Ulcers Pictures

Stasis Dermatitis

Fri 24 Feb 2017 09:57:06 +0200

Stasis dermatitis is a common inflammatory skin disease that occurs on the lower extremities. It is usually the earliest cutaneous sequela of chronic venous insufficiency with venous hypertension and may be a precursor to more problematic conditions, such as venous leg ulceration and lipodermatosclerosis.

Pruritus - Patients with stasis dermatitis typically present with an insidious onset of pruritus affecting 1 or both lower extremities.
Discoloration - Reddish-brown skin discoloration is an early sign of stasis dermatitis and may precede the onset of symptoms.
Ankle involvement - The medial ankle is most frequently involved, with symptoms progressing to involve the foot and/or calf.
Edema - Stasis dermatitis patients may offer a prior history of dependent leg edema.

Physical examination in stasis dermatitis patients reveals erythematous, scaling, and eczematous patches affecting the lower extremity.

The medial ankle is most frequently and severely involved, a result of the fact that it represents a watershed area with relatively poor blood flow compared with the rest of the leg. In advanced cases of stasis dermatitis, the inflammation may encircle the ankle and extend to just below the knee; this is sometimes referred to as stocking erythroderma. The dorsal part of the foot may be involved in severe cases.

Secondary infection can cause typical honey-colored crusting due to bacteria or can produce monomorphous pustules due to cutaneous candidiasis.

Venous Eczema on Legs

Sat 18 Feb 2017 14:54:08 +0200

Varicose eczema, also known as venous, gravitational or stasis eczema, is a long-term skin condition that affects the lower legs. It's common in people with varicose veins.

Like all types of eczema, the affected skin becomes:

itchy
red and swollen
dry and flaky
scaly or crusty

There may be periods when these symptoms improve and periods when they become more severe.

Your legs may become swollen, especially towards the end of the day or after long periods of standing. Varicose veins (swollen and enlarged veins) are often visible on the legs.

Some people also have other symptoms, such as:

brown discolouration of the skin
red, tender and tight skin that can eventually become hardened (lipodermatosclerosis)
small, white scars (atrophie blanche)
pain
eczema affecting other parts of the body

Left untreated, leg ulcers can develop. These are long-lasting wounds that form where the skin has become damaged.

Venous Eczema

Sun 12 Feb 2017 12:16:46 +0200

Venous eczema is a common form of eczema / dermatitis that affects one or both lower legs in association with venous insufficiency.

Venous eczema can form discrete patches or become confluent and circumferential. Features include:

Itchy red, blistered and crusted plaques; or dry fissured and scaly plaques on one or both lower legs
Orange-brown macular pigmentation due to haemosiderin deposition
Atrophie blanche (white irregular scars surrounded by red spots)
“Champagne bottle” shape of lower leg (narrowing at the ankles) and induration (lipodermatosclerosis)

Treat the eczema

Dry up oozing patches with Condy's solution (potassium permanganate) or dilute vinegar on gauze as compresses.
Oral antibiotics such as flucloxacillin may be prescribed for secondary infection.
Apply a prescribed topical steroid: start with a potent steroid cream applied accurately daily to the patches until they have flattened out. After a few days, change to a milder steroid cream (eg. hydrocortisone) until the itchy patches have resolved (maintenance treatment). Check with your doctor if you are using steroid creams for more than a few weeks. Overuse can thin the skin, but short courses of stronger preparations can be used from time to time if necessary to control the dermatitis. Coal tar ointment may also help.
Use a moisturising cream frequently to keep the skin on the legs smooth and soft. If the skin is very scaly, urea cream may be especially effective.
Protect your skin from injury: this can result in infection or ulceration that may be difficult to heal.

Stasis Dermatitis on Legs

Tue 07 Feb 2017 11:22:26 +0200

Stasis dermatitis is skin inflammation that develops in people with poor circulation. It most often occurs in the lower legs because that’s where blood typically collects.

When blood collects or pools in the veins of your lower legs, the pressure on the veins increases. The increased pressure damages your capillaries, which are very small blood vessels. This allows proteins to leak into your tissues. This leakage leads to a buildup of blood cells, fluid, and proteins, which causes your legs to swell. This swelling is called peripheral edema.

People with stasis dermatitis usually experience swollen legs and feet, open sores, or itchy and reddish skin. A protein called fibrinogen may be responsible for the changes you see in your skin. When fibrinogen leaks into your tissues, your body converts it to the active form of the protein, which is called fibrin. As it leaks out, the fibrin surrounds your capillaries, forming what are known as fibrin cuffs. According to the Cleveland Clinic, these fibrin cuffs may prevent oxygen from entering your tissues. When your cells don’t receive enough oxygen, they can become damaged and die.

The symptoms of stasis dermatitis include:

skin discoloration
itching
scaling
ulcers

You may also experience symptoms of venous insufficiency, including:

leg swelling
calf pain
calf tenderness
a dull ache or heaviness in your legs that gets worse when you stand

In the early stages of stasis dermatitis, the skin on your legs may look thin. Your skin may also itch, but try not to scratch it. Scratching can cause the skin to crack and fluid to seep out.

Herpes Symptoms in Men

Mon 15 Feb 2016 15:08:00 +0200

Genital herpes symptoms in men can range from so mild that they go unnoticed by the affected man, to severe outbreaks on the skin surface. Symptoms usually appear within two days to two weeks of first exposure to the virus, but this isn’t always the case as some people have it for a long time before seeing the signs.

Herpes outbreaks in men tend to show up as blisters on the tip or shaft of the penis (as opposed to the base), the inner thighs and buttocks. Homosexual men may also get blisters around the anus. These outbreaks are highly contagious if they come into contact with someone’s skin.

Milder symptoms of herpes in men can include fever, fatigue, headache, muscle pain, difficulty urinating, and chills.

Symptoms of Herpes

Mon 15 Feb 2016 15:07:00 +0200

The virus starts to multiply when it gets into the skin cells. The skin becomes red and sensitive, and soon afterward, one or more blisters or bumps appear. The blisters first open, scab over, and then heal as new skin tissue forms. During a first outbreak, the area is usually painful and may itch, burn or tingle. Flu-like symptoms are also common. These include swollen glands, headache, muscle ache, lower back pain, and fever. Herpes may also infect the urethra, and urinating may cause a burning sensation.

People diagnosed with herpes can expect to have several, typically four or five, outbreaks within a year. As time passes, these recurrences usually decrease in frequency. Herpes recurrences vary individually.

Erysipelas Leg

Mon 15 Feb 2016 14:51:00 +0200

Erysipelas is often of sudden onset, marked by frank systemic signs—fever >38°5, chills—and general malaise. Patients with lymphedema, who present with recurrent episodes of erysipelas, often recognize these inaugural signs. Local signs develop within a few hours: a red, warm, painful, inflammatory spreading lesion, with centrifugal extension within a few days. Erysipelas can start at any point of lymphedema and can extend to all or part of the lymphedematous cutaneous tissue, in an anterograde or retrograde pattern. Inflammatory, satellite adenopathy and lymphangitis are associated with erysipelas in 25% to 50% of cases.

In the case of erysipelas complicating lymphedema, the clinical presentation is more serious. Statistically significant differences (P<0.05) were seen between 20 controls with erysipelas but without lymphedema and 10 age- and sex-matched patients with lymphedema hospitalized for erysipelas: prolonged persistence of fever, more frequent tachycardia, delayed recovery, and positive blood cultures (30% vs 0%).

The diagnosis of erysipelas is clinical: sudden occurrence of an inflammatory lesion that spreads within a few days, preceded by or concomitant with fever and chills, and general malaise. No bacterium other than ß-hemolytic streptococcus has been demonstrated as responsible for erysipelas. Streptococcus was isolated 15 times more often in lymphedema with an infectious complication than outside any acute inflammatory episode, and serology testing for streptococcus (ASLO) was more often positive in patients with lymphedema (78%) than in a healthy control population (46%). Bacteriological samples are positive in erysipelas in only 4% to 35% of cases with standard methods. Using the most sophisticated methods (immunofluorescence, polymerase chain reaction), streptococcus is isolated at a frequency of 70% to 80%.5 Other bacteria (Staphylococcus aureus, Enterobacteriaceae, Pseudomonas) have been isolated alone or in combination with streptococcus. But to date a causal relationship has never been demonstrated.

Furthermore, these bacteria are commonly found on skin and colonize wounds, and their isolation from samples collected from the skin is difficult to interpret. Laboratory tests are not helpful in establishing the diagnosis: the complete blood count shows leukocytosis in one-half of cases, and a nonspecific inflammatory syndrome is indicated by laboratory findings in two-thirds of cases.

Define Erysipelas

Mon 15 Feb 2016 14:50:00 +0200

Erysipelas is a nonnecrotizing bacterial hypodermal cellulitis usually associated with streptococcal infection. It may be a mainly secondary complication of chronic lymphedema, and occurs in 20% to 30% of cases. The first presenting signs are sudden fever and shivering. The clinical feature is inflammatory plaque, which is often chronic and accompanied by fever. Inflammatory plaque is promoted by lymph stasis, and is marked by inflammatory episodes that often regress spontaneously. Erysipelas per se is mainly treated with antibiotics, and adjuvant therapies are not justified. The prevention of recurrence is primary. Since lymphedema is the first risk factor for recurrence, its treatment and risk of occurrence must be considered. This includes physiotherapy, well-adapted compression therapy, and avoidance of wounds.

The lymphatic system has a role in antigen presentation and defense against infection. Infection is the most common type of complication observed in lymphedema, and is promoted by lymphatic system dysfunction, which causes locoregional immune disorders. Infectious complications are primarily bacterial, and most commonly are erysipelas (cellulitis) and sometimes lymphangitis. ß-hemolytic streptococcus (groups A, C, G) is the organism usually (and even almost exclusively) observed in everyday practice. Bacterial complications are promoted by the abundance of proteins characteristic of edema in lymphatic insufficiency related to obstructed lymphatic vessels. This high protein content of the interstitial fluid is an ideal culture medium for the growth of bacteria.

Erysipelas Face

Mon 15 Feb 2016 14:48:00 +0200

Erysipelas contagious infection of the skin and underlying tissue, caused by group A B-hemolytic streptococcus bacteria. Erysipelas causes affected areas of skin to turn bright red and become slightly swollen. The swollen blotches have a distinct border and slowly expand into the surrounding skin. The lesions are most commonly seen on the face, scalp, hands, and legs. They feel hot to the touch and the patient is feverish.

Erysipelas Definition

Mon 15 Feb 2016 14:47:00 +0200

Erysipelas is an infection of the upper layers of the skin (superficial). The most common cause is group A streptococcal bacteria, especially Streptococcus pyogenes. Erysipelas results in a fiery red rash with raised edges that can easily be distinguished from the skin around it. The affected skin may be warm to the touch. At one time, erysipelas was thought to affect mostly the face, but recent studies suggest that the distribution of the inflammation is changing since at the present time the legs are involved in almost 80% of cases. The rash may also appear on the arms or trunk. Erysipelas begins with minor trauma, such as a bruise, burn, wound, or incision. When the rash appears on the trunk, arms, or legs, it is usually at the site of a surgical incision or a wound.

Erysipelas usually first appears as a localized lesion that is tender and red. The lesion quickly develops a bright red, shiny color and a spreading, raised border. The typical lesion is so characteristic that its presence is diagnostic. The lesion may feel hot and be painful. There may be accompanying high fever, chills, headache, nausea, and a general feeling of ill health (malaise). The skin in the affected area may resemble the peel of an orange. In infants, erysipelas may appear on the abdomen due to infection of the umbilical cord. In children and adults, erysipelas most commonly develops on the legs, arms and face. Erysipelas may also develop at sites of minor surgery or trauma, or it may be due to lymphatic obstruction.

Erysipelas is caused by one of several strains of streptococcus bacteria, or less frequently by a staphylococcus infection. Streptococci are involved in about 80% of cases.

Erysipelas on Face Symptoms

Mon 15 Feb 2016 14:43:00 +0200

Erysipelas is a bacterial infection of the skin and subcutaneous tissue, usually involving the face, ears and lower legs. It is characterized by well demarcated areas of redness, heat, pain, and swelling and may be associated with constitution symptoms including fever, chills, headache, joint pain, and back pain.

Predisposing factors of erysipelas are operative wounds, scrapes, or abrasions of the skin. The onset is usually abrupt with high fever, chills, and weakness. Over the next 24- 48 hours a red shiny plaque forms usually proximal to the area of entry into the skin. A dermatologist can usually make a diagnosis by examining the patient but sometimes other tests including bacterial skin culture, white blood cell count and blood cultures may be needed. In adults, Group A streptococcal bacterial infection is the most common cause and in children Hemophilus influenza bacterial infection is the most common cause.

Malignant Melanoma

Mon 15 Feb 2016 14:42:00 +0200

Melanocytes are derived from a structure in the human embryo called the neural crest. They are distributed in the epidermis and thus are found throughout the skin. They produce a brown pigment known as melanin and are responsible for racial variation in skin color as well as the color of moles. Malignant degeneration of the melanocyte gives rise to the tumor known as melanoma, which has four subtypes. These are: superficial spreading, nodular, lentigo maligna, and acral lentiginous melanomas, accounting for 70%, 15% to 30%, 4% to 10%, and 2% to 8% of cases, respectively. Malignant melanoma may develop anywhere on the body. In men, it is most common on the trunk. In women, it is most common on the back or legs. The subtype also may influence where the tumor develops; lentigo melanoma is more common on the face while acral lentiginous melanoma is more common on the palms of the hand, soles of the feet, or in the nail beds.

The locally invasive characteristic of this tumor involves vertical penetration through the skin and into the dermis and subcutaneous (under-the-skin) tissues of the malignant melanocytes. With the exception of the nodular variety of melanoma, there is often a phase of radial or lateral growth associated with these tumors. Since it is the vertical growth that characterizes the malignancy, the nodular variant of melanoma carries the worst prognosis. Fortunately, the superficial spreading type is most common.

The primary tumor begins in the skin, often from the melanocytes of a pre-existing mole. Once it becomes invasive, it may progress beyond the site of origin to the regional lymph nodes or travel to other organ systems in the body and become systemic in nature.

Lymph is the clear, protein-rich fluid that bathes the cells throughout our body. Lymph will work its way back to the bloodstream via small channels known as lymphatics. Along the way, the lymph is filtered through cellular stations known as nodes, thus they are called lymph nodes. Nearly all organs in the body have a primary lymph node group filtering the tissue fluid, or lymph, that comes from that organ. Different areas of the skin have different primary nodal stations. For the leg, they are in the groin. For the arm, the armpit or axilla. For the face, it is the neck. Depending where on the torso the tumor develops, it may drain into one groin or armpit, or both.

Cancer, as it invades in its place of origin, may also work its way into blood vessels. If this occurs, it provides yet another route for the cancer to spread to other organs of the body. When the cancer spreads elsewhere in the body, it has become systemic in extent and the tumor growing elsewhere is known as a metastasis. Untreated malignant melanoma follows a classic progression. It begins and grows locally, penetrating vertically. It may be carried via the lymph to the regional nodes, known as regional metastasis. It may go from the lymph to the bloodstream or penetrate blood vessels, directly allowing it a route to go elsewhere in the body. When systemic disease or distant metastasis occur, melanoma commonly involves the lung, brain, liver, or occasionally bone. The malignancy causes death when its uncontrolled growth compromises vital organ function.