Periorbital edema and mees' lines in systemic lupus erythematosus.

There are many cutaneous findings that have been described in systemic lupus erythematosus (SLE). These include disease-specific and nonspecific lesions. Periorbital edema in the absence of proteinuria or hypoalbuminemia has been only rarely described. We report three patients who developed marked periorbital edema in association with a flare of SLE. All patients were without proteinuria or significant hypoalbuminemia, and no other etiology for the periorbital swelling was identified. This occurred despite all three taking antimalarial therapy, but the edema resolved promptly and completely with glucocorticoids. One of these patients also had transverse leukonychia, or Mees' lines, present on several fingernails, that appeared to correspond with previous SLE flares.Mees' lines and periorbital edema may represent two additional nonspecific but disease-related dermatologic manifestations of SLE. Whereas periorbital edema usually develops in concert with other clinical evidence of a lupus flare and is easily treated, Mees' lines appear to serve as a time line for previous SLE activity.

Surgical wound healing complicated by Aspergillus infection in a nonimmunocompromised host.

BACKGROUND: An unusual complication of cutaneous surgery and its management is presented. Aspergillus flavus was identified from a nonhealing surgical wound of the ear undergoing cartilaginous necrosis in an immunocompetent host. OBJECTIVE: We wish to alert clinicians that Aspergillus may infect surgical wounds of the ear causing significant morbidity. METHOD: A healthy man underwent Mohs micrographic surgery for invasive Bowen's disease of the ear. Due to the size and location of the defect it was allowed to heal by secondary intent. The patient developed inflammation and subsequent destruction of the ear cartilage. Aspergillus was demonstrated by touch preps and cultured from swabs and tissue from the necrotic wound. RESULTS: In spite of aggressive topical and oral antifungal therapy severe distortion of the pinna occurred, resulting in surgical removal of the upper two-thirds of the ear. CONCLUSIONS: In the presence of cartilage necrosis following surgery on the ear, Aspergillus infection should be considered. Early aggressive management with surgical debridement, and topical and oral antifungal therapy may prevent destruction of the cartilage and a significant cosmetic defect.

Ischemic complications of tubular gauze dressings.

BACKGROUND: Ischemic pressure complications associated with tubular gauze digital dressings have been occasionally reported in the medical literature. Previous authors have implicated specific mechanisms. We report a 10th case of this type of complication and hypothesize that a "Chinese finger trap" mechanism was responsible. OBJECTIVE: To compare pressures generated using different application techniques of tubular gauze digital dressings. METHODS: A simple device to measure dressing pressure was constructed. Comparative pressure measurements using different application techniques were obtained. RESULTS: Too many layers, excess longitudinal traction during application, using more than a 90 degrees twist during application, and rolled proximal dressing edges all increased measured pressures significantly. CONCLUSIONS: Physicians and other health care providers involved in the application of these dressings should be aware of their correct application and the mechanisms that may produce complications.

Cutaneous candidiasis as a cause of delayed surgical wound healing.

BACKGROUND: Reports in the literature of surgical wounds infected with Candida species are scant. OBJECTIVE: We describe a subset of patients with cutaneous candidiasis whose only clinical finding was delayed wound healing. METHODS: Surgical wounds managed with moist occlusive postoperative dressings were observed for delayed healing. RESULTS: Three patients are described who demonstrated delayed wound healing with failure to epithelialize. Fungal cultures from each patient revealed heavy growth of Candida. The problem resolved quickly with a modified wound care regimen and application of an antiyeast cream. CONCLUSION: Cutaneous candidiasis can be a cause of delayed wound healing, especially in surgical wounds treated with antibacterial ointments and occlusive dressings.