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Pretibial myxoedema: stimulation of mucopolysaccharide production of fibroblasts by serum.
We have shown that sera from normal individuals and from patients with pretibial myxoedema contain a factor which simulates mucopolysaccharide biosynthesis in normal human skin fibroblasts cultured in vitro. This factor was present in larger amounts in sera of patients with pretibial myxoedema. The role of growth stimulating factors in serum is reviewed and a hypothesis is put forward that the fibroblast stimulating factor is somatomedin and that its presence in increased amounts in thyroid disease may lead to pretibial myxoedema.
Sarcoidosis mimicking lipodermatosclerosis.
The clinical presentation of cutaneous sarcoidosis is highly variable. Rare presentations include ulcerated plaques, morpheaform lesions, and unilateral lower extremity edema. We report the case of a woman who presented with unilateral ulcerating sarcoidosis of the lower leg with progressive fibrosis and edema mimicking lipodermatosclerosis. This case is unique in that the patient exhibited all 3 of the rare manifestations of sarcoidosis; to our knowledge, this presentation has not been previously reported in the literature.
A case of calciphylaxis and chronic myelomonocytic leukemia.
A 70-year-old woman presented for evaluation of symmetric necrotic ulcers of the lower extremities. Biopsy results revealed changes consistent with calciphylaxis. The predisposing factors in this patient included calcium supplementation, obesity, female gender, viscous blood, renal failure, and diabetes mellitus. To our knowledge, this is the first report of calciphylaxis occurring in the setting of chronic myelomonocytic leukemia. We discuss the history, clinical presentation, diagnosis, and treatment of calciphylaxis.
Elephantiasis Nostras Verrucosa: a rare thyroid dermopathy in Graves' disease.
Elephantiasis Nostras Verrucosa (ENV) is a rare form of pretibial myxedema, which is nearly always associated with Graves' disease. A case is presented here of Graves' disease who had elephantiasis variety of pre-tibial myxedema (PTM).
[Pathogenesis and principles of conservative and surgical treatment of recurrent erysipelas].
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Tolerance to calcitriol and tacalcitol in three patients with allergic contact dermatitis to calcipotriol.
We describe 3 cases of psoriatic patients who developed a severe eczematous eruption after the use of calcipotriol ointment. For all of them, the dermatitis recovered after the suspension of the calcipotriol ointment and topical application of corticosteroids. We performed patch tests with the standard series of SIDAPA (Italian Society of Environmental, Occupational and Allergological Dermatology), with an integrative series of vehicles and preservatives, with the commercial ointment containing calcipotriol, with its excipients and, finally, with a series of diluted calcipotriol in isopropanol and petrolatum. They all revealed a strong allergic reaction to calcipotriol and also to its dilution in isopropanol (for all patients) and in petrolatum (only one patient). It is interesting to underline that the reactions always occurred on the legs, even if the patients had applied the ointment elsewhere. We can hypothesize that the venom stasis dermatitis of the legs, associated with xerosis, may have favored the penetration of the drug through the skin, increasing the risk of allergic contact sensitization. Finally, cross-reactivity to other vitamin D3 analogue, tacalcitol, and calcitriol was excluded.
Asymptomatic skin coloured plaques over the lower limbs.
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Ichthyosiform sarcoisis.
A 39-year-old woman with a 4-year history of paraparesis developed asymptomatic, ichthyosiform scale on her lower extremities. The lesions consisted of polygonal, pigmented, adherent scales, which were most prominent on the pretibial areas. A biopsy specimen showed granulomatous dermatitis in a patient with pulmonary and neurologic sarcoidosis. Ichthyosiform sarcoidosis is a rare, specific cutaneous manifestation of sarcoidosis, which may be responsive to topical or systemic glucocorticoids.
Linear porokeratosis.
A 66-year-old man presented with linear lesions of 5-years duration on his right lower extremity along Blaschko's lines. Physical examination showed hyperpigmented and violaceous papules with hypopigmented centers that were surrounded by fine, raised hyperkeratototic rims. The lesions were characteristic of porokeratosis, and the diagnosis was confirmed by histopathological examination. Associated medical conditions and treatment modalities are reviewed.
[Cutaneous mucormycosis and diabetes: about one observation].
Mucormycosis is a rare opportunistic infection but a fulminant disease. Varying clinical forms have been described, including cutaneous localisations which are mainly observed in diabetic and burned patients. The cutaneous lesions induced by the mucormycosis affection are often atypical and gangrenous. We report a case of cutaneous mucormycosis in a Tunisian patient with diabetic ketoacidosis. He developed cutaneous necrotic lesions at the low limb. The diagnosis of mucormycosis was not initially evoked but tardily confirmed by identifying mucorale hyphae in tissue sections and Rhizopus oryzae in the sample culture. The treatment consisted of an extensive surgical debridement associated with intravenous perfusion of amphotericin B. The patient had a fatal outcome.
Elephantiasic thyroid dermopathy.
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[A case of Rothmann-Makai syndrome associated with mononeuropathy].
We reported the first case of Rothmann-Makai syndrome associated with mononeuropathy in a 31-year-old woman. In June 1989, she noticed several small subcutaneous nodules in the bilateral upper arms. On July 2, she woke up because of severe pain below the knee in the right leg which lasted 15 hours. On admission, subcutaneous nodules were recognized on bilateral upper arms, abdomen, gluteal regions and thighs. None of these nodules were associated with local heat or pain. Muscle weakness and dysesthesia were observed in the right foot, but deep tendon reflexes were normal. Electrophysiological studies revealed a decrease of the amplitude of action potential and of the conduction velocity in the right tibial nerve. Microscopic examination of skin biopsy showed lipolysis and diffuse lymphocyte infiltration (panniculitis) and perivascular lymphocyte infiltration was also observed. Routine laboratory data including peripheral blood, ESR, blood chemistry, and CRP were in the normal range and antinuclear antibodies and LE cells were not detected. By those findings, she was diagnosed as Rothmann-Makai syndrome associated with mononeuropathy. Steroid treatment was effective on both skin lesions and mononeuropathy. Steroid treatment was effective on both skin lesions and mononeuropathy. We concluded that this mononeuropathy may be induced by a ischemic change which may be caused by panniculitis.
[Diagnostic image (279). A man with swelling and crusts on his lower legs and feet].
A 68-year-old man presented with painful swollen legs due to elephantiasis nostras verrucosa.
Porokeratosis with large skin lesions. Histologic, cytologic and cytogenetic study of three cases.
Three porokeratosis patients with large skin lesion(s) are reported. The histopathology of the large lesions revealed that the epidermis 1) frequently presented slight or marked acanthosis and/or elongation of the rete ridge, and 2) contained abnormal cells, e.g. hyperchromatic, large, multinucleated, and/or irregular shaped nuclei. The DAPI-DNA microfluorometric study revealed DNA polyploidy and/or an increased population of epidermal cells with hyperdiploid and/or tetraploid DNA content. These results indicate the proliferating potential of the epidermis and the existence of a neoplastic clone or clones therein. This finding may explain the enlargement of skin lesions and possibly the development of malignancy, as sometimes occurs in large skin lesions. Furthermore, cultured skin fibroblasts from a patient's skin lesion or its surrounding skin revealed various kinds of chromosomal structural abnormalities, which may serve as a basis for the development of abnormal neoplastic clones in the porokeratotic epidermis.
Superficial actinic porokeratosis and cystic fibrosis.
A 24-year-old woman, presenting with cystic fibrosis, developed superficial actinic porokeratosis. Immunosuppression due to cystic fibrosis may be either the cause of or the exacerbating factor in superficial actinic porokeratosis in our patient.
[Dermatitis from the green lawn].
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