ABSTRACT
We report a 44-year-old man with a diagnosis of right-sided periorbital cellulitis caused by a group A ß-hemolytic streptococcus who developed severe eyelid necrosis. After intravenous antibiotic treatment and necrotomy, reconstructive eyelid surgery was needed.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Cellulitis/diagnosis , Eyelid Diseases/diagnosis , Streptococcal Infections/diagnosis , Streptococcus pyogenes , Adult , Cellulitis/drug therapy , Cellulitis/surgery , Eyelid Diseases/drug therapy , Eyelid Diseases/surgery , Eyelids/microbiology , Eyelids/pathology , Eyelids/surgery , Fever/diagnosis , Fever/etiology , Humans , Male , Necrosis/diagnosis , Necrosis/drug therapy , Necrosis/surgery , Plastic Surgery Procedures , Streptococcal Infections/drug therapy , Streptococcal Infections/surgery , Treatment OutcomeABSTRACT
BACKGROUND: Treatment of early-stage mycosis fungoides (MF) consists of topical steroids, phototherapy (UVB), photochemotherapy (psoralen plus UVA [PUVA]), topical nitrogen mustard, or total skin electron-beam irradiation. It has been reported that the same effective UVB dose is safer than PUVA regarding carcinogenicity and produces fewer side effects. Narrowband UVB (311 nm) results in less irritation and erythema and is more effective compared with broadband UVB. OBJECTIVE: Our purpose in this retrospective study was to analyze the response to treatment, relapse-free interval, and irradiation dose in 56 patients with early-stage MF (stage Ia and Ib). A total of 21 patients were treated with narrowband UVB (311 nm); 35 patients were treated with PUVA. RESULTS: Narrowband UVB treatment led to complete remission in 17 of 21 patients (81%), partial remission in 4 of 21 (19%), and none showed progressive disease. PUVA treatment led to complete remission in 25 of 35 patients (71%), partial remission in 10 of 35 (29%), and none showed progressive disease. The mean relapse-free interval for patients treated with UVB was 24.5 months (range, 2-66 months) and for patients treated with PUVA, 22.8 months (range, 1-43 months). CONCLUSION: Narrowband UVB therapy for patients with early-stage MF is an effective treatment modality. It has several advantages over treatment with broadband UVB and PUVA. When treating patients with early-stage MF it may be beneficial to start with narrowband UVB therapy and, if there is progression or no response, switch to PUVA therapy.
