Nummular Eczema: An Updated Review

2020 ◽  
Vol 14 ◽  
Author(s):  
Alexander K.C. Leung ◽  
Joseph M. Lam ◽  
Kin Fon Leong ◽  
Amy A.M. Leung ◽  
Alex H.C. Wong ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
English Literature ◽  
Contact Allergy ◽  
Correct Diagnosis ◽  
Hot Water ◽  
Lower Limbs ◽  
Pubmed Search ◽  
Annular Lesions ◽  
Key Terms ◽  
Nummular Eczema

Background: Nummular eczema may mimic diseases that present with annular configuration and the differential diagnosis is broad. Objective: This article aimed to provide an update on the evaluation, diagnosis, and treatment of nummular eczema. Methods: A PubMed search was performed in Clinical Queries using the key terms “nummular eczema”, “discoid eczema”, OR “nummular dermatitis”. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to the English literature. The information retrieved from the above search was used in the compilation of the present article. Patents were searched using the key terms “nummular eczema”, “discoid eczema”, OR “nummular dermatitis” in www.google.com/patents and www.freepatentsonline.com. Results: Nummular eczema is characterized by sharply defined, oval or coin-shaped, erythematous, eczematous plaques. Typically, the size of the lesion varies from 1 to 10 cm in diameter. The lesions are usually multiple and symmetrically distributed. Sites of predilection include the lower limbs followed by the upper limbs. The lesions are usually intensely pruritic. The diagnosis is mainly clinical based on the characteristic round to oval erythematous plaques in a patient with diffusely dry skin. Nummular eczema should be distinguished from other annular lesions. Dermoscopy can reveal additional features that can be valuable for correct diagnosis. Biopsy or laboratory tests are generally not necessary. However, a potassium hydroxide wet-mount examination of skin scrapings should be performed if tinea corporis is suspected. Because contact allergy is common with nummular eczema, patch testing should be considered in patients with chronic, recalcitrant nummular eczema. Avoidance of precipitating factors, optimal skin care, and high or ultra-high potency topical corticosteroids are the mainstay of therapy. Recent patents related to the management of nummular eczema are also discussed. Conclusion: With proper treatment, nummular eczema can be cleared over a few weeks, although the course can be chronic and characterized by relapses and remissions. Moisturizing of the skin and avoidance of identifiable exacerbating factors such as hot water baths and harsh soaps may reduce the frequency of recurrence. Diseases that present with annular lesions may mimic nummular eczema and the differential diagnosis is broad. As such, physicians must be familiar with this condition so that an accurate diagnosis can be made, and appropriate treatment initiated.

scholarly journals A RARE CASE OF EXTRADURAL THORACIC SPINAL CHORDOMA WITH MEDULLARY COMPRESSION AND LITERATURE REVIEW

2021 ◽  
Vol 20 (2) ◽  
pp. 237-240
Author(s):  
A. Ene ◽  
◽  
Iulia Elena Petre ◽  
A.N. Dabu ◽  
◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Back Pain ◽  
Thoracic Spine ◽  
Rare Case ◽  
English Literature ◽  
Lower Limbs ◽  
Spinal Tumors ◽  
Histopathological Study ◽  
Low Grade ◽  
Thoracic Spinal

Background. Chordomas are low-grade, slow-growing, but locally invasive and aggressive malignant tumors, arising from the remnants of the embryonic notochord. Given its origin, the distribution of chordomas is along the axial skeleton: 50% of cases in the sacral region, 35% skull base and 15% occur in the vertebral bodies of the spine, which most commonly involve cervical (particularly C2), followed by lumbar, and then the thoracic spine. Without a prompt and aggressive treatment the chances of metastasis are low, but the local recurrence rate is high (about 50%) with a 40% chance of 10-year survival. Objective. Our purpose is to present a rare case of an extradural thoracic chordoma, the importance of differential diagnosis and the management of this case for a better outcome. Case presentation. A 61-year-old man presented with a 1-month history of thoracic back pain, followed by rapidly progressive paraparesis and paresthesia in both lower limbs, and 24 hour urinary retention. MRI of the thoracic spine revealed an contrast-enhancing lesion arising from T5 to T6 vertebral level, with pre and paravertebral extension and medullary compression. The diagnosis of chordoma was made by tissue biopsy and histopathological study. There are few reports of chordomas with this localization in English literature. After surgery, the patient showed slightly good clinical outcome in terms of improvement of muscle strength in lower limbs and back pain decrease in intensity of back pain. Conclusions. Primary chordoma in the thoracic spine is extremely rare (less than 15% of the cases). This case highlights the importance of emergency surgery in the treatment of spinal tumors and the need to consider chordoma as a differential diagnosis for extradural spinal tumors. On the other hand the treatment is challenging because the current literature is lacking in evidence based guidelines due to low incidence.

scholarly journals Neurogenic Thoracic Outlet Syndrome Reviewed

2020 ◽  
Vol 4 (2) ◽  
pp. 709-714
Author(s):  
Ermira PAJAJ ◽  
Ridvan ALIMEHMETI ◽  
Florian DASHI ◽  
Aiola STOJA ◽  
Arsen SEFERI
Keyword(s):  
Differential Diagnosis ◽  
Clinical Characteristics ◽  
Thoracic Outlet Syndrome ◽  
English Literature ◽  
Treatment Options ◽  
Correct Diagnosis ◽  
Motor Deficit ◽  
Surgical Indications ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
Work Up

Neurogenic Thoracic Outlet Syndrome (NTOS) is a rare, but controversial syndrome in relation to its diagnosis, treatment modality, and approaches in case of surgical treatment. In the English literature, there are sparse studies dealing with these aspects. We conducted a PubMed 2000-2017 literature review and found a total of 3953 cases reported with NTOS. The clinical characteristics, etiology, electrophysiological and radiological work-up and treatment options were reviewed and reported. It seems that, as far as surgical indication criteria are concerned, there is a consensus for NTOS in its motor deficit stage and its techniques are generally well established. This review showed that differential diagnosis, radiological, and electrophysiological criteria for correct diagnosis of NTOS are not controversial. However, surgical indications and types of approaches and techniques reflect the surgeon’s affiliation with specialties dealing with NTOS (vascular, plastic, hand, orthopedic or neurosurgeons), and the surgeon’s experience with this specific and rare syndrome.

scholarly journals Phyllodes Tumor of the Breast: Histopathologic Features, Differential Diagnosis, and Molecular/Genetic Updates

2016 ◽  
Vol 140 (7) ◽  
pp. 665-671 ◽  
Author(s):  
Yanhong Zhang ◽  
Celina G Kleer
Keyword(s):  
Differential Diagnosis ◽  
Drug Targets ◽  
Wide Spectrum ◽  
English Literature ◽  
Correct Diagnosis ◽  
Molecular Genetic ◽  
Phyllodes Tumor ◽  
Molecular Pathogenesis ◽  
World Health ◽  
Pathologic Features

Context.—Phyllodes tumor (PT) of the breast is a rare fibroepithelial neoplasm with risks of local recurrence and uncommon metastases. The classification proposed by the World Health Organization for PTs into benign, borderline, and malignant is based on a combination of several histologic features. The differential diagnosis between PT and fibroadenoma and the histologic grading of PT remain challenging. In addition, the molecular pathogenesis of PT is largely unknown. Objective.—To provide an updated overview of pathologic features, diagnostic terminology, and molecular alterations of PT. Data Sources.—Current English literature related to PT of the breast. Conclusions.—Phyllodes tumor shows a wide spectrum of morphology. There are no clearly distinct boundaries between PT and fibroadenoma. Strict histologic assessment of a combination of histologic features with classification can help to achieve the correct diagnosis and provide useful clinical information. The genomic landscapes of PT generated from genomic sequencing provide insights into the molecular pathogenesis of PT and help to improve diagnostic accuracy and identify potential drug targets in malignant PT.

Neoplasia of Gallbladder and Biliary Epithelium

2010 ◽  
Vol 134 (11) ◽  
pp. 1621-1627
Author(s):  
Nora Katabi
Keyword(s):  
Differential Diagnosis ◽  
Liver Biopsy ◽  
Clinical Management ◽  
Invasive Carcinoma ◽  
Wide Spectrum ◽  
English Literature ◽  
Correct Diagnosis ◽  
Data Sources ◽  
Careful Examination ◽  
Biliary Epithelium

Abstract Context.—Diagnosis of biliary neoplasia can be challenging but is essential for the appropriate clinical management of patients. Therefore, it is important to recognize the morphologic features of the biliary neoplasms to report a correct diagnosis. Objectives.—(1) To discuss the differential diagnosis of dysplasia in the gallbladder and differentiate dysplasia from reactive atypia and invasive carcinoma, (2) review the histologic features of adenoma and polypoid biliary lesions, (3) highlight the differential diagnosis of adenocarcinoma in liver biopsy, and (4) discuss the differential diagnosis of atypical biliary glandular lesions. Data Sources.—Current English literature related to gallbladder and biliary neoplasia. Conclusions.—Biliary glandular neoplasms show a wide spectrum of morphology and have many mimics. Careful examination of the histologic features of these lesions and familiarity with their morphology can help to achieve the correct diagnosis.

Can conversation analytic findings help with differential diagnosis in routine seizure clinic interactions?

2016 ◽  
Vol 12 (1) ◽  
pp. 13-24 ◽  
Author(s):  
Katie Ekberg ◽  
Markus Reuber
Keyword(s):  
Differential Diagnosis ◽  
Correct Diagnosis ◽  
Diagnostic Errors ◽  
Epileptic Seizures ◽  
Routine Clinical Setting ◽  
Choice Of Treatment ◽  
Transient Loss ◽  
Factual Content ◽  
Patient’S History ◽  
Linguistic Methods

There are many areas in medicine in which the diagnosis poses significant difficulties and depends essentially on the clinician’s ability to take and interpret the patient’s history. The differential diagnosis of transient loss of consciousness (TLOC) is one such example, in particular the distinction between epilepsy and ‘psychogenic’ non-epileptic seizures (NES) is often difficult. A correct diagnosis is crucial because it determines the choice of treatment. Diagnosis is typically reliant on patients’ (and witnesses’) descriptions; however, conventional methods of history-taking focusing on the factual content of these descriptions are associated with relatively high rates of diagnostic errors. The use of linguistic methods (particularly conversation analysis) in research settings has demonstrated that these approaches can provide hints likely to be useful in the differentiation of epileptic and non-epileptic seizures. This paper explores to what extent (and under which conditions) the findings of these previous studies could be transposed from a research into a routine clinical setting.

Vitiligo: An Updated Narrative Review

2020 ◽  
Vol 16 ◽  
Author(s):  
Alexander K. C. Leung ◽  
Joseph M. Lam ◽  
Kin Fon Leong ◽  
Kam Lun Hon
Keyword(s):  
Present Article ◽  
English Literature ◽  
Disease Onset ◽  
Clinical Manifestations ◽  
Calcineurin Inhibitors ◽  
Ultraviolet B ◽  
Lower Limbs ◽  
Treatment Modalities ◽  
Topical Corticosteroids ◽  
Topical Calcineurin Inhibitors

Background: Vitiligo is a relatively common acquired pigmentation disorder that can cause significant psychological stress and stigmatism. Objective: This article aims to familiarize physicians with the clinical manifestations, evaluation, diagnosis, and management of vitiligo. Methods: A Pubmed search was conducted in Clinical Queries using the key term "vitiligo". The search included metaanalyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to the English literature. The information retrieved from the above search was used in the compilation of the present article. The information retrieved from the above search was used in the compilation of the present article. Results: Approximately one quarter of patients with vitiligo have the onset before 10 years of age. Genetic, immunological, neurogenic and environmental factors may have a role to play in the pathogenesis. Vitiligo typically presents as acquired depigmented, well-demarcated macules/patches that appear milk- or chalk-white in color. Lesions tend to increase in number and enlarge centrifugally in size with time. Sites of predilection include the face, followed by the neck, lower limbs, trunk, and upper limbs. The clinical course is generally unpredictable. In children with fair skin, no active treatment is usually necessary other than the use of sunscreens and camouflage cosmetics. If treatment is preferred for cosmesis, topical corticosteroids, topical calcineurin inhibitors, and narrowband ultraviolet B phototherapy are the mainstays of treatment. Conclusion: The therapeutic effect of all the treatment modalities varies considerably from individual to individual. As such, treatment must be individualized. In general, the best treatment response is seen in younger patients, recent disease onset, darker skin types, and head and neck lesions. Topical corticosteroids and calcineurin inhibitors are the treatment of choice for those with localized disease. Topical calcineurin inhibitors are generally preferred for lesions on genitalia, intertriginous areas, face, and neck. Narrowband ultraviolet B phototherapy should be considered in patients who have widespread vitiligo or those with localized vitiligo associated with a significant impact on the quality of life who do not respond to treatment with topical corticosteroids and calcineurin inhibitors.

Nickel Allergy of the Skin and Beyond

2020 ◽  
Vol 20 (7) ◽  
pp. 1003-1009
Author(s):  
Malena Gergovska ◽  
Razvigor Darlenski ◽  
Jana Kazandjieva
Keyword(s):  
Contact Dermatitis ◽  
Allergic Contact Dermatitis ◽  
Contact Allergy ◽  
Correct Diagnosis ◽  
Large Population ◽  
Modern World ◽  
Nickel Allergy ◽  
Positive Skin ◽  
Diagnostic Potential ◽  
Allergic Contact

Background: Hypersensitization to nickel is one of the most common contact allergies in the modern world and it is considered to be a major cause of contact dermatitis, especially for hand eczema. Objective: The aim of this paper is to describe many faces of the nickel allergy and to find out different diagnostic, potential strategies for treatment and prevention in hypersensitized patients. A personal clinical experience with practical clinical cases of contact dermatitis to nickel has also been presented. Methods: Electronic databases on this topic was carried out using PubMed-Medline. Results: The literature review identified many articles reporting for nickel contact allergy and pointing the metal as number one allergen in the frequency of positive skin patch test reactions in a large population worldwide. Herein, a summary of the current understanding and evidence on nickel allergy with practical approach and proposed recommendations to the dermatologist, general practitioner, and the allergist were prepared. Conclusions: The prevalence of nickel allergy represents an important socio-economical and health issue. Metal is one of the most common sensitizing agents worldwide. The morbidity due to this metal represents the allergic contact dermatitis and it is constantly growing in many countries. There are also cases of systemic allergic contact dermatitis, where they could be easily misdiagnosed as adverse drug reactions, which lead to delay of the correct diagnosis and inappropriate treatment.

scholarly journals Large multicystic spinal lesion in a young African migrant: a problem of differential diagnosis

2021 ◽  
Vol 14 (7) ◽  
pp. e242690
Author(s):  
Tamara Ursini ◽  
Paola Rodari ◽  
Geraldo Badona Monteiro ◽  
Valeria Barresi ◽  
Carmelo Cicciò ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Cystic Echinococcosis ◽  
Bone Cyst ◽  
Spinal Tuberculosis ◽  
Final Diagnosis ◽  
Lower Limbs ◽  
Migration Flow ◽  
Spinal Lesion ◽  
African Migrant ◽  
Expansive Lesion

We describe a rare case of large, fully cystic spinal schwannoma in a young adult from The Gambia. The initial clinical suspicion was spinal cystic echinococcosis. He came to our attention reporting progressive walking impairment and neurological symptoms in the lower limbs. An expansive lesion extending from L2 to S1 was shown by imaging (ie, CT scan and MRI). Differential diagnoses included aneurysmal bone cyst and spinal tuberculosis and abscess; the initial suggested diagnosis of spinal cystic echinococcosis was discarded based on contrast enhancement results. The final diagnosis of cystic schwannoma was obtained by histopathology of the excised mass. Cystic spinal lesions are rare and their differential diagnosis is challenging. Awareness of autochthonous and tropical infectious diseases is important, especially in countries experiencing consistent migration flow; however, it must be kept in mind that migrants may also present with ‘non-tropical’ pathologies.

Eczematous Disorders, Atopic Dermatitis, and Ichthyoses

2018 ◽  
Author(s):  
Seth R Stevens
Keyword(s):  
Atopic Dermatitis ◽  
Differential Diagnosis ◽  
Contact Dermatitis ◽  
Seborrheic Dermatitis ◽  
Inflammatory Dermatosis ◽  
Poison Ivy ◽  
Eczematous Dermatitis ◽  
Total Body ◽  
Allergic Contact ◽  
Nummular Eczema

This review describes eczematous dermatitis, or eczema, a skin disease that is characterized by erythematous vesicular, weeping, and crusting patches; atopic dermatitis, a common chronic inflammatory dermatosis that generally begins in infancy; and the ichthyoses, a group of diseases of cornification that are characterized by excessive scaling. The purpose of this review is to examine the major variants, epidemiology, etiology, diagnosis, differential diagnosis, and treatment of these dermatologic diseases. Figures depict chronic eczematous dermatitis, allergic contact dermatitis to poison ivy, seborrheic dermatitis, nummular eczema, acute eczematous patches, lichenified patches that appear after chronic rubbing of eczematous patches, erythroderma (total body erythema), and marked scaling (acquired ichthyosis). Tables list the diagnostic criteria for atopic dermatitis and the differential diagnosis of atopic dermatitis. This review contains 9 highly rendered figures, 2 tables, and 88 references.

Perianal Lymphangioma Circumscriptum Mistaken for Genital Warts

PEDIATRICS ◽  
1996 ◽  
Vol 98 (3) ◽  
pp. 461-463
Author(s):  
Gary L. Darmstadt
Keyword(s):  
Sexual Abuse ◽  
Differential Diagnosis ◽  
Case Report ◽  
Correct Diagnosis ◽  
Genital Warts ◽  
Diagnosis And Treatment ◽  
Perianal Region ◽  
Anogenital Region ◽  
Left Buttock ◽  
Lymphangioma Circumscriptum

Genital warts are common relative to other verrucous lesions of the anogenital region. Consideration of the differential diagnosis of verrucous anogenital lesions is necessary, however, to make a correct diagnosis consistently and to avoid futile, painful, and possibly traumatic attempts at treatment. In this report, I describe a child with a history suspicious for sexual abuse who was treated with inappropriate measures because of misdiagnosis of perianal lymphangioma circumscriptum as genital warts. The pathogenesis, differential diagnosis, and treatment of lymphangioma is presented. CASE REPORT A 5-year-old Hispanic boy was referred by his pediatrician to the Dermatology Service with an eruption of red papules on the left buttock and perianal region.

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