1/7. Greater trochanter enthesopathy: an example of "short course retinoid enthesopathy": a case report.Irreversible skeletal changes have been described in patients with dermatologic disorders treated with isotretinoin (Accutane), a synthetic vitamin a derivative. Although retinoids were developed to avoid toxicity associated with vitamin a, skeletal lesions and rheumatologic consequences are possible hazards of isotretinoin treatment. Enthesopathy is one of the potential musculoskeletal sequelae and is characterized by pathologic, sometimes painful changes at the insertion sites (entheses) of tendons, ligaments, and articular capsules into bone. We report a patient who was referred secondary to an extended history of bilateral hip region pain. She was subsequently found to have a greater trochanteric enthesopathy. A detailed patient history revealed past use of Accutane for cystic acne. The subsequent treatment course, including medications, corticosteroid injections, physical therapy, and activity modifications, is described and the pertinent literature is reviewed. We believe that patients who are prescribed isotretinoin should be warned about this potential pathologic condition at the initiation of treatment and that physicians who are treating patients with a history of Accutane use should be suspicious of underlying enthesopathies as the etiology behind pain of musculoskeletal origin.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Accutane-exposed pregnancies--california, 1999.Accutane (Roche laboratories, Nutley, new jersey), known by the generic name "isotretinoin," is a prescription oral medication approved by the food and Drug Administration (FDA) to treat severe, recalcitrant nodular acne. It is also a known human teratogen that can cause multiple major malformations. Embryopathy associated with the mother's exposure to isotretinoin during the first trimester of pregnancy includes craniofacial, cardiac, thymic, and central nervous system malformations . In response to FDA recommendations, the manufacturer began a pregnancy-prevention program (PPP) in 1988 that included educational materials for physicians and patients and offered women reimbursement for contraceptive counseling by a physician. The PPP coordinators asked reproductive-aged women being treated with isotretinoin to enroll voluntarily in the boston University Accutane Survey (BUAS). The total number of reproductive-aged women taking isotretinoin in the united states is unknown; however, 454,273 women enrolled in the BUAS from 1989 to October 1999. BUAS has estimated that 38%-40% of reproductive-aged women taking isotretinoin chose to enroll in the survey (BUAS, unpublished data, 1999). Although isotretinoin is contraindicated in pregnancy and has a package label warning users to avoid pregnancy while taking it, exposed pregnancies occur. Approximately 900 pregnancies occurred among BUAS enrollees during 1989-1998 (BUAS, unpublished data, 1999). Roche laboratories began direct-to-consumer print advertisements in 1996, added television and radio advertisements to selected cities in 1997, and expanded the campaign to the entire united states in 1998.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/7. pseudotumor cerebri secondary to minocycline intake.BACKGROUND: pseudotumor cerebri, or idiopathic intracranial hypertension, is a condition most commonly affecting women of childbearing age who are obese or who have experienced recent weight gain. Frequently the patient complains of headache accompanied by dizziness, nausea, or visual defects, and it is characterized by elevated intracranial pressure in the absence of a space-occupying lesion or infection methods: A patient had been prescribed minocycline and subsequently developed symptoms 6 weeks after an increase in the original dosage. She was initially examined by an ophthalmologist, then was sent to the Emergency Department, and finally admitted under the family practice service. Articles were searched through medline, MD Consult, and Google. Key words included "pseudotumor cerebri," benign intracranial hypertension," idiopathic intracranial hypertension," and "minocycline." RESULTS AND CONCLUSION: Although the pathogenesis of pseudotumor cerebri is not completely understood, an association has been observed with minocycline use. This report describes a 16-year-old girl who developed idiopathic intracranial hypertension while taking minocycline for acne. Symptoms of blurred vision and severe headache unrelated to position or activity; an absence of fever, bilateral disk edema, and focalizing neurologic signs; negative neuroradiographic findings; increased cerebrospinal fluid pressure with a normal cell count; and exclusion of systemic or structural cause of increased intracranial pressure satisfy the criteria for the diagnosis of idiopathic intracranial hypertension. minocycline is often used by family physicians for the treatment of acne, and this complication requires vigilance to protect against potential vision loss.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Toxic effects associated with consumption of zinc.A 27-year-old man with a history of acne presented to his primary care physician because of fatigue and dyspnea on exertion of 4 weeks' duration. He was remarkably pale, orthostatic pulse changes were noted, and a systolic ejection murmur was heard. The patient had profound anemia (hemoglobin concentration, 5.0 g/dL) and neutropenia (neutrophil count, 0.06 x 10(9)/L); he was admitted for further evaluation. A detailed inquiry into his medication history revealed that he was taking several vitamins and zinc gluconate, 850 to 1000 mg/d for 1 year (US recommended daily allowance, 15 mg), as therapy for acne. A zinc toxic and copper-deficient state was confirmed by laboratory studies. The patient was treated with intravenous copper sulfate, followed by 3 months of oral therapy. The complete blood cell count, serum copper level, and serum zinc level returned to normal.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. Treatment site reactions to Zyderm collagen Implantation.Two cases of treatment site granulomatous reaction to Zyderm collagen Implant that occurred in spite of a negative skin test are reported. A delayed hypersensitivity reaction to ZCI is suggested by the clinical time course and the histologic findings of hypersensitivity granulomas. Humoral immunity is also implicated in the reaction since elevated anti-Zyderm serum antibodies and plasma cell infiltrates are present. Resolution of the clinical signs and symptoms occurred over several months with no treatment. The physician using ZCI should be aware of this rare adverse reaction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. Comb and brush acne.Frequent combing or brushing of the hair may result in an exacerbation of existing acne or be the cause of localized acne. Because of today's hair styling habits and methods, this type of acne is commonly encountered but poorly appreciated by physicians. Patient education is the most important factor in the management of this condition. Comb and brush acne is another external factor to be added to the list of causes of "acne mechanica."- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. Case report. synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome.A case of the SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome in a 35-year-old woman is presented. Ignorance of this entity on the part of the physicians treating the patient may have contributed to her having repeated diagnostic procedures and treatment, some of which may have been unnecessary. dentists are encouraged to suspect the SAPHO syndrome when they encounter a patient with mandibular osteomyelitis together with symptoms involving other bones and skin lesions such as pustulosis or psoriasis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |