livedo reticularis

Livedo reticularis is a vascular condition characterized by a purplish discoloration of the skin, usually on the legs. This discoloration is described as lacy or net-like in appearance and may be aggravated by cold exposure.

Most often livedo reticularis causes no symptoms and needs no treatment. But it can be associated with serious underlying disorders, such as lupus, anti-phospholipid syndrome or Sneddon's syndrome. A rare complication of chronic renal dialysis known as calciphylaxis may first present with a livedo reticularis pattern. In addition, livedo reticularis may occur as a side effect of certain medications, such as hydroxyurea (Droxia, Hydrea).

When to see a doctor
See your doctor if:

Pain or discomfort accompanies livedo reticularis
Ulcers develop in the affected skin

When necessary, treatment depends on the underlying cause, if known, and the severity of symptoms.

diagnose this?

Diagnosis : Caput medusae

Caput medusae is the appearance of distended and engorged paraumbilical veins, which are seen radiating from the umbilicus across the abdomen to joinsystemic veins. The name caput medusae (Latin for "head of Medusa") originates from the apparent similarity to Medusa's hair once Venus had turned it into snakes.

Differential diagnosis

Inferior vena cava obstruction

Cirrhosis cause portal hypertension.
Produces abdominal collateral veins to bypass the high pressure portal system and permit venous return from the legs.

How to differentiate

Determine the direction of flow in the veins below the umbilicus. After pushing down on the prominent vein, blood will:

Caput Medusae - flow is towards the legs
Inferior vena cava obstruction - flow is towards the head.

diagnose this?

dermatomyositis

An 82-year-old man presents with 8 weeks of periorbital edema,

6 weeks of rash, and 2 weeks of bilateral shoulder and arm aches

and weakness. What is the diagnosis?

a. Polymyalgia rheumatica

b. Inclusion body myositis

c. Hypothyroidism

d. Polymyositis

e. Dermatomyositis

Ans. Dermatomyositis

• Three causes of idiopathic inflammatory myopathy:

Dermatomyositis (DM)

Polymyositis

Inclusion body myositis

• Dermatomyositis has a bimodal age distribution

• Skin findings associated with DM:

Heliotrope hue of the eyelids

Rash of the metacarpophalangeal and proximal interphalangeal

joints (Gottron’s papules)

Photosensitivity dermatitis of the face

• Proximal myositis with associated pain and weakness is

characteristic of DM

• The serum creatine kinase and aldolase values are usually

increased in DM

• The anti-Jo1 antibody is present in 25% of patients with DM

• The electromyogram is characteristic, but not diagnostic, of

the inflammatory myopathies

• Amuscle biopsy is suggested for all patients with inflammatory

Myopathy

• Patients with DM have an increased risk for cancer

• DM is treated with immunosuppressive drugs.

This is a dermatology question.this might not come in this way as a picture but the most tested points are heliotrope

rash and gottrons papules.you have to at least remember these and try asking your friends as many times as you can

….this is important…

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Cushing Syndrome

Symptoms

Most people with Cushing syndrome will have:

Upper body obesity (above the waist) and thin arms and legs
Round, red, full face (moon face)
Slow growth rate in children

Skin changes that are often seen:

Acne or skin infections
Purple marks (1/2 inch or more wide) called striae on the skin of the abdomen, thighs, and breasts
Thin skin with easy bruising

Muscle and bone changes include:

Backache, which occurs with routine activities
Bone pain or tenderness
Collection of fat between the shoulders (buffalo hump)
Thinning of the bones, which leads to rib and spine fractures
Weak muscles

Women with Cushing syndrome often have:

Excess hair growth on the face, neck, chest, abdomen, and thighs
Menstrual cycle becomes irregular or stops

Men may have:

Decreased fertility
Decreased or no desire for sex
Impotence

Other symptoms that may occur with this disease:

Mental changes, such as depression, anxiety, or changes in behavior
Fatigue
Headache
High blood pressure
Increased thirst and urination

diagnose this?

Pellagra.

The Casal collar or Casal necklace is a clinical sign in which there is erythematous pigmented skin rash in the distribution of a broad collar (dermatomes C3 and C4). It is seen in patients with pellagra

Pellagra is a systemic nutritional wasting disease caused by a deficiency of vitamin B3 (niacin), which is an essential component of several coenzymes.

Niacin is essential for adequate cellular function because of its required roles in 2 similar but distinct coenzymes (ie, nicotinamide adenine dinucleotide [NAD] and nicotinamide adenine dinucleotide phosphate [NADP]). Both of these are cofactors that can be recycled by serving as both oxidizing (NAD, NADP) and reducing (NADH, NADPH) agents.

Pellagra defines systemic disease as resulting from a marked cellular deficiency of niacin. It is characterized by 4 "D's": diarrhea, dermatitis, dementia, and death. Diagnosis of pellagra is difficult in the absence of the skin lesions, and is often facilitated by the presence of characteristic ones. The dermatitis begins as an erythema. Acute pellagra resembles sunburn in its first stages, but tanning occurs more slowly than typically in sunburn.

Nicotinamide or niacin taken orally is usually effective in reversing the clinical manifestations of pellagra. Because patients are often malnourished and suffer from other vitamin deficiencies, provision of a high-protein diet and B-complex vitamins is needed for complete restoration of health.

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diagnose this?

Diagnosis : Herpes Zoster Opthalmicus

Reason : Involvement of opthalmic division of trigeminal nerve which is evidence of post-inflammatory hypopigmentation of the skin at the left opthamic region and loss of vision of the left eye.

Risk factor : HIV +ve

diagnose this?

PALMAR ERYTHEMA

Synonym: Liver palms

Reddening of skin on the palmar aspect of the hands, usually over the hypothenar eminence. It may also involve the thenar eminence and fingers. It can be found on the soles of the feet, when it is termed plantar erythema. It is a sign associated with many diseases but is probably most commonly seen as a normal variant. Because of the fact that it can be present in individuals without an identifiable illness or underlying cause, it is often very difficult to tell if a new claimed association for the sign is of any significance or just part of the background 'noise'. There have been no useful surveys of its prevalence in the community or the exact incidence in specific disease populations. It is probably a manifestation of many underlying pathophysiological processes, depending on the individual cause. These may include increased cardiac output, capillary dilatation in the palms due to local factors or systemic mediators, localised inflammation, an effect of high circulating oestrogen levels or a toxic dermatological reaction. It is not a very discriminative sign in terms of reaching a diagnosis, but can be useful as a marker or suggester of alternative diagnoses when conducting an initial clinical assessment.

Causes of palmar erythema :

* Established

• Idiopathic.
• Cirrhosis/chronic liver disease/excess alcohol consumption.
• Pregnancy.
• Connective tissue disorders, particularly rheumatoid arthritis, rarely sarcoidosis and systemic lupus erythematosus.
• Thyrotoxicosis.
• Polycythaemia.
• Leukaemia.

• Eczema and psoriasis.

* Purported/recently suggested

• Shoulder-hand syndrome/algodystrophy (reflex sympathetic dystrophy).
• Associated with use of a variety of chemotherapeutic agents as early manifestation of palmar/plantar erythrodysesthesia.
• Neoplastic disease, particularly cerebral tumoursSome antiepileptic drugs.
• Infection with human T lymphotropic virus (HTLV-I) causing myelopathy/tropical paraparesis.

diagnose this?

Varicella zoster infection

Description: Red vesicular rash on the the axilla and chest
Causes:
Varicella-Zoster infection
Herpes Semplex infection
DDX:
Small pox
Herpes simplex infection

whats this?

Clubbing of finger

brief description ;

bulbous fusiform enlargement of the distal portion of a digits

possible 2 causes :

1- idiopathic
2- familial
3- pachydermoperiostosis
dDx :

1- bronchiectasis
2- Biliary cirrhosis

diagnose this?

Angular Chelitis
Description:

cracks and inflammation ant the angle of the mouth

Possible 2 reasons:

Iron deficency anemia
Vitamin B12 deficency

DDx:

Herpes ulcer
Aphthos ulcer

diagnose this?

Klippel Trenaunay Syndrome. It is characterized by a triad of port wine stain, varicose veins and bony and soft tissue hypertrophy involving an extremity {1}. Most cases are sporadic {2}, although few cases in the literature report an autosomal dominant pattern of inheritance {3}. The exact cause of this syndrome remains to be elucidated, underlying mixed mesodermal and ectodermal dysplasia is likely responsible {4}. It generally affects the single extremity although cases of multiple affected limbs have been reported. Diagnosis is mainly clinical {1}. Treatment is conservative and symptomatic. Hypertrophy of limb may lead to subsequent vertebral scoliosis, gait abnormalities and compromise of function {5}. Important differentials are Maffucci syndrome and Proteus syndrome.

2 ½ years old girl presented with self mutilation and multiple ulcers. What is the diagnosis?

Hereditary sensory neuropathy. Patients have absent pain sensation and present with recurrent ulcers, no pain or crying while immunization/injections and self mutilatory behavior.

Tinea faciei

Diagnosis : Tinea faciei

Tinea faciei is a superficial dermatophyte infection limited to the glabrous skin of the face.In pediatric and female patients, the infection may appear on any surface of the face, including the upper lip and chin. In men, the condition is known as tinea barbae when a dermatophyte infection of bearded areas occurs.

neurofibromatosis

Neurofibromatosis (NF) is a neurocutaneous syndrome that can affect many parts of the body, including the brain, spinal cord, nerves, skin, and other body systems. NF can cause growth of non-cancerous tumors on nerve tissue, producing skin and bone abnormalities.

Effects of NF vary widely — some children live almost unaffected by it; rarely, others can be severely disabled.

NF is defined by tumors, called neurofibromas, that grow along nerves in the body or on or under the skin. As the tumors increase in size, they can press on vital areas of the body, causing problems in the way the body functions.

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