These findings, along with sunburn-like eruptions on the neck and face, should prompt laboratory testing. Fortunately, magnification can easily be carried out with either an ophthalmoscope or dermatoscope, an examination enhanced by the application of oil first. These must be specifically sought they are not always as obvious as in this case. The first diagnostic step is to identify the changes to the cuticular vasculature. The definitive diagnosis is usually made by a rheumatologist, who is able to distinguish dermatomyositis from the rest of the differential-a process that can be rather complex. Both lupus erythematosus and mixed connective tissue disease (MCTD choice “d”) can present with similar changes in the cuticles, but neither present with such profound muscle weakness.ĭermatomyositis is one of three main conditions that present with characteristic changes in the cuticular vasculature (the other two being scleroderma and MCTD). However, when it affects the fingers, it specifically affects the interphalangeal skin, sharply sparing the knuckles. ![]() Lupus erythematosus (choice “b”) can present with similar symptoms. But carcinoid involves neither muscle weakness nor the particular skin changes seen with dermatomyositis. The correct answer is dermatomyositis (choice “c”), thought to be a vasculopathy mediated by the deposition of complement and lysis of capillaries in skin and muscle.Ĭarcinoid (choice “a”) is a rare tumor that can release vasoactive peptides, which cause episodic flushing, and if prolonged, can cause permanent changes in the skin. Examination of the rest of the patient’s skin reveals a blanchable, faintly sunburned appearance to her anterior neck. Several of her cuticles are also overgrown and frayed. The cuticles demonstrate the presence of dilated and irregularly shaped capillary loops. On examination, atrophic pinkish red planar plaques are noted on 10/10 fingers, confined to the dorsal aspects of her joints and sharply sparing the interphalangeal spaces. She then purchased a number of products from her health food store, which she started taking until the skin on her hands began to change. ![]() She first consulted her primary care provider (PCP), who informed her that she was not anemic and did not have thyroid disease the PCP felt that stress was probably a factor. Otherwise healthy prior to the onset of these symptoms, she has had to take a leave of absence from work due to her inability to carry out her duties, which include light lifting and prolonged periods of time on her feet as a clerk in a pharmacy. ![]() In the end do what's best for you love.A three-month history of muscle weakness, fatigue, and skin changes prompts a 59-year-old woman to self-refer to dermatology. When it comes to removal whatever the technician is most confident using is going to be the best option. In this case I might use both a pushing back and nipping technique and finish it with my e file. An e file is not as easy to use when the client has an oilier or more damp skin type though. In regards to removal I prefer to use an e file. We can always find a happy medium between not removing it at all and removing way to much and causing tissue damage. This is coming from a technician who wants to barf when she sees those "Russian manicure" videos. So I would personally remove some of it to give a cleaner application of product. This tissue on your client will certainly be a hindrance in this process. When doing enhancement services I always prepare my clients nail beds for the best possible adhesion of product. It will appear more white or clear because it no longer has a blood supply. Not the tissue that is attached to the nail folds. I see it as the tissue that is grows with the nail plate. We have to remember that cuticle is dead tissue that's attached to nail plate. ![]() It's a difficult situation when the definition of cuticle is so different from one person to the next. It is coming straight off of the eponychium. I would call this an overgrown eponychium personally.
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