Question
Vitiligo and tinea versicolor are both hypomelanocytic dermatologic afflications. What are some ways to differentiate these two conditions?
Answer
Langer’s Lines
Other known aliases – Langer’s lines of skin tension, cleavage lines
Definition – topographical lines on the human body that correspond to the natural orientation of the collagen fibers of the dermis and are parallel to the orientation of the underlying muscle fibers
Clinical Significance – Incisions made on the skin that run parallel with these lines produce much less tension on the wound, heal better with less scarring, and have a much better cosmetic appearance. This is important in cosmetic surgery applications, as well as elective surgical procedures when you can select where to make your incision.
History – Named after Karl Langer (1819-1887), an Austrian anatomist, who received his medical doctorate from the Universities of Vienna and Prague. He worked under Joseph Hyrtl as a prosector for the University of Vienna and later becoming the director in 1874. In his famous procedure discovering these tension lines, he punctured circular holes on the skin of cadavers and noticed that they would result in ellipisoidal wounds. By following the direction of these ellipses, he was able to topographically map these lines on the entire body. He did give credit to Baron Dupuytren as being the first to observe this phenomenon and published his findings in 1861 entitled “Zur Anatomie und Physiologie der Haut. Über die Spaltbarkeit der Cutis”
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Question
Vitiligo and tinea versicolor are both hypomelanocytic dermatologic afflications. What are some ways to differentiate these two conditions?
Dix-Hallpike Manuever
Other known aliases – Nylen-Barany test
Definition – Starting supine, the patient’s head is rotated to one side and then quickly lowered to supine with the neck extended over the exam table. Patient is observed for nystagmus for 30 seconds and then returned to supine and observed for another 30 seconds. This is then repeated for the other side.
Clinical Significance – The Dix-Hallpike maneuver is the diagnostic maneuver to induce vertigo and nystagmus in patients with benign paroxysmal positional vertigo by relocating canaliths to the posterior semicircular canals.
History – Named after Margaret Ruth Dix (1902-1991), a British neuro-otologist, and Charles Skinner Hallpike (1900-1979), an English otologist. Dr. Dix earned her medical doctorate in 1937 from the Royal Free Hospital School of Medicine and Dr. Hallpike earned his from the University of London in 1926. Dr. Dix was training to become a surgeon when she was injured during the World War II air raids of London and suffered facial and ocular injuries which forced her to change her medical career path. It was during this time she was hired by Dr. Hallpike to pursue the field of neuro-otology. Their work resulted in a landmark series in the Proceedings of the Royal Society of Medicine and Annals of Otology, Rhinology, and Laryngology. It was this series in 1952 where one of the papers describing their eponymous finding entitled “The Pathology, Symptomatology, and Diagnosis of Certain Common Disorders of the Vestibular System” was published.
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Question
Benign paroxysmal positional vertigo (BPPV) can be quite a debilitating condition for patient it effects. What are the two maneuvers that are used at the bedside for this condition and how do they differ?
Answer
The two maneuvers used clinically in the evaluation and treatment of BPPV are:
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Epley Manuever
Other known aliases – canalith repositioning manuever
Definition – series of positions and manual manipulations used to reposition free-floating otoconia in the semicircular canals of the inner ear
Clinical Significance – The Epley maneuver is used to treat benign paroxysmal positional vertigo (BPPV) by relocating the otoconia back to the utricle where they can no longer stimulate the cupula of the semicircular canal and cause vertigo.
History – Named after John Epley, an American otolaryngologist from Portland, OR, who received his medical degree from the Oregon Health Sciences University and fellowship from Stanford Medical Center. He pioneered the “canalith theory” of vestibular disease and published his eponymous maneuver in 1980 in the article entitled “New Dimensions of Benign Paroxysmal Positional Vertigo”. Dr. Epley is still in practice today.
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