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Nail Telangiectasia

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81. Tinea Corporis (Follow-up)

be added to the topical antifungal regimen to relieve symptoms. The steroid can provide rapid relief from the inflammatory component of the infection, but the steroid should only be applied for the first few days of treatment. Prolonged use of steroids can lead to persistent and recurrent infections, longer duration of treatment regimens, and adverse effects of skin atrophy, striae, and telangiectasias. Systemic therapy may be indicated for tinea corporis that includes extensive skin infection (...) vesicles, bullae, pustules, or deep abscesses. Previous Next: Complications The tinea corporis may recur if therapy does not result in complete eradication of the organism, such as when patients stop applying topical therapy too soon or if the organism is resistant to the antifungal agent used. Reinfection may occur if a reservoir, such as an infected nail or hair follicle, is present. Many, if not most, adult patients with tinea corporis also have and unguium, which should be treated. Previous Next

2014 eMedicine.com

83. Dermatologic Manifestations of Cardiac Disease (Follow-up)

Clubbing (Hypertrophic Osteoarthropathy) Definition represents a localized drumsticklike swelling of the distal segments of fingers and toes, particularly over the extensor surface. It is caused by connective tissue proliferation leading to increases in the sponginess of the soft tissue at the base of the nails due to stimulation by a humoral substance that causes dilation of the vessels of the fingertip or toe tip. [ ] Differential diagnosis Clubbing, as illustrated below, is seen in persons (...) of clubbing of a finger in a patient with Eisenmenger syndrome (right-to-left shunt). Cyanosis Definition is a bluish discoloration of the skin and mucous membranes due to an increased amount of reduced hemoglobin in the small blood vessels of the skin. It is most appreciable in the lips, nail beds, earlobes, and cheeks. The mechanism includes either dilatation of cutaneous venules or a reduction in the oxygen saturation of intracapillary blood. Cyanosis manifests when the absolute concentration

2014 eMedicine.com

84. Dermatologic Manifestations of Renal Disease (Follow-up)

) dermatologic manifestations of uremia, and (3) dermatologic disorders associated with renal transplantation. The image below illustrates several uremia-related cutaneous disorders. Hands of a transfusion-dependent patient on long-term hemodialysis. Several uremia-related cutaneous disorders are visible. The pigmentary alteration results from retained urochromes and hemosiderin deposition. The large bullae are consistent with either porphyria cutanea tarda or the bullous disease of dialysis. All nails show (...) the distal brown-red and proximal white coloring of half-and-half nails. This article does not discuss systemic disorders, because most of them are discussed in other articles in . The purpose of this article is to integrate renal and cutaneous aspects of disease as well as highlight some important, although frequently underappreciated, clinical or laboratory findings that ally renal and skin diseases. Recognition of the details may provide clinicians with greater insight into the management of patients

2014 eMedicine.com

85. Dermatologic Manifestations of Gastrointestinal Disease (Follow-up)

macular or papular, sharply demarcated telangiectases on the face, lips, palate, tongue, ears, chest, or extremities, with occasional presentation under nails. The age of onset for the telangiectases is most often the third decade of life, although earlier presentations may occur during adolescence. Although the distribution of lesions and associated bleeding diathesis are clinically suggestive of hereditary hemorrhagic telangiectasia, it may occasionally be difficult to distinguish from similar (...) within the GI tract. This review attempts to explore this relationship by describing disorders involving both the GI tract and the skin. [ , ] Table 1. Dermatologic Manifestations of Alimentary Disorders Dermatologic Manifestation GI Abnormality Disorder Periorificial granulomas [ ] Malabsorption Crohn disease Koilonychia Esophageal webs Plummer-Vinson syndrome Liver disease Hemochromatosis Palmoplantar keratoderma Esophageal carcinoma Howel-Evans syndrome Acral rash Bazex syndrome [ ] Telangiectasia

2014 eMedicine.com

86. Dermatologic Manifestations of Pulmonary Disease (Follow-up)

decades (see the image below). Lesions typically range from one to several millimeters in diameter, but they may grow much larger. Three-dimensional reconstructions of serial sections of skin biopsy specimens have established these lesions to be arteriovenous malformations. Hereditary hemorrhagic telangiectasia. Photographs show characteristic telangiectasias of the lips and tongue (left) and nail (right). Treatment The treatment of PAVMs consists of surgical resection or obliteration of the shunt (...) by interstitial edema and infiltration by plasma cells and lymphocytes. Connective-tissue proliferation and interstitial edema result in a characteristic spongy quality to the proximal nail fold—as if the nail were floating in the nail bed. Clinical findings Clinical examination findings may correlate with the severity of clubbing. The earliest finding may be the Schamroth sign, first described by a South African physician when he developed clubbing secondary to infective endocarditis. [ ] In healthy

2014 eMedicine.com

87. Dermatologic Manifestations of Hematologic Disease (Follow-up)

Manifestations of Anemia Pallor of the skin and mucocutaneous membranes can be a sign of severe anemia of any cause. Severe anemia (hemoglobin Iron deficiency anemia can cause changes in the appearance of the nails, tongue, and hair. In iron deficiency, nails become fragile and develop longitudinal ridges. Nail-plate alterations follow, with the development of koilonychia, a spoonlike convexity (see the images below). Koilonychia. Koilonychia. In iron deficiency anemia, reduced oxygen availability (...) is believed to diminish disulfide bond formation, which consequently reduces nail-plate pliability. Changes also occur in the oral mucosa and on the tongue. Of 378 patients with iron deficiency, 14% had angular stomatitis and almost half had alterations in tongue papillae, either a change to the filiform type or atrophy. [ , ] Diffuse hair thinning is reported in female blood donors and is believed to be caused by a decrease in the iron storage pool. Changes in hair quality, primarily increased splitting

2014 eMedicine.com

88. Dermoscopy (Follow-up)

% for the examination by naked eye and 90% for dermoscopy. The equipment; technologic methods; diagnostic features; and primary aspects of melanoma, common nevi, atypical nevi, and other nonmelanocytic pigmented skin lesions are discussed in this article. The technique is also commonly used to assist in the evaluation of nail fold capillaries and features of alopecia. [ , ] Next: Technical Procedures and Equipment Dermoscopy involves an evaluation of the skin surface. During a dermoscopy assessment, the pigmented (...) occur in white areas that correspond to well-defined white or milky red-white areas. In contrast to hypopigmented areas, depigmented areas completely lack pigment. Histologically, they correspond to fibroplasia, telangiectasias, and loss of melanin. See images below. Hypopigmented areas in a melanocytic nevus. White areas in invasive melanoma. Negative pigment network Negative pigment network is seen as a negative of the pigmented network with relatively lighter serpiginous lines making up

2014 eMedicine.com

89. White Blood Cell Function (Follow-up)

) Lymphohi-stiocytic syndrome Fever, pancytopenia, coagulopathy, hemophagocytosis, and hepatosplenomegaly, CNS involvement Increased interferon-g and TNF-a, hypofibrino-genemia, and hypertrigly-ceridemia, hyperferritinemia Autosomal recessive FHL2 associated with perforin deficiency at 10q22; FHL1 associated with 9q21; FHL3 associated with Munc 13-4 at 17q25, FHL4 6q24 Ataxia telangiectasia Syndrome that includes combined immuno-deficiency Progressive ataxia, oculocutaneous telangiectasias, and recurrent

2014 eMedicine Pediatrics

90. White Blood Cell Function (Treatment)

) Lymphohi-stiocytic syndrome Fever, pancytopenia, coagulopathy, hemophagocytosis, and hepatosplenomegaly, CNS involvement Increased interferon-g and TNF-a, hypofibrino-genemia, and hypertrigly-ceridemia, hyperferritinemia Autosomal recessive FHL2 associated with perforin deficiency at 10q22; FHL1 associated with 9q21; FHL3 associated with Munc 13-4 at 17q25, FHL4 6q24 Ataxia telangiectasia Syndrome that includes combined immuno-deficiency Progressive ataxia, oculocutaneous telangiectasias, and recurrent

2014 eMedicine Pediatrics

91. B-Cell and T-Cell Combined Disorders (Overview)

poor antibody responses to polysaccharide antigens but elevated levels of serum immunoglobulin A (IgA) and immunoglobulin E (IgE) with low levels of immunoglobulin M (IgM). See . Two autosomal recessive syndromes involving DNA repair indicate some interaction between the immune system and neurologic function. Ataxia-telangiectasia (AT) is a rare, autosomal recessive, neurodegenerative disorder in which the diagnosis is obvious when both ataxia and telangiectasia are present. Multisystemic (...) manifestations of AT include motor impairments secondary to a neurodegenerative process, oculocutaneous telangiectasia, sinopulmonary infections, hypersensitivity to ionizing radiation, and a combined immunodeficiency that can be quite variable. This is discussed in additional detail in this article. Nijmegen breakage syndrome (NBS) is also an autosomal recessive chromosomal instability syndrome. NBS is characterized by microcephaly with growth retardation, normal or impaired intelligence, birdlike facies

2014 eMedicine Pediatrics

92. Colorectal Tumors (Follow-up)

pigmentation of lips, oral mucosa, and perioral region Cronkhite-Canada syndrome - GI polyposis, skin hyperpigmentation, alopecia, and nail changes Osler-Weber-Rendu syndrome - Juvenile polyps and hepatic telangiectasia Oldfield syndrome - Polyposis and multiple sebaceous cysts Bloom syndrome - Growth retardation, accelerated aging, immune deficiency, and malignant tumors Cowden syndrome - Hamartomas, GI polyps, breast, thyroid, and GI cancer Ruvalcaba-Myhre-Smith syndrome - Microcephaly and juvenile (...) in which the GI polyps are associated with skin hyperpigmentation, alopecia, and nail changes (Cronkhite, 1955). Hair loss, and skin and nail changes may be evident long before GI symptoms appear. The hamartomatous polyps appear in the stomach and colon. Chronic diarrhea results in malabsorption, hypovitaminosis, hypoproteinemia, and fluid and electrolyte imbalance. Because patients with Cronkhite-Canada syndrome may develop colonic malignancy, close follow-up is recommended (see Syndromes associated

2014 eMedicine Pediatrics

93. Colorectal Tumors (Diagnosis)

pigmentation of lips, oral mucosa, and perioral region Cronkhite-Canada syndrome - GI polyposis, skin hyperpigmentation, alopecia, and nail changes Osler-Weber-Rendu syndrome - Juvenile polyps and hepatic telangiectasia Oldfield syndrome - Polyposis and multiple sebaceous cysts Bloom syndrome - Growth retardation, accelerated aging, immune deficiency, and malignant tumors Cowden syndrome - Hamartomas, GI polyps, breast, thyroid, and GI cancer Ruvalcaba-Myhre-Smith syndrome - Microcephaly and juvenile (...) in which the GI polyps are associated with skin hyperpigmentation, alopecia, and nail changes (Cronkhite, 1955). Hair loss, and skin and nail changes may be evident long before GI symptoms appear. The hamartomatous polyps appear in the stomach and colon. Chronic diarrhea results in malabsorption, hypovitaminosis, hypoproteinemia, and fluid and electrolyte imbalance. Because patients with Cronkhite-Canada syndrome may develop colonic malignancy, close follow-up is recommended (see Syndromes associated

2014 eMedicine Pediatrics

94. Colorectal Tumors (Treatment)

pigmentation of lips, oral mucosa, and perioral region Cronkhite-Canada syndrome - GI polyposis, skin hyperpigmentation, alopecia, and nail changes Osler-Weber-Rendu syndrome - Juvenile polyps and hepatic telangiectasia Oldfield syndrome - Polyposis and multiple sebaceous cysts Bloom syndrome - Growth retardation, accelerated aging, immune deficiency, and malignant tumors Cowden syndrome - Hamartomas, GI polyps, breast, thyroid, and GI cancer Ruvalcaba-Myhre-Smith syndrome - Microcephaly and juvenile (...) in which the GI polyps are associated with skin hyperpigmentation, alopecia, and nail changes (Cronkhite, 1955). Hair loss, and skin and nail changes may be evident long before GI symptoms appear. The hamartomatous polyps appear in the stomach and colon. Chronic diarrhea results in malabsorption, hypovitaminosis, hypoproteinemia, and fluid and electrolyte imbalance. Because patients with Cronkhite-Canada syndrome may develop colonic malignancy, close follow-up is recommended (see Syndromes associated

2014 eMedicine Pediatrics

95. Epistaxis (Treatment)

Hemorrhagic Telangiectasia Management of hereditary hemorrhagic telangiectasia (HHT) is palliative because the underlying defect is not curable. Options include coagulation with potassium-titanyl-phosphate (KTP) or neodymium:yttrium-aluminum-garnet (Nd:YAG) lasers, septodermoplasty, embolization, and estrogen therapy. [ ] A study by Wirsching et al indicated that in patients with HHT, supplementing Nd:YAG laser therapy with temporary nasal occlusion with hypoallergenic tape can reduce the Epistaxis (...) activities - Protection from direct trauma from some sports activities is afforded by the use of helmets or face pieces. Hot and dry environments – The effects of such environments can be mitigated by using humidifiers, better thermostatic control, saline spray, and antibiotic ointment on the Kiesselbach area. Hot and spicy foods Digital trauma – In children, nose picking is difficult to deter and should probably be considered inevitable. Keeping the child’s nails well trimmed may be helpful. Nose

2014 eMedicine Pediatrics

96. Colorectal Tumors (Overview)

pigmentation of lips, oral mucosa, and perioral region Cronkhite-Canada syndrome - GI polyposis, skin hyperpigmentation, alopecia, and nail changes Osler-Weber-Rendu syndrome - Juvenile polyps and hepatic telangiectasia Oldfield syndrome - Polyposis and multiple sebaceous cysts Bloom syndrome - Growth retardation, accelerated aging, immune deficiency, and malignant tumors Cowden syndrome - Hamartomas, GI polyps, breast, thyroid, and GI cancer Ruvalcaba-Myhre-Smith syndrome - Microcephaly and juvenile (...) in which the GI polyps are associated with skin hyperpigmentation, alopecia, and nail changes (Cronkhite, 1955). Hair loss, and skin and nail changes may be evident long before GI symptoms appear. The hamartomatous polyps appear in the stomach and colon. Chronic diarrhea results in malabsorption, hypovitaminosis, hypoproteinemia, and fluid and electrolyte imbalance. Because patients with Cronkhite-Canada syndrome may develop colonic malignancy, close follow-up is recommended (see Syndromes associated

2014 eMedicine Pediatrics

97. Nevus Araneus (Spider Nevus) (Diagnosis)

failure, and cirrhosis. [ , , ] In fact, the spider angioma is rumored to have received its name from barmaids in New York, who used the lesion as a marker of liver disease in their customers. [ ] When associated with liver disease, spider angiomas may be numerous, large in size, [ ] and appear in atypical locations [ ] ; other findings may be present, including palmar erythema, muscle atrophy, gynecomastia, ascites, jaundice, splenomegaly, [ ] leukonychia, , and longitudinal nail striations (...) , Galal S. Nail changes in patients with liver disease. J Eur Acad Dermatol Venereol . 2010 Jun. 24(6):649-54. . . Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH, et al. Role of substance P in the pathogenesis of spider angiomas in patients with nonalcoholic liver cirrhosis. Am J Gastroenterol . 1999 Feb. 94(2):502-7. . . Isner JM, Pieczek A, Schainfeld R, Blair R, Haley L, Asahara T, et al. Clinical evidence of angiogenesis after arterial gene transfer of phVEGF165 in patient with ischaemic limb

2014 eMedicine.com

98. Paraneoplastic Diseases (Diagnosis)

include symmetrical, scaly, violaceous plaques on the acral surfaces, with severe forms progressing to bullae. The lesions predominantly occur on the hands, feet, ear helices, nose tip, and scalp. Skin changes may spread to involve the knees, elbows, and malar surface of the face. [ ] Bazex syndrome occurs more commonly in men older than 40 years. [ ] Alopecia and nail changes are common and can be early findings. Subungual hyperkeratosis, onychodystrophy, and white flaking of the nail surface (...) are the usual manifestations. These changes may progress to the point that the nail sheds. Diagnosis Histopathologic analysis of samples from the affected sites reveals nonspecific changes, including hyperkeratosis, acanthosis, parakeratosis, and dyskeratotic keratinocytes. Perivascular lymphocytic infiltrates are variably present with eosinophils and neutrophils. Direct immunofluorescence is also nonspecific. The diagnosis is based on the characteristic distribution of skin changes. The main entity

2014 eMedicine.com

99. Oral Manifestations of Systemic Diseases (Diagnosis)

with a prevalence estimated between 0.4-4% in the general population. [ , ] Notably, however, the association between HCV infection and LP is greater in Europe and Asia than it is in the United States. [ , ] Cutaneous lesions are classically pruritic, violaceous, polygonal papules and often present on the trunk or extremities, although nail, vulvar mucosal, and oral mucosal involvement can be significant. [ ] Oral manifestations of LP are more common in women aged 30-70 years. [ , ] Oral LP may be classified (...) lupus rash Photosensitive lupus rash in the absence of dermatomyositis OR subacute cutaneous lupus (nonindurated psoriasiform and/or annular polycyclic lesions that resolve without scarring, although occasionally with postinflammatory dyspigmentation or telangiectasias) Chronic cutaneous lupus, including: Classic discoid rash Localized (above the neck) Generalized (above and below the neck) Hypertrophic (verrucous) lupus Lupus panniculitis (profundus) Mucosal lupus Lupus erythematosus tumidus

2014 eMedicine.com

100. External Ear, Inflammatory Diseases

, elbows, scalp, anogenital region, and nails are most commonly affected. Eighteen percent of patients, especially those with extensive scalp involvement, have external ear involvement at some time during their lives. The periauricular skin, conchae, and external auditory meatus are the regions of the ear most likely to be affected. Ear involvement may be intensely pruritic, and the scaly lesions may accumulate in the external auditory canal, which results in diminished hearing. The ear is affected (...) more often in women, and nearly 50% of ear involvement occurs in individuals aged 10-29 years. In addition to the classic skin lesions, psoriasis may also manifest as nail and joint involvement. Up to 30% of patients may present with thickening of distal nail plates, separation and pitting of nails, and a white or yellow opacification, commonly referred to as oil spots. Finally, approximately 5% of patients have joint involvement. Diagnosis is generally made with the help of a history and physical

2014 eMedicine Surgery

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