1/12. 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) |
2/12. Of pills and pillows: pseudopigmentation in a patient taking amiodarone.Blue discoloration of the skin can alarm patients and physicians alike. Blue coloring may, however, have a trivial and easily correctable cause, as is shown in the following case.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/12. Pigmentary changes after alexandrite laser hair removal.BACKGROUND: Postinflammatory pigmentary changes are a frequently encountered problem with numerous dermatologic procedures. Limited literature is available that documents this complication with laser hair removal. OBJECTIVE: It is important for all physicians performing laser hair removal to be aware of this potential complication. We present our experience with postinflammatory pigmentary change and discuss some potential etiologic factors. methods: Seven patients who experienced postinflammatory complications after alexandrite laser hair removal are presented. These are all the patients who developed this complication in our office over the past 2.5 years. RESULTS: The patients who we describe in this article all developed a similar pattern of initial hyperpigmented rings, later developing into a thin wafer-like crust followed by hypopigmentation with gradual return to their normal skin color. CONCLUSION: In general, the alexandrite laser is both safe and effective for hair removal in patients of varying skin types. Complication rates will increase as skin pigment increases and as the power used increases. However, even in light-skinned individuals without recent pretreatment or posttreatment sun exposure, with proper treatment parameters, complications, and side effects can arise. We have found this to be especially true when treating areas other than the face.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/12. The harlequin color change and association with prostaglandin E1.The harlequin color change is an unusual cutaneous phenomenon observed in newborn infants as transient, benign episodes of a sharply demarcated erythema on half of the infant, with simultaneous contralateral blanching. In this report, two newborns with congenital heart anomalies demonstrated the harlequin color change, one whose skin findings showed a course related to the dose of systemic prostaglandin E1, suggesting a possible association. The benign, self-limited nature of the color change mandates that prostaglandin E1 not be discontinued for this reason. The entity is likely more common than the paucity of reports in the world literature suggests, and all physicians should recognize its graphic appearance to avoid unnecessary exposure to agents in an effort to treat it.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/12. A non-healing ulcerated fingertip following injury.A man went to his primary care physician 3 months after slamming his right thumb in a car door. The nail had turned black and sloughed off several weeks later, leaving a red, draining wound on the tip of his thumb. The wound drained continuously for the next 2 months and showed little progress in healing. His physician started him on antibiotics, but the wound still showed no progress in healing over the next 6 weeks. Cultures were obtained that grew out staphylococcus and streptococcus spp. Another course of antibiotics was given, but the patient's condition failed to improve. At this point the patient was referred to a surgeon. He missed several appointments before finally presenting to the surgery clinic nearly 6 months after his original office visit. He was diagnosed clinically as having a giant pyogenic granuloma and was given antibiotics as well as silver nitrate sticks to cauterize the wound daily. After missing several more follow-up appointments, the patient returned with a spongy, weeping soft-tissue wound over the dorsum of his right thumb [that] doubled in size over the past 3 months. Radiographs obtained at that time were normal, but a bone scan revealed late uptake, cause for concern that this was osteomyelitis. What is the differential diagnosis, and what tests are necessary?- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
6/12. Aquagenic syringeal acrokeratoderma: report of a case with histologic findings.Aquagenic syringeal acrokeratoderma is a rare acquired condition characterized by painful symmetric swelling and hypopigmentation of the palms and lateral fingers, which develops after brief exposure to water. Histopathologic examination suggests that an aberration in the eccrine sweat gland apparatus may be the underlying cause of this condition. The "hand-in-the-bucket sign," in which patients arrive in their physician's office with their hand in a bucket of water to more readily demonstrate their lesions, is such a common presentation that it almost can be regarded as pathognomonic. All 12 cases reported to date have been in young females. We report a case of aquagenic syringeal acrokeratoderma in a male with unique histologic findings.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/12. Pigmented nail streak associated with bowen's disease of the nail matrix.We described a 59-year-old male physician with bowen's disease occurring on the nail matrix of his right 5th finger. The rapid growth of the pigmented nail streak accompanied by nail deformity led us to consider the possibility of subungual melanoma clinically. Histologic features, however, were compatible with those of bowen's disease accompanied by melanocytes with melanin-rich long dendrites in the nail matrix. We speculate that his occupational exposure to x-rays for 25 years played an important role in the pathomechanism of the present case.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/12. Nail, skin, and scleral pigmentation induced by minocycline.minocycline-induced cutaneous and nail bed discoloration, although uncommon, should be closely watched for during treatment. The initial changes may be subtle and may mimic other processes that may deceive both patient and physician. patients should be counseled about the remote possibility of pigmentation with the understanding that any such changes should resolve upon discontinuation of the drug. The time required for resolution depends upon the degree of pigmentation and may take longer than a year in extensive cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/12. dyskeratosis congenita in a girl simulating chronic graft-vs-host disease.dyskeratosis congenita (DCG) is a rare genodermatosis characterized primarily by reticular hyperpigmentation of the skin, dystrophy of the nails, and leukoplakia. It is frequently associated with Fanconi-type pancytopenia. Although DCG has a male predisposition, it has been reported in several female patients. We encountered a case of DCG occurring in a girl whose clinical features simulated chronic graft-vs-host disease (GVHD). Because DCG and chronic GVHD share several clinical and histologic features, physicians should always examine a patient for possible DCG whenever a diagnosis of chronic GVHD is considered. In addition, the similar manifestations of the two disorders suggest a similar pathogenesis on a cellular level in the immunologic system.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/12. Pigmented penile lesions (fixed drug eruptions) associated with tetracycline therapy for sexually transmitted diseases.Two men had pigmented penile lesions that were diagnosed as fixed drug eruptions. The lesions developed after ingestion of tetracycline for nongonococcal urethritis and syphilis, respectively. Because use of tetracycline for treatment of sexually transmitted diseases is becoming more common, physicians must be able to recognize the allergic reactions to this drug.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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