1/13. Finger 'pebbles'. A dermatologic sign of diabetes mellitus.A 35-year-old obese man presented with a chief complaint of hand dryness of 5 years' duration. He was a store manager and denied exposure to chemicals, repetitive trauma, chronic irritation, and hard manual labor. However, he did admit to frequent hand washing. He had no itching or swelling in his hands, but on occasion he had tenderness in the dry areas. He had no personal or family history of diabetes, heart disease, or renal disease, and he stated that at his annual physical examination 6 months earlier, routine blood work was normal. He reported polyuria (every 2 hours), nocturia (five times per night), and polydipsia but no weakness, weight loss, visual changes, or neurosensory changes. Examination revealed xerosis of his hands and "pebbles" on the dorsal aspect of his fingers. The papules were most dense over the knuckles and interphalangeal joints (figures 1 through 3). He also had dozens of acrochordons (i.e., cutaneous papillomas, or skin tags) 1 to 4 mm in diameter on his neck, axilla, and groin. No other cutaneous lesions were noted. Specifically, there was no scleredema adultorum, necrobiosis lipoidica diabeticorum, acanthosis nigricans, bullae, or patchy pretibial pigmentation, although he did have several brown macules 1 to 5 mm in diameter on the sides of his lower legs. The macules had been present for years. Levels of hemoglobin A1c and glycated hemoglobin were 7.5% and 9.5%, respectively (normal, 4.4% to 5.9% and 5.0% to 7.3%). The patient was referred to his family physician, and his diabetes has been well controlled with insulin.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/13. Cowden disease. Report of two additional cases.Two patients with Cowden disease, a syndrome consisting of cutaneous papules and nodules on the face, oral mucous membranes and dorsal aspects of the forearms and hands in association with tumours of the thyroid gland, breasts, gastro-intestinal tract, and female reproductive tract, are reported. This disease is important to the physician because recognition of these cutaneous lesions may allow early diagnosis of internal neoplasia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/13. Severe human urticaria produced by ant (Odontomachus bauri, Emery 1892) (hymenoptera: Formicidae) venom.BACKGROUND: Ant sting reactions are becoming an increasing problem in tropical countries. It is important for physicians to be aware of their possible cutaneous and systemic manifestations. methods: A child with a severe allergic reaction to an ant sting was examined and is discussed. This is the first case described in the literature caused by the ant Odontomachus bauri, and the biology of the ant and the clinical signs in the patient are described. RESULTS: A child developed a strong allergic reaction to an ant sting. The case was not associated with a previous ant sting. Treatment with the systemic antihistamine loratadine (Clarityn) was favorable in this patient. CONCLUSIONS: In tropical areas, ant stings are usually benign, self-limited pathologic processes. In some cases, however, severe allergic reactions can develop, including urticaria and anaphylactic shock. Physicians should be aware of the possible complications of ant stings.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/13. Acute allergic contact dermatitis due to para-phenylenediamine after temporary henna painting.The use of temporary natural henna painting for body adornment and hair dyeing is very common in several countries of the Indian subcontinent, middle east, and North africa, and the fad is spreading in other parts of the world. Several cases of para-phenylenediamine (PPD) contaminated, temporary traditional/natural henna induced sensitization and acute allergic reaction have been reported, along with occasional serious long term and rare fatal consequences. We report here a 17-year-old girl with blisters over her hands of five-days duration that appeared within 72 hours of applying a temporary henna paint to her hands during a social occasion. Similar lesions were noted on her face. She had previously applied black henna only once, a year earlier without developing any lesions. Clinical diagnosis of acute allergic contact dermatitis (ACD) was made. After a short course of oral corticosteroids, topical mometasone furaote 1.0% cream, and oral antihistamines, the lesions healed completely over the next four weeks leaving post-inflammatory hypopigmentation. Patch testing done with standard European battery, PPD 1% in petrolatum, and commercially available natural henna powder revealed a 3 reaction to PPD at 48 hours. No reaction was seen at the natural henna site. awareness of the condition among physicians and the public and regulation regarding warnings of the risks of using such products is urgently warranted.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/13. porphyria cutanea tarda, hepatitis c, alcoholism, and hemochromatosis: a case report and review of the literature.porphyria cutanea tarda (PCT) is associated with estrogen, certain medications, alcohol abuse, hepatitis viruses, and iron overload. Numerous studies have demonstrated an increased incidence of hepatitis c in patients with PCT; therefore, hepatitis screening should be routinely performed on these patients. On the other hand, although studies have long suspected hereditary hemochromatosis (HH) to be an underlying condition of PCT, many physicians have a low index of suspicion. Also, diagnosis of HH has been difficult until recently, when the gene mutation was identified. We present a case of a patient with PCT, hepatitis c, and alcoholism who was homozygous for the HH gene mutation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/13. 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) |
7/13. 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) |
8/13. Urticarial contact dermatitis in food handlers.OBJECTIVE: To show that prick testing (using fresh samples of the food suspected from the patient's history) and not only patch testing is the appropriate investigation in selected cases of hand dermatitis in patients who spend considerable time handling foods (for example, catering workers, cooks). SETTING: The Contact and Occupational dermatitis Clinic at the skin and Cancer Foundation, a tertiary referral centre in Sydney. patients: Fourteen patients with hand dermatitis present for an average of 6.17 years referred by dermatologists and occupational health physicians. INTERVENTIONS: Patch and prick tests were performed for each patient. RESULT: In all patients prick tests identified the food allergens. seafood was the most common allergen giving positive results in 10 patients. patch tests did not identify any of the food allergens. Of the 14 patients nine were followed up and seven of these had been forced to change their career direction. CONCLUSION: Prick testing is the appropriate investigation in selected cases for the diagnosis of urticarial contact dermatitis in food handlers.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/13. A look-back investigation of patients of an hiv-infected physician. public health implications.BACKGROUND. Transmission of the human immunodeficiency virus (hiv) to five patients receiving care from an hiv-infected dentist in florida has recently been reported. Current data indicate that the risk of hiv transmission from health care workers to patients is low. Despite this low risk, programs to notify patients of past exposure to an hiv-infected health care worker are being conducted with increasing frequency. methods. We recently conducted an investigation of all the patients cared for by an hiv-infected family physician during a period when he had severe dermatitis caused by mycobacterium marinum on his hands and forearms. After reviewing the patients' records, we notified 336 patients who had undergone one or more procedures (digital examination of a body cavity or vaginal delivery) placing them at potentially increased risk of hiv infection. The patients were offered tests for hiv infection and counseling. RESULTS. Of the 336 patients, 325 (97 percent) had negative tests for hiv antibody, 3 (1 percent) refused testing, 1 (less than 1 percent) died of a cause unrelated to hiv infection before notification, and the hiv-antibody status of 7 (2 percent) remained unknown. The direct and indirect public health costs of this investigation were approximately $130,000. CONCLUSIONS. The results of this investigation raise important questions about the risk of hiv transmission from health care workers to patients and the usefulness of hiv look-back programs, particularly in the light of recently published recommendations from the Centers for disease Control. We propose that before a look-back investigation is undertaken, there should be a clearly identifiable risk of transmission of the infection, substantially higher than the risk requiring limitation of an hiv-infected health care worker's practice prospectively.- - - - - - - - - - ranking = 5keywords = physician (Clic here for more details about this article) |
10/13. Disuse contractures in a patient with tinea manuum and irritant contact dermatitis.Disuse contractures are reported in a patient with tinea manuum and irritant contact dermatitis. The case is presented to alert the physician to the potential for this problem in any patient with a chronic fissured dermatosis of the hands.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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