Chad Hivnor, Author at Clinical Pain Advisor

Chad Hivnor

All articles by Chad Hivnor

Cutis verticis gyrata

Are You Confident of the Diagnosis? What you should be alert for in the history –Recent onset of puberty. –Endocrinologic disorder. –Neurologic, cranial, psychological disorder. –Systemic or inflammatory disease. –Skin folds are typically asymptomatic and not painful but secondary infection may result in symptoms of malodor, tenderness, and wet/sticky skin with discharge. Characteristic findings on…


Are You Confident of the Diagnosis? Pellagra is classically described as the 4 D’s in order of symptoms starting: diarrhea (watery, but may contain pus or blood), dermatitis, dementia, death. Three 3 P’s also apply: photosensitive, painful, pruritic. Pellagra is the clinical manifestation of Vitamin B3 (niacin) deficiency. Early cutaneous findings, like many skin diseases,…

Hypothyroidism (cretinism)

Are You Confident of the Diagnosis? Myxedema is characterized by swollen, dry, pale, and waxy induration of the skin caused from depositions of mucopolysaccharides in the setting of hypothyroidism versus hyperthyroidism, which can manifest with pretibial myxedema. Generalized myxedema is the most characteristic cutaneous finding of hypothyroidism. This deposition is not specific to the dermis…

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