RESUMEN
Functional disorders within dermatology present as various constellations of skin symptoms, but without evidence of organic pathology. Examples can include mucocutaneous pain syndromes, functional pruritus, somatoform pain disorder and rarer entities, such as undifferentiated somatoform idiopathic anaphylaxis and multiple chemical sensitivity syndrome. These conditions can have a significant impact on a patient's quality of life, and can present challenges in communication, investigation and management. The aetiology of functional disorders is not fully understood, but with an effective collaborative approach, a psychological explanation for these symptoms is often found. A structured approach to assessment can lead to a confident diagnosis, and understanding a patient's belief system and the impact of symptoms on their functioning can give better grounding for successful management. Treatment is dependent on the level of the patient's engagement with healthcare professionals, and often takes a measured and rehabilitative approach. Psychological therapies have been shown to be effective, often alongside both psychopharmacological and topical medications.
Asunto(s)
Anafilaxia , Dolor Crónico , Enfermedades Ambientales , Prurito , Trastornos Somatomorfos , Anafilaxia/diagnóstico , Anafilaxia/terapia , Dolor Crónico/diagnóstico , Dolor Crónico/terapia , Enfermedades Ambientales/diagnóstico , Enfermedades Ambientales/terapia , Humanos , Prurito/diagnóstico , Prurito/terapia , Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/terapiaRESUMEN
Functional - or somatoform - symptoms are those that arise with no proven organic pathology. Also known as 'medically unexplained' symptoms, they can present in any medical speciality, including dermatology. Mucocutaneous pain syndromes and functional pruritus are two examples of functional disorders encountered by dermatologists. Patients presenting with somatoform symptoms have paradoxically complex and often subjectively severe symptomatology, yet minimal abnormalities on clinical examination or investigation. Such disparity can be frustrating and distressing for patients and clinicians alike, and there are many pitfalls regarding overinvestigation and misleading communication. However, with an honest and open approach - sometimes requiring collaboration with psychological services - management of functional symptoms can be effective, and patients can be successfully rehabilitated.
Asunto(s)
Dolor Crónico , Enfermedades Ambientales/psicología , Trastornos Somatomorfos , Anafilaxia , Dolor Crónico/etiología , Dolor Crónico/psicología , Humanos , Prurito/diagnósticoAsunto(s)
Fármacos Dermatológicos/efectos adversos , Isotretinoína/efectos adversos , Salud Mental/estadística & datos numéricos , Trastornos del Humor/inducido químicamente , Acné Vulgar/tratamiento farmacológico , Acné Vulgar/psicología , Depresión/inducido químicamente , Depresión/epidemiología , Depresión/psicología , Dermatólogos/estadística & datos numéricos , Dermatología/organización & administración , Humanos , Trastornos del Humor/epidemiología , Trastornos del Humor/psicología , Prevalencia , Factores de Riesgo , Escocia/epidemiología , Suicidio Completo/estadística & datos numéricos , Encuestas y CuestionariosAsunto(s)
Antipruriginosos/administración & dosificación , Prurito/terapia , Administración Cutánea , Adulto , Anciano , Terapias Complementarias , Erupciones por Medicamentos/complicaciones , Infestaciones Ectoparasitarias/complicaciones , Emociones , Enfermedades del Sistema Endocrino/complicaciones , Predicción , Enfermedades Hematológicas/complicaciones , Humanos , Infecciones/complicaciones , Deficiencias de Hierro , Sobrecarga de Hierro/complicaciones , Hepatopatías/complicaciones , Trastornos Mentales/complicaciones , Neoplasias/complicaciones , Enfermedades del Sistema Nervioso/complicaciones , Fototerapia/métodos , Atención Primaria de Salud , Prurito/diagnóstico , Prurito/etiología , Uremia/complicacionesRESUMEN
Dermatofibrosarcoma protuberans (DFSP), a rare medium grade sarcoma, occasionally occurs in childhood and is even more rarely present at birth. In children, the clinical appearance may be mistaken for a vascular malformation and so delayed diagnosis is not uncommon. Dermatofibrosarcoma protuberans is locally invasive and notorious for its high recurrence rate even after attempted wide local excision owing to extensive subclinical and asymmetrical extensions. In adult DFSP, Mohs Micrographic Surgery (MMS) is the treatment of choice because it offers a higher clearance rate compared to wide local excision. However, MMS may result in extended operating times owing to tissue processing and multiple stages. In children, this means a prolonged period under general anesthetic, which may be undesirable. We describe an interesting case of a 4- year-old girl diagnosed with DFSP. She underwent a modified MMS procedure in which she had two short general anesthetics. The advantage of MMS technique in which the full peripheral and deep margin of the specimen was examined.
Asunto(s)
Contusiones/diagnóstico , Dermatofibrosarcoma/diagnóstico , Cirugía de Mohs , Neoplasias Cutáneas/diagnóstico , Anestesia General/métodos , Preescolar , Dermatofibrosarcoma/patología , Dermatofibrosarcoma/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Recurrencia Local de Neoplasia/prevención & control , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugíaRESUMEN
The dermatoscopic features of classic lentigo maligna (LM) are well described; however, there is little literature available on extrafacial LM, which is a less frequently reported condition. The skin architecture is especially rich in adnexae on sun-exposed areas such as the face, relative to other parts of the body, thus it is possible that the dermatoscopic findings of extrafacial LM will differ from the usual findings of LM. We carried out a dermatoscopic study on three patients with extrafacial LM. The dermatoscopic patterns reflected the underlying histological features of the disease, with increased melanocytes seen along the rete ridges and around follicular ostia, which result in a unique pigment network architecture.
Asunto(s)
Peca Melanótica de Hutchinson/patología , Neoplasias Cutáneas/patología , Anciano , Femenino , Humanos , Persona de Mediana Edad , MuñecaAsunto(s)
Carcinoma Basocelular/tratamiento farmacológico , Neoplasias Nasales/tratamiento farmacológico , Fitoterapia , Sanguinaria , Neoplasias Cutáneas/tratamiento farmacológico , Humanos , Internet , Masculino , Persona de Mediana Edad , Cirugía de Mohs , Preparaciones de Plantas/uso terapéutico , Automedicación/efectos adversosAsunto(s)
Carcinoma Basocelular/secundario , Neoplasias Hepáticas/secundario , Neoplasias Cutáneas/patología , Carcinoma Basocelular/tratamiento farmacológico , Carcinoma Basocelular/radioterapia , Terapia Combinada , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/radioterapiaAsunto(s)
Acrilatos/efectos adversos , Técnicas Cosméticas/efectos adversos , Erupciones por Medicamentos/etiología , Dermatosis Facial/inducido químicamente , Granuloma de Cuerpo Extraño/inducido químicamente , Ácido Hialurónico/efectos adversos , Hidrogeles/efectos adversos , Anciano , Femenino , HumanosRESUMEN
We present an unusual case of eccrine porocarcinoma in that diagnosis was delayed for many years after the initial lesion appeared, resulting in relatively large tumor.
Asunto(s)
Acrospiroma/patología , Pierna , Neoplasias de las Glándulas Sudoríparas/patología , Acrospiroma/cirugía , Anciano , Humanos , Masculino , Invasividad Neoplásica , Neoplasias de las Glándulas Sudoríparas/cirugíaRESUMEN
The guidelines pertaining to prescription of prophylactic antibiotics to prevent endocarditis during dermatological surgery appear clear and well-documented. The British Society for Dermatological Surgery, in agreement with the British Society for Antimicrobial Chemotherapy, state that antibiotic prophylaxis for endocarditis is not required for routine dermatological surgery procedures even in the presence of a pre-existing heart lesion. Pre-existing cardiac lesions include prosthetic valves, history of bacterial endocarditis, congenital cardiac malformation, rheumatic or other acquired valvular dysfunction, hypertrophic cardiomyopathy or mitral valve prolapse with regurgitation. It is important to distinguish between antibiotic prophylaxis for wound infection and that for bacterial endocarditis. Routine procedures, such as punches, shaves, curettage and simple excisions, performed on clean intact skin have an extremely low risk of wound infection (1-4%). The risk of wound infection increases to 5-15% with clean-contaminated skin surgery that includes procedures involving eroded or ulcerated skin, respiratory or buccal mucosa, flexural areas and protracted procedures such as Mohs' micrographic surgery. In such cases, antibiotic prophylaxis may be considered in patients with a cardiac lesion because a wound infection may result in bacteraemia and subsequent endocarditis. This should therefore not be considered 'routine' dermatological surgery. In contaminated, dirty and/or infected classes of wounds the risk of wound infection is higher (> 25%). Elective skin surgery should be postponed if possible until the wound infection is treated with therapeutic antibiotics.
Asunto(s)
Profilaxis Antibiótica/estadística & datos numéricos , Procedimientos Quirúrgicos Dermatologicos , Endocarditis Bacteriana/prevención & control , Enfermedades de las Válvulas Cardíacas/complicaciones , Complicaciones Posoperatorias/prevención & control , Toma de Decisiones , Utilización de Medicamentos , Humanos , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina , Infección de la Herida Quirúrgica/prevención & control , Reino UnidoRESUMEN
The development of a squamous cell carcinoma (SCC) in a linear epidermal naevus is a rare event previously reported in long-standing and often extensive lesions of middle-aged to elderly patients. To the best of our knowledge, this case appears to be only the second report of an SCC arising in a linear epidermal naevus in a young patient and the first report of two SCCs developing in a small epidermal naevus, over a short time, in a young patient with no other risk factors.
Asunto(s)
Carcinoma de Células Escamosas/patología , Neoplasias Primarias Secundarias/patología , Nevo Pigmentado/patología , Neoplasias Cutáneas/patología , Adulto , Femenino , HumanosRESUMEN
INTRODUCTION: The diagnosis of adult-onset Still's disease (AOSD) can be very difficult. There are no specific tests and reliance is usually placed on a symptom complex and the well described typical rash seen in most patients. In recent years, however, other cutaneous manifestations of AOSD have been reported but these are not so well known. OBSERVATIONS: We report a patient with urticaria and fixed plaques and review the other 'atypical' cutaneous findings associated with AOSD. CONCLUSIONS: The diagnosis of AOSD can be made in the absence of the typical Still's rash but in the presence of other atypical cutaneous features.