Necrobiosis lipoidica in a 9-year-old girl with new-onset type II diabetes mellitus.

Necrobiosis lipoidica (NL) is an idiopathic dermatologic condition that is strongly associated with, but not pathognomonic for, diabetes mellitus. It is more commonly seen in women than men and in adults than children. We present the youngest child, to our knowledge, diagnosed with NL at initial presentation with type II diabetes mellitus. We review the literature and discuss pathogenesis, clinical features, and treatment options for NL.

Review of teleconsultations for dermatologic diseases.

BACKGROUND: Telemedicine has been increasingly used in some areas to provide consultation for isolated populations that might otherwise have difficulty accessing specialty care. Little information exists on what types of patients or diseases are being seen in dermatology telemedicine consultation services. OBJECTIVE: To review our consultations done over a regional telemedicine network with an emphasis on looking at what type of patient, cutaneous diseases, and diagnostic or therapeutic recommendations were made. RESULTS: Between August 1992 and December 1997, 796 teleconsultations were done. The most common diagnoses made were eczemas, follicular based diseases, skin infections, and skin tumours. Steroids were the most commonly recommended therapy, along with antibiotics, antihistamines, and antifungal therapy. Diagnostic recommendations commonly made were a skin biopsy and potassium hydroxide preparation. CONCLUSIONS: Common skin problems were seen by our dermatology teleconsultation service. A significant number of diagnostic biopsies and potassium hydroxide preparations were recommended. The efficacy of telemedicine in the delivery of dermatologic care is reviewed.

Reliability of telemedicine in evaluating skin tumors.

OBJECTIVES: To determine the reliability of videoconferencing technology in evaluating skin tumors, the impact of the technology on the clinicians' degree of suspicion that a skin tumor is malignant, and the recommendation to do a biopsy. MATERIALS AND METHODS: Four skin cancer screenings were conducted at rural health care facilities in eastern North Carolina that were connected to East Carolina University School of Medicine. A dermatologist saw the patients in person at the local facility, and the same patient was seen by a dermatologist via a T-1 connection to Greenville, North Carolina. RESULTS: The two physicians were in absolute agreement on 59% of the 107 skin tumors evaluated. There were five lesions identified by the on-site dermatologist as a probable or definite malignancy. The degree of concern about a lesion being malignant and the decision whether to do a biopsy were not significantly different, as shown by kappa analysis. CONCLUSION: The concern about the malignancy of a particular skin lesion and the recommendation whether to do a biopsy were not significantly affected by telemedicine technology.

Eruptive cherry angiomas and irritant symptoms after one acute exposure to the glycol ether solvent 2-butoxyethanol.

Seven clerical workers were evaluated in 1993, 8 months after exposure to vaporized 2-butoxyethanol (2-BE; also called butyl cellosolve or ethylene glycol monobutyl ether [EGMBE or EGBE]), which had been applied overnight to strip the floor of their file room. At the time of exposure, they had noted intense eye and respiratory irritation, marked dyspnea, nausea, and faintness, suggesting a concentration of 2-BE in the air of 200-300 parts per million (ppm). All seven workers later experienced recurrent eye and respiratory irritation, dry cough, and headache. Four months after the exposure, cherry angiomas began to appear on the arms, trunk, and thighs of six workers, who voiced concerns about the possibility of cancer. Our evaluation found no evidence of hematologic, liver, lung, or renal toxicity, but elevations in the erythrocyte sedimentation rate and blood pressure of each subject were found. Workplace air sampling found no detectable 2-BE, but traces (0.1-0.2 ppm) of formaldehyde were identified. Irritant symptoms abated after the group was moved to a room with better ventilation, and the mild hypertension gradually cleared, but new cherry angiomas have continued to appear 5 years after the acute exposure, as the initial ones persisted. These angiomas occur in healthy persons as they age but in this instance appear to have resulted from a single overexposure to 2-BE. We felt confident in reassuring the workers that they would suffer no serious consequences from this exposure.

Reliability of dermatology teleconsultations with the use of teleconferencing technology.

BACKGROUND: Recent advances in telecommunications technology allow physicians to consult on patients at a distance via an interactive video format. Few data exist as to the reliability of this form of consultation. OBJECTIVE: Our purpose was to measure the degree of concordance between a dermatologist seeing a patient in a clinic and another dermatologist seeing the same patient over a commercially available videoconferencing system. METHODS: Patients referred to a general dermatology clinic were seen by both a "live" dermatologist and a "teledermatologist" via a T1 connection. Diagnosis and recommendations were recorded by both physicians and compared. The physicians were also asked to rate the degree of confidence they had in their diagnosis. RESULTS: Seventy-nine diagnoses were made on 60 patients. The two physicians were in absolute agreement on 61 of the diagnoses (77.2%). Race or sex of the patient, nature of the skin problems, or which of the two physicians was the teledermatologist did not statistically correlate with the concordance of the two physicians. CONCLUSION: There was a reasonable degree of agreement between the two examining physicians. Despite the relatively high degree of concordance the teledermatologist had a significantly lower degree of confidence in his diagnoses.

Cutaneous hazards of the coast.

Through recreational and commercial pursuits, more people than ever before are coming in contact with coastal waters containing a variety of bacteria, aquatic flora, and sea creatures potentially harmful to the skin. It is important for dermatology nurses to be aware of some of the more common cutaneous hazards related to the coastal environment as well as the basic treatment of these problems.

Dermatology teleconsultations to Central Prison: experience at East Carolina University.

OBJECTIVE: To review our experience with dermatology teleconsultations between East Carolina University School of Medicine in Greenville and Central Prison in Raleigh, NC. MATERIALS AND METHODS: Consultation forms kept on file in the Department of Internal Medicine served as the source of data. One physician reviewed the forms from the initial 22 months of our dermatology teleconsultation service to Central Prison. Patient demographics and the diagnoses made by the consulting physician were recorded. Recommendations were tabulated as either diagnostic or therapeutic. Diagnoses and recommendations for known HIV-positive individuals were separately recorded. RESULTS: One hundred thirty-eight dermatology teleconsultations were performed over the 22-month period. Seventy two per cent of the patients seen were African-American. The average age was 32 years. One hundred fifty-nine diagnoses were made. The most common problems were eczema and acneiform eruptions. Fifty-nine diagnostic and 252 therapeutic recommendations were made. CONCLUSION: Consultants generally were confident of their diagnoses and management decisions. Dermatologists can assist primary care physicians through telemedicine consultation.

Tinea nigra: treatment with topical ketoconazole.

Tinea nigra is a relatively uncommon fungal infection presenting as a pigmented macule of the palms or soles. Since the lesion can easily mimic a melanocytic process, it is important to recognize the infection before recommending unnecessary surgical procedures. A case of tinea nigra that responded to treatment with topical ketoconazole is presented.

Pruritus and the parakeet.

Pruritus can be due to a variety of factors and can often be difficult for a physician to manage. Often the etiology is psychosomatic, wherein a careful history is the key to proper diagnosis. Such a case is presented.

Increased frequency of HLA-DR2 in patients with autoantibodies to epidermolysis bullosa acquisita antigen: evidence that the expression of autoimmunity to type VII collagen is HLA class II allele associated.

Epidermolysis bullosa acquisita (EBA) is a chronic blistering disease characterized by circulating and tissue bound IgG auto-antibodies to the basement membrane zone (BMZ) of stratified squamous epithelium. Recent studies have shown that antibodies recognize epitopes present in the noncollagenous carboxyl-terminal domain of type VII collagen, a BMZ matrix protein. Antibodies with identical specificity also have been detected in patients with the rare blistering disease, bullous systemic lupus erythematosus (bullous SLE), suggesting EBA and bullous SLE are immunologically related diseases. In this study we determined the major histo-compatibility antigen types of 29 EBA patients and 6 patients with bullous SLE. Analysis of the results showed HLA-DR2 was significantly increased in both black EBA patients, P = 0.013 (corrected, RR = 4.8) and white EBA patients, P = 0.0008 (corrected, RR = 13.1). Five of the six bullous SLE patients also were positive for the DR2 antigen, P = 0.009. These results show the expression of autoimmunity to type VII collagen is HLA class II allele associated and that EBA and bullous SLE are immunogenetically related diseases.