Pseudomonas aeruginosa, hot tubs, and skin infections.
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Biomedical subjects
Publications and source records attributed to J E Rasmussen.
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The human clinical use of 1% lindane formulations has become somewhat controversial during the past five years. This review is an in-depth report of the efficacy and safety of 1% lindane compared with the agents that have been preferred as alternative. Almost all of the suspected adverse drug reactions (ADR) from 1% lindane have involved substantial misuse. The number of suspected ADRs remains small, especially when compared with the magnitude of human clinical use of 1% lindane preparations in the United States (50 million ounces during the past five years). One percent lindane should continue to remain the preparation of choice for nearly all patients with scabies and lice, but dermatologists should appreciate that these views are not necessarily shared by all health professionals. Consequently, it is most appropriate to explain the possible side effects from misuse of lindane to each patient. This brief period of patient education is time well spent--it will help maintain proper compliance and allay the upset that many of your patients may have if they encounter negative opinions about lindane in the lay and medical press or from other health professionals.
Sarcoidosis in children less than 6 years of age is a rare occurrence. Affected patients, however, have a characteristic triad of involved organs-skin, joints, and eyes. Cutaneous changes usually take the form of asymptomatic eczematous or infiltrated plaques and papules. Swollen synovium produces articular changes which are much more visible than symptomatic-pain is minimal and range of motion is usually not substantially impaired. Involvement of the eye may produce much more severe and permanent damage, however. Chest and joint x-rays are usually normal.
Gram-negative acne is an unusual, distinctive disease that is probably increasing in frequency. It seems directly related to long-term therapy with multiple antibiotics and in one of our cases with the misue of topical corticosteroids. Cultures should be taken from the obvious as well as the not so obvious sites--nares, ear canals, and perineum--with special technique to maximize growth of gram-negative and anaerobic bacteria. Our patients had a good response to appropriate systemic antibiotic and topical therapy.
We determined the prevalence of keratosis punctata of the palmar creases in 534 individuals. The group screened included patients, visitors, and staff in clinics and in a private office setting. The seven cases discovered were all found in black patients, representing 3.1% of this racial group. No relationship to arsenical agents, syphilis, or genetic factors could be ascertained by history.
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Of 52 patients with proved Trichophyton tonsurans infection of the scalp, 16 had an inflammatory reaction to this infection (kerion), while the rest had only slight scaling and broken hairs (black dot ring-worm). Each patient was tested with trichophytin antigen to determine whether cell-mediated immunity (CMI) was responsible for the differences in these different clinical presentations. Fifteen of 16 with kerion had a 48-hour reaction greater than 10 mm, while none of the 36 with noninflammatory (black dot) tinea capitis had a similar response. This suggests that the patient's immune response (CMI) may be responsible for kerion infections of the scalp and that therapy could be directed initially toward suppressing this reaction.
The real and potential problems associated with the percutaneous absorption of topically applied corticosteroids have been used as an argument against the prolonged administration of these drugs. Many pediatricians and dermatologists consider children to be more likely to absorb substantial quantities of topically applied corticosteroids than adults. This study examines the percutaneous absorption of 0.1% triamcinolone acetonide ointment applied four times a day for a period of six weeks to patients with severe atopic eczema. The results of 8 AM and 4 PM plasma cortisol and 24-hour urinary cortisol determinations do not indicate any notable adrenal suppression. No patient had an 8 AM cortisol value that would be considered in the abnormal range. These results indicate that the use of a medium-strength topical corticosteroid for this length of time probably poses no noteworthy hazard from percutaneous absorption.
Seasonal variations in skin diseases are most noticeable in those parts of the country with significant changes of seasons. For the past 5 years, I have noticed an unusual recurrent prurigo of the elbows which was originally described by Sutton. This disease, which I feel is related to atopic eczema, usually occurs on the elbows of children during the first few weeks of good spring weather. The disease appears as a papular eczematous dermatitis which is usually limited to the elbows but may also affect the knees, hands and chest. It responds well to topical corticosteroids but has a tendency to recur each spring for several years.
The effect of the amount of emulsified corn oil ingested on the gastrointestinal absorption of griseofulvin in man was assessed after oral administration of 5, 10, 15, or 30 gm doses of a corn oil (40% w/w)-in-water emulsion dosage form, each containing 250 mg of microsize griseofulvin. For comparison, griseofulvin absorption from two-125 mg commercial tablets of ultramicrosize drug dispersed in polyethylene glycol 6;000 was also determined. Griseofulvin was almost completely absorbed from the microsize drug emulsions and ultramicrosize drug tablets, whereas 50% of an oral dose is absorbed from commercial microsize griseofulvin tablets. Only 4 gm of emulsified corn oil (as a 10-gm dose of emulsion) is required to maximize the uniformity and extent of griseofulvin absorptions. The emulsion dosage form is uniquely suited for pediatric use.
Xanthelasmoidea is an old term that has been used to describe yellow papules of urticaria pigmentosa. I used it to describe the cutaneous lesions in a young child with 1- to 2-cm oval papules, each of which was studded with 10 to 20 yellow puncta. Biopsy disclosed the puncta to be small nests of mast cells separated by normal dermis.
It is generally accepted that the correct treatment for patients with severe erythema multiforme is systemic corticosteroids. This paper is a review of thirty-two paediatric patients with severe erythema multiforme (Stevens-Johnson syndrome) who were treated with either large doses of systemic corticosteroids or supportive care only. Those patients treated with steroids did not recover sooner than those treated in other fashions and the steroid treated group had a significant incidence of medical complications. This retrospective study proves nothing but it does suggest that treatment of patients with the Stevens-Johnson syndrome with systemic corticosteroids may be associated with significant side effects and prolonged recovery.