Introduction:
Papular pruritic eruption (PPE) is the most common cutaneous manifestation of HIV, and is recognized as a WHO Clinical Stage 2 disease of HIV. PPE has a reported prevalence of 11-46% depending on geographic region, and is most commonly reported in African countries, Haiti, Brazil, and Thailand, and is less common in European and North American countries. PPE is characterized by multiple discrete skin-colored or erythematous urticarial papules symmetrically distributed on the body. The lesions are most commonly located on the extremities but can also be found on the trunk, face, or are generalized with sparing of mucous membranes, palms and soles, and digital web spaces. Pruritus begins with lesion appearance, and itching
…show more content…
PPE may also be related to HIV infection of the skin and immune dysregulation in the skin. Some studies have suggested that the lesions of PPE are an immunologic manifestation related to the inversion of the normal ratio of CD4:CD8 T cells and the normal ratio of Th1:Th2 response and cytokine profile that occurs in HIV infection and results in the inability to recognize endogenous proteins.
Findings:
PPE is characterized by multiple sharply demarcated urticarial papules that are either skin-colored or erythematous. The lesions are symmetrically distributed and more commonly seen on the extremities, but are also found on the trunk, face, or be generalized with sparing of mucous membranes, palms and soles, and digital web spaces. Studies have shown that 95% of lesions are located on the extremities, arms and legs, most frequently on the extensor surfaces and dorsum of the hands. PPE has a chronic course that waxes and wanes, and the lesions change appearance over time, with new lesions appearing daily. As the pruritus beings with lesion appearance, scratching leads to excoriations, secondary infections, and post-inflammatory hyperpigmentation, eventually leading to scarring and prurigo-like nodules. The lesions of PPE are predominantly papular, but there have been variants reported that display pustular lesions with acneform appearance.
Diagnostic pearls:
• PPE is more common in developing countries in individuals with history of insect bites and NO history of
Specific skin cancers including Kaposi's Sarcoma and lymphomas also happen in patients who are HIV positive” (Mayo Clinic, 2013).
Impetigo can appear anywhere, but is most common on exposed areas of skin such as the face, around the nose, mouth and on the hands. Initially it appears as groups of thin-roofed pus-filled blisters which tend to break quickly to leave round oozing patches covered with crusts. The patches are small at first but slowly get bigger.
The Acquired Immune Deficiency Syndrome denotes a spectrum of conditions that are caused by the HIV virus. Infection with this disease does not result in the instant occurrence of the related signs and symptoms. However, an individual is likely to experience flu-like symptoms after he or she is infected with it. Eventually, the person experiences a prolonged period of apparent health with no visible signs. On progression, the infection adversely interferes with the immune system of the individual. The weakening of the body’s defense system increases the risk of recurrence of common infections and opportunistic illnesses that
K.D. is a 36-year-old gay professional man who has been human immunodeficiency virus (HIV) positive for 6 years. Until recently, he demonstrated no signs and symptoms (S/S) of acquired immunodeficiency syndrome (AIDS). The appearance of purplish spots on his neck and arms persuaded him to make an appointment with his physician. When he arrives at the physician’s office, the nurse performs a brief assessment. His vital signs (VS) are 138/86, 100, 30, 100.8° F. K.D. states that he has been feeling fatigued for several months and is experiencing occasional night sweats, but he also has been working long hours, has skipped meals, and has been particularly stressed over a project at work. K.D.’s physical examination is within normal limits (WNL) except for his rapid heart rate and respirations, low-grade fever, and skin lesions. The doctor orders a chest x-ray (CXR), CBC, lymphocyte studies, ultra viral load, Cytomegalovirus (CMV) assay, and a PPD (purified protein derivative) test. K.D. made an appointment
Patient is a 9 year old adolescent male, presents with a 2 day history of itching encrusted sores especially around the mouth area. Parent is using OTC antibiotic ointment with no improvement, no recent history of fever. Parent states that pat recently visited a petting zoo
Psoriasis: This is a common, chronic and recurring skin disorder that changes and alters the life cycle of skin cells. It causes cells to accumulate quickly on the skin surface. The extra cells from the skin forms a thick, itchy, silvery scale and a red patch. It can appear at any part of the body such as the knee, scalp, elbow etc. it is treated with drugs applied to the skin, ingested and with ultraviolet radiation. This disease has affected about 1%-5% of the world population and it is more common to the light skinned people. Psoriasis may persist throughout a person’s life as it comes and goes but it is usually reduced during the summer period when the skin is exposed to ultraviolent radiation and flare ups are common during
Idiopathic disorders as Vitiligo may be confused with PA. Vitiligo is an acquired pigmentary disorder of the skin and mucous membranes that is characterized by circumscribed, depigmented
Then there is generalized erythema rapidly followed by the development of flaccid blisters and desquamation, as seen in this patient. The mucous membranes are not involved, which is also consistent with our patient. The surrounding areas of her face were involved, but the mucous membranes were spared. This condition is also associated with a positive Nikolsky sign. A Nikolsky sign is the ability to extend the area of superficial sloughing by applying gentle lateral pressure on the surface of the skin at an apparently uninvolved site. This was found incidentally in our patient when the adhesive tape of an IV line was removed resulting in sloughing off of the skin below it. Furthermore, due to the sloughing off of skin with pressure, there tends to be increased desquamation in areas of mechanical stress like the flexural areas, buttocks, hands, and feet. If SSSS is suspected, cultures should be obtained from the blood, the urine, the nasopharynx, the perianal area, and any other abnormal skin or suspected focus of infection. The intact bullae are sterile and will come back without growth. In this patient, blood cultures had no growth to date and the pan-cultures from the mouth, nares, eyes, and anus were non-specific. Diagnosis for SSSS is usually clinical, although it may be confirmed with skin biopsy that shows a cleavage plane in the lower stratum
On April 7th, 2016, a 36 year old male inpatient at Tattnall Optim Medical Center come to radiology department for a procedure that include two views of chest and five views of bilateral ribs. Human Immunodeficiency Virus (HIV) and decreased white blood cell (WBC) were included in the patient’s medical history. The patient also experiences a chest pain, cough, shortness of breath, and weakness. He mentions that he have a bilateral ribs pain. HIV infection is a disease that affect the body’s immune system by attacking and destroying T lymphocytes, making the affected person susceptible to numerous respiratory infection and malignant tumor (Crowley, 2007. p. 158).
40 patients were reported to have Psoriasis (skin rash) within their peripheral extremities. The skin rash appear to be red with pus, liquid oozing from the rash (looking like a zombie rash). Each patients are also reports that their extremities itch, and sometime even inflamed.
The foreskin also contains a high density of HIV target cells (ie, Langerhans cells, CD4 T cells,
Mount Vesuvius is one of history’s most recognizable Volcanoes, as each of its eruptions have gone down as a significant event in geologic history. The events that transpired during and after these eruptions have shaped the way scientists and people view the sheer power that these volcanoes possessed. This report will take a look at Vesuvius’ most prolific eruption in 79 AD. The geologic setting of the mountain, precursor activity, and the impact the eruption had on the surrounding populations and towns will all be detailed. Along with these details, this report will also look at the further history of Vesuvius’s explosive past by detailing its eruption cycle. Finally, the current state of Vesuvius and the possible danger
The first and most common form is the Plaque Psoriasis. It is an infected area that appears red on the base of the skin and covered by silvery scales. About 80% of patients with the disorder have this type of form. The second form is the Guttate Psoriasis where there are small infected areas are on the trunk, limbs, and scalp. This type of form can be triggered by infections in the upper respiratory such as a sore throat. The third form is called the Pustular Psoriasis where the infected areas will develop noninfectious pus inside blisters on the skin. This is said to be triggered through medication, infections, stress, or exposure to certain chemicals. The fourth form is called the Inverse Psoriasis. This form is caused by irritation such as friction or sweating and will cause the infected area to appear smooth and red in the folds of the skin near the genitals. Lastly, the Erythrodermic Psoriasis form is the most severe among the forms. It appears throughout the body causing reddening and scaling of the skin and can be triggered by severe sunburn or specific medication.
The reason why I agree with the thought question is because there are a lot of places people can't get to. For example people can't go to the bottom of the ocean because of the pressure from the water. In order to go deep into the ocean you need special equipment like submarines. For example scientists used a submarine that was controlled by a remote and the scientists found the world's deepest volcanic vent. Scientists believe the vent could contain unknown marine species.
The etiology is unknown, however viral disorder is believed to be involved due to presence of a prodrome in some cases and the appearance of small case clusters.