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PubMed2004

A study of leprosy reactions in a tertiary hospital in Delhi.

A retrospective study of 531 leprosy patients was undertaken to study the profile of reactions in the post Multi-Drug-Therapy period in a tertiary hospital in Delhi. BT was the most common group. The prevalence of reactions was found to be 8.09% for the Type 1 and 4.70% for the Type 2 reactions for a male:female ratio of 2.2. The Type 1 reaction was most frequently observed in the BB group followed by BL, BT and LL groups respectively. More than half of the patients had reactions at the time of presentation. In only 39.8% of the patients did reaction follow Multi-Drug-Therapy. In 4.5% of the patients with Type 1 reactions (T1R), concomitant infections were noted. The most common presentation of T1R was cutaneous lesions (74.41%) followed by cutaneous lesions and neuritis (53.6%), neuritis alone (12.1%), and only edema of hands and feet (7.31%) respectively. The Type 2 reactions (T2R) presented chiefly as papulo-nodular (92%) lesions followed by pustulonecrotic (8%) lesions. Associated neuritis was found in 40% and periosteitis and iritis in 8% and 4%, respectively. In 8.6% of the patients with T2R, precipitating factors could be observed. The prevalence of deformities in patients with reaction was 25%, and was more common in females. Deformities were observed in 23.25% of the T1R patients and 28% of the T2R patients.

Adolescent↗
PubMed1988

Painful red hands: a side-effect of leukaemia therapy.

Five cases of 'painful red hands', following chemotherapy for leukaemia, are reported. All the patients were women who had received treatment with cytosine arabinoside, 6-thioguanine and adriamycin. Several days after courses of chemotherapy, painful erythematous swelling of the palms and soles developed. In all cases the reaction was self-limiting and did not adversely affect their prognosis. Physicians should be aware of this reaction in order to reassure their patients. No treatment is required and the chemotherapy need not be stopped or altered.

Adult↗
PubMed2006

UVA1 phototherapy for cutaneous diseases: an experience of 92 cases in the United States.

BACKGROUND: The efficacy and safety of UVA1 (340-400 nm) phototherapy were established by studies from European countries. PURPOSE: Evaluate experience with UVA1 phototherapy for patients with cutaneous diseases in the United States. METHODS: A retrospective analysis of 92 cases of UVA1-treated cutaneous conditions from four medical centers in the United States was performed. RESULTS: Two-third of the patients showed a fair to good response (26-100% improvement) and one-third of the patients showed a poor response (0-25% improvement). Diseases with a moderate to good response (51-100% improvement) included scleredema adultorum, hand or foot dermatitis, atopic dermatitis, morphea (medium or medium- to high-dose UVA1), systemic sclerosis, and urticaria pigmentosa. Besides tanning, other adverse effects were found in 15% of patients, which include pruritus, erythema, tenderness, and burning sensation. Patients with skin types I-III responded better that those with a darker skin type. CONCLUSION: UVA1 phototherapy is a useful and well-tolerated treatment option for a variety of skin conditions.

Adolescent↗
PubMed1986

Toxic erythema of palms and soles associated with high-dose mercaptopurine chemotherapy.

We encountered a case of distinctive palmar-plantar erythema with desquamation of the fingers in a patient receiving high-dose mercaptopurine combined with allopurinol. He was receiving 400 mg/d of mercaptopurine with 200 mg/d of allopurinol when a painful, livid erythema involving his hands and feet developed. Over the ensuing 24 hours, desquamation of the distal fingertips was noted. The mercaptopurine was discontinued and the patient was treated with topical fluocinonide ointment under occlusion. Over the next 96 hours, the erythema and pain resolved entirely. To date, this is the eighth case of a painful desquamating erythema of the palms and soles occurring as a complication of chemotherapy. We suggest that high-dose mercaptopurine combined with allopurinol that blocks xanthine oxidase, a necessary enzyme in the catabolism of mercaptopurine, was responsible for our patient's clinical presentation.

Adult↗
PubMed1989

Bacteriology of infected hands and feet in leprosy patients.

70 cases of infected hands and feet admitted to ALERT Hospital during 1986/1987 (3/10/86-5/5/87) were studied for the infecting organisms and the sensitivity of these organisms to available antibiotics. Single organisms were isolated in 56 cases (95%), two organisms were isolated in 3 cases (5%), no organisms were isolated in 11 cases (15.7%). Proteus was the commonest organism. Most effective drug was Ampicillin. Three organisms isolated in 7 cases proved resistant to all drugs tested. The study shows that commonly available drugs are effective in the great majority of secondary infections in leprosy patients.

Adolescent↗
PubMed1979

Topical methoxsalen photochemotherapy in the treatment of palmoplantar pustulosis and psoriasis.

Topical methoxsalen photochemotherapy has been assessed in 22 patients suffering from recalcitrant palmoplantar pustulosis or psoriasis predominantly involving the hands and feet. Although 20 out of 22 patients improved and good results were obtained in exactly half of those treated, only 4 patients were classified as being "clear" or "minimally involved" at the end of 12 weeks. Two patients have shown no improvement at all. Minor local side effects were relatively common and included symptomatic erythema, blistering and local pigmentation. The histological findings in post PUVA treated skin are discussed and the pros and cons of topical photochemotherapy in this group of diseases is reviewed.

Administration, Topical↗
PubMed2003

Papular-purpuric "gloves and socks" syndrome in a mother and daughter.

The papular-purpuric "gloves and socks" syndrome (PPGSS) is a unique exanthem characterized by petechiae with painful edema of the hands and feet extending proximally with less severity. Constitutional symptoms of fever, lethargy, and arthralgia have also been described. Human parvovirus B19 has been implicated in most cases as the causative agent. We describe a mother and her daughter presenting with the characteristic findings of PPGSS and demonstrating the seroconversion of human parvovirus B19 a few days after the onset of their illness. Additional clinical findings of cutaneous vesicles, bullae, and conjunctivitis are reported in the mother's case. To our knowledge, these are the first 2 cases of PPGSS in a household setting.

Adolescent↗
PubMed1975

Acral keratoderma.

Three siblings displayed an unusual form of keratoderma characterized by diffuse and striate hyperkeratosis of the palms and soles, hyperkeratotic plaques over the dorsum of the hands and toes, and linear hyperkeratotic lesions over the Achilles tendon area, ankles, elbows, and knees. The predominant location of these lesions led to the term acral keratoderma for this disorder. Histologically, besides thickening of all epidermal layers with that of the stratum corneum being most notable, various dyskeratotic changes were evident in the epidermis. Pedigree analysis of the family suggested an autosomal recessive inheritance pattern. There were similarities and differences between the type of keratoderma displayed by these three patients and that of patients described previously with the disorder known as keratoma hereditarium mutilans.

Adolescent↗
PubMed1997

Dyschromatosis.

The dyschromatoses are a group of disorders characterized by the presence of both hyperpigmented and hypopigmented macules, many of which are small in size and irregular in shape. There are two major forms-dyschromatosis symmetrica hereditaria (DSH) and dyschromatosis universalis hereditaria (DUH), both of which are seen most commonly in Japan. DSH was first described by Toyama in 1929 and is characterized by a symmetrical distribution of hyperpigmented and hypopigmented macules on the extremities, especially over the dorsa of the hands and feet. In 1933, Ichikawa and Hiraga were the first to describe DUH as well-demarcated brown macules admixed with various-sized hypopigmented macules in a generalized as opposed to acral distribution. DUH was noted to appear within the first month of life. Some clinicians have suggested that DSH might be a subtype of DUH; however, we have to wait for the cloning of the causal genes of these diseases before coming to any definite conclusions. The differential diagnosis of dyschromatosis includes xeroderma pigmentosum, dyschromic amyloidosis, and exposure to chemicals such as diphenylcyclopropenone and monobenzyl ether of hydroquinone.

Age Factors↗
PubMed2003

An open-label pilot study to evaluate the safety and efficacy of topically applied tacrolimus ointment for the treatment of hand and/or foot eczema.

BACKGROUND: Hand and foot eczema is a chronic skin disorder. Although topical corticosteroids are often used to control the predominant symptoms of the disease, the chronicity of the condition increases the risk of long-term adverse effects. A safer alternative is needed. OBJECTIVE: To evaluate the safety and efficacy of tacrolimus ointment 0.1% in hand and/or foot eczema. METHODS: Twenty-five adults applied tacrolimus ointment 0.1% to affected areas three times daily for 8 weeks and were followed for 2 additional weeks. RESULTS: Except for vesiculation, compared with baseline there were significant improvements in erythema, scaling, induration, fissuring, composite severity, and pruritus (p<0.007). Two weeks after discontinuing treatment, significant improvement in scaling and composite severity (p<0.03) persisted, whereas erythema, induration, vesiculation, fissuring, and pruritus had returned to pre-treatment levels. CONCLUSION: Tacrolimus ointment 0.1% is a promising corticosteroid alternative for hand/foot eczema.

Administration, Topical↗
PubMed2005

Skin disease in paper mill workers.

BACKGROUND: Paper mill workers have frequent and prolonged exposure to skin irritants and allergens and may have a higher risk of developing occupational dermatitis. Aims The aim of this study was to determine the extent of skin problems in a paper mill and how much was attributable to contact with allergens. METHODS: A cross-sectional study was carried out among 80 paper mill workers having daily exposure to skin irritants and allergens. They all completed a questionnaire, underwent a standard interview and physical examination. Workers whose history indicated possible contact allergy were patch tested and prick tested. RESULTS: Workers reported a high exposure to skin irritants, especially when carrying out tasks that caused the hands and feet to become wet from perspiration and having contact with process water. Atopic dermatitis was seen in 3% of the workers. Contact dermatitis was seen in 26% of the workers and 36% were diagnosed with mycosis of the feet. All cases of contact dermatitis and mycosis could be attributed to occupational exposure to skin irritants. No cases of relevant contact allergy were seen. CONCLUSION: Occupational dermatitis in paper mills is primarily related to the exposure to skin irritants. Occupational physicians should be aware of the risk of occupational dermatitis in paper mill workers.

Cross-Sectional Studies↗
PubMed1992

Bullous lesions in acrodermatitis enteropathica. Histopathologic findings regarding two patients.

Acrodermatitis enteropathica (AE) is an autosomic recessive disorder affecting early infancy. Two cases of infantile AE with low plasma zinc levels are reported in which unusually prominent bullous and vesicobullous lesions were seen on the hands and feet, in addition to the more typical erythematous and scaly patches. Both psoriasiform and bullous lesions responded dramatically to oral zinc-sulfate supplementation. The histopathologic features of the bullous lesions of AE have not previously been fully examined. Histologically, the bullous lesions were characterized by intraepidermal vacuolar changes with massive ballooning, leading to intraepidermal vesiculation and blistering, with prominent epidermal necrosis and with no acantholysis. The bullous lesions did not arise on erythematous patchy lesions, but developed ex novo on unaffected skin. The histopathologic differential diagnosis with other bullous conditions is discussed.

Acrodermatitis↗
PubMed1997

Verrucosis of hands and feet in a patient with combined immune deficiency.

In immunocompromised patients, warts occur frequently and can be extensive. We describe a 24-year-old patient with severe therapy-resistant warts. In addition to human papillomavirus infection, he had chronic sinusitis, candidiasis, and atopic dermatitis. Anergy to delayed-type hypersensitivity skin test reaction, significant CD4 lymphopenia, and diminished in vitro T-cell proliferative response and interferon-gamma production indicated a deficiency of cellular immunity. Extremely low concentrations of serum IgM and IgG2 and a severe deficiency of in vitro IgM production pointed also to a humoral immunodeficiency syndrome. This case represents a combination of cellular and humoral immunodeficiencies that has not been previously described in association with warts.

Adult↗
PubMedDate not supplied

Costello syndrome with decreased glucose tolerance.

We report a case of Costello syndrome, which is an uncommon multisystemic condition with cutaneous manifestations on the palms and soles. In the literature there are 29 cases described, all the studies are published in the genetic literature with a few exceptions. We add a further case associated with impaired glucose tolerance. The diagnostic clinical signs are impressive, and highly characteristic. Cutaneous manifestations are: loose skin of the hands and feet "washer woman's hand", hyperkeratosis palmoplantaris, curly or sparse hair, acanthosis nigricans, papillomata nasi. Coarse, progeroid facial features with a bulbous nose, feeding difficulties in infancy, cardiac involvement with cardiomyopathy or conduction defect, and in our case impaired glucose tolerance also presented. Postnatal growth retardation, mental retardation, and a distinctive friendly personality is characteristic. Hyperextensible fingers with broad distal phalanges and joint contractures were observed, and peroneal hypertonicity required treatment by Achilles tendon lengthening. The decreased glucose tolerance is interesting in the view of the acanthosis nigricans. No storage disease and no chromosomal abnormality were observed. Only in one case is a balanced translocation described in the literature.

Abnormalities, Multiple↗
PubMed1996

[Glove-sock syndrome. A new disease entity].

Papular-purpuric "gloves and socks" syndrome (PPGSS) is a rare acute dermatosis characterized by pruritic erythematous and slightly papular lesions on the hands and feet in a "gloves and socks" distribution associated with oral aphtoid lesions and fever. It was first described in 1990 by Harms et al. Until now 17 cases have been reported. In five of these cases an association with Parvovirus-B19 (PB19) was observed, suggesting that PPGSS could be another manifestation of PB19 infection. Since PB19 cannot be shown in all the cases, this virus should be considered as one possible etiologic factor and other viruses may be responsible for this entity as well. A 42 year old Danish woman with PPGSS is described. This case could not be associated to primary PB19 infection.

Adult↗
PubMed2004

Contact allergy to progesterone and estradiol in a patient with multiple corticosteroid allergies.

A 61-year-old woman with a persistent hand and foot dermatitis developed multiple contact allergies to topical steroids. She had a past history of allergic contact dermatitis (ACD) to a hormone replacement patch containing both estrogen and progesterone. The aim of this report is to highlight the potential cross-reactions between topical corticosteroids and sex steroids. Patch testing with a standard series, a corticosteroid series, and the sex steroids progesterone and estradiol was performed. Positive ACD reactions to hydroxyprogesterone, progesterone, and estradiol occurred. There were also multiple corticosteroid allergies. This case demonstrates that patients who develop contact allergies to sex steroids are at risk of developing multiple corticosteroid allergies.

Adrenal Cortex Hormones↗
PubMed1992

Reiter's syndrome of the vulva. The psoriasis spectrum.

BACKGROUND: Reiter's syndrome is a disease characterized by crusted, scaling, acral and genital plaques; urethritis or cervicitis; and arthritis, which occur in genetically susceptible patients in response to any of many infections. This disease rarely occurs in women, and specific characterizations of vulvar and cervical lesions are rare. OBSERVATIONS: We describe a 39-year-old woman with a history of mucocutaneous candidiasis that was refractory to oral ketoconazole therapy. She presented with well-demarcated, erythematous, crusted plaques over the vulva, hands, and feet, as well as with cervical lesions and a history of conjunctivitis and iritis. Following the biopsy of characteristic skin lesions, recognition of systemic signs, and cultures that were negative for yeast, her condition was diagnosed as Reiter's syndrome. CONCLUSIONS: Reiter's syndrome of the vulva, vagina, and cervix may not be recognized because of its uncommon occurrence in women and the physician's consequent unfamiliarity with its clinical appearance in the genital area. This disease and pustular psoriasis share many common features and exist on a spectrum. A high index of suspicion and correlation of the many facets of the disease will better enable the clinician to make this diagnosis.

Adult↗
PubMed2004

Fluconazole (Fungolon) in the treatment of onychomycoses.

UNLABELLED: Onychomycoses are fungal infections of the hand and foot nails, caused by dermatophytes, yeasts and molds. These conditions are difficult to treat, spontaneous remissions are rare and recurrences are not infrequent. AIM: The present study aimed at establishing the efficacy of pulse fluconazole therapy (200 mg once weekly for 4 months) in cases of hand nails infections and 200 mg once weekly for 6 months in cases of feet nail infections. MATERIAL AND METHODS: The study comprised 36 patients--23 with hand onychomycosis and 13 with feet onychomycosis (patients' age ranging from 22 to 67 years). More than 25% of the nail bed was affected in all cases. Diagnosis was based on direct microscopy of KOH treated specimens and by culturing on Sabouraud medium. RESULTS: Treatment outcome was categorized as follows: clinical cure--in 91.3% of the cases with hand onychomycosis and improvement--in 8.7% of the cases; eradication of fungal infection--in 95.6% of the cases. Feet onychomycosis--clinical cure--61.5% of the patients, improvement--in 38.5% and eradication of fungal infection--in 69.2 % of the cases. Fluconazole (Fungolon) has only been recently used in the treatment of nail fungal infections. So far, no standard dosage has been established. CONCLUSIONS: On the basis of the accumulated evidence it is concluded that pulse fluconazole (Fungolon) therapy--200 mg once weekly is effective and safe. However, for better disease outcome, especially in cases of foot nail infections--dosage of 300 mg once weekly and 300-450 mg once weekly (if molds are the offending agents) is recommended.

Adult↗