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Hypersensitive and insensitive extremities. The dermatological aspects.

The importance of physically intact hands and feet is taken for granted and consequently not appreciated until they are functionally impaired by vascular or neural injury of disease. The pathogenesis and clinical manifestations of cutaneous lesions complicating hypersensitive and insensitive limbs are described. The current therapeutic approaches and measures for these conditions are presented. Protection and prophylaxis trauma for neurologically impaired parts are emphasized.

Female↗

Hand, foot, and mouth disease: a case report.

Hand, foot, and mouth disease is a viral infection related to coxsackieviruses A5, A6, A9, and A10, coxsackieviruses B2 and B5, and echovirus 11. It generally affects children, but this article presents a clinical case of a young woman with hand, foot, and mouth disease. Patients with this disease have oral and skin lesions that may be confused with other diseases. The differential diagnosis is very important because both dental and medical professionals may misdiagnose the disease and sometimes prescribe an inappropriate medication.

Adult↗

[Lentigo benigna. Removal with the Q-switched ruby laser].

The Q-switched ruby laser (wave-length 694 nm, pulse duration 25 ns or 40 ns) causes selective damage to natural or artificial pigment. This laser has produced very good results in the treatment of amateur, professional and traumatic tattoos and of a number of benign pigmented lesions. We report on two patients with lentigines treated effectively with a Q-switched ruby laser.

Aged↗

Non-dermatophytic molds as agents of onychomycosis in Izmir, Turkey - a prospective study.

The purpose of this study was to determine the prevalence of causative non-dermatophytic filamentous fungi in onychomycosis. Totally 1,222 (1,222 x 3 = 3,666) samples of nail scrapings from 1,146 patients (from 76 patients two specimens: both from finger- and toe-nails) with prediagnosis of onychomycosis sent to the Mycology Laboratory from the Clinic of Dermatology, Ege University Hospital, Izmir, Turkey, July 2001-December 2003, were prospectively studied with conventional mycological procedures. The set criteria for the diagnosis of onychomycosis due to non-dermatophytic molds were: (1) Observation of fungal elements in 15% KOH-preparations made from nail scrapings, (2) growth of the same mold in all three consecutive cultures of the specimens taken three times from the same patient with one-week intervals, (3) no growth of a dermatophyte or yeast in three consecutive cultures. As agents of onychomycosis molds were detected in 33 (9%), dermatophytes in 175 (48%), yeasts in 150 (41%), and mixed (two different fungi) in 8 (2%) patients. In cases of mold onychomycosis, 11 (33%) had finger-nail and 22 (67%) toe-nail infection; 25 (76%) were female and 8 (24%) male; and 27 (82%) were above 40 years of age. The agents of mold onychomycosis, in order of frequency, were Aspergillus niger (7), Acremonium spp. (6), Fusarium spp. (6), Ulocladium spp. (4), sterile mycelia (2), Alternaria sp. (1), Aspergillus flavus (1), Aspergillus fumigatus (1), Aspergillus terreus (1), Cladosporium sp. (1), Paecilomyces spp. (1), Scopulariopsis sp. (1) and Trichoderma sp. (1). In conclusion, this study showed that non-dermatophytic molds were responsible for nearly 10% of onychomycoses cases attending the dermatology outpatient clinic of a university hospital in Izmir, Turkey. Since molds are common contaminants in the laboratory, cultures from consecutively taken nail scrapings should be made and carefully evaluated in order to diagnose a "mold onychomycosis".

Acremonium↗

Human orf.

Human Orf is an uncommon viral disease acquired through contact with infected sheep and goats. We report five cases of human Orf acquired while preparing mutton. The clinical picture and the management of human Orf are presented. Awareness of the benign nature of the condition is important in preventing ill-advised therapy.

Adult↗

Childhood-onset familial porphyria cutanea tarda: effects of therapeutic phlebotomy.

Cutaneous fragility at age 2 years with blistering, scarring, milia, and hypertrichosis at age 4 years were noted in an otherwise healthy girl who had no family history of porphyria. Results of porphyrin analyses of urine, serum, and red blood cells revealed a pattern consistent with porphyria cutanea tarda. Red blood cell uroporphyrinogen decarboxylase activity was diminished to approximately 50% of normal in the child and in her mother and maternal grandmother, who were without symptoms; activity was normal in her sister, father, and maternal grandfather. Therapeutic phlebotomies were followed by a biochemical and clinical remission.

Bloodletting↗

Sure signs.

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Adult↗

Generalized melanosis in occult primary melanoma.

Once encountered, generalized melanosis as a consequence of disseminated melanoma is not easily forgotten. Cases in the literature usually have resulted from primary cutaneous melanoma. A case of generalized melanosis caused by an occult primary melanoma is reported in a patient who originally complained of increased pigmentation. Findings of light microscopic studies of involved skin, pathogenesis of generalized melanosis, and possible sites of origin of the primary neoplasm are discussed.

Adult↗

[Skin manifestations associated with myelodysplastic syndromes].

PURPOSE: Our purpose was to describe cutaneous manifestations associated with myelodysplastic syndromes. METHODS: Data from seven patients with cutaneous vasculitis (four cases), neutrophilic dermatosis (one case), relapsing polychondritis (one case), and possible erythema elevatum diutinum (one case) in association with myelodysplastic syndrome (refractory anaemia RA, RA with excess of blasts--RAEB-, RAEB in transformation RAEBt, chronic myelomonocytic leukaemia--CMML-), and analysis of the literature were reviewed. RESULTS: The cutaneous manifestations of myelodysplastic syndrome may or may not be specific, and may reveal hemopathy transformation. The cutaneous vasculitis are the most frequent and polymorphic. The relation with neutrophilic dermatosis is more specific; they are a spectrum of diseases including pyoderma gangrenosum, Sweet's syndrome, erythema elevatum diutinum (nuclear segmentation anomalies of neutrophils both in the skin and in the blood are a biological marker of the association). Relapsing polychondritis is significantly associated with myelodysplastic syndromes. Their pathogenesis are controversial. CONCLUSION: Early biopsy of cutaneous lesions in myelodysplastic syndromes is indicated. Analysis of blood cell count (and more bone marrow biopsy in relapsing polychondritis) is indispensable in these neutrophilic cutaneous or vasculitis diseases.

Adult↗

Allergic contact dermatitis caused by parabens: 2 case reports and a review.

Parabens, methyl, ethyl, propyl, benzyl, and butyl, are the most common preservatives in use today. They are the alkyl esters of p-hydroxybenzoic acid and are used extensively because they are relatively nonirritating and nontoxic and offer good antimicrobial coverage. Testing for paraben allergen can be done by patch testing. Two cases of allergic contact dermatitis (ACD) to parabens are used to discuss the background of parabens, their allergenicity, patch testing issues, and several "paraben paradoxes." Although ACD to parabens has been reported, given the widespread use, it is relatively uncommon. Because of their low rate of allergenicity and their favorable preservative profile and efficacy, parabens remain the number one preservative in use.

Adult↗

Occupational protein contact dermatitis to cornstarch in a paper adhesive.

BACKGROUND: Protein contact dermatitis is better known in food-service and health-care workers than in industrial workers. Cornstarch has seldom been a problem, although it can cause contact urticaria to glove powder. OBJECTIVE: To present the case of a paper-bag maker who developed severe occupational (protein) contact dermatitis within two-three hours after returning to work. She lacked any evidence of urticaria and demonstrated largely negative patch-test results. METHODS: Following a history of occupational exposure to a cornstarch-based adhesive, the patient was patch-tested to materials with which she had worked, which she contacted, and with which she had attempted treatment. Following patch testing, she was prick-tested to cornstarch, the principal ingredient in the adhesive. RESULTS: Patch testing was negative except for a very mild reaction to the adhesive. Prick testing to cornstarch was more severe than the histamine control. The test site became eczematous and remained so for more than ten weeks. Avoidance of cornstarch and the adhesive was followed by clearing. CONCLUSION: Workup for prominent occupational contact dermatitis without urticaria may sometimes require testing for type 1 allergy.

Adhesives↗

Allergic contact dermatitis in American aircraft manufacture.

BACKGROUND: This study was prompted by the paucity of generally available information on the materials used in modern aircraft manufacture and the allergic contact dermatitis caused by those materials. OBJECTIVE: The purpose of this study was to review the author's experience with aircraft workers over a period of 5 years, with attention to documentable allergic contact dermatitis (ACD) that can be attributed to their work. METHODS: All patients who were referred for evaluation of a possible work-related injury were subjected to a routine workup. This included an occupational history, a specific delineation of their jobs, review of Material Safety Data Sheets, physical examinations, patch testing to possible causative agents, and, when necessary, inspection of the specific workplaces. RESULTS: Forty-four workers were found to have ACD that, more probably than not, was caused by a specific material in their workplaces. Although many common contactants appeared with predictable frequency, the use of "pre-preg" materials and modern sealants often led to ACD that could not be diagnosed with "standard" screening trays of test materials. CONCLUSION: When evaluating dermatitis in someone engaged in the manufacture of aircraft, one must be aware of the numerous materials used in this industry that have the potential to cause ACD.

Adult↗