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Sunday, January 31, 2016

Pyoderma gangrenosum

Pyoderma gangrenosum is an uncommon, ulcerative cutaneous condition of uncertain etiology. It is associated with systemic diseases in at least 50% of patients who are affected.The diagnosis is made by excluding other causes of similar-appearing cutaneous ulceration, including infection, malignancy, vasculitis, collagen vascular diseases, diabetes, and trauma. 
The prognosis of pyoderma gangrenosum is generally good; however, the disease may recur, and residual scarring is common. Pain is a common complaint of patients and may require narcotics.Other organs systems that may be involved include the heart, the central nervous system, the gastrointestinal (GI) tract, the eyes,[4, 5] the liver, the spleen, the bones, and the lymph nodes.
Most patients with pyoderma gangrenosum improve with initial immunosuppressive therapy and require minimal care afterwards. However, many patients follow a refractory course, and multiple therapies may fail. These patients pose a difficult clinical problem that requires frequent follow-up and long-term care.

Tenia versicolor 

his title designates a superficial fungal infection (tinea) that changes color (versicolor). The causative organism was originally called Malassezia furfur and is now called Pityrosporum orbiculare. TV typically causes numerous patchy scally macules on the upper chest and back,  arms, and neck. Facial involvement may occur as shown. The lesions may behypopigmented  as illustrated here, or brown-orange, depending on th e skib color of the patient and the degree of recent sun exposure. The organism is believed to prevent either the formation of melanin or the transfer of melanosomes into keratinocytes. The formation of azelaic acid is another suggested mechanism for the resultant hypopigmentation. Although tinea versicolor usually makes its appearance after puberty, it can develop in child and is occasionally seen in breast-fed infants. Tinea versicolor is usually asymptomatic  but may itch slightly. The organism cannot be cultured, but diagnosis is aided by the orange or brown glow of lesional skin under a Wood's light and by the “spaghetti and meatballs” appearance of clustered hyphae and spores on KOH.

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