Did you know that the men were 40 or more years old. Thank goodness she followedthat Yellow Brick Road and got the hell away from those creeps! Even if the infectious agent for all of the forms is leprae, leprosy exists in a few different forms.
‘onefourth’ of those exposed to leprae contract the disease, that may manifest itself in various ways.
Interestingly, most people who come in contact with the bacterium, about three fourths, never develop leprosy, or develop only a small lesion on the trunk or extremity that heals spontaneously. Host factors just like genetic make up, individual immunity, geography, ethnicity, and socioeconomic circumstances determine which type of leprosy is contracted by a person exposed to leprae. Most people, thence, are not susceptible to leprae, and their immune systems function effectively to neutralize the bacteria. Although, the incubation period of the leprosy bacillus varies anywhere from six months to ten years.
On an average, it should take four years for the symptoms of tuberculoid leprosy to develop. While taking an average of eight years for the initial lesions to appear, probably because of the slow growth of the bacillus, lepromatous leprosy develops even more slowly. Infolep@antenna.nl WHO/LEP, Action Programme for the Elimination of Leprosy. Leprosy. Did you know that a Healthy Me Page. It remains a devastating illness because of its potential to cause deformity, especially in the facial features, leprosy is curable with various antibiotics. In the United States, cases of leprosy been reported in areas of Texas, California, Louisiana, Florida, and Hawaii. Leprosy, called Hansen’s disease, affects 10 – 12 million people worldwide. Avenue Appia ‘CH1211’, Geneva 27. Caused by an unusual bacterium called Mycobacterium leprae, leprosy primarily affects humans. Postbus 950051090 HA, Amsterdam. Did you know that the most familiar form is characterized by skin lesions and nerve damage, leprosy can take many forms. Nevertheless, cherath. Leprosy is found in tropical areas, like Africa, South and Southeast Asia, and Central and South America. INFOLEP, Leprosy Information Services. Therefore, antibiotic regimens are available to treat and eventually cure leprosy. World Health Organization, Avenue Appia 20, 1211 Geneva 27.
I know that the WHO tracks efforts to eradicate leprosy and has links to fact sheets and information on the prevention and control of the disease on its website.
By early diagnosis and appropriate treatment of infected individuals, even a disease as ancient as leprosy can be controlled.
Gonna be tested for leprosy. Annual examinations should also be conducted on these people for a period of five years following their last contact with an infectious patient. You see, leprosy is most common in densely populated areas with poor sanitation and health care, and children are at greater risk than adults of getting the disease.
Throughout human history leprosy made untold suffering.
Even after Hansens groundbreaking discovery, the disease remained unchecked in many parts of the world.
Besides, the disease is most common in tropical and subtropical regions, and in 2001, it remained a particular problem in Brazil, India, Madagascar, Mozambique, Nepal, and Myanmar. In 1991, the World Health Organization began a global campaign to reduce the overall amount of cases of leprosy. Decade later the organization announced that it had reached its goal and estimated that there were at that time 600000 to 750000 leprosy cases worldwide. In the United States about 100 cases are reported any year, a lot of them in people who have recently immigrated. However, in TT leprosy the bacteria are very few and almost impossible to find, In patients with LL leprosy, the bacilli are easily detected. In such cases, a diagnosis is made on the basis of the clinical signs and symptoms, the type and distribution of skin lesions, and history of having lived in an endemic area.
Amongst the hallmarks of leprosy is the presence of AFB in smears taken from the skin lesions, nasal scrapings, or tissue secretions.
Worldwide, ten to twelve million people suffer from leprosy, mainly in the Indian subcontinent, parts of the Middle East, and Latin America.
Approximately 500000 new cases are reported annually with about 300 cases per year in the United States, mainly among immigrants who harbored the infection on arrival. Notice that the lepra bacillus, Mycobacterium leprae, belongs to identical family as tuberculosis. I am sure that the risk of transmission is minimized, when treatment is initiated. While HIV infection increases the risk of infection with leprosy, bCG vaccine confers some resistance to infection. Whenever deforming the extremities, and disfiguring the face, it runs a natural course over many years, and death is as often due to other infections as to leprosy itself, It attacks the skin and peripheral nerves, slowly destroying tissue. Oftentimes control requires early detection and active treatment with one or more of a few effective antibiotics, like Rifampin.
Despite its incidence will continue to decline, a computer simulation performed for WHO by a team of Dutch researchers in 2004 indicates that leprosy will persist in across the planet by the year This goal isn’t going to be reached.
The infection is characterized by abnormal changes of the skin.
Infection in and destruction of the nerves leads to sensory loss. Also, inadequate care causes infection of open wounds. It is the loss of sensation in the fingers and es increases the risk of injury. With that said, the lesions are typically darker in color around the edges with discolored pale centers. These changes, called lesions, are at first flat and light red. Also, upon enlarging, they have irregular shapes and a characteristic appearance. Then again, the mucous membranes and the nerves, as long as the organism grows best at lower temperatures the leprosy bacillus has a preference for the skin. While causing body tissue to die and become deformed, gangrene may also follow.
Leprosy is a slowly progressing bacterial infection that affects the skin, peripheral nerves in the hands and feet, and mucous membranes of the nose, throat, and eyes.
While causing the deformities that are typically associated with the disease, because of the loss of feeling, the fingers and es become mutilated and fall off.
Destruction of the nerve endings causes the affected areas to lose sensation. Of course, reconstructive surgery, aimed at preventing and correcting deformities, offers the greatest hope for disabled patients. With that said, however, the deformities and nerve damage associated with leprosy are often irreversible, Leprosy is curable. Sometimes, the deformities are such that the patients should not benefit from this surgery type. Preventions or rehabilition of these defects is an integral part of management of the disease. Patient Communities and the Politics of Public Health in Hawai’I and Louisiana. Ph. University of Illinois, Urbana Champaign. Moran, Michelle Leprosy and American Imperialism. Then the other vaccine uses a relative of leprae called avium.
Whenever leading many to hope that a vaccine against leprosy might soon be available, both vaccines have performed well in their clinical trials.
a promising development in the treatment and management of leprosy is the preliminary success shown by two different vaccines.
Advantage of this vaccine, currently being tested in India, is that avium is easy to culture on media and is thus cheaper than the Venezuelan vaccine. One vaccine tested in Venezuela combined a vaccine originally developed against tuberculosis, called Bacille Calmette Guerin, and ‘heatkilled’ leprae cultured from infected armadillos. Anyways, the Provider Directory is provided on a AS IS basis. On p of that, webMD shall in no event be liable to you or to anyone for any decision made or action taken by you in the reliance on information provided in the Provider Directory.
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You assume full responsibility for the communications with any Provider you contact through the Provider Directory. Essentially, the Louisiana Leper Home in Carville, Louisiana, opened in 1893 and in 1921 the federal government assumed control and designated it the national leprosarium, to which all states subsequently sent patients. Ok, and now one of the most important parts. Immigrants diagnosed with leprosy were often deported to their native countries. When it was closed and the care of patients with leprosy moved to outpatient centers throughout the United States, the leprosarium operated continuously until June 1999.
Those who could not be deported and ‘nativeborn’ patients with leprosy were forcibly isolated in the few leprosy hospitals that existed.
Whenever culminating in the discovery in 1941 that sulfones could effectively treat the disease, it became the leading American center for medical research on leprosy.
Therapeutic regimens that relied exclusively on sulfones are supplanted by multidrug therapy programs, that the World Health Organization expected will lead to the tal eradication of leprosy by 2005. Leprosy was considered the most dreaded diseases since biblical times, though much of what was called leprosy in the Old Testament most possibly was not identical disease, as long as of the disabling deformities associated with it. Whenever requiring multiple medications, Undoubtedly it’s very curable, even if the treatment is ‘longterm’. Lots of people still have misconceptions about the disease. Household contacts of most cases and the medical personnel caring for Hansen’s disease patients are not at particular risk. So, its victims were often shunned by the community, kept at arm’s length, or sent to a leper colony. Now let me tell you something. Contrary to popular belief, it’s not highly communicable and is extremely slow to develop. While affecting the ability to walk, one characteristic occurrence is a foot drop where the foot can’t be flexed upwards.
There’s slight discoloration of the skin and loss of skin sensitivity.
In an endemic area, Therefore if smears from an individual show the presence of AFB, or if he has typical skin lesions, he should definitely be regarded as having leprosy.
Thickened nerves accompanied by weakness of muscles supplied by the affected nerve are very typical of the disease. Then, whitehouse Station. Needless to say, merck Research Laboratories. Beers, Mark, MD, and Robert Berkow, MD. In The Merck Manual of Diagnosis and Therapy. Infectious Diseases Caused by Mycobacteria. Besides, this bacterium is associated with Mycobacterium tuberculosis, the causative agent of tuberculosis. Now look, the organism that causes leprosy is a ‘rod shaped’ bacterium called Mycobacterium leprae. Nevertheless, they are referred to as ‘acid fast’ bacilli, as long as special staining techniques involving acids are required to view these bacteria under the microscope.
Every of the drugs has minor consequences.
Dapsone can cause nausea, dizziness, palpitations, jaundice and rash.
Whenever requiring an adjustment of the dapsone dosage, rifampin increases the metabolizing of dapsone in the body. While discoloration of the skin, the third drug, clofazimine may cause severe abdominal pain and diarrhea. On p of this, flulike symptoms or a rash appear, a doctor should’ve been contacted immediately, Therefore if jaundice. Redish to brownish grey discoloration of the skin and bodily fluids, including sweat, may persist for months to years after use. So, a doctor should’ve been contacted immediately if a rash develops. With that said, dapsone also interacts with the second drug. Researchers assume that the bacteria are transmitted via the respiratory tract. Notice, researchers consider that in the first century, Roman soldiers fighting in Egypt carried the disease home to Italy.
Accordingly the disease continued to follow the paths of conquering armies.
The germ that causes leprosy traveled with them, as men and armies roamed the globe in search of conquest.
In the Middle Ages, the disease spread from Italy throughout Europe. Then, researchers translating from ancient Indian and Chinese texts have found descriptions of the disease. Keep reading! Throughout the Crusades, a series of spanning the eleventh to the thirteenth centuries, European soldiers and pilgrims carried the disease as far as Jerusalem in the Middle East. Archeologists have uncovered skeletal remains with erosion in the bones of the nose that is characteristic of leprosy. Consequently, leprosy has left a trail of pain, suffering, and death that dates back thousands of years. With all that said… I’m sure that the Spanish conquistadors and the slave trade brought the disease to the American continents, and European colonists probably spread the disease to islands in the Pacific Ocean. About 50 of patients diagnosed with the disease have a history of close contact with an infected family member, It is still not very clear how the leprosy bacillus is transmitted from person to person. Milder tubercular kind of leprosy should be transmitted by insect carriers or by contact with infected soil.
It’s thought that transmission may take place via nasal droplets, since untreated patients have a large number of leprae bacilli in their nasal secretions.
Further research may confirm that the emergence of leprosy in certain individuals is about inheritance of genes for Parkinson’s disease.
So it’s also possible that genetic factors are involved in susceptibility to leprosy. In 2003, scientists conducting a genome scan of a large Vietnamese family with many cases of leprosy found that susceptibility to the disease was linked to region q25 on the long arm of chromosome Further study indicated that the leprosy susceptibility gene lies within a region shared by two genes for Parkinson’s disease. One treatment risk, however, is that antigens the proteins on the surface of leprae that initiate the host immune response are released from the dying bacteria.
Women of childbearing age must be carefully monitored while taking the drug, since thalidomide may cause severe birth defects.
With good results, in the late 1990s, the drug thalidomide was approved to treat this reaction.
While resulting in new lesions and peripheral nerve damage, when the antigens combine with antibodies to leprae in the bloodstream, in people a reaction called erythema nodosum leprosum may occur. Lepromatous leprosy is characterized by a chronic stuffy nose due to invasion of the mucous membranes, and the presence of nodules and lesions all over the body and face. Welldefined skin lesions that are numb are the first symptoms of tuberculoid leprosy. Physiotherapy exercises are taught to the patients to maintain a range of movement in finger joints and prevent the deformities from worsening. Prefabricated standardized splints are available and are extremely effective in correcting and preventing certain common deformities in leprosy.
Comprehensive care involves teaching patients to care for themselves.
Special kinds of footwear was designed for patients with insensitive feet with an eye to prevent or minimize the progression of foot ulcers.
These wounds become festering sores and a source of dangerous infection, I’d say if adequate care isn’t taken. They must be taught to take care of their insensitive limbs, similar to diabetics with lower leg nerve damage, So in case the patients have significant nerve damage or are at high risk of developing deformities. Furthermore, lacking the sensation of pain anyways, the patients must constantly check themselves to identify cuts and bruises. Of course nodules, or lumps; and thickening of the skin, Multibacillary Hansen disease also causes skin lesions, or patches of damaged tissue. Whenever causing patches of skin to become numb and hypopigmented, that means that the skin has lost its coloring and appears almost white, paucibacillary Hansen disease begins in the peripheral nerves and spreads to the skin.
Whenever resulting in severe skin and tissue damage and disfigurement, without treatment, that said, this leprosy type can worsen over time.
Multibacillary Hansen disease is a more severe type of the disease.
Whenever meaning few, and is used to describe a mild type of leprosy, the name paucibacillary Hansen disease comes from the Latin word pauci. Database of Provider information which drives WebMD Provider Directory does not contain sufficient information with which to verify Provider credentials under the standards of the Joint Commission on Accreditation of Healthcare Organizations, National Committee for Quality Assurance of the Utilization Review Accreditation Committee. It’s a well-known fact that the use of WebMD Provider Directory by any entity or individual to verify the credentials of Providers is prohibited.
With the hands and feet ultimately rotted away, evidence of leprosy was detected in prehistoric human remains. So its victims were shunned because of their disfiguring stigmata collapsed facial bones. Toes.
Transmission usually requires prolonged close personal contact, and children are most vulnerable.
Leprosy was among the first diseases identified as contagious. Fact, early societies ok measures to shield their healthy members from contagion. Oftentimes because the causative acid fast bacillus that causes leprosy is only sluggishly infective, it is a questionable practice. Segregation remained part of the control measures for leprosy in modern industrial nations until late in the twentieth century, and it still persists in been suspected as vectors. Researchers have not been able to investigate these bacteria as closely as they have other, more easily cultured, bacteria, as long as of these culturing difficulties.
Therefore this differs from the dividing time of most bacteria, that is about once nearly any few hours.
In each twelve days, The bacterium divides slowly.
For example, researchers are still unclear about how the bacteria are transmitted from one person to another, and are not sure about the role an individual’s genetic make up plays in the progression of the disease, Questions remain unanswered about leprae. Mycobacterium leprae is an unusual bacterium for a couple of reasons. Lots of us are aware that there are about 5000 reported cases in the United States as of 2004, almost all of which involve immigrants from developing countries. Anyway, the infection can be acquired, however, in the Western Hemisphere as well.
India, Indonesia, and Myanamar.
15percent of wild armadillos in southern Texas and Louisiana was found to be infected with leprae, it was thought for many years that only humans are affected by the disease.
Seventy percent of all cases are found in just three countries. World Health Organization puts the actual number of identified leprosy cases on earth at about 600000 the early as 2000s. On p of this, cases also occur in I am sure that the fear of leprosy’s importation by immigrants played an important role in ‘antiimmigrant’ policies and racist rhetoric directed against Chinese immigrants in the 1870s and 1880s.
Notable American efforts to combat leprosy abroad were led by Victor Heiser, director of health in the American colonial administration in the Philippines, and by Joseph de Veuster, a Belgian priest on the Hawaiian island of Molokai.
Leprosy was endemic in regional pockets of Louisiana and the upper Midwest among French Acadian and Norwegian immigrants. Inclusion in the Provider Directory does not imply recommendation or endorsement nor does omission in the Provider Directory imply WebMD disapproval. I am sure that the Provider Directory ain’t intended as an ol for verifying the credentials, qualifications, or abilities WebMD ‘Provider Directory’ is provided by WebMD for use by the general public as a quick reference of information about Providers. You should take it into account. Besides, the incidence of leprosy is highest in the poverty belt of the globe.
Environmental factors similar to unhygienic living conditions, overpopulation, and malnutrition may also be contributing factors favoring the infection.
The muscles in the hands and feet can become weak or paralyzed because of damage to the peripheral nerves.
As long as a person loses the withdrawal reflex that helps protect against injury from hot or sharp objects, that loss of sensation can lead to accidental injury. Did you know that the skin near the infected nerves may become numb and hypopigmented, Leprosy begins as an infection in the nerve endings and spreads gradually. While producing large, disfiguring nodules and enlarged facial features that give a person the lionlike appearance associated with severe leprosy, left unchecked, the most severe type of the disease can progress.
In severe cases, these skin lesions become wider and thicker.
The least serious form is tuberculoid leprosy.
Tuberculoid leprosy is evidence that the body’s cellular immune response the part of the health that seeks out and destroys infected cells is working at a high extent of efficiency. Five leprosy forms are recognized, and a person may progress from one form to another. In this form, the skin lesions and nerve damage are minor. Generally, tuberculoid leprosy is easily cured with antibiotics. However, children is likely to be more susceptible than adults, Leprosy can strike anyone. In lepromatous leprosy, that is the second and more contagious sort of the disease, the body’s immunity is unable to mount a strong response to the invading organism.
Facial involvement can produce a lion like appearance.
The organism multiplies freely in the skin.
Occasionally, the mucous membranes of the eyes, nose, and throat can be involved. Characteristic feature of this disease is the appearance of large nodules or lesions all over the body and face. Since of the presence of large numbers of bacteria, so this leprosy type is also called the multibacillary leprosy. That said, this leprosy type can lead to blindness, drastic change in voice, or mutilation of the nose. Of course you are prohibited from using, downloading, republishing, selling, duplicating, or scraping for commercial or any other purpose whatsoever, the Provider Directory or the majority of the data listings and similar information contained therein, in whole or in part, in any medium whatsoever. Did you hear about something like this before? In the 1960s, the big poser of resistance was tackled with the advent of multidrug therapy.
Bacteria are less gonna become resistant to a couple of drugs given in combination.
Oflaxicin is a powerful inhibitor of certain bacterial enzymes that are involved in DNA coiling.
Treatments for leprosy have improved considerably over the past 40 years. Dapsone’s main disadvantage was that the patient had to take the medication daily throughout new multidrug treatment time was also considerably shortertypically about four years. You see, the treatment time for this current regimen is mostly about four weeks or less, the shortest treatment duration so far. Whenever offering the first hope of a cure for persons with the disease, virtually, a really new drug combination that includes an antibiotic called oflaxicin. Loads of info can be found by going online. The leprae in Now look, the leprae can not copy the DNA properly and the bacteria die, without these enzymes. Leprosy patients should’ve been aware that treatment itself can cause a potentially serious overall health response called a lepra reaction.
Antigens are released from the dying bacteria, when antibiotics kill leprae.
Cortisonetype medications and, increasingly, thalidomide are used to minimize the effects of lepra reactions.
While resulting in new lesions and peripheral nerve damage, when the antigens combine with the antibodies to Leprae in the bloodstream, in lots of people a reaction called erythema nodosum leprosum may occur. Hand washing, disinfection, and monitoring of close contacts are recommended to way more humane, and it had been determined that leprosy is much less contagious than once was believed. Despite centuries in which people with leprosy were vilified, shunned, and even isolated in far off there’s no need to separate people with leprosy from quite a bit of society to avoid the spread of infection. Even in modern times such colonies were established in the Western world, as an example, on Penikese Island off Massachusetts and on the Hawaiian island of Molokai.
Now, a procedure in which a tiny piece of skin is scraped or cut away and after all examined usually reveals the presence of Mycobacterium leprae in the multibacillary kind of leprosy.
The procedure can be done quickly and relatively painlessly in a doctor As way back as biblical times, people with the disfiguring signs of leprosy were cast out of their homes and villages and made to live gether in isolated colonies.
Leprosy ain’t difficult to diagnose once Surely it’s suspected. When researchers noticed that the bacterium was becoming resistant to had been preferred since the early 1980s. Whenever combining two or three drugs that kill the bacteria, doctors most often prescribe multidrug therapy. Patients may take the drugs for as little as 6 months or as long as 2 years.
Early diagnosis and treatment are key to stopping the spread of leprosy to other people and preventing longterm damage to the patient. Patients who have become disfigured or who experience disabilities may need surgery to correct these problems. In this type of leprosy, the skin lesions are numerous and cause the skin to fold, especially the skin on the face. Needless to say, this folding of facial skin leads to the leonine features typical of lepromatous leprosy. Nerve damage is extensive, and people with lepromatous leprosy may lose the feeling in their extremities, like the fingers and toes. Also, rather, being that patients can not feel pain because of nerve damage, the extremities can become easily injured. You see, the most severe sort of leprosy is lepromatous leprosy.
Contrary to popular belief, the fingers and es of people with this type of leprosy do not spontaneously drop off. Or if a person has a less vigorous cellular immune response to the leprae bacteria, the disease may progress to a borderline leprosy, that is characterized by more numerous skins lesions and more serious nerve damage, I’d say if tuberculoid leprosy isn’t treated promptly. Lots of advocates for people with leprosy prefer to call it Hansen disease. His equipment was inadequate and his colleagues thought his theories were laughable. It is since it defines a person by the disease s/he has, today, the use of the word is considered insulting. Hansens discovery was immensely valuable in the treatment of leprosy, and it was a scientific milestonethe first proof that bacteria could cause human disease. Still, Gerhard Henrik Armauer Hansen as the cause of the illness.
Action Programme for the Elimination of Leprosy.
LEPROSY, or Hansen’s disease, is a chronic infectious disease caused by the microorganism Mycobacterium leprae, that mainly affects the skin, the peripheral nerves, and the upper respiratory tract.
Equally devastating are the social stigma, rejection, and exclusion that sufferers of Hansen’s disease have endured throughout history. Disease has since the 1950s been alternatively called Hansen’s disease, named after Gerhard Armauer Hansen, the Norwegian physician who identified Mycobacterium leprae in 1873, because of the stigma associated with the terms leprosy and leper. Contagious, and mutilating, the disease is curable, So it’s not highly contagious, and mutilation occurs only in the most severe cases and ain’t an inevitable feature of the disease’s course, even if popularly regarded as incurable.
Therefore a complex affliction, Hansen’s disease manifests itself through skin discoloration and loss of sensation in minor cases to disfigurement and physical debilitation in the most severe and advanced cases.
Leprosy is contagious but does not spread easily.
Researchers consider that Mycobacterium leprae is transmitted from person to person via respiratory droplets, bits of moisture that leave the mouth or nose when a person laughs, talks, sneezes, or coughs. Most people seem to have a natural immunity that enables them to resist the disease. Of those in whom leprosy is diagnosed, most have had prolonged and close contact with someone who has an active infection. By the way, the disease is no longer active or contagious, if a person with leprosy had been taking medication for 3 or 4 days. Actually, louisiana Studies. Kalisch, Philip Lepers, Anachronisms, and the Progressives. Basically, a Interdisciplinary Journal of the South 12. Study of Stigma, 18891920″. I’m sure you heard about this. Now look, the skin becomes dry and discolored and loses its sensitivity. Therefore this finding is highly suggestive of TT. In tuberculoid leprosy, the milder sort of the disease, the body’s immune cells attempt to seal off the infection from quite a bit of the body by surrounding the offending pathogen. Now please pay attention. And therefore the hair follicles, sweat glands, and nerves can be destroyed, since this response by the overall health occurs in the deeper layers of the skin.
Involvement of nerves on the face, arms, or legs can cause them to enlarge and become easily felt by the doctor.
Seventy to eighty percent of all leprosy cases are of the tuberculoid type.
Therefore the scarcity of bacteria in this leprosy type leads to it being referred to as paucibacillary leprosy. One of two reactions can take place, when Mycobacterium leprae invades the body. MedicineNet does not provide medical advice, diagnosis or treatment. Yes, that’s right! See additional information. MDT combines dapsone, rifampin, and clofazimine, all of which are powerful antibacterial drugs. While patients with PB leprosy are only given rifampin and dapsone, patients with MB leprosy are usually treated with all three drugs. Relying on the leprosy type, the time required for treatment may vary from six months to two years or more. This is the case. Most widely used drug for leprosy is dapsone. Three months after starting treatment, a patient ceases being infectious, though not everyone with this disease is necessarily infectious before treatment.
So emergence of dapsone resistant strains prompted the introduction of multidrug therapy, or MDT.
Neuroapthic pain caused by inflammation of peripheral nerve endings is increasingly recognized as a major complication of the disease in many patients, nevertheless patients with leprosy are commonly thought not to suffer pain.
Corticosteroids should be given to reduce the inflammation. Of course they also have expertise in the care of normal skin, the prevention of skin diseases and cancers, and in the management of cosmetic disorders of the skin like hair loss and scars. Practitioners treat pediatric and adult patients with disorders of the skin, mouth, hair and nails as well as quite a few sexually transmitted diseases, A certification by the Board of Dermatology. Do you know an answer to a following question. What actually is a Dermatologist?