Folded pachydermia of the scalp and vocal cords

Such a diagnosis, like pachydermia, doctors do not often establish - it is a relatively small disease, which is the appearance of epidermal layers on the skin and mucous tissues. The disease is characterized by uncontrolled growth and division of pathologically altered cellular structures.

[1], [2], [3], [4]

Epidemiology

According to statistics, pachydermia is more common in men, approximately in the ratio of 8: 1. The disease is relatively rare. The incidence rate increases after 50 years.

[5], [6], [7]

Causes of the pachydermia

Pahidermy can be classified into congenital and acquired, which depends on the underlying cause of the disease.

Congenital pachydermia can be a consequence of:

• various intrauterine anomalies of the vascular system;
• damage to the central nervous system;
• endocrine disorders.

In many cases, the cause of congenital pachydermia can not be established - in such cases they speak of an idiopathic form of the disease.

Acquired pachydermia is more common and can be caused by a number of reasons:

• diseases of skin and mucous membranes;
• systemic lupus erythematosus;
• tuberculous changes;
• thrombophlebitis and other vascular diseases.

Also, a significant role is played by certain risk factors for the development of pachydermia:

• smoking, especially regular and frequent;
• alcohol abuse;
• chronic intoxications, work in harmful industries, in dusty or contaminated rooms;
• ignoring the rules of hygiene;
• genetic predisposition;
• elderly age;
• eczema, psoriasis.

[8], [9], [10], [11]

Pathogenesis

The circulatory and lymphatic circulation systems play a primary role in the processes of metabolism and trophism in tissues. However, the normal supply of tissues and the purification of cells from the products of vital activity can be carried out qualitatively only if the flow of blood or lymph flow is free. Otherwise, there may be problems with metabolism and tissue nutrition, which can lead to the development of pachydermia.

In general, the pathogenesis of the appearance of a disease such as pachydermia has not been studied enough. However, it is suggested that the pathogenetic chain is based on imbalance and insufficiency of blood flow and lymph circulation. As a consequence, stagnation or edema can occur, followed by fibrosis of the dermis, subcutaneous fat, fascia, etc.

These processes lead to a diffuse proliferation of cutaneous or mucous membranes, depending on the localization of the disease.

[12], [13], [14], [15]

Symptoms of the pachydermia

Symptoms of pachydermia appear gradually. It may take several years before the defeat becomes noticeable.

The first signs can be expressed in the defeat of limbs or separate organs. In the beginning, there is swelling of the skin, which can periodically disappear. However, this edema differs from the heart or kidney - first of all, because it is more dense, and after pressing the finger pad on it there is no trace left.

Over time, the swelling grows and becomes permanent. Soft tissues become more dense and even firm.

Often on the skin appear outgrowths by the type of warts or papillomas. Between the growths, distinct folds are formed. The skin thickens and contracts, the opportunity to fold the skin into the fold is lost. Occasionally, hyperpigmentation occurs, and erysipelas are periodically resumed.

In advanced stages of development of pachydermia, eczematous and ulcerative foci may appear. At the same time, motor activity does not suffer, there is no change in the musculoskeletal system with pachydermia.

Typical clinical picture may also depend on the localization of the pathological process of pachydermia.

• Folded head pahidermy is characterized by hypertrophy of the dermis and epidermis on the scalp, in the nape of the neck and the crown, simultaneously with the stable expansion of lymphatic vessels and with lymphostasis. Externally, one can observe the appearance of prominent tubercles, folds: the overall picture visually resembles the brain convolutions. Hair in the area of the folds thickened, thick.

• Pachydermia of the larynx can proceed as an independent disease, or in combination with the defeat of other organs. The first signs of pachydermia are expressed in the appearance in the larynx of tubercles of different sizes, the color of which varies from yellowish to pink or gray. The mucous larynx becomes friable and bluish in appearance. The following additional symptoms may occur:
  • difficulty swallowing;
  • fits of dry cough;
  • hoarseness of voice, until its complete loss;
  • itching and swallowing in the throat;
  • signs of general intoxication (loss of appetite, fatigue, drowsiness).

• Pachydermia of the intercapital area of the larynx is accompanied by a thickening of the mucous membrane, the appearance of epidermal limited growths (tubercles) and granulation in the region of vocal folds and inter-head space. In the laryngeal cavity, a small amount of viscous mass (excretions) and crusts can be detected.

Stages

Given the clinical picture of pachydermia, it is common to distinguish several stages of the development of the disease:

• a soft stage, which is accompanied by periodic swelling, a dough-like consistency of tissues;
• The mixed (intermediate) stage is characterized by the spread of edema, which becomes permanent; the skin becomes thick and pale, with no pain;
• the stage of compaction with pachydermia proceeds with a thickening of the skin in the form of foci or cushions, the appearance of ulcers, warts, hyperkeratosis, hyperpigmented areas, cracks.

[16], [17], [18]

Complications and consequences

Possible complications of pachydermia may include:

• development of thrombophlebitis;
• common dermatitis;
• joining purulent infection, sepsis;
• malignancy of areas with pachidermy;
• violations of the heart and blood vessels, kidneys, a change in the picture of blood (due to a permanent deficit of protein);
• psychoneurological disorders.

[19], [20]

For what time does pachydermia grow into cancer?

Pachydermia refers to an optional precancerous condition. This means that a patient with pachidermia has a high risk of developing a malignant tumor. However, one should not think that every case of pahidermy must necessarily be regenerated into a cancerous process. Moreover, one can not predict when exactly this can happen.

Given that the disease is prone to malignancy, patients need to be cautious, seek medical help on time and regularly undergo treatment for pachydermia.

[21], [22], [23]

Diagnostics of the pachydermia

Diagnosis, in the first place, is based on a survey and examination of the patient. In order to establish an accurate diagnosis of pachydermia, additional studies may also be necessary.

• Blood tests for pachydermia:
  • serological examination of blood serum, indicating the presence of antibodies to the products of vital activity of parasites;
  • a general blood test may indicate an increase in the level of eosinophils, a decrease in the number of albumins, an increase in blood coagulability.
• Instrumental diagnostics:
  • magnetic resonance angiography demonstrates the state of the vessels;
  • Doppler study of blood vessels can detect blockage of vessels, the presence of enlarged and narrowed sections, damage to the valve system;
  • Radiography helps to track changes in the bone system (thickening, osteoporosis, calcification);
  • thermography indicates a decrease in temperature on the affected parts of the body, or a rise in temperature in the areas of inflammation;
  • magnetic resonance imaging allows us to consider layer by layer the structure of the organs and parts of the body affected by the pachydermia.

Differential diagnosis

Differential diagnosis is carried out with such diseases:

• Lymphangioma - benign growth of lymphatic vessels (often - since birth);
• limited scleroderma - tissue tightening and epidermal layer atrophy;
• Congenital form of elephantiasis is a variant of hypertrophy of the lower extremities.

Also sometimes there is a need to differentiate pachidermy from vascular insufficiency, malignant tumors, diseases of the endocrine system.

[24], [25], [26], [27], [28], [29]

Treatment of the pachydermia

Treatment of pachydermia is prescribed only after the malignant origin of the disease has been completely rejected. Any physical procedures and even some medicines can accelerate the development of the process of pachydermia, if it is of an oncological nature.

When the pachydermia of the larynx is recommended to observe the so-called "voice rest" and you can not say anything aloud or whisper. Rinses with such a disease do not bring any tangible effect. Instead, they successfully use inhalation:

• vegetable inhalation with chamomile infusions, sage;
• inhalation with alkaline waters;
• dioxin, miramistin;
• sofradex.

Steam inhalation is completely excluded in case of pachydermia.

In stationary conditions, it is possible to use intra-oral lavages with collargol, 1% dioxidine, sophhedex (except for children under 18 and pregnant women).

Medications for external involvement of extremities and trunk areas are prescribed taking into account the initial cause of pachydermia.

	Dosing and Administration	Side effects	Special instructions
Troxerutin	1 capsule up to 3 times a day, for several weeks.	Stool disorder, headache, allergies.	Angioprotector, strengthening vessels and reducing edema.
Detralex	1 tablet twice a day with food, for a month.	Nausea, diarrhea, dizziness, rash.	Angioprotector, which improves blood microcirculation.
Aloe extract	Subcutaneously, one ampoule daily.	Rarely: pain at the injection site.	Biological stimulant, softening the dense connective tissue and promoting its resorption.
Lidase	Subcutaneously or in / m in the amount of 64 E in novocaine, daily or every other day, with a course of 20 injections.	Rarely: allergic rashes.	Enzyme active drug, which dissolves connective tissue fibers, causing thickening of the subcutaneous tissue.
Ketotifen	1 tablet twice a day.	Pain and dry eyes, thirst, dizziness.	Antihistamine, which reduces the manifestations of allergies and tissue proliferation.

It is very important to take vitamins: retinol acetate, tocopherol, vitamins B, and also fish oil. Such drugs contribute to improving the nutrition of tissues and prevent the proliferation of connective tissue fibers.

Vitamins B Neurovitan	Take 1 to 4 tablets daily, immediately after eating.
Vitamin C	Take from 0.05 to 0.1 g three times a day.

Physiotherapeutic treatment

Physis procedures for pahidermy can be prescribed only when the benign nature of the disease is established. With pachydermia, it is usually prescribed:

• Electrophoresis with enzyme preparations (eg, lidaz) - eliminates stagnation and improves blood and lymph circulation.
• Magnetotherapy (Cascade apparatus) - helps to cope with edema and inflammation.
• Phonophoresis with caripain, lengidase, streptokinase - promotes dissolution of fibrin fibers and inhibits the processes of tissue tightening.
• Laser therapy - accelerates intravascular circulation, eliminates swelling.
• Amplipulse therapy - improves trophism in tissues.

Additionally shown are balneotherapy (sulfide and carbon dioxide baths) and hydrotherapy.

Alternative treatment

With the diagnosis of "pachydermia", the patient is prescribed medication. To accelerate the recovery of tissues and general maintenance of the body, you can also use alternative means.

• The affected skin from morning and night is treated with thistle oil, which successfully eliminates inflammation and disinfects.
• Instead of regular tea during the day, it is recommended to drink infusion of rose hips or compote of cranberries.
• Raw clay is mixed with water until a doughy condition, form a cake that is applied to the affected skin, fixed and held on the body overnight. A similar procedure is repeated daily, until a persistent effect is obtained.
• For the night make compresses of fresh leaves of birch, mint or lilac.
• Instead of coffee in the morning, it is recommended to drink a drink from chicory with the addition of a dry or fresh ginger root.

Herbal Treatment

• Brewed 30 grams of dried hazelnut leaves in 500 ml of boiling water, insist up to 2 hours. Take 100 ml 4 times a day, daily.
• Cowberry tea is prepared: brew 1 tbsp. L. Leaves in 250 ml of boiling water, stand for 1 hour and drink. You can add a little honey to the drink.
• Prepare a mixture of 20 g of dried chestnuts, the same number of birch and oak bark, 30 g of astragalus and immortelle. Two spoons of the mixture are poured into 500 ml of boiling water, insist in a thermos for at least 2 hours. Filter and take 100 ml 4 times a day.
• The ground garlic is mixed with honey in equal proportions, placed in a glass container and kept in a cool place for one week. After this, the medicine can be taken at 1 tbsp. L. An hour before the main meals. The course of treatment - at least 2 months.

Homeopathy

• Acidum nitrikum in the dilution of 12C to 3 granules before bedtime.
• Petroleum 6C 3 granules sublingually every morning for half an hour before meals.
• Sulfur 6C for 5 pellets at night, for a long time.
• Teukrium marum 6C for 5 granules sublingually from morning to meal and at night.
• Apis 6C for 7 granules in the morning and 3 granules per night.
• Medusa 6C for 5 pellets in the morning and at night.

Homeopathic preparations are taken for a long period - for several months until stable positive results are achieved. If there are undesirable signs in the form of deterioration, then you should discuss with a doctor-homeopathic the possibility of replacing the medication.

Surgery

Surgery can significantly improve the patient's condition with pachidermy, and also stop the course of the pathological process. Indications for the operation are:

• increasing stagnation of fluid in tissues;
• rapid proliferation of tissues;
• formation of pockets and hillocks;
• unbearable pain.

Contraindications to surgical treatment can be:

• decompensated states;
• old age;
• diseases of the hematopoietic system, cardinal changes in the pattern of blood.

The operation is performed using different methods, depending on the nature of the lesion and its localization. So, the main methods of surgical intervention for pahidermy are:

• operative recovery of normal blood and lymph flow;
• paving vascular anastomoses, to ensure normal nutrition of tissues;
• excision of overgrown tissues, subcutaneous fat and fascia.

Stop the development of pachydermia can be if you hold all possible procedures as early as possible, when the disease finds itself the first stage.

Prevention

The main measure for the prevention of pachydermia is the timely and proper treatment of any disease and condition that may cause the disease.

It is recommended that you follow certain rules:

• drink adequate daily amount of fluid;
• avoid overloading;
• if necessary, take medications that improve blood circulation;
• to refrain from drinking alcohol;
• qualitatively and diversely eat;
• regularly visit doctors for preventive examination.

[30], [31], [32], [33], [34], [35], [36], [37], [38]

Forecast

Pachydermia is characterized by a relatively favorable life forecast. If drug therapy was carried out at the initial stage of the development of the pathological process, it is often possible to stop the progression of the disease. Surgical treatment gives a positive result in 80-90% of cases.

Nevertheless, it is impossible to completely eliminate the pachydermia.

[39]