RESUMO
There is little published literature about dermatological conditions in paediatric intensive care units (PICUs). The aim of this study was to describe the range of skin disorders in children admitted to PICUs in the UK and Ireland using data from a national audit. An analysis was conducted using data for 2002 - 2010 from the Paediatric Intensive Care Audit Network (PICANet). In total, 999 admissions of 882 children were identified, representing 0.8% of all PICU admissions. The most frequent dermatological conditions were skin infections, including cellulitis and necrotizing fasciitis, and inflammatory conditions. In 28% of cases, the dermatological diagnosis was considered the reason for PICU admission, in 35% it was a manifestation of systemic disease and in 37% it was considered incidental. Overall mortality was similar to the general PICU population, with 52 deaths (5.2%), but was greater in children with vascular/haematological conditions.
Assuntos
Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Dermatopatias/classificação , Dermatopatias/epidemiologia , Dermatopatias/mortalidade , Adolescente , Criança , Pré-Escolar , Cuidados Críticos/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Irlanda/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Admissão do Paciente/estatística & dados numéricos , Reino Unido/epidemiologiaRESUMO
Focal dermal hypoplasia (Goltz) syndrome is a rare genetic disorder characterized by cutaneous, ectodermal and mesodermal defects. We present a case in which painful, exophytic granulation tissue has been the main symptom over the past 15 years. After unsatisfactory results with a number of treatment modalities including topical steroids, silver-nitrate applications, cryotherapy, curettage, excision and pulsed-dye laser, we achieved significant benefit with curettage in combination with photodynamic therapy. Although impaired wound healing has been described in focal dermal hypoplasia, this is, to our knowledge, the first time that pyogenic granuloma-like lesions have been reported.
Assuntos
Ácido Aminolevulínico/análogos & derivados , Hipoplasia Dérmica Focal/tratamento farmacológico , Hipoplasia Dérmica Focal/cirurgia , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Adulto , Ácido Aminolevulínico/uso terapêutico , Curetagem , Feminino , Hipoplasia Dérmica Focal/patologia , Tecido de Granulação/patologia , HumanosRESUMO
Eye complications arising during systemic and ophthalmic steroid use are well known. In contrast, there is little highlighting the similar risks associated with topical steroid use around the eyelids. We now describe a 29-year-old lady who used topical steroids in prolonged fashion throughout most of her life for severe eczema, with the recent application of large quantities of potent steroid continuously for one month, including to the periorbital region. Soon after, she presented to her ophthalmologist with severe bilateral glaucoma and irreversible visual loss attributed to the steroid use. Here we emphasise the possible risks of periorbital topical steroid use, as well as the importance of patient education and ophthalmological follow-up.
Assuntos
Betametasona/análogos & derivados , Betametasona/efeitos adversos , Glaucoma/induzido quimicamente , Glucocorticoides/efeitos adversos , Administração Cutânea , Adulto , Esquema de Medicação , Eczema/tratamento farmacológico , Doenças Palpebrais/tratamento farmacológico , Dermatoses Faciais/tratamento farmacológico , Feminino , Humanos , Transtornos da Visão/induzido quimicamenteRESUMO
Cutis verticis gyrata (CVG) is a rare disorder; it is characterized by thickening of the scalp which becomes raised to form ridges and furrows resembling the cerebral gyri. We report a case of CVG associated with the autosomal dominant insulin resistance syndrome. This syndrome is characterized by obesity, mild mental retardation, delayed puberty, acanthosis nigricans and hyperinsulinaemia. The association of CVG and autosomal dominant insulin resistance has not been previously described.
Assuntos
Hiperinsulinismo/complicações , Resistência à Insulina/genética , Dermatoses do Couro Cabeludo/complicações , Adulto , Biópsia , Feminino , Humanos , Couro Cabeludo/patologia , Dermatoses do Couro Cabeludo/patologia , SíndromeRESUMO
Childhood dermatitis herpetiformis (DH) is rare. The true prevalence and incidence of this condition are unknown. We report a 7-year-old boy presenting with nonpruritic inflammatory papules on the buttocks and extensor surfaces, clinico-pathologically consistent with Sweet's neutrophilic dermatosis. Immunofluorescence studies showed IgA deposits in the dermal papillae consistent with DH. Remission was achieved with a gluten-free diet and dapsone. Childhood DH may present different clinical signs to the adult form and misdiagnosis can occur if immunofluorescence is not requested on skin biopsy.
Assuntos
Dermatite Herpetiforme/diagnóstico , Anti-Inflamatórios não Esteroides/uso terapêutico , Criança , Dapsona/uso terapêutico , Dermatite Herpetiforme/patologia , Diagnóstico Diferencial , Dieta com Restrição de Proteínas , Proteínas Alimentares/administração & dosagem , Técnica Direta de Fluorescência para Anticorpo , Glutens/administração & dosagem , Humanos , Imunoglobulina A/análise , Masculino , Pele/patologia , Síndrome de Sweet/diagnósticoRESUMO
Xanthoma disseminatum (XD) is a rare benign non-X-histiocytic disorder of unknown aetiology. We report a 37-year-old man who presented with XD preceded by a decade of cranial diabetes insipidus, with associated type IIb hyperlipidaemia and computed tomographic evidence of hepatic involvement. A review of the literature is also included.
Assuntos
Diabetes Insípido/complicações , Histiocitose de Células não Langerhans/complicações , Hiperlipidemias/complicações , Hepatopatias/complicações , Adulto , Diabetes Insípido/patologia , Histiocitose de Células não Langerhans/patologia , Humanos , Hiperlipidemias/patologia , Hepatopatias/patologia , MasculinoRESUMO
A cross-sectional study of human immunodeficiency virus (HIV) positive patients who attended the HIV clinic in Brighton over a 4-month period was carried out to describe the prevalence and severity of skin manifestations in HIV-positive patients and to elucidate their association with the peripheral CD4 cell count and with the HIV disease stage. The subjects were consecutively examined by an experienced dermatologist. Skin manifestations were classified into infections, dermatoses, pruritus and neoplasm. A severity index was derived by scoring each condition as either absent, mild, moderate or severe. One hundred and fifty-one patients were enrolled with a mean age of 38.3 years. One hundred and thirty-nine were homo/bisexual men; 58 were asymptomatic and 35 had acquired immune deficiency syndrome (AIDS); 37 had CD4 counts below 200. Skin conditions were present in 138 of the 151 subjects (91.4%). The total number of events was 331. The most frequent problem was infection followed by dermatoses, pruritus and malignancy. The most frequent condition was seborrhoeic eczema followed by tinea and xerosis. We have demonstrated a statistically significant association between CD4 count, disease stage and skin manifestations in HIV-positive individuals.
Assuntos
Soropositividade para HIV/complicações , Hospedeiro Imunocomprometido , Dermatopatias/complicações , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/imunologia , Adulto , Contagem de Linfócito CD4 , Estudos Transversais , Soropositividade para HIV/epidemiologia , Soropositividade para HIV/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Dermatopatias/epidemiologia , Dermatopatias/imunologia , Dermatopatias Infecciosas/complicaçõesAssuntos
Dor Abdominal/etiologia , Neoplasias do Ceco/diagnóstico , Melanoma/diagnóstico , Neoplasias Gástricas/diagnóstico , Dor Abdominal/diagnóstico , Idoso , Neoplasias do Ceco/patologia , Neoplasias do Ceco/cirurgia , Colectomia , Intervalo Livre de Doença , Evolução Fatal , Gastrectomia , Humanos , Neoplasias Intestinais/secundário , Masculino , Melanoma/patologia , Melanoma/secundário , Melanoma/cirurgia , Pessoa de Meia-Idade , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgiaRESUMO
We report the case of a 22-year-old woman presenting with the unilateral naevoid telangiectasia syndrome in her third pregnancy. The development of this is well documented but the occurrence in a third pregnancy is unusual. A brief review of the literature is included.
Assuntos
Complicações na Gravidez/patologia , Dermatopatias/patologia , Telangiectasia/patologia , Adulto , Dorso , Face , Feminino , Humanos , Gravidez , TóraxRESUMO
Calcipotriol (Dovonex) ointment has been shown to be an effective, well tolerated, and acceptable treatment for psoriasis vulgaris in adults. This open study was conducted in 16 U.K. centres to assess the safety and efficacy of calcipotriol ointment in treating psoriasis vulgaris in children. Following a 2-week washout, patients were treated with calcipotriol ointment, 50 micrograms/g twice daily, for up to 8 weeks. A blood sample was taken on entry and a second 'on treatment' sample was taken after either 2 or 8 weeks treatment. Sixty-six children (26 boys, 40 girls, age range from 3 to 14 years) entered and 58 completed the study. There was a statistically significant reduction in the mean (+/- SD) Psoriasis Area and Severity Index (PASI) from 6.1 +/- 3.5 at the start of treatment to 2.7 +/- 1.9 at the end of treatment (P < 0.001). Marked improvement or clearance of psoriasis at the end of treatment occurred in 65% of patients as assessed by the investigator and 62% as assessed by the patient. Cosmetic acceptability of calcipotriol ointment was found to be good or excellent in 79% of patients. Eight patients withdrew from the study (four defaulted, two unacceptable responses, two adverse events). Adverse events were reported by 16 patients: the most common being local irritation (seven patients). There was no significant change in the mean serum ionized calcium from baseline to 2 or 8 weeks treatment. Similarly, there were no consistent or clinically important changes in haematological, or other biochemical parameters, measured during the study period. Calcipotriol ointment has been shown to be an effective, well tolerated, and acceptable treatment for psoriasis vulgaris in children.
Assuntos
Calcitriol/análogos & derivados , Fármacos Dermatológicos/uso terapêutico , Psoríase/tratamento farmacológico , Adolescente , Calcitriol/efeitos adversos , Calcitriol/uso terapêutico , Cálcio/sangue , Criança , Pré-Escolar , Doença Crônica , Fármacos Dermatológicos/efeitos adversos , Feminino , Humanos , Masculino , Cooperação do Paciente , Estudos Prospectivos , Resultado do TratamentoRESUMO
A patient with long-standing rheumatoid arthritis presented with a painful pigmented chronic nodule on the dorsum of the right hand, at the site of intra-articular steroid injections undertaken 5 years previously. Histology showed pigmented fungal elements consistent with phaeohyphomycosis. Cultures yielded black yeast-like colonies, identified as Exophiala dermatitidis and sensitive to itraconazole and amphotericin. A 1-month course of itraconazole resulted in marked clinical improvement but surgical excision and skin grafting were required for complete resolution. Phaeohyphomycosis has been related to inoculation injury but association with intra-articular steroid injection appears hitherto to be unreported.
Assuntos
Dermatomicoses/etiologia , Exophiala , Dermatoses da Mão/microbiologia , Injeções Intra-Articulares/efeitos adversos , Infecções Oportunistas/etiologia , Dermatomicoses/patologia , Feminino , Dermatoses da Mão/patologia , Humanos , Pessoa de Meia-Idade , Infecções Oportunistas/patologiaRESUMO
Darier's disease is an inherited disorder with well-recognized patterns of presentation. Lesions commonly affect the trunk and flexures. The diagnosis is based on the typical clinical appearance and histology showing acantholytic dyskeratosis. We report two unusual cases with prominent nodular, comedonal lesions on the face and scalp.
Assuntos
Doença de Darier/patologia , Dermatoses Faciais/patologia , Dermatoses do Couro Cabeludo/patologia , Idoso , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Doenças das Cartilagens , Orelha Externa , Adulto , Biópsia , Doenças das Cartilagens/etiologia , Doenças das Cartilagens/patologia , Doenças das Cartilagens/fisiopatologia , Doença Crônica , Otopatias/etiologia , Otopatias/patologia , Otopatias/fisiopatologia , Orelha Externa/lesões , Humanos , MasculinoRESUMO
Two hundred and forty patients with basal cell carcinomas (BCCs) on the head or neck were studied. Scrapings of the lesions were taken for cytological examination, and a 3-mm punch biopsy was performed for histopathological study. The accuracy of diagnosis by each method was compared. Both methods confirmed the clinical diagnosis in 226 cases, and both were negative in 10 cases. Cytopathology gave one false negative result (0.42%), and histopathology gave two false negative results (0.83%). Cytopathology gave one false positive result (0.42%), and histopathology did not produce any false positive results. We conclude that cytological examination of skin scrapings from suspected BCCs is a rapid and reliable method of diagnosis.