20 Jaundice#e856

Q: Q: WHAT TEGUMENT IS ?WHAT TEGUMENT IS ?A:A:

Simply:Simply:

““scientific definition”scientific definition”


Simply:Simply: = “WHAT COVERS” the body= “WHAT COVERS” the body



Simply:Simply: = “WHAT COVERS” the body= “WHAT COVERS” the body


= is the outer covering of = is the outer covering of living tissueliving tissue

QQWHAT ARE TEGUMENTUM FUNCTION ? WHAT ARE TEGUMENTUM FUNCTION ? AA

QQWHAT ARE TEGUMENTUM FUNCTION ? WHAT ARE TEGUMENTUM FUNCTION ? AA

1.1. Sensation (feeling)Sensation (feeling)2.2. heat regulationheat regulation3.3. excretionexcretion4.4. Contribute to immune systemContribute to immune system5.5. storage and synthesisstorage and synthesis

? Thickness? Thickness

? Surface? Surface ==

? Appearance:? Appearance:

? Thickness? Thickness Between: 0,2 - 0,5 mm Between: 0,2 - 0,5 mm →→ 4 - 8mm 4 - 8mm

? Surface? Surface ==



? Surface? Surface == 1,5 - 2 m 1,5 - 2 m22



? Surface? Surface == 1,5 - 2 m 1,5 - 2 m22

? Appearance:? Appearance:– folds:folds: coarsely, discreet, fine, etccoarsely, discreet, fine, etc

– ““pores”pores” (infundibular depressions)(infundibular depressions)–– the the openings of sudoriferous or sebaceous glandsopenings of sudoriferous or sebaceous glands

Q:Q: How many layers tegument have How many layers tegument have ??

A:A:

Q:Q: How many layers tegument have How many layers tegument have ??

A:A: 3 layers 3 layers

1.1. The epidermis:The epidermis: Role:Role: Layers of cellsLayers of cells

2.2. The dermis:The dermis: Role:Role: nutrition, skin analyzer nutrition, skin analyzer

3.3. The hypodermis:The hypodermis: Role:Role: tegument support tegument support

What are the SKIN GLANDS ?What are the SKIN GLANDS ?

What are the SKIN GLANDS ?What are the SKIN GLANDS ?

Sudoriferous glands:Sudoriferous glands: = = merocrinemerocrine glands glands

– – produce sweatproduce sweatSebaceous glandsSebaceous glands

= = holocrineholocrine glands glands - produce produce sebumsebum

What are the What are the visiblevisible annexa of skin ? annexa of skin ?

What are the What are the visiblevisible annexa of skin ? annexa of skin ?

1.1. NAILS NAILS 2.2. HAIRHAIR

What pruritus (itch) is ?

Produced by :

Cause:

What pruritus (itch) is ? = cutaneous symptom Experienced as An “attenuated pain”

Produced by :

Cause:

What pruritus (itch) is ? = cutaneous symptom Experienced as An “attenuated pain”

Produced by : irritation of skin nerves

Cause:– Genetic factors– Emotion ( Psychological factor)

Which are the Secondary lesions in pruritus:

Which are the Secondary lesions in pruritus:

1. excoriations2. lichenification3. cutaneous infections4. local pigmentations5. degraded nails

Q PRURITUS CLASIFICATION:

Q PRURITUS CLASIFICATION:

1. SECONDARY

(Determined by cutaneous affections)

2. PRIMITIVE (“SINE MATERIA”)

a) GENERALIZED

b) LOCAL

Q. Q. Common causes of systemic pruritusCommon causes of systemic pruritus

Q. Q. Common causes of systemic pruritusCommon causes of systemic pruritus

1.1. JaundiceJaundice2.2. Cancers ( called paraneoplasic pruritus)Cancers ( called paraneoplasic pruritus)3.3. Diabetes mellitus Diabetes mellitus 4.4. UremiaUremia5.5. Parasitic infections, ScabiesParasitic infections, Scabies6.6. Old age (Senile pruritus)Old age (Senile pruritus)7.7. Drugs allergy (Drugs allergy (associated with skin eruptionassociated with skin eruption))8.8. PsychologicalPsychological

Woman: VulvarWoman: Vulvar Diabetes mellitusDiabetes mellitus menopause menopause cancercancer psychogenicpsychogenicMen: Scrotal/PenianMen: Scrotal/Penian Diabetes mellitusDiabetes mellitus CancerCancer Urinary tract infections Urinary tract infections psychogenicpsychogenic

Nasal:Nasal:• asthma, allergic asthma, allergic

rhinitis rhinitis • lambliase (children)lambliase (children)• morphinomaniamorphinomania

Scalp:Scalp: alcohol abusealcohol abuseAuricularAuricular

• diabetes mellitusdiabetes mellitus

Anal:Anal:• parasitic infectionsparasitic infections• hemorrhoidshemorrhoids

Q. Common site and cause of local pruritusQ. Common site and cause of local pruritus

skin colour changesskin colour changes are due to ?are due to ?

skin colour changesskin colour changes are due to ?are due to ?A: A: pigments ( 4 natural pigments ( 4 natural ± pathologic ones)± pathologic ones) melanin (brown)melanin (brown) oxyhemoglobin (bright red) oxyhemoglobin (bright red) deoxyhemoglobin (more bluish) deoxyhemoglobin (more bluish) carotene (yellow)carotene (yellow)

Special conditions/pathologic ones:Special conditions/pathologic ones: hemosiderinhemosiderin bilirubinbilirubin metalsmetals

REMEMBER REMEMBER !!!

The examination of skin color must be done in sunlight

What are skin colour changes ?What are skin colour changes ?

What are skin colour changes ?What are skin colour changes ?

1.1. PALLORPALLOR

2.2. CYANOSISCYANOSIS

3.3. JAUNDICEJAUNDICE

4.4. HYPERCAROTENEMIAHYPERCAROTENEMIA

5.5. CHANGES OF SKIN PIGMENTATIONCHANGES OF SKIN PIGMENTATION

6.6. HYPEREMIAHYPEREMIA

What mean pallorWhat mean pallor ? ?

Causes by: ???Causes by: ???

Sites where the Pallor is best appreciated ?Sites where the Pallor is best appreciated ?

What mean pallorWhat mean pallor ? ?= lighter color of the skin and visible mucosae= lighter color of the skin and visible mucosae

Causes by: ???Causes by: ???



Causes by: ???Causes by: ??? – a reduced amount of oxyhemoglobina reduced amount of oxyhemoglobin



Causes by: ???Causes by: ??? – a reduced amount of oxyhemoglobina reduced amount of oxyhemoglobin

Sites where the Pallor is best appreciated ?Sites where the Pallor is best appreciated ?At thinnest epidermis !!! : At thinnest epidermis !!! :

1.1. palpebral conjunctivapalpebral conjunctiva2.2. palmar skin palmar skin 3.3. fingernailsfingernails4.4. lipslips5.5. TongueTongue

? Definition of ? Definition of CYANOSISCYANOSIS

? Cause of cianosis? Cause of cianosis

Characteristic Characteristic

? Definition of ? Definition of CYANOSISCYANOSIS = bluish color of the skin and mucosal surfaces= bluish color of the skin and mucosal surfaces ? Cause of cianosis? Cause of cianosis

Characteristic Characteristic

? Definition of ? Definition of CYANOSISCYANOSIS = bluish color of the skin and mucosal surfaces= bluish color of the skin and mucosal surfaces ? Cause of cianosis? Cause of cianosis = presence of reduced Hb in the blood (= presence of reduced Hb in the blood ( 5g/dl) 5g/dl) Characteristic Characteristic

? Definition of ? Definition of CYANOSISCYANOSIS = bluish color of the skin and mucosal surfaces= bluish color of the skin and mucosal surfaces ? Cause of cianosis? Cause of cianosis = presence of reduced Hb in the blood (= presence of reduced Hb in the blood ( 5g/dl) 5g/dl) Characteristic Characteristic Disappears with digital pressureDisappears with digital pressure

REMEMBERREMEMBERFalse cyanosis doesn’t disappear with digital pressureFalse cyanosis doesn’t disappear with digital pressure

?? Cause of central cyanosis?? Cause of central cyanosis

Mechanism Mechanism

Characteristics of CENTRAL CYANOSIS :Characteristics of CENTRAL CYANOSIS :

?? Cause of central cyanosis?? Cause of central cyanosis PULMONARY (respiratory insufficiency)PULMONARY (respiratory insufficiency)

Mechanism Mechanism



Mechanism Mechanism low arterial oxygen saturation in the lungslow arterial oxygen saturation in the lungs



Mechanism Mechanism low arterial oxygen saturation in the lungslow arterial oxygen saturation in the lungs

Characteristics of CENTRAL CYANOSIS :Characteristics of CENTRAL CYANOSIS : Generalized Generalized WarmWarm Negative Lewis test Negative Lewis test

((cyanosis not disappear with ear lobe rubbingcyanosis not disappear with ear lobe rubbing)) OxygenOxygen administered by masc administered by masc correct cyanosiscorrect cyanosis

?? Other Cause of central cyanosis?? Other Cause of central cyanosis

It is influenced by oxygen administration ?It is influenced by oxygen administration ?


heart disease (HD) heart disease (HD)

Congenital HD with right-to-left shunt Congenital HD with right-to-left shunt

It is also called “the blue syndrome” It is also called “the blue syndrome”



heart disease (HD) heart disease (HD)

Congenital HD with right-to-left shunt Congenital HD with right-to-left shunt

It is also called “the blue syndrome” It is also called “the blue syndrome”


NONO

JAUNDICEJAUNDICE(also called icterus)(also called icterus)

Definition: the Definition: the yellow coloryellow color of skin and mucosae of skin and mucosae

caused by a high level of seric bilirubincaused by a high level of seric bilirubin does not disappear with digital pressure does not disappear with digital pressure Bilirubin colors the elastic tissue digital pressure emphasizes the jaundice

!!! Icterus must be examined in sunlight, !!! Icterus must be examined in sunlight, because artificial lights distorts colours, because artificial lights distorts colours, being visible only the verdinicterus/ being visible only the verdinicterus/ melasicterusmelasicterus

Better seen on:Better seen on:1.1. The The bulbar conjunctivesbulbar conjunctives

(visible at the level of inferior fornix of (visible at the level of inferior fornix of conjunctivae)conjunctivae)

2.2. Under the tongueUnder the tongue3.3. Hard palateHard palate4.4. The lipsThe lips (after digital pressure)(after digital pressure)

JAUNDICEJAUNDICE

plasma bilirubin value : 0,5 – 1 mg%plasma bilirubin value : 0,5 – 1 mg% If bilirubin exceeds 7 mg %, If bilirubin exceeds 7 mg %, the jaundice becomes more obvious both the jaundice becomes more obvious both for the patient and entouragefor the patient and entourage

In natural hyperpigmentated patients, In natural hyperpigmentated patients, icterus is put in evidence by:icterus is put in evidence by:

Plasma aspectPlasma aspect Urine color changesUrine color changes Seminal fluid color changesSeminal fluid color changes Serosae color changesSerosae color changes

JAUNDICEJAUNDICE

!!XANTHOPSIAXANTHOPSIA= a visual disturbance in which = a visual disturbance in which

objects appear yellow due to objects appear yellow due to problem of the eye (dyeing of problem of the eye (dyeing of ocular media)ocular media)

JAUNDICEJAUNDICE

Differential diagnosticDifferential diagnostic of jaundice of jaundice

is done withis done with::

HypercarotenimaHypercarotenima

Chronic renal failureChronic renal failure

JAUNDICEJAUNDICE

Depending on shade Orange – hepatocellular icterus

Flavin – hemolytic jaundice, hepatocellular icterus associated

Rubin – leptospiroses (icterus + fever)

Verdin - mechanical icterus, critical hepatocellular

icterus- due to the convertion of bilirubin into

biliverdin;- associated with pruritus

Melas – pancreatic head cancer (there is a large amount of biliar salts and biliverdin at the level of tegumentum)

JAUNDICEJAUNDICEclassificationclassification

RUBINIC JAUNDICERUBINIC JAUNDICE

ORANGE JAUNDICEORANGE JAUNDICE

VERDINIC JAUNDICEVERDINIC JAUNDICE

HYPERCAROTENEMIAHYPERCAROTENEMIA

carotenoids carotenoids = are lipid soluble compounds = are lipid soluble compounds which give the yellow to yellow-orange which give the yellow to yellow-orange discoloration of the skin (adipose tissue)discoloration of the skin (adipose tissue)

the color change is most prominent in the color change is most prominent in

regions of increased regions of increased sweating (face) and sweating (face) and thickness of the stratum corneum (palms thickness of the stratum corneum (palms

and soles)and soles)

Primary hypercarotenemiaPrimary hypercarotenemia (CAROTENODERMA) (CAROTENODERMA) – – due to increased dietary foods intake or due to increased dietary foods intake or

nutritional supplements (children – yellow nutritional supplements (children – yellow parsnips)parsnips)

Conditions associated with hypercarotenemia:Conditions associated with hypercarotenemia: Simmonds disease Simmonds disease (secondary panhypopituitarism)(secondary panhypopituitarism) MyxedemaMyxedema DiabetesDiabetes Chronic renal failureChronic renal failure EunuchesEunuches

HYPERCAROTENEMIAHYPERCAROTENEMIAclassificationclassification

! Carotenoderma is CLINICALLY ! Carotenoderma is CLINICALLY differentiated from jaundice differentiated from jaundice by the characteristic by the characteristic sparing of the sparing of the

ConjunctivaConjunctiva urine and urine and FecesFeces

! Existence of carotenoderma invalidates the ! Existence of carotenoderma invalidates the malabsorption syndromemalabsorption syndrome



DISORDERS OF PIGMENTATIONDISORDERS OF PIGMENTATION

MELANIN MELANIN = The main cutaneous pigment = The main cutaneous pigment

produced by produced by melanocytesmelanocytes

The number of melanocytes is the same for all The number of melanocytes is the same for all

races (inclusively for albinos), but races (inclusively for albinos), but

the number of melanin granules variesthe number of melanin granules varies

MelanocytesMelanocytes predominates in: predominates in:

axillas axillas genital regionsgenital regions AreolasAreolas elbows,elbows, kneesknees

Rare location: Rare location: mucosae, palms and solesmucosae, palms and soles

Melanogenesis Melanogenesis = is hormonally controlled= is hormonally controlled

↑ ↑ by MSH (→ stimulated in ACROMEGALY, ADDISON by MSH (→ stimulated in ACROMEGALY, ADDISON dis.)dis.)

↓ ↓ by catecholamine, corticosteroids, estrogensby catecholamine, corticosteroids, estrogens


Melanin → melanoid→ excoriation → Melanin → melanoid→ excoriation →

corneous layer corneous layer

→ → YELLOISH - SOIL colorYELLOISH - SOIL color


DISORDERS OF PIGMENTATIONDISORDERS OF PIGMENTATIONclassification classification

Disorders of

pigmentation

HYPOPIGMENTATION

GENERALIZED

LOCAL

HYPERPIGMENTATION

GENERALIZED

LOCAL

DISCOLORATIONS

GENERALIZED HYPOPIGMENTATIONGENERALIZED HYPOPIGMENTATION

AlbinismAlbinism = genetic disease = genetic disease• TotalTotal- - with with amelanosisamelanosis • PartialPartial - only the eyes lack pigment - only the eyes lack pigment

Total oculocutaneous albinismTotal oculocutaneous albinism The most obvious example of hypopigmentation The most obvious example of hypopigmentation Genetic disease (autosomal recessive) with:Genetic disease (autosomal recessive) with:

white tegument,white tegument, northern white hair,northern white hair, decolorized iris through which the eye fundus is seendecolorized iris through which the eye fundus is seen Decreased visual acuiity, nistagmus, photophobiaDecreased visual acuiity, nistagmus, photophobia skin cancers on the regions exposed to sunlight ( ! skin cancers on the regions exposed to sunlight ( !

frequent )frequent )

LOCAL HYPOPIGMENTATIONLOCAL HYPOPIGMENTATION

PhenylketonuriaPhenylketonuria– an inherited metabolic disorder an inherited metabolic disorder – caused by an enzyme deficiency caused by an enzyme deficiency – resulting in accumulation in the blood of resulting in accumulation in the blood of

phenylalanine and its metabolitesphenylalanine and its metabolites

– severe mental retardationsevere mental retardation, , – decolorized hair and irisdecolorized hair and iris

((comparing with the rest of familycomparing with the rest of family) ) – urine ”smelling like mouse”urine ”smelling like mouse”

LOCAL HYPOPIGMENTATIONLOCAL HYPOPIGMENTATION

OTHERS: OTHERS: Biermer diseaseBiermer disease burns, scarsburns, scars melanocytes deficiency in melanocytes deficiency in protein deficienciesprotein deficiencies shadows around the nevi shadows around the nevi Simmonds diseaseSimmonds disease

– is a chronic skin disease is a chronic skin disease – causes loss of pigment resulting in causes loss of pigment resulting in – irregular pale patches of skinirregular pale patches of skin– Due to Due to Migration of melanocytesMigration of melanocytes to the to the

border of affected areaborder of affected area– Areas of hypopigmentation with Areas of hypopigmentation with

surround hyperpigmentationsurround hyperpigmentation

DISCOLORATIONDISCOLORATION

Vitiligo (leukoderma)Vitiligo (leukoderma)

– primary diseaseprimary disease – dominant autosomal – dominant autosomal transmissiontransmission

– secondary disease:secondary disease:autoimmune diseaseautoimmune diseaseHyperthyroid conditions- “meche blanche”Hyperthyroid conditions- “meche blanche”Biermer anemiaBiermer anemiaAddison diseaseAddison diseaseReclinghausen neurofibromatosisReclinghausen neurofibromatosisIntoxications with hydroquinone, phenolIntoxications with hydroquinone, phenol

DISCOLORATIONDISCOLORATIONVitiligo (leukoderma)Vitiligo (leukoderma)

VITILIGOVITILIGO

VITILIGOVITILIGO

Conditions in which there is the Conditions in which there is the darkening of an area of skin caused by caused by increased depositsincreased deposits of of

MelaninMelanin HemosiderinHemosiderin metals (pseudocyanosis)metals (pseudocyanosis)

MelanodermaMelanoderma= abnormally intense pigmentation of the skin = abnormally intense pigmentation of the skin Pathologic hyperpigmentations:Pathologic hyperpigmentations:

generalized (melanoderma)generalized (melanoderma) locallocal circumscribedcircumscribed

GENERALIZED HYPERPIGMENTATIONGENERALIZED HYPERPIGMENTATION

(MELANODERMA)(MELANODERMA)

Addison diseaseAddison disease– The The most typical melanodermamost typical melanoderma

– determined by determined by ACTH, ACTH, MSH MSH

– Early diagnosis-initial Early diagnosis-initial affected areasaffected areas:: nipples,nipples, axillas,axillas, folds,folds, palmary crests,palmary crests, genitalia,genitalia, white linea,white linea, mucosae,mucosae, areas submitted to frictions or pressure, scarsareas submitted to frictions or pressure, scars

GENERALIZED HYPERPIGMENTATIONGENERALIZED HYPERPIGMENTATION (MELANODERMA)(MELANODERMA)

Addisonian melanodermaAddisonian melanoderma– Covers all the tegument, excepting the palms and Covers all the tegument, excepting the palms and

solessoles– Sometimes associated with vitiligoSometimes associated with vitiligo– Accompanied by:Accompanied by:

asthenia, asthenia, weight lossweight loss→ → emaciation, emaciation, hTA (TAs<90 mmHg), hTA (TAs<90 mmHg), inappetence, nausea, vomiting, inappetence, nausea, vomiting, associated abnormal lab values associated abnormal lab values


HEMOCHROMATOSISHEMOCHROMATOSISa a hereditary diseasehereditary disease characterized by characterized by

– excessive absorption of dietary iron excessive absorption of dietary iron resulting in resulting in

– a pathological increase in total body iron a pathological increase in total body iron

( 50 - 100 x at the level of liver, ( 50 - 100 x at the level of liver,

pancreas pancreas “bronzed diabetes”, “bronzed diabetes”,

““pigmentary cirrhosis”)pigmentary cirrhosis”)


HEMOCHROMATOSISHEMOCHROMATOSIS– Hyperpigmentation of tegument with “metal shade”Hyperpigmentation of tegument with “metal shade”– (Iron deposits (hemosiderin))(Iron deposits (hemosiderin))– Distribution areas:Distribution areas:

faceface bellybelly nipplesnipples genitaliagenitalia the extension faces of forearmsthe extension faces of forearms scarsscars

– Atrophic tegument, with loss of hairAtrophic tegument, with loss of hair– Differential diagnosis Differential diagnosis

with with hemosiderosis (post transfusional hemochromatosis) (post transfusional hemochromatosis) in which in which pigmentation is progressivepigmentation is progressive


OTHER GENERALIZED HYPERPIMENTATIONOTHER GENERALIZED HYPERPIMENTATION

– physical:physical: Exposure to sunlight and UVExposure to sunlight and UV pruritus, + vitamin/proteins deficiencies pruritus, + vitamin/proteins deficiencies - - -”the tramps (melanoderma) pelerine”-”the tramps (melanoderma) pelerine” – – neck and scapular-humeral regionneck and scapular-humeral region

– nutritional:nutritional: pellagra associated with photosensibilitypellagra associated with photosensibility vitamin A deficiencyvitamin A deficiency

Causes:Causes:

– metabolicmetabolichepatolenticullary cirrhosishepatolenticullary cirrhosistardive cutaneous porphyriatardive cutaneous porphyria

– hormonal:hormonal:pregnancypregnancypubertypubertyACTH secreting pulmonary tumorsACTH secreting pulmonary tumors

– deposits of metaldeposits of metal (silver, gold, mercury, chrome, arsenic)(silver, gold, mercury, chrome, arsenic)

– drugs:: chlorpromazine (chlorpromazine (brownbrown), amiodarone (), amiodarone (blue-greyblue-grey), ), tetracyclinetetracycline

OTHER GENERALIZED HYPERPIMENTATIONOTHER GENERALIZED HYPERPIMENTATION

Causes:Causes:

LOCAL HYPERPIGMENTATIONLOCAL HYPERPIGMENTATION

PREGNANCY MASKPREGNANCY MASK = = irregular symmetric patches like a irregular symmetric patches like a mask- pregnant women after the 5mask- pregnant women after the 5thth month month

FACEFACE - - thalassemia, malabsorption syndrome, thalassemia, malabsorption syndrome, contraceptivescontraceptives

PERIOCULAR PIGMENTATIONPERIOCULAR PIGMENTATION – – hepatic diseases, hepatic diseases, ovarian tumors, Graves-Basedow diseaseovarian tumors, Graves-Basedow disease

RIEHL DISEASERIEHL DISEASE Pigmentary patches at the level of face and thoraxPigmentary patches at the level of face and thorax Carencies syndromes, malabsorption, emotionsCarencies syndromes, malabsorption, emotions

REGIONAL HYPERPIGMENTATIONSREGIONAL HYPERPIGMENTATIONS SHANKS- chronic venous insufficiencySHANKS- chronic venous insufficiency NIPPLES AND MAMMARY AREOLAS NIPPLES AND MAMMARY AREOLAS

- - pregnant women, patients with prostate cancer pregnant women, patients with prostate cancer treated treated

with estrogenswith estrogens AXXILAS - “acantosis nigricans” AXXILAS - “acantosis nigricans”

- associated with hyperkeratosis in plaques --- - associated with hyperkeratosis in plaques --- “carbon “carbon

powder” appearance powder” appearance - gigantism, acromegaly, diabetes mellitus, - gigantism, acromegaly, diabetes mellitus,

abdominal abdominal cancercancer UNCLOTHED PARTS OF THE BODY UNCLOTHED PARTS OF THE BODY

- - porphyria, pellagra, Felty syndromeporphyria, pellagra, Felty syndrome DIFFERENT ZONESDIFFERENT ZONES

- - due to the itching lesions or to the application of due to the itching lesions or to the application of

heated objectsheated objects

ACANTOSIS NIGRICANS

CHRONIC VENOUS INSUFFICIENCY

PELLAGRA

PORPHYRIA

CIRCUMSCRIBED HYPERPIGMENTATIONCIRCUMSCRIBED HYPERPIGMENTATION FRECKLESFRECKLES LENTIGO (moles) = AGE SPOTSLENTIGO (moles) = AGE SPOTS ““CAFÉ AU LAIT” PACTHES – CAFÉ AU LAIT” PACTHES – Recklinghausen neurofibromatosisRecklinghausen neurofibromatosis

PEUTZ-JEGHERS SYNDROME PEUTZ-JEGHERS SYNDROME

= periorificial lenticulosis + colic poliposis= periorificial lenticulosis + colic poliposis LEOPARD SYNDROME (L= lentigo, Ecg =conduction problems,LEOPARD SYNDROME (L= lentigo, Ecg =conduction problems,

O= ocular hypertelorism, P= pulmonary – pulmonary stenosis,O= ocular hypertelorism, P= pulmonary – pulmonary stenosis,

A = genetic anomalies, R= retard, D= deaf)A = genetic anomalies, R= retard, D= deaf) FIX DRUG ERUPTION FIX DRUG ERUPTION

- erythemaous- pigmentary plaques- erythemaous- pigmentary plaques URTICARIA - mastocytosisURTICARIA - mastocytosis MALIGN MELANOMA – tumor developed around a nevusMALIGN MELANOMA – tumor developed around a nevus

Recklinghausen neurofibromatosisRecklinghausen neurofibromatosis URTICARIA - mastocytosisURTICARIA - mastocytosis

PEUTZ-JEGHERS SYNDROMEPEUTZ-JEGHERS SYNDROME MALIGN MELANOMAMALIGN MELANOMA

FIX DRUG ERUPTIONFIX DRUG ERUPTION

Ocular hypertelorismOcular hypertelorism

FRECKLES

LENTIGO

ERYTHEMAERYTHEMA= redness of the skin which = redness of the skin which Is due to tegument vasodilatation (hyperemia ) Is due to tegument vasodilatation (hyperemia ) disappears with digital pressuredisappears with digital pressure

Classification :Classification :A.A. LOCALIZEDLOCALIZED

PHYSIOLOGICAL:PHYSIOLOGICAL: pudic, emotional pudic, emotional

PATHOLOGICAL:PATHOLOGICAL: PALMO-PLANTAR: liver cirrhosis PALMO-PLANTAR: liver cirrhosis

E. of ZONES EXPOSED TO SUNLIGTH: E. of ZONES EXPOSED TO SUNLIGTH: pellagra, photosensibilisating diseasespellagra, photosensibilisating diseases

ERYTHEMAERYTHEMAB.B. GENERALIZEDGENERALIZED

– PHYSIOLOGICAPHYSIOLOGICALL: solar: solar– PATHOLOGICALPATHOLOGICAL

ERUPTIVE DISEASESERUPTIVE DISEASES ““RASH” = diffuse erythema, transient, precedes the eruptionRASH” = diffuse erythema, transient, precedes the eruption MORBILIFORM E. in MEASLESMORBILIFORM E. in MEASLES SCARLATINIFORM E. SCARLATINIFORM E.

DRUG ALLERGIESDRUG ALLERGIES ROSEOLA ROSEOLA (secondary syphilis)(secondary syphilis) CARCINOIDCARCINOID

– “– “FLASH”FLASH” = sensation of heat followed by redness = sensation of heat followed by redness

FIGURATE/ANULLAR ERYTHEMAFIGURATE/ANULLAR ERYTHEMA→ → RHEUMATHIC RHEUMATHIC

FEVERFEVER children, teenagerschildren, teenagers EXFOLIANT ERYTHEMA:EXFOLIANT ERYTHEMA: leukemiasleukemias

FIGURATE/ANULLAR ERYTHEMAFIGURATE/ANULLAR ERYTHEMA

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20 Jaundice#e856