A 39‐year‐old African‐American woman was referred to the department of dermatology, Mount Sinal Hospital, New York for evaluation of a skin lesion on her scalp which had been present for 3 years and had recently changed in appearance. On examination, she was found to have erythematous plaques with hair loss extending from the frontal hairline on the right side in a “C‐shaped” distribution, terminating behind the left ear. Two years later the lesion had rapidly extended to the vertex of the scalp and left temporal area (Fig. 1). There was a 10 cm × 12 cm area of alopecia at the vertex with slight erythema, but there was no evidence of scarring, inflammation or nodularity of the scalp (Fig. 2). A skin biopsy taken from the forehead revealed granulomatous dermatitis showing noncaseating granuloma with negative acid fast bacilli (AFBC) and ammonical‐silverstain for fungus (GMS) (Fig. 3). 1 Erythematous plaque with hair loss on the left temporal area 2 Nonscarring alopecia at the vertex with slight erythema 3 Noncaseating granuloma consisting of lymphocytes, histiocytes, plasma cells and multinucleated giant cells (hematoxylin and eosin staining; magnification ×100) She complained of chronic nasal congestion for 8 months. Nasal cavity examination and laryngeal endoscopy showed multiple nodules on the nasal septum and vocal cord. At that time, a presumptive diagnosis of sarcoidal nodule of the nasal septum and vocal cord was made and corticosteroids were administered orally. A chest X‐ray demonstrated prominence of the right peritracheal and perihilar regions consistent with sarcoid. A 67 Gallium scan disclosed increased uptake in the lung and perihilar lymph nodes. A skull X‐ray showed soft tissue density of the skull, probably indicating a subcutaneous sarcoidal nodule. Computed tomography (CT) scanning of her brain and skull base showed a soft tissue mass along the outer table of the calvarium within the frontal region. Six years ago, she experienced visual changes: blurred vision, tearing, floaters on both eyes and a 1 cm × 1 cm subcutaneous, painful, firm mass on the lateral side of her left upper eyelid. A skin biopsy was performed in another hospital and revealed noncaseating granuloma. A diagnosis of sarcoidosis involving the central nervous system, lacrimal gland, nasal septum, vocal cord, lung and scalp was made, and the patient was treated with 20 mg of methylprednisone on alternate days with intralesional triamcinolone injection for skin lesions. During the follow‐up period, nasal, laryngeal, pulmonary, ocular and cutaneous lesions were slightly improved and magnetic resonance imaging (MRI) scanning will be carried out for further evaluation of the brain lesion.
Introducti on: Approximately 90% pregnant women are associated with skin changes. The skin undergoes profound alterati ons during pregnancy as a result of endocrine, metabolic and immunologic changes. Some of these are trivial and chiefl y cosmeti c, producing no or minor symptoms, others can be distressing and/or of major medical importance. For the necessity of proper and complex care of the pregnant woman,the knowledge about the changes are crucial. The ability of precise diagnosis of physiological skin changes allows specifying the suspected cases of pathologic eti ology and referring them to the dermatological referral centers for in-depth diagnosis and eventual treatment. The aim of this study was to identi fy the incidence and types of dermatological changes in our populati on.Methods: Pregnant pati ents att ending the antenatal clinic of the Gynecology department in Shree Birendra Hospital, and presenti ng to the outpati ent clinic of the Department of Dermatology, Bir Hospital, for any dermatologic problem, were enrolled. The study spanned a period of 10months (January 2008 to October 2008). We evaluated 150 pregnant women to determine the patt ern of pregnancy-induced physiologic skin changes in Nepalese community.Results: Majority of pati ent developed dermatological changes in second and third trimester. The commonest sign was hyper pigmentati on of the skin followed by striae and edema. Fungal infecti ons were the commonest infecti ons observed,Tineacorporis accounti ng for 10 (6.66%) and ti neaversicolarwas seen in Eight (5.33%) pati ents. Three (2%) pati ents hadScabies. A total of 3 pati ents had sexually transmitt ed disease. 2 (1.3%) had Condyloma acuminate and 1 (.006%) had syphilis. Conclusions:Hyperpigmentati on was the commonest sign (87.33%) followed by striae (82%), edema (45.3%), vascular changes (17.3%) and melasma (8%). Varicositi es of veins, spider nevi and palmar erythema are relati vely less frequent in our populati on.
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