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261. 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

262. Macular degeneration - age-related

obvious precipitating cause, which occur in the central area of the retina (macula) in people aged 55 years and over. Changes which occur in AMD include one or more of: Drusen — collections of lipid and protein material which occur beneath the retinal pigment epithelium (RPE) and within Bruch’s membrane. Abnormalities of the RPE — areas of hypopigmentation or hyperpigmentation. Geographic atrophy — one or more sharply demarcated areas of depigmentation (atrophy) of the RPE which can enlarge over time

2018 NICE Clinical Knowledge Summaries

263. Leg ulcer - venous: How should I assess a person with a suspected venous leg ulcer?

of the infected area), fever, increased pain, rapid extension of the area 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

2018 NICE Clinical Knowledge Summaries

264. Addison's disease

; hyperpigmentation; gastrointestinal symptoms; cravings for salt, soy sauce, or liquorice; musculoskeletal symptoms; or postural dizziness due to hypotension. The possibility of Addison's disease should also be considered in people with: hypothyroidism whose symptoms worsen when thyroxine is started; type 1 diabetes mellitus with recurrent unexplained hypoglycaemic episodes; other autoimmune diseases; or low sodium and high potassium levels on blood biochemistry. In adults, if adrenal insufficiency is suspected

2018 NICE Clinical Knowledge Summaries

265. Warts and verrucae: Cryotherapy

forms. Swelling and redness — this usually settles after 2–3 days. Scarring (rare). Leg ulceration. Hypo- or hyperpigmentation, particularly in dark skin — this usually improves with time but it may be permanent. Numbness may occur if a superficial nerve is frozen. Normal feeling usually returns within a few months. Tendon or nerve damage especially with treatment to warts on the fingers. Onychodystrophy (malformation of the nails) following treatment of periungual warts. [ ; ; ; ] © .

2018 NICE Clinical Knowledge Summaries

266. Venous eczema and lipodermatosclerosis

include: Asking about other symptoms of venous insufficiency, such as pain, heaviness, aching, swelling, and itching of the affected leg. Identifying risk factors for venous insufficiency. Assessing the nature and severity of skin changes — venous skin changes vary from hyperpigmentation (due to haemosiderin deposition), to venous eczema, to lipodermatosclerosis and atrophie blanche (star-shaped, ivory-white, depressed, atrophic scars with surrounding pigmentation). Examining the legs for other signs

2018 NICE Clinical Knowledge Summaries

267. Psoriasis: How should I classify psoriasis?

(such as forearms, shins, elbows, and knees). Lesions which are typically distributed symmetrically and can coalesce to form larger lesions. On white skin, the plaques are pink or red; in deeply pigmented skin, plaques usually have a grey colour and may cause marked post-inflammatory hyperpigmentation. Most lesions are 1 cm to several centimetres in diameter, with an oval or irregular shape. There is usually a clear delineation between normal and affected skin. Scale is usually present — it is usually silver

2018 NICE Clinical Knowledge Summaries

268. 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

269. 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

271. 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

272. Evaluation and Treatment of Hirsutism in Premenopausal Women Full Text available with Trip Pro

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

273. Guidelines for the use of hydroxycarbamide in children and adults with sickle cell disease Full Text available with Trip Pro

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

275. 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

276. 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

277. Diagnosis of Upper Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of the American Physical Therapy Association Full Text available with Trip Pro

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

278. Pityriasis versicolor: Topical imidazole creams

hyperpigmentation, and itching. Treatment should be discontinued if these are severe. [ ; ; ; ] © .

2017 NICE Clinical Knowledge Summaries

279. Chilblains: When should I suspect chilblains?

on sides of fingers often on a background of . Equestrian perniosis — clustered indurated, red-purple papules or plaques which may blister or ulcerate on the outer thighs (and occasionally the buttocks) of people who ride horses. Lesions typically appear 24-48 hours after exposure to cold and are self-limiting. Occasionally post-inflammatory hyperpigmentation, atrophy or scarring can be present after chilblains resolve. Severe chronic perniosis — irreversible changes including fibrosis, lymphoedema

2017 NICE Clinical Knowledge Summaries

280. Burns and scalds: What else might it be?

hyperpigmentation (rare) — occurs spontaneously from one month after birth; presents as symmetrical, loop-like raised areas of skin on the posterior calves. Basis for recommendation The information on differential diagnosis is based on the expert opinion of the National Burn Care Review Committee [ ], the Royal College of Paediatrics and Child Health (RCPCH) publication Child protection evidence: Systematic review on burns [ ], and the National Society for the Prevention of Cruelty to Children (NSPCC

2017 NICE Clinical Knowledge Summaries

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