RESUMEN
Systematic analysis of possible dermatophyte and candidal skin infections leads to an accurate diagnosis and prompt treatment with a specific regimen. The first steps are thorough skin examination and evaluation with a potassium hydroxide preparation. Tinea corporis, tinea cruris, tinea pedis, cutaneous candidiasis, and tinea versicolor can be treated with many topical antifungal agents, whereas tinea capitis requires oral griseofulvin therapy. Frequently used topical medications for tinea and candidal infections include clotrimazole (Lotrimin, Mycelex), econazole nitrate (Spectazole), ketoconazole (Nizoral), miconazole nitrate (Monistat-Derm, Micatin), oxiconazole nitrate (Oxistat), and ciclopirox olamine (Loprox). Topical selenium sulfide lotion can also be used for tinea versicolor, which is often a recalcitrant problem.
Asunto(s)
Dermatomicosis , Candidiasis Cutánea , Dermatomicosis/tratamiento farmacológico , Humanos , Tiña del Cuero Cabelludo , Tiña del Pie , Tiña VersicolorRESUMEN
Xeroderma pigmentosum is a group of rare autosomal recessive disorders with defective DNA repair that provide insight into the basic mechanism of carcinogenesis. It is the best human model linking clinical abnormalities and neoplasia to carcinogen exposure. We describe a patient with xeroderma pigmentosum and numerous basal cell carcinomas, squamous cell carcinomas, and melanomas treated with radiation therapy, Mohs micrographic surgery, dermabrasion, and isotretinoin prophylaxis.
Asunto(s)
Neoplasias Faciales/terapia , Neoplasias Cutáneas/terapia , Xerodermia Pigmentosa/terapia , Adolescente , Carcinoma Basocelular/terapia , Carcinoma de Células Escamosas/terapia , Terapia Combinada , Estudios de Seguimiento , Humanos , Masculino , Melanoma/terapia , Recurrencia Local de Neoplasia , Neoplasias Primarias Múltiples/terapiaRESUMEN
A newborn black boy had two facial blisters at birth that progressed to bullous lesions over the trunk, genitals, extremities, and oral and tracheal mucosa. A biopsy specimen demonstrated a subepidermal bulla with mixed eosinophilic and neutrophilic, inflammatory infiltrate. Direct immunofluorescence showed linear IgA, IgG, and C3 depositions along the basement membrane zone, consistent with a diagnosis of childhood linear IgA bullous dermatosis (chronic bullous dermatosis of childhood). The skin disease was controlled with combined prednisone and dapsone. This is the youngest reported patient with the disease. Linear IgA bullous dermatosis should be considered in the differential diagnosis of blistering diseases of the newborn, and immunofluorescence should be performed on a skin biopsy specimen.
Asunto(s)
Enfermedades Cutáneas Vesiculoampollosas/diagnóstico , Piel/patología , Membrana Basal/química , Membrana Basal/patología , Biopsia , Enfermedad Crónica , Complemento C3/análisis , Humanos , Inmunoglobulina A/análisis , Inmunoglobulina G/análisis , Recién Nacido , Masculino , Enfermedades Cutáneas Vesiculoampollosas/inmunología , Enfermedades Cutáneas Vesiculoampollosas/terapiaRESUMEN
BACKGROUND: Coronary artery bypass grafting for atherosclerotic heart disease is commonly performed throughout the world. Complications of coronary artery bypass grafting include saphenous neuralgia due to injury to the saphenous nerve during harvest of the saphenous vein. Dermatologic complications of coronary revascularization are infrequently reported and include an eruption overlying the vein donor-site scar. OBSERVATIONS: We describe two cases of saphenous vein donor site dermatitis associated with sensory peripheral neuropathy in the distribution of the dermatitis. Histopathologic studies revealed a subacute spongiotic dermatitis. The course of the eruption was characterized by exacerbations and remissions with gradual resolution of both the dermatitis and neuropathy over a 1- to 2-year period. CONCLUSIONS: Our cases are unique because the dermatitis developed in the area of the neurologic changes. We propose that the dermatitis may be a trophic change secondary to saphenous neuralgia.
Asunto(s)
Puente de Arteria Coronaria/efectos adversos , Dermatitis/etiología , Enfermedades del Sistema Nervioso Periférico/etiología , Vena Safena/trasplante , Anciano , Dermatitis/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso Periférico/complicacionesRESUMEN
The inflammation produced by exposure to ultraviolet (UV) light has been well documented clinically and histologically. However, the mechanisms by which mediators induce this clinical response remain poorly defined. It is clear that photochemistry occurring after UV absorption must be responsible for initiating these events. Some of these underlying mechanisms have been defined. After exposure to UV light, the formation of prostaglandins and the release of histamine are increased. In addition to an increase in the quantity of these mediators, an increase in sensitivity of irradiated tissue to agonist stimulation also occurs. This increased sensitivity may cause tissue to respond to agonist levels previously present. Phospholipase activity also increases, making more substrate available for prostaglandin formation. Oxygen radical-induced peroxidation of membrane lipids caused by irradiation may contribute to increased phospholipase activity. Oxygen-free radicals also participate in sunburn cell formation and in UV-induced decreases in Langerhans cell numbers. Several enzymatic and non-enzymatic mechanisms are present in skin for reducing these highly reactive oxygen species.
Asunto(s)
Dermatitis/etiología , Traumatismos por Radiación , Piel/efectos de la radiación , Rayos Ultravioleta , Dermatitis/patología , Dermatitis/prevención & control , Epidermis/metabolismo , Histamina/farmacología , Humanos , Peróxidos Lipídicos/metabolismo , Fotoquímica , Prostaglandinas/biosíntesis , Prostaglandinas/fisiología , Traumatismos por Radiación/prevención & control , Especies Reactivas de Oxígeno/metabolismo , Piel/patologíaRESUMEN
alpha-Tocopherol and three derivatives in which the phytol chain is modified or deleted were examined for their effect on cultured keratinocyte arachidonic acid metabolism. 2,2,5,7,8-Pentamethyl-6-hydroxychromane (PMC), in which the phytol chain is replaced by a methyl group, inhibited basal, bradykinin (BK)- and A23187-stimulated prostaglandin E2 (PGE2) synthesis with an apparent Ki of 1.3 microM. The Ki of the analogue with six carbon atoms in the side chain (C6) was 5 microM while that of the C11 analogue was 10 microM. No effect of alpha-tocopherol was observed. The mechanism of inhibition was studied using PMC. The effect of PMC on phospholipase and cyclooxygenase activity was assayed using stable isotope mass measurements of PGE2 formation, which assesses arachidonate release and cyclooxygenase metabolism simultaneously. BK-stimulated formation of PGE2, derived from endogenous phospholipid, was decreased 60% by 5 microM PMC and eliminated by 50 microM PMC, compared with controls. No difference in PGE2 formed from exogenous arachidonic acid was observed, indicating no effect of PMC on cyclooxygenase activity. In contrast, no effect of 5 microM PMC was observed on BK-stimulated [3H]arachidonic acid release from prelabeled cultures. The capacity of PMC to inhibit phospholipase activity in vitro was also assessed. PMC inhibited hydrolysis of phospholipid substrate by up to 60%. These results suggest that alpha-tocopherol analogues with alterations in the phytol chain inhibit eicosanoid synthesis by preferential inhibition of phospholipase.