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Papule

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122. Overview of pregnancy complications

, urticaria, and papules of pregnancy (PUPPS). Sequelae include premature birth and respiratory distress syndrome in pre-term infants. Pre-eclampsia is the occurrence of BP ≥140/90 mmHg in the third trimester, with proteinuria ≥300 mg/24 hours, developing at the same time or shortly thereafter. Eclampsia is the occurrence of seizures without any other cause in a patient with pre-eclampsia. Report of the National High Blood Pressure Education Program: working group on high blood pressure in pregnancy. Am J

2018 BMJ Best Practice

123. Hidradenitis suppurativa

/18159906?tool=bestpractice.com While the name and distribution imply that the disease originates in the sweat glands, the pathogenesis is likely to be around hair follicles with sweat gland involvement being a secondary event. It is a member of the 'follicular occlusion tetrad' of nodulocystic acne, dissecting cellulitis of the scalp, pilonidal cysts, and HS. The disease manifests clinically as inflammatory papules, nodules, and abscesses that can lead to scarring. Jemec GB. Hidradenitis suppurativa. J

2018 BMJ Best Practice

124. Assessment of rash in children

and rubella], morbilliform drug eruption). Papule: a raised area <1 cm in size (e.g., wart). Nodule: a larger papule, >1 cm in size (e.g., nodular prurigo). Plaque: a flat-topped raised area (a cross between a nodule and a patch; e.g., psoriasis). Vesicle: a small fluid-filled lesion (blister) <0.5 cm in size (e.g., varicella, eczema herpeticum). Bulla: a larger vesicle >0.5 cm (e.g., bullous impetigo). Pustule: a pus-filled lesion (e.g., folliculitis). Wheal: a transient raised papule or plaque caused

2018 BMJ Best Practice

125. Bed bugs

Bed bugs Bed bugs - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Bed bugs Last reviewed: February 2019 Last updated: January 2018 Summary Nocturnal, obligate, blood-feeding parasites that take refuge in furniture and bedding. Reports of bites are increasing in prevalence. Bites are painless but cause discomfort owing to the associated reactions. Characteristic lesions are pruritic papules in an irregular linear (...) of the bedbugs (Cimicidae). Ann Rev Entomol. 2007;52:351-74. http://www.ncbi.nlm.nih.gov/pubmed/16968204?tool=bestpractice.com Typical lesions are erythematous, pruritic papules on skin exposed while sleeping. Lesions may appear hours to days after being bitten. Bed bugs are unlikely vectors of disease, so treatment is symptomatic control and avoidance of the parasite. Potter M. Bed bugs. University of Kentucky, Cooperative Extension Service. Online entfact - 636. 2008. http://www.ca.uky.edu [internet

2018 BMJ Best Practice

126. Chancroid

coccobacillus Haemophilus ducreyi , most commonly presenting with a painful genital ulcer, and often associated with fluctuant lymphadenitis. History and exam presence of risk factors genital papules genital ulcers lymphadenitis and buboes urethritis and dysuria vaginal discharge dyspareunia rectal pain or bleeding rectovaginal fistula extra-genital ulcers multiple sex partners sexual contact with sex worker unprotected intercourse substance abuse male sex lack of circumcision (in men) poor personal hygiene

2018 BMJ Best Practice

127. 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

128. Assessment of maculopapular rash

Assessment of maculopapular rash Assessment of maculopapular rash - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Assessment of maculopapular rash Last reviewed: February 2019 Last updated: February 2019 Summary The patient with an acute maculopapular rash presents a diagnostic challenge to the clinician. The term 'maculopapular is non-specific, as many eruptions have a primary morphology of macules or papules (...) . Morphological terms: Macule: a flat skin lesion ≤1 cm in greatest diameter. When macules are >1 cm, the appropriate term is patch. Papule: a raised bump ≤1 cm in diameter. When papules are >1 cm in size, the appropriate term is plaque (palpable lesions elevated above the skin surface) or nodule (a larger, firm papule with a significant vertical dimension). Other morphological terms encountered in this clinical setting include: Pustule: a papule containing purulent fluid Vesicle: a papule containing clear

2018 BMJ Best Practice

129. 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 (...) and papules. Febrile seizures may occur. Roseola is usually caused by human herpesvirus (HHV)-6B, but occasionally by HHV-7 and rarely by other viruses. HHV-6A (associated with thyroiditis), HHV-6B (roseola), and HHV-7 (roseola) are roseoloviruses (within the betaherpesviruses subfamily), and all establish latency. HHV-6A and HHV-6B can occasionally integrate into the host chromosome. Reactivation of roseoloviruses may occur with immunosuppression. History and exam presence of risk factors high fever

2018 BMJ Best Practice

130. 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

131. Pediculosis capitis

who are socially active, particularly young children. History and exam presence of risk factors scalp pruritus live nymphal or adult louse eggs visible on hair shaft within 1 cm of scalp small red papules under hairline at nape of neck lymphadenopathy erythema with honey-coloured crust on scalp aged 3-12 years female sex ethnicity other than black close contact with infested individual overcrowding or close living conditions low socioeconomic status poor hygiene contact with contaminated clothes

2018 BMJ Best Practice

132. Overview of pregnancy complications

, urticaria, and papules of pregnancy (PUPPS). Sequelae include premature birth and respiratory distress syndrome in pre-term infants. Pre-eclampsia is the occurrence of BP ≥140/90 mmHg in the third trimester, with proteinuria ≥300 mg/24 hours, developing at the same time or shortly thereafter. Eclampsia is the occurrence of seizures without any other cause in a patient with pre-eclampsia. Report of the National High Blood Pressure Education Program: working group on high blood pressure in pregnancy. Am J

2018 BMJ Best Practice

133. Balanoposthitis

papules or micro-papules pustules congenital or acquired dysfunctional foreskin uncircumcised state poor hygiene; urinary dribbling or leakage over-washing human papillomavirus (HPV) infection inflammatory skin diseases Borrelia infection Diagnostic investigations swab for microbiology (Gram stain and culture) and PCR swab for virology dark-field microscopy skin biopsy patch testing Treatment algorithm ACUTE Contributors Authors Consultant Dermatologist St Mary's Hospital Imperial College Healthcare

2018 BMJ Best Practice

134. Polymorphous light eruption

Polymorphous light eruption Polymorphous light eruption - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Polymorphous light eruption Last reviewed: February 2019 Last updated: March 2018 Summary Onset occurs during adolescence and young adulthood. Mainly affects women. Typically, manifests after intensive UV exposure; clinical symptoms last several days; remission occurs without complication. Papules/papulovesicles (...) include severe itching and small papules, plaques, and papulovesicles on predilection sites, such as the V-neck area, dorsal aspects of the arms and hands, legs, and less commonly on the face. Aetiology remains elusive; however, UV-A-induced oxidative stress appears to play a key role. History and exam recurrent hx of lesions following UV exposure young women and adolescents FHx of PLE severe itching reduced symptoms over course of 1 year erythematous patches papules plaques vesicles UV-A exposure

2018 BMJ Best Practice

135. Lichen simplex chronicus

erythematous to violaceous plaques lesions on neck, ankles, scalp, vulva, scrotum, pubis, and extensor forearms altered pigmentation erosions linear fissures grouped hyperpigmented papules on the shins hyperpigmented patch on the interscapular back underlying psychiatric disorder underlying systemic condition causing pruritus atopic diathesis environmental irritants psychiatric disorder dermatological disease systemic conditions causing pruritus Diagnostic investigations skin biopsy patch testing potassium

2018 BMJ Best Practice

136. Actinic keratosis

, fissuring, and ulceration of the lower lip to the commissures lesion on sun-exposed area of body skin-coloured, papillomatous, elevated wart-like papules plaques with very mild scale over very thin shiny skin violaceous well-defined papules with fine white lines on the surface evidence of sun damage to skin pruritus or bleeding chronic exposure to UVB radiation light-coloured skin, freckling, and albinism age >40 years male sex immunocompromise xeroderma pigmentosum Diagnostic investigations dermoscopy

2018 BMJ Best Practice

137. Common warts

% at 5 years. Definition Warts are elevated, round, hyperkeratotic skin papules with a rough greyish-white or light brown surface. Although lesions may occur anywhere, they have a tendency to occur at sites prone to trauma, such as knees and elbows. Filiform warts have a stalk-like appearance with multiple spikes. James WD, Berger T, Elston D. Andrews' diseases of the skin: clinical dermatology. 10th ed. New York, NY: W.B. Saunders; 2006. Lipke MM. An armamentarium of wart treatments. Clin Med Res (...) . 2006;4:273-293. http://www.clinmedres.org/content/4/4/273.full http://www.ncbi.nlm.nih.gov/pubmed/17210977?tool=bestpractice.com History and exam presence of risk factors lesion growth over weeks to months round, raised papule tiny black dots on surface of lesion satellite lesions fingers or nail fold lesions facial lesions fissuring hyperkeratosis greyish-white or light brown colour filiform papule with sharp spikes water immersion occupations involving handling of meat or fish nail biting age under

2018 BMJ Best Practice

138. Miliaria

with prompt self-resolution. Miliaria rubra consists of non-folliculocentric, erythematous papulovesicles with associated pruritus. Miliaria profunda consists of non-folliculocentric, pruritic flesh-coloured papules as a result of multiple bouts of miliaria rubra. This form of miliaria is often associated with anhidrosis of the affected skin and can result in heat exhaustion. The main treatment of choice for all forms of miliaria is placement of the patient in a cool environment. Definition Miliaria (...) is a generic term referring to a cutaneous eruption due to retention of sweat as a result of occlusion or disruption of eccrine sweat ducts. The three types of miliaria are miliaria crystallina, miliaria rubra, and miliaria profunda. Wenzel FG, Horn TD. Nonneoplastic disorders of the eccrine glands. J Am Acad Dermatol. 1998 Jan;38(1):1-17; quiz 18-20. http://www.ncbi.nlm.nih.gov/pubmed/9448199?tool=bestpractice.com History and exam presence of risk factors non-follicular vesicles and papules (all types

2018 BMJ Best Practice

139. Dermatomyositis

Dermatomyositis Dermatomyositis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Dermatomyositis Last reviewed: February 2019 Last updated: April 2018 Summary An idiopathic inflammatory myopathy characterised by the presence of hallmark cutaneous lesions (e.g., heliotrope rash, Gottron's papules). Skin lesions are frequently the initial presenting complaint, with muscle involvement developing later. Some patients have (...) factors Gottron's papules heliotrope rash with or without peri-orbital oedema macular violaceous erythema peri-ungual erythema, nail-fold capillary dilation, cuticular over-growth 'mechanic's' hands proximal muscle weakness photosensitivity poikiloderma vasculare atrophicans pruritus fatigue and malaise dyspnoea weight loss fever myalgia arthralgia dysphagia palpitations and syncope Raynaud's phenomenon cutaneous calcinosis erythroderma vesicobullous lesions leukocytoclastic vasculitis cutaneous

2018 BMJ Best Practice

140. Gonorrhoea infection

pelvic pain in women tenderness and/or swelling of the epididymis mucopurulent or purulent exudate at the endocervix urethral irritation in men dysuria in men tenderness and/or swelling of testis tenderness and/or swelling of prostate anal pruritus mucopurulent discharge from the rectum rectal pain tenesmus rectal bleeding vaginal discharge cervical friability uterine, adnexal, or cervical motion tenderness uterine mass anterior cervical lymphadenopathy conjunctivitis fever skin lesions (papules

2018 BMJ Best Practice

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