tag:blogger.com,1999:blog-9870114.post7145311442451968941..comments2024-03-10T08:41:32.400+00:00Comments on VIRTUAL GRAND ROUNDS IN DERMATOLOGY 2.0: Post-Bypass DermatitisHumane Medicine Huihttp://www.blogger.com/profile/07113291188306363130noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-9870114.post-40685597741097107762009-10-12T19:50:45.056+00:002009-10-12T19:50:45.056+00:00We have a lot of bypass surgery done in our hospit...We have a lot of bypass surgery done in our hospital. Perhaps I have seen this but not noted the fact it does not cross the excision site!Dr Ian McCollhttps://www.blogger.com/profile/01609385802531645972noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-49647428971075099482009-10-12T17:07:53.669+00:002009-10-12T17:07:53.669+00:00Something is very interesting,the rash appear at s...Something is very interesting,the rash appear at side of incision scar where there is neuropathy(sensory loss):while no rash at all at other side of the scar with normal sensations.This explain why there is no itching.So the pathophysiology of the dermatitis could be related to neurological or specifically to autonomic dysfunction.<br />khalifa sharquieAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-9870114.post-39861321860469023172009-10-12T11:18:41.251+00:002009-10-12T11:18:41.251+00:00This is an interesting case that may represents a ...This is an interesting case that may represents a point on a spectrum of "post bypass" dermatitis. The underlying pathophysiology may be disruption of venous return with small foci of "stasis eczema." This can be minor, or, in the presence of more venous or lymphatic disease can progress to the post bypass cellulitis (we had a case on VGRD blog: http://vgrd.blogspot.com/search/label/bypass%20surgery a while back). I suspect that a combination of wet dressings and a potent topical steroid cream will be helpful and either mupirocin or a systemic antibiotic if it is complicated by secondary infection which can complicate matters.Humane Medicine Huihttps://www.blogger.com/profile/07113291188306363130noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-40516455367830232472009-10-11T18:39:49.798+00:002009-10-11T18:39:49.798+00:00Just to add to history,the rash is reccurent from ...Just to add to history,the rash is reccurent from now and then,nonpruritic and does not leave pigmentation or scar after healing.O/E also there is neuropathy along the incision scar.<br />khalifa sharquieAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-9870114.post-62331307757405215492009-10-11T15:37:24.384+00:002009-10-11T15:37:24.384+00:00I have seen at least two similar cases, dermatitis...I have seen at least two similar cases, dermatitis developing on the saphenous vein graft donor site. Very itchy and can be very troubling to the patient. Important to reassure the patient that they will improve and eventually clear with a potent topical steroid. Wet compress with dil. KMNO4 would be useful during the acute stage. Some cases may benefit from patch test if there is a strong suspicion of contact dermatitis.Henry Foonghttps://www.blogger.com/profile/02804592640968503188noreply@blogger.com