1/14. Scanning electron microscope imaging of onychomycosis.Although scanning electron microscope technology has been used for more than 60 years in many fields of medical research, no studies have focused on obtaining high-resolution microscopic images of onychomycosis of the toenail caused by trichophyton rubrum in a geriatric population. To provide new insight into the intricate structure and behavior of chronic toenail onychomycosis, we produced three-dimensional images of onychomycosis obtained from two geriatric patients with confirmed growth of T rubrum. The photomicrographs illustrate the pervasive integration and penetration of the fungus hyphal elements, underscoring the clinical difficulty of obtaining rapid treatment of fungal infections in the distal and lateral subungual space of the human toenail. Although the scanning electron microscope may not be a practical diagnostic tool for most physicians, it remains invaluable for the researcher to obtain insight into the spatial orientation, behavior, and appearance of onychomycosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/14. Hyperkeratosis of the heels: treatment with salicylic acid in a novel delivery system.A 43-year-old woman presented with dryness and scaling of the lateral and posterior aspects of both heels, which was diagnosed as hyperkeratotic xerosis (Figure 1). Pertinent medical history included dry skin with winter exacerbation and painful hyperkeratosis of the heels present for many years. The patient applied a topical multivesicular cream formulation of 6% salicylic add (Salex, Healthpoint Ltd., Fort Worth, TX) to one foot b.i.d. The physician was blinded as to which foot was treated. After 2 weeks of treatment, it was apparent that the patient was applying the cream to the right foot, as evidenced by reduced dryness, scaling, and hyperkeratosis (Figure2). The patient continued treatment of the same foot for an additional 2 weeks, revealing a dramatic improvement of the right heel,which appeared smooth and soft and devoid of pain. No irritation was associated with treatment; the patient commented that this was the best her heel had been "in years." Subsequently, the patient treated both heels with salicylic acid 60%, multivesicular cream. A second patient, a 25-year-old woman, was treated for ichthyosis vulgaris and hyperkeratosis of both heels. She presented w ith multiple painful fissures and hyperkeratosis of the posterior heels bilaterally (Figure 3). After I week of topical treatment with salicylic add 6%, multivesicular cream applied b.i.d. to the left heel only, there was rapid resolution of both hyperkeratosis and pain (Figure 4).- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/14. Allergic contact dermatitis to propolis.A 35-year-old Asian woman was referred to the dermatology clinic with a 2-week history of enlarging, fluid-filled, pruritic lesions on the right foot. The affected area had a recent history of minor trauma for which the patient applied an over-the-counter propolis ointment. At presentation, the patient was also noted to have been using the following, as prescribed by her primary care physician: valacyclovir, ciprofloxacin, terbinafine cream, mupirocin ointment, and 2% hydrocortisone cream. No clinical improvement was observed with these agents. Examination revealed grouped erythematous papules progressing into vesicles and bulla on the lateral side of the right foot. A KOH scraping was negative. We diagnosed the patient with allergic contact dermatitis to propolis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/14. Chemotherapy-induced palmer planter erythrodysesthesia.We report a case of palmar plantar erythrodysesthesia (PPE) in a case of acute lymphoblastic leukemia treated with VALP regime. The treating physician must be aware of this uncommon complication of chemotherapeutic agents to avoid unnecessary investigations.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/14. Cutaneous larva migrans: case report with current recommendations for treatment.Cutaneous larva migrans is a common skin pathology that occurs in people who have recently visited tropical or subtropical climates. Given the ubiquity of this condition, the podiatric physician may encounter cutaneous larva migrans during clinical practice and should be cognizant of the presenting signs and typical patient history given in these cases. We describe the case of a 62-year-old man who presented with a pruritic, erythematous, serpiginous lesion on the dorsum of his left foot after having vacationed in florida for several weeks. The patient was treated successfully with oral thiabendazole, 500 mg after meals 4 times daily for 5 days.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/14. 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.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/14. Silent stroke associated with minor podiatric surgery.life-threatening intraoperative complications during minor podiatric surgery are rare. This paper presents a case of a "silent stroke," which occurred during total matrixectomies of hallux nails. The podiatric physician must be aware of the risk factors involved in each case and must be prepared to treat any complications that may arise.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/14. Pitted keratolysis: a manifestation of human dermatophilosis.A case of pitted keratolysis caused by Dermatophilus congolensis is reported. The organism was isolated from the lesion and identified by its morphological, cultural, and biochemical characteristics. A survey of the literature revealed that it rarely causes human infections, but is a common causative agent of disease in domesticated and wild animals. Human infections reported previously were traced to contact with infected animals or contaminated soil. We report pitted keratolysis in a 44-year-old physician with no known history of such a contact.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/14. Sternocostoclavicular hyperostosis: rheumatologic, radiologic, and dermatologic characteristics.Two recently observed patients with sternocostoclavicular hyperostosis exemplify the characteristic presentation of this rheumatologic disorder. We describe its manifestations, review the literature on this subject, and discuss clinical and radiologic aspects, including the frequently associated dermatologic disorder palmoplantar pustulosis. Sternocostoclavicular hyperostosis is an increasingly common diagnosis, and practicing physicians should be aware of the distinctive features that allow accurate differentiation from psoriatic arthritis and other diseases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/14. Alkali burns from wet cement.When water is added to the dry materials of Portland cement calcium hydroxide is formed; the wet cement is caustic (with a pH as high as 12.9) and can produce third-degree alkali burns after 2 hours of contact. Unlike professional cement workers, amateurs are usually not aware of any danger and may stand or kneel in the cement for long periods. As illustrated in a case report, general physicians may recognize neither the seriousness of the injury in its early stages nor the significance of a history of prolonged contact with wet cement. All people working with cement should be warned about its dangers and advised to immediately wash and dry the skin if contact does occur.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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