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Angioedema is an area of swelling of the lower layer of skin and tissue just under the skin or mucous membranes. [1] [3] The swelling may occur in the face, tongue, larynx, abdomen, or arms and legs. [1] Often it is associated with hives, which are swelling within the upper skin. [1] [3] Onset is typically over minutes to hours. [1]
Typical areas of swelling include the face, arms, and legs, while internally some individuals have swelling of the tongue and upper airways. [3] In contrast to hereditary angioedema, there tend to be fewer symptoms of the abdomen or gastrointestinal tract, but symptoms of nausea, vomiting, and diarrhea have been seen in acquired angioedema. [3]
Normal C1 inhibitor level hereditary angioedema is thought to involve various mutations that increased bradykinin activity and cause a decreased threshold for activation of the plasma contact system thus leading to the symptoms of angioedema. [7] Hereditary angioedema with normal C1-inhibitor is a genetically heterogeneous disorder.
[1] [2] Lower legs and heels may also be involved, however the distal parts of feet and toes are usually spared. Patients may also experience high-graded fever, pitting edema and hypotension. The clinical presentation usually resembles cellulitis, however bilateral involvement is a differentiating feature.
The disease mechanism (pathophysiology) of RS3PE remains unknown. One study suggested a possible role for vascular endothelial growth factor. [13] A study using magnetic resonance imaging found that tenosynovitis of the extensors of the hands and feet is the major contributor to edema. [14]
[19] [20] Clinically, the diagnosis of any particular skin condition is made by gathering pertinent information regarding the presenting skin lesion(s), including the location (such as arms, head, legs), symptoms (pruritus, pain), duration (acute or chronic), arrangement (solitary, generalized, annular, linear), morphology (macules, papules ...
A person with a two hour history of phlegmasia cerulea dolens (left leg, right side of image) Phlegmasia cerulea dolens (PCD) (literally: 'painful blue inflammation'), not to be confused with preceding phlegmasia alba dolens , is an uncommon severe form of lower extremity deep venous thrombosis (DVT) that obstructs blood outflow from a vein.
No treatment is usually needed as they usually go away anywhere from months to years. The lesions may last from anywhere between 4 weeks to 34 years with an average duration of 11 months. If caused by an underlying disease or malignancy, then treating and removing the disease or malignancy will stop the lesions.
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