[Sepsis associated cholestasis in adults].

Hepatic injury presenting as jaundice, hypglycemia, encephalopathy, coagulation disturbances and a significant increase in transaminases in a late well recognized complication of sepsis. Less known is a cholestatic liver injury, which can precede sepsis. This type of early liver injury is characterized by a rise of direct bilirubin and less prominent increase in liver enzymes. Experimental work in animal models demonstrates that sepsis associated cholestasis is mediated by a variety of gram negative bacterial endotoxins and cytokines which interfere with the function of bile acid intracellular transporters. Although sepsis associated cholestasis is quite common, its clinical and prognostic characteristics are not widely appreciated. This often results in performance of unnecessary procedures and delayed diagnosis. Here we review the relevant updated literature regarding the pathophysiological basis of this phenomenon and its clinical presentation and implications.

Eyelid dermatitis.

Eyelid dermatitis is a common problem, probably owing to the thinness of eyelid skin and to myriad chemical preparations that touch or are placed near the eyelids. These include eye makeups, ophthalmic preparations, airborne allergens, anti-aging medications, sun screening agents, and chemicals that touch the face from hand usage. Finding the cause starts with an excellent history followed by an exacting examination of the skin.

Prolonged erythema after facial laser resurfacing or phenol peel secondary to corticosteroid addiction.

BACKGROUND: Prolonged persistent erythema postprocedure using phenol or carbon dioxide (CO2) lasers occurs frequently and the reasons have not been fully ascertained. OBJECTIVE: To describe patients whose postoperative care consisted of prolonged use of topical corticosteroids and to assess the outcome of cessation of this medicine. METHODS: Twelve patients who underwent CO2 laser resurfacing or phenol peels to their face are presented. All patients were seen between 3 and 30 months after the procedures were performed. All dressings, wound care, and other medicaments had been stopped prior to being seen. Most were patch tested to a wide variety of chemicals including corticosteroids, topical medications, and preservatives. They were observed during the poststeroid cessation period and the clinical response is described. RESULTS: All patch testing showed insignificant results. All postpeel patients cleared within 6 months of steroid cessation, experiencing several flares of erythema before the end result. Three of the six laser resurfacing patients cleared fully within 12 months and three are still being followed. The erythema and severe burning in the patients that cleared stayed clear during long-term follow-up. No scars or atrophy were seen. CONCLUSION: The use of topical corticosteroid preparations postoperatively in peel and resurfacing patients is believed to be a major cause of prolonged erythema, dermatitis, burning, and telangiectasias in these patients. The mechanism is believed to be one of vasoconstriction/vasodilatation secondary to the corticosteroids through a nonintact barrier.

Eyelid dermatitis to red face syndrome to cure: clinical experience in 100 cases.

A retrospective review of all eyelid dermatitis patients seen over an 18-year period revealed a large subgroup of patients who had, as the basis for their ongoing problem, an addiction to the use of topical or systemic corticosteroids. This group of 100 patients often sought many consultations with various physicians. Unrelenting eyelid or facial dermatitis often resulted in the use of increasing amounts of corticosteroids for longer periods of time. Soon the skin became addicted. Once the work-up ruled out other causes, the remedy for the problem was absolute total cessation of corticosteroid usage. This article describes the typical history of the problem, the evaluation of these patients, and the distinctive pattern of flaring erythema that ensued when the corticosteroids were ceased. We stress the absolute necessity of total cessation of corticosteroid use as the only treatment for corticosteroid addiction. We also demonstrate that no additional therapy or further consultations were necessary once remission was obtained after topical corticosteroid abuse was halted.

Injectable silicone: cause of facial nodules, cellulitis, ulceration, and migration.

Fifty-four patients with problems following "medical grade" silicone injections into the face and legs were seen from 1974 until 1995. Complications consisted of chronic cellulitis, nodules, foreign body reactions, and movement of material to near and distant parts of the body. These difficulties usually demonstrated themselves many years after injection. It is suggested that problems occur despite good technique, good material, and small amounts injected. Because the side effects are unpredictable and often uncorrectable, further studies must be performed to insure silicone's safety.

Choosing a broad-spectrum sunscreen with UVA protection.

Concern over the effect of broadspectrum (UVA and UVB) radiation is growing. This article provides an up-to-date discussion of broadspectrum protection.

Participation of volunteer faculty members in education research projects.

Physicians in private practice who are also volunteer clinical faculty members are a recognized resource for teaching and patient care at teaching hospitals. Clinical faculty members have seldom been included in education research despite the frequent complaint from community practitioners that the results from studies at teaching hospitals are not applicable to community practice. The authors report on a study involving volunteer clinical faculty members in a randomized education trial to improve patients' everyday functioning. Seventy-six clinical faculty physicians in office practice of internal medicine participated. At the end of the study the physician participants were asked to complete an evaluation questionnaire concerning the appropriateness of clinical faculty members' participation in such research projects. Ninety-five percent said the experiment was appropriate, and 88 percent would participate again.

Pellagra in a patient with anorexia nervosa.

A 20-year-old woman was seen with the associated disorders of pellagra and anorexia nervosa, both of which had been present for approximately six months. Treatment with niacin induced resolution of the pellagra skin changes.

Collagen injections for aging skin lines (wrinkles).

It appears that benefit from collagen injections accrued to a large percentage of patients who responded to our questionnaire. It is interesting that 70% did not forward any information. Of those who reported benefit, the benefit lasted less than a year and was, in fact, within the 6-month range. Still, a large percentage of those responding were enthusiastic about further injections to correct their wrinkling.

Patch testing in Japanese subjects.

Experience with various patch tests, usage tests, and other studies on Japanese and Caucasian subjects is presented. Differences between the races are noted by their responses.

Exacerbation of facial herpes simplex after phenolic face peels.

The development of widespread herpes simplex on the face after phenolic face peels is not considered rare. Precaution in choosing patients is recommended. Four cases of acute exacerbation of herpes simplex are presented in patients who had recently undergone phenolic face peels.