Pedunculated Osteochondroma Presenting as Verruca Vulgaris: A Diagnosis Requiring a High Index of Suspicion: Case Report.

Introduction: Osteochondromas are the most common benign tumors of the bone and can be sessile or pedunculated. Although osteochondromas are typically seen in the long bones, they are rarely seen in the small bones of the hand or foot. Verruca vulgaris, also known as the common wart, is one of the most common skin conditions presenting to physicians and must be distinguished either clinically or histologically from other hyperkeratotic conditions, including bone conditions such as bone tumors that can place pressure on the skin and cause callus formation that can mimic a wart or create skin deformity. A high index of suspicion for underlying bone mass or tumor should be entertained when evaluating patients for skin conditions, particularly of the hand or foot, with failure to improve with treatment. Case Report: This case report presents a 20-year-old male with a pedunculated osteochondroma of the left fourth distal phalanx with hyperkeratotic skin overlying the mass at the end of the toe. He was initially treated by a family doctor and podiatrist for verruca vulgaris for over 5 years with two treatments of liquid nitrogen cryotherapy and surgical excision of the mass when the treating podiatrist encountered bone and recommended radiographs. The family requested follow-up with our practice several days later after they were told the patient had a bone tumor. The patient requested surgical excision of the osteochondroma secondary to pain with activities and difficulties with his vocation as a pilot. Conclusion: All physicians must be mindful of an underlying bone tumor or mass in patients presenting with skin changes, particularly about the foot or hand. Knowledge that an underlying bone tumor can present as a verruca vulgaris may prevent a delay in diagnosis or unnecessary treatment when evaluating and treating a patient with a skin lesion. Fortunately, our case was a benign osteochondroma; a malignant tumor with a delay in diagnosis could lead to loss of limb or life.

Correction of age-related changes in the skin at the dermal and subdermal level using radiofrequency macroneedling therapy.

BACKGROUND: The negative effects of skin aging are primarily related to the destruction of dermal architectural structure. More specifically, this includes changes in the spatial arrangement of collagen, elastin fibers, mucopolysaccharides, proteoglycans, and ground substances. AIMS: The purpose of this study is to investigate the histologic effects of dermal and subdermal tissue after a controlled single treatment with radiofrequency (RF) macroneedling. This therapy provides a controlled, localized, thermal effect on the dermis whereby triggering the body's own healing processes of extracellular matrix remodeling. Clinically benefits include skin tightening. METHODS: Biopsies were obtained for histologic evaluation from four patients (n = 4), 4 weeks after completing a single RF macroneedling facial treatment. RESULTS: Age-related changes of the dermal and subdermal architecture were observed at baseline. After treatment, all biopsies demonstrated an increase in epidermal cells, collagen, elastin, fibroblasts, vasculature, and a decrease in inflammatory cells. CONCLUSIONS: The results of this histologic study confirm a significant "subsurfacing" thermal effect from the noncoagulative ascendant thermal injury. The obtained results characterize RF macroneedling therapy as an effective method for correcting age-related changes in facial skin.

Polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes syndrome with dilated cardiomyopathy: A case report.

BACKGROUND: Polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes (POEMS) syndrome is a rare paraneoplastic syndrome that encompass multiple systems. The most common clinical symptoms of POEMS syndrome are progressive sensorimotor polyneuropathy, organ enlargement, endocrine disorders, darkening skin, a monoclonal plasma cell proliferative disorder, and lymph node hyperplasia. The organomegaly consists of hepatosplenomegaly and/or lymphadenopathy; cases of cardiomyopathy are rare. Diagnoses are often delayed because of the atypical nature of the syndrome, exposing patients to possibly severe disability. Therefore, identifying atypical symptoms can improve the prognosis and quality of life among POEMS syndrome patients. CASE SUMMARY: Herein, we report the case of a 59-year-old woman with POEMS syndrome that involved dilated cardiomyopathy. The patient presented to the hospital with complaints of shortness of breath and discomfort in the chest. The patient reported previous experiences of limb numbness. During hospitalization, the brain natriuretic peptide levels were 3504.0 pg/mL. Color doppler echocardiography showed an enlarged left side of the heart, along with ventricular wall hypokinesis and compromised functioning of the same side of the heart. Abdominal color ultrasonography revealed that the patient's spleen was enlarged. Observations from cardiac magnetic resonance imaging showed that the left side of the heart was enlarged. Slight myocardical fibrosis was also observed. Electromyography was described as a symmetric sensorimotor demyelinating polyneuropathy. Further immunoelectrophoresis of the serum showed the presence of a monoclonal IGA λ M protein. The vascular endothelial growth factor levels were 622.56 pg/mL. Flow cytometric and immunohistochemical staining of the bone marrow detected no monoclonal plasma cells. Finally, the patient was diagnosed with POEMS syndrome associated with dilated cardiomyopathy. The chest-related discomfort and the shortness of breath resolved after the administration of lenalidomide and dexamethasone. CONCLUSION: When patients with cardiomyopathy have systemic manifestations such as numb limbs and darkening skin, the POEMS syndrome is the most possible diagnosis.

Comparison of Histological Skin Changes After Massive Weight Loss in Post-bariatric and Non-bariatric Patients.

BACKGROUND: Changes in the skin structure, including the collagen and elastin content, have been reported with massive weight loss (MWL) following bariatric metabolic surgery (BMS) and have been correlated to a higher risk of complications after body-contouring surgery (BCS). This study aimed at comparing the histological characteristics of the skin of patients having surgical MWL (SMWL) post-BMS to those with non-surgical massive weight loss (NSMWL). METHODS: This prospective study compared the epidermal thickness, and collagen and elastin fibers content in 80 skin biopsies obtained from BCS procedures performed to patients who experienced MWL defined more than 50% of excess weight loss (%EWL) either SMWL (40 biopsies) or NSMWL (40 biopsies). Twenty biopsies in each group were obtained from abdominoplasties and 20 from breast reductions. Epidermal thickness was measured in H&E-stained sections, collagen fibers were assessed using Masson trichrome-stained sections, and elastin fibers were assessed using Modified Verhoeff's stained sections. Image analysis software was used to calculate the fractions of collagen and elastin fibers. RESULTS: This study included 77 patients, 38 SMWL patients, and 39 NSMWL patients. The SMWL group had a significantly higher age (p < 0.001), a longer time interval from intervention (p < 0.001), higher initial weight (p < 0.001), higher initial BMI (p < 0.001), lower current weight (p = 0.005), lower current BMI (p < 0.001), and significantly higher %EWL than NSMWL group (p < 0.001). No significant differences were detected between the two groups regarding complications after abdominoplasty (p = 1.000). The elastic fibers content in the dermis was significantly higher in the abdominal region of the NSMWL group than SMWL (p = 0.029). All other parameters showed non-significant differences between NSMWL and SMWL in the skin of abdomen and breast. CONCLUSION: The SMWL group had a significant reduction in elastic fiber content in the skin of the abdomen compared to the NSMWL group. The collagen content was equally reduced in both groups with non-significant differences in both breast and abdomen regions in both groups.

Baricitinib treatment for refractory skin changes in POEMS syndrome: a case report.

Polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes (POEMS) syndrome is a multisystem disorder that has limited treatment options. Here, we described a case of a 55-year-old female subject who was treated for multiple drugs, but the skin symptoms continued to progress; the patient responded well to baricitinib. This suggests that JAK/STAT signaling pathways play an essential role in the pathological process of POEMS syndrome.

Xioglican Cream in Italian Patients with Chronic Venous Disease: A Post-Marketing Study Investigating Effects on Clinical and Cutaneous Signs and Symptoms.

INTRODUCTION: The progression of chronic venous disease (CVD) is characterized by edema of the legs and/or venous ulcers of the lower limbs in association with cutaneous signs and/or skin alterations, such as hyperpigmentation, corona phlebectatica, telangiectasia, eczematous dermatitis, lipodermatosclerosis, atrophie blanche, cellulitis, and induration. Xioglican cream is a galactosaminoglycan polysulfate and hyaluronic acid-containing medical device with strong hydrophilic, moisturizing, and soothing properties. This post-marketing observational study evaluated topical Xioglican cream in the amelioration of skin manifestations and clinical signs and symptoms in patients with CVD treated in routine clinical practice. METHODS: Adult patients (18-75 years) with a clinical diagnosis of C2-C3 CVD according to Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification who received 12 weeks of treatment with Xioglican (applied up to 3 times daily), according to investigator decision (and consistent with conventional clinical practice and established standard of care), were enrolled from two study sites in Italy. A range of endpoints were used to evaluate efficacy, safety, effect on patient quality of life (QoL), and patient satisfaction with topical application of Xioglican cream in the physiological restoration of skin signs and symptoms. RESULTS: In patients with CVD (n = 30), Xioglican cream reduced CVD-related skin manifestations and associated symptoms, with significant reductions in leg circumference [mean ± standard deviation (SD): - 3.21 ± 3.39 cm for left and - 2.92 ± 2.70 cm for right legs, both p < 0.0001] and local edema (- 5.52 ± 7.94 cm, p = 0.0034) and significant improvement in Venous Clinical Severity Scores (mean 0.52 ± 1.94 decrease from baseline, p = 0.1952) observed after 12 weeks. Skin burning, pain, aching or tiredness, and QoL were also significantly improved. There was no change in CEAP classification. Globally, 92.0% of patients were "Very satisfied" or "Satisfied" with the product. CONCLUSIONS: Topical treatment with Xioglican cream improves the signs, symptoms, and QoL of patients with CVD class C2-C3.

Updates on Evaluation and Treatment of Common Complaints in Pregnancy.

Patients experience many new and concerning symptoms during pregnancy and it is the role of the obstetric clinician to provide appropriate guidance, recommendations, and treatment options. Often times, these symptoms are related to hormonal and physiologic changes that occur and will resolve in the postpartum period. However, clinicians must be able to recognize more concerning pathologic symptoms that require further evaluation and treatment. This review provides updates on the evaluation and management of some of the common symptoms during pregnancy.

Inflammatory Skin Change From a Small 0.9 cm Primary Breast Cancer Not Seen on Initial Imaging: A Case Report.

Most inflammatory breast cancers are caused by invasive ductal cell carcinomas that arise from mammary epithelial cells lining the breast ducts. Typically, in these cancers, radiological signs are conspicuous, and a diagnosis is made after standard mammographic imaging or ultrasound. We report the case of a 54-year-old female who presented to a mammography clinic with right-sided breast pain and swelling. Upon physical examination, there was no palpable mass. Ultrasound and mammogram findings included mild skin thickening, normal-sized but irregularly shaped axillary lymph nodes, and no breast mass. Due to the presence of inflammatory changes (skin thickening) and abnormal lymph nodes but no obvious mass, an MRI was done to find the primary mass after a core needle biopsy of one lymph node showed metastatic ductal disease. In this patient, a 0.9 cm mass was found at the right 8:00 position on MRI. A second-look ultrasound was then performed and the mass was identified, followed by an ultrasound-guided core biopsy. The biopsy showed an invasive ductal cell carcinoma. In most cases, inflammatory breast cancer is associated with larger tumor sizes. However, a subset of patients with inflammatory breast cancer may present with a small primary breast tumor that causes inflammatory changes. Here, we present a rare case of inflammatory breast cancer associated with a small breast mass measuring less than 1 cm in size.

Diagnostic ultrasound of the chest wall in the symptomatic patient after mastectomy.

BACKGROUND: Lack of standardized imaging recommendations among mastectomy patients has led to variability in how recurrences are detected. OBJECTIVE: To describe the findings and assess the diagnostic efficacy of ultrasound in the evaluation of symptomatic post-mastectomy patients. MATERIALS AND METHODS: This single institution, retrospective study included 749 consecutive diagnostic chest wall ultrasound examinations performed in mastectomy patients, from January 2016 to June 2017. Chest wall ultrasound evaluated the mastectomy bed with or without reconstruction. Electronic health records were queried for the primary breast cancer histology prior to mastectomy, clinical symptoms prompting the diagnostic ultrasound, ultrasound findings, subsequent cytology and pathology, and follow-up data. Excluded were patients with a known recurrence, asymptomatic patients, and those with <2 years of clinical or imaging follow-up. Descriptive and comparative statistical analyses were performed. RESULTS: Among the 749 ultrasounds performed, 58 malignancies were identified for a 7.7% (58/749) malignancy rate, with a median tumor size of 20 mm. Patients diagnosed with a malignancy most often presented with a palpable abnormality (79.3%, 46/58) or skin changes (13.8%, 8/58) and rarely with pain (1.7%, 1/58). Patients who underwent a biopsy yielding a benign result most often presented with a palpable abnormality (41.5%, 287/691), pain (25.6%,177/691), or postoperative swelling/suspected fluid collection (17.8%, 123/691). Diagnostic ultrasound yielded a 91.4% sensitivity (95% CI 81.0, 97.1), 96.1% specificity (95% CI 94.4, 97.4), 66.3% PPV3 (95% CI 57.4, 74.1), and 99.3% negative predictive value (95% CI 98.3, 99.7) for cancer detection. There were 5 false negative ultrasound cases after a skin punch biopsy was performed due to clinically suspicious skin changes. CONCLUSIONS: Chest wall ultrasound has a high sensitivity and negative predictive value for detection of breast cancer recurrence in symptomatic patients after mastectomy. Skin changes remain an important clinical manifestation of a cancer recurrence.

Dermal Fibroblasts as the Main Target for Skin Anti-Age Correction Using a Combination of Regenerative Medicine Methods.

This article includes the data from current studies regarding the pathophysiological mechanisms of skin aging and the regenerative processes occurring in the epidermis and dermis at the molecular and cellular level, mainly, the key role of dermal fibroblasts in skin regeneration. Analyzing these data, the authors proposed the concept of skin anti-age therapy that is based on the correction of age-related skin changes by stimulating regenerative processes at the molecular and cellular level. The main target of the skin anti-age therapy is dermal fibroblasts (DFs). A variant of the cosmetological anti-age program using the combination of laser and cellular methods of regenerative medicine is presented in the paper. The program includes three stages of implementation and defines the tasks and methods of each stage. Thus, laser technologies allow one to remodel the collagen matrix and create favorable conditions for DFs functions, whereas the cultivated autologous dermal fibroblasts replenish the pool of mature DFs decreasing with age and are responsible for the synthesis of components of the dermal extracellular matrix. Finally, the use of autological platelet-rich plasma (PRP) enables to maintenance of the achieved results by stimulating DF function. It has been shown that growth factors/cytokines contained in α-granules of platelets injected into the skin bind to the corresponding transmembrane receptors on the surface of DFs and stimulate their synthetic activity. Thus, the consecutive, step-by-step application of the described methods of regenerative medicine amplifies the effect on the molecular and cellular aging processes and thereby allows one to optimize and prolong the clinical results of skin rejuvenation.

Lichen myxedematosus associated with monoclonal gammopathy of undetermined significance: A case report and literature review.

Lichen myxedematosus (LM) is an idiopathic cutaneous mucinosis disorder, and monoclonal gammopathy of undetermined significance (MGUS) is a preneoplastic plasma cell disease with a monoclonal increase in globulin. Patients with LM combined with monoclonal gammopathy are normally diagnosed with scleromyxedema. However, we report a case of generalized papules combined with MGUS in a 78-year-old man who was eventually diagnosed with atypical or intermediate forms of LM because it only involved the skin, and the pathological type was not consistent with scleromyxedema. Few cases of atypical or intermediate forms of LM have been reported, so the course of atypical or intermediate forms of LM is unpredictable. We report the diagnosis and treatment of a case of atypical forms of LM to discuss the current understanding of the disease, hoping to provide a reference for clinical research on this disease.

Typical time courses and appearance of skin reactions at the site of Bacillus Calmette-Guérin vaccination for infants inoculated at 5-8 months of age.

BACKGROUND: Taiwan increased the Bacillus Calmette-Guerin (BCG) vaccination age from 24 h after birth to 5-8 months of age to lower BCG-related osteitis/osteomyelitis in 2016. However, the sequences of skin changes at the injection site and in the corresponding lymph nodes are unknown for infants vaccinated at an older age. METHODS: We prospectively collected the photographs of skin reactions within 6 months after vaccination. The type, size, onset time, and duration of the skin reactions were recorded and analyzed. RESULTS: We enrolled 532 infants. The types and median times at onset of skin reactions were as follows: erythema at week 1, induration at week 3, ecchymosis at week 4, and ulceration at week 6. The peak skin responses were at week 6, with average sizes of 8.4 mm, 7.4 mm, and 8.2 mm for erythema, induration, and ecchymosis, respectively. The duration of induration was long, with 57.6 % and 23 % of the infants still having a response at week 12 and 24, respectively. The rate of induration size ≥ 20 mm was 1.7 % (95 % confidence interval: 0.8 %-3.2 %). Overall, 46.4 % of the infants experienced ulcerative change, with most occurring at week 6 (34.1 %), and 9.5 % and 4.1 % of the infants still had ulceration at week 12 and 16, respectively. Twelve infants (2.3 %) had spontaneous resolution of regional lymphadenitis, with the onset time ranging from week 1 to 12. All infants had developed a scar at the end of follow-up. CONCLUSION: Our study demonstrates the typical appearance and time courses of skin reactions in infants who received the BCG vaccination at older than 5 months of age. Infants vaccinated at this age may have a more potent skin response with longer induration and ulceration than those vaccinated at birth.

Polyneuropathy organomegaly endocrinopathy M-protein and skin changes syndrome with ascites as an early-stage manifestation: A case report.

BACKGROUND: Polyneuropathy organomegaly endocrinopathy M-protein and skin changes (POEMS) syndrome is a rare paraneoplastic syndrome caused by a potential plasma cell tumor. The clinical manifestations of POEMS syndrome are diverse. Due to the insidious onset and lack of specific early-stage manifestations, POEMS syndrome is easily misdiagnosed or never diagnosed, leading to delayed treatment. Neurological symptoms are usually the first clinical manifestation, while ascites is a rare symptom in patients with POEMS syndrome. CASE SUMMARY: A female patient presented with unexplained ascites as an initial symptom, which is a rare early-stage manifestation of the condition. After 1 year, the patient gradually developed progressive renal impairment, anemia, polyserosal effusion, edema, swollen lymph nodes on the neck, armpits, and groin, and decreased muscle strength of the lower extremities. The patient was eventually diagnosed with POEMS syndrome after multidisciplinary team discussion. Treatment comprised bortezomib + dexamethasone, continuous renal replacement therapy, chest and abdominal closed drainage, transfusions of erythrocytes and platelets, and other symptomatic and supportive treatments. The patient's condition initially improved after treatment. However, then her symptoms worsened, and she succumbed to the illness and died. CONCLUSION: Ascites is a potential early manifestation of POEMS syndrome, and this diagnosis should be considered for patients with unexplained ascites. Furthermore, multidisciplinary team discussion is helpful in diagnosing POEMS syndrome.

"It's Like You Stuck a Pin in It:" African American/Black Patients Describe Cutaneous Toxicity From Epidermal Growth Factor Receptor Inhibitors.

Background: Epidermal growth factor receptor (EGFR) inhibitors cause cutaneous toxicity in over 90% of patients. Conceivably, healthcare providers could overlook such toxicity in African American/Black patients because of a darker complexion. This qualitative study sought to learn about such cutaneous signs and symptoms and, if present, to report them in patients' own words. Methods: Any patient who self-identified as African American/Black and who had been prescribed an EGFR inhibitor was eligible. The current report focuses on patients' responses to the following question, "What have you noticed since starting your cancer treatment (the EGFR inhibitor), any particular symptoms or reactions, positive or negative?" All interview data were audio-recorded, transcribed, and then independently coded and analyzed by two investigators. Results: Fifteen patients are the focus of this report, and all described cutaneous toxicity. Patients appeared troubled by the cosmetic aspect of these drug-induced skin changes, including their acneiform appearance, describing "little pimples with little, little pus in it." Notable were comments on hyperpigmentation, "I'm a black person but…. became darker." Furthermore, patients experienced physical symptoms: "it itches;" "it's like you stuck a pin in it;" "stinging;" and "burning;". Conclusion: Although cutaneous toxicity from EGFR inhibitors might be more difficult to visualize among darkly complected patients, the graphic descriptions offered in this qualitative study underscore the need for clinicians to heighten their awareness of such toxicity in African American/Black patients.

Intervenções de enfermagem especializadas às pessoas submetidas a transplante de progenitores hematopoiéticos para prevenção e tratamento de alterações cutâneas / Specialized nursing interventions for people undergoing transplantation of hematopoietic progenitors for the prevention and treatment of skin changes

Um dos desafios para os enfermeiros na abordagem ao doente submetido a transplante de células progenitoras hematopoiéticas é a prevenção, apreciação, diagnóstico diferencial e tratamento das alterações cutâneas, vistas aqui como sinais alarmantes, durante o período pós-transplante. A complexidade, especificidade e carácter multifatorial da situação clínica, plano de tratamento submetido e contexto em que se encontra, sujeitam a pessoa a risco de surgimento de alterações cutâneas. Os enfermeiros devem ter um papel ativo nas estratégias de transição dos cuidados a fim de prevenir e tratar alterações cutâneas, bem como garantir que o doente compreende os sinais de alerta e está capacitado para adequar medidas. Como tal, deliberou-se mapear a evidência disponível sobre a prevenção e tratamento de alterações cutâneas dos doentes submetidos a transplante de células progenitoras hematopoiéticas, com a finalidade de acautelar complicações e controlar sintomas. Como consequência, surge o título "Intervenções de enfermagem especializadas às pessoas submetidas a transplante de células progenitoras hematopoiéticas para prevenção e tratamento de alterações cutâneas". O Neuman Systems Model, desenvolvido por Betty Neuman em 1995, foi a teórica de enfermagem utilizada, enquanto a metodologia consistiu na execução de uma Scoping Review, na elaboração de uma reflexão crítica perseverante e na realização de estágios em três contextos clínicos diferenciados. A implementação deste projeto, para além de contribuir para o desenvolvimento de competências de Enfermeiro Especialista em Enfermagem Médico-Cirúrgica, na vertente oncológica e Mestre em Enfermagem, também contribui para a melhoria da qualidade dos cuidados de enfermagem na prevenção e controlo sintomático das alterações cutâneas do doente submetido a transplante de células progenitoras hematopoiéticas durante o período póstransplante e para a melhoria da qualidade de vida dos doentes submetidos a transplante de células progenitoras hematopoiéticas.

One of the challenges for nurses in their approach to patients undergoing hematopoietic progenitor cell transplantation is the prevention, assessment, differential diagnosis and treatment of skin changes, seen here as alarming signs, during the posttransplantation period. The complexity, specificity and multifactorial nature of the clinical situation, the treatment plan submitted and the context in which it takes place, subject the person to the risk of skin changes. Nurses should play an active role in care transition strategies in order to prevent and treat skin changes, as well as ensure that the patient understands the warning signs and is empowered to adapt measures. Therefore, it was decided to map the available evidence on the prevention and treatment of skin disorders in patients undergoing hematopoietic progenitor cell transplantation, with the aim of avoiding complications and controlling symptoms. As a result, the title "Intervenções de enfermagem especializadas às pessoas submetidas a transplante de células progenitoras hematopoiéticas para prevenção e tratamento de alterações cutâneas" was created. The Neuman Systems Model, developed by Betty Neuman in 1995, was the nursing theory used, while the methodology consisted of the implementation of a Scoping Review, the elaboration of a persevering critical reflection and the internship in three different clinical settings. The implementation of this project, in addition to contributing to the development of competencies as a Nurse Specialist in Medical-Surgical Nursing, in the oncology area and Master in Nursing, also contributes to improving the quality of nursing care in the prevention and symptomatic control of skin changes in patients undergoing hematopoietic progenitor cell transplantation during the post-transplantation period and to improving the quality of life of patients undergoing hematopoietic progenitor cell transplantation.

Examination of Cutaneous Changes Among Patients Following SARS-CoV-2 Infection.

Individuals infected with SARS-CoV-2 have been found to develop a variety of cutaneous symptoms. This study sought to describe varying cutaneous manifestations of COVID-19 in individuals presenting to an inpatient healthcare facility. We screened individuals who presented with COVID-19 for skin changes throughout the illness and administered a survey regarding demographics, medical history, and their cutaneous findings. Three individuals reported varying skin findings including wheals, petechiae, ecchymosis, and papules. One individual reported a worsening skin condition, psoriasis, as well as a new skin condition, seborrheic dermatitis. In conclusion, cutaneous manifestations of patients suffering from COVID-19 are wide-ranging and worsening skin conditions amongst these patients should be further investigated.

Skin Changes in Cirrhosis.

Skin manifestations of systemic disorders give a clue to the organ involved and help identify the possible disease-causing injury. Skin changes of liver cirrhosis are not specific, as they may be seen in disorders not involving the liver. Thus, a constellation of skin changes along with systemic features may help us to identify the disease-causing liver cirrhosis. Pruritus is one of the most common and distressful symptoms of liver cirrhosis, severely affecting the quality of life, which further necessitates understanding cutaneous manifestations of cirrhosis. Other nonspecific cutaneous manifestations include spider telangiectasia, palmar erythema, paper money skin, xanthomas, pigmentation changes, nutritional deficiencies, hair changes, and nail changes. This review discusses the nonspecific skin manifestations associated with liver cirrhosis followed by specific cutaneous findings seen in common diseases causing liver cirrhosis, such as viral infections, biliary tract disorders, chronic alcoholism, and metabolic disorders. Early recognition of cutaneous features can help prevent or delay the development of complications and end-stage disease, decreasing morbidity and mortality.

A rare presentation of POEMS syndrome on magnetic resonance neurography: a case series.

Polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, skin changes (POEMS) syndrome is a multisystem disease associated with underlying plasma cell neoplasm. Here, we present two cases of POEMS syndrome that manifested on magnetic resonance neurography as an increasing bone mass with cortical disruption, direct invading nerve roots and lumbar gluteal muscles. These features have not been previously reported. We also report a case with diffuse hypertrophy and enhancement of the brachial and lumbosacral plexus, which mimics the most common chronic inflammatory demyelinating polyradiculoneuropathy. Moreover, we detected perineurium effusions in the plexus, coupled with a variety of myofascitis and atrophy in denervated muscle. The case series is of concern to atypical magnetic resonance imaging findings of POEMS syndrome in the bone and peripheral nerve system as critical attacked target organs, which would be facilitating diagnosis.