Getting Powerful Shapely Glutes
ANS The term indicates a marbling reticulation or fishnet type of mottling of the lower trunk, buttocks, and extremities, precipitated or exaggerated by cold or by emotional upsets. It occurs in about 20 of patients with lupus erythematosus, periarteritis nodosa, or cryoglobulinemia. If it has occurred recently in a man over age 50, it suggests cholesterol embo-lization from an abdominal aortic aneurysm 1 .
In 1928, Yeoman first described a syndrome involving compression of the sciatic nerve by the piriformis muscle. The nerve compression occurs as it exits deep to the piriformis muscle.12 Patients complain of pain and symptoms in the sciatic nerve distribution. A history of past acute trauma to the buttock is often present. Patients will have difficulty sitting or participating in activities, such as ice skating, which involve hip flexion and internal rotation.13 On physical examination, tenderness is present over the piriformis tendon in the gluteal area. Pain is elicited by forced internal rotation on an extended thigh, or Pace's sign, (ie pain and weakness on resisted abduction and external rotation of the thigh). Rectal or vaginal examination may produce pain in the piriformis area. An MRI can be helpful to demonstrate sciatic nerve inflammation in the area of the piriformis tendon. Pain occurs over the sacroiliac joint region, with referred pain into the lower buttock and thigh....
Students should note that an area may have a temporarypranic surplus in which case there is nothing wrong with it. For instance, a person who has been sitting down for a long time may have a big protrusion of the inner aura around the buttocks area when scanned. Since the surrounding meridians are not blocked, the condition normalizes after a short period of time. Or, an area may have temporary pranic reduction, in which case there is also nothing wrong with it. An altercation that has just occurred is likely to cause a temporary pranic reduction around the solar plexus. After a few hours of rest, the condition will normalize. Habitual altercation or anger may cause pranic depletion around the solar plexus which results in abdominal ailments and possibly heart disease.
This is a rare but disabling disorder that may occur in the context of common hives, but usually occurs alone and is more easily confused with urticarial vasculitis. Following sustained pressure, deep soft tissue swelling occur at the site after a 3- to 6-hour delay. Erythema or hive-like change may overlie the swellings. Lesions are usually painful rather than pruritic and persist for 1 to 2 days. The soles and buttocks are the most common sites, and constitutional symptoms are common. Most cases respond to systemic steroids however, the condition is chronic and the steroids cannot be justified except on a short-term crisis basis. Recently, success has been reported in five cases treated with 50 mg day dap-sone. Cetirizine, a nonsedating H1 blocker, has also been reported as effective. NSAIDs may also be helpful.
Note that pain radiating into the legs is not necessarily due to nerve root involvement it seems that irritation of facet joints, ligaments and muscles may produce dull, aching pain in the buttocks and backs of the thighs. In contrast, pain arising from nerve roots is usually sharp and knife-like, and in addition, in the case of the commonly affected L5 and S1 roots, it often extends below the knee to the ankle or foot. In the common situation where there is involvement of one, or at the most two, nerve roots, the whole limb cannot be affected instead, the area of sensory disturbance should correspond with the relevant dermatome(s) and it should be noted whether paraesthesia occurs within the same restricted territory. Both spondylolysis and spondylolisthesis give rise to low back pain which radiates into the buttocks. In adolescents, the majority of whom are active in sports, resolution of symptoms may be achieved in 80 of cases by the avoidance of sports and the use of a corset...
Hirsutism and obesity common findings among affected women early symptoms of pruritus, erythema, and local hyperhidro-sis lesions occur in the axillae, groin area, nipples, and buttocks painful and or tender red papules and nodules lesion heal with fibrosis and eventual recurrence in the adjacent area painful or tender abscesses and inflamed, discharging papules or nodules nodules coalesce and sometimes become infected, resulting in acute abscesses dermal contractures and ropelike elevation of the skin multiple abscesses and sinus tracts form a subcutaneous honeycomb double-ended comedones associated arthropathy sometimes presenting with asymmetric pauciarticular arthritis, symmetric polyarthritis, or polyarthralgia syndrome
Aortic regurgitation also has been described in patients with inborn errors of metabolism including Morquio's syndrome (mucopolysaccharidosis IV) and Scheie's syndrome (mucopolysaccharidosis V).55 Patients with Morquio's syndrome are identified by their short stature, short neck, barrel chest, broad mouth, short nose, widely spaced teeth, and cloudy cornea. In Scheie's syndrome, growth retardation, sternal protrusion, facial abnormalities, and cloudy cornea are present. In Fabry's disease, angiokeratomas identified as purplish pinpoint skin lesions occur on the lips, underarm, buttocks, scrotum, and penis (Fig. 10-8). Cardiomyopathy, ischemic heart disease, and conduction defects beginning in the third decade are associated with this sex-linked recessive disorder, in which there is a genetic deficiency of the enzyme d-galactosidase A.56 Coronary artery stenosis from atherosclerosis can be associated with hyperlipidemia,111 cerebrotendinous xanthomatoses, Werner's syndrome, uremia,...
Patrick's test 183 Trendelenburg's test 1 86 Testing the gluteal muscles 1 87 Aspiratior of the hip 1 87 Ortolani's lest 187 Barlow's test 1 88 Radiographs of the neonate 1 88 DDH in the older child 188-189 Pain is often poorly localized in the hip, groin, buttock or greater trochanter, and may be referred to the knee. There is increasing difficulty in walking and standing. Sleep is often disturbed, and the general health of the patient becomes undermined as a result. Stiffness may first declare itself when the patient notices difficulty in putting on stockings and cutting the toenails.
Symptomatic disease has a clinical pattern identical to that of idiopathic disease. Patients develop low back pain, especially during the night, followed by morning stiffness and buttock, chest or neck pain. The characteristic clinical signs are spine motility impairment and chest expansion. The main feature of axial involvement is that its onset and course are independent of the bowel disease. HLA-B27 has a high prevalence in ankylosing spondylitis (90 ) while in patients with IBD and spondylitis, its prevalence varies from 50-75 . The simultaneous presence of HLA-B60 and HLA-B44 seems to increase the patient's susceptibility to axial involvement 26 .
Definition Pain is considered widespread when all of the following are present pain in the left side of the body, pain in the right side of the body, pain above the waist, and pain below the waist. In addition, axial skeletal pain (cervical spine or anterior chest or thoracic spine or low back) must be present. In this definition, shoulder and buttock pain is considered as pain for each involved side. Low back pain is considered lower-segment pain. Gluteal bilateral, in upper outer quadrants of buttocks in anterior fold of muscle.
Immunologic A 64-year-old woman, who had had monthly intramuscular injections of long-acting octreotide in the buttocks for 6 years, had increased uptake of 111In-pentetre-otide in both buttocks, thought to represent granuloma formation at the injection sites (49a). Localized granulomas have previously been described in isolated cases after intramuscular somatostatin analogues, and somatostatin receptors are expressed in high density in activated lymphocytes.
A different sort of gene therapy recently was applied to human buttocks. Skin exposed to the ultraviolet radiation of sunlight is subject to DNA damages that can lead to skin cancer. The problem would be much worse were it not for DNA-repair enzymes that exist naturally in skin cells and mend most molecular injuries. Researchers recently developed a lotion, containing DNA-repair enzymes, that when applied to the skin may augment the body's UV damage control. When tested experimentally on UV-exposed buttocks, the skin cells apparently took up the enzymes and showed marginally improved levels of DNA repair.
Sciatica A syndrome characterized by pain radiating from the back into the buttock and into the lower extremity along its posterior or lateral aspect, and most commonly caused by prolapse of the intervertebral disk the term is also used to refer to pain anywhere along the course of the sciatic nerve. eu
Oblique axial T2 fat-saturated image of an intact labrum, but there is a partial tear of the undersurface of gluteus minimus tendon insertion (white arrow) with surrounding lateral edema and inflammation (black arrow). It is essential to search for surrounding extra-articular abnormalities. Fig. 10. Oblique axial T2 fat-saturated image of an intact labrum, but there is a partial tear of the undersurface of gluteus minimus tendon insertion (white arrow) with surrounding lateral edema and inflammation (black arrow). It is essential to search for surrounding extra-articular abnormalities.
Symptomatic hip joint disease is usually confused with upper lumbar radiculopathy as the hip can refer pain down the anterior thigh to the knee and occasionally further. Variable pain locations may also include the groin, buttock, or other areas in the thigh. The severity of arthritis demonstrated on x-ray only roughly correlates with pain which can be severe and often at night. Hip motion asymmetry is often diagnostic as is Trendelenberg gait, Faber's test, or Stinchfield's test compared to the well leg.46
Pathology (8) The lateral radiographs show that there is forward slip of L5 on SI of a little less than 25 . There is an associated defect in the pars interarticularis of L5. In the oblique projection the 'Scotty dog' has been decapitated. The patient complained of low back and buttock pain.
Henoch-Schonlein purpura, also known as anaphylactoid purpura or allergic purpura, is manifested by acute purpura, arthritis, colicky abdominal pain, and nephritis. The disease is more common in children than in adults, although an adult form of the disease exists. The mean age is 17 years with equal occurrence in males and females. Morphological characteristics include arteriolitis and venulitis in the superficial dermis and the bowel, and mild proliferative and necrotizing glomerulonephritis. Immunofluorescence histology reveals significant deposits of IgA in the dermis and kidney. Palpable purpura over the buttocks and lower extremities and fever are generally the first signs of the disease. The triad of purpura, arthritis, and abdominal pain is present in approximately 80 per cent of patients. Joint involvement is typically monoarticular, transient, involves large joints, and causes pain out of proportion to objective evidence of synovitis. Peritonitis and melena
Radiate to the buttock (never below the knee), and can be unilateral or bilateral. In the latter group, new bone formation leads to spinal stenosis, resulting in neurogenic claudication, radicular pain, and, at times, cauda equina syndrome or frank myelopathy. Acute back pain may develop when a fracture occurs in the pagetic bone.
Morning pain and stiffness is a common symptom of this disease. Pain is often described as intermittent and can present with painful radiation to the buttock or posterior thigh. Pain is increased by activity, especially with extension and twisting motions of the spine, and relieved by rest. Patients demonstrate decreased range of motion and localized back pain. Radiographic findings frequently include spondylosis and facet joint hypertrophy. The spine is made up of vertebral bodies and intervertebral discs. The disc is located between the bony vertebrae and acts as the shock absorber of the spine. The disc is composed of a tough outer annulus surrounding a soft center called the nucleus pulposus. In the normal course of aging, the annulus becomes more friable and is subject to cracking and fissuring called annular tears. The annulus is highly innervated and these tears can be painful. Typically, patients will present with localized back pain with occasional radiation to paravertebral...
Herniation is the L5-S1 level, followed by the L4-L5 level and then higher levels. Symptoms of lumbosacral herniation often follow lifting or twisting injuries, or they may result from accumulated low-level trauma. Pain typically occurs in the parasacral area and radiates to the buttocks. Below C8, the roots exit through the neural foramina below the correspondingly numbered vertebral bodies. In patients with the most common posterolateral herniation, dermatomal radicular pain typically Gluteus medius Gluteus maximus The symptom most suggestive of lumbar spinal stenosis is neurogenic claudication. Low back pain radiates to the buttocks and thighs and may extend more distally along the lumbosacral dermatomes. This pain is brought on by walking. Unlike vascular claudication, rest in the upright position does not relieve the pain, but rest while seated or forward bending, such as leaning on a shopping cart, may provide relief. Pain is exacerbated by spinal extension, such as downhill...
Or sometimes painful subcutaneous plaques or nodules of varying sizes (Peters and Su, 1989 Costner et al., 2003). The overlying skin becomes attached to the firm lesions, producing a deep depression into the subcutis with a normal or erythematous, inflammatory surface. Dystrophic calcifications or ulcerations within older lesions of LEP, leaving atrophic scars or sometimes resembling lipatrophy, may occur and at times can be a prominent clinical feature of the disease requiring surgical excision. Trauma may often directly be related to the lesions of LEP (Tuffanelli, 1971). Most lesions of LEP are usually found on the trunk, buttocks, and proximal upper and lower extremities, but the shoulders and thighs are further sites of predominant involvement (Martens et al., 1999). This subtype may also develop on the scalp clinically simulating alopecia areata (Kossard, 2002) and in unusual areas on the face, such as the parotid region. Furthermore, periorbital edema as an initial symptom of...
Psoriasis Typical skin plaques are reddish raised areas covered with thick silvery scales. Both sides of the body are usually affected. Frequently affected areas include elbows, knees, scalp, and buttocks. Similar plaques may occur at sites of trauma or surgical scars (Koebner phenomenon). The nails may be affected with small pits on their surface or heaping up of layers of skin underneath the nail (subungual hyperkeratosis) and lifting of the nail off its bed (onycholysis). This can look very like a chronic fungal infection. The diagnosis is made on the clinical grounds described. Most patients will have the rash of psoriasis as an obvious clue. The rash, however, may be very subtle. Minor scaling around the scalp may have been thought by the patient to be dandruff for many years. The rash of psoriasis is not always irritating, and patients can be relatively unaware of small patches around the buttocks or belly button or, not seeing their relevance, not tell their physician about...
With an acute slip, mild symptoms are present for a short time before the displacement occurs minimal trauma may then cause an acute separation, with pain so severe the child cannot bear weight on the affected side. Patients with the chronic form have hip pain localized to the groin, buttock, or lateral hip. Occasionally, the child has only knee pain. There is a decrease in abduction, flexion, and internal rotation, and as the hip is gently flexed it may roll into external rotation.
Most adults first see their doctor with painless weakness of upper arm, shoulder, buttock, and thigh muscles coming on over three to six months. children and younger adults may have a more rapid onset and often have fever and fatigue as well. A few people also have muscle aches. This pattern of muscle involvement causes difficulty doing things above shoulder height, such as brushing hair, as well as lower limb activities like running or climbing stairs. The muscles involved in speech or swallowing are affected 10-20 percent of the time, leading to hoarseness, abnormal voice, difficulty swallowing, or food and fluids going up into the back of the nose. There is some tenderness of the muscles in 50 percent of people.
Lentigines, 254-255, 258, 345, 355, 375, 376f. PUVA-induced or tanning bed. Stellate or star-like brown macules on buttocks, groin, penis, trunk but spares palms, soles, gluteal cleft and axillae. May persist up to 2 years after PUVA therapy. Tanning bed lentigines. Acral brown macules especially on legs, arms, neck and chest. May occur abruptly or after prolonged tanning-bed exposure. Lentigo maligna, 347, 355 blue, cellular. Histology differs from common blue nevus. Rare malignant degeneration, especially sacrococcygeal and buttocks, 1-3 cm, and slightly larger than common blue nevus, blue-black, slightly elevated.
HsP cannot be diagnosed without the characteristic skin rash. This comprises small 2-10 mm diameter blue-black spots on the legs and buttocks. These spots are easily felt to be lumpy. They may start as reddish lumps or wheals. About 75 percent of patients get arthritis, usually affecting the ankles or knees, that may start before the rash. A smaller number develop gut problems, usually colicky pain, vomiting, and passing of blood in the stools. A serious complication of gut involvement is intussusception. This is where one section of bowel pushes through the next section so that the first lies inside the second. This double tube of bowel causes obstruction. If it does not resolve, it can lead to perforation or bursting of the bowel wall. In HSP this usually affects the small bowel.
Clinical feature identified (Bernacchi et al., 2004). Purpura appears as recurrent crops of round, pink, separated or confluent lesions turning dull purple and brown in a few days and finally resolving or leaving a pale brown stain (Roguedas et al., 2004) in contrast with simple purpura, palpable purpura does not blanch when pressure is applied to the skin. Moreover, due to the increased hydrostatic pressure, it typically involves lower extremity and buttocks (Gonzalez-Gay et al., 2003). Cutaneous purpura has been associated with lymphoma development and mortality, cutaneous vasculitis thus becoming significant in the prognosis and outcome of patients with pSS (Voulgarelis et al., 1999 Ramos-Casals et al., 2005). Two different types of vasculits have been histopathologically described in pSS the neutrophilic inflammatory vascular disease, indistinguishable from a leukocytoclastic vasculitis, and the mononuclear inflammatory vascular disease (Provost and Watson, 1992 Roguedas, et al.,...
The physical examination test recommended for assessing any contracture of the rectus femoris muscle is Ely's test. This assessment is performed by flexing the knee and drawing the lower leg into the thigh. A negative test demonstrates full flexion of the knee to the thigh with no movement in the pelvis. A positive Ely's sign demonstrates that with flexion at the knee, the pelvis will tilt, raising the buttocks from the table.
Groin pain with radiation into the buttock indicates hip joint dysfunction. Pure buttock or back pain without a groin component is usually back in origin. When patients say their hip hurts, they mostly point to the buttock. Lateral hip pain with radiation to the lateral thigh may be related to greater trochanteric bursitis or abductor tendinitis. Discomfort over the anterior superior iliac spine extending down the anterior thigh is associated with meralgia paresthetica (inflammation of the lateral femoral cutaneous nerve). 4. Buttock pain may be related to ischial tuberosity bursitis or spinal disorders such as spinal stenosis, ruptured intervertebral disk, and instability.
Straight leg-raising test to screen for lumbosacral nerve root symptoms note angle of elevation that induces back or buttock pain. b. Gaenslen maneuver to detect sacroiliac joint inflammation. Instruct the patient to lie supine on the examining table with knees flexed and one buttock over the edge. Ask the patient to drop the unsupported leg off the table. This maneuver will elicit pain in the sacroiliac joint ipsilateral to the extended hip. The maneuver exerts a traction force on the sacroiliac joint, which opens it up.
Sacroiliac arthritis can cause buttock or low back pain. Inflammation of the synovial compartment resulting from erosion and laxity of the ligaments can decrease the fluidity of the pelvic girdle and cause a faulty posture or gait. History The pain from sacroilitis is caused by peri-osteal irritation at the myofascial insertions. The joint line is innervated from several levels including L3-S1. A deep dull ache or hypersensitivity to the ipsilateral joint line is often found. In males the discomfort may radiate to the groin or testicles. Pain emanating from the sacroiliac joint can cause buttock discomfort that can be referred to the hip or anterior thigh. The pain of the sacroiliac joint may become worse with sitting and relieved with walking. Patients have reported to be worse in the morning and relieved as mobility progresses throughout the day. Another etiology of low back pain is the anomalous lumboiliac transitional articulation. The articulation between the L5 transverse...
In hanging, asphyxia is secondary to compression or constriction of the neck structures by a noose or other constricting band tightened by the weight of the body. There may be either complete or incomplete suspension of the body (Figure 8.13). Incomplete suspension, with the toes or feet (less commonly the knees or buttocks) touching the ground, is extremely common. Virtually all hangings are suicidal. Accidental hangings are uncommon and homicidal hangings very rare. Death is caused by compression of the blood vessels of the neck such that an insufficient amount of oxygenated blood reaches the brain. Obstruction of the airway can also occur, either through compression of the trachea or, when the noose is above the larynx, elevation and posterior displacement of the tongue and floor of the mouth. Blockage or compression of the air passages is not necessary to cause death in hanging. A number of individuals have hanged themselves with the noose above the larynx and a permanent...
The range of motion test is commonly normal. Typically, motor strength is intact and rarely is there weakness. Patients may have vague paralumbar tenderness when palpated over the facet joints. In the acute setting, warmth and muscle spasm are present. At times there are no neurological findings. Although the patients have pain in the buttocks, hips, and thighs, the discomfort does not extend below the knees. The discomfort is aggravated with extension of the back and hyperextension of the spine. From the prone position the patient is asked to arch the back and extend the spine, which may re-create the pain in the lumbar, thoracic, and cervical regions. Passive range of motion twisting, lateral bending, and rotational movements from the sitting position can exacerbate the symptoms. The recumbent position can sometimes provide pain relief. The sensation and response to vibration are intact. The deep tendon reflexes will generally be normal to diminished.
Fig. 3. (A) Test of hip flexion L2. (B) Test of knee extension L3. (C) Test of foot dorsiflexion L4. (D) Test of great toe extension L5. (E) Test of foot eversion S1. (F) Test of buttock contraction S2. Fig. 3. (A) Test of hip flexion L2. (B) Test of knee extension L3. (C) Test of foot dorsiflexion L4. (D) Test of great toe extension L5. (E) Test of foot eversion S1. (F) Test of buttock contraction S2.
Wear and tear on the hip can result in bursitis (the most common cause of hip pain see page 305) or osteoarthritis (see page 308). Bursitis can cause pain on the outer side of the hip that worsens after lying on that side, walking, or climbing stairs. Bursitis in the area of the upper buttocks is most noticeable while walking uphill or after sitting for a long period on a hard surface.
CV the large vessels are affected, skin ulceration develops, often on lower extremities, or where skin is exposed to pressure, for example, in interphalangeal joints of the toes, over bunions, ankles, elbows and, in bedridden patients, the buttocks. These ulcerations may be very painful, come in crops, and tend to grow and become chronic. Superinfection frequently occurs, particularly being a great risk for patients with joints prostheses. In severe cases, ulcerations may form over subcutaneous nodules. CV or leucocytoclastic vasculitis, seen as palpable purpura, heals as a rule and responds to conventional DMARDs (Heurkens et al., 1991). Large-vessel vasculitis requires prompt treatment with cor-ticosteroids and cytotoxic drugs. In addition to drug treatment, pressure ulcers should be treated by eliminating pressure, frequent bathing in soda or beta-dine water, and careful local bandage therapy (Dowsett, 2005). It is difficult to determine whether pressure is the only cause of such...
Osteoarthritis, classified as primary (idiopathic) or secondary, represents a final common pathway for a number of conditions of diverse etiologies.6 Primary OA is further classified as localized (e.g., hands, feet, knees, or other single sites) or generalized including three or more local areas. Secondary OA is classified as (1) posttraumatic, (2) congenital or developmental, (3) metabolic, (4) endocrine, (5) other bone and joint diseases, (6) neuropathic, and (7) miscellaneous. Commonly affected joints include the interphalangeal, knee, hip, acromioclavicular, subtalar, first metatarsophalangeal, sacroiliac, temporomandibular, and carpometacarpal joint of the thumb. Joints usually spared include the metacarpophalangeal, wrist, elbow, and shoulder. Early during the symptomatic phase, OA pain is often described as a deep, aching discomfort. It occurs with motion, particularly with weight-bearing, and is relieved by rest. As the disease progresses, pain can occur with minimal motion...
Cauda equina patients usually present with backache accompanied by bilateral radicular symptoms. Severe pain may suddenly appear and radiate bilaterally to the buttocks, thighs, or legs. Perineal numbness may develop. The phrase Don't beat around the bush with numbness in the tush is apt. The most common early urological manifestation of cauda equina syndrome is inability to empty the bladder rather than incontinence. Urinary retention is frequently overlooked, because the patient does not complain of it in the first few hours.
The facet joint is a synovial joint and therefore subject to osteoarthritis. The joint is well innervated and most likely contributes to back pain, although the extent to which it does so is unclear. The diagnosis of facet joint often can be controversial and difficult to isolate. Patients may present with non-specific back pain which may radiate to the buttocks or down the leg but not below the knee. The patient may have a normal neurologic examination and may exhibit paravertebral muscle tenderness and symptoms with lumbar rotation and flexion. Diagnosis of facet joint pain can be made with intra-articular injection of local anesthetic or block of the medial branch of the posterior rami at two levels.
Inspection (3) Look at the patient from behind. Note (A) any scoliosis (possibly secondary to pelvic tilting from, for example, an adduction deformity of the hip). (B) gluteal muscle wasting (e.g. from disuse, infection), (C) sinus scars (e.g. secondary to tuberculosis).
Figure 17-4 illustrates gluteal spread from a traumatic perforation of the rectum occasioned by a barium enema study. Dissection from the pelvis toward the gluteal area is strikingly illustrated in this case by the extravasated contrast agent tracking within the fascial extension of the superior gluteal artery through the greater sciatic foramen. Indeed, the vessel is shown as a tubular filling defect within its opacified endopelvic sheath. Tenderness in the buttock was a consequence of this anatomic extension. Figure 17-5 illustrates a similar pathway in an instance of sigmoid diverticulitis perforating to the buttock, in a patient presenting with fever and vague pain in the right buttock. Perforation of the sigmoid colon in this case is directed along the extension of the supe rior gluteal artery through the greater sciatic foramen to the right buttock. The initial symptom of pain in this site heralded the progression to a prominent gluteal abscess. Figure 17-6 illustrates extension...
The superior gluteal nerve (arrow) is shown coursing transversely on the deep surface of the gluteus medius. It passes above the anterolateral portal (double arrows), which is seen between the deep surface of the gluteus medius and the capsule. (Reprinted with permission from Byrd et al.13) FIGURE 7.8. The superior gluteal nerve (arrow) is shown coursing transversely on the deep surface of the gluteus medius. It passes above the anterolateral portal (double arrows), which is seen between the deep surface of the gluteus medius and the capsule. (Reprinted with permission from Byrd et al.13)
Hand, foot, and mouth disease is an acute infectious illness, caused by enteroviruses, that primarily affects children. Initial manifestations include fever, anorexia, malaise, and sore mouth. Oral lesions appear 1 to 2 days later and cutaneous lesions shortly thereafter. The oral lesions begin as vesicles on an erythematous base which ulcerate. The vesicles are usually 4 to 8 mm in size, and are very painful. They are located on the buccal mucosa, tongue, soft palate, and gingiva. The exanthem starts as red papules which change to gray vesicles about 3 to 7 mm in size. They are found on the palms and soles but may occur on the dorsum of the feet and hands and on the buttocks, as well. They may be oval, linear, or crescentic and may run parallel to skin lines. They heal in 7 to 10 days.
Acne arthralgia Severe acne that causes cysts and nodules on the buttocks, thighs, and upper arms as well as in areas more usually affected by acne can be associated with attacks of arthralgia and myalgia that can last several weeks or months. Joint problems related to acne are rare and occur most often in adolescent males. in addition to arthralgia and myalgia, fever, loss of weight, and arthritis can occur. The cause of this illness is not known, but it may be a reaction to the bacteria that cause acne. Treatment of the arthralgia is symptomatic with NSAIDs and is combined with treatment to control the acne. This can include long-term antibiotic treatment, often with a tetracycline type of antibiotic, topical creams, retinoids, or in females, drugs that block their male hormones (androgens) that stimulate acne. Severe acne is occasionally complicated by the sapho syndrome.
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