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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5220_Библиотеки_им_академика_М_И_Перельмана.pdf
216 14 Legs
Fig. 14.1 Cutaneous small
vessel vasculitis
– Diagnosis: When typical purpuric lesions are present in lower extremities, the
diagnosis is obvious clinically. Histopathology can help in diagnosing CSVV, in
scenarios where clinical presentation is ambiguous.
14.1.1 Management
It is usually self-limited. About 10% of cases can become chronic or recurrent
–
(Russell and Gibson 2006).
– Aggressive treatment is usually not needed. Eliminating any triggers need to
be done. Topical moderate-to-potent steroids for itching can be prescribed. Oral
prednisone can be administered in cases that have extensive involvement.
14.2 Stasis Dermatitis (Fig. 14.2)
– Caused by chronic venous insufficiency.
– It presents with bilateral erythematous, eczematous plaques usually involving the
lower one third of the leg, more so around the medial malleolus (Zepecki and
2018
Blasiak
).
14.2 Stasis Dermatitis (Fig. 14.2) 217
Fig. 14.2 Stasis dermatitis
– Usually associated with edema of the lower legs.
14.2.1 Management
–
Includes elevation of the leg and compression stockings.
Unna boot, a bandage that contains moist zinc oxide, was found to be beneficial.
–
It improves the pruritus, inflammation and eczema. It can also be combined with
topical corticosteroids (Yosipovitch et al.
– Mid-potency topical steroids or high potent topical corticosteroids can be used
(Yosipovitch et al.
2023).
– Usage of emollients also needs to be encouraged.
–
Referral to vascular surgeon to address the underlying venous insufficiency is a
vital component of management (Sundaresan et al.
2023).
2017).
218 14 Legs
14.3 Erythema Nodosum (EN) (Fig. 14.3)
– EN is a type of panniculitis.
– Etiology is precisely unknown.
– In most cases, EN is primary or idiopathic. However, it can be due to infections
such as tuberculosis, streptococcal infections, infectious mononucleosis, herpes,
hepatitis B, systemic fungal infections or drugs such as sulfonamides, oral contra-
ceptives, penicillin, minocycline, salicylates or inflammatory bowel diseases
or granulomatous diseases like sarcoidosis. Malignancies such as Hodgkin’s,
non-Hodgkin’s lymphoma and leukemia can also cause EN (Pérez-Garza et al.
2021).
– More common in females.
Fig. 14.3 Erythema
nodosum
14.4 Lichen Simplex Chronicus (LSC) (Fig. 14.4) 219
14.3.1 Clinical Features
– Characterized by the appearance of painful or tender erythematous nodules on
the lower legs, commonly.
– Usually bilateral and symmetric.
– Lesions could turn different colors such as violaceous, brown, green or yellow as
they age and resemble bruises.
– Often systemic symptoms such as fever, arthralgia, headache and gastrointestinal
symptoms can be present (Pérez-Garza et al.
– Course of the EN depends on etiology. Lesions are usually self-limiting. May last
for about 1–6 weeks. Please keep in mind, new lesions could occur during this
time. Therefore, patient needs to be informed about it.
Lesions do not ulcerate and heal without scarring.
–
2021).
14.3.2 Management
– Bed rest, compression stockings, anti-inflammatory drugs can be used for symp-
tomatic relief. In secondary EN cases, the cause needs to be treated. Similarly,
any off ending drugs to be stopped.
14.4 Lichen Simplex Chronicus (LSC) (Fig. 14.4)
– It can be classified as a type of endogenous eczema.
– Usually manifests as an itchy, isolated, circumscribed, lichenified plaque.
– Repetitive rubbing and scratching is often a triggering factor.
– Common areas are nape of the neck, scalp, ankles, lower part of the legs (ankles,
lateral part of the shin), upper thighs, outer aspects of the forearms and wrists,
).
vulva, pubis, anal area, scrotum (Lichen Simplex
2022
220 14 Legs
Fig. 14.4 Lichen simplex
chronicus
14.4.1 Management
Foremost important aspect of management is educating the patient about stopping
–
the rubbing and scratching. Topical potent steroids with or without occlusion are
helpful.
– Intralesional triamcinolone can also be used in cases not responding to the above
measures (Lichen Simplex
2022
).
14.5 Nummular Eczema (Nummular Dermatitis) (Discoid
Eczema)
– Usually manifests on extremities, as erythematous plaques that are coin shaped
14.5).
(Fig.
Bilaterally symmetrical presentation is common.
–
14.5 Nummular Eczema (Nummular Dermatitis) (Discoid Eczema) 221
Fig. 14.5 Nummular
eczema
– Common in lower extremities followed by upper extremities (Leung et al. 2021
– Relapses are common.
14.5.1 Management
– Topical potent corticosteroids and super potent steroids also can be used (Leung
).
2021
et al.
– Emollient usage also needs to be encouraged.
).
222 14 Legs
14.6 Asteatotic Eczema (Eczema Craquele)
– It is a type of endogenous eczema.
– It is characterized by itchy, dry, fissured skin with scales (Fig. 14.6).
– The fissured skin manifests in a curvilinear pattern.
– There is usually underlying xerosis.
– Anterolateral aspects of the lower legs are a common site. Arms and back of the
trunk are the other common s ites (Specht and Persaud
– Typically presents in the elderly during the winter seasons.
Fig. 14.6 Asteatotic eczema
2023).
14.7 Atopic Dermatitis (AD) (Fig. 14.7) 223
14.6.1 Management
– Includes application of daily emollients. Antihistamines and topical corticos-
teroids can be used.
14.7 Atopic Dermatitis (AD) (Fig. 14.7)
Please see Chap. 5, ‘Eczema’, for more details on its clinical presentation and
management.
Fig. 14.7 Atopic dermatitis
in adult
224 14 Legs
14.8 Psoriasis Vulgaris (Fig. 14.8)
Psoriasis vulgaris is a common papulosquamous disorder (scaly dermatosis). Its
distribution and appearance are quite distinct. A common form of it, psoriasis
vulgaris, can occur on the shins. Examining other common areas where it can occur
(such as back of elbows, lumbosacral area) can help in its clinical diagnosis.
Please see Chap. 3, ‘Papulosquamous Disorders’, for more details on its clinical
presentation and management.
Please note that any infections discussed in Chap. 6, ‘Common Cutaneous
Infections’, can also occur on legs.
Fig. 14.8 Psoriasis vulgaris
Bibliography 225
Bibliography
Goeser MR, Laniosz V, Wetter DA. A practical approach to the diagnosis, evaluation, and
management of cutaneous small-vessel vasculitis. Am J Clin Dermatol. 2014;15(4):299–306.
Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. Revised International Chapel
Hill consensus conference nomenclature of vasculitides. Arthritis Rheum. 2012;65(1):1–11.
Leung AKC, Lam JM, Leong KF, Leung AAM, Wong AHC, Hon KL. Nummular eczema: an
updated review. Recent Pat Inflam Allergy Drug Discov. 2021;14(2):146–55.
Lichen Simplex. DermNet NZ. dermnetnz.org; 2022. https://dermnetnz.org/topics/lichen-simplex
Micheletti RG. Cutaneous small vessel vasculitis: a practical guide to diagnosis and management.
Am J Clin Dermatol. 2022;24(1):89.
Micheletti RG, Werth VP. Small vessel vasculitis of the skin. Rheum Dis Clin North America.
2015;41(1):21–32.
Pérez-Garza DM, Chavez-Alvarez S, Ocampo-Candiani J, Gomez-Flores M. Erythema nodosum:
a practical approach and diagnostic algorithm. Am J Clin Dermatol. 2021;22(3):367–78.
Russell JP, Gibson LE. Primary cutaneous small vessel vasculitis: approach to diagnosis and
treatment. Int J Dermatol. 2006;45(1):3–13.
Specht S, Persaud Y (2023) Asteatotic eczema. In: StatPearls. StatPearls Publishing, Treasure Island
(FL) (2024). PMID: 31747214
Sundaresan S, Migden MR, Silapunt S. Stasis dermatitis: pathophysiology, evaluation, and
management. Am J Clin Dermatol. 2017;18(3):383–90.
Yosipovitch G, Nedorost ST, Silverberg JI, Friedman AJ, Canosa JM, Cha A. Stasis dermatitis:
an overview of its clinical presentation, pathogenesis, and management. Am J Clin Dermatol.
2023;24(2):275–86.
Zepecki AK, Blasiak R. Stasis dermatitis: differentiation from other common causes of lower leg
inflammation and management strategies. Curr Geriatr Rep. 2018;7(4):222–7.