ABSTRACT
BACKGROUND: Toxic epidermal necrolysis(TEN) is the most dramatic and life-threatening cutaneous drug reaction. However, specific and effective treatment for TEN have not yet been identified. Recently several reports suggested that high dose intravenous immunoglobulin(IV Ig) treatment has produced good results in patients with TEN. OBJECTIVE: To analyze the efficacy and side effects of IV Ig in treatement of TEN. METHODS: Ten patients with clinicopathological diagnosis of TEN were treated with IV Ig(1.6-3.4g/kg), and clinical efficacy and side effects were observed. RESULTS: Nine patients were healed and one died of sepsis. Interruption of further epidermal detachment occurred after an average 3 days from the onset of IV Ig therapy. Complete wound healing occurred after an average of 14.3 days. The side effects of IV Ig including headache, myalgia, nausea, transient neutropenia, and coombs positive hemolytic anemia were observed in 4 patients but normalized after cessation of IV Ig therapy. Three of them showed complete healing of detached skin but died with aggravation of underlying disease. CONCLUSION: IV Ig therapy represents a safe and very effective treatment for TEN. Furthermore, intensive care for underlying diseases is also very important for reducing the mortality rate in patients with TEN.
Subject(s)
Humans , Anemia, Hemolytic , Diagnosis , Headache , Immunoglobulins , Critical Care , Mortality , Myalgia , Nausea , Neutropenia , Sepsis , Skin , Stevens-Johnson Syndrome , Wound HealingABSTRACT
Cutaneous metastases from internal malignancies are uncommon and a zosteriform pattern is very rare. Malignancies with zosteriform cutaneous metastases have their origin from skin cancers, vascular tumors, hematologic malignancies, and visceral neoplasia. We present the case of a 44-year-old female with zosteriform metastasis secondary to breast carcinoma. In our case, as in some of the cases from the literature, the patient was initially misdiagnosed clinically as having herpes zoster. Moreover, herpes viral infections are common in immunosuppressed patients and must be ruled out.
Subject(s)
Adult , Female , Humans , Breast Neoplasms , Breast , Hematologic Neoplasms , Herpes Zoster , Neoplasm Metastasis , Skin NeoplasmsABSTRACT
BACKGROUND: In many epidemiologic reports of distribution of skin diseases, the outpatients of university hospitals have been the target groups of the analysis. But there has been no epidemiologic study of dermatoses in the field of rural area. OBJECTIVE: The purposes of this study were to investigate the distribution of skin diseases in rural areas and to evaluate the rural population's concept of skin disease and the attitude to their skin problems. METHOD: We analysed the results of interview and responses of questionnaires from 481 residents who visited the local public health centers and the free clinics in the rural areas of Kyonggi-Do and Ulsan city. RESULTS: The results of the study are summarized as follows : 1. Of 481 residents, there were 328 females and 153 males. The mean age was 56.6 years old. The residents over 50 years old formed 73.2 percent of total population. 2. The common dermatoses were tinea pedis, onychomycosis, xerosis, seborrheic keratosis, chloasma, pruritus, hand eczema, contact dermatitis, lentigo, seborrheic dermatitis in order of frequency. 3. The cutaneous fungal infection was the most common dermatoses in each study population. 4. To treat skin diseases, 51.2% of the residents visited the drug store initially. 5. The major reason of not taking dermatological care in the rural population was customary habit. 6. The 39.5% of 238 respondents have used self-treatments, and 15.5% of 90 respondents have experienced side effects of self-treatments. 7. On the question about the negative concepts of dermatoses, 61.7% of 462 respondents agreed to the statement that dermatoses look unclean. 8. Half of the 463 respondents thought that dermatologic medicine was harmful. The 50.6% of the 328 respondents had no specific reason, and 34.1% experienced gastrointestinal trouble. 9. The most favorite type of dermatologic medicine was topical agent, which was preferred especially by the group of respondents using nonmedical service including drug store. CONCLUSION: The distribution of the skin diseases in rural areas was similar to other reported results except the high frequency of cutaneous fungal infection. This research could be a basis on the following epidemiologic studies of the skin diseases in rural areas. It is also suggested that the educational program to improve understanding of skin diseases should be performed in the rural areas.
Subject(s)
Female , Humans , Male , Middle Aged , Surveys and Questionnaires , Dermatitis , Dermatitis, Contact , Dermatitis, Seborrheic , Epidemiologic Studies , Epidemiology , Hand , Hospitals, University , Keratosis, Seborrheic , Lentigo , Melanosis , Onychomycosis , Outpatients , Pruritus , Public Health , Rural Population , Skin Diseases , Skin , Tinea PedisABSTRACT
An atypical form of scabies is crusted or Norwegian sacbies, which is often seen in the physically or mentally handicapped, immunocompromised, and institutionalized persons. The characteristic skin lesions in this form are gross scaling and hyperkeratotic plaque, especially on the hands, feet, scalp, face, and pressure bearing areas with varying degrees of pruritus. We report a case of Norwegian scabies in a 81 year old patient with a chronic obstructive pulmonary disease using systemic steroid.
Subject(s)
Aged, 80 and over , Humans , Foot , Hand , Institutionalization , Persons with Mental Disabilities , Pruritus , Pulmonary Disease, Chronic Obstructive , Scabies , Scalp , SkinABSTRACT
Cheilitis granulomatosa as a monosymtomatic form of the Melkersson-Rosenthal sydrome, was charaterized by reccurrent or persistent edema in the orofacial lesion that could not be explained on the basis of infections, systemic, malignant, or connective tissue disorders. Herein we report two cases of cheilitis granulomatosa which have been treated with triamcinolone acetonide intralesional injection, hydroxychloroquine 400mg per day. After a short course of systemic steroids the swelling of the lip improved.
Subject(s)
Cheilitis , Connective Tissue , Edema , Hydroxychloroquine , Injections, Intralesional , Lip , Melkersson-Rosenthal Syndrome , Steroids , Triamcinolone AcetonideABSTRACT
Toxic epidermal necrolysis(TEN) is the most dramatic, life-threatening cutaneous drug reaction. TEN is characterized by extensive detachment of the epidermis undergoing full-thickness necrosis. The pathogenetic pathway and specific treatments of TEN have not yet been identified. Recently, several reports suggested that apoptosis in TEN is promoted by proteins such as Fas antigen and high dose intravenous immunoglobulin(IVIG) inhibits Fas-mediated cell death by blocking the Fas receptor. We report a case of TEN in a 26-year-old woman who had been treated with prednisolone due to iritis. She was treated with high dose IVIG(0.4g/Kg/day for 4 days one day and 0.7g/Kg/day for consecutive). In our case, the progression of skin lesion was interrupted after IVIG infusion and favorable vital outcome was achieved with mild adverse effects.
Subject(s)
Adult , Female , Humans , fas Receptor , Apoptosis , Cell Death , Epidermis , Immunoglobulins , Immunoglobulins, Intravenous , Iritis , Necrosis , Prednisolone , Skin , Stevens-Johnson SyndromeABSTRACT
Toxic epidermal necrolysis(TEN) is the most dramatic, life-threatening cutaneous drug reaction. TEN is characterized by extensive detachment of the epidermis undergoing full-thickness necrosis. The pathogenetic pathway and specific treatments of TEN have not yet been identified. Recently, several reports suggested that apoptosis in TEN is promoted by proteins such as Fas antigen and high dose intravenous immunoglobulin(IVIG) inhibits Fas-mediated cell death by blocking the Fas receptor. We report a case of TEN in a 26-year-old woman who had been treated with prednisolone due to iritis. She was treated with high dose IVIG(0.4g/Kg/day for 4 days one day and 0.7g/Kg/day for consecutive). In our case, the progression of skin lesion was interrupted after IVIG infusion and favorable vital outcome was achieved with mild adverse effects.
Subject(s)
Adult , Female , Humans , fas Receptor , Apoptosis , Cell Death , Epidermis , Immunoglobulins , Immunoglobulins, Intravenous , Iritis , Necrosis , Prednisolone , Skin , Stevens-Johnson SyndromeABSTRACT
According to the size of nevus, a congenital pigmented nevus may be classified as small, medium, and giant. Among these, giant congenital pigmented nevus is known to have high potential for malignant transformation. The rate of malignant transformation is different according to lesional anatomical sites. We describ a case of a 48-year-old man who had a maignant melanoma arising from giant congenital pigmented nevus on the left thigh. Wide excision and inguinal lymph node dissection were performed but distant metastases were found four months later.
Subject(s)
Humans , Middle Aged , Lymph Node Excision , Melanoma , Neoplasm Metastasis , Nevus , Nevus, Pigmented , ThighABSTRACT
BACKGROUND: Onychomycosis is a common superficial fungal infection. Causative organisms in onychomycosis have been extensively studied, but the role of non-dermatophytes is controversial. Trichosporon beigelii are soil and water inhabiting yeasts, occasionally found in flora normally associated with human skin, mouth, and nails. Several reports in the literature have suggested that T. beigelii is one of the pathogens in onychomycosis. OBJECTIVE: We performed mycologic studies to investigate the causative organisms of onychomycosis and to confirm the pathogenic role of T. beigeliis in onychomycosis. METHODS: We performed a survey of the mycologic labaratory records of patients clinically suspected of onychomycosis from July 1996 to December 1998. RESULTS: 1) Out of a total of 1934 nail samples examined, 928(48.0%) of these were culture positive, including 192(10.8%)cases with T. beigelii. 2) The overall positive rate for the KOH mount examination was 59% and in the cases with T. beigelii was 89.1%. 3) Among the age groups, the incidence rate was highest in the fifth decade(26.6%). 4) The monthly prevalence of onychomycosis was highest in July(10.6%), the distribution of T. beigelii was high in July and August. 5) The most common causative organism of onychomycosis was Trichophyton rubrum(62.0%), and the others in decreasing frequency were T. beigelii(20.7%), Candida spp.(7.2%), Trichophyton mentagrophytes(4.0%) and mixed infection(2.2%). 6) T. beigelii was repeatedly isolated in the successive nail cultures from 10 out of 20 patients with T. beigelii nail infection. CONCLUSION: T. beigelii was the second commonly isolated fungus in onychomycosis had the high positive rate of the which KOH mount examination on nails and successive repeated cultures. We suggest that T. beigelii might be a pathogen of onychomycosis.
Subject(s)
Humans , Candida , Fungi , Incidence , Mouth , Onychomycosis , Prevalence , Skin , Soil , Trichophyton , Trichosporon , YeastsABSTRACT
Sneddon's syndrome consists of widespread livedo reticularis and ischemic cerebral manifestations. We report a case of a 70-year-old Korean woman with extensive livedo reticularis, hypertension, positive laboratory results for antinuclear antibodies and the lupus anticoagulant test, and idiopathic Parkinson's disease.