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161. Varicose veins

) are intradermal veins that are less than 1 mm in diameter. Reticular veins are permanently dilated intradermal veins that range between 1–3 mm in diameter. They may be tortuous but are usually asymptomatic. Assess for any , including: Skin changes — look for hyperpigmentation (brown-red discolouration caused by haemosiderin deposition), venous eczema (itchy, red, scaly, and/or flaky skin which may have blisters and crusts on the surface), lipodermatosclerosis (painful, hardened, tight skin), and atrophie

2019 NICE Clinical Knowledge Summaries

162. Cholesteatoma

retraction pocket, with or without granulation tissue and skin debris. Crust or keratin in the upper part of the tympanic membrane. The tympanic membrane may be perforated. Congenital cholesteatoma (rare) may appear as a white mass behind an intact tympanic membrane, in a person with no prior history of ear discharge, tympanic membrane perforation, or surgical procedures on the ear. If there is significant discharge occluding the tympanic membrane, referral for examination with an otomicroscope and micro (...) , with or without granulation tissue and skin debris. Crust or keratin in the upper part of the tympanic membrane. The tympanic membrane may be perforated. Congenital cholesteatoma (rare) may appear as a white mass behind an intact tympanic membrane, in a person with no prior history of ear discharge, tympanic membrane perforation, or surgical procedures on the ear. If there is significant discharge occluding the tympanic membrane, referral for examination with an otomicroscope and micro-suctioning of the ear

2019 NICE Clinical Knowledge Summaries

163. Seborrhoeic dermatitis

to surrounding skin. Symmetrically distributed lesions — usually one or two body areas are affected but signs may be more widespread. Mild itching (in particular where the scalp is affected). The most commonly affected areas are the: Scalp — lesions can range from mild desquamation (dandruff) to thick brownish crusts adherent to skin and hair. Face (in particular the nasolabial folds, glabellar area, eyebrows, and behind the ears). The eyelids may be red, swollen and flaky (seborrhoeic blepharitis (...) are associated with seborrhoeic dermatitis including chlorpromazine, cimetidine, gold, haloperidol, interferon‐alpha, lithium, and methyldopa. Examine the person looking for: of seborrhoeic dermatitis such as erythematous scaly patches in areas rich in sebaceous glands — severity can vary from mild flaking to widespread, oily, dense scaling or crusting. Consider the need for further investigations: Diagnosis is usually clinical — investigations (such as blood tests, skin scrapings, or skin biopsy) may

2019 NICE Clinical Knowledge Summaries

164. Blepharitis

prevent complications, periodic relapses and exacerbations are typical. Characteristic clinical features include burning, itching, erythema and crusting of the eyelids, worse in the mornings. Conditions commonly associated with blepharitis include dry eye syndrome, seborrhoeic dermatitis and rosacea. The differential diagnosis of chronic blepharitis includes malignant tumours of the eyelid (such as squamous cell, basal cell, or sebaceous cell carcinoma), eczema, infection, infestation (such as pubic (...) — incidence of these complications is greater in children. See the CKS topic on for more information. [ ; ; ] Diagnosis Diagnosis of blepharitis Clinical features When should I suspect blepharitis? Suspect blepharitis if the person has: Characteristic symptoms (often intermittent, with exacerbations and remissions occurring over long periods): Burning, itching and/or crusting of the eyelids. Symptoms are worse in the mornings. Both eyes are affected. Recurrent hordeolum. Contact lens intolerance

2019 NICE Clinical Knowledge Summaries

165. Leg ulcer - venous

of ulceration, malodour, and increased exudate. Examine both legs for signs of venous insufficiency, including: Pitting oedema — rule out non-venous causes of oedema, such as heart failure and chronic kidney disease. See the CKS topics on and . Skin changes — look for hyperpigmentation (brown-red discolouration caused by haemosiderin deposition), venous eczema (itchy, red, scaly, and/or flaky skin which may have blisters and crusts on the surface), lipodermatosclerosis (painful, hardened, tight skin

2019 NICE Clinical Knowledge Summaries

166. Cellulitis - acute

, red, swollen and painful swelling, which may need incision and drainage. Erysipelas — a form of cellulitis involving more superficial dermal structures distinguished clinically by raised and well demarcated borders. Chronic conditions (these are usually bilateral but if worse on one side, it may be difficult to exclude superimposed cellulitis): Varicose eczema/venous insufficiency — crusting, scaling, and itching. Contact allergic dermatitis — can present acutely as erythematous, sore and tender (...) lymphoedema who develop cellulitis but do not require : Prescribe amoxicillin 500 mg three times daily. If there is any evidence of Staphylococcus aureus infection, for example, folliculitis, pus formation, or crusted dermatitis, prescribe flucloxacillin 500 mg four times a day in addition to amoxicillin, or as an alternative. If the person has a penicillin allergy, prescribe clarithromycin 500 mg twice daily. Continue antibiotic treatment until all signs of acute inflammation have resolved. The course

2019 NICE Clinical Knowledge Summaries

167. Geological significance of new zircon U-Pb geochronology and geochemistry: Niuxinshan intrusive complex, northern North China Craton. (PubMed)

into two groups. One group's geochemical signature exhibits steep rare earth element (REE) patterns with negligible Eu anomalies, lower Yb, higher Sr, and negative Nb-Ta-Ti (NTT) anomalies, which indicate a volcanic-arc environment with a thickened crust in a convergent setting. The other group exhibits flat REE patterns with obvious negative Eu anomalies, higher Yb, lower Sr, and weak NTT anomalies, which indicate an intra-plate extensional environment with a thinning crust. Combining geochronologic

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2019 PLoS ONE

168. Is There an Association Between Hyperbaric Oxygen Therapy and Improved Outcome of Deep Chemical Peeling? A Randomized Pilot Clinical Study. (PubMed)

PCP underwent 5 consecutive daily HBOT sessions, compared with PCP alone. Pain, pruritus, erythema, crusting, scaling, and edema were daily evaluated up to 28 days following PCP. Photographs taken on days 14 and 35 following PCP were assessed. Confidence to appear in public was assessed 14 days following PCP.Eight participants equally assigned to HBOT and control groups. Lower severity scores for erythema, scaling, and pruritus were documented in the HBOT group (mean difference 1.19, P = .006; .84 (...) , P = .04; and 2.19, P = .001, respectively). Photographic assessment severity score was higher for skin tightness, edema, erythema, crusting, and scaling in the control group on day 14 post PCP (P < .05) and for erythema on day 35 post PCP (P < .05). Epithelialization percentage was higher in the HBOT group on day 14 post PCP compared with controls (98.5% ± 1% vs 94.2% ± 1%; P = .021). The HBOT group scored higher in confidence to appear in public (20.8 ± 1.7 vs 14.5 ± 1.3; P = .029).Hyperbaric

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2018 Plastic surgery (Oakville, Ont.) Controlled trial quality: uncertain

169. Interventions for prevention of herpes simplex labialis (cold sores on the lips). (PubMed)

Interventions for prevention of herpes simplex labialis (cold sores on the lips). Herpes simplex labialis (HSL), also known as cold sores, is a common disease of the lips caused by the herpes simplex virus, which is found throughout the world. It presents as a painful vesicular eruption, forming unsightly crusts, which cause cosmetic disfigurement and psychosocial distress. There is no cure available, and it recurs periodically.To assess the effects of interventions for the prevention of HSL

2015 Cochrane

170. Mycosis Fungoides (Including Sézary Syndrome) Treatment (PDQ®): Health Professional Version

for Cutaneous Lymphomas; LN = lymph nodes; NCI = National Cancer Institute. a Reprinted with permission from AJCC: Primary cutaneous lymphomas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, p 613-5. b For skin, patch indicates any size skin lesion without significant elevation or induration. Presence/absence of hypo- or hyperpigmentation, scale, crusting, and/or poikiloderma should be noted. c For skin, plaque indicates any size skin lesion (...) that is elevated or indurated. Presence or absence of scale, crusting, and/or poikiloderma should be noted. Histologic features such as folliculotropism or large-cell transformation (>25% large cells), CD30+ or CD30-, and clinical features, such as ulceration, are important to document. d For skin, tumor indicates at least 1 cm diameter solid or nodular lesion with evidence of depth and/or vertical growth. Note total number of lesions, total volume of lesions, largest size lesion, and region of body involved

2018 PDQ - NCI's Comprehensive Cancer Database

171. International Consolidated Venous Ulcer Guideline

. >1.985 mm as measured using high frequency ultrasound or other clinically documented technique. A (Choh et al., 2010; Vesic et al., 2008; Volikova et al., 2009; Xia et al., 2004), CVI= 0.667, Moderate SOR A.2.b.iii. Stasis dermatitis including tan or red-brown skin color (hemosiderin deposits) usually at medial ankle, or small erosions that may be open or crusted. A (Alguire et al., 1997; Burton, 1993; Pappas et al., 1997) CVI= 0.952, High SOR A.2.b.iv. Lipodermatosclerosis, (fibrosis of dermis

2015 Association for the Advancement of Wound Care

172. Skin Cancer Treatment (PDQ®): Patient Version

and raised (right panel). Squamous cell carcinoma occurs on areas of the skin that have been damaged by the sun, such as the ears, lower lip, and the back of the hands. Squamous cell carcinoma may also appear on areas of the skin that have been sunburned or exposed to or . Often this looks like a firm red bump. The may feel scaly, bleed, or form a crust. Squamous cell tumors may spread to nearby . Squamous cell carcinoma that has not spread can usually be . Actinic keratosis is a skin

2018 PDQ - NCI's Comprehensive Cancer Database

173. Langerhans Cell Histiocytosis Treatment (PDQ®): Patient Version

: Flaking of the scalp that may look like dandruff. Raised, red or brown, crusted rash in the area, , back, or chest, that may be itchy or painful. Bumps or on the scalp. Ulcers behind the ears, under the , or in the groin area. Fingernails that fall off or have discolored grooves that run the across the nail. Mouth Signs or symptoms of LCH that affects the mouth may include: Swollen . Sores on the roof of the mouth, inside the cheeks, or on the tongue or lips. Teeth that become uneven or fall out. Bone

2018 PDQ - NCI's Comprehensive Cancer Database

175. Public health guidance on varicella vaccination in the European Union

to vesicular lesions before crusting. Successive crops (usually two to four) appear over several days. The rash tends to have central distribution, with the highest concentration of lesions on the trunk [31]. Lesions can also occur on mucous membranes and cornea [5]. Humans are the only VZV reservoir which can be transmitted person-to-person by direct contact with respiratory secretions or inhalation of vesicle fluid (airborne spread) [31]. The period of communicability goes from one to two days before (...) the onset of the rash to when the lesions are crusted over, usually four to five days after the appearance of the rash. The incubation period goes from 10 to 21 days, commonly 14 to 16 days [31]. Although most people with varicella make full recoveries, complications can occur, especially in older age groups, pregnant women (including congenital varicella syndrome and neonatal varicella) and immunocompromised patients. Varicella is responsible for a substantial burden of hospitalisations

2015 European Centre for Disease Prevention and Control - Public Health Guidance

176. Sofosbuvir induced steven Johnson Syndrome in a patient with hepatitis C virus‐related cirrhosis (PubMed)

weeks of therapy with peginterferon alpha-2a and oral ribavirin. After peginterferon withdrawal and stabilization, oral sofosbuvir and ribavirin were started; 10 days later, he developed itching over the trunk and legs, followed by multiple papules and vesicles over an erythematous base. Over the next 15 days, the rash progressed with the formation of blisters and peeling skin. Simultaneously, the oral mucosa and lips developed crusting and painful erosions. Considering drug-induced Steven John

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2017 Hepatology communications

177. Breastfeeding Healthy Term Infants

• Mothers with active herpes simplex lesions on or near the nipple should interrupt breastfeeding on the breast and nipple affected until lesions are crusted or resolved 2,26,45 • Mothers receiving a high-dose of the antibiotic Metroridazole: discontinue breastfeeding for 12 – 24 hours to allow excretion of the dose 45 • Mothers with active tuberculosis who are not receiving adequate therapy are considered infectious. 2 Following 2-weeks of appropriate TB drug therapy breastfeeding is recommended

2015 British Columbia Perinatal Health Program

178. Does lowering a fever >101F in children improve clinical outcomes?

? View/ Open Date 2010-06 Format Metadata Abstract Treating fever significantly increases comfort, activity, feeding, and fluid intake and decreases the patient's temperature compared with placebo (strength of recommendation (SOR): A, multiple randomized controlled trials [RCTs]). It doesn't shorten or prolong the overall duration of illness or reduce the recurrence of febrile seizures (SOR: A, multiple RCTs). In patients with varicella, reducing fever prolongs the time it takes for lesions to crust

2015 Clinical Inquiries

179. Chickenpox in Pregnancy

a chickenpox rash should immediately contact their general practitioner. Women should avoid contact with potentially susceptible individuals, e.g. other pregnant women and neonates, until the lesions have crusted over. This is usually about 5 days after the onset of the rash. Symptomatic treatment and hygiene is advised to prevent secondary bacterial infection of the lesions. Oral aciclovir should be prescribed for pregnant women with chickenpox if they present within 24 hours of the onset of the rash (...) , clothing and bedding). The primary infection is characterised by fever, malaise and a pruritic rash that develops into crops of maculopapules, which become vesicular and crust over before healing. The incubation C C P P P P P DRCOG Green-top Guideline No. 13 © Royal College of Obstetricians and Gynaecologists 5 of 17 period is between 1 and 3 weeks and the disease is infectious 48 hours before the rash appears and continues to be infectious until the vesicles crust over. The vesicles usually crust over

2015 Royal College of Obstetricians and Gynaecologists

180. Scabies

: Crusted scabies; Indigenous communities; Infestations; Norwegian scabies; Poverty; Pruritus

2015 Canadian Paediatric Society

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