Skin diseases

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  • Harrison's Internal Medicine Chapter 55. Immunologically Mediated Skin Diseases Immunologically Mediated Skin Diseases: Introduction A number of immunologically mediated skin diseases and immunologically mediated systemic disorders with cutaneous manifestations are now recognized as distinct entities with consistent clinical, histologic, and immunopathologic findings. Many of these disorders are due to autoimmune mechanisms.

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  • Pemphigus Vulgaris Pemphigus refers to a group of autoantibody-mediated intraepidermal blistering diseases characterized by loss of cohesion between epidermal cells (a process termed acantholysis). Manual pressure to the skin of these patients may elicit the separation of the epidermis (Nikolsky's sign). This finding, while characteristic of pemphigus, is not specific to this group of disorders and is also seen in toxic epidermal necrolysis, Stevens-Johnson syndrome, and a few other skin diseases.

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  • Pemphigus Foliaceus Pemphigus foliaceus (PF) is distinguished from PV by several features. In PF, acantholytic blisters are located high within the epidermis, usually just beneath the stratum corneum. Hence PF is a more superficial blistering disease than PV. The distribution of lesions in the two disorders is much the same, except that in PF mucous membranes are almost always spared. Patients with PF rarely demonstrate intact blisters but rather exhibit shallow erosions associated with erythema, scale, and crust formation.

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  • Bullous Pemphigoid Bullous pemphigoid (BP) is a polymorphic autoimmune subepidermal blistering disease usually seen in the elderly. Initial lesions may consist of urticarial plaques; most patients eventually display tense blisters on either normalappearing or erythematous skin (Fig. 55-2). The lesions are usually distributed over the lower abdomen, groin, and flexor surface of the extremities; oral mucosal lesions are found in some patients. Pruritus may be nonexistent or severe.

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  • Pemphigoid Gestationis Pemphigoid gestationis (PG), also known as herpes gestationis, is a rare, nonviral, subepidermal blistering disease of pregnancy and the puerperium. PG may begin during any trimester of pregnancy or present shortly after delivery. Lesions are usually distributed over the abdomen, trunk, and extremities; mucous membrane lesions are rare. Skin lesions in these patients may be quite polymorphic and consist of erythematous urticarial papules and plaques, vesiculopapules, and/or frank bullae. Lesions are almost always very pruritic.

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  • Linear IgA Disease Linear IgA disease, once considered a variant form of dermatitis herpetiformis, is actually a separate and distinct entity. Clinically, these patients may resemble individuals with DH, BP, or other subepidermal blistering diseases. Lesions typically consist of papulovesicles, bullae, and/or urticarial plaques predominantly on central or flexural sites. Oral mucosal involvement occurs in some patients. Severe pruritus resembles that seen in patients with DH.

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  • Dermatomyositis The cutaneous manifestations of dermatomyositis (Chap. 383) are often distinctive but at times may resemble those of systemic lupus erythematosus (SLE) (Chap. 313), scleroderma (Chap. 316), or other overlapping connective tissue diseases (Chap. 316). The extent and severity of cutaneous disease may or may not correlate with the extent and severity of the myositis.

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  • Discoid lupus erythematosus. Violaceous, hyperpigmented, atrophic plaques, often with evidence of follicular plugging, which may result in scarring, are characteristic of discoid lupus erythematosus (also called chronic cutaneous lupus erythematosus). Scleroderma and Morphea The skin changes of scleroderma (Chap. 316) usually begin on the hands, feet, and face, with episodes of recurrent nonpitting edema.

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  • Scleroderma often eventuates in development of an expressionless, masklike facies. Morphea is characterized by localized thickening and sclerosis of skin, usually affecting young adults or children. Morphea begins as erythematous or flesh-colored plaques that become sclerotic, develop central hypopigmentation, and demonstrate an erythematous border. In most cases, patients have one or a few lesions, and the disease is termed localized morphea. In some patients, widespread cutaneous lesions may occur, without systemic involvement. This form is called generalized morphea.

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  • For two main reasons, dermatology is one of the later medical disciplines to use imaging techniques: skin lesions are readily visible to the naked eye or through a magnifying glass, allowing clinical diagnosis with no invasive examination; skin lesions can easily be biopsied or removed for histological study. This approach has therefore remained the basis of clinicopathological diagnosis of skin diseases for a long time. There has also been a third factor.

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  • It has long been noted anecdotally that affect, psychological state and neurologic state have influences on inflammatory skin diseases. Disorders such as psoriasis, atopic dermatitis, acne and rosacea, among many others, are reported to become exacerbated by stress. Furthermore, it is widely believed that stress alters cutaneous immunity. However, mechanisms responsible for these effects have remained incompletely understood. Scientific evidence for an influence of the nervous system on immune and inflammatory processes in the skin has been developed only relatively recently.

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  • A–D. The distribution of some common dermatologic diseases and lesions Figure 52-7 Psoriasis. This papulosquamous skin disease is characterized by small and large erythematous papules and plaques with overlying adherent silvery scale.

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  • The skin plays an important role in maintaining the integrity of the living organism while allowing the interaction of the organism with its environment. To fulfill these functions, mechanical stability is as important as flexibility. The mechanical properties of skin are very diverse depending on the anatomical location, and they evolve throughout life from the fetus to old age. Both genetic and acquired skin diseases modify skin biomechanics, as do intrinsic and photoaging.

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  • A number of immunologically mediated skin diseases and immunologically mediated systemic disorders with cutaneous manifestations are now recognized as distinct entities with consistent clinical, histologic, and immunopathologic findings. Many of these disorders are due to autoimmune mechanisms. Clinically, they are characterized by morbidity (pain, pruritus, disfigurement) and in some instances by mortality (largely due to loss of epidermal barrier function and/or secondary infection).

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  • Lupus Erythematosus The cutaneous manifestations of lupus erythematosus (LE) (Chap. 313) can be divided into acute, subacute, and chronic types. Acute cutaneous LE is characterized by erythema of the nose and malar eminences in a "butterfly" distribution (Fig. 55-5). The erythema is often sudden in onset, accompanied by edema and fine scale, and correlated with systemic involvement. Patients may have widespread involvement of the face as well as erythema and scaling of the extensor surfaces of the extremities and upper chest.

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  • Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Activator protein 1 (Fos/Jun) functions in inflammatory bone and skin disease...

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  • Tuyển tập các báo cáo nghiên cứu về hóa học được đăng trên tạp chí sinh học quốc tế đề tài : Social care and changes in occupational accidents and diseases - the situation in Eastern Europe in general and for skin diseases in particular

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  • Malassezia are common lipiddependent fungi that grow on the sebaceous areas of human skin. Malassezia can cause and exacebate several skin diseases: Tinea versicolor, pitirosporum folliculitis and seborrheic dermatitis. Malassezia also have been associated with subsets of psoriasis and atopic dermatitis, especially those affecting the scalp.

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  • This account is confined to therapy directed primarily at the skin. • Pharmacokinetics of the skin • Topical preparations:Vehicles for presenting drugs to the skin; Emollients, barrier preparations and dusting powders;Topical analgesics; Antipruritics; Adrenocortical steroids; Sunscreens • Cutaneous adverse drug reactions • Individual disorders: Psoriasis.Acne, Urticaria, Skin infections It is easy to do more harm than good with potent drugs, and this is particularly true in skin diseases.

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  • Though alternative methods of controlling insects, rodents, insect pests, pathogens, microbes and weeds have been developed, pesticides could not be replaced. The prosperous role of pesticides in the management of insect pests and diseases is indisputable. However, its nature of non selective toxicity towards other organisms and deposition in the environment warrants the legislation of usage. Pesticide use raises a number of environmental concerns.

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