Vesicular, bullous and pustular disorders in infancy and childhood.
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Pregnancy is a period of profound endocrine and metabolic changes which are tolerated by the body for a relatively short time. During gestation both physiologic and pathologic changes can occur in the skin, nails, and hair shafts which should be recognized and appropriately managed by the dermatologist. These changes can conveniently be placed into five broad categories: (1) physiologic changes in skin and appendages caused principally by the hormonal milieu, (2) cutaneous tumors affected by pregnancy, (3) diseases specifically associated with pregnancy, (4) genital infections of perinatal importance, and (5) other dermatologic diseases influenced by pregnancy. A discussion of each of these topics reveals the vast spectrum of dermatologic disease seen in pregnancy and underscores the important role of the dermatologist in the care of pregnant patients.
The practicing dermatologist is faced with an ever-changing epidemiologic spectrum of cutaneous bacterial diseases. Studies have stated that bacterial skin infections may account for up to 17% of clinical visits. It is hoped that the information presented in this article will enable the practicing dermatologist to provide improved patient care in the diagnosis and management of bacterial infections of the skin.
The pustular disorders constitute a subgroup of the vesiculobullous disorders defined by the presence of eosinophils or neutrophils with prominent accompanying intercellular edema or a canthelysis involving various levels of the epithelium. Herein, we describe the clinical and pathologic attributes of the subcorneal, infectious, neonatal, papulosquamous, drug-induced and miscellaneous pustular conditions.
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Conventional serotyping for T antigens, rRNA gene restriction fragment length polymorphism analysis (ribotyping) and pulsed-field gel electrophoresis were compared for distinguishing among group A streptococci isolated in Albania between 1980-1982 and in 1995. A total of twelve serotypes were identified among seventy GAS strains. Ribotyping revealed eight and eleven distinct patterns after digestion with HindIII and PvuII, respectively. Twenty-three strains of serotype T12 were subdivided in 10 ribotypes and 11 strains of T2 serotype were differentiated in 5 ribotypes. By comparison, PFGE generated 37 patterns after SmaI digestion. The index of discrimination, using the Hunter-Gaston formula, was applied to assess the value of these methods for interpretation of the epidemiological data. For serotyping the value of index was 0.85. The ribotyping system revealed an ID of 0.83 when the combination HindIII and PvuII was used. This index reached 0.97 for PFGE. The methods used were useful to subtype the isolates of GAS.
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Geriatric dermatology is a specialty that is receiving particular attention. Among the other topics and diseases briefly covered here are dermatologic nursing home visits, decubitus ulcers, pruritus/xerosis, eczematous dermatitis, psychogenic dermatitides, infections of the skin, purpura, vascular compromise, chronic venous insufficiency, and bullous pemphigoid. Illnesses originating in other organ systems that are made manifest on the skin often complicate the diagnostic and therapeutic picture. Chronic diseases such as diabetes mellitus and HIV compound the problems in diagnosing and treating geriatric dermatologic diseases. Since the human population is living longer, chronic diseases will become more prevalent, as will diseases of the skin.
A 15 year old boy with scabies has been treated with local form of therapy for 3 month without effect. He was then admitted to our pediatric clinic with pyrexia and restricted movement of the right knee. The med. history, the consequent laboratory findings, positive bloodcultures, skin swabs and bone scintigraphy lead to diagnosis of acute haem. osteomyelitis. The early antibiotic therapy assured uneventful recovery.
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