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2681. Lentigo

are useful for a variety of lentigines. Aggressive therapy for using quality-switched lasers is effective in the treatment of solar lentigines but carries the risk of post-inflammatory hyperpigmentation (PIH). For darker skin types, less intensive irradiation reduces this risk, with no reduction in efficacy. [ ] Intense pulsed light (IPL) is another option. When to refer For doubt over diagnosis and for diagnostic biopsy. When treatment is required but cannot be provided within primary care - eg (...) . ; Safety and efficacy evaluation of tretinoin cream 0.02% for the reduction of photodamage: a pilot study. J Drugs Dermatol. 2012 Jan11(1):83-90. ; Comparative study of treatment efficacy and the incidence of post-inflammatory hyperpigmentation with different degrees of irradiation using two different quality-switched lasers for removing solar lentigines on Asian skin. J Eur Acad Dermatol Venereol. 2011 Dec 20. doi: 10.1111/j.1468-3083.2011.04385.x. ; Lentigo Maligna-Outcomes of Treatment with Q

2008 Mentor

2682. Leg Ulcers

the ulcer. Hyperpigmentation is due to haemosiderin deposition or iron pigments in the skin. Lipodermatosclerosis is dermatitis followed by induration and dermal fibrosis. There may be atrophie blanche (smooth, ivory-white plaques stippled with telangiectasias and surrounded by hyperpigmentation). Patients often complain of mild pain that is relieved by elevation. Oedema of the lower leg is common. Arterial ulcers These are often more distal and on the dorsum of the foot or toes. Initially they have

2008 Mentor

2683. Keloid Scars

been shown to reduce keloid scars to a greater extent than steroids and may be particularly useful in cases which are resistant to intralesional steroids. [ ] 5-fluorouracil [ ] May be beneficial when used alone or in combination with other treatments. Possible side-effects are pain, hypopigmentation and tissue sloughing. Bleomycin [ ] This cytotoxic agent can be given locally as intralesional injections and improved scars in one small study. Side-effects were hyperpigmentation and dermal atrophy

2008 Mentor

2684. Systemic Sclerosis (Scleroderma)

break through the skin. Face and mouth: Tightening of facial skin. Tight lips (microstomia) - can make dental hygiene difficult. Telangiectasia. 'Salt and pepper' appearance of skin, due to areas of hypopigmentation and hyperpigmentation. Dry or itchy skin; reduced hair over affected skin areas. Musculoskeletal features Joint pain and swelling. Myalgia (due to inflammatory myopathy). Restriction of joint movement, contractures and muscle atrophy due to skin sclerosis. Tendon friction rubs - palpable

2008 Mentor

2685. Superficial Thrombophlebitis

(to prevent one PE or DVT). Antibiotics are only required if there is evidence of infection. Surgical If there are recurrences of the thrombophlebitis associated with extensive varicose veins, they should be excised. Complications Extension into the deep veins. [ , ] Suppurative phlebitis can lead to metastatic abscesses and septicaemia. Hyperpigmentation over the vein. Persistent firm nodule in subcutaneous tissues at the affected site. Prognosis The prognosis is usually good but the disease process

2008 Mentor

2686. Neurofibromatosis

growths that can be locally invasive and quite deep. There may be bony erosion and pain. They may also be accompanied by hyperpigmentation or hypertrichosis over the lesions. [ ] Risk of disfigurement from facial plexiform neurofibromas appears to be greatest during the first three years of life. In NF2, sensorimotor polyneuropathy may be seen and there may be identifiable tumours along the relevant peripheral nerves. Ocular problems Tumours of the optic nerve (gliomas) occur in about 15% of children

2008 Mentor

2687. Nelson's Syndrome

to adrenalectomy are not predictive of developing Nelson's syndrome. Insufficient exogenous steroid following TBA is also no longer thought to be a risk factor. Presentation [ ] History - early presentation Hyperpigmentation occurs in up to 42% of people even when diagnosed early, due to the action of ACTH on melanocytes. Visual field defects occur in 10-57% and should be enquired about. They may be too insidious to have been noticed and formal testing may be required. History - late presentation Headaches (...) also cause diplopia and cranial nerve lesions by involving the oculomotor, trochlear and abducens nerves and also the ophthalmic branch of trigeminal. Visual symptoms or signs depend upon where the tumour presses. Examination In children and adolescents, note height and weight. Hyperpigmentation is usually obvious. A linea nigra is often apparent. This is a dark line from the pubis to the umbilicus. Scars and areolae are pigmented and, as with Addison's disease, pigmentation is more marked

2008 Mentor

2688. Dermatological Descriptive Terms

circulating beta-carotene results in yellow-to-orange skin colouration. It is most pronounced on palms and soles and, unlike jaundice, it does not affect the cornea. Hyperpigmentation may be caused by excess of melanin or haemosiderin deposits which result in skin colour that is darker than normal. Hypopigmentation is loss of normal melanin and results in skin colour which is paler than normal but not completely white. In leukoderma, also known as achromia, the skin is white. Infarcts are black areas

2008 Mentor

2689. Deep Vein Thrombosis

[ ] . The most serious complication of DVT is PE. The risk of PE is higher in proximal clots. Thrombosis of the iliofemoral veins carries a worse prognosis with increased incidence of late clinical complications such as post-thrombotic syndrome [ ] . Post-thrombotic syndrome [ , ] Post-thrombotic syndrome is a chronic venous hypertension, which may result in pain, swelling, hyperpigmentation, dermatitis, ulcers, gangrene and lipodermatosclerosis. It may develop after a DVT, due to damage to the deep veins

2008 Mentor

2690. Cystinuria

after exposure to sunlight. Continuing exposure leads to dry, scaly, well-delineated eruptions, sometimes resembling chronic eczema. These eruptions tend to affect the forehead, cheeks, periorbital regions, the dorsum of the hands, and other light-exposed areas. Lesions on the face may be similar to the butterfly rash of systemic lupus erythematosus. Skin changes cause permanent hypopigmentation and/or hyperpigmentation, made worse by further exposure to sunlight. Mental development is usually (...) at 50 mg to 300 mg daily can provide remission from both the skin and neurological manifestations. Maternal Hartnup disease does not have an adverse effect on the fetus. [ ] Complications Severe CNS involvement may, rarely, be fatal in the first years of life. Psychotic episodes and delirium occur in a few patients. Mild mental retardation is uncommon. Permanent hypopigmentation and/or hyperpigmentation of the skin occur with repeated exposure to sunlight. Prognosis Malnutrition and a low-protein

2008 Mentor

2691. Dubin-Johnson Syndrome

in colour with deposition of a pigment that is rather like melanin. Oral cholecystograms will usually not show the gallbladder. Hepatobiliary radioisotope scans show an intense and prolonged liver image with a very delayed or absent picture of the gallbladder. Differential diagnosis Another form of familial hyperbilirubinaemia is but that shows no hyperpigmentation of the liver. [ ] The poor or absent imaging of the gallbladder may lead to an erroneous diagnosis of . Hyperbilirubinaemia often indicates

2008 Mentor

2692. Drug Eruptions

, omeprazole, phenytoin, St John's wort and sulfonamides. Fixed drug eruptions These occur when lesions recur in the same area when the same drug is given. Plaques are circular, violaceous and oedematous and they resolve with macular hyperpigmentation. The latent period is half an hour to eight hours after taking the drug. Perioral and periorbital lesions may occur but the hands, feet and genitalia are the usual sites to be involved. Fixed drug eruptions are well recognised with many drugs, including

2008 Mentor

2693. Discoid (Nummular) Eczema

below the knee. The lesions then flatten to macules, usually with brown hyperpigmentation from the inflammation. It gradually lightens but the pigment may never completely fade, particularly below the knee. Plaques may clear in the centre and resemble tinea corporis. The condition varies in intensity rather than being constant. The eruptions are intensely itchy but they may also burn or sting. Pruritus is always worst at night, almost irrespective of the aetiology. There tends to be seasonal

2008 Mentor

2694. Erythema Induratum (Bazin's Disease)

be involved but this is much rarer. The nodules are tender and erythematous. The nodules may ulcerate with bluish borders, and cold weather may be the precipitating factor. This produces irregular, shallow ulcers that may cause permanent scarring with hyperpigmentation of the lesions.They may run a chronic and recurrent course. The legs may be oedematous. About half of patients will give a past or present history of tuberculosis. This is most often pulmonary tuberculosis with cervical lymphadenopathy (...) is the cause, the lesions will disappear with appropriate TB treatment. Spontaneous resolution of lesions is common within a few months, leaving areas of postinflammatory hyperpigmentation and atrophic scarring. Erythema induratum usually runs a chronic, recurrent course in which lesions return every three to four months over the span of many years. [ ] Did you find this information useful? Thanks for your feedback! Why not subscribe to the newsletter? Email address * We'd love to send you our articles

2008 Mentor

2695. Erythema Annulare Centrifugum

on the inner aspect of the advancing edge. The diameter of the polycyclic lesions varies from a few to several centimetres. There may be vesiculation. The lesions tend to be on the thighs or legs but they may occur anywhere, except on the palms and the soles. The colour of lesions is pink to red with central clear areas. Occasionally, residual hyperpigmentation of dull red, brown or violet is present. Nails The toenails may show white bands. Lymph nodes Lymphadenopathy may occur in association

2008 Mentor

2696. Epidermal Naevus Syndromes

hypoplasia and cardiac abnormalities are reported. Becker's naevus (pigmented hairy epidermal naevus) is a patch of hyperpigmentation and hypertrichosis, which is androgen-dependent and so becomes more prominent after puberty in males; it is usually located on the shoulder. Onset is usually in late childhood/adolescence. It is associated with skeletal abnormalities, underlying muscle hypoplasia and ipsilateral hypoplasia of the breast. Proteus syndrome Variable clinical features, characterised

2008 Mentor

2697. Contact and Occupational Dermatitis

exposure). Hyperpigmentation (chronic exposure). Pain or burning sensation from an affected area Contact and allergic dermatitis may, however, have some differences in presentation: [ ] Typical features of irritant contact dermatitis Typical features of allergic contact dermatitis Burning, stinging and soreness are predominant Redness, itch and scaling are predominant Usual onset within 48 hours; may be immediate Delayed onset Rash only in areas of skin exposed to the irritant Rash may be in areas

2008 Mentor

2698. Chloasma (Melasma)

websites [ , ] . Differential diagnosis [ , ] . Drug reactions can cause hyperpigmentation via a number of processes. Maturational dyschromia. (Age-related diffuse discolouration caused by cumulative ultraviolet exposure.) . (mast cell proliferation and accumulation within various organs, most commonly the skin). Poikiloderma of Civatte (erythema associated with a mottled pigmentation seen on the sides of the neck, more commonly in women). . Freckles. Naevus of Oti (blue/grey to slate-brown patches (...) of hyperpigmentation, usually unilateral and usually presenting in infancy or puberty). Naevus of Hori (bilateral symmetrical blue-grey or grey-brown macules on the cheeks, presenting in adults). Investigations Diagnosis is essentially clinical. Wood's light helps to locate the pigmentation in the dermis or epidermis. In many cases it is found in both locations. Occasionally skin biopsy is performed. Management [ , , ] General Melasma is a difficult condition to manage, as sunlight is a considerable aggravating

2008 Mentor

2699. Coma

observations - BP, PR, temperature (rectal ideally - if hypothermic, consider myxoedema coma), capillary blood glucose and oxygen saturation. Response to external stimuli - usually none present. Primary survey of skin and mucous membranes - any evidence of hyperpigmentation, sepsis, myxoedema, intravenous drug misuse, anaemia, jaundice, purpura, cherry-red discolouration (suggesting carbon monoxide poisoning). Note whether there is a medical emergency identification bracelet or similar or whether

2008 Mentor

2700. Corticotrophins (Tetracosactide and ACTH)

feature). Anorexia. Nausea. Vomiting. Weight loss. Abdominal pain. Diarrhoea. Constipation. Cravings for salt and salty foods such as soy sauce or liquorice (primary insufficiency). Muscle cramps and joint pains. Syncope or dizziness (due to hypotension). Confusion. Personality change. Irritability. Loss of pubic or axillary hair in women, delayed puberty in children. Signs Hyperpigmentation - look at buccal mucosa, lips, palmar creases, new scars and in areas subject to pressure such as elbows

2008 Mentor

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