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Wood’s Light Examination

Wood’s Light Examination

The Wood’s Light Examination is a useful and inexpensive tool in clinical practice. It is powered by alternating or direct current that converts ultraviolet light into visible light, and it usually has an accompanying magnification lens. It provides a simple diagnostic method in the evaluation of
● Many dermatological problems
Fluorescein-staining evaluation of eye injuries



OVERVIEW
● Most common dermatological lesions that fluoresce are listed on the table below.
● Detection of chemicals applied to the skin. Affected areas are a different color from that of the surrounding skin.
● Prior cleansing of the area to be examined causes false-negative result.
● Certain skin lesions do not fluoresce.
● Systemic antibiotic therapy, such as with tetracyclines, can cause fluorescence in some lesions.
● Cosmetics present on the skin interfere with fluorescence.
● Detection of eye injuries with fluorescein. When applied to the eye, fluorescein has a higher concentration of uptake in areas in which there has been disruption of the cornea or sclera. Under a Wood’s light, the injured area fluoresces as a bright yellow-green.
● Detection of porphyrins in the urine. These appear bright red.
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Fluorescence of Lesions and Parasites With the Wood’s Light

LESION FLUORESCENCE
Erythrasma
Corynebacterium minutissimum Varying shades of pink to coral red
Tinea Capitis (Three Varieties)
Microsporum audouinii Brilliant green
M. canis Brilliant green
Trichophyton schoenleinii Pale green
Tinea Versicolor Yellow to deep green
Pseudomonas aeruginosa Blue green to green
Pigmentation Alterations
Albinism Cold bright white
Ash-leaf spot of tuberous sclerosis Blue-white
Depigmentation Cold bright white
Hypopigmentation Blue-white
Hyperpigmentation Purple-brown
Leprosy Blue-white
Vitiligo Blue-white
Squamous cell carcinoma* Bright red
Common Parasitic Infestations
Scabies Magnification of track and/or mite
Pediculosis (capitis, corporis, pubis) Visualization of louse

* The diagnosis of this dermatological disorder should be made by pathological assessment.

RATIONALE
● Skin—To allow the clinician to differentiate dermatological presentation of types of bacterial, fungal, and pigmented lesions found on the skin
● Eye—To allow the visual assessment of injuries to the cornea and conjunctiva with fluorescein staining
● Urine—To screen for porphyria—a rare metabolic disorder
● Clinical evaluation of dermatitis, the eye, or urine by the unaided eye alone may result in an inappropriate assessment and render an unsuccessful treatment regimen.



INDICATIONS
● Skin or hair lesions
● Corneal abrasion
● Suspicion of porphyria

CONTRAINDICATIONS
● None

PROCEDURE
Wood’s Light—Skin
Equipment
● Wood’s light
● Darkened room

Procedure
● Have the client position himself or herself comfortably.
● Explain to the client that the Wood’s light has the same characteristics as a typical black light; the room will be darkened, and the black light will be turned on to examine for fluorescence of the lesion in question.
● Have all lights turned off.
● Hold the Wood’s light approximately 6 to 8 inches from the lesion in question, and observe the characteristics of the fluorescence of the lesion.



BIBLIOGRAPHY
Driscoll C, Bope ET. The Family Practice Desk Reference. 4th ed. St. Louis, MO: Mosby; 2002.
Habif T. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 5th ed. St. Louis, MO: Mosby; 2011.
Murtagh J. Practice Tips. 5th ed. New York, NY: McGraw-Hill; 2008.
Pfenninger JL, Fowler GC. Procedures for Primary Care Physicians. St. Louis, MO: Mosby; 2011.

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Severity of skin psoriasis linked to blood vessel inflammation, cardiovascular risk

Severity of skin psoriasis linked to blood vessel inflammation, cardiovascular risk
By AMERICAN HEART ASSOCIATION NEWS

People with more psoriasis may also have more inflammation in their blood vessels, according to research published in the American Heart Association journal Arteriosclerosis, Thrombosis and Vascular Biology.

Psoriasis is a chronic inflammatory disease affecting about 3 percent of U.S. adults. It occurs when skin cells grow too quickly, resulting in thick white or red patches of skin.

Previous research suggests psoriasis may be linked with a higher risk of cardiac events and cardiovascular-related death. This may be the first study to examine whether psoriasis severity impacts inflammation in the blood vessels.




In the study, researchers analyzed 60 adults (average age 47) with psoriasis and 20 (average age 41) without psoriasis. All study participants were at low risk for cardiovascular disease based on a traditional risk assessment. They underwent a nuclear scan that measured blood vessel inflammation, and a dermatologist assessed the amount of psoriasis.

Researchers found:

  • Patients had psoriasis ranging from mild (only a few patches, less than 3 percent of the skin surface affected) to severe (when patches cover more than 10 percent of the skin surface).
  • Patients had high levels of inflammation in their blood vessels — even though they were at low risk for cardiovascular disease.
  • The most extensive forms of psoriasis were associated with a 51 percent increase in blood vessel inflammation.
  • The relationship between psoriasis and increased blood vessel inflammation didn’t change much after accounting for other heart disease risk factors.

“The most important observation we made was that the more psoriasis was on the skin, the more inflammation there was in the blood vessels,” said senior study author Nehal N. Mehta, M.D., M.S.C.E., a Lasker clinical investigator in the Cardiovascular and Pulmonary Branch of the National Heart, Lung, and Blood Institute in Bethesda, Maryland. “In other words, what we see on the outside is mirrored on the inside.”

The findings support the idea that the skin disease and cardiovascular disease may share an immune-related underlying mechanism, but it doesn’t prove one causes the other.

“People who have psoriasis — particularly if it is severe — should be assessed by their doctor for cardiovascular risk factors, including diabetes, high cholesterol and obesity,” Mehta said. “They should also maintain an active lifestyle, avoid smoking and follow a balanced diet.”

Severity of skin psoriasis linked to blood vessel inflammation, cardiovascular risk

Severity of skin psoriasis linked to blood vessel inflammation, cardiovascular risk
By AMERICAN HEART ASSOCIATION NEWS

People with more psoriasis may also have more inflammation in their blood vessels, according to research published in the American Heart Association journal Arteriosclerosis, Thrombosis and Vascular Biology.

Psoriasis is a chronic inflammatory disease affecting about 3 percent of U.S. adults. It occurs when skin cells grow too quickly, resulting in thick white or red patches of skin.

Previous research suggests psoriasis may be linked with a higher risk of cardiac events and cardiovascular-related death. This may be the first study to examine whether psoriasis severity impacts inflammation in the blood vessels.




In the study, researchers analyzed 60 adults (average age 47) with psoriasis and 20 (average age 41) without psoriasis. All study participants were at low risk for cardiovascular disease based on a traditional risk assessment. They underwent a nuclear scan that measured blood vessel inflammation, and a dermatologist assessed the amount of psoriasis.

Researchers found:

  • Patients had psoriasis ranging from mild (only a few patches, less than 3 percent of the skin surface affected) to severe (when patches cover more than 10 percent of the skin surface).
  • Patients had high levels of inflammation in their blood vessels — even though they were at low risk for cardiovascular disease.
  • The most extensive forms of psoriasis were associated with a 51 percent increase in blood vessel inflammation.
  • The relationship between psoriasis and increased blood vessel inflammation didn’t change much after accounting for other heart disease risk factors.

“The most important observation we made was that the more psoriasis was on the skin, the more inflammation there was in the blood vessels,” said senior study author Nehal N. Mehta, M.D., M.S.C.E., a Lasker clinical investigator in the Cardiovascular and Pulmonary Branch of the National Heart, Lung, and Blood Institute in Bethesda, Maryland. “In other words, what we see on the outside is mirrored on the inside.”

The findings support the idea that the skin disease and cardiovascular disease may share an immune-related underlying mechanism, but it doesn’t prove one causes the other.

“People who have psoriasis — particularly if it is severe — should be assessed by their doctor for cardiovascular risk factors, including diabetes, high cholesterol and obesity,” Mehta said. “They should also maintain an active lifestyle, avoid smoking and follow a balanced diet.”

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