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At least 235 records · Page 13Linked to original sources
PubMed1998

Unusual clinical variants of cutaneous leishmaniasis in Pakistan.

Cutaneous leishmaniasis is endemic in the Baluchistan province of Pakistan and poses a great risk to non-immune visitors to the area. The wide spectrum of clinical variants of this common disease is at times a diagnostic challenge. A total of 1709 patients with cutaneous leishmaniasis were recorded over a 1-year period. In 37 (2%) patients the lesions were very unusual, and therefore worth reporting. These included acute paronychial, chancriform, annular, palmoplantar, zosteriform and erysipeloid forms. The zosteriform and erysipeloid forms have rarely been reported previously, but to the best of our knowledge, acute paronychial, chancriform, annular and palmoplantar lesions are being reported for the first time. The morphologically unusual lesions may be attributed to an altered host response or involvement of an atypical strain of parasite in these lesions.

Acute Disease↗
PubMed1999

Lichenoid tissue reaction in porphyria cutanea tarda.

We report a patient presenting with lichenoid plaques on exposed skin who had the metabolic features of porphyria cutanea tarda (PCT). Histology of lesional skin demonstrated a lichenoid inflammatory cell infiltrate in the upper dermis, while direct immunofluorescence revealed immunoreactive colloid bodies. Monochromator irradiation testing demonstrated photosensitivity in the visible spectrum consistent with porphyria. Solar-simulated irradiation induced a papular reaction with lichenoid histological changes. We propose that this atypical presentation of PCT may reflect a lichenoid tissue response to a porphyrin-mediated photochemical reaction.

Facial Dermatoses↗
PubMed1998

A case of hydroa vacciniforme with unusual ear mutilation.

A 22 year-old man visited our department with a 18-year-history of recurrent vesicular eruption on his skin when exposed to the sun. History revealed that the skin lesions developed as vesicles at first, then over the next several days, they formed crusts and healed with scarring. We were able to induce skin lesions by a repetitive UV-A provocation test. By the clinical and histologic features of the induced lesions, the case was diagnosed as hydroa vacciniforme (HV). However, no vesicular lesions were found on physical examination. Instead, in addition to varioliform scarring, we found various unusual clinical manifestations: burn-like lesions and crusts, flexion contracture of the digitum, and ear lobe mutilation. The ear lobe mutilation, which had not been reported previously in HV, was especially interesting.

Adult↗
PubMed1998

Hydroa vacciniforme presenting in an adult successfully treated with cyclosporin A.

Hydroa vacciniforme (HV) is a rare photodermatosis first described by Bazin in the mid-nineteenth century. It typically presents in childhood and resolves during adolescence. Rarely, however, symptoms may persist into adult life.2,3 We now describe a patient with this condition presenting unusually for the first time at the age of 58 years and responding to treatment with cyclosporin A.

Cyclosporine↗
PubMed1999

Recalcitrant viral warts: results of treatment with the KTP laser.

We report the use of a potassium-titanyl-phosphate (KTP) continuous wave laser in an open study to treat 25 patients with multiple nongenital warts that had failed to respond to conventional therapies. All patients were treated monthly using the 532 nm KTP continuous wave laser and robotic scanner. Twenty patients (80%) responded to treatment with warts: in 12 patients there was complete clearing. Moderate discomfort was reported during the procedure but subsequent morbidity was slight with no evidence of scarring. Follow-up by postal questionnaire revealed that warts recurred in those patients who had stopped treatment early but not in those whose warts had been treated to complete clearance.

Adolescent↗
PubMed1999

Chemotherapy-induced acral erythema (CIAE) with bullous reaction.

Chemotherapy-induced acral erythema (CIAE) is a cutaneous response to a number of different chemotherapeutic agents. It causes a symmetrical, painful erythema of both the palms and soles which is self-limiting. CIAE with bullous reaction has been reported in relation to methotrexate, but it has been more commonly associated with cytosine arabinoside. We describe a case of CIAE with bullous reaction in a patient treated for Hodgkin's disease with a number of chemotherapeutic agents. We discuss the differential diagnosis of this condition which includes eccrine squamous syringometaplasia and acute graft vs. host disease

Adult↗
PubMed2000

Treatment of viral warts with cimetidine: an open-label study.

The immunomodulatory actions of cimetidine, an H2-receptor antagonist, and its use in the treatment of viral warts has been described previously but its effectiveness is still debated. We report the results in 47 patients with multiple, nongenital viral warts who were treated with oral cimetidine in a 3-month open-label study. The drug was generally well tolerated and 87% of children and 68% of adults improved with treatment. Follow-up data in 65% of the patients showed that there had been no recurrence in the majority of those whose warts had cleared completely during treatment, whereas warts tended to persist or recur in those who had stopped treatment before all the warts had resolved. Our data suggests that cimetidine may be helpful in the treatment of viral warts in both adults and children and supports the need for a randomized controlled trial.

Adjuvants, Immunologic↗
PubMed1997

Itraconazole in onychomycosis: intermittent dose schedule.

Fifty (13 men and 37 women) consecutive patients, attending the Dermatology. Department of the General Hospital of Mexico, with mycologically proven onychomycosis of the finger and toenails were included in an open clinical trial. These patients received a pulse regimen of itraconazole (200 mg twice daily) given after meals during the first week of each month, for 3 consecutive months. After the last dose, the drug was discontinued, and patients were followed-up for 9 months. Initially, the patients underwent a clinical and fungal evaluation. The study included those with positive potassium hydroxide (KOH) preparation and mycologic cultures, who had not been treated either with a systemic antifungal agent for a period of 3 months prior to the study or with a topical agent for a 1-month period prior to the study. Complete blood count and liver test functions that included transaminase, total bilirubin, alkaline phosphatase, and lactic dehydrogenase were carried out at the beginning of the study, after the first half of the study (second pulse), and 2 weeks after completion of treatment. Exclusion criteria were pregnant or lactating women, patients receiving antimycotic treatment during the 3 previous months or patients under treatment for gastric hyperacidity. Three mycologic examinations were carried out: before starting treatment in order to identify the fungal species; after the third pulse; and 3, 6, and 9 months after the last drug administration. The effectiveness of the drug was evaluated based on Zaias' method to estimate the reduction of the affected area. A 400 mg/day dose of oral itraconazole was administered in two takes: 200 mg after breakfast and 200 mg after dinner for 1 week (first pulse). The drug was discontinued for a 3-week period and this regimen was applied twice. This meant that only three treatment periods or pulses were carried out. Follow-up visits were scheduled at 6 months after completion of treatment for handnails and 9 months for toenails. At the end of the study, a correlation between clinical-mycologic outcome and liver function tests were carried out to assess the effectiveness and safety of the proposed treatment regimen.

Administration, Oral↗
PubMed1997

The effect of toenail onychomycosis on patient quality of life.

BACKGROUND: Onychomycosis is a common fungal infection of the toenails which has historically been regarded as a cosmetic problem. A previous study has suggested that this is not the case and that toenail and fingernail onychomycosis adversely impacts patient quality of life (QOL). METHODS: A survey was used to self-assess the physical symptoms and psychosocial dimensions of toenail onychomycosis in 93 patients. Positive responses scored one point each, and points were summed for each patient. RESULTS: Ninety-two per cent of patients reported experiencing negative psychosocial and/or physical effects. Forty-four per cent indicated that their toenails had a negative effect on their self-image, and 41% reported experiencing pain or discomfort as a result of onychomycosis. CONCLUSIONS: Toenail onychomycosis has a significant impact on the overall QOL of patients, and should be evaluated further to develop guidelines for total patient care.

Activities of Daily Living↗
PubMed1997

Prevalence and epidemiology of unsuspected onychomycosis in patients visiting dermatologists' offices in Ontario, Canada--a multicenter survey of 2001 patients.

BACKGROUND: Questionnaire studies have been used to determine the prevalence of onychomycosis in the United Kingdom and Europe. One disadvantage of this methodology is that the patient self-diagnoses the onychomycosis. There have been very few large studies involving clinical examination of the nails of subjects, followed by mycological confirmation of the onychomycosis. We therefore determined the prevalence of onychomycosis in patients visiting dermatologists' offices in Ontario, Canada. METHODS: In a prospective, multicenter study, the finger- and toenails of all new patients presenting to dermatologists' offices were examined by a board-certified dermatologist. If there was clinical suspicion of onychomycosis, then nail samples were obtained for mycological examination at a central laboratory. Patients referred specifically for the management of onychomycosis were excluded. RESULTS: Toenails appeared abnormal in 455 (22.7%) of 2001 patients. Mycologically-confirmed pedal onychomycosis was present in 182 (9.1%) of the 2001 patients. The estimated value of the prevalence of onychomycosis in Ontario is 6.86% (95% confidence interval (CI): 5.8-8.0%), when corrected for age and sex of the general population using census data. Onychomycosis increased with age (P < 0.0001). The odds of males having onychomycosis was 84.3% greater than females of the same age (P = 0.0003). The distribution of organisms in the 141 patients with pedal onychomycosis who were culture positive was: dermatophytes 131 (92.9%), Candida species 4 (2.8%) and non-dermatophyte molds 6 (4.3%). CONCLUSIONS: The prevalence of mycologically-confirmed toenail onychomycosis was 9.1%, with the estimated prevalence in Ontario being 6.86%. The majority of patients with abnormal-appearing nails were unaware they might have onychomycosis, that it is infectious and potentially treatable, suggesting that there is potential for increased public awareness and education.

Adolescent↗