with regard to the stratum corneum and stratum granulosum
parakeratosis : process of keratinization
in which the keratinocytes in stratum corneum retain their nuclei; abnormal
in skin, normal in mucous membranes. It occurs in ...
hyperkeratosis / lichenification / lichenoid
dermatosis : hypertrophy of the stratum corneum layer of the skin,
whether by normal or abnormal keratinocytes. It occurs in ...
Kyrle's disease
/ hyperkeratosis penetrans : a rare chronic disorder of keratinization
characterized by a papular eruption with hyperkeratotic cone-shaped plugs
in the hair follicles and eccrine ducts, which project through the epidermis
into the dermis, producing a foreign body giant cell reaction and pain.
The usually discrete lesions leave a depression on removal; they may coalesce
to form patches, and coalescing plaques are often seen
keratosis pilaris : a condition
in which hyperkeratosis is limited to the hair follicles, usually on the
extensor surfaces of the thighs and arms, but occurring anywhere, with
discrete follicular papules which re-form after removal
keratosis punctata : a form of
hyperkeratosis in which the lesions are localized in multiple points on
the palms and soles; it is transmitted as an autosomal dominant trait.
hypergranulosis : increase in thickness
of the granular layer. It occurs in ...
keratolysis : softening and dissolution
or peeling of the horny layer of the epidermis.
pitted keratolysis / keratolysis plantare
sulcatum / cracked heels : a superficial bacterial infection of the
skin of worldwide distribution usually involving the weight-bearing portions
of the soles of the feet, and characterized by the formation of shallow
asymptomatic discrete round pits, some of which become confluent and form
fissures; the specific etiologic agent is unknown
ulcus interdigitale : keratolysis
of the horny layer of the skin between the toes, a disease similar to cracked
heel.
with regard to the stratum spinosum and stratum basale
acanthosis : keratinocyte (acanthocyte
/ spur cell) hyperplasia in stratum spinosum with thickening of the
epidermis
papillomatosis : increase in keratinocytes
with formation of projections from the surface of the skin, i.e. papillae.
It occurs in ...
confluent and
reticulate papillomatosis / Gougerot-Carteaud syndrome : a progressive,
pruritic papillomatosis, probably a genodermatosis, seen chiefly in girls,
especially those at or near puberty, beginning in the intramammary and
midback areas as slightly keratotic pigmented papules that increase in
size and spread over the trunk and other body areas; centrally located
lesions tend to become confluent and peripherally located ones to become
reticulate
psoriasiform epidermal
hyperplasia : increase in keratinocytes with elongation of rete ridges
and elongation of dermal papillae. It occurs in ...
acanthosis nigricans (AN) : a
skin disease characterized by diffuse velvety acanthosis
with gray-black warty patches usually situated in back of the neck, the
axillae or groin or on elbows or knees
acantholysis : detachment of keratinocytes
from each other due to loss of intercellular contacts. This often is associated
with the cell assuming a spherical shape, i.e., a round profile in sections
vacuolization : the formation of vacuoles
within cells. This term is used often in reference to changes in the basal
keratinocytes
ballooning degeneration :
intracellular edema with cellular swelling. This is often secondary to
viral injury or nutritional deficiency
with regard to dermis
necrobiosis : swelling, basophilia, and
distortion of collagen bundles in the dermis, sometimes with obliteration
of normal structure, but without actual necrosis, seen especially in granuloma
annulare and necrobiosis lipoidica
Symptoms :
pruritis / pruritis / itching : an
unpleasant cutaneous sensation that provokes the desire to rub or scratch
the skin to obtain relief.
photodermatosis : a morbid condition produced in the skin by exposure
to light
aquagenic pruritus : pruritus and other skin sensations, such as
burning, lasting for 30' to 2 hours, after contact with water, without
the overt skin changes seen in aquagenic
urticaria.
The etiology is usually unknown, although it is sometimes seen accompanying
polycythemia
vera
and in other cases it may be familial. A similar condition is seen in elderly
women but lasts only 10 to 20' and is relieved by emollients.
third trimester of pregnancy
(prurigo gestationis of
Besnier) : development of tiny crust-covered excoriated papules mainly
on the extensor surfaces of the limbs but also found on the upper trunk
and other areas of the body, and leaving postinflammatory residua on resolution
of the lesions. It tends to clear after delivery, and occasionally recurs
with subsequent pregnancies
prurigo agria / prurigo ferox : a severe, chronic pruriginous dermatosis
characterized chiefly by hard excoriated prurigo papules and lichenification
prurigo chronica multiformis : a pruriginous dermatosis characterized
by the presence of prurigo papules, patches of lichenification and eczematization,
enlarged regional lymph nodes, and eosinophilia
senile pruritus / pruritus senilis : an itching in the aged, possibly
due to dryness of the skin occurring as a result of decreased sweat and
sebum secretion, or bathing too frequently, or both
prurigo mitis / pruritus of Hebra : an extremely pruritic, chronic
pruriginous dermatosis beginning in early childhood, characterized by excoriations,
lichenification, and eczematization that become progressively more pronounced,
and accompanied by enlarged glands and associated constitutional symptoms.
The condition may be the same as papular urticaria
nodular prurigo : a chronic, intensely pruritic form of neurodermatitis,
usually occurring in women, located chiefly on the extremities, especially
on the anterior thighs and legs, and characterized by the presence of single
or multiple, pea-sized or larger, firm, and erythematous or brownish nodules
that become verrucous or fissured
prurigo simplex : a form in which the prurigo papules are present
in various stages of development, especially on the trunk and extensor
surfaces of the extremities in middle-aged persons, and usually occur in
crops
prurigo estivalis / summer prurigo of Hutchinson : a papular dermatosis
regarded as a form of polymorphous light eruption, usually occurring in
childhood during the summer months, and sometimes improving or resolving
after puberty
Pathogenesis : stimulation of receptors linked
to Ad (mild and localized pruritus) and C (intense
and poorly defined pruritus) nerve fibers. Itch can be classified into
4 types:
pruritoceptive itch develops in the skin because of dryness, inflammation,
or other skin damage
psychogenic itch can arise in patients with psychiatric disorders,
such as delusional parasitosis
neurogenic itch originates in the CNS without evidence of neural
pathology: one example is the itch of cholestasis, caused by the action
of neuropeptides on opioid receptors
neuropathic itch derives from lesions located at any point along
the sensory pathway, and has been linked to conditions including post-herpetic
neuralgia, multiple sclerosis, and spinal tumours; the compression of spinal
nerve roots can cause brachioradial itch, notalgia paraesthetica, and anogenital
itch.
dermatorrhagia : discharge of blood into or from the skin
skin trophism
normotrophic
hypotrophic
skin pigmentation
hypopigmentation
localized hypopigmentation
Aetiology :
primitive cutaneous diseases
idiopathic guttate hypomelanosis
/ leukopathia punctata reticularis symmetrica : a common condition
of unknown etiology manifested by small, sharply demarcated, irregular
hypopigmented spots that appear chiefly on the sun-exposed areas of the
extremities in individuals over the age of 30
syphilitic leukoderma / collar of pearls / collar of Venus / venereal
collar / leukoderma colli / melanoleukoderma colli : round or oval,
ill-defined, depigmented spots surrounded by hyperpigmentation occurring
on the anterior region and sides of the neck and on the chest in secondary
syphilis
chlorosis : a disorder that was common during
the nineteenth century but has now disappeared, characterized by greenish
yellow skin discoloration and hypochromic erythrocytes; it was usually
seen in adolescent females and may have been associated with iron
deficiency anemia.
senile melanoderma : pigmentation of the skin in the aged.
érythrose
péribuccale pigmentaire of Brocq : a patchy facial melanoderma
seen chiefly in women that may involve an inflammatory photosensitivity,
perhaps phototoxic, reaction, and characterized by the presence of a combination
of erythema and a diffuse brownish red pigmentation of the perioral region.
systemic diseases
epidermal alteration
seborrheic keratosis (Leser-Trélat
sign) : eruptive appearance of numerous seborrheic keratoses or the
sudden increase in the number and size of previous seborrheic keratoses,
in association with an internal malignancy. In 50% it concers an adenocarcinoma
(gastrointestinal tract, breast and others), in 20% a lymphoproliferative
disorder (Leser Edmund. Ueber ein die Krebskrankheit beim Menschen haufig
begleitendes, noch wenig bekanntes Symptom. Munch. Wochenschr. 48:2035-2036
(1901). Trélat Ulysse)
lentigines (multiple), electrocardiographic conduction
abnormalities, ocular hypertelorism, pulmonary stenosis, abnormalities
of genitalia, retardation of growth, deafness (LEOPARD) syndrome :
a hereditary syndrome transmitted as an autosomal dominant trait, consisting
of multiple lentigines, asymptomatic cardiac defects, and typical coarse
facies; it may also be associated with pulmonary stenosis, sensorineural
deafness, skeletal changes, ocular hypertelorism, and abnormalities of
the genitalia
chrysoderma / aurochromoderma / chrysiasis
: a manifestation of chrysiasis
presenting as a permanent gray- to lilac-colored permanent pigmentation
on the face, eyelids, and other sun-exposed areas of the body due to long-lasting
parenteral chrysotherapy
Riehl's melanosis : a patchy melanoderma manifested as a light to
dark brown pigmentation, which is most intense on the forehead, on the
malar regions, behind the ears, on the sides of the neck, and on other
sun-exposed areas. It is seen most often in women and may involve an inflammatory
photosensitivity, perhaps phototoxic, reaction.
tar melanosis / melanodermatitis toxica lichenoides : a dermatosis
representing photosensitivity or phototoxicity induced by exposure to tar
or other hydrocarbons, usually occupationally, most often involving the
face or back of the hands, and characterized by pruritus associated with
the development of reticular pigmentation, telangiectases, and small, dark,
lichenoid, follicular papules
transient neonatal pustular melanosis : a congenital skin condition
usually seen in babies of African descent, characterized by pigmented macules
and vesicopustules that may rupture and leave a scaly collar. It usually
resolves completely within a few weeks to 2 years
melanism : excessive
pigmentation or blackening of the integuments or tissues, usually of genetic
origin; melanosis.
dyschromia : any disorder of pigmentation of the skin or hair
dyschromatoses are a group of disorders
characterized by the presence of both hyperpigmented and hypopigmented
macules, many of which are small in size and irregular in shape. There
are 2 major forms, both of which are seen most commonly in Japan
dyschromatosis
symmetrica hereditaria (DSH) was first described by Toyama in 1929
and is characterized by a symmetrical distribution of hyperpigmented and
hypopigmented macules on the extremities, especially over the dorsa of
the hands and feet
dyschromatosis
universalis hereditaria (DUH) was first described in 1933 by Ichikawa
and Hiraga as well-demarcated brown macules admixed with various-sized
hypopigmented macules in a generalized as opposed to acral distribution.
DUH was noted to appear within the first month of life. Some clinicians
have suggested that DSH might be a subtype of DUH
The differential diagnosis of dyschromatosis includes xeroderma
pigmentosum,
dyschromic amyloidosis,
and exposure to chemicals such as diphenylcyclopropenone and monobenzyl
ether of hydroquinone.
primary lesions (if
new onset : skin eruptions / exanthema (as opposed to mucosal eruption
/ enanthema): a disease in which skin eruptions (visible efflorescent
lesions of the skin due to disease, especially an exanthematous disease,
and marked by redness and prominence; a rash) or rashes (a temporary
eruption on the skin, as in urticaria; a drug eruption or viral exanthem)
are a prominent manifestation. Classically, 6 exanthems (or exanthematous
diseases) were described that had similar rashes; they were numbered in
the order in which they were reported:
Brunsting's syndrome : a recurrent eruptive syndrome usually affecting
middle-aged men, in which grouped, vesicular lesions occur about the head
and neck, and result in scarring.
hypoproliferation of melanocytes. It occurs in tuberous
sclerosis
(ash-leaf macule / lance-ovate macule / ash-leaf spot or patch :
usually 1 to 3 cm in size and having the general shape of an ash leaf,
round at one end and pointed at the other)
cyanematous macula : bluish macula
due to passive hyperemia
erythema / erythematous macula : abnormal
redness of the skin due to active hyperemia
Grading :
E0 : no erythema
E+/- : minimal perceptible erythema with sharp borders.
E+ : pink erythema
E++ : fiery red erythema with oedema
E+++ : fiery red erythema with oedema and blistering
erythema infectiosum / fifth disease
/ Sticker's disease : a moderately contagious, often benign epidemic
disease seen mainly in children and caused by parvovirus
B19,
characterized by a rash of abrupt onset with 3 stages:
livid erythema of the cheeks, which appear to have been slapped
erythematous maculopapular rash on the trunk and extremities
fading of the rash with central clearing, leaving a lacelike pattern.
More severe cases may be seen in immunocompromised patients.
necrolytic migratory
erythema (NME) / necrolytic erythema migrans / glucagonoma syndrome
:a generalized symmetrical scaling eczematous dermatitis, followed
by migratory necrolysis of the upper epidermis, liquefaction of the granular
layer, and subcorneal clefting, flaccid bulla formation, erosions, crusts,
and postinflammatory hyperpigmentation It is usually seen on the central
third of the face, lower abdomen, perineum, groin, buttocks, thighs, and
distal extremities in association with a glucagon-secreting
tumor of the a cells of the pancreas
erythema caloricum : that caused by exposure to heat or cold
Aetiology :
cold erythema : a congenital hypersensitivity
to cold seen in children, characterized by localized pain, widespread erythema,
occasional muscle spasms, and vascular collapse on exposure to cold, and
vomiting after drinking cold liquids
chilblain / chilblains / erythema pernio / pernio
: a recurrent localized erythema and doughy subcutaneous swelling caused
by exposure to cold associated with dampness, and accompanied by pruritus
and a burning sensation, usually involving the hands, feet, ears, and face
in children, the legs and toes in women, and the hands and fingers in men
erythema ab igne : permanent erythema
or a brown to red reticulated residual pigmentation produced by prolonged
exposure to excessive nonburning heat. It is seen most often on the legs
of women, but under appropriate environmental circumstances, it can occur
anywhere on the body in either sex
palmar erythema / erythema palmare :
persistent redness of the palms
toxic erythema / erythema toxicum :
a generalized, diffuse erythematous eruption or a widespread erythematomacular
eruption occurring as a result of hypersensitivity to certain foods or
drugs, or caused by bacterial or other toxins, or associated with various
systemic diseases.
erythema toxicum neonatorum
: a benign, idiopathic, very common, generalized, transient eruption occurring
in infants during the first week of life, usually consisting of small papules
or pustules that become sterile, yellow-white,
firm vesicles surrounded by an erythematous
halo and some edema. It is due to microchimerism
scale / squama : dead skin cells that look
like flakes or dry skin produced because of dyskeratosis
or parakeratosis => epidermis exfoliation.
collarette : a narrow rim of loosened keratin
overhanging the periphery of a circumscribed skin lesion, attached to the
normal surrounding skin, especially in syphilid,
moniliasis and Gilbert's pityriasis rosea.
pityriasis : any of various skin diseases
characterized by the formation of fine, branny scales.
pityriasis alba, maculata or simplex / erythroderma streptogenes / pityriasis
: a common skin disorder most often seen in young children and adolescents,
usually involving the face, especially the cheeks and the area around the
mouth, and characterized by the presence of round or oval, slightly scaling,
hypopigmented patches; it usually involutes spontaneously
parapsoriasis : any of a group of slowly
evolving erythrodermas having common characteristics of scaling, resistance
to treatment, and chronicity
plaque parapsoriasis
small plaque parapsoriasis / parapsoriasis guttata / guttate parapsoriasis
/ xanthoerythrodermia perstans : a benign, asymptomatic, chronic eruption
consisting of small to moderate sized, red-blue to yellow plaques, occurring
chiefly on the trunk and proximal extremities, which have distinct, thin
borders and fine, adherent scales, giving the surface a cigarette paper–like
appearance
large plaque parapsoriasis / atrophic parapsoriasis : a chronic,
asymptomatic or mildly symptomatic eruption consisting of red-blue, oval,
poorly defined, flat, sometimes indurated large plaques with superficial
scaling, which preferentially involves the trunk, especially the hips and
buttocks, proximal extremities, and breasts in women. It may progress to
cutaneous
T cells lymphomas (CTCL),
particularly if atrophy and poikiloderma are prominent features
retiform parapsoriasis /parapsoriasis lichenoides / parapsoriasis
variegata / parakeratosis variegata / poikilodermatous parapsoriasis /
poikilodermic parapsoriasis : a chronic eruption consisting of red
to brown, scaly lesions with a netlike distribution, intermixed with which
are deep red plaques, some exhibiting lichenoid papules, which is histologically
similar to large plaque parapsoriasis (considered by some authorities to
be a variant) except that atrophy and poikiloderma are prominent features.
It is the form of parapsoriasis from which cutaneous
T cells lymphomas (CTCL)
is most likely to arise
lichenoid pityriasis
acute lichenoid pityriasis
/ pityriasis lichenoides acuta / acute parapsoriasis / Habermann's, Mucha-Habermann,
or Mucha's disease / parapsoriasis varioliformis acuta / pityriasis lichenoides
et varioliformis acuta : an acute or subacute, sometimes relapsing,
widespread macular, papular, or vesicular eruption that tends to crusting,
necrosis, and hemorrhage, which heals, leaving pigmented depressed scars,
followed by the development of a new crop of lesions. Occasionally, progression
to the chronic lichenoid form may occur
chronic lichenoid pityriasis / pityriasis lichenoides chronica / chronic
or guttate parapsoriasis, parapsoriasis guttata / parapsoriasis varioliformis
chronica : a chronic brown to red-brown scaly macular eruption, distributed
chiefly over the trunk, characterized histologically by epidermal alterations
and a perivascular lymphocytic infiltrate. It may represent progression
of the acute lichenoid form or arise de novo
pityriasis rotunda : a form of acquired ichthyosis manifested by
circular or oval, brown, scaly, sharply demarcated patches on the trunk
and extremities, which become worse during the winter and improve in the
summer.
Leiner's disease / erythroderma desquamativum : a disorder of infancy
characterized principally by generalized seborrheic-like dermatitis and
erythroderma, intractable, severe diarrhea, recurrent infections, and failure
to thrive. The cause is unclear, but familial cases associated with a dysfunction
of the C5 component of complement, which results in decreased phagocytosis
of the patient's serum (opsonic activity), have been reported
Symptoms & signs : scaly erythematous
dermatitis often associated with loss of hair and nails, hyperkeratosis
of the palms and soles, pruritus, and sometimes severe and debilitating
secondary physiological effects
Therapy : IVIG,
GR
agonists,
aseptical environments
pityriasis rubra pilaris
: a chronic inflammatory cutaneous disease characterized by tiny acuminate,
reddish brown follicular papules topped by central horny plugs in which
are embedded hairs, partial or complete; disseminated yellowish pink scaling
patches; and often solid confluent hyperkeratosis of the palms and soles
with a tendency to fissuring.
pityriasis sicca / dandruff : seborrheic
dermatitis of the scalp. Dandruff is made up of small flakes of dead
scalp skin. It occurs under circumstances in which the surface skin cells
of the scalp grow unusually fast
Gottron's papules / Gottron's sign : a cutaneous manifestation pathognomonic
of dermatomyositis
moist papule / mucous papule / condyloma latum
pearly penile papules / hirsutoid papillomas of penis : numerous
tiny white, dome-shaped asymptomatic angiofibromas occurring circumferentially
around the penile coronal sulcus
piezogenic papules / painful fat herniation / painful piezogenic pedal
papules : transitory, noninflammatory, soft, sometimes painful, large
papules appearing above the heel on the side of one or both feet, elicited
by weight bearing associated with prolonged standing or running, and presumed
to result from temporary herniation of fat tissue together with its blood
vessels and nerves through connective tissue defects. They disappear when
the pressure is removed
split papules : fissured papular syphilides sometimes seen at the
corners of the mouth.
papulosis : a state marked by the presence
of multiple papules.
lymphomatoid papulosis : a
usually benign, self-healing, recurrent eruption of hemorrhagic papules,
similar to acute lichenoid pityriasis
(of which it may be a variant); lesions occur asynchronously primarily
on the trunk and extremities and, after healing, either leave macular scars
or form crusted scales or a central necrotic mass. Histologic features
may suggest malignancy and include clusters of large mononuclear cells
with dark-staining nuclei and large pale-staining histoid cells.
malignant atrophic papulosis / Degos' disease : an often fatal disease
occurring most often in men, characterized by endovasculitis of the skin,
gastrointestinal tract, and sometimes other organs, resulting in ischemic
infarction of involved tissues. Cutaneous lesions occur in crops of erythematous
papules that become umbilicated with characteristic porcelain-white centers
with telangiectatic borders, many of which atrophy and leave white scars
Degos clear cell acanthoma : a slightly elevated, erythematous,
dome-shaped plaque or papule, with some crusting or scaling, usually occurring
on the lower leg in older adults; it is characterized by acanthotic epithelium
containing large, pale, glycogen-rich squamous cells.
Fraenkel's nodules : typhus nodules of the cutaneous blood vessels
Sister Mary Joseph's nodule
:
a nodule deep in the subcutis in the umbilical area associated with metastasizing
intra-abdominal cancer, usually of gastric, ovarian, colorectal, or pancreatic
origin. Sister Mary Joseph, a nurse assistant of Dr.William Mayo, was the
first person to observe that a firm umbilical nodule was associated with
intra-abdominal cancer. The late Hamilon Bailey subsequently described
the lesion and named it Sister Joseph's nodule in her memory. Several observations
of it were in fact already published before (Bailey Hamilton. Demonstration
of physical signs in clinical surgery. Wiliams & Wilkins 13th edition
p.356)
surfers' nodules, knobs or knots / Malibu disease : hyperplastic,
fibrosing, rarely ulcerated granulomas 1 to 3 cm in diameter, occurring
over bony prominences of the feet and legs of surfers, occurring as a result
of repeated trauma from kneeling on surfboards
Wohlbach's or typhus nodules
: minute nodules, originally described in typhus, produced by perivascular
infiltration of polymorphonuclear leukocytes and mononuclear cells in rickettsial
disease.
Osler's sign : Osler's nodes
: small, raised, swollen tender areas, about the size of a pea, characteristically
bluish but sometimes pink or red, and sometimes having a blanched center,
occurring most commonly in the pads of the fingers or toes, in the thenar
or hypothenar eminences, or the soles of the feet; they are practically
pathognomonic of subacute
bacterial endocarditis
tumor : Ø >
5 cm
crust / scab : a formation of coagulated
exudate over a break in the skin
serous exudate = yellow scab
haemorrhagic exudate = red scab
purulent exudate = brown scab
evolutive polymorphic
dermatoses
plaque : Ø > 1
cm, formed by the coalescence of more elementary lesions. Elementary lesions
are still distinguishable in periphery of the plaque. It occurs in ...
pinky / transparent lesions (darker in individuals with very pigmented
skin)
cutaneous amyloidosis : amyloidosis
localized to the skin and usually associated with pruritus,
which may be a characteristic of primary disease or occur in secondary
amyloidosis.
lichen amyloidosis
/ lichen amyloidosus : the most common form of cutaneous amyloidosis,
characterized by the symmetrical distribution over the extensor surfaces
of the lower extremities, thighs, dorsal feet, and lower back of translucent,
yellow to brown, dome-shaped, discrete pruritic papules; the chest, shoulders,
and skin of the abdominal walls may be involved later
macular amyloidosis : cutaneous
amyloidosis manifested by ill-defined, sometimes pruritic grayish brown
macules distributed on the upper back, breasts, buttocks, arms, ankles,
and thighs
nodular amyloidosis : a form of
localized amyloidosis in which single or multiple, amyloid-containing nodular
or tumefactive masses are found most often in the lung, urinary bladder,
larynx, tongue, conjunctiva, and skin, especially that of the extremities,
trunk, genitals, and face.
xanthoma : a fatty irregular yellow patch
or nodule on the skin composed of lipid-laden foam cells, which are histiocytes
containing cytoplasmic lipid material
planar xanthoma / plane xanthoma / xanthoma
planum : a form manifested as soft yellowish, tannish, or dark red
flat macules or slightly raised plaques, sometimes having a white central
area, which may be localized or generalized, often occurring in association
with other types of xanthomas
xanthochromia striata palmaris
:
planar xanthoma involving the volar creases of the palms and finger joints,
manifested by yellowish brown discoloration of the creases of the palmar
aspect of the hands, which is assumed by some to gradually progress to
...
xanthoma striatum palmare :
planar xanthoma involving the creases of the palms and volar finger joints,
manifested by linear, slightly elevated papules in the palmar creases,
especially of the fingers
xanthoma tendinosum / tendinous
xanthoma : a form manifested by the presence of freely movable papules
or nodules in the tendons, ligaments, fascia, and periosteum, especially
on the dorsum of the hands, fingers, elbows, knees, and heels (Achilles
tendon), which occurs in association with tuberous
xanthoma, xanthelasma,
and cerebrotendinous
xanthomatosis
xanthoma tuberosum / xanthoma tuberosum
multiplex / tuberous xanthoma : development of groups of large, flat
or elevated, yellow to orange indurated nodules on the extensor surfaces
and areas subjected to trauma, particularly on the elbows and knees; lesions
tend to coalesce
diabetic or eruptive xanthoma / xanthoma
diabeticorum or eruptivum : crops of small yellowish orange or yellow
papules surrounded by an erythematous halo, occurring suddenly, usually
on the buttocks, posterior thighs, knees, and elbows; the papules may be
intensely pruritic and may ulcerate
Aetiology : hypertriglyceridemia Prognosis : usually disappears when the
underlying condition is corrected
tuberoeruptive xanthoma :
a form in which lesions of eruptive xanthoma develop in association with
already existing tuberous xanthoma and have a tendency to coalesce
verruciform xanthoma : an uncommon
solitary xanthoma of the oral mucosa; it is covered with a rough parakeratinized
layer and usually occurs on the lower alveolar ridge.
xanthomatosis / xanthelasmatosis : a
condition characterized by the presence of xanthomas
biliary hypercholesterolemic xanthomatosis : widespread xanthomatosis
resulting from hypercholesterolemia due to biliary
cirrhosis
leukemia cutis : a cutaneous manifestation
of leukemia resulting from infiltration of the skin by malignant leukocytes
and occurring as specific or nonspecific lesions (leukemid), or both coexisting
cutaneous lymphoid hyperplasia
(CLH) : a term for several benign cutaneous disorders with lesions
clinically and histologically resembling those of malignant lymphoma. The
lesions may be lymphoreticular, granulomatous, and follicular and include
lymphocytes, histiocytes, eosinophils, plasma cells, and lymphoid follicles.
The disorders may be of unknown etiology or be reactions to insect bites,
allergy hyposensitization injections, light, trauma, and tattoo pigment.
The term embraces :
lymphocytic infiltration of the skin / Jessner-Kanof
disease : first described in 1953 (Jessner M, Kanof NB. Lymphocytic
infiltration of the skin. Arch Dermatol. 1953;68:447-79). The lesions are
asymptomatic, erythematous, discoid plaques that frequently clear centrally
and are found most often on the head, neck and upper trunk of middle-aged
men. The disorder has a prolonged course characterized by remissions and
relapses. Lesions usually resolve without scarring. Lymphocytic infiltration
is mainly considered to be a variant of systemic lupus erythematosus tumidus.
Other investigators favour polymorphic light eruption or pseudolymphoma.
Lymphocytic infiltration clinically manifests in the face, in particular
on the cheeks and earlobe, but also on the neck and upper trunk or proximal
extremities of middle-aged men. Lesions consist of solitary or multiple
erythematous plaques. Histologicallt, dermal lymphocytic infiltrates are
distributed with with perivascular and periadnexal accentuation. Besides
small, cytologically unsuspecious lymphocytes there a few macrophages and
plasma cells. Mucin is increased variably. The epidermis is usually normal
but may shjow junctional vacuolar alteration.
lymphocytoma cutis (LC) / Bäfverstedt's
syndrome / cutaneous lymphoplasia / Spiegler-Fendt pseudolymphoma or sarcoid
: a manifestation of CLH, seen especially in women, characterized by red-brown-colored
skin lesions ranging from a solitary plaque or nodule to several in a group
or more widespread lesions; they are usually found on the face, ears, extremities,
or areolae of the breasts. When multiple, they may resemble malignant lymphoma,
although some may regress, sometimes with recurrences
vein malformations / blue
rubber bleb nevus syndrome : a syndrome of multiple blue rubber bleb
nevi associated with hemangiomas of the gastrointestinal tract, which bleed
readily and cause chronic iron-deficiency anemia; most cases are sporadic
and present in infancy or childhood.
Peruvian
wart / verruga peruana / verruca peruana or peruviana / hemorrhagic pian:the
second or chronic stage of bartonellosis (Bartonella
bacilliformis),
characterized by a benign skin eruption of hemangioma-like macules
on whole body skin and sometimes mucosae (nodules
and often ulcers)
surrounded by hyperpigmented borders
angiolymphoid
hyperplasia with eosinophilia (epithelioid hemangioma) (ALHE/EH) / Kimura's
disease (KD) : a type of erythematous dermal or subcutaneous tumor-like
nodule occurring singly or multiply, primarily on the head and neck of
young adults, sometimes associated with lymphadenopathy, serum eosinophilia,
and markedly elevated serum IgE levelsref1,
ref2.
However, it is also known to present in many other sites including the
limbs, groin, trunk and scalp, and is often associated with regional lymphadenopathyref1,
ref2,
ref3.
Histologically, the lesions are characterised by lymphoid hyperplasia,
proliferating blood vessels and eosinophilic infiltrationref1,
ref2,
ref3.
The optimal treatment for KD remains controversial. However, early diagnosis
of KD could spare the patient unnecessary and potential harmful diagnostic
procedures. The more superficial, usually larger, lesions have been called
pseudopyogenic
granuloma. First described in China by Kim and Szeto in 1937, this
disease was given its name and became more widely known after a systematic
description by Kimura in 1948 in Japan. KD occurs endemically in the Far
East, and only a small number of cases have been reported in the West.
The disease is also reported to be associated with systemic connective
tissue disease and the nephrotic syndrome, occurring in up to 60% of patients
with the latter conditionref1,
ref2,
ref3,
ref4.
The lesions of KD may precede or coincide with the development of renal
disease. Several mechanisms have been postulated but none have gained widespread
acceptance to date. These include atopy to persistent fungal or parasitic
antigenic stimulationref1,
ref2
and alterations of immune regulationref1,
ref2,
ref3.
The onset of KD is insidious and the lesions are benign, following an indolent
course, gradually increasing in size over months or years. The overall
prognosis is good. Although spontaneous involution is rare, malignant transformation
has not been documented. Diagnosis of KD is frequently difficult. A biopsy
and/or excision of the involved lymph node or the lesion itself is frequently
required for definitive histopathological diagnosis, and is often therapeutic
as well. The histopathological findings in KD are the same, regardless
of the site of involvement, and are characterised by lymphoid follicles
formation with prominent germinal centres, infiltration of eosinophils,
sometimes forming microabscesses, fibrosis, increased postcapillary venules
and vascular proliferationref1,
ref2,
ref3.
Vessels remain thin-wall with cuboidal endothelial cellsref1,
ref2.
Polykaryocytic giant cells of the Warthin-Finkeldey type are a common feature.
These features are also present in affected lymph nodes, in which their
nodal architecture is preserved. The paracortex and sinuses showed striking
eosinophilic infiltration with eosinophilic microabscesses and increased
postcapillary venules. Although FNAC can be performed for the diagnosis
of KD, its role is largely in the diagnosis of recurrent lesions and it
may obviate the need for repeated open biopsiesref1,
ref2.
Clinical differential diagnoses for KD include reactive lymphadenopathy,
lymphoma, salivary gland tumour, nodal metastasis (breast, colorectal and
nasopharyngeal cancer), and Mikulicz’s diseaseref1,
ref2.
Lesions of KD are also frequently diagnosed as angioma, lymphangioma or
haemangioma, and other tumours. The differential diagnosis frequently highlighted
in the literature is angiolymphoid hyperplasia with eosinophilia (ALHE).
Although there has been controversy in the past, it is now widely accepted
that ALHE and Kimura’s disease are separate entities with different clinical
and histopathological featuresref1,
ref2,
ref3.
Although not diagnostic, imaging studies can play a major role in aiding
the diagnosis of KD and distinguishing the disease from other conditions.
It is also useful in delineating the extent and progression of the disease.
Radiological features, particularly on CT and MR imaging, have been reported
to be useful in the diagnosis of KD. Tissues involved in KD, for example
the parotid gland and lymph nodes, show intense enhancement on CT, reflecting
the vascular nature of the lesionsref1,
ref2,
ref3.
The borders areusually ill-defined and there is usually adjacent enhancing
cervical lymphadenopathy. The CT findings in our patients were compatible
with KD. On MR imaging, these lesions demonstrate intermediate to high
signal intensities on T1-weighted images and hyperintense signals on T2-weighted
imagesref1,
ref2.
The optimal treatment for KD is not well established. However, treatment
should aim to preserve cosmesis and function while preventing recurrences
and long-term sequelae. The range of treatment options include conservative
treatment, steroid therapy, radiotherapy, cryotherapy, laser fulguration,
and surgical excision. Other therapeutic options, including cytotoxic agents,
cyclosporin and pentoxifyline, have been used with variable resultsref1,
ref2.
At initial presentation, surgical excision is the choice for both diagnosis
and therapyref1,ref2,
ref3.
The value of achieving negative surgical margins for local control in excision
has not been studied. Nevertheless, the treatment outcome after excision
is variable and recurrence is common. In cases treated with surgical excision
alone, the recurrence can be as high as 25%ref.
Localised recurrences can often be managed by surgical excision. However,
if recurrence is frequent or there is symptomatic nephrotic syndrome, systemic
steroids should be started. Steroid dosages should be initiated at high
doses and then tapered to effectref1,
ref2,
ref3.
Unfortunately, there is a tendency for lesions to recur when steroid therapy
is stoppedref.
For recalcitrant cases or lesions not amenable to surgery due to size or
unacceptable resultant morbidity, radiotherapy can be consideredref.
Low-dose local irradiation (about 25 to 30 Gy) has been reported to yield
good control and obviates the need for long-term corticosteroidsref1,
ref2.
However, in addition to the side effects of radiotherapy, there is also
concern regarding secondary malignancies in the irradiated field, although
none has been reported yet.
Kimura's disease : a disease of the
skin considered by some authorities to be synonymous with angiolymphoid
hyperplasia with eosinophilia but differentiated by others on the basis
of differences in the nature of the proliferating vascular cells. It is
an inflammatory reactive condition of unknown origin
angiokeratoma / angiokeratosis / telangiectatic
wart : a discrete, pink to red telangiectasia having a tendency to
undergo secondary epithelial changes, including acanthosis and hyperkeratosis.
An underlying vascular abnormality is present in many cases.
angiokeratoma circumscriptum
: a condition mainly occurring in infancy or early childhood, chiefly in
females, characterized by the usually unilateral development of papules
and small nodules that may coalesce to form plaques, which are generally
localized in a small patch, often with a linear configuration.
solitary angiokeratoma : angiokeratoma
manifested as a small, bluish black warty papule that occurs most frequently
on the lower extremities, usually singly, in childhood and adolescence.
angiokeratoma of Fordyce / angiokeratoma
of scrotum : the existence of small vascular papules, which become
keratotic, along the superficial veins of the scrotum and rarely over the
penis, inguinal area, or upper thigh; seen in older men, usually with a
history of venous obstruction. Similar lesions may occur on the vulva in
women.
angiokeratoma of Mibelli
: symmetrical development on the dorsum of the fingers, toes, elbows, and
knees of discrete, aggregated, or confluent, soft red to purple vascular
papules that later become hyperkeratotic. Most cases are seen in children
or young adults, often with a history of chilblains, cold sensitivity,
or frost bite.
acral
pseudolymphomatous angiokeratoma of children (APACHE) is better interpreted
as a pseudolymphoma.
syphilid / syphilide : one of the skin lesions
of secondary syphilis,
appearing 6 weeks to 2 years after infection in a series of crops lasting
a few days to months, and becoming more severe, conspicuous, and persistent,
and less widely generalized, in successive outbreaks. Mucous membrane lesions
in this stage are typically teeming with Treponema pallidum and
are clinically the most contagious lesions of the disease. Syphilids may
be described by their shape
macular syphilid / syphilitic roseola
: a flat rose-colored spot on the skin, found in groups on various parts
of the trunk, one of the earliest signs of secondary syphilis
papular syphilid : one characterized
by papules, such as
annular syphilid : a papular syphilid
that is annular and the size of a small coin, usually found on the face,
palm, sole, or anogenital area.
corymbose syphilid : a type of
papular syphilid characterized by a large central papule surrounded by
smaller satellite lesions.
lenticular syphilid : a type of
papular syphilid characterized by small papules resembling lentils, usually
on the face or genital region
Biett's collarette
: a type of papular syphilid in which the central papule is surrounded
by a ring of scales
maculopapular syphilid : a
type seen with persistent cases of macular syphilid; the lesions may appear
on the face, trunk, palms, or soles, and are darker and more papular than
those of macular syphilid.
..., location
palmar syphilid : one on the palm, usually pink to brownish in color;
it may be either macular or papular.
plantar syphilid : one on the sole, usually pink to brownish in
color; it may be either macular or papular.
neurotic excoriation : a self-induced skin lesion, inflicted by
the fingernails or other physical means
postmortal excoriations : depressed crust-less skin areas resembling
parchment
lacerated wound / laceration
:
a torn, ragged, mangled wound
contused or nonpenetrating
wound : one in which there is no disruption of the skin but there is
injury to underlying structures
Aetiology : contusion
Symptoms & signs : lesser hemorrhage
than in edging wounds due to hemostatic effect of contusion
necrosis zone
stupefaction zone
reaction zone
penetrating or puncture
wound : one caused by a sharp, usually slender object, such as a nail
or ice pick, which passes through the skin into the underlying tissues
perforating wound : a penetrating
wound which extends into a viscus or bodily cavity.
fissure / incised wound : a linear loss of
both dermis and epidermis, with sharply defined, nearly verticle wallsmade
by a cutting instrument
seton wound : one which enters and exits
on the same side of the injured part
subcutaneous wound : one which involves only the skin and subcutaneous
tissue
skin ulcer : a lesion in which there has been
destruction under the DEJ; usually heals with scarring
bed sore / decubitus or pressure ulcer :
on areas of the skin that are under pressure from lying in bed, sitting
in wheelchairs, wearing a cast, or being immobile for a long period of
time.
atrophie blanche : a condition
characterized by ivory-white, smooth, atrophic scar tissue with telangiectasia
within a hyperpigmented areola, usually occurring on the ankles of middle-aged
women
atrophie noire : a condition characterized by ulcers surrounded
by areas of blue-black pigmentation on the ankles, the pigmentation occurring
after recurrent attacks of dermatitis with ulceration
calcifications
osteoma or osteosis cutis / osteodermia
:
a cutaneous ossification manifested by the development of one or more hard,
round to irregular, sharply defined tumors of varying size within the dermis
or subcutis
acroangiodermatitis / pseudo–Kaposi
sarcoma : unilateral subacute to chronic dermatitis, often with postinflammatory
hyperpigmentation, occurring in association with underlying arteriovenous
fistula, which closely resembles Kaposi's
sarcoma
both clinically and histologically
pigmented purpuric lichenoid dermatitis / Gougerot-Blum syndrome
: a purpuric cutaneous eruption usually seen in men 40–60 years of age,
occurring chiefly on the legs, thighs, and lower trunk, and characterized
by the presence of minute, rust-colored, lichenoid papules that tend to
fuse into plaques, which may contain variously pigmented papules
Epidemiology : each yea > 2.4 million
in the USA
Aetiology :
windburn : chapping of the skin caused by excessive exposure to
wind.
brush or friction burn : a
wound caused by violent rubbing or friction, as by a rope pulled through
the hands
chemical burn : irritant dermatitis caused by various caustic
substances, such as acids, disinfectants, and alkalis.
electric or electrical burn
produces deep lesions at input and output points
contact burn : a burn produced by contact with hot object such as
metal, plastic, glass and hot coals
radiation burn : a burn caused by
x-ray burn : a lesion caused by exposure to x-rays.
UV burn
radium
erythema solare / sunburn
: injury to the skin, with erythema, tenderness, and sometimes blistering,
following excessive exposure to sunlight, and produced by ultraviolet rays,
which are not filtered out by clouds or water.
atomic energy
any other type of radiant energy
thermal burn : injury due to contact with
flame
hot liquids (scalds), as distinguished from chemical and electric
burns.
flash burn : a thermal lesion produced
by a very brief exposure to radiant heat of high intensity, as in an explosion
or a sudden discharge of electricity.
Grading :
partial-thickness burns sensu latu :
first degree burn : erythema and edema; limited to the epidermis.
It is characterized by heat, pain, moistening and reddening of the burned
surface, but rarely shows blistering or charring of tissue. First degree
burns often heal in 3-7 days and seldom scar. Typical first degree burns
include sunburn and minor scalds.
second degree burn : flittena (bulla) / partial thickness burn sensu
strictu, extending into the dermis layer. They can cause
damage to sweat glands and hair follicles and are extremely painful, often
with intense swelling
superficial is moist, red and weepy. Most heal in 10 to 21 days,
but leave a change in skin color and pigmentation
deep can be ivory or pearly white in color and may require a process
known as debridement and additional skin grafting treatments.
full-thickness burns :
third degree burn : eschar extends below
hair follicles and sweat glands to subcutaneous (fat) tissue. With this
degree of burn, the skin becomes charred and leathery and often appears
depressed relative to surrounding tissue. The skin can be bright red, waxy
white, tan or brown; there are no blisters; and third degree burns may
cause massive swelling. Perhaps surprisingly, third degree burns are usually
not
painful because the injury has destroyed nerve endings. Skin grafting
or other replacement options are required for treatment of a third degree
burn.
fourth degree burn : carbonization involving muscle, bone, tendon
and/or ligament. These burns are often life threatening and may require
amputation
Size :
for adults : Wallace's rule of 9's : BSA is divided into sections
of 9% or multiples of 9%. It is named burn disease when > 15% of BSA is
involved
head and neck = 9%
anterior trunk = 18%
posterior trunk = 18%
left arm = 9%
right arm = 9%
left leg = 18%
right leg = 18%
genitalia and perineum = 1%
for children : Lund-Browder classification attaches % to different
BSAs similarly to the rule of 9's used for adults and is modified according
to the age of the child
Pathogenesis : disruption of stratum corneum
increases water diffusion by 100 folds (up to 3-5 L/die instead of the
normal 350 mL/die)
Therapy :
late escharoctomy (surgical incision of the constricting eschar
of a circumferentially burned limb in order to permit the cut edges to
separate and restore blood flow to unburned tissue distal to the eschar)
immersion foot : condition resembling
trench foot occurring in persons who have spent long periods in water.
tropical immersion foot :
maceration, blanching, and wrinkling of the skin of the feet and swelling
of the soles with ridging of the surface, caused by prolonged immersion
of the feet in warm water.
trench hand : contracture or other incapacity
of the hand from frostbite / congelation;
so called from its occurrence in the trenches during World War I.
trench foot : a condition of the feet
resembling frostbite. It is due to the prolonged action of water on the
skin combined with circulatory disturbance due to cold and inaction
Carrel-Dakin treatment : treatment of wounds, based on thorough
exposure of the wound, removal of all foreign material and devitalized
tissue, meticulous cleansing, and repeated irrigation with a dilute sodium
hypochlorite solution. The adjacent skin is protected with petrolatum gauze.
quitting smoking for as little as 4 weeks can dramatically reduce the risk
of wound infection after surgery (2% vs. 12%)
poikiloderma : usually a plaque
(less often a macule) that has the combination of
atrophy, telangiectasia,
and pigmentary alteration (hyperpigmentation and/or hypopigmentation)
poikiloderma vasculare
atrophicans / Rothmund-Thomson syndrome / poikiloderma congenitale
: an autosomal recessive syndrome occurring principally in females, characterized
by the presence of reticulated, atrophic, hyperpigmented, telangiectatic
cutaneous plaques, often accompanied by juvenile cataracts, saddle nose,
congenital bone defects, disturbances in the growth of hair, nails, and
teeth, and hypogonadism
Distribution of lesions :
random
linear : in a line, continuous or broken; may be secondary to trauma, or
follow vessels or nerves.
grouped (clustered)
annular : round rings
arciform : incomplete rings, arcs
polycyclic : irregular rings
herpetiform : clusters of vesicles
zosteriform : clusters in a dermatome
Koebner phenomenon
/ isomorphic response : the tendency of some lesions to flare up on
traumatized, injured skin. It occurs in ...
aplasia cutis congenita / epitheliogenesis imperfecta : a usually
lethal congenital condition consisting of localized failure of development
of skin, usually of the scalp but sometimes of the trunk or limbs. The
defects are usually covered by a thin translucent membrane or scar tissue,
or may be raw, ulcerated, or covered by granulation tissue
pterygium colli / webbed
neck : a congenital condition in which a thick fold of skin extends
from the mastoid region to the acromion on the lateral aspect of the neck
glossy skin / atrophoderma
neuriticum : a condition occurring secondary to neuritis
in which the skin, usually on an extremity, becomes erythematous and then
assumes a grayish, shiny ivory-like appearance, and may be associated with
alopecia, fissuring, and ulceration; nails on the affected part become
ridged
dermatosis : any skin disease, especially
one not characterized by inflammation (as opposed to dermatitis)
acute
febrile neutrophilic dermatosis (AFND) / Sweet's syndromeref:
a condition usually seen on the upper body of middle-aged women, characterized
by the presence of one or more large, rapidly extending, erythematous,
tender or painful plaque (papules, nodules, vesicles and pustules) and
occurring in association with fever and dense infiltration of neutrophilic
leukocytes in the upper and middle dermis. Malignancy in 10-12% (paraneoplastic),
fever, neutrophilic leukocytosis, multiple erythematous painful cutaneous
plaques and/or nodules, papillary dermal infiltrates of mature neutrophils.
Rapid response to steroid therapy. Most involved sites are extremities
and head and neck. There are associated systemic manifestations as arthralgias,
myalgias, episcleritis, and conjunctivitis
ashy
dermatosis of Ramirez / erythema dyschromicum perstans / dermatosis cenicienta
/ erythema chromicum figuratum melanodermicum : an idiopathic
dermatosis occurring predominantly in dark-skinned individuals, particularly
in Latin Americans, characterized by the presence of single or multiple
sharply demarcated ashen macules of variable size and shape, which in their
acute phase have a fine erythematous border.
Schamberg's
progressive pigmented purpuric dermatosis : a chronic, asymptomatic
dermatosis of the lower legs and feet of adolescent and young adult males,
characterized by orange to tan macules with red puncta (cayenne pepper
spots)
subcorneal
pustular dermatosis (SPD) / Sneddon-Wilkinson disease : a chronic,
superficial, pustular disorder with a chronic relapsing course, resembling
dermatitis
herpetiformis (DH),
and chiefly affecting women in middle life, with sterile pustular blebs
beneath the horny layer of the epidermis on the trunk and in the major
skin folds.
transient acantholytic
dermatosis (TAD) / Grover's diseaseref:
a self-limited papulovesicular disease occurring in middle-aged individuals
and having a predilection for the trunk; the histologic changes are suggestive
of keratosis follicularis or benign familial pemphigus
scar : hard plaque of dense fibrous tissue (replacing
injured tissue) covered by a thin epidermis that has formed after detachment
of a crust. When first developed, a scar is
red or purple, later whitish and glistening.
atrophic scar : scar that is depressed
below the skin
hypertrophic scar : scar that is
raised above the skin
keloid (scar) : benign, but sometimes
painful and/or pruritic, proliferative fibroid growths of dermal collagen
Aetiology : unknown; from the healing
process of surgical incision or traumatic skin injury (burn, vaccination,
ear piercing and operative procedures). There is a greater tendency towards
keloids in blacks and fair skinned Caucasians. Although benign, the social
and psychological impact on affected individuals must be considered.
Therapy : no single treatment modality
is always successful.
acne scar : depressed scar that results
when acne is picked. Types of acne scars include :
ice pick scars are deep, well defined
and narrow
rolling scars are subtle with an undulating
appearance
boxcar scars can be superficial (shallow
: respond best to lasers) or deep
striae distensae / striae
atrophicae / lineae atrophicae / linear atrophy / stretch marks : linear,
depressed, atrophic, pinkish or purplish, scarlike lesions that later become
white (striae albicantes, lineae albicantes), occurring on the abdomen,
breasts, buttocks, and thighs. They are due to weakening of the elastic
tissues, and are associated with :
excessive obesity
rapid growth during puberty and adolescence
pregnancy
(striae gravidarum : located only
on abdomen)
Therapy : punch grafts : small skin
grafts to replace scarred skin. A hole is punched in the skin to remove
the scar, which is then replaced with unscarred skin (often from the back
of the earlobe). Punch grafts can help treat deep acne scars
naevus / nevus : a type of hamartoma
representing a circumscribed stable malformation of the skin and occasionally
of the oral mucosa, which is not due to external causes and therefore presumed
to be of hereditary origin. The excess (or deficiency) of tissue may involve
epidermal, connective tissue, adnexal, nervous, or vascular elements.
connective tissue nevus / juvenile
elastoma / nevus elasticus of Lewandowsky : any of a group of variable-appearing
hamartomas
involving various components of the connective tissue, usually present
at birth or soon thereafter, which may be inherited or acquired, and may
be associated with other diseases. They may present clinically as single
or multiple nodules, papules, or plaques, or in various combinations of
these lesions, but individual lesions usually appear as a plaque composed
of firm, flat, closely set, white to ivory or yellow-brown papules, often
having a cobblestonelike surface
shagreen patch or skin / peau de
chagrin : a large connective tissue nevus often occurring in children
in association with Bourneville's
tuberous sclerosis,
presenting as a skin-colored or yellowish, elevated, knobby plaque resembling
shark or pig skin, which is predominantly located on the back, especially
on the lumbosacral region
nevus lipomatosus / fatty nevus
/ nevolipoma : a nevus containing a large amount of fibrofatty tissue.
nevus lipomatosus
cutaneus superficialis : a connective tissue nevus, usually congenital,
characterized histologically by the presence of ectopic, mature adipocytes
in the dermis, and clinically by multiple or single soft, skin-colored
to yellowish papules, nodules, and plaques, usually located on the lower
trunk, gluteal region, or thigh.
nevus anemicus : a congenital disorder
typically characterized by the presence of pale, round, well-defined macules
with irregular borders that may have a normal amount of melanin or may
lack melanin but are not totally amelanotic. Studies suggest that the disorder
is due to a functional incapacity of the blood vessels to dilate as a result
of increased sensitivity to catecholamines.
epidermal nevus / epithelial nevus
: a circumscribed congenital developmental anomaly resulting in faulty
production of mature or nearly mature cutaneous structures, occurring as
a result of overproduction of surface or adnexal epithelium. Such nevi
vary widely in presentation and are commonly hyperkeratotic.
neural nevus
/ neuroid nevus / neuronevus : an intradermal nevus in which the nevus
cells differentiate into neural-like structures, and may clinically resemble
neurofibroma or may have the clinical aspect of a giant hairy pigmented
nevus
lentigo (simplex) : a small, flat, tan to
dark brown or black, macular melanosis on the skin resembling a freckle
clinically but histologically distinct because of the presence of melanocyte
hyperplasia in the basal layer along the dermoepidermal junction. Lentigines
do
not darken on exposure to sunlight
freckle / ephelis : a benign, small,
tan to brown macule occurring on sun-exposed
skin, especially in children and tending to fade in adult life. Freckles
resemble lentigines, but they darken after exposure to sunlight,
when UV radiation causes melanocyte hypertrophy
nevocellular nevus / nevocytic nevus
/ mole / (melanocytic) naevus / nevus cell nevus : an acquired or inherited
tumor composed of nests (theques) of nevus cells
achromic nevus / amelanotic nevus / nevus
depigmentosus : a developmental anomaly of melanization producing long
bands or streaks of hypopigmentation on the skin, especially on the trunk
and extremities, usually unilaterally.
pigmented mole or nevus / nevus pigmentosus
: a nevocellular nevus presenting as tan to deep brown small macules
or papules => nodules
Epidemiology : common incidence in Caucasian
skin (typical Caucasian adults have 20 nevi), less common in pigmented
skin (e.g. black)
Onset :
giant nevi : usually bilaterally symmetric, having a predilection
for the chest, upper back, and shoulders; the area usually covered by bathing
trunks (bathing trunk nevus); and distal upper and lower extremities.
These nevi have been shown to be associated with other cutaneous and subcutaneous
lesions, neurofibromatosis
and other developmental anomalies, and leptomeningeal melanocytosis
(neurocutaneous melanosis : giant hairy nevus accompanied by malignant
melanomas of the meninges), and they also exhibit a predisposition to the
development of malignant
melanoma (20%, as melanocytes are already located within veins of hypodermal
septa): Ø > 20 cm (prevalence : 0.02%)
: these nevi are always congenital (never acquired)ref
nevus spilus : a smooth-surfaced, tan
to brown, macular, epidermal, melanocytic nevus, which is speckled with
smaller, darker macules.
nevus spilus tardus / Becker's nevus /
pigmented hairy epidermal nevus : a nevus occurring mostly in males
in the second to third decade of life consisting of epidermal melanosis,
presenting as segmental, uniform, light hyperpigmentation, followed several
years later by the growth of long dark hairs from the lesions; the lesions
usually have the same pattern of distribution as those of nevus
unius lateris
nevus unius lateris : a verrucous
epidermal nevus, ranging from flesh-colored to yellowish brown, but sometimes
more deeply pigmented, and occurring in a linear, unilaterally distributed
pattern; on the extremities, the lesions usually follow the long axis and
may be arranged in continuous or broken spiral streaks, bands, or patches,
and on the trunk, they usually have a transverse orientation, as if along
the distribution of the intercostal nerves.
cerebriform nevus on head skin
spindle and epithelioid cell nevus / benign
juvenile "melanoma" / Spitz nevus / compound melanocytoma : a benign
compound nevus usually seen in children before puberty, composed of spindle
and epithelioid cells located mainly in the dermis, sometimes associated
with large atypical cells and multinucleate cells, and having a close resemblance
to malignant melanoma.
It presents as a smooth to slightly scaly pink to red papule or nodule,
often with surface telangiectasia.
mongolian, blue or sacral spot / mongolian
macula : a congenital melanocytic nevus manifested by a flat, smooth,
bluish gray to gray-brown macular patch(es), most often located on the
central lumbosacral area, occurring especially in dark-skinned children
including those of African-American and East Asian ancestry, and
usually disappearing before 5 years of age
nevus fuscoceruleus ophthalmomaxillaris / nevus
of Ota / oculodermal melanocytosis : a persistent mongolian spot–like
lesion, usually present at birth, involving the conjunctiva and skin about
the eye supplied by the first and second branches of the trigeminal nerve
as well as the sclera, ocular muscles, retrobulbar fat, periosteum, and
buccal mucosa, usually unilaterally. The skin lesions are manifested as
macular bluish or gray-brown patchy areas of pigmentation that grow slowly
and become deeper in color
nevus fuscoceruleus acromiodeltoideus / nevus
of Ito : a mongolian spot–like lesion having the same features as nevus
of Ota except for localization to the areas of distribution of the posterior
supraclavicular and lateral cutaneous brachial nerves, to involve the shoulder,
side of the neck, supraclavicular areas, and upper arm.
acquired nevi (within age 25)
are mostly hairless, small nevi (Ø
<
1.5 cm) with irregular borders.
Franceschetti-Jadassohn syndrome / chromatophore nevus of Naegeli /
Naegeli syndrome / Naegeli's incontinentia pigmenti : an autosomal
dominant disorder characterized by the presence of slate-gray to brown
reticular pigmentation beginning after infancy without preceding inflammatory
changes, and associated with palmoplantar hyperkeratosis, vasomotor changes
with hypohidrosis, and yellowing of the dental
enamel
atypical nevus : asymmetry,
border
irregular, color, diameter > 6 mm, elevation,
feeling
or change in sensation, growth (mnemonic: ABCDEFG)
dysplastic nevus : compound
nevus with associated architectural disorder (cytologic atypia) or atypical
melanocytic hyperplasia (melanoma in
situ), entirely flat, > 5 mm, variable pigmentation, irregular
asymmetric outline, indistinct borders. On the contrary of melanoma it
has no pagetoid diffusion and presents lamellar fibroplasia (thickening
of subthequal connective tissue) : epidermal crests join and entrap
parts of dermal papillae.
1 dysplastic nevus : RR = 2.2
> 9 dysplastic nevi : RR = 12.0
dysplastic nevus syndrome :
the occurrence of dysplastic nevi in persons with or at risk for familial
or nonfamilial malignant melanoma
Histology : melanocytes undergo neurotization
(differentiation into neurons) while deepening into dermis
junction or junctional melanocytic
nevus of Clark : cells at DEJ (basal and eventually also spinous layer,
with intact basement membrane), tan, brown or dark brown color, on palms
and soles, trunk, face, upper and lower extremities
Laboratory examinations : junctional
nest : a nest of dysplastic cells seen at the dermoepidermal junction
as part of a junctional nevus
dermal melanocytoma / dermal melanocytic
nevus / intradermal nevus : a nevocytic nevus, clinically indistinguishable
from compound nevus, in which the nests of nevus cells lie exclusively
within the dermis.
Jadassohn-Tièche common
blue nevus / blue neuronevus / chromatophoroma / melanofibroma : skin-colored,
tan or brown colored papules; on face and neck > trunk and extremities
cellular blue nevus : a large
blue or blue-black, multilobulated, well-circumscribed nodular tumor, usually
congenital, having a tendency to occur on the buttocks and sacrococcygeal
region. It is characterized histologically by deeply pigmented, dendritic,
spindle-shaped melanocytes alternating with cellular islands of spindle
cells with ovoid nuclei and abundant pale cytoplasm in the dermis and subcutaneous
tissue. These nevi have a low incidence of malignant transformation to
melanoma,
in which case they show cellular pleomorphism, mitotic figures, and evidence
of invasion into the deep dermis
balloon cell nevus : a brown mole
with a subtle yellow halo surrounding it, consisting of balloon cells with
pale cytoplasm that contains large vacuoles formed of altered melanosomes;
it may be confused with melanoma.
compound melanocytic nevus
of Spitz : a nevocytic nevus composed of fully formed nests of nevus
cells in the epidermis as well as newly forming ones in the dermis.
Symptoms & signs : soft, sharply circumscribed
(round or oval) pigmented macules or dome shaped
papules
< 1 cm. Satellitism : minor, or attendant, lesion situated near
a larger one; normal if preexisting, unfavorable if of new onset
Prevention of malignant transformation
: surgical ablation
Web resources : Nevi
at OMIM
café au lait spots : pigmented
macules of a distinctive light brown color, like coffee with milk
cutis laxa / dermatochalasis / dermatochalazia
/ dermatolysis / dermatomegaly / generalized elastolysis / lax or loose
skin : a group of connective tissue disorders in which the skin hangs
in loose pendulous folds, believed to be associated with decreased elastic
tissue formation as well as an abnormality in elastin formation
Aetiology :
genetic disorder => congenital form, present at birth or developing soon
afterwards
autosomal recessive cutis laxa associated with severe complications,
including pulmonary and cardiovascular manifestations, diverticula of the
urinary and gastrointestinal tracts, and multiple hernia
X-linked
recessive cutis laxa / occipital horn syndrome (OHS) / Ehlers-Danlos syndrome,
type IX (associated with decreased activity of lysyl oxidase, the
enzyme responsible for the formation of aldehyde groups, which are essential
for collagen cross linkages) : bladder diverticula and dysfunction, growth
of bony occipital horns, and relatively normal intelligence. Affected individuals
have a prematurely aged appearance, hooked nose with everted nostrils,
long upper lip, everted lower eyelids, and sagging cheeks.
acquired form, which is often preceded by mild fever, usually presents
after puberty and sometimes not until middle age or later
dermatofibrosis : a condition characterized
by fibrotic changes in the skin.
dermatofibrosis
lenticularis disseminata / Buschke-Ollendorff syndrome : an autosomal
dominant syndrome, present at birth or appearing before puberty, characterized
by the development of connective tissue nevi of the elastic type in association
with osteopoikilosis; the skin lesions are manifested as small, firm, yellowish
or skin-colored papules or plaques distributed symmetrically, primarily
on the lower trunk and extremities.
dermatoglyphics : the study of the
patterns of ridges of the skin of the fingers, palms, toes, and soles;
of interest in anthropology and law enforcement as a means of establishing
identity and in medicine, both clinically and as a genetic indicator, particularly
of chromosomal abnormalities
granuloma annulare : a chronic
skin condition characterized by small, raised bumps that form a ring with
a normal or sunken center. It presents the Koebner
phenomenon / isomorphic response.
ichthyosis : any in a group of cutaneous
disorders characterized by hyperkeratosis or aberrant keratinization, resulting
in noninflammatory dry, rectangular scaling of the skin. Many different
metaphors have been used to describe the appearance and texture of the
skin in the various types and stages of ichthyosis, e.g., alligator, collodion,
crocodile, fish, and porcupine skin. Most ichthyoses are genetically determined,
while some may be acquired and develop in association with various systemic
diseases or be a prominent feature in certain genetic syndromes
ichthyosis
simplex or vulgaris / common ichthyosis : the most common form
of ichthyosis, inherited as an autosomal dominant trait, having an onset
sometime after the first year of life, especially near puberty. It is characterized
by the presence of prominent fine scaling principally on the extensor surfaces
of the extremities and back, with the flexures being spared and the abdomen
and face being relatively spared; accentuated marking and creases on the
palms and soles; and, possibly, atopic
dermatitis (AD) / type I hypersensitivity
ichthyosis congenita / congenital
ichthyosis : ichthyosis present at birth
lamellar ichthyosis (LI) : a congenital,
chronic form of ichthyosis present at birth in which the affected infant
is born encased in a collodionlike membrane (collodion baby) that is soon
shed, the skin then becoming covered with large, coarse scales with involvement
of all of the flexures as well as the palms and soles. Universal erythroderma
and pruritus are characteristic, and ectropion of variable degree is usually
present.
ichthyosis linearis circumflexa : a congenital autosomal recessive
disorder present at birth, and characterized by the presence of generalized
erythroderma and scaling associated with migratory, polycyclic lesions
with a peripheral double-edged scale and hyperkeratosis of the flexural
areas, and hyperhidrosis of the palms and soles.
X-linked
ichthyosisa chronic form of ichthyosis affecting males,
transmitted as an X-linked recessive trait and due to deficiency of the
microsomal enzyme placental steroid
sulfatase leading to excess of cholesteryl sulfate (corneocyte-cementing);
it may be present at birth or appear in early infancy. It is characterized
by the presence of prominent, very adherent scales, often brown, especially
on the neck, extremities, trunk, and buttocks. Corneal opacities that do
not interfere with vision are a frequent associated finding; these may
occur in minor form in heterozygotic female carriers.
collodion baby : an infant born encased
in a tight membrane resembling collodion or parchment, which is subsequently
shed, occasionally leaving normal-appearing skin (lamellar exfoliation
of newborn or lamellar desquamation of newborn). It is usually a primary
manifestation of various forms of ichthyosis, most often lamellar
ichthyosis.
harlequin fetus : a fetus covered
with thick, horny armorlike plates as a result of an autosomal recessive
keratinizing disorder; it may also be a severe form of collodion baby or
it may represent the extreme form of lamellar
ichthyosis. Those affected are usually stillborn or die within days
after birth
melasma / chloasma / mask of pregnancy
Aetiology : elevated levels of estrogen,
progesterone,
and a-MSH Symptoms & signs : dark, brown symmetrical
patch hyperpigmentation that occurs on the face and neck of some women
in the second or third trimester of pregnancy
or while taking oral
contraceptives.
The areas most commonly affected are the cheeks, forehead, upper lip, and
chin. Different types of melasma occur depending on the location of the
excess melanin, in the epidermis or the dermis.
Prognosis : pregnancy-induced melasma
usually resolves after delivery, but may return with subsequent pregnancies
or with oral contraceptives.
Therapy depends on the type and involves
skin-lightening agents and sometimes tretinoin (Retin-A). The proper use
of sunscreen is also important because UV light can worsen melasma.
dermatitis medicamentosa / drug
eruption or rash : an adverse cutaneous reaction produced by ingestion,
parenteral use, or local application of a drug, which may produce various
morphologic patterns and types of lesions
elastosis : degenerative changes in the
dermal connective tissue with increased amounts of elastotic material having
the staining properties of elastin
actinic, senile or solar elastosis / farmers'
or sailors' skin : premature aging of the skin due to prolonged exposure
to sunlight, occurring especially in light-skinned individuals, and chiefly
characterized by inelasticity, thinning or sometimes thickening, wrinkling,
dryness with fine scaling, and variable hyperpigmentation, often with development
of cherry angiomas, telangiectasis, senile lentigines, ecchymosis, milia,
and senile keratosis. This can lead to loose, sagging, tough skin that
can look 15 to 20 years older than normal. When sun-induced abnormal elastin
accumulates, MMPs are produced in large quantities. Normally, MMPs remodel
sun-injured skin by manufacturing and reforming collagen. However, this
process does not always work well and some of the metalloproteinases actually
break down collagen. This results in the formation of disorganized collagen
fibers known as solar scars. When
the skin repeats this imperfect rebuilding process over and over wrinkles
develop
nodular elastosis
of Favre and Racouchot / Favre-Racouchot syndrome and nodular elastoidosis
:
a type of actinic elastosis usually seen in elderly men, in which giant
comedones, pilosebaceous cysts, and large folds of furrowed and yellowish
skin are seen in the periorbital region
elastosis perforans serpiginosa
/ perforating elastosis : a chronic disorder of the dermal connective
tissue, usually occurring in males below 30 years of age, alone or in association
with more widespread disease, typically characterized by the development
of a skin-colored keratopapular eruption consisting of clustered arciform
serpiginous lesions that gradually form a circular or horseshoe-shaped
pattern, especially on the sides and nape of the neck but sometimes also
on the upper arms, face, trunk, and other areas of the body. Elongated
tortuous channels in the epidermis into which abnormal elastic tissue perforates
and is extruded into the dermis are the most significant histopathologic
features.
photoaging : exposure to UVA or UVB from
sunlight accounts for 90% of the symptoms of premature skin aging. Most
of the photoaging effects occur by age 20. The amount of damage to the
skin caused by the sun is determined by the total lifetime amount of radiation
exposure and the person's pigment protection.
age spots
/ liver spot / solar lentigo / senile lentigo / lentigo senilis : benign,
discrete, hyperpigmented (gray, brown or black) macule occurring
on chronically sun-exposed skin (especially on the back of the hands and
on the forehead) in > 90% of fair-skinned people after age 50. They range
from freckle-size to a few inches across. They may darken with sun exposure.
Therapy : true age spots never become
cancerous and don't need treatment. However, they can look like cancerous
growths. For cosmetic reasons they can be lightened with skin-bleaching
products or removed.
Prevention : avoiding the sun and using
sunscreen
chemical peels with trichloroacetic acid (TCA) burns the
outer layer of the skin, which peels off, causing new, smoother skin to
regenerate. The skin has a scab for about 10 days and is pink for about
3 months. The patient may be left with small scars, and the skin will be
permanently lighter and more susceptible to sunburn. Chemical peels can
cause blotchy skin in people with darker skin
facial rejuvenation is a combination of massage and energy work.
It assists nerve, muscle, and energy reconnection through the use of select
contact points, and employs specific massage strokes and massage patterns
to relax the muscles, and increase circulation and energy flow to the face,
neck, shoulders, and head. This combined result allows a realignment of
the facial muscles into a more stress-free, relaxed and youthful pattern.
The treatment includes herbal compressing, cleansing and natural masks
and may also utilize aromatherapy, with individually chosen aromatic essential
oils helping to move the body into a state of balance.
Fitzpatrick skin
phototypes (SPT)
phototype I : red-haired, light eyes, lentigo, light skin, always
burns, never tans
phototype II : fair-haired, light eyes, light skin, burns easily,
tans minimally (less than average, with difficulty))
phototype III : fair- or brown-haired, light or hazel eyes, light
or mildly dark skin, sometimes burns moderately, but always tans about
average gradually to light brown
phototype IV : burns minimally, always tans well to moderately brown,
dark brown-haired, dark eyes, moderately dark skin, never burn, always
tan above average
phototype V : rarely burns, tans profusely to dark, dark-haired,
dark eyes, olive skin, moderately pigmented people (Chinese, Indian)
phototype VI : never burns, black haired, black eyes, black skin
(West Indies, Africans)
People with skin types I and II are at the highest risk for photoaging
effects including wrinkles and skin cancer.
However, sun effects including wrinkles and skin cancer can occur in any
skin type.
Prevention :
Sun protection factor (SPF)number
is determined experimentally indoors by exposing human subjects to a light
spectrum meant to mimic noontime sun. Some subjects wear sunscreen and
others do not. The amount of light that induces redness in sunscreen-protected
skin, divided by the amount of light that induces redness in unprotected
skin is the SPF. It is mainly a measure of UVB protection and ranges from
1 to 45 or above. A sunscreen with an SPF of 15 filters 92% of the UVB.
Put another way, a sunscreen with an SPF of 15 will delay the onset of
a sunburn in a person who would otherwise burn in 10 minutes to burn in
150 minutes. The SPF 15 sunscreen allows a person to stay out in the sun
15 times longer. The SPF of sun lotion refers only to protection from UVB
and not the UVA (which penetrate the skin, leading to release of free radicals,
which can cause DNA damage and lead to the formation of malignant melanom),
so using sunscreen mght actually be harmful, as it encourages people to
stay in the sun for longer.
sunblock physically blocks the sun's UV radiation
of the skin, both UVA and UVB.
clothing
umbrellas
trees
chemical sunblocks scatter, reflect, and physically block UV radiation
opaque, the skin can not be seen through the sunblock. This may not be
cosmetically acceptable for many people. They can also be greasy and clog
pores, a problem for people with acne-prone skin
ZnO2
talc
red vetenary petrolatum
almost invisible
micronized TiO2
skin cancers
dermal cancers
dermatomyoma / leiomyoma
cutis : leiomyoma
arising from cutaneous or subcutaneous smooth muscle fibers, occurring
singly or multiply, usually in the form of lesions arising from arrectores
pilorum muscles (piloleiomyoma); it may also
occur as a solitary genital lesion arising from dartoic, vulvar, or mammillary
muscle or as a solitary angioleiomyoma arising from the muscle of veins.
Lesions present as smooth, firm, painful, often translucent or waxy nodules
and are characterized by interlacing bundles of elongated rod- or spindle-shaped
cells with finely fibrillar cytoplasm.
cutaneous fibroma : fibroma of the skin
benign fibrous histiocytoma
/ fibrous xanthoma : a benign, circumscribed, erythematous to brown
nodular neoplasm occurring in the dermis, particularly on the lower extremities
of women, often after minor trauma; it is composed of histiocytes which
may differentiate to resemble fibroblasts.
nodular subepidermal fibrosis
:
the formation beneath the epidermis of multiple fibrous nodules as a result
of productive inflammation. It is a form of benign fibrous histiocytoma,
and the two terms are sometimes used synonymously; alternatively, it is
sometimes used synonymously with dermatofibroma.
histiocytoma
cutis / dermatofibroma / aneurysmal ("angiomatoid") fibrous histiocytoma
: clinically, they may be larger than the usual cutaneous fibrous histiocytoma,
are blue, black, or dark red, and have a cystic consistency. They are most
commonly located on the extremities and may be associated with symptoms
of pain and rapid growth. Histologically, the lesions are characterized
by the presence of large, blood-filled tissue spaces, which, at times,
account for up to one half their size. These spaces lack an endothelial
lining, being surrounded and lined by histiocytes, many of which contain
hemosiderin pigment, fibroblasts, and foam cells. The solid portions of
the tumor have the usual features of a cutaneous fibrous histiocytoma.
This "angiomatoid" lesion is closely allied to what has been termed "hemosiderin
histiocytoma," which appears to be a precursor stage in its formation.
The presence of extravasated erythrocytes in combination with a spindle-cell
stroma may lead to an erroneous diagnosis of Kaposi's sarcoma. This cutaneous
tumor has architectural and cytologic similarities to its malignant soft
tissue counterpart recently described as angiomatoid
malignant fibrous histiocytoma.
However, unlike the latter, the cutaneous lesion is benign and lacks the
prominent inflammatory infiltrate, pleomorphic appearance, and systemic
manifestations of its soft tissue counterpart.
sclerosing hemangioma : a form
of benign fibrous histiocytoma characterized not only by histiocytic and
fibroblastic elements but also by numerous blood vessels and hemosiderin
deposits. It is sometimes considered synonymous with or a variant of dermatofibroma
dermatofibrosarcoma : a fibrosarcoma
of the skin.
dermatofibrosarcoma protuberans
(DFSP) : a bulky, protuberant, nodular, fibrotic neoplasm occurring
in the dermis, usually on the trunk, often extending into the subcutaneous
fat, muscles and bone; it is locally aggressive and frequently recurs.
It is sometimes classified as a type of malignant
fibrous histiocytoma
Epidemiology : prevalence 1 in 200,000
people, during middle age
Aetiology : t(17;22) (> 95%) leads to
upregulation of PDGFB;
no evidence exists suggesting it is caused by the sun or that it is a product
of genetic predisposition. About 20% of those diagnosed, however, experienced
some previous trauma at the tumor site, like deep cuts, vaccinations, or
burns
Prognosis : only 5% of such cancers spread
beyond the original lesion site.
Therapy : surgical ablation of primary
tumor, imatinib
if M+
acrochordon / fibroepithelial polyp / cutaneous
papilloma or tag / skin tag :a skin-colored to light brown
papillomatous cutaneous lesion usually occurring on the neck, upper chest,
or axilla of middle-aged women, characterized by a hyperplastic epidermis
enclosing a dermal connective tissue stalk composed of loose, edematous
collagen fibers; larger lesions may be pedunculated (soft fibroma /
fibroma pendulum)
carcinoma en cuirasse / cancer en cuirasse : carcinoma of the skin
manifest as thickening and induration over large areas of the thorax, frequently
as a result of metastasis from a primary breast lesion
Epidemiology : incidence is higher in
males (0.34 per 100,000 person-years) than in females (0.17 per 100,000
person-years). Cases occur mostly in whites (94%), in people older than
65 years (76%), and at the head (48%).
Aetiology :
Pathogenesis : fast-growing, painless, reddish
nodule with an iceberg-like effect, broadening in the depth. On the trunk
and the buttocks, deep clinically rather inconspicuous nodules can occur.
Early spread to regional lymph nodes and frequent regional and distant
metastases. Only 49% of cases are reported as localized
Laboratory examinations : IHC (MAP-2+CHR+SYN+NSE+CD99+chromogranin
A+Ep-CAM(MOC-31 mAb)+)
Therapy :
wide local excision or Mohs' micrographically controlled margins with a
final 5- to 10-mm layer (safety margin of 3 cm) and adjuvant radiotherapy
(the radiation field should include the area of the draining vessels and
the first regional lymph nodes). There are some reports concerning the
advantage of sentinel lymph node biopsy. In distant metastases, the therapy
is multimodal and palliative including surgery, radiation and chemotherapy.
However, wide excision may be difficult to perform in patients with tumors
of the head and neck or in older populations with comorbidities that may
be incompatible with general anesthesia.
Prognosis : the 5-year relative survival was
75%, 59%, and 25% for localized, regional, and distant MCC, respectively.
Female sex, limb presentation, localized disease, and younger age were
positive predictors of survival. There are 5 published cases of spontaneous
regression
basal cell carcinoma (BCC) / epithelioma
/ basaliomaref
(70%) : the most common form of skin cancer, consisting of an epithelial
tumor of the skin originating from neoplastic differentiation of basal
cells, rarely metastatic but locally invasive and aggressive. It has been
divided into numerous and variable subtypes on the basis of clinical and
histological characteristics
comedo basal cell carcinoma
: a form in which the cores of the basal cell masses are necrotic.
alveolar or cystic basal cell carcinoma : an uncommon subtype occurring
as a cystic lesion formed by central degeneration, characterized histologically
by edematous stroma rimmed by neoplastic cells.
morphea-like or sclerosing basal cell carcinoma : a form usually
occurring on the face or neck as scar-like, telangiectatic, ivory lesions
with poorly defined borders, characterized histologically by strands of
basal cells surrounded by dense hyalinized stroma, and usually spreading
laterally.
nodulo-ulcerative
basal cell carcinoma : the most common form of BCC, usually occurring
on the face as one or several small, waxy, translucent nodules with rolled
edges around a central depression, which may be ulcerated, crusted, or
bleeding. It may spread laterally or invade deeply.
pigmented basal cell carcinoma
:
a form in which the lesions contain brown or black pigment; it is frequently
associated with long term ingestion of arsenic.
It grows slowly and occurs more often in darker complexioned individuals.
multicentric
or superficial basal cell carcinoma : a form usually occurring on the
trunk as one or several superficial, slowly spreading, erythematous, scaly
plaques with thread-like raised borders; it is frequently associated with
long-term exposure to arsenic.
premalignant fibroepithelioma
/ premalignant fibroepithelial tumor : an uncommon, usually indolent,
variant of basal cell carcinoma presenting as a firm sessile to pedunculated
papule, usually located on the lower trunk or lumbosacral area in middle-aged
or older adults. Histologically it is characterized by prominent stromal
fibrosis with long anastomosing cords of basal cells
Pathogenesis : mutations in SHH
signalling, including PTCH,
and TP53 Symptoms & signs : one or several
small, pearly nodules or plaques with central depressions on the face of
an older adult, particularly on a sun-exposed area of persons with fair
skin. These cancers increase slowly in size from a small pimple to large
nodules that may bleed and form ulcers, very seldom cause death.
precancerous
dermatosis / Bowen's disease (Bowen JT. Precancerous dermatoses a study
of 2 cases of chronic atypical epithelial proliferation. J.Cut.Dis.incl.Syph
30:241 (1912)): a squamous cell carcinoma in situ (intraepidermal)
consisting of bowenoid cells, often due to prolonged exposure to
arsenic;
it occurs as one or more sharply defined, slightly thickened, erythematous,
scaly plaques, usually on sun-exposed areas of skin in older white males
but sometimes found on mucous membranes. The corresponding lesion on the
glans penis is termed erythroplasia
of Queyrat.
May be multiple in 30%. Trasformation to invasive squamous carcinoma in
< 10%. According to literature 20-80% have an internal malignancies.
Laboratory examinations : poikilocarynosis
: Darier's term for the formation of various types and arrangements of
cells which occurs in Bowen's disease.
‡
squamous cell carcinoma (SCC)
/ spinalioma (20%)
chimney-sweeps' or soot
cancer : SCC of the skin of the scrotum due to soot poisoning. Poor
personal hygiene allows soot to accumulate in slips in tight contact with
testes, allowing mutagenic action of benzo[a]pyrene
on keratinocytes
kang or kangri cancer : SCC
in the thigh or abdomen affecting Indian and Chinese natives, and attributed
to irritation from the kang (heated brick oven) or from the kangri (fire
basket).
mule-spinners' cancer : a form
of SCC affecting mule spinners in the cotton-spinning industry, due to
continued soaking of the clothes and abdomen by arsenic, tar, and carcinogenic
oils; it is now rare
tar cancer : SCC caused by inflammatory
irritation of fumes of tar or by the irritating effect of tar on the skin
Aetiology : sun-damaged areas or preexisting
lesions (epidermodysplasia
verruciformis)
Pathogenesis : mutations in H-Ras
and TP53.
Symptoms & signs : firm, fleshy, red,
scaly, hard-surfaced lump develops and grows steadily. It sometimes looks
like a wart, or sometimes like an ulcer that never heals completely. The
lower lip, ears, and hands are common sites for this cancer.
Differential diagnosis : keratoacanthoma
Epidemiology : population-based study demonstrated
an increase in the incidence of nonmelanoma skin cancer among young women
and men residing in Olmsted County, Minnesota. There was a disproportionate
increase in basal cell carcinoma in young women. This increase may lead
to an exponential increase in the overall occurrence of nonmelanoma skin
cancers over time as this population ages, which emphasizes the need to
focus on skin cancer prevention in young adultsref.
Therapy :
curettage (cancerous tissue is removed under local anesthesia with
a sharp curette => electrodesiccation to stop the bleeding
and to cauterize a zone of normal tissue
patients who may not be surgical candidates : TLR9
agonists
melanoacanthoma : a rare, benign epidermal
neoplasm composed of keratinocytes pervaded with large dendritic, deeply
pigmented melanocytes; it occurs on the head, predominantly in older white
males.
cutaneous (malignant)
melanoma
/ melanotic carcinoma / melanoblastoma / melanocarcinoma (4-10%): arising
de
novo or from a preexisting benign nevus or
lentigo
maligna
Epidemiology : it is projected that the
condition will affect one in 50 people in the US by 2010
Aetiology :
UV-light
exposure, related to latitude, altitude, sun-tanning, migration of fair-skinned
individuals to more sun-intensive regions, education resulting in reduced
sun exposure. Intense intermitten UV-light exposure associated with sunburn
early in life confers the highest risk for melanoma development later in
life. UV light acts as a
mutagen :
"UV-signature" mutations are represented as C=>T or CC=>TT base substitutions
at dipyrimidine sites that result from the repair of cyclobutane pyrimidine
dimers (CPDs) and 6-4 photoproducts induced by UVB light
protein-DNA crosslinks
oxidative base damage
single-strand breaks
chromosomal aberrations that are classically associated with double strand
breaks such as deletion
epigenetic changes, such as altered methylation that can lead to increased
mutation rates
mitogen
inactivating the RB pathway, either by means of p16INK4A
loss or CDK6
amplification
Signs : undifferentiated cells don't produce
melanins and hence they appear reddish or as normal skin within pigmented
nevus.
Localizations :
lentigo maligna melanoma / circumscribed
precancerous melanosis of Dubreuilh: a cutaneous malignant
melanoma found most often on the sun-exposed areas of the skin, especially
the face, which begins as a circumscribed macular patch of mottled pigmentation,
showing shades of dark brown, tan, or black (lentigo maligna / melanotic
freckle of Hutchinson (Hutchinson J. Senile freckles. Arch. Surg. 3:319
(1892)), and enlarges by lateral growth before dermal invasion occurs.
This type is the slowest growing, has the least tendency to metastasize,
and seems to be the least aggressive form of malignant melanoma (Dureuilh
MW. De la mélanose circonscritte précancéreuse. Ann.Dermat.Syph.
(Paris) 3:129-205 (1912))
subungual melanoma / melanotic whitlow:
acral-lentiginous
melanoma
occurring in the nail fold or bed more commonly in dark-skinned people.
Subungual melanoma is characterized by a dark colored stripe that runs
along the length of the nail plate, not across the nail. The mere presence
of a dark nail stripe is not necessarily melanoma. Signs
:
Hutchinson's sign : spread of pigmentation into the nail folds
pigmentation in a single digit
age > 50
in the thumb, index finger, or great toe
lurred borders
Primary prevention :
stay in the shade between 11am-3pm
make sure you never burn
always cover up with a T shirt, wide brimmed hat and sunglasses
remember to take extra care with children
use sunscreen > factor 15
report any mole changes or unusual skin growths promptly to your GP.
Therapy : as for other melanomas
Prognosis : Online
calculator at Mayo Clinic
Experimental animal models :
Cloudman's melanoma S91: a
firm, black subcutaneous tumor originally found at the base of the tail
of a female DBA mouse, and proven to be transplantable to, and invariably
metastatic in, other DBA mice and BALB/c mice.
Harding-Passey melanoma: a
transplantable, nonmetastasizing melanoma originally found on the ear of
a brown mouse.
Laboratory examinations : Mohs surgery
is a microscopically controlled excision of a lesion where each bit of
tissue removed is mapped and examined under the microscope to determine
the site and extent of malignant cells before more tissue is removed.
Web resources : Skin
Cancer Zone
keratoacanthomas : round, flesh-colored
growths with craters that contain a pasty material.
keratoacanthoma
centrifugum marginatum (KACM) may pose a diagnostic and therapeutic
challenge. Clinically and histologically, it may resemble mycobacterial
or deep fungal infection or halogenoderma. Therapy can be challenging because
the lesion can expand to a great sizeref.
Aetiology : excessive scratching
Symptoms & signs : eruption of flat
papules, lines of the skin are more pronounced than usual looking like
a washboard
lichen pilaris / keratosis
pilaris : a condition marked by the formation of hard conical elevations
in the openings of the sebaceous glands especially of the thighs, back
and sides of the upper arms that resemble permanent goose bumps
ulerythema : an erythematous disease of the skin characterized by
the formation of cicatrices and by atrophy.
ulerythema ophryogenes : keratosis pilaris affecting the follicles
of the eyebrow hairs of young men, associated with erythema, and leading
to scarring and atrophy; it is transmitted as an autosomal dominant trait
lichen sclerosus et atrophicus
:
a chronic, atrophic skin disease characterized by flat white indurated
papules with erythematous halos and black follicular keratotic plugs; it
is usually around the external genitalia or in the perianal region. In
females it is seen in older women or the very young and results in destruction
of vulvar architecture, scarring, and shrinkage of the labia with itching,
dyspareunia,
and dysuria. In males it affects the prepuce and glans penis and may result
in stricture of the external urethral meatus and phymosis.
Occasionally it may precede squamous
cell carcinoma
in females, called also atrophic leukoplakia / atrophic or leukoplakic
vulvitis / leukokraurosis / kraurosis vulvae
Breisky's disease : lichen sclerosus in women
in males, called also balanitis xerotica obliterans.
lichen corneus hypertrophicus : a papular skin eruption of thickened
and horny lesions.
mucinosis : a condition characterized by
abnormal deposits of mucopolysaccharides (mucins) in the skin. The mucinoses
have been classified as :
metabolic
myxedema, diffuse or pretibial
lichen myxedematosus / lichen fibromucinoidosus
/ papular mucinosis / papular myxedema / scleromyxedema : a condition
resembling myxedema but not associated with hypothyroidism,
characterized by a fibrocystic proliferation, increased deposition of acid
mucopolysaccharides in the skin, and the presence of a circulating paraprotein,
usually an IgG, which presents as either discrete or generalized lichenoid
papules with or without diffuse scleroderma, or as urticaria-like plaques
and nodules
secondary or catabolic (degeneration in a variety of neoplasms)
localized
follicular mucinosis
/ alopecia mucinosis : a disease of the pilosebaceous unit, presenting
clinically as grouped follicular papules or plaques with associated hair
loss, caused by mucinous infiltration of tissues, and usually involving
the scalp, face, and neck
lichen nitidus : a usually asymptomatic chronic inflammatory eruption
consisting of numerous glistening, flat-topped, discrete, smooth, commonly
skin-colored micropapules, located most often on the penis, lower abdomen,
inner thighs, flexor aspects of the wrists and forearms, breasts, and buttocks.
Widespread involvement may produce confluence of the lesions, with formation
of scaly plaques.
lichen obtusus corneus : a papular eruption of thickened, blunt
lesions; probably identical with prurigo nodularis
lichen ruber planus / lichen ruber moniliformis / morbus moniliformis
: a generalized or localized eruption presenting as either round, dome-shaped,
waxy, dark or bright red papules, or as waxy yellow, milia-like papules
with a keloidal consistency, often forming a moniliform pattern, sometimes
arranged in keloidal bands. Some authorities consider the condition to
be a variant of lichen simplex chronicus
lichen spinulosus / lichen pilaris : a cutaneous disorder seen chiefly
in children, characterized by the presence of discrete groups of minute,
filiform, horny spines protruding from acuminate follicular openings, occurring
in crops and located especially on the neck, buttocks, abdominal wall,
popliteal spaces, and extensor surfaces of the arms.
lichen striatus : a self-limited, usually unilateral eruption most
commonly seen in children, predominantly located on the extremities and
sides of the neck, and typically presenting as discrete, pink, papular
or lichenoid lesions with an inconspicuous scale that tend to coalesce
and form a continuous or interrupted linear patch.
lichen syphiliticus / follicular syphilid
: a skin lesion seen in secondary
syphilis,
consisting of groups of small follicular papules
solar or actinic keratosis (AK) / keratoma
senile / senile keratosis : a sharply outlined, red or skin-colored,
flat or elevated, verrucous or keratotic growth, which may develop into
a cutaneous horn, and may give rise to a squamous cell carcinoma; it usually
affects the middle-aged or elderly, especially those of fair complexion,
and is caused by excessive exposure to the sun.
arsenic or arsenical keratosis :
a cutaneous manifestation of chronic arsenic
poisoning, after use for medicinal purposes or other exposure, which may
occur years after arsenic ingestion, characterized by the development of
discrete hyperkeratotic papules, chiefly located on the palms and soles,
and sometimes associated with premalignant and malignant epidermal lesions
on other skin areas.
tar keratosis : a keratosis caused by
exposure to tar, in which keratotic foci develop, sometimes followed by
the formation of keratoacanthomas or intraepidermal, squamous, or basal
cell carcinoma.
keratosis
follicularis / Darier-White disease (DD) : a slowly progressive autosomal
dominant disorder of keratinization characterized by pinkish to tan or
skin-colored papules on the seborrheic areas of the body that coalesce
to form plaques, which may become crusted and secondarily infected; over
time, the lesions may become darker and may fuse to form papillomatous
and warty malodorous growths
keratosis
follicularis contagiosa / epidemic acne : a widespread, symmetrical
eruption of the skin resembling keratosis follicularis, most often involving
the back of the neck, shoulders, and extensor surfaces of the extremities,
which occurs in children, and is apparently an infectious disease
inverted follicular keratosis
: a benign, usually solitary epithelial tumor originating in a hair follicle;
it occurs as a flesh-colored papule or nodule, usually on the face, and
is characterized histologically by eddies of keratinizing squamous cells
adjoining epidermis or follicular epithelium
seborrheic keratosis or wart / verruca
seborrheica / keratosis seborrheica : a common benign, noninvasive
tumor composed of basaloid cells, usually occurring in middle life, sometimes
rapidly in crops, commonly presenting as soft, friable plaques that show
slight to marked pigmentation (flesh-colored, yellow, brown, or black wart-like)
and are most often located on the face, trunk, and extremities
dermatosis papulosa nigra :
a variant of seborrheic keratosis seen almost exclusively in blacks, characterized
by the development of small, pedunculated, pigmented papules on the malar
regions, upper cheeks, or lateral orbital areas.
stucco keratosis : a condition seen
especially in men over the age of 40 who have dry skin, characterized by
the presence of multiple superficial, gray to light brown, flat keratotic
lesions with a “stuck-on” appearance on the dorsa of the feet and hands,
ankles, instep, and forearms; thought by some authorities to be a variant
of seborrheic keratosis
Leser-Trélat sign : sudden appearance and rapid increase
in size and number of seborrheic keratoses, which may be a sign of internal
malignancy, especially of the gastrointestinal tract
keratoderma blennorrhagicum
/ keratosis blennorrhagica / palmoplantar pustulosis : a disease that
is characterized by a scaly rash especially on the palms and soles and
is associated especially with Reiter's
syndrome.
Differential diagnosis with generalized
pustular psoriasis / von Zumbusch psoriasis)
porokeratosis of Mibelli
: a rare, chronic, progressive autosomal dominant skin disorder, seen most
often in males, usually first appearing in early childhood, and characterized
clinically by the presence of crater-like patches with central atrophy
and an elevated thick keratotic border that enlarge to form circinate,
serpiginous, or gyrate lesions, and histologically by a cornoid lamella.
disseminated
superficial actinic porokeratosis : an autosomal dominant skin disorder
occurring on sun-exposed skin in individuals over 16 years of age, especially
in females, and characterized by the presence of numerous superficial,
annular, keratotic, brownish red macules, the centers of which become depressed
and the borders form a sharp ridge.
porokeratosis
palmaris et plantaris disseminata : a distinctive form of porokeratosis
inherited as an autosomal dominant trait, in which hundreds of gyrate and
annular porokeratotic plaques occur on the soles or palms or both, and
later elsewhere.
Cutaneous carcinomas have been reported in association with porokeratosis
palmoplantar keratoderma / hyperkeratosis
of the palms and soles / ichthyosis palmaris et plantaris / keratoderma
palmare et plantare / keratosis palmaris et plantaris / tylosis palmaris
et plantaris : a group of mostly inherited disorders characterized
by the excessive formation of keratin, localized or diffuse, on the palms
and soles, sometimes with painful lesions resulting from fissuring of the
skin, which may occur alone or may accompany or be part of another disorder
Aetiology :
tylosis (focal palmoplantar keratoderma)
and esophageal
squamous cell carcinoma (ESCC)
(TOC) / Clark-Howel-Evans-McConnell syndrome / palmoplantar ectodermal
dysplasia type III (Howel-Evans W., McConnell RB, Clarke CA & Sheppard
PM. Carcinoma of the esophagus with keratosis palmaris et plantaris (tylossi)
a study of 2 families. Quart.J.Med. 27:413-430 (1958))
Aetiology : LOH on chromosome 17q25-qter,
telomeric to the keratin II gene cluster
Symptoms & signs : diffuse palmoplantar
keratoderma occurring between the ages of 5 and 15 and associated with
95% malignancy risk (30% esophageal
squamous cell carcinoma (ESCC),
others leukoplakia, some bronchogenic carcinoma) later in life.
Unna-Thost syndrome / diffuse
palmoplantar keratoderma / ichthyosis palmaris et plantaris : an autosomal
dominant disorder characterized by the presence of well-demarcated, usually
bilateral and symmetrical, confluent areas of scaling on the palms and
soles, sometimes involving adjacent skin of the hands and feet, which is
usually present early but may appear later in life. Striate and punctate
variants have also been reported; the latter may be associated with focal
gingival hyperkeratosis
Meleda disease / mal de Meleda
[Meleda, a small island in the eastern Adriatic Sea, where the condition
is prevalent because of intermarriage] : a chronic, autosomal recessive
form of palmoplantar keratoderma in which the hyperkeratosis spreads to
involve the dorsal aspects of the hands and feet and other areas of the
body, with erythematous, scaling, malodorous cutaneous lesions that may
cause deep fissuring
keratoma hereditarium mutilans / progressive dystrophic hyperkeratosis
/ Vohwinkel's syndrome : an autosomal dominant, progressive, dystrophic
form of palmoplantar keratoderma, beginning in childhood, characterized
by a stellate pattern of hyperkeratosis on the backs of the hands and feet,
linear keratoses on the elbows and knees, and annular ainhum-like constriction
of the digits, and sometimes associated with scarring alopecia and deafness
Aetiology : in patients with carcinomas
of the upper respiratory and digestive tracts (UADTCs),
most often a squamous cell carcinomaref
, and rarely colon adenocarcinomaref,
acquired ichthyosis in Hodgkin's
diseaseref,
metastatic neuroendocrine tumourref,
simultaneous multiple genitourinary tumors (multifocal basal cell carcinoma,
epidermoid carcinoma of the lung, adenocarcinoma of the prostate, and possibly
undifferentiated carcinoma of the bladder)ref,
or breast cancerref,
appearing mostly at the same time as the underlying neoplasm with possible
cervical lymph node metastases.
Symptoms & signs : eczematous and
psoriasiform (erythrosquamous) lesions on the ears, nose, cheeks, palms
and soles, and knees, onychodystrophy and paronychia; the cutaneous lesions
occurring in the syndrome are non-metastatic skin involvement that parallels
(as cutaneous marker) the evolution of the malignancy. The association
of acral hyperkeratosis and malignancy was first described by Bazex in
1965 (A Bazex, R Salvador, A Dupre and B Christol, Syndrome para-néoplasique
à type d'hyperkératose des extrémités, Bull
Soc Fr Dermatol Syphiligr 72 (1965), p. 182). Bazex syndrome generally
affects men over the age of 40 years and has universally been associated
with malignancy in over 125 case reports. The most common sites of involvement
are the ears (79%), nails (75%), nose (63%), fingers (61%), hands (57%),
and feet (50%)ref.
Pruritus and pain, are not usually associated with Bazex syndromeref,
although pruritus can occur in up to 18% of casesref.
A wide range of histological findings has been described in Bazex syndrome,
including acanthosis, psoriasiform epidermal hyperplasia, hyperkeratosis,
parakeratosis, and perivascular lymphocytic infiltrate. Less common but
more specific findings include dyskeratotic keratinocytes and vacuolar
degeneration of the basal epidermal layer. More than half of acrokeratosis
paraneoplastica associated malignancies are found in the upper aerodigestive
tract (upper parts of the respiratory and gastrointestinal tracts). Regional
lymphadenopathy is often present. In nearly two-thirds of cases, cutaneous
lesions precede the symptoms or diagnosis of malignancyref.
Thus, suspicion of Bazex syndrome should include a skin biopsy followed
by a complete evaluation of the upper aerodigestive tract. If this is negative,
a search for the other malignancies reported with Bazex syndrome would
have to include screening for colon cancer, lymphoma, bladder, prostate,
uterine, vulvar, and neuroendocrine tumoursref Therapy : the skin lesions either improve
significantly (or resolved) when the underlying neoplasm is treated or
they remain unchanged in the setting of persistent disease. Occasionally,
the reappearance of skin lesions has signaled a recurrence of the tumorref.
The severity of the clinical manifestations of AP paralleled the serum
concentrations of squamous
cell carcinoma antigen (SCC-Ag),
so that an immune-mediated mechanism is suggestedref
pachyderma : abnormal thickening of the
skin and subcutaneous tissues
elephantiasis : chronic obstruction
of the lymphatics with pachyderma, usually affecting dependent areas such
as the legs, arms, or external genitalia; it is a filarial disease generally
seen in the tropics due to infection of the lymphatics with any of the
nematodes Wuchereria bancrofti, Brugia malayi, or B. timori.
It begins with lymphangitis and enlargement of the part, along with chills
and fever (elephantoid fever), followed by formation of ulcers and tubercles,
with thickening, discoloration, and fissuring of the skin
podoconiosis / nonfilarial elephantiasis
/ mossy foot : a locally endemic, noninfectious condition is caused
by the long-term exposure of susceptible persons to irritant volcanic soil.
Colloid particles are thought to be absorbed through the skin and taken
up by macrophages, leading to lymphatic fibrosis and elephantiasis. Affected
persons are typically barefoot agricultural workers in the highland tropics.
Social stigma associated with this condition is widespread; patients are
banned from schools, churches, and marriage. Economic productivity is often
impaired. Podoconiosis is preventable with fastidious shoe wearing and
foot hygiene. Treatment is limited to compression bandaging and elevationref
Therapy : salicylic acid : a keratolytic
drug (a drug that removes the outer layer of skin) that is used to treat
various skin conditions
achrochordon : soft, small, painless,
flesh-colored skin flaps connected to the body by a short stalk (skin
tags) most commonly protruding from the skin of the armpits, neck,
and groin. People who develop skin tags tend to get more as they grow older.
Skin tags can be surgically removed is a harmless
suction blister
Aetiology : Develops from infant sucking
on skin
Signs : bullous lesion (erosion or crusting
may be present) on body part accessible to infant's mouth
Therapy : topical antibiotic ointment
if signs of impetigo
pyoderma gangrenosum : a chronic
noninfectious condition that is marked by the formation of purplish nodules
and pustules which tend to coalesce and form ulcers
Therapy : infliximab 4-6 mg/kg at week 0,
2, and 8 and then every 6-8 weeks
pemphigus : disruption of desmosomes =>
loss of keratinocyte cohesions (acantholysis)
=> acanthocytes become rounded (from polyhedral) => (intra)epidermal blisters
pemphigus vegetans / benign familial
chronic pemphigus (BCPM) / Hailey-Hailey disease (HHD) : a variant
of pemphigus vulgaris. According to some authorities, there are 2 types:
benign or Hallopeau type, which has a more benign course and prognosis
Neumann type, which closely resembles pemphigus vulgaris in all
respects.
Aetiology : mutations in the ATP2C1
gene, exacerbated by superficial bacterial infection and warm weather
Symptoms & signs : large proliferating
verrucous granulations (center with moist granular tissue, border composed
of vesicles and pustules), which seemingly arise from denuded bullae, and
have a tendency to coalesce into patches in intertriginous areas
(groin, axillae), neck folds and scalp or face
Laboratory examinations : suprabasal cell
acantholysis Therapy : antimicrobials and surgical
excision of large vegetative growths
Symptoms & signs : Nikolsky's sign
(ready separation of the outer layer of the epidermis from the basal layer
with sloughing of the skin produced by minor trauma, such as by exerting
a sliding or rubbing lateral pressure on the area involved, which may occur
in pemphigus and in other conditions such as certain hereditary blistering
skin diseases, scalded skin syndrome, adult toxic epidermal necrolysis,
and thermal burns), flaccid skin bullae (easily rupture, developing
into painful erosions and crusts
Laboratory examinations : Tzanck cell
(a degenerated epithelial cell caused by acantholysis, and found especially
in pemphigus)
epidermolysis bullosa : a group
of heterogeneous, chronic, mostly hereditary, mechanobullous dermatoses.
epidermolysis bullosa hereditaria
epidermolysis bullosa
(EB) letalis / junctional epidermolysis bullosa / Herlitz-Pearson type
: an autosomal recessive disorder having onset at birth or during
the neonatal period
Aetiology : mutations in any 1 of the
3 polypeptides of laminin-5
In addition, specific mutations in the gene for CD104
/ b4 integrin have been demonstrated
in a subset of patients with junctional EB associated with pyloric atresia
Symptoms & signs : severe generalized
blistering, particularly on the perioral area, scalp, legs, diaper area,
and trunk, and extensive denudation that may be associated with secondary
infection and death from septicemia, onychodystrophy, and dental dysplasia;
growth retardation and refractory anemia are frequent findings in those
who survive. Nonscarring. On electron microscopy, a cleavage plane
between the plasma membranes of the basal cells and the basement membrane
is seen.
Therapy : gene
therapy
epidermolysis
bullosa dystrophica / dystrophic epidermolysis bullosa (DEB) / dermatolytic
bullous dermatosis : a generalized form of epidermolysis bullosa often
present at birth or in early infancy, and marked by atrophy of previously
blistered areas, severe scarring after healing, and dystrophy or
absence of the nails
autosomal dominant (relatively mild)
Pasini (albopapuloid) variant is the more severe, is usually present
at birth or in infancy, and is characterized by extensive blistering that
heals with atrophic scarring, primarily confined to skin over the
joints and extremities but sometimes generalized; spontaneous flesh-colored,
scarlike (albopapuloid) lesions on the trunk, usually appearing during
adolescence; and frequent involvement of the mucous membranes, including
the oral, esophageal, and pharyngeal mucosa
Cockayne-Touraine (dysplastic or hyperplastic) variant usually occurs
in infancy or early childhood, and is characterized by keratotic lesions
that may show ichthyotic changes, generally confined to the extremities,
which may heal with hypertrophic rather than atrophic scars
Bart's syndrome : a form of epidermolysis bullosa dystrophica inherited
as an autosomal dominant trait, characterized by congenital localized absence
of the skin with blister formation as a result of mechanical trauma and
onychodystrophy
autosomal recessive DEB (RDEB) / polydysplastic : more severe than
the dominant disorder, characterized by the presence of extensive denuded
hemorrhagic erosions and blisters on all body surfaces at birth or in early
infancy, including mucous membranes, the subsequent healing of which produces
esophageal strictures that may impair feeding and atrophic scars that may
restrict mobility owing to fusion of the digits, mitten-like deformity
of the hands and feet, and flexion contractures of joints. Patients often
develop squamous cell carcinoma.
RDEB is caused by mutations in the gene encoding the extracellular matrix
(ECM) protein collagen VII.
RDEB patients who develop cancer express an aberrant, truncated version
of collagen VII that confers tumorigenic properties to skin cells, by enhancing
their ability to invade surrounding tissue. In mice, tumor induction can
be blocked by administration of antibodies targeting this collagen fragment.
These results highlight the critical role of the ECM in tumorigenesis and
suggest that ECM proteins may be valuable therapeutic targets for certain
forms of cancerref
epidermolysis bullosa simplex
:
a dominantly inherited, relatively benign, nonscarring form
of epidermolysis bullosa, most often involving the extremities, and usually
presenting during the first few years of life; blistering may cease in
adulthood.
generalized : a form of epidermolysis bullosa simplex present at
birth or occurring in early infancy, in which the lesions, consisting of
vesicles, bullae, and milia, are usually located on areas subjected to
repeated minor trauma, such as the elbows, knees, hands, and feet.
localized / Weber-Cockayne syndrome : a form of epidermolysis bullosa
primarily confined to the hands and feet, especially the palms and soles,
appearing in infancy or later life, and often associated with hyperhidrosis.
It may be exacerbated by unusual trauma such as prolonged walking.
melanodermatitis : dermatitis associated
with an increased deposit of melanin in the skin.
omphalitis : inflammation of the umbilicus
acrodermatitis : inflammation involving
the skin of the extremities, especially the hands and feet.
acrodermatitis chronica
atrophicans : a diffuse chronic skin disease usually confined to the
extremities, occurring almost exclusively in Northern, Central, and Eastern
Europe, most often in women, and characterized initially by an erythematous,
edematous, pruritic phase followed by sclerosis and atrophy, with discoloration
and swelling progressing to a condition resembling localized
scleroderma.
It occurs after > 7 months from infection by the spirochete Borrelia
burgdorferi
and expecially by Borrelia
afzelii.
acrodermatitis enteropathica
:
a severe gastrointestinal and cutaneous disease of early childhood, due
to hypozinchemia
caused by an autosomal recessive disorder of zinc uptake or malbsorption,
and characterized by a vesiculopustulous dermatitis, preferentially located
around the body orifices and on the head, hands, and feet, with diarrhea,
true steatorrhea,
and loss of hair.
Epidemiology : children, adults (especially
common among health care workers, homemakers, janitors, mechanics, machinists
and hairdressers, but it can occur in anyone whose household chores or
hobbies involve exposure to irritating chemicals)
dermatitis hiemalis : dermatitis
coming on with cold weather
factitial dermatitis / dematitis
artefacta : various types of self-inflicted lesions, usually produced
by mechanical means, burning, or application of chemical irritants or caustics
copra itch : a dermatitis affecting those who unload coconuts, caused
by the mite Tyrophagus
castellani
grain itch/ acarodermatitis
urticarioides / prairie itch / straw itch : a self-limited, wheal-like,
pruritic eruption caused by the mite Pyemotes
ventricosus, which parasitizes the larvae of various insects that infest
straw, grain, and other plants, and affecting those coming in contact with
host plants.
irritant diaper dermatitis
/ ammonia dermatitis / napkin dermatitis / Jacquet's dermatitis caused
by prolonged contact with the natural chemicals found in urine and stool
in children
Prevention : change your baby's diaper
frequently, cleanse the soiled area with warm water and a soft cloth, and
apply a protective coat of zinc oxide ointment.
mouth dermatitis caused by prolonged
contact with dribbles of baby food or drools of saliva in children
insect dermatitis : a transient
localized or widespread dermatitis caused by the toxin-containing irritant
hairs of certain insects, especially moths and their caterpillars, which
may be associated with severe conjunctivitis, pruritus, a burning sensation,
and pain; clinical manifestations vary according to the species involved
and the intensity of exposure.
brown-tail moth dermatitis / brown-tail rash : a type of insect
dermatitis produced by the hairs of the brown-tail moth, Euproctis chrysorrhoea
caterpillar dermatitis or rash
:
insect dermatitis caused by caterpillar hairs
moth dermatitis : insect dermatitis
caused by moth hairs.
dermatitis calorica / erythema ab
igne : inflammation of the skin due to heat or cold
onion mite dermatitis : dermatitis
affecting handlers of decaying onions, caused by the onion mite, Acarus
rhyzoglypticus hyacinthi.
garlic, with the rare variant of zosteriform dermatitisref
Symptoms : erythema => oedema => blister =>
ulcers => scaling and fissures in thin skin regions (eyelids, intertriginous
areas) usually rather quickly after the skin is exposed to a harmful chemical
Therapy : glucocorticoids, nonirritating
moisturizer to help restore the normal texture of the skin (ointment or
cream that contains few potential allergens : petroleum jelly, Vanicream,
Cetaphil, Eucerin, oatmeal baths (Aveeno))
x-ray dermatitis /
radiodermatitis from exposure to biologically effective levels of ionizing
radiation.
roentgen keratosis : premalignant keratotic lesions occurring at
the site of severe chronic radiodermatitis
photodermatitis : an abnormal state
of the skin in which light is an important causative factor
phototoxic dermatitis : an exaggerated
sunburn-like reaction, sometimes with vesiculation, resulting in hyperpigmentation
and desquamation, which occurs on the light-exposed areas of the skin as
the cutaneous manifestation of phototoxicity.
phytophotodermatitis / phytophototoxic
dermatitis : phototoxic dermatitis induced by the sequential exposure
to certain plants containing psoralen-type photosensitizers and then to
sunlight. It is manifested by burning erythema, followed by edema and the
development of small vesicles that coalesce into large bullae, and this
is followed by intense residual hyperpigmentation in the areas of the skin
that come in contact with the psoralen photosensitizer.
berlock dermatitis / berloque
dermatitis / perfume dermatitis : phytophotodermatitis due to sequential
exposure to cologne, perfume, or other toilet articles containing bergamot
oil
and then to sunlight. In women, the lesions usually present as brown pigmented
patches on the sides of the neck, behind the ears, and sometimes on the
face, breasts, shoulders, or elsewhere. Aftershave lotion containing bergamot
oil or a related substance may cause a similar reaction in men
dermatitis bullosa
striata pratensis / grass disease / meadow disease / meadow-grass disease
:
phytophotodermatitis manifested as a bizarrely arranged linear or streaky
eruption of vesicles and bullae that heal with intense residual melanoderma,
caused by contact with meadow grass, usually Agrimonia eupatoria,
and then exposure to sunlight
fagopyrism : photosensitization in humans
or animals that eat excessive amounts of buckwheat (Fagopyrum esculentum).
Fagopyrum
is a genus of herbs of the family Polygonaceae, native to temperate regions
of Europe and Asia
polymorphous light eruption
: a cutaneous eruption occurring after exposure to sunlight without evidence
of any other precipitating factor, which may consist of papular, papulovesicular,
nodular, eczematoid, or plaquelike lesions.
vacciniform hydroa / hydroa vacciniforme
or estivale / summer prurigo of Hutchinson : a vesicular and bullous
eruption, which may be preceded by pruritus and burning sensation, having
a tendency to recur each summer during childhood on sun-exposed areas of
the skin; the lesions dry up with the formation of brown adherent crusts,
and each lesion is surrounded by an erythematous zone, giving the appearance
of a vaccination vesicle
actinic reticuloid : chronic photodermatitis
with sensitivity to a broad spectrum of radiation, usually occurring in
older men; it first occurs on sun-exposed areas as a scaly pruritic erythema,
often spreading and leading to thick plaques, furrows, and leonine facies.
Lesions are characterized histologically by a polymorphous dermal infiltrate
that resembles lymphoma.
livedoid dermatitis : a condition
due to temporary or prolonged local ischemia resulting from vasculitis
or accidental arterial obliteration from intragluteal administration of
medications, marked by severe local pain, swelling, livedoid changes, and
local increase in temperature; fever, tachycardia, dyspnea, and albuminuria
also occur, and gangrene may supervene
infectious dermatitis from
dermatotropic / dermotropic microorganisms => skin and soft tissue
infections (SSTI)
id reaction : a sterile secondary skin
eruption occurring somewhere else on the body in sensitized patients as
a result of circulation of allergenic products from a primary site of infection;
the morphology and site of the lesion vary.
Gilbert's pityriasis rosea (PR) :
first named as such in 1860, a common acute or subacute, self-limited exanthematous
disease of unknown etiology, the onset of which is marked by the presence
of a solitary erythematous or salmon- or fawn-colored herald plaque, most
often seen on the trunk, arms, or thighs, followed by the development of
papular or macular lesions, similar to but smaller than the initial lesion,
which have vesicular borders subsequently that tend to peel and produce
a scaly collarette.
Aetiology : the distinctly programmed
clinical course, the lack of recurrence for most patients, and the presence
of temporal case clustering provide the strongest evidence to support an
infectious aetiology. Further support comes from seasonal variation and
the association with respiratory tract infections, the unfavourable social
and economic background of cases, and a history in some cases of contact
with patients with pityriasis rosea. The apparent therapeutic efficacy
of several treatment modalities does not provide strong evidence for or
against an infectious aetiology. The roles of HHV-7
and to a lesser extent HHV-6
remain controversial. There exists reasonable evidence that pityriasis
rosea is not associated with HHV-5
/ CMV,
HHV-4
/ EBV,
parvovirus
B19,
picornavirus, influenza and parainfluenza viruses, Legionella spp.,
Mycoplasma
spp. and Chlamydia spp. infections. Evidence is also unsubstantiated
as yet for alternative aetiological hypotheses such as autoimmunityref,
atopy, and genetic predispositionref
Neither HHV-7 nor parvovirus B19 infect skin cells, but both
can be detected in the infiltrating lymphocytes of skin eruptions, in which
they induce an altered mediator production, that might be responsible for
the general and local symptomsref.
Symptoms & signs : crops of monomorphous,
usually nonpruritic, dusky or coppery red, flat-topped, firm papules forming
a symmetrical eruption on the face, buttocks, and limbs, including the
palms and soles, and associated with malaise, low-grade fever, and few
other constitutional symptoms
Prognosis : generally benign and self-limited
Aetiology : orf
virus Symptoms & signs : single or small
number of painless pustules on a finger, arm, or face. Occasionally, several
bumpy lesions are present, each measuring up to 3 cm. in diameter, persisting
for 3-6 weeks, and regressing spontaneously. Progression to generalized
disease is considered rare: if lesions become disseminated, systematic
symptoms such as lymphadenitis
and fever
may occur
Transmission : HFMD is moderately contagious.
Infection is spread from person to person by direct contact with nose and
throat discharges, saliva, fluid from blisters, or the stool of infected
persons. A person is most contagious during the 1st week of the illness.
HFMD is not transmitted to or from pets or other animals.
Symptoms & signs : HFMD begins with
a mild fever, poor appetite, malaise ("feeling sick"), and frequently a
sore throat. One or 2 days after the fever begins, painful sores develop
in the mouth. They begin as small red spots that blister and then often
become ulcers. They are usually located on the tongue, gums, and inside
of the cheeks. The skin rash develops over 1 to 2 days with flat or raised
red spots, some with blisters. The rash does not itch, and it is usually
located on the palms of the hands and soles of the feet. It may also appear
on the buttocks. A person with HFMD may have only the rash or the mouth
ulcersref.
Prognosis : HFMD usually is not serious.
HFMD caused by Human
coxsackievirus A16
infection is a mild disease, and nearly all patients recover without medical
treatment in 7 to 10 days. Complications are uncommon. Rarely, the patient
with coxsackievirus A16 infection may also develop "aseptic" or viral meningitis,
in which the person has fever, headache, stiff neck, or back pain, and
may need to be hospitalized for a few days. Another cause of HFMD, Human
enterovirus 71 (EV71)
may also cause viral meningitis and, rarely, more serious diseases, such
as encephalitis, or a poliomyelitis-like paralysis. EV71 encephalitis may
be fatal. Cases of fatal encephalitis occurred during outbreaks of HFMD
in Malaysia in 1997 and in Taiwan in 1998
Aetiology : molluscum
contagiosum virus Signs : after 14-50 days incubation =>
painless, wart-like, pearly, flesh colored, raised nodules with Ø
= 2-5 mm consisting of hypertrophied epidermal and dermal cells (anywhere
on the body, but rarely occur on the palms or soles). At the top of each
lesion, there is usually an opening through which a distinctive small,
white cone can be seen. The disease is chronic, with lesions persisting
for months and, in some cases, years. Lesions in children tend to disappear
as they grow older. Recovery usually occurs spontaneously, or following
bacterial infection, which triggers otherwise very little inflammatory
reaction. However, recurrences may occur rather frequently due to little
immunity. In patients with CMI deficiencies (e.g. patients with AIDS),
lesions are generalized and may appear in the anogenital area and on the
head and neck.
Laboratory examinations : tiny pearl-like
projections with a core of white matter, acanthosis
which grows into the dermis to form multiple lobule, intracytoplasmic inclusion
bodies which are eosinophilic at the base but become more basophilic at
the superficial layer, central crater into which the inclusion bodies discharge
their content
Treatment : ablation by cryotherapy or
surgery
wart / verruca (differential diagnosis with verrucous
/ wart-like lesions)
mule-spinners' disease : warts or ulcers of the skin, especially
of the scrotum, which tend to become malignant (mule-spinners' cancer);
so called because they were found chiefly among the operators of spinning
mules in cotton mills.
verruca vulgaris / common
wart (70% of all cutaneous warts)
Epidemiology : up to 20% of school aged
children
Aetiology :
Symptoms & signs : hard, rough surfaced
papule 0.2 - 2 cm (solitary or multiple) on periungual region of the fingers
consisting of exophytic, symmetric, papillomatous lesion with large keratohyaline
granules and characteristic inturning of the rete ridges. Their surface
interrupts skin lines. Parakeratotic columnar
tiers of stratum corneum overlie the papillomatous surface. Small amounts
of haemorrhage may be present within the columns of parakeratosis.
Other characteristic features include koilocytosis (koilocytes are not
seen in older lesions), hypergranulosis and presence of multinucleated
cells. Usually multiple, and are most often seen on the hands and
feet of children, sites of trauma, but also affect the face and genitalia.
Types :
Epidemiology : older children and young adults’
feet
Pathogenesis : pressure causes them to
grow into the dermis.
Symptoms & signs : symmetric and endophytic
lesions found over pressure points of the heel or metatarsal heads characterised
by epidermal hyperplasia and presence of large intracytoplasmic,
keratohyaline granules in the superficial keratinocytes. They are painful
and covered by callus / tyloma / keratoma, which when pared, reveals
the dark punctate spots of thrombosed capillaries. Mosaic
warts are plaques on the soles, which comprise multiple individual
warts.
Image links : 1
verruca plana / plane wart
/ flat wart (4% of all cutaneous warts)
Epidemiology : both children and adults
Aetiology :
Symptoms & signs : multiple smooth-flat
topped to slightly papular lesions, often slightly brown in color, and
commonest on the face, neck and dorsal aspects of the hands. Microscopically
these are symmetric lesions with slightly hyperplastic epidermis. Verrucous
changes and parakeratosis are minimal. There
is vacuolation of cells in the upper epidermis and basket weave pattern
is noted in the overlying stratum corneum. Plane warts are usually multiple,
resist treatment, but eventually resolve spontaneously often after becoming
inflamed. They can show the Koebner isomorphic phenomenon.
Image links : 1
extrinsic : familial occurrence, parental consanguinity, and mental retardation
are often associated with the disorder; direct contact with abrasions of
patients infected with ...
autosomal recessive hereditary cell-mediated immunodeficiency (=> difficult
development of vaccines) : large proportions of people with the disease
are descendants of consanguineous marriages
Symptoms & signs : the widespread and
persistent, sometimes for decades, dissemination of verruca
plana associated with a tendency to malignant degeneration. It typically
begins in early childhood with the development of flat-topped papules,
varying in color from pink and flesh to gray or brown, which increase in
number and coalesce to form large plaques, especially on the knees, elbows,
and trunk.
flat papular warts / verruca plana : incubation period of up to
2 years, can regress and recur spontaneously
reddish-brownish macular scaly patches
Microscopically, some lesions are similar to plane warts where as others
resemble seborrheic keratosis. These
lesions display epidermal thickening with swollen cells in the upper epidermis.
There are nests of large cells with prominent perinuclear halo and clear
cytoplasm. Both basket weave orthokeratosis and parakeratosis
may be present. Epidermal cells may show dysplastic changes.
Prognosis : life-long disease; malignant
transformation to squamous
cell carcinoma (SCC) occurs in immunocompromised patients (25-30%
of patients with EV), expecially from HPV-5
and HPV-8.
Malignancies are most likely to develop in sun-exposed and traumatised
area.
Epidemiology : peak incidence is in children
between the ages of 10 and 14 years of age
Therapy : in most
people skin warts regress spontaneously, otherwise ...
acids
for small lesions : collodion of salicylic acid and lactic acid
for large lesions : 40% salicylic acid plaster for 1 week; then collodion
of salicylic acid and lactic acid
chemical peels with trichloroacetic acid (TCA) burns the
outer layer of the skin, which peels off, causing new, smoother skin to
regenerate. The skin has a scab for about 10 days and is pink for about
3 months. The patient may be left with small scars, and the skin will be
permanently lighter and more susceptible to sunburn. Chemical peels can
cause blotchy skin in people with darker skin
freezing
cryotherapy : liquid nitrogen freeze via spray gun or cotton-tipped
applicator at 196°C (320.8°F) causing the tissue to form
a blister. As the blister heals, unwanted surface cells are shed.
cryogun with nitrous oxide tank freeze at 89°C (128.2°F)
aerosol spray with adapter freeze (e.g., Verruca-Freeze) at 70°C
(94°F)
cryosurgery : liquid nitrogen freezing of wart and 1-2 mm of surrounding
normal tissue for approximately 30 seconds. Freezing kills infected
tissue but not HPV. Usually, cryosurgery is repeated every 4 weeks until
warts disappear. Procedure is painful. This technique is used to treat
some skin cancers, and results in tissue destruction and wound healing
with minimal scarring.
burning
electro-dessication / electrosurgery with electrocautery
: more effective than cryosurgery, but has a greater chance of scarring.
EMLA cream used as anesthetic for flat warts, lidocaine injections for
thicker warts (verruca
plantaris)
loop electrosurgical excision procedure (LEEP) : effective for single,
nonplantar, verruca vulgaris:
curettage after freon freezing
CO2LASER
surgery : indicated for recalcitrant warts.
hyperthermia for verruca
plantaris : hot water (113°F) immersion for ½ to ¾
hour 2-3x/week for 16 treatments.
biofeedback-assisted
hypnotherapyref
using the Simonton visualization techniqueref,
self-hypnosisref.
Published, controlled studies of the use of hypnosis to cure warts are
confined to using direct suggestion in hypnosis (DSIH), with cure
rates of 27-55% (higher in prepubertal children, lower in adults : clinically,
80% of adults who fail to respond to DSIH will heal with individual hypnoanalytic
techniques that cannot be tested against controlsref)
bacterial dermatitis
erysipelas : an acute superficial form
of cellulitis involving the dermal lymphatics, chiefly characterized by
a peripherally spreading hot, bright red, edematous, brawny, infiltrated,
and sharply circumscribed plaque with a raised indurated border. Formerly
called St. Anthony's fire.
Symptoms & signs : shiny, red macule,
vesicles, and lymphadenopathy in armpits, legs, or face
erythrasma : a chronic, superficial bacterial
infection of the skin involving the body folds and toe webs, sometimes
becoming generalized, caused by Corynebacterium
minutissimum,
and characterized by the presence of sharply demarcated, dry, pink to brown,
slightly scaly, and slowly spreading brown patches.
impetigo (contagiosa) / pyoderma
Epidemiology : most commonly seen in preschool
children
Risk factors : minor skin trauma (e.g. abrasions), hot, humid weather,
poor hygiene,
comorbid conditions, malnutrition, atopic
dermatitis (AD) / type I hypersensitivity
Fox' streptococcal impetigo
Aetiology : Streptococcus
pyogenes Symptoms & signs : regional lymphadenopathy,
onset with 2 mm vesicles (erythematous margin) in face and other exposed
areas => erosion with honey colored crust
ecthyma
Aetiology : Staphylococcus
aureus Symptoms & signs : an ulcerative pyoderma
at the site of minor trauma, predominantly involving the shins and dorsal
feet, and generally healing with variable scar formation.
staphylococcal impetigo
Aetiology : Staphylococcus
aureus Symptoms & signs : beginning on nose
and mouth, minimal surrounding erythema, lesion more shallow
bullous impetigo (10%)
Aetiology : Staphylococcus
aureus
phage group 2
Symptoms & signs : 1-2 cm bullae on
face, neck and extremities => thin serous crust and small rim of blister
roof at edge of lesion
Aetiology : Streptococcus
pyogenes
type 4 and 22
Symptoms & signs : maculopapular
exanthema on elbows and knees (yellow appearance after pressure), but
not on perioral skin. Petechiae are due to lesions in small vessels (Rumpel-Leede
sign appears positive). Borsieri's sign or line : when the fingernail
is drawn along the skin in early stages of scarlet fever, a white line
is left which quickly turns red.
Filatov-Dukes disease
/ scarlatinella : a mild febrile disease of childhood characterized
by a bright rosy red, generalized exanthematous eruption, probably a viral
exanthem of the Coxsackie-ECHO group; it was given the ordinal designation
fourth disease to differentiate it from other exanthems
ecthyma gangrenosum / gangrenous ecthyma
:
a condition most often seen in debilitated patients in association with
septicemia caused by gram negative organisms
Aetiology : Dermatophilus
congolensis Symptoms & signs : nonpainful pustules
on the hands and arms that later break down, forming shallow red ulcers
that heal to leave scars
perianal streptococcal
dermatitis or cellulitis
Epidemiology : children ages 6 months
to 10 years
Aetiology : Streptococcus
pyogenes
(pharyngeal carrier or streptococcal
impetigo)
Symptoms & signs : painful defecation,
melena associated with anal fissures, perianal pruritus,
bright red, sharply demarcated perianal rash (local spread to genitalia
may occur), yellow crust or mucoid discharge may be present.
bacterid : an id reaction
associated with a bacterial infection.
pustular bacterid : a chronic relapsing
cutaneous eruption consisting of vesicles or pustules frequently localized
to the palms and soles, which generally occurs in association with a focal
infection elsewhere in the body
tuberculid : recurrent eruptions of the
skin usually characterized by spontaneous involution. Some believe tuberculids
to occur as local hyperergic reactions to mycobacteria or their antigens
that are spread hematogenously to the skin from foci of active tuberculosis
(an id reaction), while others believe that
the lesions are unrelated to tuberculosis. Considered to comprise :
lichen scrofulosorum or scrofulosus
/ tuberculosis cutis lichenoides / tuberculosis lichenoides : a form
of tuberculid manifested as an eruption of clusters of lichenoid papules
on the trunk of children with tuberculous disease
papulonecrotic tuberculid /
acne scrofulosorum / papulonecrotic tuberculosis : a grouped symmetric
eruption of symptomless papules appearing in successive crops and healing
spontaneously with superficially depressed scars, which occur chiefly on
the extensor surface of the extremities in infants, children, and young
adults
lupus miliaris disseminatus faciei : a papular eruption involving
the central part of the face of adults that heals spontaneously with scarring.
It has been variously considered to be a tuberculid, as a variant of granulomatous
rosacea, and as a papular eruption of unknown etiology.
micronodular tuberculid / granulomatous rosacea / rosacea-like tuberculid
/ lupoid rosacea / micronodular tuberculid : rosacea
in which discrete papules occur on the medial and lateral facial areas
of the face as well as periorally; on diascopy the lesions appear as yellowish
brown nodules, and as noncaseating epithelioid cell granulomas histologically
cutaneous tuberculosis / tuberculoderma
/ tuberculosis cutis : tuberculosis of the skin
Aetiology : exogenous (e.g., autoinoculation)
or endogenous (e.g., by extension of an existing infection) infection or
by lymphatic or hematogenous spread of infection by Mycobacterium
tuberculosis Symptoms & signs :
tuberculosis cutis orificialis / orificial tuberculosis / tuberculosis
ulcerosa : tuberculous infection of the mucosal orifices and adjacent
skin (nose, mouth and tongue, anus, vulva, penis), usually either by direct
hematogenous or lymphatic extension of infection from an internal organ
or by inoculation; characteristics include nodules that break down to form
painful, shallow oval ulcers with undermined bluish edges. It generally
occurs as a manifestation of advanced systemic disease in middle-aged and
elderly males
tuberculosis verrucosa cutis / anatomical tubercle or wart, necrogenic,
postmortem, prosector's, or tuberculous wart, verruca necrogenica, and
warty tuberculosis : a tuberculous warty granulomatous lesion acquired
accidentally by inoculation, from an infected source, of an individual
having a certain degree of immunity or tuberculin sensitivity owing to
previous infection or contact with Mycobacterium spp., and occurring
often as a result of occupational inoculation (e.g., in pathologists, surgeons,
postmortem attendants, or farmers) or as a consequence of autoinoculation
or of superinfection from contact with tuberculous sputum
scrofuloderma / tuberculosis colliquativa
cutis : a tuberculous or nontuberculous mycobacterial infection affecting
children and young adults, representing direct extension of tuberculosis
into the skin from underlying structures such as lymph nodes (especially
the cervical), bone or lung or by contact exposure to tuberculosis. It
is manifested by the development of painless subcutaneous swellings that
evolve into cold abscesses, multiple ulcers, and draining sinus tracts.
primary inoculation tuberculosis / primary inoculation complex and primary
tuberculous complex : the cutaneous reaction at the site of inoculation
of tubercle bacilli in individuals with no previous exposure to Mycobacterium
tuberculosis, associated with prominent involvement of regional lymph
nodes, and manifested by a chancriform (tuberculous chancre, the
most common manifestation), impetiginous, or ecthymatous lesion
tubercular lupus / lupus
vulgaris : the most common, severe, and variable, but rare, form of
tuberculosis of the skin, consisting of tuberculomas usually of
the face, especially the nasal, buccal, and conjunctival mucosa, predominantly
in women
lupus agminatus : appearance in normal-appearing skin of a reddish
brown plaque with deeply embedded peripheral nodules, characterized by
extensive atrophy and progressive destruction of cartilage in involved
sites, resulting in disfiguring scars, keloids, lymphedema, and functional
impairment from contractures. The lesions may also present in other morphological
forms
lupus exedens : ulcers and the resulting scar are slight
lupus son-exedens : the ulcerative process is deep and extensive,
destroying a large portion of the nose or cheek, and leaving much disfigurement
=> parrot beaked nose
lupus hypertrophicus : lesions consist of a warty vegetative growth,
often crusted or slightly exudative, usually occurring on moist areas near
body orifices
lupus tumidus / cicatricial lupus : a variant of lupus vulgaris
in which the lesions consist of localized, soft edematous patches somewhat
resembling keloids
Laboratory examinations : apple jelly nodules
(minute translucent nodules of a distinctive yellowish or reddish brown
color, visible on diascopic examination of the lesions of lupus vulgaris.
tuberculosis miliaris
disseminata / tjuberculosis cutis miliaris disseminata : a severe form
of acute miliary tuberculosis
involving the skin, seen especially in children, occurring as a generalized
cutaneous eruption of brownish, acuminate papules that become necrotic,
and may form minute circular ulcers with red borders and pale granulating
bases covered by a seropurulent exudate. It may occur in immunocompromised
patients, or following an exanthematous disease or some other type of serious
infection
Aetiology : Mycobacterium
leprae Symptoms & signs : one or few well-circumscribed
maculae on the back or distal limbs, which are self-limiting in 75% of
people. In the remaining 25%, leprosy may have one of the following clinical
manifestations, which if untreated tend to evolve from the less severe
to the more severe ones :
paucibacillar forms
tuberculoid or maculoanaesthetic polar leprosy (TT) : Th1
polarization => type IV hypersensitivity => granulomas (lepromas
: thanks to high PO2 macrophages don't undergo formation
of giant cells or caseous necrosis) that damage hair follicles (=> hairless
skin) and sensitive terminal fibers (=> local anaesthesia => casual amputations
of fingers and toes). Regional neuritis due to infection of Schwann
cells and Tc-mediated killing : flaccid paralysis =>
muscular atrophy (loss of facial mimicry, lagophthalmus,
ectropion
=> corneal ulcers,
..). CMI is uneffective against Mycobacteria-infected cells due
to lack of IL-2 production by Th1
cells (substitutive chemotherapy has many side effects) ; low Ig titres
lepromatous indeterminate or subpolar leprosy (LLs)
lepromatous polar or lepromatous lepromatous (LLp) leprosy in individuals
with TNF-a-308
polymorphism : anti-CD2 autoAb and cross-reactivity between bacterial hsp65
and HLA-DR => CMID ; hsp65 is also cross-reactive against lactoferrin;
type IV hypersensitivity => erythema
nodosum
leprosum (ENL) (a recurrent lepra reaction resembling an Arthus
reaction,
occurring during chemotherapy for lepromatous leprosy, sometimes in the
borderline form, and occasionally spontaneously, usually characterized
histologically by vasculitis and clinically by the appearance of crops
of small erythematous, tender cutaneous nodules or plaques, which are widely
distributed, especially on the extremities and face; it may be associated
with severe systemic symptoms and visceral manifestations) or its variant Lucio's
phenomenon / erythema necroticum (a local exacerbation reaction occurring
in diffuse lepromatous leprosy, characterized histologically by ischemic
necrosis of the epidermis as a result of necrotizing vasculitis of small
blood vessels of the subpapillary plexus, and clinically by the eruption
of crops of small erythematous lesions with central necrosis; the eschar
may be shed, revealing ulceration, with eventual scar formation), arthritis,
glomerulonephritis.
HLA-DQ-restricted CD8+ CTLs, but CMI is uneffective due to lack
of IL-2R on Tc
and lack of IL-12 production by macrophages.
Macrophages become foaming due to accumulation of mycobacterial lipids
(Virchow cells) and are uneffective in creating lepromas => skin
folds (when on face : leonine
facies / facies leontina),
coryza, epistaxis, perforation of nasal septum, gynecomastia.Th2
polarization, leproma ulcerations and casual body injuries allow superinfections
and dissequestration of cryptic Ags => high Ig titres. Hematogenous dissemination
cause MOFs.
cutaneous malacoplakia
is rareref
and should be considered in the differential diagnosis of nodules or draining
ulcers
Aeromonas hydrophila
in mud football players : the pitch was prepared by flooding it for a month
with water from a nearby stagnant river. Letting the water stand stagnant
helped bacteria to flourish. And stones on the pitch left many players
with cuts that let in
another outbreak of pustular dermatitis in college students after a mud-wrestling
event was reported at the University of Washington, Seattle, in 1993 :
wrestlers developed pustules through exposure to bacteria from the family
Enterobacteriaceaeref.
Increased time spent wrestling was associated with increased risk. Skin
trauma during wrestling or immersion in the mud increased the risk of infection
Fresh water is the key to safer mud : mud should be prepared using treated
water, or at least water from flowing rivers, to minimize microbial contamination.
Natural mud caused by rain is usually okay too. The best strategy, however,
could be to abstain from mud sports entirely. However, if they are to be
conducted, appropriate strategies to prevent wound infections should be
adopted : safety measures could include removing abrasive material from
the pitch, watering the playing surface closer to the event, instead of
weeks in advance and providing warm showers and disinfectant after the
game, the researchers recommend
Symptoms & signs : fever, fluctuance
(indication of the presence of pus : sometimes the pus leaks out and the
lesion drains, but other times the pus is prevented from draining. The
skin overlying the pus remains red, but touching this area produces a soft,
boggy feel. Often fluctuance is surrounded by induration making it even
more noticeable. In general, lesions that are fluctuant need to be incised
and drained (I&D), because the chemical reactions in the pus prevent
antibiotics from penetrating well into the surrounding tissues)
Therapy : warm soaks are often
used to help treat infections. They are especially useful to promote drainage
if there is pus involved. They also help reduce pain associated with infection
or inflammation. The affected area should be soaked in warm water for no
longer than 10 minutes at a time. This can be repeated as often as needed
- usually 3 to 5 times a day. Care must be taken to make sure the water
used is not hot enough to cause a burn.
stratum corneum of the skin : superficial mycosis / dermatophytosis
/ epidermophytosis / epidermomycosis
dermatophyte : any of a group of imperfect
fungi parasitic on keratinized tissue (skin, nails, or hair) of humans
(anthropophilic) or other animals (zoophilic); some usually
found in soil (geophilic) will infect patients who are weak or immunocompromised.
The 3 most common infecting genera are :
Microsporum spp.
Epidermophyton spp.
Trichophyton spp.
tinea faciei
tinea manuum / hand ringworm
tinea corporis / ringworm of the body /
tinea circinata / tinea glabrosa :tinea involving glabrous
skin areas other than hands and feet
Symptoms & signs : one or more well-demarcated
erythematous, scaly macules with raised borders and central healing, producing
annular outlines. Other types of lesions include vesicular, eczematous,
psoriasiform, verrucous, plaquelike, and deep types
Therapy : itraconazole
200 mg/die
tinea cruris / groin ringworm / jock itch
/ Dhobie itch : itchy, red, moist, well-marked patches. It affects
more men than women
tinea pedis / ringworm of foot / dermatophytosis
of foot / athlete's foot due to tinea
Symptoms & signs : painless (eventually
pruritic), maleodorant, eventually overinfected with gram-negative bacteria
(Pseudomonas spp.)
Moccasin foot : cutis lignea like a
moccasin
Hong Kong foot : an infectious mycotic
disease (dermatophytosis) of the foot occurring in China.
also in cellular layers of the skin : ring-shaped, red, scaly, or blistery
patches
erosio interdigitalis
blastomycetica : candidal intertrigo manifested by an area of macerated
white skin in the interdigital webs between and extending onto the sides
of the fingers, and particularly involving the webs between the third and
fourth fingers of those whose hands are frequently or continually immersed
in water such as domestic, laundry, and cannery workers, bartenders, and
dishwashers.
Aetiology : Malassezia
furfur Pathogenesis : azelaic acid damages
keratinocytes
Symptoms & signs : white or light
brown scaly patches on superficial skin on the neck and torso of young
adults, enhanced by exposure to sunlight (hence unproperly named sea or
beach fungus)
Laboratory examinations : green fluorescence
under Wood lamp
seborrheic dermatitis / seborrhea
is a chronic disorder in which inflammation occurs in those skin areas
having the greatest numbers of oil glands, such as the scalp (dandruff),
sides of the nose, eyebrows, eyelids, skin behind the ears, and middle
of the chest. The skin becomes red and covered by a yellowish scale, and
it may or may not be itchy.
tetter : a once popular name for various eczematous skin diseases.
milky tetter / crusta lactea / cradle cap : seborrhea of the scalp
of nursing infants
... overgrowth in areas of the body that have skin touching skin such as
the armpits, groin (Candida
diaper dermatitis / monilial rash), and under heavy breasts or fat
folds, where the environment is warm and moist.
Symptoms & signs : intensely red,
moist rash with scaling on the edges. Satellite lesions, small areas of
the same rash that are close to the main rash, are characteristic of intertrigo
and other Candida skin infections.
Therapy : clotrimazole and miconazole,
keeping the skin folds as dry as possible. A drying solution such as Burow's
compresses can be applied to the skin folds for 20-30' several times a
day to promote drying.
chronic mucocutaneous
candidiasis : any of a diverse group of papulo-pustular candidal infections
of the oral mucosa, skin, nails, and vaginal mucosa; they are usually resistant
to treatment, may be localized or diffuse, are sometimes familial, and
may be associated with endocrinopathy or immunosuppression (APECED
/ APS1)
chronic
subcutaneous lymphatic sporotrichosis
Aetiology : Sporothrix
schenckii Symptoms & signs : nodular lesions
of the cutaneous and subcutaneous tissues and adjacent lymphatics that
suppurate (pustule) and ulcerate. It is acquired by fungal implantation
into the skin by trauma or through an abrasion
dermatophytid /
epidermophytid / mycid
trichophytid : a dermatophytid associated
with trichophytosis; applied especially to allergic manifestations of any
ringworm infection
Aetiology : an id reaction
associated with a dermatophytosis
Symptoms & signs : itchy, vesicular
rash occurring on the hands, wrists, and sides of the fingers in association
with tinea pedis.
Therapy : treating the fungal infection
makes the rash on the finger go away.
Pathogenesis : infection starting from a locus
minoris resistentiae
Laboratory examinations :
dermatozoonosis / dermatozoiasis from
ectoparasites / dermatozoon
coast erysipelas : a cutaneous manifestation
of onchocerciasis
seen in Central America, so called because of its resemblance to streptococcal
erysipelas, characterized by an erythematous macular rash and edema
of the face; in chronic cases the skin loses its elasticity, atrophies,
becomes wrinkled, and causes leonine
facies / facies leontina.
creeping disease : a condition marked by cutaneous lesions similar
to those seen in larva migrans, but produced by nematodes of the genus
Gnathostoma, expecially Gnathostoma
spinigerum
Symptoms & signs : subcutaneous migrating
larvae; if it invades lymph vessels it may cause lymphedema
Dermatophagoides scheremetewskyiattacks humans and causes
a mangelike inflammation
scabies / seven-year itch
Norwegian scabies / crusted scabies : a rare, severe form with an
unusually heavy, very contagious mite infestation, seen especially in senile,
mentally retarded, or immunocompromised patients, those with poor sensation
(lack of pruritus), or those with severe systemic disease, thought to represent
an abnormal host immune response to the mites. It is characterized by crusting
dermatitis of the hands and feet with subungual horny debris, erythematous
scaling plaques on the neck, scalp, and trunk that may become generalized,
and usually lymphadenopathy and eosinophilia
Aetiology : the egg-laying female mite of
Sarcoptes
scabiei
digs into the upper layer of the epidermis and makes raised sinuous burrows
(cuniculi)
Symptoms & signs : papular eruption
accompanied by intense pruritus during bedtime sometimes associated with
eczema from scratching and secondary bacterial infection (impetigo)
Therapy : benzoyl benzoate, potassium
polysulfate, lindane. Hypergic lesions remain after eradication can be
cured with GR
agonists.
Signs : burrow
(narrow, elevated channel made by a parasite), perlaceous vesicle
dermatitis gangrenosa infantum
:
a gangrenous disease occurring as a primary condition or secondarily to
varicella or another exanthematous disease, chiefly in children under the
age of 3, in which multiple small erosive and pustular lesions coalesce
to form extensive sloughs, usually over the lower back and buttocks
infectious eczematous
dermatitis : a condition arising from a primary lesion that is the
source of an infectious exudate (e.g., a boil, surgical wound, draining
ear or nose), spreads by autoinoculation, and has a tendency to the formation
of circumscribed eczematous plaques that enlarge gradually, and in which
vesicles and pustules may occur
Signs : induration(red,
inflamed, thickened, and tender skin : the swelling and thickening of the
skin are a result of the infectious process and the skin's response to
fighting off the infection)
perioral dermatitis : a papular
eruption of unknown etiology that progresses to residual papular erythema
and scaling usually confined to the area about the mouth, and almost exclusively
occurring in young women; it may also be localized or extend to involve
the eyelids and adjacent glabella area of the forehead (periocular dermatitis)
pigmented purpuric
lichenoid dermatitis / Gougerot-Blum syndrome : a purpuric cutaneous
eruption usually seen in men 40–60 years of age, occurring chiefly on the
legs, thighs, and lower trunk, and characterized by the presence of minute,
rust-colored, lichenoid papules that tend to fuse into plaques, which may
contain variously pigmented papules
necrobiosis lipoidica : a degenerative
disease of dermal connective tissue characterized by development of erythematous
papules or nodules in the pretibial area and sometimes elsewhere, extending
to form shiny yellow to red plaques that are covered with telangiectatic
vessels and have a scaly, atrophic, depressed center.
Aetiology : type
1 diabetes mellitus
with neuropathy and retinopathy (> 50%) (necrobiosis lipoidica diabeticorum
/ Urbach-Oppenheim disease)
granulomatosis
disciformis progressiva et chronica : a condition clinically resembling
necrobiosis lipoidica in nondiabetics (and believed by some authorities
to be a variant), characterized by the development on the dorsa of the
hands, forearms, shins, and sometimes the face of yellowish red, sharply
marginated, smooth, plaquelike granulomas with a tendency to enlarge peripherally.
idiopathic dermal necrosis
Aetiology : necrotic
arachnidism
(often used as a default diagnosis, despite the lack of solid evidence)
nephrogenic systemic fibrosis
(NSF) / nephrogenic fibrosing dermopathy (NFD), was first documented
in 1997. It is an acquired, idiopathic, chronic, progressive eruption of
the skin sometimes accompanied by systemic fibrosis that occurs in patients
undergoing MRI scans with gadodiamideref1,
ref2
in the context of renal
failure.
The age of patients with NFD ranges from 8 to 87 years at the time of onset,
with a mean age of 46.4 years. Most cases have been reported in the US
and Europe, but recently cases have also been reported in India. About
175 cases have been noted in a registry established for NFD patients. Even
in the setting of renal disease, NFD still occurs rarely and its cause
is unknown. Patients present with hard, indurated, sometimes peau d'orange
plaques. They often show a distinctive physical appearance, with elbows
and knees angled inward, and most patients complain of a loss of range
of motion. Histology demonstrates thickened collagen bundles with surrounding
clefts, mucin, and a proliferation of fibroblasts and elastic fibers, sometimes
with reticular, dermal, large epithelioid or stellate spindle cells. Fibrosis
of NFD can affect the internal organs and thus the term nephrogenic systemic
fibrosis has been used by some analysts to describe this fibrosing process.
The fibrosis of NFD appears to be due to the effects of a cell referred
to as the circulating fibrocyte. Rare cases of partial-to-complete spontaneous
resolution have been reported in the absence of specific therapyref1,
ref2.
Gadodiamide exposure in patients with renal insufficiency may result in
a substantial decrease in total iron-binding capacity and increased iron
mobilization, resulting in transferrin oversaturation. On this basis, in
some patients, iron mobilization may lead to transmetallation and release
of free gadolinium. Indeed, previous studies have shown the presence of
gadolinium and iron in tissues affected by nephrogenic systemic fibrosisref.
Free gadolinium and catalytic ironref
may synergistically coordinate, resulting in oxidative stress, inflammation,
and tissue injury. Exaggerated wound healing (in which erythropoietin may
participate) occurs in response to the injury, resulting in a phenotype
characteristic of nephrogenic systemic fibrosisref.
Treatments yield inconsistent results
and include restoration of renal function, extracorporeal photopheresis,
photodynamic therapy, high-dose intravenous immunoglobulin, and other immunosuppressive
therapies.
cosmetic disorders
cosmetology is increasingly alternating with dermatology as a discipline
concerns the treatment of non pathological skin. One of the main problems
is the transcutaneous absorption of active principles across the stratum
conneum
liposomes are artificial phospholipid membranes that can facility
the passage of active principles.
phytosome : complexes with catechin, quercetin, escin and glycyrrhetinic
acid
cosmetic unit : an area of the body
often treated separately from others. Examples of cosmetic units: the skin
around the eyes, the skin around the mouth, the cheeks.
dynamic lines : lines on the face, e.g.,
laugh lines and frown lines, which develop as a result of repetitious right-angled
pull on the skin by the muscles of expression; they are considered a sign
of aging
wrinkles / rhytides : with aging the skin
becomes thinner. Sebaceous glands become less active, and skin becomes
drier (which is why moisturizing is one of the best things one can do).
The number of blood vessels in the skin decreases, and the dermis. which
lies right under the top layer of the skin, thins and becomes more fragile.
The skin replaces old cells more slowly, and cells repair themselves less
effectively. Collagen and elastin, two fibrous proteins that keep skin
taut, start to diminish, contributing to wrinkling and sagging.
collagen injections : collagen from cattle can be injected into
deeper wrinkles on the face. The injected collagen smoothes out wrinkles
and fills in furrows, such as those around the nose and mouth and between
the eyebrows. The collagen degrades over several months but may trigger
the body to produce new collagen. The procedure may need to be repeated
every few month. However, collagen is not safe in patients with certain
diseases and retreatment is necessary.
laser skin resurfacing : a controlled vaporizing of the outer layer
of skin (epidermis). Layers of skin underneath shrink to tighten skin and
eliminate wrinkles. The underlying skin (dermis) eventually heals more
tightly and smoothly
thermescent skin technique / non-ablative skin "resurfacing" : a
non-invasive treatment that heats the subsurface tissue while preserving
the epidermis using 1320 nm laser energy and cryogen cooling spray. There
is selective injury only to the upper dermal tissue, which initiates a
healing response by the body to stimulate fibroblasts to produce collagen.
T-max : a measurement of the peak or maximum surface skin temperature
obtained following the delivery the laser pulse in thermescent skin treatment.
dermabrasion : fine wrinkles, age spots and scars can be "sanded
down" with a small, high-speed rotary abrasive wheel. Scabbing and swelling
generally last a couple of weeks. Complete healing takes longer
microdermabrasion : Al2O3 crystals are projected
onto the skin in a uniform manner to exfoliate layers of the epidermis.
These crystals, along with dead skin cells, are vacuumed into a closed
filter container and discarded. A control gauge allows for increased vacuum
for a more aggressive peel and decreased vacuum for a more gentle peel.
Microdermabrasion leaves skin smooth and clean with mild erythema. Blackheads
are loosened, whiteheads become unsurfaced, hyperpigmentation lightens
and acne scars, enlarged pores and epidermal wrinkles become less prominent.
Blood, containing oxygen and nutrients, is drawn to the surface to feed
and repair cells. Microdermabrasion is performed in a doctor's office by
a doctor, esthetician or nurse or in spa by an Non-ablative skin rejuvenation
- non-invasive treatment to reduce the signs of aging; does not require
the removal of surface tissue to accomplish collagen regeneration, wrinkle
reduction and a more youthful appearance
augmentation : patients seek to augment
one or more of the facial regions to give a more youthful and defined appearance
to the face. The nasolabial creases and lips usually are augmented with
small, soft synthetic implants that are placed deeply in the skin and underlying
subcutaneous tissue.
Artecoll® : a tissue agent comprised of 3 ingredients
:
polymethylmethacrylate (PMMA), is a material used to bind bones and artificial
hips. For cosmetic purposes, the PMMA is prepared in smooth microscopic
beads specifically sized to go through a fine needle.
collagen, as a delivery system
anesthetic to minimize discomfort
Artecoll is injected into the target area where the beads provide a lift
and support structure beneath the skin. While the injected collagen eventually
dissipates, the procedure stimulates production of the patient's own collagen
so that it can grow around the beads and serve as a permanent filler.
soft form : synthetic tissue augmentation implant placed in the
face used to smooth out wrinkles and furrows
congenital ectodermal
dysplasia : a group of hereditary disorders involving tissues and structures
derived from the embryonic ectoderm; ectodermal dysplasia is a component
of various syndromes, including anhidrotic and hidrotic ectodermal dysplasia
and the EEC syndrome.
ectrodactyly,
ectodermal dysplasia, and cleft
lip/palate
(EEC) syndrome : a congenital syndrome inherited as an
autosomal dominant trait involving both ectodermal and mesodermal tissues,
which consists of ectodermal dysplasia associated with hypopigmentation
of the skin and hair, scanty hair and eyebrows, absence of lashes, nail
dystrophy, hypo- and microdontia, ectrodactyly, and cleft lip and palate.
hydrotic ectodermal dysplasia /Clouston's syndrome :an autosomal
dominant disorder, characterized by ectodermal dysplasia associated with
dystrophic, hypoplastic, or absent teeth, hypotrichosis, hyperpigmentation
of the skin over joints, hyperkeratosis of the palms and soles, and occasionally
small teeth with extensive decay
anhidrotic
ectodermal dysplasia / Christ-Siemens-Touraine syndrome / congenital ectodermal
defect : a congenital X-linked disorder fully expressed in males,
or rarely as an autosomal recessive trait with full expression in both
sexes, characterized by ectodermal dysplasia associated with aplasia or
hypoplasia of the sweat glands, hypothermia, alopecia, anodontia, conical
teeth, and typical facies with frontal bossing, midfacial hypoplasia, saddle
nose, large chin, and thick lips
Aetiology : mutations of anhidrotic
ectodermal dysplasia 1 (ED-1) / ectodysplasin A (EDA)
gene
Symptoms & signs : absence or deficient
function of hair, teeth and sweat glands. Affected children may experience
life-threatening high fever resulting from reduced ability to sweat
Experimental animal models : mice with
the Tabby phenotype
Therapy : treatment of pregnants with
a recombinant form of EDA1,
engineered to cross the placental barrier, permanently rescues the phenotype
in the offspring. Notably, sweat glands can also be induced by EDA1 after
birth
trichonodosis : a rare condition characterized
by apparent or actual knotting of the hair, thought to be the result of
inability of new hairs to grow freely from their follicles, because of
toughness of the surrounding tissues.
trichoptilosis : the condition in which
the hairs are split and feather-like.
trichorrhexis : a condition in which
the hairs break.
trichorrhexis nodosa / bamboo hair / clastothrix / trichoclasia / trichoclasis:
a condition characterized by what look like white nodes on the hairs but
are actually sites where the cortex of the shaft has fractured and split
into strands. The most common type affects the proximal hair shafts, so
that hairs grow a few centimeters and break off; it may be either idiopathic
and congenital or acquired, usually in persons with tightly curled hair
who repeatedly straighten their hair
trichoschisis : splitting of the hairs.
trichosis : any disease or abnormal growth of the hair.
trichosis carunculae : abnormal development of the hair on the lacrimal
caruncle.
trichostasis spinulosa : a condition in which the hair follicles
contain a dark, horny, comedo-like keratin plug, which contains a bundle
of villus hair
trichothiodystrophy (TTD) : a
hair abnormality, probably congenital, in which hair is sparse and brittle,
has an unusually low sulfur content, and has a banded appearance under
polarized light; often accompanied by short stature and varying degrees
of mental retardation. DNA repair-deficient TTD results from mutations
in subunits of the DNA repair and transcription factor TFIIH
:
cutis anserina / goose flesh
:
a transitory localized change in the skin surface caused by elevation of
the hair follicles as a result of contraction of the arrectores pilorum
muscles
Aetiology : reflection of sympathetic nerve
discharge
boil : tender, swollen areas that form around
hair follicles due to infections by certain bacteria
carbuncles : clusters of boils
on the skin, walled-off collection of pus. Carbuncles often appear in areas
of friction or minor trauma such as underneath the belt, the fronts of
the thighs, buttocks, groin, and armpits
comedone : a plug of sebaceous and dead skin
material (keratin) stuck in the opening of a hair follicle which is
open (blackhead / open comedone)
closed (whitehead / closed comedone / milium)
Epidemiology : incidence: 40% of newborns
Pathogenesis : superficial inclusion cysts
Signs : whitish papules 1-2 mm in diameter
on forehead, cheeks or nose (when found in oral cavity, known as Epstein's
pearls)
nevus comedonicus : a rare epidermal
nevus thought to represent a developmental abnormality of the pilosebaceous
apparatus, characterized by the presence of aggregations of dilated keratin-filled
hair follicles, producing large cutaneous patches studded with comedo-like
lesions that are usually unilateral and generally localized to areas such
as the trunk, an upper extremity, or the neck, sometimes in a linear or
zosteriform pattern. The condition is occasionally associated with other
lesions such as ichthyosis, nevoid
cell carcinoma, vascular
nevi / nevi vasculares,
and cataracts
furuncle / furunculus / boil : a painful
nodule
formed in the skin by circumscribed inflammation of the corium and subcutaneous
tissue, enclosing a central slough or “core.” It is caused by staphylococci,
which enter through the hair follicles, and its formation is favored by
constitutional or digestive derangement and local irritation. Furuncles
often appear in areas of friction or minor trauma such as underneath the
belt, the fronts of the thighs, buttocks, groin, and armpits.
furunculosis : the persistent sequential
occurrence of furuncles over a period of weeks or months or the simultaneous
occurrence of a number of furuncles.
pustular lesions
folliculitis : an inflammation of the
hair follicles due to ...
Aetiology :
infection by ...
bacteria
Gram-negative folliculitis
may
be the result of long-term antibacterial treatment in acne
patients. It is caused by bacterial interference and replacement of the
Gram-positive flora of the facial skin and the mucous membranes of the
nose and infestation with Gram-negative bacteria (Escherischia
coli,
Pseudomonas
aeruginosa,
Serratia
marcescens,Klebsiella
spp.and
Proteus
mirabilis).
The occurrence of Gram-negative folliculitis should be considered in acne
patients in whom oral treatment with tetracyclines has not resulted in
a significant improvement of acne lesions after 3-6 months' treatment.
The occurrence of Gram-negative folliculitis in acne patients is believed
to be generally underestimated, since correct sampling and bacteriology
is rarely performed by clinicians.
Therapy : isotretinoin (0.5-1 mg/kg daily
for 4-5 months).
fungi (trichophytia)
endothrix : a dermatophyte whose growth
and spore production are confined chiefly within the shaft of the hair,
without formation of conspicuous external spores; such fungi include Trichophyton
tonsurans and Trichophyton violaceum.
ectothrix : a fungus that grows inside the
hair shaft and also produces a sheath of arthrospores on the outside of
the hair.
large-spored ectothrix : one
that forms chains or sheaths of large spores; this type includes Microsporum
fulvum, Microsporum gypseum, Microsporum nanum, Microsporum
vanbreuseghemii, and Trichophyton gallinae.
small-spored ectothrix : one
that forms small spores in sheaths, mosaic masses, or occasionally chains;
this type includes Microsporum audouinii, Microsporum canis,
Microsporum
ferrugineum, and Trichophyton mentagrophytes.
irritation
Symptoms & signs : small, white-headed
pimples
The folliculitis lesion is usually smaller than a boil and there are
usually numerous folliculitis lesions with an outbreak
Anatomical classification :
tinea capitis / trichophytia capitis / tinea
black dot / ringworm of scalp / ringworm black dot / scalp ringworm
trichophytic
tinea
Aetiology :
Epidemiology : epidemics in schools
Prognosis : usually self-limiting with
restitutio ad integrum
Aetiology : Trichophyton
schoenleinii Symptoms & signs : heavy, maleodorant
cup-shaped crusts (scutulae) and hair invaded throughout its length.
Prognosis : cicatricial
alopecia Therapy : systemic therapy with griseofulvin
20 mg/kg/die for at least 1 month and topical therapy with imidazoles,
sulfur and catram
tinea tonsurans / microsporic tinea
: normal hair growth, breakage at some millimeter of length
Therapy : systemic therapy with griseofulvin
15-20 mg/kg/die for at least 1 month and topical therapy with imidazoles
tinea ciliorum : tinea capitis involving
the eyelashes
sycosis : folliculitis of beard
tinea barbae / trichophytia barbae / ringworm
of beard / barber's itch / sycosis barbae or vulgaris / folliculitis barbae
: bacterial folliculitis involving the bearded region, usually caused by
Staphylococcus
aureus,
in which the primary lesion is a pinhead-sized pustule, pierced by a hair,
which may, if neglected, lead to impetiginization and crust formation and
become chronic
lupoid sycosis : a chronic, scarring
form of deep sycosis barbae, characterized by a slowly enlarging patch
with follicular papulopustules in the active, advancing border, and healing
in the central area leaving scars.
pseudofolliculitis barbae /
razor bumps
Aetiology : regrowth of hair after it
has been shaved in people with very curly, kinky hair which tend to kink
into the skin instead of out the follicle causing a mechanical irritation
Symptoms & signs : red or hyperpigmented
papules. Sometimes pustules can form especially if the papule gets secondarily
infected.
Therapy : not shave the hair
kerion (celsi) : a nodular, boggy, exudative,
circumscribed tumefaction which is covered with pustules, occurring in
association with tinea infections, usually tinea
barbae and tinea capitis
trichomycosis nodularis or nodosa / piedra
:
a fungal infection of the hair shaft characterized by the presence of dark
or pale, firm, irregular nodules composed of fungal elements
Aetiology : Trichosporon
beigelii Symptoms & signs : white to light
brown nodules on the hair of the beard, axilla, or groin, softer than the
nodules of the black variety, with neither immune nor inflammatory reactions.
; usually seen in tropical regions
black piedra / piedra nigra / trichomycosis
nodularis black
Aetiology : Piedraia
hortae Symptoms & signs : small black or
brown gritty nodules on the shafts of the scalp (and occasionally axillary
and pubic) hair; usually seen in tropical regions.
dermatitis papillaris
capillitii / acne keloid / folliculitis keloidalis / keloidal folliculitis
/ sycosis nuchae : a rare disease seen most commonly in black males,
characterized by the development of persistent hard follicular plaques
along the posterior hairline of the scalp that fuse to form a thick, sclerotic,
hypertrophic, pseudokeloidall band extending
across the occiput.
acneiform eruptions
Aetiology :
primitive cutaneous diseases
acne vulgaris : a chronic disorder of the hair
follicles and sebaceous glands
water based 2.5% benzoyl peroxide
(Ambi 10®, Dermoxyl®, Vanoxide®;
Benzamycin®, Persa-Gel® in combination with
erythromycin; ? in combination with clindamycin; TRIAZ®
in combination with glycolic acid and zinc)
higher density of the commensal Demodex
folliculorum
(>= 5 live parasites/cm2 of skin), triggering inflammatory or
specific immune reactions, mechanically blocking the follicles, or acting
as a vector for bacteria. Immunohistochemical findings suggest that a delayed
hypersensitivity reaction, possibly triggered by antigens of follicular
origin, probably related to D. folliculorum, may occur, stimulating
progression of the affection to the papulopustular stageref.
Ongoing research has shown that bacteria from patients with rosacea may
behave differently at the higher skin temperature that may be present in
patients with rosacea. Another group has isolated bacteria from the
Demodex
mites; these bacteria may play a pathogenic role in papulopustular rosacea
by facilitating follicular-based inflammatory changesref.
In rosacea patients (ages 11-50 years old) 44% were infested with D.
folliculorum as compared to normal controls (23.0%). The difference
was significant. The mean +/-SD of mite density ranged between 13.2+/-0.9
to 18.2+/-1.2 as compared to normal controls with mite density ranged between
1.4+/-0.25 to 2.4+/-0.3. Demodex infestation in rosacea patients
was 66.1% in squamous, 66.7% in erythemato-telangiectate and 83.3% in papulo-pustular
rosacea. The highly infested site was check (27.3%) with mean mite density
of 25.3+/-1.3, followed by the area around the orbit (23.4%) with a density
of 19.0+/-1.2, the area around the nose (19.5%) with mite density of 7.1+/-1.5,
then chin (15.6%) with a density of 8.2+/-1.4 and lastly the area around
the mouth (14.1%) with a mite density of 14.2+/-1.3. Undoubtedly, infestation
with D. folliculorum particularly in large number causes rosacearef.
The mite prevalence in the rosacea group (51%) was significantly higher
than in the rest of the study population (eczema 28% and lupus discoides
31%). Demodex mites were found on all facial sites. The most infested areas
in the whole study group were the forehead (49%) and the cheeks (44%).
Males were more frequently infested (59%) than females (30%). We did not
find any significant difference in mite counts of infested follicles between
rosacea and the control group. A lympho-histiocytic cell infiltration was
seen around the infested hair folliclesref.
Recently, a standard grading system for assessing gradations of the severity
of rosacea has been reported. Little is known about the cause of rosacea.
Symptoms & signs : transient or persistent
facial erythema, telangiectasia, edema, papules and pustules that are usually
confined to the central portion of the face; chronic inflammation that
may begin as a tendency to flush or blush easily, and progress to persistent
redness
in the center of the face that may gradually involve the cheeks, forehead,
chin and nose. It also may involve the ears, chest and back. As the disease
progresses, small blood vessels, tiny pimples and pustules begin
to appear on and around the reddened area; however, unlike acne, there
are no blackheads. In more advanced cases of rosacea pimples and
pustules may cause enlargement of the sebaceous glands of the nose resulting
in puffy cheeks and enlarged red nose (rhinophyme).
Rosacea fulminans is a rare
disease of unknown cause which occurs exclusively in women years after
adolescence. Although the etiology is unknown, immunologic, hormonal, and
vascular factors have been suggested. When rosacea fulminans occurs during
pregnancy and in women taking oral contraceptive pills, hormonal factors
may be a trigger. Rosacea fulminans is localized specifically to the face,
with the chin, cheeks, and forehead bearing the brunt of the attack. A
dull red, cyanotic erythema of all involved facial areas, extending beyond
the inflammatory nodules, is typicalref Laboratory examinations : standardised
skin surface biopsy (SSSB)
Therapyref
:
flushing is better prevented rather than treated, and its etiology investigated.
b-blockers,
atenolol in particular, are worthy of prophylactic trials examining their
efficacy in treating the flushing associated with rosacea. Currently, clonidine
is the only drug available for the treatment of flushing
treatment for erythrosis includes topical and systemic therapies. Metronidazole
1% cream and azelaic acid 20% cream have been reported to reduce
the severity score of erythema. The systemic treatment of erythrosis is
based on the association of Helicobacter pylori with rosacea. However,
this role is still being debated. Eradication of H. pylori can be
achieved using a triple therapy regimen lasting 1 to 2 weeks [omeprazole
and a combination of 2 antibacterials (a choice from clarithromycin,
metronidazole
or amoxicillin)]
treatment of facial telangiectases : flashlamp-pumped long-pulse dye
laser and the potassium-titanyl-phosphate laser
benzoyl peroxide-erythromycin
gel was superior to metronidazole gel in decreasing Demodex folliculorum
by
the first examination, but the effect of the two drugs on Demodex folliculorum
was similar by the second examinationref
5% permethrin
creamref
is superior to metronidazole 0.75% gel and placebo in decreasing Demodex
folliculorum, and is as effective as metronidazole 0.75% gel in treating
erythema and papulesref1,
ref2.
daily topical application of >50% diluted Eucalyptus globulus (camphor
oil)ref
with glycerol and 500 mg metronidazole
orallyref
topical treatment is based on metronidazole cream and gel. Crotamiton 10%
cream or permethrin 5% cream may be useful medications for papulopustular
rosacea, although they are rarely successful in eradicating D. folliculorum.
Oral or topical ivermectin may also be useful in such cases. Ocular involvement
is common in patients with cutaneous rosacea and can be treated with orally
administered or topical antibacterials.
once rhinophyma starts to be evident, the only way to correct it is by
aggressive dermatosurgical procedures. Decortication and various types
of lasers can also be used. Associated conditions, such as seborrheic dermatitis
and possible contact sensitizations, deserve attention.
drugs
bromide button : a verrucous cutaneous
lesion occurring as a result of sensitivity to bromides
(bromoderma)
iodide button : a verrucous cutaneous
lesion occurring as a result of sensitivity to iodides
canities : diffuse grayness or whiteness
of the scalp hair, especially as associated with aging.
hemicanities : grayness of the hair on one side of the body.
Pathogenesis : defective self-maintenance
of melanocyte stem-cells. This process is accelerated dramatically (gray
a few weeks after birth) with Bcl2-deficiency,
which causes selective apoptosis of melanocyte stem-cells within the niche
at their entry into the dormant state, but not of differentiated melanocytes.
Furthermore, physiologic aging of melanocyte stem-cells was associated
with "ectopic pigmentation or differentiation" within the niche, a process
accelerated by mutation of the melanocyte master transcriptional regulator
Mitf (mice goes white in 6 to 10 months)ref
achromotrichia / hypochromotrichia
: loss of pigment in the hair
leukotrichia : whiteness of the hair
in a circumscribed area
melanotrichia : abnormal hyperpigmentation
of the hair.
heterotrichosis : growth of hair of
different colors on the body.
Graham Little syndrome : a
syndrome characterized by the presence of cicatricial patches of alopecia
of the scalp with prominent follicular plugging and follicular keratoses
involving the trunk and extremities, sometimes associated with noncicatricial
alopecia of the axillae, pubes, trunk, and extremities.
congenital alopecia / alopecia congenitalis : congenital absence
of the scalp hair, which may occur alone or be part of a more widespread
disorder.
autosomal recessive congenital alopecia and atrichia with papular lesions
Aetiology : hairless
homolog (mouse) Pathogenesis : when the follicles break
down they prevent the formation of a second generation of hair follicles
effluvium : outflowing, or shedding, of the hair.
anagen effluvium : abnormal loss
of hair during the anagen phase, which may occur following administration
of certain cancer chemotherapeutic agents or exposure to certain chemicals,
or in association with various other factors and diseases.
telogen effluvium : the early, excessive,
temporary loss of normal club hairs from normal resting follicles in the
scalp as a result of traumatization by some stimulus (e.g., surgery, starvation
diet, parturition, drugs, traction, high fever, certain diseases, or psychogenic
stress) that prematurely precipitates the anagen phase into catagen and
telogen phases, altering the normal hair cycle.
postpartum alopecia : telogen
effluvium occurring shortly after parturition
psychogenic alopecia / stress alopecia : telogen effluvium due to
severe and acute emotional stress, which is believed to be of the alopecia
areata type
traumatic alopecia : telogen effluvium due to injury to the hair
follicle, as by rubbing, traction, or chemical agent, and limited to the
areas thus traumatized.
pressure alopecia : traumatic alopecia due to persistent pressure
on the scalp, as may be seen in babies lying on their backs and in adults
after prolonged surgical procedures or in ill persons after prolonged bed
rest
traction alopecia : traumatic alopecia due to continuous or prolonged
traction on the hair, as applied in certain styles of hair dressing or
in the habit of twisting the hair.
traumatic marginal alopecia : traction alopecia occurring along
the scalp margin.
androgenetic alopecia (AGA) / alopecia
androgenetica : a progressive, diffuse, symmetric loss of scalp hair.
In men it begins in the twenties or early thirties with hair loss from
the vertex and the frontoparietal regions, ultimately leaving only a sparse
peripheral rim of scalp hair (male pattern alopecia or baldness (MPB)).
In females it begins later, with less severe hair loss in the front area
of the scalp. In affected areas, the follicles produce finer and lighter
terminal hairs until terminal hair production ceases, with lengthening
of the anagen phase and shortening of the telogen phase of hair growth
premature alopecia : androgenetic alopecia occurring in young men
in their early twenties or before
Aetiology : SNPs in
a polyglycine-encoding GGN repeat in exon 1 of AR.
The X-chromosomal location of AR stresses the importance of the maternal
line in the inheritance of AGAref
increased response of hair follicles to DHT. So far, we do not understand
the molecular steps involved in androgen-dependent beard growth versus
androgen-dependent hair loss. However, the local androgen metabolism plays
a central role in the intrafollicular conversion of weak androgens, such
as DHEAS, to more potent androgens such as T or DHT within the hair follicle.
The dermal papilla plays a central role by exhibiting an array of important
steroidogenic isoenzymes. Provided that the dermal papilla (DP) cell triggers
and regulates the growth of hair follicles, this physiological role may
be reflected by metabolic differences, which could account for differences
in androgen sensitivity as observed in hair follicles from different body
sites, and in conditions such as male pattern baldness. The observation
of STS, 17b-HSD, 3b-HSD,
3a-HSD and type 2 5a-reductase
within the DP could be a clue to understanding the regulation of androgen
action in the human hair follicle by local androgen modification on target
cell level
secondary syphilis
(syphilitic alopecia / alopecia syphilitica : alopecia involving
the eyebrows, beard, and scalp)
moth-eaten alopecia : syphilitic alopecia involving the scalp and
beard and occurring in small, irregular scattered patches, resulting in
a moth-eaten appearance)
acquired hypertrichosis
lanuginosa is a rare disorder, which consists of abnormal and excessive
growth of fine lanugo hair, with the degree of hairiness being variable,
and usually involving the face. Stomatologic symptoms are frequently associated
with the disorder. The disorder is usually linked to an internal malignant
condition, especially colorectal
cancer,
and it may regress with removal of the tumorref.
hypertrichosis pinnae auris / hairy ears : hypertrichosis involving
the pinna of the ear; it may be a Y-linked
or an autosomal
dominant trait
Ferriman-Gallwey semiquantitative grading evaluate density in moustaches,
beard, breast, abdomen, external genitalia, hips, back and glutei with
numbers from 1 to 4
Therapy :
trichomegaly : a congenital syndrome
consisting of excessive growth of the eyelashes and brow hair associated
with dwarfism,
mental retardation, and pigmentary degeneration of the retina
uncombable hair syndrome / pili
trianguli et canaliculi / spun glass hair syndrome : an abnormality
of the hair inherited as an autosomal dominant trait, in which the individual
hairs are triangular in cross section, with a longitudinal groove; the
hair has a spun-glass appearance and is arranged in bundles that stand
out in different directions
pilonidal cyst, fistula or sinus / piliferous
cyst, pilonidal : a suppurating subcutaneous sinus containing a tuft
of hair, occurring chiefly in the coccygeal region (coccygeal sinus),
but also seen in other regions of the body.
Epidemiology : prevalence = 1.3% in males,
0.11% in females. It is most commonly found in the natal cleft of hirsute
men in postpuberal age.
Aetiology : repeated friction that has
caused hairs to penetrate the skin
Therapy : surgical ablation
hair cancers
bening cancers
trichilemmoma / tricholemmoma : a benign
neoplasm of the lower outer root sheath of the hair.
pilomatricoma / pilomatrixoma / benign calcifying
or calcified epithelioma / calcifying epithelioma of Malherbe : a solitary
benign calcifying tumor of hair follicle origin manifested as a sharply
circumscribed, firm intracutaneous nodule, usually occurring on the face,
neck, or upper extremity, and most often presenting before the age of 20.
Histological features include a fibrous stroma surrounding nests of basophilic
cells and ghost, or shadow, cells
fibrofolliculoma : a benign tumor
of the perifollicular connective tissue, occurring as one or more yellowish-white,
smooth, dome-shaped papules, usually on the face, and characterized histologically
by proliferation of strands of follicular epithelium extending into the
stroma. Multiple lesions usually occur as part of an autosomal dominant
Birt-Hogg-Dubé
(BHD) syndrome, due to mutations in folliculin
trichofolliculoma / hair
follicle nevus : a benign usually solitary dome-shaped nodular lesion
with a central pore that frequently contains a woolly hair-like tuft; it
usually occurs on the head or neck, is derived from a hair follicle, and
is characterized histologically by a central keratinous cystic cavity into
which numerous abortive hair follicles radiate
trichoadenoma : a benign follicular
tumor occurring on the face or trunk, with histologic features midway between
those of trichofolliculoma
and trichoepithelioma, with large cystic
spaces lined by squamous epithelium and squamous cells
trichoepithelioma : a benign skin
tumor originating in the hair matrix, generally occurring on the face and
characterized histologically by strands of basal cells surrounded by fibrocellular
stroma. It usually occurs in young women as an autosomal dominant disorder,
characterized by multiple smooth, flesh-colored, cystic and solid nodules
or papules (multiple trichoepithelioma / trichoepithelioma papillosum
multiplex / Brooke's tumor / acanthoma adenoides cysticum), but it
may occur as a nonhereditary solitary lesion, usually in young adult women
(solitary trichoepithelioma).
desmoplastic trichoepithelioma / sclerosing epithelial hamartoma
: a benign, solitary, whitish, hard nodule with a central nonulcerated
depression, usually occurring on the face in young to middle-aged women
and characterized by strands of basaloid cells and epidermal cysts infiltrating
fibrotic stroma
piloleiomyoma : cutaneous leiomyoma,
single or multiple, arising from the arrectores pilorum muscles
tumor of follicular infundibulum : a smooth papular lesion of the
hair follicle occurring on the face and neck of older patients, characterized
by plate-like proliferation of squamous cells that are connected at many
points to the lower surface of the epidermis.
proliferating trichilemmal tumor : a large, solitary, multilobulated
lesion of the hair follicle occurring on the scalp, usually in middle-aged
or older women; it is composed of large follicular sheath cells with glycogen-rich
cytoplasms and is often confused with squamous
cell carcinoma.
perifollicular fibroma : one or more small, flesh-colored, papular
follicular lesions on the head and neck, characterized by hyperplastic,
well-differentiated connective tissue surrounding the hair follicles.
pilar sheath acanthoma : a benign tumor of the hair follicle, usually
occurring as an asymptomatic lesion on the upper lip of middle-aged adults;
it is characterized by a central keratin-filled cavity lined by stratified
squamous epithelium projecting into the connective stroma.
Birt-Hogg-Dubé
(BHD) syndromeref
: an autosomal dominant disorder of proliferation of ectodermal and mesodermal
components of the pilar system, occurring as multiple trichodiscomas,
acrochordons,
and fibrofolliculomas on the head, chest,
back, and arms. Multiple asymptomatic flesh coloured papules on the face
mainly around the nose. Features of fibrous skin tags
sebaceous neoplasms
sebaceous adenoma : an uncommon,
benign, yellow or flesh-colored, usually solitary, circumscribed nodule
occurring on the face or scalp, generally in older men, consisting of incompletely
differentiated sebaceous lobules; it may be seen in Muir-Torre
syndrome (MTS). The term is sometimes used to denote ...
cystic sebaceous adenoma
adenoma sebaceum :
Pringle type : cutaneous angiofibromatous
proliferation, usually on the face, occurring in association with Bourneville's
tuberous sclerosis;
the term is a misnomer since the sebaceous glands are rarely involved
Balzer type : nevoid hyperplasia of sebaceous
glands, forming multiple yellow papules or nodules of the face.
Pathogenesis : mutations in MSH2
and MLH1
and also LEF1
in mice. 30% of human sebaceous tumors examined had double-nucleotide substitutions
in the same LEF1
allele, irrespective of DNA mismatch repair status. The mutations impaired
both LEF1 binding to -catenin and transcriptional activation, and are the
first tumor-associated mutations that inactivate Wnt signaling. Mutant
LEF1 not only inhibited expression of b-catenin
target genes but also stimulated expression of sebocyte markers, suggesting
that it may determine the differentiated characteristics of sebaceous tumorsref.
with apocrine glandular differentiation originated from pluripotent
stem cells destined to become sebaceous stem cells or from sebaceous stem
cells, which also have the ability to differentiate within apocrine glands
sebaceoma : benign neoplasm of basaloid
cells with varying numbers of mature sebocytes
rippled-pattern sebaceoma is composed of immature sebaceous germinative
cells with some foci of advanced sebaceous differentiation (toward the
sebaceous duct and sebaceous lobule). It consists of an arrangement of
small, monomorphous, cigar-shaped basaloid cells in linear rows parallel
to one another, resembling the palisading of nuclei of Verocay
bodies,
namely a rippled-pattern
ductal sebaceoma (sebomatricoma)
with reticulated and cribriform basaloid epithelial islands
trichoblastoma (TB) with sebaceous differentiation
apocrine poroma with sebaceous differentiation
basal cell carcinoma (BCC) with sebaceous differentiation
Jadassohn's sebaceous
nevus / nevus sebaceus (NS) of Jadassohn / Feuerstein-Mims syndrome / linear
sebaceous nevus syndrome / organoid nevus : a syndrome characterized
by single or linear hamartomas
of the scalp, face, or neck that change progressively throughout life;
many patients have neurologic symptoms (retardation or seizures) or ophthalmologic
abnormalities. In children there are yellow or tan waxy patches with hypoplastic
sebaceous glands and hair follicles or with scalp alopecia. After puberty
the patches become thickened and verrucous, often with papillomatous projections
and hyperplastic sebaceous glands, papillary epidermal hyperplasia, and
ectopic apocrine glands of the deep dermis. Later some lesions become nodular
and may develop benign or malignant adnexal tumors (trichoblastoma
(92%), sebaceoma, sebaceous
carcinoma) or basal cell carcinoma
(BCC) (8%)
sebaceous cyst / epidermal
or epidermoid cyst / wen : a benign cyst derived from the epidermis
or the epithelium of the hair follicle, which is formed by cystic enclosures
of epithelium within the dermis that become filled with keratin admixed
with variable amounts of lipid-rich debris. The 2 main types are :
epidermal inclusion cyst :
a well-circumscribed mobile epidermal cyst occurring on the head, neck,
and trunk, formed by keratinizing squamous epithelium with a granular layer,
similar to the normal epithelium of the follicular infundibulum
pilar cyst / sebaceous cyst / trichilemmal
cyst / wen : an epidermal cyst usually occurring as a firm, well-circumscribed,
subepidermal nodule, especially on the scalp, and formed by an outer wall
of keratinizing epithelium without a granular layer, similar to the normal
epithelium of the hair follicle at and distal to the sebaceous duct.
multiple
sebaceous cyst / steatocystoma multiplex : an autosomal dominant
disorder chiefly affecting males at birth or presenting about the time
of puberty, characterized by the development of numerous flesh-colored
to yellow epidermal cysts, especially involving the skin of the sternum,
the proximal extremities, and the scrotum in males. The cysts typically
have an intricately infolded thin epidermal lining, without a granular
layer, incorporating abortive hair follicles and at times sebaceous, eccrine,
or apocrine structures, and contain lanugo hair and an oily material.
... being less common variants. The sebaceous cyst normally has a small
opening that communicates with the skin and may not be very well seen.
Sebaceous cysts can occur on any skin surface, but are most common on the
face, back or base of the ears, chest, and back.
urhidrosis / uridrosis : the
presence in the sweat of urinous materials, such as uric acid, urea, etc.
urhidrosis crystallina
/ urea or uremic frost : a form in which urea and other nitrogenous
waste products accumulate in sweat over the skin and crystallize after
evaporation.
Symptoms & signs : boil-like lumps develop
in intertriginous areas
groin (expecially in women)
axilla (hidradenitis axillaris)
under the breasts
behind the ears
in the crease of the buttocks
around the genitals
The disease involves the apocrine and (rarely) eccrine sweat glands,
the sebaceous glands and the hair follicles, although there is some disagreement
as to whether the infection starts in the follicles and spreads to the
sweat and oil glands, or vice-versa. There are often outbreaks linked with
periods in women. It is thought that hidradenitis is dependent on the androgen
sex hormones but the levels of androgens in hidradenitis sufferers are
usually the same as in non-sufferers, although other disorders linked to
androgens, such as acne, are commonly found with hidradenitis.
The disease often shows itself during puberty, but has appeared as late
as post-menopausal age.
sudoriparous abscess : an abscess arising in a sweat gland.
sweat retention syndrome
: a dermatologic condition due to occlusion of sweat ducts
Pathogenesis : sweat gland duct obstruction
Signs : papulovesicular lesions in intertriginous
areas and occluded areas, intense itching and tingling
miliaria rubra / heat rash (default
type of miliaria) : sweat infiltrates below epidermis, results in pruritic
erythematous papulovesicles
miliaria profunda : limited to hot,
humid climates, follows severe miliaria rubra
miliaria
crystallina or alba / sudamina : sweat infiltrates below stratum corneum,
noninflammatory minute translucent vesicles resemble water droplets
sudamen : a whitish vesicle caused by the
retention of sweat in the sudorific ducts or the layers of the epidermis.
In the plural (sudamina), an eruption of such vesicles, known as miliaria
crystallina.
apocrine miliaria
/ Fox-Fordyce disease : a chronic, usually pruritic disease chiefly
seen in women, characterized by the development of small follicular papular
eruptions of apocrine gland–bearing areas, especially the axillae and pubes,
and caused by obstruction and rupture of the intraepidermal portion of
the ducts of affected apocrine glands, resulting in alteration of the regional
ductal epidermis, apocrine secretory tubule, and adjacent dermis
Therapy : avoid occlusion and excessive heat
very persistent inflammatory changes depending upon the extent of the blockage,
environmental temperature, and duration of sweating stimulus
hidration / skin turgor
anhidrosis / anidrosis / hidroschesis :
absence or severe deficiency of sweating; in humans this is usually due
to absence or paralysis of the sweat glands or to obstruction of the sweat
ducts
thermogenic anhidrosis / tropical
anhidrotic asthenia / sweat retention syndrome : a rare condition seen
under conditions of heat stress, in which miliaria
profunda causes extensive occlusion of the sweat ducts, producing anhidrosis
and heat retention that may lead to heat exhaustion with weakness, dyspnea,
tachycardia, elevation of body temperature, and collapse
hypohidrosis : abnormally diminished
perspiration
xerosis : dry, scaly skin that shows accentuated
skin lines. Xerosis is often seen in atopic
dermatitis (AD) / type I hypersensitivity.
Xerosis is often noted on extensor surfaces especially in the winter. Conditions
that dry the skin out include the low humidity of winter, frequent washing,
contact with hot water, the use of soaps and detergents, and older age
diaphoresis / sudoresis : sweating, especially
of a profuse type
hemihidrosis / hemidrosis : sweating on one side of the body only
hyperhidrosis unilateralis / hemihyperidrosis / hemidiaphoresis
: excessive sweating on one side of the body only.
Epidemiology : the prevalence of primary hyperhidrosis
is 2.8% in the U.S. population, 1.4% have axillary hyperhidrosis, and 14%
are projected to have sweating that is intolerable or interferes with daily
activities
Aetiology :
there also is a hereditary component, as approximately 50% of these patients
have a relative with hyperhidrosis
hyperhidrosis
palmaris et plantaris : an autosomal dominant disorder of the eccrine
sweat glands, most often of the palms, soles, and axillae, in which emotional
stimuli (e.g., anxiety) and sometimes mental or sensory stimuli elicit
volar and axillary hyperhidrosis (usually not both in the same individual);
eccrine sweat glands in other areas of the body are affected less often
and are less sensitive to such stimuli.
primary hyperhidrosis affects people while they are awake, but nighttime
sweating is never normal. A careful history and physical examination must
be performed to rule out other causes of excessive sweating, which physicians
call secondary hyperhidrosis. In contrast to the primary form, secondary
hyperhidrosis is associated with other potentially serious medical problems
that need further workup from physicians.
Localization :
face hyperhidrosis
hyperhidrosis of the axilla
/ axillary hyperhidrosis
syringocystadenoma / syringocystoma
: a benign cystic tumor of the sweat glands.
hidradenoma / hidroadenoma : a benign
tumor originating in sweat gland epithelial cells; subtypes are variously
designated according to histologic pattern and specific component from
which the tumor appears to be derived.
spiradenoma : a benign tumor of the sweat
glands, particularly of the coil portion.
apocrine sweat gland
syringocystadenoma
papilliferum (SP) : a hamartoma of an apocrine sweat gland,
occurring as a grouping of firm, rose red papules, usually on the scalp
but sometimes on the face or trunk or in the genital or inguinal region,
and characterized by papillary projections extending into the lumina of
dilated cystic sweat glands and ducts. It commonly arises in conjunction
with nevus sebaceous. Other
less common lesions reported with SP include apocrine adenoma, condyloma
acuminatum, hidradenoma papilliferum associated with hidrocystoma, poroma
folliculare, and verrucous carcinoma.
papillary hidradenoma / hidradenoma
papilliferum : a benign tumor of apocrine glands, usually occurring
as a solitary, firm, nodular, well-circumscribed, intradermal lesion in
the vulva or anal region in adult women, and characterized by a central
cystic space into which extend papilliferous projections.
apocrine poroma : differentiation
toward the folliculosebaceous-apocrine unit; trichoblastoma
arising within an apocrine poroma has been reported.
with follicular differentiation
hidrocystoma : a retention cyst of a
sweat gland
apocrine hidrocystoma
or cystadenoma : a smooth, frequently bluish, firm, dome-shaped, translucent,
usually solitary lesion occurring chiefly on the face; it is an adenomatous
cystic proliferation of the apocrine glands.
eccrine sweat gland
dermal duct tumor : a small, intradermal,
papular, eccrine lesion occurring on the head and neck in older
adults.
syringoma : a benign tumor believed to originate
from the ductal portion of the eccrine sweat glands, occurring as
multiple small flesh-colored papules on the face, neck, and upper chest,
usually in postpubertal women, and characterized by dilated cystic sweat
ducts in a fibrous stroma.
chondroid syringoma : a usually
benign tumor originating in the sweat glands, occurring as a solitary,
firm, deep-seated intradermal or subcutaneous nodule on the head or neck;
it is characterized by ductal and cystic glandular proliferation and is
believed to be of eccrine origin.
hidradenoma eruptivum : an eruptive
form of syringoma in which the lesions arise in large numbers in successive
crops, usually on the anterior trunk or abdomen of a young person.
eccrine poroma is a benign tumor which
arises from the intraepidermal portion of the eccrine sweat glands.
It usually occurs as a solitary lesion in the extremity, with the foot
and sole as a common site. It may present as a foot mass, ulcerative lesion,
bleeding lesion, or suspected melanoma. The clinical diagnosis is often
delayed or inaccurate. Rapid evolution to eccrine
porocarcinoma has been reported.
pigmented eccrine poroma
eccrine spiradenoma : a benign,
solitary, deep-seated nodule arising from the coil portion of an eccrine
gland; it is covered by normal appearing skin and may be accompanied by
paroxysmal pain
clear cell hidradenoma / nodular
hidradenoma / eccrine acrospiroma : an epithelial tumor of the eccrine
sweat glands usually occurring as a benign, solitary, well circumscribed,
nodular, both solid and cystic skin lesion in middle-aged or older women;
it is characterized histologically by large cuboidal or polyhedral glycogen-rich
clear cells.
hidroacanthoma : a benign tumor of
an eccrine gland.
hidroacanthoma simplex : a slightly raised keratotic lesion sometimes
described as the intraepidermal counterpart of an eccrine poroma.
eccrine hidrocystoma : a small
cystic lesion occurring singly or multiply, most often on the faces of
older adults, particularly women, and frequently exacerbated by hot weather
and perspiration.
eccrine syringofibroadenoma
(ESFA)
cylindroma : a usually benign tumor of
either apocrine or eccrine origin generally arising in early life
as single or multiple nodules located on the scalp and less often on the
face and extremities, and consisting of cylindrical epithelial masses containing
small basophilic and larger pale-staining cells surrounded by pink hyaline
sheaths. Multiple lesions (cylindromatosis), which affect females
more often and may completely cover the scalp (hence the descriptive term
turban
tumor syndrome), are usually dominantly inherited : they are due to
mutation of the tumour suppressor CYLD,
a de-ubiquitylating enzyme for TRAF2,
TRAF6,
and IKKg
that negatively regulates the anti-apoptotic activity of NF-kB
: it may also be associated with multiple trichoepitheliomas.
hidradenocarcinoma : carcinoma
of the sweat glands.
porocarcinoma :carcinoma arising
in or from the intraepidermal portion of the sweat gland.
apocrine carcinoma : carcinoma
of an apocrine gland
eccrine carcinoma : carcinoma of
the eccrine sweat glands.
eccrine porocarcinoma / malignant
eccrine poroma : a porocarcinoma arising from the intraepidermal and
upper dermal eccrine ducts, usually occurring as a verrucous plaque, nodule,
ulcer, or pedunculated mast (polypoid growths) on an extremity. The tumour
either
arises spontaneously or develops in a long-standing eccrine
poroma, generally in elderly people over 60. Unusual metastatic spread
to regional lymph nodes, followed by lymphangitic cutaneous spread has
been reported
clear cell hidradenocarcinoma
: a very rare tumor occurring as an erythematous, sometimes ulcerated,
nodule on the face or scalp; it histologically resembles a clear cell hidradenoma
but displays cellular atypia and frequently deep invasion.
polyonychia : the occurrence of supernumerary nails.
megalonychia / macronychia : the condition of having unusually large
nails
schizonychia : splitting of the nails.
trachyonychia : roughness of nails with brittleness and splitting,
often associated with psoriasis, alopecia areata, and lichen planus
onychodystrophy : any deformity of
a nail
eggshell nail : a fingernail which has become thin and curved upward
at its anterior edge.
parrot beak nail : a curvation of the fingernail like that of a
parrot's beak
racket nail : thumbnails that are much shorter than they are wide;
rarely, other fingers may be affected. In the commonest form, the distal
phalanges of affected digits are shortened as well. It is believed to be
an autosomal dominant disorder.
reedy nail : a fingernail marked by longitudinal furrows
spoon nail : depression of the central portion of the fingernail,
with raising of the edges at the sides
turtle-back nail : a fingernail which is greatly distorted, being
more convex than normal
nail groove : a pathologic linear depression
of the nail plate, running usually transversely but occasionally lengthwise
Beau's line : deep transverse grooves
resulting from nail growth arrest, suggests systemic illness; median nail
groove causes habit tics and self-limiting dystrophy of Heller
koilonychia : nails are flattened and
have concavities
Risk factors : GR
agonists,
diabetes
mellitus,
antibacterials, shoes with low transpiration
Pathogenesis : usually starting from distal
border (if from proximal border : severe immunodepression). Often accompanied
by bacterial overinfection
Laboratory examinations : KOH
test Therapy : systemic antifungal (fluconazole,
itraconazole,
and terbinafine)
and antibacterial enters with growing nail (up to 6 months for fingernails,
up to 12 months for toenails), topic laques (mophidine), keratolytic (sulfur),
mycostatics (eosin, mercurochrome)
periungual fibroma / Koenen's tumor : one of multiple smooth, firm,
protruding nodules, histologically angiofibromas, occurring at the nail
folds and considered to be pathognomonic of Bourneville's
tuberous sclerosis
ingrown or ingrowing toenail / onychocryptosis
/ onyxis / unguis incarnatus : aberrant growth of a toenail, with one
or, less often, both lateral margins pushing deeply into the adjacent soft
tissues; unilateral in 80% of cases, usually affects hallux (great toe)
Aetiology :
improper nail cutting (nail incurves into nail fold)
pachyonychia congenita / Jadassohn-Lewandowsky
syndrome : an autosomal dominant syndrome characterized by increased
thickness of the nails that progresses to onychogryphosis; hyperkeratosis
of the palms, soles, knees, and elbows; widespread tiny cutaneous horns;
leukoplakia of the mucous membranes; and usually hyperhidrosis of the hands
and feet. Bullae may develop on the palms and soles following trauma
Pathogenesis : ingrown nail, erythema, trace
edema and pain at lateral nail fold => increased pain and discharge from
nail edge => bacterial paronychia, lateral nail fold hypertrophy and granulation
tissue
Therapy : warm water soaks, insert cotton-wick
at lateral nail groove edge, silver nitrate to lateral nail granulation
tissue, antibiotics if present, surgical nail avulsion
digital hippocratism
/ digital clubbing / hippocratic nail
2 : watch-crystal nail : a nail convex lengthwise as well as crosswise,
and often as broad as it is long
3 : drumstick-shaped fingers
pseudoclubbing : soft-tissue collapse
owing to severe bone erosions of the terminal phalanges
Aetiology : hyperparathyroidism Laboratory examinations : the nail-fold
angle, or Lovibond's angle, was well preserved and bony erosion of the
terminal phalanges are seen on radiographyref
nail bed laceration
Aetiology : high force crush or laceration
injury (machine press, rotary saw, ...)
Symptoms & signs : large subungual
hematomas (> 50% of nail), distal tuft fracture
Laboratory examinations : AP, lateral
and oblique X-ray of digit
Therapy : repair, digital nerve block,
apply tourniquet at digit base, clamp 1/4 inch penrose drain at base of
finger, nail removal in normal fashion, suture nail bed laceration, use
6-0 or 7-0 absorbable suture, bandage nail bed (to be left in place 2-3
weeks), consider cleaning and re-applying nail or apply petroleum gauze
over exposed nail
splinter hemorrhages : linear
hemorrhages beneath the nail; when located near the base of the nail they
are characteristic of subacute
bacterial endocarditis.
subungual hematomas : an accumulation
of blood under the nail plate
Therapy : drainage (ontraindicated if
phalanx fracture present, large subungual hematomas (>50% of nail), requires
nail bed laceration suturing) by gently drilling 2-3 small holes into nail
with number 11 blade or spin 18 gauge needle between fingers or heated
paper clip, splint fingertip (e.g. AlumaFoam Splint) and apply for up to
3 days until pain subsides
hangnail : a shred of eponychium on a proximal or lateral nail fold
perionyxis : inflammation of the pad surrounding
the nail.
melanonychia striata / longitudinal
melanonychia : pigmented stripe, usually brown or black, along the
length of the nail bed in darker-skinned individuals
hypodermolithiasis : the formation or presence of subcutaneous calcareous
nodes.
cutaneous orsubcutaneous
emphysema / pneumoderma / aerodermectasia : interstitial
emphysema
characterized by the presence of air in the subcutaneous tissue
dilated pore of Winer : a solitary pore on the face, back, or extremities,
filled by a keratinous plug that is surrounded by hyperplastic follicular
epithelium.
fibroma molluscum : small subcutaneous
nodules scattered over the body surface, seen in some forms of neurofibromatosis.
acute panniculitis / nodular necrosis of
adipose tissue : inflammation of the subcutaneous layer of fat
relapsing febrile nodular nonsuppurative panniculitis / Weber-Christian
disease (Weber Christian HA. Relapsing febrile nodular non-suppurative
panniculitis. Arch.Int.Med. 42:338-351 (1928)): recurring fever and usually
painful inflammatory and necrotic nodules in the subcutaneous tissues especially
of the thighs, abdomen, or buttocks. Fever unresponsive to antibiotics,
synovitis of small joints, pancreatic disease (including carcinoma of the
acinar type), pancreatic enzymes in serum, urine and tissues. May have
polyserositis, lytic bone lesions and visceral adipose lesions, predominantly
in pancreas carcinoma.
erythema induratum : a type of
panniculitis seen in young and middle-aged women, characterized by granulomas,
vasculitis, and caseation necrosis; it was formerly considered the tuberculous
(Mycobacterium
tuberculosis)
counterpart of nodular vasculitis, but has been found to occur without
tuberculous causation, although of uncertain etiology. It is initiated
or exacerbated by cold weather, usually presenting as recurrent erythrocyanotic
nodules or plaques on the calves, which may progress to form deep-seated
indurations, ulcerations, and scars. Cases of tuberculous origin are called
also Bazin's disease / tuberculosis (cutis) indurativa
Rothmann-Makai syndrome : idiopathic circumscribed panniculitis
with fat cell necrosis, lipophagic granuloma, and cyst formation; it usually
subsides spontaneously
cellulitis : diffuse and especially subcutaneous
inflammation of connective tissue
Aetiology : bacterial infection
Erysipelothrix
rhusiopathiae
(erysipeloid of Rosenbach) : usually occurring
as an occupational disease associated with cut in the skin of handlers
of infected fish, shellfish, meat, or poultry (butchers, kitchen workers,
vets, and turkey growers). It is an erythematous and painful swelling at
the site of inoculation, which spreads peripherally with central clearing
and resolves without consequences. Erysipeloid most commonly affects the
hands, mainly the webs of the fingers. However, any exposed area of the
body may be affected. Lesions consist of well-demarcated, bright red-to-purple
plaques with a smooth shiny surface. Lesions are warm and tender. They
leave a brownish discoloration on the skin when resolving. Sometimes vesicles
may be present. Fever,
malaise, and other constitutional symptoms may or may not be present
Ludwig's angina : a severe form of
cellulitis of the submaxillary space and secondary involvement of the sublingual
and submental spaces, usually resulting from an infection in the mandibular
molar area or a penetrating injury of the floor of the mouth (e.g. periapical
abscess).
Elevation of the tongue, difficulty in eating and swallowing, edema of
the glottis, fever, rapid breathing, and moderate leukocytosis are the
most common symptoms.
Wells' syndrome
/ eosinophilic cellulitis : cellulitis with erythema, edema, and often
blistering of the skin accompanied by eosinophilia, flame figures, and
a mild fever; a single episode lasts 2 to 6 weeks and recurrences or exacerbations
are common
Symptoms & signs : redness, swelling,
tenderness and warmth. Commonly, red streaks radiate from a site of previous
skin injury toward nearby lymph glands. May also cause blistering of the
skin and other symptoms such as fever and flu-like symptoms
Profichet's syndrome : a gradual growth of calcareous nodules in
the subcutaneous tissues (skin stones) especially about the larger joints,
with a tendency to ulceration or cicatrization and attended by atrophic
and nervous symptoms.
felon / whitlow : an extremely painful abscess
on the palmar aspect of the fingertips, occurring as the result of infection
in the closed space of the terminal phalanx, usually following inoculation
into the skin of a pathogenic microorganism
subcutaneous mycoses / mycetomas / maduromycoses
: a slowly progressive, destructive infection of the cutaneous and subcutaneous
tissues, fascia, and bone acquired by traumatic implantation of the fungus
or bacterium. It usually involves the foot (Madura
foot) or leg, although the hand or any other site may be inoculated.
The primary lesion is a tumefaction, with granulomas, suppurating abscesses,
and sinuses discharging grains or granules representing microcolonies of
the pathogen
filamentous (the commonest), consists of brown septate and branched
hyphae that may be slightly more swollen towards the periphery. In the
cortex, the filaments are arranged radially while in the medulla they tend
to run multi-directionally. Round or oval cells, 7-15 mm
in diameter, are seen, particularly in the periphery.
vesicular (less common) is composed of unusually large cells that
look like vesicles. Both types of the grain can be found in the same lesion.
Grains that are partially vesicular and partially filamentous are not uncommonly
seen.
The surface of the grain may be scalloped giving the periphery a hob-nail
appearance and a brightly eosinophilic layer of fibrin–like material sometimes
covers the grain (Fig. 6). This layer is of host origin, contains fibrin,
immunoglobulins and complement. A similar material is seen around parasites
as Hoepple phenomenon. Occasionally a thin layer of a haematoxophilic
granular material is found on the surface of the grain. This material is
Feulgen positive and is derived from the nuclei of disintegrating inflammatory
cells surrounding the grains.
Staging of inflammatory cellular reaction around the grain :
type I : neutrophils in the vicinity of the grain or within
the grain substance causing its disintegration. Some histocytes may also
be seen among the neutrophils but they are more numerous outside the neutrophil
zone. Capillaries, which are sometimes abundant, surround the neutrophil/
histiocyte zone and they are occasionally, surrounded by a layer of fibrin.
Lymphocytes, plasma cells, fibroblasts and some macrophages are usually
seen in this vascular zone. The lymphocytes and plasma cells increase in
number towards the investing fibrous tissue in the periphery of the lesion.
type II : the neutrophils largely disappear and are replaced by
histocytes
and multinucleated giant cells. Some of the latter contain fragments
of grain or pigmented cement substance without any hyphae. The macrophages
may contain a black pigment derived from the grain. At this stage the grain
itself is usually small and fragmented.
type III : the grain material has largely or completely disappeared
leaving a compact epithelioid granuloma with or without Langhans
giant cells. This however, is an uncommon reaction but represents spontaneous
regression in some grains.
The 3 types of tissue reaction may be found in the same lesion.
Laboratory examinations : KOH
test (the skin is scraped with a scalpel or glass slide causing dead
skin cells to fall off onto a glass slide. A few drops of potassium hydroxide
are added to the slide and the slide is heated for a short time. The KOH
dissolves the material binding the skin cells together releasing the fungus.
The slide is then viewed under the microscope looking for fungal elements)
Web resources : Mycetoma
Research Centre, University of Khartoum, Sudan
Dupuytren contracture
or disease is a proliferative fibroplasia of the subcutaneous palmar
tissue, occurring in the form of nodular and cords. Evidence is certainly
accumulating for raised levels in Dupuytren's tissue of growth factors
known to stimulate fibroblasts, IL-1, bFGF, TGF-b,
PG-F2, PG-E2, PDGF and CTGF have been suggested to
have a role
palmar fibromatosis : fibromatosis involving the palmar fascia,
and resulting in Dupuytren's contracture.
Therapy : immune modification of profibrotic
cytokines would provide a novel means to treat dupuytren contracture. Imiquimod
cream 5% (Aldara) is an immune modifier, that downregulates TGF-b
and FGF-2 (the 2 most important cytokine in producing fibrosis). Based
on previous mentioned evidence we suggest: imquimod as a potential drug
for dupuytren contracture treatmentref