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We report a case of palmar plantar erythrodysesthesia (PPE) in a case of acute lymphoblastic leukemia treated with VALP regime. The treating physician must be aware of this uncommon complication of chemotherapeutic agents to avoid unnecessary investigations.
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Onychomycosis is a frequent disorder in adults. The objective of the study was evaluation of finger and toe nails susceptibility to Candida albicans and a dermatophyte Trichophyton mentagrophytes infection in patients with symptomatic hypothyroidism and hyperthyroidism as compared with healthy persons. The materials comprised finger and toe nails from 23 patients with hypothyroidism (in 8 cases postoperative, and in 15 cases caused by Hashimoto type thyroiditis), and from 27 patients with hyperthyroidism (including 17 cases of Graves-Basedow disease, and 10 with nodular goitre). Nails from 22 healthy persons of similar sex and age distribution served as controls. A significantly more frequent and more intensive than in control group toe nail infection with C. albicans was found in the patients with both hypothyroidism and hyperthyroidism. The enhanced toe nail susceptibility to C. albicans infection did not depend on autoimmunological aetiology of both hypothyroidism and hyperthyroidism.
This paper reports on a case of oral melanosis resultng from Peutz-Jeghers Syndrome, a hereditary disease characterized by harmatomatous polyposis and by mucocutaneous melanic pigmentation, in a 14-year-old Fijian girl with a family history of the disease. The patient underwent surgery for treatment of an intestinal obstruction due to a small intestine intussusception. Recognition of the characteristic pigmentation by dentists may lead to early diagnosis of associated harmatomatous polyps or neoplastic disease that may be life threatening.
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BACKGROUND: Although hand dermatitis (HD) is a common occupational problem among hospital nurses, few epidemiological studies of this disease have been conducted in regional areas or tropical environments. AIM: The aim of our investigation was, therefore, to investigate HD prevalence and correlates among nurses within a unique Australian setting. DESIGN: We recruited a cohort of 148 female nurses from a large tertiary hospital in north Queensland, Australia, and administered a previously validated, self-reporting HD questionnaire. RESULTS: The 12-month period prevalence ranged from 43.2% to 59.3%, with an overall group mean of 50.0%. There were no statistically significant differences in HD prevalence between the different hospital wards (p=0.4238). During multiple logistic regression, a history of allergic rash was shown to increase the HD risk 5.5-fold (odds ratio: 5.5, 95% CI: 1.9-19.2, p=0.0038). The risk of HD was also related to increased hand washing frequency (OR 5.8, 95% CI: 1.1-33.4, p=0.0402). CONCLUSIONS: Overall, the occurrence of HD among Australian nurses was relatively consistent across the various hospital wards. Their 12-month period-prevalence of HD was, however, generally higher than previous reports from other countries.
Trachyonychia is the term used to describe nail plate roughness, pitting, and ridging that may affect 1 to 20 nails. Alopecia areata, psoriasis, lichen planus, atopic dermatitis, ichthyosis vulgaris, as well as other skin conditions have been associated with trachyonychia, but the causal relationship is often challenging to demonstrate histologically. Clinical evidence of these cutaneous disorders in conjunction with a nail matrix biopsy may help elucidate an etiology of trachyonychia, but many cases often remain idiopathic. Nail biopsy findings may match skin histology, but more commonly show spongiotic or nonspecific changes. We present an interesting case of a female with progressive development of trachyonychia in all 20 nails coinciding with a new diagnosis of sarcoidosis.
A 35-year-old female developed generalized pustules within a short period of time. Clinically, two distinct types of pustules were observed, viz. erythematous patches studded with crops of small pustules, and isolated large pustules with a red halo. Histologically, the former were subcorneal spongiform pustules, whereas the latter were unilocular pustules involving the hair follicular infundibulum or a subcorneal unilocular pustule on the palmo-plantar skin. On the basis of the sudden appearance of the pustules without any pre-existing lesions of psoriasis and the histological findings of the spongiform pustules, we made a diagnosis of the exanthematic type of pustular psoriasis. The lesions responded in a dose-dependent fashion to oral cyclosporin.
The purpose of this study was to compare the therapeutic efficacy of a hydrocolloid dressing (Actiderm) over a medium strength corticosteroid (triamcinolone acetonide (TAA) 0.1% cream) with that of a highly potent corticosteroid (clobetasol propionate 0.05% cream) in palmo-plantar pustulosis and localized pustular psoriasis. It was a randomized, open, prospective, right-left comparative trial in 19 patients. The Actiderm dressing and the TAA cream were applied every third day, whereas the clobetasol cream was applied twice daily for 4 weeks. Both treatments resulted in a significant improvement. On completion of treatment, complete clearance was found in 13 patients (63%) with Actiderm plus TAA, but in only 3 patients (21%) with clobetasol (p = 0.001). Four weeks after stopping therapy, the clinical parameters had returned to their pre-treatment level, except for erythema on the Actiderm plus TAA treated lesions (p less than 0.05). No clinically important adverse effects were reported or observed; in particular there was no sign of skin atrophy at the end of study. The results of this study demonstrate that Actiderm applied over a medium strength corticosteroid every third day is highly effective against palmoplantar pustulosis and localized pustular psoriasis. However, it is necessary to develop treatment regimens to maintain the improvement achieved.
The aim of the study was to present the own observations concerning treatment of patients above 50 years of age suffering the toe nail dermatophyte onychomycosis with intensified subungual keratosis and considerable nail plates destruction. Three different treatment methods were administered: 40 patients were treated only with itraconazole pulse method for 3 month, 35 patients besides itraconazole were given also pentoxifylline. In case of 20 individuals besides 3-month itraconazole pulse method treatment, the amorolfine varnish application onto changed nails once a week for 6 month was administered. In the group of patients treated only with itraconazole, in 22 cases (55,0%) the cure was obtained, while in the group of individuals given the combined therapy with pentoxifylline, the cures made 71,4% (25 individuals). From among patients treated with itraconazole and external amorolfine application the cures made 75,0% (15 individuals).
Onychomycosis is a public health concern because of its high world wide prevalence, and its potential for spread of fungal elements to others. About one half of all patients presenting to dermatologists' offices for nail disorders have onychomycosis. This kind of infection may impact upon physical, functional, and emotional aspects of life. Onychomycosis can be treated with the new generation of oral antifungals. Efficacy rates for fingernail onychomycosis are high; however, for toenail onychomycosis, efficacy rates may range from 60% to 80%. Relapse rates have been estimated to be 15% to 20% measured at 2 years following therapy initiation. Because many factors may be associated with a suboptimal clinical response, consideration to measures that reflect the most appropriate pharmacologic and supportive regimens must be made in order to meet the challenge of onychomycosis cure. In some situations supplemental therapy consisting of extra antifungal or adjunctive (topical/surgical) therapy may be beneficial.
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This case of Rothmund-Thomson Syndrome is presented because of its association with hitherto unrecognized disorders, especially internal malignancy. The position and linkage of these associated symptomes with the genetically determined syndrome of Rothmund and Thomson is discussed.
Alefacept is the first biologic agent approved by the US Food and Drug Administration for moderate to severe chronic plaque psoriasis. Prior clinical studies excluded patients with palmoplantar psoriasis or erythroderma. We report 2 patients with recalcitrant psoriasis who responded completely to a full course of alefacept. One patient presented with severe palmoplantar psoriasis recalcitrant to acitretin and methotrexate; another patient presented with erythroderma and was transitioned successfully from cyclosporine A. Alefacept provides another treatment option for palmoplantar and erythrodermic psoriasis and should be considered in the management of patients with these conditions.
Cutaneous warts are caused by human papillomavirus (HPV). Prevalence studies of the types of HPV present in cutaneous warts have been carried out more frequently in immunosuppressed patients. The present study was designed to study the association of high-risk HPV in cutaneous warts of immunocompetent patients. A total of 45 cases of cutaneous warts from various sites in immunocompetent subjects were analyzed for HPV. Samples included both archival material i.e., paraffin embedded and fresh tissue. Highly sensitive and comprehensive polymerase chain reaction (PCR) methodology for detection of HPV of high oncogenic potential, HPV 16/18, was employed. Human papillomavirus 16 was detected in 3 (6.6%) patients. None of the lesions demonstrated HPV 18. None of the cutaneous warts demonstrated histopathological features associated with dysplasia or neoplasia. The identification of HPV 16 in cutaneous warts, which are benign proliferations of the skin, further expands the spectrum of HPV-linked lesions. It remains of critical interest to determine whether these types are specifically associated with the development of malignant lesions analogous to those seen in anogenital cancer.
Papular-Purpuric Glove-and-Sock Syndrome is a rare, infectious disease, of viral etiology, characterized by the presence of pruritus, edema and symmetrical erythema, very well defined at the wrists and ankles with a gloves-and-socks distribution. Other areas can be affected, with a moderate erythema appearing in cheeks, elbows, knees, armpits, abdomen, groin, external genitalia, internal face of the thighs and the buttocks. Erosions, small ulcers, enanthema and blisters can be observed in the oral cavity and lips, and less frequently in other mucous membranes. Complications are rare, although they can be severe, 50% of the published cases are related with the Parvovirus B19. Due to its oral involvement stomatologists should be aware of this syndrome in order to carry out a correct diagnosis of the disease.