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61. Leprosy

Leprosy Leprosy - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Leprosy Last reviewed: February 2019 Last updated: February 2018 Summary Chronic infectious disease caused by the acid-fast bacteria Mycobacterium leprae , characterised by skin lesion(s) and involvement of peripheral nerves. Skin lesions can be erythematous or hypopigmented, single or multiple macules, papules, or nodules, sometimes with loss

2018 BMJ Best Practice

62. Roseola

are discrete 3- to 5-mm pink-red macules and papules that commonly begin on the neck and trunk and spread to the extremities. Roseola is usually a benign self-limited illness that has been associated with febrile seizures. Definition Roseola infantum (also called exanthema subitum, sixth disease) is a common early childhood febrile illness, usually characterised by 3 to 5 days of high fever followed by onset of rash that appears with defervescence. The rash consists of asymptomatic pink-red macules

2018 BMJ Best Practice

63. Erythema infectiosum

populations may be at risk for chronic anaemia or transient aplastic crises. Fetal complications include hydrops fetalis and intrauterine fetal demise. History and exam close contact with other infected individuals bright red macular erythema of the bilateral cheeks with sparing of the nasal ridge and peri-oral areas erythematous macules and papules evolving into lacy reticular erythema, most notable on the extremities immunodeficiency arthralgia/arthritis prodrome (fever, headache, pharyngitis, coryza

2018 BMJ Best Practice

64. 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

65. 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

66. 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. 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

67. 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

68. 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

70. British Association of Dermatologists guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in children and young people

, 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

72. 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

73. 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. (...) 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

74. 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

75. 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

76. 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

77. Guidelines on autopsy practice: Industrial/occupational-related lung disease deaths including asbestos

macules (impalpable) secondary dust nodules (palpable) diffuse interstitial fibrosis. · complicated coal workers pneumoconiosis progressive massive fibrosis (lesions >1 cm). · coal dust tattoos · diffuse interstitial fibrosis. [Level of evidence: B.] 4 Specific health and safety aspects Subjects with silicosis are at increased risk of tuberculosis. [Level of evidence: B.] No other aspects beyond standard health and safety standards. [Level of evidence: GPP.] 5 Clinical information relevant (...) post mortem confirmed to examination of the thoracic cavity is considered sub-optimal. [Level of evidence: GPP.] 7 Specific significant organ systems Organ Pathology Agent Skin Linear tattoos Coal Corns (knuckles, finger tips) Asbestos Thorax/lungs Adult respiratory distress syndrome (shock lung) Smoke, fumes Emphysema Coal Macules Coal, silicates, iron Nodular fibrosis Coal, silica Silicate (talc, mica) Progressive massive fibrosis Coal, silica, silicates Diffuse interstitial fibrosis, lower zone

2017 Royal College of Pathologists

78. 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

79. 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

80. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy

presentations vary with focal to diffuse distributions, including flexural, inverse, and erythrodermic variants. Pruritus can be severe and is the most common associated symptom. Vitiligo presents as well-demarcated depigmented macules and patches, reported exclusively in patients with melanoma. Besides varying clinical presentation, the time to onset varies greatly among these rashes, as vitiligo can appear months after treatment initiation; however, the inflammatory dermatoses usually present within

2018 American Society of Clinical Oncology Guidelines

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