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A Symptoms and Signs
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Symptoms may include itching, weakness, malaise, fever, and weight loss Chills are prominent Redness and scaling is generalized and sometimes include loss of hair and nails Generalized lymphadenopathy may be due to lymphoma or leukemia or may be part of the clinical picture of the skin disease (dermatopathic lymphadenitis) The mucosa is spared
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MISCELLANEOUS SCALING DERMATOSES
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Isolated scaly patches may represent actinic (solar) keratoses, nonpigmented seborrheic keratoses, or Bowen s or Paget s disease
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B Laboratory Findings
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A skin biopsy is required and may show changes of a specific inflammatory dermatitis or cutaneous T cell lymphoma or leukemia Peripheral leukocytes may show clonal rearrangements of the T cell receptor in S zary syndrome
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1 Actinic Keratoses
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Actinic keratoses are small (02 06 cm) papules fleshcolored, pink, or slightly hyperpigmented that feel like sandpaper and are tender when the finger is drawn over them They occur on sun-exposed parts of the body in persons of fair complexion Actinic keratoses are considered premalignant, but only 1:1000 lesions per year progress to become squamous cell carcinomas Application of liquid nitrogen is a rapid and effective method of eradication The lesions crust and disappear in 10 14 days An alternative treatment is the use of fluorouracil cream This agent may be rubbed into the lesions morning and
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It may be impossible to identify the cause of exfoliative dermatitis early in the course of the disease, so careful follow-up is necessary
CMDT 2008
May follow minor infections, trauma, stress, or sun exposure; regional lymph nodes may be swollen and tender Viral cultures and direct fluorescent antibody tests are positive
night until they become first red and sore and then crusted and eroded (usually 2 3 weeks) Carac (05% fluorouracil) may be used once daily for a longer period (4 weeks to several months) Keratoses may clear with less irritation Imiquimod 5% cream applied two to three times weekly for 3 6 weeks is the more costly alternative to topical fluorouracil (5FU) Any lesions that persist should be evaluated for possible biopsy
Berman B et al; Primary Care Education Consortium; Texas Academy of Family Physician Actinic keratoses: sequelae and treatments Recommendations from a consensus panel J Fam Pract 2006 May;55(5 suppl):1 8 [PMID: 16672155]
General Considerations
Over 85% of adults have serologic evidence of herpes simplex type 1 (HSV-1) infections, most often acquired asymptomatically in childhood Occasionally, primary infections may be manifested as severe gingivostomatitis Thereafter, the patient may have recurrent self-limited attacks, provoked by sun exposure, orofacial surgery, fever, or a viral infection About 25% of the United States population has serologic evidence of infection with herpes simplex type 2 (HSV-2) HSV-2 causes lesions whose morphology and natural history are similar to those caused by HSV-1 on the genitalia of both sexes The infection is acquired by sexual contact In monogamous heterosexual couples where one partner has HSV-2 infection, seroconversion of the noninfected partner occurs in 10% over a 1-year period Up to 70% of such infections appeared to be transmitted during periods of asymptomatic shedding Genital herpes may also be due to HSV-1
2 Bowen s Disease & Paget s Disease
Bowen s disease (intraepidermal squamous cell carcinoma) occurs either on sun-exposed or sun-protected skin The lesion is usually a small (1 3 cm), well-demarcated, slightly raised, pink to red, scaly plaque and may resemble psoriasis or a large actinic keratosis These lesions may progress to invasive squamous cell carcinoma Excision or other definitive treatment is indicated Extramammary Paget s disease, a manifestation of intraepidermal carcinoma or underlying genitourinary or gastrointestinal cancer, resembles chronic eczema and usually involves apocrine areas such as the genitalia Mammary Paget s disease of the nipple, a unilateral or rarely bilateral red scaling plaque that may ooze, is associated with an underlying intraductal mammary carcinoma
Akhdari N et al Bowen disease CMAJ 2006 Sep 26;175(7):739 [PMID: 17001052] Shepherd V et al Extramammary Paget s disease BJOG 2005 Mar;112(3):273 9 [PMID: 15713139]
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