Accredited Social Health Activist (ASHA)

One of the key components of the National Rural Health Mission is to provide every village in the country with a trained female community health activist ASHA or Accredited Social Health Activist. Selected from the village itself and accountable to it, the ASHA will be trained to work as an interface between the community and the public health system. Following are the key components of ASHA :

• ASHA must primarily be a woman resident of the village married/ widowed/ divorced, preferably in the age group of 25 to 45 years.
• She should be a literate woman with due preference in selection to those who are qualified up to 10 standard wherever they are interested and available in good numbers. This may be relaxed only if no suitable person with this qualification is available.
• ASHA will be chosen through a rigorous process of selection involving various community groups, self-help groups, Anganwadi Institutions, the Block Nodal officer, District Nodal officer, the village Health Committee and the Gram Sabha.
• Capacity building of ASHA is being seen as a continuous process. ASHA will have to undergo series of training episodes to acquire the necessary knowledge, skills and confidence for performing her spelled out roles.
• The ASHAs will receive performance-based incentives for promoting universal immunization, referral and escort services for Reproductive & Child Health (RCH) and other healthcare programmes, and construction of household toilets.
• Empowered with knowledge and a drug-kit to deliver first-contact healthcare, every ASHA is expected to be a fountainhead of community participation in public health programmes in her village.
• ASHA will be the first port of call for any health related demands of deprived sections of the population, especially women and children, who find it difficult to access health services.
• ASHA will be a health activist in the community who will create awareness on health and its social determinants and mobilise the community towards local health planning and increased utilisation and accountability of the existing health services.
• She would be a promoter of good health practices and will also provide a minimum package of curative care as appropriate and feasible for that level and make timely referrals.
• ASHA will provide information to the community on determinants of health such as nutrition, basic sanitation & hygienic practices, healthy living and working conditions, information on existing health services and the need for timely utilisation of health & family welfare services.
• She will counsel women on birth preparedness, importance of safe delivery, breast-feeding and complementary feeding, immunization, contraception and prevention of common infections including Reproductive Tract Infection/Sexually Transmitted Infections (RTIs/STIs) and care of the young child.
• ASHA will mobilise the community and facilitate them in accessing health and health related services available at the Anganwadi/sub-centre/primary health centers, such as immunisation, Ante Natal Check-up (ANC), Post Natal Check-up supplementary nutrition, sanitation and other services being provided by the government.
• She will act as a depot older for essential provisions being made available to all habitations like Oral Rehydration Therapy (ORS), Iron Folic Acid Tablet(IFA), chloroquine, Disposable Delivery Kits (DDK), Oral Pills & Condoms, etc.
• At the village level it is recognised that ASHA cannot function without adequate institutional support. Women's committees (like self-help groups or women's health committees), village Health & Sanitation Committee of the Gram Panchayat, peripheral health workers especially ANMs and Anganwadi workers, and the trainers of ASHA and in-service periodic training would be a major source of support to ASHA.

Dermatology signs

Important Dermatology signs

[ 1] Nikolskiy- pemphigus, staphylococcal scalded skin syndrome, Toxic Epidermal necrolysis (pseudo-nikolskiy). Refers to easy peeling of skin on applying tangential pressure over a bony prominence on perilesional skin.

[2 ] Asboe-Hansen sign/Bulla spread sign : Enlargement of bulla by applying finger pressure to bulla in patients with pemphigus and bullous pemphigoid.

In pemphigus, blister extends angularly while in BP, it extends in oval fashion.

Extra edge fact: Rare causes of bulla spread sign are- other subepidermal blisters like dermatitis herpetiformis, epidermolysis bullosa acquisita, cicatricial pemphigoid, dystrophic epidermolysis bullosa. Also seen in drug reactions like Stevens-Johnson syndrome and toxic epidermal necrolysis.
Negative in SSSS and PF as in these disorders blisters are very fragile

[3 ] Auspitz sign: described in psoriasis, where there is pinpoint bleeding on removal of scales from the lesions of psoriasis.
The test by which Auspitz sign is elicited is called as Grattage test (scratching). It is attributed to parakeratosis, suprapapillary thinning of the stratum malphighii, elongation of dermal papillae and dilatation and tortuosity of the papillary capillaries. The thin membrane visible after removal of all scales from the lesion is called bulkeley membrane.  However, Auspitz sign is not sensitive or specific for psoriasis. It is not seen in inverse psoriasis; pustular, erythrodermic psoriasis; guttate psoriasis. Not specific because it is also seen in nonpsoriatic scaling disorders, including Darier's disease and actinic keratosis.

[ 4] Button  hole sign: In type 1 neurofibromatosis, neurofibromas can be invaginated with the tip of index finger back into the subcutis and again reappear after release of pressure. Other condition where one can find positive buttonhole sign is dermatofibroma.

[ 5] Carpet tac sign/ tin tack sign/ cats tongue sign: When the adherent scale is removed from the lesions of discoid lupus erythematosus, the undersurface of the scale shows horny plugs that have occupied dilated hair follicles. This sign is also seen in seborrheic dermatitis

[6 ] Darier's sign: Rubbing a lesion of mastocytoma causes urticaria, flare, swelling. In contrast, pseudo-Darer's sign is seen in smooth muscle hamartoma where there is increase in induration and piloerection after firm stroking. Other conditions where one could find positive Darier's sign are leukemia cutis, juvenile xanthogranuloma, and Langerhans cell histiocytosis.

[7 ] Dory Flop sign: It is described in relation to syphilitic chancre on the coronal border of the prepucial skin in an uncircumscribed male, whereupon on retracting the foreskin the entire ulcer flips out all at once because it is too hard to bend due to underlying button like induration.

[8 ] Groove sign: seen in lymphogranuloma venereum (LGV).  Enlargement of both inguinal and femoral group of lymph nodes separated by inguinal ligament produces a groove known as the "Groove sign of Greenblatt."

[9 ] Hanging curtain sign: It is seen in patients with pityriasis rosea. When the skin is stretched across the long axis of the herald patch, the scale is noted to be attached at one end and free at the other end, and stretches like hanging curtain

[ 10]  Scratch sign: In Pityriasis versicolor often the scale is not visible. An important diagnostic clue may be the loosing of barely perceptible scale with a fingernail, which is called as the scratch sign. This sign may be negative if patient has taken recent bath or in case of treated lesion, in which case, only hypopigmentation persists.

[11] Bushke-ollendorf sign/Deep dermal tenderness: This is a sign to be elicited in case of secondary syphilis and cutaneous vasculitis, where there is deep dermal tenderness on pressing the lesion (e.g., papular lesions of syphilis) with a pinhead

Compiled by Dr. Saurabh Jindal