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PubMed1999

[Localized nocardiosis].

Primary cutaneous nocardiosis is a rare disease. It is observed in people in contact with soil, after trauma. It is produced by an aerobic actinomyces which is found on the ground. We present a case of localized Nocardiosis placed on the left anatomical snuffbox. The patient was a 52 year old farmer. At the time of first consultation, the three year old lesions appeared as plaques which showed crusts and numerous suppurative fistulae, together with non painful nodules. He had no regional adenopathies. Material was taken for mycological direct and culture exams. A biopsy was taken for Anatomopathology. The patient remembered having suffered a trauma on the left hand by his tools in harvest time.

Hand Dermatoses↗
PubMed2000

[Why should we treat onychomycosis with patience and perseverance? How can we overcome therapeutic failure?].

Antifungal treatments for onychomycoses may be long and expensive without, however, affording the guarantee of success. A review of the literature reveals that the current topical treatments and the oral intake of fluconazole are of long duration. They show moderate clinical efficacy and/or a pharmaco-economic profile less favorable than those of intermittent itraconazole therapy and terbinafine continuous therapy. Between the latter two options, itraconazole has some advantages because of its broad spectrum of activity against diverse types of fungi responsible for onychomycoses. The fungicidal activity of terbinafine exhibited in vitro cannot unfortunately be claimed in the in vivo situation when treating a patient. Some interactions exist between these antifungals and a few other drugs. Other side effects are rare and usually discrete and reversible.

Antifungal Agents↗
PubMed2000

Squamous cell carcinoma arising from lesions of porokeratosis palmaris et plantaris disseminata.

We report a 63-year-old Japanese man with numerous hyperkeratotic papules of porokeratosis palmaris et plantaris disseminata (PPPD) who developed multiple squamous cell carcinomas on the lesional sites of the palms and soles. The hyperkeratotic papules, which showed tightly packed columns of parakeratotic cells in the cornified layer (cornoid lamella), lost granular layer, and dyskeratotic keratinocytes in the epidermis below the cornoid lamella histologically, had been noticed on the palms and soles from the age of 28 and 43, respectively. He has no family history of such hyperkeratotic papules. Treatment with etretinate (10-50 mg/day) was given discontinuously, and the total dose of etretinate amounted to approximately 21 g over 14 years (average: 0.07 mg/kg/day). He noticed erosions on the hyperkeratotic papules on the left sole and palm more than 9 months after cessation of treatment with etretinate. Histological findings showed numerous atypical keratinocytes in the epidermis and upper dermis with mononuclear cell infiltration seen in the upper dermis. The diagnosis of squamous cell carcinoma arising from the lesions of porokeratosis palmaris et plantaris was made. Five erosions with histologically malignant changes were removed 1 cm from the margin of the erosions. These findings suggest that etretinate may have an inhibitory action on malignant changes in PPPD.

Aged↗
PubMedDate not supplied

Spiny keratoderma of the palms and soles - report of two cases.

We report two patients with spiny keratoderma of the palms and soles characterized by multiple tiny keratotic plugs on the palms and soles. This disease was reported to be possibly associated with internal malignancies. We found a tumor from the esophagus to cardia in one patient. Another had no tumor but the lesion occurred soon after a severe bronchial asthma attack. Causal relation between spiny keratoderma of the palms and soles and bronchial asthma is obscure. Since this disease has been under-diagnosed and under-reported, it is important for dermatologists to keep spiny keratoderma of the palms and soles in mind in daily clinical examinations.

Aged↗
PubMedDate not supplied

[Onychomycoses caused by non-dermatophytic filamentous fungi in Cádiz].

BACKGROUND: The incidence and clinical significance of other than dermatophytes fungi or moulds causing onychomycosis is unknown, because they may be colonising organisms rather than pathogen. This report presents the results of a study conducted between 1997 and 1999 to determine the incidence and aetiology of onychomycosis by non-dermatophytic filamentous fungi in the population of Cádiz (Spain). PATIENTS AND METHODS: Diagnosis of onychomycosis was performed by direct microscopic examination, culture and, some times, by histologic examination, on samples from 610 patients with clinical suspected fungal nail infections. RESULTS: Among 196 (32%) cases of ungual mycosis detected, 29 (15%) of them were caused by non-dermatophytic filamentous fungi, presenting positive direct microscopy and repeated cultures. Superficial and distal onychomycosis were the most frequent clinical types. Twenty two patients had onychomycosis of toenails. The highest incidence was found in women and subjects over the age 40. Scopulariopsis spp. (n = 11), Aspergillus spp. (n = 6), Alternaria spp. (n = 5) and Fusarium spp. (n = 4) were the most common fungi. Occasionally, Acremonium spp. and Scedosporium spp. were isolated. CONCLUSION: The incidence of onychomycosis caused by opportunistic fungi is not well known. For their diagnosis, it is important to select correctly the appropriate site for specimen collection, as well as direct microscopy and fungal cultures. The incidence of onychomycosis is high in Cádiz (Spain), being higher in women and older people. Predispondent factors are not always identified in the patients. Toenails were infected more than fingernails in both sexes. The results of our study suggest that Scopulariopsis spp. is an important agent of onychomycosis. Epidemiological investigations should be performed in every country in order to determine the fungal species responsible of onychomycosis.

Female↗
PubMed2000

[Endoscopic sympathectomy for palmar and plantar hyperhidrosis: results in 107 patients].

INTRODUCTION: Transthoracic endoscopic sympathectomy for palmar hyperhidrosis is a safe and effective method. However, no radical and definite treatment exists for plantar hyperhidrosis. We report our experience, immediate post-operative and mid-term results after transthoracic and lumbar endoscopic sympathectomy for palmar and plantar hyperhidrosis. PATIENTS AND METHODS: One hundred and seven of 117 patients cured between January 94 and December 98, answered a questionnaire regarding their past history, the early post-operative results, side effects and complications caused by the operation and mid-term results with particular emphasis on patient satisfaction. RESULTS: Seventy-eight thoracic and lumbar endoscopic sympathectomies and 125 thoracic endoscopic sympathectomies were performed. The patients were 30 men (median age 30 years) and 77 women (median age 26 years). Only women underwent lumbar endoscopic sympathectomy because of risk of retrograde ejaculation. No severe complications were noted. The success rate was 96 p. 100 for palmar hyperhidrosis and 98,5 p. 100 for plantar hyperhidrosis. No recurrences were noted in 97 p. 100 of the patients with median follow-up of 28 months. The main side effect was compensatory sweating which was the reason for dissatisfaction for 5 p. 100 of the patients. Cutaneous dryness and gustatory sweating were also described. However, 95 p. 100 of the patients were "satisfied" or "very satisfied". CONCLUSION: Our experience proved that lumbar endoscopic sympathectomy is as safe and effective for treatment of plantar hyperhidrosis, as thoracic endoscopic sympathectomy for palmar hyperhidrosis.

Adolescent↗
PubMedDate not supplied

Occupational allergic contact dermatitis from alkylammonium amidobenzoate.

Quaternary ammonium compounds are water-soluble antimicrobials which are widely used in disinfectants, sterilizers, skin cleansers and antiseptic creams. One quaternary ammonium compound, alkylammonium amidobenzoate (Osmaron B) has for decades been used in udder ointments. Here we present a ship technician with occupationally induced sensitization to alkylammonium amidobenzoate. The diagnosis was reached only when it emerged, after careful questioning, that the patient was exposed to a substance peculiar to his workplace but not to his occupation and was then patch tested for it. It turned out that an udder ointment had been used at the patient's workplace as a hand ointment. Patch testing was positive to the patient's hand ointment, and Osmaron B at 0.1-0.01% in petrolatum. Other sensitizing quaternary ammonium compounds, namely benzalkonium chloride, benzethonium chloride, benzoxonium chloride, N-benzyl-N,N-dihydroxyethyl-N-cocosalkyl-ammonium chloride, cetalkonium chloride, cetylpyridinium chloride, cetrimonium bromide, chloroallylhexaminium chloride, dequalinium chloride, domiphen bromide, methylbenzethonium chloride and 2,3-epoxypropyl trimethyl ammonium chloride are reviewed briefly. The importance of patch testing to all materials in use by the patient is emphasized. It is also important to select non-allergenic hand creams for use at work places.

Benzoates↗
PubMed2001

Occlusive versus nonocclusive calcipotriol ointment treatment for palmoplantar psoriasis.

Thirty-nine patients with a clinical diagnosis of palmoplantar psoriasis [23 (58%) males and 16 (42%) females] were included in this study with the aim of evaluating the efficacy of occlusive calcipotriol 50 micrograms/mg ointment vs. nonocclusive therapy. Patients were randomized to either twice-weekly overnight calcipotriol ointment under occlusion or twice-daily topical nonocclusive application of the same ointment for 6 weeks. The effect of treatment was assessed on the basis of a psoriasis signs score for erythema, thickness and scaliness, which was graded from 0 (absent) to 4 (most severe) at the first visit, after 2 weeks and at the end of treatment. Analysis of our results showed that twice-weekly occlusive calcipotriol ointment was as effective as the twice-daily application. The mean total score at baseline was 6 for the occlusive group and 6.1 for the nonocclusive group. The score decreased to 1.5 in both groups at the end of treatment. No significant adverse effects were reported by patients or investigators. We conclude that occlusive calcipotriol ointment is effective in the treatment of palmoplantar psoriasis and may produce even better results with more frequent use, such as application on alternate days.

Administration, Topical↗
PubMed2001

Types of onychomycosis.

Onychomycosis may be classified into several types: distal subungual, white superficial, proximal subungual, endonyx, and total dystrophic. Distal subungual onychomycosis (DSO), the most common type, involves the nail bed and, subsequently, the nail plate. White superficial onychomycosis (WSO) usually manifests as superficial white patches with distinct edges on the surface of the nail plate. Proximal subungual onychomycosis results when the fungal organism enters via the cuticle and the ventral aspect of the proximal nail fold. In endonyx onychomycosis, fungal organisms invade the nail plate without resulting nail bed hyperkeratosis, onycholysis, or nail bed inflammatory changes. In total dystrophic onychomycosis, complete dystrophy of the nail plate occurs; these changes may be primary or secondary.

Foot Dermatoses↗