DOCSLIB.ORG

Genital Dermatology

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Genital Dermatology Wendy Grube, PhD, CRNP University of Pennsylvania School of Nursing Disclosure No conflicts of interest Objectives Identify common genital dermatological conditions. List appropriate diagnostic approaches to common genital dermatological conditions. Describe appropriate management of common genital dermatologic disorders. Demonstrate good local anesthetic perfusion technique. Perform a skin biopsy with skill and precision. Perform basic interrupted suture insertion. Comparative Anatomy Variants of Normal Vulva Shaft of Penis Fordyce spots Variants of Normal Benign papillae Variants of Normal Physiologic hyperpigmentation Algorithm for Diagnosis of Genital Disorders Are there visible changes? No, only symptoms Pruritus Pain Yes Lifted/removed epithelium Pustules Blisters Ulcers Lesions are red, but epithelium is intact Patches and plaques Papules and nodules Lesions, but other than red Skin colored White Brown/black/blue Edwards & Lynch (2011) Genital Dermatology Atlas, LWW Pruritus Idiopathic Atopic dermatitis Tissue appears normal Allergic IgE reaction Characterized by to common scratching or rubbing environmental Itch-scratch cycle allergens (eczema) Probably a subclinical History of allergies or variant of atopic asthma dermatitis Localized form: Lichen Simplex Chronicus Red Plaques and Patches Atopic dermatitis Psoriasis Contact dermatitis Tinea cruris Irritant Contact Erythrasma dermatitis Candidiasis Allergic contact Lichen planus dermatitis Extramammary Paget Seborrheic dermatitis disease Intraepithelial neoplasia Lichen Simplex Chronicus Lichen Simplex Chronicus Cause: not known, Consider: probably genetic Wet mounts: rule out predisposition candidiasis Heat, sweat triggers KOH: for dermatophyte fungi (tineas) Diagnosis: Based on clinical findings Biopsy helpful if there is loss of architectural Biopsy not very helpful landmarks (labia in finding underlying minora) in women to problem rule out lichen sclerosis Lichen Simplex Chronicus Management Goals: Breathable fabrics Reduce triggers in local Weight loss environment Manage fecal, urinary, vaginal secretions Restore normal barrier Stop excessive bathing layer function Lubricant/barrier Reduce inflammation Topical steroids Stop itch-scratch cycle (ointment, high potency) for a month or until clinical improvement Antihistamines Irritant Contact Dermatitis Eczematous reaction to a Identify and eliminate substance on the skin irritants Most data on women Mid-potency topical Irritation, soreness, steroid rawness Barriers: zinc oxide, Urine, feces, soap, lubricants antifungal creams, panty liners, spermicides Tepid soaks TCA, imiquimod, podophyllin products Allergic Contact Dermatitis Immunological response Cell-mediated delayed hypersensitivity reaction OTC preparations: benzocaine, bacitracin, spermicides, parabens, fragrances Latex: IgE response, immediate reaction Seborrheic Dermatitis/Intertrigo Located where Diagnosis: Clinical moisture is retained Can have superimposed (sweat, urine) candida Maceration Management Skin folds Reduce heat and moisture Crural folds Topical corticosteroids Axillae Hydrocortisone 1-2.5% Umbilicus Triamcinolone 0.1% Indistinct margins Topical ketoconazole Red patches and scale cream BID Seborrheic Dermatitis/Intertrigo Candidiasis Candidiasis Diagnose with KOH Management: prep Eliminate heat, moisture Topical azoles BID until clear Attention to DM, obesity, immunocompromised patients Tinea Cruris Tinea Cruris Diagnose: Management: KOH prep from skin Topical azoles 1-2x scraping day until clear Hair follicle involvement: oral therapy (i.e. fluconazole 100- 200mg/day for 1-2 weeks) Topical triamcinolone 0.1% first few days Erythrasma Mimics tinea cruris Diagnosis: Found mostly in men Clinical exam Proximal, medial thigh Wood’s light and crural crease fluorescence (coral- Scrotum, penis, vulva pink) usually not affected Negative KOH prep Corynebacterium minutissimum, bacteria Treat with Erythromycin prevalent in warm 500 mg BID for 1-2 weeks environments Erythrasma Psoriasis Affects 2-3% of people Plaques and silvery scales Onset: young adults on scalp, elbows, knees, Etiology: genetic, gluteal cleft, genitals autoimmune, 20% with Koebner’s environmental phenomenon Contributing factors: Inverse psoriasis: skin alcohol, smoking, obesity, folds medications (NSAIDs and Genitals lithium) Women: affects hair- Rapid proliferation of bearing areas (vulva) epidermis Men: glans, shaft, Associated arthritis scrotum, groin Psoriasis Psoriasis Psoriasis Diagnosis: Management: Other psoriatic Potent topical lesions? corticosteroids with Biopsy helpful, but tapering doses can be nonspecific in Triamcinolone 0.1% older lesions Ultraviolet light of Negative fungal little use to genitalia scrapings/cultures Oral methotrexate No response to Immunosuppressant antifungal medication agents Lichen Planus Different clinical presentations Autoimmune disorder, cell-mediated Usually self-limiting Resolves in few years Lichen Planus Lichen Planus Diagnosis: Management: Clinical findings Topical corticosteroids Biopsy (clobetasol 0.05% and Differential: Bowen taper down) disease, candidiasis, Short burst of oral psoriasis, herpes prednisone if needed Plasma Cell Mucositis Poorly understood Diagnosis by biopsy Onset after puberty Management: Deep red solitary No good therapy plaque Circumcision May erode, bleed Potent topical Related to lichen steroids? planus? Imiquimod? CO2 or YAG laser? Plasma Cell Mucositis Extramammary Paget’s Disease Primary or secondary forms Onset: usually >50 More common in women 10-20% with underlying GU/GI malignancy Initial symptom: pruritus Presentation: Well demarcated red plaque Rough, scaling or moist surface White thickened islands Erosions Extramammary Paget’s Disease Diagnosis Management: excision Clinical suspicion <1 mm invasion: good Resembles benign prognosis skin disorders and Laser, radiation, Bowen’s disease imiquimod Biopsy >1mm invasion: node evaluation Determine primary or secondary Evaluate for GU/GI malignancy Intraepithelial Neoplasia Non-invasive but full thickness dysplasia Many types HPV-related Bowen’s disease: older Presentation Well-demarcated plaques, scaling, hyperkeratosis Intraepithelial Neoplasia Bowen Disease/VIN/PIN Lesions may be Undifferentiated: accentuated with 5% HPV 16, 18, 31, 33 acetic acid 2/3 – full thickness White, red, skin colored Differentiated: plaques Lower 1/3 of Diagnosis: biopsy epithelium Management: surgical, No HPV link imiquimod, laser Red Papules and Nodules Folliculitis Pyogenic granuloma Keratosis pilaris Urethral caruncle Bites & infestations Vulvar endometriosis Angiomas, Hematoma angiokeratomas Kaposi Sarcoma Prurigo nodularis Keratosis Pilaris Common in children, disappears in 4th decade Clusters of papules Excess keratinization of outer hair follicles Noninfectious Management Bath soaks/loofah Moisturizer Bites & Infestations Insect bites on genitals are rare Nodular scabies Almost exclusively in males Presentation Red-brown dome- shaped papules Glans, shaft, scrotum Diagnosis: biopsy Management: scabicide Cherry Angiomas & Angiokeratomas Prurigo Nodularis (Picker’s Nodules) Increased keratin Results from chronic scratching, picking May have underlying folliculitis Diagnosis: Biopsy Differential: Scabies Treat: Intralesional triamcinolone Liquid nitrogen Nighttime sedation SSRIs Pyogenic Granuloma Benign neoplasm Cause unknown, may be second to trauma Pregnancy Management: shaved excision Urethral Caruncle & Prolapse Vulvar Endometriosis Cyclic enlargement and pain with menses Implantation may occur during parturition Diagnosis: presumptive, by clinical presentation Management: refer for surgical excision May require hormonal suppression Hematoma Kaposi Sarcoma Crohn’s Disease Asymmetrical edema Linear ulcers Fistulae Also: skin tags, papules, nodules Pustular Lesions Folliculitis Solid lesions that appear Furuncles pustular: Carbuncles Epidermal cysts Hidradenitis Molluscum suppurativa contagiosum Folliculitis Etiology: bacterial, fungal, or irritant inflammation of follicle Superficial Folliculitis Folliculitis Irritant: shaving Diagnosis Fungal: middle aged Clinical presentation Culture and older men (tinea) Management Bacterial: Bacterial: oral, topical Staphylococcus antibiotics No known risk factor Fungal: oral antifungal Irritant: avoid shaving Pseudomonas Loose, cool clothing Bathing suits Oral anti- Hot tubs inflammatory antibiotics Furuncles Involves deeper follicle Red, painful nodules Rupture and drain More common in immunosuppression, diabetes Usually S. aureas Furuncles Diagnosis: Management Clinical presentation Oral antibiotics Culture: S. aureus Clindamycin Clinical confusion: Warm soaks Hidradenitis Incision and draining Limited to genital and axillary areas Has comedones and scarring Cultures: normal skin flora Carbuncles Hidradenitis Supperativa Cystic acne of skin folds Affects groin, axillae, inner thighs, vulva, scrotum Occurs after puberty Strong association with smoking Hidradenitis Supperativa Hidradenitis Supperativa Presentation Management Fluctuant, draining I&D of fluctuant lesions nodules Oral antibiotics Location Surgical excision of Sinus tracts and scars affected areas Comedones Hormonal: high
Load more

Recommended publications
  • Smelly Foot Rash
    CLINICAL Smelly foot rash Paulo Morais Ligia Peralta Keywords: skin diseases, infectious Case study A previously healthy Caucasian girl, 6 years of age, presented with pruritic rash on both heels of 6 months duration. The lesions appeared as multiple depressions 1–2 mm in diameter that progressively increased in size. There was no history of trauma or insect bite. She reported local pain when walking, worse with moisture and wearing sneakers. On examination, multiple small crater- like depressions were present, some Figure 1. Heel of patient coalescing into a larger lesion on both heels (Figure 1). There was an unpleasant ‘cheesy’ protective/occluded footwear for prolonged odour and a moist appearance. Wood lamp periods.1–4 examination and potassium hydroxide testing for fungal hyphae were negative. Answer 2 Question 1 Pitted keratolysis is frequently seen during What is the diagnosis? summer and rainy seasons, particularly in tropical regions, although it occurs Question 2 worldwide.1,3,4 It is caused by Kytococcus What causes this condition? sedentarius, Dermatophilus congolensis, or species of Corynebacterium, Actinomyces or Question 3 Streptomyces.1–4 Under favourable conditions How would you confirm the diagnosis? (ie. hyperhidrosis, prolonged occlusion and increased skin surface pH), these bacteria Question 4 proliferate and produce proteinases that destroy What are the differential diagnoses? the stratum corneum, creating pits. Sulphur containing compounds produced by the bacteria Question 5 cause the characteristic malodor. What is your management strategy? Answer 3 Answer 1 Pitted keratolysis is usually a clinical Based on the typical clinical picture and the negative diagnosis with typical hyperhidrosis, malodor ancillary tests, the diagnosis of pitted keratolysis (PK) (bromhidrosis) and occasionally, tenderness, is likely.
    [Show full text]
  • Tinea Infections: Athlete's Foot, Jock Itch and Ringworm
    Tinea Infections: Athlete’s Fo ot, Jock Itch and Ringworm What is tinea? Tinea is caused by a fungus that grows on your skin, hair or nails. As it grows, it spreads out in a circle, leaving normal-looking skin in the middle. This makes it look like a ring. At the edge of the ring, the skin is lifted up by the irritation and looks like a red and scaly rash. To some people, the infection looks like a worm is under the skin. Because of the way it looks, tinea infection is often called “ringworm.” However, there really is not a worm under the skin. How did I get a ringworm/tinea? You can get a fungal infection by contact with person or environment. Some fungi live on damp surfaces, like the floors of showers or locker rooms. You can even catch a fungal infection from your pets. Dogs and cats, as well as farm animals, can be infected with a fungus. Often this infection looks like a patch of skin where fur is missing (mange). What areas of the body are affected by tinea infections? Fungal infections are named for the part of the body they infect. Tinea corporis is a fungal infection of the skin on the body. If you have this infection, you may see small, red spots that grow into large rings almost anywhere on your arms, legs or chest. Tinea pedis is usually called “athlete’s foot.” The moist skin between your toes is a perfect place for a fungus to grow. The skin may become itchy and red, with a white, wet surface.
    [Show full text]
  • A Diagnostic Approach to Pruritus
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by DigitalCommons@University of Nebraska University of Nebraska - Lincoln DigitalCommons@University of Nebraska - Lincoln U.S. Air Force Research U.S. Department of Defense 2011 A Diagnostic Approach to Pruritus Brian V. Reamy Christopher W. Bunt Stacy Fletcher Follow this and additional works at: https://digitalcommons.unl.edu/usafresearch This Article is brought to you for free and open access by the U.S. Department of Defense at DigitalCommons@University of Nebraska - Lincoln. It has been accepted for inclusion in U.S. Air Force Research by an authorized administrator of DigitalCommons@University of Nebraska - Lincoln. A Diagnostic Approach to Pruritus BRIAN V. REAMY, MD, Uniformed Services University of the Health Sciences, Bethesda, Maryland CHRISTOPHER W. BUNT, MAJ, USAF, MC, and STACY FLETCHER, CAPT, USAF, MC Ehrling Bergquist Family Medicine Residency Program, Offutt Air Force Base, Nebraska, and the University of Nebraska Medical Center, Omaha, Nebraska Pruritus can be a symptom of a distinct dermatologic condition or of an occult underlying systemic disease. Of the patients referred to a dermatologist for generalized pruritus with no apparent primary cutaneous cause, 14 to 24 percent have a systemic etiology. In the absence of a primary skin lesion, the review of systems should include evaluation for thyroid disorders, lymphoma, kidney and liver diseases, and diabetes mellitus. Findings suggestive of less seri- ous etiologies include younger age, localized symptoms, acute onset, involvement limited to exposed areas, and a clear association with a sick contact or recent travel. Chronic or general- ized pruritus, older age, and abnormal physical findings should increase concern for underly- ing systemic conditions.
    [Show full text]
  • 3628-3641-Pruritus in Selected Dermatoses
    Eur opean Rev iew for Med ical and Pharmacol ogical Sci ences 2016; 20: 3628-3641 Pruritus in selected dermatoses K. OLEK-HRAB 1, M. HRAB 2, J. SZYFTER-HARRIS 1, Z. ADAMSKI 1 1Department of Dermatology, University of Medical Sciences, Poznan, Poland 2Department of Urology, University of Medical Sciences, Poznan, Poland Abstract. – Pruritus is a natural defence mech - logical self-defence mechanism similar to other anism of the body and creates the scratch reflex skin sensations, such as touch, pain, vibration, as a defensive reaction to potentially dangerous cold or heat, enabling the protection of the skin environmental factors. Together with pain, pruritus from external factors. Pruritus is a frequent is a type of superficial sensory experience. Pruri - symptom associated with dermatoses and various tus is a symptom often experienced both in 1 healthy subjects and in those who have symptoms systemic diseases . Acute pruritus often develops of a disease. In dermatology, pruritus is a frequent simultaneously with urticarial symptoms or as an symptom associated with a number of dermatoses acute undesirable reaction to drugs. The treat - and is sometimes an auxiliary factor in the diag - ment of this form of pruritus is much easier. nostic process. Apart from histamine, the most The chronic pruritus that often develops in pa - popular pruritus mediators include tryptase, en - tients with cholestasis, kidney diseases or skin dothelins, substance P, bradykinin, prostaglandins diseases (e.g. atopic dermatitis) is often more dif - and acetylcholine. The group of atopic diseases is 2,3 characterized by the presence of very persistent ficult to treat . Persistent rubbing, scratching or pruritus.
    [Show full text]
  • Chapter 3 Bacterial and Viral Infections
    GBB03 10/4/06 12:20 PM Page 19 Chapter 3 Bacterial and viral infections A mighty creature is the germ gain entry into the skin via minor abrasions, or fis- Though smaller than the pachyderm sures between the toes associated with tinea pedis, His customary dwelling place and leg ulcers provide a portal of entry in many Is deep within the human race cases. A frequent predisposing factor is oedema of His childish pride he often pleases the legs, and cellulitis is a common condition in By giving people strange diseases elderly people, who often suffer from leg oedema Do you, my poppet, feel infirm? of cardiac, venous or lymphatic origin. You probably contain a germ The affected area becomes red, hot and swollen (Ogden Nash, The Germ) (Fig. 3.1), and blister formation and areas of skin necrosis may occur. The patient is pyrexial and feels unwell. Rigors may occur and, in elderly Bacterial infections people, a toxic confusional state. In presumed streptococcal cellulitis, penicillin is Streptococcal infection the treatment of choice, initially given as ben- zylpenicillin intravenously. If the leg is affected, Cellulitis bed rest is an important aspect of treatment. Where Cellulitis is a bacterial infection of subcutaneous there is extensive tissue necrosis, surgical debride- tissues that, in immunologically normal individu- ment may be necessary. als, is usually caused by Streptococcus pyogenes. A particularly severe, deep form of cellulitis, in- ‘Erysipelas’ is a term applied to superficial volving fascia and muscles, is known as ‘necrotiz- streptococcal cellulitis that has a well-demarcated ing fasciitis’. This disorder achieved notoriety a few edge.
    [Show full text]
  • Benign Tumors and Tumor-Like Lesions of the Vulva
    Please do not remove this page Benign Tumors and Tumor-like Lesions of the Vulva Heller, Debra https://scholarship.libraries.rutgers.edu/discovery/delivery/01RUT_INST:ResearchRepository/12643402930004646?l#13643525330004646 Heller, D. (2015). Benign Tumors and Tumor-like Lesions of the Vulva. In Clinical Obstetrics & Gynecology (Vol. 58, Issue 3, pp. 526–535). Rutgers University. https://doi.org/10.7282/T3RN3B2N This work is protected by copyright. You are free to use this resource, with proper attribution, for research and educational purposes. Other uses, such as reproduction or publication, may require the permission of the copyright holder. Downloaded On 2021/09/23 14:56:57 -0400 Heller DS Benign Tumors and Tumor-like lesions of the Vulva Debra S. Heller, MD From the Department of Pathology & Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, NJ Address Correspondence to: Debra S. Heller, MD Dept of Pathology-UH/E158 Rutgers-New Jersey Medical School 185 South Orange Ave Newark, NJ, 07103 Tel 973-972-0751 Fax 973-972-5724 [email protected] Funding: None Disclosures: None 1 Heller DS Abstract: A variety of mass lesions may affect the vulva. These may be non-neoplastic, or represent benign or malignant neoplasms. A review of benign mass lesions and neoplasms of the vulva is presented. Key words: Vulvar neoplasms, vulvar diseases, vulva 2 Heller DS Introduction: A variety of mass lesions may affect the vulva. These may be non-neoplastic, or represent benign or malignant neoplasms. Often an excision is required for both diagnosis and therapy. A review of the more commonly encountered non-neoplastic mass lesions and benign neoplasms of the vulva is presented.
    [Show full text]
  • The Cyclist's Vulva
    The Cyclist’s Vulva Dr. Chimsom T. Oleka, MD FACOG Board Certified OBGYN Fellowship Trained Pediatric and Adolescent Gynecologist National Medical Network –USOPC Houston, TX DEPARTMENT NAME DISCLOSURES None [email protected] DEPARTMENT NAME PRONOUNS The use of “female” and “woman” in this talk, as well as in the highlighted studies refer to cis gender females with vulvas DEPARTMENT NAME GOALS To highlight an issue To discuss why this issue matters To inspire future research and exploration To normalize the conversation DEPARTMENT NAME The consensus is that when you first start cycling on your good‐as‐new, unbruised foof, it is going to hurt. After a “breaking‐in” period, the pain‐to‐numbness ratio becomes favourable. As long as you protect against infection, wear padded shorts with a generous layer of chamois cream, no underwear and make regular offerings to the ingrown hair goddess, things are manageable. This is wrong. Hannah Dines British T2 trike rider who competed at the 2016 Summer Paralympics DEPARTMENT NAME MY INTRODUCTION TO CYCLING Childhood Adolescence Adult Life DEPARTMENT NAME THE CYCLIST’S VULVA The Issue Vulva Anatomy Vulva Trauma Prevention DEPARTMENT NAME CYCLING HAS POSITIVE BENEFITS Popular Means of Exercise Has gained popularity among Ideal nonimpact women in the past aerobic exercise decade Increases Lowers all cause cardiorespiratory mortality risks fitness DEPARTMENT NAME Hermans TJN, Wijn RPWF, Winkens B, et al. Urogenital and Sexual complaints in female club cyclists‐a cross‐sectional study. J Sex Med 2016 CYCLING ALSO PREDISPOSES TO VULVAR TRAUMA • Significant decreases in pudendal nerve sensory function in women cyclists • Similar to men, women cyclists suffer from compression injuries that compromise normal function of the main neurovascular bundle of the vulva • Buller et al.
    [Show full text]
  • Detail Report
    Supplemental Update Report CR Number: 2012319113 Implementation Date: 16-Jan-19 Related CR: 2012319113 MedDRA Change Requested Add a new SMQ Final Disposition Final Placement Code # Proposed SMQ Infusion related reactions Rejected After Suspension MSSO The proposal to add a new SMQ Infusion related reactions is not approved after suspension. The ICH Advisory Panel did approve this SMQ topic to go into the development phase and it Comment: underwent testing in three databases (two regulatory authorities and one company). However, there were numerous challenges encountered in testing and the consensus decision of the CIOMS SMQ Implementation Working Group was that the topic could not be developed to go into production as an SMQ. Most notably, in contrast to other SMQs, this query could not be tested using negative control compounds because it was not possible to identify suitable compounds administered via infusion that were not associated with some type of reaction. In addition, there is no internationally agreed definition of an infusion related reaction and the range of potential reactions associated with the large variety of compounds given by infusion is very broad and heterogenous. Testing was conducted on a set of around 500 terms, the majority of which was already included in Anaphylactic reaction (SMQ), Angioedema (SMQ), and Hypersensitivity (SMQ). It proved difficult to identify potential cases of infusion related reactions in post-marketing databases where the temporal relationship of the event to the infusion is typically not available. In clinical trial databases where this information is more easily available, users are encouraged to provide more specificity about the event, e.g., by reporting “Anaphylactic reaction” when it is known that this event is temporally associated with the infusion.
    [Show full text]
  • Pediatric and Adolescent Dermatology
    Pediatric and adolescent dermatology Management and referral guidelines ICD-10 guide • Acne: L70.0 acne vulgaris; L70.1 acne conglobata; • Molluscum contagiosum: B08.1 L70.4 infantile acne; L70.5 acne excoriae; L70.8 • Nevi (moles): Start with D22 and rest depends other acne; or L70.9 acne unspecified on site • Alopecia areata: L63 alopecia; L63.0 alopecia • Onychomycosis (nail fungus): B35.1 (capitis) totalis; L63.1 alopecia universalis; L63.8 other alopecia areata; or L63.9 alopecia areata • Psoriasis: L40.0 plaque; L40.1 generalized unspecified pustular psoriasis; L40.3 palmoplantar pustulosis; L40.4 guttate; L40.54 psoriatic juvenile • Atopic dermatitis (eczema): L20.82 flexural; arthropathy; L40.8 other psoriasis; or L40.9 L20.83 infantile; L20.89 other atopic dermatitis; or psoriasis unspecified L20.9 atopic dermatitis unspecified • Scabies: B86 • Hemangioma of infancy: D18 hemangioma and lymphangioma any site; D18.0 hemangioma; • Seborrheic dermatitis: L21.0 capitis; L21.1 infantile; D18.00 hemangioma unspecified site; D18.01 L21.8 other seborrheic dermatitis; or L21.9 hemangioma of skin and subcutaneous tissue; seborrheic dermatitis unspecified D18.02 hemangioma of intracranial structures; • Tinea capitis: B35.0 D18.03 hemangioma of intraabdominal structures; or D18.09 hemangioma of other sites • Tinea versicolor: B36.0 • Hyperhidrosis: R61 generalized hyperhidrosis; • Vitiligo: L80 L74.5 focal hyperhidrosis; L74.51 primary focal • Warts: B07.0 verruca plantaris; B07.8 verruca hyperhidrosis, rest depends on site; L74.52 vulgaris (common warts); B07.9 viral wart secondary focal hyperhidrosis unspecified; or A63.0 anogenital warts • Keratosis pilaris: L85.8 other specified epidermal thickening 1 Acne Treatment basics • Tretinoin 0.025% or 0.05% cream • Education: Medications often take weeks to work AND and the patient’s skin may get “worse” (dry and red) • Clindamycin-benzoyl peroxide 1%-5% gel in the before it gets better.
    [Show full text]
  • WO 2014/134709 Al 12 September 2014 (12.09.2014) P O P C T
    (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date WO 2014/134709 Al 12 September 2014 (12.09.2014) P O P C T (51) International Patent Classification: (81) Designated States (unless otherwise indicated, for every A61K 31/05 (2006.01) A61P 31/02 (2006.01) kind of national protection available): AE, AG, AL, AM, AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, (21) International Application Number: BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, PCT/CA20 14/000 174 DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, (22) International Filing Date: HN, HR, HU, ID, IL, IN, IR, IS, JP, KE, KG, KN, KP, KR, 4 March 2014 (04.03.2014) KZ, LA, LC, LK, LR, LS, LT, LU, LY, MA, MD, ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, (25) Filing Language: English OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, (26) Publication Language: English SC, SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, (30) Priority Data: ZW. 13/790,91 1 8 March 2013 (08.03.2013) US (84) Designated States (unless otherwise indicated, for every (71) Applicant: LABORATOIRE M2 [CA/CA]; 4005-A, rue kind of regional protection available): ARIPO (BW, GH, de la Garlock, Sherbrooke, Quebec J1L 1W9 (CA). GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, SZ, TZ, UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, TJ, (72) Inventors: LEMIRE, Gaetan; 6505, rue de la fougere, TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, DK, Sherbrooke, Quebec JIN 3W3 (CA).
    [Show full text]
  • Download PDF (Inglês)
    Revista6Vol89ingles_Layout 1 10/10/14 11:08 AM Página 1003 WHAT IS YOUR DIAGNOSIS? 1003 s Case for diagnosis* João Roberto Antonio1 Larissa Cannizza Pacheco de Lucca1 Mariana Perez Borim1 Natália Cristina Pires Rossi1 Guilherme Bueno de Oliveira1 DOI: http://dx.doi.org/10.1590/abd1806-4841.20143156 CASE REPORT A 60-year-old woman reports a 5-year history of violaceous and intensely pruritic lesions on the dorsum and scalp, associated with a 2-year history of hair loss. She also reports decreased hair growth in the axillary and inguinal regions in the same period. Dermatological examination shows small, scaly, erythematous-violaceous, flat papules on the dorsal region; multifocal scarring alopecia areas, with smooth, bright and atrophic surface; discrete hair rarefaction in the axillary and inguinal regions; presence of longitu- FIGURE 2: dinal grooves and some depressions on the surface of Perifollicular the nail plate; no oral lesions (Figures 1 and 2). The erythema with desquamation at histopathology of the dorsal lesion is shown in figure the vertex of the 3A and that of the scalp is shown in figure 3B. scalp; cicatricial The treatment was performed using high- alopecia and potency corticoids and resulted, after three months, in smooth, bright and atrophic surface an improvement of pruritus and a slight lightening of the lesions. A FIGURE 1: B Cutaneous, erythematous- FIGURE 3: A. HE 200x. Interface dermatitis with lichenoid pattern purpuric lesions associated with dermo-epidermic detachment and lymphocytic on the infiltrate in band-like pattern in the upper dermis. B. HE 200x. dorsal region Detail of partially destroyed follicle, with perifollicular fibrosis and perivascular lymphocytic infiltrate Received on 19.09.2013.
    [Show full text]
  • ORIGINAL ARTICLE a Clinical and Histopathological Study of Lichenoid Eruption of Skin in Two Tertiary Care Hospitals of Dhaka
    ORIGINAL ARTICLE A Clinical and Histopathological study of Lichenoid Eruption of Skin in Two Tertiary Care Hospitals of Dhaka. Khaled A1, Banu SG 2, Kamal M 3, Manzoor J 4, Nasir TA 5 Introduction studies from other countries. Skin diseases manifested by lichenoid eruption, With this background, this present study was is common in our country. Patients usually undertaken to know the clinical and attend the skin disease clinic in advanced stage histopathological pattern of lichenoid eruption, of disease because of improper treatment due to age and sex distribution of the diseases and to difficulties in differentiation of myriads of well assess the clinical diagnostic accuracy by established diseases which present as lichenoid histopathology. eruption. When we call a clinical eruption lichenoid, we Materials and Method usually mean it resembles lichen planus1, the A total of 134 cases were included in this study prototype of this group of disease. The term and these cases were collected from lichenoid used clinically to describe a flat Bangabandhu Sheikh Mujib Medical University topped, shiny papular eruption resembling 2 (Jan 2003 to Feb 2005) and Apollo Hospitals lichen planus. Histopathologically these Dhaka (Oct 2006 to May 2008), both of these are diseases show lichenoid tissue reaction. The large tertiary care hospitals in Dhaka. Biopsy lichenoid tissue reaction is characterized by specimen from patients of all age group having epidermal basal cell damage that is intimately lichenoid eruption was included in this study. associated with massive infiltration of T cells in 3 Detailed clinical history including age, sex, upper dermis. distribution of lesions, presence of itching, The spectrum of clinical diseases related to exacerbating factors, drug history, family history lichenoid tissue reaction is wider and usually and any systemic manifestation were noted.
    [Show full text]