8 Minimal Variants of Atopic Eczema
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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. -
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 -
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. -
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. -
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. -
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. -
Lichen Simplex Chronicus: Easy Psychological Interventions That Every Dermatologist Should Know
SMGr up Review Article SM Dermatology Lichen Simplex Chronicus: Easy Journal Psychological Interventions that Every Dermatologist Should Know Julio Torales1*, Iván Barrios2, Liz Lezcano3 and Beatriz Di Martino4 1Professor and Head of the Psychodermatology Unit, Clinicas Hospital, National University of Asunción, Paraguay, USA 2Student fellow, Neuroscience Department, Clinicas Hospital, National University of Asunción, Paraguay, USA 3Professor of Dermatology, Clinicas Hospital, National University of Asunción, Paraguay, USA 4Professor and Head of the Dermato-pathology Unit, Clinicas Hospital, National University of Asunción, Paraguay, USA Article Information Abstract Received date: Jul 02, 2016 Lichen Simplex Chronicus (LSC) is a chronic skin disease characterized by lichenified plaques, which Accepted date: Nov 04, 2016 occur as result of constant scratching or rubbing of skin. Pruritus is the predominant symptom that leads to the development of LSC. Frequent pruritus triggers include mechanical irritation, environmental factors, such as heat Published date: Nov 10, 2016 and sweating, and psychological factors, such as stress and anxiety. *Corresponding author From a psychodermatology point of view, the interruption of the never-ending itch-scratch cycle, which characterizes LSC, is of supreme importance for patient’s recovery. Furthermore, emotional tensions, as seen Julio Torales, Professor and Head in patients with anxiety, depression, or obsessive-compulsive disorder, may play a key role in inducing a pruritic of the Psychodermatology Unit, sensation, leading to scratching that can become self-perpetuating. National University of Asunción, Referral to a psychiatrist or a psychotherapist might be required in many cases. However, this referral San Lorenzo - Paraguay, USA, could be difficult in daily practice, given the patient’s unwillingness to seek mental health counseling. -
Experience of the National Scottish Photobiology Service (1989–2015) H Naasan1, RS Dawe2, H Moseley3, SH Ibbotson4
J R Coll Physicians Edinb 2017; 47: 345–50 | doi: 10.4997/JRCPE.2017.408 PAPER A review of photodiagnostic investigations over 26 years: experience of the National Scottish Photobiology Service (1989–2015) H Naasan1, RS Dawe2, H Moseley3, SH Ibbotson4 ClinicalBackground The Scottish Photobiology Service is the national referral Correspondence to: pathway for patients with cutaneous photosensitivity diseases in Scotland. H Naasan Abstract We reviewed the pattern of diagnosis of photosensitivity diseases and Dermatology Department investigations performed between 1989 and 2015. Ninewells Hospital & Medical School Methods and Results Data were collected from the Photodiagnostic Dundee Database, annual reports and paper records. The total number of patients assessed each UK year was stable over the period studied (median 242 [range 231–266]), with most being new patients (median 69 [range 62–73]%). Monochromator phototesting was the most utilised Email: investigation, although the use of provocation testing and photopatch testing has increased. The [email protected] most common diagnosis was polymorphic light eruption, and there was a trend to increasing diagnosis of photoaggravated atopic eczema. Conclusions The pattern of diagnosis of photosensitivity diseases remains fairly stable in Scotland and we wish to emphasise the importance of this Scottish specialist service for patients with photosensitivity diseases and referrers. Keywords: national service, photobiology, photodermatosis, photosensitivity diseases Declaration of interests: No confl ict of interests declared Introduction whether they are or are not abnormally photosensitive and, if so, which wavelengths they are sensitive to and the Abnormal photosensitivity typically presents as a heightened degree and type of photosensitivity, is essential for accurate exaggerated sunburn-like reaction to sunlight or daylight diagnosis, optimised management and holistic patient care. -
Dermatology Grand Rounds 2019 Skin Signs of Internal Disease
Dermatology Grand Rounds 2019 skin signs of internal disease John Strasswimmer, MD, PhD Affiliate Clinical Professor (Dermatology), FAU College of Medicine Research Professor of Biochemistry, FAU College of Science Associate Clinical Professor, U. Miami Miller School of Medicine Dermatologist and Internal Medicine “Normal” abnormal skin findings in internal disease • Thyroid • Renal insufficiency • Diabetes “Abnormal” skin findings as clue to internal disease • Markers of infectious disease • Markers of internal malignancy risk “Consultation Cases” • Very large dermatology finding • A very tiny dermatology finding Dermatologist and Internal Medicine The "Red and Scaly” patient “Big and Small” red rashes not to miss The "Red and Scaly” patient • 29 Year old man with two year pruritic eruption • PMHx: • seasonal allergies • childhood eczema • no medications Erythroderma Erythroderma • Also called “exfoliative dermatitis” • Not stevens-Johnson / toxic epidermal necrosis ( More sudden onset, associated with target lesions, mucosal) • Generalized erythema and scale >80-90% of body surface • May be associated with telogen effluvium It is not a diagnosis per se Erythroderma Erythroderma Work up 1) Exam for pertinent positives and negatives: • lymphadenopathy • primary skin lesions (i.e. nail pits of psoriasis) • mucosal involvement • Hepatosplenomagaly 2) laboratory • Chem 7, LFT, CBC • HIV • Multiple biopsies over time 3) review of medications 4) age-appropriate malignancy screening 5) evaluate hemodynamic stability Erythroderma Management 1) -
Menlo Therapeutics Inc. June 2019
Menlo Therapeutics Inc. June 2019 Developing Serlopitant, a Once-Daily Oral NK1 Receptor Antagonist for Pruritus Safe Harbor Statements Special Note Regarding Forward-Looking Statements This presentation contains forward-looking statements, including statements about our plans to develop and commercialize our product candidates, our planned clinical trials for serlopitant, the timing of the availability of data from our clinical trials, the timing of our planned regulatory filings, the timing of and our ability to obtain and maintain regulatory approvals for serlopitant and the clinical utility of serlopitant, alone and as compared to other treatment options, the duration of patent protection, and other statements regarding strategy, future operations and plans, as well as assumptions underlying such statements. These statements involve substantial known and unknown risks, uncertainties and other factors, some of which are outside of our control, that may cause our actual results, levels of activity, performance or achievements to be materially different from the information expressed or implied by these forward- looking statements, including risks related to the clinical drug development process, the regulatory approval process, our reliance on third parties, and our ability to defend our intellectual property. We may not actually achieve the plans, intentions or expectations disclosed in our forward-looking statements, and you should not place undue reliance on our forward-looking statements. Actual results or events could differ materially from the plans, intentions and expectations disclosed in the forward-looking statements we make. Additional information that could lead to material changes in our performance is contained in our filings with the U.S. Securities and Exchange Commission. -
Boards' Fodder
boards’ fodder Sound-alikes in dermatology by Jeffrey Kushner, DO, and Kristen Whitney, DO Disease Entity Description Actinic granuloma/ Annular elastolytic Variant of granuloma annulare on sun-damaged skin; annular erythematous giant cell granuloma plaques with slightly atrophic center in sun-exposed areas, which may be precipi- tated by actinic damage. Actinic prurigo PMLE-like disease with photodistributed erythematous papules or nodules and hemorrhagic crust and excoriation. Conjunctivitis and cheilitis are commonly found. Seen more frequently in Native Americans (especially Mestizos). Actinomycetoma “Madura Foot”; suppurative infection due to Nocaria, Actinomadura, or Streptomyces resulting in tissue tumefaction, draining sinuses and extrusion of grains. Actinomycosis “Lumpy Jaw”; Actinomyces israelii; erythematous nodules at the angle of jaw leads to fistulous abscess that drain purulent material with yellow sulfur granules. Acrokeratosis verruciformis Multiple skin-colored, warty papules on the dorsal hands and feet. Often seen in conjunction with Darier disease. Acrodermatitis enteropathica AR; SLC39A4 mutation; eczematous patches on acral, perineal and periorificial skin; diarrhea and alopecia; secondary to zinc malabsorption. Atrophoderma 1) Atrophoderma vermiculatum: Pitted atrophic scars in a honeycomb pattern around follicles on the face; associated with Rombo, Nicolau-Balus, Tuzun and Braun-Falco-Marghescu syndromes. 2) Follicular atrophoderma: Icepick depressions at follicular orifices on dorsal hands/feet or cheeks; associated with Bazex-Dupré-Christol and Conradi- Hünermann-Happle syndromes. 3) Atrophoderma of Pasini and Pierini: Depressed patches on the back with a “cliff-drop” transition from normal skin. 4) Atrophoderma of Moulin: Similar to Pasini/Pierini, except lesions follow the lines of Blaschko. Anetoderma Localized area of flaccid skin due to decreased or absent elastic fibers; exhibits “buttonhole” sign. -
Prurigo Nodularis and Lichen Simplex Chronicus
Dermatologic Therapy, Vol. 21, 2008, 42–46 Copyright © Blackwell Publishing, Inc., 2008 Printed in the United States · All rights reserved DERMATOLOGIC THERAPY ISSN 1396-0296 Blackwell Publishing Inc Prurigo nodularis and lichen simplex chronicus TORELLO LOTTI, GIONATA BUGGIANI & FRANCESCA PRIGNANO Department of Dermatological Sciences, University of Florence, Florence, Italy ABSTRACT: Emotional tensions in predisposed subjects may play a key role in inducing a pruritic sensation, leading to a scratching that, becoming a self-perpetuating pathomechanism, may represent the main feature of two distinct cutaneous clinical entities: prurigo nodularis and lichen simplex chronicus. Psychogenic factors play a relevant role in both conditions, and they are often associated with depression and dissociative experiences. Hence, the importance of the evaluation of these patients from the point of view of psychodermatology, which may analyze the relationship between skin disease and psychological factors. Patients with real or perceived imperfections in particular areas of the body (face, scalp, hands, and genital area) are more prone to psychologic distress, whereas cutaneous diseases may lead to experience a heightened level of distress. As psychosomatic factors have been estimated to be present in at least one-third of dermatologic patients, effective management of skin conditions involves consideration of the associated emotional factors. KEYWORDS: lichen simplex chronicus, management, prurigo nodularis, psychodermatology Introduction scars when spontaneously regress (FIG. 2). Itch is intense, and severe crises can be triggered by According to a psychosomatic perspective usually emotional stress. agreed upon in the scientific community, emo- Lichen simplex chronicus (LSC) is a skin disorder tional tensions in predisposed subjects may play characterized by lichenification of the skin as a a key role in inducing itch, thus provoking result of primary excessive scratching (FIG.