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DERMATOLOGIC DISORDERS & NEUROMUSCULAR DISEASE

• Flushing: Anticholinergic toxicity; Hypermagnesemia; Mercury; Erythermalgia
• Petechiae or purpura: Vasculitis; Cryoglobulinemia; Alcoholism (Telangectasia); Amyloidosis
• Pigment
  • Hypo: Leprosy
  • Hyper: POEMS; Neurofibromatosis; Adrenomyeloneuropathy
• Thickening
  • POEMS: Angiomas; Hirsutism
  • Scleroderma: Sclerodactyly; Raynaud's
  • Refsum: Ichthyosis
  • CEDNIK: Ichthyosis; Palmoplantar keratoderma
• Rash
  • Infections
    • Leprosy: Focal hypopigmented; Erythema nodosum leprosum
    • Lyme: Erythema chronicum migrans
    • Syphilis: 1° chancre; 2° syphilis
    • Trichinosis: Periorbital edema
    • HIV: Seborrheic dermatitis (Pitysporum orbiculare); Kaposi's sarcoma
    • Herpes zoster
  • Immune
    • Dermatomyositis (Mi-2+)
    • Jo-1 myositis
    • Sarcoidosis: Hypohidrosis; Alopecia; Erythema nodosum; Scars & Keloids
  • Toxic
    • Hexacarbon
    • Alcoholism: Malar rash
    • Arsenic: Scaly desquamation
  • Other
    • Pellagra: Erythematous photosensitive rash; Hyperkeratotic
• Finger nail change
  • Mees lines: Arsenic; Thallium; Hexacarbon
  • Splinter hemorrhage: Trichinosis; Dermatomyositis
  • Dark pigmentation: Vitamin B₁₂ deficiency
• Sweating: Autonomic disorders
• Angiokeratomas: Fabry's
• Ischemia: Calciphylaxis
• Burns: Neuropathy
• Ulcers
  • Diabetes: Necrobiosis lipoidica diabeticorum; Poorly healing skin ulcers
  • Sensory neuronopathy
• Alopecia: Thallium; Sarcoidosis
• Local infections: Diphtheria; Tetanus; Botulism
• Venous insufficiency: Neuropathy
• Osmiophilic vessels: Congenital spastic ataxia
• Other
  • Bethlem/Ullrich
  • Blistering: Congenital Muscular Dystrophy with Familial Junctional Epidermolysis Bullosa
• Pemphigus: Associated with
  • Thymoma & acquired myasthenia gravis & other immune disorders
  • D-penicillamine induced syndrome
• Nodular prurigo: Subclinical axonal sensory neuropathy²

BURNS & NEUROPATHY

• Burn severity
  • Most (69%) > 20% surface area
  • 28% full thickness
• Patterns of neuropathy
  • Mononeuritis multiplex (69%)
    • Onset: Recognized 10 to 124 days after burn
    • Especially Median, Ulnar & Peroneal
    • Localization: Regions near & remote from burn
  • Mononeuropathy: Common in burned area; Arms > Legs
  • Axonal polyneuropathy: Rare
  • Electrical burns: Nerve lesions at entry area
• Associated factors: Burn severity; Length of hospitalization
• Systemic disorders: Sepsis; Renal failure; Low serum albumin
• Rule out: Myosin-loss myopathy

VENOUS INSUFFICIENCY¹

• Neuropathy
  • Clinical
    • Cramps (79%)
    • Pain: Dysesthesias; Paresthesias
    • Sensory loss: Vibration, Warm & Cold perception
  • Electrophysiology
    • Prolonged distal motor latency in legs
    • Abnormal Aα, Aβ, Aδ & thermaoafferent C-fibers
    • Upper extremities: Normal
• Skin
  • Edema
  • Venous dilation
  • Pigmentation
  • Ulceration
• Laboratory
  • Continuous wave Doppler: Reflux
  • Duplex sonography: Reflux
  • Plethysmography: Obstruction
  • Phlebography: Reflux & Obstruction