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Hyperpigmentation

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221. Pityriasis rosea

of lesions continuing to appear for up to 6 weeks. It will usually settle without treatment within 2–3 months, but may take up to 5 months to disappear. After the rash has disappeared, there may be some hyperpigmentation or hypopigmentation of the affected skin for several months, but there should be no scarring. For people with itch, an emollient or a mild or moderately-potent topical corticosteroid (depending on the severity of itch) may provide symptomatic relief. A sedating oral antihistamine may

2020 NICE Clinical Knowledge Summaries

222. Diarrhoea - adult's assessment: Scenario: Chronic diarrhoea ( 4weeks)

). Systemic illness affecting gastrointestinal motility (for example scleroderma, diabetes mellitus); history of inflammatory bowel disease; previous gastrointestinal surgery with risk of stricture — consider small intestinal bacterial overgrowth (SIBO). Rashes (for example pyoderma gangrenosum or erythema nodosum in inflammatory bowel disease; hyperpigmentation in Addison's disease; dermatitis herpetiformis in coeliac disease). Assess for features that indicate a diagnosis of irritable bowel syndrome

2020 NICE Clinical Knowledge Summaries

223. Acne vulgaris

and inflammation of the pilosebaceous unit (the hair follicle, hair shaft and sebaceous gland). It presents with lesions which can be non-inflammatory (comedones), inflammatory (papules, pustules and nodules) or a mixture of both. Up to 95% of adolescents in Western industrialized countries are affected by acne to some extent — 20 to 35% develop moderate or severe acne. Complications of acne include skin changes such as scarring, post-inflammatory hyperpigmentation or depigmentation and psychosocial problems (...) variant of acne such as acne conglobata or acne fulminans (immediate referral) is suspected. Acne is severe, there is visible scarring or the person is at risk of scarring or significant hyperpigmentation. Multiple treatments in primary care have failed. Significant psychological distress is associated with acne, regardless of severity. There is diagnostic uncertainty. Follow-up should be arranged 8-12 weeks after initiation of each treatment step: If there has been an adequate response, treatment

2020 NICE Clinical Knowledge Summaries

225. An unusual case of capecitabine hyperpigmentation: Is hyperpigmentation a part of hand-foot syndrome or a separate entity? Full Text available with Trip Pro

An unusual case of capecitabine hyperpigmentation: Is hyperpigmentation a part of hand-foot syndrome or a separate entity? A 59-year-old man with adenocarcinoma of stomach was prescribed capecitabine as adjuvant chemotherapy. After two cycles of therapy, patient developed hyperpigmentation on hands and feet. Examination revealed a peculiar distribution of hyperpigmentation on hands and feet and in addition, hyperpigmented spots on the dorsum of tongue. Although hand-foot syndrome (HFS (...) ) to capecitabine solely manifesting as palmoplantar hyperpigmentation has been described earlier, this is probably the first instance wherein oral pigmentation has also been found in association. In addition, this finding lends support to the growing argument of hyperpigmentation being a separate entity: different from HFS, both therefore being separate adverse effects of the same drug.

2010 Indian journal of pharmacology

226. Addison's disease

Addison's disease Addison's disease - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Addison's disease Last reviewed: February 2019 Last updated: December 2018 Summary Presentation may be acute or insidious, with substantial fatigue and weakness associated with mucocutaneous hyperpigmentation, hypotension and/or postural hypotension, and salt craving. Adrenocorticotrophic hormone stimulation test is performed (...) in children is not specifically covered in this topic, but should result in referral to a paediatric endocrinology specialist. History and exam presence of risk factors fatigue anorexia weight loss hyperpigmentation salt craving nausea vomiting hypotension arthralgia and myalgia female sex adrenocortical autoantibodies adrenal haemorrhage autoimmune diseases tuberculosis (TB) non-TB bacterial infection fungal infection HIV drugs that inhibit cortisol production metastatic malignancy coeliac disease

2018 BMJ Best Practice

227. Refractory extrapulmonary sarcoidosis: infliximab

involving several organs and causing severe symptoms and functional impairment. It is characterised by the presence of non-caseating granulomas (non-necrotising nodules of inflammation and scarring) in the organs. The lungs are affected in more than 90% of people with sarcoidosis (see the evidence summary on pulmonary sarcoidosis for more information). The skin is the second most commonly affected organ. Manifestations include hyperpigmentation, hypopigmentation, keloid reaction, lupus pernio (lesions

2017 National Institute for Health and Clinical Excellence - Advice

228. Adrenal suppression

or orthostatic symptoms myalgia or arthralgia abdominal pain cushingoid examination features hx of difficult-to-control diabetes or hypertension absence of hyperpigmentation or autoimmune stigmata typical features of underlying disease medroxyprogesterone acetate use hx of treatment for endogenous Cushing's syndrome hypotension with or without orthostasis systemic glucocorticoid administration high potency or dose of exogenous glucocorticoids local glucocorticoid administration glucocorticoid treatment >3

2018 BMJ Best Practice

229. Epidermolysis bullosa

combination of milia, scarring, and dystrophic nails absence of milia, scarring, and dystrophic nails exuberant granulation tissue herpetiform blistering pseudosyndactyly enamel hypoplasia reticulate hyperpigmentation muscular dystrophy tracheolaryngeal stenosis or stricture severe upper airway disease onset in mid or late childhood inverse (intertriginous), acral, or centripetal distribution of skin involvement severe cardiomyopathy Family history of EB Diagnostic investigations immunofluorescence

2018 BMJ Best Practice

230. Tropical sprue

]. History and exam prolonged exposure to an endemic area constitutional symptoms diarrhoea bloating foul-smelling, greasy stools swollen/sore tongue and lips glossitis numbness of fingers and toes abdominal cramping fever leg swelling hair loss cheilitis/angular stomatitis pedal oedema hyperactive bowel sounds/borborygmi hyperpigmentation/eczematous rash pallor dry eyes corneal xerosis night blindness decreased deep tendon reflexes/decreased vibratory sensation prolonged exposure to an endemic area HLA

2018 BMJ Best Practice

231. Melasma

. This is due to an increase in melanocyte activity and melanin deposition in the skin. Sunlight and hormonal influence are important factors in disease aetiology. Victor FC, Gelber J, Rao B. Melasma: a review. J Cutan Med Surg. 2004 Mar-Apr;8(2):97-102. http://www.ncbi.nlm.nih.gov/pubmed/15685388?tool=bestpractice.com History and exam centrofacial, malar, or mandibular distribution of muddy brown to grey hyperpigmentation female sex Fitzpatrick III to VI skin types UV radiation oral contraceptive pill

2018 BMJ Best Practice

232. Assessment of hypocalcaemia

examination may show dermatitis, eczema, hyperpigmentation, psoriasis, brittle hair with patchy alopecia, and brittle nails with characteristic transverse grooves. [Figure caption and citation for the preceding image starts]: Nail dystrophy due to hypocalcaemia Nijjer S et al. BMJ Case Reports 2010;2010:bcr.08.2009.2216 [Citation ends]. Patients rarely may have congestive heart failure, angina, and hypotension. Differentials Iatrogenic postsurgical hypoparathyroidism Vitamin D deficiency Hypomagnesaemia

2018 BMJ Best Practice

233. Contact dermatitis

lichenoid lesions corrosion or ulceration pustules and acneiform lesions social hx of exposure persistence of symptoms scaling lichenification crusting erythema multiforme cellulitic lesions leukoderma hypopigmentation hyperpigmentation purpura miliaria alopecia granulomatous lesions occupation with frequent exposure to water or caustic material atopic dermatitis Diagnostic investigations patch testing repeated open application test (ROAT) or provocative use test (PUT) skin biopsy reflectance confocal

2018 BMJ Best Practice

234. Overview of dermatitis

clearly delineated with sharp borders. Hyperpigmentation, fissuring, and scaling may also occur. Belsito DV. The diagnostic evaluation, treatment, and prevention of allergic contact dermatitis in the new millennium. J Allergy Clin Immunol. 2000 Mar;105(3):409-20. http://www.ncbi.nlm.nih.gov/pubmed/10719287?tool=bestpractice.com After an allergen or irritant is identified, the main goals of treatment are avoidance of future exposure and resolution of existing dermatitis. ICD is treated with exposure

2018 BMJ Best Practice

235. Addison's disease

Addison's disease Addison's disease - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Addison's disease Last reviewed: February 2019 Last updated: December 2018 Summary Presentation may be acute or insidious, with substantial fatigue and weakness associated with mucocutaneous hyperpigmentation, hypotension and/or postural hypotension, and salt craving. Adrenocorticotrophic hormone stimulation test is performed (...) in children is not specifically covered in this topic, but should result in referral to a paediatric endocrinology specialist. History and exam presence of risk factors fatigue anorexia weight loss hyperpigmentation salt craving nausea vomiting hypotension arthralgia and myalgia female sex adrenocortical autoantibodies adrenal haemorrhage autoimmune diseases tuberculosis (TB) non-TB bacterial infection fungal infection HIV drugs that inhibit cortisol production metastatic malignancy coeliac disease

2018 BMJ Best Practice

236. Porphyria cutanea tarda

hyperpigmentation, and dark or reddish urine. Factors that contribute to susceptibility include alcohol use, smoking, hepatitis C, HIV, iron overload, hereditary haemochromatosis gene mutations, oestrogen use, and uroporphyrinogen decarboxylase (UROD) mutations. Results from an acquired, substantial deficiency of UROD in the liver. Diagnosis is established by finding substantial increases in porphyrins in urine or plasma. Treatment includes repeated phlebotomy or low-dose hydroxychloroquine or chloroquine (...) (Chapter 58). In: Kaushansky K, Lichtman MA, Beutler E, et al, eds. Williams Hematology, 9th ed. New York, NY: McGraw-Hill;2016: 889-914. PCT is usually associated with liver cell damage. History and exam presence of risk factors blistering skin lesions skin hyperpigmentation hypertrichosis scarring alopecia red urine males, middle age, white alcohol use smoking oestrogen use hepatitis C HIV hereditary haemochromatosis gene (HFE) mutation uroporphyrinogen decarboxylase (UROD) mutations exposure

2018 BMJ Best Practice

237. Non-diabetic hypoglycaemia

unexplained weight gain unexplained weight loss hyperpigmentation hypotension short stature middle age female gender ethanol consumption bariatric surgery liver failure renal failure intense exercise fibromas sarcomas fibrosarcomas insulinoma adrenal insufficiency growth hormone deficiency hypopituitarism sepsis glycogen storage diseases anorexia nervosa malnutrition exogenous insulin ackee fruit ingestion haloperidol exposure quinine exposure quinolone exposure sulfonylurea exposure disopyramide exposure

2018 BMJ Best Practice

238. Bullous pemphigoid

or urticarial lesions for weeks or months. In the bullous stage, characteristic, tense vesicles or bullae develop on apparently normal or erythematous skin of the pre-existing eczematous or urticarial eruption. If the blisters burst, the eroded, crusty areas slowly heal to leave post-inflammatory hyperpigmentation. The lesions are usually symmetrical and favour the flexural aspects of the extremities, lower trunk, and abdomen. The treatment goal is to decrease or stop blister formation, to promote healing

2018 BMJ Best Practice

239. Bullous pemphigoid

or urticarial lesions for weeks or months. In the bullous stage, characteristic, tense vesicles or bullae develop on apparently normal or erythematous skin of the pre-existing eczematous or urticarial eruption. If the blisters burst, the eroded, crusty areas slowly heal to leave post-inflammatory hyperpigmentation. The lesions are usually symmetrical and favour the flexural aspects of the extremities, lower trunk, and abdomen. The treatment goal is to decrease or stop blister formation, to promote healing

2018 BMJ Best Practice

240. Overview of dermatitis

clearly delineated with sharp borders. Hyperpigmentation, fissuring, and scaling may also occur. Belsito DV. The diagnostic evaluation, treatment, and prevention of allergic contact dermatitis in the new millennium. J Allergy Clin Immunol. 2000 Mar;105(3):409-20. http://www.ncbi.nlm.nih.gov/pubmed/10719287?tool=bestpractice.com After an allergen or irritant is identified, the main goals of treatment are avoidance of future exposure and resolution of existing dermatitis. ICD is treated with exposure

2018 BMJ Best Practice

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