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At least 919 records · Page 51Linked to original sources
PubMed2003

Epidermal grafting in vitiligo: influence of age, site of lesion, and type of disease on outcome.

BACKGROUND: The success of suction blister epidermal grafting may be influenced by various factors, all of which have not been studied to date. OBJECTIVE: We sought to determine the influence of age of the patient, site of vitiligo patch, and type of disease on the outcome of the procedure in our patients and in the cumulative data derived from literature analysis. METHODS: This was a retrospective, uncontrolled case series and literature review of suction blister epidermal grafting in patients with stable and recalcitrant vitiligo. All published studies of suction blister epidermal grafting in vitiligo involving 10 or more patients were included in the literature analysis. RESULTS: The procedure was performed in 143 patients. However, sufficient length (6 postoperative months) of follow-up was available in only 117 patients, and only these patients were included for analysis. Only limited information was available about various factors in the majority of published studies. The success rates for generalized and segmental/focal disease in this study were 53% (confidence interval [CI] 42-64) and 91% (CI 81-100), respectively (P <.001), and in the literature, 61% (CI 46-76) and 88% (CI 82-94), respectively (P <.01). The success rates in patients aged < 20 years and >or= 20 years in this study were 82% (CI 67-97) and 58% (CI 48-68), respectively (P <.05), and in the literature, 100% and 66% (CI 56-76), respectively (P <.05). There was no significant difference in the success rates achieved on different body sites in this study and in the screened literature. Among adverse reactions, hyperpigmentation in 32% (CI 24-40) and 17% (CI 14-20), infection in 6% (CI 2-10) and 0%, and contact dermatitis in 1% (CI 0-3) and 1% (CI 0-2) of patients were observed in this study and in the analyzed literature, respectively. CONCLUSIONS: The results were significantly better in segmental/focal vitiligo than in the generalized type, and in individuals < 20 years of age. However, unlike in medical therapies, localization of the vitiligo patch did not influence the treatment outcome significantly.

Adolescent↗
PubMed2000

Modulation of urokinase-type and tissue-type plasminogen activator occurs at an early stage of progressing stages of chronic venous insufficiency.

Chronic venous insufficiency (CVI) progresses through a series of clinical stages, from healthy skin to poorly healing leg ulcers. The aim of this study was to analyse the distribution pattern and activity level of urokinase-type (uPA) and tissue-type plasminogen activators (tPA) in normal skin and in tissue biopsies of progressing stages of CVI, prior to and including venous ulceration. Biopsies 6 mm thick were taken from 14 healthy volunteers and 37 patients with 5 different stages of CVI: telangiectases; stasis dermatitis; hyperpigmentation; lipodermatosclerosis; and leg ulcer. Changes in the enzymatic activity and spatial localization of uPA and tPA during the progression of CVI were examined using in situ histological zymography. Normal skin and skin with telangiectases showed a punctate PA activity, consisting of both uPA and tPA activity. As CVI progressed, an increase in the distribution of uPA and a decrease in tPA activity was observed. The spatial localization of uPA was widespread within the dermis of biopsies from stasis dermatitis and lipodermatosclerosis and was associated in particular with the dermoepidermal junction. Hyperpigmented skin revealed a pattern of PA expression similar to that of healthy skin. However, leg ulcer specimens exhibited peak levels of uPA with little tPA. Furthermore, a plasminogen-independent protease activity that was not present in any of the earlier stages of CVI appeared. Our results indicate that there are profound changes in PA activity during the progression of CVI and that these changes begin early in CVI, for example, in stasis dermatitis. We hypothesize that the balance or imbalance of the PA activity in the later stages of CVI is an important pathogenic factor for the development of venous leg ulcer.

Adult↗
PubMed1998

Side effects from the pulsed dye laser: the importance of skin pigmentation and skin redness.

The pulsed dye laser is the treatment of choice for port-wine stains. In this study we evaluate the importance of preoperative skin pigmentation and skin redness for the development of side effects from one treatment with the pulsed dye laser. A risk assessment is performed and skin reflectance measurement objectifies postoperative pigmentary changes. Fourteen human volunteers (skin types I to V) were laser-treated on the inside of the proximal brachium. Photographic documentation was used for blinded, clinical evaluation of side effects 3 and 6 months postoperatively. Skin was artificially reddened using topical application of 10% nicotinic acid cream. The development of pigmentary alterations and texture changes depended on the preoperative pigmentation and redness degrees. The risk of inducing clinically visible pigmentary alterations and texture changes increased with higher preoperative skin pigmentation and redness degrees, and with the application of increasing laser doses. Pigmentary alterations were induced at a lower fluence level than texture changes. The risk of side effects was higher 3 months postoperatively than 6 months postoperatively, substantiating a gradual disappearance of side effects. Skin reflectance measurements documented postoperative hyperpigmentation that faded partially from 3 to 6 months postoperatively. This is the first human experimental model for port-wine stains which provides quantitative data on the relationship between preoperative skin colours and postoperative clinically disturbing side effects.

Administration, Cutaneous↗
PubMed1999

Expression of the adhesion molecules ICAM-1, VCAM-1, LFA-1 and VLA-4 in the skin is modulated in progressing stages of chronic venous insufficiency.

In inflammation and wound healing, dynamic changes in cell adhesion and migration are fundamental properties of the cells involved. Disturbed interaction of leukocytes with microvascular endothelial cells has been proposed to be a central pathogenic factor in chronic venous insufficiency. This disease may therefore serve to elucidate dysregulated modulation of adhesion molecule expression in conditions of chronic inflammation and impaired wound healing. In this study, we determined how the expression of ICAM-1/VCAM-1 on endothelial cells and their ligands LFA-1/VLA-4 on leukocytes is modulated in skin of progressing stages of chronic venous insufficiency. Immunohistochemical staining of skin biopsies revealed an increase in the expression of ICAM-1 and VCAM-1 on endothelial cells in an early stage of venous disease such as stasis dermatitis. Such protein expression correlated with an increase of corresponding mRNA in skin biopsies. Expression of these CAMs on endothelial cells was accompanied by the occurrence of a marked perivascular infiltration of leukocytes, which expressed increased levels of LFA-1 and VLA-4. In progressing stages of chronic venous insufficiency, characterized by hyperpigmentation and lipodermatosclerosis, which precede skin ulceration, all these CAMs remained upregulated on endothelial cells and infiltrating leukocytes. Our findings indicate that following an initial peak expression during stasis dermatitis, vascular ICAM-1 and VCAM-1 expression is not downmodulated to baseline levels, but remains upregulated. This possibly promotes tissue damage by a perpetuated, upregulated influx of activated leukocytes, finally leading to skin ulceration.

Adult↗
PubMed1993

Unusual presentation of cytomegaloviral infection in a 5-month-old baby: case report.

Painful restricted movements of the extremities, hyperpigmentation over swollen joints, and a sclerema-like feel to the skin with increased serum triglyceride was seen in a 5-month-old baby with postnatal CMV infection. In an infant with pseudoparalysis of the limbs, the possibility of CMV infection has to be considered.

Cytomegalovirus Infections↗
PubMed1999

Treatment of spider veins of the leg using a long-pulsed Nd:YAG laser (Versapulse) at 532 nm.

BACKGROUND AND OBJECTIVE: Prior studies have shown improvement in leg telangiectasias using a long pulse, frequency-doubled nd:YAG laser at 532 nm. The following study, with longer follow-up, was undertaken to determine the effectiveness of this laser and incidence of side-effects from a single treatment for lower extremity telangiectasia of less than 1 mm in diameter. MATERIALS AND METHODS: Ten patients of skin types I-III received a single treatment on each of 18 treatment sites. One to three passes were used on each vessel with a repetition rate of 2 Hz. Two energy fluences of 12 J/cm2 and 16 J/cm2 were compared. Patients were followed for 1 year with follow-up photographs taken, from which the percentage of vessel clearance and side-effects were rated. RESULTS: Overall, 44% of patients had a greater than 50% clearance from a single treatment using the frequency-doubled Nd:YAG laser at 532 nm. The higher fluence of 16 J/cm2 showed a better response than the lower fluence of 12 J/cm2. Side-effects were more marked and were seen in more patients treated at 16 J/cm2 than at the 12 J/cm2 setting. Some 94% of patients had hyperpigmentation that took up to 6 months to resolve. One patient treated at 16 J/cm2 experienced blisters, crusts and scarring, which persisted for 1 year. There was further improvement from 6 months to 1 year in one-third of the treatment sites. CONCLUSION: The long-pulsed Nd:YAG laser at 532 nm with a chilled sapphire tip can treat leg telangiectasias of 0.5 to 1.0 mm in diameter with greater than 50% clearance at 44% of sites with a single treatment. Higher fluences of 16 J/cm2 demonstrated a greater clearance, but also greater adverse effects, including atrophic scarring persisting for 1 year. Further clinical improvement was seen at 6-month to 1-year follow-ups.

Adult↗
PubMed2006

Tazarotene versus tazarotene plus hydroquinone in the treatment of photodamaged facial skin: a multicenter, double-blind, randomized study.

OBJECTIVES: To compare the efficacy and tolerability of tazarotene plus hydroquinone versus tazarotene alone in the treatment of facial photodamage. METHODS: Patients with facial mottled hyperpigmentation of at least moderate severity and an overall integrated assessment of photodamage score of at least moderate applied tazarotene 0.1% cream each evening and either hydroquinone 4% cream or placebo cream each morning for up to 24 weeks. RESULTS: Among 131 patients enrolled, 114/124 (92%) with exit data completed. Both regimens were highly effective in reducing photodamage, with tazarotene plus hydroquinone showing superiority over tazarotene alone for some efficacy measures. The incidence of >or=1-grade improvement from baseline (on a scale of none, minimal, mild, moderate, or severe) was significantly greater with tazarotene plus hydroquinone than with tazarotene alone for lentigines (weeks 12-24, p or=50% global improvement was also significantly superior with the combination regimen as early as week 8 (p<or=0.01). Both regimens were associated with good tolerability and high patient satisfaction (no significant between-group differences). CONCLUSIONS: The adjunctive use of hydroquinone can enhance the efficacy of tazarotene in reducing dyspigmentation associated with photodamage.

Administration, Topical↗
PubMed2006

Appearance-related side effects of HIV-1 treatment.

In the early years of the AIDS epidemic, HIV infection was associated with visible signs and symptoms, adding to the stigma associated with the disease. Physical manifestations associated with HIV infection included muscle wasting, lymphadenopathy, Kaposi's sarcoma, candidiasis, molluscum contagiosum, and hairy leukoplakia. With the advent of antiretroviral therapy, particularly the introduction of highly active antiretroviral therapy in 1996, many of these outward manifestations of the disease became rare. Ironically, however, the treatments used to control HIV infection (and its visible markers) have themselves been associated with appearance-related side effects. Patients may develop changes in fat distribution, rashes, skin hyperpigmentation, or paronychia. These effects not only have cosmetic and psychological consequences but also may decrease adherence to therapy, potentially causing regimen failure and drug resistance. Newer antiretroviral agents offer improved potency, more convenient dosing, and more treatment options with the potential for fewer side effects and drug interactions, which should foster optimal adherence by the patient. However, these newer drugs are also associated with appearance-related side effects, which must be considered in the selection of treatment regimens. This paper reviews the appearance-related side effects associated with classes of antiretroviral drugs as well as individual agents, including the newer antiretrovirals.

Alopecia↗
PubMed2006

Traumatic tattoo: use of the variable pulsed erbium:YAG laser.

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of removing traumatic tattoos in the skin by laser. The objective was to achieve selective dermabrasion on the tattoo site without injuries to the surrounding skin, as in the classical mechanical dermabrasion. METHODS: Four patients with traumatic tattoos in the face were treated by a variable pulsed erbium:YAG laser. The fluence of the ablative pulses was 5 J/cm(2). The end-point for the treatment was the macroscopic removal of the foreign bodies. Postoperatively, silver sulphadiazine or polyvinylpyrrolidone was applied daily until wound closure occured. Use of a total sun block was mandatory for a period of 6 months. Pre- and post-operative photographs were taken of all cases. The results were evaluated by a panel of four independent observers, who were asked to judge the percentage of tattoo clearance as well as any evidence of pigmentation problems or scarring. RESULTS: All results were rated from good to excellent. In all patients, a nearly complete clearance of the traumatic tattoo was achieved in one laser session. No scarring, skin atrophy, or hypo- or hyperpigmentation was observed. Furthermore, a high patient satisfaction rate was achieved. CONCLUSION: The selective ablation of scar/foreign body tissue is a safe procedure. Compared to results reported with 1064-nm laser treatments, where several laser procedures are necessary, better clearance and scar quality was observed. Compared to mechanical dermabrasion, the procedure is more reliable and causes fewer side effects.

Accidents, Traffic↗
PubMed1995

Pigmented longitudinal bands of the nail. A clinicopathologic study.

Eighteen patients with pigmented longitudinal bands of the nail were evaluated. The following clinical data were obtained: age, gender, and race, duration of the pigmented bands, description and location of the lesion, history of any clinical changes; other nail changes; and family and past history. Nail matrix and/or nail bed biopsy were performed in all cases. The histopathologic findings of 18 patients with longitudinal melanonychia showed hyperpigmentation of the epidermis with no apparent increase in the number of melanocytes in 10 cases. One case showed melanoma in situ; another showed keratinocytic proliferation with focal atypia. Three cases showed subungual hemorrhage. The cause of solitary pigmented bands is often not readily apparent, making the clinical diagnosis challenging. Melanotic macule of the nail matrix, consisting of increased pigmentation of the epidermis with no apparent increased in the number of melanocytes, seems to be the most common cause. When the cause of longitudinal melanonychia is not clinically apparent, biopsy of the nail matrix and the nail bed should help to establish it.

Adult↗
PubMed1998

Weekly 24 h infusion of high-dose 5-fluorouracil and leucovorin in patients with biliary tract carcinomas.

From October 1995 to June 1997, 19 chemotherapy-naive patients with pathology-proven locally advanced or metastatic biliary tract carcinomas (BTC) were enrolled. The regimen consisted of 5-fluorouracil (5-FU) 2600 mg/m2 and leucovorin (LV) 150 mg by weekly 24 h infusion for 6 weeks and followed by a 2 week break. The treatment was terminated if disease progressed, the patient refused or unacceptable toxicity occurred. All patients required a Port-A catheter insertion and were treated at outpatient clinics by portable infusion pumps. There were 12 males and seven females with a median age of 62 years (range 45-77). The primary tumor sites were nine intrahepatic cholangiocarcinomas (CC), three perihilar CC, one distal BTC and six gallbladder cancers. A total of 179 chemotherapy sessions were given with a mean of 9.5 (range 2-18). Eighteen patients were evaluable for response. The response rates were: 33% (six of 18) partial response (PR), 39% (seven of 18) stable disease (SD) and 28% (five of 18) progressive disease (PD). All of the patients were evaluable for toxicity. The most common toxicities were mild fatigue (nine of 19, 47%), loss of appetite (nine of 19, 47%), skin hyperpigmentation (five of 19, 26%) and diarrhea (two of 19, 11%). Only one patient had grade IV myelotoxicity with sepsis but without treatment-related death. The median time to progression was 4 months. The overall median survival time was 7.0 months. The median survival time of the PR was not reached, SD was 8.0 months and PD 3.5 months. In conclusion, weekly high-dose 5-FU with LV by 24 h infusion in an outpatient setting for patients with BTC is effective, only mildly toxic and deserves further study.

Aged↗
PubMed2002

Green skin discoloration associated with multiple organ failure.

OBJECTIVE: To report intense green hyperpigmentation related to FD & C Blue No. 1. DESIGN: Retrospective case review. SETTING: Surgical intensive care unit. PATIENT: A 67-yr-old woman with unstable angina, electrocardiographic S-T segment elevation, and a left ventricle thrombus requiring emergent coronary revascularization surgery. INTERVENTIONS: Postoperative monitoring and treatment for multiple organ dysfunction that included small-bowel tube feeding and propofol sedation. MEASUREMENTS AND MAIN RESULTS: The patient developed an intense green skin color. CONCLUSION: Patients with multiple organ failure may be at risk for unusual pigmentation effects from tube feeding dyes.

Acute Kidney Injury↗
PubMed1997

Postoperative care following CO2 laser resurfacing: avoiding pitfalls.

Facial skin resurfacing using the carbon dioxide laser has become an increasingly popular procedure. Improvements in carbon dioxide laser technology have made the procedure simpler and more reliable. However, difficulties in the postoperative period can lead to patient morbidity and physician anxiety. Common problems such as prolonged erythema, hyperpigmentation, acne, milia, dermatitis, and infection can be controlled or avoided with proper postoperative care. Less common sequela such as hypertrophic scarring and prolonged healing are often a results of errors committed in the postoperative period. The authors have performed laser resurfacing in almost 2100 patients in the last 4 years. Changes in the postoperative regimen to include no pretreatment, use of semipermeable dressings, antiviral and antibacterial prophylaxis, and early treatment with sunscreens and bleaching agents have made for a smoother recovery with more predictable results.

Antiviral Agents↗
PubMed2003

Arsenic in drinking water and skin lesions: dose-response data from West Bengal, India.

BACKGROUND: Over 6 million people live in areas of West Bengal, India, where groundwater sources are contaminated with naturally occurring arsenic. The key objective of this nested case-control study was to characterize the dose-response relation between low arsenic concentrations in drinking water and arsenic-induced skin keratoses and hyperpigmentation. METHODS: We selected cases (persons with arsenic-induced skin lesions) and age- and sex-matched controls from participants in a 1995-1996 cross-sectional survey in West Bengal. We used a detailed assessment of arsenic exposure that covered at least 20 years. Participants were reexamined between 1998 and 2000. Consensus agreement by four physicians reviewing the skin lesion photographs confirmed the diagnosis in 87% of cases clinically diagnosed in the field. RESULTS: The average peak arsenic concentration in drinking water was 325 microg/liter for cases and 180 microg/liter for controls. The average latency for skin lesions was 23 years from first exposure. We found strong dose-response gradients with both peak and average arsenic water concentrations. CONCLUSIONS: The lowest peak arsenic ingested by a confirmed case was 115 microg/liter. Confirmation of case diagnosis and intensive longitudinal exposure assessment provide the basis for a detailed dose-response evaluation of arsenic-caused skin lesions.

Adolescent↗
PubMed2005

Nail discoloration induced by doxycycline.

All tetracyclines are deposited in calcifying areas of the bones and teeth and may cause discoloration. Although hyperpigmentation of the skin, teeth and nails have been reported and well documented due to other tetracycline intake, it has been rarely reported that discolored nails induced by doxycycline in pediatric patients. Here we report an 11-year-old-boy with nail discoloration caused by doxycycline intake.

Brucellosis↗
PubMed2005

Atypical presentation of shock from acute adrenal insufficiency in an adolescent male.

OBJECTIVE: To report an atypical presentation of shock and acute adrenal insufficiency in an adolescent male. CASE SUMMARY: A 14-year-old boy with a history of nocturnal enuresis presented with a clinical picture suggestive of septic shock refractory to aggressive fluid and vasopressor management. History and physical examination were suggestive of shock secondary to an infectious etiology, associated with skin findings of hyperpigmentation. The laboratory studies were remarkable for normal sodium, potassium, glucose, as well as normal renin levels. Hydrocortisone therapy led to improvement of his blood pressure and allowed weaning of vasopressor medications. Further laboratory studies, including adrenocorticotropic hormone stimulation test and adrenal antibodies, confirmed the diagnosis of primary adrenal insufficiency. CONCLUSION: Acute adrenal insufficiency is an uncommon cause of shock in the adolescent population. We report a clinical presentation suggestive of shock secondary to acute adrenal insufficiency remarkable for an atypical clinical and laboratory presentation. We further provide information on the management of acute adrenal crisis.

Acute Disease↗
PubMed2003

Lipoaspiration and its complications: a safe operation.

Although lipoaspiration has been considered a safe surgical procedure for the last 30 years, reports indicate that this procedure has a high index of complications. This study was performed to analyze experience with patients in a clinical practice for the past 8 years who underwent lipoaspiration, either alone or in combination with another surgical procedure, and to compare the results with previous reports in the literature. The patients were divided into four groups: lipoaspiration alone of less than 5 liters, lipoaspiration alone of more than 5 liters, lipoaspiration combined with abdominoplasty, and lipoaspiration combined with another surgical procedure. Complications were divided into minor or major, depending on previous reports, and statistical analysis was used to determine any significant difference among the four groups. From January of 1994 to December of 2001, 1047 patients underwent lipoaspiration, either alone or in combination with another surgical procedure. A 21.7 percent incidence of minor complications was noted, as well as a 0.38 percent incidence of major complications. Minor complications included palpable and visible irregularities, seromas, cutaneous hyperpigmentation, overcorrection, cutaneous slough, and local infection. Major complications included fat embolism syndrome, cutaneous necrosis, and extended infection. No statistical difference was noted among the groups studied. The incidence of complications was similar to that in clinical reports in the world literature, being of a low percentage rate when compared with the reports of other types of surgical procedures. On the basis of these results, lipoaspiration continues to be a safe surgical procedure, but to maximally avoid complications, one should be mindful of all the factors that could predispose to them.

Adolescent↗
PubMed2006

A side-by-side prospective study of intense pulsed light and Nd:YAG laser treatment for vascular lesions.

Recently, lasers and light systems are used more for the treatment of vascular lesions due to their noninvasiveness, ease of use, and short recovery time. This side-by-side prospective study compares results, satisfaction, and complications after intense pulsed light (IPL) and Nd:Yag laser treatment of small vascular lesions. Twenty-five patients with telangiectases, leg veins, or cherry angiomas underwent treatment of the same category of lesion in the same area. One year after completing treatment, patients were asked to report their satisfaction level after comparing digital photos before and after treatment; 72% felt they had good to excellent results after Nd:Yag treatment, while only 48% felt the same after IPL. The most common side effect after Nd:Yag was hyperpigmentation. Satisfaction level was significantly higher after Nd:Yag than after IPL. Patients with telangiectases, cherry angiomas, or leg veins <1 mm were more satisfied after IPL, while those with leg veins >1 mm were more satisfied after Nd:Yag. Overall, satisfaction with treatment of vascular lesions was greater with Nd:Yag although this method was more painful.

Adult↗