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Itching is mild to severe The lesions are violaceous, flattopped, angulated papules, up to 1 cm in diameter, discrete or in clusters, with very fine white streaks (Wickham s striae) on the flexor surfaces of the wrists and on the penis, lips, tongue, and buccal and vaginal mucous membranes The papules may become bullous or eroded The disease may be generalized Mucosal lichen planus has been reported in the genital and anorectal areas, the gastrointestinal tract, the bladder, the larynx, and the conjunctiva Mucous membrane lesions have a lacy white network overlying them that may be confused with leukoplakia The Koebner phenomenon (appearance of lesions in areas of trauma) may be seen A special form of lichen planus is the erosive or ulcerative variety, a major problem in the mouth or genitalia Squamous cell carcinoma develops in 5% of patients with erosive oral or genital lichen planus

Cooper SM et al Influence of treatment of erosive lichen planus of the vulva on its prognosis Arch Dermatol 2006 Mar;142 (3):289 94 [PMID: 16549703]

Tapioca vesicles of 1 2 mm on the palms, soles, and sides of fingers, associated with pruritus (Plate 12) Vesicles may coalesce to form multiloculated blisters Scaling and fissuring may follow drying of the blisters Appearance in the third decade, with lifelong recurrences

namespace Example_5_18_ _ _ _for_Loop_Without_Initialization { class Program { public static void Main( ) { int counter = 0; // some work here counter = 3; // more work here for (; counter < 10; counter++) { Console.WriteLine("counter: {0} ", counter); } } } }

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Dyshidrotic eczema is a misnomer, suggesting that the vesicles of this condition are related to eccrine sweat ducts and sweating, which they are not This is an extremely common form of hand dermatitis, preferably called pompholyx (Gr bubble ) or vesiculobullous dermatitis of the palms and soles Patients often have an atopic background and report flares with stress Patients with widespread dermatitis due to any cause may develop pompholyx-like eruptions as a part of an autoeczematization response

Small clear vesicles stud the skin at the sides of the fingers and on the palms or soles They look like the grains in tapioca They may be associated with intense itching Later, the vesicles dry and the area becomes scaly and fissured

Smallpox and vaccinia are to be distinguished from generalized varicella zoster virus infection or generalized herpes simplex The latter two viral infections are not associated with a severe febrile prodrome Lesions are at various stages at each anatomic site Varicella usually appears in waves or crops Multiple palm and sole lesions are common in variola and uncommon in generalized varicellazoster and herpes simplex infection Direct fluorescent antibody testing for HSV and varicella zoster virus are the first-line diagnostic tests to differentiate varicella zoster virus, HSV, vaccinia, and variola Until the diagnosis is confirmed, strict isolation of the patient is indicated Similar fluorescent testing for variola can be performed in special laboratories

The output looks like this:

Unroofing the vesicles and examining the blister roof with a KOH preparation will reveal hyphae in cases of bullous tinea Patients with inflammatory tinea pedis may have a vesicular dermatophytid of the palms Always examine the feet of a patient with a hand eruption Nonsteroidal antiinflammatory drugs (NSAIDs) may produce an eruption very similar to that of dyshidrosis on the hands

Topical and systemic corticosteroids help some patients dramatically Since this is a chronic problem, systemic corticosteroids are generally not appropriate therapy A high-potency topical corticosteroid used early in the attack may help abort the flare and ameliorate pruritus Topical corticosteroids are also important in treating the scaling and fissuring that are seen after the vesicular phase It is

There is no specific and proven antiviral therapy for vaccinia or variola Vaccinia immune globulin is used to treat eczema vaccinatum and progressive vaccinia Cidofovir may have some activity against these poxviruses

Table 7.6 The data types for the various interface objects of the MemoryTracker program Item Process to track (as well as the other window labels) All test fields Buttons Data To Plot menu Help reference System Font Text Type

essential that patients avoid anything that irritates the skin; they should wear cotton gloves inside vinyl gloves when doing dishes or other wet chores, use long-handled brushes instead of sponges, and use a hand cream after washing the hands Patients respond to PUVA therapy and injection of botulinum toxin into the palms as for hyperhidrosis

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Although the lesions are triggered by sun exposure, the wavelength of light triggering the lesions is beyond that absorbed by sunscreens, which for that reason are ineffective Barrier sun protection with clothing is required

For most patients, the disease is an inconvenience For some, vesiculobullous hand eczema can be incapacitating

Ogden S et al Recalcitrant hand pompholyx: variable response to etanercept Clin Exp Dermatol 2006 Jan;31(1):145 6 [PMID: 16309517]

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