Instant Remedies for Rosacea

Rosacea Free Forever Cure By Laura Taylor

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. You will get an all-natural remedy, which can help clear up nearly every type of rosacea such as semi-permanent rosacea, rhinophyma (swollen, red, and bulbous-like nose), telangiectasia, superficial swelling of all blood vessels on the face, scalp rosacea, rosacea on the chest or neck, and facial rosacea. The Rosacea Free Forever book will help you save your time and energy because it will work effectively for you and you do not have to waste your time and energy on finding other rosacea treatment methods. When buying this book, Laura Taylor will provide you with a 24/7 support via email. Read more...

Rosacea Free Forever Overview


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Erythema multiforme bullosum

Erythema multiforme bullosum has a clinical picture and course distinct from that of erythema multiforme (see Chap, 12). Many drugs can cause an erythema True erythema multiforme bullosum has no known cause. Clinically, one sees large vesicles and bullae usually overlying red, iris-like macules. The lesions most commonly appear on the arms, the legs, and the face but can occur elsewhere, including, on occasion, the mouth. Erythema multiforme bullosum can last from days to months.

Rickettsia Slovaca Tickborne Lymphadenopathy And Dermacentorbornenecrosiserythemalymphadenopathy

The clinical syndrome called (DEBONEL) has been recently reported in Spain (115). In half of the cases, patients were bitten by D. marginatus, which contributed to the name of the syndrome. Most cases occurred between October and April, with a peak in November. The incubation period was approximately four days (range one to eight days). All patients had an eschar at the tick-bite site (86 on the scalp) associated with regional painful lymphadenopathy, and all but one complained of headache. Low-grade fever was reported in 45 of patients. After antibiotic


Rosacea. (Hoechst-Roussel Pharmaceuticals, Inc.) Figure 13-9. Rosacea. (Hoechst-Roussel Pharmaceuticals, Inc.) A common pustular eruption with flushing and telangiectasias of the butterfly area of the face may occur in adults in the 40- to 60-year-old age group. PRIMARY LESIONS. Diffuse redness, papules, pustules, and, later, dilated venules, mainly of the nose, the cheeks, and the forehead, are seen. SECONDARY LESIONS. Severe, longstanding cases eventuate in the bulbous, greasy, hypertrophic nose characteristic of rhinophyma. COURSE. The pustules are recurrent and difficult to heal. Rosacea keratitis of the eye may occur. CAUSES. Several factors influence the disease (1) hereditary factor of oily skin (2) excess ingestion of alcoholic beverages, hot drinks, and spicy foods (3) Demodex mites have been implicated as causative for some cases of rosacea. Excess sun exposure and emotional stress can aggravate some cases of rosacea. Systemic lupus erythematosus No papules or...

Erythema infectiosum

Also known as fifth disease, erythema infectiosum occurs in epidemics and is believed to be caused by parvovirus B19. It affects children primarily, but in a large epidemic many cases are seen in adults. Herpangina is an acute febrile disease that occurs mainly in children in the summer months. The first complaints are fever, headache, sore throat, nausea, and stiff neck. Blisters are seen in the throat that are approximately 2 mm in size and surrounded by an intense erythema. These lesions may coalesce, and some may ulcerate. The course is usually 7 to 10 days.

Associated Medical Findings

Proptosis or periorbital fullness suggests an orbital process such as Graves' disease, orbital meningioma, or orbital pseudotumor. The patient's general appearance may suggest an underlying chromosomal, endocrinological, or metabolic disorder. For instance, the disfiguring frontal bossing and enlargement of the mandible and hands are characteristic of acromegaly associated with a growth hormone-secreting pituitary adenoma. The heart rate, blood pressure, and carotid and cardiac examinations are important in any patient with a possible ischemic event. Patients with pseudotumor cerebri tend to be young females with obesity or a history of recent weight gain. Skin lesions such as erythema migrans (Lyme disease) or malar rash (systemic lupus erythematosus), and abnormal discolorations, such as cafe(c)-au-lait spots and axillary freckling (neurofibromatosis), or hypopigmented ash-leaf spots (tuberous sclerosis) also may be helpful in guiding the evaluation of patients with visual...

German measles rubella

Infants born to mothers who had rubella in the first trimester of pregnancy can have multiple system abnormalities. The skin lesions include thrombocytopenic purpura hyperpigmentation of the navel, forehead, and cheeks acne seborrhea and reticulated erythema of the face and extremities.

Cutaneous and Mucosal Manifestations The Primary Lesion

The primary lesion of rickettsialpox represents the site of inoculation of rickettsiae from the bite of an infected L. sanguineus mite and is described for 83 to 100 of patients in several large series (10,13,22,24,99,127,128). In its early stages, this lesion is a firm, nonpruritic, erythematous papule that soon enlarges and develops a central vesicle containing clear or opaque fluid. The lesion is generally painless and is often described by patients as a pimple, boil, or insect bite. Eventually, the vesicle ruptures and a dark brown or black crust develops over the lesion, forming the characteristic eschar (Fig. 5A). The eschar often is surrounded by a larger zone of erythema. Primary lesions range in size from 0.5 to 2.5 cm and are located, in order of decreasing frequency, on the upper extremities, lower extremities, back and shoulders, neck, face, chest, and abdomen. Eschars have also been reported uncommonly in the nostril and on the scalp, axillae, vulva, penis, buttocks, and...

Telomerase and Ageing

Late generations of mTR knockout mice and DC patients share similar pheno-types in terms of hair loss or early greying of hair, increased incidence of malignancy, decreased capacity for wound healing, and telomere shortening, which are common to the process of normal ageing. Furthermore, several syndromes diseases have also been considered to be related to telomere shortening, and have been referred to as premature ageing syndromes. These include cardiovascular disease (Cawthon et al. 2003), hypertension (Serrano and Andres 2004), paroxysmal nocturnal hemoglobinuria (PNH) (Beier et al. 2005), Fanconi anemia (Franco et al. 2004), Werner syndrome (Chang et al. 2004), ataxia telangiectasia (Metcalfe et al. 1996), Bloom syndrome (Cohen and Sinclair 2001), and Nijmegen breakage syndrome (Paull and Gellert 1999). In this chapter, DC, which is caused by mutations in the components of telomerase ribonucleoprotein complex, will be discussed in order to understand the role of telomerase in a...

Primary exfoliative dermatitis

Clinically, it is impossible to differentiate this primary form from the one in which the etiology is known or suspected. Various degrees of scaling and redness are seen, ranging from fine, generalized, granular scales with mild erythema to scaling in large plaques, with marked erythema (generalized erythroderma) and lichenification. Widespread lymphadenopathy is usually present. The nails become thick and lusterless, and the hair falls out in varying degrees.

Signaling Pathways Implicated in Cell Intrinsic HSC Ageing

The free radical theory of ageing proposed by Harman in 1956 suggests that ageing, as well as age-related degenerative diseases, can be attributed to the deleterious effects that free radicals impose on a cell (Harman 1956 see Passos et al., this volume). Thus, long-lived cells run the risk of accumulating damage from oxidative stress as a result of normal metabolism, exposure to cellular toxins, and cellular stress. Ataxia telangiectasia mutated (ATM) is a protein kinase encoded by the ATM gene (Savitsky et al. 1995), which is mutated in the disease ataxia telangiectasia (AT). ATM functions by regulating telomere length, its primary role, and response to cellular damage (Wang et al. 2005). HSCs in ATM-'- mice, as expected, show signs of telomere dysfunction, increased cellular oxidant levels, and reduced numbers of HSCs. This dysfunction in the HSC compartment results in aplasia and severe anemia in mice as early as six months of age. Administration of the hydrogen peroxide...

Differential Diagnosis

Discoid lupus erythematosus See Table. 25-1. Subacute cutaneous lupus erythematosus See IabJe.2.5.- 1 Rosacea Presence of acne-like lesions and telangiectasia on nose and butterfly area of cheeks, without systemic symptoms but may have associated eye abnormalities, may worsen with sun exposure (see Chap 13). Mixed connective tissue disease This is a distinct clinical syndrome sharing features of systemic lupus erythematosus, progressive systemic sclerosis, and polymyositis. A high titer of particulate fluorescent antinuclear antibody is significant.

Figure 2615 Periungal fibromas Koenens tumor in tuberous sclerosis

Plaques, and maculopapular eruptions are relatively specific lesions for this disease. Lupus pernio is the most characteristic skin lesion in sarcoidosis. It consists of chronic, violaceous, indurated plaques with a predilection for the face, nose, ears and lips. Skin plaques are similar to lupus pernio, but they are located on the limbs, face, back, and buttocks. These plaques may have central atrophy or a hypopigmented appearance. Erythema nodosum is the most common nonspecific cutaneous manifestation of sarcoidosis and is a hallmark of acute disease with associated hilar adenopathy. Erythema nodosum is a hypersensitivity reaction that occurs with exposure to various antigens and appears clinically as tender, erythematous, subcutaneous nodules predominantly on the anterior shins. Other nonspecific skin changes include alopecia, erythroderma, erythema multiforme, pruritus, acquired ichthyosis, and dystrophic calcification.

Detection and Screening

Screening of childhood cancer survivors treated with hepatotoxic chemotherapy and radiation therapy should begin with a thorough physical examination (Table 12.1). Physical findings suggesting liver dysfunction, e. g. spider angioma, palmar erythema, hepatomegaly, splenomegaly, icterus or ascites, may be observed in individuals with long-standing liver dysfunction associated with significant hepatitic fibrosis. Patients transfused with any blood product before implementation of blood donor testing for hepatitis-B (1971) or -C (1992) should been screened for viral hepatitis PCR can establish the diagnosis of chronic infection. Since most childhood cancer sur

Acquired Immunodeficiency Syndrome

Flagrant, recalcitrant fungal infections of the nails, a destructive, almost granulomatous-like psoriatic involvement of the nails, melanonychia striata (sometimes with a pseudo-Hutchinson's sign and seen with or without antiretroviral treatment), proximal or total leukonychia, Beau's lines, clubbing, onychoschizia, brittle nails, yellow nails, blue nails, small lunulae, periungual erythema, and squamous cell carcinoma of the nail bed have all been associated with HIV infection.

Malignant Bone Tumors

Ewing's sarcoma is a tumor of uncertain origin. It is most common in children and young adults. It is more common in whites than blacks. The tumor may occur in any bone but has some predilection for long tubular bones and the pelvis. The presenting complaints include pain, swelling, tenderness, and erythema, which makes it resemble osteomyelitis. Early there may be no radiographic abnormalities, but later a typical lytic lesion with an onion-skin appearance of the periosteum is seen. The prognosis is improving with the use of surgery, chemotherapy, and in some cases radiotherapy. Long-term cures are now seen in about 50 of five-year survivors.27

Diagnostie Criteria for Neurofibromatosis

28 , y and in 1941, Louis-Bar proposed that ataxia- telangiectasia should also be considered as one of the phakomatoses. During the last 50 years a wide variety of disorders, all of which are unusual and many of which lack dysplastic or neoplastic characteristics, have been considered to belong to this heterogeneous group of disorders. The major neurocutaneous syndromes are considered herein, and others are noted in Tablei -ii .

Autosomal Recessive Disease

ATAXIA-TELANGIECTASIA Syllaba and Hennery first reported three adolescent patients with progressive choreoathetosis and ocular telangiectasia in 1926, but it was not until 1964 that Martin recognized their clinical description as ataxia-telangiectasia (AT). y A second report in 1941 by Louis-Bar described a young boy with progressive cerebellar ataxia and extensive cutaneous telangiectasias she identified the syndrome as one of the phakomatoses. y After the 1958 descriptions by Bean, y Boder and Sedgwick,y , 58 and Centerwall and AT is an autosomal recessive disorder characterized by a constellation of signs and symptoms associated with progressive cerebellar dysfunction, conjunctival and cutaneous telangiectasias, severe immune deficiencies, premature aging, and a predisposition to cancer. y AT is inherited as a single mendelian locus on chromosome 11q22-23. Recent studies have identified the mutated gene in AT and its identification provides answers to the link between the mutated...

Life stages and the skin

Certain physiologic skin changes occur. Perspiration is increased. Hyper-pigmentation of the abdominal midline, nipples, vulva, and face (chloasma) is seen, and, in some brunettes, nevi and freckles also become more prominent and more pigmented. Malignant melanoma is not more common in pregnancy. Hypertrichosis of the scalp may be unnoticed until the excess hair begins to be shed after delivery. Striae of breasts, abdomen, and thighs appear. The skin diseases of pregnancy are herpes gestationis (see Fiig.M 26-11D-E), impetigo herpetiformis, vulvar pruritus (often due to candidal infection), palmar erythema, spider hemangiomas, pyogenic granulomas, rarely erythema multiforme, and pedunculated fibromas. The following dermatoses are usually better, or disappear, during pregnancy psoriasis, acne (can be worse), alopecia areata, and, possibly, systemic scleroderma. MENOPAUSE. Common physiologic changes in the skin of women during menopause include hot flashes, increased...

Helminthic Dermatosis Roundworm

And they remain viable in sandy, moist ground. The larva then penetrate the skin of bathers or people who walk on the contaminated ground. Usually the culprits are Ancylostoma duodenal, Necator americanus, and other hookworms. Clinically, the parasite causes a serpentine, erythematous, papular, pruritic skin eruption. The parasite is usually ahead of the tract. Vesicles, excoriation, and crusts are present. Treatment includes topical thiabendazole and albendazole 200 mg by mouth twice ONCHOCERCIASIS. Onchocerciasis is a chronic infestation of the skin by Onchocerca volvulus. This is a microfilarial nematode whose natural hosts are humans and fleas from the genus Simulium. The disease was first described in Africa and later in Central America. Recently, the reports extend the disease to the northern countries of South America. The transmission occurs when flies become infected by biting sick people. After a short period of maturation, the microfilariae move to the buccal apparatus of...

Congenital Abnormalities and Metabolic Disorders

These include Alagille's syndrome, ataxia-telangiectasia, familial polyposis of the colon, hereditary haemorrhagic telangiectasia, familial cholestatic cirrhosis, neonatal hepatitis biliary atresia, neurofibromatosis and Soto syndrome. All of these are rare and some cases may have been pure chance associations (Anthony, 1994).

Cranial and Spinal Subdural Empyema

Subdural empyema.y A progressive disturbance of consciousness occurs as the subdural empyema produces a mass effect that results in increased ICP. Focal neurological deficits are present in 80 to 90 percent of patients and are caused by mass effect from the subdural collection of fluid and to cortical vein thrombophlebitis. Periorbital edema and erythema may be present in patients with a subdural empyema originating from the frontal sinus. y , y Seizures, which are typically focal, occur in 30 to 60 percent of patients. y Infants with subdural empyemas usually have an increase in their head size, a bulging fontanel, irritability, poor feeding followed by hemiparesis, convulsions, stupor, and coma. y A spinal subdural empyema presents as fever with signs of rapidly progressive spinal cord compression. Backache may be present, but it is not as characteristic of the presentation of a spinal subdural empyema as it is of the presentation of spinal epidural abscess.

Congenital triangular alopecia Brauer nevus temporally limited alopecia

A granulomatous disease of the bowel. Cutaneous manifestations include pyoderma gangrenosum, exfoliative dermatitis, erythema multiforme and Stevens-Johnson syndrome, urticaria, herpes zoster, palmar erythema, cutaneous Crohn's disease, and necrotizing vasculitis. Demodex mites. 123. Demodex folliculorum and D. brevis are ubiquitous hair follicle mites. They may play a role in blepharitis, rosacea, folliculitis, and perioral dermatitis.

Mechanical Influences

PICD may result from poorly fitting prostheses including callus formation, lichenification, erythema and acroangiodermatitis associated with suction socket prostheses. A total of 34 of 210 amputees experienced skin problems. Airborne particles are important when working with metals, woods, plastics, cement and plaster. The mechanical friction from sanding-down these materials may cause a chronic dermatitis of the hands and the face. Abrading dusts produced by finishing work, combined with the frictional effect of clothes, mechanically provoke PICD appearing as erythema, papules and eczematous reactions. Many workers have also symptoms on their lower legs and ankles, probably caused by the dust on the floor driven up into the air by the workers' steps.

Autosomal Dominant Cerebellar Ataxia

EOCA may be confused with other early-onset disorders associated with ataxia, such as ataxia telangiectasia, abetalipoproteinemia, Refsum's disease, ataxia with isolated vitamin E deficiency, juvenile and adult forms of GM2 -gangliosidosis, adrenoleukodystrophy, and mitochondrial encephalomyopathies. To exclude these disorders, the workup of an EOCA patient should include determination of the serum levels of alpha-fetoprotein, serum lipids, phytanic acid, vitamin E, hexosaminidase A, and very long chain fatty acids. In addition, cerebrospinal fluid (CSF) lactate levels should be measured. In some cases, a muscle and skin biopsy may be helpful to exclude mitochondrial encephalomyopathies and lipid storage diseases.

Abridged Dictionaryindex

Intense redness of palms and soles with dysesthesia and occasionally blisters. Associated with anticancer chemotherapy. Acrodermatitis chronica atrophicans, 173, 260. A chronic, biphasic disease seen rather commonly in western Europe. The first phase begins with an erythematous patch on an extremity, which, in weeks or months, develops the second phase of skin atrophy. The cause is believed to be a mixed infection with group B arboviruses, transmitted by the wood tick Ixodes ricinus, and a penicillin-sensitive bacterium or spirochete. Can be a chronic late stage of Lyme disease. Allergic granulomatosis. The combination of transitory pulmonary infiltrations of Loffler's syndrome, asthma, blood eosinophilia, and nodular purpuric or erythema Antimalarial agents, 97, 301. Dermatologically active agents include quinacrine (Atabrine), chloroquine (Aralen), and hydroxychloroquine (Plaquenil). Their mode of action is unknown, but these agents are used in the treatment of...

Syndromes of Lesions Involving Peripheral Branches of Cranial Nerve V

Various pathological processes including tumors, aneurysms, infarctions, trauma, and infections can damage the ophthalmic division of the trigeminal nerve. y Superior orbital fissure involvement is characterized by numbness, paresthesias, or pain in the distribution of V1 and within the orbit, Horner's syndrome, and ophthalmoparesis. Involvement of the optic nerve suggests extension into the orbital apex. If, on funduscopic examination, there is evidence of venous congestion, cavernous sinus thrombosis is likely. Cavernous sinus thrombosis is almost always caused by spread of an infection from the face, nose, or mouth. Patients may initially complain of fever, malaise, and frontal headache, but they subsequently develop proptosis, ptosis, ophthalmoparesis, and vasocongestion. Initially the CSF test result may be normal, but findings characteristic of meningitis may occur if treatment is delayed. Mortality is linked to spread of bacteria to the meninges, which warrants early and...

Anatomic Variation And Evaluation

Grade II Mucosal erythema with superficial ulceration, typically linear and vertical and with an overlying fibrinous membranous exudate that is easily wiped away, leaving a bleeding surface (which is often misinterpreted as scope trauma by the inexperienced endoscopist). Grade III Mucosal erythema with superficial ulceration and associated mural fibrosis a dilatable early stricture. Grade IV Extensive ulceration and fibrous luminal stenosis, which may represent irreversible panmural fibrosis. Grade 1 Single or multiple erosions (may be erythematous or covered by exudate) on a single mucosal fold. Grade 2 Multiple erosions covering several mucosal folds (may be confluent, but not circumferential). Grade 3 Multiple circumferential erosions. Grade 4 Ulcer, stenosis, or esophageal shortening.

Squamous Cell Carcinoma

As in basal cell carcinomas, many factors contribute to provide the soil for growth of a squamous cell carcinoma. A simple listing of factors is sufficient hereditarily determined type of skin age of patient (elderly) trauma from chemicals (tars, oils), heat, wind, sunlight, x-radiation, PUVA therapy (psoralen plus long wave ultraviolet light), and severe burns skin diseases that form scars, such as discoid lupus erythematosus, lupus vulgaris, and chronic ulcers ingestion of inorganic arsenic and in the natural course of xeroderma pigmentosum. Immunosuppressed patients, such as organ-transplant patients and patients with the acquired immunodeficiency syndrome, have an increased incidence of basal cell and squamous cell carcinoma. Basal cell carcinoma Slower growth, pearly border with telangiectasis, less inflammation biopsy may be necessary to differentiate (see preceding section). Actinic keratosis Slow-growing, flat, scaly lesions no induration little surrounding erythema...

Protection against Irritants

In a randomized double-blind study with hospital nurses 21 , Excipial Protect was compared with its vehicle. Fifty hospital nurses with mild signs of compromised skin on their hands, such as roughness or slight erythema, were included. Half of the test population received the commercial product, whereas the other half received the vehicle for a month. The effects of both types of preparation were studied weekly by clinical examination and instrumental assessment of bioengineering parameters. Results showed no significant differences between barrier cream and vehicle. Even the vehicle alone was capable of positively influencing the skin status. Critical points of this study are the small study population, the lack of a control group without any cream application, the short observation time and inclusion of subjects with already impaired skin conditions (roughness or slight erythema). Therefore the study qualifies for evaluating the therapeutic rather than the preventive properties of...

Physical Irritant Contact Dermatitis

The basic concept of PICD is physical skin damage without preceding or concomitant chemical irritation and sensitization, respectively. Initial PICD is characterized by a local inflammatory reaction, i.e. erythema, scaling and induration. PICD is accompanied by barrier disruption, i.e. stratum corneum changes. However, in vitro excessive physical insults, such as irradiation with 3,000 rad of X-ray, heating at 90 C for 3 min, freezing at -196 C for 60 s or repeated placement in an extremely dry or humid condition, do not cause any change in the stratum corneum functions 2 . Because the viable skin is more vulnerable to environmental

Pagets Disease of the Nipple

This is an uncommon form of breast cancer that is clinically characterized by an eczematoid reaction of the nipple and symptoms of itching, erythema and nipple discharge. In 45 of patients there is an associated underlying breast mass which is an infiltrating ductal carcinoma or ductal carcinoma in situ. It is often treated with mastectomy but may be treated by central breast lumpectomy if the cancer is well localized. Prognosis is similar to infiltrating ductal carcinoma and is determined similarly by the stage of the disease.

Organ Damage Induced by Cytotoxic Therapy

Late dermal reactions are caused by the development of subendothelial fibrous hyperplasia in the blood vessels. This causes telangiectasia and a decreased blood supply to the dermis, which results in increased fibroblastic activity. The skin then takes on a woody texture called fibrosis 41 .

Clinical Manifestations

Damage to skin can be divided into acute effects and late effects. During a course of high-dose irradiation to the skin, the first sign of a skin reaction is faint erythema around the hair follicles. If the radiation is fractionated conventionally (less than 2 Gy per fraction), a dose of 20 Gy will usually produce erythema. Higher doses cause a progression to a generalized erythema, epilation and a decrease in sweating, as well as diminished sebaceous gland secretion. The skin next becomes brightly erythematous, warm and edematous, as well as painful to touch, all of which are sharply limited to the irradiation field. Dry desquamation (occurring at 30 Gy), then moist desquamation follows (occurring at about 40 Gy), leaving the dermis bare with a layer of fibrin covering it. After treatment, these effects heal, usually within 1-2 weeks 80 . Most children never develop such a severe reaction, since usually the dose to any region of skin is considerably less than the dose to the tumor...

Checkpoints Mutations And Cancer

The minority of cancer-prone mutations are hereditary. In these cases, a mutated gene on one of a pair of chromosomes is inherited. If, later in life, a mutation occurs of this gene in its partner chromosome, a cancer cell can be produced. Several inherited diseases that are associated with cancer susceptibility have defective checkpoint control. Li--Fraumeni syndrome is a hereditary disease characterized by cancers arising in close relatives. It is a result of a germline mutation in the p53 gene that abrogates the G1 checkpoint. Ataxia telangiectasia is characterized by acute cancer predisposition and also other major dysfunctions. Cells from AT patients in culture exhibit severely impaired G1, S and G2 checkpoint functions. As mentioned, the ATM gene is activated in response to DNA damage and is necessary for activating p53. Another cancer, retinoblastoma, involves mutations in the Rb gene, and produces childhood retinal tumours. Survivors have a high risk of developing secondary...

Control of Symptoms and Biochemical Responses in Functionally Active Gep Net

In the first trial reported by Kvols et al.,16 octreotide subcutaneously (150 g t.i.d.) was observed to present symptomatic responses in 88 and biochemical responses in 72 of patients with carcinoid tumors. The median duration of the biochemical response was 12 months. In 1989 Gorden et al17 performed a meta-analysis of all reported cases of neuroendocrine tumors treated with somatostatin analogs. The meta-analysis indicated symptomatic improvement in 92 and a biochemical response in 66 of the patients.18 More than 50 patients with gastrinomas were treated with doses of 100-1,500 g octreotide day, most of them in the short term. A clinical response defined as control of gastric hypersecretion, pain and diarrhea was observed in 90 of the patients and was accompanied by a significant reduction in serum gastrin and basal acid secretion.18,19 The two most common clinical syndromes related to endocrine pancreatic tumors are the Zollinger-Ellison syndrome resulting from gastrin...

Arteriovenous Malformations

Vascular malformations are congenital in origin. They are classified into several subtypes according to the predominant vasculature. The most common type is venous angiomas, which are composed of anomalous veins without any direct feeding artery. The next most common is telangiectasia, usually found deep within the brain, particularly in the brain stem. It is composed of vessels morphologically resembling capillaries but slightly larger and often found at necropsy. Another less common vascular abnormality, which also rarely causes symptoms, is the venous varix. Two other common symptomatic angiomas are AVMs and cavernous angiomas. , y , y AVMs are composed of clusters of abnormal arteries and veins of varying size, without intervening capillaries. Some cavernous angiomas are familial. Patients with hereditary hemorrhagic telangiectasias (Osler-Weber-Rendu syndrome) have a higher than normal incidence of vascular malformations.

Brief Review Of The Clinical Features Of Lyme Disease

The pathognomonic skin rash of LD, erythema migrans (EM), seen in about 50-70 of patients, usually begins as an erythematous macule or papule at the site of the (usually asymptomatic) tick bite. The lesion expands within a few days, often with central clearing. The organism can be grown from the lesion, especially from the outer margin of the expanding erythema. Secondary lesions are almost certainly due to hematogenous dissemination of the organism that is, spirochetemia and not multiple bites. Early localized disease often includes nonspecific symptoms, described as a virus-like syndrome, thought to be due to the production and liberation of cytokines. Many patients with early disease are asymptomatic. Other findings, including pain on neck flexation, malar rash, conjunctivitis, erythematous throat, joint pains, and muscle tenderness, have been noted.

Staging The Decubitus Ulcer

Stage I nonblanchable erythema of intact skin, considered the heralding lesion of impending skin ulceration. Discoloration of the skin, warmth, edema, induration, or hardness also may be indicators in individuals with darker skin. eschar is dry (or mummified), well adherent, and without associated drainage, erythema, cellulitis, or crepitance it may often be simply kept dry to perform as a biologic dressing. If there are signs of infection (pain, redness, drainage) or expanding areas of necrosis a surgical consultation for debridement should be sought.

Reviews And Selected Updates

Boder E, Sedgwick RP Ataxia-telangiectasia. A familial syndrome of progressive cerebellar ataxia, oculocutaneous telangiectasia and frequent pulmonary infection. Pediatrics i958 2i 526-554 58. Boder E, Sedgwick RP Ataxia-telangiectasia dermatological aspects. Trans Los Angeles Dermatol Soc Arch Dermatol i958 78 402-40 59. Centerwall WR, Miller MM Ataxia, telangiectasia, and sinopulmonary infections. A syndrome of slowly progressive deterioration in childhood. Am J Dis Child i958 95 385-396 60. Sedgwick RP, Boder E Ataxia-telangiectasia. In Jong JMBV de (ed) Hereditary Neuropathies and Spinocerebellar Atrophies. Handbook of Clinical Neurology, Vol 60. Amsterdam, Elsevier Science, i99i, pp 347- 423. 61. Savitsky K, Bar-Shira A, Gilad S, et al A single ataxia telangiectasia gene with a product similar to Pl-3 kinase. Science i995 268 i749- 1753

Role of Telomere Length and Telomerase in Human Disease

In addition to DC and aplastic anemia patients, who have defective telomerase activity and short telomeres, a number of additional human premature ageing syndromes are also characterized by an accelerated rate of telomere loss and chromosomal instability. Interestingly, these diseases are produced by mutations in DNA repair proteins such as Nbs1 (Nijmegen breakage syndrome), Mre11 (ataxia telangiectasia-like disorder), WRN (Werner syndrome see Davis and Kipling, this volume), BLM (Bloom syndrome), ATM (ataxia telangiectasia) (ATM), and FANC genes (Fanconi anemia) (reviewed in Blasco 2005), many of which interact with the TRF2 telomere-binding protein (reviewed in Blasco 2005). Strikingly, when mice deficient for these proteins have been generated they do not faithfully reproduce premature ageing pathologies. In fact, the ageing pathologies associated with the Werner, Bloom, and ATM syndromes have been modeled in mice only when in combination with telomerase deficiency and short...

Telomerase For The Development Of In Vitro Models Of Cancer Progression

The ability of telomerase to immortalize cells without altering the underlying genetic background has also been demonstrated in cells with inherited susceptibility syndromes, such as ataxia-telangiectasia, Bloom syndrome, xeroderma pigmentosum and premature ageing syndromes such as Werner syndrome and Hutchinson-Gilford pro-geria. Thus, telomerase may be an important tool for establishing premalignant cell lines which can be used for the development of in vitro models of cancer progression, for amassing large numbers of cells required for other assays or as standard cellular reagents for microarray analysis. Microarray is a novel technique which utilizes microchip technology to analyze cellular RNA for changes in patterns of genetic expression in mutated cells versus their normal counterparts.

Biological Effects and Side Effects of Suncare Products

In the past years, the safety and usefulness of sunscreens had been controversially and critically discussed on the basis of the following objections the use of a sunscreen may convey a misleading impression of security to the consumer, which may result in longer sun exposure and, therefore, greater skin damage 12 and, therefore, UV erythema should serve as a warning signal to discontinue sun exposure instead of being suppressed by sunscreen use 13 . Ingredients of sunscreen products may also cause irritative, allergic or even photoallergic reactions on the skin. Allergic and photoallergic reactions to active ingredients in sunscreens are fairly uncommon 14 . There had been concern that sunscreens suppress the vitamin D synthesis in the skin following UVB exposure. However, in a double-blind randomized-control trial comparing sunscreen users to people using a placebo, the mean levels of 25-hydroxy-vitamin D were the same for each group. None of the sunscreen users had a vitamin...

Clinical Features and Associated Findings

The differential diagnosis of measles includes illnesses associated with fever and an erythematous maculopapular rash such as scarlet fever, rubella, meningococcemia, Kawasaki's disease, toxic shock syndrome, and erythema multiforme due to a hypersensitivity to medications. y , y During the viremia of measles infection, measles virus can be isolated from peripheral blood mononuclear cells. y The clinical diagnosis, however, is more typically based on the presence or a history of the characteristic findings of fever, an erythematous maculopapular rash demonstrating a cephalocaudal spread, coryza, cough, conjunctivitis, and Koplik's spots. Laboratory results that support a diagnosis of measles are the detection of measles IgM and a fourfold increase in measles IgG between acute and convalescent sera. y The diagnosis of postmeasles encephalomyelitis is based on the occurrence of encephalitis within 2 weeks of the rash of measles associated with a recurrence of...

Cirrhosis In Liver Disease

The liver has immense reserve and regenerative powers. It is estimated that at least 75 of normal hepatic function must be absent for any changes in standard hepatic function tests to occur. Thus, taking an accurate history is important. Careful attention should be given to factors such as alcohol ingestion, state of nutrition, previous history of hepatitis, jaundice, or anorexia, and protean manifestations such fatigue and loss of stamina. A carefully directed physical examination includes a search for petechiae, rhinophyma, Dupuytren's contracture, telangiectasia in the upper trunk, ascites, asterixis, palmar erythema, and testicular atrophy. In our opinion, the classic live function tests, especially of synthetic function, give as good a measurement of hepatic reserve as other more sophisticated tests, such as galactose elimination, urea

Lymphogranuloma venereum

The primary erosion or blister is rarely seen, especially on the female patient. Within 10 to 30 days after exposure, the inguinal nodes, particularly in the male patient, enlarge unilaterally. This inguinal mass may rupture if treatment is delayed. In the female patient the lymph drainage most commonly is toward the pelvic and the perirectal nodes, and their enlargement may be overlooked. Low-grade fever, malaise, and generalized lymphadenopathy frequently occur during the adenitis stage. Scarlatina-like rashes and erythema nodosum lesions also may develop. The later manifestations of lymphogranuloma venereum occur as the result of scarring of the lymph channels and fibrosis of the nodes. These changes result in rectal stricture, swelling of the penis or the vulva, and ulceration.

Exostosis subungual See Subungual

A glucagon-secreting islet cell neoplasm of the pancreas results in a polymorphous skin eruption characterized by superficial epidermal necrosis with fragile blister formation (necrolytic migratory erythema). The perioral area and intertriginous areas are frequently involved. Graft-versus-host disease. 96. Both the acute and chronic forms are accompanied by erythematous lesions that may develop into an erythroderma, with bullae and necrolysis. The chronic type can eventuate in sclerodermatous-like lesions with ulcerations or lichen planus-like eruptions. Nails and hair can be affected. Clinical situations in which this disease can occur are small bowel, pancreas-spleen, lung-heart, lung, heart, liver, and bone marrow transplants, non-irradiated whole blood transfusions to immunocompromised patients, and neonates that are immunocompromised after in utero transfusions.

Solvents Not Widely Used for Topical Preparations

Dimethylsulphoxide is a universal solvent but can cause itching erythema and uticaria when applied to skin. However, it has been used medicinally in bladder instillations (at 50 in water) for interstitial cystitis, and is a vehicle for idoxuridine for herpes infections (though is of little value). Together with acetone, DMSO is a class 3 solvent under the FDA guidance, not known as a human health hazard at levels normally expected in pharmaceuticals and which can thus be limited by appropriate GMP practices.

Avoidance of Photosensitizing Drugs

Intake of phototoxic drugs (whose action spectrum almost always involves the UVA range) and exposure to UV radiation cause erythema and edema or even vesiculobullous lesions on sun-exposed skin within hours in susceptible patients. In contrast, a photoallergic reaction is a delayed-type hypersensitivity response in which patients do not have clinical manifestations upon the first exposure to the photoallergic drugs. Sensitized individuals may develop pruritic eczematous eruptions. Photoinduced lichenoid drug eruption (e.g. thiazide) can develop long after the drug has first been started 5 .

Pathological Aspects of Skin Irritation

Exposure to skin irritants such as heat and ultraviolet light causes an inflammatory response initiated by erythema (local vasodilation) followed by blister formation and or dermal and epidermal ulceration and necrosis. In general, this is a feature common to the pathology of skin irritants however, they differ from each other by the kinetics of the evolution of the tissue response. For instance, heat burns develop rapidly there is an immediate burning sensation, and the appearance of erythema and blisters within minutes or tens of minutes following exposure depends on the severity of the burn. In general, strong acids and alkalis induce skin damage rapidly after exposure although they are somewhat slower 1 than thermal burns. In contrast, the known chemical warfare mustard gas (sulfur mustard, SM) operates at a much slower kinetics. Slight erythema may start at least 20-30 min after exposure and in some cases this period may be extended to several hours, depending on the...

Evaluation Guidelines Table173

Metabolic disorders (e.g., lipid, mitochondrial and storage disorders, Refsum's and Wilson's diseases, hypothyroidism) should be excluded in early-onset chronic progressive ataxia and in adult-onset forms of the disorder, which are not dominantly inherited. Lipids, vitamin E, lactate, very long-chain fatty acids, adrenocorticotropic hormone (in males), phytanic acid, ceruloplasmin, and thyroxine should be analyzed. Alpha-fetoprotein is increased and immunoglobulins are decreased in ataxia-telangiectasia. A muscle biopsy should be performed in cases of suspected mitochondrial myopathy. Poisoning or drug intoxication has to be excluded. Anemia, macrocytosis, and raised gamma-glutamyltranspeptidase suggest alcoholic cerebellar degeneration. In children, neuroblastoma may be associated with paraneoplastic cerebellar degeneration leading to opsoclonus. Urinary catecholamine levels are increased. Diabetes mellitus should be excluded in Friedreich's ataxia. Genetic testing is available for...

Skin and Mucous Membranes

An increase in melanin- containing cells at 2-3 weeks enhances pigmentation. Moist desquamation that occurs 3-4 weeks from the initiation of treatment has been found to correlate with the development of severe delayed telangiectasias 2 . Late radiation effects are primarily caused by fibrosis and vascular damage, particularly to small vessels. Arterioles become narrow as a result of my-ointimal proliferation and destruction of capillaries and sinusoids 19 . Delayed histologic manifestations of these changes include fibrin deposition, ulceration and fibrosis. Telangiectasias are caused by endothe-lial cell depletion and basement membrane damage that causes capillary loops to contract into distorted sinusoidal channels.

Organ Damage and Developmental Effects of Cytotoxic Therapy

Each has a unique response to cytotoxic therapy. In general, two types of effects are seen. Acute effects that occur during or shortly after the course of treatment usually involve tissues that divide rapidly, resulting in erythema and pseudomembrane vs. ulceration of mucosa, erythema and desquamation of skin, reduced serous output from salivary glands and reduction of taste acuity. Cell populations in late-reacting tissues proliferate slowly and may not manifest injury until months to years after treatment. Early changes within these tissues may also occur but are usually not detected by standard methods of observation. Late changes,how-ever, can occur in all organs. Table 7.1 shows some of the more common late toxicities in relation to radiotherapy dose and type of chemotherapy.

Salvia plebeia RBrown

The mucilaginous seeds have long been used in native medicine in that country to treat gonorrhoea and menorrhagia Watt, 1893 , to which conditions Chopra, 1958 adds diarrhoea and haemorrhoids. In China Chiang-su, 1982 2 the plant is used as a febrifuge, detoxifier, diuretic, blood cooler, haemostatic, and for the reduction of swellings. It relieves painful swellings, bleeding piles and inflammation of the mammary gland. A decoction taken hot is used to treat tonsillitis, haemorrhage in pulmonary consumption, and sluggish blood developing slight erythema.

The Dna Replication Checkpoint

DNA damage during S phase normally causes temporary arrest of DNA replication. Proteins required for this checkpoint include ATM, Mre11, Rad50 and NBS1. Genetic defects occur in ATM (ataxia telangiectasia), NBS1 (Nijmegen breakage syndrome) and Mre11 (ataxia telangiectasia-like disorder) (see the chapter Inherited Predispositions to Cancer). In all three syndromes, DNA damage (e.g. by ionizing radiation) fails to arrest replication and leads to extensive chromosome damage (Petrini, 2000). Although the mechanistic details are not yet in, we know a few steps in the process. DNA damage causes phosphorylation of NBS1. This is required for replication arrest. ATM senses the DNA damage and carries out the phosphorylation of NBS1. The activity of JNK (c-Jun N-terminal kinase), which is normally stimulated in response to DNA damage, fails to respond in cells derived from patients having any of the three syndromes (see review by Petrini (2000)). Figure 6 includes the molecular interactions for...

Risk Factors for Occupational Skin Diseases Examples

The surfactants in modern cleansing products are anionics, non-ionics and amphoters, each with a specific active profile. The dermatological effects of surfactants on skin can be attributed to four fundamental mechanisms, finally affecting barrier homoeostasis of the skin and other physiological factors (1) adsorption to the skin surface (2) removal of skin components (3) penetration into deeper skin layers, and (4) cytotoxic effects on living cells in the epidermis. Consequences of this interaction with the skin, particularly with the SC, are the clinically well-studied symptoms of erythema, scaling, swelling and dryness,

Chronic Radiation Effects

The late effects of RT to the eyelids following doses from 30-60 Gy include madarosis, telangiectasia (dilated, tortuous blood vessels Fig. 6.3), hyperpigmen-tation, depigmentation, ectropion, hyperkeratosis, atrophy, necrosis, ulceration and punctual occlusion. Although rarely seen today, lid deformities, such as ectropion (out-turning of eyelid margin), entropion

Acute Radiation Effects

Madarosis, or loss of eyelashes, and erythema are the first side effects of radiation therapy (RT) involving the eye. Usually, eyelashes will grow back however, permanent loss does occur. Erythema can occur within days of treatment (generally after doses of at least 20-30 Gy) and usually persists for a few days. Dermatitis is the most common acute side effect of RT. Dry dermatitis of irradiated skin can occur with doses greater than 20 Gy and often leads to desquamation. Moist dermatitis, with exposure of the dermis and associated serum leakage, can occur after the fourth week of RT following doses of 40 Gy or more,

Evaluation Guidelines Table95

AT, Ataxia-telangiectasia CSF, cerebrospinal fluid CT, computed tomography EMG, electromyography HD, Huntington's disease HIV, human immunodeficiency virus MG, myasthenia gravis MRA, magnetic resonance angiography MRI, magnetic resonance imaging N A, not applicable NCV, nerve conduction velocity TFTs, thyroid function tests. AT, Ataxia-telangiectasia CSF, cerebrospinal fluid CT, computed tomography EMG, electromyography HD, Huntington's disease HIV, human immunodeficiency virus MG, myasthenia gravis MRA, magnetic resonance angiography MRI, magnetic resonance imaging N A, not applicable NCV, nerve conduction velocity TFTs, thyroid function tests.

Mechanism of Telomere Induced Senescence

A number of recent studies have also demonstrated that, at the advent of telomere-induced senescence of primary human cells, critically short telomeres are initially sensed by the DNA damage response pathway (Fig. 3.3 see Chang, this volume, and Rudolph, this volume). The DNA damage sensor encoded by the ataxia-telangiectasia mutated (ATM) gene appears to play a particularly important role in initiating the DNA damage response signal, since HDF which lack functional ATM are able to bypass the normal G1 S phase checkpoint at senescence, but then subsequently undergo cell cycle arrest via activation of a G2 phase DNA dam

Diagnosis of Achilles Paratendinopathy

Patients with Achilles paratendinopathy present with pain in the Achilles tendon region or posterior heel region. The severity of pain is used to classify the severity of the disorder and is also used as an outcome measure.1 Clinical examination reveals that the tendon is diffusely swollen on palpation, and is tender in the middle third of the tendon. A crepitus may be occasionally palpable in the acute phase 4,9 however, the swelling and tenderness does not move when the ankle joint is dorsiflexed. Areas of erythema, increased local warmth, and palpable tendon nodules or defects may also be present. Ankle instability and mala-lignment of the lower extremity, especially in the foot, should be actively sought for in patients with Achilles tendon complaints.1-3

The DNA Damageinduced Gi Checkpoint

After DNA is damaged, other checkpoint controls delay entry into the next phase of the cell cycle. One such major checkpoint is at the G1 to S transition, which prevents cells from beginning DNA synthesis until the damaged DNA is repaired. Several proteins, in particular p53, have been implicated in this checkpoint mechanism (Figure 5). Individuals who are mutated in the ataxia telangiectasia gene, ATM, are very sensitive to X-rays and have a high incidence of tumorigenesis. In response to DNA damage, ATM phosphorylates and increases the level of the p53 protein, a tumour suppressor that is mutated in more than 50 of cancers (Levine, 1997). p53 causes cells to arrest at the G1-- S boundary, which is at least partly due to its production of p21, one of the proteins that inhibits cyclin-cdk complexes.

Superficial fungal infections

The superficial fungi live on the dead horny layer of the skin and elaborate an enzyme that enables them to digest keratin, causing the superficial skin to scale and disintegrate, the nails to crumble, and the hairs to break off. The deeper reactions of vesicles, erythema, and infiltration are presumably due to the fungi liberating an exotoxin. Fungi are also capable of eliciting an allergic or id reaction.


Kawasaki's syndrome, also known as mucocutaneous lymph node syndrome, is a self-limited systemic disorder of childhood. It has a propensity for coronary artery involvement with aneurysms, angina pectoris, or myocardial infarction in 15 to 20 of cases. The diagnosis of Kawasaki's syndrome is based on a constellation of clinical findings including fever, nonsuppurative cervical adenopathy, bilateral nonpurulent conjunctival injection, reddening and fissuring of the lips, strawberry tongue, and several cutaneous findings. The skin changes begin with erythema of the palms and soles, which may spread to the trunk. Indurative edema and desquamation starting on the tips of the fingers and toes and around the nails is then noted. A polymorphous rash that can vary from maculopapular to morbilliform to scarlatiniform may also be present. SUBACUTE BACTERIAL ENDOCARDITIS. Several cutaneous lesions can develop secondary to subacute bacterial endocarditis. These lesions vary in...

External Agents

Clinically, photoallergic contact dermatitis appears eczematous, whereas acute phototoxic contact dermatitis is edematous or bullous. Erythema is common to both. Occasionally, photoallergy lingers for months or even years without further exposure to the allergen (persistent light reactor).


Painful erythematous plaques or macules seen especially on groin, axilla, palms and soles in bone marrow transplant patients due to high dose chemotherapy. Histologically distinctive lesions in eccrine sweat glands may also be seen in squamous cell cancer, pyoderma gangrenosum, exposure to toxic chemicals, and elastolytic granuloma annulare. Ectodermosis erosiva pluriorificialis. A synonym for Stevens-Johnson form of erythema multiforme. Eczema 30-31 Eosinophilic fasciitis (Shulman's syndrome). Acute onset of induration, tenderness, swelling, and erythema of one or more extremities resulting in sclerodermatous skin changes. Believed by some to be a variant of scleroderma with a diagnosis confirmed by deep biopsy into the fascia showing significant inflammation with eosinophils. Erythema ab igne. A marmoraceous-appearing redness that follows the prolonged application to the skin of radiant heat, such as from a heating pad or pretibial areas from...

Acquired atrophies

From inflammatory diseases such as syphilis, chronic discoid lupus erythematosus, leprosy, tuberculosis, scleroderma, etc. Autoeczematization. See Id reaction Balanitis circumscripta plasmacellularis (balanitis of Zoon). Erythematous papules and plaques on the glans penis in uncircumcised males that is benign and that may resolve after circumcision. A similar condition in females is called vulvitis circumscripta plasmacellularis. Bazin's disease. See Erythema induratum Carcinoid syndrome, A potentially malignant tumor of the argentaffin chromaffin cells of the appendix or the ileum. Some of these tumors or their metastases produce large amounts of serotonin (5-hydroxytryptamine), which causes transient flushing of the skin accompanied by weakness, nausea, abdominal pain, diarrhea, and sweating. The redness usually begins on the head and the neck and then extends down on the body. These episodes last from several minutes to a few hours. Repeated attacks of the...

Basic immunology

ERYTHEMA MULTIFORME AND TOXIC EPIDERMAL NECROLYSIS Erythema multiforme is a severe bullous eruption, marked by necrosis of the full thickness of the epidermis. When involving more than 30 of body surface, it is called toxic epidermal necrolysis. Toxic epidermal necrolysis has a significant mortality rate. Erythema multiforme involving mucous membranes and systemic toxicity is also called Stevens Johnson syndrome. These conditions may be a continuous spectrum. It is proposed that they are mediated by T lymphocytes. Mild, recurrent erythema multiforme may result from recurrent herpes simplex infection. Severe forms are generally drug reactions. erythematosus, scleroderma, and dermatomyositis. Most of these diseases are associated with autoantibodies, including antinuclear antibodies. Clinical presentation, serology, and histology are used to classify the disorders. Overlap syndromes combining one or more of these illnesses are common. GRAFT-VERSUS-HOST DISEASE (GVH). This condition...

Suncare Products

The biological activity and efficacy of a suncare product, as represented by the SPF, is evaluated by its ability to protect human skin from erythema and edema. It is measured by determination of the dose which is required to induce a just perceptible redness (MED minimal erythema dose) on untreated and on sunscreen-treated skin. The SPF is defined as the ratio of the dose of UV radiation required to produce a minimal erythematic response 24 h after exposure on protected skin after application of 2 mg cm2 of a sunscreen product to the dose needed to produce the same degree of erythema in unprotected skin (SPF MED of sunscreen-treated skin MED of unprotected skin). The SPF is therefore a useful assessment of primarily UVB (290-320 nm) filters. However, the SPF test does not adequately assess the complete photoprotective profile of sunscreens, specifically against long-wavelength UVA1 (340-400 nm). Currently, the SPF scale specified in a sunscreen product applies solely to UVB...

Fungal infections

Histoplasmosis occurs and is caused by direct inoculation. It is a nodular or indurated ulcer with accompanying lymphadenopathy. Occasionally an allergic response has been seen appearing as urticaria or as erythema annulare centrifugum. The diagnosis is accomplished by demonstrating the small intracellular histoplasma in sputum, bone marrow, or biopsy specimens. Treatment is done with ketoconazole or itraconazole. COCCIDIOIDOMYCOSIS OR SAN JOAQUIN VALLEY FEVER This disease is caused by Coccidioides immitis, a soil inhabitant. Infection in both humans and animals is acquired by the inhalation of fungus-laden dust particles or, rarely, through a primary infection of the skin. The severity of coccidioidomycosis can range from very mild, simulating a common cold, to an acute disseminated fatal disease, especially in patients with AIDS. An allergic reaction with erythema multiforme or erythema nodosum occurs in some cases. The basic symptoms of malaise and fever may suggest...


Dermatomyositis is an inflammatory myopathy with associated cutaneous manifestations. Progressive weakness is the major clinical finding and usually affects the muscles of the trunk and limb girdles more frequently than the peripheral muscles. There is an increased risk of internal malignancy. The cutaneous manifestations of dermatomyositis are pathognomonic and help one to make the diagnosis with confidence. Gottron's sign is the most specific skin finding Macular or papular erythema develops on bony prominences such as the knuckles, elbows, and knees. Erythema may develop on sun-exposed areas, and chronic changes may include poikilodermatous lesions on the trunk and proximal extremities. The heliotrope rash, a subtle, erythematous or violaceous blush on the eyelids and periorbital region, is seen in approximately 60 of cases. Periungual telangiectasias and cuticular thromboses may also be noted along the nail fold. SYSTEMIC LUPUS ERYTHEMATOSUS. Sys-temic lupus...


Acute sialadenitis may involve any salivary gland, though the major salivary glands, particularly the parotid, are most commonly affected 399, 462 . Causes may be bacterial or viral. This entity typically presents unilaterally with localized erythema, swelling, and tenderness in the affected region. Purulent exudate can often be expressed from the excretory duct orifices. Acute viral sialadenitis, in contrast,

Papules Nodules

Papular urticaria lesions caused by a delayed hypersensitivity to a variety of arthropod bites present as pruritic erythematous papules with surrounding urticaria. Recurrent crops are seen in the summer and can be quite extensive. c. Erythema multiforme (see Chap 12) an acute hypersensitivity syndrome presenting with macular, urticarial, or vesiculobullous lesions, especially on the palms, soles, hands, and feet. Target or bull's eye lesions with concentric alternating rings of red and white are a hallmark of this condition. It is commonly divided into erythema multiforme minor, which is a more benign, recurrent, and self-limited condition with one mucous-membrane surface involved and commonly associated with herpes-simples virus and erythema multiforme major, which presents with at least two mucous-membrane surfaces involved, widespread bullous lesions, and more systemic symptoms and is associated with mycoplasma pneumoniae or drugs. e. Viral exanthems (see Fig, 33-16) Roseola,...

Infectious disease

Erythema chronicum migrans (ECM), borrelial lymphocytoma (BL), and acrodermatitis chronica atrophicans (ACA). ECM is the principal cutaneous hallmark of Lyme disease. An initially homogenous erythema starts at the site of the tick bite and spreads in centrifugal fashion. The center may fade or clears leaving an annular erythema. BL, also known as lymphadenosis benigna cutis, often starts at or near the site of the tick bite. Some patients have a preceding or concomitant lesion of ECM. The classic lesion of BL is a solitary bluish-red nodule with regional lymphadenopathy. Sites of predilection include the earlobe, nipple and areola, scrotum, and nose. Lesions of ACA usually develop 6 months to 10 years after a tick bite. The connection between the two is rarely suspected by patients. ACA is a chronic dermatitis of the acral sites. The lesions often develop insidiously with a waxing and waning of edematous swelling and a bluish-red discoloration. As it progresses, the skin becomes...


In areas of high sebaceous-gland concentration and activity such as the T area of the face and in patients with acne and rosacea, incisions often tend to spread and widen no matter how meticulous and precise the surgery. This is a phenomenon of wound healing. The patient should be preadvised that this is a potential problem. What the patient is told before surgery is informed consent, what is told after surgery is an excuse.

Malignant melanoma

The changes in a recent or longstanding skin lesion that should arouse suspicion include change in the size or shape, change in pigmentation (particularly the development of pseudopodia or areas of satellite pigmentation or leakage of pigment into surrounding skin), erythema surrounding the lesion, induration, friability with easy bleeding tendency, and ulceration.


Radiodermite Acuta

Acute radiodermatitis is divided into three degrees of severity, similar to the reactions from thermal burns. The first degree is manifested by the slow development of erythema, hyperpigmentation, and usually hair loss. A single dose of x-rays necessary to produce these changes is called an erythema dose. All of the changes in the first degree are reversible. The second degree is characterized by vesicle formation, erosions, hair loss secondary to infection, and delayed healing. Atrophy and telangiectasia are the end results.

Iron Losses

Feeding to infants, aspirin, nonsteroidal anti-inflammatory drugs or corticosteroid administration, and hereditary hemorrhagic telangiectasia see (4) for review . In addition to these conditions, a significant amount of iron (210-240 mg unit) can be lost with regular blood donation.


Clinical Features and Associated Disorders. Patients often present with subtle problems that evolve over extended periods of time. In some patients, symptoms can exist for over 3 months before the tumor is diagnosed. Ihe most common complaints include symptoms of increased intracranial pressure such as headache (especially in the morning) and vomiting. In younger children, behavioral changes such as decreases in activity or appetite may exist. Examination may demonstrate papilledema, truncal or limb ataxia, or nystagmus. A few patients have an increased head circumference or symptoms of leptomeningeal seeding similar to that seen in metastatic meningitis. Ihere is a higher incidence of medulloblastoma in patients with nevoid basal cell syndrome, Iurcot's syndrome, ataxia telangiectasia, and xeroderma pigmentosa.


The dermatological examination of the hands was performed by dermatologists trained in allergy and occupational dermatology. Hand dermatitis was defined as mild when erythema and scaling appeared on the dorsal aspects and or interdigital folds of the hands, as moderate when infiltration and papules were seen and the affected area was enlarged and as severe when the palms and back of the hands were involved and vesicles and fissures appeared. Decisions about differential diagnoses were made from the clinical picture, course of the disease, personal history and pre-existing allergy tests. No further allergy tests were performed. The apprentices in the UV group were asked about their light sensitivity prior to the onset of the study. All apprentices were skin type II and III, no apprentice had pathological light sensitivity. The UV hardening was started with an initial dose as low as 0.01 J cm2 (minimal erythema dose of UV 0.108 J cm2) and was increased by 20-30 at each application time...

Epithelial Tissue

Most teenagers have a mild form of acne this can become serious and may also occur in the adult years. Rosacea somewhat resembles acne but is not related to it. Usually found in middle-aged adults, rosacea causes flushing, acnelike bumps on the skin and discomfort. Bacterial infections can cause boils or other symptoms. Dermatitis, or skin irritation, can result from exposure to certain chemical compounds or even from psychological stress. Lice, mites, and other parasites may find homes on the skin. Red patches on the skin, covered with silvery gray scaly areas, are symptoms of psoriasis.

Detection Screening

Late effects progress with time, and may be subtle at first. Careful physical exams are necessary in order to detect any cutaneous late effects. These exams should be performed by a physician who is knowledgeable of the treatment received. Areas of pigmentation changes, dryness, atrophy, telangiectasia, contraction, and scarring should be noted and carefully recorded. If chemotherapy has been given, then skin coloration should be checked as well, along with the status of the nail beds.

Fruit Acids

In a second study, we assessed the irritant effects and barrier disruption properties of ascorbic acid, acetic acid (ACA) and sodium hydroxide (NaOH), again in combination with SLS. Repeated application of ascorbic acid and ACA caused a moderate increase in TEWL and erythema. The sequential application of ascorbic acid or ACA and SLS enhanced these effects. NaOH induced a strong reaction when applied both occlusively and non-occlusively as well as in combination with SLS, with an early onset of the inflammatory signs, leading to discontinuation of the application on the third day in most of the test fields. Notably, the irritant effect of NaOH was not as marked when applied sequentially with SLS.

DNA Repair

In addition to polymorphisms in carcinogen metabolism, a potentially important source of variability is also DNA repair capability, including the genetic instability syndromes. These are rare, recessive traits that include ataxia-telangiectasia, Fanconi anaemia and Bloom syndrome, all characterized by both chromosome instability and high risk of cancer, and xeroderma pigmentosum, characterized by extreme susceptibility to UV radiation-induced skin cancer (Friedberg et a ., 1995). In addition to these rare syndromes, individuals differ for their capability in repairing DNA damage. At least part of such interindividual differences are likely to have a genetic origin. A number of studies have been conducted on the subject, based on comparisons between cancer cases and healthy controls for their supposed DNA repair function. A variety of tests to measure DNA repair have been developed. In fact, these studies can be broadly grouped into three categories, depending on the tests used. The...

Physical Examination

A complete head and neck examination should be performed in the initial patient evaluation. The presence of lymphadenopathy may suggest sarcoidosis, chronic serous otitis media could be associated with Wegener's granulomatosis, or laryngeal findings of posterior glottic erythema and edema may reveal underlying gastroesophageal reflux.


The spectral distribution of solar UV radiation reaching the surface of the earth encompasses wavelengths between 285 and 400 nm. Commonly defined ranges for specific bands of the terrestrial UV spectrum are UVB (290-320 nm) and UVA (320-400nm). In addition, the UVA waveband is often further divided into UVA2 (320-340nm) and UVA1 (340-400nm), generally reflecting the higher erythematogenic efficiency of shorter UVA wavelengths (UVA2). While there is a greater prevalence of UVA radiation in the sun's spectrum compared with UVB, the intensity is not constant during the day or during the year. Data from Central New Jersey have shown that in winter the UVA daily doses are only half that of a summer, spring or fall day. The UVB radiation changes more dramatically than the UVA radiation during the daytime as well as over the seasons as it is absorbed preferentially by the ozone in the stratosphere (longer path length during the winter and at low sun angles at the beginning and end of the...

Raynauds Disease

During the late nineteenth century Maurice Raynaud described digital vasospasm that seemed to be cold-induced. He believed that this phenomenon, now known as Raynaud's disease, was due to changes in the CNS control over vascular innervation. Raynaud's phenomenon is classically described in patients who develop extremity blanching and numbness with cold exposure, followed by cyanosis and then erythema on rewarming. The fingers are affected most commonly, but the toes and ears may also be involved.


Excessive scaling of the skin, is most often associated with lymphoma and has been reported in association with Hodgkin's lymphoma, mycosis fungoides, multiple myeloma, Kaposi's sarcoma, leiomyosarcoma, and breast, cervix, and lung cancer. It is most often a late manifestation of lymphoma but can precede the diagnosis by many years. Erythroderma is defined as a diffuse erythema or redness of the skin usually with-induration and scaling. When associated with-an internal malignancy, erythroderma is seen more commonly with hematologic malignancies, especially leukemia, lymphoma, and Sezary-syndrome.


Critical to the effective care of patients with necrotizing soft-tissue infections is early diagnosis and intervention. Early manifestations of the necrolytic process include erythema, often mistaken for cellulitis, or red, shiny, swollen skin that progresses to purplish or bluish areas with fluid-filled bullae or vesicles with a watery, thin, foul-smelling discharge, often termed dishwater pus. Patients may have fever and an elevated white blood cell count, in addition to pain

Inflammatory Phase

During the inflammatory phase, initiated by blood clotting and platelet degranulation, there is vasodilation and increased capillary permeability, which give rise to the visible signs of inflammation erythema, swelling (edema), and a rise in temperature in the injured tissue. At the molecular level, the release of growth factors from platelets is responsible for inducing vasodilatation and an increase in blood flow to the site of injury. Vascular permeability is also increased, enabling an influx of phagocytic cells (macrophages), polymorphonuclear granu-locytes (neutrophils), mast cells and complement, and antibody.

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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