The shin is swollen and aching
Hereditary edema of the lower legs is Milroy's disease. Nodular chronic chondrodermatitis and scabies
Hereditary edema of the lower legs - Milroy's disease characterized by dense white painless and persistent swelling of the lower extremities. Usually several family members are ill.
Histopathology of hereditary edema of the lower legs. In the dermis and especially in the subcutaneous fat layerpronounced interstitial edema. In the spaces lined with the endothelium, significant amounts of fluid accumulate. There is an increase in the amount of collagen in the dermis, as well as the segmentation of subcutaneous fat with thick interlayers of collagen.
Bloody capillaries and lymphatic blood vessels dilated, sometimes noticeable small perivascular lymphocytic infiltration. The walls of large blood vessels can be thickened due to fibrosis.
With nodular chronic chondrodermatitis In the region of the upper corner of the auricle, there isone or several small, sharply outlined, dense, painful nodules. The surface of the nodules is often hyperkeratotic. After removal of the hyperkeratotic layer, a small ulcer can be exposed.
Histopathology of nodular chondrodermatitis. In the epidermis there is hyperkeratosis,uneven acanthosis and usually also central ulceration. Dermis, and often also perichondria, are permeated with a chronic inflammatory, granulomatous infiltrate consisting of lymphocytes, plasma cells, histiocytes and fibroblasts. Infiltrate can contain areas of necrosis, permeated with neutrophils. They can also cause superficial erosion of the cartilage.
The latter is characterized degenerative changes of varying severity and extent. Focal disappearance of cartilaginous cells may be noted; sometimes there is focal degeneration of the cartilage, as a result of which the affected areas are stained with hematoxylin-eosin not in a blue, but in a homogeneous pink color.
Pathogenesis is not clear. Many authors believe that the primarydegenerative changes in cartilage [Forster and Ebenius (Foerster, Ebenius)]. Newcomer recently noted that similar degenerative lesions develop in the cartilage of the auricle with age-related changes. It is possible that trauma, burns, and pressure cause focal degeneration of the dermis of the auricle. Due to poor vascularization of affected areas, healing does not occur and a focus of chronic inflammation develops.
Scabies causes a bite of Acarus scabiei; characteristicis itch. The course of the tick is formed by the female tick, mainly on the palms and fingers of the hands, between the fingers, on the flex surfaces of the forearms, in the nipples in women and on the genitals in men. The moves look like gentle, twisted lines of black color, several millimeters long. Near the blind end of the stroke is often seen a vial. In addition to strokes, with scabies there are nodular eruptions, usually the most pronounced on the skin of the abdomen, the lower parts of the buttocks and the front portions of the axillary depressions.
In particularly sensitive individuals can develop a picture of the so-called Norwegianscabies, characterized by diffuse hyperkeratosis, peeling and crusts on the skin, as well as scabies in different parts of the skin, even on the face and scalp.
Histopathology of scabies. The scabies are almost entirely instratum corneum. Only the blind end of the course reaches the level of the Malpighian layer or penetrates into it. In this blind end, the female mite is located. The mite head more or less deeply digs the Malpighian layer, in which intracellular and intercellular edema develops, reaching the degree of formation of the bladder. In the dermis under the move is a chronic inflammatory infiltrate, consisting mainly of lymphocytes.
With Norwegian scabies there is a much larger number of itching strokes than with conventional scabies; In almost every preparation, several moves are seen [Ingram].