Development of Periungual Pyogenic Granuloma with Associated Paronychia Following Isotretinoin Therapy: A Case Report and a Review of the Literature.

The development of periungual pyogenic granulomas while taking the oral acne drug isotretinoin is a known yet uncommon and potentially severe side effect of the oral vitamin A derivative. Previous reports have detailed the development of pyogenic granulomas most commonly arising at sites of previous acne lesions as well as both subungual and periungual locations, with associated paronychia, bleeding, and discomfort. This is thought to arise as a result of the nail bed's fragility and propensity toward spicule formation brought on by the proliferative action of isotretinoin. Here, we report a case of periungual pyogenic granuloma with associated paronychia in a patient taking oral isotretinoin. A review of the pathogenesis and available treatment modalities based on the current literature is provided.

The prevalence of impaired glucose metabolism in patients referred to cardiac rehabilitation.

PURPOSE: The aim of this study was to assess the prevalence of impaired glucose metabolism in patients who attended hospital-based cardiac rehabilitation. METHODS: We performed a single-group cross-sectional study. In a 7-month period, from September 2010. The study was conducted in a cardiac rehabilitation setting at a university hospital. Overall, 273 patients, with an established diagnosis of ischemic heart disease, who were referred to the cardiac rehabilitation center, were included. The primary outcome measure was the prevalence of impaired glucose metabolism. We also compared cardiovascular disease risk profile among participants. RESULTS: One hundred twenty-one participants (44%) had diabetes mellitus, of which, for 80 patients, the diagnosis was previously established. Of the 193 patients without a previous diagnosis of diabetes, 52 patients (27%) had normal glucose levels, 41 (21.2%) had diabetes, 51 (26.4%) showed impaired glucose tolerance, and 49 (25.4%) had isolated impaired fasting glucose according to the American Diabetic Association criteria. Consistent with the World Health Organization criteria, 27 patients (14%) would have had isolated impaired fasting glucose and using fasting criteria alone, 22 patients would have had undiagnosed diabetes. CONCLUSION: Impaired fasting glucose and impaired glucose tolerance did not identify the same patients. It seems that both fasting plasma glucose and oral glucose tolerance test are necessary in the diagnosis of impaired glucose metabolism in patients with coronary artery disease.

A variant of nephrogenic fibrosing dermopathy with osteoclast-like giant cells: a syndrome of dysregulated matrix remodeling?

Nephrogenic fibrosing dermopathy (NFD) is a disorder characterized by dramatic thickening and hardening of skin in the extremities and trunk, which occurs in individuals on dialysis for renal disease. The pathophysiology is unknown. Increased transforming growth factor-beta (TGF-beta) and collagen deposition have been reported in a small group of patients studied by Jimenez et al.1 We report two patients with NFD and osteoclast-like giant cells in the fibrotic dermis; one patient also had dystrophic cutaneous calcification. These findings have been seen in a small percentage of NFD patients (estimated 2-5%) and may represent a variant of the disease. The hypothesis of altered matrix dysregulation due to altered TGF-beta, metalloproteinases, and activation of osteoclasts as an explanation for this variant is proposed.