Dermatology therapy essentials - part 10 pptx

Dermatologic indications and dosage Acanthosis nigricans Apply once daily, preferably at bedtime; apply 20–30 minutes after washing and drying skin Apply once daily, preferably at bedt

Trang 1

Localized skin dyspigmentation secondary

to deposition of colored material in the skin

from a deep dirty abrasion or other

pene-trating injury

Pathogenesis

Deposition of material into dermis, often

after high velocity penetration

dis-Differential diagnosis

Melanoma; melanocytic nevus; lentigo;drug-induced pigmentation; exogenousochronosis

Therapy

Ablation by Q-switched laser; surgical sion; dermabrasion; laser resurfacing;chemical peel

exci-References

Fusade T, Toubel G, Grognard C, Mazer JM (2000) Treatment of gunpowder traumatic tattoo by Q-switched Nd:YAG laser: an unusual adverse effect Dermatologic Surgery 26(11):1057–1059

Definition

Blood-borne bacterial infection ized by fever, systemic signs and symp-toms, and an eruption occurring at theonset of the disease

character-Pathogenesis

Caused by Bartonella quintana, gram tive bacteria introduced to human host bybody louse; inoculation of organism inlouse feces through a skin break or a lousebite

Trang 2

nega-578 Trench foot

Clinical manifestation

Fever, varying from single episode to

recur-rent episodes to persistently elevated body

temperature for weeks; conjunctivitis; skin

eruption most commonly occurring during

first fever episode; groups of erythematous

macules or papules on abdomen, chest, and

back; splenomegaly; hepatomegaly;

tachy-cardia

Differential diagnosis

Babesiosis; bacillary angiomatosis;

crypto-coccosis; Lyme disease; relapsing fever;

Rocky Mountain spotted fever; HIV

Ohl ME, Spach DH (2000) Bartonella quintana

and urban trench fever Clinical Infectious

recep-Dosage form

0.025%, 0.05%, 0.1% cream; 0.04%, 0.1%micro gel; 0.025% gel

Dermatologic indications and dosage

See table

Common side effects

Cutaneous: scaling, erythema, blistering,

Trang 3

Trichilemmal cyst 579

T

Tretinoin Dermatologic indications and dosage

Acanthosis nigricans Apply once daily, preferably at

bedtime; apply 20–30 minutes after washing and drying skin

Apply once daily, preferably at bedtime; apply 20–30 minutes after washing and drying skin

Acne vulgaris Apply once daily, preferably at

Acrokeratoelastoidosis Apply once daily, preferably at

Actinic elastosis Apply once daily, preferably at

Not applicable

Actinic keratosis Apply twice daily for up to 3 months Apply once daily, preferably at

Bowenoid papulosis Apply twice daily for up to 3 months Not applicable

Chloracne Apply once daily, preferably at

Epidermolytic

hyperkeratosis

Favre Racouchot

disease

Not applicable

Fox-Fordyce disease Apply once daily, preferably at

Hairy tongue Apply twice daily for up to 3 months Apply once daily, preferably at

Idiopathic guttate

hypomelanosis

Not applicable

Keratosis pilaris Apply once daily, preferably at

Kyrle’s disease Apply once daily, preferably at

Trang 4

Benign neoplasm with differentiation

toward pilosebaceous follicular epithelium

Lamellar ichthyosis Apply once daily, preferably at

Melasma Apply once daily, preferably at

Nevus comedonicus Apply once daily, preferably at

Nevus verrucosus Apply once daily, preferably at

Perforating folliculitis Apply once daily, preferably at

Photo-aging Apply once daily, preferably at

Not applicable

Pomade acne Apply once daily, preferably at

Postinflammatory

hyperpigmentation

Reactive perforating

collagenosis

Rosacea Apply once daily, preferably at

Striae Apply once daily, preferably at

Tretinoin Dermatologic indications and dosage (Continued)

Trang 5

Trichoepithelioma 581

T

Basal cell carcinoma; epidermoid cyst; wart;

neurilemmoma; trichoepithelioma;

tricho-folliculoma; clear cell acanthoma

Therapy

Shave removal; elliptical excision

References

Tellechea O, Reis JP, Baptista AP (1992)

Desmo-plastic trichilemmoma American Journal of

Hamartomatous proliferation of

mesoder-mal component of haarscheibe, slowly

reacting nerve receptor around hair follicle

Pathogenesis

Unknown

Solitary or multiple, discrete, flat-topped

papules, usually located on central face

Nova MP, Zung M, Halperin A (1991)

Neurofollic-ular hamartoma A clinicopathological study

American Journal of Dermatopathology 13(5):459–462

Trichoepithelioma

Synonym(s)

Trichoblastoma; epithelioma adenoidescysticum; trichoepithelioma papulosummultiplex; sclerosing epithelial hamar-toma; Brooke tumor

Definition

Benign adnexal tumor with differentiationtoward hair follicle epithelium

Pathogenesis

Autosomal dominant familial form related

to a mutation in tumor suppressor gene,located on 9q21

Round, skin-colored, firm papule or ule, located mainly on nasolabial folds,nose, forehead, upper lip, and scalp; occa-sional lesions on neck and upper trunk;rare ulceration; multiple lesions in familialform, usually on nasolabial folds; solitarygiant trichoepithelioma: large, polypoidtumor, usually in the lower trunk or in glu-teal area

nod-Differential diagnosis

Basal cell epithelioma; colloid milium;cylindroma; angiofibroma; milium; pilar

Trichoepithelioma Multiple flesh-colored

papules in the central facial area

Trang 6

582 Trichoepithelioma papulosum multiplex

cyst; syringoma; trichilemmoma;

micro-cystic adnexal carcinoma

Smith KJ, Skelton HG, Holland T (1992) Recent

advances and controversies concerning

adnex-al neoplasms Dermatologic Clinics 10(1):117–

Hamartoma of follicular epithelium,

typi-cally occurring on the face

Pathogenesis

May be abortive differentiation of

pluripo-tent skin cells towards hair follicles

Single, flesh-colored or whitish papule,

typ-ically on face, most frequently around the

nose; central pore or black dot, sometimes

draining sebaceous-like material; tuft of

white hair sometimes emerges from central

pore

Basal cell epithelioma; colloid milium;

cylindroma; angiofibroma; milium; pilar

cyst; syringoma; trichilemmoma; cystic adnexal carcinoma; trichoepitheli-oma; vellus hair cyst

References

Walsh KH, McDougle CJ (2001) Trichotillomania presentation, etiology, diagnosis and therapy American Journal of Clinical Dermatology 2(5):327–333

Trichomatricoma

Pilomatricoma

Trichomatrioma

Pilomatricoma

Trang 7

Superficial bacterial colonization of the

axillary hair shafts, characterized by

granu-lar concretions adhering to hair shaft

Pathogenesis

Caused by several species of the

gram-posi-tive diphtheroid Corynebacterium

over-growth on hair shafts in moist regions of

the body

Seen more often in tropical climates;

some-times associated with hyperhidrosis;

con-cretions encircling hair shaft, giving it

beaded appearance; most common on the

central portion of axillary hair

(trichomy-cosis axillaris) or inguinal region, often on

scrotum (trichomycosis pubis); red, black,

or yellow concretions firmly adhering to

hair shaft; yellow color sometimes stains

clothes yellow, black, and red

Pediculosis; piedra; hair casts; soap or

deo-dorant remnants

Therapy

Shaving of affected hair; use of

antiperspi-rants to prevent recurrence

References

O'Dell ML (1998) Skin and wound infections: an

overview American Family Physician

Trang 8

584 Trichosporosis

References

Rogers M (1995) Hair shaft abnormalities: Part I

Australasian Journal of Dermatology

Dark follicular papules, caused by multiple

vellus hairs imbedded in follicular orifice

Pathogenesis

Results from successive production and

retention of vellus telogen club hairs from

single hair matrix in single follicle

Dark, follicular plugs or papules,

some-times with tufts or spines of fine hair

protu-ding; most common on nose and upper

trunk

Comedonal acne; lichen spinulosus;

retained dirt; keratosis pilaris

Therapy

Depilatory wax or adhesive strips; drainage

with comedone extractor

References

Harford RR, Cobb MW, Miller ML (1996)

Trichos-tasis spinulosa: a clinical simulant of acne open

comedones Pediatric Dermatology 13(6):490–

492

Trichothiodystrophy

Tay syndrome

Trichothiodystrophy with congenital ichthyosis

Alopecia caused by compulsive pulling and/

or twisting of the hair until it breaks off

Pathogenesis

Impulse control disorder, often with lying emotional problem; become habitualonce behavior is established, regardless ofinitial emotional problem

under-Trichotillomania Alopecic plaque with broken

hairs in the scalp

Trang 9

Trimox 585

T

Incomplete nonscarring alopecia, in

rela-tively localized sites; geometric shapes of

involved area, with broken hair; occurs

most frequently in scalp, but sometimes

involves eyebrows or eyelashes

Alopecia areata; tinea capitis; androgenetic

alopecia; syphilis; lupus erythematosus;

monilethrix; traction alopecia; pili torti;

temporal triangular alopecia

Therapy

Selective serotonin reuptake inhibitors in

patients unable to control impulse after

understanding nature of disorder

References

Hautmann G, Hercogova J, Lotti T (2002)

Tri-chotillomania Journal of the American

Cutaneous: urticaria or other vascular

reac-tion, photosensitivity

Gastrointestinal: anorexia, nausea,

vomit-ing, diarrhea

Neurologic: dizziness

Serious side effects

Bone marrow: aplastic anemia,

agranulocy-tosis

Cutaneous: Stevens-Johnson syndrome,

toxic epidermal necrolysis

Gastrointestinal: hepatitis, hepatic

necro-sis, pseudomembranous colitis

Renal: interstitial nephritis

Drug interactions

Oral contraceptives; dapsone; MAO tors; metformin; methotrexate; phenytoin;probenecid; procainamide; sulfonylureas;warfarin

Trimethoprim-sulfamethoxa-Trimox

Amoxicillin

Trang 10

586 Tropical anhidrosis

Tropical anhidrosis

Miliaria

Tropical anhidrotic asthenia

Acquired generalized anhidrosis

Tropical jungle foot

Immersion foot

Tropical phagedenic ulcer

Synonym(s)

Vincent’s ulcer; tropical sloughing

phagedena; ulcus tropicum

Definition

Acute, painful, destructive skin ulceration

occurring in presence of fusiform bacilli

and spirochetes

Pathogenesis

Multiple contributing factors, includingprotein deficiency, presence of fusiformbacilli and spirochetes, and minor trauma

to affected site

Papule or vesicle at site of minor trauma,often on lower extremity; rapid evolution ofnecrotic, purulent, putrid ulceration oftendown to fascia, tendon, and bone; chronicstage with indolent, non-purulent ulcera-tion

Leishmaniasis; bacterial pyoderma; derma gangrenosum; cutaneous diphthe-ria; gummatous syphilis; yaws; leprosy;chromomycosis; squamous cell carcinoma;venous stasis ulcer; atypical mycobacterialinfection; venomous sting or bite

pyo-Therapy

Acute stage: Benzathine penicillin G; racycline; metronidazole: 400 mg PO 3times daily until healing

tet-Chronic stage: no specific antibiotic therapy

References

Robinson DC, Adriaans B, Hay RJ, Yesudian P (1988) The clinical and epidemiologic features

of tropical ulcer (tropical phagedenic ulcer)

Trimethoprim-sulfamethoxazole Dermatologic indications and dosage

Granuloma inguinale DS capsule twice daily for at least 3

weeks

Not established Melioidosis DS capsule twice daily until

ulceration heals

Not established Mycetoma DS capsule twice daily until

ulceration heals

Not established Mycobacterium

marinum infection

DS capsule PO twice daily for 4–6 weeks after clincial resolution

Not established Nocardiosis DS capsule twice daily for at least 3

weeks

Not established South American

blastomycosis

DS capsule twice daily for 2–3 years Not established

Trang 11

Skin lesions: angiofibromas (adenomasebaceum) often in nasolabial folds and oncheeks and chin; periungual fibromas(Koenen tumors); connective tissue nevus(Shagreen patch), presenting as flesh-colored, soft plaque in the lumbosacralarea; ash leaf-shaped macules on trunk orlimb; guttate leukoderma; café au lait mac-ules; poliosis

Neurologic changes: tuberosclerotic ules of glial proliferation in cerebral cortex,

Trang 12

nod-588 Tuberous sclerosis complex

basal ganglia, and ventricular walls;

number of tubers appears to correlate with

clinical disease severity; epilepsy; mental

retardation

Other features noted: schizophrenia;

autis-tic behavior; and attention-deficit

hyperac-tivity disorder

Miscellaneous findings: cardiac

rhabdomy-omas; aortic aneurysm; renal

angiomyol-ipoma and renal cysts; pulmonary

lym-phangiomatosis with cyst formation;

microhamartomatous polyps in bone cysts;

pituitary adrenal dysfunction; thyroid

dis-orders; premature puberty; diffuse

cutane-ous reticulohistiocytosis; gigantism

Acne; connective tissue nevus; nevus

ane-micus; vitiligo; warts; trichoepithelioma;

syringoma; rosacea

Therapy

Pulsed dye or CO2 laser ablation or

derma-brasion for facial angiofibromas; CO2 laser

vaporization for periungual fibromas

Nakagawa’s angioma; Nakagawa's

angio-blastoma; progressive capillary

hemangi-oma; acquired tufted angioma;angioblastoma

Definition

Vascular skin tumor, characterized by slowangiomatous proliferation and a distinctivehistologic presentation

Capillary hemangioma; Kaposi’s sarcoma;kaposiform hemangioendothelioma;hemangiopericytoma; pyogenic granu-loma; endovascular papillary angioen-dothelioma; melanoma

Tularemia

Synonym(s)

Rabbit fever; deer-fly fever; wild hare ease; water-rat trapper’s disease; marketmen’s disease

dis-Definition

Acute infectious zoonosis, characterized byskin eruption and/or ulceration, lymphade-nopathy, and variable systemic signs andsymptoms

Trang 13

Tungiasis 589

T

Pathogenesis

Caused by aerobic gram-negative

pleomor-phic bacillus Francisella tularensis, after

introduction of bacillus by inhalation,

intradermal injection, or oral ingestion;

rabbits and ticks (especially

Dermatocen-tor and Amblyomma species) most

com-mon vectors

Ulceroglandular variant: organism usually

gaining entry via scratch or abrasion; ulcer

at the site of entry begins as tender papule

and eventually ulcerates; sharply

demar-cated border with a yellowish exudate; base

of the ulcer with yellow exudate becomes

black; regional lymphadenopathy

Glandular variant: similar to

ulceroglandu-lar form except for absence of skin lesion

Oculoglandular variant: organism enters

via the conjunctivae after inoculation from

either splashing of blood or rubbing of eyes

after contact with infectious materials;

uni-lateral, painful, purulent conjunctivitis with

preauricular or cervical lymphadenopathy

Oropharyngeal variant: occurs after eating

poorly cooked rabbit meat; sore throat;

abdominal pain; nausea; vomiting;

diarrhea; and; occasional gastrointestinal

bleeding

Pneumonic variant: occurring after

inhala-tion of organism; pneumonia also

some-times occurs after hematogenous spread in

patients with ulceroglandular tularemia or

typhoidal tularemia; dry cough; dyspnea;

and pleuritic-type chest pain

Typhoidal (septicemic) variant: represents

bacteremia; fever; chills; myalgias; malaise;

weight loss, often with subsequent

pneumo-nia

Anthrax; orf; milker’s nodule; foreign body

granuloma; Q fever; Rocky Mountain

spot-ted fever; Lyme disease; Majocchi’s

granu-loma; sporotrichosis; coccidioidomycosis;

North American blastomycosis; plague;

brucellosis; diphtheria; bacterial

endocardi-tis; legionella infection; malaria;

mononucl-eosis; syphilis; rat bite fever; atypical

myco-bacterial infection

Therapy

Streptomycin: adult dose: 1–2 gm IM, giventwice daily for 7–14 days or until patient isafebrile for 5–7 days; pediatric dose: 20–40

mg per kg per day IM given twice daily for7–14 days or until patient is afebrile for 5–7daysw; doxycycline

Common areas of involvement: plantarfoot, intertriginous regions of the toes, andperiungual regions; pruritic white papulewith central black dot

More advanced infestation: crusted thematous papules, painful pruritic nod-ules, crateriform lesions, and secondaryinfection including lymphangitis and septi-cemia

ery-Differential diagnosis

Insect bite reaction; scabies; cercarial matitis; tick bite; myiasis; fire ant sting;creeping eruption; dracunculiasis

der-Therapy

Surgical extirpation of the parasite usingsterile needle or curette

Trang 14

590 Turban tumor

References

Fein H, Naseem S, Witte DP, Garcia VF, Lucky A,

Staat MA (2001) Tungiasis in North America: a

report of 2 cases in internationally adopted

children Journal of Pediatrics 139(5):744–746

Disorder in women caused by a

chromo-somal defect, producing impaired sexual

development, infertility, and multiple other

congenital defects

Pathogenesis

Results from lack of second SHOX gene on

X chromosome; many features, including

the short stature

Short stature; signs of ovarian failure;

hypo-plastic or hyperconvex nails; many

nevocel-lular nevi; cutis laxa; webbed neck; skeletalanomalies including cubitus valgus, scolio-sis, short fourth metacarpal or metatarsalbone, shield chest, hip dislocation; eyechanges including ptosis, strabismus,amblyopia and cataracts; gastrointestinalbleeding

Noonan’s syndrome; gonadal dysgenesis;autoimmune thyroiditis; XY gonadal agene-sis syndrome

Pathogenesis

Many cases with no known cause; someassociated with alopecia areata, psoriasis,lichen planus, atopy, ichthyosis, or otherinflammatory dermatoses

Rough linear edges of nail plates; cent and frequently brittle nail plates thatsplit at free margin; more common in chil-

Trang 15

Onychomycosis; lichen planus; psoriasis;

onychophagia; traumatic nail dystrophy

Therapy

No effective therapy

References

Tosti A, Bardazzi F, Piraccini BM, Fanti PA (1994)

Idiopathic trachyonychia (twenty-nail

dystro-phy): a pathological study of 23 patients British

Keratosis palmaris et plantaris with

carci-noma of the esophagus; Howell-Evans

syn-drome

Definition

Familial hyperkeratosis of the palms and

soles associated with carcinoma of the

esophagus

Pathogenesis

Autosomal dominant gene; tylosis

esopha-geal cancer gene (TOC) localized to

chro-mosome 17q25

Focal palmoplantar keratoderma

begin-ning by age 5–15 years; variable oral

leukok-eratosis; follicular kleukok-eratosis; increased

sus-ceptibility to carcinoma of esophagus

Tyrosinemia type II; pachyonycia ita; focal palmoplantar and oral mucosahyperkeratosis; acrokeratoelastoidosis;focal acral hyperkeratosis; acrokeratois ofBazex; arsenical keratosis

rick-References

Cowan G (2000) Rickettsial diseases: the typhus group of fevers – a review Postgraduate Medi- cal Journal 76(895):269–272

Trang 16

592 Typus degenerativus amstelodamensis

Richner-Hanhart syndrome;

Hanhart-Rich-ner syndrome; tyrosinosis; keratosis

palmo-plantaris circumscripta

Definition

Hereditary disease characterized by

tyro-sinemia, palmar and plantar erosion,

kera-titis, and occasional mental retardation

Pathogenesis

Deficiency of hepatic tyrosine

aminotrans-ferase, leading to elevated levels of

tyro-sine, which crystalizes in tissues and causes

inflammatory response

Skin findings: painful erosions of the palms

and soles, which become crusted and then

hyperkeratotic; hyperkeratosis of thetongue

Ocular findings: tearing and photophobia;corneal ulcerations and subsequent scar-ring

Neurologic findings: mental retardation;self-mutilating behavior; fine coordinationdisturbances

Other forms of focal palmo-plantar derma, such as Wachter syndrome andHowel-Evans syndrome; epidermolysis bul-losa; Spanlang-Tappeiner syndrome

kerato-Therapy

Low tyrosine, low phenylalanine diet, such

as Mead Johnson 3200 AB; acitretin

References

Rabinowitz LG, Williams LR, Anderson CE,

Maz-ur A, Kaplan P (1995) Painful keratoderma and photophobia: hallmarks of tyrosinemia type II Journal of Pediatrics 126(2):266–269

Tyrosinosis

Tyrosinemia II

Trang 17

Disorder characterized by inflammatorykeratotic facial papules with scarring, atro-phy, and alopecia

Keratosis pilaris; acne vulgaris; folliculitis;rosacea; lupus erythematosus; pityriasisrubra pilaris; constitutive flushing

Treat-Ullrich-Noonan syndrome

Noonan’s syndrome

PART21.MIF Page 593 Friday, October 31, 2003 12:38 PM

Trang 18

594 Uncombable hair syndrome

Uncombable hair syndrome

Synonym(s)

Spun glass hair; cheveux incoiffables; pili

trianguli et canaliculi

Definition

Hereditary disorder characterized by dry,

brittle, hypopigmented, spangled scalp hair

Pathogenesis

Autosomal dominant trait; hair fiber

inflex-ible, making it difficult to lay flat against

the scalp

Most frequently develops shortly after birth

but possibly any time until puberty;

slow-growing scalp hair, with little or no

pig-ment, easily pulled out; very dry;

some-times brittle; spangled appearance;

eye-brow and eyelash hairs usually normal but

sometimes sparse; nails sometimes short,

brittle, and easy to split; teeth aberrations

such as enamel defects; possibility of

spon-taneous recovery with advancing age

Loose anagen hair syndrome; monilethrix;

pili torti; Marie-Unna syndrome; progeria;

Menke disease

Therapy

No effective therapy

References

Hicks J, Metry DW, Barrish J, Levy M (2001)

Un-combable hair (cheveux incoiffables, pili

trian-guli et canaliculi) syndrome: brief review and

role of scanning electron microscopy in

diag-nosis Ultrastructural Pathology 25(2):99–103

Onset in the first few months of life; slowlyincreasing pigmentation of the skin andmucous membranes

Unna-Thost palmoplantar keratoderma

Synonym(s)

Diffuse nonepidermolytic palmoplantarkeratoderma; Thost-Unna disease;palmoplantar keratoderma diffusa circum-scripta; congenital keratoderma of thepalms and soles; hereditary palmo-plantarkeratoderma; hyperkeratosis palmaris etplantaris; ichthyosis palmaris et plantaris

Definition

Hereditary keratoderma of the palms andsoles, characterized by thick plaques overpalms and soles

Pathogenesis

Autosomal dominant trait; linkage to type

II keratin locus on 12q11–13PART21.MIF Page 594 Friday, October 31, 2003 12:38 PM

Trang 19

Urea, topical 595

U

Keratotic lesions confined to palms and

soles; thick, horny, hard, yellowish plaques

with waxy smooth surfaces; plaques

some-times pitted and verrucous, surrounded by

erythematous halos; occasional corneal

opacites; pili torti, sensorineural hearing

loss; hypohidrosis; dental abnormalities

Mal de Meleda; Papillon-Lefèvre syndrome;

hereditary epidermolytic palmoplantar

ker-atoderma; Vohwinkel syndrome;

Richner-Hanhart syndrome; progressive

kerato-derma; punctate keratokerato-derma; pityriasis

rubra pilaris; xerosis

Therapy

Alpha hydroxy acids; urea; keratolytic

agents such as salicylic acid 6 % gel;

propyl-ene glycol 60 %

References

Zemtsov A, Veitschegger M (1993) Keratodermas

International Journal of Dermatology

Dosage form

10%, 20%, 40% cream; 25% lotion

Dermatologic indications and dosage

See table

Cutaneous: burning sensation, stinging,irritation

compo-Urea, topical Dermatologic indications and dosage

Ichthyosis Apply twice daily Apply twice daily

Keratoderma Apply twice daily Apply twice daily

Keratosis pilaris Apply twice daily Apply twice daily

Trang 20

596 Uremic gangrene syndrome

References

Swanbeck G (1992) Urea in the treatment of dry

skin Acta Dermato-Venereologica (Suppl)

May involve unidentified pruritogenic

substances accumulating in dialysis

patient as a result of molecular size; other

theories: xerosis; hyperparathyroidism;

hypercalcemia; hyperphosphatemia;

ele-vated plasma histamine levels; uremic

neuropathy

Generalized or localized paroxysmal

pruri-tus, most commonly occurring on forearm

and back

Xerosis; atopic dermatitis; scabies;

drug-induced pruritus; hyperthyroidism;

hyper-parathyroidism; psychogenic pruritus

Therapy

UVB phototherapy; naltrexone: 50 mg POdaily; cholestyramine: 4 gm PO twice daily;activated charcoal: 6 gm PO daily dividedinto 4–6 doses; antihistamines, first genera-tion; emollients; acupuncture

oper-Clinical manifestation

Transient, pruritic, edematous, pink or redpapules or plaques (wheals) of variable sizeand shape, with surrounding erythemaAngioedema variant: ill-defined, subcuta-neous, edematous plaques, with associatedpruritus, pain, or burning sensation inlesions

Physical urticaria (dermatographism): carial wheal at site of light stroking or rub-bing; may occur with concomitant chronicPART21.MIF Page 596 Friday, October 31, 2003 12:38 PM

Trang 21

urti-Urticarial vasculitis 597

U

idiopathic urticaria; pressure-induced

urti-caria; delayed response to pressure applied

to skin

Cold urticaria: wheal at site of cold

applica-tion; may occur with rapid temperature

change, without extremes of cold

Solar urticaria: wheals after brief exposure

to sunlight

Cholinergic urticaria: small wheals

trig-gered by heat, exercise, or emotional stress

Exercise-induced urticaria: wheals

appear-ing after vigorous exercise

Aquagenic urticaria: wheals appearing after

exposure to water

Urticarial vasculitis; erythema multiforme;

insect bite reaction; mastocytosis; bullous

pemphigoid; pruritic urticarial papules and

plaques of pregnancy;

Melkersson-Rosenthal syndrome

Therapy

Antihistamines, first generation;

antihista-mines, second generation; severely

sympto-matic, recalcitrant disease: prednisone;

nifedipine: 10 mg PO 2–3 times daily;

cyclo-sporine; dapsone

References

Grattan CE, Sabroe RA, Greaves MW (2002)

Chronic urticaria Journal of the American

in damage to the vascular lumina

Erythematous wheals, accompanied by apainful or burning sensation, which remainfor several days; as lesions evolve, purpuramay appear; lesions may resolve withpostinflammatory pigmentation; associ-ated photosensitivity, lymphadenopathy,arthralgia, angioedema, fever, abdominalpain, dyspnea, and pleural and pericardialeffusions

Main identifiable causes: drug induced,such as angiotensin-converting enzymeinhibitors, penicillin, sulfonamides, fluoxet-ine, and thiazides; rheumatic diseases, such

as lupus erythematosus and Sjögren drome; viral diseases, such as hepatitis B,hepatitis C, and infectious mononucleosis;hypocomplementemia occurs in patientswith associated systemic diseases, such assystemic lupus erythematosus; regardless ofcause, disease tends to run chronic cours

recalci-PART21.MIF Page 597 Friday, October 31, 2003 12:38 PM

Trang 22

Vogt-Koyanagi-Harada syndrome

Trang 23

Gastrointestinal: nausea, vomiting

Neurologic: headache

Bone marrow: suppression

compo-Valacyclovir Dermatologic indications and dosage

Herpes simplex virus infection, first episode

1000 mg PO twice daily for 10 days Not established Herpes simplex virus

infection, prophylaxis

500 mg-1000 mg PO daily for up to 1 year

Not established Herpes simplex virus

infection, recurrent episode

2000 mg PO twice daily for 1 day Not established

Herpes zoster 1000 mg PO 3 times daily for 7 days Not established Varicella 1000 mg PO 3 times daily for 7 days Not established PART22.MIF Page 599 Friday, October 31, 2003 12:41 PM

Trang 24

600 Valley fever

References

Baker DA (2002) Valacyclovir in the treatment of

genital herpes and herpes zoster Expert

Acquired by the inhalation of airborne

res-piratory droplets containing virus from an

infected host; viremia disseminates the

virus to the skin; transmission also occurs

through direct contact with

virus-contain-ing cutaneous vesicles

Rash, malaise, and low-grade fever at the

onset; small, red macules appearing on the

scalp, face, trunk, and proximal limbs, with

progression to pruritic papules, vesicles,

and pustules; central umbilication and

crust formation as lesions evolve; new crops

of lesions over a few days; infectious for 1–2

days prior to the development of rash and

for 4–5 days afterwards; healing without

scarring, except with excoriation or

second-ary bacterial superinfection

Herpes simplex virus infection; drug tion; other viral exanthem; bullous pemphi-goid; dermatitis herpetiformis; erythemamultiforme; pityriasis lichenoides et vari-oliformis acuta; congenital syphilis

immuno-Healthy children: avoidance of use of cylates; calamine lotion, oatmeal baths forpruritus; antihistamines, first generation

sali-References

McCrary ML, Severson J, Tyring SK (1999) cella zoster virus Journal of the American Academy of Dermatology 41(1):1–14

Vari-Varicose and telangiectatic leg veins

Pathogenesis

Dilatation of normal veins under the ence of increased venous pressure, mostoften resulting from venous insufficiencydue to valve incompetence in the deep orsuperficial veins; increased venous pres-sure from outflow obstruction, either fromintravascular thrombosis or from extrinsiccompression; changes during pregnancyPART22.MIF Page 600 Friday, October 31, 2003 12:41 PM

Trang 25

influ-Variegate porphyria 601

V

most often caused by hormonal changes

rendering vein wall and the valves more

pli-able; genetic component to primary

valvu-lar failure susceptibility

Visible distension of superficial veins,

mostly along the course of greater

saphen-ous vein on leg and over medial thigh;

sometimes associated with acute varicose

complications, including variceal bleeding,

stasis dermatitis, thrombophlebitis,

celluli-tis, and ulceration

Thrombophlebitis; cellulitis;

Osler-Weber-Rendu syndrome; stasis dermatitis

Therapy

Small or superficial vein disease: support

hose; intermittent leg elevation; weight loss;

chemical sclerosis (sclerotherapy);

transcu-taneous laser therapy; intense-pulsed-light

(IPL) therapy

Large and deep vein disease: ligation of

saphenofemoral junction with vein

strip-ping; phlebectomy; endovenous

radiofre-quency thermal ablation; endovenous laser

thermal ablation

References

Weksberg F (1999) Leg vein evaluation and

thera-py Journal of Cutaneous Medicine & Surgery 3

metabo-Pathogenesis

Autosomal dominant trait; gene mutationencoding defective protoporphyrinogenoxidase; trigger factors: certain drugs, hor-monal fluctuations, carbohydrate restric-tion, infections

Skin manifestations: photosensitivity;mechanical fragility; non-inflammatoryvesicles and bullae, most commonly overdorsum of hands; scarring of sun-exposedskin; hypertrichosis; hyperpigmentationGastrointestinal manifestations: abdominalpain; nausea and vomiting

Neurologic manifestations: confusion; rientation; agitation; psychotic behavior;seizures; coma; peripheral neuropathy caus-ing paresthesias, and/or paralysis; auto-nomic neuropathy

diso-Differential diagnosis

Porphyria cutanea tarda; hereditary porphyria; erythropoietic protoporphyria;acute intermittent porphyria; lupus ery-thematosus; polymorphous light eruption;epidermolysis bullosa; epidermolysis bul-losa acquisita; pseudoporphyria; drug-induced photosensitivity

copro-PART22.MIF Page 601 Friday, October 31, 2003 12:41 PM

Trang 26

602 Variola

Therapy

Acute attack management: panhematin – 3–

5 mg per kg IV 1–2 times daily for 3–4

days; strict avoidance of triggers, such as

extreme carbohydrate-restricted dieting,

certain medications, alcohol, and smoking

References

Lim HW, Cohen JL (1999) The cutaneous

porphy-rias Seminars in Cutaneous Medicine &

Viral infection causing widespread

cutane-ous vesicular eruption and sericutane-ous

sys-temic illness

Pathogenesis

Caused by infection with variola virus,

spread via the respiratory route; major role

of cell-mediated immunity in controlling

disease; virus-specific cytotoxic T cells

sometimes limit viral spread

7–17 day incubation, followed by prodrome

of fever, headache, pharyngitis, backache,

nausea, vomiting, and feeling of general

debility; oral mucous membrane

enan-them; skin eruption begins with small, red

macules on face and then spreads to

extremities and trunk; lesions evolve into

firm papules, then vesiculate, develop into

pustules, and coalesce; by day 17, pustules

form crusts and heal with pitted scars;

lesions tend to be in same stage of

develop-ment

Variola minor variant: constitutional

symp-toms, with fewer and smaller skin lesions

Varicella; other viral exanthems, includingcoxsackievirus, parvovirus; infectiousmononucleosis, rubella and rubeola; her-pes simples virus infection; disseminatedherpes zoster infection; impetigo; ery-thema multiforme; rickettsialpox; Kawa-saki disease; rat bite fever; leukemia; con-tact dermatitis

Therapy

Strict respiratory and contact isolation for

17 days; vaccination for contacts in earlyincubation period

References

Patt HA, Feigin RD (2002) Diagnosis and agement of suspected cases of bioterrorism: a pediatric perspective Pediatrics 109(4):685– 692

abnor-References

Fishman SJ, Mulliken JB (1993) Hemangiomas and vascular malformations of infancy and childhood Pediatric Clinics of North America 40(6):1177–1200

Trang 27

bromide toxic dermatitis

Granuloma gluteale infantum

Venous-lake angioma; Bean-Walsh

angi-oma; venous varix; senile hemangioma of

the lips

Definition

Bluish-purple papule secondary to vasculardilatation, occurring usually in elderly peo-ple with excess sun exposure

Pathogenesis

Alteration of vascular and dermal elasticfibers secondary to solar damage, causingvascular dilatation

Well demarcated, blue-purple, soft, pressible, smooth papules, distributed onthe sun-exposed surfaces of face and neck,especially on helix or antihelix of ear, pos-terior pinna, or vermilion border of lowerlip

com-Differential diagnosis

Hemangioma; blue nevus; mucosal sis; melanoma; angiokeratoma circumscrip-tum; traumatic tattoo

melano-Therapy

Cryosurgery; electrosurgery, surgical sion; flashlamp pulse dye laser ablation;intense pulse light ablation

exci-References

Requena L, Sangueza OP (1997) Cutaneous lar anomalies Part I Hamartomas, malformations, and dilation of preexisting vessels

vascu-Journal of the American Academy of ogy 37(4):523–549

Dermatol-Venous stasis dermatitis

Trang 28

Ackerman tumor; Ackerman’s tumor;

carcinoma cuniculatum; warty cancer;

epithelioma cuniculatum

Definition

Low grade squamous cell carcinoma

char-acterized by slow growth of a verrucous

nodule or plaque and rare metastatic spread

Pathogenesis

May be related to human papillomavirus

(HPV) infection (particularly on penis,

vulva, and periungual region), chemical

carcinogens, and/or chronic irritation and

inflammation, such as that occurring in

patients who chew tobacco or betel nuts or

use snuff

Oral florid papillomatosis variant: white,translucent plaque on erythematous base,located on buccal mucosa, alveolar ridge,upper and lower gingiva, floor of mouth,tongue, tonsil, vermilion border of lip;

sometimes develops in previous areas ofleukoplakia, lichen planus, chronic lupuserythematous, cheilitis, or candidiasis;

lesions evolve into white, cauliflower-likepapillomas with a pebbly surface, some-times extending and coalescing over largeareas of the oral mucosa; ulceration, fistula-tion, and invasion locally into soft tissuesand bone

Anourologic type (Buschke-Loewensteintumor): most commonly on the glans penis,mainly in uncircumcised men; may alsooccur in the bladder and the vaginal, cervi-cal, perianal, and pelvic organs; large, cauli-flower-like nodule

Palmoplantar variant (epithelioma latum): most commonly involves skin over-lying the first metatarsal head, but also ontoes, heel, medioplantar region, and ampu-tated stumps; exophytic tumors with ulcer-ation and sinuses draining foul-smellingdischarge; pain; bleeding; difficulty walking

cunicu-Differential diagnosis

Wart; keratoacanthoma; North Americanblastomycosis; leishmaniasis; leprosy;

actinomycosis; tuberculosis; mycetoma;

granular cell tumor

Therapy

Mohs micrographic surgery; destruction

by electrodesiccation and curettage or uid nitrogen cryotherapy; local radiationtherapy

liq-References

Kanik AB, Lee J, Wax F, Bhawan J (1997) Penile verrucous carcinoma in a 37-year-old circum- cised man Journal of the American Academy of Dermatology 37(2 Pt 2):329–331

Miller SB, Brandes BA, Mahmarian RR, Durham

JR (2001) Verrucous carcinoma of the foot: a view and report of two cases Journal of Foot &

re-Ankle Surgery 40(4):225–231 PART22.MIF Page 604 Friday, October 31, 2003 12:41 PM

Trang 29

Barlow’s disease

Scurvy

Vitiligo

Synonym(s)

White spot disease

Vitiligo Depigmented patch on the upper lip

Trang 30

606 Vogt-Koyanagi-Harada syndrome

Definition

Acquired progressive leukoderma,

charac-terized by depigmented patches

Pathogenesis

Theories of causation: aberration of

immune surveillance, melanocyte

destruc-tion by neurochemical mediator,

melano-cyte destruction by intermediate or

meta-bolic product of melanin synthesis, inborn

melanocyte abnormality

Sharply circumscribed, white macules and

patches, sometimes with perilesional

hyperpigmentation, beginning with few

lesions and expanding over time

Localized variant: restricted to one area,

often in segmental distribution; onset early

in life, then spreading rapidly within

affected area; patches persist indefinitely

Generalized variant: bilaterally

symmetri-cal, white macules and patches; sometimes

involve mucous membranes, particularly

the lip and genitalia; occur in areas of

minor trauma (Koebner phenomenon),

such as elbow, knee, dorsal aspect of hands;

periorificial location of involvement;

depig-mentation of body hair, including scalp,

eyebrow, and pubic and axillary hair

Nevoid hypomelanosis; leprosy;

piebald-ism; tinea versicolor; post-inflammatory

hypopigmentation; pityriasis alba; halo

nevus; scleroderma; lichen sclerosus;

tuber-ous sclerosis

Therapy

Photochemotherapy; corticosteroids,

topi-cal, superpotent; skin transplants for local

areas of depigmentation; widespread

involvement: 20 % monobenzylether of

hydroquinone applied twice daily for 3–12

months to induce total depigmentation

References

Shaffrali F, Gawkrodger D (2000) Management of

vitiligo Clinical & Experimental Dermatology

25(8):575–579

Vogt-Koyanagi-Harada syndrome

con-Pathogenesis

May be a post-viral syndrome, perhaps ondary to Epstein-Barr virus; possibly anautoimmune disorder; susceptibility related

sec-to presence of HLA-DR4 antigen andDRB*0405 allele

Prodromal stage: non-specific symptoms,including headache, vertigo, nausea, nuchalrigidity, vomiting, and low-grade feverMeningoencephalitis phase: generalizedmuscle weakness; hemiparesis; hemiplegia;dysarthria; aphasia, and other mental sta-tus changes

Ophthalmic-auditory phase: decreasedacuity; eye pain and irritation; dysacusis,usually bilateral; tinnitus

Convalescent phase: cutaneous signs oping after uveitis begins to subside; polio-isis; vitiligo; halo nevi; alopecia

References

Read RW (2002) Vogt-Koyanagi-Harada disease Ophthalmology Clinics of North America 15(3):333–341

Trang 31

Vulvodynia 607

V

Vohwinkel syndrome

Synonym(s)

Vohwinkel’s syndrome; keratoderma

hereditaria mutilans; palmoplantar

kerato-derma mutilans

Definition

Disorder characterized by hyperkeratosis of

the palms and soles with a honeycomb

appearance, constrictions of the skin

around the digits, and hyperkeratotic

plaques over the dorsal aspects of the

extremities

Pathogenesis

Autosomal dominant trait; phenotype due

to abnormal gap junctions caused by the

mutation D66H in the gene GJB2 encoding

connexin 26; possibly also insertional

mutation of the loricrin gene

Honeycomb-like hyperkeratosis of the

palms and soles; constriction of skin

around digits, causing autoamputation

(pseudo-ainhum); starfish-shaped

hyperk-eratotic plaques on the dorsum of the hands

and feet, elbows, and knees; occasional

deafness

Erythropoetic protoporphyria; discoid

lupus erythematosus; mal de Meleda;

pach-yonychia congenita; palmoplantar

kerato-derma of Sybert; Olmsted syndrome;

pal-moplantar keratoderma of Gamborg

Nielsen; hereditary bullous acrokeratotic

poikiloderma of Weary-Kindler; Clouston

syndrome; psoriasis

Therapy

Surgical release of constriction bands to

preserve digits; acitretin

References

Solis RR, Diven DG, Trizna Z (2001) Vohwinkel's syndrome in three generations Journal of the American Academy of Dermatology 44(2 Sup- pl):376–378

itch-References

Masheb RM, Nash JM, Brondolo E, Kerns RD (2000) Vulvodynia: an introduction and criti- cal review of a chronic pain condition Pain 86(1-2):3–10

Định dạng
Số trang	64
Dung lượng	2,71 MB