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ADS 12Ed > 3.B. Dermatoses from Physical Factors [Cold Injuries] > Flashcards

3.B. Dermatoses from Physical Factors [Cold Injuries] Flashcards

Cold Injuries

1
Q

Three mechanisms of cold injuries

A
  1. Direct damage to tissues
  2. Hypoperfusion due to vascular spasm causing vascular and tissue injury
  3. Adipose tissue are predisposed to cold injury due to composition and location.
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2
Q

People predisposed to cold injuries

A

Outdoor workers

Recreationalists

Military service members

Alcoholic persons

Homeless people

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3
Q

A persistent blue discoloration of the entire
hand or foot worsened by cold exposure.

A

Acrocyanosis

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4
Q

High-risk for Acrocyanosis

A

Young women

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5
Q

.

Evolution of lesion in Acrocyanosis

A

Cyanosis increases as the temperature decreases ⇒

⇒ Erythema with elevation of the dependent part

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6
Q

Cause of Acrocyanosis

A

Unknown

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7
Q

Findings that differentiate

Raynaud syndrome from Acrocyanosis

A

Raynaud syndrome has

  1. Episodic nature
  2. Ulceration/Distal finfertip resorption
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8
Q

Findings that differentiate

Acrocyanosis from Raynaud syndrome

A

Acrocyanosis has

  1. Persistent nature
  2. Lack of tissue damage
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9
Q

Trigger of Acrocyanosis

with swelling of nose, ears and dorsal hands

A

Inhalation of Butyl nitrite.

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10
Q

Puffy hand syndrome

A

Lymphedema of the dorsal hands with

Erythema or Bluish discoloration of the digits

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11
Q

Cause of Puffy Hand Syndrome

A

Repeated injection of the dorsal hand
with narcotic drugs

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12
Q

Other groups prone to Acrocyanosis

A
  • Anorexia nervosa
  • POEMS syndrome (polyneuropathy, organomegaly,
    endocrinopathy, M component, skin changes)
  • Homozygous mutation in SAMDH1
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13
Q

A recombinant interferon which may induce Acrocyanosis

A

Interferon alpha-2a

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14
Q

Malignancy in acral vascular syndromes

A

47% of 68 of reported cases

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15
Q

Localized erythema and swelling

caused by exposure to cold

A

Chilblains

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16
Q
A
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17
Q

Other terms for Chilblains

A

Pernio

Perniosis

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18
Q

Lesions that may be found in

severe Chilblains

A

Blisters

Ulcers

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19
Q

Present in the blood in Chilblain cases

A

Cryoglobulins

Cryofibrinogens

Antiphospholipid antibodies

Cold agglutinins

20
Q

Conditions associated with Chilblains:

A
  1. Discoid and Systemic lupus erythematosus (Chilblain lupus)
  2. Leukemia cutis
  3. Nakajo-Nishimura syndrome (infancy)
  4. Aicardi-Goutières syndrome (diagnostic sign)
  5. Chronic use of crack cocaine
21
Q

Sites of Chilblains

A
  • Hands
  • Feet
  • Ears
  • Face

*especially in children

22
Q

What enhances the onset of Chilblains?

A

Dampness

23
Q

Clinical picture of patient with Chilblain

A
  • Unaware of cold
  • Later experiences burning, itching and redness
  • Extremities may be clammy due to excessive sweat
24
Q

High index of suspicion

for underlying cause of Chilblain:

A
  • Recurrent
  • Chronic
  • Extending into warm seasons
  • Poorly responsive to treatment
25
Q

Histopathology of Chilblain

A

Lymphocytic vasculitis

  • Dermal edema
  • Superficial and deep perivascular, tightly-cuffed, lymphocytic infiltrate.
  • “Fluffy” edema of the vessel walls.
26
Q

Treatment for Chilblains

(Non-medical)

A
  • Protection against cold and dampness
  • Heating pads
  • Cessation of smoking
27
Q

Treatment for Chilblain

(Medical)

A
  • Nifedipine 20 mg TID
  • Nicotinamide 500 mg TID
  • Dipyridamole 25 mg TID
  • Sildenafil 50 mg BID

*Pentoxifylline

*Hydroxychloroquine

28
Q

With no treatment, Chilblain will resolve in…

A

1-3 weeks

29
Q

Injury where soft tissue is frozen

and locally deprived of blood supply.

A

Frostbite

30
Q

Frozen part in frostbite

A

Painlessly pale and waxy.

31
Q

Tissue destruction in Frostbite similar to Burns

A
  • Erythema and edema
  • Vesicles and bullae
  • Superficial gangrene
  • Deep gangrene
  • injury to muscles, tendons,
  • periosteum, and nerves
32
Q

When should treatment of Frostbite be initiated?

A

Before swelling develops.

33
Q

Treatment of choice for Frostbite

A

Rapid rewarming in water bath

(37-43°C or 100–110°F)

34
Q

When should rewarming be delayed?

A

When there is risk of refreezing.

35
Q

Treatment of Frostbite

A
  • Covering of affected area with warm surface
  • Rapid thawing with warm bath
  • Analgesics
  • Tissue plasminogen activator within 24 hrs
36
Q

Adjunct therapy for Frostbite

A
  • Bed rest
  • High-protein/high-calorie diet
  • Wound care and avoidance of trauma
  • Massage of proximal portions of the extremity that are not numb.
  • Anticoagulants
  • Pentoxifylline,ibuprofen, and aspirin
  • Antibiotics
37
Q

Recovery period in Frostbite

A

Months

38
Q

Assessing frosbite requiring amputation

A
  • Proximal phalanx
  • Lack of radiotracer uptake on bone scan
39
Q

Immersion foot syndromes

A

Trench foot (cold)

Warm water immersion foot

40
Q

Injury resulting from prolonged exposure to cold, wet conditions without immersion or actual freezing

A

Trench foot

41
Q

Syndrome produced when there is exposure of the feet to warm, wet conditions for 48 h or more.

A

Warm water immersion foot

42
Q

Characterize Warm Immersion Foot Syndrome

A

Maceration, blanching,
and wrinkling of the soles and sides of the feet

43
Q

Symptoms associated with

Warm water immersion foot

that lasts for a few days

A

Itching and burning with swelling

44
Q

Prevention of Warm water immersion foot

A
  1. Allow feet to dry for a few hours in every 24
  2. Greasing the soles with a silicone grease OD
45
Q

Distinguish Paddy Foot Syndrome from WWIF

A

Continuous immersion of the feet in water or mud

Above 22°C (71.6°F)
for 2–10 days

46
Q

Paddy Foot or Tropical Immersion Syndrome

is characterized by:

A
  • Erythema
  • Edema
  • Pain of the dorsal feet
  • Fever
  • Adenopathy

ADS 12Ed (7 decks)

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