Dimethyl sulfoxide (DMSO): a solvent that may solve selected cutaneous clinical challenges.

Dimethyl sulfoxide (DMSO) is a clear, odorless liquid, inexpensively produced as a by-product of the wood pulp industry. DMSO's unique chemical properties allow for its broad applications in a wide variety of cutaneous challenges. Widely available in the USA as a solvent, DMSO is FDA-approved only for the treatment of interstitial cystitis and for use as a preservative for organ transplant. DMSO readily penetrates and diffuses through biological membranes. At low concentrations, DMSO exhibits anti-inflammatory, analgesic, diuretic, vasodilator, anti-platelet aggregation, radio-protective, and muscle-relaxing properties. DMSO is also a vigorous scavenger of hydroxyl free radicals, which may explain its observed beneficial effects on skin rejuvenation and recovery from thermal injury. DMSO has a relatively low level of toxicity. DMSO has shown promise in the off-label treatment of basal cell carcinoma, pressure ulcers, scleroderma, herpes simplex, cutaneous fungal infections, and amyloidosis. The potential of DMSO to serve as an independent or adjuvant topical treatment for these conditions is explored in this review.

Facial bacterial infections: folliculitis.

Facial bacterial infections are most commonly caused by infections of the hair follicles. Wherever pilosebaceous units are found folliculitis can occur, with the most frequent bacterial culprit being Staphylococcus aureus. We review different origins of facial folliculitis, distinguishing bacterial forms from other infectious and non-infectious mimickers. We distinguish folliculitis from pseudofolliculitis and perifolliculitis. Clinical features, etiology, pathology, and management options are also discussed.

Pediatric parvovirus B19: spectrum of clinical manifestations.

Parvovirus B19 (PVB19) infection has a varied spectrum of clinical manifestations, ranging from subclinical infection to skin and joint symptoms to hematologic effects with potential fatality. The most common manifestation of PVB19 infection in children is erythema infectiosum (EI). Also known as fifth disease or slapped cheek syndrome, EI presents as an erythematous exanthem limited to the malar eminences that follows a mild prodromal illness. In healthy children, infection is selflimiting and has an excellent prognosis; however, in high-risk pediatric groups (eg, immunocompromised patients, children with hemolytic anemia or prenatal infection), clinical manifestations are hematologic in nature and typically are more severe. Diagnosis often is made clinically. Serologic testing can be confirmatory. Treatment is aimed at symptomatic relief, and a vaccine currently is under investigation.

Flexural and extensoral eruptions in dermatologic disease.

Dermatologic eruptions can be generalized or localized to specific areas of the body. Eruptions in specific body regions may suggest specific diagnosis. Recognizing such clinical patterns can facilitate the identification of the underlying pathology. In this contribution, we shall discuss those dermatologic lesions that tend to affect the flexure and extensor surfaces.

Drug-resistant herpes simplex virus in HIV infected patients.

Herpes simplex virus type 2 (HSV2) infection is a major source of morbidity in human immunodeficiency virus (HIV)-infected patients, since reactivations - whether symptomatic or asymptomatic - are associated with increased HIV viral load and viral shedding. Acyclovir, valacyclovir and famcyclovir are indicated for the treatment of HSV2 in HIV patients. This class of drugs has been shown to enhance survival in HIV-infected individuals. However, with the emergence of drug-resistant strains of HSV2, the rates of resistance among HIV patients are almost ten-fold those in immunocompetent individuals, comparing 0.6% to 6%. These HSV2 infections tend to be more severe and to recur. More ominously, disease progression of HIV is promoted by concurrent infection with HSV2. Intravenous foscarnet and cidofovir may be used for acyclovir-resistant HSV; however, resistance to these drugs has been documented. Newer therapies such as the toll-like receptor agonist imiquimod and immunomodulating dipeptides offer promise for the treatment of HSV2 in HIV-infected individuals.

Nevus of Ota in children.

Nevus of Ota, synonymously termed oculodermal melanosis, is an uncommon dermal melanosis most commonly seen at birth in children of Japanese descent, though it can affect individuals of any age or ethnicity. The disease tends to persist and extend locally, becoming increasingly prominent with age, puberty, and postmenopausal state. Treatment should begin early after diagnosis using multiple sessions of laser photothermolysis to avoid darkening and extension of the lesion. Important associated disorders include ipsilateral glaucoma; intracranial melanocytosis; and rarely cutaneous, ocular, or intracranial melanoma. Recommendations are discussed for managing nevus of Ota in children.