ABSTRACT
BACKGROUND: Local anaesthesia often is insufficient for more extensive procedures. Instead of general anaesthesia or sedation, pediatricians, gynaecologists and dentists increasingly use nitrous oxide (N2O). This study evaluates the suitability of this form of anesthesia in dermatology. PATIENTS AND METHODS: In 24 patients (18 w, 6 m, mean age 49 y.) N2O/O2 inhalation (Livopan®) was used during 46 procedures with indications including fractional RF/wrinkle reduction, IPL/rosacea, q-sw. laser/tattoos and hemosiderosis as well as fractional Er:Glass laser for scars and hypopigmentation. In 26 procedures subjective pain intensity was measured (visual analogue scale 0-10). RESULTS: With N2O the treatment pain was lowered from 6.6 ± 1.6 to 2.9 ± 1.7 (median, p = 0.000). 23/24 patients chose N2O for their next treatment. Beside euphoria, fatigue, slight drowsiness, dizziness, nausea or change in auditory perception, no other side effects occurred. CONCLUSION: The pronounced analgesia, the easy self-administration, the fast onset and complete recovery after a few minutes and the low ratio of side effects make the N2O/O2 inhalation to an ideal addendum in the management of larger painful procedures in dermatology as long as contraindications and safety precautions are respected.
Subject(s)
Dermatologic Surgical Procedures/adverse effects , Nitrous Oxide/administration & dosage , Oxygen Inhalation Therapy/methods , Pain, Postoperative/etiology , Pain, Postoperative/prevention & control , Plastic Surgery Procedures/adverse effects , Administration, Inhalation , Adult , Anesthetics, Inhalation/administration & dosage , Dermatologic Surgical Procedures/methods , Female , Humans , Male , Plastic Surgery Procedures/methods , Self Administration/methods , Treatment OutcomeABSTRACT
In a retrospective study 47 patients with 68 amateur and 25 professional tattoos were examined, considering clearance of tattoo pigments and the frequency of side effects after finished treatments with the Q-switched ruby (694 nm) and the Q-switched Nd:YAG laser (532 and 1064 nm). Black amateur tattoos were found to lighten faster than professional tattoos (13.2 and 18.6 treatments respectively). For the clearance of multicolored tattoos (amateur or professional), similar numbers of laser treatments were needed. Green pigments were removed with the Q-switched ruby laser and red pigments with the frequency-doubled Nd:YAG laser (532 nm). Compared to the Q-switched Nd:YAG laser (1064 nm), the Q-switched ruby laser and the frequency-doubled Nd:YAG laser (532 nm) more often caused blistering and transient hypopigmentation (5.4% and 7.5% vs. 1.1% (blisters); 8.6% and 15.1% vs. 4.3% (hypopigmentation).
Subject(s)
Laser Therapy , Tattooing , Adult , Aged , Aged, 80 and over , Equipment Design , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
We report a patient with Niemann-Pick disease who developed papular lesions on the face. These showed ultrastructural findings typical of this disorder. Specific skin lesions such as these are an extremely rare manifestation of Niemann-Pick disease.
Subject(s)
Niemann-Pick Diseases/pathology , Skin Diseases/pathology , Adult , Facial Dermatoses/pathology , Humans , Male , Phagocytes/ultrastructureABSTRACT
This report deals with a 15-year-old girl suffering from the verrucous type of Thomson's syndrome. Initial poikilodermatous skin changes developed on both cheeks at the age of 3 months. Subsequently, rapid generalization of typical skin findings was observed. The clinical heterogenity of this syndrome is discussed with reference to the existing literature and the present case. Up to now, very few comparable cases of associated neurological symptoms have been described.
Subject(s)
Muscular Atrophy/diagnosis , Rothmund-Thomson Syndrome/diagnosis , Adolescent , Connective Tissue/pathology , Diagnosis, Differential , Female , Humans , Muscular Atrophy/genetics , Muscular Atrophy/pathology , Rothmund-Thomson Syndrome/genetics , Rothmund-Thomson Syndrome/pathology , Skin/pathologyABSTRACT
The POEMS syndrome is a synopsis of different symptoms such as polyneuropathy, organomegaly, endocrine disturbances, M-protein and skin changes. The leading symptoms are neuropathy and the skin symptoms. Additionally, a monoclonal light chain gammopathy is often found. The administration of immunosuppressive drugs yields a substantial improvement in some cases. We report here about a 72 year old lady who fell ill with a rapidly progressive neuropathy accompanied by hyperpigmentation and a morphea-like induration of the skin. A biopsy of the sural nerve showed a demyelinating axonal neuropathy and a focal vasculitis. Isoelectric focussing revealed oligoclonal bands in cerebrospinal fluid and serum. The cortisol serum level was very low and there were signs of a latent diabetes mellitus. These clinical features correspond to the POEMS syndrome. The prescription of initially 1 mg and later 0.5 mg prednisone improved the patient's condition dramatically.
Subject(s)
POEMS Syndrome/diagnosis , Aged , Biopsy , Electromagnetic Fields , Electromyography/drug effects , Female , Humans , Immunoglobulin E/analysis , Muscles/innervation , Neurologic Examination/drug effects , POEMS Syndrome/pathology , POEMS Syndrome/physiopathology , Peripheral Nerves/drug effects , Peripheral Nerves/pathology , Peripheral Nerves/physiopathology , Prednisolone/administration & dosageABSTRACT
Not until corticosteroids came into use did it become possible for modern dermatotherapy to cure numerous skin diseases, and if not cure them, at least rapidly lead to major improvements and the transition to symptom-free intervals. Through indiscriminate use, corticosteroid therapy has become discredited by patient and doctor alike due to the increased incidence of side effects. Due to this intensified rejection--bordering on "cortisone phobia"--corticosteroids today are often not being used when justifiable or even when mandatory. Most side effects can be avoided or reduced if the instructions for use are properly adhered to, thus increasing acceptance. Another way of further improving compliance is the use of low-side effect corticosteroids, such as hydrocortisone, since now the difference in effective strength compared to potent halogenated preparations can be compensated by the addition of 10% urea. With regard to active strength, a hydrocortisone/urea combination preparation should be used like a medium-strength cortisone preparation and is particularly suited for the long-term therapy of chronic dermatosis. Additional properties of urea, such as alleviation of itching and water binding, which are important in the treatment of chronic eczemas, enhance hydrocortisone in combination preparations.
Subject(s)
Anti-Inflammatory Agents/administration & dosage , Dermatitis, Atopic/drug therapy , Glucocorticoids/adverse effects , Urea/administration & dosage , Administration, Topical , Drug Combinations , Drug Synergism , Humans , Hydrocortisone , Patient ComplianceABSTRACT
71 patients suffering from allergies and chronic skin diseases were questioned as to the so-called "alternative-medical" methods of treatment they had undergone. Two thirds of the patients judged the treatment as favorable or excellent, although the typical symptoms of only half of them, at the most, were actually improved. Part of the patients were able to reduce or do without their former medication. The vast majority of those patients who had already experienced a climatic therapy judged the success of such a treatment as good or excellent, when it was compared to a traditional or "alternative-medical" therapy alone. We discuss our results.
Subject(s)
Complementary Therapies/methods , Consumer Behavior , Dermatitis, Atopic/therapy , Skin Diseases/therapy , Adolescent , Adult , Aged , Child , Child, Preschool , Chronic Disease , Female , Humans , Male , Middle AgedABSTRACT
Tar distillates and topical corticosteroids are still being used to treat chronic eczema. With the use of halogenised corticosteroids local and systemic side-effects are increasing. There fore this both doctor and patient often reject treatment. To avoid this a local treatment with corticosteroids should be effective without having side-effects. In a double-blind investigation we compared a new preparation of 1% hydrocortisone plus 10% urea with hydrocortisone 17-valerate in the treatment of atopic dermatitis. There was no difference between the two preparations concerning the improvement of symptoms and the course of the disease. However, as opposed to the monopreparation, the combination of hydrocortisone and urea caused no side-effects.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , Eczema/drug therapy , Urea/administration & dosage , Administration, Topical , Anti-Inflammatory Agents/administration & dosage , Drug Therapy, Combination , Humans , Hydrocortisone/administration & dosage , Hydrocortisone/analogs & derivativesABSTRACT
The cell-mediated immunity was investigated by delayed hypersensitivity reactions on recall antigens (tetanus, diphtheria, streptococci, tuberkulin, candida, trichophyton, proteus/Multitest-Merieux) in 56 patients with atopic dermatitis (34 females, 22 males) under mountain-climatic therapy (Davos, 5118 ft). The testscore of 7.9 mm (females 8.2/males 7.5) was lowered in comparison to the normals within the literature (females 15.4/males 21.0). Anergy was found in 8.8% in females (normal 4%) and in 9.1% in males (0.4%). After treatment the score raised up to 9.9 mm (25.3%, p less than 0.005), more obvious in males (29.3%/9.7 mm) than in females (22.0%/10.0 mm). The mean number of positive skin-reactions raised from 2.0 to 2.6 (p less than 0.001). These data let assume an influence of mountain-climatic therapy on the cell-mediated immunity.
Subject(s)
Altitude , Climate , Immunity, Cellular , Neurodermatitis/therapy , Adult , Aged , Female , Humans , Immunologic Memory , Intradermal Tests , Male , Middle Aged , Neurodermatitis/immunologyABSTRACT
Since VLDL and LDL are involved in atherogenesis, their response to dietary modification was studied in 15 normal male prisoners. A 3-month reference diet (P/S ratio 0.3, daily cholesterol intake 370 mg) was compared with a modified fat diet (P/S 1.0, 250 mg) given for further 3 months. The decrement in serum cholesterol by 32 mg/dl reflected a decrease in VLDL and LDL. It was associated with a decrease in serum apolipoprotein B by 16 mg/dl and in serum apolipoprotein E by 1.2 mg/dl. The decrement in VLDL cholesterol was paralleled by a lowered VLDL apolipoprotein E content. Serum and VLDL triglycerides, HDL cholesterol and the serum apolipoproteins A-I and A-II did not change significantly. One beneficial result of a conventional dietary regimen is lowered LDL with unaffected HDL. Another effect is the apparent modification of VLDL with a decrement of cholesterol and apolipoprotein E-enriched particles.
Subject(s)
Dietary Fats/administration & dosage , Lipoproteins, LDL/blood , Lipoproteins, VLDL/blood , Adult , Apolipoproteins/blood , Cholesterol/blood , Cholesterol, Dietary/administration & dosage , Humans , Lipoproteins, HDL/blood , Male , Middle Aged , Triglycerides/bloodABSTRACT
To evaluate possible influences of dietary intervention on the composition of very low-density lipoproteins (VLDL), ten subjects with Type 2 (non-insulin dependent) diabetes mellitus received a hypocaloric regimen. Fifteen healthy subjects served as controls. Ultracentrifuged VLDL were analysed as cholesterol, triglycerides, apolipoprotein B (apo B), and the soluble apolipoproteins C and E (polyacrylamide gel electrophoresis in urea and densitometry) before the study, after 2 weeks and then after 3 months. Compared with the control subjects, the content of cholesterol and apo E in the VLDL was elevated in the diabetic subjects, while the area ratio of apo C-II to apo C-III1 was lowered. After diet the reduction in VLDL was accompanied by compositional changes: a decrease of the cholesterol/triglyceride ratio and of the apo E/apo C area ratio. The apo C-II/apo C-III1 area ratio remained unaffected. We conclude that one beneficial effect of therapeutic intervention in diabetes may lie in lowering the level of possibly atherogenic VLDL-components.
