Diagnosis

Proven Lupus Treatment By Dr Gary Levin

Proven Lupus Treatment

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Lesions and/or symptoms in the following areas could help in diagnosis:

a the thighs - not laterally, not medially, not frontal but the frontal-medial aspect; b the axillae - not in the vaults but in the anterior axillary fold; c the buttocks;

d the mid-abdominal area - the patient will usually describe the area as a belt (Figure 24.2); e the volar surfaces of the lower parts of the arms, and sometimes the hands, especially the finger webs (Figure 24.1); and f the breasts in women and the penis in men.

The back, the distal parts of the legs, and the face (except in children), are usually not affected. The tentative diagnosis of scabies (Figure 24.2) should always be confirmed by the identification of burrows (Figure 24.3) and preferably by the identification of the parasite. This can usually be achieved through the use of a blunt sewing needle top (Figure 24.4). The parasite, that is, the female mite, measures about 0.4mm, and can easily be identified in the microscope.

Figure 24.1 Scabies: eczematous lesions of the finger webs are common, but not always observed. (See Colour Plate V.)
Figure 24.2 Scabies: an important clue for the clinical diagnosis is that 'the symptoms are much worse than the clinical signs'- intense itch, but minimal skin lesions - urticarial or excoriated papules. (See Colour Plate VI.)
Figure 24.3 Scabies: burrows are typical and can be described as tortuous lines with a slight scaling, most often found on the flexor surface of the wrist, between the fingers, and sometimes on the genitals. At the end of the burrow often a dark spot can be seen. (See Colour Plate VIII.)
Scabbies Parasites
Figure 24.4 The scabies mite: the 'dark spot' represents the mite, which can usually be 'catched' by a blunt needle and identified microscopically with low-grade magnification (x100).

Figure 24.5 Crusted scabies: while in otherwise healthy persons the infestation usually means only 10-20 mites, an immuno-compromised patient (HIV, tumor diseases, etc.), might develop quite another clinical disease with widespread hyperkeratotic lesions: crusted scabies or 'Norwegian scabies'. This patient suffered from systemic lupus erythematosus and was on high doses of cortisone since a long time. (See Colour Plate VII.)

Figure 24.5 Crusted scabies: while in otherwise healthy persons the infestation usually means only 10-20 mites, an immuno-compromised patient (HIV, tumor diseases, etc.), might develop quite another clinical disease with widespread hyperkeratotic lesions: crusted scabies or 'Norwegian scabies'. This patient suffered from systemic lupus erythematosus and was on high doses of cortisone since a long time. (See Colour Plate VII.)

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