ABSTRACT
Acanthosis nigricans (AN) is a well-known cutaneous condition that is most commonly associated with insulin resistance and obesity when present in a pediatric patient. We present a unique presentation of AN in an adolescent African American girl with a history of perennial allergic rhinitis. She presented with AN affecting the neck, axillae, as well as the transverse nasal crease, a consequence of habitual pushing of the nasal tip upward due to chronic obstruction and itching from allergic rhinitis known as the "allergic salute." All providers should be aware of this rare presentation, as the presence of AN should prompt additional evaluation to determine the underlying cause and effect of appropriate treatment.
Subject(s)
Acanthosis Nigricans/etiology , Nose , Pediatric Obesity/complications , Rhinitis, Allergic, Perennial/complications , Acanthosis Nigricans/pathology , Child , Female , Humans , Nasal Obstruction/etiologySubject(s)
Analgesics/adverse effects , Burns/etiology , Hot Temperature/adverse effects , Salicylates/adverse effects , Administration, Cutaneous , Analgesics/administration & dosage , Female , Humans , Middle Aged , Musculoskeletal Pain/therapy , Nonprescription Drugs/administration & dosage , Nonprescription Drugs/adverse effects , Salicylates/administration & dosageABSTRACT
Ablative fractional laser resurfacing (AFLR) is emerging as a safe and effective treatment option for the mitigation of cosmetic and functional deficits resulting from traumatic scars and scar contractures. Military centers of excellence engaged in the multidisciplinary rehabilitation of wounded warriors have been instrumental in the widening acceptance of the technique in both the military and civilian realms. Despite the end of large-scale combat operations, AFLR remains a promising complement to surgical reconstruction and a novel option in challenging clinical situations that defy resolution with traditional methods. Herein, we present the case of a man in his 50s who underwent extensive genital and perineal debridement related to Fournier's gangrene. Despite successful reconstruction including extensive skin grafting, the patient suffered from intractable discomfort related to developing scar contractures that responded rapidly to a course of AFLR. This case serves to highlight the potential benefits of AFLR for postoperative wound management, and the importance of a multidisciplinary approach for the care of complex injuries.
Subject(s)
Fournier Gangrene/complications , Laser Therapy/methods , Plasma Skin Regeneration/methods , Acidosis, Lactic/diagnosis , Acidosis, Lactic/etiology , Cicatrix/complications , Cicatrix/etiology , Emergency Service, Hospital/organization & administration , Humans , Laser Therapy/instrumentation , Leukocytosis/diagnosis , Leukocytosis/etiology , Male , Middle Aged , Perineum/abnormalities , Perineum/microbiology , Pruritus/etiology , Plastic Surgery Procedures/adverse effects , Treatment OutcomeABSTRACT
Isotretinoin (13-cis-retinoic acid) is widely used for the treatment of severe acne as well as for disorders of conification, for psoriasis, and for skin cancer prevention. As a member of the retinoid family, it has a wide spectrum of side effects, including reproductive, cutaneous, ocular, neurological, musculoskeletal, and hepatic. As long as patients are able to tolerate these side effects, it can be a very effective treatment option. This article examines both the most common and the most concerning side effects as well as ways in which providers and patients may best manage them to be able to benefit from isotretinoin treatment.
