ABSTRACT
Patients with intractable eczema are often referred for patch testing to exclude contact dermatitis. If this is excluded, then a diagnosis of endogenous eczema is made. At our clinic, we find a sizeable proportion of these patients do not fit any of the known patterns of endogenous eczema. These patients are given the diagnosis of unclassified endogenous eczema and make up 8% of the patients seen at our Occupational and Contact Dermatitis Clinic. There is little information available on this group of patients, with no mention of this problem in the recent dermatological literature. Since March 1996, we have further investigated these patients, to develop some understanding of this category. 12 of 34 patients reviewed over this period had an elevated IgE level above 100 IU/ ml. Thus, despite no past history or family history of eczema, asthma or hayfever, at least 1/3 of these patients are probably suffering from atypical, late onset atopic dermatitis. Patients were later contacted by telephone (average 2 years) to assess the natural history of this condition. In 20 of the 31 patients contacted, their eczema had either improved or resolved. We think that this important category of eczema needs to be recognized and further investigated.
Subject(s)
Eczema/classification , Eczema/diagnosis , Immunoglobulin E/blood , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Australia/epidemiology , Diagnosis, Differential , Eczema/epidemiology , Eczema/immunology , Female , Humans , Incidence , Male , Middle Aged , Patch Tests , Risk Assessment , Sex DistributionABSTRACT
A 16-year-old male developed numerous pyogenic granuloma like-lesions across his neck, chest and back after 6 weeks isotretinoin therapy for cystic acne. The isotretinoin was ceased and he was commenced on oral steroids. After 6 weeks, the lesions were almost completely healed. However, due to worsening comedonal acne, the patient was commenced on topical tretinoin cream 0.05% twice daily to his chest. He was reviewed 2 weeks later and, surprisingly, 2 new pyogenic granuloma-like lesions had developed on his chest. These lesions persisted until the topical tretinoin was ceased 3 months later.
Subject(s)
Acne Vulgaris/drug therapy , Drug Eruptions/etiology , Granuloma, Pyogenic/chemically induced , Isotretinoin/adverse effects , Keratolytic Agents/adverse effects , Skin Ulcer/chemically induced , Acne Vulgaris/complications , Adolescent , Granuloma, Pyogenic/drug therapy , Humans , MaleABSTRACT
Clinical diagnosis of melanoma can be difficult. A review of the accuracy of clinical diagnosis of melanoma, over a 12 month period, was undertaken at the Skin and Cancer Foundation Australia. The overall accuracy rate was 65.6% with seborrhoeic keratosis, melanocytic naevi and basal cell carcinoma the most common clinical misdiagnoses given to melanoma. Specialist doctors with more than 10 years experience had a higher rate of correct diagnosis than trainee doctors with 0-5 years experience.
Subject(s)
Melanoma/diagnosis , Skin Neoplasms/diagnosis , Australia , Clinical Competence , Diagnosis, Differential , Humans , Skin Diseases/diagnosisABSTRACT
A 40-year-old male developed a constant hand and foot dermatitis in 1980 while using sorbolene cream as a barrier cream at work. He was forced to leave his trade as a motor mechanic because of his hand dermatitis. It was not until 16 years later that he was diagnosed as having an allergic contact dermatitis to chlorocresol secondary to an endogenous hand and foot dermatitis. Chlorocresol is the preservative used in sorbolene cream as well as many corticosteroid creams. Patch testing carried out in 1983 was negative but had omitted testing with chlorocresol or sorbolene cream.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Cresols/adverse effects , Dermatitis, Allergic Contact/etiology , Preservatives, Pharmaceutical/adverse effects , Administration, Topical , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/adverse effects , Adult , Cresols/administration & dosage , Cresols/therapeutic use , Dermatitis, Allergic Contact/physiopathology , Dermatitis, Allergic Contact/therapy , Diagnosis, Differential , Foot Dermatoses/drug therapy , Hand Dermatoses , Humans , Male , Patch TestsABSTRACT
Ionizing radiation was recognized very early after its discovery as a useful weapon against both neoplasia and inflammation. Following an initial period of enthusiastic use, recognition of its drawbacks and the development of safe and effective alternative treatments for many applications have resulted in a marked reduction in the use of radiotherapy in most dermatological offices. Nonetheless, this modality remains an important component of our modern therapeutic armamentarium. It is a treatment of choice in some situations, and a useful alternative in many more. A thorough understanding of the principles and practice of safe radiotherapy remains vital to the full practice of dermatology in 1996. The present review summarizes the current practice of radiotherapy and offers some guidelines for safe and effective use of this important tool. Detailed discussions of radiobiology, deep radiotherapy (DXRT) and electron beam (EB) therapy are beyond the scope of this clinical review.
