1/10. Sinus histiocytosis (Rosai-Dorfman disease) clinically limited to the skin.Sinus histiocytosis with massive lymphadenopathy (SHML) is an idiopathic proliferation of unique histiocytes that have vesicular nuclei and voluminous pale cytoplasm, often with emperipolesis. Pure cutaneous involvement is very rare. We describe a patient with SHML limited to the skin whose lesion has spontaneously regressed. A 35-year-old Korean male visited the Department of dermatology due to facial rash for 2 months. A 3 x 3.5 cm-sized well-demarcated dark erythematous nontender plaque was noted on the right cheek. skin biopsy showed dense, nodular infiltrates of histiocytes with abundant cytoplasm and vesicular nuclei rimmed by lymphoplasma cell aggregates throughout the upper and mid-dermis. The histiocytes were immunohistochemically positive for S-100 protein and CD68, but negative for CD1a. Laboratory tests and a thorough physical examination revealed no abnormalities. These findings suggested that this was a case of SHML clinically limited to the skin. The skin lesion was initially resistant to steroid therapy, but began to regress 10 months after the onset without further treatment.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/10. Excessive concern with physical appearance leading to a diagnosis of adrenal adenoma.We report an unusual case of Cushing's syndrome manifested by anxiety over body image in a 26-year-old nurse. Initial presentation was a 'dermatological non-disease'. Clinical signs became increasingly evident during the course of the disease, justifying an adrenal gland evaluation which showed a secreting adrenocortical adenoma. Surgical treatment led to recovery with return to normal appearance and cessation of her aesthetic complaints. Our observation shows that persistent aesthetic complaints may sometimes reveal early hypercorticism.- - - - - - - - - - ranking = 0.40855415640609keywords = physical (Clic here for more details about this article) |
3/10. Necrotic facial papules in an adolescent: C2 deficiency with eventual development of lupus erythematosus.A 14-year-old girl was admitted to the hospital because of persistent throat pain, fever, fatigue, 25 pound weight loss, and leukopenia. On physical examination she was thin, ill-appearing, and had necrotic papules on the face and palpable cervical lymph nodes. Presumptive differential diagnosis included occult malignancy and infection. Numerous investigative procedures failed to elucidate a source. vasculitis was eventually appreciated after repeat skin biopsy. Numerous serologic studies were performed and were notable for a very low level of the second component of complement without direct evidence of lupus erythematosus (LE) or other autoimmune conditions. A diagnosis of C2 deficiency-associated vasculitis was made. She was treated with high-dose prednisone and cyclophosphamide with resolution of her symptoms. Two years later she returned with marked malar erythema. Antinuclear and Smith antibodies were then detected and a diagnosis of LE was made. She was treated with hydroxychloroquine and sun-avoidance measures with clearance of the malar rash.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/10. Successful treatment of recalcitrant chronic actinic dermatitis with tacrolimus.Therapeutically, chronic actinic dermatitis is a problematic condition. Frequently applied sunscreen usually fails to mitigate the clinical symptoms, and steroids--while efficient--exert many undesired side-effects with prolonged usage. We present a case of chronic actinic dermatitis responding well to topically applied tacrolimus (Protopic) in combination with chemical and physical UV protection.- - - - - - - - - - ranking = 0.10213853910152keywords = physical (Clic here for more details about this article) |
5/10. Recurrent ectopic calcification involving the maxillofacial skeleton: A potential harbinger of Albright's osteodystrophy.We present a case of osteoma cutis as the initial presenting sign of Albright's osteodystrophy. Albright's osteodystrophy represents a challenge in both diagnosis and treatment because the phenotype manifests as a broad spectrum of biochemical and physical findings. The syndrome may be overlooked, particularly in the early phases when serum calcium and phosphorous levels may be normal. Although surgery is the treatment of osteoma cutis, recurrence is common, creating frustration for the patient's family and the surgeon. In the present case, a girl 4 months and 2 years of age presented with refractory ectopic calcification emanating from the maxilla and demonstrated repeated recurrence after surgical resection. This ectopic calcification was not adequately controlled until Albright's osteodystrophy was properly diagnosed and treated. A differential diagnosis and surgical approach to deal with recurrent ectopic calcification of the facial skeleton is outlined.- - - - - - - - - - ranking = 0.10213853910152keywords = physical (Clic here for more details about this article) |
6/10. What is standard of care in the evaluation of elastosis perforans serpiginosa? A survey of pediatric dermatologists.Elastosis perforans serpiginosa is a rare chronic dermatosis characterized by extrusion of altered elastic fibers through the epidermis. It often occurs in association with a variety of connective tissue disorders, and may develop following penicillamine therapy; however, it may also present without comorbidities. There are currently no well-established protocols for the investigation of possible associated disorders in patients who present with elastosis perforans serpiginosa. We describe three patients with idiopathic elastosis perforans serpiginosa seen at our clinic and review the standard of care among 31 pediatric dermatologists surveyed who have cared for such a patient within the last 2 years. Based upon the results of our survey, we conclude that most pediatric dermatologists limit their evaluation of such patients to a thorough patient history and physical examination. This limited approach may be a sufficient evaluation in affected patients who are otherwise healthy.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/10. dermatitis artefacta of the paraoral region.Factitial injuries constitute a group of lesions that relate only in the manner in which they are produced and have no particular physical appearance. The possibility of correctly diagnosing a factitial injury is difficult unless this unusual condition is considered in a differential diagnosis. In this article, a case report of factitial injury of the paraoral soft tissue in a 33-year-old white man is presented. A review of self-mutilation and of the psychological aspects of self-destructive behavior is also included.- - - - - - - - - - ranking = 0.10213853910152keywords = physical (Clic here for more details about this article) |
8/10. Xanthoma disseminatum: an unusual cause of facial and limb deformity.A rare case of xanthoma disseminatum producing deformity of the head, neck, and extremities is reported. This pathologically benign disease, considered to represent one of the histiocyte proliferative disorders, is manifested by numerous cutaneous xanthomas primarily in flexion areas. Progressive enlargement of these lesions accompanied by marked fibrosis has produced the severe cosmetic and functional deformities described in this patient. Treatment in this case involved excision of xanthomatous contraction bands with split-thickness skin grafting, followed by intensive physical therapy.- - - - - - - - - - ranking = 0.10213853910152keywords = physical (Clic here for more details about this article) |
9/10. A case of hydroa vacciniforme with unusual ear mutilation.A 22 year-old man visited our department with a 18-year-history of recurrent vesicular eruption on his skin when exposed to the sun. history revealed that the skin lesions developed as vesicles at first, then over the next several days, they formed crusts and healed with scarring. We were able to induce skin lesions by a repetitive UV-A provocation test. By the clinical and histologic features of the induced lesions, the case was diagnosed as hydroa vacciniforme (HV). However, no vesicular lesions were found on physical examination. Instead, in addition to varioliform scarring, we found various unusual clinical manifestations: burn-like lesions and crusts, flexion contracture of the digitum, and ear lobe mutilation. The ear lobe mutilation, which had not been reported previously in HV, was especially interesting.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
10/10. Complications of cutaneous laser resurfacing: a nursing guide.Laser use for various cutaneous conditions has advanced rapidly in the past several years. Initial background and physical history is important when determining if a patient is a candidate for laser resurfacing. nurses must be able not only to identify appropriate candidates preoperatively, but to discuss the risks associated with the procedure. Because proper postoperative management is critical to the healing process, nurses must identify complications early in their course to provide appropriate intervention and, thus, reduce long-term side effects.- - - - - - - - - - ranking = 0.10213853910152keywords = physical (Clic here for more details about this article) |
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