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Clinical Aspects and Differential Diagnosis of Atopic Dermatitis
Published in Donald Rudikoff, Steven R. Cohen, Noah Scheinfeld, Atopic Dermatitis and Eczematous Disorders, 2014
Donald Rudikoff, Diana Lee, Steven R. Cohen
Nummular dermatitis consists of coin-shaped eczematous lesions (hence the name) (Fig 3.50). In general, it is uncommon to develop nummular dermatitis in the first few years of life. This disorder starts around 5 years of age and the lesions appear as small, pruritic, follicular papules that form large, exudative, crusted plaques. These lesions can be anywhere on the body but facial involvement is unusual. A nummular morphology can be seen in patients with AD but clinical presentations vary. In patients with nummular dermatitis, there is generally no xerosis. Also, the disease rarely persists beyond puberty (Krol and Krafchik 2006).
Real-life experience on effectiveness and safety of dupilumab in adult patients with moderate-to-severe atopic dermatitis
Published in Journal of Dermatological Treatment, 2021
M. C. Fargnoli, M. Esposito, S. Ferrucci, G. Girolomoni, A. Offidani, A. Patrizi, K. Peris, A. Costanzo, G. Malara, G. Pellacani, M. Romanelli, P. Amerio, A. Cristaudo, M. L. Flori, A. Motolese, P. Betto, C. Patruno, P. Pigatto, R. Sirna, G. Stinco, I. Zalaudek, L. Bianchi, V. Boccaletti, S. P. Cannavò, F. Cusano, S. Lembo, R. Mozzillo, R. Gallo, C. Potenza, F. Rongioletti, R. Tiberio, T. Grieco, G. Micali, S. Persechino, M. Pettinato, S. Pucci, E. Savi, L. Stingeni, A. Romano, G. Argenziano
A total of 109 (71 M/38F) patients, with a mean age of 37.9 years (SD 14.7, range 19–80) was included in the study. Demographic and clinical baseline characteristics of patients are summarized in Table 1. Mean age at disease onset was 14.2 years (range 0–77, SD 17.8), mean BMI was 23.9 (range 17–34.6, SD 3.4) and the pattern of AD was persistent in 59/109 (54.1%) patients, relapsing in 27/109 (24.8%) patients and late-onset in 23/109 (21.1%). The most frequent AD phenotype was the classic adult-type with lichenified/exudative flexural dermatitis, often associated with head/neck eczema and/or hand/feet eczema, observed in 79/109 (72.5%) patients, followed by erythrodermic in 13/109 (13%), prurigo in 9/109 (8.2%) and nummular dermatitis in 8/109 (7.3%). Face was affected in 83/109 (76.1%) patients, hands in 67/109 (61.5%) and genitals in 25/109 (22.9%). Allergic comorbidities were mostly represented by allergic rhinitis (44.9%), asthma (38.5%), conjunctivitis (33.0%) and food allergy (15.6%). Other comorbidities including psychiatric or psychological conditions (11%), hypertension and cardiovascular disorders (9.1%) and obesity (6.4%) were less frequent. The majority of patients had been treated with cyclosporine (88.9%), followed by oral corticosteroids (88.1%), phototherapy (UVB) (45.8%), methotrexate (24.7%), azathioprine (16.5%), omalizumab (7.3%) and mycophenolate mofetil (0.9%).
Eosinophilic Granulomatosis with Polyangiitis Presenting as Unilateral Acute Anterior Ischaemic Optic Neuropathy
Published in Neuro-Ophthalmology, 2021
Anthony Fong, Shahzada Ahmed, Satheesh Ramalingam, Rachel M. Brown, Lorraine Harper, Susan P. Mollan
On examination, the visual acuity in her right eye (OD) was 6/5 and left eye (OS) was 6/6. She could see 16/17 OD and 15/17 OS of the Ishihara colour plates. She had a mild left relative afferent pupillary defect. Slit lamp examination showed a nodular episcleral injection of the right eye temporally. No intraocular inflammation was present. Fundus examination was normal on the right but there was marked optic disc swelling on the left with cotton wool spots overlying the disc but no haemorrhages (Figure 1). The peripheral retina and vessels were otherwise normal. Optical coherence tomography (OCT) of her peripapillary retinal nerve fibre layer (RNFL) likewise was normal in the right eye, but markedly swollen on the left in a diffuse pattern with a mean thickness of 337 µm (Figure 2a). Her Goldmann visual field in the right eye was normal but in the left showed an enlarged blind spot with an inferior arcuate scotoma (Figure 2c). There were no other orbital signs present. Her other cranial nerves were normal. Examination of her areas of rash on the face showed small <1 cm patches of nummular dermatitis consistent with eczema, while the occipital scalp lesion was larger (6–7 cm) with scaly hyperkeratosis reminiscent of psoriasis. No erythema nodosum or areas of necrosis were evident.
Mindfulness-Based Cognitive Hypnotherapy and Skin Disorders
Published in American Journal of Clinical Hypnosis, 2018
Hypnosis has been used to assist in improving a wide variety of skin disorders. These include acne excoriée, alopecia areata, atopic dermatitis, congenital ichthyosiform erythroderma, dyshidrotic dermatitis, erythromelalgia, furuncles, glossodynia, herpes simplex, hyperhidrosis, ichthyosis vulgaris, lichen planus, neurodermatitis, nummular dermatitis, postherpetic neuralgia, pruritus, psoriasis, rosacea, trichotillomania, urticaria, verruca vulgaris, and vitiligo (Shenefelt, 2000). Behavioral medicine approaches using hypnosis for skin disorders such as acne, eczema, herpes, neurodermatitis, pruritus, psoriasis, and warts have been successful (Brown & Fromm, 1987, pp. 126–134). When hypnotic suggestion proves insufficient, such as for resistant warts, prurigo nodularis, or erythema nodosum, psychosomatic hypnoanalysis can often produce improvement or resolution (Shenefelt, 2007). Psychosomatic hypnoanalysis has also been reported effective in specific cases for herpes simplex, neurodermatiits, urticaria from chocolate, and persistent warts resistant to ordinary hypnotic suggestion (Ewin & Eimer, 2006, pp. 73–92). The affect bridge technique or the somatic bridge technique is often employed. Cheek and LeCron’s seven key factors can be recalled by the mnemonic C.O.M.P.A.S.S. for Conflict, Organ language (skin), Motivation or secondary gain, Past traumatic experiences, Active identification with a significant person, Self-punishment, and Suggestion or imprint (Shenefelt, 2010). If there is still no response, where appropriate spiritual aspects can be explored and if spiritual blockages are present they can be removed to allow healing to proceed (Shenefelt & Shenefelt, 2014). Spiritual experiences often involve trance and can be explored through hypnosis. Hypnotic relaxation for dermatologic procedures and surgeries has been shown to significantly reduce anxiety associated with the procedures (Shenefelt, 2013).