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QUIZ - Diagnose it.

Quiz :- A 44-yo man w/ poor self-care and nutrition presented w/ facial lesions. Face: cone-shaped follicular papules w/ surrounding redness. Tongue: smooth, grooved red, atrophic. Skin: scattered petechiae, corkscrew hairs. What is the dx?

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VITAMIN A & C DEFICIENCY Corkscrew hairs, perifollicular erythema, and petechiae are pathognomonic for vitamin C deficiency. Vitamin A levels were <0.2 µmol/L (normal range: 1.1-2.8 µmol/L) and vitamin C levels were 7 µmol/L (normal range: 28-120 µmol/L). Limited dietary intake or malabsorption of fat-soluble vitamins (secondary to intestinal surgery, intestinal d/o, or liver dz) causes vitamin A deficiency.

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C) Fissured Tounge is also seen in Melkersson-Rosenthal syndrome & reported in chronic granulomatous cheilitis & disease, and cranial nerve VII paralysis (Bell palsy). Ddx - Geographic Tounge - It is an inflammatory condition histologically, a polygenic mode of inheritance has been suggested because it is seen clustering in families. Associations with human leukocyte antigen (HLA)–DR5, HLA-DRW6, and HLA-Cw6 have also been reported. These are identical to those seen in pustular psoriasis. At the periphery, elongation of the rete ridges is noted with associated hyperparakeratosis and acanthosis. Toward the center of the lesion, corresponding to the erythematous area clinically, loss of filiform papillae with migration and clustering of neutrophils within the epithelium (spongiform pustule) is seen. The predominant inflammatory infiltrate in the lamina propria is neutrophils with an admixture of chronic inflammatory cells. Management Of C - No medical intervention is required because the lesion is benign and most often asymptomatic.However, Abetal report successful treatment with cyclosporin, and Sigal and Mock reported treatment with topical and systemic antihistamines.Topical retinoids and topical corticosteroids are occasionally of benefit. In psoriatic patients, the lesions may resolve during systemic therapy for the psoriasis. No definitive therapy or medication is required for fissured tongue.If symptomatic, patients with fissured tongue are encouraged to brush the dorsum of the tongue to eliminate debris that may serve as an irritant. A biopsy is rarely performed on a fissured tongue because of its characteristic diagnostic clinical appearance; however, histologic examination has shown an increase in the thickness of the lamina propria, loss of filiform papillae of the surface mucosa, hyperplasia of the rete pegs, neutrophilic microabscesses within the epithelium, and a mixed inflammatory infiltrate in the lamina propria. B) Sebaceous hypetplasia A) Actinic keratosis , Hperkeratosis

Thanx Dr. Dinesh Gupta Sir Ji
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VITAMIN A & C DEFICIENCY Corkscrew hairs, perifollicular erythema, and petechiae are pathognomonic for vitamin C deficiency. Vitamin A levels were <0.2 µmol/L (normal range: 1.1-2.8 µmol/L) and vitamin C levels were 7 µmol/L (normal range: 28-120 µmol/L). Limited dietary intake or malabsorption of fat-soluble vitamins (secondary to intestinal surgery, intestinal d/o, or liver dz) causes vitamin A deficiency.

Nutritional Deficiency Diseases With ? Actinic Keratosis Nutritional Deficiencies are usually multiple like of Vitamin Iron Zinc Calcium Essential Fatty Acids Essential Amino Acids etc. Correct nutritional deficiency. For lesion at face if possible skin biopsy.

A-Impetigo-contogosa -healed lesion with crust formation.2-Boil.3-fissure and straw berry tongue-vitamin b complex and vit c and multiminerals deficiency present.Rx-Tab bcomplex 1od2-personal self care and adequate nutrition required.3-Analgesic and antibiotics Tab ×7days.

IT'S A CASE OF.. ? BMG .. ? GEOGRAPHIC TONGUE WITH.. ? FACIAL FOLLICULITIS.. ? ACTINIC KERATOSIS..

Tnx Dr Ashok Leel sir
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Geographic tonque Nutritional deficiency. Multivitamins and antioxidant orally. Improve general health and oral hygiene.

Thanks Dr Dinesh Gupta
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Fissured tongue due to nutritional deficiency with Actinic keratosis

Geographic tongue fissured

Geographic tongue Nutritional deficiency Fissured Tongue No treatment required Oral hygiene maintain Multivitamin

SUGGESTIVE OF ACTINIC KERATOSIS And NUTRITIONAL DEFICIENCY SEBACEOUS HYPERPLASIA

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