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Biomedical subjects

Noah S Scheinfeld

Publications and source records attributed to Noah S Scheinfeld.

36 records · Page 2Linked to original sources

Obesity and dermatology.

Obesity is associated with a number of dermatoses. It affects cutaneous sensation, temperature regulation, foot shape, and vasculature. Acanthosis nigricans is the most common dermatological manifestation of obesity. Skin tags are more commonly associated with diabetes than with obesity. Obesity increases the incidence of cutaneous infections that include: candidiasis, intertigo, candida folliculitis, furunculosis, erythrasma, tinea cruris, and folliculitis. Less common infections include cellulitis, necrotizing fasciitis, and gas gangrene. Leg ulcerations, lymphedema, plantar hyperkeratosis, and striae are more common with obesity. Hormonal abnormalities and genetic syndromes (Prader-Willi) are related to obesity and its dermatoses; however, cellulite is not related to obesity.

Acanthosis Nigricans↗

The preauricular sinus: a review of its clinical presentation, treatment, and associations.

Preauricular sinuses (ear pits) are common congenital abnormalities. Usually asymptomatic, they manifest as small dells adjacent to the external ear near the anterior margin of the ascending limb of the helix, most frequently on the right side. Preauricular sinuses can be either inherited or sporadic. When inherited, they show an incomplete autosomal dominant pattern with reduced penetrance and variable expression. They may be bilateral, increasing the likelihood of being inherited, in 25-50% of cases. Preauricular sinuses are features of other conditions or syndromes in 3-10% of cases, primarily in association with deafness and branchio-oto-renal (BOR) syndrome. When other congenital anomalies coexist with these sinuses, auditory testing and renal ultrasound should be considered. Sinuses may become infected, most commonly with gram-positive bacteria, in which case their exudates should be cultured and appropriate antibiotics administered. Recurrent infection is a clear indication for complete excision and provides the only definitive cure. Recurrence rates after surgery range from 9% to 42%. Meticulous excision by an experienced head and neck surgeon minimizes the risk of recurrence.

Abnormalities, Multiple↗

Treatment options: herpes simplex viruses.

A 35-year-old woman presented with a 1-week history of vesiculopustules on erythematous bases on and in proximity to her lips (Figure 1). The patient had noted burning and itching in the area of these vesiculo-pustules before they developed. She had no systematic symptoms and had not noted similar vesiculopustules in this location in the past. A Tzanck smear was done that revealed multinucleated giant cells. A viral culture was performed. The patient was diagnosed with herpes labialis and received valacyclovir 500 mg b.i.d. for 5 days. One week later, the eruption was noted to have resolved, at which time the results of the viral culture showed growth of Herpes Simplex Virus-1. Thereafter, the patient was lost to follow-up.

Herpes Simplex↗

Creating and utilizing a multimedia dermatology medical record for a PocketPC personal digital assistant.

Personal digital assistants are lightweight computers that capture and display data via tapping on their screens with a stylus and are easily linked to desktop and network computers. They have been used in medicine for a variety of purposes, and many believe personal digital assistant use can improve the provision of medical care. The author created a multimedia dermatology electronic medical record for a PocketPC (Microsoft Corp., Redmond, WA) personal digital assistant that contains patient images, tables of phototherapy, laboratory and systemic medication data, and typed chart notes. Such a record can be created and utilized but requires more time to assemble than a handwritten note, mostly due to capturing and organizing images. Future challenges involve streamlining record assembly, integrating multimedia records with hospital and office medical records, and assessing how having multimedia data available might affect care.

Computers, Handheld↗

Condyloma with lichen nitidus.

A 32-year-old black man presented with two separate eruptions on his penis (Figure). He has had a 10-year history of asymptomatic 1-3 mm shiny papules on the shaft of his penis. He also has had one asymptomatic verrucous brown plaque 1.5 cm in diameter on his penis. A small shave biopsy was performed for each process. The former showed lymphocytes and histocytes in the papillary dermis in a "ball-in-claw" relation to the rete ridges of the epidermis. The latter showed an acanthotic epidermis with papillomatosis. Diagnoses of lichen nitidus and condyloma acuminata were respectively made. As the shiny papules did not bother the patient, but he wanted to be rid of the verrucous plaque, only the latter was treated. Liquid nitrogen was applied to the plaque. The patient was also given podofilox 0.5% gel to apply to the condyloma overnight on Monday, Tuesday, and Wednesday, with a 4-day respite. This cycle was to be repeated for 3 more weeks. He was examined several more times and treated with cryotherapy and podofilox gel with the near disappearance of the condyloma over 4 months.

Administration, Topical↗

Rosacea.

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Administration, Topical↗

Tretin-X (tretinoin).

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Acne Vulgaris↗

Melasma.

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Female↗

Common diseases/treatment options: treatment options for psoriasis part 1: topical treatments.

A 40-year-old Hispanic man presented for treatment of dermatitis on his elbows and knees that had been evident for 5 years (Figure 1). He also had scaling plaques on his scalp. He had not been treated previously. He did not have any other medical problems and did not complain of arthritis. A clinical diagnosis was made of psoriasis and he was prescribed clobetasol propionate ointment with salicylic acid 6% in petrolatum that should be applied in the evening to his elbows and knees and calcipotriene ointment with clobetasol that should be applied in the morning. For his scalp, he was prescribed betamethasone valerate foam 0.12% to be applied directly to the scalp once a day and told to use a tar shampoo contain-ing 4% neutar solubilized coal tar extract (1.0% coal tar) three times a week. He followed this regimen for 2 weeks and the plaques became much less keratotic. He continued his scalp regimen. He then started using calcipotriene ointment and clobetasol propionate ointment together twice a day. Three weeks later the plaques were much flatter and less erythematous. The patient was instructed to apply clobetasol propionate to the affected areas twice a day on Saturday and Sunday and calcipotriene twice a day Monday through Friday. At this point, his scalp was almost clear and the patient was told touse the foam as necessary and to continue the shampoo.

Administration, Cutaneous↗

Ulcerative paraneoplastic dermatomyositis secondary to metastatic breast cancer.

A 40-year-old Chinese-American woman with breast carcinoma metastatic to her lungs presented with a 3-month history of erosions on her inner thighs (Figure 1) and medial left shoulder. Faint livedo reticularis was evident on her legs as well. She had difficulty in walking and raising her shoulders. Her cutaneous examination was also notable for cuticular erythema (Figure 2) and mild periorbital erythema and edema. She had no systemic or rheumatologic complaints other than some difficulty in swallowing. Her blood chemistry values were notable for a creatinine kinase of 564 IU/L (5-200 IU/L), alanine aminotransferase 161 U/L (0-40 U/L) and aspartate aminotransferase 93 U/L (0-40 U/L), and an antinuclear antibody titer of 1:2560. Other blood chemistries and antibody serologies (anti-Jo-1, anti-Mi-2 and other anti-tRNA synthetase, anti-Ro/SSA, anti-U1RNP, anti-PM/Scl, and anti-Ku) were within normal limits. A biopsy specimen was obtained from an area of intact skin close to a right thigh ulceration that showed subtle vacuolar alteration at the dermo-epidermal junction with occasional necrotic keratinocyte (Figure 3). Melanophages and telangiectases were present. Within the subcutis there was fibrin deposition and neutrophils. A diagnosis of dermatomyositis was made. The patient received oral prednisone 20 mg three times a day, and her ulcerations resolved. Her creatinine kinase, alanine aminotransferase, and aspartate aminotransferase values returned to normal over the course of 3 weeks, but her antinuclear antibody was unchanged. Radiographic studies concurrently noted that her breast cancer had recurred in her lungs; plans were made to treat her with chemotherapy. The patient was lost to close follow-up, but it was learned that her erosions had reoccurred while her prednisone was tapered and resolved when her dosage of prednisone was increased.

Adult↗