DOCSLIB.ORG

Onychomycosis/ (Suspected) Fungal Nail and Skin Protocol

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Onychomycosis/ (Suspected) Fungal Nail and Skin Protocol Onychomycosis/ (suspected) Fungal Nail and Skin Protocol Please check the boxes of the evaluation questions, actions and dispensing items you wish to include in your customized protocol. If additional or alternative products or services are provided, please include when making your selections. If you wish to include the condition description please also check the box. Description of Condition: Onychomycosis is a common nail condition. It is a fungal infection of the nail that differs from bacterial infections (often referred to as paronychia infections). It is very common for a patient to present with onychomycosis without a true paronychia infection. It is also very common for a patient with a paronychia infection to have secondary onychomycosis. Factors that can cause onychomycosis include: (1) environment: dark, closed, and damp like the conventional shoe, (2) trauma: blunt or repetitive, (3) heredity, (4) compromised immune system, (5) carbohydrate-rich diet, (6) vitamin deficiency or thyroid issues, (7) poor circulation or PVD, (8) poor-fitting shoe gear, (9) pedicures received in places with unsanitary conditions. Nails that are acute or in the early stages of infection may simply have some white spots or a white linear line. Chronic nail conditions may appear thickened, discolored, brittle or hardened (to the point that the patient is unable to trim the nails on their own). The nails may be painful to touch or with closed shoe gear or the nail condition may be purely cosmetic and not painful at all. *Ask patient to remove nail polish prior to visit Evaluation Questions: □ Which toenails appear to be affected? □ How long have your nails looked this way? □ Are your nails painful? □ Is the problem getting worse or better, or is it unchanged? □ Have you had any treatment for this problem? □ Have you tried any at home treatments? □ Did you have an injury to your nail that might have caused the infection? □ Do you play any sports? If yes, what type of shoes do you wear? □ Do you get frequent pedicures? □ Do you notice that your feet perspire excessively or that your socks are wet/damp at the end of the day? □ How often do you change your shoes? □ Do you currently have/have you ever had Athlete’s Foot? □ Do you have a family history of psoriasis? □ Do you have a family history of fungal nail infections? Post-Evaluation Actions: □ Brochure on onychomycosis and laser treatment options. If patient is diabetic, also include a brochure on diabetic foot care, which stresses the importance of prevention. □ X-rays if nail is dystrophic (misshapen). o To include: AP or DP/lateral/medial oblique o Evaluate for any bone changes such as a bone spur or old fracture that could be contributing May see an arthritic condition referred to as hallux limitus (limited range of motion of the great toe) and contracted toes, which may put repetitive strain on the nail □ Debridement of nails (mechanically/with drill) o If nails are very thick, place a gauze pad lightly soaked in water over the nail and gently keep it in place prior to treating. o Staff to apply Tri-Soft or other softening agent to nails prior to debridement □ Nail culture/biopsy o A small 1cc lidocaine/epinephrine block is given with a tuberculosis syringe when performing a nail biopsy. o Place culture in a specimen bag for a dtm/koh prep. Site (which toe/site of specimen) must be placed on the lab form. o Double check that the lab accepts the insurance. o Culture/biopsy results must be shown to the DPM prior to scanning. □ Topical preparations o Recommend or dispense Oil based treatment for nails: Clarus solution, Fortinia , Formula 3, etc. (1% tolnaftate) o Recommend or dispense Kera Nail Gel (47% urea) if nails very thick o Recommend or dispense Skin Cream; Clarus, Fortinia, Fungi-Foam, etc. o Rx for Spectazole, Naftin, Zulu or tincture of fungoid with 3 tabs of Lamisil mixed in o Recommend or dispense Drying agents and Shoe treatments such as: . Gordons No. 5 powder to be applied to the foot 2x daily, if the patient complains that feet perspire excessively . Clarus shoe spray to maintain dryness and to rid the shoe of bacteria and fungus, if the patient exercises regularly . Mycomist . Aarica . DryFeet Wipes . Rx for a topical cream in addition to the suggestion of using Clarus cream, if patient has a secondary athlete's foot infection . Sterilization of shoes (Steri-Shoe) Oral preparations o Oral biotin and acidophilus to promote nail and skin health (Theranail) o Oral medications such as Lamisil (liver function test before patient starts medication and 6 wks into protocol to ensure liver enzymes are not elevated) o Rx for alternative oral medication Laser treatment Options include: o Minimum of 4 sessions and to include DPM recommendations for at home nail/skin/shoe treatment between visits) o May begin at current visit, or schedule for 1st laser treatment o All staff should be trained on treatment procedure, cost and efficacy At-Home Care Recommendations o File nails gently after a shower o Soak with warm water + 2 capfuls white vinegar; 15 minutes, 3-4 times/week o Purchase socks with “wicking” properties that keep moisture away o UV light appliances to be inserted into shoes o Hyperhydrosis (dry body wipes) o Any DPM recommendations listed above Schedule follow-up visit: 4 weeks 6 weeks 8 -12 weeks (at DPM discretion) .
Load more

Recommended publications
  • Fungal Infections from Human and Animal Contact
    Journal of Patient-Centered Research and Reviews Volume 4 Issue 2 Article 4 4-25-2017 Fungal Infections From Human and Animal Contact Dennis J. Baumgardner Follow this and additional works at: https://aurora.org/jpcrr Part of the Bacterial Infections and Mycoses Commons, Infectious Disease Commons, and the Skin and Connective Tissue Diseases Commons Recommended Citation Baumgardner DJ. Fungal infections from human and animal contact. J Patient Cent Res Rev. 2017;4:78-89. doi: 10.17294/2330-0698.1418 Published quarterly by Midwest-based health system Advocate Aurora Health and indexed in PubMed Central, the Journal of Patient-Centered Research and Reviews (JPCRR) is an open access, peer-reviewed medical journal focused on disseminating scholarly works devoted to improving patient-centered care practices, health outcomes, and the patient experience. REVIEW Fungal Infections From Human and Animal Contact Dennis J. Baumgardner, MD Aurora University of Wisconsin Medical Group, Aurora Health Care, Milwaukee, WI; Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI; Center for Urban Population Health, Milwaukee, WI Abstract Fungal infections in humans resulting from human or animal contact are relatively uncommon, but they include a significant proportion of dermatophyte infections. Some of the most commonly encountered diseases of the integument are dermatomycoses. Human or animal contact may be the source of all types of tinea infections, occasional candidal infections, and some other types of superficial or deep fungal infections. This narrative review focuses on the epidemiology, clinical features, diagnosis and treatment of anthropophilic dermatophyte infections primarily found in North America.
    [Show full text]
  • Isotretinoin Induced Periungal Pyogenic Granuloma Resolution with Combination Therapy Jonathan G
    Isotretinoin Induced Periungal Pyogenic Granuloma Resolution with Combination Therapy Jonathan G. Bellew, DO, PGY3; Chad Taylor, DO; Jaldeep Daulat, DO; Vernon T. Mackey, DO Advanced Desert Dermatology & Mohave Centers for Dermatology and Plastic Surgery, Peoria, AZ & Las Vegas, NV Abstract Management & Clinical Course Discussion Conclusion Pyogenic granulomas are vascular hyperplasias presenting At the time of the periungal eruption on the distal fingernails, Excess granulation tissue and pyogenic granulomas have It has been reported that the resolution of excess as red papules, polyps, or nodules on the gingiva, fingers, the patient was undergoing isotretinoin therapy for severe been described in both previous acne scars and periungal granulation tissue secondary to systemic retinoid therapy lips, face and tongue of children and young adults. Most nodulocystic acne with significant scarring. He was in his locations.4 Literature review illustrates rare reports of this occurs on withdrawal of isotretinoin.7 Unfortunately for our commonly they are associated with trauma, but systemic fifth month of isotretinoin therapy with a cumulative dose of adverse event. In addition, the mechanism by which patient, discontinuation of isotretinoin and prevention of retinoids have rarely been implicated as a causative factor 140 mg/kg. He began isotretinoin therapy at a dose of 40 retinoids cause excess granulation tissue of the skin is not secondary infection in areas of excess granulation tissue in their appearance. mg daily (0.52 mg/kg/day) for the first month and his dose well known. According to the available literature, a course was insufficient in resolving these lesions. To date, there is We present a case of eruptive pyogenic granulomas of the later increased to 80 mg daily (1.04 mg/kg/day).
    [Show full text]
  • Ingrown Nail/Paronychia Referral Guide: Podiatry Referral Page 1 of 1 Diagnosis/Definition
    Ingrown Nail/Paronychia Referral Guide: Podiatry Referral Page 1 of 1 Diagnosis/Definition: Redness, warmth, tenderness and exudate coming from the areas adjacent to the nail plate. Initial Diagnosis and Management: History and physical examination. In chronic infection appropriate radiographic (foot or toe series to rule out distal phalanx osteomyelitis) and laboratory evaluation (CBC and ESR). Ongoing Management and Objectives: Primary care should consist of Epsom salt soaks, or soapy water, and antibiotics for ten days. If Epsom salt soaks and antibiotics are ineffective, the primary care provider has the following options: Reevaluate and refer to podiatry. Perform temporary avulsion/I&D. Perform permanent avulsion followed by chemical cautery (89% Phenol or 10% NaOH application – 3 applications maintained for 30 second intervals, alcohol dilution between each application). Aftercare for all of the above is continued soaks, daily tip cleaning and bandage application. Indications for Specialty Care Referral: After the reevaluation at the end of the antibiotic period the primary care provider can refer the patient to Podiatry for avulsion/ surgical care if they do not feel comfortable performing the procedure themselves. The patient should be given a prescription for antibiotics renewal and orders to continue soaks until avulsion can be performed. Test(s) to Prepare for Consult: Test(s) Consultant May Need To Do: Criteria for Return to Primary Care: After completion of the surgical procedure, patients will be returned to the primary care provider for follow-up. Revision History: Created Revised Disclaimer: Adherence to these guidelines will not ensure successful treatment in every situation. Further, these guidelines should not be considered inclusive of all accepted methods of care or exclusive of other methods of care reasonably directed to obtaining the same results.
    [Show full text]
  • Skin Disease and Disorders
    Sports Dermatology Robert Kiningham, MD, FACSM Department of Family Medicine University of Michigan Health System Disclosures/Conflicts of Interest ◼ None Goals and Objectives ◼ Review skin infections common in athletes ◼ Establish a logical treatment approach to skin infections ◼ Discuss ways to decrease the risk of athlete’s acquiring and spreading skin infections ◼ Discuss disqualification and return-to-play criteria for athletes with skin infections ◼ Recognize and treat non-infectious skin conditions in athletes Skin Infections in Athletes ◼ Bacterial ◼ Herpetic ◼ Fungal Skin Infections in Athletes ◼ Very common – most common cause of practice-loss time in wrestlers ◼ Athletes are susceptible because: – Prone to skin breakdown (abrasions, cuts) – Warm, moist environment – Close contacts Cases 1 -3 ◼ 21 year old male football player with 4 day h/o left axillary pain and tenderness. Two days ago he noticed a tender “bump” that is getting bigger and more tender. ◼ 16 year old football player with 3 day h/o mildly tender lesions on chin. Started as a single lesion, but now has “spread”. Over the past day the lesions have developed a dark yellowish crust. ◼ 19 year old wrestler with a 3 day h/o lesions on right side of face. Noticed “tingling” 4 days ago, small fluid filled lesions then appeared that have now started to crust over. Skin Infections Bacterial Skin Infections ◼ Cellulitis ◼ Erysipelas ◼ Impetigo ◼ Furunculosis ◼ Folliculitis ◼ Paronychea Cellulitis Cellulitis ◼ Diffuse infection of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin – Triad of erythema, edema, and warmth in the absence of underlying foci ◼ S. aureus or S. pyogenes Erysipelas Erysipelas ◼ Superficial infection of the dermis ◼ Distinguished from cellulitis by the intracutaneous edema that produces palpable margins of the skin.
    [Show full text]
  • Pediatric Cutaneous Bacterial Infections Dr
    PEDIATRIC CUTANEOUS BACTERIAL INFECTIONS DR. PEARL C. KWONG MD PHD BOARD CERTIFIED PEDIATRIC DERMATOLOGIST JACKSONVILLE, FLORIDA DISCLOSURE • No relevant relationships PRETEST QUESTIONS • In Staph scalded skin syndrome: • A. The staph bacteria can be isolated from the nares , conjunctiva or the perianal area • B. The patients always have associated multiple system involvement including GI hepatic MSK renal and CNS • C. common in adults and adolescents • D. can also be caused by Pseudomonas aeruginosa • E. None of the above PRETEST QUESTIONS • Scarlet fever • A. should be treated with penicillins • B. should be treated with sulfa drugs • C. can lead to toxic shock syndrome • D. can be associated with pharyngitis or circumoral pallor • E. Both A and D are correct PRETEST QUESTIONS • Strep can be treated with the following antibiotics • A. Penicillin • B. First generation cephalosporin • C. clindamycin • D. Septra • E. A B or C • F. A and D only PRETEST QUESTIONS • MRSA • A. is only acquired via hospital • B. can be acquired in the community • C. is more aggressive than OSSA • D. needs treatment with first generation cephalosporin • E. A and C • F. B and C CUTANEOUS BACTERIAL PATHOGENS • Staphylococcus aureus: OSSA and MRSA • Gp A Streptococcus GABHS • Pseudomonas aeruginosa CUTANEOUS BACTERIAL INFECTIONS • Folliculitis • Non bullous Impetigo/Bullous Impetigo • Furuncle/Carbuncle/Abscess • Cellulitis • Acute Paronychia • Dactylitis • Erysipelas • Impetiginization of dermatoses BACTERIAL INFECTION • Important to diagnose early • Almost always
    [Show full text]
  • Dermatologic Nuances in Children with Skin of Color
    5/21/2019 Dermatologic Nuances in Children with Skin of Color Candrice R. Heath, MD, FAAP, FAAD Director, Pediatric Dermatology LKSOM Temple University @DrCandriceHeath Advisory Board – Pfizer, Regeneron-Sanofi Consultant –Marketing – Unilever, Proctor & Gamble Speaker’s Bureau - Pfizer I do not intend to discuss on-FDA approved or investigational use of products in my presentation. • Recognize common hair, scalp and skin disorders that may present differently in children with skin of color • Select appropriate treatment options based upon common cultural preferences to increase adherence • Establish treatment algorithm for challenging cases 1 5/21/2019 • 2050 : Over half of the United States population will be people of color • 2050 : 1 in 3 US residents will be Hispanic • 2023 : Over half of the children in the US will be people of color • Focuses on ethnic and racial groups who have – similar skin characteristics – similar skin diseases – similar reaction patterns to those skin diseases Taylor SC et al. (2016) Defining Skin of Color. In Taylor & Kelly’s Dermatology for Skin of Color. 2016 Type I always burns, never tans (palest) Type II usually burns, tans minimally Type III sometimes mild burn, tans uniformly Type IV burns minimally, always tans well (moderate brown) Type V very rarely burns, tans very easily (dark brown) Type VI Never burns (deeply pigmented dark brown to darkest brown) 2 5/21/2019 • Black • Asian • Hispanic • Other Not so fast… • Darker skin hues • The term “race” is faulty – Race may not equal biological or genetic inheritance – There is not one gene or characteristic that separates every person of one race from another Taylor SC et al.
    [Show full text]
  • Dermatology Gp Booklet
    These guidelines are provided by the Departments of Dermatology of County Durham and Darlington Acute Hospitals NHS Trust and South Tees NHS Foundation Trust, April 2010. More detailed information and patient handouts on some of the conditions may be obtained from the British Association of Dermatologists’ website www.bad.org.uk Contents Acne Alopecia Atopic Eczema Hand Eczema Intertrigo Molluscum Contagiosum Psoriasis Generalised Pruritus Pruritus Ani Pityriasis Versicolor Paronychia - Chronic Rosacea Scabies Skin Cancers Tinea Unguium Urticaria Venous Leg Ulcers Warts Topical Treatment Cryosurgery Acne Assess severity of acne by noting presence of comedones, papules, pustules, cysts and scars on face, back and chest. Emphasise to patient that acne may continue for several years from teens and treatment may need to be prolonged. Treatment depends on the severity and morphology of the acne lesions. Mild acne Comedonal (Non-inflammatory blackheads or whiteheads) • Benzoyl peroxide 5-10% for mild cases • Topical tretinoin (Retin-A) 0.01% - 0.025% or isotretinoin (Isotrex) Use o.d. but increase to b.d. if tolerated. Warn the patient that the creams will cause the skin to become dry and initially may cause irritation. Stop if the patient becomes pregnant- although there is no evidence of harmful effects • Adapalene 0.1% or azelaic acid 20% may be useful alternatives Inflammatory (Papules and pustules) • Any of the above • Topical antibiotics – Benzoyl peroxide + clindamycin (Duac), Erythromycin + zinc (Zineryt) Erythromycin + benzoyl peroxide (Benzamycin gel) Clindamycin (Dalacin T) • Continue treatment for at least 6 months • In patients with more ‘stubborn’ acne consider a combination of topical antibiotics o.d with adapalene, retinoic acid or isotretinoin od.
    [Show full text]
  • Hair and Nail Disorders
    Hair and Nail Disorders E.J. Mayeaux, Jr., M.D., FAAFP Professor of Family Medicine Professor of Obstetrics/Gynecology Louisiana State University Health Sciences Center Shreveport, LA Hair Classification • Terminal (large) hairs – Found on the head and beard – Larger diameters and roots that extend into sub q fat LSUCourtesy Health of SciencesDr. E.J. Mayeaux, Center Jr., – M.D.USA Hair Classification • Vellus hairs are smaller in length and diameter and have less pigment • Intermediate hairs have mixed characteristics CourtesyLSU Health of E.J. Sciences Mayeaux, Jr.,Center M.D. – USA Life cycle of a hair • Hair grows at 0.35 mm/day • Cycle is typically as follows: – Anagen phase (active growth) - 3 years – Catagen (transitional) - 2-3 weeks – Telogen (preshedding or rest) about 3 Mon. • > 85% of hairs of the scalp are in Anagen – Lose 75 – 100 hairs a day • Each hair follicle’s cycle is usually asynchronous with others around it LSU Health Sciences Center – USA Alopecia Definition • Defined as partial or complete loss of hair from where it would normally grow • Can be total, diffuse, patchy, or localized Courtesy of E.J. Mayeaux, Jr., M.D. CourtesyLSU of Healththe Color Sciences Atlas of Family Center Medicine – USA Classification of Alopecia Scarring Nonscarring Neoplastic Medications Nevoid Congenital Injury such as burns Infectious Systemic illnesses Genetic (male pattern) (LE) Toxic (arsenic) Congenital Nutritional Traumatic Endocrine Immunologic PhysiologicLSU Health Sciences Center – USA General Evaluation of Hair Loss • Hx is
    [Show full text]
  • Avoid Systemic Antifungals for Chronic Paronychia
    32 Skin Disorders FAMILY P RACTICE N EWS • October 1, 2006 Avoid Systemic Antifungals for Chronic Paronychia BY SHERRY BOSCHERT not,” said Dr. Tosti, professor of derma- causing inflammation in the nail matrix. ondary problem, not the primary inflam- San Francisco Bureau tology at the University of Bologna, Italy. Yeast and bacteria also may penetrate the mation, Dr. Tosti said. Instead, it starts with loss of the cuticle proximal nail fold, leading to secondary Chronic paronychia should be managed W INNIPEG, MAN. — Chronic parony- due to trauma or other causes, followed by colonization that may produce self-limit- like contact dermatitis is treated, with chia is a variety of contact dermatitis that irritation, immediate or delayed allergic re- ed episodes of painful acute inflammation hand protection and topical steroids, she affects the proximal nail fold, so treating it action, or immediate hypersensitivity to with pus. A green discoloration of the nail advised. For patients with secondary can- with systemic antifungals is not useful, Dr. food ingredients handled by the patient. develops with colonization by Pseudomonas dida colonization, recommend a high-po- Antonella Tosti said at the annual confer- Chronic paronychia is a common occupa- aeruginosa. tency topical steroid at bedtime and a top- ence of the Canadian Dermatology Asso- tional problem among food workers, she That’s why clinicians may be able to cul- ical antifungal in the morning. “I may use ciation. said. ture bacteria or yeast, but treating with systemic steroids in severe cases” to pro- “Most people still believe that chronic With the cuticle gone, environmental systemic antifungals will not cure the pa- vide fast relief of inflammation and pain, paronychia is a candida infection.
    [Show full text]
  • Procedural Review of Toenail Excision Scott Klosterman, DO, Candace Prince, OSM 4
    Osteopathic Family Physician (2012) 4, 18-23 Procedural review of toenail excision Scott Klosterman, DO, Candace Prince, OSM 4 From Spartanburg Regional Family Medicine Residency Program, Spartanburg, SC KEYWORDS: Toenail removal is a common procedure that family physicians routinely perform in the office. This article Toenail removal; highlights the acute and chronic indications for toenail removal and its contraindications, potential compli- Paronychia; cations, and procedural details including digital block anesthesia. A sample consent form and patient Onychomycrosis; educational handout are provided as well as the current diagnostic International Classification of Diseases, Ingrown toenail; 9th revision, and current procedural terminology codes for the clinician to use. Matrixectomy © 2012 Elsevier Inc. All rights reserved. Family physicians are often the primary health care con- a partial or complete matrixectomy (permanent nail removal) tact for patients with toenail problems. Toenail complaints may be necessary for these chronic conditions, and with on- ranging from paronychia to onychomycosis affect every age ychocryptosis because of its high rate of recurrence.2,4,11 Fi- group, and surgical excision of the nail may be an appro- nally, in cases of growths or discoloration beneath the nail, nail priate treatment option. Our purpose is to review the indi- plate removal with biopsy may be needed to rule out malignant cations and procedural details for toenail removal, provide a neoplasms, although biopsy techniques of the nail and nail bed concise patient consent form and educational handout for are outside the scope of this review.2,3 postprocedural care, and review the current International Classification of Diseases, 9th revision (ICD-9) and current procedural terminology (CPT) coding for such procedures.
    [Show full text]
  • Trachyonychia Associated with Alopecia Areata and Secondary Onychomycosis
    TRACHYONYCHIA ASSOCIATED WITH ALOPECIA AREATA AND SECONDARY ONYCHOMYCOSIS Jose L. Anggowarsito Renate T. Kandou Department of Dermatovenereology Medical Faculty of Sam Ratulangi University Prof. Dr. R. D. Kandou Hospital Manado Email: [email protected] Abstract: Trachyonychia is an idiopathic nail inflammatory disorder that causes nail matrix keratinization abnormality, often found in children, and associated with alopecia areata, psoriasis, atopic dermatitis, or nail lichen planus. Trachyonychia could be a manifestation of associated pleomorphic or idiopathic disorders; therefore, it may occur without skin or other systemic disorders. There is no specific diagnostic criteria for tracyonychia. A biopsy is needed to determine the definite pathologic diagnosis for nail matrix disorder; albeit, in a trachyonychia case it is not entirely necessary. Trachyonychia assessment is often unsatisfactory and its management is focused primarily on the underlying disease. We reported an 8-year-old girl with twenty dystrophic nails associated with alopecia areata. Cultures of nail base scrapings were performed two times and the final impression was trichophyton rubrum. Conclusion: Based on the clinical examination and all the tests performed the diagnosis of this case was trachyonychia with twenty dystrophic nails associated with alopecia areata and secondary onychomycosis.The majority of trachyonychia cases undergo spontaneous improvement; therefore, a specific therapy seems unnecessary. Onychomycosis is often difficult to be treated. Eradication of the fungi is not always followed by nail restructure, especially if there has been dystrophy before the infection. Keywords: trachyonychia, alopecia areata, onychomycosis. Abstrak: Trakionikia adalah inflamasi kuku idiopatik yang menyebabkan gangguan keratinisasi matriks kuku, sering terjadi pada anak, dan terkait dengan alopesia areata, psoriasis, dermatitis atopik atau lichen planus kuku.
    [Show full text]
  • Milia Like Idiopathic Calcinosis Cutis in a Child with Down Syndrome
    Volume 22 Number 5 May 2016 Case Presentation Milia-like idiopathic calcinosis cutis in a child with Down syndrome Piyush Kumar1, Sushil S Savant2, Esther Nimisha3, Anupam Das4, Panchami Debbarman5 Dermatology Online Journal 22 (5): 9 1 Dermatology, Katihar Medical college , Katihar 2 Dermatology, Katihar Medical College, Bihar 3 Consultant Dermatologist 4 Dermatology, KPC Medical College and Hospital, Kolkata 5Consultant Dermatology Correspondence: Piyush Kumar [email protected] Abstract Idiopathic calcinosis cutis refers to progressive deposition of crystals of calcium phosphate in the skin and other areas of the body, in the absence of any inciting factor. Idiopathic calcinosis cutis may sometimes take the form of small, milia-like lesions. Most commonly, such milia like lesions are seen in the setting of Down syndrome. Herein, we report a 5-year-old girl with multiple asymptomatic discrete milia-like firm papules distributed over the face and extremities. A diagnosis of milia-like idiopathic calcinosis cutis associated with Down Syndrome was provisionally made and was confirmed by histopathology and karyotyping. Keywords: Down syndrome, calcinosis cutis, milia Introduction Calcification represents the deposition of amorphous, insoluble calcium salts and when it occurs in cutaneous tissue it is termed “calcinosis cutis" [1, 2, 3]. Milia-like idiopathic calcinosis cutis (MICC), first described by Sano et al in 1978 [4] and named by Smith in 1989 [5], usually appears in children with Down syndrome, but some rare cases of MICC without any association with Down syndrome are also known [6]. Similar but perforating lesions have been reported by Maroon et al [7] and by Kanzaki and Nakajima [8].
    [Show full text]