Cutaneous Manifestations of Systemic Disease

Total Page:16

File Type:pdf, Size:1020Kb

Cutaneous Manifestations of Systemic Disease CUTANEOUS MANIFESTATIONS OF SYSTEMIC DISEASE Kathleen Haycraft, DNP, FNP/PNP-BC, DCNP, FAANP, AANP BOD, REGION 7 Objectives • Identify cutaneous manifestations related to /endocrine dysfunction. • Identify cutaneous manifestations related to renal failure. • Identify cutaneous manifestations related to gastrointestinal.. • Identify cutaneous manifestations related to internal malignancies. Conflicts of Interest: ■ Celgene ■ Lilly ■ Pfizer ■ AbbVie ■ Valeant ■ Novartis ■ Sanofi/Aventis/Regeneron ■ None will influence the discussion today. Cutaneous Manifestations R/T Endocrine ACA© kathleen Haycraft Acanthosis Nigricans © kathleen haycraft Acanthosis Nigricans on hands © kathleen haycraft Acanthosis Nigricans ■ Concern if sudden: – Growth Hormone – Contraception – Malignancy ■ Pearl: Signs of malignancy include: Rapid, pruritic, and extensive acanthosis nigricans in a patient of normal or low BMI Granuloma Annulare © kathleen haycraft Granuloma Annulare ■ Granuloma annulare (GA) is common, self limited, dermatosis of the dermis and subcutaneous tissue. ■ May be local lesions or disseminated ■ May last years or decade ■ Interesting new treatment Augmentin (amoxicillin and clavulanate) 875 bid two weeks. Concerns ■ Associated with DM and thyroid autoimmune disease Diabetes Necrobiosis Lipoidica © kathleen Haycraft Lichen Planus © susan Voss Lichen Planus ■ Self-limiting pruritic inflammatory condition ■ Abnormal immune reaction provoked by a viral infection. ■ Strong association with Hepatitis C virus ■ Prognosis is good with the majority of cases resolving within 18 months. ■ The 5 P’s Pruritic, Planar, Polyangular, Purple Papules ■ Wickham’s Striae ■ 2mm-1cm ■ Triggered by Hep B, C, Flu vaccine, Nsaids Lichen Planus ■ Aspartame ■ Graft Vs Host ■ Primary Biliary Cirrhosis ■ May be beta blockers, plaquenyl, thiazide diuretics, furosemide, spironolactone, metformin penicillin, NSAIDs, Hep B, C disease, Flu vaccine Concerns ■ Hepatitis C ■ Hepatitis B ■ LFTs ■ Low but existent risk for DM Xanthelesma © kathleen haycraft Xanthelesma/Xanthoma Xanthomas develop from a deposition of cholesterol rich materials. Yellowish in color due to the yellow color of cholesterol. They are common Usually associated with hyperlipidemia. They can occur anywhere on the body and when a xanthoma occurs near the eyelids it is referred to as a xanthelesma. The lesion is soft and usually has sharp demarcations. Concern: Monitor lipids…less necessary if Xanthelsma. Screen for family history of cardiovascular disease Cutaneous Manifestations Renal Perforating Dermatosis © Susan Voss Perforating Dermatoses • Umbilicated dome-shape papules on the arms and legs • Papules hyperkeratotic, ranging in size from 2 to 10mm • Varying degrees of pruritus • Tends to be distributed on trauma-prone areas and often can be reproduced by scratching. Concerns ■ Renal Failure ■ Diabetes Mellitus ■ Refer to Dermatology Calciphylaxis © kathleen haycraft Calciphylaxis • Rare systemic Rare syndrome involving vascular calcification and skin necrosis. • Seen with chronic renal failure with dialysis. • Accumulation of calcium deposits in the tunica media of the walls of small arterial vessels is responsible for the presentation of calciphylaxis. Concerns • High mortality rate of 60-80%. The one year and five year survival rates have been reported at 45% and 35% ,respectively. • The most common cause of death is usually secondary sepsis • REFER TO DERM ASAP Cutaneous GI Seborrheic Keratosis © kathleen Haycraft Sign of Leser Trelat kathleen haycraft Seborrheic Keratosis ■ The most common cutaneous neoplasm. ■ Correlated with senescence and genetics. ■ Increase after age 40. ■ Associated with failure of keratinocyte repressor gene (FGFR3 and P13K genes). ■ Common sites face, chest, back, and friction sites. Concern: ■ Pigmented SK can mimic melanoma ■ If suddenly occur screen for genitourinary and gastrointestinal malignancy ■ If concerned may refer to dermatology Porphyria Cutanea Tarda © Kathleen Haycraft PCT © kathleen haycraft © kathleen haycraft ©kathleen haycraft Woods light on PCT Urine Kathleen haycraft Porphyria Cutanea Tarda ■ Disorder of the heme pathway which causes buildup of porphyrins which are activated by UV light ■ Genetic predisposition that has trigger of alcohol abuse, oral contraceptives, viral illnesses eg HIV and Hep C ■ Fragile skin with vesicles and bullae of sun exposed areas, classically pull hands out of pants and blisters open. ■ Facial hypertrichosis ■ REFER TO DERMATOLOGY Concerns ■ Strong link to hepatitis C ■ May develop hepatocellular carcinoma ■ Modest risk HIV ■ Disease treatment will eliminate PCT Palmar Erythema © Kathleen Haycraft Concerns ■ May be a normal variant ■ Look for alcohol abuse ■ Look for underlying liver disease Dermatitis Herpetiformis © Susan Voss Dermatitis Herpetiformis ■ Chronic, itchy, burning, blistering rash. ■ Lesions are found symmetrically on the extensor surfaces of the knees, elbows, back, and buttocks. ■ Seen with Celiac Disease Concerns ■ Related to Celiac Disease Cutaneous manifestations related to internal malignancies Muir Torre Syndrome © kathleen haycraft Muir Torre Syndrome ■ Cutaneous sebaceous adenoma or carcinoma and Keratocanthoma with visceral malignancy GU, GI, small intestinal, some thyroid ■ Lynch syndrome ■ Mismatch repair gene ■ Isotretinoin and interferon have been used to reduce risk Concern ■ REFER TO DERMATOLOGY AND INTERNIST FAMILIAR WITH DISEASE for appropriate screening Puetz-Jehgers Syndrome ©kathleen haycraft Puetz-Jeghers Syndrome ■ Autosomal dominant inherited with hyperpigmentation and polyps ■ Early marked freckling in unusual places eg. Lips, soles of feet and palms. They are blue gray Concerns ■ Small intestine malignancy ■ Refer to Dermatology GI and Oncology Concerns ■ Nanoparticles may be carcinogenic black and red ink are worse ■ Tattoo removal may increase spread ■ Infections esp. Hep C as well as unusual bacteria ■ Allergic Reactions Dermatomyositis © kathleen haycraft Dermatomyositis ■ Rare autoimmune disease that can affect skin, joints, muscles and many organs ■ Muscle weakness ■ Scaly or psoriaform plaques on forehead and scalp ■ Gottron papules, violaceous hues like violet eyeshadow ■ Pigmentary changes and telangectasias follows shawl sign on sun exposed areas Concerns ■ Myopathies ■ Esophageal involvement ■ Cardiac arrhythmias including conduction abnormalities ■ 10% have interstitial lung disease ■ Esophageal involvement ■ Dependent upon genetic type determines risk for cancer types, always screen for ovarian ■ Cancer risk in first five years with highest in first year. ■ Refer to dermatology also consider rheumatology Bullous Pemphigoid © kathleen haycraft Bullous Pemphigoid ■ Disease is a tense blistering disease that is bellow the epidermis and is a chronic inflammatory illness that persists for months or years It can have remissions and exacerbations. It can be fatal. ■ Blisters are firm and antibodies attack the area below the epidermis ■ BP 230 and 180 are circulating antibodies that target the hemidesmosome and can be measured for disease severity ■ May be triggered by medications eg diuretics, captopril, antibiotics and neuroleptic agents Pemphigus Vulgaris © kathleen haycraft Pemphigus Vulgaris ■ Autoimmune blistering disease where the antibodies target the epithelial cell and mucous membrane ■ Blisters are soft ■ No known cause is linked to some medications and may be linked to cancers. Concerns: ■ Treatments side effects of immune suppression and ulcers. ■ Dermatologic emergency as affects many mucous membranes in body Sepsis, Treatments put patients at risk for ulcers, immune suppression ■ High risk of sepsis ■ Involves the mucosa in 25% ■ HPN, MI, DM. thromboembolism, neurologic disorders and cancer risks are elevated ■ Optical lesions can result in blindness ■ Cancer development secondary to immune suppression ■ Refer to dermatology Pruritus/Chronic Lichen Simplex © kathleen haycraft Concerns: ■ Drugs associated with pruritus: ■ Nsaids, steroids, testosterone, opiates, allopurinol, antidepressants, ED drugs, Statins, tamoxifen, antibiotics, ACE, ARB, Beta blocker, Calcium channel blocker, neuroleptics, heparin, amiodarone, biguanides, sulfonylurea derivative diabetic agents Concerns ■ If pruritus has been treated for a reasonable time with cool creams, low potency steroid creams, four time dose antihistamines, negative immuno-cap testing, negative patch testing, gabapentin DO A WORK UP ■ Work up; ■ CMP, TSH, HIV, CBC, Sed, SPEP, CXR, ■ Consider psych referral and further malignancy work up Sweet Syndrome Sweet’s Syndrome ■ Painful violaceous juicy plaque often on back of hand ■ May have a nipple like look ■ May have dusky papules and plaques there may be vesicles and bulla ■ Believed to be a hypersensitivity reaction to drugs or disease ■ Frequently have had a preceding infectious disease that is respiratory Concerns ■ Previous trigger eg. Infection or meds eg., isotretinoin, oral contraceptives, sulfa, furosemide, cyclins, quinolones and cyclins ■ Risks include: – Pyoderma granulosum – Bullous disease – Genitourinary cancer – Hematologic malignancy – REFER TO DERMATOLOGY Systemic Disease with common cutaneous disorders Acne kathleen haycraft Concerns: ■ The issue of depression, inflammatory bowel disease is likely a comorbid of nodular cystic acne and not due to isotretinoin or doxycycline ■ Screen for GI and depression/suicide Rosacea © kathleen haycraft Rosacea ■ Genetic link to increase central vasculature of face ■ Initial face is erythrotelengectasia,
Recommended publications
  • Skin Test Christina P
    SKINTEST Skin Test Christina P. Linton 1. A middle-aged, diabetic woman presents with 6. What is the estimated 5-year survival rate for well-demarcated, yellow-brown, atrophic, telangiectatic melanoma that has spread beyond the original area plaques with a raised, violaceous border on her shins. of involvement to the nearby lymph nodes (but What is the most likely diagnosis? not to distant nodes or organs)? a. Lipodermatosclerosis a. 25% b. Pyoderma gangrenosum b. 41% c. Necrobiosis lipoidica c. 63% d. Erythema nodosum d. 87% 2. Which of the following types of fruit is most likely 7. What is another name for leprosy? to cause phytophotodermatitis? a. von Recklinghausen’s disease a. Pineapple b. MuchaYHabermann disease b. Grapefruit c. Schamberg’s disease c. Kiwi d. Hansen’s disease d. Peach 8. Which of the following is not an expected 3. Hypothyroidism can cause several changes to the skin extracutaneous finding in patients with and skin appendages including all of the following, HenochYScho¨ nlein purpura? except: a. Abdominal pain a. Hyperpigmentation b. Hematuria b. Easy bruising c. Shortness of breath c. Thin, brittle nails d. Arthralgias d. Dry, coarse skin 9. When the term ‘‘papillomatous’’ is used to describe 4. In a patient with neurofibromatosis, which sign refers a skin lesion, it means that the lesion is to the presence of bilateral axillary freckling? a. characterized by multiple fine surface projections. a. Auspitz sign b. erupting like a mushroom or fungus. b. Crowe sign c. characterized by fine fissures and cracks in the skin. c. Russell sign d. sieve like and contains many perforations.
    [Show full text]
  • Skin Lesions in Diabetic Patients
    Rev Saúde Pública 2005;39(4) 1 www.fsp.usp.br/rsp Skin lesions in diabetic patients N T Foss, D P Polon, M H Takada, M C Foss-Freitas and M C Foss Departamento de Clínica Médica. Faculdade de Medicina de Ribeirão Preto. Universidade de São Paulo. Ribeirão Preto, SP, Brasil Keywords Abstract Skin diseases. Dermatomycoses. Diabetes mellitus. Metabolic control. Objective It is yet unknown the relationship between diabetes and determinants or triggering factors of skin lesions in diabetic patients. The purpose of the present study was to investigate the presence of unreported skin lesions in diabetic patients and their relationship with metabolic control of diabetes. Methods A total of 403 diabetic patients, 31% type 1 and 69% type 2, underwent dermatological examination in an outpatient clinic of a university hospital. The endocrine-metabolic evaluation was carried out by an endocrinologist followed by the dermatological evaluation by a dermatologist. The metabolic control of 136 patients was evaluated using glycated hemoglobin. Results High number of dermophytosis (82.6%) followed by different types of skin lesions such as acne and actinic degeneration (66.7%), pyoderma (5%), cutaneous tumors (3%) and necrobiosis lipoidic (1%) were found. Among the most common skin lesions in diabetic patients, confirmed by histopathology, there were seen necrobiosis lipoidic (2 cases, 0.4%), diabetic dermopathy (5 cases, 1.2%) and foot ulcerations (3 cases, 0.7%). Glycated hemoglobin was 7.2% in both type 1 and 2 patients with adequate metabolic control and 11.9% and 12.7% in type 1 and 2 diabetic patients, respectively, with inadequate metabolic controls.
    [Show full text]
  • The Prevalence of Cutaneous Manifestations in Young Patients with Type 1 Diabetes
    Clinical Care/Education/Nutrition/Psychosocial Research ORIGINAL ARTICLE The Prevalence of Cutaneous Manifestations in Young Patients With Type 1 Diabetes 1 2 MILOSˇ D. PAVLOVIC´, MD, PHD SLAANA TODOROVIC´, MD tions, such as neuropathic foot ulcers; 2 4 TATJANA MILENKOVIC´, MD ZORANA ÐAKOVIC´, MD and 4) skin reactions to diabetes treat- 1 1 MIROSLAV DINIC´, MD RADOSˇ D. ZECEVIˇ , MD, PHD ment (1). 1 5 MILAN MISOVIˇ C´, MD RADOJE DODER, MD, PHD 3 To understand the development of DRAGANA DAKOVIC´, DS skin lesions and their relationship to dia- betes complications, a useful approach would be a long-term follow-up of type 1 OBJECTIVE — The aim of the study was to assess the prevalence of cutaneous disorders and diabetic patients and/or surveys of cuta- their relation to disease duration, metabolic control, and microvascular complications in chil- neous disorders in younger type 1 dia- dren and adolescents with type 1 diabetes. betic subjects. Available data suggest that skin dryness and scleroderma-like RESEARCH DESIGN AND METHODS — The presence and frequency of skin mani- festations were examined and compared in 212 unselected type 1 diabetic patients (aged 2–22 changes of the hand represent the most years, diabetes duration 1–15 years) and 196 healthy sex- and age-matched control subjects. common cutaneous manifestations of Logistic regression was used to analyze the relation of cutaneous disorders with diabetes dura- type 1 diabetes seen in up to 49% of the tion, glycemic control, and microvascular complications. patients (3). They are interrelated and also related to diabetes duration. Timing RESULTS — One hundred forty-two (68%) type 1 diabetic patients had at least one cutaneous of appearance of various cutaneous le- disorder vs.
    [Show full text]
  • Interstitial Granuloma Annulare Triggered by Lyme Disease
    Volume 27 Number 5| May 2021 Dermatology Online Journal || Case Presentation 27(5):11 Interstitial granuloma annulare triggered by Lyme disease Jordan Hyde1 MD, Jose A Plaza1,2 MD, Jessica Kaffenberger1 MD Affiliations: 1Division of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA, 2Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA Corresponding Author: Jessica Kaffenberger MD, Division of Dermatology, The Ohio State University Medical Wexner Medical Center, Suite 240, 540 Officenter Place, Columbus, OH 43230, Tel: 614-293-1707, Email: [email protected] been associated with a variety of systemic diseases Abstract including diabetes mellitus, malignancy, thyroid Granuloma annulare is a non-infectious disease, dyslipidemia, and infection [3,4]. granulomatous skin condition with multiple different associations. We present a case of a man in his 60s There are multiple histological variants of GA, with a three-week history of progressive targetoid including interstitial GA. The histopathology of plaques on his arms, legs, and trunk. Skin biopsy classic GA demonstrates a focal degeneration of demonstrated interstitial granuloma annulare. collagen surrounded by an inflammatory infiltrate Additional testing revealed IgM antibodies to Borrelia composed of lymphocytes and histiocytes. In a less burgdorferi on western blot suggesting interstitial common variant, interstitial GA, scattered histiocytes granuloma annulare was precipitated by the recent are seen
    [Show full text]
  • Topical Treatments for Seborrheic Keratosis: a Systematic Review
    SYSTEMATIC REVIEW AND META-ANALYSIS Topical Treatments for Seborrheic Keratosis: A Systematic Review Ma. Celina Cephyr C. Gonzalez, Veronica Marie E. Ramos and Cynthia P. Ciriaco-Tan Department of Dermatology, College of Medicine and Philippine General Hospital, University of the Philippines Manila ABSTRACT Background. Seborrheic keratosis is a benign skin tumor removed through electrodessication, cryotherapy, or surgery. Alternative options may be beneficial to patients with contraindications to standard treatment, or those who prefer a non-invasive approach. Objectives. To determine the effectiveness and safety of topical medications on seborrheic keratosis in the clearance of lesions, compared to placebo or standard therapy. Methods. Studies involving seborrheic keratosis treated with any topical medication, compared to cryotherapy, electrodessication or placebo were obtained from MEDLINE, HERDIN, and Cochrane electronic databases from 1990 to June 2018. Results. The search strategy yielded sixty articles. Nine publications (two randomized controlled trials, two non- randomized controlled trials, three cohort studies, two case reports) covering twelve medications (hydrogen peroxide, tacalcitol, calcipotriol, maxacalcitol, ammonium lactate, tazarotene, imiquimod, trichloroacetic acid, urea, nitric-zinc oxide, potassium dobesilate, 5-fluorouracil) were identified. The analysis showed that hydrogen peroxide 40% presented the highest level of evidence and was significantly more effective in the clearance of lesions compared to placebo. Conclusion. Most of the treatments reviewed resulted in good to excellent lesion clearance, with a few well- tolerated minor adverse events. Topical therapy is a viable option; however, the level of evidence is low. Standard invasive therapy remains to be the more acceptable modality. Key Words: seborrheic keratosis, topical, systematic review INTRODUCTION Description of the condition Seborrheic keratoses (SK) are very common benign tumors of the hair-bearing skin, typically seen in the elderly population.
    [Show full text]
  • HEALTH-RELATED QUALITY of LIFE in MORPHEA by NATASHA
    HEALTH-RELATED QUALITY OF LIFE IN MORPHEA by NATASHA KLIMAS In collaboration with Angela D. Shedd, M.D., Ira H. Bernstein, Ph.D., and Heidi T. Jacobe, M.D., M.S.C.S. DISSERTATION Presented to the Faculty of the Medical School The University of Texas Southwestern Medical Center In Partial Fulfillment of the Requirements For the Degree of DOCTOR OF MEDICINE WITH DISTINCTION IN RESEARCH The University of Texas Southwestern Medical Center Dallas, TX TABLE OF CONTENTS ABSTRACT …………………………………………… iii INTRODUCTION …………………………………………… iv MATERIALS AND METHODS …………………………………….. v RESULTS ………………….………………………………………… x DISCUSSION …….…………………………………………………………….. xiii KEY MESSAGES………………………………………………………………………….. xvi TABLES AND FIGURES…………………………………………………………………… xvii ACKNOWLEDGEMENTS ………………………………………………………………. xxvi REFERENCES…………………………………………………………………………… xxvii ii ABSTRACT Objective: Little is known about health-related quality of life (HRQOL) of patients with morphea (localized scleroderma). We determined the impact of morphea on HRQOL and clinical and demographic correlates of HRQOL. Methods: Cross sectional survey of Morphea in Adults and Children (MAC) cohort. Results: Morphea impairs HRQOL. Patients were particularly affected with respect to emotional well-being and concerns that the disease will progress to their internal organs. Patients with morphea had worse skin-specific HRQOL than those with other skin diseases, including non-melanoma skin cancer, vitiligo, and alopecia (lowest P <.0001). The morphea population was found to have significantly worse global HRQOL scores than the general U.S. population for all subscales (all P ≤.004) with the exception of bodily pain. Comorbidity (r =.35-.51, P ≤ .0029 -.0001) and symptoms of pruritus (r =.38 -.64, P ≤.001-.0001) and pain (r =.46-.74, P <.0001) were associated with impairment in multiple domains of skin-specific and global HRQOL.
    [Show full text]
  • A Case of Focal Acral Hyperkeratosis
    Ann Dermatol Vol. 21, No. 4, 2009 CASE REPORT A Case of Focal Acral Hyperkeratosis Eun Ah Lee, M.D., Hei Sung Kim, M.D., Hyung Ok Kim, M.D., Young Min Park, M.D. Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea Focal acral hyperkeratosis (FAH) is a rare genodermatosis the two; FAH does not have elastorrhexis. There has been with an autosomal dominant pattern of inheritance; how- only one previous report of FAH in a Korean patient; a ever, it may also be sporadic. FAH is characterized by 23-year-old female with a non-specific family history of late-onset crateriform keratotic papules, some coalescing in- FAH has been previously described3. We herein report a to plaques, along the borders of the hands and feet. We here- typical case of FAH in a 47-year-old Korean male with an in report a case of FAH in a 47-year-old male with a family autosomal dominant pattern of inheritance. history of similar lesions in three generations. The histo- logical findings revealed focal areas of orthohyperkeratosis CASE REPORT over an area of depressed but otherwise normal epidermis. The dermis showed no specific changes, which dis- A 47-year-old male presented with multiple persistent tinguished this case from acrokeratoelastoidosis, which flesh colored papules on the hands that were first noted shows elastorrhexis of clinically similar lesions. (Ann during early adulthood. The number of lesions had gradu- Dermatol 21(4) 426∼428, 2009) ally increased over the years.
    [Show full text]
  • Mycosis Fungoides: a Dermatological Masquerader D
    REVIEW ARTICLE DOI 10.1111/j.1365-2133.2006.07526.x Mycosis fungoides: a dermatological masquerader D. Nashan, D. Faulhaber,* S. Sta¨nder,* T.A. Luger* and R. Stadler Department of Dermatology, University of Freiburg, Hautstr. 7, 79104 Freiburg, Germany *Department of Dermatology, University of Mu¨nster, Mu¨nster, Germany Department of Dermatology, Klinikum Minden, Minden, Germany Summary Correspondence Mycosis fungoides (MF), a low-grade lymphoproliferative disorder, is the most D. Nashan. common type of cutaneous T-cell lymphoma. Typically, neoplastic T cells localize E-mail: [email protected] to the skin and produce patches, plaques, tumours or erythroderma. Diagnosis of MF can be difficult due to highly variable presentations and the sometimes non- Accepted for publication 8 June 2006 specific nature of histological findings. Molecular biology has improved the diag- nostic accuracy. Nevertheless, clinical experience is of substantial importance as Key words MF can resemble a wide variety of skin diseases. We performed a literature clinical subtypes, differential diagnoses, mycosis review and found that MF can mimic >50 different clinical entities. We present fungoides, overview a structured framework of clinical variations of classical, unusual and distinct Conflicts of interest forms of MF. Distinct subforms such as ichthyotic MF, adnexotropic (including None declared. syringotropic and folliculotropic) MF, MF with follicular mucinosis, granuloma- tous MF with granulomatous slack skin and papuloerythroderma of Ofuji are delineated in more detail. Mycosis fungoides (MF), a low-grade lymphoproliferative dis- fungoides’ with ‘differential diagnosis’ and ‘clinical picture’, order, is the most common type of cutaneous T-cell lymph- and ‘mycosis fungoides’ and ‘cutaneous T-cell lymphoma’ in oma.
    [Show full text]
  • 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,
    [Show full text]
  • Advances in Seborrheic Keratosis
    A CME/CE-Certified Supplement to Original Release Date: December 2018 Advances in Seborrheic Expiration Date: December 31, 2020 Estimated Time To Complete Activity: 1 hour Participants should read the activity information, Keratosis review the activity in its entirety, and complete the online post-test and evaluation. Upon completing this activity as designed and achieving a passing score on FACULTY the post-test, you will be directed to a Web page that will Joseph F. Fowler Jr, MD Michael S. Kaminer, MD allow you to receive your certificate of credit via e-mail Clinical Professor and Director Associate Clinical Professor of Dermatology or you may print it out at that time. Contact and Occupational Yale Medical School The online post-test and evaluation can be accessed Dermatology New Haven, Connecticut at http://tinyurl.com/SebK2018. University of Louisville School of Adjunct Assistant Professor of Medicine Medicine (Dermatology), Warren Alpert Medical School Inquiries about continuing medical education (CME) Louisville, Kentucky of Brown University accreditation may be directed to the University of Providence, Rhode Island Louisville Office of Continuing Medical Education & Professional Development (CME & PD) at cmepd@ louisville.edu or (502) 852-5329. Designation Statement eborrheic keratosis (SK) has been called keratinizing surface.12 They can develop virtually The University of Louisville School of Medicine the “Rodney Dangerfield of skin lesions”— anywhere except for the palms, soles, and mucous designates this Enduring material for a maximum of 9 1.0 AMA PRA Category 1 Credit(s)™. Physicians should it earns little respect (as a clinical concern) membranes, but are most commonly observed claim only the credit commensurate with the extent of Sbecause of its benignity, commonality, usual on the trunk and face.6,13 The tendency to develop their participation in the activity.
    [Show full text]
  • Cryosurgery Using the Cryopen®
    Cryosurgery using the CryoPen® FAQ CRYOSURGERY What is cryosurgery? Cryosurgery is a procedure that uses extreme cold to destroy tissue. How can my practice benefit from using cryosurgery in my practice? Cryosurgery in the office offers an excellent modality for eliminating referral time while creating an added source of revenue. How can my patients benefit from having cryosurgery in my practice? Patients will appreciate the efficient use of their time and decreased cost of services by avoiding secondary visits to specialists. By keeping the procedure in house, patients will put a greater value on your practice. How is cryosurgery better than other methods of removing skin lesions? Cryosurgery requires no anesthesia and has less scarring than other techniques of skin lesion removal with minimal post-op care. What is the mechanism of cell destruction in cryosurgery? Cell destruction occurs when a cell is rapidly brought down to a very low temperature. When these two criteria are met (varies with cell type), ice crystals form, destroying the cell organelles and protein matrixes. Water then rushes into the surrounding area causing a blister and a disruption of the local blood supply. Cytologic evidence of cell destruction can be seen as soon as two hours after the procedure. What types of lesions are appropriate to freeze? Almost any unwanted skin lesions are appropriate such as warts, moles, actinic keratosis, seborrheic keratosis, keloids, lentigos, dermatofibromas, and hemangiomas to just name a few. In most practices, over 90% of unwanted lesions encountered are amenable to using cryosurgery. What types of lesions are not appropriate to freeze? All Melanomas and Recurrent Basal Cell Carcinomas are contraindicated for cryosurgery.
    [Show full text]
  • Granulomatous Dermatitis As a Postherpetic Isotopic Response in Immunocompromised Patients: a Report of 5 Cases William H
    Washington University School of Medicine Digital Commons@Becker Open Access Publications 2018 Granulomatous dermatitis as a postherpetic isotopic response in immunocompromised patients: A report of 5 cases William H. McCoy Washington University School of Medicine in St. Louis Elaine Otchere Washington University School of Medicine in St. Louis Amy C. Musiek Washington University School of Medicine in St. Louis Milan J. Anadkat Washington University School of Medicine in St. Louis Follow this and additional works at: https://digitalcommons.wustl.edu/open_access_pubs Recommended Citation McCoy, William H.; Otchere, Elaine; Musiek, Amy C.; and Anadkat, Milan J., ,"Granulomatous dermatitis as a postherpetic isotopic response in immunocompromised patients: A report of 5 cases." JAAD Case Reports.4,8. 752-760. (2018). https://digitalcommons.wustl.edu/open_access_pubs/7169 This Open Access Publication is brought to you for free and open access by Digital Commons@Becker. It has been accepted for inclusion in Open Access Publications by an authorized administrator of Digital Commons@Becker. For more information, please contact [email protected]. CASE SERIES Granulomatous dermatitis as a postherpetic isotopic response in immunocompromised patients: A report of 5 cases William H. McCoy 4th, MD, PhD,a,b,c Elaine Otchere, BS,a Amy C. Musiek, MD,a,b,c and MilanJ.Anadkat,MDa,b,c Saint Louis, Missouri Key words: Chronic lymphocytic leukemia; granuloma annulare; granulomatous dermatitis; immunocom- promised district; immunodeficiency; immunocompromise; immunosuppression; isotopic response; locus minoris resistentiae; postherpetic isotopic response; Wolf’s isotopic response. INTRODUCTION Abbreviations used: Granulomatous dermatitis (GD) describes disor- ders in which mixed inflammatory infiltrates AML: acute myelogenous leukemia CLL: chronic lymphocytic leukemia composed primarily of histiocytes invade the skin.
    [Show full text]