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281. Mycosis Fungoides (Including Sézary Syndrome) Treatment (PDQ®): Health Professional Version

significant elevation or induration. Presence/absence of hypo- or hyperpigmentation, scale, crusting, and/or poikiloderma should be noted. c For skin, plaque indicates any size skin lesion that is elevated or indurated. Presence/absence of scale, crusting, and/or poikiloderma should be noted. Histologic features such as folliculotropism, large cell transformation (>25% large cells) and CD30 positivity or negativity, as well as clinical features such as ulceration, are important to document. d For blood

2018 PDQ - NCI's Comprehensive Cancer Database

282. Chilblains

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 and hyperkeratosis may develop. Signs of severe

2018 NICE Clinical Knowledge Summaries

283. Acne vulgaris

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 such as depression and anxiety. All people with acne should be advised: To avoid over cleaning the skin (which may cause dryness and irritation) - acne is not caused by poor hygiene. To use non-comedogenic make-up, cleansers and/or emollients with a pH close to the skin if needed (...) ) in combination with topical agents can be considered as an alternative to systemic antibiotics in women – prescription should be guided by the UK Medical Eligibility Criteria for Contraceptive Use. Referral to dermatology should be arranged if: A severe 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

2018 NICE Clinical Knowledge Summaries

284. Pubic lice

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. Blepharitis, conjunctivitis, or corneal epithelial keratitis if the eyelashes are involved. Pubic lice infestation commonly presents as genital pruritus, which is worse at night — pruritus may occasionally be localised to other areas or become generalised. Pubic lice can infest any coarse (...) include: Mild fever and malaise if infestation is extensive. Excoriation and secondary bacterial skin infection as a result of scratching. Lichenification and hyperpigmentation of skin with chronic infestation. Conjunctivitis, blepharitis or corneal epithelial keratitis if infestation involves the eyelashes. [ ; ; ; ] Prognosis What is the prognosis of pubic lice infestation? Resolution of infestation is unlikely without active management. A prospective cohort study (n = 8,955) of people attending

2018 NICE Clinical Knowledge Summaries

285. Diarrhoea - adult's assessment

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. For more information see the CKS topic on . Perform an abdominal examination, looking for distension, an abdominal mass

2018 NICE Clinical Knowledge Summaries

286. Blackouts

that is relieved by sitting or leaning forward. Severe hypoglycaemia — suggested by confusion, anxiety, somnolence, 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

2018 NICE Clinical Knowledge Summaries

287. Deep vein thrombosis

to a vein (for example intravenous catheter). Hormone treatment (for example oestrogen-containing contraception or hormone replacement therapy). Pregnancy and the postpartum period. Dehydration. [ ] Complications What are the complications? The most serious complication of deep vein thrombosis (DVT) is death due to (PE). Other complications of DVT include: Post-thrombotic syndrome — a chronic venous hypertension causing limb pain, swelling, hyperpigmentation, dermatitis, ulcers, venous gangrene

2018 NICE Clinical Knowledge Summaries

288. Psoriasis

, behind the ears, trunk, buttocks, periumbilical area, and extensor surfaces (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

2018 NICE Clinical Knowledge Summaries

290. Guideline for the Treatment of Acne

and inflammatory lesions including papules, pustules and nodules. Scarring and post inflammatory hyperpigmentation are frequently seen clinical signs in acne. It also commonly affects the back (60 %) and chest (15 %) [2]. Seborrhoea is a frequent feature [3]. The clinical picture embraces a spectrum of signs, ranging from mild comedonal acne, with or without sparse inflammatory lesions (IL), to acne conglobate or aggressive fulminate disease with deep-seated inflammation, nodules and in some cases associated (...) and the use of both disease and quality of life scores is suggested [21]. Persisting hyperpigmentation after active acne has settled is of great concern to many patients. An instrument to measure this has been described, the post acne hyperpigmentation index (PAHPI) [22]. Global assessment techniques Global assessment scales incorporate the entirety of the clinical presentation into a single category of severity. Each category is defined by either photographs with a corresponding numeric scale

2016 European Dermatology Forum

292. The effect of melasma on self-esteem: A pilot study Full Text available with Trip Pro

The effect of melasma on self-esteem: A pilot study Melasma is a common disorder of hyperpigmentation characterized by tan or brown macules and patches affecting sun-exposed areas, particularly the face. Melasma has been shown to have a significant impact on the quality of life and self-esteem of those affected. We interviewed six patients who were diagnosed with moderate-to-severe melasma with regard to the effect of their disorder on their self-esteem. All patients reported a significant

2017 International journal of women's dermatology

293. Black tongue Full Text available with Trip Pro

, Malaysia. eng Case Reports 2017 12 31 Malaysia Malays Fam Physician 101466855 1985-2274 antiretroviral therapy tongue hyperpigmentation 2018 3 13 6 0 2018 3 13 6 0 2018 3 13 6 1 epublish 29527277 PMC5842421 Am J Ther. 2010 Jul-Aug;17(4):e115-7 20634649 Lancet. 2011 Apr 2;377(9772):1183 21440293 Contemp Clin Dent. 2010 Jul;1(3):204-6 22114419 Clin Pediatr (Phila). 2015 Oct;54(11):1110-2 25500499

2017 Malaysian family physician : the official journal of the Academy of Family Physicians of Malaysia

294. Melanoma in pregnancy Full Text available with Trip Pro

Melanoma in pregnancy Melanoma is one of the most common cancers diagnosed in pregnancy and has a high metastatic potential. As the incidence of melanoma increases, careful clinical evaluation of suspicious skin lesions remains the mainstay of early diagnosis. There is controversy in the literature as to whether pregnancy-associated melanoma has worse survival than other melanomas. Any changing-pigmented lesion should be biopsied, regardless of pregnancy hyperpigmentation. Increased

2017 Obstetric medicine

295. Physiologic changes of pregnancy: A review of the literature Full Text available with Trip Pro

Physiologic changes of pregnancy: A review of the literature Throughout pregnancy, the body undergoes a variety of physiologic changes. The cutaneous findings can be most noticeable and often worrisome to both physicians and patients. Obstetricians and dermatologists must be able to differentiate between changes that are benign and those that may be pathologic. Most physicians recognize benign changes that are commonly described in literature such as hyperpigmentation, melasma, striae

2017 International journal of women's dermatology

296. Sofosbuvir induced steven Johnson Syndrome in a patient with hepatitis C virus‐related cirrhosis Full Text available with Trip Pro

Syndrome (SJS), sofosbuvir and ribavirin were withdrawn and the patient was treated with topical emollients, steroids, and supportive care. The lesions improved over the next 4 weeks, with some residual hyperpigmentation. Rechallenge with sofosbuvir alone at one eighth the dose resulted in similar skin and mucosal lesions after 2 months; these lesions also improved after sofosbuvir withdrawal. The Algorithm of Drug Causality for Epidermal Necrolysis score was 7, which suggested sofosbuvir as the very

2017 Hepatology communications

297. Compression stockings as an effective treatment for erythema nodosum: Case series Full Text available with Trip Pro

effects or require a change in lifestyle. We investigated the effects of moderate 20 mmHg to 30 mmHg compression stockings as an alternative treatment method in two female patients with recurrent erythema nodosum. In both cases, the patients wore the compression stockings daily. At the follow-up visit, the EN lesions were no longer tender to the touch, and postinflammatory hyperpigmentation changes had started. Both patients had a lasting clinical resolution.

2017 International journal of women's dermatology

298. A review of laser and light therapy in melasma Full Text available with Trip Pro

a benefit. Vascular-specific lasers do not appear to be effective for the treatment of melasma. Ablative fractionated lasers should be used with caution because they have a very high risk for postinflammatory hypo- and hyperpigmentation. The use of nonablative fractionated laser treatments compared with other laser and light options may result in slightly longer remission intervals. Picosecond lasers, fractional radiofrequency, and laser-assisted drug delivery are promising future approaches to treat

2017 International journal of women's dermatology

299. NASPGHAN Clinical Report on the Diagnosis and Treatment of Gluten-related Disorders

and is more common in adults or older teenagers. It is characterized by symmetrical, pruritic blisters followed by erosions, excoriations, and hyperpigmentation most commonly involving elbows (90%), knees (30%), shoulders, buttocks, sacral region, and face (22). The diagnosis of DH depends on demonstrating typical immunoglobulin A (IgA) deposits on skin biopsies (23). Other manifestations include dental enamel hypoplasia (24), recurrent aphthous ulcers in the mouth, low–bone mineral density, and arthritis

2016 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

300. Diagnosis and Treatment of Primary Adrenal Insufficiency

salt craving, light-headedness, blood pressure changes and swelling of the legs and feet. Summary of Recommendations 1.1 We recommend diagnostic testing to exclude primary adrenal insufficiency (PAI) in acutely ill patients with otherwise unexplained symptoms or signs suggestive of PAI (volume depletion, hypotension, hyponatremia, hyperkalemia, fever, abdominal pain, hyperpigmentation or, especially in children, hypoglycemia). (1|⊕⊕⊕⚪) 1.2 We recommend confirmatory testing with the corticotropin

2016 The Endocrine Society

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