Facial Redness Food List

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. You will learn the causes of your rosacea outbreaks; the foods that will make your rosacea better or worse; the core supplements which help your bodys natural recovery process; additional rosacea treatments that you could find in your kitchen; plus much more. 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. Continue reading...

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All of the information that the author discovered has been compiled into a downloadable book so that purchasers of Rosacea Free Forever can begin putting the methods it teaches to use as soon as possible.

As a whole, this book contains everything you need to know about this subject. I would recommend it as a guide for beginners as well as experts and everyone in between.

Discoid Lupus Erythematosus

Discoid Lip

The most common form of all chronic cutaneous variants is DLE, which can be localized or generalized, both with and without systemic manifestations of LE. Typical DLE lesions may be present at the onset of SLE in about 5 -10 of patients, and approximately 30 of patients may develop DLE lesions, usually of the generalized type, during the course of SLE (Cervera et al. 1993,Hymes and Jordon 1989,Tebbe et al. 1997). The localized form presents with sharply demarcated, erythematokeratotic, atrophic or scarring lesions, and it is often seen on the face and scalp, whereas the generalized form also involves the regions below the neck (Fabbri et al. 2003, McCau-liffe 2001, Patel and Werth 2002). DLE occurs mostly in the third to fourth decade of life however, in two recent studies, more than 40 children with DLE ranging in age from 2 to 16 years have been described in the literature (Cherif et al. 2003, Moises-Alfaro et al. 2003). Earlier reports indicated that DLE may be more prevalent in...

Erythema Multiformelike Lesions

Rowell et al. (Rowell et al. 1963) described erythema multiforme-like lesions in patients with LE. Pernio has also been described in these patients (Millard and Row-ell 1978). These patients were found to possess an antibody against the saline extract of human tissue termed anti-SjT . This antibody was named for the original patient who had Sjogren's syndrome. It is now postulated that the SjT antibody system is identical to the anti-La SSB antibody system. The absence of an anti-Ro SSA antibody equivalent (SjD antibody) in this cohort of four patients is of interest. The author, in more than 25 years' experience dealing with these antibody systems, has never seen the occurrence of anti-La SSB antibodies in the absence of anti-Ro SSA. Furthermore, based on experience, this author suspects that these patients had Sjo-gren's syndrome LE overlap syndrome. In the evaluation of several patients with both anti-U1RNP and anti-Ro SSA antibody-associated neonatal lupus, the author detected the...

Acute Cutaneous Lupus Erythematosus

Transient Maculopapular Butterfly Rash

The typical clinical manifestations of ACLE are characterized by a localized erythema known as the malar rash or butterfly rash on the central portion of the face or by a generalized, more widespread form (Fabbri et al. 2003, Sontheimer and Provost 2003). Localized ACLE may only affect the skin transiently, and the lesions may last for only several days up to a few weeks. Therefore, at the onset of disease, the patients may mistake this rash for sunburn and may seek medical advice only after the lesions have persisted for a longer period. Generalized ACLE, also known as photosensitve lupus rash , is a less common variety and may be located anywhere on the body however, it has a predilection for sun-exposed areas of the face, extensor aspects of the arms and forearms, and the dorsal aspects of the hands. It generally presents as a maculopapular or exanthematous eruption with a pruritic component. In most of the patients, systemic manifestation is strongly associated with ACLE,...

Subacute Cutaneous Lupus Erythematosus

Subacute Cutaneous Lupus

Papulosquamous subacute cutaneous lupus erythematosus (SCLE). Psoriasiform lesions with superficial scale and the tendency for individual lesions to merge into a vetiform pattern systemic disease, and only half of them have four or more of the American Rheumatism Association (ARA) criteria for the diagnosis of systemic lupus erythematosus (SLE) (Cohen and Crosby 1994, Crowson and Magro 2001, Tan et al. 1982). Therefore, SCLE can be considered a relatively benign illness that is intermediate in severity between ACLE and CCLE (Sontheimer 1989). Initially, SCLE lesions present with erythematous macules and papules that evolve into scaly papulosquamous or annular polycyclic plaques (Sontheimer et al. 1981). Approximately 50 of patients have predominantly papulosquamous or psoriasiform lesions (Fig. 6.4), and the other half have the annular polycyclic type (Fig. 6.5) a few patients may develop both forms of lesions (Sontheimer 1985a, Sontheimer et al. 1979). However, some groups...

Of Cutaneous Lupus Erythematosus

Handatlas Kaposi

The term lupus erythemateaux was used for the first time by Cazenave (Cazenave 1851) in 1851 to distinguish the noninfectious forms of lupus from cutaneous tuberculosis (lupus vulgaris). Cazenave referred in his original paper to Biett's earlier report on this disease, which was termed erytheme centrifuge, as being a very good description of what nowadays would be called discoid lupus erythematosus (DLE). Also, in 1845, Hebra (Hebra 1845) precisely described systemic manifestations of LE that occurred in patients who had the classic butterfly erythema, which he named seborrhea congestive . Since the earlier descriptions had always discussed LE in the context of cutaneous tuberculosis, it is very much Cazenave's achievement to have clearly separated LE from an infectious disease, thus clearing the way for further studies on this complex disease following other hypotheses and directions. Based on Hebra's work, further clinical and histopathologic studies on the relation of cutaneous...

Systemic Lupus Erythematosus Differential Diagnosis

Skin lesions of SLE are manifold and often quite characteristic. Most of the cutaneous symptoms are erythematous lesions without or with only mild epidermal involvement (scaling, atrophy, etc) malar erythema (butterfly rash), morbilliform macular rashes, circumscribed erythemas. A second and less frequent morphologic component consists of bullous or ulcerative lesions. Differential diagnosis in SLE is not dominated by the morphology of the cutaneous lesions but by systemic symptoms and laboratory data.

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

Erythematosus The Role of Ultraviolet Light

Cutaneous lupus erythematosus (CLE) defines a spectrum of diseases, including subacute CLE (SCLE), LE tumidus (LET), discoid LE (DLE), and systemic LE (SLE). Of these, the most photosensitive are SCLE and LET. The anti-Ro SSA antibody and the human leukocyte antigen (HLA) DR3 genotype are strongly correlated with SCLE but are rarely present in DLE (Lee and Farris 1999) or LET (Alexiades-Armenakas et al. 2003). Photosensitivity defines a predisposition to developing lesions from the sun, as these patients have a normal range of minimal erythema dose compared with the general population (Sanders et al. 2003). Photoprovocation studies clearly demonstrate that ultraviolet (UV) light (UVA, UVB) (Kuhn et al. 2001a, b, Lehmann et al. 1990, Walchner et al. 1997), and visible light (Sanders et al. 2003) can provoke lesions in all photosensitive forms of LE (Cheong et al. 1994).

CAMs in Cutaneous Lupus Erythematosus

Figurate Erythema Dermatology

Different patterns of ICAM-1 expression in the epidermis have been documented in LE vs other cutaneous inflammation and also between subsets of LE. In experimentally UVA- and UVB-induced lesions in patients with LE and PLE, those with SCLE showed ICAM-1 expression throughout the epidermis, those with DLE showed basal ICAM-1 staining, and those with PLE showed focal basal ICAM-1 staining associated with lymphocyte infiltrates (Stephansson and Ros 1993). SCLE, erythema multiforme, and lichen planus showed diffuse ICAM-1 expression throughout the epidermis in SCLE, basal and focal suprabasal ICAM-1 expression in erythema multiforme, and ICAM-1 expression on basal keratinocytes in lichen planus.Virus, UVB, and perhaps other triggers of cytokine release or possibly of ICAM-1 directly were suggested to explain these different ICAM-1 expression patterns (Bennion et al. 1995). Another group found no significant differences in CAM expression patterns in biopsy samples from spontaneous CCLE and...

Differential Diagnosis at Particular Sites Discoid Lupus Erythematosus of the Scalp

Scutula Favus

DLE of the scalp (Fig. 11.2A) typically arises as one or a few roundish erythematous plaques identical to DLE lesions elsewhere on the skin. When atrophy develops, they gradually transform into patches of scarring alopecia that may be surrounded by rims of scaly erythema. In the early phase, it must be distinguished from psoriasis and seborrheic dermatitis (see previously herein). In advanced stages, DLE may Fig. 11.2. A Atrophic alopecia in discoid lupus erythematosus. Note the widened erythematous follicular openings between flattened atrophic areas. B Lichen ruber planopilaris confluent small areas of atrophic skin with interspersed unaffected hair-bearing follicles Fig. 11.2. A Atrophic alopecia in discoid lupus erythematosus. Note the widened erythematous follicular openings between flattened atrophic areas. B Lichen ruber planopilaris confluent small areas of atrophic skin with interspersed unaffected hair-bearing follicles Linear morphea (coup de sabre) is an easy clinical...

Nonspecific Skin Lesions in Patients with Systemic Lupus Erythematosus

Vascular lesions play a dominant role. Raynaud's phenomenon occurs frequently in SLE, as it does in other collagen vascular diseases. Leukocytoclastic vasculitis may arise, often associated with periods of increased disease activity it may present as cutaneous necrotizing vasculitis (palpable purpura) or as urticarial vasculitis, less often as arteritis, with symptoms similar to polyarteritis nodosa. Thrombophlebitis and thrombotic vessel damage is seen particularly in patients with secondary antiphospholipid syndrome, leading to livedo reticularis or acral cyanosis or necrosis. Thrombocytopenia may cause thrombocytopenic purpura. Similar to patients with dermatomyositis, patients with SLE often show nailfold erythema, telangiectasia, or hemorrhage. Characteristic nonspecific signs are thin, brittle hair with an uncombed appearance, referred to as woolly or lupus hair, and telogen effluvium.

Old burntout Lesions of Discoid Lupus Erythematosus

Cutaneous Lupus Hyperpigmented

Atrophic scars may be indistinguishable from burnt-out DLE, lacking any signs of inflammation, particularly depigmented scars after superficial third-degree burns. Atrophic acne scars differ by their multiplicity and characteristic distribution. They are not accompanied by pigmentary changes in white skin. The characteristically depressed scars after cutaneous leishmaniosis, in contrast, are hyperpigmented. In all instances, the borders of the scars must be carefully inspected to detect residual rims of scaling erythemas, which would be a clue for DLE. Fig. 11.1. A Actinic keratoses irregular, firm, hyperkeratotic masses ( limestonelike ) on erythematous ground. Note the photodamaged skin at the periphery. B M. Bowen a flat, irregularly hyperkera-totic, partially erosive lesion with polycyclic borders and little inflammation. C Discoid lupus erythematosus lesions of intermediate age with central atrophy and raised ery-thematous borders Hypopigmented lesions of tuberculous leprosy...

Subacute Cutaneos Lupus Erythematosus Differential Diagnosis

Psoriasis Erythematosus

Is documented) that is localized at the trunk and the extensor aspects of the upper extremities, more rarely in the face and neck (Sontheimer et al. 1979). Lesions have an intermediate morphology between DLE and SLE they are erythematous flat plaques, much thinner than DLE, with some dry scaling but without adherent scales and hyperkeratotic follicular plaques. There is a tendency for central regression (which often results in annular lesions), but there is no full-blown atrophy or scarring and depigmentation (Fig. 11.3A). Patients with SCLE only rarely have systemic symptoms, but there is a clear history of photosensitivity. Fig. 11.3. A Annular subacute cutaneous lupus erythematosus lesions. Except for their slight central atrophy, almost indistinguishable from annular psoriasis (B). C Erythema annulare centrifugum no epidermal involvement (scaling and atrophy) Tinea corporis and superficial trichomycosis may be confused with SCLE because they represent annular lesions with a...

Chilblain Lupus Erythematosus

Chilblain Lupus Erythematosus

CHLE, a rare manifestation of CCLE distinguished by Hutchinson in 1888 (Hutchinson 1888), is strongly influenced by environmental factors (Breathnach and Wells 1979, Doutre et al. 1992, Helm and Jones 2002, Rowell 1987, Uter et al. 1988). This subtype seems to be more frequent in women and, interestingly, very uncommon in the United States, as Tuffanelli and Dubois (Tuffanelli and Dubois 1964) failed to detect such lesions among 520 patients however, these patients were collected for the most part from the warm Southern California area. In contrast, Millard and Rowell (Millard and Rowell 1978) detected 17 cases with this subtype in a review of 150 patients with CLE (11.3 ). Four of these patients demonstrated erythema multiforme-like lesions, and 3 of these 17 patients subsequently developed features of SLE. One further reported case of CHLE was induced by pregnancy and disappeared after delivery (Stainforth et al. 1993). The pathogenesis is unknown, but microvascular injury secondary...

How to Perform the Best Peeling for the Treatment of Rosacea

Erythema Multiforme Peeling

Salicylic acid peelings performed at 3- to 4-week intervals are a good choice for patients with rosacea. Salicylic acid peeling has antimicrobial activity, reduces erythrosis and prevents relapses. In papulo-pustular rosacea 25-30 salicylic acid peeling is utilized in association with systemic treatment with metronidazole or antibiotics and topical treatment as for erythrosis (Figs. 17.15,17.16 and 17.17). Salicylic acid penetrates more deeply in the areas of inflammation and produces rapid drying of papules and pustules 1 or 2 days after the peeling. These beneficial effects are determined by the antimicrobic activity of salicylic acid, which also stimulates fibroblasts, inducing an improvement of the vascular component of ro-sacea. Application of salicylic acid in inflammatory rosacea is equally as safe and effective in residual or initial lesions. Fig. 17.16a, b. Papulo-pustular rosacea before (a) and after (b) chemical peel Fig. 17.16a, b. Papulo-pustular rosacea before (a) and...

Dermatosurgical and Laser Therapy in Cutaneous Lupus Erythematosus

Vascular lesions with telangiectasias on visible areas, such as the face, are common in DLE however, efficient management of these skin lesions can sometimes be difficult. Since argon laser light can specifically coagulate vascular structures, it has been used in the treatment of various vascular skin malformations. Effective use of argon laser has been reported by two groups (Kuhn et al. 2000, Zachariae et al. 1988) (Table 25.1). Table 25.1. Treatment of lupus erythematosus (LE) with laser review of the literature. (Modified after Kuhn et al. 2000) Table 25.1. Treatment of lupus erythematosus (LE) with laser review of the literature. (Modified after Kuhn et al. 2000) a patient with DLE by using the carbon dioxide laser and observed a dramatic clinical and cosmetic improvement in the cutaneous lesions. Hypopigmentation in the tested areas and reactivation of DLE in the periphery were described as side effects. Nunez et al. (Nunez et al. 1995,1996) described telangiectatic chronic...

Lupus Erythematosus Profundus

Lupus Onion Skin

Lupus erythematosus profundus. Patchy lymphocytic infiltrates in the dermis and subcutaneous tissue Fig. 21.3A, B. Lupus erythematosus profundus. Patchy lymphocytic infiltrates in the dermis and subcutaneous tissue Another characteristic feature is the presence of reactive lymphoid follicles. Lymphoid follicles are rare in panniculitis but may be seen in rare cases of erythema nodosum, erythema induratum, and morphea (Harris et al. 1979). These entities are also part of the differential diagnosis of LE profundus. However, erythema induratum is usually on the calves of women, a location that is not common in LE profundus. In morphea, there are thickened collagen bundles, which are not present in LE profundus. Erythema nodosum usually does not display the histologic changes in the epidermis that may be seen in LE profundus. Another important differential diagnosis is subcutaneous panniculitis-like T-cell lymphoma, which is a cytotoxic T-cell malignancy. The neoplastic...

Discoid Lupus Erythematosus Lesions of Intermediate

At this stage, central atrophy becomes apparent, and active sectors of the lesion appear as annular or semicircular peripheral erythemas (Fig. 11.1C). DLE lesions of the scalp usually belong to this category (see below). Superficial dermatophytic infections typically present as nummular lesions with raised erythematous, scaly borders and central clearing. Annular and semicircular lesions are often found. In contrast to DLE, there is no atrophy. In adults, superficial mycoses are mainly found in the context of tinea pedis and in the inguinal folds and only exceptionally on the trunk or face. Children are much more prone to develop superficial mycoses of the face, but they only rarely develop DLE. Potassium hydroxide examination of scales will quickly reveal the etiology. Erythema arcuatum, the superficial variant of granuloma annulare, is characterized by stable, erythematous, slightly infiltrated annular lesions predominantly of the upper trunk. In contrast to DLE, the lesions are...

Lupus Erythematosus and Neutrophilic Dermatosis Sweets Syndrome

Neutrophilic dermatosis was first reported in association with SCLE by Goette in 1985. The next patient, described by Levenstein et al. (Levenstein et al. 1991), had a simultaneous appearance of both SCLE and Sweet's syndrome. The patient was later investigated for SS, and the latter was diagnosed in him. Therefore, the authors recommended that each patient with the clinical picture of both diseases be investigated for SS. Their suggestion is based on the article by Katayama et al. (Katayama et al. 1991), who found clinical evidence of annular erythema resembling Sweet's syndrome in 14 of 22 patients with SS. Choi and Chung (Choi and Chung 1999) described a patient with SLE, Sweet's syndrome and herpes zoster. SLE preceded for 3 months the appearance of Sweet's syndrome. Choi and Chung presumed that antibodies of SLE may have a role in the development of Sweet's syndrome because autoantibodies are incriminated in the pathogenesis of Sweet's syndrome. The patient described by Choi and...

Clinical Photosensitivity in Lupus Erythematosus

Provocative Phototesting

Cific lesions of LE in the test area in 5 of the 25 tested patients. The eliciting wavelengths were in the UVB range. In the same year, Everett and Olson (Everett and Olson 1965) demonstrated that 1 minimal erythema dose (MED) of hot quartz UV light exposure produced an increase in the size of skin lesions in patients with DLE. Baer and Harber (Baer and Harber 1965) administered phototests to 29 patients with LE by applying one to six times the MED of UVB in single exposures to multiple test sites. An abnormal reaction was detected in only one patient with SCLE, and it consisted of a markedly decreased erythema threshold dose and persistence of the erythema for 4 weeks. Wavelengths longer than 315 nm were not evaluated in this study. Freeman et al. (Freeman et al. 1969) used monochromatic light to determine the wavelength dependency of phototest reactions in 15 patients with LE by also applying the repeated UV exposure technique, which became a valuable tool later on for...

Lupus Erythematosus and Sjgrens Syndrome

Anti-La SSB occurs in approximately 15 of patients, and most have SS and may be diagnosed as having SS-SLE overlap syndromes. Anti-Ro SSA (without anti-La SSB) occurs in approximately 30 of patients with SLE without dry eyes or mouth. SS can precede LE by years, but LE can precede the appearance of SS also. Anti-Ro SSA antibodies etc found in polymyositis, scleroderma, and primary biliary cirrhosis, and association with SS is invariably (Venables 1988). The skin changes associated with SS include dry eyes, dry mouth, and dry genitals as major clinical symptoms. Other clinical symptoms include annular erythema, Sweet's syndrome-like lesions, vitiligo-like changes, sarcoidosis, and LP-like and amyloidosis nodularis-like symptoms (Ueki 1994, personal communication). Annular erythema is one of the prominent clinical features of both SS and SLE. Katayama et al. (Katayama et al. 1991) subdivided annular erythema into three types. Type I is an isolated annular erythema with an elevated and...

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

Epidemiology of the Cutaneous Manifestations of Lupus Erythematosus

ACLE appears in 30 -60 of patients with SLE. It includes localized (malar) erythema, widespread (face, scalp, neck, upper chest, shoulders, extensor arms, and back of hands) erythema, and bullous (toxic epidermal necrolysis-like) LE. Additionally, nonspecific but disease-related cutaneous manifestations can appear in patients with LE, including photosensitivity, alopecia, urticaria, livedo reticularis, dermal vasculi-tis, and Raynaud's phenomenon (Yell et al. 1996). The prevalence of photosensitivity ranges from 28 to 71 . It is one of the major diagnostic criteria for SLE. Photosensitivity precedes the clinical onset of internal manifestations of SLE in about one third of patients. Some patients may not notice erythema after prolonged UV exposure, but hours or days later they may note increased arthralgia, malaise, or fever. Table 3.7. Prevalence of cutaneous manifestations in systemic lupus erythematosus in several series Table 3.7. Prevalence of cutaneous manifestations in systemic...


Autosomal, recessive, multisystem disorder characterized by progressive neurological impairment, cerebellar ataxia, variable immunodeficiency, impaired organ maturation, x-ray hypersensitivity, ocular and cutaneous telangiectasia, and a predisposition to malignancy Ocular and cutaneous telangiectasia neurological abnormalities, mainly ataxia, abnormal eye movements, and chore-oathetosis Telangiectatic diseases hereditary hemor-rhagic telangiectasia chronic liver disease benign essential telangiectasia sun damage neurologic disorders Friedreich disease cerebral palsy familial spinocerebel-lar atrophies GM1 and GM2 gangliosi-doses progressive rubella panencephalitis subacute sclerosing panencephalitis postinfectious encephalomyelitis cerebel-lar tumor Gatti RA (1995) Ataxia-telangiectasia. Dermato-logic Clinics 13(1) 1-6

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

Lupus Erythematosus

Keratoconjunctivitis Sicca Lupus

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...

Erythema multiforme

Erythema Exudativum

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...


Mild Rosacea Pictures

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...

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

Erythromelalgia Erythromalgia

Erythromelalgia is characterized by prominent erythema and increased temperature involving predominantly the feet, but the hands also may be involved. Characteristically intense burning pain is present. The condition may be bilateral but at times may involve only one extremity. Exposure to warmth frequently triggers an attack. Ice water immersion of the affected extremity produces pain relief.

Effects of UV Irradiation on CAMs

PA Norris and coworkers reported in vivo sequential expression of CAMs in UVB-induced erythema compared with intracutaneous injection of purified protein derivative (PPD). E-selectin expression on endothelial cells was seen after 6h in both reactions, with a prolonged expression (1 week) in the PPD reaction. PPD but not UVB induced basal keratinocyte ICAM-1 expression and VCAM-1 expression on stellate-shaped cells in the upper dermis, first seen at 24 h (Norris et al. 1991). In PLE, similar findings regarding CAM expression were found as after PPD injection, but keratinocyte ICAM-1 expression was strong already after 5 h, and VCAM-1 was expressed on perivascular cells (Norris et al. 1992). UVA irradiation in vivo on healthy skin increased endothelial ICAM-1 after 24 h, whereas ICAM-1 expression on cultured keratinocytes decreased after UVA but increased on cultured fibroblasts 6-48 h after irradiation. These authors also reported constitutive keratinocyte ICAM-1 expression (Treina et...

Maculopapular Exanthemas

Erythema annulare centrifugum may mimic stable lesions of SLE (see previously herein). Acral maculopapular lesions of dermatomyositis resemble acral maculopapular lesions of SLE. Both appear as reddish and slightly elevated scaly papules of the dorsa of the fingers there is a peculiar and unexplained difference, however, in that the lesions of dermatomyositis are localized over the interphalangeal joints and spare the skin in between, whereas the opposite is true for the lesions of SLE. Also, those of der-matomyositis are more elevated and hyperkeratotic nailfold erythemas, telangi-ectasias, and hemorrhage may occur in both conditions but are more pronounced in dermatomyositis. Acral vasculitic skin lesions in SLE present as flat, erythematous palmoplantar painful plaques or nodules and resemble chilblains ( chilblain lupus ). These lesions are also typically found in LE-like syndromes of C2 or C4 deficiency.


ACLE acute cutaneous lupus erythematosus BLE bullous lupus erythematosus CCLE chronic cutaneous lupus erythematosus CHLE chilblain lupus erythematosus CLE cutaneous lupus erythematosus DLE discoid lupus erythematosus EM erythema multiforme ICLE intermittent cutaneous lupus erythematosus LE lupus erythematosus LEP lupus erythematosus profundus LET lupus erythematosus tumidus NLE neonatal lupus erythematosus REM reticular erythematous mucinosis SCID severe combined immunodeficient SCLE subacute cutaneous lupus erythematosus SLAM Systemic Lupus Activity Measure SLE systemic lupus erythematosus SLEDAI Systemic Lupus Erythematosus Disease Activity Index snRNP small nuclear ribonucleoprotein

Cutaneous Lesions

Malar erythema has been noted in up to four fifths of children with SLE (Font et al. 1998, Lehman 1993, Schaller 1982, Wananukul et al. 1998). Discoid lesions may occur in children with SLE, sometimes as a presenting sign. In a review of 16 cases of childhood discoid LE (DLE) with onset before age 10 years (10 boys and 6 girls), progression to systemic disease was common (George and Tunnessen 1993). Of the 16 cases, 10 were followed into adulthood, and 5 of the 10 developed SLE. SCLE, LE tumidus, LE panniculitis, and bullous LE have all been noted in children (Kettler et al. 1988, Kuhn et al. 2000, Provost et al. 1983, Siamopoulou et al. 1989, Taieb et al. 1986).

Butterfly Rash

Lupus Rash Nasolabial Lines

A Butterfly rash in systemic lupus erythematosus. A well-demarcated, symmetrical erythema of the malar areas and the back of the nose that has progressed to the forehead and perioral skin. Note the sparing of the nasolabial folds. B Seborrheic dermatitis note the yellowish color and involvement of the nasolabial folds Fig. 11.4. A Butterfly rash in systemic lupus erythematosus. A well-demarcated, symmetrical erythema of the malar areas and the back of the nose that has progressed to the forehead and perioral skin. Note the sparing of the nasolabial folds. B Seborrheic dermatitis note the yellowish color and involvement of the nasolabial folds demarcated symmetrical erythemas (and edema) of the malar areas that are connected over the bridge of the nose and thus result in a butterfly-like shape. The forehead and chin may be affected, and the nasolabial folds are characteristically spared (Fig. 11.4A). If the malar rash persists for some time, scales and mild atrophy may...


Sunscreens have been developed to prevent the short- and long-term damaging effects of UV irradiation. However, the sun protective factor (SPF), which is defined as the ratio of the minimal erythema dose (MED) of sun-protected skin divided by the MED erythema of non-sun-protected skin, gives only a quantitative level of protection against sunburn and edema. Therefore, there is an ongoing debate on the potency of sunscreens to protect against many other deleterious biological UV effects such as photoimmunosuppression, skin aging, or skin cancer. Recent efforts have been directed toward determining the end points of sunscreen efficacy, such as immune protection factor (IPF), mutation protection factor (MPF), and protection against photocarcinogenesis (Gil and Kim 2000). Although standardized phototest procedures are available and can be used as tools to evaluate the protective effects of sunscreens toward UV induction of LE lesions, studies addressing this important topic are lacking....


Temic contact hypersensitivity, and UV-induced activation of ERK1 2 and p38 activation (Steenvoerden and Beijersbergen van Henegouwen 1999, Tebbe et al. 1997). Tocopherol inhibits UVB-induced erythema, photocarcinogenic DNA damage, and suppression of local contact hypersensitivity, as well as depletion of Langerhans cells (McVean and Liebler 1997, Trevithick et al 1992,Yuen and Halliday 1997).


Dapsone (4,4'-diaminodiphenylsulphone) has been in clinical use for more than 60 years. It is widely used in the treatment of a variety of infectious diseases, including leprosy and malaria, and it has some action against other parasites. In addition, it has been effective in the treatment of a diversity of cutaneous disorders, particularly those characterized by a neutrophilic infiltrate but also cutaneous manifestations of lupus erythematosus (LE), erythema nodosum, cutaneous vasculitides, pyoderma gangrenosum, bullous dermatoses, and dermatitis herpetiformis (Lang 1979, Mok et al. 1998).


Erythema elevatum diutinum Dermatitis herpetiformis Linear IgA dermatosis Cicatricial pemphigoid Bullous pemphigoid Pemphigus vulgaris Actinomycetoma Systemic lupus erythematosus Subacute cutaneous lupus erythematosus Discoid lupus erythematosus Bullous lupus erythematosus Fig. 27.2. a 10-year-old Turkish girl with non-scarring form of discoid lupus erythematosus before therapy. b Almost total clearing of skin lesions 3 weeks after therapy with dapsone Fig. 27.2. a 10-year-old Turkish girl with non-scarring form of discoid lupus erythematosus before therapy. b Almost total clearing of skin lesions 3 weeks after therapy with dapsone

Nail Changes

Nail alterations have been detected in patients with SLE. One study detected nail alterations in 42 (31 ) of 165 patients with SLE (Urowitz et al. 1978). The most common abnormality is onycholysis. These SLE patients also demonstrated pitting, horizontal and longitudinal ridging, and leukonychia. Atrophy and telangiectasia of the cuticle nail fold were also commonly detected.

Evaluation of Eyelid Lesions

Fluid Filled Cyst Eyelid

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...

Eyelid Lesions and Tissues of Origin

Microcystic Adnexal Carcinoma

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.

Iipsoriasis A Introduction

Vasodilation and erythema, and leukotrienes, such as acid (LT-B4) and acid (12-HETE), as well as interleukin (IL)-8, and the complement product C5a des arg may cause neutrophil accumulation (1-4). Raised levels of calmodulin, a cellular receptor protein for calcium, have been demonstrated in psoriatic lesions. The calcium-calmodulin complex may influence cell proliferation in psoriasis by modulating the activities of phospholipase-A2 (which releases arachidonic acid from cell membranes) and phosphodiesterase. Drugs such as anthralin (dithranol) and cy-closporine, which are beneficial in psoriasis, are calmodulin antagonists. Intracellular cAMP levels are decreased within psoriatic lesions and drugs that decrease cAMP levels, such as -blockers or lithium, may worsen psoriasis. Conversely, drugs such as benoxaprofen (now withdrawn) which elevate cAMP levels may improve psoriasis.

Histopathologic Terminology

Granulation Tissue

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,...

Clinical Evaluation Of The Infant

The vesicular rash that occurs with HSV infection may be confused with the cutaneous manifestations of other infectious diseases, such as varicella-zoster virus infection, postnatally acquired enteroviral disease, and disseminated cytomegalovirus infection. Such distinctions are especially difficult when HSV assumes an atypical cutaneous presentation. Definitive confirmation of HSV disease can be achieved by culture of the skin vesicles. Noninfectious cutaneous conditions such as incontinentia pigmenti, acrodermatitis enteropathica, erythema toxicum, and neonatal melanosis should also be considered. Lesions associated with these diseases can often be distinguished rapidly from those caused by HSV by the presence of eosinophils on staining of a tissue scraping, by peripheral eosinophilia, and by appropriate viral cultures.

Treatment of Eczema

Creams are suitable for moist or weeping areas of eczema, whereas ointments should be used for dry, scaly, or lichenified areas. Local side effects of topical steroids include masking or worsening of infection (especially fungal infections), thinning of the skin, induction of striae, bruising and telangectasia, on aggravation of rosacea.

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...

Brown recluse spider bite

Plaque with early necrosis in the center and an erythematous border,, Brown recluse spider bite. Plaque with early necrosis in the center and an erythematous border,, 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

Patients Informed Consent

Will cause a modification in the treated area of my face (body), which may be unpleasant. My face will become red and subsequently dry and in some cases areas of dry hyperpigmented skin may occur. Crusts may occur in some areas and must be medicated with topical antibiotics. Exfoliation will then start and last about 5-10 days. An erythema may persist for 15-20 days.

Perivascular And Interstitial Dermatitis

Erythema Figuratum

Figure 2 (A) Sharply demarcated purpuric erythema on the leg, a bulla Is seen in the uppermost part of the lesion. (B) Perivascular and Interstitial dermatitis without epidermal changes. (C) Lymphocytes and neutrophils perivascular and interstitial accompanied by numerous extravasated erythrocytes. Figure 2 (A) Sharply demarcated purpuric erythema on the leg, a bulla Is seen in the uppermost part of the lesion. (B) Perivascular and Interstitial dermatitis without epidermal changes. (C) Lymphocytes and neutrophils perivascular and interstitial accompanied by numerous extravasated erythrocytes. Figure 4 (A) Erythematous patch on the thigh with a bright red slightly elevated border and a paler red in the center. (B) Perivascular dermatitis without epidermal changes. (C) Infiltrate consisting of lymphocytes and plasma cells. Figure 4 (A) Erythematous patch on the thigh with a bright red slightly elevated border and a paler red in the center. (B) Perivascular dermatitis without epidermal...

Necrotic Keratinocytes

Lichen Striatus Histology

Figure 1 Erythema multiforme minor and major. There is obscuration of the dermoepidermal junction with vacuolar alteration of the basal keratinocytes (A and B). Necrotic keratinocytes may be individual or confluent (B). The process may progress to frank subepidermal vesiculation (C). Toxic epidermal necrosis with confluent, full-thickness epidermal necrosis (D). Note the preservation of the basket-weave horn. Figure 1 Erythema multiforme minor and major. There is obscuration of the dermoepidermal junction with vacuolar alteration of the basal keratinocytes (A and B). Necrotic keratinocytes may be individual or confluent (B). The process may progress to frank subepidermal vesiculation (C). Toxic epidermal necrosis with confluent, full-thickness epidermal necrosis (D). Note the preservation of the basket-weave horn. Figure 3 Systemic lupus erythematosus. There is obscuration of the dermoepidermal junction with vacuolar alteration of the basal keratinocytes with a sparse lymphocytic...

Mast Cell Disease Urticaria Pigmentosa

Urticaria Pigmentosa Histopathology

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....

Acne And Pseudofolliculitis Treatment

Another modality of acne treatment has been proposed using high concentrations of glycolic acid in an office setting (12). The procedure has to be repeated weekly or so. Improvement has been reported to be precipitous while patients were also taking tetracyclines (12). Discomfort, mild diffuse erythema, and fine scaling are often experienced by patients. In addition, there is a risk for stronger irritation leading to a papular and perifollicular erythema that can persist for a few weeks.

Classification Antibiotic penicillin

Special Concerns Safety and efficacy in children less than 12 years of age have not been established. Side Effects At site of injection Pain and thrombophlebitis. GI Diarrhea, N&V, flatulence, abdominal distention, glossitis. CNS Fatigue, malaise, headache. GU Dysuria, urinary retention. Miscellaneous Itching, chest pain, edema, facial swelling, erythema, chills, tightness in throat, epistaxis, substernal pain, mucosal bleeding, candidiasis. Drug Interactions See also Anti-Infectives and Penicillins. How Supplied See Content

Clinical manifestation

Skin disease sometimes initial or sole manifestation muscle disease occurring concurrently, sometimes preceding skin disease or following skin disease by weeks to years eruption photodistributed and photo-exacerbated violaceous-to-dusky, erythematous plaques with or without edema in a symmetrical distribution involving periorbital skin central facial erythema Scalp involvement erythematous to violaceous, psoriasiform plaques slightly elevated, violaceous papules and plaques Gottron papules over bony prominences, particularly the metacarpophalangeal joints, the proximal interphalangeal joints, and or the distal interphalangeal joints Similar lesions overly the elbows, knees, and or feet periungual telangiectases irregular, ragged cuticles with hypertrophy and hemorrhagic infarcts calcinosis of the

Preoperative Considerations

Most clinicians use the modified Fitzpatrick scale (types I-VI Table 30-1). This is based on response to UV radiation. It is generally felt that type III and above (usually tan, sometimes burn) should be pretreated b.i.d. (twice a day) with hydro-quinone plus glycolic acid or Retin-A with or without topical steroids for 6 to 8 weeks before the resurfacing and beginning again after reepithelialization for several months to avoid postin-flammatory hyperpigmentation. Of equal importance is absolute avoidance of UV exposure until the erythema is completely resolved. Patients with Fitzpatrick types V or VI have the additional potential problem of postoperative hypopigmen-tation. This is directly related to the depth of the treatment, and a conservative approach in stages is highly recommended.

Comparison With Other Surface Modalities

Level II methods may include trichloroacetic acid (TCA) and certain other peels, as well as deep erbium-YAG resurfacing. These methods penetrate into the superficial papillary dermis, have limited recovery downtime and post-inflammatory erythema, and are generally felt to be most useful in treating dyspigmentation. Level III methods include CO2 resurfacing, phenol peels, and dermabrasion. Because of deeper penetration to or beyond the papillary-reticular junction, these manifest longer recovery and post-inflammatory erythema, as well as increased risk of scarring or pigmentary changes. They also produce the most significant improvement with regard to superficial rhytids, acne scars, and solar elastosis. I believe that CO2 resurfacing has effectively replaced the other two modalities in this level, but whether or not you agree, this algorithm may be useful in your consultation room. This simple approach permits every practitioner the ability to adapt it to his or her own preferences...

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

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

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).

Counseling Of Pregnant Women

The prenatal evaluation and diagnosis of parvovirus B19 infection in the mother is not difficult, but determination of infection in the fetus may be complicated. Universal screening for parvovirus B19 is not recommended because of the low risk of maternal infection and low risk of adverse outcome to the fetus (33). Screening is recommended for pregnant women exposed to individuals with erythema infectiosum, in an aplastic crisis, and in an outbreak (because of a high attack rate in some situations) (26- Erythema infectiosum (fifth disease) Arthropathy

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

Nasel Cyst Hearling Loss

Basal Cell Carcinoma Nose Flaps

Fig. 3.11a, b Rhinophyma, in which the skin becomes thickened and vascular, may produce gross nasal deformity in which the skin epithelium becomes thickened and vascular. Shaving of the excess skin (without skin grafting) is the surgical treatment. Irregular areas of epithelium (arrow) should be sent for histology since basal- or squamous cell carcinoma may occur within a rhinophyma. Fig. 3.11a, b Rhinophyma, in which the skin becomes thickened and vascular, may produce gross nasal deformity in which the skin epithelium becomes thickened and vascular. Shaving of the excess skin (without skin grafting) is the surgical treatment. Irregular areas of epithelium (arrow) should be sent for histology since basal- or squamous cell carcinoma may occur within a rhinophyma.

Summary And Conclusion

Animal and human studies have convincingly demonstrated significant photopro-tective effects of ''natural'' and synthetic antioxidants when applied topically before UVA and UVB exposure. However, particularly with respect to UVB-induced skin damage, the photoprotective effects of most antioxidants were modest as compared to sunscreens. More successful in preventing such damage were appropriate combinations of antioxidants resulting in a sustained antioxidant capacity of the skin, possibly due to antioxidant synergisms. On the other hand, regarding photoprotective effects against UVA-induced skin alterations, which are largely determined by oxidative processes (75,189-192), topical administration of antioxidants might be particularly promising (193-195). In fact, topical application of antioxidants resulted in a remarkable reduction of UVA-induced ROS generation in mice (134), and diminished UVA-induced polymorphous light eruption in humans (178). Furthermore, topical application of...

Clinical Features

Classical IV-LBL shows erythematous or violaceous plaques or nodules on the face, trunk or lower extremities (4,5). Clinically, they closely resemble livedo racemosa. Other lesions mimic erythema nodosum (6). Coexistence with hemangiomas has been reported (7). Neurologic signs and symptoms are also frequent. In contrast, the Asian variant of intravascular large B-cell lymphoma is characterized by

Differential Diagnosis

Erythematous or violaceous plaques or nodules on the face, trunk, or lower extremities Livedo racemosa or erythema nodosum-like features Neurologic signs and symptoms Histological features Erythema nodosum may be a clinical differential diagnosis in some cases of IV-BCL (6). Reactive and neoplastic angioendotheliomatosis show some differences in the immunocytochemical pattern using antibodies to leukocyte common antigen (LCA), specialized B- and T-lymphocytic determinants, Factor VIII-related antigen (FVIIIRAG), blood group isoantigens A, B, and H, epithelial antigens, vimentin, and actin, and Ulex europaeus I lectin (20).

Physical examination

The vulva usually appears normal in bacterial vaginosis. Erythema, edema, or fissure formation suggest candidiasis, trichomoniasis, or dermatitis. Trichomonas is associated with a purulent discharge candidiasis is associated with a thick, adherent, cottage cheese-like discharge and bacterial vaginosis is associated with a thin, homogeneous, fishy smelling discharge. The cervix in women with cervicitis is usually erythematous and friable, with a mucopurulent discharge. Abdominal or cervical motion tenderness is suggestive of PID.

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...

Candida vulvovaginitis

Vulvar pruritus is the dominant feature. Women may also complain of dysuria (external rather than urethral), soreness, irritation, and dyspareunia. There is often little or no discharge that which is present is typically white and clumpy. Physical examination often reveals erythema of the vulva and vaginal mucosa. The discharge is thick, adherent, and cottage cheese-like.

Clinical evaluation

Variceal bleeding should be considered in any patient who presents with significant upper gastrointestinal bleeding. Signs of cirrhosis may include spider angiomas, palmar erythema, leukonychia, clubbing, parotid enlargement, and Dupuytren's contracture. Jaundice, lower extremity edema and ascites are indicative of decompensated liver disease.

Chalazion and Hordeolum

Chalazion Multiple

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...

Pharyngocutaneous Fistula

Pharyngocutaneous fistulae usually follows oncologic resection of oropharyngeal, hypopharyngeal, or laryngeal tumors. Once this occurs, saliva pours into the neck and this may lead to skin breakdown, flap necrosis, vessel exposure, and or rupture. Initially erythema and tenderness in the lower neck incision or skin flap are present, which leads to the development of a fistula. There may be an associated pyrexia and leukocytosis. The extent of the fistula will become apparent over a number of days and is primarily dependent on the degree of mucosal separation at the site of closure. With massive fistulae, the entire neck skin may slough, exposing major neural and vascular structures.

Repeat Insult Patch Tests

In the Draize human sensitization test (34), an occlusive patch containing the test material is applied to the upper arm or upper back of 200 volunteers for 48 h. The test site is evaluated at patch removal for erythema and edema. This process is repeated until a total of 9 to 10 patches have been applied. Ten to 14 days after application of the last induction patches, subjects are challenged via a patch applied to a new site for 48 h. Sites are visually evaluated at removal of the patch and the response at challenge is compared to the response to patches applied early in induction.

Benign migratory glossitis

Geographic tongue stomatitis areata migrans, erythema areata migrans Irregular, smooth, red plaques on the dorsal surface of the tongue, rapidly changing in pattern surrounding the area of erythema and loss of filiform papillae is a well-defined hyperkeratotic yellow-white border with an irregular outline often associated with burning sensation

Severity of Burn Injuries

Skin Slippage

Figure 13.2 ( A and B) Radiant heat burns with erythema, blistering of skin and skin slippage (continued). Figure 13.2 ( A and B) Radiant heat burns with erythema, blistering of skin and skin slippage (continued). Burns can be described as being first-, second-, third-, or fourth-degree superficial, partial-thickness, or full-thickness burns or a combination of both systems of nomenclature. In first-degree (superficial) burns, the skin is erythematous without blisters. Microscopically, there are dilated congested vessels in the dermis. The epidermis is intact, but there is some injury of the cells. There is subsequent desquamation of necrotic epidermal cells, e.g., peeling in sunburns. First-degree burns can be caused by prolonged exposure to low-intensity heat or light (e.g., sunburn), or a short-duration exposure to high-intensity heat or light.

Safety and Tolerability

Safety data accumulated from 3500 MS patients treated with GA in controlled and uncontrolled studies indicate withdrawal from therapy for adverse experience in 8.4 .28 The most frequent reasons recorded for treatment withdrawals were dyspnea and vasodilation (2 for each). The most commonly reported adverse experiences are local injection site reactions which generally decline over time. They consist of erythema, pain, inflammation, pruritus, and swelling, but no skin necrosis. Localized lipoathrophy occurs in some areas after X 1 year of GA treatment.

Guinea Pig Ear Swelling Test

Materials can also be screened for nonimmunological contact urticaria in humans. A small amount of the test material is applied to a marked site on the forehead and the vehicle is applied to a parallel site. The areas are evaluated at about 20 to 39 min after application for erythema and or edema (52). signs of irritation (erythema, scaling, or crusting) 24 h later. Some substances have only irritant properties (e.g., benzoic acid and nicotinic acid esters), some are pure irritants (e.g., SLS), and some have both these features e.g., dimethyl

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.

Eosinophilic pustular 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

Thrombophlebitis Pictures

Acrodermatitis Enteropathica

Necrolytic Migratory Erythema Rash erythematous, scaly patches intertriginous and Necrolytic migratory erythema (NME), referred to as the glucagonoma syndrome, is a rare paraneoplastic syndrome consisting of the classic triad of diarrhea, diabetes mellitus, and rash associated with serum hyperglucagone-mia (1-3). The most common etiology involves the elaboration of glucagons from an islet cell tumor of the pancreas but may rarely follow the metabolic consequences of cirrhosis, pancreatic insufficiency, or celiac disease. There is no ethnic or gender predilection and age of onset is usually in the sixties. NME is associated with type 1 multiple endocrine neoplasia syndrome (MEN I) sequence and or Zollinger-Ellison hypergastrinemia syndrome in a minority of the cases (4-6). The rash consists of an expanding erythematous and scaly patch typically observed within the intertriginous areas including the inguinal creases, nasolabial sulcus, and popliteal fossae (Figure 23.1) (7). Other...

Epidermal Necrolysis Disease Spectrum

Early Photos Stevens Johnson Syndrome

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...

Nonimmunological Contact Urticaria

Nonimmunological contact urticaria (NICU) is the most common form and occurs without previous exposure in most individuals. The reaction remains localized and does not cause systemic symptoms to spread to become generalized urticaria. Typically, the strength of this type of contact urticaria reaction varies from erythema to a generalized urticarial response, depending on the concentration, skin site, and substance. The mechanism of nonimmunological contact urti- caria has not been delineated, but a direct influence on dermal vessel walls or a nonantibody-mediated release of histamine, prostaglandins, leukotrienes, sub- ja stance P, other inflammatory mediators, or different combinations of these media- tors represents possible mechanisms (56). The most potent and best studied sub- 4 stances producing nonimmunological contact urticaria are benzoic acid, cinnamic

Herpes and Varicella Zoster

Dermis Multinucleated Cells Neutrophils

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...

Open Epicutaneous Test

The open epicutaneous test (OET) (28) simulates the conditions of human use by utilizing topical application of the test material. The procedure determines the doses required to induce sensitization and to elicit a response in sensitized animals. The irritancy profile is determined by applying 0.025 mL of varying concentrations to a 2 cm2 area of the shaved flanks of six to eight guinea pigs. Test sites are visually evaluated 24 h after application of test solutions to erythema. The dose not causing a reaction in any animal (maximal nonirritant concentration) and the dose causing a reaction in 25 of the animals (minimal irritant concentration) are determined. During induction, test solution is applied to flank skin of six to eight guinea pigs for 3 weeks, or 5 times a week for 4 weeks. A control group is treated with vehicle only. The highest dose tested is usually the minimal irritant concentration and lower doses are based on usage concentration or a step-wise reduction. Twenty-four...

Dermatologist Fibrosing Dermopathy

Radiation Dermatitisdermatopathology

High and low power views of previously radiated areas demonstrating poikilodermatous changes, including hyper-pigmentation and hypopigmentation, atrophy, and telangiectasia. Source Courtesy of Yale University, Department of Dermatology, residency slide collection. Figure 11 Radiation dermatitis. High and low power views of previously radiated areas demonstrating poikilodermatous changes, including hyper-pigmentation and hypopigmentation, atrophy, and telangiectasia. Source Courtesy of Yale University, Department of Dermatology, residency slide collection.

Scorpaenids Stonefish

Venom Myotoxic heat-labile, high-MW proteins injected through sharp spines on dorsal pectoral, and anal fins. Antidote Contact major aquariums. Diagnosis Intensifying local pain, erythema, ecchymoses, induration, hyperesthesia dyses-thesia, nausea, vomiting, dyspnea, diaphoresis, later lymphadenopathy, syncope, hypotension, dysrhythmias.

Balanitis xerotica obliterans

Presents with soreness, burning sensation, mild erythema and hypopigmentation as disease progresses, single or multiple discrete erythematous papules or macules coalescing into atrophic ivory, white, or purple-white patches or plaques, which may erode possible development of vesiculation possible phimosis occurring in uncircumcised men occasional signs of lichen sclerosus at other skin sites

Methodology And Efficacy Of Barrier Creams

In 1940, Schwartz et al. (10) introduced an in vivo method to evaluate the efficacy of a vanishing cream against poison ivy extract utilizing visual erythema on human skin. The test cream was an effective prophylaxis against poison ivy dermatitis as compared to unprotected skin.

Pellagra Skin Photomicrograph Pathology

Necrolytic migratory erythema. Arch Dermatol 1980 116 861. 7. Thorisdottir K, Camisa C, Tomecki K, et al. Necrolytic migratory erythema A report of three cases. J Am Acad Dermatol 1994 30 324. 8. Goodenberger D, Lawley T, Strober W, et al. Necrolytic migratory erythema without glucagonoma Report of two cases. Arch Dermatol 1979 115 1429.

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.

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.

Acute Febrile Neutrophilic Dermatosis

Figure 1 Erythema gyratum repens concentric expanding rings on the trunk. Sweet syndrome is characterized by painful erythematous plaques on the face, extremities and the trunk (Fig. 3). In addition, patients are febrile and suffer from malaise. Laboratory examination reveals an elevated neutrophil count. Histologi-cally, a diffuse heavy infiltrate of neutrophils extending through the entire dermis is the hallmark of the lesion. Subepidermal edema can lead to blister formation. Additional findings may include erythrocyte extravasation, mild leukocytoklasia, and presence of lymphocytes and a few eosinophils. The differential diagnosis includes vasculitis secondary to leukemia as well as leukemia cutis in chronic neutro-philic leukemia (13,14).

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.

Clinical Assessment And Quantitative Methods

Table 2 Scale to Score Erythema 1 + Slight erythema, either spotty or diffuse. 2 + Moderate uniform erythema. 3+ Intense redness. Contact urticaria can be graded visually by marking the degree of erythema and edema on an ordinal scale. Tables 2 and 3 provide examples. Measurement of Erythema Erythema, redness of the skin, is part of the skin inflammatory response that reflects localized increase in capillary blood flow elicited. Therefore, erythema can be measured by both the redness and the blood flow in the inflamed area.

Ocular pathologies in animals and available drugs4244

Ocular inflammation is one of the most common eye disorders in animals.45 The precise observation and interpretation of signs provides the basis for diagnosing the disease and its associated disorders, and for establishing their etiology (trauma, lid or lacrimal abnormalities, viral or bacterial infection, immune-related phenomena, corneal ulceration). Topical steroidal therapy in combination with non steroidal anti-inflammatory drugs, immunosuppressive agents such cyclosporine and azathiopr-ine, antimicrobial agents, mydriatic-cycloplegic agents (atropine) and additional specific therapies are frequently prescribed to treat conjunctivitis, keratitis and uveitis (Table l).46,47 Topically applied steroids are in most cases used in combination with an antimicrobial agent. The reason is probably that the concomitant administration of steroid can increase the efficacy of antibiotics.48 In addition, this association prevents a secondary infection that may occur after a corticosteroid...

Local Radiation Exposure

Clinical picture consists of cutaneous changes. Doses above 2-3 Gy may present with erythema, itching. Occurs within hours. Faster occurrence signifies higher doses. Other changes include epilation, desquamation, and necrosis. Appear similar to thermal burns, but unlike thermal burns erythema may reappear, delayed onset of pain, and more chronic, severe pain. Exception High dose radiation may give 3rd degree transdermal burn, pain immediate and excruciating. Surgical resection and grafting may be required.

Special Blood Products II Irradiated Blood Products and Transfusion Associated Graft Versus Host Disease

Regardless of the mechanism by which this rare event occurs, TA-GVHD exhibits clinical manifestations 4-21 days after the transfusion and is, therefore, a delayed adverse reaction to blood transfusion (Chapter 33). TA-GVHD affects the liver, skin, and gastrointestinal tract, giving rise to hepatitis, skin rashes, erythema and diarrhea. These clinical manifestations are similar to a graft versus host reaction

Unmet Medical Need

There is an increasing clinical use and reliance on anti-TNF-a agents for the treatment of steroid refractory, or fistulating CD. The effectiveness of these agents in severe CD has revolutionized the treatment of this patient group, despite their cost and notable side effects. For the induction and maintenance of remission infliximab is given as an intravenous infusion. It is a chimeric mouse human immunoglobulin G1 (IgG1) anti-TNF-a antibody with high levels of immunogenicity, which is both a cause of erythema and reactions during infusion, and reduces the pharmacokinetic half-life, increasing the risk of systemic infections. While other anti-TNF-a approaches are in clinical development (Onercept, CDP-870, ISIS 104838, etc.), none is likely to avoid the core issue relating to increased risks of opportunistic infection and malignancy. Additionally, approximately 30 of CD patients will not respond to infliximab and currently the agent has not been approved for use in patients with UC,...

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.

Peeling Technique

Chemical Peel Frosting

If a Jessner's-35 TCA peel (Monheit) is performed, Jessner's solution is applied first prior to the TCA in an even sequential fashion from the forehead to the rest of the face, waiting 2 to 3 min to allow for penetration and assessment of frost. Typically this will produce a level 1 frost, erythema with faint reticulate whitening Level 1 Erythema with blotchy or wispy areas of white frosting.This indicates a superficial epidermal peel as can be achieved with TCA concentrations 30 .This peel will result in full exfoliation of the epidermis (Fig. 4). Level 3 Solid white frosting with no erythema.This is indicative of penetration of TCA through the papillary dermis

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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