1/11. Epidemic Norwegian scabies.Norwegian scabies is an ectoparasitic infestation by sarcoptes scabiei, characterized by hyperkeratotic lesions of the hands, feet, ears, and scalp, which contain many mites. An epidemic of Norwegian scabies involved 22 patients in a 25-patient ward of mentally and physically handicapped persons (mostly mongoloids). The pathogenesis of the prolific mite population is unclear, but either a specific immunologic deficit or the inability to effectively eliminate the mites by scratching is a plausible possibility.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/11. Case study: erythrokeratodermia variabilis.A 4-year-old girl presented to the dermatology clinic with complaints of erythematous skin lesions on her face, extremities,forearms, and joints. The patient was a product of a full-term, normal pregnancy and delivery and was born to healthy parents. The parents are cousins. The condition started a few months after birth with small, hyperkeratotic patches on her cheeks. These lesions did not respond to the treatment that was given. The condition progressed and a few months later similar skin lesions started to appear on her forearms and knees. Different types of treatment, such as topical antibiotics,emollients, topical steroids, and systemic antihistamines, have been tried without any benefit. Some lesions showed variable exacerbations and remissions. There was no family history of a similar problem, although her older brother showed marginal hair loss without any skin lesions. On physical examination (Figures 1-3), hyperkeratotic erythrodermic plaques of variable thickness with sharply demarcated borders were seen on cheeks, extensor surfaces of forearms, and on the knees. The palms,soles, nails, and teeth were normal. The hair showed normal appearance, but there was no hair growth on the margins of the scalp. The laboratory investigations showed normal complete blood count and normal serum zinc and ferritin levels.urine microscopy and examination was normal. skin biopsy was taken and histopathology showed nonspecific features of hyperkeratosis with moderate papillomatosis and acanthosis (Figure 4). A diagnosis of erythrokeratodermia variabilis was made and the patient was started on emollients as treatment. There was not much improvement with the treatment.- - - - - - - - - - ranking = 10.308659361409keywords = physical examination, physical (Clic here for more details about this article) |
3/11. 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 = 10.308659361409keywords = physical examination, physical (Clic here for more details about this article) |
4/11. Hereditary woolly hair and keratosis pilaris.We describe a family with woolly hair and ulerythema ophryogenes spanning four generations. Both woolly hair and ulerythema ophryogenes have been associated with noonan syndrome and cardiofaciocutaneous syndrome (CFC), two disorders with considerable phenotypic overlap. This family did not exhibit any of the other findings characteristic of either noonan syndrome or CFC, similar to a previously described pedigree with hereditary woolly hair. Woolly hair elicits a broad differential diagnosis, including woolly hair nevus and several genodermatoses. Our report reviews the evaluation of woolly hair and discusses the conditions associated with this physical finding.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/11. child syndrome in 3 generations: the importance of mild or minimal skin lesions.BACKGROUND: child syndrome (congenital hemidysplasia with ichthyosiform nevus and limb defects, Online Mendelian Inheritance in Man 308050) is an X-linked dominant trait with lethality for male embryos. The disorder is caused by mutations in NSDHL (Online Mendelian Inheritance in Man 300275), a gene playing an important role in the cholesterol biosynthetic pathway. Most reports deal with sporadic cases, and only 5 cases of mother-to-daughter transmission have been documented. We present here a family with mild features of child syndrome in 3 generations. Molecular analysis was used to confirm the diagnosis. OBSERVATIONS: We studied 14 members of a family with child syndrome. The 23-year-old proposita, her mother, 2 aunts, and her grandmother presented with mild or minimal skin lesions that had been present since infancy. Analysis of the NSDHL gene showed missense mutation c.370G-->A in these 5 patients. This mutation was absent in the 9 clinically unaffected family members tested. CONCLUSIONS: In this family, we recognized child syndrome with mild or minimal features in 3 generations because we were able to verify our clinical diagnosis by means of molecular analysis. We assume that many cases that so far have been considered sporadic may in fact be familial when a meticulous physical examination of female family members is combined with molecular testing.- - - - - - - - - - ranking = 10.308659361409keywords = physical examination, physical (Clic here for more details about this article) |
6/11. syphilis mimicking Reiter's syndrome in an hiv-positive patient.A 38-year-old man with hiv infection presented with panuveitis, urethritis, and a papulosquamous eruption on his palms and soles. Careful physical and laboratory examination led to the diagnosis of syphilitic keratoderma, uveitis, and balanitis. The patient was successfully treated with penicillin and prednisone therapy. Because the initial presentation was difficult to distinguish from the symptoms of Reiter's syndrome, a high degree of clinical suspicion was required to accurately diagnose syphilis, a curable and potentially fatal disease.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/11. Video game induced knuckle pad.Controversy and concern surround the video game playing fascination of children. Scientific reports have explored the negative effects of video games on youth, with a growing number recognizing the actual physical implications of this activity. We offer another reason to discourage children's focus on video games: knuckle pads. A 13-year-old black boy presented with an asymptomatic, slightly hyperpigmented plaque over his right second distal interphalangeal joint. A punch biopsy specimen confirmed knuckle pad as the diagnosis, and a traumatic etiology from video game playing was suspected. Knuckle pads can be painful, cosmetically unappealing, and refractory to treatment. They can now be recognized as yet another potential adverse consequence of chronic video game playing.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/11. cholesteatoma of the external auditory canal and keratosis obturans.keratosis obturans and external auditory canal cholesteatoma have often been regarded as a single entity. However, these are two distinct disorders with their own clinical presentations, physical and pathologic findings, and treatment. keratosis obturans is an accumulation of obstructive desquamated keratin in the external auditory meatus. External auditory canal cholesteatoma is an invasion and erosion of squamous epithelium into a localized area of the bony ear canal. The origin of both entities remains obscure. The clinical symptoms, pathologic processes, and treatment are outlined and compared. case reports are presented to illustrate the features of these two diseases.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/11. Painful subungual keratotic tumors in incontinentia pigmenti.We report a case of dyskeratotic subungual tumor in a 28-year-old woman. The patient presented achromic lineal lesions, typical of residual incontinentia pigmenti (IP), on her legs. Furthermore, the physical examination showed anodontia of the right incisor tooth. The familial background demonstrated miscarriages of male fetuses and characteristic dental abnormalities of IP in female siblings. The patient's daughter presented a typical background of IP and dyschromic splashed lesions. light and electron microscopic studies of the subungual tumors were made. The analogy between subungual tumors of IP and keratoacanthoma is emphasized.- - - - - - - - - - ranking = 10.308659361409keywords = physical examination, physical (Clic here for more details about this article) |
10/11. acanthosis nigricans presenting as hyperkeratosis of the palms and soles.A patient with an unusual form of palmoplantar hyperkeratosis is described. On thorough physical examination, widespread acanthosis nigricans was discovered. We believe this patient's distinctive keratoderma represents acanthosis nigricans.- - - - - - - - - - ranking = 10.308659361409keywords = physical examination, physical (Clic here for more details about this article) |
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