Other Dermatologic Manifestations



Other Dermatologic Manifestations

Chondrodermatitis Nodularis Helicis
Chondrodermatitis nodularis helicis is a reactive phenomenon of the helix that results in the clinical appearance of an eroded papule along the helical rim or crus. Chronic trauma and resultant vasculitis are thought to be causative. The lesion is typically unilateral, located on the side of frequent pressure from phone usage or sleeping. The lesions are painful to the touch. Because chondrodermatitis nodularis helicis can clinically mimic nonmelanoma skin cancer, a biopsy is critical to distinguish the two. Effective treatment must both remove the abnormal tissue and decrease chronic pressure to prevent recurrence. Because the vasculitis extends deeply, an excision through cartilage is often necessary. Cryotherapy can also be used to destroy the abnormal tissue. Prevention of recurrence includes alternating sides during sleep and phone usage and/or the use of a custom pillow to decrease pressure on the affected area.

Vitiligo
Vitiligo is a dermatologic condition characterized by patches of depigmentation on the skin in various patterns of presentation: the localized form affects only one area of skin, the generalized form affects many areas, and universal vitiligo affects the entire body. Although typically an isolated clinical finding, vitiligo can be associated with autoimmune disease, or it may be seen as part of a syndrome. The incidence of vitiligo is approximately 1% in the United States and up to 8% in India. It may appear at any age and occurs equally in men and women. Vitiligo can substantially impair a patient’s quality of life, because it is poorly understood and in some cultures is erroneously believed to be a sign of leprosy or sexually transmitted disease.
Treatment of vitiligo should be offered under the direction of a dermatologist, because the disease can be a challenge to manage. Camouflage is a useful adjunct to all treatments, and consultation with an aesthetician is worthwhile for patients. Light therapy has been shown to stimulate repigmentation in some cases, although at times it can cause increased pigmentation of surrounding normal skin, making the depigmented area more noticeable. High-potency topical steroids, topical nonsteroidal antiinflammatory drugs, and topical irritants have also been shown to promote repigmentation. In cases of severe refractory disease, depigmentation of uninvolved skin can be considered. Surgical treatment with grafting of pigmented skin has also been described.

Seborrheic Dermatitis
Seborrheic dermatitis is a common condition of the head and neck that manifests as scale with or without erythema of the scalp (dandruff), eyebrows, and central face. The pathologic role of the yeast Malassezia furfur is suspected, although the yeast can be found on normal skin as well. Low-potency steroids, alone or in combination with topical antifungals, are the most effective treatment modality. Steroidsparing calcineurin inhibitors and selenium sulfide have been demonstrated to be equally effective in some studies.

Stevens-Johnson Syndrome
Stevens-Johnson syndrome is a severe cutaneous reaction to a drug or infectious trigger characterized by erythema and blistering of the skin and mucous membranes of less than 10% of body surface area. More severe cases, characterized by greater than 30% of body surface area, constitute toxic epidermal necrolysis, whereas cases of 10% to 30% involvement are considered Stevens-Johnson/toxic epidermal necrolysis overlap syndrome.
In adults, cases are usually drug induced, but pediatric cases may occur in response to an infection. A definitive cause cannot always be identified. Fever and malaise are commonly the first symptoms to appear, followed by cutaneous lesions and variable involvement of mucosae, including conjunctivitis, stomatitis, and balanitis.
Early diagnosis and identification of the offending agent is critical. Suspected medications should be stopped immediately. Common causes include sulfa antibiotics, allopurinol, and antiepileptics, although numerous medications have been associated with the disease. Supportive treatment in a burn unit is necessary in the event of significant desquamation. Ocular involvement should be managed by an ophthalmologist to minimize permanent sequelae. Likewise, genital disease should be guided by consultation with a gynecologist or urologist. Pulsed oral corticosteroids are given early in the course of disease, but their use after substantial desquamation has been associated with increased morbidity. Intravenous immunoglobulins have been shown to have an overall positive effect on the progression of disease.

Morphea (Including en Coup de Sabre)
Localized scleroderma, or morphea, is a focal scarring process of the skin and subcutaneous tissue. The en coup de sabre variant is characterized by an atrophic plaque of the central forehead and frontal scalp. The sclerosis may extend deeply into the muscle and bon

Source: Cummings Otolaryngology, 6E (2015)

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