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At least 253 records · Page 14Linked to original sources
PubMed1999

The hyperkeratotic variant of disseminated superficial actinic porokeratosis (DSAP).

A 78-year-old South Korean man was referred to us from the Medical Intensive Care Unit (MICU) for an opinion. He was comatose and was on ventilatory care due to aspiration pneumonia. Multiple tiny papules had developed 10 years previously and since then the number and size had been increasing gradually. He had been diabetic for the past 4 years, and had Parkinson's disease diagnosed 1 year previously. Laboratory examinations revealed an elevated level of white blood cells (WBCs) (25,000/microL) and decreased hemoglobin (8.8 g/dL). Other laboratory results were negative or within normal limits. Skin examination showed multiple, discrete, crust-like, brownish papules over the erythematous base on the face, upper extremities, and lower extremities. With the clinical impressions of irritated verruca vulgaris, seborrheic keratosis, or cutaneous fungal infection, a skin biopsy was taken from a papule on the left shin, and histopathologic examination revealed several pronounced hyperkeratotic and parakeratotic columns, and characteristic cornoid lamellae in the stratum corneum. Beneath the cornoid lamellae, the granular layer was decreased. A number of round or oval, dyskeratotic, homogenized eosinophilic cells with pyknotic nuclei were scattered in the prickle cell layer below the cornoid lamellae. A mild lymphohistiocytic infiltrate was observed in the papillary dermis and around the blood vessels in the upper dermis. Also, actinic degeneration was present in the upper dermis.

Aged↗
PubMed1999

Onychomycosis in Lahore, Pakistan.

BACKGROUND: Onychomycosis, a common nail disorder, is caused by yeasts, dermatophytes, and nondermatophyte molds. These fungi give rise to diverse clinical presentations. The present study aimed to isolate the causative pathogens and to determine the various clinical patterns of onychomycosis in the population in Lahore, Pakistan. PATIENTS: In 100 clinically suspected cases, the diagnosis was confirmed by mycologic culture. Different clinical patterns were noted and correlated with causative pathogens. RESULTS: Seventy-two women (mean age, 32.6 +/- 14.8 years) and 28 men (mean age, 40.6 +/- 15.8 years) were studied. Fingernails were involved in 50%, toenails in 23%, and both fingernails and toenails in 27% of patients. The various clinical types noted were distolateral subungual onychomycosis (47%), candidal onychomycosis (36%), total dystrophic onychomycosis (12%), superficial white onychomycosis (3%), and proximal subungual onychomycosis (2%). Candida was the most common pathogen (46%), followed by dermatophytes (43%) (Trichophyton rubrum (31%), T. violaceum (5%), T. mentagrophytes (4%), T. tonsurans (2%), and Epidermophyton floccosum (1%) and nondermatophyte molds (11%) (Fusarium (4%), Scopulariopsis brevicaulis (2%), Aspergillus (2%), Acremonium (1%), Scytalidium dimidiatum (1%), and Alternaria (1%). CONCLUSIONS: Onychomycosis is more common in women of 20-40 years of age. Distolateral subungual onychomycosis and candidal onychomycosis are the most common clinical presentations, and Candida and T. rubrum are the major pathogens in Pakistan.

Adolescent↗
PubMed2000

The molecular basis of dystrophic epidermolysis bullosa in Mexico.

BACKGROUND: Type VII collagen gene (COL7A1) mutations are the cause of dystrophic epidermolysis bullosa (DEB), but most mutations are specific to individual families, and there are limited data on the nature of COL7A1 mutations in certain ethnic populations. OBJECTIVE: To determine the molecular basis of DEB in Hispanic Mexican patients. METHODS: Patients were recruited through a newly established support group, Fundacion DEBRA Mexico. Molecular analysis was performed by polymerase chain reaction (PCR) of genomic DNA using COL7A1-specific primers, heteroduplex analysis, and direct nucleotide sequencing. RESULTS: Fifty-nine of a possible 67 COL7A1 mutations (88%) were identified in 36 affected individuals (31 recessive, five dominant) in 21 families. Recessive mutations included six frameshift mutations, four silent glycine substitutions, and two splice-site mutations. Dominant mutations comprised a de novo glycine substitution and an internal deletion. Conclusions This study establishes the molecular basis of DEB in a group of Mexican patients. Only two of the mutations have been identified previously in other ethnic groups; the remainder are specific to this population. These new data are helpful in facilitating the accurate diagnosis of DEB subtype, in improving genetic counseling, and in providing further insight into the pathophysiology of this mechanobullous disease.

Adolescent↗
PubMed2002

Safe control of palmoplantar hyperhidrosis with direct electrical current.

BACKGROUND: Primary (idiopathic) hyperhidrosis is a benign disease of unknown etiology, leading to the disruption of professional and social life and emotional problems. A variety of treatment methods have been used to control or reduce the profuse sweating. In this study, we report the efficacy of direct current (d.c.) administration in the treatment of idiopathic hyperhidrosis. METHODS: One hundred and twelve patients with idiopathic hyperhidrosis were enrolled in the study. Initial sweat intensities of the palms were measured by means of the pad glove method. The patients were treated in eight sessions with d.c. administration using a complete regulated d.c. unit based on tap water iontophoresis. The final sweat intensities of responders were determined 20 days after the last treatment. Nonresponders returned earlier than 20 days, with final sweat intensities measured at least 5 days after the last treatment. In 26 responders, plantar hyperhidrosis was also treated. After the first remission period, the second of eight treatments was applied to the palms of 37 responders. RESULTS: This therapy controlled palmar hyperhidrosis in 81.2% of cases. The final sweat intensities of the palms of responders were significantly reduced after eight treatments (P < 0.001). The first average remission period was 35 days. Minimal undesirable effects were noted. CONCLUSIONS: This technique appears to control hyperhidrosis on the palms and soles only if regular treatment is applied. Plantar hyperhidrosis appeared to resolve simultaneously when palmar hyperhidrosis was successfully treated.

Adolescent↗
PubMed2002

Atypical varicella with palm and sole involvement.

Varicella is a common disease characterized by a typical presentation. We report a case of an atypical presentation of varicella with a centrifugal distribution, eruption with many vesicles, no pustular stage in evolution and distal involvement. There were none of the known modifying factors (immunosuppression, skin disease, injury or sun exposure). To explain the distal involvement we suggest intraepidermic lesions caused by a pre-existing B1 coxsackie infection.

Chickenpox↗
PubMed2002

Skin manifestations of arsenicosis in two villages in Bangladesh.

BACKGROUND: Arsenic contamination in groundwater affects 35 million people in Bangladesh, but the prevalence of arsenic contamination in local communities remains to be clarified. As skin manifestations are sensitive markers of arsenicosis, we examined the skin of adults and adolescents in two villages to elucidate the severity of arsenicosis. METHODS: Five hundred and sixty-one villagers were randomly selected for the evaluation of their skin. Three indicators, i.e. keratosis on the soles, keratosis on the palms, and melanosis and hypopigmentation on the trunk, were quantified for analysis. RESULTS: More than 50% of the villagers showed some skin manifestations due to arsenicosis. Keratosis on the soles was the most sensitive marker for the detection of arsenicosis at an early stage. Interestingly, the skin manifestations were more severe in males than in females. There was no correlation between the age and the severity of skin manifestations. CONCLUSIONS: The prevalence of arsenicosis was quite high and males were more vulnerable to arsenic contamination. Using skin manifestations, especially keratosis on the soles, as useful markers to detect and evaluate arsenicosis, it is clear that there is an urgent need to assess the exact prevalence and severity of arsenicosis in the population of Bangladesh in order to take measures to treat and control this problem.

Adolescent↗
PubMed1999

Clinical and pharmacokinetic investigations of oral intraconazole in the treatment of onychomycosis.

A clinical study was carried out in 19 patients with onychomycosis in whom itraconazole was orally administered in a single daily dose of 100 mg. A follow-up period was instituted subsequent to the administration period to that the course of the nail lesions could be monitored. The concentrations of the drug in the plasma and in the nails were also determined. In patients in whom itraconazole was administered for 12-16 weeks, the decrease in the turbidity and thickening of the nails was maintained even after the administration period was completed. The efficacy rating in the overall evaluation at 12 weeks was 84.2% (16/19). In the evaluation performed at 24 weeks, the rating was 94.7% (18/19). These data indicate that the effect of itraconazole was maintained even after completion of the administration period. The retention of the drug in the nail after completion of the administration period was investigated in terms of the mean concentration of the drug in the nail with the passage of time in patients administered itraconazole for 10-16 weeks. It was found that a certain level of itraconazole was retained in the nail until at least the 24th week. Adverse reactions seen in this study consisted of diarrhoea and drug eruption, one case cach, and elevations of glutamic oxaloacetic transaminase and glutamic pyruvic transminase in one case.

Administration, Oral↗
PubMed1999

A comparison among four regimens of itraconazole treatment in onychomycosis.

The purpose of this study was to compare the efficacy of different dosage regimens in the management of onychomycosis with itraconazole and to determine the results of a further 1-week intermittent pulse treatment in non-cured patients. In this study, 153 patients were randomly allocated to four groups. Patients in group A were treated with daily doses of 100 mg for 3 months in the case of fingernail onychomycosis and for 4 months in the case of toenail onychomycosis. Patients in the other groups received a intermittent pulse therapy, in which the drug was taken for 1 week, then discontinued for 3 weeks, three cycles for fingernail and four cycles for toenail infection. The daily doses were 400 mg (group B), 300 mg (group C) and 200 mg (group D). After therapy, non-cured patients were treated further with one cycle in which the daily dose was 400 mg. Patients were subsequently observed for 9 months and efficacy was assessed by mycological examination and the growth of unaffected nails. At the end of the therapy, the cure rates in the four groups were 19.1% (A), 15.2% (B), 18.9% (C) and 17.9% (D), and no significant differences were found between each of B, C, D and A. At the end of the study, the cure rates were 76.2%, 91.3%, 78.4%, 28.6% respectively. The group that received further treatment had a cure rate of 55.6% at the end of the first month and of 83.3% in the second month. Drug tolerability was equally good in the four groups. Intermittent pulse therapy with a daily dose of 400 mg had the highest cure rate. Treatment of improved but non-cured patients with a dose of 400 mg intermittent pulse therapy markedly increased the cure rate. All treatment regimens were well tolerated.

Adolescent↗
PubMed1999

The epidemiology of onychomycoses in Istanbul, Turkey.

Between September 1995 and September 1997, 1840 patients attending our mycology department were suspected as having onychomycoses. Of the patients 985 were females and 855 were males. A total of 426 finger nail and 1414 toe nail scrapings were examined. Both microscopic and culture tests were carried out for each specimen. In 759 cases positive fungal cultures were found and 1081 cases were determined as negative. One fungal species was isolated from 715 specimens, in 44 of the cases two different species were found.

Candida↗
PubMed2000

Non-dermatophytic onychomycosis. An understimated entity? A study of 51 cases.

The aim of our study was to evaluate the incidence, the clinic characteristics, the therapeutic antifungal response and the evaluation of side-effects in 51 non-dermatophytic onychomycosis cases which were observed in a case-study of 1012 patients, affected by different types of onychopathy, attending the Mycology Ambulatory of San Paolo Hospital, Milan, Italy during the period 1994-97.

Antifungal Agents↗
PubMed2000

Intermittent pulse therapy with itraconazole for onychomycosis. Experience in Hong Kong Chinese.

Forty-four Hong Kong Chinese adults comprising 10 cases of fingernail and 42 cases of toenail onychomycosis were recruited for a 3-weekly itraconazole pulse therapy. Each pulse consisted of seven consecutive daily 400 mg doses with a 3-week interval between treatments. All patients in the fingernail group and 37 in the toenail group completed the study. The clinical cure, clinical response and mycological cure rates at week 36 were 70, 90 and 90% for fingernail and 35, 81 and 68% for toenail groups, respectively. Side-effects including biochemical abnormalities were minimal, and returned to normal upon cessation of treatment. We conclude that itraconazole pulse therapy is very effective, safe and well-tolerated for fingernail and toenail onychomycosis.

Adult↗
PubMed2000

The frequency of Candida parapsilosis in onychomycosis. An epidemiological survey in Israel.

Candida albicans is regarded as the major pathogen in yeast-induced onychomycosis. Based on our impression of an increasing prevalence of Candida parapsilosis in this disease, we examined the data of two mycology laboratories in the same geographic location, from 1994 to 1996 in one (centre A) and for 1995 (6 months) in the other (centre B). A total of 954 and 230 toenails and 621 and 190 fingernails, respectively, underwent KOH microscopy and culture studies in each centre. Positive findings were noted in 45 and 65% of the toenails and 44 and 72% of the fingernails, respectively. In the toenails, Candida spp. were found in 22 and 15%, respectively, and in the fingernails, in 77 and 63%, respectively. The most frequent Candida species was C. parapsilosis (39.5% in toenails, 36.7% in fingernails), followed by C. albicans (19.5% in toenails, and 34.4% in fingernails). These results demonstrate a higher frequency of isolation of C. parapsilosis compared with C. albicans in onychomycosis. This might have important therapeutic implications.

Candida↗
PubMed2001

Age as limiting factor of the efficacy of itraconazole for treatment of onychomycosis.

A clinical study was carried out involving 24 patients between 18 and 64 years of age with disto-lateral onychomycosis of finger and/or toenail in whom intermittent therapy with itraconazole was orally administered for 4 months. A follow-up period of 9 months was instituted to monitor the efficacy of the treatment. Clinical and mycological outcome at the end of the study was correlated with a checklist that included age and sex of the patient, site of infection and species of the causative agent. Nails that were free of disease in both gross and mycological examinations were achieved in 58% of our patients. Age was shown to be the only parameter, among those taken into consideration, that was correlated with the cure rate. The association was found to be statistically significant.

Administration, Oral↗