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Skin Test Christina P
SKINTEST Skin Test Christina P. Linton 1. A middle-aged, diabetic woman presents with 6. What is the estimated 5-year survival rate for well-demarcated, yellow-brown, atrophic, telangiectatic melanoma that has spread beyond the original area plaques with a raised, violaceous border on her shins. of involvement to the nearby lymph nodes (but What is the most likely diagnosis? not to distant nodes or organs)? a. Lipodermatosclerosis a. 25% b. Pyoderma gangrenosum b. 41% c. Necrobiosis lipoidica c. 63% d. Erythema nodosum d. 87% 2. Which of the following types of fruit is most likely 7. What is another name for leprosy? to cause phytophotodermatitis? a. von Recklinghausen’s disease a. Pineapple b. MuchaYHabermann disease b. Grapefruit c. Schamberg’s disease c. Kiwi d. Hansen’s disease d. Peach 8. Which of the following is not an expected 3. Hypothyroidism can cause several changes to the skin extracutaneous finding in patients with and skin appendages including all of the following, HenochYScho¨ nlein purpura? except: a. Abdominal pain a. Hyperpigmentation b. Hematuria b. Easy bruising c. Shortness of breath c. Thin, brittle nails d. Arthralgias d. Dry, coarse skin 9. When the term ‘‘papillomatous’’ is used to describe 4. In a patient with neurofibromatosis, which sign refers a skin lesion, it means that the lesion is to the presence of bilateral axillary freckling? a. characterized by multiple fine surface projections. a. Auspitz sign b. erupting like a mushroom or fungus. b. Crowe sign c. characterized by fine fissures and cracks in the skin. c. Russell sign d. sieve like and contains many perforations. -
Skin Lesions in Diabetic Patients
Rev Saúde Pública 2005;39(4) 1 www.fsp.usp.br/rsp Skin lesions in diabetic patients N T Foss, D P Polon, M H Takada, M C Foss-Freitas and M C Foss Departamento de Clínica Médica. Faculdade de Medicina de Ribeirão Preto. Universidade de São Paulo. Ribeirão Preto, SP, Brasil Keywords Abstract Skin diseases. Dermatomycoses. Diabetes mellitus. Metabolic control. Objective It is yet unknown the relationship between diabetes and determinants or triggering factors of skin lesions in diabetic patients. The purpose of the present study was to investigate the presence of unreported skin lesions in diabetic patients and their relationship with metabolic control of diabetes. Methods A total of 403 diabetic patients, 31% type 1 and 69% type 2, underwent dermatological examination in an outpatient clinic of a university hospital. The endocrine-metabolic evaluation was carried out by an endocrinologist followed by the dermatological evaluation by a dermatologist. The metabolic control of 136 patients was evaluated using glycated hemoglobin. Results High number of dermophytosis (82.6%) followed by different types of skin lesions such as acne and actinic degeneration (66.7%), pyoderma (5%), cutaneous tumors (3%) and necrobiosis lipoidic (1%) were found. Among the most common skin lesions in diabetic patients, confirmed by histopathology, there were seen necrobiosis lipoidic (2 cases, 0.4%), diabetic dermopathy (5 cases, 1.2%) and foot ulcerations (3 cases, 0.7%). Glycated hemoglobin was 7.2% in both type 1 and 2 patients with adequate metabolic control and 11.9% and 12.7% in type 1 and 2 diabetic patients, respectively, with inadequate metabolic controls. -
The Prevalence of Cutaneous Manifestations in Young Patients with Type 1 Diabetes
Clinical Care/Education/Nutrition/Psychosocial Research ORIGINAL ARTICLE The Prevalence of Cutaneous Manifestations in Young Patients With Type 1 Diabetes 1 2 MILOSˇ D. PAVLOVIC´, MD, PHD SLAANA TODOROVIC´, MD tions, such as neuropathic foot ulcers; 2 4 TATJANA MILENKOVIC´, MD ZORANA ÐAKOVIC´, MD and 4) skin reactions to diabetes treat- 1 1 MIROSLAV DINIC´, MD RADOSˇ D. ZECEVIˇ , MD, PHD ment (1). 1 5 MILAN MISOVIˇ C´, MD RADOJE DODER, MD, PHD 3 To understand the development of DRAGANA DAKOVIC´, DS skin lesions and their relationship to dia- betes complications, a useful approach would be a long-term follow-up of type 1 OBJECTIVE — The aim of the study was to assess the prevalence of cutaneous disorders and diabetic patients and/or surveys of cuta- their relation to disease duration, metabolic control, and microvascular complications in chil- neous disorders in younger type 1 dia- dren and adolescents with type 1 diabetes. betic subjects. Available data suggest that skin dryness and scleroderma-like RESEARCH DESIGN AND METHODS — The presence and frequency of skin mani- festations were examined and compared in 212 unselected type 1 diabetic patients (aged 2–22 changes of the hand represent the most years, diabetes duration 1–15 years) and 196 healthy sex- and age-matched control subjects. common cutaneous manifestations of Logistic regression was used to analyze the relation of cutaneous disorders with diabetes dura- type 1 diabetes seen in up to 49% of the tion, glycemic control, and microvascular complications. patients (3). They are interrelated and also related to diabetes duration. Timing RESULTS — One hundred forty-two (68%) type 1 diabetic patients had at least one cutaneous of appearance of various cutaneous le- disorder vs. -
Interstitial Granuloma Annulare Triggered by Lyme Disease
Volume 27 Number 5| May 2021 Dermatology Online Journal || Case Presentation 27(5):11 Interstitial granuloma annulare triggered by Lyme disease Jordan Hyde1 MD, Jose A Plaza1,2 MD, Jessica Kaffenberger1 MD Affiliations: 1Division of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA, 2Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA Corresponding Author: Jessica Kaffenberger MD, Division of Dermatology, The Ohio State University Medical Wexner Medical Center, Suite 240, 540 Officenter Place, Columbus, OH 43230, Tel: 614-293-1707, Email: [email protected] been associated with a variety of systemic diseases Abstract including diabetes mellitus, malignancy, thyroid Granuloma annulare is a non-infectious disease, dyslipidemia, and infection [3,4]. granulomatous skin condition with multiple different associations. We present a case of a man in his 60s There are multiple histological variants of GA, with a three-week history of progressive targetoid including interstitial GA. The histopathology of plaques on his arms, legs, and trunk. Skin biopsy classic GA demonstrates a focal degeneration of demonstrated interstitial granuloma annulare. collagen surrounded by an inflammatory infiltrate Additional testing revealed IgM antibodies to Borrelia composed of lymphocytes and histiocytes. In a less burgdorferi on western blot suggesting interstitial common variant, interstitial GA, scattered histiocytes granuloma annulare was precipitated by the recent are seen -
2017 Oregon Dental Conference® Course Handout
2017 Oregon Dental Conference® Course Handout Nasser Said-Al-Naief, DDS, MS Course 8125: “The Mouth as The Body’s Mirror: Oral, Maxillofacial, and Head and Neck Manifestations of Systemic Disease” Thursday, April 6 2 pm - 3:30 pm 2/28/2017 The Mouth as The Body’s Mirror Oral Maxillofacial and Head and Neck Manifestation of Ulcerative Conditions of Allergic & Immunological Systemic Disease the Oro-Maxillofacial Diseases Region Nasser Said-Al-Naief, DDS, MS Professor & Chair, Oral Pathology and Radiology Director, OMFP Laboratory Oral manifestations of Office 503-494-8904// Direct: 503-494-0041 systemic diseases Oral Manifestations of Fax: 503-494-8905 Dermatological Diseases Cell: 1-205-215-5699 Common Oral [email protected] Conditions [email protected] OHSU School of Dentistry OHSU School of Medicine 2730 SW Moody Ave, CLSB 5N008 Portland, Oregon 97201 Recurrent aphthous stomatitis (RAS) Recurrent aphthous stomatitis (RAS) • Aphthous" comes from the Greek word "aphtha”- • Recurrence of one or more painful oral ulcers, in periods of days months. = ulcer • Usually begins in childhood or adolescence, • The most common oral mucosal disease in North • May decrease in frequency and severity by age America. (30+). • Affect 5% to 66% of the North American • Ulcers are confined to the lining (non-keratinized) population. mucosa: • * 60% of those affected are members of the • Buccal/labial mucosa, lateral/ventral tongue/floor of professional class. the mouth, soft palate/oropharyngeal mucosa • Etiopathogenesis: 1 2/28/2017 Etiology of RAU Recurrent Aphthous Stomatitis (RAS): Types: Minor; small size, shallow, regular, preceeded by prodrome, heal in 7-10 days Bacteria ( S. -
A Patient with Plaque Type Morphea Mimicking Systemic Lupus Erythematosus
CASE REPORT A Patient With Plaque Type Morphea Mimicking Systemic Lupus Erythematosus Wardhana1, EA Datau2 1 Department of Internal Medicine, Siloam International Hospitals. Karawaci, Indonesia. 2 Department of Internal Medicine, Prof. Dr. RD Kandou General Hospital & Sitti Maryam Islamic Hospital, Manado, North Sulawesi, Indonesia. Correspondence mail: Siloam Hospitals Group’s CEO Office, Siloam Hospital Lippo Village. 5th floor. Jl. Siloam No.6, Karawaci, Indonesia. email: [email protected] ABSTRAK Morfea merupakan penyakit jaringan penyambung yang jarang dengan gambaran utama berupa penebalan dermis tanpa disertai keterlibatan organ dalam. Penyakit ini juga dikenal sebagai bagian dari skleroderma terlokalisir. Berdasarkan gambaran klinis dan kedalaman jaringan yang terlibat, morfea dikelompokkan ke dalam beberapa bentuk dan sekitar dua pertiga orang dewasa dengan morfea mempunyai tipe plak. Produksi kolagen yang berlebihan oleh fibroblast merupakan penyebab kelainan pada morfea dan mekanisme terjadinya aktivitas fibroblast yang berlebihan ini masih belum diketahui, meskipun beberapa mekanisme pernah diajukan. Morfe tipe plak biasanya bersifat ringan dan dapat sembuh dengan sendirinya. Morfea tipe plak yang penampilan klinisnya menyerupai lupus eritematosus sistemik, misalnya meliputi alopesia dan ulkus mukosa di mulut, jarang dijumpai. Sebuah kasus morfea tipe plak pada wanita berusia 20 tahun dibahas. Pasien ini diobati dengan imunosupresan dan antioksidan local maupun sistemik. Kondisi paisen membaik tanpa disertai efek samping yang berarti. Kata kunci: morfea, tipe plak. ABSTRACT Morphea is an uncommon connective tissue disease with the most prominent feature being thickening or fibrosis of the dermal without internal organ involvement. It is also known as a part of localized scleroderma. Based on clinical presentation and depth of tissue involvement, morphea is classified into several forms, and about two thirds of adults with morphea have plaque type. -
Nodular Morphea
Case Report Dermatology 2009;218:63–66 Received: July 13, 2008 DOI: 10.1159/000173976 Accepted: July 23, 2008 Published online: November 13, 2008 Nodular Morphea a b c F. Kauer J.C. Simon M. Sticherling a b Department of Dermatology and Venerology, Vivantes Klinikum Neukölln, Berlin , Department of Dermatology, c Venerology and Allergology, University of Leipzig, Leipzig , and Department of Dermatology, Venerology and Allergology, University of Erlangen, Erlangen , Germany Key Words can range in size from 2 mm to 4–5 cm, flamed skin that is already involved in an -Scleroderma ؒ Keloid ؒ Hypertrophic scar ؒ usually appear spontaneously and tend to active fibrotic process inherent to the dis Morphea involve the trunk and upper extremities. ease in those patients who are genetically A linear presentation has also been de- predisposed to keloid development, or at scribed. The literature on this topic is con- sites of the skin that show a high predilec- Abstract fusing because the terms ‘nodular sclero- tion for keloid formation, such as the trunk Scleroderma may present as being strictly derma’ and ‘keloidal scleroderma’ are used [6, 7] . limited to the skin, as in morphea, or within interchangeably even though there is a a multiorgan disease, as in systemic sclero- great degree of variability in the histologi- sis. Accordingly, cutaneous manifestations cal findings of these nodules [4] . In con- C a s e R e p o r t vary clinically. In nodular or keloidal sclero- trast, other authors stress that the cutane- derma, patients develop lesions that are ous manifestations may vary clinically, but Medical History clinically indistinguishable from a keloid; all share the same histopathological pat- A 16-year-old girl presented with mul- however, the histopathological findings are tern of both morphea/scleroderma and ke- tiple progressive morpheic skin lesions more variable. -
Response of Ulcerated Necrobiosis Lipoidica to Clofazimine
Letters to the Editor 651 Response of Ulcerated Necrobiosis Lipoidica to Clofazimine Frauke Benedix, Annette Geyer, Verena Lichte, Gisela Metzler, Martin Röcken and Anke Strölin* Department of Dermatology, University Hospital of Tuebingen, Liebermeisterstrasse 25, DE-72076 Tuebingen, Germany. *E-mail: anke.stroelin@med. uni-tuebingen.de Accepted May 25, 2009. Sir, The patient was referred to our department with multiple, Necrobiosis lipoidica (NL) is a chronic granulomatous pre-tibial brownish-livid, bizarrely configured, partly sclerotic maculae and plaques, pronounced central atrophy and several inflammatory disease of the skin of unknown aetiology, fibrinous ulcerations. which can be associated with diabetes mellitus. NL is Chronic venous insufficiency and peripheral arterial occlusion characterized by slowly growing initially erythematous were excluded by digital photoplethysmography, arterial and plaques that turn into yellow-brown, partly telangiectatic venous dopplersonography. Laboratory tests showed normal and atrophic scars. Ulcerations occur in approximately liver enzymes, creatinine and blood count. Borrelia serology, anti-nuclear antibody screening and HbA1c were in normal 35% of cases. ranges. Microbiological swabs detected Staphylococcus aureus Many therapies have been recommended for this without clinical signs of local inflammation. chronic disease; nevertheless, therapeutic success The biopsy showed granulomatous inflammation involving the is rare. We report here the successful treatment of entire corium and the upper subcutaneous fat tissue, with homo- ulcerated NL with clofazimine, without noteworthy genous necrobiosis lined by epithelioid histiocytes, foreign body giant cells and lymphoid cell aggregates with germinal centres, side-effects. as well as lymphoplasmacellular infiltrations around the vessels. Histology thus confirmed the diagnosis of NL (Fig. 1a). As the previous therapies were without effect, we started anti- CASE REPORT inflammatory treatment with clofazimine, 100 mg/day. -
Successful Treatment of Ulcerative and Diabeticorum
Letters 1. Picardi A, Pasquini P, Cattaruzza MS, et al. Psychosomatic factors in first- Another prevalent transverse linear crease of the face, the onset alopecia areata. Psychosomatics. 2003;44(5):374-381. nasal crease, appears across the lower third of the nasal dor- 2. Vannatta K, Gartstein MA, Zeller MH, Noll RB. Peer acceptance and social sum. In some cases, changes of pigmentation, milia, or pseudo- behavior during childhood and adolescence: how important are appearance, comedones are present along the nasal crease.5 Transverse na- athleticism, and academic competence? Int J Behav Dev. 2009;33(4): 303-311. sal milia in the absence of a transverse nasal crease are less frequently reported. Recently, our research team6 reported a OBSERVATION case of seborrheic keratosis–like hyperplasia and horn cysts aligned along this crease. These findings were attributed to the Deep Labiomental Fold With Pseudocomedones fact that the triangular cartilage and the alar cartilage attach The labiomental fold is a transverse indentation of the face, in a linear fashion at the junction of the middle and lower third which marks the intersection of the lower lip and chin.1 It plays of the nose, producing a potential embryonic fault line in which a significant role in movement of the lower lip and in facial ex- retention cysts presenting as milia and comedones can occur.5 pression. We describe herein a child with a linear pattern of Early acne lesions favor the forehead, nose, and chin in microcomedones located along a deep labiomental fold. many children. Although many times overlooked, the exter- nal ear is another common location for open and closed com- Report of a Case | A 7-year-old healthy girl presented with a line edones in young patients with acne.7 We think that the com- of black papules on her chin. -
Chest Scars P.27 4
DERM CASE DERM CASE Test your knowledge wTeitsht ymouulrtikpnleo-wchleodicgee cwaisthes multiple-choice cases This month – 6 cases: 1. Chest Scars p.27 4. Torso Clusters p.30 2. Redish-Brown Plaques p.28 5. Face Protrusions p.31 3. Demarcated Facial Birthmark p.29 6. Hypopigmented Papules p.32 Case 1 Chest Scars This gentleman has developed these skin lesions on his chest. He used to excessively pick his cystic acne, which was in the same area. What is your diagnosis? a. Dermatofibroma protuberans b. Keloid scar c. Perifollicular fibroma d. Angio fibroma Answer Keloid scar (answer b) , which is excessive connec - tive tissue proliferation following an injury. Therapy: No good therapy is available for Pathogenesis: Predisposing factors for keloid for - keloids. Never make any bold promises. Simple re- mation are: excision almost never works and oftentsigonifnicantly • Ethnic factors: Keloids are far more common in worsens th©e problem. ibu blacks. Treatmtent: Possibilities tinrcludead–,corticosteroid h is nlo • Location: Sternum, shoulders, neck (after iingjection, tangenltiaDl debudlkoiwng excision, and exci - yr ia an se thyroid operation), ear lobes (piercing), apnkles, sion and ccoveragerswcith skinalgruaft can be considered o er use son shins, over clavicle, edge of chin, and other sites monly if itedis certaipnetrhat the new wound can heal C ris for m tho py where skin tension is generally increaseCd. o . Auunder lcesos skin tension with exogenous pressure r ited gle • Type of injury: Burns and infections morheiboften saipnplied and that the graft donor site can be placed e pro t a form keloids, leading to aconltractusrees and prin under prophylactic pressure. -
Necrobiosis Lipoidica with Superimposed Pyoderma Vegetans
CASE REPORT Necrobiosis Lipoidica With Superimposed Pyoderma Vegetans Carl J. Barrick, DO; Omobola Onikoyi, DO; Nektarios I. Lountzis, MD; Tanya Ermolovich, DO; Stephen M. Purcell, DO foul odor was noted in the area underlying the lesion. PRACTICE POINTS Initial punch biopsy demonstrated epidermal hyperplasia • Necrobiosis lipoidica (NL), a chronic granulomatous with neutrophil-rich sinus tracts consistent with pyoderma disease characterized by collagen degeneration, vegetans (PV)(Figure 2A). Tissue culture was positive for granulomatous formation, and endothelial-wall thick- Staphylococcus aureus and Streptococcus anginosus. Cultures ening, is most often seen in association with insulin- for both fungi and acid-fast bacilli were negative for growth. dependent diabetes mellitus (DM). The patient was treated with mupirocin ointment 2% • Asymptomatic, well-circumscribed, violaceous pap- and 3 months of cephalexin 250 mg twice daily, which ules and nodules coalesce into plaques on the lower cleared the purulent crust; however, serous drainage, extremities, face, or trunk in NL. ulceration, and erythemacopy persisted. The patient needed an • Treatment mainstay is topical and intralesional extended course of antibiotics, which had not been previ- corticosteroids at active borders of lesions. Other ously administered to clear the purulence. During this treat- treatments used with some success include tumor ment regimen, the patient’s DM remained uncontrolled. necrosis factor α inhibitors, topical tretinoin, topical tacrolimus, and skin grafting. Control and manage- notA second deeper punch biopsy revealed a layered gran- ment of DM can be helpful. ulomatous infiltrate with sclerosis throughout the dermis most consistent with necrobiosis lipoidica (NL)(Figure 2B). Direct immunofluorescence biopsy was negative. Once the Necrobiosis lipoidica (NL) is a granulomatous inflammatory skin PV was clear, betamethasone dipropionate ointment 0.05% disease strongly associated with diabetes mellitus (DM). -
Treatment of Necrobiosis Lipoidica
22 The Open Dermatology Journal, 2008, 2, 22-25 Treatment of Necrobiosis Lipoidica with 595 nm Pulsed Dye Laser – A Case Report Jean-Loïc Michel*,a and Odile Richardb aPrivate Office of Dermatology, Residence V° Avenue, 14 Place des Grenadiers-Quartier Grouchy, 42000 Saint- Etienne, France bService de Pédiatrie, Centre hospitalier universitaire, 42055 Saint-Etienne, France Abstract: Introduction: Necrobiosis Lipoidica (NL) had no adequate treatment. Some case has been treated by different vascular lasers. Third generation pulsed dye lasers with a wavelength of 595 nm has been attempted. Their selectively de- stroys shallower ectatic blood vessels. Material and Methods: We used a 595 nm, Dermobeam 2000® laser (manufactured by Deka© MELA Calenzano, Italy), with a dynamic skin cooling system (Spray). The parameters were 7 mm spot, 6 J/cm2, 0.5 Hz, and 0.5 msec. Case Report: A young Caucasian girl was diagnosed at 9 years of age (January 2002) with Necrobiosis Lipoidica over the entire pretibial region of both legs. She had been suffering from type 1 diabetes mellitus for 4 years. She received 3 insu- lin injections per day. Results: A long-standing skin breakdown of the left leg was observed which required two months’ dressing with hydrocol- loids. A cosmetic improvement was obtained after this single treatment, with a decrease in erythema and telangiectasias, and stabilization in terms of progression. However, 13 months after treatment, an extension of the peripheral telangiectasis and erythema border of the lesions was observed. Discussion: Laser therapy is proven useful to treat Necrobiosis Lipoidica only in rare cases. It is possible to treat te- langiectasias, however there is a risk of ulceration.