RESUMEN
Diabetes is a common condition that is increasing in incidence worldwide. Although the skin manifestations of this condition are well described, there is scant literature on the associated nail changes. In this review, we describe the various clinical features of nail changes associated with diabetes, which can be broadly divided into infections, vascular changes, neuropathic manifestations and miscellaneous changes, although there is overlap between them. There is no pathognomonic nail alteration, but it is important for clinicians to be aware of the potential nail manifestations in diabetes as they can facilitate investigations and thereby early diagnosis of diabetes, resulting in holistic management of the patient.
Asunto(s)
Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/terapia , Enfermedades de la Uña/diagnóstico , Enfermedades de la Uña/terapia , Humanos , Enfermedades de la Uña/etiologíaAsunto(s)
Acantoma , Pénfigo , Neoplasias Cutáneas , Acantoma/diagnóstico , Humanos , Pénfigo/diagnósticoRESUMEN
Nail changes are frequently seen in patients with cutaneous lichen planus and alopecia areata. This manuscript provides an updated overview on the clinical features, management and prognosis of both conditions. Searches of electronic databases PubMed and EMBASE were conducted and eligible articles were accessed. Practical management principles relevant to these two conditions are also included.
Asunto(s)
Alopecia Areata/complicaciones , Liquen Plano/complicaciones , Enfermedades de la Uña/etiología , Uñas/patología , Administración Intravesical , Administración Tópica , Humanos , Enfermedades de la Uña/tratamiento farmacológico , Pronóstico , Esteroides/administración & dosificaciónRESUMEN
Narrative fallacy is a problematic heuristic that leads us to make inaccurate cause-effect relationships. They are a particular issue in case reports because of the limited scope of these papers, the perpetuated biases they proffer and the misperception of 'black swan' events. This article highlights the negative effects of these fallacies in dermatological practice through three case studies: the use of epinephrine with lignocaine at distal sites, the difference between once-daily and twice-daily application of topical steroids, and the effect of sterile gloves for skin surgery on infection rates. Awareness of the biases in case reports and the employment of metacognition may help us to avoid falling victim to narrative fallacies. Given the potential problems with this heuristic, Clinical and Experimental Dermatology (CED) utilizes case reports to further medical education and offer different clinical perspectives, rather than as a driver of medical knowledge.
Asunto(s)
Causalidad , Dermatología , Medicina Basada en la Evidencia , Humanos , NarraciónRESUMEN
Nail changes are visible in a variety of inflammatory dermatoses. The commonest dermatological condition with nail manifestations is chronic plaque psoriasis. This two-part article reviews the nail signs in psoriasis in Part 1, and the nail changes in cutaneous lichen planus and alopecia areata in Part 2. It provides a brief summary of the salient points in the clinical features, management and prognosis of these entities, with practical recommendations that may be beneficial to all dermatologists.
Asunto(s)
Fármacos Dermatológicos/administración & dosificación , Glucocorticoides/administración & dosificación , Enfermedades de la Uña/etiología , Uñas/patología , Psoriasis/complicaciones , Administración Tópica , Dermoscopía , Humanos , Inyecciones Intralesiones , Metotrexato/uso terapéutico , Enfermedades de la Uña/diagnóstico , Enfermedades de la Uña/tratamiento farmacológico , Psoriasis/patología , Esteroides/administración & dosificación , Triamcinolona/administración & dosificaciónAsunto(s)
Acne Conglobata/tratamiento farmacológico , Acné Vulgar/tratamiento farmacológico , Fármacos Dermatológicos/uso terapéutico , Isotretinoína/uso terapéutico , Acne Conglobata/patología , Acné Vulgar/patología , Animales , Quistes/patología , Fármacos Dermatológicos/administración & dosificación , Fármacos Dermatológicos/historia , Historia del Siglo XX , Humanos , Isotretinoína/administración & dosificación , Isotretinoína/historia , Ratones , Modelos Animales , Papiloma/inducido químicamente , Papiloma/tratamiento farmacológico , Efecto Placebo , Neoplasias Cutáneas/prevención & control , Vitamina A/químicaRESUMEN
BACKGROUND: Mycobacterial species other than Mycobacterium tuberculosis and Mycobacterium leprae are generally free-living organisms and Mycobacterium simiae is one of the slowest growing Non-tuberculous mycobacteria. This is the first case report of Mycobacterium simiae infection in Sri Lanka and only very few cases with extrapulmonary manifestation reported in the literature. CASE PRESENTATION: A 24-year-old, previously healthy Sri Lankan male presented with generalized lymphadenopathy with discharging sinuses, evening pyrexia, weight loss, poor appetite and splenomegaly. Lymph node biopsies showed sheets of macrophages packed with organisms in the absence of granulomata. Ziehl Neelsen, Wade Fite and Giemsa stains revealed numerous red coloured acid-fast bacilli within foamy histiocytes. Slit skin smear for leprosy was negative and tuberculosis, fungal and bacterial cultures of the lymph node and bone marrow did not reveal any growth. Later he developed watery diarrhea and colonoscopy revealed multiple small polyps and ulcers throughout the colon extending up to the ileum, Which was confirmed to be due to cytomegalovirus confirmed by PCR and successfully treated with ganciclovir. Positron emission tomography scan guided biopsies of the gut and lymph nodes confirmed presence of mycobacterial spindle cell pseudo-tumours and PCR assays revealed positive HSP65. The culture grew Mycobacterium Simiae. Flow cytometry analysis on patient's blood showed extremely low T and B cell counts and immunofixation revealed low immunoglobulin levels. His condition was later diagnosed as adult onset immunodeficiency due to anti- interferon - gamma autoantibodies. He was initially commenced on empirical anti-TB treatment with atypical mycobacterial coverage. He is currently on a combination of daily clarithromycin, ciprofloxacin, linezolid with monthly 2 g/kg/intravenous immunoglobulin to which, he had a remarkable clinical response with complete resolution of lymphadenopathy and healing of sinuses. CONCLUSIONS: This infection is considered to be restricted to certain geographic areas such as mainly Iran, Cuba, Israel and Arizona and this is the first case report from Sri lanka. Even though the infection is mostly seen in the elderly patients, our patient was only 24 years old. In the literature pulmonary involvement was common presentation, but in this case the patient had generalized lymphadenopathy and colonic involvement without pulmonary involvement.
Asunto(s)
Síndromes de Inmunodeficiencia/inmunología , Infecciones por Mycobacterium no Tuberculosas/microbiología , Mycobacterium/patogenicidad , Autoanticuerpos/sangre , Ciprofloxacina/uso terapéutico , Claritromicina/uso terapéutico , Humanos , Biopsia Guiada por Imagen , Interferón gamma/sangre , Ganglios Linfáticos/microbiología , Linfadenopatía/etiología , Masculino , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Infecciones por Mycobacterium no Tuberculosas/patología , Tomografía de Emisión de Positrones , Sri Lanka , Adulto JovenRESUMEN
BACKGROUND: Mucous membrane pemphigoid (MMP) comprises a group of immunobullous diseases involving the mucosa and skin. Potential sequelae include painful mucosal erosions, vision loss and laryngeal stenosis. AIM: To characterize the features of patients with MMP seen within an Oral Medicine setting, including clinical features, immunofluorescence results and response to treatment. METHODS: A retrospective case note analysis was undertaken. Treatment effect was divided into response and nonresponse using predetermined adjective terms. RESULTS: In total, 42 cases of MMP were identified (18 men, 24 women), mean age 65 years (range 36-85 years). Oral involvement was most common on the gingivae (n = 38; 90.5%) while the most common extraoral sites involved were ocular (n = 13; 31.0%) and skin (n = 12; 28.6%). Features of MMP were found in 21 of 34 (61.8%) of routine biopsies, 31 of 34 (91.2%) direct immunofluorescence samples and 8 of 25 (32.0%) indirect immunofluorescence samples. Topical corticosteroids provided effective symptom control in 9 of 42 cases (21.4%), while systemic therapy was used in 31 of 42 patients (73.8%). Dapsone was prescribed for 25 patients, of whom 18 (72.0%) responded. Mycophenolate mofetil was used in 13 cases and had a response rate of 46.2%. Overall, 27 of 42 patients (64.3%) achieved a response using a tolerable topical or systemic treatment. CONCLUSION: This series demonstrates that MMP has a female predominance and is a disease of older age, with a predilection for specific oral sites. Direct immunofluorescence has a high sensitivity in detecting features of MMP. Although some patients achieve adequate symptom control with topical corticosteroids, many require systemic therapy.
Asunto(s)
Corticoesteroides/administración & dosificación , Enfermedades de la Boca/tratamiento farmacológico , Penfigoide Benigno de la Membrana Mucosa/tratamiento farmacológico , Administración Oral , Administración Tópica , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mucosa Bucal/patologíaAsunto(s)
Cardiomiopatías/complicaciones , Infecciones por Mycobacterium no Tuberculosas/complicaciones , Mycobacterium chelonae , Sarcoidosis/complicaciones , Enfermedades Cutáneas Infecciosas/complicaciones , Anciano , Femenino , Humanos , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Enfermedades Cutáneas Infecciosas/diagnósticoAsunto(s)
Ciclosporina/administración & dosificación , Fármacos Dermatológicos/administración & dosificación , Inmunosupresores/administración & dosificación , Fototerapia/métodos , Enfermedades de la Piel/tratamiento farmacológico , Administración Oral , Desmineralización Ósea Patológica/inducido químicamente , Niño , Contraindicaciones de los Medicamentos , Consejo , Ciclosporina/efectos adversos , Ciclosporina/farmacología , Fármacos Dermatológicos/efectos adversos , Fármacos Dermatológicos/farmacología , Vías de Administración de Medicamentos , Esquema de Medicación , Erupciones por Medicamentos/etiología , Interacciones Farmacológicas , Quimioterapia Combinada , Femenino , Humanos , Hiperlipidemias/inducido químicamente , Hipertensión/inducido químicamente , Inmunosupresores/efectos adversos , Inmunosupresores/farmacología , Anamnesis , Uso Fuera de lo Indicado , Infecciones Oportunistas/inducido químicamente , Examen Físico , Embarazo , VacunaciónAsunto(s)
Pénfigo/terapia , Administración Cutánea , Administración Oral , Corticoesteroides/administración & dosificación , Cuidados Posteriores , Vesícula/terapia , Quimioterapia Adyuvante , Niño , Técnicas de Laboratorio Clínico/métodos , Fármacos Dermatológicos/uso terapéutico , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Femenino , Predicción , Humanos , Técnicas de Inmunoadsorción , Inmunosupresores/uso terapéutico , Infusiones Intravenosas , Atención de Enfermería , Pénfigo/diagnóstico , Fotoféresis/métodos , Intercambio Plasmático/métodos , Plasmaféresis/métodos , Embarazo , Complicaciones del Embarazo/terapia , Negativa al Tratamiento , Inducción de Remisión , Apoyo SocialAsunto(s)
Fármacos Dermatológicos/uso terapéutico , Metotrexato/uso terapéutico , Enfermedades de la Piel/tratamiento farmacológico , Adulto , Consumo de Bebidas Alcohólicas , Productos Biológicos/efectos adversos , Enfermedades de la Médula Ósea/inducido químicamente , Lista de Verificación , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Varicela/complicaciones , Niño , Consejo/métodos , Ciclosporina/efectos adversos , Fármacos Dermatológicos/efectos adversos , Fármacos Dermatológicos/envenenamiento , Vías de Administración de Medicamentos , Esquema de Medicación , Aprobación de Drogas , Interacciones Farmacológicas , Monitoreo de Drogas/métodos , Sobredosis de Droga/etiología , Medicina Basada en la Evidencia , Femenino , Infecciones por VIH/complicaciones , Hepatitis Viral Humana/complicaciones , Humanos , Complicaciones Intraoperatorias/inducido químicamente , Enfermedades Renales/inducido químicamente , Enfermedades Pulmonares/inducido químicamente , Metotrexato/efectos adversos , Metotrexato/envenenamiento , Náusea/inducido químicamente , Neoplasias/inducido químicamente , Uso Fuera de lo Indicado , Educación del Paciente como Asunto/métodos , Seguridad del Paciente , Embarazo , Complicaciones del Embarazo/prevención & control , Retinoides/efectos adversos , Tuberculosis/complicaciones , Rayos Ultravioleta/efectos adversos , Vacunación/efectos adversosRESUMEN
A 2-month-old white girl born to nonconsanguineous parents presented to the dermatology department with hair loss that had commenced a few months after birth. Although her hair loss later stabilized, it remained sparse. By the age of 2 years, she was noted to have developed focal keratoderma over pressure points of the soles. Aged 5 years, she was admitted to hospital with a chest infection, and investigations at that point revealed that she had a dilated cardiomyopathy. Subsequent genetic investigations identified compound heterozygous mutations in the 3' end of the desmoplakin (DSP) gene (7567delAAGA and 6577G>A), explaining the cardiocutaneous phenotype.
Asunto(s)
Alopecia/genética , Cardiomiopatía Dilatada/genética , Desmoplaquinas/genética , Mutación del Sistema de Lectura , Folículo Piloso/anomalías , Sustitución de Aminoácidos , Resultado Fatal , Femenino , Dermatosis del Pie/genética , Heterocigoto , Humanos , Lactante , Queratodermia Palmoplantar/genéticaRESUMEN
Even though psoriasis is a common skin disorder, reports of it involving the oral cavity are exceedingly rare, with less than 100 publications in the literature. Biopsy-proven oral psoriasis has been reported in the oral medical literature, but the commonest oral mucosal findings in most studies are associated non-specific features including fissured and geographic tongue. Case series on this entity have not provided any definitive data to support its existence. From the evidence available to date, it is still unclear if oral psoriasis is a distinct entity or if, indeed, it exists.
Asunto(s)
Enfermedades de la Boca/clasificación , Enfermedades de la Boca/patología , Boca/patología , Psoriasis/clasificación , Psoriasis/patología , Biopsia , Diagnóstico Diferencial , Humanos , Boca/inmunología , Enfermedades de la Boca/inmunología , Psoriasis/inmunología , Piel/patologíaRESUMEN
Imiquimod has immune-stimulant properties that can precipitate autoimmune conditions like eczema, psoriasis and lichenoid conditions. We report two cases here where imiquimod induced florid lichen sclerosus in one patient and lichen planus in another. In both patients the condition was so aggressive and unresponsive to steroid treatment that circumcision was necessary.