8/26/14 Dermatology/Pathology S. Eliza Halcomb, MD http://en.wikipedia.org/wiki/Black_tongue 1 8/26/14 http://en.wikipedia.org/wiki/Gingival_enlargement 2 8/26/14 Oral Discoloration Tongue • Brown • Bromine, bismuth, arsenic, phenolpthalein, doxrubicin, quinacrine, tobacco • Vanadium • Green • Black, Hairy • Cefoxitin, corticosteroids,lansoprazole, penicillin, sodium perborate, sodium peroxide, tetracycline • White • Chlorhexidine, phenol, caustic acids, hydrogen peroxide • Methylene blue • Blue • Bismuth, lead, mercury, copper salts, • Blue Gray Gums thallium, zinc Fecal Discoloration • Acetazolamide, aluminum hydroxide, • Black aminophylline,amphotericin b,barium, benzene,bismuth, bromides, charcoal,chloramphenical,chlorpropamide,clindamycin,co rticosteroids,cyclophosphamide,digitalis,feroous salts,fluoruracil,formaldehyde,halides,halothane, metals (Ag,As, Cu,Hg,Mn,Pb,Tl),hydralazine,methotrexetae,methylene blue, nitrates,NSAIDs, tetracycline,theophylline,warfarin • Blue • Boric acid, chloramphenical, maganese dioxide, methylene blue • Yellow-green • Mercurous chloride, yellow phosphorus • Orange-red • Phenazopyridine, rifampin • Pink • Manganese dioxide, phenolthalein Teratogens 3 8/26/14 Teratogens • Coumadin • Quinine: – Midface hypoplasia – Hypoplasia 8th CN • Bromides • Retinoids – Polydactyly, clubfoot – Craniofacial abnormalities • Ethanol – Absent ears – FAS • SMZ/TMP • Danazol – Neural tube defects – Pseudo-hermaphrodism • Valproate • Lithium – Spina bifida – Ebstein’s anaomaly • Mycophenolate – Cleft lip/palate – Distal limb anomalies http://en.wikipedia.org/wiki/Fetal_alcohol_syndrome Buehler BA et al. N Engl J Med 1990;322:1567-1572. 4 8/26/14 http://en.wikipedia.org/wiki http://en.wikipedia.org/wiki/ Phocomelia#mediaviewer/ File:Ears_of_phocomelia_patients. jpg Adverse Drug Reactions – Cutaneous Manifestations 5 8/26/14 http://en.wikipedia.org/wiki/Stevens–Johnson_syndrome http://en.wikipedia.org/wiki/Toxic_epidermal_necrolysis An. Bras. Dermatol. vol.87 no.4 Rio de Janeiro July/Aug. 2012 6 8/26/14 Neurology November 10, 2009 vol. 73 no. 19 e94-e95 http://en.wikipedia.org/wiki/Coumadin_necrosis 7 8/26/14 8 8/26/14 http://en.wikipedia.org/wiki/Mees'_lines http://www.medicinenet.com/image-collection/melasma_picture/picture.html http://drugline.org/img/term/gray-baby-syndrome-6642_2.jpg 9 8/26/14 Cutaneous Manifestations • Red Man Syndrome - Vancomycin • Grey Baby Syndrome - Chloramphenical • Blue (MetHgb): Sulfonamides, Dapsone, Primaquine, chloroquine, nitrofurans • Yellow: Dinitrophenol • Stevens-Johnson: PNC, Cephalosporins, Sulfa, nevirapine • TEN: PNC, Sulfas, nevirapine • Vesiculobullous: PNC, Rifampin, Sulfonamides, Griseofulvin • Vasculitis: Levamisole • Acute Hypersensitivity Syndrome: Sulfas, Bacitracin, Clindamycin, Lincomycin, Nitrofurazone, nevirapine • Alopecia: Selenium Sulfide 10 8/26/14 Occupational Exposures http://www.cdc.gov/niosh/topics/skin/occderm-slides/ocderm8.html 11 8/26/14 http://www.cdc.gov/niosh/topics/skin/occderm-slides/ocderm8.html http://www.cdc.gov/niosh/topics/skin/occderm-slides/ocderm8.html http://www.cdc.gov/niosh/topics/skin/occderm-slides/ocderm10.html 12 8/26/14 http://www.cdc.gov/niosh/topics/skin/occderm-slides/ocderm11.html http://en.wikipedia.org/wiki/Hydrofluoric_acid#Health_and_safety http://roentgenrayreader.blogspot.com/2009/05/acroosteolysis.html 13 .