Generalization of palmoplantar pustulosis after withdrawal of etretinate.
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Cases of onychomycosis represent up to 30% of diagnosed superficial fungal infections and are caused by three groups of fungi: dermatophytes, yeasts, and nondermatophytic molds. The majority of toenail infections are caused by dermatophytes; Trichophyton rubrum is isolated with the greatest frequency. In infections of fingernails, Candida species can be isolated as frequently as the dermatophytes. Of the molds, Scytalidium species can infect both fingernails and toenails, as well as adjacent skin, and represent 3% of the nail infections in a temperate country such as the United Kingdom but a much higher proportion in tropical countries. Other molds such as Scopulariopsis, Acremonium, and Aspergillus species can infect damaged nails. The isolation of a dermatophyte is always considered indicative of infection, but the presence of other molds, which may be aerial contaminants, must be interpreted with care.
Dermatophytes, yeasts, and molds can be the causative organisms of fungal nail infections. Alternatives to the systemic management of onychomycosis include topical and surgical treatments. Traditionally, topical agents used as monotherapy for onychomycosis are only able to inhibit the growth of fungal nail infections; clinical and mycologic cures have recently been observed after treatment with some of the newer preparations. In contrast, surgical treatments almost always need to be used in conjunction with either topical or systemic antifungal therapy. An efficacious topical treatment alternative for onychomycosis involves applying antifungal agents concurrently or sequentially with the removal or debridement of the infected nail structures. Alternatively, the application of antifungal lacquer to fingernail and toenail fungal infections may also be an effective topical therapy for the treatment of less severe forms of onychomycosis.
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A patient with an unusual form of palmoplantar hyperkeratosis is described. On thorough physical examination, widespread acanthosis nigricans was discovered. We believe this patient's distinctive keratoderma represents acanthosis nigricans.
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A 49-year-old woman developed palmoplantar pustulosis after 6 months of lithium therapy. Topical medications provided only fair control. Remission occurred when lithium was discontinued. Palmoplantar pustulosis is another of the psoriasiform diseases precipitated or exacerbated by lithium.
The varied clinical manifestations of pitted keratolysis in the soles and of ringed keratolysis in the palms are presented. The etiologic agent, a species of Corynebacterium, has been proved to produce similar lesions in experimental patients. The histopathology in the stratum corneum and its treatment are also summarized.
A disabling case of keratodermia palmoplantare papuloverrucoides progressiva is described. Less severe cases have been reported in the American literature as keratodermia punctata. The verrucoid lesions of our patient were spontaneously shed during treatment with the aromatic retinoid etretinate, and a daily maintenance dose of 25 mg was necessary to prevent recurrence.
A set of three comparison studies under varying conditions was performed to determine the efficacy of a cotton swab technic for obtaining material for culture of dermatophyte infections. Matched fungal cultures, one by swab and one by scrape, on each of 110 subjects showed that there was no difference in the two methods. The merits of this culture technic are explored and the conclusion is drawn that the cotton swab is an efficient and reliable adjunct to the practice of dermatology.
Palmoplantar pustules may rarely be associated with chronic recurrent multifocal osteomyelitis in children and young adults. Additional features of this disorder are recurrent low-grade fevers and bone pain. Skeletal radiographs and bone films suggest osteomyelitis, but bone cultures yield no growth of organisms. The cause of this disorder is unknown, and treatment remains unsatisfactory.