Items in AFP with MESH term: Skin Diseases
ABSTRACT: A psychodermatologic disorder is a condition that involves an interaction between the mind and the skin. Psychodermatologic disorders fall into three categories: psychophysiologic disorders, primary psychiatric disorders and secondary psychiatric disorders. Psychophysiologic disorders (e.g., psoriasis and eczema) are associated with skin problems that are not directly connected to the mind but that react to emotional states, such as stress. Primary psychiatric disorders involve psychiatric conditions that result in self-induced cutaneous manifestations, such as trichotillomania and delusions of parasitosis. Secondary psychiatric disorders are associated with disfiguring skin disorders. The disfigurement results in psychologic problems, such as decreased self-esteem, depression or social phobia. Most psychodermatologic disorders can be treated with anxiety-decreasing techniques or, in extreme cases, psychotropic medications.
ABSTRACT: Sarcoidosis is a multisystem disease that may involve almost any organ system; therefore, it results in various clinical manifestations. Cutaneous sarcoidosis occurs in up to one third of patients with systemic sarcoidosis. Recognition of cutaneous lesions is important because they provide a visible clue to the diagnosis and are an easily accessible source of tissue for histologic examination. Because lesions can exhibit many different morphologies, cutaneous sarcoidosis is known as one of the "great imitators" in dermatology. Specific manifestations include papules, plaques, lupus pernio, scar sarcoidosis, and rare morphologies such as alopecia, ulcers, hypopigmented patches, and ichthyosis. Treatment of cutaneous lesions can be frustrating. For patients with severe lesions or widespread involvement, the most effective treatment is systemic glucocorticoids.
ABSTRACT: Digital mucous cysts are solitary, clear, or flesh-colored nodules that develop on the dorsal digits between the distal interphalangeal joint and the proximal nail fold. There are two types of digital mucous cysts: one type is associated with degenerative changes in the distal interphalangeal joint, and the second type is independent of the joint and arises from metabolic derangement of fibroblasts that produce large quantities of hyaluronic acid. The two types are clinically indistinguishable. The cysts can be asymptomatic, or they can cause pain, tenderness, or deformity of the nail. Aggressive surgical techniques to remove osteophytes from the joint can produce low recurrence rates. Other procedures to eliminate cysts, such as a simple surgical technique, cryosurgical destruction, or repeated needling, can be performed in an office setting.
Occupational Skin Disease - Article
ABSTRACT: Contact dermatitis, the most common occupational skin disease, is characterized by clearly demarcated areas of rash at sites of exposure. The rash improves on removal of the offending agent. In allergic contact dermatitis, even minute exposures to antigenic substances can lead to a skin rash. Common sensitizing agents include nickel and members of the Rhus genus (e.g., poison ivy, poison oak). Severe skin irritants tend to cause immediate red blisters or burns, whereas weaker irritants produce eczematous skin changes over time. An occupational cause should be suspected when rash occurs in areas that are in contact with oil, grease, or other substances. Direct skin testing (patch or scratch) or radioallergosorbent testing may help to identify a specific trigger. Skin cancer can have an occupational link in workers with prolonged exposure to sunlight and certain chemicals, although it can take decades for lesions to develop. In workers with occupational skin disease, workplace changes and protective measures are important to prevent future exposure.
Electrosurgery for the Skin - Article
ABSTRACT: The purposes of electrosurgery are to destroy benign and malignant lesions, control bleeding, and cut or excise tissue. The major modalities in electrosurgery are electrodesiccation, fulguration, electrocoagulation, and electrosection. Electrosurgery can be used for incisional techniques that produce full-thickness excision of nevi, for shave techniques that produce partial-thickness removal of superficial lesions, and for removing vascular lesions such as hemangiomas or pyogenic granulomas. The correct output power can be determined by starting low and increasing the power until the desired outcome is attained (destruction, coagulation, or cutting). Smaller cherry angiomas can be electrocoagulated lightly. Larger cherry angiomas may be easier to treat by shaving them first, then electrocoagulating or desiccating the base. The elevated portion of pyogenic granulomas can be shaved off with a scalpel or a loop electrode using a cutting/coagulation current. The base of the lesion is curetted to remove the remaining tissue and then electrodesiccated. Complications such as burns, shocks, and transmission of infection can be prevented by careful use of the electrosurgical equipment.
ABSTRACT: Antiretroviral regimens are complicated and difficult for patients to follow, and they can have serious side effects, such as osteonecrosis and bone demineralization. Protease inhibitor therapy has been associated with hyperlipidemia, hyperglycemia, gastrointestinal symptoms, and body-fat distribution abnormalities. Nonnucleoside reverse transcriptase inhibitors can cause rashes and hepatotoxicity, and nucleoside reverse transcriptase inhibitors can cause lactic acidosis, hypersensitivity reactions, neuropathies, pancreatitis, anemia, and neutropenia. Malabsorption can occur if antiretroviral agents are taken improperly with regard to meals or if they are taken with certain other drugs or herbal remedies. Some commonly prescribed drugs can cause dangerous drug toxicities if they are taken by patients who are also taking certain antiretroviral medications. Suboptimal exposure to antiretrovirals because of noncompliance or malabsorption can result in viral resistance and loss of future treatment options.
Cryosurgery for Common Skin Conditions - Article
ABSTRACT: Cryosurgery is a highly effective treatment for a broad range of benign skin problems. With appropriate instruction and supervised experience, family physicians can master the technique quickly. Cryosurgery is best suited for use in patients with light skin and for treatment of lesions in most non-hair-bearing areas of the body. Spray methods include the timed spot freeze technique, the rotary or spiral pattern, and the paintbrush method. Benign skin lesions that are suitable for freezing include actinic keratosis, solar lentigo, seborrheic keratosis, viral wart, molluscum contagiosum, and dermatofibroma. Cryosurgery requires little time and fits easily into the physician's office schedule. Advantages of this treatment include a short preparation time, low risk of infection, and minimal wound care. In addition, cryosurgery requires no expensive supplies or injectable anesthesia, and the patient does not have to return for suture removal. Potential side effects include bleeding, blister formation, headache, hair loss, and hypopigmentation, but rarely scarring. Skin lesions often can be treated in a single session, although some require several treatments.
ABSTRACT: Cutaneous warts are a common presenting complaint in children and adolescents. Common, plantar, or flat warts are cutaneous manifestations of the human papillomavirus. The treatment of warts poses a therapeutic challenge for physicians. No single therapy has been proven effective at achieving complete remission in every patient. As a result, many different approaches to wart therapy exist. These approaches are discussed to demonstrate the evidence supporting common therapies and provide a guideline for physicians. Evidence supports the at-home use of topical salicylic acid and physician-administered cryotherapy. Intralesional immunotherapy for nongenital cutaneous warts may be an option for large or recalcitrant warts.
Common Skin Conditions During Pregnancy - Article
ABSTRACT: Common skin conditions during pregnancy generally can be separated into three categories: hormone-related, preexisting, and pregnancy-specific. Normal hormone changes during pregnancy may cause benign skin conditions including striae gravidarum (stretch marks); hyperpigmentation (e.g., melasma); and hair, nail, and vascular changes. Preexisting skin conditions (e.g., atopic dermatitis, psoriasis, fungal infections, cutaneous tumors) may change during pregnancy. Pregnancy-specific skin conditions include pruritic urticarial papules and plaques of pregnancy, prurigo of pregnancy, intrahepatic cholestasis of pregnancy, pemphigoid gestationis, impetigo herpetiformis, and pruritic folliculitis of pregnancy. Pruritic urticarial papules and plaques of pregnancy are the most common of these disorders. Most skin conditions resolve postpartum and only require symptomatic treatment. However, there are specific treatments for some conditions (e.g., melasma, intrahepatic cholestasis of pregnancy, impetigo herpetiformis, pruritic folliculitis of pregnancy). Antepartum surveillance is recommended for patients with intrahepatic cholestasis of pregnancy, impetigo herpetiformis, and pemphigoid gestationis.
ABSTRACT: Lichen sclerosus, lichen planus, and lichen simplex chronicus are three of the most common non-neoplastic epithelial disorders of the vulva. Lichen sclerosus is characterized by intense vulvar itching and can affect men and women of all ages, but it manifests most commonly in postmenopausal women. Patients with lichen sclerosus have an increased risk of developing squamous cell carcinoma, and they should be monitored for malignancy. Lichen planus is an inflammatory autoimmune disorder that can affect the vulva and the vagina; it peaks in incidence between ages 30 and 60. There are three clinical variants of lichen planus affecting the vulva: erosive, papulosquamous, and hypertrophic. Lichen simplex chronicus is caused by persistent itching and scratching of the vulvar skin, which results in a thickened, leathery appearance. It is thought to be an atopic disorder in many cases and may arise in normal skin as a result of psychological stress or environmental factors. Definitive diagnosis of non-neoplastic disorders depends on the histology of biopsied tissue. All three disorders are treated with topical corticosteroid ointments of varying potency. Lichen sclerosus and lichen planus are not routinely treated with surgery, which is necessary only in patients who have a malignancy or advanced scarring that causes dyspareunia or clitoral phimosis. Educational counseling teaches patients that even though these chronic disorders cannot be cured, they can be effectively managed.