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Nail pigmentation
Published in Robert Baran, Dimitris Rigopoulos, Chander Grover, Eckart Haneke, Nail Therapies, 2021
Robert Baran, Dimitris Rigopoulos
Periungual hyperpigmentation in newborns is a physiological melanic pigmentation observed during the early months of life. In addition, several types of acro pigmentation have been described in pediatric nail disorders (Baran, Hadj-Rabia, and Silverman 2017). In adults one has to rule out Hutchinson’s sign (Figure 17.1) from nonmelanoma Hutchinson’s sign.
Answers
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Shingles is a human herpes virus which usually lies dormant in the dorsal root ganglion, or in the case of ophthalmic shingles, the trigeminal nerve root ganglion. This dormant episode follows primary infection as a child with chickenpox. Ophthalmic shingles usually occurs in the elderly population. Approximately 50% of cases of ophthalmic shingles will have nasociliary nerve involvement (Hutchinson’s sign). This is a bad prognostic sign, as it means the possibility of eye involvement. On examination, the patient will have an absence of the blink reflex when the cornea is touched lightly with some cotton wool. This then leaves the cornea exposed to abrasion. Examination of the cornea with blue light and fluorescein is needed to look for the characteristic dendritic ulcers associated with ophthalmic shingles. Management of ophthalmic shingles is specialist-led and may involve antivirals, topical steroids or topical antibiotics.
Viral infections
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Herpes zoster ophthalmicus involves the ophthalmic division of the trigeminal nerve and occurs in up to 20% of patients with herpes zoster. Hutchinson sign is the appearance of a herpes zoster lesion on the tip or side of the nose and serves as a useful prognostic factor in the ensuing ocular inflammation. Clinically, patients develop lesions on the margin of the eyelid. Early complications include periorbital edema, residual ptosis, lid scarring, deep scalp pitting, entropion, ectropion, pigmentary changes, and lid necrosis [13]. Glaucoma, optic neuritis, encephalitis, hemiplegia, and acute retinal necrosis are more severe long-term complications, the risk of which may be reduced by half with prompt initiation of antiviral therapy. Chronic disease due to neurologic damage occurs in up to 30% of patients with this form of herpes zoster.
Review for Disease of the Year: Varicella Zoster Virus-Induced Anterior Uveitis
Published in Ocular Immunology and Inflammation, 2018
Ilknur Tugal-Tutkun, Luca Cimino, Yonca Aydin Akova
The trigeminal dermatomes are most commonly affected by clinically manifest HZ.15,16 The involvement of the first or ophthalmic division of this nerve is called herpes zoster ophthalmicus (HZO),17 and it is about 20 times more common than the involvement of the second or third division. The ophthalmic division gives rise to three terminal branches: the lacrimal, frontal, and nasociliary branches. Within that division, the frontal nerve is the most commonly involved and innervates the upper lid, forehead, and some superior conjunctiva. The nasociliary branch, the primary sensory nerve to the eyeball, innervates the skin of the tip of the nose and divides further into the long ciliary nerves, which provide sensory innervation to the globe, including the sclera, cornea, and uvea.17 For this reason, the involvement of the tip of the nose, called Hutchinson’s sign, is highly correlated with ophthalmic involvement.18,(Figure 1) Ocular disease can also occur in the absence of skin rash (zoster sine herpete).19 The incidence of HZO was found to be 30.9 per 100,000 person-years in a retrospective population-based cohort study in Hawaii.20
Clinical Manifestations and Characteristics of In Vivo Confocal Microscopy in Varicella Zoster Virus-Related Corneal Endotheliitis
Published in Ocular Immunology and Inflammation, 2019
Rong-mei Peng, Yu-xin Guo, Ge-ge Xiao, Qing Lu, Bin-jia Sun, Jing Hong
In our study, only one patient had typical dermal manifestations at the onset of corneal disease. Five patients had bilateral decompensated endothelial disease. As in previous reports, the typical manifestations of VZV infection included a single involved dermatome and did not cross the midline. However, herpes zoster can also present with unique or atypical clinical manifestations, such as glioma, zoster sine herpete and bilateral herpes zoster.23 According to the literature, only 25% of VZV anterior uveitis has dermal manifestations.24 Zoster sine herpete is usually reported in the literature as case reports, and tends to be ignored by patients or physicians, with the diagnosis relying on laboratory results. In our study, all patients were atypical presentations, with the exception of one patient, and the diagnosis was supported by real-time PCR. The nasociliary branch of the ophthalmic nerve, the primary sensory nerve to the eyeball, innervates the skin of the tip of the nose and divides further into the long ciliary nerves, which provide sensory innervation to the globe, including the sclera, cornea, and uvea. 18 For this reason, the typical classic presentation of nasociliary branch infection is Hutchinson’s sign.25 However, in our study, no Hutchinson’s sign was present. The reason may simply be due to long ciliary nerve infection. In addition, infection with the VZV during pregnancy can produce an embryopathy characterized by limb hypoplasia, eye and cerebral damage, and skin lesions.26 In our study, two patients with CHED may have been infected at the fetal stage.
Eyelid and Orbital Involvement in HIV Infection – An African Perspective
Published in Ocular Immunology and Inflammation, 2020
In a prospective study, van Dyk and Meyer6 found that the presence of a positive Hutchinson’s sign in HIV+ individuals with HZO has a very high positive predictive value for intraocular involvement with the virus (Figure 1d). In their 29 patients, neither CD4 count nor age had predictive value.