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Artykuły w czasopismach na temat „Lupus erythematous disseminated”

Autor: Grafiati

Data publikacji: 31 sierpnia 2024

Data aktualizacji: 31 lipca 2025

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1

Rojas-Rojas, Eva, Wendy Rosario Cinencio-Chávez, Julia Dolores Estrada-Guzmán, and Rafael Laniado-Laborín. "A systemic lupus erythematosus patient with Mycobacterium haemophilum infection under treatment: a case report." ARP Rheumatology 4, no. 1 (2025): 54–56. https://doi.org/10.63032/ztja1939.

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Environmental mycobacteria, or nontuberculous mycobacteria (NTM), include over 170 species, with few frequently affecting humans. M. haemophilum, a slowly growing acid-fast bacillus, is known to cause various infections in immunocompromised patients. We present a case of a 29-year-old female with systemic lupus erythematosus, under immunosuppressive treatment, who developed disseminated skin lesions. Initially presenting with painful erythematous nodules that ulcerated, her condition was initially attributed to lupus. A skin biopsy revealed chronic granulomatous inflammation positive for acid-

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2

Moreno-Suarez, Fatima G., Angela Ayén-Rodriguez, and Ricardo Ruiz-Villaverde. "sQUIZ your knowledge! Disseminated erythematous annular macules and erosive crusted lesions in a patient with systemic lupus erythematosus." European Journal of Dermatology 31, no. 5 (2021): 677–79. http://dx.doi.org/10.1684/ejd.2021.4156.

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Rasool, Sheraz, Amr Afifi, and Denise De Lord. "Case of atypical cutaneous Mycobacteriumchelonae infection in patient of systemic lupus erythematosus after cyclophosphamide therapy." BMJ Case Reports 12, no. 12 (2019): e231930. http://dx.doi.org/10.1136/bcr-2019-231930.

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Mycobacteriumchelonae is one of the rapidly growing non-tuberculous mycobacteria that can be isolated from water, soils and aerosols. Localised infections have been reported associated with tattoo parlours, pedicures and cosmetic procedures. But disseminated infection is usually associated with individuals who are immunocompromised, predominantly affecting limbs but sparing abdomen and back. We herein present a case where patient was on immunosuppressive therapy and developed locally severe infection around right ankle. A 69-year-old woman known to rheumatology presents in outpatients with sev

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4

Naga Subrahmanyam, S., D. Tagoore Vijaya Lakshmi, G. V. Naga Raju, and G. V. Pavan Kumar. "Carbamazepine Induced Drug Rash with Eosinophilia and Systemic Symptoms." Journal of Drug Delivery and Therapeutics 9, no. 1-s (2019): 367–68. http://dx.doi.org/10.22270/jddt.v9i1-s.2330.

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Stabilizes inactivated state of sodium channels, thereby making neurons less excitable may reduce activity of nucleus ventralis of the thalamus or decrease synaptic transmission or summation of temporal stimulation leading to neuronal discharge.A adult of 68 years old patient came to dermatology department with chief complaints of neuralgia over scalp to relieve the symptoms physician prescribed carbamazepine 200mg Po OD. During his 2ndweek of treatment patient developed pain,fever,sore throat followed by skin rash.Better vigilance is necessary for implementation of safe and effective treatmen

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5

Rangwala, Shivani D., Ben A. Strickland, Robert C. Rennert, et al. "Ruptured Mycotic Aneurysm of the Distal Circulation in a Patient with Mucormycosis Without Direct Skull Base Extension: Case Report." Operative Neurosurgery 16, no. 3 (2018): E101—E107. http://dx.doi.org/10.1093/ons/opy127.

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Abstract BACKGROUND AND IMPORTANCE Infectious intracranial aneurysms are a rare subset of intracranial aneurysms caused by bacterial, fungal, or viral sources. Intracranial aneurysms of fungal etiology carry a high mortality risk and typically occur in immunocompromised patients via direct extension of skull base infections, or more rarely, after intracranial surgery. CLINICAL PRESENTATION We present the case of a 27-yr-old female with systemic lupus erythematous and primary pulmonary mucormycosis, who suffered a subarachnoid hemorrhage from a ruptured fusiform distal middle cerebral artery an

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6

Ateş, Öztürk. "Multidrug-Resistant Disseminated Nocardia Farcinica Infection in a Systemic Lupus Erythematosus Patient." Turkish Journal of Rheumatology 28, no. 4 (2013): 278–81. http://dx.doi.org/10.5606/tjr.2013.2854.

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7

Skogrand, Aase. "LUPUS ERYTHEMATOSUS DISSEMINATUS." Acta Pathologica Microbiologica Scandinavica 38, no. 3 (2009): 193–202. http://dx.doi.org/10.1111/j.1699-0463.1956.tb03167.x.

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VETNE, GUNNAR. "Lupus Erythematosus Disseminatus." Acta Medica Scandinavica 136, no. 5 (2009): 368–77. http://dx.doi.org/10.1111/j.0954-6820.1950.tb09651.x.

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9

Furuya, H., K. Ikeda, K. Iida, et al. "Disseminated toxoplasmosis with atypical symptoms which developed with exacerbation of systemic lupus erythematosus." Lupus 28, no. 1 (2018): 133–36. http://dx.doi.org/10.1177/0961203318815583.

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Toxoplasma is a common parasite worldwide that mainly affects the brain, lungs and eyes. Although toxoplasmic encephalitis is a lethal disease without treatment, past case reports show most patients with systemic lupus erythematosus who developed toxoplasmic encephalitis were misdiagnosed and treated as neuropsychiatric systemic lupus erythematosus, which led to unfavorable outcomes. We herein describe a case of disseminated toxoplasmosis affecting all the above organs with atypical symptoms, which developed with exacerbation of systemic lupus erythematosus. She had initially manifested with r

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10

BADEA, Mihail-Alexandru. "BULLOUS SUBACUTE CUTANEOUS LUPUS ERYTHEMATOSUS. A CASE REPORT." Bulletin of the Transilvania University of Brasov. Series VI:Medical Sciences 14(63), no. 2 (2022): 45–48. http://dx.doi.org/10.31926/but.ms.2021.63.14.2.6.

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Lupus erythematosus is an autoimmune collagen disorder with multiple organs involvement. Subacute cutaneous lupus erythematosus represents about 10% of Lupus erythematosus cases and is frequently drug induced. A 83-year-old female patient, otherwise healthy, presented for disseminated annular lesions with mild pruritus lasting for 5 days.The patient denied any new drug usage in the last two months.Laboratory findings showed raised Anti-Ro antibodies and Anti-La (SS-B). The patient received systemic corticotherapy with the remission of the lesions in one month.Subacute cutaneous lupus erythemat

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11

Sustretov, Vyacheslav A. "Effective laser correction of multiple teleangiectasia on the face." Russian Journal of Skin and Venereal Diseases 24, no. 6 (2022): 597–604. http://dx.doi.org/10.17816/dv104391.

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Telangiectasia is a persistent dilation of small-caliber skin vessels (arterioles, venules, capillaries) of a non-inflammatory nature, manifested by polymorphously convoluted and dilated vessels. Telangiectasias are classified according to the cause of occurrence, the form of changes in the vascular pattern, time and localization, and are also divided into 3 large groups ― essential (idiopathic); symptomatic in various diseases; congenital and hereditary syndromes and diseases accompanied by vascular anomalies. In addition, telangiectasias can be single and multiple, located locally or dissemi

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12

Potekaev, N. N., I. V. Khamaganova, M. V. Novoseltsev, and S. A. Chizevskaya. "Disseminated lupus erythematosus in elderly patients." Klinicheskaya dermatologiya i venerologiya 15, no. 5 (2016): 21. http://dx.doi.org/10.17116/klinderma201615521-24.

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13

Halberg, P., U. Bertram, M. Søborg, and J. Nerup. "Organ Antibodies in Disseminated Lupus Erythematosus." Acta Medica Scandinavica 178, no. 3 (2009): 291–99. http://dx.doi.org/10.1111/j.0954-6820.1965.tb04273.x.

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14

Bloxham, C. A., S. Carr, D. W. Ryan, et al. "Disseminated zygomycosis and systemic lupus erythematosus." Intensive Care Medicine 16, no. 3 (1990): 201–7. http://dx.doi.org/10.1007/bf01724803.

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15

Nagata, Masahiko, Kenji Rinpou, and Hiroko Nanko. "Disseminated Discoid Lupus Erythematosus in a Dog." Japanese Journal of Veterinary Dermatology 10, no. 3 (2004): 119–24. http://dx.doi.org/10.2736/jjvd.10.119.

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16

Olhagen, Börje. "The Plasma Proteins in Disseminated Lupus Erythematosus." Acta Medica Scandinavica 154, S312 (2009): 424–25. http://dx.doi.org/10.1111/j.0954-6820.1956.tb17028.x.

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17

Wong, Kee Lam, Yau Ting Tai, Shee Loong Loke, et al. "Disseminated Zygomycosis Masquerading as Cerebral Lupus Erythematosus." American Journal of Clinical Pathology 86, no. 4 (1986): 546–49. http://dx.doi.org/10.1093/ajcp/86.4.546.

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18

Morozova, Elena A., та Evgeniia A. Bausheva. "Сlinical cases of newly diagnosed systemic lupus erythematosus at the appointment with a dermatologist". Russian Journal of Skin and Venereal Diseases 25, № 2 (2022): 141–49. http://dx.doi.org/10.17816/dv108211.

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Lupus erythematosus is a multisystemic connective tissue disease that has a wide range of manifestations affecting the skin and mucous membranes, joints, kidneys, heart, lungs, and central nervous system. In dermatology, cutaneous forms of lupus erythematosus can be classified into discoid, disseminated, centrifugal erythema, lupus panniculitis, subacute and chronic lupus, and systemic lupus erythematosus with damage to internal organs. It can develop as an independent disease or can be a result of progression of cutaneous forms. The skin is the second most commonly affected organ in sys

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19

Новоселецкая, А. И., and А. А. Белазарович. "Lupus Erythematosus in the Practice of a Dermatologist." Дерматовенерология Косметология, no. 3 (November 11, 2020): 182–92. http://dx.doi.org/10.34883/pi.2020.6.3.005.

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На основании обзора литературы в статье представлены данные о наиболее частых причинах развития красной волчанки. Отмечено, что это заболевание чаще развивается у женщин и в возрастной группе старше 40 лет. В статье дана классификация красной волчанки по МКБ-10 и классификация J. Gilliam и соавт. Подробно описаны критерии диагностики системной красной волчанки. Представлены критерии, описанные в 1972 году В.А. Насоновой, а также классификационные критерии, предложенные Американской коллегией ревматологов (ACR) в 1997 году, и критерии Международного содружества клиник системной красной волчанки

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20

Mortensen, Vagn, and Harald Gormsen. "LUPUS ERYTHEMATOSUS DISSEMINATUS (LIBMAN-SACKS‘ DISEASE)." Acta Medica Scandinavica 142, S266 (2009): 743–74. http://dx.doi.org/10.1111/j.0954-6820.1952.tb13425.x.

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21

Myhre, Jon R. "Pleuropulmonary Manifestations in Lupus Erythematosus Disseminatus." Acta Medica Scandinavica 165, no. 1 (2009): 55–60. http://dx.doi.org/10.1111/j.0954-6820.1959.tb14472.x.

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22

Plata-Menchaca, Erika P., V. M. De la Puente-Diaz de Leon, Adriana G. Peña-Romero, and Eduardo Rivero-Sigarroa. "Pulmonary Hemorrhage Secondary to Disseminated Strongyloidiasis in a Patient with Systemic Lupus Erythematosus." Case Reports in Critical Care 2015 (2015): 1–3. http://dx.doi.org/10.1155/2015/310185.

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Introduction. Pulmonary hemorrhage secondary to disseminated strongyloidiasis is an unusual, well-recognized entity in immunocompromised patients with autoimmune disease, which is associated with the hyperinfection syndrome, sepsis, and a high mortality rate.Case Presentation. We present a case of a 44-year-old Mexican woman with systemic lupus erythematosus and acute bacterial meningitis who developed pulmonary hemorrhage with acute respiratory failure requiring mechanical ventilation, treated with broad spectrum systemic antibiotics and high dose methylprednisolone, who subsequently develope

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23

Hati, Arpita, Subhadeep Mallick, Subhasmita Baisya, Shayeri Banerjee, and Gobinda Chatterjee. "Disseminated Superficial Porokeratosis Mimicking Disseminated Discoid Lupus Erythematosus: An Unusual Presentation." Journal of the Turkish Academy of Dermatology 16, no. 1 (2022): 24–26. http://dx.doi.org/10.4274/jtad.galenos.2021.08370.

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24

Icharmouhene, R., A. Guenoun, N. Oulhyan, N. Mabrouk, H. Aitoumar, and B. Chkirat. "Disseminated Lupus Erythematosus: Neurological Manifestations in Childhood: A Case Series of Two Patients." Asian Journal of Pediatric Research 14, no. 11 (2024): 34–41. http://dx.doi.org/10.9734/ajpr/2024/v14i11401.

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Neuropsychiatric lupus encompasses the neurological and psychiatric manifestations of systemic lupus erythematosus and presents a significant diagnostic challenge due to its broad clinical variability. Affecting between 14% and 75% of lupus patients, it can occur at any stage of the disease. We present two illustrative pediatric cases compiled in a pediatric nephrology unit: Case 1: A young girl with pericarditis, cognitive impairment, and persistent headaches at the time of diagnosis. Case 2: A boy with prolonged fever, whose disease evolution revealed neuropsychiatric lupus through the onset

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25

Gopalan, Geetharani, Sudha R. Gopinath, Kothandaramasamy R., and Sathesh Pandian. "A clinical and epidemiological study on discoid lupus erythematosus." International Journal of Research in Dermatology 4, no. 3 (2018): 396. http://dx.doi.org/10.18203/issn.2455-4529.intjresdermatol20183165.

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<p class="abstract"><strong>Background:</strong> Discoid lupus erythematosus (DLE) is the commonest form of cutaneous lupus erythematosus.The objective of our study is to analyze the clinical and epidemiological aspects of DLE.</p><p class="abstract"><strong>Methods:</strong> All clinically diagnosed cases of DLE attending the dermatology OPD from October 2010 to September 2012were included in the study. A detailed history, complete physical examination, biopsy for confirmation and other relevant investigations were done in all cases.<strong><

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26

Singal, A., J. Rohtagi, and D. Pandhi. "Eyelid involvement in disseminated chronic cutaneous lupus erythematosus." Indian Journal of Dermatology, Venereology and Leprology 72, no. 5 (2006): 370. http://dx.doi.org/10.4103/0378-6323.27756.

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HAYAKAWA, KAZUHITO, and MASAJI NAGASHIMA. "SYSTEMIC SCLEROSIS ASSOCIATED WITH DISSEMINATED DISCOID LUPUS ERYTHEMATOSUS." International Journal of Dermatology 32, no. 6 (1993): 440–41. http://dx.doi.org/10.1111/j.1365-4362.1993.tb02817.x.

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LAPAUW S, WESTHOVENS R, and SPITZ B. "Lupus erythematodes disseminatus tijdens de zwangerschap." Tijdschrift voor Geneeskunde 57, no. 19 (2001): 1331–42. http://dx.doi.org/10.2143/tvg.57.19.5001153.

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LAPAUW S, WESTHOVENS R, and SPITZ B. "Lupus erythematodes disseminatus tijdens de zwangerschap." Tijdschrift voor Geneeskunde, no. 19 (January 1, 2001): 1331–42. http://dx.doi.org/10.47671/tvg.57.19.5001153.

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30

Wenzel, J., S. Zahn, and T. Tüting. "Pathogenesis of cutaneous lupus erythematosus: common and different features in distinct subsets." Lupus 19, no. 9 (2010): 1020–28. http://dx.doi.org/10.1177/0961203310370046.

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The term ‘cutaneous lupus erythematosus’ (CLE) comprises several related autoimmune skin disorders, defined as ‘specific’ skin manifestations of lupus erythematosus (LE). The spectrum of clinical presentation of CLE is wide, reaching from mild erythema to disseminated scarring skin lesions. There is increasing knowledge concerning the pathogenesis of LE skin lesions and it has been shown that a complex network of cutaneous cytokines, chemokines and adhesion molecules orchestrate and promote tissue injury observed in LE skin lesions. However, a complete understanding of the diverse pathophysiol

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31

Omo-Ogboi, A. C., S. Shirai, M. Buja, and J. Ederhion. "A rare case of Disseminated Histoplasmosis with Hemophagocytic Lymphohistiocytosis mimicking a flare of Systemic Lupus Erythematosus in a middle-aged man: A Case Report." American Journal of Clinical Pathology 160, Supplement_1 (2023): S1. http://dx.doi.org/10.1093/ajcp/aqad150.001.

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Abstract Introduction/Objective Disseminated histoplasmosis is a progressive granulomatous disease caused by Histoplasmosis capsulatum which is an intracellular dimorphic fungus endemic to Ohio and Mississippi River valleys in the United States. The progressive spread of the infection to organs is thought to be due to the failure of the activation of the T-cell mediated immune response. Hemophagocytic lymphohistiocytosis is a rare but potentially fatal condition in which histiocytes and lymphocytes build up in and damage organs and other blood cells. Diagnosing Disseminated Histoplasmosis with

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32

Robinett, Kathryn S., Bethany Weiler, and Avelino C. Verceles. "Invasive Aspergillosis Masquerading as Catastrophic Antiphospholipid Syndrome." American Journal of Critical Care 22, no. 5 (2013): 448–51. http://dx.doi.org/10.4037/ajcc2013659.

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A 25-year-old woman with a history of systemic lupus erythematosus who was taking steroids came to the hospital because of vague signs and symptoms of weight loss, constipation, and oral ulcers. Multiorgan dysfunction developed, and catastrophic antiphospholipid syndrome was suspected. She was treated with an intravenous infusion of heparin, but she experienced a subdural hemorrhage and died on day 10 of the hospitalization. An autopsy revealed disseminated invasive aspergillosis. This case illustrates that invasive aspergillosis is a frequently missed diagnosis and should be part of the diffe

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33

LINDQVIST, TORSTEN. "Lupus Erythematosus Disseminatus after Administration of Mesantoin." Acta Medica Scandinavica 158, no. 2 (2009): 131–38. http://dx.doi.org/10.1111/j.0954-6820.1957.tb15754.x.

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Bhat, MRamesh, Sukumar Dandakeri, Rohan Gatti, Manjunath Hulmani, and SrinathM Kambil. "Disseminated discoid lupus erythematosus leading to squamous cell carcinoma." Indian Journal of Dermatology 57, no. 2 (2012): 158. http://dx.doi.org/10.4103/0019-5154.94298.

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Tanaka, Hiroshi, Koichi Suzuki, Tohru Nakahata, et al. "Disseminated candidiasis following prednisolone therapy in systemic lupus erythematosus." Pediatrics International 44, no. 6 (2002): 702–4. http://dx.doi.org/10.1046/j.1442-200x.2002.01618.x.

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Ordonez, Laura, Eli Skromne, Daniel Ontaneda, and Victor M. Rivera. "Multiphasic disseminated encephalomyelitis, systemic lupus erythematosus and antiphospholipid syndrome." Clinical Neurology and Neurosurgery 109, no. 1 (2007): 102–5. http://dx.doi.org/10.1016/j.clineuro.2006.03.009.

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Mohan, Alladi, J. Harikrishna, GSivaram Naik, et al. "Disseminated tuberculosis in a patient with systemic lupus erythematosus." Journal of Clinical and Scientific Research 1, no. 4 (2012): 199. http://dx.doi.org/10.4103/2277-5706.241519.

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S. P., Gayathre, Niranjan Kumar, and Tharani Rajeswaran. "Cutaneous squamous cell carcinoma in a disseminated discoid lupus erythematosus lesion." International Surgery Journal 10, no. 3 (2023): 497–500. http://dx.doi.org/10.18203/2349-2902.isj20230506.

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The incidence of skin cancers is low in India when compared to the western world. Malignant transformation of discoid lupus erythematosus (DLE) is a rare entity. Most common site is head and neck. Our case reported is a disseminated DLE with malignant transformation to squamous cell carcinoma (SCC) of a lesion over arm with axillary node involvement. We proceeded with wide local excision and axillary node dissection.

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Widasmara, Dhelya, and Fitri Firdausiya. "Disseminated Herpes Zoster on a Child with Systemic Lupus Erythematosus and Lupus Nephritis." Infection and Drug Resistance Volume 14 (July 2021): 2777–85. http://dx.doi.org/10.2147/idr.s314220.

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TANAKA, Mitsuhiko, Shigeto KOBAYASHI, Naoto TAMURA, Hiroshi HASHIMOTO, and Shun-ichi HIROSE. "Disseminated Intravascular Coagulation in a Patient with Systemic Lupus Erythematosus with Lupus Anticoagulant." Internal Medicine 32, no. 6 (1993): 513–17. http://dx.doi.org/10.2169/internalmedicine.32.513.

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BILLE, BO S. V. "Lupus Erythematosus Disseminatus with and without Skin Eruption." Acta Medica Scandinavica 140, no. 4 (2009): 280–89. http://dx.doi.org/10.1111/j.0954-6820.1951.tb10179.x.

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Teilum, Gunnar. "MILIARY EPITHELIOID-CELL GRANULOMAS IN LUPUS ERYTHEMATOSUS DISSEMINATUS." Acta Pathologica Microbiologica Scandinavica 22, no. 1 (2009): 73–79. http://dx.doi.org/10.1111/j.1699-0463.1945.tb04055.x.

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Li, Justin C. H., Warren Fong, Limin Wijaya, and Ying Y. Leung. "Disseminated tuberculosis masquerading as a presentation of systemic lupus erythematosus." International Journal of Rheumatic Diseases 21, no. 1 (2017): 352–55. http://dx.doi.org/10.1111/1756-185x.13195.

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Gil Alzueta, M. C., M. E. Erro Aguirre, M. C. Herrera Isasi, and M. T. Cabada Giadás. "Acute disseminated encephalomyelitis as a complication of systemic lupus erythematosus." Neurología (English Edition) 31, no. 3 (2016): 209–11. http://dx.doi.org/10.1016/j.nrleng.2014.02.007.

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Den, S. "Disseminated keratoconjunctival epitheliopathy in a patient with systemic lupus erythematosus." British Journal of Ophthalmology 90, no. 8 (2006): 1068–70. http://dx.doi.org/10.1136/bjo.2006.090498.

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SHIMAMOTO, Yoshinori, Masayuki SANO, Shoko KANEDA, Seiji TSUNADA, Kyosuke YAMAMOTO, and Masaya YAMAGUCHI. "Disseminated Intravascular Coagulation in Lupus Erythematosus with Acute Liver Damage." Internal Medicine 31, no. 12 (1992): 1392–95. http://dx.doi.org/10.2169/internalmedicine.31.1392.

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Hardie, Rochelle, Tracian James-Goulbourne, Monsoon Rashid, Jeremy Sullivan, and Yamen Homsi. "Fatal Disseminated Aspergillosis in a Patient with Systemic Lupus Erythematosus." Case Reports in Infectious Diseases 2020 (February 29, 2020): 1–5. http://dx.doi.org/10.1155/2020/9623198.

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Patients with systemic lupus erythematosus (SLE) are at increased risk for infection including opportunistic infections. Fungal infection in particular can be difficult to diagnose and treat and often can be life-threatening in the immunocompromised patient. We present a case in which a patient with SLE presented to the hospital with shortness of breath and cough. Throughout the hospital course, the patient’s condition continued to decline leading to acute respiratory failure, and eventually, the patient expired. Postmortem autopsy revealed invasive fungal aspergillosis infection involving the

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Riddell, Stanley R., and A. Majid Shojania. "Disseminated intravascular coagulation in lupus erythematosus responding to prednisone therapy." American Journal of Hematology 23, no. 1 (1986): 65–68. http://dx.doi.org/10.1002/ajh.2830230110.

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Souto Filho, João Tadeu Damian, Priscilla Damião Araújo Lima, Alex Batista Paulo, and Ana Luisa Silva Souza. "Hemophagocytic lymphohistiocytosis secondary to disseminated histoplasmosis in systemic lupus erythematosus." International Journal of Hematology 106, no. 6 (2017): 727–28. http://dx.doi.org/10.1007/s12185-017-2308-z.

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To, Uyen, Joyce Kim, and David Chia. "Lupus Flare: An Uncommon Presentation of Disseminated Gonorrhea." Case Reports in Medicine 2014 (2014): 1–3. http://dx.doi.org/10.1155/2014/626095.

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Gonorrhea is one of the most common sexually transmitted diseases in the US with 700,000 annual cases. Although most cases of gonorrhea are localized, approximately 0.5–3% become disseminated. Here we discuss a rare case of a patient with systemic lupus erythematosus (SLE) who developed septic shock from disseminated gonorrhea infection (DGI). Our patient is a 24-year-old woman with SLE, mixed connective tissue disease with cutaneous vasculitis, and lupus nephritis who presented with several weeks of malaise and generalized body aches associated with a diffuse rash along her fingers, palms, an

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