Exantema intertriginoso y flexural simétrico por fármacos: presentación de un caso / Symmetrical drug-related intertriginous and flexural exanthema: a case report

Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is a benign, self-limited, immune-mediated, symmetric erythematous rash involving the buttocks and other intertriginous/flexural areas, observed after systemic exposure to a drug in an individual with or without prior sensitization. We present a 70-year old patient, who presented SDRIFE after the administration of piperacillin-tazobactam which improved rapidly after its suspension.

El exantema intertriginoso y flexural simétrico relacionado con fármacos (SDRIFE, por su sigla en inglés) es una erupción eritematosa simétrica, inmunomediada, benigna y autolimitada, que compromete glúteos y otras áreas intertriginosas, flexurales o ambas, y que se observa luego de la exposición sistémica a un fármaco en un individuo con sensibilización previa o sin ella. Se comenta el caso clínico de un paciente de 70 años de edad, que presentó SDRIFE posterior a la administración de piperacilina-tazobactam y que mejoró rápidamente luego de su suspensión.

Adaptation of the Evidence-Based Nursing Practice Guideline: Prevention and Management of Moisture Associated Skin Damage / 임상간호연구

PURPOSE: This study was done to develop an evidence-based nursing clinical practice guideline for Moisture associated skin damage (MASD) prevention and management for patients in Korea. METHODS: The guideline adaptation process was used and conducted according to the guideline adaptation manual developed by the Korean Hospital Nurses Association. It consists of three main phases and 9 modules including a total of 24 steps. RESULTS: The adapted MASD clinical practice guideline consisted of 4 sections, 8 domains and 28 recommendations. The number of recommendations in each section was: 7 on MASD assessment, 14 on MASD prevention and management, 4 on education, and 3 on organizational policy. Of the recommendations, 3.6% were marked as A grade, 28.6% as B grade, and 67.8% as C grade. CONCLUSION: This MASD clinical practice guideline is the first to be developed in Korea. The developed guideline will contribute to standardized and consistent MASD prevention and management. The guideline can be recommended for dissemination and utilization by nurses nationwide to improve the quality of MASD prevention and management. Regular revision is recommended.

Dermatosis intertriginosa crónica de aparición tardía: pénfigo de Hailey-Hailey / Chronic late-onset intertriginous dermatitis: Hailey-Hailey's pemphigus

El pénfigo familiar benigno o enfermedad de Hailey Hailey, es una genodermatosis vesico-ampollar autosómica dominante, con penetrancia incompleta y expresividad variable de presentación infrecuente. Se presenta el caso de un paciente con un cuadro de cinco años de evolución, caracterizado por lesiones vesiculares intertriginosas, de olor desagradable, con mala respuesta al tratamiento tópico con antifúngicos y corticoides. Se realiza biopsia de piel compatible con pénfigo de Hailey Hailey, el que fue manejado con antibióticoterapia y corticoides sistémicos, evolucionando favorablemente.

The benign familial pemphigus or Hailey Hailey´s disease is a rare autosomal dominant disorder. We present the clinical case of a patient with a five years history, characterized by vesicular intertriginous malodorous lesions with poor response to topical antifungal therapy. Skin biopsy it was compatible with Hailey Hailey´s disease which was managed with antibiotic therapy and systemic corticosteroids. The patient evolved favorably.

The Effect of Powders and Moisturizers on SLS Irritated, Intertriginous Skin / 대한피부과학회지

BACKGROUND: Intertrigo is a form of contact dermatitis of skin folds of the body, for which a large variety of topical medications may be recommended. Application of a suitable barrier preparation is the cornerstone for the prevention and treatment for the intertrigo. OBJECTIVE: There is a notable absence of controlled trials to support and guide the use of barrier preparations for intertrigo. METHODS: We evaluated the effect of powders and moisturizers with non-invasive measuring methods on irritated skin reactions induced by sodium lauryl sulphate in the sintertriginous skin of 21 healthy volunteers. After skin irritation for 24 hours with patch test of 1% sodium lauryl sulphate on both axilla, we applied a powder and a moisturizer respectively. Evaluation was done at 2 weeks by transepidermal water loss, electrical capacitance. RESULTS: TEWL values of the moisturizer treated side were significantly lower than that of the powder treated side. Water holding capacity values of the moisturizer treated side were significantly higher than that of the powder treated side. CONCLUSION: These results suggest that topical application of a moisturizer might improve the disruption of permeability barrier function of intertrigo. We suggest this experimental model for further barrier preparation efficacy testing of intertrigo.

Transient Zinc Deficiency Located on Unusual Sites / 대한피부과학회지

Zinc deficiency in breast-fed infants is an important disorder. Unlike acrodermatitis enteropathica, it is transient and stops when nursing ends. We report on a case of a breast-fed, full-term male infant who presented with erythematous fine scaly patches and plaques involving the flexural area and trunk at 4 month of age. Clinical impressions of intertrigo, fungal infection or inverse psoriasis were considered. These lesions did not respond to treatment with topical antifungal agents and corticosteroids. The results of laboratory investigations revealed a lowered zinc level in the infant's serum (48.4microg/dl: normal 70~121microg/dl) and in the mother's milk (16microg/dl: normal 48~75microg/dl) and a normal level of zinc in the mother's serum. After the patient's mother was given zinc supplements, the skin lesions were dramatically improved and his serum zinc level became normal. Early recognition of the disorder and introduction of zinc supplementation rapidly reversed the transient zinc deficiency.

[Dermatologic disorders of the athlete: a report of 30 cases?]

Participation in athletic activities is associated with a variety of skin problems. We aimed to precise the most important sports related dermatoses in athletes. We conducted transversal study on 30 athletes of 2 teams: one of soccer's and the other of basketball players. For each athlete dermatological exam was practiced. 18 soccer players and 12 basketball players were enrolled; the mean age was about 25.3 years [18-35 years]. The results suggest that athletic activity seems to be a predisposing factor for cutaneous infections [87%] especially fungal infections [90%]. Traumatic lesions were also frequent in our athletes [20/30], dominated by calluses and nail disorders [80%]. Sports-related dermatoses include infections, traumatic entities, allergic contact dermatitis, environmental encounters, exacerbation of preexisting dermatoses, thus regular dermatological screening of athletes is critical for rapid identification and treatment of dermatoses distrusting sport performance

Condiloma acuminado extragenital associado ao intertrigo: relato de caso / Acuminata condyloma extragenital associated to intertrigo: case report

Introdução: papilomavírus humano (HPV) é um vírus de DNA que pode infectar a pele e mucosas, com mais de 100 tipos diferentes descritos, sendo 45 deles considerados sexualmente transmissíveis. Objetivo: relatar o caso de condiloma acuminado extragenital, facilitado pela presença de intertrigo. Métodos: relato de caso de paciente com condiloma acuminado em região hipogástrica. Resultados: mulher atendida no ambulatório de DST/AIDS do setor de Ginecologia da Santa Casa de Misericórdia de Vitória, em 2007, com 46 anos de idade, apresentando lesão condilomatosa extensa associada à intertrigo em região hipogástrica, acima da cicatriz de Pfannestiel e pequenas lesões vulvares compatíveis, clinicamente, com condilomas. Feita a opção pela exérese cirúrgica em lesão de abdome, a qual evidenciou condiloma acuminado e cauterização química de lesões vulvares. Solicitados exames para doenças sexualmente transmissíveis, que foram normais, incluindo citologia oncótica, colposcopia e teste rápido para gonococo e clamídia. Conclusão: a umidade e o calor locais, provocados pelo abdome em avental, com concomitância de área de intertrigo, poderiam justifi car a presença de condiloma acuminado nesta região.

Introduction: the human papillomavirus (HPV) is a DNA virus that can infect skin and mucosa, already described in more than 100 different types,being 45 of those considered to be sexually transmitted. Objective: report the extra-genital case of condyloma acuminata, facilitated by the presenceof intertrigo. Method: report of a case of female patient presenting extensive condylomatous lesions associated to intertrigo in hypogastric region. Results: a 46-year-old female patient assisted in the DST/AIDS Clinic of the Gynecology Sector at Santa Casa de Misericórdia from Vitória in 2007, presenting extensive condylomatous lesions associated to intertrigo in hypogastric region above the Pfannestiel scar and small compatible vulvar verrucosa lesions suggestive of condyloma. Surgical excision was made in the abdomen lesion which evidenced condyloma acuminatum and chemical cauterization of vulvar warts. Tests for sexually transmitted diseases were requested, all of them were normal, including oncotic cytology, colposcopy and fast test for gonococcus and chlamydia. Conclusion: local humidity and heat provoked by abdomen in apron with concurrence of area of intertrigo could justify the presence of condyloma acuminatum in this region.

Cutaneus manifestations of diabetes in diabetic patient presenting in outdoor

The aim of our study was to evaluate the frequency of skin manifestations in diabetic patients. Cross sectional study. Outpatient Department of Nishter Hospital Multan during the period from 1-6-2006 to 1-6-2007. One hundred and fifty-one type-2 diabetic patients [106 women and 45 men] attending an outpatient clinic were included in this study. All patients were then asked about any skin problems they might have and subsequently all were examined, regardless of their response. A total of 36 dermatologic disease entities were categorized. Information regarding age, sex, and the presenting disorders was recorded. The overall prevalence of one or more identifiable/apparent skin conditions was 85.4%. The most common skin conditions were infections [31.7%] [mostly mycoses], non-Candidal intertrigo [20.5%], eczemas [15.2%] [mostly neurodermatitis], psoriasis [11.2%], diabetic dermopathy [11.2%], and prurigo [9.9%]. According to sex, there was no significant difference in the prevalence of skin disorders. This study shows that skin cenditions are common in patients with type-2 diabetes mellitus. Therefore, frequent dermatologic evaluation of these diabetic patients is warranted

[Superficial fungal infections. Epidemiology, clinical and mycological study over years period]

The object of our study is to release the epidemiological, clinical and mycological characteristics of superficial fugal infections. A retrospective study was carried out during three years [1996-1998]. Direct microscopy was positive in 86% cases, the culture in 62% cases. Trichophyton rubrum accounts for 85% of the dermatophytic flora. The superficial fugal infections account for 15% of the reasons for consultation in our service. They would touch according to data's of literature 2 to 13% of the general population. Trichophyton rubrum in accordance with the various series published, is the fungi most frequently insulated with variable rates between 46 and 82% of the superficial fugal infections. Any time, Candida albicans is prevalent on the level of the hands

Cutaneous Adverse Reactions Induced by Gefitinib (Iressa) in Lung Cancer Patients / 결핵및호흡기질환

BACKGROUND: Gefitinib (ZD 1839, Iressa) is a new anticancer agent; more specifically, it is a selective epidermal growth factor receptor tyrosine kinase inhibitor that is, widely used for various solid cancers, including lung cancer. Cutaneous adverse reactions induced by gefitinib have recently been reported; however, not much on this topic has been reported in the Korean literature. METHOD: We studied cutaneous adverse reactions of gefitinib in 23 patients who suffered with non-small cell lung cancer at Chonnam National University Hwasun Hospital from October 2004 to September 2005. RESULT: The patients ranged from 23-72 years old, and there were 17 patients with adenocarcinoma, 5 with squamous cell carcinoma and 1 with bronchioloalveolar carcinoma. The most common adverse reaction was acneiform eruptions in 15 patients (65.2%). This reaction appeared within 2 months after medication, and it didn't correlate with the therapeutic response and tumor type. Pruritus was the second most common reaction (39.1%), which was mild and generalized, especially around eyelid area. Xerosis (26.1%), exfoliation on palm and sole (21.7%), and paronychia (21.7%) followed. Hair breakage and intertrigo were rare adverse reactions. CONCLUSION: Various cutaneous adverse reactions were observed in patients with non-small cell lung carcinoma after gefitinib treatment. The skin complications could be alleviated with dermatologic consultations and treatments, skin complications could be alleviated.

Study of Clinical Features of Cutaneous Side Effects Associated with ZD 1839 / 대한피부과학회지

BACKGROUND: ZD1839 (Iressa(R)Gefitinib) is an orally active, selective epidermal growth factor (EGF) receptor tyrosine kinase inhibitor that blocks signal production pathways in cell proliferation. It is currently used in the treatment of advanced stage non-small cell lung cancer. Cutaneous side effects commonly associated with ZD 1839 treatment include acneiform eruption, dry skin and hair growth abnormalities. Cutaneous eruptions result from direct interference with functions of EGF receptor signaling in the skin. OBJECTIVE: The purpose of our study was to investigate the clinical features of cutaneous side effects of ZD 1839 in Korean with literature review. We also analysed the relationship between skin rash severity, onset and objective tumor response. METHOD: We retrospectively reviewed medical records and the histologic materials of 23 Korean patients who had been treated with ZD 1839 at Ajou University Hospital from March 2002 to September 2003 . RESULTS: The results are summarized as follows. 1. The most common cutaneous side effect was acneiform skin rash (56%) which is a well known complication of ZD 1839. 2. Acneiform eruptions were easily controlled by oral antibiotics, such as minocycline and topical retinoid ointment. 3. The second common side effect was dry scaly skin (43%). 4. We also found acute paronychia, finger tip desquamation, alopecia and intertrigo. 5. The severity of the skin rash correlated well with the treatment response of ZD 1839. 6. When the skin rash appeared within 1 week after taking ZD 1839, the skin rash was severe, and the tumor responded well to the ZD 1839. CONCLUSION: The results of this study suggest that acneiform eruption and dry skin are the most common cutaneous side effects of ZD 1839. The association between rash severity and onset of tumor response suggests that the rash may serve as a marker of response to ZD1839 therapy and may be used to guide treatment to obtain optimal response. However, further prospective studies on the potentially important association between rash severity or onset and outcome of treatment with ZD 1839 are needed.

Spectrum of skin disorders presenting to King Abdul Aziz hospital during Hajj season-2000

The pilgrimage [Hajj] to the holy mosque in the city of Makkah takes place once every year and during this huge gathering skin diseases are quite common due to hot weather and over crowding. The aim of this study was to collect and report data regarding different dermatological problems occurring during the holy month of Zil-hajj. Data regarding skin diseases was collected from pilgrims which were examined and diagnosed clinically at the Department of Dermatology King Abdul Aziz Hospital, during the month of Zil-Hajja of the year 2000. These patients were referred from various primary health centers, medical hajj missions of various countries and Children and Maternity hospital in Makkah. During the month of Zil- hajja of the year 2000, 1510 cases were seen, of these 1143 were males and 367 were females. The criteria for diagnosis for most of the cases were mainly clinical. The highest number of patients was in the age group of 20-50 years. Eczemas of different types were the most common skin disease observed in these pilgrims, intertrigo was the next most common presenting condition this was followed by fungal and bacterial infections. A high frequency of skin diseases such as eczemas, intertrigo, pyoderma and fungal infections was found among the pilgrims. More detailed studies regarding skin conditions during this season would enable us to have better understanding of skin problems there management and prevention in full

Isolation and Identification of Candida Species in Superficial Cutaneous Candidiasis / 대한피부과학회지

BACKGROUND: There have been few clinical and mycological studies of superficial cutaneous candidiasis in Korea. OBJECTIVE: The purpose of the study was to investigate the recent clinical and mycological features of superficial cutaneous candidiasis and correlation between underlying diseases and candidiasis. METHODS: Among 233 patients, 233 strains of Candida(C.) species were isolated and identified by Sabouraud's dextrose agar culture, germ tube test and sugar assimilation test using API 20C kit. RESULTS AND CONCLUSION: 1. The incidence of superficial cutaneous candidiasis was 4.0% out of a total of 5,809 out-patients. 2. The ratio of male to female patients was 1.1:1. 3. Among the age groups, the incidence rate was high in the first decade and above sixth decade. 4. Candidal intertrigo was the most common type of infection(56.7%). 5. Among 233 Candida species C. albicans(90.6%), C. parapsilosis(4.7%), C. guilliermondii(2.1%), C. tropicalis(1.7%), C. glabrata(0.9%) were identified. 6. Neurological disease was the most common underlying disease(56.4%).

Etiology of toe-web disease in Al-Ain, United Arab Emirates: bacteriological and mycological studies

We examined and sampled 45 patients with toe-web intertrigo for bacteriological and mycological studies. Prominent isolated pathogens were the genus Candida [57.7%], genus Aspergillus [28.8%], Pseudomonas aeruginosa [26.7%] and coliforms [24.4%]. Dermatophytes scored 4.4% [Trichophyton rubrum]. There were 43 patents [95.5%] who presented with marked hyperkeratosis and maceration of the toe-webs involved. The tradition of the Emirati population of sitting cross-legged may, over time, induce in the toe-webs of overweight individuals a macerated pressure-reaction hyperkeratosis that is colonized by environmental germs. T. rubrum and T. mentagrophytes are uncommon in the Al-Ain environment and this may explain the rarity of dermatophytes in toe-web intertrigo in our study

Azole Antifungal Susceptibility Testing of Candida Species Using E test / 대한피부과학회지

BACKGROUND: Because of recently increasing reports of azole-resistant Candida species, it is necessary to perform antifungal susceptibility test. E test(AB Biodisk, Sweden) is a rapid, easy-to- perform in-vitro antifungal susceptibility test. OBJECTIVE: The purpose of the study was to investigate the minimal inhibitory concentration(MIC) of azole antifungal agents against Candida sp. isolated from skin lesion using E test. METHODS: Twenty-seven clinical isolates of Candida sp.(including 24 C. albicans, 2 C. parapsilosis, and 1 C. guilliermondii) were tested. MIC endpoints of E test for itraconazole(ICZ) and fluconazole (FCZ) susceptibility were read after 24 hours for each isolates on Casitone agar. RESULTS: MIC of azole antifungal agents against Candida sp. : MIC of ICZ was 0.008-1.0microgram/mL on C. albicans, 0.023-0.125microgram/mL on C. parapsilosis, and 0.064microgram/mL on C. guilliermondii. MIC of FCZ was 0.5-4.0microgram/mL on C. albicans, 1.5-2.0microgram/mL on C. parapsilosis, and 0.5microgram/mL on C. guilliermondii. According to NCCLS(National Committee for Clinical Laboratory Standards) guidelines, two strains of C. albicans isolated from patients with Candidal intertrigo showed ICZ-resistant. CONCLUSION: We found that E test represented a simple and valuable method for susceptibility test for Candida sp.

A Case of Malassezia Intertrigo / 대한의진균학회지

Malassezia intertrigo is a very rare clinical entity in which the clinical lesions occur in intertroginous areas as erythematous scaling macules and direct microscopic examinatons of scales reveal only large numbers of yeast forms of Malassezia organism. A 59-year-old man, developed brown, finely scaling macular lesions on the inguinal areas. Direct microscopy and culture of the scalings taken from the lesional areas of the patient revealed only oval forms of Malassezia organism.

A Case of Verrucous Hyperplasia in An Amputee / 대한피부과학회지

Chronic dermatological problems associated with lower limb amputation sites include local maceration, intertrigo, blistering and ulceration, contact dermatitis, tissue atrophy, verrucous hyperplasia, lichenification, callosities, epidermoid cyst formation, and malignant neoplasia. A 60 year-old male was presented with a verrucous oozing eruption of the amputation stump of the left leg. He had been involved in a railroad logging accident 30 years before, resulting in the loss of the left lower limb. He were a below-knee prosthesis (patellar-tendon hearing). We diagnosed him as verrucous hyperplasia by clinical and histological findings and then referred him to the division of rehabilitation for a refitting of his prosthesis, after which his eruption cleared two months later.

Superficial Cutaneous Candidiasis / 대한의진균학회지

Candidiasis is an acute or chronic infection caused most commonly by Candida albicans and occasionally by other species of the genus Candida. The superficial cutaneous candidiasis is varied; oral Candidiasis, perieche, candidal vulvovaginitis, candidal balanitis, candidal intertrigo, erosio interdigitalis blastomycetica, perianal candidiasis, candidal paronychia, candidal onychia, chronic mucocutaneous candidiasis, congenital cutaneous candidiasis, and candidid. Diagnosis can be made by typical appearance of the clinical lesions and the presence of satellite vesicopustules. This can be confirmed by KOH examination and culture of skin scrapings. Treatment is the correction of predisposing factors, topical therapy of imidazoles and/or systemic administration of itraconazole or fluconazole.