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Skin Discoloration

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142. Cellulitis - acute

Cellulitis - acute Cellulitis - acute - NICE CKS Share Cellulitis - acute: Summary Cellulitis is an acute bacterial infection of the dermis and subcutaneous tissue. The infected area, most commonly the lower limb, is characterized by pain, warmth, swelling, and erythema. Blisters and bullae may form. Fever, malaise, nausea, and rigors may accompany or precede the skin changes. Cellulitis develops when microorganisms (most commonly Streptococcus pyogenes and Staphylococcus aureus) gain entry (...) to the dermal and subcutaneous tissues via disruptions in the cutaneous barrier. Risk factors include skin trauma, ulceration, and obesity. Complications of cellulitis include necrotizing fasciitis, sepsis, persistent leg ulceration, and recurrent cellulitis. Most episodes of cellulitis resolve with treatment, and major complications are absent. However, recurrence is common, and each episode increases the likelihood of subsequent recurrence. The diagnosis of cellulitis can usually be made on history

2019 NICE Clinical Knowledge Summaries

143. Scrotal pain and swelling

(both lying and standing). Skin changes. If testicular cancer, or squamous cell carcinoma of the scrotum is suspected, the person should be referred for an urgent outpatient appointment with a urologist, to be seen within 2 weeks. An urgent ultrasound scan of the scrotum should be arranged if any of the following apply: It is not evident whether the scrotal swelling is testicular or extra-testicular. The body of the testis cannot be distinguished. A hydrocele is detected in a man 20–40 years of age (...) What is epididymo-orchitis? Epididymitis is characterized by acute unilateral pain and swelling. The pain usually begins at the epididymis and can spread to the entire testicle (epididymo-orchitis). Other symptoms include fever, erythema of the scrotal skin, and dysuria. Over half of men and boys with epididymitis also have orchitis. Isolated orchitis is rare — the commonest cause is mumps infection, although it can also be caused by other viral infections. Epididymitis is the most common cause

2019 NICE Clinical Knowledge Summaries

144. Leg ulcer - venous

Leg ulcer - venous Leg ulcer - venous - NICE CKS Share Leg ulcer - venous: Summary ​​​​​​A leg ulcer is a break in the skin below the knee which has not healed within 2 weeks. A venous leg ulcer occurs in the presence of venous disease and is the most common type of leg ulcer, accounting for 60–80% of cases. It typically occurs in the gaiter area of the leg (from the ankle to mid-calf). Other causes of leg ulceration and/or delayed wound healing include arterial disease, diabetes, rheumatoid (...) %. Repeat cycles of ulceration, healing, and recurrence are common. Assessment of a person with a venous leg ulcer should include: Asking about the symptoms experienced (type, duration, and severity). Identifying risk factors, such as immobility and a history of DVT. Examining the wound (site, edge, size, depth, wound bed, and for signs of infection). Examining the legs (for oedema, varicose veins, venous skin changes, and reduced ankle mobility). Assessing for other causes of ulceration and/or delayed

2019 NICE Clinical Knowledge Summaries

145. Melanoma Treatment (PDQ®): Health Professional Version

% of the cases arise in apparently normal areas of the skin. Although melanoma can occur anywhere, including on mucosal surfaces and the uvea, melanoma in women occurs more commonly on the extremities, and in men it occurs most commonly on the trunk or head and neck.[ ] Early signs in a nevus that would suggest a malignant change include the following: Darker or variable discoloration. Itching. An increase in size or the development of satellites. Ulceration or bleeding (later signs). Melanomas (...) in the skin, they may also arise from mucosal surfaces or at other sites to which neural crest cells migrate, including the uveal tract. Uveal melanomas differ significantly from cutaneous melanoma in incidence, prognostic factors, molecular characteristics, and treatment. (Refer to the PDQ summary on for more information.) Incidence and Mortality Estimated new cases and deaths from melanoma in the United States in 2019:[ ] New cases: 96,480. Deaths: 7,230. Skin cancer is the most common malignancy

2018 PDQ - NCI's Comprehensive Cancer Database

146. Langerhans Cell Histiocytosis Treatment (PDQ®): Patient Version

quickly. This causes LCH cells to build up in certain parts of the body, where they can damage or form . LCH is not a disease of the Langerhans cells that normally occur in the skin. LCH may occur at any age, but is most common in young children. Treatment of LCH in children is different from treatment of LCH in adults. The and the are described in separate sections of this summary. Use our to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based (...) the following: Having a parent who was exposed to certain . Having a parent who was exposed to metal, granite, or wood dust in the workplace. A of cancer, including LCH. Having a or family history of disease. Having infections as a newborn. Smoking, especially in young adults. Being Hispanic. Not being as a child. The signs and symptoms of LCH depend on where it is in the body. These and other and may be caused by LCH or by other . Check with your doctor if you or your child have any of the following: Skin

2018 PDQ - NCI's Comprehensive Cancer Database

147. Neuroblastoma Treatment (PDQ®): Health Professional Version

by neuroblastoma in the stellate ganglion, and children with Horner syndrome without other apparent cause are also examined for neuroblastoma and other tumors.[ ] Subcutaneous skin nodules: Subcutaneous metastases of neuroblastoma often have bluish discoloration of the overlying skin and is usually seen only in infants. The clinical presentation of neuroblastoma in adolescents is similar to the clinical presentation in children. The only exception is that bone marrow involvement occurs less frequently

2018 PDQ - NCI's Comprehensive Cancer Database

148. Childhood Vascular Tumors Treatment (PDQ®): Patient Version

of the following signs and . Check with your child’s doctor if your child has any of the following: Skin lesions: An area of spidery veins or lightened or discolored skin may appear before the hemangioma does. Hemangiomas occur as firm, warm, bright red to crimson lesions on the skin or may look like a bruise. Lesions that form are also painful. Later, as the hemangiomas go away, they begin fading in the center before flattening and losing color. Lesions below the skin: Lesions that grow under the skin (...) echoes. The echoes form a picture of body tissues called a . The picture can be printed to be looked at later. Abdominal ultrasound. An ultrasound transducer connected to a computer is pressed against the skin of the abdomen. The transducer bounces sound waves off internal organs and tissues to make echoes that form a sonogram (computer picture). (CAT scan) : A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer

2018 PDQ - NCI's Comprehensive Cancer Database

149. Gastrointestinal Complications (PDQ®): Health Professional Version

. Trigger dehydration. Create electrolyte imbalance. Impair function. Cause fatigue. Impair skin integrity. Limit activity. Diarrhea, in some cases, can be life-threatening. Furthermore, diarrhea can lead to increased caregiver burden. Specific definitions of diarrhea vary widely. Acute diarrhea is generally considered to be an abnormal increase in stool liquid that lasts more than 4 days but less than 2 weeks. Another definition suggests that diarrhea is an increase in stool liquidity (>300 mL of stool (...) . Stimulant laxatives Stimulant laxatives increase motor activity of the bowels by direct action on the intestines. Onset: 6 to 10 hours. Caution: Prolonged use of these drugs causes laxative dependency and loss of normal bowel function. Prolonged use of danthron discolors rectal mucosa and discolors alkaline urine red. Bisacodyl must be excreted in bile to be active and is not effective with biliary obstruction or diversion. Avoid bisacodyl with known or suspected ulcerative lesions of the colon

2018 PDQ - NCI's Comprehensive Cancer Database

150. Childhood Vascular Tumors Treatment (PDQ®): Health Professional Version

that a proliferating hemangioma is an attempt to normalize hypoxic tissue that occurred in utero . Clinical presentation Most infantile hemangiomas are not present at birth but precursor lesions such as telangiectasia or faint discoloration of the skin or hypopigmentation can often be seen. The lesion can be mistaken as a bruise from birth trauma or as a capillary malformation (port wine stain) (refer to ).[ , ] Figure 1. The photos on the left depict the precursor lesion (faint color with halo ). The photos (...) of hemangioma growth. Permanent sequelae, such as telangiectasia, anetodermal skin, redundant skin, and a persistent superficial component, can occur after hemangioma involution (refer to ). In a retrospective cohort study of 184 hemangiomas, the overall incidence of significant sequelae was 54.9%. Sequelae were more common in combined hemangiomas, hemangiomas with a step or abrupt border, and cobblestone surface hemangiomas. Furthermore, this study revealed that the average age to hemangioma involution

2018 PDQ - NCI's Comprehensive Cancer Database

151. Chilblains

Chilblains Chilblains - NICE CKS Share Chilblains: Summary Chilblains (also known as perniosis) are localized cold-induced inflammatory lesions, which affect areas of skin vulnerable to cold exposure such as the fingers, toes, nose, and ears. Chilblains can be classified as acute or chronic: Acute chilblains develop within 12–24 hours of exposure to cold and usually resolve within 2–3 weeks, provided that further cold exposure is avoided. Chronic chilblains are persistent lesions which can (...) for chilblains include: Family history. Peripheral vascular disease. Low body weight or poor nutrition. Complications include: Skin excoriation from scratching. Secondary infection from blistered or scratched chilblains. Ulceration. Permanent discolouration. Scarring. Chilblains are usually diagnosed clinically and should be suspected in people with a history of recent (within 12–24 hours) cold exposure and red–purple macular, papular or nodular lesions on acral skin (most commonly the fingers and toes

2018 NICE Clinical Knowledge Summaries

152. Acne vulgaris

. Contraindications and cautions Hypersensitivity to the active substance or to any of the excipients. Avoid contact with eyes; avoid contact with mouth; avoid contact with mucous membranes. Caution is advised if considering prescribing to pregnant of breastfeeding women. Adverse effects Skin irritation including dryness, discomfort, erythema, peeling, contact dermatitis, pruritus, and skin discoloration. Worsening of asthma (rare). [ ; ; ; ] Oral antibiotics Oral antibiotics Choice of oral antibiotic Oral (...) Acne vulgaris Acne vulgaris - NICE CKS Share Acne vulgaris: Summary Acne vulgaris is a chronic inflammatory skin condition affecting mainly the face, back and chest - it is characterised by blockage and inflammation of the pilosebaceous unit (the hair follicle, hair shaft and sebaceous gland). It presents with lesions which can be non-inflammatory (comedones), inflammatory (papules, pustules and nodules) or a mixture of both. Up to 95% of adolescents in Western industrialized countries

2018 NICE Clinical Knowledge Summaries

153. Fungal nail infection

such as Candida species. Dermatophytes are responsible for about 90% of cases. Fungal nail infection is more common in older people and is rare in children. Risk factors for infection include concomitant fungal skin infection; psoriasis; diabetes mellitus, peripheral arterial disease, immunocompromised states; repeated nail trauma, and occlusive footwear. Fungal nail infection should be suspected if: The nail looks abnormal and is discoloured. There are white or yellow streaks along one side of the nail (...) . There is thickening of the nail; white or yellow spots; or complete destruction of the nail. There is associated paronychia, which may suggest Candida infection. Assessment of suspected fungal nail infection should include: Asking about symptoms such as pain and discomfort; difficulty wearing footwear and walking; psychosocial impact; any co-morbidities or risk factors for infection; any family or household members affected. Classifying the type of onychomycosis, if possible. Examining for fungal skin infection

2018 NICE Clinical Knowledge Summaries

154. Malaria prophylaxis

-intestinal disturbances; headache; pruritus; rash and skin reactions. Uncommon adverse effects include : Convulsions; discoloration of mucous membranes, nails or skin; ECG changes; hair depigmentation or loss; keratopathy; ototoxicity; retinal damage; and visual change. Retinopathy has been associated with high doses of chloroquine (for example used in treatment of rheumatoid arthritis) but appears to be unlikely with doses used for routine malaria prophylaxis. Children Store safely away from children (...) of insect repellents (such as DEET or Icardin) to exposed areas of skin — repellents must not be ingested, inhaled or come into contact with the eyes or mouth. DEET. DEET (N,N-Diethyl-meta-toluamide) based insect repellents at concentrations over 20% can be used for people over the age of 2 months (unless allergic). Duration of protection is 1 to 3 hours for 20% DEET, up to 6 hours for 30% and up to 12 hours for 50%. Duration of protection does not increase for concentrations above 50%. DEET can damage

2018 NICE Clinical Knowledge Summaries

155. Rosacea - acne

commonly include local irritation such as burning, stinging, itching, or dry skin — if adverse effects are problematic the person can reduce frequency of use or discontinue treatment temporarily. A less common adverse effect is skin discoloration. Worsening of asthma has been reported very rarely. Drug interactions There are no reported drug interactions with topical azelaic acid. [ ; ] Brimonidine 0.5% gel Brimonidine 0.5% gel Brimonidine 0.5% gel (Mirvaso®) is a licensed treatment for facial erythema (...) Rosacea - acne Rosacea - acne - NICE CKS 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, phymatous, and ocular) and one variant (granulomatous) of the condition. Change from one

2018 NICE Clinical Knowledge Summaries

156. Oncogenetic testing and follow-up for women with familial breast/ovarian cancer, Li Fraumeni syndrome and Cowden syndrome

of glans penis (a discolored area on the skin) 12 Oncogenetic testing for breast and ovarian cancer KCE Report 236Cs ? Mucocutaneous lesions o One biopsy proven trichilemmoma o Multiple palmoplantar keratoses (abnormal thickening of the hands and feet) o Multifocal or extensive oral mucosal papillomatosis o Multiple cutaneous facial papules (often verrucous) ** Minor Criteria: ? Autism spectrum disorder ? Colon cancer ? Esophageal glycogenic acanthosis ( =3) ? Mental retardation (i.e. IQ<75 (...) Introduction Li-Fraumeni syndrome (LFS) is an autosomal dominant cancer syndrome caused by heterozygous germline mutations in the TP53 gene. Half of the patients with LFS develop at least one LFS-associated cancer by age 30. While many tumor types can be seen in patients with LFS, four core cancers (breast, sarcoma, brain, and adrenocortical carcinoma) make up about 80% of LFS associated tumours. 4 The next most frequently associated cancers include leukemia, lung, colorectal, skin, gastric, and ovarian

2015 Belgian Health Care Knowledge Centre

157. Cutaneous Lupus Erythematosus (CLE), Treatment

is adherent to treatment before considering therapeutic changes [70]. Moreover, smoking, disseminated DLE, and concomitant SLE were found to be significantly associated with the lack of response to antimalarials [13, 14]. If monotherapy with HCQ or CQ is not successful, quinacrine (100 mg/day) may be added, resulting in synergistic efficacy, without increasing the risk of retinopathy [71]. The most frequent side effect of quinacrine is yellow discoloration of the skin and mucous membranes, and the most (...) Hospital, Bern, Switzerland 10 Department of Dermatology and Venereology, University Hospital Center Zagreb and School of Medicine University of Zagreb, Zagreb, Croatia 11 Department of Clinical Sciences, Karolinska Institutet, Department of Dermatology & Danderyd Hospital, Stockholm, Sweden 12 Department of Dermatology, Colentina Clinical Hospital, Bucharest, Romania 13 Department of Skin and allergic diseases, Inflammation Center, Helsinki University Central Hospital, Helsinki, Finland 14 Department

2016 European Dermatology Forum

158. Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome

of skin R20.1 Paresthesia of skin R20.2 Unspecified disturbances of skin sensation (includes temperature, localization, tactile discrimination, texture, vibration) R20.9 Methods (continued) GRADES OF RECOMMENDATION STRENGTH OF EVIDENCE A Strong evidence A preponderance of level I and/ or level II studies support the recommendation. This must include at least 1 level I study B Moderate evidence A single high-quality randomized controlled trial or a preponderance of level II studies support (...) Power of isolated muscles and muscle groups b7300 Control of simple voluntary movements b7600 Coordination of voluntary movements b7602 Protective functions of the skin b810 ICF activities and participation codes Writing d170 Carrying out daily routine d230 Using telecommunication devices and techniques d3600 Fine hand use d440 Picking up d4400 Grasping d4401 Manipulating d4402 Fine hand use other specified d4408 Driving d475 T oileting d530 Dressing d540 Eating d550 Drinking d560 Preparing meals

2019 The Orthopaedic Section of the American Physical Therapy Association (APTA), Inc.

159. Hirudotherapy: An Ugly Means of Avoiding Uglier Outcomes

forms of microsurgery. Their use in microsurgical operations spans a range that includes free tissue flap [1]. The revival of hirudotherapy was spurred by the 1960 paper, “Venous congestion of flaps treated by application of leeches,” by Deganc and Zdravic in the British Journal of Plastic Surgery . It sought to address a major issue plaguing reconstructive microsurgery at the time: the “blue flap.” This term referred to the ominous discoloration seen in a flap that had become cyanotic, [2 (...) ]. To improve blood flow, the pair introduced Hirudo medicinalis , a species of leech native to Europe. In a series of 20 cases of venous congestion, Deganc and Zdravic allowed leeches to bite and attach to patients’ skin and then suck blood from the tissue until they detached of their own volition. A 70% success rate for complete restoration of blood flow was observed, while the other 30% of patients in the cohort experienced at least partial decongestion. Deganc and Zdravic proposed a dual mechanism

2016 Clinical Correlations

160. Acne clinical guideline Full Text available with Trip Pro

process. Available at: . Accessed January 4, 2016. This guideline will be considered current for a period of 5 years from the date of publication, unless reaffirmed, updated, or retired at or before that time. Definition AV is a chronic inflammatory dermatosis notable for open or closed comedones (blackheads and whiteheads) and inflammatory lesions, including papules, pustules, or nodules (also known as cysts). Introduction Acne is a common skin disease, especially in adolescents and young adults (...) is a multifactorial inflammatory disease affecting the pilosebaceous follicles of the skin. The current understanding of acne pathogenesis is continuously evolving. Key pathogenic factors that play an important role in the development of acne are follicular hyperkeratinization, microbial colonization with Propionibacterium acnes , sebum production, and complex inflammatory mechanisms involving both innate and acquired immunity. In addition, studies have suggested that neuroendocrine regulatory mechanisms, diet

2016 American Academy of Dermatology

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