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141. Scabies

scabiei , a mite that burrows through the human stratum corneum. Spread is primarily via direct contact with an individual with scabies. Clinical clues to diagnosis include intense pruritus and linear erythematous burrows, particularly on the extremities, or erythematous papules and nodules elsewhere such as in the axilla or genital area. Rarely, it can present on the neck and scalp. Diagnosis is based on history and clinical appearance. Chosidow O. Clinical practices. Scabies. N Engl J Med. 2006;354 (...) :1718-1727. http://www.ncbi.nlm.nih.gov/pubmed/16625010?tool=bestpractice.com History and exam infants, children, and the elderly hx of overcrowding hx of itching in family members or close contacts over the same period generalised and intense pruritus, typically worse at night burrows papules, vesicles, excoriations positive ink burrow test papules on face, neck, palms, and soles in children immunosuppression bullae thick, crusted lesions occurring on elbows, knees, hands, and feet with dystrophic

2018 BMJ Best Practice

142. Rosacea

Rosacea Rosacea - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Rosacea Last reviewed: February 2019 Last updated: May 2018 Summary The diagnosis is usually clinical; avoidance of triggers is key to management. The most common manifestations are flushing, dilated prominent telangiectases (primarily on the face), persistent facial erythema, inflammatory papules, and pustules on the peri-orificial face. Prominence (...) . 2002 Apr;46(4):584-7. http://www.ncbi.nlm.nih.gov/pubmed/11907512?tool=bestpractice.com People with rosacea can also experience watery or irritated eyes. Overall, it is characterised by episodes of remission and recurrence. History and exam presence of risk factors flushing erythema papules and pustules telangiectases ocular manifestations plaque formation facial distribution phymatous changes acne vulgaris burning or stinging dry appearance oedema peripheral location fair skin hot baths/showers

2018 BMJ Best Practice

143. Acne vulgaris

Acne vulgaris Acne vulgaris - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Acne vulgaris Last reviewed: February 2019 Last updated: June 2018 Summary Acne may affect any age group, but it is most common in adolescents. Lesions consist of non-inflammatory comedones (whiteheads and blackheads) and inflammatory papules, pustules, nodules, and cysts. Systemic effects may be present with acne fulminans, a rare variant (...) of nodulocystic acne. Treatments include topical retinoids, keratolytics, and antibiotics; severe nodulocystic acne may require oral isotretinoin. Definition Acne vulgaris is a skin disease affecting the pilosebaceous unit. It is characterised by comedones, papules, pustules, nodules, cysts, and/or scarring, primarily on the face and trunk. Clinical manifestations range from mild comedonal acne to severe nodulocystic acne, which can be permanently disfiguring. In addition to the physical lesions, acne can

2018 BMJ Best Practice

144. Eczema

in this population. Eczema can be described as acute or chronic. Acute eczema is used to describe a flare-up of symptoms. Chronic is used to describe the condition when the patient develops signs of chronic inflammation (e.g., lichenification). The period of time before the condition is termed chronic is not clearly defined. History and exam presence of risk factors pruritus xerosis (dry skin) sites of skin involvement erythema scaling vesicles papules keratosis pilaris excoriations lichenification

2018 BMJ Best Practice

145. Psoriasis

Psoriasis Psoriasis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Psoriasis Last reviewed: February 2019 Last updated: January 2019 Summary Lesions are red, inflamed, silvery-white scaly, and circumscribed papules and plaques; often affecting elbows, knees, extensor limbs, and scalp, and, less commonly, nails, ear, and umbilical region. Typically lifelong, with a fluctuating course of exacerbations and remission (...) papules, and plaques. It can cause itching, irritation, burning, and stinging. Although the classification typically includes psoriatic arthritis, skin manifestations only are discussed in this topic. History and exam skin lesions family history skin discomfort genetic infection local trauma stress smoking light skin alcohol intake (beer) Diagnostic investigations clinical diagnosis skin biopsy Treatment algorithm ONGOING Contributors Authors Assistant Professor University of Pisa Consultant

2018 BMJ Best Practice

146. Molluscum contagiosum

Molluscum contagiosum Molluscum contagiosum - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Molluscum contagiosum Last reviewed: February 2019 Last updated: March 2019 Summary Acquired through skin-to-skin or fomite contact in children and is sexually transmitted in adulthood. Lesions appear as umbilicated, pearl-like, smooth papules. At least one third of patients will develop symptoms of local erythema, swelling (...) are cutaneous (less commonly mucosal). They appear as pearl-like, smooth papules, which are umbilicated. The histological equivalent of epidermal collections of molluscum bodies is referred to as Henderson-Patterson bodies; virally infected keratinocytes with a central orifice. Lesions are generally caused via skin-to-skin or fomite contact in children and by sexual transmission in adults. Silverberg NB. Warts and molluscum in children. Adv Dermatol. 2004;20:23-73. http://www.ncbi.nlm.nih.gov/pubmed

2018 BMJ Best Practice

147. Folliculitis

. Definition Folliculitis is an inflammatory process involving any part of the hair follicle; it is most commonly secondary to infection. It is important to recognise non-infectious causes of folliculitis (e.g., eosinophilic folliculitis) as well as folliculitis primarily involving the scalp (e.g., folliculitis decalvans). The condition manifests clinically as erythematous papules or pustules around hair follicles. Depending on the aetiology and chronicity of the condition, histological examination reveals (...) various populations of inflammatory cells around the pilosebaceous unit. Folliculitis commonly occurs in areas with terminal hair growth, such as the head and neck region, axillae, groin and buttocks; it also favours areas under occlusion. History and exam recent history of immersion in spa water man with dark skin and curly hair recent ingestion of drugs known to be associated with folliculitis recent history of shaving umbilicated, flesh-coloured papules papules on one side of the face

2018 BMJ Best Practice

148. Squamous cell carcinoma of the skin

and citation for the preceding image starts]: Squamous cell carcinoma on the dorsal hand with evidence of extensive sun damage From the private collection of Dr Nwaneshiudu and Dr Soltani [Citation ends]. Precursor lesions for SCCs are called actinic (or sun-damage) keratosis. History and exam presence of risk factors growing tumours previous skin cancer bleeding crusting evidence of sun damage to skin tender or itchy non-healing wound originally caused by trauma erythematous papules or plaques thin, flesh

2018 BMJ Best Practice

149. Basal cell carcinoma

, but rarely metastasises. While certain factors can result in higher-grade behaviour, in most cases early detection and treatment have made extensive local invasion and destruction from this neoplasm a thing of the past. Raasch BA, Buettner PG, Garbe C. Basal cell carcinoma: histological classification and body-site distribution. Br J Dermatol. 2006 Aug;155(2):401-7. http://www.ncbi.nlm.nih.gov/pubmed/16882181?tool=bestpractice.com History and exam presence of risk factors papules with associated (...) telangiectasias plaques, nodules, and tumours with rolled borders small crusts and non-healing wounds non-healing scabs pearly papules and/or plaques metastases associated with large or neglected BCC local destruction with advanced lesion Ultraviolet (UV) radiation sun exposure x-ray exposure arsenic exposure xeroderma pigmentosum basal cell naevus syndrome (Gorlin-Goltz syndrome) transplant patients Diagnostic investigations biopsy for dermatohistopathology in vivo multiphoton microscopy Treatment algorithm

2018 BMJ Best Practice

150. Overview of skin cancer

papules and/or plaques; non-healing scabs; small crusts and non-healing wounds; plaques, nodules, and tumours with rolled borders; or papules with associated telangiectasias. Lear W, Dahlke E, Murray CA. Basal cell carcinoma: review of epidemiology, pathogenesis, and associated risk factors. J Cutan Med Surg. 2007 Jan-Feb;11(1):19-30. http://www.ncbi.nlm.nih.gov/pubmed/17274935?tool=bestpractice.com Raasch BA, Buettner PG, Garbe C. Basal cell carcinoma: histological classification and body-site

2018 BMJ Best Practice

151. Genital warts

and is not often associated with oncogenic potential. Treatment can be challenging, as there is no cure and recurrences are common. Definition Genital warts are the most prevalent form of viral genital mucosal lesions and are caused by infection with several types of human papillomavirus (HPV). Mansur CP. Human papillomaviruses. In: Tyring SK, ed. Mucocutaneous manifestations of viral diseases. New York, NY: Marcel Dekker; 2002:247-94. The infection manifests as verrucous fleshy papules that may coalesce

2018 BMJ Best Practice

152. Idiopathic inflammatory myopathies

seems to have an autoimmune and degenerative pathogenesis. Karpati G, Hilton-Jones D, Griggs RC. Disorders of voluntary muscle. 7th ed. Cambridge, UK: Cambridge University Press; 2001. Carpenter S, Karpati G. Pathology of skeletal muscle. 2nd ed. New York, NY: Oxford University Press USA; 2001. History and exam presence of risk factors difficulty with motor tasks muscle weakness muscle atrophy heliotrope rash with eyelid oedema Gottron's papules frequent falls fatigue and generalised malaise weight

2018 BMJ Best Practice

153. 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

154. Blepharitis

. It typically occurs bilaterally. Disease is usually chronic with intermittent exacerbations. History and exam burning sensation itching sensation foreign body sensation crusting of eyelids dry eye lid erythema, telangiectasias collarettes around lashes capped meibomian glands conjunctival hyperaemia unstable tear film with rapid tear break-up time chalazion scalp changes photophobia facial telangiectasias, erythema, pustules, papules depigmentation of lashes trichiasis madarosis lid margin thickening

2018 BMJ Best Practice

155. Seborrhoeic keratosis

Seborrhoeic keratosis Seborrhoeic keratosis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Seborrhoeic keratosis Last reviewed: February 2019 Last updated: December 2018 Summary Lesions are common, multiple, benign tumours of the skin. Most people over the age of 50 years are affected. They appear as well-circumscribed 'stuck-on' plaques or papules and may look like warts. They are usually asymptomatic but can

2018 BMJ Best Practice

156. 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

157. Acne

to 'clean' blackheads. Ideally, should avoid excessive use 2014 2. Rosacea - acne Rosacea - acne - NICE CKS Clinical Knowledge Summaries Share Rosacea - acne : Summary Acne rosacea is a chronic relapsing skin condition affecting the face, characterized by recurrent episodes of facial flushing, erythema, telangiectasia, papules and pustules. There may be eye symptoms (ocular rosacea), which are usually bilateral. Acne rosacea can be classified into four types (erythematotelangiectatic, papulopustular (...) (erythematotelangiectatic rosacea). Papules and pustules (papulopustular 2016 3. Acne - pharmacologic therapy 2017 4. Treatment of Severe Acne with Low-dose Isotretinoin. Treatment of severe acne with low-dose isotretinoin. - PubMed - NCBI Warning: The NCBI web site requires JavaScript to function. Search database Search term Search Result Filters Format Summary Summary (text) Abstract Abstract (text) MEDLINE XML PMID List Apply Choose Destination File Clipboard Collections E-mail Order My Bibliography Citation manager

2018 Trip Latest and Greatest

159. Diagnosis and management of gonorrhoea and syphilis

Early Primary Acquired past year (ECDC) Acquired past 2 years (WHO) • Single papule and moderate regional lymphadenopathy evolves into ulcer (chancre): anogenital (penile, labial, cervical or peri-anal), single, painless and indurated with a clean base discharging clear serum but not pus • Chancres may also be multiple, painful, purulent, destructive, extra-genital (most frequently oral) • When present at extra-genital sites and painless, they may pass unnoticed • Ulcers resolve over 3–8 weeks 21

2019 Belgian Health Care Knowledge Centre

160. Screening and Management of the Hyperandrogenic Adolescent

), location, and quality (comedonal, inflammatory [including erythematous papules and pustules or nodules], or mixed). There is no universally agreed upon grading scale (8). Figure 1. Evaluation and Management of Clinical Hyperandrogenism. Abbreviations: BMI, body mass index; BP, blood pres- sure;CAH,congenitaladrenalhyperplasia;DHEAS, dehydroepiandrosteronesulphate; FSH, follicle-stimulating hormone; HA, hyperandrogenism; LH, luteinizing hormone; 17OHP, 17-a-hydroxyprogesterone; PCOS, polycystic ovary

2019 American College of Obstetricians and Gynecologists

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