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PubMed2003

Adverse reactions associated with an alcohol-based hand antiseptic among nurses in a neonatal intensive care unit.

BACKGROUND: Alcohol-based hand antiseptics are strongly recommended in the 2002 Centers for Disease Control and Prevention's hand-hygiene guideline. In a study comparing 2 hand-hygiene regimes, an alcohol-based (61% ethyl) antiseptic and a detergent containing 2% chlorhexidine gluconate in 2 neonatal intensive care units, we noted adverse reactions associated with the alcohol-based antiseptic. METHODS: A prospective study was conducted of the skin condition of 58 nurses using an alcohol-based product from March 2001 to January 2002. Adverse reactions to the alcohol-based product were noted and the Fisher exact test was used to determine factors associated with these reactions. Nurses with reactions to the alcohol product who were available to follow-up were patch tested to the product. RESULTS: Of 58 (1.1/100 nursing mo) nurses, 7 were evaluated by occupational health services for dermatologic symptoms that varied from mild to severe after use of the alcohol product, but 4 of 7 have resumed use. Nurses who had adverse reactions develop had been employed on the study unit and in the nursing profession for significantly less time than those with no reactions (P =.037 and P =.002, respectively), and were significantly more likely to report a history of itchy, sore skin (P =.047). A positive patch-test result was noted in 3 of 4 nurses with a previous reaction to the product. CONCLUSION: This case series will alert users in the United States and elsewhere to the nature of reactions to alcohol products and how these reactions differ from reactions to traditional hand antiseptic products.

Adult↗
PubMed2000

Acral steatocystoma multiplex.

Steatocystoma multiplex (SM) is characterized by multiple, widespread cutaneous cystic lesions. These lesions can appear virtually anywhere on the body but are more common in areas where the pilosebaceous apparatus is well developed, such as the trunk (especially the presternal area), neck, axilla, inguinal region, scalp, and proximal extremities. We present a case of a woman with predominantly acrally located SM. To the best of our knowledge, a predominantly acral distribution has never been reported. We hypothesize that this patient's phenotype may be due to her genetic predisposition, possibly involving a familial defect in keratin 17, in combination with "ectopic" acral sebaceous follicles.

Adult↗
PubMed2000

A large-scale North American study of fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns.

BACKGROUND: Onychomycosis, a fungal infection of the nail bed, is responsible for up to 50% of nail disorders. Although several surveys have been conducted in different parts of the world, there have been no multicenter epidemiologic surveys of onychomycosis in North America. OBJECTIVE: A 12-center study was undertaken to (1) determine the frequency of onychomycosis, (2) identify organisms recovered from the nails, and (3) determine the antifungal susceptibility of isolates. METHODS: A total of 1832 subjects participated in this study and completed a comprehensive questionnaire, and nail clippings were collected for potassium hydroxide examination and culturing. RESULTS: The frequency of onychomycosis, as defined by the presence of septate hyphae on direct microscopy and/or the recovery of a dermatophyte, was found to be 13.8%. In general, the dermatophyte isolates were susceptible to the antifungals tested. CONCLUSION: Because of the limited number of large-scale studies, the baseline incidence is not firmly established. However, the higher frequency of onychomycosis in this study may confirm the suspected increase in incidence of disease in North America.

Adolescent↗
PubMed2000

Dermatopharmacology of ciclopirox nail lacquer topical solution 8% in the treatment of onychomycosis.

Ciclopirox is a synthetic hydroxypyridone antifungal agent. In contrast to the azoles, glucuronidation is the main metabolic pathway of ciclopirox; therefore interactions with drugs metabolized via the cytochrome P450 system are unlikely Ciclopirox is also distinct from the common systemic agents, which interfere with sterol biosynthesis. In fact, ciclopirox chelates trivalent cations (such as Fe3+), inhibits metal-dependent enzymes that are responsible for degradation of toxic metabolites in the fungal cells, and targets diverse metabolic (eg, respiratory) and energy producing processes in microbial cells. Ciclopirox is a broad spectrum antimicrobial with activity against all the usual dermatophytes as well as yeast and nondermatophyte molds. It has demonstrated activity against gram positive and negative bacteria, including resistant strains of Staphlococcus aureus. Ciclopirox exhibits fungal inhibitory activity (minimum inhibitory concentration < 4 microg/mL for dermatophytes) as well as fungicidal activity; to date resistance to the drug has not been identified. Ciclopirox has been formulated in a nail lacquer delivery system. After evaporation of volatile solvents in the lacquer, the concentration of ciclopirox in the remaining lacquer film reaches approximately 35%, providing a high concentration gradient for penetration into the nail. Radiolabel data demonstrate penetration into infected nails after only 1 application of the lacquer. Ciclopirox nail lacquer is a topical product that provides an active fungicidal agent in a delivery system capable of promoting nail penetration. With repeated applications, the antifungal agent is homogeneously distributed through all layers of the toenail achieving concentrations of ciclopirox in excess of inhibitory and fungicidal concentrations for most pathogens. Although ciclopirox readily penetrates nails, very low levels of ciclopirox are recoverable systemically, even after chronic use. Ciclopirox nail lacquer 8% is a topical product that provides an active fungicidal agent in a delivery system capable of penetrating nails.

Administration, Topical↗
PubMed2001

Traumatic osmium tetroxide inoculation.

Osmium tetroxide is a highly oxidizing, corrosive compound commonly found in electron microscopy laboratories. Although osmium tetroxide is known to cause rapid damage to organic tissue, its cutaneous effects have not been well studied. We report a case of traumatic inoculation from a broken vial of 4% osmium tetroxide. Electron microscopy and energy dispersive x-ray spectroscopy confirmed the presence of osmium in the tissue specimen. The lesion was treated by simple excision.

Accidents↗
PubMed2002

Allergic contact dermatitis to propolis in a violin maker.

Allergy to colophony is well noted in the literature, however, there have been few case reports of allergic contact dermatitis to propolis in musicians and instrument makers. We report a case of a stringed instrument craftsman who developed allergic contact dermatitis to propolis, a component of Italian varnish. A review of the components, applications, and the clinical manifestations of hypersensitivity reactions to propolis are presented.

Dermatitis, Allergic Contact↗
PubMed2002

Pustular idiopathic recurrent palmoplantar hidradenitis: an unusual clinical feature.

A 12-year-old boy had painful lesions on both soles. He had had a similar episode several months before that resolved spontaneously. Physical examination showed erythematous, extremely tender nodules on both plantar surfaces and the toes. The second and third left toes had small pustules on top of the nodules. There was no palmar involvement. The clinical features, pathologic findings, and self-limited course suggested recurrent palmoplantar hidradenitis. This distinctive entity of unknown origin appears during childhood and is characterized histologically by a neutrophilic infiltrate affecting the eccrine glands. We report the case of a patient with unusual clinical features.

Child↗
PubMed2003

Scytalidiosis in Paris, France.

BACKGROUND: Scytalidium dimidiatum and S hyalinum are molds responsible for human skin and nail infections in tropical areas. OBJECTIVE: We sought to examine the epidemiology of cutaneous infections caused by Scytalidium species in a temperate country. METHODS: We conducted a retrospective study of patients with Scytalidium spp. infection diagnosed in our laboratory in Paris, France, from 1994 to 1999. RESULTS: Cutaneous Scytalidium infections were diagnosed in 332 patients, all of whom were from the tropics, especially the West Indies and Africa. S hyalinum and S dimidiatum were isolated in 53.6% and 43.9% of cases, respectively, and were associated with dermatophytes in 30 patients. Skin and nail lesions were found in, respectively, 65.3% and 34.7% of cases, and the feet were involved in 90.6% of cases. CONCLUSION: Cutaneous infections caused by Scytalidium species are far from rare in France, a temperate country, and must not be mistaken for dermatophytosis, given the resistance of S hyalinum and S dimidiatum to most antifungal drugs. Mycologic examination is, thus, required to identify Scytalidium spp in patients returning from or residing in tropical areas.

Adult↗
PubMed2003

Patients with palmoplantar psoriasis have more physical disability and discomfort than patients with other forms of psoriasis: implications for clinical practice.

BACKGROUND: Psoriasis is a chronic, unpredictable, and incurable disease that has a negative impact on patients' quality of life. Palm and sole psoriasis can add to this negative impact as it directly affects activities of daily living. OBJECTIVE: We sought to estimate the prevalence of palmoplantar psoriasis in a patient population and to explore associations with patient outcomes. METHODS: In all, 317 individuals with psoriasis completed a comprehensive assessment battery. Patients with palmoplantar psoriasis (n = 124, 39%) were compared with patients without palmoplantar involvement with respect to functional disability, psychiatric symptoms, physical and social discomfort, self-reported psoriasis severity, and health-related quality of life. RESULTS: Patients with palmoplantar involvement reported significantly greater physical disability and physical discomfort than patients without palmoplantar involvement (both P <.01). There were no differences between the 2 groups with respect to psychosocial outcomes. CONCLUSION: Patients with palmoplantar psoriasis are affected to a greater degree by the physical aspects of the disease than patients without palmoplantar involvement.

Adult↗
PubMed1983

Hand injuries and disorders. Principles of management for the family physician.

Hand injuries and disorders constitute a major cause of disability and time lost from work. Viewed as relatively minor, they are often neglected until permanent disability and restriction of function occur. The first physician to evaluate and treat an injured hand often determines the ultimate outcome of the patient's hand function. Skillful diagnosis and appropriate treatment are necessary. Neglected or mistreated injury may result in significant impairment in a person whose livelihood depends on the skillful, integrated function of both hands.

Burns↗
PubMed1986

Blistering diseases in children. How to recognize and treat the most common.

The most common blistering diseases encountered in children are impetigo, burns, acute dermatitis, friction blisters, viral blisters, insect bite reactions, and linear IgA dermatosis. Diagnosis should be based on specific clinical manifestations and, when necessary, results of a Tzanck test or skin biopsy. A search for an intact blister is always warranted when erosions, oozing, or crusts are noted.

Acute Disease↗