China
Africa
Explore chapters and articles related to this topic
Chilblains/Pernio
Published in Charles Theisler, Adjuvant Medical Care, 2023
Small painful or itchy red or purple bumps that form on the fingers or toes as a reaction to cold temperatures are known as chilblains. Swelling and/or blisters are often present. It is a form of localized vasculitis frequently associated with Raynaud’s disease. The disorder affects primarily women, but also children or the elderly, in damp temperate climates.1 As a rule, chilblains tends to respond poorly to treatment. Existing lesions often clear up in a few weeks with or without active treatment.
Decontextualised Chinese medicines
Published in Vivienne Lo, Michael Stanley-Baker, Dolly Yang, Routledge Handbook of Chinese Medicine, 2022
Michael Heinrich, Ka Yui Kum, Ruyu Yao
The successful transmission of Ginkgo seems to be wrapped up with these religious and poetical connotations. Yet, this did not mean that the medicine was processed or used in the original way. In 1691 the German naturalist Engelbert Kaempfer, ‘discovered’ G. biloba trees in Japan. Forty years later (1730) it arrived in Utrecht and thus Europe (Heinrich 2013). East Asian records of medical functions generally relate to the seeds (pseudofruits). Importantly, the leaves are much less frequently used. There are topical preparations including for treating chilblains (frostbites, resulting in swelling, reddening and itching of the skin) and for asthma (as a throat spray). European fascination is linked to its symbolic importance in the context of longevity. Since its European ‘discovery’, the unusual shape of the leaves has fascinated scientists and poets, including J. W. von Goethe 1749–1832), the famous Romantic poet, statesman, solicitor and natural historian from Frankfurt, who from 1775 onwards worked in Weimar. His poem on ginkgo both crystallises European fascination with the tree and stimulated its spreading fame:
Chronic erythematous rash on the face
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
An erythema on the face associated with fever and arthralgia in a female patient is suggestive of SLE. The rash characteristically occurs in a ‘butterfly’ distribution (cheeks and bridge of nose), but does not always do so. There is also nail fold telangiectasia with ragged cuticles. Although the site may be similar to rosacea, there are no papules or pustules. The patient may have renal involvement, psychiatric or neurological symptoms, pericarditis, pleurisy or abdominal pain. Chilblains and Raynaud's phenomenon are likely. A positive anti-nuclear factor will confirm the diagnosis. An illness identical to SLE can be caused by drugs such as procainamide, hydralazine, minocycline and the anti-TNF monoclonal biologic therapies. Subacute cutaneous lupus erythematosus looks like SLE and there may be positive auto-antibodies, but systemic symptoms are absent.
Use of calcium channel blockers in dermatology: a narrative review
Published in Expert Review of Clinical Pharmacology, 2021
Yang Lo, Lian-Yu Lin, Tsen-Fang Tsai
The etiology of chilblain LE is still unclear, but vasospasm may play a role in the reaction to coldness [19]; furthermore, many cases of chilblain LE are associated with Raynaud’s phenomenon (RP) [20]. Regarding RP, CCB is one of the treatment option for chilblain LE because of its association with vasodilation [20]. One double-blind crossover study showed that retreatment with oral nifedipine does not affect the cold-induced vasodilation response in healthy individuals [21]. According to a recent study [22], topical 10% nifedipine application improved the cold response in healthy fingers as assessed by thermography, but possibly caused harmful effects over previously frostbitten tissue and amputated digits. Another disease with similarities to chilblain LE is chilblains (pernio), for which CCB is also reportedly effective due to its efficacy for peripheral vasodilation, and nifedipine 20–60 mg given three times daily is the most frequently used [23]. It can also be administered topically [24]. But the efficacy of nifedipine has not been confirmed by all studies [25]. Nifedipine is considered an effective treatment for both chilblain LE and chilblains.
Progress towards precision medicine for lupus: the role of genetic biomarkers
Published in Expert Review of Precision Medicine and Drug Development, 2018
Juan-Manuel Anaya, Kelly J. Leon, Manuel Rojas, Yhojan Rodriguez, Yovana Pacheco, Yeny Acosta-Ampudia, Diana M. Monsalve, Carolina Ramirez-Santana
These can map at the major histocompatibility complex (MHC) region or outside the MHC (Table 4) [37,39,90,91,93,94,100,102–123]. There are specific causative mutations of SLE and the so-called ‘SLE-like syndromes,’ which have the strongest genotype–phenotype correlation between the SLE-associated polymorphisms, and some of them have shown Mendelian patterns of inheritance and incomplete penetrance [124]. Proteins involved in monogenic causes of SLE have been associated with specific immune system pathways [125]. C1q, C1r/s, C2, C4A, and C4B, to name a few, are complement proteins associated with SLE cutaneous involvement, glomerulonephritis, and increased frequency of infections [126]. Other pathways such as apoptosis, immune clearance, DNA damage repair, and type I IFN-related processes have also been associated with certain subphenotypes (Table 4) [125,126]. Notably, a spectrum of disorders referred to as Aicardi–Goutières syndromes are caused by mutations in SLE-associated genes. These patients usually have neonatal and childhood onset with dermatological (particularly chilblains), neurological, and renal features [127,128].
Multisystem effects of COVID-19: a concise review for practitioners
Published in Postgraduate Medicine, 2021
Gabrielle White-Dzuro, Lauren E. Gibson, Luca Zazzeron, Colin White-Dzuro, Zachary Sullivan, Daren A. Diiorio, Sarah A. Low, Marvin G. Chang, Edward A. Bittner
A variety of cutaneous manifestations such as erythematous rash, generalized urticaria, and chickenpox-like lesions have been associated with COVID-19, and can present even before the onset of symptoms and with an incidence of up to 36% of the patients depending on the cutaneous manifestation [73,74]. Interestingly, there was no association between cutaneous findings and disease severity [74]. Urticarial eruptions typically preceded additional symptoms of COVID-19 infection, were noted to occur even in the absence of fevers, and tended to be consistent on histology with a viral exanthem [53,75,76]. Acrocyanosis and limb ischemia have been described in a cohort of critically ill patients with elevated D-dimer, fibrinogen, and fibrinogen degradation products [77]. In this small cohort, 57% of the patients developed DIC. Livedo reticularis, a cutaneous manifestation commonly associated with DIC, was seen in two patients with only mild-moderate disease [78]. The authors hypothesize that these findings may represent microthrombosis of cutaneous vasculature, as similar pathophysiology has been noted in other organ systems in COVID-19 patients. Chilblains-like lesions, which are erythematous areas on the feet, described colloquially as ‘COVID toes,’ may represent endothelitis secondary to systemic COVID-19. In a small cohort of patients with severe COVID-19 and purpuric skin rash, biopsy demonstrated a thrombogenic vasculopathy of both affected and normal-appearing skin as well as localization of SARS-CoV-2 spike glycoprotein causing complement activation [79]. These findings are consistent with a catastrophic microvascular injury mediated by systemic viral spread and associated with a procoagulant state.