Skin Manifestations inICU the

Skin Manifestations Useful for theManagement of Patients in an IntensiveCare Unit or an Emergency Room : 

Skin Manifestations Useful for theManagement of Patients in an IntensiveCare Unit or an Emergency Room M.YOUSRY ABDEL-MAWLA,MD ZAGAZIG FACULTY OF MEDICINE,ZAGAZIG,EGYPT

Skin Changes Which HaveEvidences of the Background : 

M.Y.ABDEL-MAWLA Zagazig Faculty of Medicine 2 Skin Changes Which HaveEvidences of the Background Generalised pigmentation including mucosal pigmentation:metabolic or endocrine disorders Purpuric macules:these observed after months of corticosteroids therapy , in Cushing disease. on the sun-exposed areas, especially on the dorsal forearms of old patients.

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Skin Changes Which HaveEvidences of the Background : 

M.Y.ABDEL-MAWLA Zagazig Faculty of Medicine 4 Skin Changes Which HaveEvidences of the Background Pigmented spots on the trunk may be induced by the presence of mast cells as in mastocytosis. A thin, translucent skin with a clearly visible venous network on the trunk may be the sole manifestation of a rare genetic disease named Ehlers–Danlos type IV

Skin Changes Which HaveEvidences of the Background : 

M.Y.ABDEL-MAWLA Zagazig Faculty of Medicine 5 Skin Changes Which HaveEvidences of the Background When petechiae, purpura, and ecchymoses occur spontaneously or after minor trauma on an apparently normal skin, without evidence of haemostasis abnormality: amyloid infiltration of the blood vessels walls. Primary and myeloma-associated systemic amyloidosis: purpuric lesions are especially found in flexural regions( as the eyelids). Other dermatologic manifestations of systemic amyloidosis include enlarged tongue and waxy, smooth shiny papules or nodules. Pitting edema may result from nephrotic syndrome and congestive cardiac failure

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Helpful Skin Changes for the Diagnosis of the Emergency in Clinical Situations : 

M.Y.ABDEL-MAWLA Zagazig Faculty of Medicine 8 Helpful Skin Changes for the Diagnosis of the Emergency in Clinical Situations Acute Abdominal Syndrome Cerebrovascular Events (CVE) Haemorrhagic Syndrome

Acute Abdominal Syndrome : 

M.Y.ABDEL-MAWLA Zagazig Faculty of Medicine 9 Acute Abdominal Syndrome Panniculitis : Crops of painful, erythematous fluctuant nodules appear mainly on the legs or on the trunk (pancreatitis or pancreatic carcinoma). Eruptive xanthomas : yellow-orange to red-brown papules surrounded by an erythematous halo, appearing in crops on the buttocks, extensor surfaces of the extremities, and flexural creases(in hypertriglyceridemia) . Malignant atrophic papulosis ( Degos’s disease): a rare disorder characterized by widespread thrombosis( in the skin , gastrointestinal tract , in the ocular & central nervous system). skin lesions consist initially of small, fi rm papules from 2 to 5 mm in diameter. Secondly, the papules become umbilicated,and a central white, porcelain-like zone of atrophy appears. Palpable purpura: in anphylacoid purpra

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Cerebrovascular Events (CVE) : 

M.Y.ABDEL-MAWLA Zagazig Faculty of Medicine 11 Cerebrovascular Events (CVE) Livedo reticularis: a reticular pattern. When it is painful, violaceous, associated with skin necrosis or purple toes indicates cholesterol crystal microembolisms.

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Haemorrhagic Syndrome : 

M.Y.ABDEL-MAWLA Zagazig Faculty of Medicine 14 Haemorrhagic Syndrome Yellow papules on flexures (Pseudoxanthoma elasticum):intestinal bleeding or early atherosclerosis. Lesions begin as yellow papulesgradually enlarging to form plaques or redundant folds of skin. Round telangiectasia: on the cheeks , in the mouth (lips, tongue…) & hands and feet are suggestive of hereditary hemorrhagic telangiectasia

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Some Nail Abnormalities, : 

M.Y.ABDEL-MAWLA Zagazig Faculty of Medicine 17 Some Nail Abnormalities, Half and half nails:a proximal white half of the nail due to edema of the nail bed and a normal distal portion due to hypoalbuminemia ,cirrhosis and renal failure. Multiple subungual splinter hemorrhages : tiny linear longitudinally oriented, reddish-brown to black, distal subungual lesions that fail to blanch under pressure( an underlying thrombotic or embolic disease).

Some Nail Abnormalities : 

M.Y.ABDEL-MAWLA Zagazig Faculty of Medicine 18 Some Nail Abnormalities Clubbing : an enlargement of distal digits giving them a bulbous appearance. The angle between the proximal nail fold &the nail plate is normally less than 180°. In patients with clubbing, the angle straightens and exceeding 180°. Bilateral and symmetric acquired clubbing of the nails may occur in association with all pulmonary and mediastinal diseases, cyanotic cardiovascular diseases, hepatic cirrhosis, and chronic diarrhea.

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THANK YOU : 

M.Y.ABDEL-MAWLA Zagazig Faculty of Medicine 21 THANK YOU