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The Nutritional Relationships of Zinc David L
The Nutritional Relationships of Zinc David L. Watts, D.C., Ph.D., F.A.C.E.P.i Zinc was discovered to be essential for the also indicate tissue redistribution.12 The normal growth of living organisms in 1869. The range of zinc in the hair has been reported suspicion that zinc deficiency occurs in man is between 15 and 22 milligrams percent,4 the ideal relatively recent. In 1963, studies reported by being 20 milligrams Prasad and co-workers on Iranian men suffering percent. from dwarfism and hypogonadism found that nutritional zinc deficiency was a causative factor Manifestations of Zinc Deficiency Absolute or in these disorders.1 2 3 Since that time zinc has Relative gained a greater recognition for its role in human Manifestations of zinc deficiency will vary health and has stimulated extensive research. It is from one individual to another. This is true of now known that zinc is essential to over 100 almost any nutrient, and can be explained by enzymes in the body. Perhaps one of the most recognizing that two types of a deficiency state important discoveries is zinc's involvement in the can occur, either a relative deficiency, or synthesis of RNA. absolute deficiency. An absolute deficiency develops as a result of inhibited absorption Distribution accompanied by a concurrent increase in zinc The highest concentration of zinc is found in excretion or utilization. TMA patterns usually the choroid of the eye and optic nerve, followed reveal a low tissue zinc (less than 12 mg.%). An by the prostate, bone, liver and kidneys, muscles absolute deficiency of zinc can be contributed to (zinc content varies with colour and function of by hypoadrenocorticism, hyperthyroidism and muscles), heart, spleen, testes, brain, and other endocrine factors. -
The Skin in the Ehlers-Danlos Syndromes
EDS Global Learning Conference July 30-August 1, 2019 (Nashville) The Skin in the Ehlers-Danlos Syndromes Dr Nigel Burrows Consultant Dermatologist MD FRCP Department of Dermatology Addenbrooke’s Hospital Cambridge University NHS Foundation Trust Cambridge, UK No conflict of interests or disclosures Burrows, N: The Skin in EDS 1 EDS Global Learning Conference July 30-August 1, 2019 (Nashville) • Overview of skin and anatomy • Skin features in commoner EDS • Skin features in rarer EDS subtypes • Skin management The skin • Is useful organ to sustain life ØProtection - microorganisms, ultraviolet light, mechanical damage ØSensation ØAllows movement ØEndocrine - vitamin D production ØExcretion - sweat ØTemperature regulation Burrows, N: The Skin in EDS 2 EDS Global Learning Conference July 30-August 1, 2019 (Nashville) The skin • Is useful organ to sustain life • Provides a visual clue to diagnoses • Important for cultures and traditions • Ready material for research Skin Fun Facts • Largest organ in the body • In an average adult the skin weighs approx 5kg (11lbs) and covers 2m2 (21 sq ft) • 11 miles of blood vessels • The average person has about 300 million skin cells • More than half of the dust in your home is actually dead skin • Your skin is home to more than 1,000 species of bacteria Burrows, N: The Skin in EDS 3 EDS Global Learning Conference July 30-August 1, 2019 (Nashville) The skin has 3 main layers Within the Dermis Extracellular Matrix 1. Collagen 2. Elastic fibres 3. Ground Substances i) glycosaminoglycans, ii) proteoglycans, -
Rapid Development of Perifolliculitis Following Mesotherapy
CASE LETTER Rapid Development of Perifolliculitis Following Mesotherapy Weihuang Vivian Ning, MD; Sameer Bashey, MD; Gene H. Kim, MD patient received mesotherapy with an unknown substance PRACTICE POINTS for cosmetic rejuvenation; the rash was localized only to the injection sites.copy She did not note any fever, chills, • Mesotherapy—the delivery of vitamins, chemicals, and plant extracts directly into the dermis via nausea, vomiting, diarrhea, headache, arthralgia, or upper injections—is a common procedure performed respiratory tract symptoms. She further denied starting in both medical and nonmedical settings for any new medications, herbal products, or topical therapies cosmetic rejuvenation. apart from the procedure she had received 2 weeks prior. • Complications can occur from mesotherapy treatment. Thenot patient was found to be in no acute distress and • Patients should be advised to seek medical care with vital signs were stable. Laboratory testing was remarkable US Food and Drug Administration–approved cosmetic for elevations in alanine aminotransferase (62 U/L [refer- techniques and substances only. ence range, 10–40 U/L]) and aspartate aminotransferase (72 U/L [reference range 10–30 U/L]). Moreover, she had Doan absolute neutrophil count of 0.5×103 cells/µL (refer- ence range 1.8–8.0×103 cells/µL). An electrolyte panel, To the Editor: creatinine level, and urinalysis were normal. Physical Mesotherapy, also known as intradermotherapy, is a examination revealed numerous 4- to 5-mm erythematous cosmetic procedure in which multiple -
Immunocompromised Districts of Skin: a Case Series and a Literature Review
ID Design Press, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2019 Sep 30; 7(18):2969-2975. https://doi.org/10.3889/oamjms.2019.680 eISSN: 1857-9655 Global Dermatology Immunocompromised Districts of Skin: A Case Series and a Literature Review Aleksandra Vojvodic1, Michael Tirant2,3, Veronica di Nardo2, Torello Lotti2, Uwe Wollina4* 1Department of Dermatology and Venereology, Military Medical Academy of Belgrade, Belgrade, Serbia; 2Department of Dermatology, University of Rome “G. Marconi”, Rome, Italy; 3Hanoi Medical University, Hanoi, Vietnam; 4Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany Abstract Citation: Vojvodic A, Tirant M, di Nardo V, Lotti T, BACKGROUND: The concept of immunocompromised districts of skin has been developed by Ruocco and helps Wollina U. Immunocompromised Districts of Skin: A Case to explain certain aspects of the macromorphology of skin diseases. This concept unites the isomorphic response Series and a Literature Review. Open Access Maced J Med Sci. 2019 Sep 30; 7(18):2969-2975. of Koebner and the isotopic response of Wolf. https://doi.org/10.3889/oamjms.2019.680 Keywords: Immunocompromised districts of the skin; CASE REPORTS: We present different cutaneous conditions which can lead to immunocompromised districts of Macromorphology of skin diseases; Koebner skin such as scars, radiodermatitis, lymphedema, disturbed innervation or mechanical friction etc. Typical and phenomenon; Wolf’s isotopic response rarer skin disorders associated with them are discussed and illustrated by their observations. *Correspondence: Uwe Wollina. Department of Dermatology and Allergology, Städtisches Klinikum CONCLUSION: At this moment, we wish to inform dermatologists and non-dermatologists about Ruocco’s Dresden, Academic Teaching Hospital, 01067 Dresden, Germany. -
Prior Authorization Topical Retinoids – Tazarotene Products
Cigna National Formulary Coverage Policy Prior Authorization Topical Retinoids – Tazarotene Products Table of Contents Product Identifier(s) National Formulary Medical Necessity ................ 1 01541 Conditions Not Covered....................................... 2 Background .......................................................... 2 References .......................................................... 2 Revision History ................................................... 3 INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. References to standard benefit plan language and coverage determinations do not apply to those clients. Coverage Policies are intended to provide guidance in interpreting certain standard benefit plans administered by Cigna Companies. Please note, the terms of a customer’s particular benefit plan document [Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which these Coverage Policies are based. For example, a customer’s benefit plan document may contain a specific exclusion related to a topic addressed in a Coverage Policy. In the event of a conflict, a customer’s benefit plan document always supersedes the information in the Coverage Policies. In the absence of a controlling federal or state coverage mandate, benefits are ultimately determined by the terms of the applicable benefit plan document. Coverage determinations in each specific instance require consideration of 1) the terms of the applicable benefit plan document in effect on the date of service; 2) any applicable laws/regulations; 3) any relevant collateral source materials including Coverage Policies and; 4) the specific facts of the particular situation. -
Fundamentals of Dermatology Describing Rashes and Lesions
Dermatology for the Non-Dermatologist May 30 – June 3, 2018 - 1 - Fundamentals of Dermatology Describing Rashes and Lesions History remains ESSENTIAL to establish diagnosis – duration, treatments, prior history of skin conditions, drug use, systemic illness, etc., etc. Historical characteristics of lesions and rashes are also key elements of the description. Painful vs. painless? Pruritic? Burning sensation? Key descriptive elements – 1- definition and morphology of the lesion, 2- location and the extent of the disease. DEFINITIONS: Atrophy: Thinning of the epidermis and/or dermis causing a shiny appearance or fine wrinkling and/or depression of the skin (common causes: steroids, sudden weight gain, “stretch marks”) Bulla: Circumscribed superficial collection of fluid below or within the epidermis > 5mm (if <5mm vesicle), may be formed by the coalescence of vesicles (blister) Burrow: A linear, “threadlike” elevation of the skin, typically a few millimeters long. (scabies) Comedo: A plugged sebaceous follicle, such as closed (whitehead) & open comedones (blackhead) in acne Crust: Dried residue of serum, blood or pus (scab) Cyst: A circumscribed, usually slightly compressible, round, walled lesion, below the epidermis, may be filled with fluid or semi-solid material (sebaceous cyst, cystic acne) Dermatitis: nonspecific term for inflammation of the skin (many possible causes); may be a specific condition, e.g. atopic dermatitis Eczema: a generic term for acute or chronic inflammatory conditions of the skin. Typically appears erythematous, -
Case Report an Exophytic and Symptomatic Lesion of the Labial Mucosa Diagnosed As Labial Seborrheic Keratosis
Int J Clin Exp Pathol 2019;12(7):2749-2752 www.ijcep.com /ISSN:1936-2625/IJCEP0093949 Case Report An exophytic and symptomatic lesion of the labial mucosa diagnosed as labial seborrheic keratosis Hui Feng1,2, Binjie Liu1, Zhigang Yao1, Xin Zeng2, Qianming Chen2 1XiangYa Stomatological Hospital, Central South University, Changsha 410000, Hunan, P. R. China; 2State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, P. R. China Received March 16, 2019; Accepted April 23, 2019; Epub July 1, 2019; Published July 15, 2019 Abstract: Seborrheic keratosis is a common benign epidermal tumor that occurs mainly in the skin of the face and neck, trunk. The tumors are not, however, seen on the oral mucous membrane. Herein, we describe a case of labial seborrheic keratosis confirmed by histopathology. A healthy 63-year-old man was referred to our hospital for evalu- ation and treatment of a 2-month history of a labial mass with mild pain. Clinically, the initial impressions were ma- lignant transformation of chronic discoid lupus erythematosus, syphilitic chancre, or keratoacanthoma. Surprisingly, our laboratory results and histopathologic evaluations established a novel diagnosis of a hyperkeratotic type of labial seborrheic keratosis (SK). This reminds us that atypical or varying features of seborrheic keratosis make it difficult to provide an accurate diagnosis. Clinical manifestations of some benign lesions may be misdiagnosed as malignancy. Consequently, dentists should consider this as a differential diagnosis in labial or other oral lesions. Keywords: Seborrheic keratosis, exophytic lesion, symptomatic lesion, labial mucosa, oral mucous membrane Introduction findings were revealed in his medical history, and he had no known allergies to foods or me- Seborrheic keratosis is a common benign epi- dications. -
Acanthosis Nigricans As a Presentation of Severe Insulin
Acanthosis nigricans as a presentation of severe insulin resistance in obese children - a case report - Maria Krajewska, Jędrzej Nowaczyk, Dominika Labochka, Anna Kucharska, Beata Pyrżak Department of Paediatrics and Endocrinology, Medical University of Warsaw, Poland Acanthosis nigricans • Acanthosis nigricans is well known as the skin symptom of insulin resistance, nevertheless children with such skin disorders usually undergo a long way until they are properly diagnosed. • We would like to present the history of two young patients with severe acanthosis nigricans combined with insulin resistance of major grade. Patient 1 Patient 2 A 13-year-old boy referred to the Clinic by dermatologist due to acanthosis nigricans and obesity. A 14-year-old boy referred to the Clinic by general pediatrician due to acanthosis nigricans and obesity. Medical history: Medical history: •born with the forces of nature, from uncomplicated pregnancy, 40 weeks, with body weight 2700g. Delayed • born from uncomplicated pregnancy with the forces of nature, 38 weeks, body psychomotor development since the infancy period. Negative history of chronic diseases and taking weight 3100g, length 51 cm, in infancy fed with modified milk, negative history medications of chronic diseases and taking medications •excessive body weight from the early childhood: • excessive body weight from the age of five: frequent and irregular eating insufficient physical activity frequent and irregular eating, large amounts of sweets and sweet drinks (up to •family history: grandmother suffers from type 2 diabetes, brother is suffering from autism, negative history of 4-5 liters per day), insufficient physical activity; familial acanthosis nigricans and obesity acanthosis nigricans was noticed at the age of 12 years. -
Excimer Laser for Treatment of Psoriasis
Excimer and Pulsed Dye Laser Treatment Last Revision/Review Date: May 19, 2021 P&P # C.6.28 Policy This Medical Policy does not constitute medical advice. When deciding coverage, the enrollee’s specific plan document must be referenced. The terms of an enrollee’s plan document (Certificate of Coverage (COC) or Summary Plan Description (SPD)) may differ from this Medical Policy. In the event of a conflict, the enrollee’s specific benefit plan document supersedes this Medical Policy. All reviewers must first identify enrollee eligibility, any federal or state regulatory requirements, and the plan benefit coverage prior to use of this Medical Policy. Other Policies and Coverage Determination Guidelines may apply. Quartz reserves the right, in its sole discretion, to modify its Policies and Guidelines as necessary. Procedure I. Excimer Laser Treatment of Psoriasis and Vitiligo A. Documentation Required: In order to facilitate the authorization process, referral requests must include the following: 1. Dermatologist documentation of mild to moderate localized psoriasis vulgaris (plaque psoriasis) or vitiligo of the face and neck. 2. Dermatologist documentation of percent body surface area of plaque psoriasis to be treated. 3. Dermatologist documentation of failed response to previous treatment. 4. Order from a dermatologist B. Criteria for Medical Necessity-Psoriasis Initial Course of Treatment Up to 13 excimer laser treatments using an FDA approved device is considered medically necessary for the treatment of mild to moderate localized plaque psoriasis if BOTH of the following are met: 1. Treatment area of localized plaque psoriasis affects 10% or less of body surface area; AND 2. Failed response to 3 or more consecutive months of topical treatments from at least 3 of the following: a. -
Reticulate Dermatoses
[Downloaded free from http://www.e-ijd.org on Tuesday, April 08, 2014, IP: 111.93.251.154] || Click here to download free Android application for this journal CME Article Reticulate Dermatoses Keshavmurthy A Adya, Arun C Inamadar, Aparna Palit From the Department of Dermatology, Venereology and Leprosy, SBMP Medical College, Hospital and Research Center, BLDE University, Bijapur, Karnataka, India Abstract The term “reticulate” is used for clinical description of skin lesions that are configured in a net-like pattern. Many primary and secondary dermatoses present in such patterns involving specific body sites. Certain cutaneous manifestations of systemic diseases or genodermatoses also present in such manner. This review classifies and describes such conditions with reticulate lesions and briefly, their associated features. Key Words: Mottling, net-like, reticulate, retiform What was known? 3. Poikilodermatous Reticulate configuration of lesions is seen in many primary dermatoses and a. Inherited also as cutaneous reaction patterns consequent to internal pathology. • Rothmund–Thomson syndrome • Dyskeratosis congenita Reticulate Dermatoses • Xeroderma pigmentosum • Cockayne syndrome The term “reticulate” is commonly used for clinical • Fanconi anemia description of “net-like”, “sieve-like,” or “chicken wire” • Mendes da Costa syndrome configuration of the skin lesions. Various congenital • Kindler syndrome and acquired dermatoses present with this pattern of • Degos–Touraine syndrome skin lesions. Many systemic diseases also present with • Hereditary sclerosing poikiloderma of Weary such cutaneous manifestations providing useful clues to • Hereditary acrokeratotic poikiloderma of Weary diagnosis. • Werner’s syndrome (adult progeria) Classification • Chanarin–Dorfman syndrome • Diffuse and macular atrophic dermatosis 1. Vascular b. Acquired a. Cutis marmorata • Poikiloderma of Civatte b. -
Atrophic Erythematous Facial Plaques
Photo Challenge Atrophic Erythematous Facial Plaques What’s the diagnosis? A 26-year-old woman presented with a 2-year his- tory of facial lesions that had gradually increased in size and number. Initially they were tender and pruritic but eventually became asymptomatic. She denied aggravation with sun exposure and did not use regular sun protection. Multiple pulsed dye laser treatments to the lesions had not resulted in appreciable improvement. Review of systems revealed occasional blurred vision and joint pain in her wrist and fingers of her right hand. Physical examination revealed a healthy- CUTISappearing woman. On the forehead and bilateral cheeks there were multiple atrophic, erythematous, sunken plaques with discrete borders. Each plaque measured more than 5 mm. Similar plaques were scattered across the frontal scalp, trunk, and upper extremities, though fewer in number and less atrophic with mild hyperpigmentation. There was diffuse hair thinning of the scalp. Laboratory test results included a normal complete metabolic panel, anti- nuclear antibody profile, and complete blood cell count. DoHistopathology revealed Not a superficial and mid perivascular Copy and perifollicular inflammatory infiltrate composed of lymphocytes, histiocytes, and melanophages. Vacuolar changes in the dermoepidermal junction were present. There were few dyskeratotic keratinocytes and mucin deposition present in the dermis. Direct immunofluorescence was not performed. William S. Kaufman, MD; Elizabeth K. McNamara, MD; Rita Pichardo-Geisinger, MD From Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina. The authors report no conflict of interest. Correspondence: William S. Kaufman, MD, Wake Forest University Baptist Medical Center, Department of Dermatology, Medical Center Boulevard, Winston-Salem, NC 27157 ([email protected]). -
Resident's Page
Resident’s Page SScarscars iinn ddermatology:ermatology: CClinicallinical signisignifi ccanceance BB.. AAnitha,nitha, SS.. RRagunatha,agunatha, AArunrun CC.. IInamadarnamadar Department of Dermatology, Venereology and Leprosy, BLDEA’s SBMP Medical College, Hospital and Research Centre, Bijapur, Karnataka, India AAddressddress fforor ccorrespondenceorrespondence : Dr. Arun C. Inamadar, Professorand Head, Department of Dermatology, Venereology and Leprosy, BLDEA’s SBMP Medical College, Hospital and Research Centre, Bijapur - 586103, Karnataka, India. E-mail:[email protected] [2] A scar is a scar is a scar and only a scar if you don’t ask ß1 protects the collagen from degradation. why” - Shelly and Shelly CCLASSIFICATIONLASSIFICATION OOFF SSCARSCARS[[3]3] A scar is a fibrous tissue replacement that develops as a 1. Fine line scars: Surgical scars consequence of healing at the site of a prior ulcer or 2. Wide (stretched) scars: These develop when fine wound. Cutaneous scarring is a macroscopic disturbance of line surgical scars gradually become stretched the normal structure and function of the skin architecture and widened. They are typically flat, pale, soft, manifesting itself as an elevated or depressed area, with an symptomless scars. Abdominal striae of pregnancy alteration of skin texture, color, vascularity, nerve supply can be considered as variants of these. [1] and biomechanical properties. 3. Atrophic scars: These are flat or depressed below the surrounding skin. They are generally small and Histologically, dermal scars are characterized by thickened often round with an indented or inverted centre. epidermis with a flattened dermo-epidermal junction and They commonly arise after acne or chickenpox. an abnormal organization of the dermal matrix into parallel 4.