1/8. Common red scaly rashes. Traps for the unwary--Part 1.BACKGROUND: Red scaly rashes often provide difficulties for general practitioners leading to a 'try and see' approach which, although successful on many occasions, may delay adequate treatment when there is lack of a correct diagnosis. OBJECTIVE: A study of 61 general practitioners, providing them with photographs and clinical history, highlighted areas of uncertainty particularly in diagnosis, but also in treatment of common red scaly rashes including seborrhoeic dermatitis, pityriasis versicolor, psoriasis, superficial basal cell carcinoma, eczema, and tinea. On the basis of their responses, practical tips have been suggested to overcome them. DISCUSSION: Simple diagnostic procedures that can be done within the general practice setting include biopsy, skin scrapings and fungal microscopy. They have been highlighted as an important component of the approach to diagnosis of common red scaly rashes. While the study showed a substantial proportion of correct treatment being recommended, there was still an area of need, particularly in diagnosis, which could be enhanced by learning these simple techniques.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |
2/8. Too hot to handle: an unusual exposure of HDI in specialty painters.BACKGROUND: Hexamethylene Diisocyanate (HDI) is a color stable aliphatic isocyanate that is used in specialty paints as a hardener. Due to the lower vapor pressure of its commercial biuret form, it is considered a relatively "safe" isocyanate from an exposure standpoint. This case series reports on an unusual toxic exposure to HDI. Between November 1993 and May 1994, seven specialty painters and one boiler maker who were working at three different power plants were examined at the Institute of Occupational and environmental health at west virginia University. At their respective work sites, HDI was applied to the hot surfaces of boilers that were not shut down, and allowed sufficient time to cool. Consequently, these workers were exposed to volatile HDI and its thermal decomposition products. methods: All of these workers underwent a complete physical examination, spirometry, and methacholine challenge testing. RESULTS: All 8 workers complained of dyspnea, while 4 of the 8 also complained of rash. On examination 3 workers were methacholine challenge positive and 2 had persistent rash. At follow-up 4 years later, 5 workers still had to use inhalation medication and one had progressive asthma and dermatitis. All 8 workers, by the time of the follow-up, had gone through economic and occupational changes. CONCLUSIONS: This case series reports on an unusual exposure to HDI. It is unusual in that: 1) There were two simultaneous sentinel cases with two different material safety data sheets (MSDS) for the same product, 2) Exposure was to volatile HDI and its decomposition products and 3) Hazardous conditions of exposure occurred at three different sites.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |
3/8. Localized pustulosis induced by betalactams.Localized forms of pustular drug eruptions related to antibiotics are uncommon and their mechanism is still unknown. We describe herein a patient who developed numerous pin-head pustules without erythema in the peribuccal area after ingestion of ceftibuten and amoxicillin. The relationship with these drugs was confirmed by single-blind oral challenges. The following tests were performed: prick and intradermal tests with benzylpenicilloyl polylysine, minor determinant mixture, benzylpenicillin and amoxicillin; patch tests were also carried out with benzylpenicillin, amoxicillin, cloxacillin, cefuroxime, ceftriaxone, cefazolin, ceftibuten and cefaclor. All cutaneous tests were negative. Controlled single-blind challenge tests were performed with amoxicillin, cefadroxil, ceftibuten, cefuroxime, cefaclor, erythromycin and ciprofloxacin. All betalactam antibiotics tested gave a positive reaction, with good tolerance of other antibiotics; this would appear to indicate a specific mechanism of hypersensitivity and not an unspecific reaction to wide spectrum antibiotics.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |
4/8. Systemically induced allergic exanthem from mercury.Cutaneous reactions to mercury can manifest themselves in different forms. Apart from contact dermatitis, flare-up reactions, disseminated exanthem as well as skin symptoms in previously unaffected skin are known. Regarding systemic allergen application, 2 separate clinical patterns, namely acute generalized exanthematous pustulosis (AGEP) and symmetric flexural exanthem 'baboon syndrome' have been described. Systemic allergic reactions to mercury are most commonly provoked by the inhalation of metallic mercury vapours from a broken thermometer, often after previous sensitization to mercury compounds, e.g. Mercurochrome. Patch testing with mercurials yields positive reactions in approximately 80% of patients. We report 3 patients, 2 with flexural exanthem, and 1 presenting with AGEP, respectively. Positive patch tests to mercury derivatives could be demonstrated in all of them. Furthermore, non-toxic serum mercury levels were detected in 2 of the patients. The present review provides a survey of the literature on systemic allergic exanthem to mercury. However, plausible explanations for the distribution pattern of the skin manifestations in AGEP and flexural exanthem are still lacking.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |
5/8. The clinical course of a child with CINCA/NOMID syndrome improved during and after treatment with thalidomide.Chronic, infantile, neurological, cutaneous, and articular (CINCA) syndrome, also known as neonatal-onset multisystem inflammatory disease (NOMID), is a rare autosomal dominant inherited disease. It is characterized by a persistent rash with onset during the neonatal period, neurological and ocular manifestations, and articular involvement with abnormal ossification. Mutations within the CIAS1 gene are found in up to 60% of CINCA cases, but the exact underlying pathogenetic mechanisms causing this disorder are still unclear. Although the interleukin-1 (IL-1) receptor antagonist anakinra (rHuIL-1Ra) has recently been reported to be effective, no formal recommended treatment protocols exist thus far. Herein, we describe a 17-year-old girl with CINCA for whom numerous medication trials had been unsuccessful. After the introduction of thalidomide, the symptoms of arthropathy improved dramatically even months after the medication was discontinued by the patient. We propose that thalidomide can be beneficial in select patients with CINCA syndrome.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |
6/8. legionnaires' disease associated with macular rash: two cases.legionnaires' disease is an acute bacterial infection, generally sustained by legionella pneumophila, which involves primarily the lower respiratory tract, although it is often associated with multi-systemic extrapulmonary manifestations. Afflicted patients may sometimes have gastrointestinal symptoms, liver function abnormalities, renal failure or central nervous system complications, while cutaneous manifestations are very uncommon and may include erythematous, maculopapular or petechial skin lesions. Pathogenesis of skin involvement in the setting of legionnaires' disease is still uncertain, but may involve toxic or immunological mechanisms. Two exceptional cases of Legionella pneumonia complicated by diffuse, macular rash in two adult women are described, in association with severe peripheral polyneuropathy and flaccid quadriplegia in one case.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |
7/8. hepatitis c eradication and improvement of cryoglobulinemia-associated rash and membranoproliferative glomerulonephritis with interferon and ribavirin after kidney transplantation.Postrenal transplant hepatitis c is increasing in frequency due to the high prevalence of hepatitis c among patients with renal failure. Despite this, there is still no standard hepatitis c treatment available for renal transplanted recipients. Combination antiviral hepatitis c therapy, the standard of care in the nontransplant population, is generally avoided because of documented renal graft rejection secondary to interferon treatment. A case of a male patient with postrenal transplant hepatitis c, which was associated with cryoglobulinemia and glomerulonephritis of the graft, is presented. He was treated with standard interferon with ribavirin. Sustained viral clearance was achieved despite ongoing evidence of cryoglobulinemia. Renal function, which had been deteriorating before treatment, improved as evidenced by the stabilization of serum creatinine and marked improvement of proteinuria. In conclusion, in selected patients, combination antiviral therapy may still be a viable option postrenal transplant.- - - - - - - - - - ranking = 2keywords = still (Clic here for more details about this article) |
8/8. A case of anaphylactic shock possibly caused by intravesical Hexvix.BACKGROUND: We report a case of a 69-year-old Caucasian male who experienced a severe drop in blood pressure and a skin rash after fluorescence cystoscopy and transurethral resection of the prostate. The diagnostic agent used for fluorescence cystoscopy and suspected of causing the anaphylaxis was hexaminolevulinate hydrochloride (Hexvix). INCIDENT: A profound fall in blood pressure associated with atrial fibrillation, the appearance of a rash, vomiting and transient loss of consciousness occurred immediately after surgery. The hypotension persisted for several hours despite intensive treatment. The reaction commenced approximately 5 h after exposure to Hexvix. There was an increase in serum tryptase (almost nine-fold) and a positive skin prick test to undiluted Hexvix. CONCLUSION: The mechanism of the anaphylaxis is uncertain, but is considered likely to be a non-immunoglobulin e-mediated allergic reaction possibly caused by Hexvix. This is the first reported case of a severe allergic reaction after intravesical instillation of Hexvix.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |