. The process of testing consists of a number of sessions with several professionals. At least one session is meant for having genetic counseling, conducting a neurological exam, an interview with a psychologist, results’ discussion with the individual and family members and follow-up. The genetic test is only a blood test after which diagnosis is made.

Treatment

There are many ways to treat Huntington’s disease although there is still no cure for it. At the same time as no current treatments can be helpful in altering the progression of the Huntington’s disease, there are numerous medications that can be useful in the treatment of common HD symptoms like anxiety, irritation and frustration. Moreover, medications can also help in the lessening of involuntary movements. It is important to mention that a number of drugs can have disturbing side effects. This is the reason why it is the responsibility of the physician to explain them to the patient and his/her family before the beginning of the treatment.

Most of the give drug prescriptions to the patients for treating HD symptoms even when there is no need of it. In majority of cases, it has been observed that people who do not take drugs or take minimal drugs did better than those who took drugs in heavy doses. It happens a lot of time that drugs are helpful at one stage while they stop to have any effect on the patient’s condition at other stages. For such factors, it is often preferable for patients and their families to look for an experienced Huntington’s disease neurologist as not all of them are well-acquainted with it. It is also a good thing to keep the family physician involved in the continuing treatment. A critical role is played by both the HD patients and their families for the monitoring and assessment of the treatment effectiveness.

The treatment also involves physical and speech therapies so it is a good thing if both physical therapist and speech therapist are consulted. Such strategies can turn out to be really helpful in giving a positive influence to the patient and making his/her quality of life improved. In addition, the HD patients need a very well balanced diet as nutrition may have a lasting impact on their physical condition. An exceptional number of calories are needed by the HD patients for the maintenance of their body weight so the importance of diet can never be underestimated in this regard. Patients who are experiencing the last stages of HD find it really helpful to have a really good diet in order to reduce the involuntary movements (by both gaining and losing weight; depending on their physical condition). Nutritional supplements are also suggested by the nutritionists.

Research

Research in finding a cure for Huntington’s disease is the key. A number of ground-breaking theories have been propounded regarding the HD. The gene discovery in 1993 was the main highlight. Since that time, medical scientists have been able to discover certain brain proteins related to huntingtin protein. Currently, research is conducted for finding out the process with which the mentioned proteins combine for producing HD-causing symptoms. Scientists are also keen to find out a way to stop the proteins’ interaction as a main treatment method.

References

DiMaio MS, Fox JE, Mahoney MJ. 2010. Prenatal Diagnosis: Cases and Clinical Challenges [Internet]. 1. Chichester: Wiley-Blackwell; [cited 2013 Nov 10] Available from: http://books.google.com.pk/books?id=Qx2cWaAk2pEC&printsec=frontcover&dq=Prenatal+Diagnosis:+Cases+and+Clinical+Challenges&hl=en&sa=X&ei=9jCCUufnNZOrhQfh0YDACg&ved=0CC0Q6AEwAA#v=onepage&q=Prenatal%20Diagnosis%3A%20Cases%20and%20Clinical%20Challenges&f=false

Knowles J. 2007. Huntington’s Disease [Internet]. 1. New York: Rosen Pub. Group; [cited 2013 Nov 11] Available from: http://books.google.com.pk/books?id=RX2Er7NpMSUC&printsec=frontcover&dq=Huntington’s+Disease&hl=en&sa=X&ei=ameBUqWBDYjBhAfy9YDQCQ&ved=0CEcQ6AEwAw#v=onepage&q=Huntington’s%20Disease&f=false

Lemiere J. 2004. Huntington’s disease: Early Detection and Progression of Cognitive Changes in Patients and Asymptomatic Mutation Carriers [Internet]. Leuven: Leuven University Press; [cited 2013 Nov 11] Available from: http://books.google.com.pk/books?id=vdhgGGgLQSIC&printsec=frontcover&dq=Huntington’s+Disease:+Early+Detection+and+Progression+of+Cognitive+Changes+in+Patients+and+Asymptomatic+Mutation+Carriers&hl=en&sa=X&ei=aGqBUqDzJ6XG7AbVz4CIDQ&ved=0CC0Q6AEwAA#v=onepage&q=Huntington’s%20Disease%3A%20Early%20Detection%20and%20Progression%20of%20Cognitive%20Changes%20in%20Patients%20and%20Asymptomatic%20Mutation%20Carriers&f=false

Roos R. 2010. Huntington’s Disease: A Clinical Review. Orphanet Journal of Rare Diseases [Internet]. [cited 2013 Nov 12] 5:40. Available from: http://www.biomedcentral.com/content/pdf/1750-1172-5-40.pdf

Sheth K. 2013. Huntington’s Disease [Internet]. A.D.A.M. Medical Encyclopedia; [2011 April 30, cited 2013 Nov 11]. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001775/

Weiner  MF, Lipton AM. 2003. The Dementias: Diagnosis, Treatment, and Research [Internet]. 3rd. Washington(DC): American Psychiatric Pub; [cited 2013 Nov 12] Available from: http://books.google.com.pk/books?id=3h3YxCtmoRsC&printsec=frontcover&dq=The+Dementias:+Diagnosis,+Treatment,+and+Research&hl=en&sa=X&ei=LOqBUq6MGuv07Ab3rIGYCA&ved=0CC0Q6AEwAA#v=onepage&q=The%20Dementias%3A%20Diagnosis%2C%20Treatment%2C%20and%20Research&f=false

 
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Introduction

According to histological definitions, folliculitis barbae can be described as the “presence of inflammatory cells within the wall and ostia of the hair follicle, creating a follicular-based pustule” (Satter, 2012). There is a variation in the tangible kind of inflammatory cells as their nature is mainly dependent on folliculitis’ etiology. The inflammation has different effects. It may limit itself to the external phase of the follicle with the involvement of the infundibulum at a primary level. On the other hand, there may be an inflammatory effect on both aspects of the follicle i.e. external and internal (Satter, 2012).

In contrast, Perifolliculitis barbae is “the presence of inflammatory cells in the perifollicular tissues and can involve the adjacent reticular dermis” (Satter, 2012). Both the mentioned types of folliculitis have independent manifestations. However, they may also occur together as a consequence of follicular disorder, disturbance and irritation (Satter, 2012).

Folliculitis Barbae

Folliculitis Barbae is the condition in which the formation of hair occurs within the skin as hair follicles that are minute hairy structures. The word folliculitis is used to depict the inflammation of these tiny hairy structures. Even though such kind of inflammation can affect any part of the skin, folliculitis barbae is the term that specifically refers to the inflammation of the hair follicles that affect the area where beard grows.

Causes

In general, Staphylococcus aureus infection is the major cause of this condition. The mentioned infection is recognized as mainly affecting the skin of a person. Though folliculitis barbae may transpire in a bearded area that is not shaved; men who shave are mostly affected by this condition. These bacteria unnoticeably line inside the nasal area due to which there are higher chances of reinfection. In addition, shaving equipment containing contaminations also have these bacteria and when an individual uses improper and unclean equipment for shaving, reinfection may take place. In some cases, there is no involvement of S.aureus and the involvement of harmless skin bacteria results in folliculitis barbae.

More often than not, the upper part of the hair follicle is affected by the infection on the external surface of the skin. In a number of cases, on the other hand, the infection is more deep-rooted. The follicles may appear red and feel itchy due to the setting up of a constant inflammatory reaction by the immune system. Such a condition has been given the name of sycosis barbae. At seldom occasions, scarring is caused by such a condition. It is exceedingly important to note here that the infections that are caused by fungi or herpes virus cannot be considered as folliculitis barbae. It is also imperative to note that folliculitis barbae is not hereditary.

Symptoms

Folliculitis barbae is characterized by itchiness and tenderness of the beard area. The use of razor may cut the spots that have a severe effect on the beard area. Bleeding may result as a consequence. Folliculitis barbae may infect the hair follicles in the beard area by causing a small red inflammation and enlargement to appear at the root of the skin from where the hair grows up.This swelling is frequently observed to come together with a septic spot with a yellow-head. Thus, folliculitis barbae usually affects a lot of hair follicles. In case of the development of an inflammatory reaction, an extension can be seen from where the follicles appear red. These follicles are joined up often that cause itchiness and irritation.

Diagnosis

For diagnosis of folliculitis barbae, the doctors take a pus sample and then test it for infection. The sample results then makes it easier for them to recommend the antibiotics that may help the individual. In case when there is no quick clearance of the folliculitis, swabs and scrubbing down of the infected area is done and sometimes noses of the patient and family members are also checked to check whether any bacteria is the real cause of the infection. The skin is also closely examined to find out whether the spots indicate the occurrence of folliculitis barbae or pseudofolliculitis. This close examination of the skin is important as both conditions can affect the skin at the same time.

Treatment

Every now and then, this condition can be cured. However, the curing varies from person to person as every individual has a distinctive skin type. In some individuals, curing shows less response. But treatment in a timely and appropriate manner can help this condition to go away. One of the most important things to mention here is that the scars which develop as a result of this condition are life-long. The skin appearance improves usually over a period of time but the scars do not vanish. In many cases where there is a straightforward infection, a proper antibiotic course is enough for the skin to response quickly. Such antibiotics are available in the form of creams and oral medications. In case of a reinfection due to nasal bacteria, physicians usually recommend the application of an antibiotic ointment inside the nostrils. When there is a development of chronic inflammation, the patient is recommended to use a mild steroid cream. In cases that are more difficult to treat, the suggestions given by the doctors include the use of an antibiotic that may help to get rid away of both anti-inflammatory and antibacterial effects.

If an individual is persistently affected by the folliculitis barbae, he/she is advised to take necessary steps to lessen the contamination from equipment used for shaving. It is suggested that metal parts of the shaving equipment must be scalded on a regular basis with boiling water. If a person uses razor or electric shaver, the plastic parts that may infect the skin must be cleaned in a careful manner after every time they are used. Alcoholic antiseptic solutions must also be used to soak the shaving equipment. Sometimes, it is better to use an antiseptic lotion instead of using shaving soap or foams to avoid any infection of the skin.

Pseudofolliculitis barbae

Pseudofolliculitis barbae is an irritating and irking chronic condition that can develop as a result of attempts to get rid of hair from the bearded area (Quarles, Brody, Johnson, Badreshia, Vause, Brauner & Callendar, 2007). It is quite difficult to determine the occurrence of this disorder. However, studies regarding the disorder have reported that this disfiguring condition affects more or less one individual out of every five Caucasian individuals. It is also revealed from the studies that it occurs very commonly in black persons. It is not only a condition that affects men but women can also get this disorder no matter from which race they belong. The inflammatory papules and pustules appearance is the main clinical characteristic of this disorder. This condition is a direct result of the inappropriate shaving techniques causing “ingrown hairs through both transfollicular and extrafollicular mechanisms” (Halder, 1988). Same treatment as that of acne is adopted, once the pseudofolliculitis barbae is established. It can also be treated by avoiding shaving along with the medication and in extreme cases, diode lasers can be used (Yamauchi, Kelly & Lask, 1999). The long-term result is dependent entirely on prevention through a correct shaving technique. In severe cases of pseudofolliculitis, when definitive solution is sought, the choice of treatment is photodepilation (Ribera, Fernández-Chico & Casals, 2010). As the main factor that is responsible in the condition’s pathogenesis is hair, a definite treatment is the elimination of hair.

Epidemiology

In general, men with curly, coarse hair are affected by Pseudofolliculitis barbae. It is reported that 45-83% African-American men suffer from this condition and it has turned out to be a leading concern in black US army recruits. A survey carried out at the Skin of Color Center concerning 71 patients with PFB (41 females and 30 males) confirmed an average age of beginning to be 22 years (Coley & Alexis, 2009).

Pathogenesis

An ingrown hair shaft results in this chronic-body reaction that is called Pseudofolliculitis barbae. It is thought that a curved hair follicle which is present in African descent individuals, predispose cut hair and reenter the dermis which leads to this reaction. There are two mechanisms which are so far described i.e. extrafollicular penetration and transfollicular penetration. In the extrafollicular penetration, the very sharp edge of the hair that was shaved follows its natural curvature to the surface of the skin and re-penetrates in a retrograde fashion. Transfollicular penetration is the piercing of the follicular wall by the shaft of the hair recently cut, which as a consequence enters the dermis without ever exiting the epidermis (Coley & Alexis, 2009).

Pulling of the skin rigidly while shaving boosts the danger of transfollicular penetration by allowing recently cut hair to retract underneath the skin’s exterior. Transfollicular penetration can also result for ingrown hair seen with waxing or plucking, which leaves hair fragments inside the skin. In both of the types of re-entry, the shaft of the hair penetrates the dermis thus triggering the foreign-body inflammatory response that may result in the formation of pustules and papules. A single nucleotide polymorphism has been identified by medical scientists which imparts the partial genetic risk of the development of the PFB (Coley & Alexis, 2009).

Clinical Features

The hallmarks of PFB are follicular and perifollicular papules and pustules in the beard area. Post-inflammatory hyper-pigmentation (PIH) is also a commonly linked feature which is reported in a majority of cases. Commonly affected area is the bearded area of the face, which may or may not include the anterior neckline, mandibular areas, chin and cheeks. In some severe cases, hypertrophic scars are also seen. Embedded hair can also be seen with the papules in severe cases. After growing approximately 1cm in length, this hair will spontaneously release through the loop mechanism. Depressed patterns can be present due to the parallel hair growth. Some patients may feel itching and pain. In the secondary infection cases, cultures of pustules are generally sterile (Coley & Alexis, 2009).

The presence of PFB lesions can be distressing to patients. Considerable anxiety in appearance can also be present. PFB majorly contributed to racial tension among African-American soldiers in the US army due to the military grooming code which requires a clean-shaven face. For majority of these men, compliance with the code means suffering with PFB (Coley & Alexis, 2009). The Folliculitis Barbae inflammatory response is dependent on “the shape of the hair follicle, hair cuticle, and the direction of hair growth” (Perry, Cook-Bolden, Rahman, Jones & Taylor, 2002) as every one of them has a certain role. People with this condition tend to suffer emotional distress as it causes as unattractive and ugly cosmetic appearance.

Treatment

Hair Removal

This condition can be prevented by allowing the beard to grow for a month which can result in spontaneous resolution of most PFB papules cases in Folliculitis Barbae. However, in some cases, the growth of the beard for a full month is not possible. Personal preferences and clean-shaven face appearance may act as the limiting factors. In such cases, alternative hair removal and counseling about proper shaving techniques become mandatory in order to control and reduce the flares (Coley & Alexis, 2009).

Most men can easily control the condition with maintaining an optimal beard length of 0.5 to 1 mm. The hair can be cut through the electronic clippers as they allow the user to set the length of the hair and cut the rest. By tradition, most of the authorities suggest the use of a single blade razor to avoid the PFB. A recommended razor is Bump Fighter (American Safety Razor Company, VA, USA) as its blade is coated with the polymer and a foil guard that keeps the edge of the blade slightly off the skin and it prevents the trimming of the hair too close from the skin. In a study, this razor has been shown to reduce the number of PFB lesions. According to a recent study in this field, no increase was observed in the number of PFB lesions in men who used Gillette five blade razor daily for 8 weeks.  Random, blinded clinical research comparing the use of single-edged and multi-edged razors, shaving techniques and frequencies are needed in order to explain optimal shaving recommendations for PFB (Coley & Alexis, 2009).

Medical Management

Medical Management is another treatment option that includes a combination of therapies that are used to treat PFB, topical antibiotics, low-potency corticosteroids and use of topical retinoid. Topical retinoid helps to alleviate the hyperkeratosis associated with the repetition of the follicular epithelium as well as PIH.  In place of commercial aftershave products, low to mid potency topical corticosteroids can be used. Prior to shaving, benzoyl peroxide wash can also be helpful. Antimicrobials such as Benzoyl peroxide and erythromycin can be used to reduce the colonization of bacteria which can result inflammation and result to secondary infections. PFB-associated PIH can be treated successfully with bleaching agents such as hydroquinone and kojic acid etc (Coley & Alexis, 2009).

Chemical Depilatories

Chemical Depilatories can be used as an alternative too by men who are burdened with this condition as it is a useful hair-removal option. Chemical depilatories are an alternative to shaving that has been used from several years as an alternate for shaving. Barium sulfide or calcium thioglycolate are the substances that are present in cream and lotion forms and they work well in weakening the disulfide bonds in keratin. By the use of these substances in Folliculitis Barbae, the hair can be easily removed from the skin surface with a blunt instrument for the removal of hair (Bridgeman-Shah, 2004). It makes the transfollicular and extrafollicular penetration very less likely to happen. Irritant and allergic reactions may appear with the use of these chemicals resulting in PIH in case of prolonged exposure. A test patch to determine irritation potential is recommended before taking the treatment (Coley & Alexis, 2009).

Eflornithine Hydrochloride

US FDA approved a cream named as Eflornithine hydrochloride for the treatment of unwanted facial hair in women (Coquilla & Lewis, 1995). This cream irreversibly slows down the enzyme in hair cell division, which ultimately results in less hair growth rate in the area applied. Although, this cream is not indicated for the use of PFB, it has been found to be used for the purpose of decreasing the hair growth in men suffering from PFB. All the considerations need to be discussed with the patient prior to adoption to avoid the unrealistic expectations from the treatment (Coley & Alexis, 2009).

Epilating

Epilating in the form of electrolysis is one of the forms of permanent hair removals which can be considered for limited areas. This process is potentially painful and costly. This process is not of more success in African-American people as it is difficult to ablate the curved and distorted hair follicle. A merged technique of electrolysis by means of galvanic and thermolysis currents have been effective. In fact, electrolysis can actually exacerbate PFB and promotes transfollicular penetration and therefore is generally not recommended as a cure treatment (Coley & Alexis, 2009).

Chemical peels

Chemical peels is an another option to treat Folliculitis barbae as superficial chemical peels are safe and effective in addition to therapy for PFB. It has been proposed that glycolic acid have properties to reduce sulfhydryl bonds and in addition to that its exfoliating effects are good. The reduced bonds of sulfhydryl in the hair shaft can result in the growth of straighter hair and can potentially reduce the possibility for re-entry of the hair shaft in the epidermis. The peels of salicylic acid offer exfoliation and lightening in the cases complicated with PIH. Research showed reduced number of PFB lesions with both salicylic acid and glycolic acid peels (Coley & Alexis, 2009).

References

Bridgeman-Shah, S. (2004). The Medical and Surgical Therapy of Pseudofolliculitis Barbae. Dermatologic Therapy, 17(2), 158-163.

Coley, M. K., & Alexis, A. F. (2009). Dermatologic Conditions in Men of African Ancestry. Medscape Today. Retrieved August 12, 2013, from http://www.medscape.com/viewarticle/715199_2

Coquilla, B., & Lewis, C. (1995). Management of Pseudofolliculitis Barbae. Military Medicine, 160(5), 263-269.

Halder, R. (1988). Pseudofolliculitis Barbae and Related Disorders. Dermatologic Clinics, 6(3), 407-412.

Quarles, F., Brody, H., Johnson, B., Badreshia, S., Vause, S., Brauner, G., & Callendar, V. (2007). Pseudofolliculitis Barbae. Dermatologic Therapy, 20(3), 133-136.

Perry, P., Cook-Bolden, F., Rahman, Z., Jones, E., & Taylor, S. (2002). Defining Pseudofolliculitis Barbae in 2001: A Review of the Literature and Current Trends. I, 46(2 Suppl Understanding), S113-S119.

Ribera, M., Fernández-Chico, N., & Casals, M. (2010). [Pseudofolliculitis barbae]. Actas Dermo-Sifiliográficas, 101(9), 749-757.

Satter, E. K. (2012, July 10). Folliculitis .Medscape Reference: Drugs, Diseases and Procedures. Retrieved August 12, 2013, from emedicine.medscape.com/article/1070456-overview

Yamauchi, P., Kelly, A., & Lask, G. (1999). Treatment of Pseudofolliculitis Barbae with the Diode Laser. Journal Of Cutaneous Laser Therapy, 1(2), 109-111.

 
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Introduction

Multiple personality or dissociative disorder is an extremely uncommon mental disorder in which an individual has two or more different personalities.  Each of these personalities has unique characteristics such as mind-set, emotions behavioral patterns. This change takes place in sudden switches when the patient is triggered by painful events or miserable memories. Each personality is perhaps completely unaware about the others. However, the person is usually acquainted with the fact that there were mysterious gaps in times he/she remembers (“multiple personality,” 2013).

According to the Diagnostic and Statistical Manual for Mental Disorders, dissociative disorders are  “characterized by the presence of two or more distinct identities or personality states, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self, that recurrently take control of the individual’s behavior” (American Psychiatric Association, 2000).

It was in the nineteenth century that Pierre Janet, a renowned French physician, recognized and explained multiple personality/dissociative disorder for the first time. The reason behind the development of multiple personality disorder is still not evidently understood. However, this rare condition is almost always linked with rigorous physical abuse and abandonment during the early years of a person’s life. It is widely acknowledged that amnesia i.e. the loss of memory is the main factor due to which separate personalities are formed. Amnesia is believed to occur as a psychosomatic obstruction to cordon off excruciatingly agonizing experiences from one’s conscious mind. People with dissociative disorder are found to have mild to severe social and emotional mutilations. Thus, dissociation acts “as a creative survival mechanism in the face of overwhelming trauma, whereby the mind shields itself by segregating the experience, or splitting it off into its constituent parts rather than experiencing it as what would be an unendurable ‘whole’” (Spring, 2011).

Dissociative disorders have been categorized according to their severity. The severity spectrum is based on the extreme chronic traumas the person experienced as a child. Thus, Post-traumatic stress disorder is considered as the least extreme dissociative disorder whereas dissociative identity disorder is regarded as the most extreme. Other dissociative disorders between the mentioned ones are dissociative loss of memory/forgetfulness (amnesia), dissociative fugue, de-personalization disorder, de-realization disorder and DDNOS. DDNOS is the dissociative disorder not otherwise specified in which a person is unable to call important personal information to mind that is excessively general to be elucidated by normal absentmindedness/lack of memory (Spring, 2011).

Treatments and Drugs

Dissociative disorders require continuing, tête-à-tête and relationally based psychiatric therapy as the primary treatment choice. However, it depends on various factors for instance the client’s functioning capacity, assets, support and inspiration. Some clients need to be dealt with for a longer period (more than an hour). In general, it may take the therapy to extend for 5 years or more. Psychotherapists make use of miscellaneous techniques to treat dissociative conditions. These techniques include “cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), eye movement desensitization and reprocessing (EMDR), and sensor-motor psychotherapy” (Spring, 2011).

It is extremely important to mention here that a therapist must adjust EMDR protocols to work with dissociative identity disorder. This is because if a doctor is not familiar with standard EMDR treatment and dissociative disorders, his unskilled methods may lead to harmful overflow of hurtful matter and consequent decline of the mental health of the client.

Medication/Pharmacological Treatment

Till date, no medications have been found to particularly treat such disorders of dissociation. However, doctors all around the world recommend their dissociative patients to treat the disorder with antidepressants, medications to curb anxiety or tranquilizers. In the early phases of PTSD, pharmacotherapy is used to treat dissociative disorders. It has been found that the major symptoms of PTSD are re-experiencing, chaotically awakening, and forestalling. Co-morbid symptoms of PTSD comprise of anger, violent behavior, impulsivity, misery, fright, substance abuse, and feelings to have nothing to live for.

Medication is found to have an outcome on both primary and co-morbid symptoms of PTSD. PTSD is thus treated with “selected serotonin reuptake inhibitors (SSRIs) and the serotonin/norepinephrine reuptake inhibitors (SNRIs)” (Kreidler, Zupancic, Bell, & Longo, 2000). Clonidine is another medication that is found to lessen the symptoms of disturbing nightmarish dreams, invasive memories, manic alertness, sleeplessness, frightening responses and mad flare-ups. Moreover, anticonvulsants are also employed to treat mild dissociative disorders. Naltrexone can significantly reduce the length and strength of dissociative symptoms. It is especially useful for patients who have borderline personality disorder (Kreidler, Zupancic, Bell, & Longo, 2000).

Psychotherapy

For dissociative disorders, psychotherapy is the most important treatment. The other names for this therapy are talk therapy or psychosocial therapy. A client talks about his/her disorder and the problems related with it with the therapist in this treatment. It then becomes the responsibility of the therapist to help the client in understanding the cause of his/her condition. The therapist also has the responsibility of helping the client to find ways to deal with the hurting and depressive situations. Most of the times, various techniques are involved in psychotherapy such as hypnosis.

Hypnosis helps a client by making him/her remember and solve the problem by working through the disturbance that triggers his/her symptoms of dissociation. In hypnosis, the therapist creates a condition of deep rest for the client that quiets his/her mind. When the client is hypnotized, he/she starts concentrating on a particular idea, reminiscence, sensation or feeling in an intense manner at the same time as the distractions are blocked. However, hypnosis can only be conducted by a trained therapist as a corresponding method for treating patients with dissociative disorders.

It is important to note here that the course of psychotherapy may take a really long time that is also rather disturbing and hurting. However, a number of researches show that this treatment approach is the most effective for the treatment of dissociative disorder as it helps the clients to combine their disconnected personalities (“Dissociative Disorders: Treatments and Drugs”, 2011).

Creative Art Therapy

In this kind of treatment, creative processes such as art, dance, music etc. are used for helping those clients who have problems when asked to express their thoughts and share their emotions. Creative art therapy is a technique by which an individual is helped to increase his/her sense of self. It also helps people in coping with dissociative symptoms and incidents of trauma by encouraging positive changes (“Dissociative Disorders: Treatments and Drugs”, 2011).

Cognitive Therapy

Cognitive therapy is another effective treatment for dissociative disorders as it is that kind of talk therapy that helps the clients in the recognition of detrimental and pessimistic attitude and behaviors.  After identification of such off putting behavioral patterns, clients are helped in replacing them with mindset that is positive, optimistic and delightful. Cognitive therapy is founded on the notion that an individual’s thoughts are the determinants of his/her behavior and behavior is not controlled by others. It teaches the client that even if a startling and unwanted circumstance has not changed; one can change his/her thoughts and attempt to bring positivity in his/her behavior to cope with the situation (“Dissociative Disorders: Treatments and Drugs”, 2011).

As mentioned above, systematic desensitization and flooding are brought in use to treat PTSD patients. They have an effect on the patient as they minimize re-experiencing and hyper-arousal. Prolonged Exposure is the best effective method for the reduction of dissociative disorder symptoms during the early stages of therapy. As far as rape victims are concerned, the best treatment option for them is Cognitive processing therapy (CPT). SIT, assertiveness training, and supportive psychotherapy are other therapeutic methods that are successful in reducing suffering, evasion, and disturbance by improving an individual’s eloquence and self-worth (Kreidler, Zupancic, Bell, & Longo, 2000).

Behavioral Technique

It is exceedingly important to mention here that it is not safe to use every behavioral technique with individuals who suffer from dissociative disorders. It is being recommended that adjunctive cognitive therapy and medications must be active to stop and treat patients in case of any complications (Kreidler, Zupancic, Bell, & Longo, 2000).

The use of cognitive-behavioral techniques in group therapy is also a useful method to treat patients with dissociative disorder. It helps the group members to address feelings of estrangement, loneliness, vulnerability, and lack of dependence. Group therapy helps them to validate their feelings. As a consequence, there is an increase and improvement in their interpersonal and communal competency. Group therapy is especially helpful for patients who were being sexually abused so that they may heal themselves through learning and cognitive training. Cognitive restructuring helps patients to lessen their propensity to dissociation. Moreover, Psychodynamic psychotherapy is another treatment approach that is used for gaining insight into the gist of the symptoms associated with dissociation. It is useful for helping patients to feel less conscientious and guilty for the suffering (Kreidler, Zupancic, Bell, & Longo, 2000).

Conclusion

People with dissociative disorders are traumatized by the past incidents. This is the reason why they come to therapy hurt and terrified. They are sure of the fact that they cannot trust anyone as everyone is dangerous and insensible. A majority of such patients view themselves as worthless due to damaged self-concept. They have a shattered sense of security that makes them feel in the mentioned ways. Therefore, it is exceedingly imperative for the therapists to give these patients enough time that can allow them to establish a trustworthy relationship. It is also the responsibility of the therapist to offer a safe holding environment to his/her patients. The provision of a safe therapeutic environment allows such patients to restore feelings of trust and lessen their sensory warp and abandonment. The major goal of the therapy is to help the clients find the guts and develop valor to breathe and survive in a tentative world that is frequently dangerous and non-supportive (Kreidler, Zupancic, Bell, & Longo, 2000).

References

American Psychiatric Association. Diagnostic and Statistical Manual for Mental Disorders (4th edition, text revision — DSM-IV-TR). Washington DC: American Psychiatric Press; 2000.

Dissociative Disorders: Treatments and Drugs. (2011, March 3). Mayo Clinic. Retrieved August 19, 2013, from http://www.mayoclinic.com/health/dissociative-disorders/DS00574/DSECTION=treatments-and-drugs

Kreidler, M. C., Zupancic, M. K., Bell, C., & Longo, M. B. (2000). Trauma and Dissociation: Treatment Perspectives.Perspectives in Psychiatric Care, 36(2), 77. Retrieved August 18, 2013, from http://www.questia.com/read/1G1-66107329/trauma-and-dissociation-treatment-perspectives

multiple personality from The Columbia Encyclopedia, 6th ed.. (2013). Questia. Retrieved August 18, 2013, from http://www.questia.com/read/1E1-multipers/multiple-personality

Spring, C. (2011). A Guide to…Working with Dissociative Identity Disorder. Healthcare Counselling & Psychotherapy Journal, 11(4), 44-46.

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There are a number of ways by which people are affected tremendously by population density and noise. When people disregard other people’s privacy, personal space and territory with long-lasting noise, it may have an effect in a variety of ways ranging from mere frustration to harsh interfering depression-causing infirmities (Straub, 2007). With the increase in population, personal space, privacy and territorial confidentiality of people are encroached. This may require demand recognition of housings for the prevention of the psychosomatic consequences of population mass. Such circumstances also necessitate the prevention of hostility, fretfulness, and annoyance. In order to understand the effects of population mass and noise on the individual, it is exceedingly important to first understand the three concepts of personal space, privacy and territoriality, privacy, and personal space.

Privacy, Personal Space and Territoriality

As far as the notion of privacy is concerned, it is a right of every individual. According to Columbia Encyclopedia, the right of privacy is “the right to be left alone without unwarranted intrusion by government, media, or other institutions or individuals” (“privacy, right of,” 2013). Privacy includes various things. It includes having power over facts about oneself and controlling one’s interactions and communication with other people (Hutchinson & Kowalski, 1999). In today’s contemporary world, the introduction and usage of new technologies have raised concerns regarding the management and organization of information about other people.

When personal space is discussed, it simply means an unwritten and noncontact medium of communication that is held, preserved and updated by every person who reacts in case of the violation of this space by other person. It can be said that in order to maintain one’s privacy, a person uses personal space and territoriality as two significant methods.

According to various researches of neuroscience, it is the human brain that principally creates and mediates the personal space. While circumstances cause shifts in boundaries, personal space is of immense importance and consequence to everyone (Kennedy, Gläscher, Tyszka, & Adolphs, 2009).

Third Concept

The third concept that needs to be understood is that of territoriality which means the “actions or behaviors that often emanate from psychological ownership for the purposes of constructing, communicating, maintaining, and restoring one’s attachment to an object” (Brown, Lawrence & Robinson, 2005). It includes strong precautionary and imprudent behaviors for a short term covering observations and opinions, employment and protection of places, community, things, and thoughts. Territoriality is equipped to gratify certain major and minor situations important for people and society.

Particular behaviors of people help them in keeping space. Such specific behaviors in human beings make them strong enough to use their capacities for attacking and displaying violence and maintaining other characteristic reactions when their personal space and privacy is disturbed. According to recent researches in this area, scientists have given great emphasis on the presence of natural variables that play a major part in the determination of territorialism. It is important to mention here that with the limitation of the availability of critical resources, personal space and belongings are guarded by people with more heartiness and dynamism.

Concept of Privacy and Personal Space

Thus, the concepts of privacy, personal space and territoriality have turned out as increasingly important factors with the density of populations with the passage of time. Population density makes people to feel limited and restricted as necessities of life are not available in abundance. Population masses serve as a major factor in the development of aggressive behaviors, social abandonment, greater incidents of criminality and improper social dealings.

Therefore, if the symptoms of crowding are to be decreased, it is exceedingly important to take necessary steps for the preservation of privacy and personal space. Not only this, it is also the need to recognize and respect territoriality as an essential collective need of the Homo sapiens. With the decrease of physical space, more acknowledgment shall be given to privacy and personal space so that the psychological effects can be prevented. This is because the absence of privacy and personal space makes people less powerful, more competitive and negative even in tolerable circumstances. In case of the availability of ample space, it has been observed that people feel stronger and have power over their surroundings making them anxiety-free and relaxed.

Impact on Natural Environment

People who live in urban areas are affected by natural environment in several ways. When natural settings managed by human beings are considered, parks, green areas and zoos prop up in mind instantly. These managed settings are a great source for creating support and collective environment for people so that they may interact with the natural world. This kind of interaction not only makes contact with the natural surroundings possible but also it provides a basis for the environmental identity to foster. This is extremely advantageous as environmental identity is almost always gets withdrawn in metropolitan areas.

The existence of parks and zoos in the urban living settings are a motivational factor for people inspiring them to participate in the management and preservation of nature. People are influenced by the natural environment as a consequence for the reason that the natural settings result in the reduction of diseases, health promotion, community health support and minimization of criminal activities. These theories are consistently proved by the modern-day evidence. Parks in urban settings play a major role in the maximization of physical commotions and people have minimal health issues. It is also a verified fact that people whose places are near greener areas had lesser death rates. In addition, green space reduces the noise stress in cosmopolitan areas. Greener localities affect the behavioral patterns of people as well by endorsing fewer levels of aggression and violence due to close communication among people. Not only this, such green setting also result in excellent academic achievements and more positive public relations bringing the community members closer to each other.

Noise Effect and its treatment

Individuals are also affected by noise in a number of negative ways. According to the research done in health psychology, it has been revealed that recurrent noisy settings affect the health of people in a damaging manner. This is because noise makes people stressed. Cardiovascular diseases also develop and learning abilities are also hampered due to noise as people are distracted with continuous clamor and clatter in their surroundings.

Noise especially affects children and effects them by disrupting their maladaptive skills by which they are able to block particular stimuli. This results in various problems as children are not capable of completely understanding how they should respond to specific stimuli. Thus, noise makes it impossible for children to identify the stimuli that may help them in learning experience. By blocking noise, it also becomes impossible for children to develop their verbal skills as blockage may also block verbal elements. Loud noises can also disturb the short-term memory and the ability to carry out simple tasks is also reduced. Every person has a different ability to assess and judge noise. It is also important to note here that stress is not directly caused by noise. However, noise has severe effects on the sleeping patterns of people and is also responsible for provoking anxiety.

It is a good thing, that by composing various strategies, noise can be reduced. Noise can be mediated through placement of fabric. The noises that come from outside the house and cannot be controlled. This can be reduced by the fixing of extra fabrics on windows. It can also be installed on walls and other furnished materials. Glass allows noise to travel inside so it is better to cover windows with fabric layers. Noise can also be reduced through auditory masking. Cheap sound masking machines can be bought and installed easily.

Mental Health Issues

Noise pollution is a hot issue in the contemporary world especially in the urban areas as it has imposed significant threats for the mental and physical health of human beings. This is the reason why it is necessary to combat against it at various levels. Firstly, it is the responsibility of the administrative authorities to reduce noise by employing legislative measures against noise pollution. Secondly, employment of active measures is also indispensable for reducing the number of sources that generate noise or by reducing the intensity of the generated noise. Last but not the least, passive measures are also essential for the attenuation of noise by reducing the level of noise intensity on its way of propagation to receptor.

Conclusion

To cut a long story short, population density, noise and space are various environmental factors by which people are affected easily. However, if people are well-prepared to fight against the negative effects of the mentioned environmental elements, the stress in life can be minimized. It is a great thing that there have been consistent progressions in the cause of combating with noise pollution. The public awareness has been tremendous as people are acquainted with the various biological and psychological harms of noise. Ordinances are being passed in more and more cities and their enforcement is made certain. It is exceedingly important as the society can only advance if honest and determined actions are guaranteed to make a difference. It is not an untold secret that the power of people can surely initiate an environment where health and fitness of people may nurture.

References

Brown, G., Lawrence, T. B., & Robinson, S. L. (2005). Territoriality in Organizations. Academy of Management Review, 30(3), 577-594.

Clayton, S. & Myers, G. (2009). Conservation Psychology. Hoboken, NJ: Wiley-Blackwell.

Hutchison, E. D., & Kowalski, S. (1999). Dimensions of Human Behavior: Person and Environment. Thousand Oaks, CA: Pine Forge Press.

Kennedy, D. P., Gläscher, J., Tyszka, J. M., & Adolphs, R. (2009). Personal Space Regulation by the Human Amygdala. Nature Neuroscience, 12(10), 1226-1227. doi: 10.1038/nn.2381

privacy, right of from The Columbia Encyclopedia, 6th ed.. (2013). Questia. Retrieved August 25, 2013, from http://www.questia.com/read/1E1-privacy/privacy-right-of

Straub, R. O. (2007). Health Psychology (2nd ed.). New York, NY: Worth.

 
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