DOCSLIB.ORG

Chronic Pruritic Vulva Lesion

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Chronic Pruritic Vulva Lesion Photo RoUNDS Stephen Colden Cahill, DO Chronic pruritic vulva lesion College of Osteopathic Medicine, Michigan State University, East Lansing; The patient was not sexually active and denied any and Lakeshore Health vaginal discharge. So what was causing the intense Partners, Holland, Mich itching on her labia? [email protected] Department eDItOr richard p. Usatine, mD University of Texas Health Science Center at San Antonio During a routine exam, a 45-year-old Cau- both of her labia majora (FIGURE). Throughout casian woman complained of intense itching the lesion, there were scattered areas of exco- The author reported no potential conflict of interest on her labia. She said that the itching had been riation. Her labia minor were spared. relevant to this article. an issue for more than 9 months and that she A speculum and bimanual exam were found herself scratching several times a day. normal. No inguinal lymphadenopathy was She denied any vaginal discharge and said she present. hadn’t been sexually active in years. She had tried over-the-counter antifungals and topical ● WhaT is your diagnosis? Benadryl, but they provided only limited relief. The patient had red thickened plaques ● HoW Would you TREAT THIS with accentuated skin lines (furrows) covering PATIENT? Figure Red thickened plaques on labia majora p ho T o cour T esy of: St ephen c olden c ahill, DO jfponline.com Vol 62, no 2 | february 2013 | The journal of family pracTice 97 PHOTO RoUNDS Diagnosis: taneous lesion of unknown etiology. It can Lichen simplex chronicus be found throughout the body, including the This patient was given a diagnosis of lichen mucous membranes. It commonly presents simplex chronicus (circumscribed neuro- as the 5 Ps: pruritic, planar, polyangular, pur- dermatitis)—pathohistologic changes to the ple, and papules.5 Upon close examination, skin caused by habitual trauma from scratch- Wickham’s striae (reticular white lines) may ing a single area. The lesion begins as small be visible.4,5 red papules that later coalesce into a plaque z Lichen sclerosus is a cutaneous disease with furrows (lichenification).1 The plaques of unknown origin that tends to occur in post- become well circumscribed with attenuated menopausal women; it prompts complaints skin lines. This is due to the thickening of of pruritus and dyspareunia.5 It presents as both the epidermis (acanthosis) and stratum white atrophic plaques that may encompass corneum (hyperkeratosis).2 Hyperpigmen- both the vagina and rectum.4,5 tation or hypopigmentation may be pres- z psoriasis lesions are usually distinctive, ent—particularly in patients with naturally with red scaling papules that tend to coalesce dark-colored skin.1 into plaques. These lesions are associated z the epidemiology of lichen simplex with Auspitz sign—pinpoint bleeding follow- chronicus is unknown. It tends to occur in ing removal of silvery white scale.4,5 Lesions adults between 30 and 50 years of age (al- are often found on the elbows, groin, knees, the histologic though it has been seen in children) and is scalp, gluteal cleft, fingernails, and toes.4 separation more common in women and people of Asian z mycosis fungoides (MF) is a cutaneous between lichen descent.3 The areas of the body that are affect- T-cell lymphoma that can have similar clini- simplex ed are those that are easily reached, including cal characteristics to lichen simplex chroni- chronicus the:4,5 cus. It evolves through 4 phases: pre-MF, and psoriasis is • outer portion of the lower legs patch, plaque, and tumor.4 The patch phase difficult, leading • scrotum and vulva; pubic and anal may be confused with lichen simplex chroni- pathologists to areas cus because there are flat, erythematous, and report the • wrists and ankles pruritic lesions. It also presents with lymph- process as • upper eyelids adenopathy and lesions that are persistently psoriasiform • back or side of neck resistant to topical steroid treatments. High dermatitis. • ear canal clinical suspicion and multiple biopsies at • extensor forearms near the elbow different sites may be useful. • fold behind the ear z extramammary paget’s disease is a • scalp rare cutaneous form of adenocarcinoma. About 12% of patients have a concurrent un- Pathology will show lichenification, ac- derlying internal malignancy.4,5 It appears anthosis, hyperkeratosis, and eczematous as a white-to-red, scaling or macerated, in- inflammation resembling psoriasis. The his- filtrated, eroded, or ulcerated plaque, most tologic separation between lichen simplex frequently observed on the labia majora and chronicus and psoriasis is particularly diffi- scrotum.5 cult, which leads some pathologists to report the process as “psoriasiform dermatitis.”1 That was the case in this presentation. 2 keys to diagnosis A history of severe pruritus (with a chronic itch-scratch cycle) combined with the find- Differential diagnosis ings of lichenification should make you sus- includes lichen planus, psoriasis pect lichen simplex chronicus. It may be Skin conditions with a similar appearance to li- necessary to first treat the itch-scratch cycle chen simplex chronicus include lichen planus, before you can identify the underlying dis- lichen sclerosus, psoriasis, mycosis fungoides, ease.1 If clinical diagnosis is still unclear, you and extramammary Paget’s disease.1,2,4,5 may need to do a skin biopsy for pathologic z Lichen planus is an inflammatory cu- identification and to rule out neoplasia. 98 The journal of family pracTice | february 2013 | Vol 62, no 2 ChroniC pruritiC vulva lesion Look for concomitant psychiatric dis- mation and pruritus. Be sure to advise pa- orders that often have contributing factors, tients of potential adverse effects of potent such as depression, anxiety, and obsessive- topical steroids, such as atrophy, discolor- compulsive disorder.1,4,5 Correlation of his- ation, and striae.1,2,5 tory, physical exam, and pathophysiology is z Second-line topical treatments in- enough for the diagnosis. clude tacrolimus ointment 0.1%, pimecro- limus cream 1%, topical lidocaine 2%, and capsaicin 0.025% to 0.075% cream applied Focus tx on interrupting 3 times a day.2 Depending on the size and the itch-scratch cycle shape of the lesion, intralesional steroids Tell patients with lichen simplex chronicus such as triamcinolone acetate in varying con- that a permanent cure may not be possible. centrations may be beneficial. Intermittent therapy may be necessary for z Selective serotonin reuptake inhibi- years.1 The key to long-term success is dis- tors have been shown to benefit patients ruption of the itch-scratch cycle. Often, the during the day, and to address other psycho- scratching occurs during sleep without the logical comorbidities that may be present (eg, patient even being aware. So it’s helpful anxiety, depression, or obsessive-compulsive to educate patients about the itch-scratch disorder).1 cycle and to advise them to keep their nails z Be sure to screen for secondary super- trimmed, wear gloves at nighttime, and if infections (bacterial and fungal) and treat a permanent needed, apply an occlusive dressing.1,2 It’s accordingly. Follow-up should be scheduled cure may not also helpful to avoid irritants such as harsh for 4 weeks after treatment has begun.2 be possible; soaps and washcloths, panty liners, tight intermittent clothing, perfumes, and deodorants.2 Steroids provided relief therapy may Help the patient break the nighttime for my patient be necessary itch-scratch cycle by prescribing sedat- I prescribed clobetasol 0.05% ointment with- for years. ing H1 antihistamines such as hydroxyzine out occlusion twice a day for 4 weeks. I also (10-25 mg taken within 2 hours of bed time); prescribed hydroxyzine 25 mg to be taken at increase the dose every 7 days until scratching bedtime and fluoxetine 20 mg daily for under- ceases or adverse effects develop.2 Another lying depression. option is a tricyclic antidepressant—doxepin At follow-up 4 weeks later, my patient re- 25 to 75 mg or amitriptyline 25 to 75 mg— ported excellent relief from her pruritus. Her taken within 2 hours of bed time.1 labia’s erythema had greatly decreased, but z recommend that patients use lubri- chronic skin changes were still present. I ad- cants and petroleum-based ointments to re- vised her to apply the clobetasol every 2 weeks store the damaged skin barrier and its natural as needed, with follow-up in 3 months. JFP function. Using these products after bathing may be especially helpful.1 CORRESpOnDENCe z stephen colden cahill, do, assistant clinical professor, michi- Class I and II topical steroids can be gan state university, 8300 Westpark Way, Zeeland, mi 49464; used as first-line treatment to reduce inflam- [email protected] references 1. Stewart KM. Clinical care of vulvar pruritus, with emphasis on 4. Habif T. Clinical Dermatology: A Color Guide to Diagnosis and one common cause, lichen simplex chronicus. Dermatol Clin. Therapy. 4th ed. Philadelphia, Pa: Mosby; 2003. 2010;28:669-680. 5. Burgin S. Nummular eczema and lichen simplex chroni- 2. Lynch PJ. Lichen simplex chronicus (atopic/neurodermatitis) of cus/prurigo nodularis. In: Wolff K, Goldsmith LA, Katz the anogenital region. Dermatol Ther. 2004;17:8-19. SI, et al, eds. Fitzpatrick’s Dermatology in General Medi- 3. Prajapati V, Barankin B. Dermacase. Lichen simplex chronicus. cine. 4th ed. New York, NY: McGraw-Hill Companies; 2008: Can Fam Physician. 2008;54:1391-1393. 158-162. Visit us @ jfponline.com jfponline.com Vol 62, no 2 | february 2013 | The journal of family pracTice 99.
Load more

Recommended publications
  • 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]
  • 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]
  • Red, Weeping and Oozing P.51 6
    DERM CASE Test your knowledge with multiple-choice cases This month–9 cases: 1. Red, Weeping and Oozing p.51 6. A Chronic Condition p.56 2. A Rough Forehead p.52 7. “Why am I losing hair?” p.57 3. A Flat Papule p.53 8. Bothersome Bites p.58 4. Itchy Arms p.54 9. Ring-like Rashes p.59 5. A Patchy Neck p.55 on © buti t ri , h ist oad rig D wnl Case 1 y al n do p ci ca use o er sers nal C m d u rso m rise r pe o utho y fo C d. A cop or bite ngle Red, Weleepirnohig a sind Oozing a se p rint r S ed u nd p o oris w a t f uth , vie o Una lay AN12-year-old boy dpriesspents with a generalized, itchy rash over his body. The rash has been present for two years. Initially, the lesions were red, weeping and oozing. In the past year, the lesions became thickened, dry and scaly. What is your diagnosis? a. Psoriasis b. Pityriasis rosea c. Seborrheic dermatitis d. Atopic dermatitis (eczema) Answer Atopic dermatitis (eczema) (answer d) is a chroni - cally relapsing dermatosis characterized by pruritus, later by a widespread, symmetrical eruption in erythema, vesiculation, papulation, oozing, crust - which the long axes of the rash extend along skin ing, scaling and, in chronic cases, lichenification. tension lines and give rise to a “Christmas tree” Associated findings can include xerosis, hyperlin - appearance. Seborrheic dermatitis is characterized earity of the palms, double skin creases under the by a greasy, scaly, non-itchy, erythematous rash, lower eyelids (Dennie-Morgan folds), keratosis which might be patchy and focal and might spread pilaris and pityriasis alba.
    [Show full text]
  • Common Dermatoses in Patients with Obsessive Compulsive Disorders Mircea Tampa Carol Davila University of Medicine and Pharmacy, Tampa [email protected]
    Journal of Mind and Medical Sciences Volume 2 | Issue 2 Article 7 2015 Common Dermatoses in Patients with Obsessive Compulsive Disorders Mircea Tampa Carol Davila University of Medicine and Pharmacy, [email protected] Maria Isabela Sarbu Victor Babes Hospital for Infectious and Tropical Diseases, [email protected] Clara Matei Carol Davila University of Medicine and Pharmacy Vasile Benea Victor Babes Hospital for Infectious and Tropical Diseases Simona Roxana Georgescu Carol Davila University of Medicine and Pharmacy Follow this and additional works at: http://scholar.valpo.edu/jmms Part of the Medicine and Health Sciences Commons Recommended Citation Tampa, Mircea; Sarbu, Maria Isabela; Matei, Clara; Benea, Vasile; and Georgescu, Simona Roxana (2015) "Common Dermatoses in Patients with Obsessive Compulsive Disorders," Journal of Mind and Medical Sciences: Vol. 2 : Iss. 2 , Article 7. Available at: http://scholar.valpo.edu/jmms/vol2/iss2/7 This Review Article is brought to you for free and open access by ValpoScholar. It has been accepted for inclusion in Journal of Mind and Medical Sciences by an authorized administrator of ValpoScholar. For more information, please contact a ValpoScholar staff member at [email protected]. JMMS 2015, 2(2): 150- 158. Review Common dermatoses in patients with obsessive compulsive disorders Mircea Tampa1, Maria Isabela Sarbu2, Clara Matei1, Vasile Benea2, Simona Roxana Georgescu1 1 Carol Davila University of Medicine and Pharmacy, Department of Dermatology and Venereology 2 Victor Babes Hospital for Infectious and Tropical Diseases, Department of Dermatology and Venereology Corresponding author: Maria Isabela Sarbu, e-mail: [email protected] Running title: Dermatoses in obsessive compulsive disorders Keywords: Factitious disorders, obsessive-compulsive disorders, acne excoriee www.jmms.ro 2015, Vol.
    [Show full text]
  • Lichen Simplex Chronicus
    LICHEN SIMPLEX CHRONICUS http://www.aocd.org Lichen simplex chronicus is a localized form of lichenified (thickened, inflamed) atopic dermatitis or eczema that occurs in well defined plaques. It is the result of ongoing, chronic rubbing and scratching of the skin in localized areas. It is generally seen in patients greater than 20 years of age and is more frequent in women. Emotional stress can play a part in the course of this skin disease. There is mainly one symptom: itching. The rubbing and scratching that occurs in response to the itch can become automatic and even unconscious making it very difficult to treat. It can be magnified by seeming innocuous stimuli such as putting on clothes, or clothes rubbing the skin which makes the skin warmer resulting in increased itch sensation. The lesions themselves are generally very well defined areas of thickened, erythematous, raised area of skin. Frequently they are linear, oval or round in shape. Sites of predilection include the back of the neck, ankles, lower legs, upper thighs, forearms and the genital areas. They can be single lesions or multiple. This can be a very difficult condition to treat much less resolve. It is of utmost importance that the scratching and rubbing of the skin must stop. Treatment is usually initiated with topical corticosteroids for larger areas and intralesional steroids might also be considered for small lesion(s). If the patient simply cannot keep from rubbing the area an occlusive dressing might be considered to keep the skin protected from probing fingers. Since this is not a histamine driven itch phenomena oral antihistamines are generally of little use in these cases.
    [Show full text]
  • Photodermatoses  Update Knowledge and Treatment of Photodermatoses  Discuss Vitamin D Levels in Photodermatoses
    Ashley Feneran, DO Jenifer Lloyd, DO University Hospitals Regional Hospitals AMERICAN OSTEOPATHIC COLLEGE OF DERMATOLOGY Objectives Review key points of several photodermatoses Update knowledge and treatment of photodermatoses Discuss vitamin D levels in photodermatoses Types of photodermatoses Immunologically mediated disorders Defective DNA repair disorders Photoaggravated dermatoses Chemical- and drug-induced photosensitivity Types of photodermatoses Immunologically mediated disorders Polymorphous light eruption Actinic prurigo Hydroa vacciniforme Chronic actinic dermatitis Solar urticaria Polymorphous light eruption (PMLE) Most common form of idiopathic photodermatitis Possibly due to delayed-type hypersensitivity reaction to an endogenous cutaneous photo- induced antigen Presents within minutes to hours of UV exposure and lasts several days Pathology Superficial and deep lymphocytic infiltrate Marked papillary dermal edema PMLE Treatment Topical or oral corticosteroids High SPF Restriction of UV exposure Hardening – natural, NBUVB, PUVA Antimalarial PMLE updates Study suggests topical vitamin D analogue used prophylactically may provide therapeutic benefit in PMLE Gruber-Wackernagel A, Bambach FJ, Legat A, et al. Br J Dermatol, 2011. PMLE updates Study seeks to further elucidate the pathogenesis of PMLE Found a decrease in Langerhans cells and an increase in mast cell density in lesional skin Wolf P, Gruber-Wackernagel A, Bambach I, et al. Exp Dermatol, 2014. Actinic prurigo Similar to PMLE Common in native
    [Show full text]
  • Triamcinolone Acetonide Injectable Suspension, USP)
    KENALOG®-10 INJECTION (triamcinolone acetonide injectable suspension, USP) NOT FOR USE IN NEONATES CONTAINS BENZYL ALCOHOL For Intra-articular or Intralesional Use Only NOT FOR INTRAVENOUS, INTRAMUSCULAR, INTRAOCULAR, EPIDURAL, OR INTRATHECAL USE DESCRIPTION Kenalog®-10 Injection (triamcinolone acetonide injectable suspension, USP) is triamcinolone acetonide, a synthetic glucocorticoid corticosteroid with marked anti-inflammatory action, in a sterile aqueous suspension suitable for intralesional and intra-articular injection. THIS FORMULATION IS SUITABLE FOR INTRA-ARTICULAR AND INTRALESIONAL USE ONLY. Each mL of the sterile aqueous suspension provides 10 mg triamcinolone acetonide, with 0.66% sodium chloride for isotonicity, 0.99% (w/v) benzyl alcohol as a preservative, 0.63% carboxymethylcellulose sodium, and 0.04% polysorbate 80. Sodium hydroxide or hydrochloric acid may have been added to adjust pH between 5.0 and 7.5. At the time of manufacture, the air in the container is replaced by nitrogen. The chemical name for triamcinolone acetonide is 9-Fluoro-11β,16α,17,21-tetrahydroxypregna- 1,4-diene-3,20-dione cyclic 16,17-acetal with acetone. Its structural formula is: 1 Reference ID: 4241593 MW 434.50 CLINICAL PHARMACOLOGY Glucocorticoids, naturally occurring and synthetic, are adrenocortical steroids that are readily absorbed from the gastrointestinal tract. Naturally occurring glucocorticoids (hydrocortisone and cortisone), which also have salt- retaining properties, are used as replacement therapy in adrenocortical deficiency states.
    [Show full text]
  • Adolescent with Rash on Face and Scalp
    Photo RoUNDS Anna K. Allred, BS; Nancye K. McCowan, Adolescent with rash on face MS, MD; Robert Brodell, MD University of Mississippi and scalp Medical Center (Ms. Allred); Division of Dermatology, University What was causing a hypopigmented, slightly scaly facial of Mississippi Medical Center, Jackson (Drs. rash and dandruff in this otherwise healthy teenager? McCowan and Brodell); University of Rochester School of Medicine and Dentistry, NY (Dr. Brodell) A 13-year-old African American male popigmentation in the nasomesial folds and [email protected] presented with a 2-year history of a mildly eyebrows, and diffuse scaling and erythema DEpartment EDItOR pruritic central facial rash (FIGURE) and dan- throughout his scalp. Richard p. Usatine, MD druff. Recent treatment with hydrocortisone University of Texas 1% cream and nystatin cream (100,000 U/gm) Health Science Center at San Antonio for 1 week resulted in no improvement. ● What is youR diAgnosis? The patient had no history to suggest an Ms. Allred and Dr. McCowan allergic contact dermatitis or drug allergy. He ● HoW Would you TReAT THIS reported no potential conflict of interest relevant to this article. had confluent scaling and erythema with hy- pATIENT? Dr. Brodell serves on speaker’s bureaus for Allergan, Galderma, and PharmaDerm, has served as a consultant and on advisory Figure boards for Galderma, and is an investigator/received grant/research support from Slight scale and hypopigmentation in the nasomesial folds Genentech. PHO T o COU RT ESY OF : R o B e RT BR ODELL , MD jfponline.com Vol 63, no 4 | ApRIL 2014 | The jouRnAl of Family PracTice 209 PHOTO RoUNDS Diagnosis: the Malassezia yeast and topical steroids are Seborrheic dermatitis used to suppress inflammation.
    [Show full text]
  • Guías Diagnósticas Y Terapeúticas De Las 10 Patologías Más Frecuentes
    HOSPITAL INFANTIL DE MÉXICO “FEDERICO GÓMEZ” SERVICIO DE DERMATOLOGÍA GUÍAS DIAGNÓSTICAS Y TERAPÉUTICAS DE LAS 10 PATOLOGÍAS MÁS FRECUENTES DR CARLOS ALFREDO MENA CEDILLOS, JEFE DEL SERVICIO DRA ADRIANA MARÍA VALENCIA HERRERA DERMATITIS ATOPICA SINONIMIA. Neurodermatitis, prurigo de Besnier, eccema del lactante. DEFINICION. Enfermedad reaccional, crónica y recidivante de la piel, con un patrón clínico e historia natural característicos. No se conoce la causa específica, pero se ha relacionado con susceptibilidad genética, disturbios inmuológicos y constitucionales, sobre los que actúan factores desencadenantes. EPIDEMIOLOGIA: Es la dermatosis más frecuente en población pediátrica. La prevalencia ha mostrando incremento en las últimas décadas, siendo del 18-20%. Es mas frecuente en áreas urbanas de países industrializados, especialmente en inmigrantes provenientes de países con menor prevalencia. No existe clara predilección racial ni diferencia en cuanto al sexo. Puede presentarse a cualquier edad, con claro predominio en la población pediátrica, 60-85% de los casos inicia en el primer año de vida y 85-95% antes de los 5 años; 10-25% de los casos persiste con recaídas en la edad adulta. ETIOPATOGENIA. La etiología es desconocida pero parece ser resultado de una compleja interacción aspectos genéticos, inmunológicos y defectos en la barrera epidérmica, existiendo múltiples factores descencadenantes, queactúan sobre un terreno constitucionalmente alterado. 1. Anomalías genéticas. Tiene clara naturaleza familiar, pero no se ha precisado el mecanismo de herencia, existiendo en 70% de los pacientes antecedentes de atopia. Los antígenos de histocompatibilidad HL-A9, HL-A3, HL-B12 y HL-Bw40 se han descrito en estos pacientes. 2. Disturbios inmunológicos. Existen cambios significativos en la inmunidad humoral y celular.
    [Show full text]
  • Skin Manifestations of Systemic Disease
    THEME WEIRD SKIN STUFF Adriene Lee BSc(Med), MBBS(Hons), FACD, is visiting dermatologist, St Vincent's Hospital and Monash Medical Centre, and Lecturer, Department of General Practice, Monash University, Victoria. [email protected] Skin manifestations of systemic disease Dermatologic complaints are a common reason for Background presentation to a general practitioner. In such cases, one needs Dermatologic complaints are a common reason for presentation to determine if the complaint may be a manifestation of a more to a general practitioner. In some cases, one needs to determine serious underlying systemic disease. Disorders of the every if the complaint may be a manifestation of a more serious underlying systemic disease. organ system may cause skin symptoms and signs, some of which are due to treatment of these conditions. It is beyond the Objective scope of this review to cover all potential skin manifestations of This article aims to highlight common dermatologic systemic disease. This article highlights the more common, presentations where further assessment is needed to exclude classic and important manifestations in three different groups: an underlying systemic disease, to discuss classic cutaneous features of specific systemic diseases, and to outline rare • ‘When to look further’ – where dermatologic presentations cutaneous paraneoplastic syndromes. require further assessment to exclude underlying systemic disease, and guide appropriate management Discussion • ‘What to look for’ – where certain systemic diseases have Skin manifestations of systemic disease are wide, varied, classic cutaneous findings specific and nonspecific. Generalised pruritus and cutaneous • ‘What not to miss’ – where specific cutaneous signs might be vasculitis are more common cutaneous presentations where an underlying systemic disease may be present and will the initial presentation of an underlying malignancy.
    [Show full text]
  • Atopic Dermatitis (Eczema) •Chronic Inflammatory Skin Disease That Begins During Infancy Or Early Childhood
    9/18/2019 Pediatric Dermatology Jennifer Abrahams, MD, FAAD, DTM&H Collaborators: Kate Oberlin, MD; Nayoung Lee MD September 27th, 2019 1 Disclosures • Nothing to disclose 2 1 9/18/2019 Disclaimer *Pediatric dermatology is taught over 3 years of derm-specific residency training and there is an additional year of subspecialized fellowship! *We won’t cover all of pediatric derm in an hour but I hope to give you some common highlights 3 A 9 month old infant presents with the following skin lesions. Which of the following is most likely true of this disease? A.) Asthma generally precedes skin findings B.) The majority of affected children will outgrow the skin disease C.) There is no way to avoid or decrease risk of progression of the disease D.) Genetic factors account for approx 1% of susceptibility to early onset of this disease 4 2 9/18/2019 A 9 month old infant presents with the following skin lesions. Which of the following is most likely true of this disease? A.) Asthma generally precedes skin findings B.) The majority of affected children will outgrow the skin disease C.) There is no way to avoid or decrease risk of progression of the disease D.) Genetic factors account for approx 1% of susceptibility to early onset of this disease 5 6 3 9/18/2019 Atopic Dermatitis (Eczema) •Chronic inflammatory skin disease that begins during infancy or early childhood •Often associated with other “atopic” disorders • Asthma • Allergic rhinitis (seasonal allergies) • Food allergies •Characterized by intense itch and a chronic relapsing course •Prevalence almost 30% in developed countries 7 Table courtesy of Bolognia, et al.
    [Show full text]
  • Views in Allergy and Immunology
    CLINICAL REVIEWS IN ALLERGY AND IMMUNOLOGY Dermatology for the Allergist Dennis Kim, MD, and Richard Lockey, MD specific laboratory tests and pathognomonic skin findings do Abstract: Allergists/immunologists see patients with a variety of not exist (Table 1). skin disorders. Some, such as atopic and allergic contact dermatitis, There are 3 forms of AD: acute, subacute, and chronic. are caused by abnormal immunologic reactions, whereas others, Acute AD is characterized by intensely pruritic, erythematous such as seborrheic dermatitis or rosacea, lack an immunologic basis. papules associated with excoriations, vesiculations, and se- This review summarizes a select group of dermatologic problems rous exudates. Subacute AD is associated with erythematous, commonly encountered by an allergist/immunologist. excoriated, scaling papules. Chronic AD is associated with Key Words: dermatology, dermatitis, allergy, allergic, allergist, thickened lichenified skin and fibrotic papules. There is skin, disease considerable overlap of these 3 forms, especially with chronic (WAO Journal 2010; 3:202–215) AD, which can manifest in all 3 ways in the same patient. The relationship between AD and causative allergens is difficult to establish. However, clinical studies suggest that extrinsic factors can impact the course of disease. Therefore, in some cases, it is helpful to perform skin testing on foods INTRODUCTION that are commonly associated with food allergy (wheat, milk, llergists/immunologists see patients with a variety of skin soy, egg, peanut, tree nuts, molluscan, and crustaceous shell- Adisorders. Some, such as atopic and allergic contact fish) and aeroallergens to rule out allergic triggers that can dermatitis, are caused by abnormal immunologic reactions, sometimes exacerbate this disease.
    [Show full text]