Review - Clinical XI (Derma & Endocrinology)

[Intro: 80 BPM. The slow, heavy thud of a skin-covered frame drum begins. A Ney flute echoes through a vast, cavernous reverb. A deep, guttural throat-singing drone rises from the depths, vibrating the chest.] [Block 1: The Tagelharpa begins a gritty, mournful dirge. The chanter speaks of the skin, the fragile armor of the flesh.] Lichen simplex chronicus. Lichenified plaques appear on the neck, wrists, ankles, or perineum. “Treat with topical corticosteroids” simplex Atopic dermatitis, severe itching, inflamed and painful skin. Most have skin disease before age 5. Exacerbate with emotional stress and sweating. Treat emollients “avoid scratching”, topical steroids Listen Cutaneous lupus; Discoid lupus “violaceous-to-red, well-defined, single or multiple plaques, usually on the face, scalp, and external ears”. A.N.A., biopsy. Sunscreen, topical corticosteroids "Be careful" lupus In subacute cutaneous lupus “erythematous annular or psoriasiform plaques, often drug-induced, mainly cutaneous, a good prognosis” [Block 2: The Shamanic drum strikes harder. The Ney flute weaves a snake-like, sorrowful melody above the low, rumbling vocals.] Porphyria cutanea tarda “painless blistering the dorsal surfaces of the hands”. Stop triggering medications, alcohol. Phlebotomy, hydroxychloroquine. tarda arda non Acute porphyria present in adolescence. Acute attacks of severe abdominal pain, nausea, constipation, palpitations, sweating, confusion, peripheral neuropathy, seizures, and paresis, tachycardia, and hypertension. Attacks associated with menses. Behavior changes, depression, acute psychosis. Darkening of the urine (red color), particularly on exposure to light. Eliminating factors “medications, caloric deprivation, and dehydration”. I.V. hemin [Block 3: A choral hum joins the throat singer. The Tagelharpa plays a rhythmic, scraping ostinato as the afflictions of the blood and skin continue.] Dermatitis herpetiformis intensely pruritic papules, vesicles, on the elbows, knees, buttocks, posterior neck, and scalp titis, this is Pemphigus “prednisone”. Bullous pemphigoid “pruritic tense blisters in flexural areas, usually remit in 5 years, mostly over 60”. Drugs (furosemide) may induce. “Corticosteroids, doxycycline with nicotinamide, or dapsone” [Block 4: The music strips back to just the frame drum and the haunting Ney. The lyrics shift to the shedding of hair, a meditation on aging and loss.] Telogen effluvium “excessive shedding of hair without scalp itching or scaling ” This is it. Alopecia areata “smooth hairless patches without scarring” Tiny hairs called “exclamation hairs,” may be seen. Treat with steroids, occasionally associated with autoimmune disorders. Cicatricial alopecia by chemical or physical trauma, infections, chronic discoid lupus, scleroderma. Cicatricial , destruction [Block 5: The Throat Singing reaches a powerful, rumbling crescendo. The chant turns to the throat itself—the center of breath and spirit.] Painful Subacute Thyroiditis “de Quervain, granulomatous”; “N.S.A.I.D.s; for severe pain, prednisone” one and only Ig.G.4-Related (Riedel) Thyroiditis, treat with tamoxifen, g4, g4 no 5 Postpartum thyroiditis, transient hyperthyroidism followed by hypothyroidism. hyperhypo, hyperhypo Painless (silent) sporadic subacute thyroiditis; autoimmune, similar to postpartum thyroiditis, caused by amiodarone or immunotherapy [Outro: The Tagelharpa and Ney flute intertwine in a final, dissonant, and epic climax before fading into the mist.] Amiodarone, mostly hypothyroidism. Treat with levothyroxine. Discontinuation often not necessary. No need, just maybe, Causes hyperthyroidism either type 1 “iodine-induced” treat with antithyroid drugs; type 2 “painless thyroiditis” treat with steroid. Amiodarone may be continued based on patients “especially in type 2” 2 types, 1 2, 1 2 . This is the end [Ending: A final strike of the shamanic drum echoes into the void. The deep throat drone slowly fades into a heavy, lingering breath. Total silence.]