Classification Of Skin Alterations Of The Outer

Table 4.2 Classification of skin

alterations (SAs) of the outer ear according to Pata and Romoli

Category

Type of SA

Pattern

SA related to vascularization

Paleness

Hyperemia

Telangiectasia

Angioma

- reticular telangiectasia

- punctiform telangiectasia

- linear telangiectasia

- spider angioma

- punctiform angioma

SA related to pigmentation

Dyschromia Macula

- pigmented area

- mixed melanin-hemosiderin area (grey, yellow, orange)

- melanocytic

SA related to keratinization

Dyskeratosis

Dystrophy (skin is thin, lucent and fragile)

- furfuraceous scales

- psoriasiform scales

SA related to cartilaginous structure

Hypertrophy (thickening) Hypotrophy (depression)

SA related to cutaneous structure

Depressed area

Crease

Incisure

SA related to sebaceous gland structure

Milium

Sebaceous cyst Comedone

correspond to 42.6% of the total followed by pigmented skin alterations (mainly nevi and maculae) corresponding to 26.2%; skin alterations of skin structure (creases and incisures) correspond to 15%. The remaining three groups follow with percentages below 5-10% (Fig. 4.4). The six categories of skin alteration have a different distribution on the 11 areas of the auricle. Telangiectasia are mostly seen on the anthelix, nevi prevalently on the helix followed by the ear lobe. Maculae have a uniform distribution on the anthelix, helix and lobe. The skin alterations of sebaceous gland structure (particularly comedones) were found mainly on the cymba conchae followed by the cavum conchae. Also depressions and dyskeratosis were found mostly on the cavum conchae. Also interesting is the comparison between the different percentage distribution throughout the six categories in the extremes of the age groups: younger people tended to have pigmented skin alterations (especially nevi) followed by vascular and sebaceous gland skin alterations (comedones), whereas in the oldest group of patients vascular skin alterations ranked first, followed by creases, incisures and pigmented skin alterations (especially maculae) (Fig. 4.5). The scantiness of skin alterations on the medial surface compared to those on the lateral surface is remarkable and only 902 (10.2% of the total) were found there. It is possible that this percentage could be higher if inspection of the medial surface were easier, if we consider that pain pressure test (PPT) tender points of this area in 325 patients were 14.4% and those with lower electrical resistance 19% of the total.

Table 4.3 Distribution of skin alterations (SAs) (summing those of the right and left ear) on the different parts of the auricle in 711 patients

Part of the auricle

Table 4.3 Distribution of skin alterations (SAs) (summing those of the right and left ear) on the different parts of the auricle in 711 patients

Part of the auricle

Anthelix

Antitragus

Lower

Upper

Helix

Triangular

Intertragic

Ear

Scaphoid

Medial

Category of SA

Type of SA

concha

concha

fossa

notch

lobe

groove

surface

Tragus

Total

Related to

Telangiectasia

964

142

300

288

294

41

4

130

154

253

3

2573

vascularization

Hyperemia

309

81

154

62

144

28

6

72

38

27

6

927

Angioma

55

17

7

1

77

1

0

32

13

11

0

214

Paleness

38

3

3

3

1

0

1

1

1

0

0

51

Related to

Nevus

144

79

13

5

522

9

9

281

75

172

47

1356

pigmentation

Macula

227

132

29

9

223

7

3

218

35

38

20

941

Dyschromia

6

1

1

1

4

0

0

3

3

0

0

19

Related to

Dyskeratosis

6

4

82

35

11

24

10

13

13

11

8

217

keratinization

Dystrophy

6

2

3

3

8

0

0

2

0

2

0

26

Related to

Hypotrophy

6

2

17

18

4

2

1

7

2

302

0

361

cartilaginous structure

Hypertrophy

102

2

65

65

54

0

0

4

9

14

1

316

Related to

Incisure

112

129

17

15

146

1

34

205

16

12

54

741

cutaneous structure

Crease

2

1

1

2

9

0

0

261

0

1

18

295

Depressed

17

40

73

49

12

4

1

26

5

56

1

284

area

Related to

Comedone

0

1

338

68

1

16

6

6

1

3

0

440

sebaceous gland structure

Sebaceous cyst

3

0

40

19

2

0

1

1

0

0

1

67

Milium

0

0

0

0

0

0

0

0

0

0

0

0

Total

1997

636

1143

643

1512

133

76

1262

365

902

159

8828

Table 4.4

whole and

Correlation in 711 patients between age and the number of skin alterations on the auricle on its different parts

as a

The auricle

as a whole

R2

Coefficient

IC 95% for coefficient

P

0.329

0.152

(0.136; 0.168)

<0.001

Ear lobe

0.251

0.050

(0.044; 0.057)

<0.001

>■

Anthelix

0.199

0.048

(0.041; 0.055)

<0.001

n: =3

Helix

0.088

0.026

(0.020; 0.033)

<0.001

'un

Tragus

0.051

0.007

(0.005; 0.009)

<0.001

(U a:

Antitragus

0.047

0.014

(0.010; 0.019)

<0.001

CJ

Intertragic notch

0.007

0.002

(0.000; 0.003)

<0.050

=3 a:

Medial surface

0.003

0.004

(-0.002; 0.011)

NS

4—

Lower concha

0.002

-0.003

(-0.008; 0.002)

NS

LO t

Upper concha

0.001

0.002

(-0.002; 0.006)

NS

Q_

Scaphoid groove

0.001

0.001

(-0,002; 0.005)

NS

Triangular fossa

0.000

0.000

(-0,002; 0.002)

■ Surgical Interventions

Traumas □ Hospitalizations

1.5H

1.GH

■ Surgical Interventions

Traumas □ Hospitalizations

30-49

50-69

30-49

50-69

Age groups

Fig. 4.3 Average number of surgical operations, traumas and hospitalizations in 711 patients according to four age groups (<30, 30-49, 50-69, >70 years).

45 4G 35 3G

e to 25

Categories of SA

Fig. 4.4 Percentage distribution of skin alterations (SAs) in each of the six categories in 711 patients.

Categories of SA

Fig. 4.5 Percentage distribution of skin alterations (SAs) related to vascularization, pigmentation, cutaneous and sebaceous gland structure in the youngest age group (<19) and in the oldest (>70 years).

CASE STUDY

As an example of auricular inspection and correct methodology in recording skin alterations, I here report the case of an elderly woman. Considering type of skin alterations and above all their location, I could confirm the presence of some past and current health problems. In this case the difference between the richness of skin alterations on the lateral surface and their scantiness on the medial surface is clearly outlined.

The patient was a 77-year-old woman, 162 cm tall and weighing 65 kg (who in the past had weighed up to 83 kg). She had undergone the following surgical operations: appendectomy at the age of 19, uterine retroversion at age 27, crural hernia at 45, uterine-bladder prolapse at 60. She had suffered from depression when she was young and after menopause. She reported having suffered from chronic migraine for at least

50 years and even after menopause. She still suffered occasionally from attacks, mainly on the right side. She had had hypertension for at least 30 years, controlled by drugs. Some members of her family (brother, sister and nephew) had hypertriglyceridemia. Her levels of triglycerides had often been above average, reaching a maximum of 600 mg.

Her cholesterol levels had always been normal and there was no evidence of diabetes. She had had chronic lumbago in the L4-L5 herniated disk for over 20 years with recurrent sciatic and knee pain on the right side. She had also been suffering with bilateral neck pain for several years. Moreover, she suffered from gastritis and chronic dyspepsia, due also to her prolonged intake of NSAIDs. She had become increasingly deaf in recent years.

Inspection of the lateral surface of the right ear showed a series of skin alterations which can be described as follows (Fig. 4.6):

• The upper part of the ear shows a hyperemic area of the helix (sector 21 of the Sectogram); one telangiectasia and one hyperemia on the scapha and two neighboring hyperemic areas at the bifurcation of the superior and inferior crura of the anthelix. A small incisure and a few small furrows are visible respectively on the edge of the inferior crus of the anthelix and on the upper portion of the helix. The location of these skin alterations is consistent with the patient's chronic back pain and recurrent sciatic pain.

• In the central part of the ear an oval area of cartilaginous hypertrophy is visible adjoining the root of the helix and surrounded on the upper border by a linear telangiectasia. These skin alterations are consistent with the patient's gastritis and chronic dyspepsia. Below the root of the helix two sebaceous cysts are visible, one of them approaching the lung area. The sebaceous gland skin alterations of the upper and lower concha may orient the acupuncturist to suspect a hyperlipidemia (see Plate XVD) which in this case is confirmed by the increased levels of triglycerides.

• In the lower part of the ear two pigmented spots on the antitragus are visible. These can be

Incisura Heart
Fig. 4.6 Type and location of skin alterations in a 77-year-old female patient.

considered indicative of the patient's long history of migraine. Several creases and incisures are visible on the ear lobe: the creases are more evident on the anterior part and are consistent with the patient's hypertension, and generally speaking with her cardiovascular risk. The small crease and the furrows on the posterior part of the lobe are consistent with the patient's chronic depression and perhaps with her loss of hearing which has worsened in recent years. In spite of profuse skin alterations of the lateral surface, the medial surface shows only a few incisures on the lobe border and a deepening of the anthelix groove, relative to the patient's chronic neck and back pain.

The Prevention and Treatment of Headaches

The Prevention and Treatment of Headaches

Are Constant Headaches Making Your Life Stressful? Discover Proven Methods For Eliminating Even The Most Powerful Of Headaches, It’s Easier Than You Think… Stop Chronic Migraine Pain and Tension Headaches From Destroying Your Life… Proven steps anyone can take to overcome even the worst chronic head pain…

Get My Free Audio Book


Post a comment