Scapula and Bone Structure

Scapula and Bone Structure: part 1


Scapula and Bone Structure: part 2

Ephelides (freckles)

Ephelides (also called freckles) are tanned macules seen on the skin. Ephelides are usually multiple in number. Although ephelides are predominantly benign, they may be found in association with systemic disease. Ephelides are associated with fair skin and red or blonde hair. In contrast to solar lentigines, ephelides are not strongly related to age.

Freckle Dermatology The most common pigmented lesion of young light-skinned Caucasians, often of Celtic stock, consisting in light brown 1-10 mm macules which fade in winter, and are accentuated in summer.

Clinically : Ephelides appear during childhood as scattered areas of increased pigmentation, mainly limited to the body regions above the waist.
* These macules are asymptomatic, more numerous on sun-exposed areas, and fade and become smaller in the winter.

On examination, Simple ephelides appear as multiple, small, tanned macules, ranging from 1-5 mm in diameter, with uniform pigmentation. They are most commonly found on sun-exposed areas, such as the nose, the cheeks, the shoulders, and the upper part of the back. The macules may be discrete or confluent.
* Sunburn freckles present similarly to that of simple freckles, but they are darker, have irregular borders, and may be as large as a few centimeters.

Peutz-Jeghers syndrome

A 10 years old girl presents with multiple pigmented macules on the vermilion border of her lower lip.The dark brown lesions are 2–5 mm in size and are arranged in a cluster.The patient’s older brother has similar lesions. The patient complains of recurrent bouts of abdominal pain. the most likely diagnosis is?..............

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Cranial Nerve Examination

Keloids Pictures and Therapy

A Keloid is a type of scar with mainly type I and some type III collagen which results in an overgrowth of tissue at the site of a healed skin injury. Keloids are firm, rubbery lesions or shiny, fibrous nodules, and can vary from pink to flesh-colored or red to dark brown in color. A keloid scar is benign, non-contagious, and usually accompanied by severe itchiness, sharp pains, and changes in texture. In severe cases, it can affect movement of skin.

You should not be confused with hypertrophic scars,Hypertrophic scars remain limited to the traumatized area and regress spontaneously within 12-24 months, although regression may not necessarily be complete.

Prevention:
It is the first line in keloid therapy. Avoid performing nonessential cosmetic surgery in patients known to form keloids; however, the risk is lower among patients who have only earlobe lesions. Close all surgical wounds with minimal tension. Incisions should not cross joint spaces. Avoid making midchest incisions, and ensure that incisions follow skin creases whenever possible.


Treatments:
*Occlusive dressings include silicone gel sheets and dressings, nonsilicone occlusive sheets, and Cordran tape. These measures have been used with varied success. Antikeloidal effects appear to result from a combination of occlusion and hydration, rather than from an effect of the silicone.

*Compression therapy involves pressure, which has long been known to have thinning effects on skin. Reduction in the cohesiveness of collagen fibers in pressure-treated hypertrophic scars has been demonstrated by electron microscopy.

- Compression treatments include button compression, pressure earrings, ACE bandages, elastic adhesive bandages, compression wraps, spandex or elastane (Lycra) bandages, and support bandages. In one study, button compression (2 buttons sandwiching the earlobe applied after keloid excision) prevented recurrence during 8 months to 4 years of follow-up observation.

*Corticosteroids, specifically intralesional corticosteroid injections, have been the mainstay of treatment. Corticosteroids reduce excessive scarring by reducing collagen synthesis, altering glucosaminoglycan synthesis, and reducing production of inflammatory mediators and fibroblast proliferation during wound healing. The most commonly used corticosteroid is triamcinolone acetonide (TAC) in concentrations of 10-40 mg/mL administered intralesionally with a 25- to 27-gauge needle at 4- to 6-week intervals.

Recent innovations:
New treatments for keloids and hypertrophic scars include intralesional IFN; 5-FU; doxorubicin; bleomycin; verapamil; retinoic acid; imiquimod 5% cream; tacrolimus; tamoxifen; botulinum toxin; TGF-beta3; rhIL-10; VEGF inhibitors; etanercept; manose-6-phosphate inhibitors; etanercept; onion extract; the combination of hydrocortisone, silicon, and vitamin E; PDT; intense pulsed light (IPL); UVA-1; and narrowband UVB.