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PubMed1973

Pseudoendocarditis.

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Diagnosis, Differential↗
PubMed1987

Sternocostoclavicular hyperostosis: rheumatologic, radiologic, and dermatologic characteristics.

Two recently observed patients with sternocostoclavicular hyperostosis exemplify the characteristic presentation of this rheumatologic disorder. We describe its manifestations, review the literature on this subject, and discuss clinical and radiologic aspects, including the frequently associated dermatologic disorder palmoplantar pustulosis. Sternocostoclavicular hyperostosis is an increasingly common diagnosis, and practicing physicians should be aware of the distinctive features that allow accurate differentiation from psoriatic arthritis and other diseases.

Bone Diseases↗
PubMed1998

Hand dermatitis in intensive care units.

An investigation of the prevalence of occupational hand dermatitis in two intensive care units at a large teaching hospital was conducted. Information concerning the presence of occupational hand dermatitis, frequency of hand-washing, severity of the rash, aggravating conditions, history of atopy, and demographic factors (age, race, gender, and occupation) was collected via a self-administered questionnaire. The prevalence of occupational hand dermatitis was found to be 55.6% in the total reporting population of the units and was 69.7% in the most highly exposed workers (those reporting a frequency of hand-washing exceeding 35 times per shift). No relationship was found between occupational hand dermatitis and reported age, gender, race, atopic status, history of previous hand dermatitis, and duration of employment. Hand-washing frequency greater than 35 times per shift was strongly associated with occupational hand dermatitis (odds ratio = 4.13, P < 0.005). The high prevalence of occupational hand dermatitis found in this study of intensive care unit workers causes concern regarding the risk of health care workers in such units when exposed to blood-borne diseases.

Adult↗
PubMed2005

Circumscribed palmar or plantar hypokeratosis: two cases of a recently described entity of unknown origin.

Circumscribed palmar or plantar hypokeratosis is a new entity recently described by Perez et al in 2002. It seems to be underdiagnosed or clinically it is often misdiagnosed as Bowen's disease or porokeratosis. Obviously the number of case reports of circumscribed palmar or plantar hypokeratosis has increased since the first publication by Perez et al.The histopathological hallmarks of this condition are a stair-like configuration with an abrupt thinning of the stratum corneum from uninvolved to involved skin with a central hypokeratotic area. There are no atypical keratinocytes or cornoid lamellation. We describe two new patients with circumscribed palmar hypokeratosis. In one case there were additional histopathological features including the loss of granular cell layer in the center of the lesion and an overlying compact thin parakeratotic layer.

Bowen's Disease↗
PubMed2006

Histologic patterns of polyethylene glycol-liposomal doxorubicin-related cutaneous eruptions.

Polyethylene glycol (PEG)-liposomal doxorubicin (Stealth R, Doxil) is a formulation of doxorubicin, which is encapsulated in liposomes formulated with PEG. It is favored in the palliative setting over doxorubicin because of its generally favorable side effect profile. Adverse reactions are predominantly skin eruptions. We report 3 cases of women with breast cancer undergoing treatment with liposomal doxorubicin who developed palmar-plantar erythrodysesthesia and diffuse morbilliform eruptions. Biopsies in the 2 cases demonstrated vacuolar interface dermatitis with epidermal dysmaturation and the third case suggested a drug eruption. Additionally, we report a woman with metastatic breast cancer who developed a similar morbilliform eruption soon after completing a regimen of liposomal doxorubicin. The biopsy revealed an atypical squamous proliferation showing epidermal dysmaturation with focal evidence of interface damage. Both clinician and pathologist alike should be cognizant of this cutaneous eruption, as well as the histologic patterns.

Adult↗
PubMed1979

Volar melanotic macules.

Asymptomatic light brown or tannish-gray macules are seen on palms and/or soles of black patients, and occasionally on the volar surfaces of whites. They may be mistaken for lesions of secondary syphilis or other postinflammatory hyperpigmented dermatoses. Histologic examination of 14 specimens obtained at necropsy showed purely epidermal hyperpigmentation of all epidermal layers; or (3) melanin restricted to large dendritic melanocytes without appreciable transfer to keratinocytes. The number of melanocytes was not significantly increased, and with one exception, there were no nevus cells. These volar melanotic macules have close clinical and histologic resemblance to melanotic macules observed occasionally on the vermillion area of the lips.

Adult↗
PubMed2003

Chromium allergy: significance of both Cr(III) and Cr(VI).

Most studies investigating chromium allergy have been performed with Cr(VI). However, real exposure to chromium from leather products includes both Cr(III) and Cr(VI). We have determined and compared the minimum elicitation threshold (MET) concentration for Cr(III) and Cr(VI) in Cr(VI)-sensitive patients. In addition, reactions to combinations of Cr(III) and Cr(VI) were compared to reactions elicited by Cr(III) and Cr(VI) alone. Dilution series of Cr(III) and Cr(VI) were applied in Finn Chambers on the back of 18 patients. The patches were left for 2 days and readings were done on days 2, 3 and 7. The MET10% for Cr(III) and Cr(VI) was calculated from the dose-response curves to be 0.18 microg/cm2/48 h (6 p.p.m.) and 0.03 microg/cm2/48 h (1 p.p.m.), respectively. No significant differences in the response to combined Cr(III) and Cr(VI) solutions versus single solutions were found. Cr(III) was concluded to play an important role in chromium allergy, because Cr(III) and Cr(VI) were both capable of eliciting eczema at low concentrations. Rather than regarding chromium dermatitis as a result of Cr(VI) allergy alone, it may be more correct to consider it as a result of a combined Cr(III) and Cr(VI) allergy.

Carcinogens, Environmental↗
PubMed2004

The validity of the Mathias criteria for establishing occupational causation and aggravation of contact dermatitis.

Mathias proposed 7 criteria for establishing occupational causation and aggravation of contact dermatitis (Mathias, J Am Acad Dermatol 1989, 20, 842-848). 4 of the 7 criteria must be positive to conclude occupational dermatitis. In order to evaluate the validity of these criteria, we re-examined 19 patients (17 male and 2 female) with contact dermatitis, who had given a positive answer to at least 4 of the criteria and had either exchanged their workplace or stopped working. We re-evaluated them, 2-5 years later, for the presence of contact dermatitis. 14 of 19 patients (74%) reported that their dermatitis had cleared after they had left their previous workplace. Only 5 patients still suffered from dermatitis, 2-5 years later. 3 of these 5 patients could have been exposed to the causative allergens in their new workplace. We conclude that the Mathias criteria are useful to assess occupational contact dermatitis.

Adult↗
PubMed2004

Skin protection in nursing work: promoting the use of gloves and hand alcohol.

Nursing has been identified as a wet-work occupation, with a high prevalence of occupational irritant contact dermatitis. Reduction of exposure to skin irritants contributes to the prevention of occupational skin disease in nurses. The role of the use of soap and water, hand alcohol and gloves in prevention programmes is discussed. 2 additional measures for reducing exposure to skin irritants are postulated: use of hand alcohol instead of soap and water in disinfection procedures when the hands are not visibly dirty; use of gloves in wet activities such as patient washing to prevent the hands from becoming wet and visibly dirty. We investigated the effectiveness of these recommendations in a model. Mean daily wet-work exposure during nursing work was modelled: regular model. We also modelled exposure to skin irritants in combination with the implementation of these recommendations: prevention model. The hands of healthy volunteers were exposed to the regular or the prevention model over 3 weeks for 5 days a week. The change in transepidermal water loss (TEWL) on the back of the hands was measured after 3 weeks of exposure to these wet-work simulations. An increase in TEWL occurred with the regular model, while mean TEWL decreased in the prevention model. Skin irritation from occlusion by gloves appeared to be more pronounced in the regular model compared to the prevention model. The results of this study justify the conclusion that in nursing work, hand alcohol is the preferred disinfectant. Although the prevention model implies increased occlusive exposure, this has no additional irritant effect, probably because of the absence of soap exposure.

Adult↗