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241. Acne

, affecting approximately 80% of people at some point between (...) 11–30 years of age. Complications of acne include scarring, hyperpigmentation, and psychological problems. In general, it is recommended that people with acne : Do not wash more than twice a day. Use a mild soap or cleanser and lukewarm water. Do not use vigorous scrubbing when washing acne -affected skin, and the use of abrasive soaps, cleansing granules, astringents, or exfoliating agents should be discouraged. Should not attempt

2018 Trip Latest and Greatest

242. Emergency management of adrenal insufficiency in children: advocating for treatment options in outpatient and field settings

, acute onset of nausea and vomiting for the previous 24 hours. Physical examina- tion revealed an ill-appearing, thin male with tachycardia (pulse 110 bpm), mild hypoten- sion (85/60 mm Hg), signs of dehydration, and hyperpigmentation. Laboratory testing showed hyponatremia (sodium 129 mEq/L), hyperka- lemia (potassium 5.8 mEq/L) and hypoglycemia (glucose 55 mg/dL). Despite urgent fluid resus- citation with 2 intravenous boluses of normal saline and a bolus of 10% dextrose, hypoten- sion persisted (...) to gain weight and hypoglycemia may be the presenting clinical features in neonates and infants. Micropenis, bilateral cryptorchidism and, rarely, central diabetes insipidus may also be present in neonates who have AI due to panhypopituitarism. Individ- uals with primary AI may have hyperpigmentation of the skin (particularly creases, folds and scars), gums and buccal mucosa. general biochemistry In acute AI, hyponatremia is the most consistent biochem- ical finding. 12 Hyperkalemia is present

2019 Pediatric Endocrine Society

245. Hereditary Cancer Syndromes and Risk Assessment

with Cowden syndrome-associated neoplasms and condi- tions, which are classified as pathognomonic, major and minor criteria (11). Peutz-Jeghers Syndrome Peutz–Jeghers syndrome is an autosomal dominant condition caused by pathogenic variants in the serine/ threonine kinase 11 (STK11) gene. It is characterized by the presence of two of the following three criteria: 1) two or more hamartomatous polyps throughout the gastro- intestinal tract; 2) mucocutaneous hyperpigmentation of the mouth, lips, nose, eyes

2019 American College of Obstetricians and Gynecologists

248. Coeliac disease: When should I suspect a diagnosis of coeliac disease?

disease, such as primary biliary cholangitis, autoimmune hepatitis, and primary sclerosing cholangitis. See the CKS topic on for more information. Selective IgA deficiency. A with coeliac disease. Suspected dermatitis herpetiformis. This is an immune-mediated cutaneous manifestation of coeliac disease that is more common in adults and older teenagers. It is characterized by symmetrical clusters of itchy blistering skin lesions followed by erosions, excoriations, and hyperpigmentation, most commonly

2019 NICE Clinical Knowledge Summaries

249. Blackouts: How do I diagnose the underlying cause of a blackout?

, palpitations, and lethargy, for example due to excessive administration of insulin. Addisonian crisis — suspect in people with Addison's disease. Symptoms can include nausea, vomiting, fever, hypotension, hyperpigmentation, and electrolyte abnormalities. Ask the person (if possible) and any witnesses about, and record details of: The circumstances of the event. The person's posture immediately before loss of consciousness. Prodromal symptoms (such as sweating or feeling warm/hot). The person's appearance

2019 NICE Clinical Knowledge Summaries

250. Acne vulgaris: What are the clinical features of acne vulgaris?

track together and form sinuses ( ). Scarring — atropic/ice pick or hypertrophic/keloid scars may be seen. Pigmentation — post-inflammatory depigmentation or hyperpigmentation may be present. Seborrhoea — commonly present. There is no universally agreed scoring system for acne severity but categorising into mild, moderate and severe can be helpful in selection of appropriate treatment and monitoring of response: Mild acne — predominantly non-inflamed lesions (open and closed comedones) with few

2019 NICE Clinical Knowledge Summaries

251. Acne vulgaris: Scenario: Management of acne vulgaris in primary care

, see the CKS topic on . Refer the person to dermatology, with urgency depending on the clinical situation if: They have a severe variant of acne such as or (immediate referral is indicated). They have severe acne associated with visible scarring or are at risk of scarring or significant hyperpigmentation — primary care treatment should be initiated in the interim. Multiple treatments in primary care have failed. Significant psychological distress is associated with acne regardless of severity

2019 NICE Clinical Knowledge Summaries

252. Pubic lice: What are the clinical features of pubic lice infestation?

with Pithyris pubis — associated features may include erythema, crusting and matting of eyelashes and conjunctivitis. Visible lice or nits in any area with coarse body hair (most often the pubic area, less commonly the axillae, chest, abdomen, perianal area, beard area, eyelashes and eyebrows). Rust-coloured flecks of faecal material may be seen. Skin lesions such as: Small blue macules (‘maculae cerulae’) or red papules — may be seen at feeding sites. Lichenification and hyperpigmentation of pruritic areas

2019 NICE Clinical Knowledge Summaries

253. Pubic lice

occurs through sexual or non-sexual close body contact but lice may also crawl onto a host from infested materials such as bedding, clothing or towels. Children with pubic lice infestation are usually thought to have acquired this innocently, but the possibility of sexual abuse should be considered and managed appropriately. The complications of pubic lice infestation include: Excoriation and infection of the skin due to scratching. Lichenification and hyperpigmentation of skin in chronic infestation

2019 NICE Clinical Knowledge Summaries

254. Elmiron (pentosan polysulfate sodium): rare risk of pigmentary maculopathy

retrospective study, patients with pigmentary maculopathy had a median length of exposure to pentosan polysulfate of 18.3 years with a range of 3.0–21.9 years. Unique characteristics of pigmentary maculopathy associated with Elmiron The pigmentary maculopathy described differs from other forms. Fundus examination showed unique subtle paracentral hyperpigmentation at the level of the retinal pigment epithelium (RPE) with associated areas of RPE atrophy. Multi-modal retinal imaging demonstrated abnormalities

2019 MHRA Drug Safety Update

255. Hereditary Hemochromatosis

radiographically by its specific involvement of the second and third metacarpophalangeal joints and the hook-shaped osteophyte of the metacarpal head ( ). | Skin Hyperpigmentation may be one of the earlier signs of HH ( ). Iron deposits in the skin lead to increased melanin production and deposition, giving rise to the characteristic metallic or slate gray hue commonly referred to as bronzing ( ). Hypermelanotic skin pigmentation is usually generalized but frequently is deeper on the face, neck, extensor

2019 American College of Gastroenterology

256. Pigmented Fundus Lesions

) Benign congenital anomaly of the retinal pigment epithelium (RPE) Area of increased RPE hypertrophy and hyperpigmentation Malignant transformation is extremely rare, although documented enlargement in observed in 46% of those followed up photographically for >3 years Uveal melanoma 90% are choroidal, 6% arise from the ciliary body and 4% from the iris 1.3-8.6 cases per million per year in European-derived populations Life-threatening ocular malignancy (risk of metastatic disease) - detection

2020 College of Optometrists

257. Topical medication instillation techniques for glaucoma. Full Text available with Trip Pro

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

258. 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

259. Discoid lupus erythematosus

pruritic nor painful. Age of onset usually between 20 and 40 years. Lesions often precipitated or aggravated by UV light exposure; smoking also considered a risk factor. Over time, lesions slowly expand, producing areas of peripheral inflammation or hyperpigmentation, leaving a central region of scarring with telangiectasia and hypopigmentation. Diagnosis usually made on clinical grounds, but if in doubt is confirmed with skin biopsy. The mainstay of treatment is topical corticosteroids, or oral (...) . Lupus erythematosus in the 1980s: a survey of 570 patients. Semin Arthritis Rheum. 1991;21:55-64. History and exam disc-shaped erythematous maculopapular scaly lesions age 20 to 40 years hx of UV light exposure smoking hx absence of pruritus and/or pain telangiectasia, hyperpigmentation and/or hypopigmentation permanent scarring alopecia systemic features (arthritis, pleuritis, pericarditis, seizures, psychosis) age 20 to 40 years UV

2017 BMJ Best Practice

260. 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

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