1/8. Dermatosis in a child with kwashiorkor secondary to food aversion.kwashiorkor is a common affliction of children worldwide. It occurs less often in developed countries, but has been reported under a variety of circumstances, including poverty, neurologic disease, and malabsorption. Because of its rare occurrence in the united states and because the affected child has an edematous rather than wasted appearance, physicians often do not consider it as a diagnostic entity. This article describes a case of kwashiorkor in a child with food aversion that manifested as "flaky paint dermatitis." Our discussion will attempt to delineate underlying conditions that may predispose to kwashiorkor. In addition, biochemical and cellular etiologic factors that may be linked with classical and nonclassical skin findings of kwashiorkor are considered. Finally, we present a differential diagnosis for any child with a generalized eczematous or desquamative rash. Our aim is to increase the ability of health care providers to identify and treat children with kwashiorkor in a timely manner.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Zosteriform Darier's disease versus acantholytic dyskeratotic epidermal nevus.patients with keratotic lesions distributed in a unilateral, linear, zosteriform or localized pattern and revealing histologic features of dyskeratotic acantholysis have been reported. There is still some controversy regarding the appropriate nosologic placement of this entity. Some believe it represents a localized form of Darier s disease, while others argue it is a variant of epidermal nevus. We report a case of a 42-year-old physician who presented with a 15-year history of an asymptomatic eruption that had been diagnosed as "chronic zoster." Physical exam revealed hyperkeratotic papules and plaques in a dermatomal distribution. The controversy regarding the correct nosologic placement of such a patient is discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. Photodynamic therapy for actinic keratosis followed by 5-fluorouracil reaction.BACKGROUND: Actinic or solar keratoses are the earliest form of cancerous lesions that are found in sun-exposed areas of the body. Treatment involves eliminating the lesions before they have a chance to progress. Mainstay therapies include curettage, cryosurgery, and topical 5-fluorouracil. A recently food and Drug Administration-approved regime using photodynamic therapy has also been employed since 2000. OBJECTIVE: To inform physicians of the efficacy and potential inefficiency of this procedure, enabling the assessment of proper placement in the armamentarium. methods: This patient underwent photodynamic therapy. She was challenged with 5-fluorouracil 5 weeks after photodynamic treatment. RESULTS: The patient responded well to the photodynamic therapy and also to the challenge with the 5-fluorouracil. CONCLUSION: Did the photodynamic treatment really destroy lesions significantly? What is the mechanism for the response to 5-fluorouracil after such a short period between treatment modalities? If 33% of patients treated with photodynamic therapy require retreatment in 8 weeks, is this modality cost-effective, and what is its place in treating patients? How should this new treatment be implemented in practice? These questions must be seriously assessed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. Focal acantholytic dyskeratosis: a snare for the pathologist. Report of two cases associated to psoriasis and fibrous papule of the nose.Two specimens containing clinically inapparent histologic features of acantholytic dyskeratosis (on the base of a fibrous papule of the nose and overlying a psoriatic lesion) are presented. The authors discuss the conduct to be followed by the pathologist in similar cases. The general pathologist should be well trained in dermatopathology since cutaneous biopsies account for 10 to 25% of the specimens submitted for histologic diagnosis or, even, form the major part of the workload (Berry). There is a wall between the physician who submits the skin biopsies (who may be or not a dermatologist) and the pathologist. The clinical information provided by dermatologists is scant and incomplete and physicians who are not dermatologists seldom submit any information. The histological pictures found in skin biopsies are, often, common to several nosological entities and an adequate understanding of their meaning is desirable for a thorough evaluation. We ought to assess it with the maximum scientific severity, searching to solve the puzzle without depreciating the information received. In this report the authors analyse the histopathological approach to the cutaneous lesions of two patients. They displayed the association between acantholytic dyskeratosis (AD) and another cutaneous pathology. Findings like these may obstruct the final diagnosis to be issued by the pathologist.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/8. 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) |
6/8. porokeratosis of Mibelli: benzylhydrochlorothiazide-induced new lesions accompanied by eosinophilic spongiosis.We observed the course of development of porokeratosis stimulated by benzylhydrochlorothiazide (BHCTh) in normal-appearing skin of a patient with long-standing stable porokeratosis of Mibelli. A 72-year-old Japanese man had had porokeratosis of Mibelli for more than 50 years. During administration of BHCTh for 1 year because of his hypertension, a lichenoid drug eruption developed over the lesions of porokeratosis on the flexor aspects of his legs. Readministration of BHCTh by another physician for 6 months resulted in the occurrence of a similar drug eruption that converted into typical skin lesions of porokeratosis 8 weeks later. Serial microscopic examination suggested that BHCTh administration resulted in eosinophilic spongiosis and cornoid lamella formation, which developed into epidermal changes characteristic of porokeratosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. Isolated nodular cutaneous coccidioidomycosis. The initial manifestation of disseminated disease.Cutaneous manifestations of coccidioidomycosis may be divided into primary and secondary lesions. Since such lesions may be the only evidence of infection, the distinction is important. Primary (inoculation) lesions are rare. Secondary lesions develop from primary pulmonary disease, commonly. An isolated nodule on the scalp was the presenting sign of disseminated coccidioidomycosis in our patient. Because of the rarity of primary cutaneous coccidioidomycosis, cutaneous lesions due to it should alert the physician to the presence of disseminated disease. The clinical spectrum of such lesions is wide. Our patient was an elderly man with a hyperkeratotic scalp nodule clinically felt to be an actinic keratosis or an early squamous cell carcinoma. We suggest that patients with a travel or resident history in endemic areas be viewed with a high index of suspicion for skin lesions of cutaneous coccidioidomycosis. The advent of orally administered imidazole antifungal agents makes early and aggressive diagnosis of these lesions even more important.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. Scalpel sculpturing techniques for graft revision and dermatologic surgery.BACKGROUND. Postoperative scars can be revised by a variety of techniques, including dermabrasion, laser, curettage, razor blade, and scalpel surgery. Most modern methods of scar revision provide good results but at the expense of time and economy. OBJECTIVE. We present our scalpel sculpting technique that uses the #15 scalpel blade to microshave and feather the skin edges to equalize differences in skin elevations caused by uneven healing. The superficial wounds then heal by second intention. methods. Sculpting techniques were used to revise side-to-side closures (grafts and flaps), trap-door elevations, standing tricones and hypertrophic scars. In addition, we used the sculpting technique to remove superficial blemishes such as actinic and seborrheic keratoses, skin tags, and other benign lesions. RESULTS. We have used scalpel sculpting techniques to revise scars and remove blemishes for more than 5 years. We have removed thousands of skin imperfections with very gratifying results. CONCLUSION. Scalpel sculpting techniques provide a simple, efficient method of scar revision and removal of superficial skin lesions. The technique reduces operative time and streamlines instrument reprocessing. Because of its simplicity, there is a high degree of patient, nursing, and physician satisfaction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |