ABSTRACT
Loxoscelism is a condition produced by the bite of Loxosceles laeta. It can present as cutaneous loxoscelism with only vascular dermal manifestations or as viscerocutaneus loxoscelism with systemic compromise and a mortality rate of 1 to 3%. We report the case of an adult patient presenting viscerocutaneus loxoscelism, who was evolving with macrohematuria, edema, and progressive blisters, requiring treatment in the intensive care unit. He was treated according to the actual scientific evidence with antihistamines, corticosteroids, and dual antibiotic therapy covering Streptococcus spp., Staphylococcus spp., and anaerobes, particularly penicillin and tetracycline resistant C. perfringens. The use of dapsone and antiloxosceles-serum was avoided. The patient showed a favorable clinical evolution.
Subject(s)
Skin Diseases/etiology , Spider Bites/complications , Viscera , Adult , Humans , Male , Spider Bites/therapyABSTRACT
Loxoscelism is a condition produced by the bite of Loxosceles laeta. It can present as cutaneous loxoscelism with only vascular dermal manifestations or as viscerocutaneus loxoscelism with systemic compromise and a mortality rate of 1 to 3%. We report the case of an adult patient presenting viscerocutaneus loxoscelism, who was evolving with macrohematuria, edema, and progressive blisters, requiring treatment in the intensive care unit. He was treated according to the actual scientific evidence with antihistamines, corticosteroids, and dual antibiotic therapy covering Streptococcus spp., Staphylococcus spp., and anaerobes, particularly penicillin and tetracycline resistant C. perfringens. The use of dapsone and antiloxosceles-serum was avoided. The patient showed a favorable clinical evolution.
El loxoscelismo es producido por la mordedura de la araña Loxosceles laeta. Puede ser cutáneo, con alteraciones vasculares o cutáneo-visceral, con manifestaciones sistémicas y una mortalidad de 1 a 3%. Se presenta el caso de un paciente adulto con loxoscelismo cutáneo-visceral, que evolucionó con hematuria macroscópica, edema y aparición de flictenas en forma progresiva en antebrazo, requiriendo ser trasladado a la Unidad de Tratamiento Intermedio. Fue manejado según la evidencia científica actual que recomienda el uso de antihistamínicos, corticoesteroides y terapia antibacteriana asociada para la cobertura de Streptococcus spp., Staphylococcus spp. y bacterias anaerobias, especialmente C. perfringens resistente a penicilina y tetracilina, evitando el uso de dapsona y de suero anti-loxosceles. Evolucionó de manera favorable.
Subject(s)
Adult , Humans , Male , Skin Diseases/etiology , Spider Bites/complications , Viscera , Spider Bites/therapySubject(s)
Adult , Female , Humans , Lip Diseases/etiology , Oral Ulcer/etiology , Syphilis/complicationsSubject(s)
Lip Diseases/etiology , Oral Ulcer/etiology , Syphilis/complications , Adult , Female , HumansABSTRACT
INTRODUCTION: Skin disorders associated with photodamage from ultraviolet light include wrinkles, hyperpigmentation, tactile roughness, and telangiectasia, and are more common in people with white skin compared with other skin types. Wrinkles are also associated with ageing, hormonal status, smoking, and intercurrent disease. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for skin wrinkles? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 33 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: botulinum toxin injection (e.g., botulinum toxin type A and type B), carbon dioxide laser, chemical peel (including alpha and beta hydroxyl acids), dermabrasion, isotretinoin, tazarotene, tretinoin, and variable pulse erbium:YAG laser.
