Tang Hsi Ryu syndrome
Overview
A rare syndrome characterized by enlarged liver and spleen, increased pigmentation and abnormal peripheral nerve functioning
Symptoms
The list of signs and symptoms mentioned in various sources for Tang Hsi Ryu syndrome includes the 16 symptoms listed below: * Enlarged liver * Enlarged spleen * Increased skin pigmentation * Ascites * Amyotrophy * Increased body hair * Enlarged male breasts * Lymphadenopathy * Weak arm muscles * Weak leg muscles * Enlarged skin blood vessels * Lymphoedema * Increased sweating * Reduced reflexes * Deafness * Visceral angiomatosis
Causes
* Acanthosis nigricans –Velvety, hyperpigmented thickening of skin folds (e.g., axillae, groin, neck, and inframammary regions) –Associated with insulin resistance (e.g., DM, Cushing's diseases, hypothyroidism, obesity, polycystic ovarian syndrome, and exogenous corticosteroids) * Tinea versicolor –Mottled macular hyperpigmentation (and/or hypopigmentation) in rings and circles with little or no scale –Often on the upper trunk and shoulders –Caused by Pityrosporum orbiculare and P. ovale, which look like “spaghetti and meatballs” on KOH preparation –May be pruritic during acute phase, particularly in warm environments that encourage growth of the fungus * Postinflammatory hyperpigmentation –Patchy, transient hyperpigmentation after resolution of inflammatory rashes * Melasma (chloasma, “mask of pregnancy”) –Gradual blotchy macular hyperpigmentation, especially of the malar surfaces, chin, and forehead –Occurs with oral contraceptives, pregnancy, or idiopathic –May fade postpartum or after discontinuing oral contraceptives, and recur if either occurs again * Grey or blue hyperpigmentation –Medications: Amiodarone, minocycline, imipramine, chemotherapeutic drugs (e.g., bleomycin, doxorubicin), antimalarials, AZT –Heavy metal poisoning * Incontinentia pigmenti –Genetic disorder with associated systemic abnormalities; the final stage of skin disease can present as linear and whorled streaks or hyperpigmentation Hemochromatosis –Diffuse hyperpigmentation * Diabetic dermopathy –Hyperpigmented, round, atrophic lesions on shins of diabetics
Treatment
* Acanthosis nigricans improves with adequate treatment of the underlying endocrine disorder; treatments may include weight loss, dietary/medication control of insulin resistance, and topical exfoliants (e.g., lactic acid, tretinoin, urea-based medications) * Tinea versicolor: Treatment includes topical (e.g., ketoconazole) or oral antifungals (e.g., fluconazole); normalization of pigmentation may take many months; long-term maintenance therapy is necessary to prevent recurrence * Melasma often improves spontaneously after pregnancy or discontinuation of oral contraceptives; sun avoidance and topical retinoids and hydroquinones facilitate normalization of pigment; chemical peels or laser procedures restore normal pigmentation * Avoid offending medications; adjuvant laser therapy may be necessary to remove or destroy residual drug particles, hemosiderin, or excess melanin in skin