Switch to Dark theme

Physical signs for the general dental practitioner

From Volume 39, Issue 9, November 2012 | Page 673

Authors

Steve Bain

Professor of Medicine (Diabetes), University of Wales, Swansea

Articles by Steve Bain

Ritu Nirula

F1, ABMU Health Board, Wales Singleton Hospital, Swansea

Articles by Ritu Nirula

Article

Steve Bain
Dr Ritu Nirula

‘Physical Signs for the General Dental Practitioner’ aims:

  • To increase awareness of the value of identifying general clinical signs.
  • To enable the interpretation of selected clinical signs that are visible in the clothed patient.
  • To indicate the potential relevance of these clinical signs to the dental management of the patient.

    • The series will contribute to non-verifiable CPD requirements.

    A patient with known rheumatoid arthritis has developed a painful rash.

  • What does this photo show?
  • What is the underlying pathology?
  • What are the associated conditions?
  • What are the management options for this condition?

    • Answers: Case 99

  • This is a vasculitic rash.
  • Vasculitis is seen in a varied group of disorders that damage blood vessels by an inflammatory process.
  • There are many syndromes which affect different parts of the body, such as: cutaneous small-vessel vasculitides (affecting the skin and kidneys); Wegener's granulomatosis (nose, lungs and kidneys); Churg–Strauss syndrome (lungs, kidneys, heart, skin); Kawasaki disease (skin, heart, mouth, eyes); Buerger's disease (leg arteries, veins). In addition, many conditions have an associated vasculitis, eg rheumatoid arthritis (as in this case), systemic lupus erythematosus, and dermatomyositis. Drugs and infection may also be the underlying causation.
  • Typically, steroids, such as prednisolone are used along with other immunosuppressants, such as cyclophosphamide. Other agents specific to the underlying condition may also be appropriate, eg antibiotics for infection.