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DERMCASE Test Your Knowledge with Multiple-Choice Cases
DERMCASE Test your knowledge with multiple-choice cases This month—5 cases: Case 1 1. “What’s wrong with my feet?” 2. “Doc...what is this spot?” 3. “My toenail looks funny!” 4. A foot problem 5. “What’s this rash?” “What’s wrong with my feet?” This 60-year-old woman has had a problem with her feet for several years. What can it be? a. Contact dermatitis b. Pustular psoriasis c. Dyshidrotic eczema d. Mycoses fungoides e. Tinea pedis Answer Pustular psoriasis (answer b) frequently involves the palms and soles. While it does The following have also been used with occur in both sexes, it is most common in mid- varying degrees of success: dle-aged women. It is characterized by recur- • oral etretinate, rent sterile pustules on an erythematous base. • tetracycline, As the pustules dry, they form brown spots. • cyclosporin and The cause of pustular psoriasis is unknown • methotrexate. and once it is established, it can last for years. Cigarette smoking has been associated with There is significant morbidity related to chron- this condition and should be discouraged. ic itch, pain and fissuring. Treatment options consists of: • oil soaks, • emollient creams and ointments, • topical steroids and • retinoid gels. Stanley Wine, MD, FRCPC, is a Dermatologist, Toronto, Ontario. The Canadian Journal of CME / June 2006 63 DERMCASE Case 2 “Doc...what is this spot?” A 42-year-old male presents with a well- defined erythematous atrophic patch with a ker- atotic, raised border. What is it? a. Squamous cell carcinoma b. Bowen’s disease c. Porokeratosis of Mibelli d. -
Clinical Features of the SAPHO Syndrome and Their Role in Choosing the Therapeutic Approach: Report of Four Patients and Review of the Literature
Acta Dermatovenerol Croat 2014;22(3):180-188 CLINICAL ARTICLE Clinical Features of the SAPHO Syndrome and their Role in Choosing the Therapeutic Approach: Report of Four Patients and Review of the Literature Branimir Anić, Ivan Padjen, Miroslav Mayer, Dubravka Bosnić, Mislav Cerovec Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Croatia Corresponding author: SUMMarY Although the SAPHO (synovitis, acne, pustulosis, hyper- Ivan Padjen, MD ostosis, osteitis) syndrome was defined as a distinct entity more than 20 years ago, its classification within the spectrum of inflammatory Department of Internal Medicine rheumatic diseases and the proper therapeutic approach are still a Division of Clinical Immunology and matter of debate. We present four patients diagnosed with the SAPHO Rheumatology syndrome treated and followed-up in our Department, demonstrating the diversity of their clinical courses and their responses to different University of Zagreb School of Medicine therapeutic approaches. We also review the clinical, laboratory, and University Hospital Centre zagreb imaging features of the SAPHO syndrome described in the relevant Kišpatićeva 12 literature. Despite the growing quantity of published data on the clini- 10000 Zagreb, Croatia cal features of the syndrome and the recognition of two disease pat- terns (inflammatory and bone remodeling disease), it is still not clear [email protected] whether these possible disease subsets require different therapeutic strategies. Tumor necrosis factor-alpha (TNF-α) inhibitors have been Received: April 8, 2014 suggested to be effective in patients with the inflammatory pattern, whereas bisphosphonates seem to be effective in patients with bone Accepted: July 10, 2014 remodeling disease; however, this is still a hypothesis not yet confirmed by adequately designed clinical studies. -
Dermatology DDX Deck, 2Nd Edition 65
63. Herpes simplex (cold sores, fever blisters) PREMALIGNANT AND MALIGNANT NON- 64. Varicella (chicken pox) MELANOMA SKIN TUMORS Dermatology DDX Deck, 2nd Edition 65. Herpes zoster (shingles) 126. Basal cell carcinoma 66. Hand, foot, and mouth disease 127. Actinic keratosis TOPICAL THERAPY 128. Squamous cell carcinoma 1. Basic principles of treatment FUNGAL INFECTIONS 129. Bowen disease 2. Topical corticosteroids 67. Candidiasis (moniliasis) 130. Leukoplakia 68. Candidal balanitis 131. Cutaneous T-cell lymphoma ECZEMA 69. Candidiasis (diaper dermatitis) 132. Paget disease of the breast 3. Acute eczematous inflammation 70. Candidiasis of large skin folds (candidal 133. Extramammary Paget disease 4. Rhus dermatitis (poison ivy, poison oak, intertrigo) 134. Cutaneous metastasis poison sumac) 71. Tinea versicolor 5. Subacute eczematous inflammation 72. Tinea of the nails NEVI AND MALIGNANT MELANOMA 6. Chronic eczematous inflammation 73. Angular cheilitis 135. Nevi, melanocytic nevi, moles 7. Lichen simplex chronicus 74. Cutaneous fungal infections (tinea) 136. Atypical mole syndrome (dysplastic nevus 8. Hand eczema 75. Tinea of the foot syndrome) 9. Asteatotic eczema 76. Tinea of the groin 137. Malignant melanoma, lentigo maligna 10. Chapped, fissured feet 77. Tinea of the body 138. Melanoma mimics 11. Allergic contact dermatitis 78. Tinea of the hand 139. Congenital melanocytic nevi 12. Irritant contact dermatitis 79. Tinea incognito 13. Fingertip eczema 80. Tinea of the scalp VASCULAR TUMORS AND MALFORMATIONS 14. Keratolysis exfoliativa 81. Tinea of the beard 140. Hemangiomas of infancy 15. Nummular eczema 141. Vascular malformations 16. Pompholyx EXANTHEMS AND DRUG REACTIONS 142. Cherry angioma 17. Prurigo nodularis 82. Non-specific viral rash 143. Angiokeratoma 18. Stasis dermatitis 83. -
12.2% 116000 120M Top 1% 154 3800
We are IntechOpen, the world’s leading publisher of Open Access books Built by scientists, for scientists 3,800 116,000 120M Open access books available International authors and editors Downloads Our authors are among the 154 TOP 1% 12.2% Countries delivered to most cited scientists Contributors from top 500 universities Selection of our books indexed in the Book Citation Index in Web of Science™ Core Collection (BKCI) Interested in publishing with us? Contact [email protected] Numbers displayed above are based on latest data collected. For more information visit www.intechopen.com 5 Expression of Tumor Necrosis Factor-Alpha (TNF-TNF-Converting Enzyme and Matrix Metalloproteinase-3 in SAPHO Syndrome Synovium - A Rare Case Accompanied by Acrodermatitis Continua of Hallopeau: A Case Report and Review of Anti-TNF-Therapy Koichiro Komiya1, Nobuki Terada1, Yoshikazu Mizoguchi2 and Harumoto Yamada3 1Department of Orthopaedic Surgery, Fujita Health University Second Hospital 2Department of Pathology, Fujita Health University Second Hospital 3Department of Orthopaedic Surgery, Fujita Health University Japan 1. Introduction Synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome is a rare disorder characterized by osteoarticular and dermatological manifestations. The denotation was first proposed by Chamot et al. in 1987 after investigation of 85 cases (Chamot et al., 1987). The most common site of SAPHO syndrome is the upper anterior chest wall, characterized by predominantly osteosclerotic lesions and hyperostosis. The axial skeleton and peripheral bones can be involved. Peripheral synovitis is also common. Skin manifestations include palmoplantar pustulosis (PPP), severe acne and various patterns of psoriasis. The pathogenesis of SAPHO syndrome has not been determined. -
Evaluation and Treatment of Subungual Hematoma
20 EMN I October 2010 Evaluation and Treatment of InFocus Subungual Hematoma By James R. Roberts, MD Author Credentials Finan- cial Disclosure: James R. Roberts, MD, is the Chair- man of the Department of Emergency Medicine and the Director of the Divi- sion of Toxicology at Mercy Catholic Medical Center, and a Professor of Emergency Medicine and Toxicology at the Drexel University College of Medicine, both in Philadelphia. Dr. Roberts has disclosed that he is a member of the Speakers Bureau for Merck Pharmaceuticals. He and all other faculty and staff in a position to 12 control the content of this CME activity have disclosed that they and their spouses/life partners (if any) have no fi- nancial relationships with, or financial interests in, any commercial companies pertaining to this educational activity. Learning Objectives: After participat- ing in this activity, the physician should be better able to: 1. Formulate a plan to identify subun- gual hematomas that require simple nail trephination vs. nail removal. 2. Select the correct method of provid- ing nail trephination. 3. Predict the need for prophylactic an- tibiotics after hematoma evacuation. 5 mergency physicians frequently deal with patients who have suf- Efered trauma to the digits. This month’s column begins a series of discus- sions on a rational approach to fingertip problems by reviewing the ubiquitous subungual hematoma (SUH). SUHs are rather common, and cause incapacitating and throbbing pain, prompting the hardiest of souls to seek relief. Even narcotics may fail to relieve the pain produced by an ex- panding subungual hematoma as it compresses the sensitive nailbed so some method to release the pressure is usually required, and is usually imme- 6 7 diately curative. -
Aars Hot Topics Member Newsletter
AARS HOT TOPICS MEMBER NEWSLETTER American Acne and Rosacea Society 201 Claremont Avenue • Montclair, NJ 07042 (888) 744-DERM (3376) • [email protected] www.acneandrosacea.org Like Our YouTube Page Visit acneandrosacea.org to Become an AARS Member and TABLE OF CONTENTS Donate Now on acneandrosacea.org/donate AARS News Register Now for the AARS 9th Annual Scientific Symposium .................................... 2 Our Officers AARS BoD Member Emmy Graber invites you to earn free CME! ............................. 3 J. Mark Jackson, MD AARS President New Medical Research The effect of 577-nm pro-yellow laser on demodex density in patients with rosacea 4 Andrea Zaenglein, MD Aspirin alleviates skin inflammation and angiogenesis in rosacea ............................. 4 AARS President-Elect Efficacy and safety of intense pulsed light using a dual-band filter ............................ 4 Split-face comparative study of fractional Er:YAG laser ............................................. 5 Joshua Zeichner, MD Evaluation of biophysical skin parameters and hair changes ..................................... 5 AARS Treasurer Dermal delivery and follicular targeting of adapalene using PAMAM dendrimers ...... 6 Therapeutic effects of a new invasive pulsed-type bipolar radiofrequency ................ 6 Bethanee Schlosser, MD Efficacy and safety of a novel water-soluble herbal patch for acne vulgaris .............. 6 AARS Secretary A clinical study evaluating the efficacy of topical bakuchiol ........................................ 7 Tolerability and efficacy of clindamycin/tretinoin versus adapalene/benzoyl peroxide7 James Del Rosso, DO Photothermal therapy using gold nanoparticles for acne in Asian patients ................ 8 Director Development of a novel freeze-dried mulberry leaf extract-based transfersome gel . 8 The efficacy and safety of dual-frequency ultrasound for improving skin hydration ... 9 Emmy Graber, MD Director Clinical Reviews Jonathan Weiss, MD What the pediatric and adolescent gynecology clinician needs to know about acne . -
SAPHO Syndrome from Hidradenitis Suppurativa Veesta Falahati, Msc, MD and Paul B
JGIM CLINICAL PRACTICE Clinical Images SAPHO Syndrome from Hidradenitis Suppurativa Veesta Falahati, MSc, MD and Paul B. Aronowitz, MD Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, CA, USA. KEY WORDS: clinical image; dermatology; diagnosis; rheumatology. SAPHO syndrome is a poorly understood inflammatory – disorder thought to be an autoimmune reaction provoked by J Gen Intern Med 35(4):1307 8 2 DOI: 10.1007/s11606-019-05131-2 an indolent inflammatory process (in this case, HS). The © Society of General Internal Medicine 2020 acronym SAPHO represents the variable presence of synovi- tis, acne, pustulosis, hyperostosis, and osteitis seen in this syndrome.3 The most common skin lesion is palmoplantar pustulosis. Osteoarticular manifestations include osteitis, hy- perostosis synovitis, arthropathy, and enthesopathy.3 Involve- 36-year-old man with 10 years of hidradenitis ment of bone and joints of the anterior chest wall is felt to be A suppurativa (HS) presented with worsened HS and joint highly characteristic. Treatment of SAPHO is variable de- pain in both hands after stopping adalimumab therapy 1 year pending on the case presentation. earlier. Examination revealed a temperature of 38.2 °C, HS lesions draining purulent material over the chest (Fig. 1), and erosions in bilateral proximal interphalangeal joints (Fig. 2). His white blood cell count was 21,000/μL and hand radio- graphs were consistent with inflammatory arthropathy. He received a diagnosis of hidradenitis suppurativa with superimposed cellulitis in the setting of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. Treatment included antibiotics and wound care. He resumed adalimumab and started doxycycline for long-term suppres- sive therapy.1 He failed to improve, and his treatment was escalated from adalimumab to secukinumab. -
Finger Injuries in Primary Care
FINGER INJURIES IN PRIMARY CARE www.orthoedu.com © 2020 ORTHOPAEDIC EDUCATIONAL SERVICES, INC. ALL RIGHTS RESERVED Faculty Disclosures • Orthopaedic Educational Services, Inc. Financial Intellectual Property No off-label product discussions American Academy of Physician Assistants Financial Splinting/Casting Workshop Director, Guide to the MSK Galaxy Course • JBJS- JOPA Journal of Orthopaedics for Physician Assistants- Associate Editor • Americian Academy of Surgical Physician Assistants – Editorial Review Board • © 2020 ORTHOPAEDIC EDUCATIONAL SERVICES, INC ALL RIGHTS RESERVED LEARNING OBJECTIVES Attendees will be able to…………… • Recognize and treat Mallet finger injuries • Recognize and treat adult Trigger finger • Recognize and treat Subungual Hematoma & Nail bed injuries • Recognize and treat Superficial Finger infections • Paronychia • Felon • Abscess • Recognize and treat Herpetic Whitlow © 2020 ORTHOPAEDIC EDUCATIONAL SERVICES, INC ALL RIGHTS RESERVED MALLET FINGER DEFORMITY © 2020 ORTHOPAEDIC EDUCATIONAL SERVICES, INC ALL RIGHTS RESERVED Epidemiology MALLET FINGER • “Baseball Finger” • 2 types injury: Soft tissue tendinous vs. Bone avulsion fracture • Pathophysiology • Occurs 2nd to disruption of terminal extensor tendon @ insertion into distal phalanx • Traumatic blow tip of finger causing eccentric flexion @ DIP jt. • Laceration dorsal finger over area to EDC insertion into distal phalanx • All injury mechanisms result in droop at DIP jt. Wieschhoff GG, Sheehan Se, Wortman JR, Et Al, Traumatic Finger Injuries: What the Orthopaedic Surgeon Wants to Know, RadioGraphics, 2016; 36(4):1106-1128 Wang QC, Johnson BA, Fingertip Injuries, Am Fam Physician 2001;63(10): 1961-6 © 2020 ORTHOPAEDIC EDUCATIONAL SERVICES, INC ALL RIGHTS RESERVED MALLET FINGER DEFORMITY Presentation: • obvious droop deformity DIP jt. • Swelling & tenderness dorsal Pictures courtesy T Gocke, PA-C DIP jt. region • Inability to actively extend finger @ DIP jt. -
Poudre School District Ssn# 21-690-002 Exhibit A
POUDRE SCHOOL DISTRICT SSN# 21-690-002 EXHIBIT A Poudre School District Employee Health Clinic Service Provision Matrix Included Acute Provided Services Billed to Excluded Illness/Physical Exam Included Acute Injury Services Medical TPA Services Services Professional services in this category Items in this category are not covered include evaluation and treatment of Services in this category are common injuries under the capitated payment and will Specifically common illnesses typical to any typically treated in a primary care office or UC. be billed to the Employee's normal excluded services. primary care practice. Initial visit Visit codes using CPT codes. Initial visit plus PSD medical insurance. All charges This list is not plus any clinically appropriate short- any clinically appropriate short-term f/u will be applied by the medical TPA exhaustive or all- term f/u appointments are also appointments are also included. E.g. Suture according to the applicable plan inclusive. included. 30- day initial pharmacy removal after a laceration repair. benefits. prescription. Acute respiratory illness: URI's, All DME supplies such as crutches, influenza, bronchitis, otitis media, Joint sprains and muscle strains; commercial splints, air casts, wheel Obstetrical Care sinus infections, pharyngitis, strep Minor burn care chairs, walkers. throat, mononucleosis. Initial evaluation, stabilization and treatment Genitourinary problems: Urinary of fractures. (Complex fractures will be Radiology imaging: Technical tract infections, STD's, Vaginitis. referred to PCP or orthopedics at the component (obtaining image) is Hospital Skin disorders: Acne, insect bites, discretion of the provider.) Non-commercial included in capitated rate. Professional Rounding or bee stings, rashes, sunburn, DME supplies needed for fracture care component (interpretation of image) inpatient care of evaluation and initial treatment of including fiberglass and plaster splinting will be performed by a radiologist and any kind. -
Chronic Non-Bacterial Osteomyelitis/Osteitis (Or CRMO) Version of 2016
https://www.printo.it/pediatric-rheumatology/IE/intro Chronic non-Bacterial Osteomyelitis/Osteitis (or CRMO) Version of 2016 1. WHAT IS CRMO 1.1 What is it? Chronic Recurrent Multifocal Osteomyelitis (CRMO) is the most severe form of Chronic Non-bacterial Osteomyelitis (CNO). In children and adolescents, the inflammatory lesions predominantly affect the metaphyses of the long bones of the lower limbs. However, lesions can occur at any site of the skeleton. Furthermore, other organs such as the skin, eyes, gastrointestinal tract and joints can be affected. 1.2 How common is it? The frequency of this disease has not been studied in detail. Based on data from European national registries, approximately 1-5 of 10,000 inhabitants might be affected. There is no gender predominance. 1.3 What are the causes of the disease? The causes are unknown. It is hypothesised that this disease is linked to a disturbance in the innate immune system. Rare diseases of bone metabolism might mimic CNO, such as hypophosphatasia, Camurati- Engelman syndrome, benign hyperostosis-pachydermoperiostosis and histiocytosis. 1.4 Is it inherited? 1 / 6 Inheritance has not been proven but is hypothesized. In fact, only a minority of cases is familial. 1.5 Why does my child have this disease? Can it be prevented? The causes are unknown to date. Preventive measures are unknown. 1.6 Is it contagious or infectious? No, it is not. In recent analyses, no causative infectious agent (such as bacteria) has been found. 1.7 What are the main symptoms? Patients usually complain of bone or joint pain; therefore, the differential diagnosis includes juvenile idiopathic arthritis and bacterial osteomyelitis. -
Memorial Sloan-Kettering Cancer Centerc Dermatology Service New
JAM ACAD DERMATOL Letters 163 VOLUME 55, NUMBER 1 Memorial Sloan-Kettering Cancer Centerc factor; an erythrocyte sedimentation rate of 100 Dermatology Service millimeters per hour; normal complements levels; New York, New York and no anemia. A bone scan revealed increased uptake in the bilateral patellae and proximal tibias The authors have no conflicts of interest to disclose. likely caused by degenerative changes and, less Correspondence to: likely, by osteomyelitis. There were multiple foci of Ralph P. Braun, MD increased uptake in the right costal cartilage. There Department of Dermatology was increased uptake in both patellas and proximal University Hospital Geneva tibias because of degenerative changes or osteomy- 24, rue Micheli-du-Crest elitis. There was an increased uptake in the mid- CH-1211 Geneva 14, Switzerland thoracic spine and sternum. Diagnoses entertained for this patient included E-mail: [email protected] the SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis [or osteomyelitis]) syndrome or the REFERENCES follicular occlusion triad with associated arthritise 1. Miyazaki A, Saida T, Koga H, Oguchi S, Suzuki T, Tsuchida T. Anatomical and histopathological correlates of the dermo- disease entities likely on a continuum rather than scopic patterns seen in melanocytic nevi on the sole: wholly distinct. The later seemed more likely be- a retrospective study. J Am Acad Dermatol 2005;53:230-6. cause hidradenitis was his most significant and 2. Braun RP, Krischer J, Saurat JH. The ‘‘wobble sign’’ in epilumi- protracted cutaneous symptom and his radiographic nescence microscopy as a novel clue to the differential diag- finding did not clearly show osteomyelitis. The nosis of pigmented skin lesions. -
View a Copy of This Licence, Visit Iveco Mmons. Org/ Licen Ses/ By/4. 0/
Leyens et al. Orphanet J Rare Dis (2021) 16:326 https://doi.org/10.1186/s13023-021-01945-8 RESEARCH Open Access The combined prevalence of classifed rare rheumatic diseases is almost double that of ankylosing spondylitis Judith Leyens1,2, Tim Th. A. Bender1,3, Martin Mücke1, Christiane Stieber4, Dmitrij Kravchenko1,5, Christian Dernbach6 and Matthias F. Seidel7* Abstract Background: Rare diseases (RDs) afect less than 5/10,000 people in Europe and fewer than 200,000 individuals in the United States. In rheumatology, RDs are heterogeneous and lack systemic classifcation. Clinical courses involve a variety of diverse symptoms, and patients may be misdiagnosed and not receive appropriate treatment. The objec- tive of this study was to identify and classify some of the most important RDs in rheumatology. We also attempted to determine their combined prevalence to more precisely defne this area of rheumatology and increase awareness of RDs in healthcare systems. We conducted a comprehensive literature search and analyzed each disease for the speci- fed criteria, such as clinical symptoms, treatment regimens, prognoses, and point prevalences. If no epidemiological data were available, we estimated the prevalence as 1/1,000,000. The total point prevalence for all RDs in rheumatol- ogy was estimated as the sum of the individually determined prevalences. Results: A total of 76 syndromes and diseases were identifed, including vasculitis/vasculopathy (n 15), arthritis/ arthropathy (n 11), autoinfammatory syndromes (n 11), myositis (n 9), bone disorders (n 11),= connective tissue diseases =(n 8), overgrowth syndromes (n 3), =and others (n 8).= Out of the 76 diseases,= 61 (80%) are clas- sifed as chronic, with= a remitting-relapsing course= in 27 cases (35%)= upon adequate treatment.