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Environmental Terminology in the Language Of “Raindrops” describe the pattern of hypopigmented areas ENVIRONMENTAL TERMINOLOGY IN THE LANGUAGE OF DERMATOLOGY within larger areas of hyperpigmentation associated with Patricia Ting, BSc& Benjamin Barankin, MD arsenic -induced pigmentation Division of Dermatology and Cutaneous Sciences, University of Alberta, Edmonton, Alberta, Canada Background: Arsenic exposure often results in pigmentary changes (hyper- and/or hypopigmentation) and multiple punctate keratoses on the palms and soles. The latter may ABSTRACT develop into skin cancers (i.e. Bowen's, squamous cell, basal cell carcinoma). The source of inorganic arsenicals comes Communication in dermatology is based upon the accurate morphological description of cutaneous lesions. To facilitate this goal, dermatologists have adopted Multicentric reticulohistiocytosis (MRH) is a multi-system from agricultural, environmental (well water), industrial (glass interesting and descriptive terminology to portray dermatoses that are difficult to depict and visualize, including frequently e ncountered objects in nature disorder with distinct cutaneous lesions of 2 to 10 cm non- workers, miners), and medicinal (herbal) remedies. and natural phenomena. Many of these descriptions are able to effectively create rich visual imagery, and they are useful aids f or learning and recall. Many tender papules or nodules on the upper trunk and extremities, have stood the test of time. For example, varicella has been described as “dewdrops on a rose petal” and linear palmoplantar lesions of pachydermoperiotosis Pathophysiology : Arsenicals may increase susceptibility to hands and nail base that range in color from shades of yellow have been depicted as a “wind blown desert” of rippling sand. The “Christmas tree” pattern has been classically used to describe pityriasis rosea while the to red. Coalescent plaques of such lesions are morphologically mutagens, impair DNA repair mechanisms and alter gene “wood-grain ” pattern is reminiscent of erythema gyratum repens. expression via DNA methylation. similar to the appearance of "coral beads." After perusing numerous dermatology books and journals, and the Internet, a collection of words and phrases related to nature that have been commonly Background: A rare condition of destructive arthritis with Synonyms: arsenic -induced pigmentation, chronic effects of applied to various dermatoses has been compiled. There are alsoaccompanying illustrations and brief explanations of these environmental-descriptors. arsenic exposure multiple cutaneous nodules. Less than 200 cases are reported in the literature. It is associated with an underlying internal malignancy in 25% of cases, suggesting that MRH may be a An “oil drop ” appearance of the nails is a common sign of nail psoriasis. The lesion is a translucent, brownish - paraneoplastic condition. yellow coloration of the nail bed that gives rise to an “oil drop” appearance. Nail pits are the most common Pathophysiology : Histologically, the "coral bead" lesions appear “Field fire ” epithelioma is used to describe cicatricial basal cell signs of psoriatic nail disease. carcinoma (BCC), which often appear as a scar or scleroderma -like as an infiltrate of histiocytic multinucleated giant cells with plaque with ulceration, raised borders and surrounding Background: Psoriasis is a common chronic skin disorder characterized by erythematous, scaly plaques with Source (above): Cutaneous Manifestations of Systemic Disease, 1st ed. (p.270) eosinophilic ground-glass cytoplasm. telangiectases. Cicatricial BCC occur almost exclusively on the silvery scale. Up to 50% of patients with psoriasis have associa ted nail findings. Less than 5% of “oil drop” Synonyms: arthritis mutilans, giant cell reticulohistiocytosis, cheek. Mohs micrographic surgery is recommended to ensure the nails are idiopathic. lipoid dermatoarthritis, lipoid rheumatism complete removal of tumor. Pathophysiology : Unknown. Background: BCC is the most common nonmelanocytic skin cancer in Associated Symptoms: Other nail changes include pitting, onycholysis, and subungualhyperkeratosis. humans. Lesions usually occur on sun -exposed areas (i.e. head, A ”wind blown desert of rippling sand” describes the neck, upper trunk). Risk factors include fair skin (Fitzpatrick type Synonyms: psoriatic nail disease appearance of hyperkeratotic linear lesions on the palms and I & II), excessive sun exposure and history of sunburn. soles found in the majority of patients with Pathophysiology : UV light-induced DNA damage and mutations pachydermoperiostosis. Synonyms: morpheaform BCC, sclerosing BCC, fibrosing BCC “Footprints in the snow” depicts a diffuse pattern of scarring alopecia on the scalp, also known as Background: Pachydermoperiostosis, first described in 1868, is pseudopelade of Brocq. The lesions resemble those of alopecia areata, for which “pelade ” is the French a rare multi-system disorder with variable penetrance. translation. Footprints in the snow alludes to the slight depression of the scalp caused by dermal atrophy Pathophysiology : Genetic inheritance as autosomal dominant and at the lesion site. Nevertheless, this finding is not commonly o bserved in pseudopelade. Kangri cancer is a type of heat-induced skin cancer (usually recessive forms. squamous cell carcinoma) on the abdomen and/or thighs. The Background: This randomly distributed, irregularly -shaped, patchy pattern of hair loss may be seen as an Source (above): Derm Image Atlas – Associated Symptoms: Thickened skin folds and deep creases Johns Hopkins University www.dermatlas.org kangri (aka . fire basket) is an earthen pot used to burn charcoal endpoint in chronic discoid lupus erythematosus, lichen planopilaris, and other forms of scarring alopecia. A and Chinan leaves. similar form of hair loss is sometimes associated with secondary syphilis. Pseudopelade of Brocq is in face and scalp (especially on the forehead), finger clubbing, considered a diagnosis of exclusion. The condition may end spontaneously and/or reactivate periodically. painful periostosis of long bones, polyarthritis and Background: Kangri is used by the people of Kashmir Valley during hyperhidrosis. winter months to keep their bodies warm by placing the Kangri on Pathophysiology: Unknown.Likely related to an underlying cutaneous disease . the lower abdomen and thigh. In China, similar cancers were Synonyms: primary hypertrophic osteoarthropathy , Touraine- reported with the use of heated brick ovens (kang ). Involvement Solente -Gole syndrome Source (above): Derm Image Atlas –Johns Hopkins University www.dermatlas.org of lymph nodes is seen only in 33% of cases in spite of the fact A “dry river bed ” is often used to describe the appearance of that lesions are enormous in size. Kangri cancer is now on the generalized scales on the body in lamellar ichthyosis. Very thick scales decline in Kashmir Valley due to improvement in socio -economic have been referred to as an “armor plate .” "Bamboo hair" describes a ball-and -socket hair shaft conditions and the spread of education among inhabitants. abnormality caused by invagination of the distal hair shaft Background: Lamellar ichthyosis is a rare condition that affects the Pathophysiology : Unknown. Smoke and heat are thought to induce into a cup formed by the soft proximal hair shaft as noted in entire skin surface. It is almost always present at birth with the affected cancers at these sites secondary to chronic irritation. trichorrhexis invaginata (TI). baby encased in a collodion membrane. Source (above): Derm Image Atlas –Johns Hopkins University www.dermatlas.org Synonyms: fire basket cancer Background: Trichorrhexis invaginata is a genetic abnormality Pathophysiology : Lamellar ichthyosis is an extremely rare autosomal resulting in hair shaft deformity. A fracture of the hair recessive condition that affects transglutaminase 1 (TGM1) genes on shaft results in a distal end that appears as a “golf tee.” chromosomes 14q11 and 2q33-35. Approximately 50% of patients have a Pathophysiology : Invagination of the distal into the proximal “Dewdrops on a rose petal” is a commonly used phrase to Source (above): Derm Image Atlas –Johns Hopkins University defect or absence of TGM1 function. portray the appearance of fragile vesicles with an www. dermatlas.org hair shaft occurs at a site of intermittent keratinizing erythematous base observed in varicella . defect of hair cortex from incomplete formation of S-S disulfide bonds from the sulfhydryl–SH group in the protein. Background: Varicella is a mild, self -limited viral infection An “ash -leaf ” spot is commonly used to describe the shape of lance -ovate hypopigmented The result is a soft hair cortex prone to a bulging deformity. caused by the varicella -zoster virus (VZV). Lesions progress macules in tuberous sclerosis (TS). Macular leukoderma variants in TS may resemble thumb- through several stages: erythematous macule –> papule –> print, confetti or segmental hypopigmented macules. Lesions are present at birth and most Synonyms: bamboo hair, cane stick deformity, golf tee hairs, trichorrhexis nodosa vesicle –> pustule –> crust. often occur on the trunk and lower limbs. The triad of three or more ash -leaf lesions with seizures and mental retardation is highly diagnostic of TS. Source: Andrews’ Diseases of the Skin, 9th ed. (p. 959) Pathophysiology : The VZV is highly contagious and spread via respiratory droplets. Lesions in the papular and vesicular Background: Up to 98% of patients with tuberous sclerosis also have adenoma sebaceum,
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