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241. Congenital adrenal hyperplasia

hydroxysteroid dehydrogenase deficiency. History and exam genetic predisposition weight loss failure to thrive vomiting hypotension ambiguous genitalia hyperpigmentation poor feeding irregular menses infertility male-pattern baldness (females) short stature precocious puberty polycystic ovaries hirsutism severe cystic acne genetic predisposition Diagnostic investigations serum 17-hydroxyprogesterone serum 11-deoxycortisol serum chemistry microfilter paper radioimmunoassay for 17-hydroxyprogesterone genetic

2017 BMJ Best Practice

242. Chronic venous insufficiency

. This most commonly results from venous reflux due to faulty valve function developing as a long-term sequela of DVT and recanalisation and may also develop due to primary valvular incompetence without previous episode(s) of DVT. The term 'CVI' is usually reserved for more advanced disease involving oedema, skin changes, or frank ulcers. History and exam presence of risk factors corona phlebectatica (malleolar flare or ankle flare) ankle swelling hyperpigmentation (brawny oedema) lipodermatosclerosis

2017 BMJ Best Practice

243. Topical medication instillation techniques for glaucoma. (Full text)

in the fluid removal group compared with the no fluid removal group (MD -1.70 mm, 95% CI -3.46 to 0.06; 10 participants; low-certainty evidence). Fewer eyes showed skin hyperpigmentation in the eyelid region towards the nose in the fluid removal group compared with the no removal group (RR 0.07, 95% CI 0.01 to 0.84; 10 participants; low-certainty evidence); however, the difference was uncertain in the eyelid region towards the temples (RR 0.44, 95% CI 0.07 to 2.66; 10 participants; low-certainty evidence

2017 Cochrane PubMed abstract

244. Acne - Guidelines for Prescribing Topical Treatment

Occurs near hair-line cosmetic X XX XX X Occurs where cosmetics used occupational XX X X Excoriated X X Crusts, scar, erosions, hyperpigmentation Mechanical XX XX X occurs when sinus tracts (channels) form between acne lesions resulting in the formation of cysts and abscesses. This type of acne is considered severe and often requires systemic treatment. Suspected cases should be referred to their physician. is an acute eruption of large inflammatory nodules, occurring most frequent in males. It also (...) at their lesions. A hallmark sign of this are scars in the absence of cysts or nodules, or hyperpigmentation of an area that can last years. Mechanical acne is the result of physical irritation to an area leading to the acne lesions, such as a sweat band rubbing against the forehead. Drug-induced acne. Medications that can cause/worsen acne: glucocorticoids (oral, inhaled, and topical), androgens, oral contraceptives containing progestins with more potent androgenic actiivity (norethindrone, levonorgestrel

2018 medSask

245. Guidelines for the Management of Genital, Anal and Throat HPV Infection in New Zealand

with nitrous oxide or carbon dioxide cryoguns. Patients can be referred for treatment. Side effects: Pain and necrosis following application of cryotherapy are fairly universal, and blistering may occur. The treatment of large warts or areas at one time can create wound care problems. Adverse effects include irritation, local oedema, necrosis, ulceration and pain, especially when the treated area thaws. Both hypo- and hyperpigmentation can occur, but this is usually temporary. Although the use of injected (...) . Suitable for: Vulval, vaginal, cervical and perianal warts. Not considered first-line treatment because of expense. Can be considered if there are obstructive or large lesions. 61 Contraindications: None. Can be used in pregnancy. Technique: Advanced training and expertise required. Specialist only. Side effects: Local pain. Scarring and hypo- or hyperpigmentation can be minimised by controlling depth and avoiding treatment beyond the dermal papillae. Trichloroacetic acid (TCA) Mechanism of action: TCA

2017 New Zealand Sexual Health Society

246. Scleroderma Morphea

in childhood. Linear LS is characterized by longitudinally arranged linear, band-like lesions that are predominantly located on the extremities. Evidence indicates that linear LS may follow the lines of Blaschko. 27 In mild disease the lesions may heal with residual hyperpigmentation. However, depending on the extent of the fibrotic process, linear LS may lead to severe growth retardation, muscle atrophy, flexion contractures, myositis and myalgia, arthritis and arthalgia, and psychologic disability. LS (...) in linear types that affect the extremities in children 27 Table 3 Differential diagnoses of localized scleroderma* Initial inflammatory phase in limited localized scleroderma (morphea) • Lichen sclerosus • Erythema migrans • Cutaneous mastocytosis • Granuloma annulare • Mycosis fungoides • Drug-related reactions • Chronic radiation dermatitis • Porokeratosis Mibelli Late stage in limited localized scleroderma (morphea) mainly with hyperpigmentation • Post-inflammatory hyperpigmentation • Lichen planus

2018 European Dermatology Forum

247. Lichen Planus

by the patients, and depends on the type of lesions and extent of involvement. Some of the affected patients may be completely asymptomatic (approximately 20%) and oral lesions may have a burning sensation or may even be painful. Classical cutaneous LP is self-limited and usually resolves within 6 (>50%) to 18 months (85%). Chronic disease is more typical in hypertrophic cutaneous lesions, orogenital lichen planus, and with nail or scalp involvement. Hyperpigmentation as a result of inflammation is often (...) verrucosus, calcitriant lichen planus): The most pruritic variant of LP, which is usually found on the extensor surfaces of the lower extremities. Lesions are purplish or reddish-brown in color and hyperkeratotic. Hypertrophic lesions are often persistent and have the potential for malignant transformation (Squamous Cell Carcinoma, SCC). Scarring, hyperpigmentation or hypopigmentation can occur when the lesions eventually clear. Frequently, a chronic venous insufficiency is present. 5. Atrophic LP

2018 European Dermatology Forum

249. Evaluation and Treatment of Hirsutism in Premenopausal Women (Full text)

of uncut hair, which gives the illusion of thicker hair. Chemical depilatory agents are also commonly used to dissolve the hair. Most depilatories contain sulfur and have an unpleasant odor. In addition, irritant dermatitis can occur. Epilation methods, such as plucking or waxing, are relatively safe and inexpensive, but cause some discomfort. These methods do not cause an increase in hair diameter. Scarring, folliculitis, and hyperpigmentation (particularly in women of color) may occur. Although

2018 The Endocrine Society PubMed abstract

250. Guidelines for the use of hydroxycarbamide in children and adults with sickle cell disease (Full text)

tolerated with few side effects. Some patients may experience mild gastrointestinal symptoms (Kinney et al , ), or hyperpigmentation of the skin and darkening of nails, which is not dose‐dependant (O'Branki et al , ). Some patients note hair thinning. Skin ulcers have been reported but do not seem to be any more frequent than in those not on hydroxycarbamide (Charache et al , ). Marrow suppression, which is transient and reversible, is the most expected short‐term effect. This side effect also

2018 British Committee for Standards in Haematology PubMed abstract

251. Assessment of the complications of cryolipolysis for aesthetic purpose

mais d’intensité modérée (hyperpigmentation), et d’autres, très rares, d’une sévérité, d’une durée ou d’une nature (hernie, malaise vagal) les classant en événements indésirables graves (EIG). A contrario , les données plus récentes, essentiellement des études de cas, une revue systématique et des signalements aux autorités sanitaires ou judiciaires, montrent que surviennent également avec la cryolipolyse des neuropathies sensorielles périphériques, des hernies inguinales ou des atteintes des

2018 Haute Autorite de sante

253. Endovenous mechanochemical ablation for varicose veins

of 50 and 63 patients respectively. Ecchymosis was reported in 9% of patients (absolute numbers not reported) and haematoma in 1% of patients (absolute numbers not reported) in the case series of 126 patients. 5.6 Hyperpigmentation was reported in 9% (3/34) of patients treated by mechanochemical ablation and in 9% (3/34) of patients treated by radiofrequency ablation in the non-randomised comparative study of 68 patients. Mild hyperpigmentation at the puncture site was reported in 5% of patients

2016 National Institute for Health and Clinical Excellence - Interventional Procedures

254. Erythema dyschromicum perstans: A case report and systematic review of histologic presentation and treatment. (Full text)

was effective, but demonstrated significant-to-intolerable side effects. Griseofulvin, isotretinoin, and dapsone provided unsatisfactory results as lesions recurred after discontinuation. Lasers were largely ineffective and may cause postinflammatory hyperpigmentation and fibrosis.A diagnosis of EDP should not be based on histologic findings alone. Clinical history, morphology, and distribution should be used to differentiate EDP and LPP. NB-UVB and tacrolimus are promising treatments for EDP with minimal

2020 International journal of women's dermatology PubMed abstract

255. Minocycline

dysfunction (including potentially fatal liver failure) autoimmune disorders (such as systemic lupus erythematosus-like syndrome, which has a strong relationship with duration of exposure, and autoimmune hepatitis) hypersensitivity reactions (including eosinophilia, pneumonitis and nephritis). In addition, minocycline can cause slate-grey hyperpigmentation of the skin, which may be irreversible (Drug and Therapeutics Bulletin, 2006). The Cochrane review (CD002086) found no evidence to justify the use

2015 National Institute for Health and Clinical Excellence - Advice

256. CRACKCast E128 – Thyroid and Adrenal Disorders

characteristically have more pronounced clinical manifestations and skin hyperpigmentation. Measurement of cortisol in the ACTH stimulation test is the standard and most convenient method to assist in confirming the diagnosis. Refractory hypotension in the acutely ill patient may be the only clue to adrenal insufficiency and is readily treated with the IV administration of glucocorticoids (dexamethasone, 4 mg, or hydrocortisone, 100 mg). Rosen’s In Perspective Here’s the physiology of thyroid production (...) [12] List 5 causes of chronic primary adrenal insufficiency + 1 acute + 3 secondary The clinical manifestations are the result of primary adrenal failure or secondary adrenal disease from malfunction of the hypothalamic-pituitary-adrenal (HPA) axis in its production of adrenocorticotropic hormone (ACTH). Secondary causes are much more common than primary causes. Primary = high ACTH and low cortisol (get subsequent hyperpigmentation) Mild to moderate hyponatremia, with levels typically above 120

2017 CandiEM

257. CRACKCast E120 – Dermatologic presentations

in dermal-epidermal junction, often erythematous Hyperpigmentation Increase in melanin containing epidermal cells Lichenification Abnormally dense layer of keratinised epidermal cells [3] List systemic diseases that present with cutaneous signs for each of the following locations (table): ( See table 110.4 in Rosen’s 9 th edition) Generalized rash Head and neck Hands Legs Palms and Soles Infectious Secondary syphilis Hand foot and mouth disease (coxsackie) RMSF Kawasaki syndrome Aureus endocarditis

2017 CandiEM

259. Hepatitis C Virus Infection Care Pathway?A Report From the American Gastroenterological Association Institute HCV Care Pathway Work Group

digits, arthralgia, peripheral neuropathy Serum cryoblobulins, low C4, RFþ Skin biopsy showing leukocytoclastic vasculitis Mixed Cryoglobulinemia Mono/oligo-arthritis Non-erosive synovitis (x-ray) RFþ, anti-CCP-, Arthritis Xerostomia Xeroftalmia Schirmer’s testþ, mild salivary gland involvement Absent or low titer autoAntibody (ANA/ENA) Sicca Syndrome Skin hyperpigmentation, erosions at sun-exposed areas and bullae Elevated serum & urinary porphyrins, URO-D de?ciency Porphyria Cutanea Tarda

2017 American Gastroenterological Association Institute

260. Diagnosis of Upper Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of the American Physical Therapy Association (Full text)

and progressive tissue fibrosis occurs. Stage III —Skin changes such as thickening, hyperpigmentation, increased skin folds, fat deposits, and warty overgrowths occur. Tissue is very fibrotic and pitting is absent. Early detection of lymphatic insufficiency, coupled with appropriate intervention, may be important to prevent progression of the condition and may provide a cost-effective approach. , Diagnostic definitions of lymphedema that require a consistent volume increase, and thus being at ISL stage II

2017 American Physical Therapy Association PubMed abstract

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