Alternative Cures for Facial Redness

Rosacea Free Forever Cure

Laura Taylor, the author of Rosacea Free Forever is an Alternative Medical Practicioner and Researcher and was also a long term sufferer of chronic Rosacea. After a 12 year battle with Rosacea, she became frustrated at the lack of straightforward, simple and honest information available and so took the decision to write this book. Laura Taylor teaches you how to intake proper amounts of lysine that is an amino acid that servers as an anti-inflammatory agent, and how to adjust your diet with certain foods and supplements in order that you can get rid of rosacea permanently and in the fastest way possible. You will also learn how to take hydrochloric acid properly and where to find hydrochloric acid. I have spent such a long time researching and experimenting with Rosacea treatments. The techniques in Rosacea Free Forever DO work and if you spent a little time trying to implement everything then you will find relief from your Rosacea. Read more...

Rosacea Free Forever Overview

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Erythema gyratum repens

Figurate erythema with a distinctive clinical appearance, which serves as a marker of internal malignancy Eruption often precedes diagnosis of underlying malignancy wood-grain appearance created by concentric, pruritic, mildly scaling bands of flat-to-slightly-palpable erythema, with rapid migration of the bands course of eruption mirrors course of the underlying illness, with clearance of rash and relief of pruritus within 6 weeks of underlying illness resolution sites of predilection trunk and extremities

Erythema elevatum diutinum

Erythema induratum 219 Acute bebrile neutrophilic dermatosis granuloma annulare insect bite reaction sarcoidosis rheumatoid nodules gouty tophi multicentric reticulohistiocytosis xanthomas erythema multiforme Gibson LE, el-Azhary RA (2000) Erythema eleva-tum diutinum. Clinics in Dermatology

Erythema infectiosum

First stage erythema of the cheeks, with nasal, perioral, and periorbital sparing (slapped-cheek appearance) and fades over 2-4 days Second stage within 1-4 days of the facial rash, erythematous macular-to-morbilli-form eruption occurs primarily on the extremities Other viral exanthems medication reaction Lyme disease lupus erythematosus

Erythema multiforme

Erythema exudativum erythema polymorphe Erythema multiforme. Target-like papules on the palm Erythema multiforme. Target-like papules on the palm becoming violaceous and forming concentric target lesion lesions appear predominantly on the extensor surfaces of acral extremities and spread centripetally mild erosions of one mucosal surface palms, neck, and face frequently involved Erythema multiforme major variant prodrome of moderate fever, general discomfort, cough, sore throat, vomiting, chest pain, and diarrhea, usually for 1-14 days preceding the eruption skin lesions same as with erythema multiforme minor severe erosions of at least 2 mucosal surfaces generalized lymphadenopathy Stevens-Johnson syndrome toxic epidermal necrolysis Henoch-Schonlein purpura urticaria viral exanthem Kawasaki disease figurate erythema fixed drug eruption lupus erythematosus primary her-petic gingivostomatitis Behcet's disease aphthous stomatitis Most commonly associated with herpes simplex virus...

Erythema toxicum

Erythema toxicum neonatorum erythema neonatorum toxic erythema erythema neonatorum allergicum erythema papulo-sum urticaria neonatorum erythema dys-pepsicum Usual onset within the first 4 days of life in full-term infants, with peak onset occurring within the first 48 hours following birth presents with a blotchy, evanescent, macular erythema, often on the face or trunk sites of predilection include the forehead, face, trunk, and proximal extremities mucous membranes usually spared

Rosacea

INTRODUCTION Rosacea is a common chronic condition of unknown etiology characterized by facial flushing, inflammatory papules and pustules, erythema, and telangiectasia. The onset is usually between ages 25 to 50 years, but has been reported in all age groups including children as young as two years. There is a 2 1 predilection for males. The clinical findings result from inflammation of the skin, capillary proliferation, and collagen deposition. Recent studies have shown an increase in the presence of a prostaglandin-like substance and an increase in free fatty acids in the sebaceous glands. Symptoms tend to be worsened by heat, hot or spicy foods, and alcohol. Symptoms may be caused by or worsened by potent topical steroids. CLINICAL PRESENTATION Skin lesions consisting of variable combinations of patchy erythema, telangiectasia, small papules, pustules, and hypertrophic sebaceous glands occur on the brow, eyelids, and midface. Heat, sunlight and possibly gastrointestinal stimuli...

Lupus Erythematosus

Lupus Ana Levels

INTRODUCTION Lupus erythematosus is a chronic inflammatory autoimmune disease with a spectrum of clinical forms ranging from a benign chronic cutaneous variety (discoid lupus erythematosus) to an often-fatal systemic type with nephritis (systemic lupus erythematosus). Intermediate types, variously known as disseminated discoid lupus erythematosus and subacute cutaneous lupus erythematosus, are characterized by various combinations of widespread cutaneous lesions and mild to severe systemic manifestations. The role of immune complexes in the inflammatory manifestations of lupus is well recognized, and in about 4 of cases an associated vasculitis may be seen from small vessel involvement. Lupus erythematosus occurs most commonly in women in the third to fifth decades. When skin lesions occur they typically appear in areas exposed to the ultraviolet rays of the sun. Rarely discoid lupus can degenerate into squamous cell carcinoma. Common nonscarring eyelid lesions include a pruritic...

Clinical manifestation

Bite minimally symptomatic fewer than 10 of bites result in severe skin necrosis signs of progression within 48-72 hours of the bite mild-to-severe pain beginning 2-8 hours after bite central papule and associated erythema occur 6-12 hours after bite purple vesicle sometimes ulcerates stellate necrotic area sometimes ensues. Constitutional signs and symptoms hemol-ysis hemoglobinuria thrombocytopenia disseminated intravascular coagulation fever headache malaise arthralgia nausea vomiting

Clinical Presentation and Differential Diagnosis

Cutaneous reactions (erythema, urticaria ) and soft tissue swelling (e.g., eyelids, lips) Hypotension and tachycardia Grade 1 Only cutaneous signs diffuse erythema, urticaria Grade 2 Same as grade 1 + nausea, cough, dyspnea, In more than 90 of all cases, cutaneous symptoms such as pruritus, flush, or erythema happen prior to systemic reaction. However, cutaneous manifestations might be delayed or absent in rapidly progressive ana-phylactic shock.

Acute Rheumatic Fever Introduction

Acute rheumatic fever is an autoimmune disease responsible for cardiac valve disease or rheumatic heart disease. It is associated with infections caused by the group A streptococcus and occurs about 2 to 6 weeks following a streptococcal upper respiratory infection. It is prevented by adequate treatment of the infection with appropriate antibiotic therapy within 9 days of onset of streptococcal infection before further complications can occur. Because rheumatic heart disease does not occur after only one attack and children are susceptible to recurrent attacks of rheumatic fever, it is vital that an initial episode is diagnosed and treated, and that long-term prophylactic therapy (5 years or more) is given following the acute phase. There is no specific test for rheumatic fever the diagnosis is based upon the manifestations using the revised Jones criteria as a guideline. Jones criteria consist of major manifestations (polyarthritis, carditis, chorea, subcutaneous nodules, and...

Clinical Presentation

Genital and perineal discomfort worsens, leading to pain, itching, burning sensation, erythema, swelling, and eventual skin necrosis. There may be a purulent discharge with a feculent odor. The pain may subside as neural damage develops (Corman et al. 1999). Crepitus may be difficult to elicit, due to pain on palpation, but is present in up to 50 -60 of cases (Corman et al. 1999 Benizri et al. 1996).

Conditions That May Simulate Tinea

Alopecia areata causes patchy hair loss and may show erythema of the scalp. Scale is absent, however, and the presence of exclamation-point and dystrophic anagen hairs should differentiate it. In older patients with alopecia areata, gray hairs continue to grow within the patches of alopecia.

Epidermolytic hyperkeratosis

Presents at birth or shortly thereafter as erythema, blistering, and or scaling marked hyperkeratosis shortly after birth scales are small, dark, with corrugated appearance scales sometimes shedand, reaccumulate keratotic skin in intertrigi-nous areas which may become macerated and foul smelling blisters occur in crops, rupturing, and leaving red, painful, denuded base bullae tend to disappear before age 20 NPS subtype - lacks severe palmoplantar involvement PS subtype -severe palmoplantar involvement no ectro-pion

Erythrokeratodermia variabilis

Disorder of cornification associated with transient noninflammatory erythema and persistent, but changing, scaliness Transient, circumscribed, highly variable, figurate erythematous patches, sometimes surrounded by a hypomelanotic halo, involving any part of the skin lesions most prevalent during childhood and sometimes becoming less frequent as the patient ages burning sensation sometimes preceding or accompanying erythema variably changing, brownish, hyperkeratotic plaques with geographic borders, symmetrically distributed over the limbs, buttocks, and trunk flexures, face, and scalp usually spared Progressive symmetric erythrokeratoder-mia Giroux-Barbeau erythrokeratodermia with ataxia Greither disease erythrokera-tolysis hiemalis ichthyosis linearis circum-flexa psoriasis mycosis fungoides lupus erythematosus lamellar ichthyosis gyrate erythema atopic dermatitis

Clinical Application Questions

A 12-year-old schoolgirl presents in your office with a 2-day history of fever, intense oral pain, crusting and blistering of the lower lip, and severe dysuria. She also has scattered skin lesions over the trunk and extremities. Some are target lesions. You suspect erythema multiforme major. 1. What history is indicated with regard to the cause of erythema multiforme major 3. What laboratory studies are indicated with regard to the cause of erythema multiforme major 4. What treatment is appropriate for erythema multiforme major

Idiopathic Scrotal Edema

Acute idiopathic scrotal edema (AISE) is a fairly common, yet underreported cause of the acute scrotum in children, accounting for as many as 30 of patients who undergo assessment (Najmaldin and Burge 1987). It is characterized by the rapid onset of nontender, frequently unilateral scrotal and penile erythema and edema. The patient is usually afebrile and is otherwise asymptomatic, apart from the distressing appearance of the genitalia. It is usually found in prepubertal children from 5 to 11 years of age. As the name implies, the cause of AISE is unknown however, some children present with a history of asthma or allergic conditions such as eczema or dermatitis (Klin et al. 2002). Laboratory investigations are usually normal, with occasional Physical examination reveals an edematous, erythematous, hyperthermic scrotal wall without underlying testicular tenderness. The penile shaft skin maybe involved however, there is no history of irritative or obstructive voiding symptoms. Lower...

Clinical Features of Infection

Matic breaks due to burns or abrasions in the normal skin of a susceptible child). Herpetic whitlow is an occupational hazard (dentists, hospital personnel, wrestlers) resulting from infection of broken skin (often on fingers) in contact with virus on another individual. Erythema multiforme is a severe recurrent skin disease that follows HSV episodes. It is initiated by expression of the HSV DNA polymerase gene in the epidermis and has a T cell immunopathology involving, primarily, CD4+ V i2 T cells.

Dermatologic Physical Exam

Sharply demarcated areas of erythema that can rapidly enlarge and coalesce. Size varies, but lesions are often several centimeters in diameter, and as they mature, secondary changes occur. A loose white scale develops in some cases, and the lesions may simulate a papulosquamous disease. There is no follicular accentuation as in DLE, and the carpet-tack sign is negative. As the lesions evolve, they exhibit telangiectatic vessels and a dusky color not seen with pityriasis rosea or psoriasis. When the lesions regress they may leave mild epidermal atrophy, telangectasia, and hypopigmentation, but they do not scar. Annular lesions usually enlarge peripherally with a border that has erythema and loose white scale. The central areas show gray-white hypopigmentation. These lesions tend to coalesce to form polycyclic and gyrate patterns (see Chapter 2).

Pathophysiologic And Genetic Features

The first step in the telangiectasia formation consists a focal dilatation of postcapillary venules with predominant stress fibers in pericytes along the luminal border. As the venules enlarge, they become convoluted and form excessive layers of smooth muscle cells without elastic fibers and connect directly with the dilated arterioles.1-1-1

Epidermal Necrolysis Disease Spectrum

INTRODUCTION Erythema multiforme is an acute mucocutaneous hypersensitivity reaction. Although once believed to be distinct diseases, many observers currently consider erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis (TENS) to represent a mild to severe continuum of the same process. Erythema multiforme minor represents the mildest form. These three entities share certain clinical, histologic, and etiologic characteristics in common. Although ocular involvement in erythema multiforme minor is rare, it is seen frequently in both Stevens-Johnson syndrome and TENS. The majority of cases occur in children and young adults. Most cases follow exposure to a drug or infectious agent. The most frequently implicated organisms have been herpes simplex, Mycoplasma pneumoniae, and Streptococcus. Drugs include antibiotics and seizure medications. Recurrences can occur and the disease is fatal in 10 of cases. CLINICAL PRESENTATION Erythema multiforme minor is...

Severe allergic reactions

This can be quite dramatic, with erythema and rash all over the body surface, and swelling of the face, lips and tongue. However, if confined to the skin and oral mucosa, it is usually not life-threatening. This reaction responds to oral or parentral antihistamine in addition to corticosteroids. Treatment may need to be continued for a few days until symptoms have completely subsided. Unless the cause of the reaction is known, the patient should be referred to an allergy clinic for evaluation.

TNF Receptor Associated Periodic Syndrome

TRAPS patients suffer febrile episodes of variable duration but at times lasting more than 1 week (Hull et al. 2002), longer than the attacks of FMF, HIDS, FCAS, or MWS. As is the case for FMF, fever may be accompanied by serosal inflammation, most commonly sterile peritonitis or pleurisy. In addition, many patients have cutaneous symptoms consisting of migratory areas of macular erythema on the torso or limb(s). Frequently, patients complain of myalgia underlying areas of rash. Ocular inflammation, most commonly conjunctivitis and or periorbital edema, may also be part of the febrile attacks. Laboratory findings include leukocytosis, thrombocytosis, elevations in the C-reactive protein and serum amyloid A, and an accelerated erythrocyte sedimentation rate. Up to 10 of patients may eventually develop systemic amyloidosis (Aksentijevich et al. 2001). With the initial description of TRAPS, studies of a family with the C52F TN-FRSF1A mutation demonstrated impaired activation-induced in...

Ultraviolet Radiation and Skin

Both UVB and UVA are now regarded complete carcinogens, i.e. triggering both initiation and promotion of carcinogenesis 2 . Furthermore, UVB is associated with erythema (sunburn) and immunosuppression, while UVA is made responsible for pigmentation changes as well as skin aging.

Diagnostic Highlights

Note Patients may remain seropositive for long periods and the enzyme-linked immunosorbent assay (ELISA) test cannot be used as a proof of cure. A negative lyme test result does not indicate the absence of disease, nor does a positive result indicate the presence of disease. A positive result is not required to diagnose Lyme disease for someone with clear-cut erythema migrans, and those patients should be treated regardless of test results.

Henoch Schonlein Purpura

Henoch-Schonlein purpura (HSP) is a disease that manifests symptoms of purple spots on the skin, joint pain, gastrointestinal symptoms, and glomerulone-phritis. HSP is a type of hypersensitivity vasculitis and inflammatory response within the blood vessel. It is caused by an abnormal response of the immune system. The exact cause for this disorder is unknown. The syndrome is usually seen in children, but people of any age maybe affected. It is more common in boys than in girls. Many people with HSP had an upper respiratory illness in the previous weeks. Purpuric lesions are usually over the buttocks, lower legs, and elbows. Besides purpuric lesions, nephritis, angioedema, joint pains, abdominal pain, nausea, vomiting, diarrhea, and he-matochezia can be seen. The scrotum can also be affected in 13 -35 of cases (Ioannides and Turnock 2001). While the testis and or scrotum can rarelybe involved, usually the scrotum is diffusely tender with erythema distributed all over the scrotum....

Clinical Features

Nonspecific, flu-like symptoms such as fever, chills, and malaise appear abruptly in infected individuals after an incubation period that ranges from 2 to 21 days, but on average lasts 4-10 days. Subsequently, multisystemic symptoms such as prostration, anorexia, vomiting, chest pain, and shortness of breath develop. Macropapular rash associated with varying degrees of erythema may also occur and is a valuable differential diagnostic feature. At the peak of the disease, vascular dysfunction signs appear ranging from petechiae, echymoses, and uncontrolled bleeding at venipuncture sites, to mucosal bleeding and diffuse coagulopathy. Massive blood loss is atypical, although it may happen in the gastrointestinal tract, and is not sufficient to lead to death. Fatal cases develop shock, multiorgan failure, and coma with death occurring between days 6 and 16. Survivors can have multiple sequelae such as hepatitis, myelitis, ocular disease, myalgia, asthenia, and psychosis. The mortality and...

Patients And Methods

Patients of both sexes, aged between 17 and 72 years, with clinical symptoms such as epigastric pain, dyspepsia, heartburn, or anorexia, were enrolled in this open, noncomparative study. They were included in the study on the basis of endoscopic findings (endoscopic appearance of duodenal ulcer, measuring between 5 and 20 mm in longest dimension, or endoscopic appearance of antral erosions, spotty erythema of antral mucosa, pale areas, goose-pimple-like appearance of antral mucosa, fine spotty erythema of the body of the stomach), histologically defined gastritis (by the Sidney system), and HP seropositivity (ELISA IgG > 1.0 U), Patients were excluded if they had received nonsteroidal antiinflammatory drug therapy, corticosteroids, antimicrobial drugs, or bismuth salts within 4 weeks prior to entry or antiulcer medications within 2 weeks prior to entry. Patients with evidence of chronic renal or liver disease, gastric surgery or vagotomy, pregnancy, and chronic alcohol abuse were...

Chronic Exit Site Care of Healed Exit Site

All patients underwent double-cuff coiled swan neck catheters implantation surgically with downward exit-site at lower abdomen below the belt line. The patients received cefazolin 1 g IV peri-operatively. All patients underwent exit-site care training session and received written instructions. They were instructed to shower daily and to clean the exit-site with a dedicated soap and water followed by an application of Amuchina 10 or povidone- iodine 10 with one to two cotton tip applicators. The exit-site was then air dried and covered with gauze dressing. Exit-site was examined at least once a month for drainage, crust, pain, swelling, induration or irritation. Drainage was sent for gram stain, culture and sensitivity. Catheter ESI was defined by purulent discharge and erythema with or without tenderness.

Primary Nursing Diagnosis

Surgical open reduction and internal fixation of pelvic ring disruptions are accomplished with the use of a variety of plates and screws that are secured internally. The goal of internal fixation is to restore the pelvis to its original anatomic configuration. When to perform the open reduction and internal fixation is controversial. Monitor for erythema, drainage, and edema at all wound sites, incision sites, and external fixator appliance insertion sites every 4 hours. Perform pin care as prescribed every 4 to 6 hours.

Differential diagnosis

Diaper dermatitis pityriasis rosea pityriasis lichenoides chronica lupus erythemato-sus rosacea Darier disease Hailey-Hailey disease Grover's disease pemphigus foliaceus xerotic eczema chronic granulo-matous disease exfoliative erythroderma infectious eczematoid dermatitis Letterer-Siwe disease staphylococcal blepharitis tinea amiantacea vitamin B and or zinc deficiency glucagonoma syndrome

Genetic Considerations

Familial primary pulmonary hypertension typically shows an autosomal dominant mode of inheritance and reduced penetrance and is more common in women than in men. Autosomal recessive transmission has also been documented. When pulmonary hypertension is inherited, it demonstrates the genetic concept of anticipation, where subsequent generations often have severe cases of the disease. Pulmonary hypertension is also seen in conjunction with other genetic problems such as hereditary hemorrhagic telangiectasia type 2. Mutations in the BMPR2 gene are associated with both heritable and sporadic forms of the disease, but for many cases, a gene mutation has not yet been identified.

Angiogenesis inhibition

Calcium dobesilate was investigated for its ability to interfere with the process of angiogenesis in a mouse gelatine sponge assay using acidic fibroblast growth factor (aFGF) as an inducer of neovascularization. According to the reported results, calcium dobesilate remarkably reduced vessel ingrowth in aFGF-containing subcutaneous sponges in mice. These findings suggest that calcium dobesilate could be an effective agent in the treatment of angiogenesis-dependent diseases involving FGFs (Cuevas et al., 2005). This knowledge was successfully used in the treatment of erythematotelangiestatic rosacea, which is characterized by uncontrolled angiogenesis (Cuevas & Arrazola, 2005). Angiogenesis is, however, recently considered to be a main contributor to the pathogenesis of diabetic retinopathy (Aiello, 2003,Campochiaro, 2000 Campochiaro and Hackett, 2003). The anti-angiogenic effect of calcium dobesilate can also be mediated by aminopeptidases inhibition, namely by inhibition of...

See Risk For Impaired Skin Integrity

Defining Characteristics (Specify radiation effects erythema, dryness, itching, increased pigmentation, dry desquamation, necrotic tissue chemotherapy and antibiotic induced side effects local phlebitis, stomatitis, mucositis, maculopapular rash, hyperpigmentation, nail changes, pruritus, dermatitis, alopecia, photosensitivity, acne, erythema, poor wound healing.)

Decorative Cosmetics Sunscreens Toiletries Tables 4 and

Many allergens are included in the standard series, the series for vehicles, emulsifiers, and preservatives. Fine fragrances may contain ingredients that are not present in commercially available test compounds. Perfumes in alcoholic solutions can be tested as is -occasionally slight irritant reactions (erythema without infiltration) might occur the frequency of these reactions can be reduced by allowing the patch to dry before applied to the skin 15 .

Clinical Examination And Screening Techniques To Identify The Patient At Risk Of Foot Ulceration

Clinical examination concludes with a thorough musculoskeletal examination to appreciate and understand the overall structure and dynamics of the foot being evaluated. An inspection for the presence of foot deformities and limitation of joint mobility is carried out. Both these entities increase foot pressures that lead to ulceration. Osseous prominences can be observed secondary to Charcot neuroarthropathy, motor neuropathy, and common foot deformities, such as hallux abductovalgus, hallux limitus rigidus, and hammertoes. In addition, the examiner should look for callus formation. In the past, the presence of calluses was speculated to be a protective mechanism with debridement of these lesions not recommended. However, it is now well-known that most calluses are actually focal areas of increased pressure and can serve as sites of potential ulceration (77). Any areas of erythema secondary to shoe wear irritation should be protected with padding or appropriate accommodative shoe wear...

Charcot Neuroarthropathy

There are three identifiable clinical phases of Charcot neuroarthropathy acute, coalescence, and remodeling. The acute phase is characterized by clinical findings of edema, erythema, localized warmth, and joint crepitus with range of motion examination. The coalescence phase begins when skin temperature normalizes and joint crepi-tus diminishes. With a period of duration lasting from months to years, the remodeling phase is characterized by joint stabilization and remodeling. Immobilization and nonweight-bearing should continue until the acute phase of Charcot has ended and the coalescence phase commenced. The duration of immobilization varies from 8 to 32 weeks (123,124). The decision to begin weight-bearing may be best made by clinical parameters such as foot temperature (should be the same with the contralateral limb) and resolution of erythema and edema, rather than an arbitrary time period. Serial radiographs may also aid in the decision making process. Evidence Once...

Appendix A Table of Primary Lesions and Related Disorders

Erysipelas Part III Erythema multiforme Part III Fixed drug eruption Part III Impetigo Part VI Actinic keratosis (erythematous) Part V Atypical nevi Part V Common benign nevi (pigmented) Part V Ephelides Part V Erysipelas (erythematous) Part III Erythema multiforme (erythematous) Part III Erythrasma Part III Fixed drug eruption Part III Halo nevi Part V Impetigo (deep red) Part VI Lentigines Part V Malignant melanoma Part V Nodules Basal cell carcinoma (translucent, dome-shaped) Part V Keratoacanthoma (dome-shaped) Part V Malignant melanoma Part V Molluscum (dome-shaped umbilicated) Part II Rosacea (red) Part VI Squamous cell carcinoma (indurated) Part V Verruca vulgaris Part II Papules Basal cell carcinoma (translucent, dome-shaped) Part V Developed dermal nevi (sharply defined) Part V DLE (sharply defined, raised, smooth, shiny) Part IV Early compound nevi (dome-shaped) Part V Erythema multiforme (erythematous) Part III Miliaria (small, erythematous) Part II Psoriasis (erythematous,...

Eyelid Lesions and Tissues of Origin

Excretory Glands

All lesions that involve the eyelids or any other region of the body can be thought of as deriving from two basic sources. Those that arrive in the lids from other more remote sources are exogenous lesions. These include metastatic tumors from sites such as the breast or lung. Also included here are infiltrations in the dermis and epidermis of cellular or other materials that secondarily involve eyelid structures. Included here are diseases such as amyloidosis, sarcoidosis, infectious inflammations such as herpes and cellulitis, xanthelamas, acute atopic dermatitis, erythema multiforme, granuloma annulare, and lymphoid and myeloid infiltrates. All exogenous lesions disturb the normal eyelid architechture to some extent, and may be generalized or confined to specific eyelid tissue types.

Evaluation of Eyelid Lesions

Eyelid Blood Vessels

Eyelid lesions are classified according to the anatomic structures from which they arise. These include the epidermis, dermis, and various cells and adnexal structures within these layers. Eyelid inflammations may present as a localized or diffuse erythematous area. They can be associated with ulceration, induration, eczematous changes, necrosis, edema, or loss of eyelashes. If skin contraction occurs the eyelid margins may be malpositioned manifesting as an ectropion or canthal angle dystopia. Inflammatory lesions may be painful and at times can be associated with lymphadenopathy. Infectious conditions of the eyelid result from viral, bacterial, fungal or parasitic processes and may be primary or secondary. The latter can result as extensions from head and neck foci such as the sinuses or lacrimal sac, or from hematoge-nous spread from distant sites. The cause of the infection on the eyelid is often evident, such as in a site of trauma or recent surgery. However, when the infection...

Chalazion and Hordeolum

Eyelid Erythema

INTRODUCTION A chalazion and hordeolum are focal inflammatory lesions of the eyelid that results from the obstruction of secretory glands. In a chalazion there is no acute bacterial infection, but rather a chronic inflammatory lesion with circumferential fibrosis. When this involves the meibomian glands they form a deep chalazion, whereas when there is involvement of the more superficial glands of Zeis in the dermis or glands of Moll associated with the pilosebaceous unit a more superficial chalazion results. A hordeolum is an acute bacterial abscess filled with pus and associated with pain and inflammatory signs. They can involve the meibomian glands (deep hordeolum) or the Zeis and Moll glands ( superficial hordeolum). Superficial hordeola are usually found near the eyelid margin where the Zeis glands are concentrated. Two-thirds of cha-lazia show mixed-cell cytology, and one-third are suppurating granulomas. The latter tend to occur in older patients with a longer duration of...

Mast Cell Disease Urticaria Pigmentosa

Urticaria pigmentosa, telangiectasia macularis eruptive hyperpigmentation and telangiectasia positive Darier's Adults with mast cell disease are more likely to present with a widely scattered macular eruption. Individual lesions are often red-brown or hyperpigmented. The lesions are randomly distributed and generalized, but are accentuated on the chest. Petechiae and ecchymoses may occur. Depending upon the mast cell burden within each lesion, an urticarial reaction can be elicited by gently stroking these lesions. Pruritus is the most common symptom. Less commonly, nausea, vomiting, diarrhea, and abdominal pain may be reported. These symptoms occur in patients with limited cutaneous disease as frequently as those with systemic involvement. One type of adult-onset form of the disease is known as telangiectasia macularis eruptive perstans (TMEP). In this variant, abundant hyperpigmented 2-6-mm macules are present on the back and chest in concert with telangiectasias. Pru- Figure 6.1....

Histopathologic Terminology

Cytoid Bodies

Colloid bodies are also known as cytoid bodies, Civatte bodies, hyalin bodies, and apoptotic bodies. They are apoptotic epidermal cells (keratinocytes) lacking nuclei and appear as homogeneous, eosinophilic, and round structures. Colloid bodies are not specific for any disease, but they are commonly seen in lupus erythematosus, lichen planus, and graft-versus-host disease. The meaning of the term dyskeratosis varies depending on the disease. In acute graft-versus-host disease, lichen planus, and lupus erythematosus, dyskeratot-ic cells are cells undergoing apoptosis and are smaller than adjacent epidermal keratinocytes, have brightly eosinophilic cytoplasm, and shrunken hyper-basophilic nuclei (see Apoptosis). In acan-tholytic dermatosis, the dyskeratotic cells are also termed corps ronds and have a central, basophilic, pyknotic nucleus surrounded by a clear halo and enveloped within a basophilic or eosinophilic rim. Neoplastic dyskeratosis is manifest as brightly eosinophilic bodies,...

Necrobiotic Xanthogranuloma

Plaques with prominent telangiectasia, as deeper violaceous plaques, or as flesh-colored nodules. The lesions are usually inflamed and become ulcerated and undergo some degree of scarring. The nodules can cause loss of function of the eyelid with secondary lagophthalmos and corneal exposure and subsequent ulceration. Associated ocular findings include episcleritis, scleritis, keratitis, uveitis, and proptosis.

Herpes and Varicella Zoster

Impetigo Eyelid

CLINICAL PRESENTATION Following an incubation period of approximately two weeks and a prodrome of fever and malaise, the cutaneous lesions begin as a mild maculo-papular eruption. The papules evolve into clear vesicles that show an umbilicated center. Characteristic vesicles overlie a larger patch of erythema and develop in several successive crops. The vesicles become cloudy, rupture, and form crusts. Healing occurs over the ensuing few weeks with little or no scarring unless they become infected. In contrast to varicella, the lesions in herpes zoster are limited to a single dermatome however, hematologic dissemination of the virus can result in a few distant skin lesions as well. Pain in the region supplied by the involved nerve is not common but can precede the skin changes by several days. Preauricular adenopathy is often seen. The nasociliary branch of the ophthalmic nerve supplies sensation to the eye, with terminal branches going to the tip of the nose. Lesions on the tip of...

Glomerulonephritis Introduction

Acute glomerulonephritis (AGN) is an alteration in renal function caused by glomerular injury, which is displayed by the classic symptoms of gross hematuria, mild proteinuria, edema (usually periorbital), hypertension, and oliguria. AGN is also classified as either a primary disease, associated with group A, beta-hemolytic streptococcal infection or a secondary disease, associated with various systemic diseases (i.e., systemic lupus erythema, sickle cell disease, Henoch's chorea purpura). The most common type of AGN is the primary disease, described as an immune-complex disease (or an antigen-antibody complex formed during the streptococcal infection which becomes entrapped in the glomerular membrane, causing inflammation 8 to 14 days after the onset of this infection). AGN is primarily observed in the early school-age child, with a peak age of onset of 6 to 7 years. The onset of the classic symptoms of AGN is usually abrupt, self-limiting (unpredictable), and prolonged hematuria and...

Oxidative Stress Related Disorders

Oxidative stress is implicated in the inflammatory demy-elination that characterizes multiple sclerosis suggesting GST polymorphisms may be associated with disability. In 177 patients with disease duration over 10 years, GSTM3 AA (OR 2.4) and homozygosity for both GSTM1*0 and GSTP1*Ile105-encoding allele (OR 5.0) were linked with severe disability suggesting that long-term prognosis in MS is influenced by GST-mediated ability to remove toxic products of oxidative stress. 1 Exposure to ultraviolet radiation also results in local oxidative stress in skin. Response to such exposure, examined as minimal erythema dose, has been shown to be mediated by GSTM1 and GSTT1 genotype in a gene dosage-dependent manner. 19 Furthermore, nonmela-noma skin cancer has also been linked to these poly-

Diagnostic Criteria for Kawasaki Syndrome

Changes of the extremities peripheral edema, peripheral erythema, periungual desquamation Figure 36.3. Acral edema and erythema. Courtesy of Nancy Figure 36.4. Morbilliform exanthem. Courtesy of Nancy Figure 36.3. Acral edema and erythema. Courtesy of Nancy Figure 36.4. Morbilliform exanthem. Courtesy of Nancy

Why Inhibit Il1

Although the systemic effects of IL-1 have been studied in animals, there are now data on the effects and sensitivity to IL-1 in humans. The overwhelming conclusion of these studies is that IL-1 is a highly inflammatory molecule and reduction in its production or activity in a variety of disease states is likely a sensible therapeutic strategy. IL-1 a or IL-1P has been injected in patients with various solid tumors or as part of a reconstitution strategy in bone marrow transplantation. Acute toxicities of either IL-1 a or IL-1P were greater following intravenous compared to subcutaneous injection subcutaneous injection was associated with significant local pain, erythema, and swelling (10,11). Chills and fever are observed in nearly all patients, even in the 1 ng kg dose group (12). The febrile response increased in magnitude with increasing doses (13-17) and chills and fever were abated with indomethacin treatment (18). In patients receiving IL-1a (16,17) or IL-1P (13,14), nearly all...

Oooocoo

Supporting this observation, there are a number of other less well-known forms of progeria, including acrogeria, metageria, and acrometage-ria, as well as several dozen human clinical syndromes and diseases with features that have been considered to have progeroid aspects. The latter category includes Wiedemann-Rautenstrauch, Donohue's, Cockayne's, Klinefelter's, Seip's, Rothmund's, Bloom's, and Turner's syndromes, ataxia telangiectasia, cervical lipodysplasia, myotonic dystrophy, dyskeratosis congenita, and trisomy 21 (Down syndrome). In each of these cases, there are features that are genetic and that have been considered segmental forms of aging.

Examination

The signs of eczema and atopic dermatitis have proved difficult to define.17 The acute signs include erythematous (red) and vesicular (blistered) skin. More chronically one finds lichenified (thickened), oedematous (swollen) and cracked areas of skin. The picture and distribution is slightly different depending upon the age of the patient. The physical examination of a patient who lists urticaria and or angioedema as their symptom is often unremarkable. There should be a particular emphasis on the search for the signs of other systemic illnesses known to be associated with urticaria. Any urticarial lesion should be noted, such as an itchy well-demarcated raised area, often with surrounding erythema. Patients with perennial or seasonal rhinoconjunctivitis may have injected conjunctivae (visible small blood vessels), erythematous conjunctivae (reddened whites of eyes), puffy eyelids, and erythematous, oedematous nasal mucosa (the lining of the nose appearing swollen and red). Studies...

Diphtheria cutaneous

Skin findings seen mainly in homeless persons erythematous scaling plaques ulcers with an overlying membrane and demarcated edges mucous membranes sometimes involved Other bacterial pyodermas erythema multiforme tropical ulcer pyoderma gan-grenosum Majocchi's granuloma atypical mycobacterial infection nocardiosis aspergillosis syphilis granuloma inguinale chancroid

Skin testing

Skin tests are simple, readily available, rapidly performed and inexpensive. They have the disadvantage of producing a significant number of false positives and false negatives, especially when improperly performed. They rely upon the presence within the skin of all the necessary cells and mediators for the occurrence of a Type I hypersensitivity reaction. A small amount of allergen is introduced percutaneously. An immediate weal-and-flare reaction (see below) is provoked in the patient's skin. This is dependent upon proinflammatory and neurogenic mediators. Histamine and tryptase are released by mast cell degranulation after the introduction of allergen, recognised by specific IgE. Histamine is the major mediator of the weal-and-flare reaction. The immediate reaction occurs about 15-20 minutes after the test, and is used as evidence of a positive reaction. Visual evidence of this reaction is oedema (the swollen weal) and erythema (the surrounding red flare). The patient will often...

Fraser Syndrome

The Curacao Criteria for Hereditary Hemorrhagic Telangiectasia Syndrome Criteria a. Gastrointestinal telangiectasia (with or without bleeding). 4. Family history (a first-degree relative with hemorrhagic telangiectasia syndrome HHT according to the following criteria) (Adapted with permission from Shovlin CL, Guttmacher AE, Buscarini E, et al. Diagnostic criteria for hereditary hemorrhagic telangiectasia Rendu-Osler-Weber syndrome . Am J Med Gen 2000 91 66, 67, and from John Wiley and Sons.) HEREDITARY HEMORRHAGIC TELANGIECTASIA (OSLER-WEBER-RENDU SYNDROME) Hereditary hemorrhagic telangiectasia syndrome is an autosomal-dominant disorder, presenting classically as anemia with epistaxis or gastrointestinal bleeding and demonstration of cutaneous or visceral telangiectasias. Neurological symptoms may be the result of cerebral hemorrhages or strokes associated with pulmonary arteriovenous malformations and strokes with paradoxical embolism. Arteriovenous malformations may also occur in...

Patch testing

A standardised battery of substances is placed upon the patient's back within small aluminium chambers, under occlusive dressing. There exist a European and a North American Standard Series. Occasionally more specific series are chosen. They are left in situ for 48 hours. The dressing is then removed and the back is wiped free of any residual chemicals. Each specific area of the patient's skin is examined for any signs of dermatitis - erythema, oedema and blistering -and a score of 1+ to 3+ is assigned depending on the severity of the reaction. The score is defined as 1+ if there is erythema and oedema covering at least half the test area, 2+ if there are also papules and 3+ if there are vesicles or bullae present. Each area is then read again between 96 hours and 7 days later, for persistence of the reactions, or for emergence of new reactions. This later reading increases the sensitivity of the test.

Specific History

Tinea manuum and tinea pedis Tinea manuum (TM hands) and tinea pedis (TP feet) often occur together and usually present as a gradual progression of erythema, superficial scale, and moderate pruritus on the palmar and plantar surfaces. Confluent involvement is common the classic presentation is involvement of both feet and the dominant hand, or so-called two foot one hand disease (see Photo 2). The authors have seen every possible variation, however. Disease on the dorsal surface of the hands and feet is similar to tinea corporis in onset and appearance. A deeper vesicular variant that presents with rings of intensely pruritic blisters is less common. The course of TCa is variable. Changes may continue to consist only of broken hairs with minimal scale, erythema, and pruritus in noninflammatory cases. Some patients will develop thick scale, obscuring the underlying scalp, while in other cases deep follicular pustules occur. A common scenario in children is the development of a kerion,...

Folliculitis

Follicular-based erythematous papules and pustules, with or without coalescence into plaques face, back, and extensor surfaces of the upper extremities most commonly involved in adults scalp most common site in children increased incidence in HIV-infected patients peripheral eosinophilia often present Other forms of folliculitis, including bacterial and fungal varieties pustular psoriasis acne rosacea perioral dermatitis scabies candidiasis folliculitis decalvans insect bite reaction Langerhans cell histiocytosis follicular mucinosis superficial pemphigus

Erysipeloid

Diffuse cutaneous form multiple, well demarcated, violaceous plaques with an advancing border and central clearing Systemic form localized areas of swelling surrounding a necrotic center sometimes presenting as follicular, erythematous papules endocarditis as complication of septicemia Cellulitis erysipelas fixed medication reaction erythema nodosum leishmaniasis Erythema annulare centrifugum 217

Dimethoate

This organophosphorus compound is used as a contact and systemic insecticide and acaricide. It induced an erythema-multiform-like contact dermatitis in a warehouseman in an agricultural consortium. Schena D, Barba A (1992) Erythema-multiforme-like contact dermatitis from dimethoate. Contact Dermatitis 27 116-117

Fogo selvagem

Impetigo lupus erythematosus pemphigus vulgaris seborrheic dermatitis atopic dermatitis subcorneal pustular dermatosis epidermolysis bullosa glucagonoma syndrome erythema multiforme Other causes of erythroderma drug reaction cutaneous T-cell lymphoma psoriasis pityriasis rubra pilaris contact dermatitis

Retroviridae

3 3-hydroxysteroid dehydrogenase activity. Resolution may be accompanied by erythema, initially at the base of the lesion, and a predominantly mononuclear infiltrate has been taken to imply a cell-mediated immune response. In one study, two-thirds of patients had an antibody response, predominantly of the IgG class. The lack of response in the remainder may be due to the superficial site of infection and the outward migration of infected cells within the epidermis. Most patients retain virus-specific antibody after resolution. The involvement of immune responses in the resolution of molluscum contagiosum lesions is implicated by the observation that lesions may be numerous, widespread and long-lasting in the iatro-genically immunosuppressed, those with atopic dermatitis and those with acquired immunodeficiency syndrome (AIDS).

Epididymitis

While some men may have only a nonspecific finding of fever or other signs of infection, patients with acute epididymitis usually complain of sudden-onset, severely painful swelling of the scrotum. Pain may radiate along the spermatic cord and reach the abdomen, or possibly even the flank. The onset may be acute over 1 or 2 days, or sometimes more gradual it is often accompanied by dysuria or irritative lower urinary tract symptoms. Erythema of the scrotum may develop, and the epididymis may double in size in as little as 3 - 4 h. Many patients also have urethral discharge. In acute epididymitis, inflammation and swelling usually begin in the tail of the epididymis and may spread to involve the rest of the epididymis and testicle. The spermatic cord is usually tender and swollen. Epididymitis is frequently accompanied by erythema, which is generally unilateral and primarily in the posterior aspect of the scrotum. If the patient is examined early in the course of the disease, the...

Fourniers Gangrene

The origin is most often from a genitourinary source, such as a periurethral abscess, or from a colorectal source, such as a perirectal abscess. Additionally, surgery or local trauma to the genitalia are additional risk factors. In presentation of the patient in the classic form, there is an acute onset of spreading cellulitis adjacent to the site of injury and very often frank necrosis (Fig. 12.9). Genital and scrotal pain out of proportion to the exam, swelling, and erythema are the most common symptoms. Interval examination usually shows rapid progression of the disease. Radiographic studies may be valuable when the physical examination is in doubt. While CT scans may be most sensitive at determining the presence of subcutaneous gas, bedside ultrasound maybe more rapid, depending on the institutional capabilities (Morrison et al. 2005). Occasionally, subcutaneous and deep tissue gas can be observed on a KUB by an observant radiographer. The identification of subcutaneous gas should...

Leprosy

Fall in an intermediate category called borderline leprosy. In approximately 50 of leprosy patients under treatment, acute inflammatory reactions develop that are immuno-logically mediated responses to M. leprae. 1 Type 1 reactions are seen in patients with significant T-cell immunity to M. leprae and in extreme cases may result in necrosis with abscess formation in nerve trunks with irreparable loss of nerve function. Type 2 reactions, or erythema nodosum leprosum (ENL), are characterized histologically by a vasculitis and a neutrophilic infiltrate superimposed on a lepromatous infiltrate. Chronic episodes of ENL can lead to nerve damage and eventual loss of nerve function. Both reactions can be managed with anti-inflammatory agents such as steroids or in the case of ENL, thalidomide.

Glucagonoma

They may present with weight loss, necrolytic migratory erythema (a painful, pruritic cutaneous eruption), cheilosis, diabetes mellitus, normochromic and normocytic anemia, venous thrombosis, and neuropsy-chiatric symptoms, as well as diarrhea. The most common presentation is diabetes, necrolytic migratory erythema, and imaging demonstrating an islet cell tumor. The diagnosis is most frequently made by obtaining a fasting glucagon level, which should be markedly elevated, followed by identification of a pancreatic islet cell tumor by imaging.

History And Exam

Later she developed painful swelling of multiple joints and erythema nodosum. Chest X-ray revealed hilar adenopathy and ESR was 48 mm h. These findings resolved with a further course of prednisone. At her most recent evaluation, visual acuity and color vision were normal OU, but there was a left RAPD and the left optic disk was pale.

Herpes Simplex

Eosiniphlic Keratynocytes

CLINICAL PRESENTATION Following a 2 to 14 day incubation period there develops a mild fever with moderately painful, usually unilateral, edema and erythema of the eyelid region. This is soon followed by the development of multiple discrete 2 to 3 mm vesicles that generally have a central umblilication. These break, crust over, and most often resolve without bacterial infection or scarring over the ensuing few weeks. There is a mildly tender preauricular lymphadenopa-thy, and often vesicular lesions are found elsewhere on the face or mucous membranes. Atypical dermal manifestations include the development of a black eschar early on, or edema without obvious vesicles. A careful search often reveals a few minute vesicles sometimes hidden at the base of the lashes. Following resolution the herpes virus retreats to the trigeminal ganglion where it can later reactivate and incite recurrent infections. Recurrent herpetic infections frequently follow a fever, head cold, sun exposure, or some...

Ecthyma Gangrenosum

Early Ecthyma Gangrenosum

Similar lesions caused by opportunistic fungi Associations Immunosuppression, premature infants Clinical Indurated plaques with black eschar and rim of erythema, Ecthyma gangrenosum usually starts as an erythematous macule, which subsequently forms a vesicle. Multiple lesions may occur. Lesions rapidly become indurated and may develop pustules or bullae, which slough and leave an ulcer. An eschar forms, with a rim of erythema (Figure 25.1). The disease has a strong predilection for axillae, inguinal folds, and perineum, so-called apocrine areas. Extremities, trunk, and face are affected less frequently. Though once regarded as cutaneous seeding during Pseudomonas bacteremia, most cases represent aggressive primary infection, which may disseminate in immuno-suppressed patients. Synchronous multiple lesions of the perineum, genitalia, and axillae are common. This pattern of infection supports the notion that ecthyma gangrenosum arises in the skin and then disseminates. In one Figure...

Abscess

Difference Abscess Cellulitis Skin Layer

INTRODUCTION An abscess is a collection of pus within a cavity formed in soft tissue or bone. It is usually associated with an infection caused by bacteria or parasites that gain access via a break in the skin or sometimes through hematogenous spread. Sometimes a sterile abscess can be induced by retained foreign material. Local tissue cells are destroyed by bacterial action or toxins and this triggers an inflammatory response by attracting large numbers of white blood cells. Regional blood flow is increased causing erythema, and vascular permeability is increased under the influence of released cytokines resulting in tissue edema. Patients with systemic diseases such as diabetes, or who are immunocompromized are at greater risk for developing an abscess from relatively trivial trauma or from a surgical wound. Eyelid abscess can be associated with paranasal and sinus infections or with diseases such as tuberculosis. Obstruction of skin glands or lacrimal ducts can become infected...

Insect Bite

Bug Bite Eyelid

INTRODUCTION Insect bites or stings result in the introduction of venom or toxins into the skin, which in turn cause the release of vasoactive amines. This results in marked swelling and erythema of the thin tissues of the eyelid. Unless secondary infection occurs, these reactions tend to resolve rapidly. Dermatitis nodosa is a specific type of insult due to barbed cilia acquired from caterpillar contact. The barbs result in the cilia working their way into the skin where they set up a prolonged, sometimes severe inflammatory irritation. If the caterpillar hairs get into the eye, they cause a severe, painful reaction and can lead to later ocular sequelae from intractable inflammation (ophthalmia nodosa).

Cellulitis

Mucormycosis

CLINICAL PRESENTATION The initial skin lesion is often a small, erythematous focus, suggesting an early furuncle, but instead of localizing, it rapidly spreads through the adjacent subcutaneous tissues after 5 to 10 days. Eyelid edema, erythema, and inflammation may be severe. Unless the infection spreads to the post-septal orbit, the globe is uninvolved pupillary reaction, visual acuity, and ocular motility are not disturbed pain on eye movement and chemosis are absent. Complications can result in lagophthalmos, ectropion, and lid necrosis.

Impetigo

CLINICAL PRESENTATION Impetigo can begin in either a bullous or vesicular form, with both types eventuating in pustule formation and then in ulceration. Invasion of the superficial regions of the skin by pathogenic streptococci or staphylococci produces small erythe-matous macules followed by dissolution of the basal epithelial layers and the formation of superficial vesicles or bullae ranging from 2 to 20 mm in diameter and surrounded by a narrow halo of erythema. These soon become pustules that, upon rupturing, spread the infection to new areas. A tan crust made of dried blood and cellular debris forms over the lesion. Most lesions will heal without scarring however, when

Erysipelas

CLINICAL PRESENTATION In 40 of cases the portal of entry may not be obvious. After an incubation period of several days the disease commences abruptly with fever, malaise, and sometimes mental confusion. A small erythematous patch at the infected site rapidly spreads. The erythema is irregular with extensions or tongues along lymphatic vessels. The clinical appearance of an elevated, erythematous, indurated area with a sharp border is very characteristic. The area is hot to the touch, and tiny vesicles may be seen at the advancing margin. The tense edema gives the skin a shiny glazed appearance and is sufficient to greatly distort the facial features. Local complications include hemorrhagic infarction, ulceration, and necrosis. Regional lymphadenopathy accompanies the infection. Chronic lymphedema is a possible sequel resulting from occlusion of lymph vessels. As with many streptococcal infections acute glomerulonephritis may develop later in the convalescent period.

Melanocytic Nevus

Eyelid Diseases

INTRODUCTION Also known as nevocellular or nevomelanocytic nevi, these common benign neoplasms or hamartomas are composed of melanocytes. Nevi are nests of melanocytes that may be congenital or acquired. Congenital nevi probably represent malformations or errors in development and migration of these neural crest elements. When nevocytes are sequestered along the palpe-bral fissure of the embryo, this results in the presence of a nevus on both the upper and lower eyelid margin, so-called kissing nevi. Acquired nevi are not present at birth and the incidence increases during the first 3-4 decades of life with a peak incidence in the third to fourth decades. They are especially common in individuals with fair complexion and frequently occur on the sun-exposed areas of eyelid skin. Occasionally they arise in an eruptive fashion, usually following some generalized insult to the skin such as erythema multiforme or burns. Melanocytic nevi can take on several distinct forms. In lentigo...

Blepharitis

Atrophic Vagina Histology

CLINICAL PRESENTATION Blepharitis is characterized by small brittle scales and collarettes at the base of the lashes, and moderate erythema along the eyelid margin. A more severe ulcerative form has larger mottled crusts surrounding the base of the lashes, which upon removal result in small ulcers and even bleeding. With time the lid margins develop telangiectasias and become permanently thickened, roughened, and keratinized on the inner surface. The orifices of the meibomian glands may be dilated and inflamed, and become capped by a dome of inspisated oil or it may take on a pouting appearance. The tear film may appear foamy with suspended particulate debris over the surface of the cornea. Recurrent hordeola and loss of lashes are often seen. Angular blepharitis represents a distinct form of blepharitis characterized by a subacute or chronic inflammation of the skin of the lateral canthal region associated with a low-grade conjunctivitis. Symptoms of blepharitis include burning,...

Sarcoidosis

Sarcoidosis Disease

CLINICAL PRESENTATION Eyelid lesions most commonly take the form of unilateral or bilateral slightly elevated, discrete, yellow-to-brown or purplish papules and plaques that eventually demonstrate central clearing. They usually evolve into annular or circinate lesions with or without central ulceration. Millet-seed subcutaneous nodules or confluent violaceous nodules may also occur. Associated eyelid edema and erythema is common. Occasionally sarcoid lesions can result in full-thickness destruction of eyelid tissues. Associated ocular involvement may include acute anterior uveitis, keratitis sicca, conjunctival granulomas, lacrimal gland infiltration, orbital inflammation, chorioditis, optic neuritis, and retinal vasculitis. Candle wax exudates along the retinal veins are thought to be virtually pathognomonic, but they seldom occur. Constitutional symptoms of fever and malaise are common, as is hilar adenopathy, lung infiltrations, and arthralgias. Rarely, eyelid sarcoid can be seen...

Physical examination

Vaginal examination should commence with a careful inspection of the vulva and introitus, paying particular attention to presence of erythema which might suggest primary vulval vestibulitis 17 . More frequently, no erythema is evident but a gentle touch with a cotton-tipped swab in the area just external to the hymeneal ring elicits intense sharp pain, even in patients who do not complain of dyspareunia. This allodynia in the absence of visible erythema probably represents referred sensation from painful areas higher in the pelvis but for some women represents the primary problem and can be termed 'vestibu-lodynia'. Vulval varices may indicate incompetence of valves in the pelvic venous circulation this subgroup of patients may benefit from radiological assessment and treatment.

Granuloma Annulare

Deep Granuloma Annulare

CLINICAL PRESENTATION Lesions present as one or more skin colored erythematous or violaceous dermal plaques, nodules or papules arranged in rings. They are seen most frequently on the lateral upper eyelid and lateral canthus. Lesions appear as nontender mobile cutaneous masses generally less than 1 to 1.5 cm in diameter. Eyelid edema may be moderate, and there may be ptosis of the upper eyelid. With deep lesions they may involve fascia and tendons, and are rubbery in consistency, immobile and often fixed to the orbital rim. DIFFERENTIAL DIAGNOSIS The differential diagnosis includes insect bites, erythema multiforme, syphilis, rheumatoid nodules, tuberculous granulomas, metastatic lesions, fibrosarcoma, and amyloidosis.

Radiation Cystitis

Initiation of radiation treatment but maybe delayed up to 10 years or more (Cox et al. 1995). Most patients develop severe irritative voiding symptoms however, gross hematuria dominates the clinical picture (Pas-quier et al. 2004). While any patient receiving pelvic radiotherapy is at risk, radiation cystitis is most common among those treated for prostate or cervical cancer. Three to five percent of such patients will develop late grade 3 hematuria, the incidence of which is directly related to both the biologic dose and the volume of tissue irradiated (Perez 1998 Lawton et al. 1991 Shipley et al. 1988 Dearnaley et al. 1999). In contrast to acute changes, late radiation injuries are irreversible and often progressive. There appears to be no correlation between the development of early and late radiation injuries. The pathophysiology of late radiation damage includes cellular depletion, fibrosis, and obliterative endarteritis (Pasquier et al. 2004). All of these changes lead to tissue...

Atopic Dermatitis

Of these types 70 result from allergic contact dermatitis, and about 9 to 10 each from irritant contact dermatitis, atopic dermatitis, and seborrheic dermatitis. Atopic dermatitis is a chronically relapsing inflammatory skin disease. It is a genetically fixed disease that remains with the patient all their lives, whether they show symptoms or not. It occurs in approximately 2 of the population. In several large series 80 to 90 of patients with eyelid dermatitis were female. Distinct infantile, juvenile, and adult stages of the disease have been reported. Associated diffuse eczematous skin changes vary with the age of the patient and often disappear during puberty or adolescence. In the infantile stages associated manifestations include facial erythema and crusting. After age two to three years erosions, lichenification, and hyper or hypopigmentaton develop particularly on the face and flexural surface of the extremities. In adults the rash may be bright red, edematous and oozing or...

Photodynamic Therapy

After PDT, patients may develop transient substernal or epigastric pain, odynophagia, or worsening dysphagia. Fever, leukocytosis, and asymptomatic pleural effusions may be present, and often resolve after several days without any intervention. Major complications include perforation, aspiration, fistulae, and stricture formation with rates varying between 2 and 10 (81-83, 88). Photosensitivity occurs in approx 60 of patients treated with PDT (89). Photofrin is primarily retained by the reticuloendothelial system of the liver, spleen, and kidney and redistributed into the skin. Given that the longest half-life of photofrin is 36 d, skin photosensitivity can occur for up to 3 mo. Patients are cautioned to avoid direct sunlight, strong fluorescent or incandescent light, strong residential indoor lights, and radiant heat for at least 30 d. Skin photosensitivity can vary from mild erythema and pruritus, to severe erythema and edema, to blisters with skin desquamation. Topical suncreens...

Madarosis

INTRODUCTION Madarosis refers to the loss of eyelashes. It may result from trauma, rubbing the eyelids, or it can follow eyelid surgery with injury to the lash follicles. Madarosis is also associated with systemic diseases such as alopecia areata, but here hair loss is usually seen in other parts of the body as well. Discoid lupus erythematosis involving the eyelids presents with erythema, scarring, and madarosis, but the latter can be the only presenting finding before any other CLINICAL PRESENTATION Patients present with absent lashes over some or all of the eyelid margin. In some cases stumps may be seen broken off at or a few millimeters from the skin surface. The lid margin may show evidence of chronic inflammation including erythema, meibomianitis, blepharitis, chalazion, crusting, or ulceration. When the madarosis is localized and associated with lid thickening and telangiectasias, malignancy should be suspected. When associated with excoriations of the facial skin in a young...

Leukemia Cutis

Eyelid Infiltrative Disorders

Associated orbital disease is not uncommon and presents with pain, lid edema, and exophthalmos. Systemic manifestations include purpura due to thrombocytopenia, urticaria, pruritis, erythema multiforme, leonine facies, alopecia, exfoliative dermatitis, and infection with opportunistic organisms may be seen. Death may result from infection or hemorrhage. DIFFERENTIAL DIAGNOSIS The differential diagnosis includes syphilis, dermatitis, leprosy, erythema multiforme, exfoliative dermatitis, and infection.

Inspection

Severe incontinence, particularly to liquid feces, can cause erosion and erythema of the perianal skin. Those lesions, as well as scratching erosions that may accompany them, can present signs of infection, frequently due to streptococcus and fungi. In that case, specimen cultures may be taken.

Hemorrhagic Cystitis

The association between hemorrhagic cystitis and the oxazaphosphorine alkylating agents, cyclophosphamide and ifosfamide, has been well documented (Philips et al. 1961 Burkert 1983 Klastersky 2003). These chemotherapeutic drugs are used frequently in the treatment of breast cancer, lymphoma, and sarcoma but also have application in poor-risk and chemotherapy-resistant germ cell tumors. Cyclophosphamide is associated with a 24 incidence of irritative voiding symptoms, 7 -53 incidence of microscopic hematuria, and 1 -15 incidence of gross hematuria (Ta-lar-Williams et al. 1996). Older series report hemor-rhagic cystitis in as many as 68 of patients treated with cyclophosphamide (Burkert 1983). The causative agent of urothelial toxicity is acrolein, a hepatic metabolite eliminated primarily through urinary excretion (Cox 1979). Peak urine levels occur approximately 5 h after the start of chemotherapy infusion (Takamoto et al. 2004). Early pathologic changes include transmural edema,...

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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