Subject(s)
Ectodermal Dysplasia/diagnosis , Limb Deformities, Congenital/diagnosis , Scalp Dermatoses/congenital , Debridement , Diagnosis, Differential , Ectodermal Dysplasia/surgery , Female , Follow-Up Studies , Humans , Infant, Newborn , Limb Deformities, Congenital/surgery , Reoperation , Scalp Dermatoses/diagnosis , Scalp Dermatoses/surgerySubject(s)
Agricultural Workers' Diseases/pathology , Ecthyma, Contagious/pathology , Lymph Nodes/pathology , Orf virus/immunology , Skin/pathology , Adolescent , Agricultural Workers' Diseases/immunology , Agricultural Workers' Diseases/virology , Animals , Ecthyma, Contagious/immunology , Ecthyma, Contagious/virology , Humans , Lymph Nodes/immunology , Lymph Nodes/virology , Male , Polymerase Chain Reaction , Sheep , Skin/immunology , Zoonoses/etiologyABSTRACT
Dermatology fulfills the prerequisites for telemedicine. An important application of telemedicine might be the field of dermatologic consultations. In this comparative study images of skin disease were taken of 120 patients hospitalized in the University Hospitals of Tuebingen to answer the following questions: (1) are the preconditions in daily routine given for teledermatology, (2) is there adequate agreement between the diagnoses reached in dermatologic consultations and with teledermatology, and (3) can the images be utilized for teaching purposes. Patient acceptance was very good and the images captured with a digital camera were easily obtained. The results of intraobserver analysis for the two teledermatologists without any knowledge of the patients' history were 70.2% and 46.4%, respectively, and with knowledge of the history 76.6% and 64.3%. The results of interobserver analysis without any knowledge of the patients' history were 46.4% and 57.2% and with knowledge of the history 64.3% and 66%, respectively. With the reduction of the image quality, reduced reliability of the diagnoses was observed. Seven of ten images could be used for teaching purposes. It was demonstrated that in dermatology telemedicine is applicable in many, but not in all patients who are referred for dermatologic consultations.
Subject(s)
Dermatology/statistics & numerical data , Image Interpretation, Computer-Assisted/methods , Referral and Consultation/statistics & numerical data , Remote Consultation/statistics & numerical data , Skin Diseases/epidemiology , Skin Diseases/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Dermatology/methods , Female , Germany/epidemiology , Humans , Infant , Male , Middle Aged , Remote Consultation/methods , Reproducibility of Results , Sensitivity and Specificity , Signal Processing, Computer-Assisted , Single-Blind Method , Telemedicine/methods , Telemedicine/statistics & numerical data , User-Computer InterfaceABSTRACT
PATIENT: A 62-year-old former miner with silicosis of the lungs but otherwise in good general condition presented with a solid nodule in the nasal left lid area for a duration of three months. Because of a central ulceration the reference diagnosis was basalioma. The tumour infiltrated the nasal part of the upper and lower eyelid and the tear ducts so that these were unrinseable. Similar lesions have been present since two years in other skin regions. METHODS: Two cutaneous biopsies confirmed the diagnosis of a Mycosis fungoides without detectable expression of the CD30-antigen. Medical investigation finally revealed hepatosplenomegaly and cervical, inguinal and abdominal lymph node involvement. A lymph node biopsy three months after presentation again showed a T-cell-lymphoma which was CD30-positive now. THERAPY: Systemic polychemotherapy was started. The lid lesions completely resolved, and the tear ducts were rinseable again.
Subject(s)
Eye Neoplasms/diagnosis , Eyelid Neoplasms/diagnosis , Lacrimal Apparatus Diseases/diagnosis , Mycosis Fungoides/diagnosis , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biopsy , Eye Neoplasms/drug therapy , Eye Neoplasms/pathology , Eyelid Neoplasms/drug therapy , Eyelid Neoplasms/pathology , Eyelids/pathology , Humans , Lacrimal Apparatus Diseases/drug therapy , Lacrimal Apparatus Diseases/pathology , Male , Middle Aged , Mycosis Fungoides/drug therapy , Mycosis Fungoides/pathologyABSTRACT
A 39-year old male developed multiple verrucous papules on his back following a severe sunburn. Both the clinical features and pathology were typical for disseminated epidermolytic acanthomas. These benign skin lesions resemble the papules of Darier's disease, seborrhoic keratoses or verrucae planae. The light-exposed skin of the back is the site of predilection. Electron microscopy reveals a premature and altered cornification of keratinocytes. Epidermolytic acanthomas are acquired, harmless lesions and must be differentiated from more serious, congenital ichthyoses of the skin, showing the same histopathologic picture.
Subject(s)
Hyperkeratosis, Epidermolytic/diagnosis , Neoplasms, Glandular and Epithelial/diagnosis , Neoplasms, Multiple Primary/diagnosis , Skin Neoplasms/diagnosis , Adult , Biopsy , Diagnosis, Differential , Humans , Hyperkeratosis, Epidermolytic/pathology , Male , Neoplasms, Glandular and Epithelial/pathology , Neoplasms, Multiple Primary/pathology , Skin/pathology , Skin Neoplasms/pathology , Sunburn/complications , Sunburn/pathologyABSTRACT
Pemphigus vulgaris (PV) is an immune-mediated vesiculobullous disease of the skin and mucous membranes. Generally, patients with PV present first with oral lesions, which may precede the cutaneous lesions, such as bullae and erosions, by several months. An ocular manifestation is unusual. The most common ophthalmologic involvement in pemphigus is conjunctivitis, but without progressive scarring such as occurs in ocular cictricial pemphigoid. Corneal involvement is very rare. CASE REPORT. We report on severe ocular involvement in a 56-year-old male Turkish patient with PV. Ophthalmologic findings included conjunctival cicatrization, corneal ulceration and corneal perforation, despite immunosuppressive therapy with azathioprine and corticosteroids. A penetrating keratoplasty was performed, but rapidly failed because of corneal vascularization. CONCLUSION. If a chronic bullous dermatosis leads to severe eye involvement, PV should be considered in the differential diagnosis besides ocular cicatricial pemphigoid. Pemphigus vulgaris can be differentiated on the basis of clinical findings and histopathological and immunohistological features. Generally, PV can be treated with steroids or with a combination of an immunosuppressant and steroids. However, the combination of prednisone and azathioprine could not prevent corneal perforation in our patient.
Subject(s)
Conjunctivitis/diagnosis , Corneal Ulcer/diagnosis , Pemphigus/diagnosis , Conjunctiva/pathology , Conjunctivitis/pathology , Cornea/pathology , Corneal Ulcer/pathology , Fluorescent Antibody Technique, Direct , Humans , Keratoplasty, Penetrating , Male , Middle Aged , Pemphigus/pathology , Recurrence , Skin/pathologyABSTRACT
A 16-year-old boy had a 6-year history of a generalized bullous eruption that was resistant to multiple therapies. Findings of immunofluorescent split-skin studies and electron microscopy were consistent with a diagnosis of epidermolysis bullosa acquisita. Treatment with cyclosporine and prednisolone decreased new blister formation. Additional therapy with high-dose intravenous immunoglobulins was successful in controlling the patient's disease.
Subject(s)
Cyclosporine/therapeutic use , Epidermolysis Bullosa Acquisita/therapy , Immunoglobulins, Intravenous/therapeutic use , Prednisolone/therapeutic use , Adolescent , Chronic Disease , Drug Therapy, Combination , Epidermolysis Bullosa Acquisita/diagnosis , Humans , Immunoglobulin G/therapeutic use , MaleABSTRACT
A 23-year-old man had epidermolysis bullosa acquisita that was diagnosed at the age of 20 years. The eye examination showed bilateral, small subepithelial vesicles in the cornea. The direct immunofluorescence microscopic examination of the conjunctiva revealed homogeneous, linear IgG and fibrinogen deposits in the basement membrane area. The same pattern appeared in the skin biopsy specimen. No systemic disease common to epidermolysis bullosa acquisita was found in the patient.
Subject(s)
Epidermolysis Bullosa/complications , Eye Diseases/etiology , Adult , Conjunctiva/pathology , Cornea/pathology , Epidermolysis Bullosa/diagnosis , Epidermolysis Bullosa/pathology , Eye Diseases/diagnosis , Eye Diseases/pathology , Fibrinogen , Fluorescent Antibody Technique , Humans , Immunoglobulin G/analysis , Male , Skin/pathologyABSTRACT
Chronic blister-forming dermatosis can lead to conjunctival and corneal involvement. Taking one such case as an example, the authors show that while disorders of this kind can be classified as a form of bullous dermatosis, the differential diagnostic classification is not unequivocal, regardless of the examination method adopted. The term "overlay syndrome" has been introduced into the dermatologic literature to cover clinical pictures of this kind.
