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61. Tuberous sclerosis complex

, hypopigmented macules (ash leaf spots), facial angiofibromas, and ungual fibromas. The most often identified clinical presentations are epilepsy (infantile spasms), autism and cognitive impairment, and neonatal cardiac rhabdomyomas. Cardiac rhabdomyomas regress in early childhood and are generally asymptomatic, whereas renal angiomyolipomas and giant cell astrocytomas progress in adolescence and adulthood. The renal complications are second only to the central nervous system complications as a cause (...) facial angiofibromas cephalic plaque(s) non-traumatic ungual or periungual fibromas hypomelanotic macules shagreen patch(es) (connective tissue nevus) numerous dental enamel pits and gingival fibromas polycystic kidney disease autism cognitive impairment behavioural problems retinal nodular hamartoma(s) multiple hamartomatous colonic polyps genetic predisposition Diagnostic investigations neurodevelopmental testing EEG ECG echocardiography renal ultrasound, CT, or MRI chest CT cranial CT cranial MRI

2018 BMJ Best Practice

62. Vitiligo

people and in sun-protected areas, Wood's lamp examination helps with diagnosis and evaluation of extent of disease. Presents typically as round, depigmented macules and patches that slowly enlarge, most often in a symmetrical distribution, and with a particular affinity to periorificial and acral skin. Hair in affected areas may be white, particularly in areas of long-standing disease. When repigmentation occurs, it typically occurs in a perifollicular pattern. While there are no licensed treatments

2018 BMJ Best Practice

63. Melasma

for maintaining the effects of treatment. Definition Melasma is an acquired pigmentary disorder of sun-exposed areas. Ball Arefiev KL, Hantash BM. Advances in the treatment of melasma: a review of the recent literature. Dermatol Surg. 2012 Jul;38(7 Pt 1):971-84. http://www.ncbi.nlm.nih.gov/pubmed/22583339?tool=bestpractice.com Characteristically, patients have muddy brown macules on the skin, predominantly in the malar and central facial areas; however, it can also affect areas such as the forearms and neck

2018 BMJ Best Practice

64. Actinic keratosis

consists of destructive methods (e.g., cryotherapy with liquid nitrogen, curettage with or without electrodesiccation, chemical peels, and photodynamic therapy) or topical medication (e.g., topical fluorouracil, imiquimod, diclofenac, or ingenol mebutate). Definition Actinic keratosis (AK) lesions are skin-coloured, yellowish, or erythematous, ill-defined, irregularly shaped, small, scaly macules or plaques localised in sun-exposed areas of the body. Typically, they occur in middle-aged or older men (...) with light-coloured skin and a history of chronic sun exposure. They can potentially progress into squamous cell carcinoma (SCC). History and exam presence of risk factors single or multiple scaly macules or plaques scaly lesions with a hyperkeratotic surface well-defined, scaly, brown lesions lesions resembling seborrhoeic keratosis, melanocytic naevus, and early malignant melanoma hypertrophic conical-shaped protuberances growing from the surface of the skin scaly red roughness with induration

2018 BMJ Best Practice

65. Overview of skin cancer

or systemic treatment is usually dependent on both doctor and patient preference, as no one treatment option has been shown to be superior to another. Lesions are skin-coloured, yellowish or erythematous, ill-defined, irregularly shaped, small scaly macules or plaques localised in sun-exposed areas of the body (e.g., face, lower lip, dorsum of the hands, forearms, bald areas of the scalp, and ears). [Figure caption and citation for the preceding image starts]: Regular actinic keratosis From the collection

2018 BMJ Best Practice

66. Infantile spasms

identification and treatment of the spasms improves prognosis. History and exam presence of risk factors spasms head nodding neurodevelopmental delay or regression ash leaf macules onset age 3-12 months perinatal complication abnormal eye movements microcephaly motor system abnormalities brain malformation neurocutaneous syndrome antenatal or perinatal vascular event intrauterine or perinatal infections inherited metabolic disorder genetic disorders family history neonatal sinovenous thrombosis postnatal

2018 BMJ Best Practice

67. Assessment of rash in children

, ranging from self-limiting conditions (e.g., roseola) to life-threatening illnesses such as meningococcal disease. Several systemic conditions with a serious clinical course may have a rash as a component and should be assessed urgently if suspected (see Urgent considerations). Definitions Macule: a flat area of colour change <1 cm in size (e.g., viral exanthem [such as measles and rubella], morbilliform drug eruption). Patch: a large macule >1 cm in size (e.g., viral exanthem [such as measles

2018 BMJ Best Practice

69. British Association of Dermatologists guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in children and young people Full Text available with Trip Pro

, purpuric macules, blisters, and areas of epidermal detachment Examine mouth, eyes and genitalia (including perianal skin) looking for mucositis, blisters and erosions Record the extent of erythema and extent of epidermal detachment separately on a body map (Fig. ); for each parameter estimate the percentage of body surface area (BSA) involved using the Lund and Browder chart. Figure 1 Body map schematics demonstrating examples of skin involvement in Stevens–Johnson syndrome/toxic epidermal necrolysis (...) necrolysis? SJS/TEN represents a spectrum of reactive disorders with mucocutaneous involvement. , It is important to note that epidermal necrolysis comprises both detached and detachable epidermis. The former is characterized by blisters and epidermal sloughing, the latter by areas of dusky erythema. The following conditions can be differentiated within the spectrum: SJS – epidermal detachment less than 10% BSA plus widespread purple/red macules or flat atypical targets Overlap SJS‐TEN – detachment

2019 British Association of Dermatologists

70. Pruritus

be considered. Clinical examination of the patient should always include a thorough inspection of the entire skin including scalp, nails, oral cavity and anogenital region. While examining skin lesions, the distinction between primary and secondary skin lesions is of the utmost importance, since this allows a distinction between the three clinical presentations of pruritus as proposed by the IFSI classification (Ständer, Weisshaar et al. 2007). If primary skin lesions such as macules/erythema, vesicles

2019 European Dermatology Forum

71. Discoid lupus erythematosus

Discoid lupus erythematosus Discoid lupus erythematosus - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Discoid lupus erythematosus Last reviewed: February 2019 Last updated: November 2017 Summary Most common form of chronic cutaneous lupus erythematosus. Lesions are well-demarcated erythematous macules or papules with a scaly surface, which frequently evolve into larger coin-shaped plaques; typically neither (...) antimalarials if no response. Definition Discoid lupus erythematosus (DLE) is a chronic inflammatory condition of the skin. DLE lesions begin as well-demarcated erythematous macules or papules with a scaly surface, and frequently evolve into larger coin-shaped plaques. In most DLE patients the condition remains confined to the skin; antinuclear antibodies (ANA) are often negative or present in a low titre. Provost TT. The relationship between discoid and systemic lupus erythematosus. Arch Dermatol. 1994;130

2017 BMJ Best Practice

72. Pityriasis versicolor

a change to the mycelial (filamentous fungus or mould) state of dimorphic yeasts of the genus Malassezia . It leads to hypo- or hyperpigmented coalescing scaly macules on the trunk and upper arms. The eruption is most common in the summer months in adolescents and young adults, favours oily areas of the skin, and often has a relapsing nature requiring frequent treatment. Schwartz RA. Superficial fungal infections. Lancet. 2004 Sep 25-Oct 1;364(9440):1173-82. http://www.ncbi.nlm.nih.gov/pubmed/15451228 (...) presence of risk factors lack of pruritus or pain dyspigmentation macules or patches seborrhoeic distribution fine overlying scale yellow fluorescence under Wood lamp examination high ambient temperature and humidity adolescent and young adult age hyperhidrosis systemic corticosteroid or other immunosuppressant use participation in athletics greasy skin FHx of PV malnutrition use of oral contraceptives HIV infection and other immunosuppressive conditions use of occlusive ointments or creams Diagnostic

2017 BMJ Best Practice

73. Nevi

nevus are: high clinical suspicion of melanoma; history of change in the lesion, supported by physical examination; and/or high suspicion of atypical features suggestive of melanoma. Definition Melanocytic nevi are a group of benign neoplasms or hamartomas made up of melanocytes, the pigment-producing cells of the epidermis. They can present in a variety of ways, most commonly as small, brown, flat macules, raised mammillated dome-shaped papules, bluish-grey macules and papules, and even amelanotic (...) skin-coloured papules. Unless congenital, they first appear in childhood and are more common in people with light skin and eyes. McKee PH, Calonje E, Granter SR, eds. Pathology of the skin. 3rd ed. London: Elsevier; 2005. History and exam presence of risk factors presence since birth asymmetrical, indistinct or irregularly bordered, variably coloured papules with diameter >5 mm history of change in shape and colour asymptomatic (usually) multiple lesions flat, brown macule dome-shaped papule light

2017 BMJ Best Practice

74. Infantile spasms

identification and treatment of the spasms improves prognosis. History and exam presence of risk factors spasms head nodding neurodevelopmental delay or regression ash leaf macules onset age 3-12 months perinatal complication abnormal eye movements microcephaly motor system abnormalities brain malformation neurocutaneous syndrome antenatal or perinatal vascular event intrauterine or perinatal infections inherited metabolic disorder genetic disorders family history neonatal sinovenous thrombosis postnatal

2017 BMJ Best Practice

75. Granuloma annulare

-coloured, pink, or brown macules or small papules soft-tissue nodules perforating papules, crusting or ulcerated lesions erythematous patches diabetes mellitus haematological malignancy herpes zoster HIV hepatitis hyperlipidaemia thyroid disease medications Diagnostic investigations clinical diagnosis skin biopsy fasting blood sugar thyroid function tests lipid screening hepatitis screen HIV testing Treatment algorithm ACUTE Contributors Authors Assistant Professor Dermatology and Internal Medicine

2017 BMJ Best Practice

76. Shingles

, does not cross the body midline May involve any area of skin, but thoracic, cranial ( ), lumbar and cervical dermatomes most common Rash typically consists of macules or papules that evolve into vesicles or pustules: Begins with macule formation, quickly turns into papules Clear vesicles form within 1-2 days of rash onset; new ones appear over 3-5 days Vesicles evolve into pustules within 1 week Lesions ulcerate and crust 3-5 days later Healing occurs within 2 to 4 weeks (but may take longer (...) urticarial plaques and bullae (blisters) typically in a bilateral, symmetric formation on the trunk and/or limbs. Does not follow dermatomes Related to celiac disease Vesicles form most commonly on scalp, shoulders, buttocks, elbows and knees. Typically not as wide-spread as a shingles rash and does not follow dermatomes. Suspect if patient has celiac disease Drug eruptions - typically appears on trunk, then spreads to limbs symmetrically. Rash consists of macules and papules and is commonly wide-spread

2018 medSask

77. Guidelines for the Management of Genital Herpes in New Zealand

. The area may be oedematous and can be extremely tender. Pain on urination is typical, particularly in women and spontaneous urination may be impossible. The ulcers dry to form crusts and later heal, leaving a transient red macule with minimal scarring (if any). Less commonly, lesions can pass through the blister phase quickly and blisters may not be noticed. Involvement of the cervix occurs but speculum examination may not be possible. Lesions may also appear extra-genitally, commonly on thighs (...) often caused by infections and sometimes drugs. Many cases have no obvious precipitating cause. It develops 3–14 days following HSV infection. Mild forms of this condition are common and start and present as macules, papules and urticarial lesions which reach up to 3cm on extremities. They especially affect the hands and feet, dorsum of elbows and knees, and less often the trunk. Some lesions develop into the classical “target” lesion with three colour zones: central dusky erythema, surrounded

2017 New Zealand Sexual Health Society

78. Care of Adults with Neurofibromatosis Type 1

evaluation because of clinical signs (e.g., café- au-lait macules); 5) diagnostic evaluation after detection of an NF1 variant of uncertain significance from ahereditary cancer predisposition gene panel. METHODS At the request of the American College of Medical Genetics and Genomics (ACMG) Professional Practice and Guidelines (PP&G) committee, a work group of experts was convened in July 2015 to develop a Clinical Practice Resource for the clinical care of adults with NF1. Work-group members were

2018 American College of Medical Genetics and Genomics

79. Diagnosis of Idiopathic Pulmonary Fibrosis

pneumonitis (e.g., bronchiolocentric distribution with lymphocyte-rich bronchiolitis, extensive peribronchiolar metaplasia, poorly formed nonnecrotizing granulomas in peribronchiolar interstitium), acute exacerbation of IPF or acute interstitial pneumonia (i.e., hyaline membranes), cicatricialvariantsofcryptogenicorganizing pneumonia with ?brosis (prominent organizing pneumonia), pneumoconiosis (e.g., asbestos bodies, prominent dust macules and/or silicotic nodules), sarcoidosis (prominent well-formed

2018 American Thoracic Society

80. Bruising

eruptions Allergic contact dermatitis. See the Prodigy topic on for more information. Phytophotodermatitis — an inflammatory and pigmentary reaction of the skin to light, following contact with phototoxic substances from certain plants, such as giant hogweed. Stretch marks (striae). Non-linear eruptions Slate-grey naevi (Mongolian blue spots) — macular blue-grey non-tender macules present at birth on the sacrum and buttocks in normal dark-skinned infants. Haemangiomas — benign congenital cutaneous

2017 Prodigy

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