1/15. Finger 'pebbles'. A dermatologic sign of diabetes mellitus.A 35-year-old obese man presented with a chief complaint of hand dryness of 5 years' duration. He was a store manager and denied exposure to chemicals, repetitive trauma, chronic irritation, and hard manual labor. However, he did admit to frequent hand washing. He had no itching or swelling in his hands, but on occasion he had tenderness in the dry areas. He had no personal or family history of diabetes, heart disease, or renal disease, and he stated that at his annual physical examination 6 months earlier, routine blood work was normal. He reported polyuria (every 2 hours), nocturia (five times per night), and polydipsia but no weakness, weight loss, visual changes, or neurosensory changes. Examination revealed xerosis of his hands and "pebbles" on the dorsal aspect of his fingers. The papules were most dense over the knuckles and interphalangeal joints (figures 1 through 3). He also had dozens of acrochordons (i.e., cutaneous papillomas, or skin tags) 1 to 4 mm in diameter on his neck, axilla, and groin. No other cutaneous lesions were noted. Specifically, there was no scleredema adultorum, necrobiosis lipoidica diabeticorum, acanthosis nigricans, bullae, or patchy pretibial pigmentation, although he did have several brown macules 1 to 5 mm in diameter on the sides of his lower legs. The macules had been present for years. Levels of hemoglobin A1c and glycated hemoglobin were 7.5% and 9.5%, respectively (normal, 4.4% to 5.9% and 5.0% to 7.3%). The patient was referred to his family physician, and his diabetes has been well controlled with insulin.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/15. Novel cases of blastomycosis acquired in Toronto, ontario.blastomycosis a potentially fatal fungal disease, is well known from defined areas of endemicity in ontario, primarily in the northern part of the province. We present 2 unusual cases that appear to extend the area of endemicity into urban southern ontario, specifically Toronto. Both patients presented to a dermatology clinic with skin lesions. Chest radiography, history and general physical evaluation indicated no disease at other body sites. Both cases appeared to represent "inoculation blastomycosis" connected with minor gardening injuries and a cat scratch respectively. Atypical dissemination could not be completely excluded in either case. Neither patient had travelled recently to a known area of high endemicity for blastomycosis, nor had the cat that was involved in one of the cases. physicians must become aware that blastomycosis may mimic other diseases, including dermal infections, and may occur in patients whose travel histories would not normally suggest this infection.- - - - - - - - - - ranking = 0.056923680440995keywords = physical (Clic here for more details about this article) |
3/15. Idiopathic palmoplantar eccrine hidradenitis in children.Idiopathic palmoplantar eccrine hidradenitis (IPPH) is a recently described disorder characterized by painful erythematous plantar nodules and in three cases, showed a typical neutrophilic infiltrate around and within the eccrine sweat apparatus. Five cases of IPPH on the soles of the feet in healthy children are reported. The disorder presented after intense physical activity in four cases. The course was benign and self-limiting. Complete bed rest for several days without any medical therapy led to alleviation of the pain and disappearance of all the lesions. Conclusion. Idiopathic palmoplantar eccrine hidradenitis may be more common than reported. Paediatricians should be aware of it in order to avoid unnecessary diagnostic tests and treatments.- - - - - - - - - - ranking = 0.056923680440995keywords = physical (Clic here for more details about this article) |
4/15. Contact dermatitis due to printer's ink in a milk industry employee: case report and review of the allergen paraphenylenediamine.Paraphenylenediamine is a common cause of occupational dermatoses in hairdressers, metallurgy workers, and others. hand dermatitis developed in an employee of a milk packaging facility. The employee's hands were exposed to milk cartons embossed with wet printer's ink on a daily basis for 2 years. The worker was evaluated through a history, physical examination, and patch testing with 50 standard allergens. Patch testing revealed a positive reaction to paraphenylenediamine. The hand dermatitis resolved once the patient instituted protective measures. The worker's reaction might represent a delayed-type hypersensitivity reaction to printer's ink that contained this agent. More likely, the inciting agent was some other ingredient of the printer's ink that cross-reacts with paraphenylenediamine.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/15. Nargile (Hubble-Bubble) smoking-induced hand eczema.A 65-year-old retired man with hand eczema presented to the dermatology clinic in October of 2001. He complained of scaly, fissured plaque-type lesions over the radial margin of his right index finger and thumb (Fig. 1). He first noticed these changes 2 years ago.There was no history of irritation from his occupation. None of the other family members were affected. There was no history of atopy or psoriasis. The physical examination was remarkable for scaly, fissured, hyperkeratotic patches on the palms and palmar surfaces of the finger tips of the right hand. No nail changes were noted. The other fingers were free from lesions.There were no changes on the feet or soles. A diagnosis of eczema was suspected. hobbies and repeated trauma to the hands were investigated. He had a habit of "nargile" smoking,starting at 35 years of age and he was using this apparatus more than 2 h a day. We performed patch tests with European standart test serial and they were negative. Yeast examination using KOH was negative. The diagnosis of Nargile (Hubble-bubble) eczema was made. It was advised that he stop smoking. Mild topical corticosteroids and emollient with urea were started. Clinical evaluation demonstrated resolution of the lesions after 2 weeks of therapy.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/15. dermatitis artefacta?A 35-year-old man presented with a 2-month history of intensely pruritic excoriated and crusted linear lesions on the dorsa of the left hand and left forearm (Fig 1). The patient had worked in construction for 2 years, and his job consisted mainly in covering the facades of buildings with cement. The patient was right-handed and used a black rubber glove as a protective measure only on his left hand (Fig 2). He reported that the lesions resolved partially during holidays and weekends and clearly flared in association with his work. There was no history of atopic dermatitis, drug use, or intolerance to metals, rubber, or fruits. On physical examination, linear excoriations with crusts were observed on the dorsa of the left hand, extending to the ventral and dorsal aspects of the forearm, involving the whole area that was in contact with the glove. Lichenified erythematous plaques and excoriations on the dorsal surface of the metacarpophalangeal joints and scaly lesions on the dorsal surfaces of the fingers were also present. On the palm, only discrete hyperkeratosis was seen. The right hand and forearm were free of lesions. He complained of intense pruritus when wearing the rubber glove and admitted to continuous scratching to relieve his discomfort, inducing the linear and excoriated lesions. Treatment with topical corticosteroids was initiated, with progressive resolution of the lesions.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/15. Acrokeratosis paraneoplastica (Bazex syndrome): an atypical presentation.A 62-year-old male presented with a 2-year history of hyperkeratotic lesions of the hands and feet. Previous treatment with topical steroids was unsuccessful. A complete physical examination revealed the presence of blood in the stool, and sigmoidoscopy showed an ulcerative growth at the rectosigmoid junction. The histopathology showed adenocarcinoma.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/15. Acrokeratoelastoidosis.A 45-year-old white woman presented with several years' history of firm, shiny papules on the lateral hands with slight extension to the dorsal fingers. The lesions first appeared between the index fingers and thumbs on both hands. They gradually increased in number, coalescing into plaques and affecting the junction between the palmar and dorsal skin. The patient did not have involvement of her feet. She had been diagnosed previously with chronic eczema that had failed to respond to multiple topical medications. In addition, the patient's sister had similar lesions on both hands. The patient denied any symptoms of hyperhidrosis, excessive sun exposure, or trauma. The plaques were asymptomatic, but were cosmetically unappealing to the patient. On physical examination, small, firm, skin-colored, hyperkeratotic papules, coalescing into plaques, were located on the junction between the palmar and dorsal skin on both lateral margins of the thumb and on the radial side of the index finger (Fig. 1). There were no lesions on the feet. A biopsy taken from a papule on the patient's left hand was consistent histologically with acrokeratoelastoidosis. The biopsy showed marked degeneration of collagen in the dermis with solar elastosis and some smudging of the papillary dermal collagen (Fig. 2). She was treated with clobetasone cream to the affected areas on the hands. After 6 weeks of treatment, she reported no significant improvement.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/15. Successful treatment of hand and foot psoriasis with efalizumab therapy.hand and foot psoriasis can appear in a plaque-type or pustular-type form. Any form of psoriasis that occurs on the hands and feet can have a debilitating effect on the patient's daily functions. Here we present a case series of patients with plaqueor pustular-type hand and foot psoriasis whose conditions were successfully managed with the biologic agent efalizumab. In many of these patients, the disease was refractory to multiple systemic psoriasis treatments. Treatment with efalizumab was effective and well-tolerated, with few adverse events. Many of the patients described here reported an improvement in both their physical functioning and health-related quality of life. The efficacy of efalizumab in treating these cases of hand and foot psoriasis suggests that it may provide therapeutic benefit.- - - - - - - - - - ranking = 0.056923680440995keywords = physical (Clic here for more details about this article) |
10/15. keratoacanthoma necessitating metacarpal amputation.keratoacanthoma is usually considered a benign self-limiting lesion. First described in 1888 by Hutchinson, it most commonly involves the face and hands. It is usually controlled by complete soft tissue excision. A variant, subungual keratoacanthoma, affects bone by pressure erosion of the distal phalangeal tip. We report a case of keratoacanthoma clinically involving a metacarpal and phalanges with a radiologic and physical appearance at variance with previous reports. After multiple recurrences following erosion and cryosurgery, as well as attempted digit salvage with Mohs' surgery, ray amputation was required. The world literature pertaining to keratoacanthoma is reviewed and discussed.- - - - - - - - - - ranking = 0.056923680440995keywords = physical (Clic here for more details about this article) |
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