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Surgical Rejuvenation of the Ageing Face
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Gregory S. Dibelius, John M. Hilinski, Dean M. Toriumi
Skin slough most commonly arises as a consequence of unrecognized and untreated haematoma. Excess skin tension and disruption of the subdermal plexus are also frequent causes. The toxic effects of smoking have long been recognized as another predisposing factor in skin sloughing.31 The postauricular flap is at greatest risk because skin tension is typically highest in this region. Dependent flap length is also maximal and the skin is relatively thin along this surface. In general, expectant management with meticulous wound care is the rule for skin sloughing. However, frequent visits and repeated patient reassurance are necessary. Superficial epidermal sloughing typically results in an acceptable appearance after healing. In cases of full-thickness sloughing, eschar formation is seen and serial debridement is required to promote healing by secondary intention. Invariably, patients with full-thickness loss can expect some degree of hypertrophic scarring and abnormal pigmentation.
Skin
Published in Pritam S. Sahota, James A. Popp, Jerry F. Hardisty, Chirukandath Gopinath, Page R. Bouchard, Toxicologic Pathology, 2018
Zbigniew W. Wojcinski, Lydia Andrews-Jones, Daher Ibrahim Aibo, Rie Kikkawa, Robert Dunstan
Photoirritation reactions may occur after a single exposure whereas photoallergic reactions require a period of induction for a reaction to occur. Acute photoirritation may manifest as mild erythema (resembling sunburn) or, in more severe cases, as blistered skin with skin sloughing. Photoallergic reactions are immune mediated and most often idiosyncratic. It should be noted that compounds causing photoirritancy may also be associated with photoallergenic reactions (Shimoda 1998; Tokura 1998). Examples include benzocaine, p-aminobenzoic acid, and promethazine (Johnson and Grimwood 1994).
Deaths of the Young and Elderly
Published in John M. Wayne, Cynthia A. Schandl, S. Erin Presnell, Forensic Pathology Review, 2017
John M. Wayne, Cynthia A. Schandl, S. Erin Presnell
Answer B is incorrect. Skin sloughing is seen in decomposition; however, the pattern is not compatible with decompositional skin sloughing. In addition, associated findings such as bulla formation and marbling are not apparent making this interpretation highly unlikely.
Did hypervitaminosis A have a role in Mawson’s ill-fated Antarctic exploration?
Published in Clinical Toxicology, 2022
Hypervitaminosis A also affects other parts of the body. After the onset of neurologic symptoms, skin peeling, starting in many cases on the face at the corners of the mouth, may occur [15]. It can generalize to the whole body. Mawson clearly had dramatic skin sloughing with the entire skin of his ears and soles peeling off [6]. Less apparent organ damage involves leaching of calcium from bones, causing an increased risk of fractures, and inflammation of the liver [21]. Advanced liver disease with ascites accumulation in the abdominal cavity may be a consequence of cirrhosis. Neither of these manifestations of hypervitaminosis A are hinted out in Mawson’s journals. However, these two manifestations are much more common in the chronic stages of hypervitaminosis A with daily exposures exceeding 50,000 IU per day for a period of months – a time line that Mawson and Mertz did not have – as all their dogs were consumed over 23 days [21].
Skin hypersensitivity following application of tissue adhesive (2-octyl cyanoacrylate)
Published in Baylor University Medical Center Proceedings, 2021
Raymond P. Shupak, Sid Blackmore, Roderick Y. Kim
Two women presented for evaluation of primary hyperparathyroidism. Workup included serum parathyroid hormone, calcium levels, and a nuclear medicine parathyroid SPECT scan (Table 1). Both underwent an uncomplicated transcervical approach to their parathyroid adenoma. Closure was undertaken in a standard layered fashion, followed by 4-0 Monocryl running subcuticular closure with topical application of Dermabond. The first patient experienced significant pain, pruritus, and swelling associated with the surgical incision (Figure 1). She was treated with intravenous diphenhydramine and steroids, and an unsuccessful attempt was made to remove the skin adhesive, despite following the manufacturer’s recommendations. In the second case, the patient denied pruritus or pain associated with the reaction. Postoperatively, skin sloughing, necrosis, and superficial infection were observed, requiring a course of antibiotics. Local wound care was prescribed until resolution. She refused any additional revision surgery (Figure 2).
Painful purpura from intravascular large B-cell lymphoma cutaneous variant
Published in Baylor University Medical Center Proceedings, 2021
Rosalyn Ortiz-Manso, Kelvin Soewono, Hao Nguyen
One week after being discharged from his second hospitalization, he presented to the same hospital with new onset of a painful purpuric rash on his upper and lower extremities. His only new medication was trimethoprim/sulfamethoxazole for Pneumocystis jiroveci prophylaxis since he was on chronic steroids for panhypopituitarism. Physical examination showed pitting edema of the abdomen and bilateral lower extremities. Painful purpuric exanthem (Figure 1a–c) was seen on the upper and lower extremities. His purpuric rash enlarged and formed bullae and some skin sloughing (Figure 1d–f) during his hospitalization. A skin biopsy showed clonal lymphocytes in the lumina of blood vessels with an increased nuclear-to-cytoplasmic ratio, prominent nuclei, and multiple mitotic figures. Combined with the immunohistochemical stains for CD20, these findings confirmed a diagnosis of IVLBCL.