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==CAUSES OF LIVEDOID VASCULITIS==
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
A number of conditions may cause the appearance of livedo reticularis:
|-
* [[Cutis marmorata telangiectatica congenita]] a rare [[congenital]] condition
| style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center | '''Diagnosis'''||style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center |'''Incidence'''||style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center |'''Onset'''||style="padding: 0 9px; font-size: 100%; background: #F5F5F5;" align=center | '''Common symptom'''
* [[Sneddon syndrome]] - association of Livedoid vasculitis and systemic vascular disorders, such as  strokes, due to underlying genetic cause.<ref>{{cite journal |author=Sneddon I |title=Cerebro-Vascular Lesions And Livedo Reticularis |journal=Br J Dermatol |volume=77 |issue= |pages=180-5 |year=1965 | month=Apr |id=PMID 14278790}}</ref>
|-
* '''Idiopathic livedo reticularis''' - is the commonest cause of livedo reticularis appearance and is a completely benign condition of unknown cause affecting mostly young women during the winter.<ref>{{cite journal |author=Gibbs M, English J, Zirwas M |title=Livedo reticularis: an update |journal=J Am Acad Dermatol |volume=52 |issue=6 |pages=1009-19 |year=2005 |id=PMID 15928620}}</ref> May be mild, but ulceration may occur later in the summer.<ref>{{cite journal |author=Feldaker M, Hines E, Kierland R |title=Livedo reticularis with summer ulcerations |journal=AMA Arch Derm |volume=72 |issue=1 |pages=31-42 |year=1955 |id=PMID 14387292}}</ref>
| style="font-size: 90%; padding: 0 10px; background: #DCDCDC" align=left |❑ [[Polycystic ovary syndrome]] <br>
* '''Secondary livedo reticularis''':
 
** [[Vasculitis]] [[Autoimmunity|autoimmune conditions]]:
[[hirsutism|Idiopathic hirsutism]]<br>
*** Livedoid vasculitis - with painful ulceration occurring in the lower legs
 
*** [[Polyarteritis nodosa]]
[[Congenital adrenal hyperplasia]] <br>
*** [[Systemic lupus erythematosus]]<ref>{{cite journal |author=Golden R |title=Livedo reticularis in systemic lupus erythematosus |journal=Arch Dermatol |volume=87 |issue= |pages=299-301 |year=1963 | month=Mar |id=PMID 13948706}}</ref>
 
*** [[Dermatomyositis]]  
❑ Ovarian and androgen secreting tumors <br>
*** [[Rheumatoid arthritis]]  
 
*** [[Lymphoma]]  
❑ Drug induced <br>
*** [[Pancreatitis]]<ref>{{cite journal |author=Sigmund W, Shelley W |title=Cutaneous manifestations of acute pancreatitis, with special reference to livedo reticularis |journal=N Engl J Med |volume=251 |issue=21 |pages=851-3 |year=1954 |id=PMID 13214346}}</ref>
 
*** [[Tuberculosis]]  
[[HAIR-AN Syndrome]] <br>
*** [[Amantadine]] (drug)
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |❑ 70-85%<br><br> ❑ 5-15%<br><br> ❑ 1-8%<br><br>
** Obstruction of capillaries:
❑ 0.3-0.1%<br>
*** [[Cryoglobulinaemia]] - proteins in the blood that clump together in cold conditions.<ref>{{cite journal |author=Langhof H, Braun G, Matzkowski H |title=[Livedo reticularis due to cold gelation of the blood by gamma-plasmacytoma.] |journal=Arch Klin Exp Dermatol |volume=205 |issue=4 |pages=343-50 |year=1957 |id=PMID 13522017}}</ref>
 
*** [[Antiphospholipid syndrome]] due to small blood clots
 
*** [[Hypercalcaemia]] (raised blood calcium levels which may be deposited in the capillaries)
❑ 0.5-1% <br>
*** Haematological disorders of [[Polycythemia|Polycythaemia rubra vera]] or [[Thrombocytosis]] (excessive red cells or platelets)
 
*** Infections ([[syphilis]] and tuberculosis)
 
*** [[Arteriosclerosis]] ([[cholesterol emboli syndrome]])<ref>{{cite journal |author=Kazmier F, Sheps S, Bernatz P, Sayre G |title=Livedo reticularis and digital infarcts: a syndrome due to cholesterol emboli arising from atheromatous abdominal aortic aneurysms |journal=Vasc Dis |volume=3 |issue=1 |pages=12-24 |year=1966 |id=PMID 5903590}}</ref><ref>{{cite journal |author=Stewart W, Lauret P, Testart J, Thomine E, Boulliê M, Leroy D |title=[Cutaneous cholesterol emboli (author's transl)] |journal=Ann Dermatol Venereol |volume=104 |issue=1 |pages=5-8 |year=1977 |id=PMID 843026}}</ref> and [[homocystinuria]] (due to [[Chromosome 21 (human)|Chromosome 21]] autosomal recessive [[Cystathionine beta synthase deficiency]])
❑ 3-4%
*** Intra-arterial injection (especially in drug addicts)
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |❑ PCOS insidious<br> 
 
❑ Idiopathic hirsutism Insidious<br>
❑ CAH rapid <br><br>
❑ Tumors rapid <br>
 
 
 
 
 
❑ HAIRAN syndrome insidious
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |
❑ Irregular menses, hyperandrogenism, polycystic ovary <br>
❑ No other known cause, normal ovaries, normal anbdrogens <br>
 
 
 
❑ Total testosterone > 200ng and does not respond to treatment <br>
 
❑ Related to medications (steroids, danazol etc) <br>
 
❑ Subset of PCOS with insulin resistance and acanthosis nigricans
|}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
'''For patient information, click [[Hirsutism (patient information)|here]]'''
 
{{Infobox_Disease |
  Name          = {{PAGENAME}} |
  Image          = |Nuremberg chronicles - Strange People - Hairy Lady (XIIv).jpg
  Caption        = |A lady with hirsutism, as depicted in the ''Nuremberg Chronicle'' (1493)
        = |
}}
{{SI}}
{{CMG}}
 
==Overview==
'''Hirsutism''' (from Latin ''hirsutus'' = shaggy, hairy) is defined as excessive and increased [[hair]] growth in women in locations where the occurrence of [[terminal hair]] normally is minimal or absent. It refers to a male pattern of body hair ([[androgenic hair]]) and it is therefore primarily of cosmetic and [[psychological]] concern. Hirsutism is a [[symptom]] rather than a [[disease]] and may be a sign of a more serious medical indication, especially if it develops well after [[puberty]].
 
== Appearance and evaluation ==
Hirsutism only affects women, since the rising of androgens causes a male pattern of body hair, particularly in locations where women normally do not develop terminal hair within their [[puberty]] ([[chest hair|chest]], [[abdominal hair|abdomen]], back and [[facial hair|face]]). The medical term for excessive hair growth that affect both men and women is [[hypertrichosis]].
 
One method of evaluating hirsutism is the [[Ferriman-Gallwey score]] which gives a score based on the amount and location of hair growth on a woman.
==Etiology==
The cause of hirsutism can be either an increased level of [[androgen]]s (male [[hormone]]s) or an oversensitivity of [[hair follicles]] to androgens. Male hormones such as [[testosterone]] stimulate hair growth, increase size and intensify the pigmentation of hair. Other symptoms associated with a high level of male hormones include [[Acne vulgaris|acne]] and deepening of the voice and increased muscle mass.
 
Growing evidence implicates high circulating levels of insulin in women to the development of hirsutism. This theory is consistent with the observation that obese (and thus presumably insulin resistant hyperinsulinemic) women are at high risk of becoming hirsute. Further, treatments that lower insulin levels will lead to a reduction in hirsutism.
 
It is speculated that insulin, at high enough concentration, stimulates the ovarian theca cells to produce androgens. There may also be an effect of high levels of insulin to activate the insulin-like growth factor-I (IGF-1) receptor in those same cells. Again, the result is increased androgen production.
 
The following may be some of the conditions that may increase a woman's normally low level of male hormones:
* [[Polycystic ovary syndrome]]  
* [[Cushing's disease]]
* [[Tumor]]s in the [[ovaries]] or [[adrenal gland]] ([[cancer]])
* [[Congenital adrenal hyperplasia]]
* [[Insulin resistance]]
* Drugs like [[Ciclosporin]], [[conjugated estrogens]], [[Desogestrel and Ethinyl Estradiol]], [[Dexamethasone]], [[ethynodiol diacetate and ethinyl estradiol]], [[Ethosuximide]], [[Fluoxymesterone]], [[Methyltestosterone]], [[Oxandrolone]], [[Oxymetholone]], [[prednisolone]], [[Tiagabine]]
 
== Physical Examination ==
====Skin====
[[Image:hirsuitism (PCOS, Cushing's Syndrome, Phenytoin, Leydig Cell Tumor).jpg|thumb|left|hirsuitism (PCOS, Cushing's Syndrome, Phenytoin, Leydig Cell Tumor)
<ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages/</ref>]]
{{clr}}
 
==Differential Diagnosis of Causes of {{PAGENAME}}==
 
#Idiopathic:
#*familial,
#*possibly increased sensitivity to androgens.
#variant of normal menopause.
#Polycystic ovarian syndrome.
#obesity
#Drugs:
#*androgens,
#*anabolic steroids,
#*methyltestosterone,
#*minoxidil,
#*diazoxide,  
#*phenytoin,  
#*glucocorticoids,  
#*cyclosporine.
#*phenytoin,  
#Congenital adrenal hyperplasia.
#Adrenal virilizing tumor.
#Ovarian virilizing tumor:
#*arrhenoblastoma,  
#*hilus cell tumor.
#Pituitary adenoma.
#pregnancy
#Insulin resistance
#Cushing's syndrome.
#Hypothyroidism (congenital and juvenile).
#Acromegaly.
#Androgen-secreting tumors of the ovaries
#*Sertoli-Leydig cell tumors,
#*granulosa-theca cell tumors,
#*hilus-cell tumors
#hyperprolactinemia
#Testicular feminization.
 
== Treatment ==
Many women with unwanted hair seek methods of [[hair removal]] to control the appearance of hirsutism. But the actual causes should be evaluated by physicians, who can conduct blood tests, pinpoint the specific origin of the abnormal hair growth, and advise on the best course of treatment.
 
== See also ==
* [[androgenic hair]]
* [[hypertrichosis]]
* [[hair removal]]
 
==References==
* Ferriman D, Gallwey JD: Clinical assessment of body hair growth in women. ''Journal of Clinical Endocrinology'' 1961; 21:1440-1447.
 
 
{{Diseases of the skin and subcutaneous tissue}}
 
 
[[Category:Integumentary system]]
[[Category:Gynecology]]
[[Category:Dermatology]]
[[Category:Hair-related diseases]]
 
<!-- The below are interlanguage links. -->
 
<br>
[[bg:Хирзутизъм]]
[[de:Hirsutismus]]
[[et:Hirsutism]]
[[es:Hirsutismo]]
[[fr:Hirsutisme]]
[[id:Hirsutisme]]
[[nl:Hirsutisme]]
[[pl:Hirsutyzm]]
[[pt:Hirsutismo]]
 
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{{WikiDoc Sources}}
 
 
 
 
 


*[[Cutis marmorata telangiectatica congenita]], a rare [[congenital]] condition
*[[Sneddon syndrome]] - association of livedoid vasculitis and systemic vascular disorders, such as  strokes, due to underlying genetic cause<ref>{{cite journal |last1=Sneddon |first1=I. B. |first2=I. B. |title=Cerebro-Vascular Lesions And Livedo Reticularis |journal=British Journal of Dermatology |volume=77 |issue=4 |pages=180–5 |date=April 1965 |pmid=14278790 |doi=10.1111/j.1365-2133.1965.tb14628.x}}</ref>
*Idiopathic livedo reticularis - the most common form of livedo reticularis, completely benign condition of unknown cause affecting mostly young women during the winter:<ref>{{cite journal |first1=Mark B. |last1=Gibbs |first2=Joseph C. |last2=English |first3=Matthew J. |last3=Zirwas |title=Livedo reticularis: an update |journal=J Am Acad Dermatol |volume=52 |issue=6 |pages=1009–19 |year=2005 |pmid=15928620 |doi=10.1016/j.jaad.2004.11.051}}</ref> It is a lacy purple appearance of skin in extremities due to sluggish venous blood flow. It may be mild, but ulceration may occur later in the summer.<ref>{{cite journal |author=Feldaker M, Hines E, Kierland R |title=Livedo reticularis with summer ulcerations |journal=AMA Arch Derm |volume=72 |issue=1 |pages=31–42 |year=1955 |pmid=14387292 |doi=10.1001/archderm.1955.03730310033007}}</ref>
*Secondary livedo reticularis:
**[[Vasculitis]] [[Autoimmunity|autoimmune conditions]]:
***[[Livedoid vasculitis]] - with painful ulceration occurring in the lower legs
***[[Polyarteritis nodosa]]
***[[Systemic lupus erythematosus]]<ref>{{cite journal |author=Golden R |title=Livedo reticularis in systemic lupus erythematosus |journal=Arch Dermatol |volume=87 |issue= |pages=299–301 |date=March 1963 |pmid=13948706 |doi=10.1001/archderm.1963.01590150015002}}</ref>
***[[Dermatomyositis]]
***[[Rheumatoid arthritis]]
***[[Lymphoma]]
***[[Pancreatitis]]<ref>{{cite journal |author=Sigmund W, Shelley W |title=Cutaneous manifestations of acute pancreatitis, with special reference to livedo reticularis |journal=N Engl J Med |volume=251 |issue=21 |pages=851–3 |year=1954 |pmid=13214346 |doi=10.1056/NEJM195411182512104}}</ref>
***Chronic pancreatitis.<ref>{{cite journal |last1=Gould |first1=Jennifer W. |last2=Helms |first2=Stephen E. |last3=Schulz |first3=Susan M.| last4=Stevens |first4=Seth R. |year=1998 |title=Relapsing livedo reticularis in the setting of chronic pancreatitis |journal=Journal of the American Academy of Dermatology |volume=39 |issue=6 |pages=1035–1036 |pmid=9843029 |doi=10.1016/S0190-9622(98)70290-7}}</ref>
***[[Tuberculosis]]
**Drug-related:
***[[Amantadine]] (side effect)
**Obstruction of capillaries:
***[[Cryoglobulinaemia]] - proteins in the blood that clump together in cold conditions<ref>{{cite journal |author=Langhof H, Braun G, Matzkowski H |title=Livedo reticularis durch Kältegelierung des Blutes bei γ-Plasmocytom |trans_title=Livedo reticularis due to cold gelation of the blood by gamma-plasmacytoma |language=de |journal=Archiv für klinische und experimentelle Dermatologie |volume=205 |issue=4 |pages=343–50 |year=1957 |pmid=13522017 |doi=10.1007/BF00693523}}</ref>
***[[Antiphospholipid syndrome]] due to small blood clots
***[[Hypercalcaemia]] (raised blood calcium levels which may be deposited in the capillaries)
***Haematological disorders of [[Polycythemia|polycythaemia rubra vera]] or [[thrombocytosis]] (excessive red cells or platelets)
***Infections ([[syphilis]], tuberculosis, Lyme disease)
***Associated with [[acute renal failure]] due to cholesterol emboli status after cardiac catheterization
***[[Arteriosclerosis]] ([[cholesterol emboli]])<ref>{{cite journal |author=Kazmier F, Sheps S, Bernatz P, Sayre G |title=Livedo reticularis and digital infarcts: a syndrome due to cholesterol emboli arising from atheromatous abdominal aortic aneurysms |journal=Vasc Dis |volume=3 |issue=1 |pages=12–24 |year=1966 |pmid=5903590}}</ref><ref>{{cite journal |author=Stewart W, Lauret P, Testart J, Thomine E, Boulliê M, Leroy D |title=Les manifestations cutanées des emoblies de critaux de cholestérol |trans_title=Cutaneous cholesterol emboli |language=fr |journal=Ann Dermatol Venereol |volume=104 |issue=1 |pages=5–8 |year=1977 |pmid=843026}}</ref> and [[homocystinuria]] (due to [[Chromosome 21 (human)|Chromosome 21]] autosomal recessive [[Cystathionine beta synthase deficiency]])
***Intra-arterial injection (especially in drug addicts)
**[[Ehlers-Danlos syndrome]]—connective tissue disorder, often with many secondary conditions, may be present in all types
***Beta IFN treatment in ''i.e.'' multiple sclerosis<ref>{{cite journal  |last1=Rot |first1=Uroš |last2=Ledinek |first2=Alenka Horvat |date=December 2013 |title=Interferons beta have vasoconstrictive and procoagulant effects: a woman who developed livedo reticularis and Raynaud phenomenon in association with interferon beta treatment for multiple sclerosis |journal=Clinical Neurology and Neurosurgery |volume=115 |issue=Suppl 1 |pages=S79–81 |doi=10.1016/j.clineuro.2013.09.027 |pmid=24321162}}</ref><ref>{{cite journal |last1=Fox |first1=Michelle |last2=Tahan |first2=Steven |last3=Kim |first3=Caroline C. |year=2012 |title=Livedo Reticularis: A Side Effect of Interferon Therapy in a Pediatric Patient with Melanoma |journal=Pediatric Dermatology |volume=29 |issue=3 |pages=333–5 |pmid=21575046 |doi=10.1111/j.1525-1470.2011.01426.x}}</ref><ref>{{cite journal |last1=Cruz |first1=Boris Afonso |last2=de Queiroz |first2=Eustáquio |last3=Nunes |first3=Simone Vilela |last4=Cruz Filho |first4=Achiles |last5=Campos |first5=Gilberto Belisario |last6=de Carvalho Monteiro |first6=Ernesto Lentz |last7=Crivellari |first7=Humberto |title=Fênomeno de Raynaud grave associado a terapia com interferon-beta para esclerose múltipla: relato de caso |trans_title=Severe Raynaud's phenomenon associated with interferon-beta therapy for multiple sclerosis: case report |language=Portuguese |journal=Arquivos de Neuro-Psiquiatria |volume=58 |issue=2B |year=2000 |pages=556–9 |pmid=10920422 |doi=10.1590/S0004-282X2000000300025}}</ref>
***Pheochromocytoma<ref>{{cite journal |doi=10.1210/jc.2012-2842 |title=Livedo Reticularis in a Patient with Pheochromocytoma Resolving After Adrenalectomy |journal=The Journal of Clinical Endocrinology & Metabolism |volume=98 |issue=2 |pages=439–40 |year=2013 |last1=Buckley |first1=Sarah A. |last2=Lessing |first2=Juan N. |last3=Mark |first3=Nicholas M.}}</ref>
***Livedoid vasculopathy and its association with factor V Leiden mutation<ref>{{cite journal |pmid=23268168 |title=Livedoid vasculopathy and its association with factor V Leiden mutation |url=http://www.sma.org.sg/UploadedImg/files/SMJ/5312/5312cr3.pdf}}</ref>
***FILS syndrome (polymerase ε1 mutation in a human syndrome with facial dysmorphism, immunodeficiency, livedo, and short stature)<ref>{{cite journal |doi=10.1084/jem.20121303 |pmid=23230001 |pmc=3526359 |title=Polymerase ε1 mutation in a human syndrome with facial dysmorphism, immunodeficiency, livedo, and short stature ('FILS syndrome') |journal=Journal of Experimental Medicine |year=2012 |first1=Jana |last1=Pachlopnik Schmid |last2=Lemoine |first3=Nadine |last3=Nehme |first4=Valéry |last4=Cormier-Daire |first5=Patrick |last5=Revy |first6=Franck |last6=Debeurme |first7=Marianne |last7=Debré |first8=Patrick |last8=Nitschke |first9=Christine |last9=Bole-Feysot |first10=Laurence |last10=Legeai-Mallet |first11=Annick |last11=Lim |first12=Jean-Pierre |last12=de Villartay |first13=Capucine |last13=Picard |first14=Anne |last14=Durandy |first15=Alain |last15=Fischer |first16=Geneviève |last16=de Saint Basile |volume=209 |issue=13 |pages=2323–30}}</ref>
***Primary hyperoxaluria, oxalosis (oxalate vasculopathy)<ref>{{cite journal |doi=10.1016/j.ad.2012.04.019 |title=Oxalosis y livedo reticularis |trans_title=Oxalosis and Livedo Reticularis |language=Spanish |journal=Actas Dermo-Sifiliográficas |volume=104 |issue=9 |pages=815–8 |year=2013 |last1=Jorquera-Barquero |first1=E.|last2=Súarez-Marrero |first2=M.C. |last3=Fernández Girón |first3=F. |last4=Borrero Martín |first4=J.J. |pmid=23103120}}</ref><ref>{{cite journal |title=Primary hyperoxaluria in a 27-year-old woman |pmid=14512927}}</ref><ref>{{cite journal |title=Primary hyperoxaluria: report of a patient with livedo reticularis and digital infarcts |pmid=11807460}}</ref><ref>{{cite journal |title=Livedo reticularis, ulcers, and peripheral gangrene: cutaneous manifestations of primary hyperoxaluria |pmid=11030785}}</ref><ref>{{cite journal |title= Steroid-responsive pleuropericarditis and livedo reticularis in an unusual case of adult-onset primary hyperoxaluria |pmid=10196036}}</ref>
***Cytomegalovirus infection (very rare clinical form, presenting with persistent fever and livedo reticularis on the extremities and cutaneous necrotizing vasculitis of the toes)<ref>{{cite journal |doi=10.1016/j.bjid.2012.08.002 |pmid=22975173 |title=Cytomegalovirus (CMV)-related cutaneous necrotizing vasculitis: Case report and literature review |journal=The Brazilian Journal of Infectious Diseases |volume=16 |issue=5 |pages=482–5 |year=2012 |last1=Arslan |first1=Ferhat |last2=Batirel |first2=Ayse |last3=Mert |first3=Ali |last4=Ozer |first4=Serdar}}</ref>
***Livedo reticularis associated with rasagiline<ref>{{cite journal |first1=Lindsay C. |last1=Strowd |first2=Andrew D. |last2=Lee |first3=Gil |last3=Yosipovitch |date=June 2012 |title=Livedo Reticularis Associated With Rasagiline (Azilect) |journal=Journal of Drugs in Dermatology |volume=11 |issue=6 |pages=764–5 |pmid=22648227 |url=http://jddonline.com/articles/dermatology/S1545961612P0764X}}</ref>
***Generalized livedo reticularis induced by silicone implants for soft tissue augmentation<ref>{{cite journal |doi=10.1097/DAD.0b013e31821cb3c5 |pmid=22441370 |title=Generalized Livedo Reticularis Induced by Silicone Implants for Soft Tissue Augmentation |journal=The American Journal of Dermatopathology |volume=34 |issue=2 |pages=203–7 |year=2012 |last1=Camacho |first1=Diana |last2=Machan |first2=Shalma |last3=Pilesanski |first3=Ursula |last4=Revelles |first4=Juan Maria |last5=Martín |first5=Lucia |last6=Requena |first6=Luis}}</ref>
***As a rare skin finding in children with Down syndrome<ref>{{cite journal |title=Mucocutaneous disorders in children with down syndrome: case-controlled study |pmid=22303799}}</ref><ref>{{cite journal |title=Mucocutaneous findings in 100 children with Down syndrome |pmid=17542890}}</ref>
***Idiopathic livedo reticularis with polyclonal IgM hypergammopathy<ref>{{cite web |url=http://www.jle.com/en/revues/medecine/ejd/e-docs/00/04/66/BD/article.phtml |title=John Libbey Eurotext : Éditions médicales et scientifiques France : revues, médicales, scientifiques, médecine, santé, livres |publisher=Jle.com |date= |accessdate=2014-03-19}}{{dead link|date=March 2014}}</ref>
***CO<sub>2</sub> angiography (rare, reported case)<ref>{{cite journal |doi=10.1016/j.jvir.2010.11.012|pmid=21277800|title=Livedo Reticularis and Bowel Ischemia after Carbon Dioxide Arteriography in a Patient with CREST Syndrome|journal=Journal of Vascular and Interventional Radiology|volume=22|issue=3|pages=395|year=2011|last1=Johnson|first1=Philip L.|last2=Neperud|first2=Julie|last3=Arnold|first3=Jill|last4=Thomas|first4=James}}</ref>
***A less common skin lesion of Churg-Strauss syndrome<ref>{{cite journal |doi=10.1007/s10067-010-1593-1 |pmid=20949297 |title=Cutaneous manifestations of Churg–Strauss syndrome: Report of two cases and review of the literature |journal=Clinical Rheumatology |volume=30 |issue=4 |pages=573–80 |year=2010 |last1=Bosco |first1=Laura |last2=Peroni |first2=Anna |last3=Schena |first3=Donatella |last4=Colato |first4=Chiara |last5=Girolomoni |first5=Giampiero}}</ref>
***Erythema nodosum-like cutaneous lesions of sarcoidosis showing livedoid changes in a patient with sarcoidosis and Sjögren's syndrome<ref>{{cite web |url=http://www.jle.com/en/revues/medecine/ejd/e-docs/00/04/5C/C9/article.phtml |title=John Libbey Eurotext : Éditions médicales et scientifiques France : revues, médicales, scientifiques, médecine, santé, livres |publisher=Jle.com |date= |accessdate=2014-03-19}}{{dead link|date=March 2014}}</ref>
***Livedo vasculopathy associated with IgM antiphosphatidylserine-prothrombin complex antibody<ref name=pmid20526560>{{cite journal |doi=10.2340/00015555-0835 |pmid=20526560 |title=Livedo Vasculopathy Associated with IgM Anti-phosphatidylserine-prothrombin Complex Antibody |journal=Acta Dermato Venereologica |volume=90 |issue=3 |pages=313–4 |year=2010 |last1=Tabata |first1=N |last2=Oonami |first2=K |last3=Ishibashi |first3=M |last4=Yamazaki |first4=M}}</ref>
***Livedo vasculopathy associated with plasminogen activator inhibitor-1 promoter homozygosity and prothrombin G20210A heterozygosity<ref name=pmid20526560/>
***As a first sign of metastatic breast carcinoma (very rare)<ref>{{cite journal |doi=10.1111/j.1365-2230.2008.02801.x|pmid=19120398|title=Generalized livedo reticularis as the first sign of metastatic breast carcinoma|journal=Clinical and Experimental Dermatology|volume=34|issue=2|pages=253|year=2009|last1=Gambichler|first1=T.|last2=Baier|first2=P.|last3=Altmeyer|first3=P.}}</ref>
***Livedo reticularis associated with renal cell carcinoma (rare)<ref>{{cite journal |doi=10.1046/j.1365-4362.2001.00895.x|pmid=11454094|title=Livedo reticularis associated with renal cell carcinoma|journal=International Journal of Dermatology|volume=40|issue=4|pages=299|year=2001|last1=Erel|first1=Arzu|last2=Ozsoy|first2=Esra|last3=University|first3=Gazi}}</ref>
***Methylphenidate and dextroamphetamine-induced peripheral vasculopathy<ref>{{cite journal |doi=10.1097/RHU.0b013e3181639aaa|title=Methylphenidate and Dextroamphetamine-Induced Peripheral Vasculopathy|journal=JCR: Journal of Clinical Rheumatology|volume=14|pages=30|year=2008|last1=Syed|first1=Reema H.|last2=Moore|first2=Terry L.}}</ref>
***Gefitinib<ref>{{cite journal |doi=10.1111/j.1365-4632.2007.03319.x|pmid=18173531|title=Livedo reticularis with retiform purpura associated with gefitinib (Iressa®)|journal=International Journal of Dermatology|volume=46|issue=12|pages=1307|year=2007|last1=Blume|first1=Jonathan E.|last2=Miller|first2=Craig C.}}</ref>
***Buerger's disease (as an initial symptom)<ref>{{cite journal |doi=10.2169/internalmedicine.46.0143 |pmid=17978541|title=Buerger's Disease Manifesting Nodular Erythema with Livedo Reticularis|journal=Internal Medicine|volume=46|issue=21|pages=1815|year=2007|last1=Takanashi|first1=Tetsuo|last2=Horigome|first2=Reiko|last3=Okuda|first3=Yasuaki|last4=Nose|first4=Masato|last5=Matsuda|first5=Masayuki|last6=Ikeda|first6=Shu-Ichi}}</ref>
***As a rare manifestation of Graves hyperthyroidism<ref>{{cite journal |title=Livedo reticularis: a rare manifestation of Graves hyperthyroidism associated with anticardiolipin antibodies |pmid=15255431}}</ref>
***Associated with pernicious anaemia<ref>{{cite journal |doi=10.1046/j.1365-2230.2003.01285_5.x|title=Celecoxib-induced fixed drug eruption|journal=Clinical and Experimental Dermatology|volume=28|issue=4|pages=452|year=2003|last1=Bandyopadhyay|first1=D.}}</ref>
***Moyamoya disease (a rare, chronic cerebrovascular occlusive disease of unknown etiology, characterized by progressive stenosis of the arteries of the circle of Willis leading to an abnormal capillary network and resultant ischemic strokes or cerebral hemorrhages)<ref>{{cite journal |doi=10.1046/j.1525-1470.2003.20205.x|pmid=12657007|title=Livedo Reticularis in a Child with Moyamoya Disease|journal=Pediatric Dermatology|volume=20|issue=2|pages=124|year=2003|last1=Richards|first1=Kristen A.|last2=Paller|first2=Amy S.}}</ref>
***Associated with the use of a midline catheter<ref>{{cite journal |title=Livedo reticularis associated with the use of a midline catheter |pmid=12578157}}</ref>
***Familial primary cryofibrinogenemia.<ref>{{cite journal |title=Familial primary cryofibrinogenemia|pmid=10188150}}</ref>




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*[[Adenine phosphoribosyltransferase deficiency]]
*[[Allopurinol]]
*[[Aniline]]
*[[Behcet's disease]]
*[[Benign prostatic hyperplasia]]
*[[Benzidine]]
*[[Bladder incontinence]]
*[[Bladder stones]]
*[[Bleomycin]]
*[[Candida]]
*[[Carbenicillin]]
*[[Cetirizine]]
*[[Chemical cystitis]]
*[[Chlamydia]]
*[[Chlordimeform]]
*[[Congenital abnormalities of the urinary tract]]
*[[Crohn's disease]]
*[[Cyclophosphamide]]
*[[Cystoscopy]]
*[[Danazol]]
*[[Dehydration]]
*[[Diabetes]]
*[[Diabetic neuropathy]]
*[[Diaphragm]]
*[[Diarrhea]]
*[[Diverticulitis]]
*[[Doxorubicin]]
*[[Drug induced cystitis]]
*[[Endometriosis]]
*[[Enterobacter]]
*[[Episiotomy scar infection]]
*[[Escherichia coli]]
*[[Ether]]
*[[Foreign body cystitis]]
*[[Gonorrhea]]
*[[carcinoma|Gynecological cancers]]
*[[Hemorrhagic cystitis]]
*[[Honeymoon cystitis]]
*[[Hunner's ulcer]]
*[[Ifosfamide]]
*[[Immobility]]
*[[Interstitial cystitis]]
*[[acetic acid|Intravesical acetic acid]]
*[[Kidney stones]]
*[[Klebsiella]]
*[[Lupus]]
*[[Methaqualone]]
*[[Methenamine mandelate]]
*[[Methicillin]]
*[[Methotrexate]]
*[[Mucoepithelial dysplasia, Witkop type]]
*[[nonoxynol-9|Nonoxynol-9 suppositories]]
*[[NSAIDS]]
*[[Penicillin VK]]
*[[Penicillins]]
*[[PID]]
*[[Piperacillin]]
*[[Posterior urethral valves]]
*[[Prostatitis]]
*[[Pseudomonas aeruginosa]]
*[[Radiotherapy]]
*[[Schistosomiasis]]
*[[Serratia]]
*[[Sexually transmitted diseases]]
*[[spermicide|Spermicidal jellies]]
*[[Spinal cord injury]]
*[[Staphylococcus saprophyticus]]
*[[Tampon]]
*[[Temozolomide]]
*[[Tiaprofenic acid]]
*[[Ticarcillin]]
*[[Toluidine]]
*[[Trichomoniasis]]
*[[Tuberculosis]]
*[[Urachal cancer]]
*[[Urachal cyst]]
*[[Urethral syndrome]]
*[[Urethritis]]
*[[Urinary catheter]]
*[[Urinary obstruction]]
*[[Urinary stones]]
*[[Urofacial syndrome]]
*[[Vesicoenteric fistula]]
*[[Xanthinuria]]
==References==
{{Reflist|2}}


==Overview==
==Overview==

Latest revision as of 02:18, 14 September 2017

Diagnosis Incidence Onset Common symptom
Polycystic ovary syndrome

Idiopathic hirsutism

Congenital adrenal hyperplasia

❑ Ovarian and androgen secreting tumors

❑ Drug induced

HAIR-AN Syndrome

❑ 70-85%

❑ 5-15%

❑ 1-8%

❑ 0.3-0.1%


❑ 0.5-1%


❑ 3-4%

❑ PCOS insidious

❑ Idiopathic hirsutism Insidious
❑ CAH rapid

❑ Tumors rapid



❑ HAIRAN syndrome insidious

❑ Irregular menses, hyperandrogenism, polycystic ovary
❑ No other known cause, normal ovaries, normal anbdrogens


❑ Total testosterone > 200ng and does not respond to treatment

❑ Related to medications (steroids, danazol etc)

❑ Subset of PCOS with insulin resistance and acanthosis nigricans










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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Hirsutism (from Latin hirsutus = shaggy, hairy) is defined as excessive and increased hair growth in women in locations where the occurrence of terminal hair normally is minimal or absent. It refers to a male pattern of body hair (androgenic hair) and it is therefore primarily of cosmetic and psychological concern. Hirsutism is a symptom rather than a disease and may be a sign of a more serious medical indication, especially if it develops well after puberty.

Appearance and evaluation

Hirsutism only affects women, since the rising of androgens causes a male pattern of body hair, particularly in locations where women normally do not develop terminal hair within their puberty (chest, abdomen, back and face). The medical term for excessive hair growth that affect both men and women is hypertrichosis.

One method of evaluating hirsutism is the Ferriman-Gallwey score which gives a score based on the amount and location of hair growth on a woman.

Etiology

The cause of hirsutism can be either an increased level of androgens (male hormones) or an oversensitivity of hair follicles to androgens. Male hormones such as testosterone stimulate hair growth, increase size and intensify the pigmentation of hair. Other symptoms associated with a high level of male hormones include acne and deepening of the voice and increased muscle mass.

Growing evidence implicates high circulating levels of insulin in women to the development of hirsutism. This theory is consistent with the observation that obese (and thus presumably insulin resistant hyperinsulinemic) women are at high risk of becoming hirsute. Further, treatments that lower insulin levels will lead to a reduction in hirsutism.

It is speculated that insulin, at high enough concentration, stimulates the ovarian theca cells to produce androgens. There may also be an effect of high levels of insulin to activate the insulin-like growth factor-I (IGF-1) receptor in those same cells. Again, the result is increased androgen production.

The following may be some of the conditions that may increase a woman's normally low level of male hormones:

Physical Examination

Skin

hirsuitism (PCOS, Cushing's Syndrome, Phenytoin, Leydig Cell Tumor) [1]

Differential Diagnosis of Causes of Sandbox Ochuko

  1. Idiopathic:
    • familial,
    • possibly increased sensitivity to androgens.
  2. variant of normal menopause.
  3. Polycystic ovarian syndrome.
  4. obesity
  5. Drugs:
    • androgens,
    • anabolic steroids,
    • methyltestosterone,
    • minoxidil,
    • diazoxide,
    • phenytoin,
    • glucocorticoids,
    • cyclosporine.
    • phenytoin,
  6. Congenital adrenal hyperplasia.
  7. Adrenal virilizing tumor.
  8. Ovarian virilizing tumor:
    • arrhenoblastoma,
    • hilus cell tumor.
  9. Pituitary adenoma.
  10. pregnancy
  11. Insulin resistance
  12. Cushing's syndrome.
  13. Hypothyroidism (congenital and juvenile).
  14. Acromegaly.
  15. Androgen-secreting tumors of the ovaries
    • Sertoli-Leydig cell tumors,
    • granulosa-theca cell tumors,
    • hilus-cell tumors
  16. hyperprolactinemia
  17. Testicular feminization.

Treatment

Many women with unwanted hair seek methods of hair removal to control the appearance of hirsutism. But the actual causes should be evaluated by physicians, who can conduct blood tests, pinpoint the specific origin of the abnormal hair growth, and advise on the best course of treatment.

See also

References

  • Ferriman D, Gallwey JD: Clinical assessment of body hair growth in women. Journal of Clinical Endocrinology 1961; 21:1440-1447.




bg:Хирзутизъм de:Hirsutismus et:Hirsutism id:Hirsutisme nl:Hirsutisme


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Primary treatment option
Atropine
❑ Administer a first dose 0.5 mg IV bolus
❑ Repeat every 3-5 minutes
❑ Administer a maximum dose of 3 mg
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Secondary treatment options
If atropine ineffective:
❑ Administer dopamine infusion (2-10 mcg/kg/min)
OR
❑ Administer epinephrine infusion (2-10 mcg/min)
OR
❑ Proceed with transcutaneous pacing
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Consult a cardiologist
❑ Consider transvenous pacing
 
 
 
 
 
 




Overview

Causes

Life Threatening Causes

Common Causes

Diagnosis

Focused Initial Rapid Evaluation

Complete Evaluation

 
 
 
 
 
 
 
 
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Treatment

Do's

Don'ts

References

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