Subject(s)
Adenocarcinoma, Sebaceous/surgery , Mohs Surgery , Nevus/surgery , Sebaceous Gland Neoplasms/surgery , Skin Neoplasms/surgery , Adenocarcinoma, Sebaceous/pathology , Biopsy , Female , Humans , Middle Aged , Nevus/pathology , Scalp , Sebaceous Gland Neoplasms/pathology , Skin Neoplasms/pathology , Tomography, X-Ray ComputedSubject(s)
Neoplastic Syndromes, Hereditary/genetics , Neoplastic Syndromes, Hereditary/pathology , Skin Diseases, Papulosquamous/pathology , Skin Neoplasms/genetics , Skin Neoplasms/pathology , Tumor Suppressor Proteins/genetics , Biopsy, Needle , Deubiquitinating Enzyme CYLD , Diagnosis, Differential , Facial Dermatoses/genetics , Facial Dermatoses/pathology , Facial Dermatoses/therapy , Female , Gene Expression Regulation , Humans , Middle Aged , Mutation , Neoplastic Syndromes, Hereditary/therapy , Rare Diseases , Scalp Dermatoses/genetics , Scalp Dermatoses/pathology , Scalp Dermatoses/therapy , Skin Diseases, Papulosquamous/diagnosis , Skin Diseases, Papulosquamous/therapy , Skin Neoplasms/therapy , Teaching RoundsABSTRACT
Tumor necrosis factor-? (TNF-?) inhibitors are biologic agents that are currently in wide use for the treatment of psoriasis as well as other inflammatory diseases. Following reports of thrombocytopenia as a potential adverse effect of anti-TNF-? therapy, we performed a retrospective study to determine the frequency of thrombocytopenia, defined as a platelet count <50x109 cells/L, in a cohort of 187 psoriatic patients treated with anti-TNF-? agents over a nine-year period. Although none of our patients met serologic criteria for thrombocytopenia or displayed clinical manifestations of thrombocytopenia, two patients developed platelet counts below 100×109 cells/L. Thrombocytopenia induced by anti-TNF-? agents is a potential adverse effect, it is a rare occurrence that will require further investigation in large, placebo-controlled, double-blind, prospective studies.
Subject(s)
Anti-Inflammatory Agents/adverse effects , Antibodies, Monoclonal/adverse effects , Immunoglobulin G/adverse effects , Psoriasis/drug therapy , Thrombocytopenia/chemically induced , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adalimumab , Adult , Aged , Anti-Inflammatory Agents/therapeutic use , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized , Blood Cell Count , Etanercept , Female , Humans , Immunoglobulin G/therapeutic use , Infliximab , Male , Middle Aged , Platelet Count , Psoriasis/immunology , Psoriasis/pathology , Receptors, Tumor Necrosis Factor/therapeutic use , Retrospective Studies , Thrombocytopenia/epidemiology , Tumor Necrosis Factor-alpha/metabolism , Young AdultABSTRACT
Candida krusei is an emerging fungal pathogen found primarily in immunocompromised patients. Intrinsic resistance to fluconazole and decreasing susceptibility to other anti-fungal agents are problematic. When colonization occurs, dissemination may follow rapidly. We present a case of a patient with acute lymphoblastic leukemia who, despite being treated prophylactically with fluconazole, developed disseminated C. krusei.
Subject(s)
Candidiasis, Cutaneous/diagnosis , Candidiasis, Cutaneous/immunology , Fungemia/diagnosis , Fungemia/immunology , Immunocompromised Host , Leukemia, Biphenotypic, Acute/complications , Antifungal Agents/therapeutic use , Candida , Candidiasis, Cutaneous/prevention & control , Fluconazole/therapeutic use , Fungemia/prevention & control , Humans , Leukemia, Biphenotypic, Acute/immunology , Male , Young AdultSubject(s)
Leprosy/pathology , Skin Diseases/pathology , Aged , Humans , Leprosy/microbiology , Male , Skin Diseases/microbiologyABSTRACT
Vogt-Koyanagi-Harada (VKH) syndrome is an inflammatory condition characterized by bilateral uveitis, vitiligo, poliosis, alopecia, and dysacousia. The syndrome results from a T cell mediated autoimmune attack on melanocytes in genetically susceptible individuals. We present a case of VKH syndrome and propose that the alopecia and poliosis described in the original reports by ophthalmologists could instead be alopecia areata with re-growth of white hair.
Subject(s)
Alopecia Areata/complications , Alopecia Areata/pathology , Uveomeningoencephalitic Syndrome/complications , Uveomeningoencephalitic Syndrome/pathology , Adult , Female , HumansABSTRACT
BACKGROUND: The number of cosmetic procedures performed annually is on the rise and is being performed by more specialties. PURPOSE: We sought to determine the relative outpatient cosmetic procedure experience of dermatology and other specialties. We also examined demographic data of patients who underwent cosmetic procedures. METHODS: Demographics and data from the National Ambulatory Medical Care Survey (NAMCS) were analyzed to estimate the number of visits for office-based cosmetic procedures from 1995 to 2003 by specialty and type of procedure. RESULTS: In order of decreasing frequency, the percentage of all cosmetic procedures performed in the outpatient setting by specialty was as follows: dermatology (48%), plastic surgery (38%), general surgery (>4%), otolaryngology (>3%), ophthalmology (>3%), facial plastic surgery (1%), family practice (<1%), pediatrics (<1%), and internal medicine (<1%). Most cosmetic procedures were performed on white, female patients in the 40- to 59-year-old age group. There was a mean of 55 visits per 1,000 whites and 27 visits per 1,000 nonwhites. Chemical peels and soft tissue fillers were the two most common procedures. CONCLUSIONS: Dermatology as a specialty performs more office-based cosmetic procedures than other specialties. On a per-physician basis, dermatologists and plastic surgeons have far more experience with cosmetic procedures than other physicians.
