RESUMO
Pressure ulcers (PUs) are economically burdensome medical conditions. Early changes in pressure ulcers are associated with erythema. In this study, bioelectrical impedance was used to measure the differences between PUs and blanchable erythema. We divided 21 ICR mice into three groups: control, 1000 mmHg-1h, and 1000 mmHg-6h. Healthy skin, blanchable erythema, and PUs were induced on the dorsal skin. The results indicated an immediate increase in impedance, resistance, and reactance values in the pressure group after release, followed by a subsequent decrease until two days after release. Compared with the control group, impedance and reactance significantly increased by 30.9% (p < 0.05) and 30.1% (p < 0.01), respectively, in the 6 h-loading group immediately after release. One and two days after release, the 1 h-loading and 6 h-loading groups exhibited significantly different degrees of decline. One day after release, impedance and resistance decreased by 30.2% (p < 0.05) and 19.8% (p < 0.05), respectively, in the 1 h-loading group; while impedance, resistance, and reactance decreased by 39.2% (p < 0.01), 26.8% (p < 0.01), and 45.7% (p < 0.05), respectively, in the 6 h-loading group. Two days after release, in the 1 h-loading group, impedance and resistance decreased by 28.3% (p < 0.05) and 21.7% (p < 0.05), respectively; while in the 6 h-loading group, impedance, resistance, and reactance decreased by 49.8% (p < 0.001), 34.2% (p < 0.001), and 59.8% (p < 0.01), respectively. One and two days after release the pressure group reductions were significantly greater than those in the control group. Additionally, we monitored changes during wound healing. Distinguishing early PUs from blanchable erythema by noninvasive bioelectrical impedance technology may have applications value in early assessment of PUs.
Assuntos
Modelos Animais de Doenças , Impedância Elétrica , Eritema , Camundongos Endogâmicos ICR , Úlcera por Pressão , Cicatrização , Animais , Úlcera por Pressão/fisiopatologia , Impedância Elétrica/uso terapêutico , Eritema/fisiopatologia , Eritema/etiologia , Camundongos , Cicatrização/fisiologia , MasculinoRESUMO
BACKGROUND: Red ear syndrome (RES) was first described by Lance in 1994. It is characterized by recurrent attacks of redness of the ear, accompanied by burning pain, increased temperature, dysesthesia, and nosological relationship with headache. CASE: We report the case of a 43-year-old woman with migraine who developed RES. Redness episodes occurred at the same time of the day. She had a good therapeutic response to gabapentin. CONCLUSIONS: To the best of our knowledge, this is the first case of RES in which redness episodes occurred at the same time of the day.
Assuntos
Ritmo Circadiano , Orelha , Eritema/fisiopatologia , Transtornos de Enxaqueca/fisiopatologia , Dor/fisiopatologia , Adulto , Feminino , Gabapentina/uso terapêutico , Humanos , Parestesia/fisiopatologiaRESUMO
This case reminded us that not every moist, erythematous, crusting eruption is purely infectious.
Assuntos
Cefalexina/uso terapêutico , Otopatias/diagnóstico , Otopatias/tratamento farmacológico , Eczema/diagnóstico , Eczema/tratamento farmacológico , Eritema/diagnóstico , Eritema/tratamento farmacológico , Prednisona/uso terapêutico , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Criança , Doenças Transmissíveis/diagnóstico , Doenças Transmissíveis/tratamento farmacológico , Doenças Transmissíveis/fisiopatologia , Otopatias/fisiopatologia , Eczema/fisiopatologia , Eritema/fisiopatologia , Humanos , Masculino , Resultado do TratamentoRESUMO
In the American Southwest, a common problem can be diagnosed with the knowledge of the local environment and its inhabitants.
Assuntos
Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/cirurgia , Picadas de Escorpião/diagnóstico , Picadas de Escorpião/fisiopatologia , Picadas de Escorpião/cirurgia , Úlcera/diagnóstico , Úlcera/cirurgia , Celulite (Flegmão)/fisiopatologia , Edema/diagnóstico , Edema/fisiopatologia , Edema/cirurgia , Eritema/diagnóstico , Eritema/fisiopatologia , Eritema/cirurgia , Traumatismos da Mão/diagnóstico , Traumatismos da Mão/fisiopatologia , Traumatismos da Mão/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Texas , Resultado do Tratamento , Úlcera/fisiopatologiaRESUMO
BACKGROUND: Transepidermal water loss (TEWL), stratum corneum hydration (SCH), and skin surface pH are indicators of skin barrier integrity. There is scant evidence on normative data for cutaneous homeostasis parameters in healthy individuals. OBJECTIVES: To develop normative data for skin erythema, melanin, pH, SCH, and TEWL; identify differences in these variables among different anatomical locations; and explore factors that may modify these values. MATERIAL & METHODS: A cross-sectional study was conducted in 87 healthy volunteers (34 males) aged 20 to 40 years. TEWL, SCH, pH, erythema, and melanin were measured on the cheeks, volar forearms, and palms. RESULTS: The lowest TEWL value corresponded to volar forearms (9.69 ± 2.94 g m-2·h-1) and the highest to palms (49.32 ± 14.55 g m-2·h-1). Erythema was more evident on cheeks than palms or volar forearms (413.51 arbitruary units [AU] vs. 259.98 AU vs. 252.02 AU). The lowest melanin index was documented for palms (92.72 ± 41.70 AU). pH levels were similar among the different locations. The erythema index was significantly higher in males versus females for all locations. Linear regression analysis adjusted for age and SCH revealed an increase in 0.45 ± 0.18 g m-2·h-1 for TEWL on the cheek and 0.32 ± 0.10 g m-2·h-1 for TEWL on the forearm for each one-year increase in age. CONCLUSION: We provide normative data for individuals aged 20-40 years, across three anatomical locations, and propose a predictive model for TEWL on the cheek and forearm as a function of age and SCH.
Assuntos
Epiderme/fisiologia , Fenômenos Fisiológicos da Pele , Perda Insensível de Água , Adulto , Fatores Etários , Bochecha , Estudos Transversais , Epiderme/química , Epiderme/metabolismo , Eritema/fisiopatologia , Feminino , Antebraço , Mãos , Voluntários Saudáveis , Homeostase , Humanos , Concentração de Íons de Hidrogênio , Masculino , Melaninas/metabolismo , Fatores Sexuais , População Branca , Adulto JovemAssuntos
Sarcoidose/diagnóstico , Dermatopatias/diagnóstico , Biópsia , Eritema/complicações , Eritema/fisiopatologia , Feminino , Humanos , Inflamação , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Sarcoidose/fisiopatologia , Dermatopatias/fisiopatologia , Câncer Papilífero da Tireoide/complicações , Neoplasias da Glândula Tireoide/complicaçõesRESUMO
BACKGROUND: There are no reported cases of 2,4-dichloro-5-methylpyrimidine (DCP)-induced irritant contact dermatitis (ICD). OBJECTIVE: The aim of the study was to summarize the clinical features, treatment, and protective measures for DCP-induced ICD. METHODS: We retrospectively reviewed the clinical data from 64 patients with DCP-induced ICD and the protective measures in a DCP manufacturing factory. RESULTS: Disease onset occurred 1 to 10 minutes after DCP single exposure in all 64 patients. The contact site developed edematous erythematous skin lesions with clear boundaries. Other symptoms included a burning sensation (n = 48), pruritus (n = 16), headache (n = 4), nausea/vomiting (n = 3), and syncope (n = 1). Ten patients developed pruritic rash over the whole body 1 to 4 days after contacting DCP. Histopathologic examination of the lesions was performed in 8 patients; all 8 showed manifestations of ICD. A patch test with 1% DCP ethanol solution was performed in 7 patients. One patient withdrew because of pruritus and massive erythema over the whole body. Four patients had a strong reaction, and 2 patients had a very strong reaction. All patients were cured. Positive-pressure inflatable protective clothing protected workers from the outside environment to prevent DCP-induced ICD. CONCLUSIONS: 2,4-Dichloro-5-methylpyrimidine exposure induces acute ICD and a delayed allergic reaction in some patients (15.6%). Positive-pressure inflatable protective clothing prevents DCP-induced ICD.
Assuntos
Dermatite Irritante/fisiopatologia , Dermatite Ocupacional/fisiopatologia , Edema/fisiopatologia , Eritema/fisiopatologia , Prurido/fisiopatologia , Doença Aguda , Adulto , Indústria Química , Dermatite Irritante/etiologia , Dermatite Irritante/prevenção & controle , Dermatite Irritante/terapia , Dermatite Ocupacional/etiologia , Dermatite Ocupacional/prevenção & controle , Dermatite Ocupacional/terapia , Feminino , Cefaleia/fisiopatologia , Humanos , Masculino , Instalações Industriais e de Manufatura , Pessoa de Meia-Idade , Náusea/fisiopatologia , Testes do Emplastro , Roupa de Proteção , Pirimidinas/efeitos adversos , Vômito/fisiopatologiaRESUMO
Mangos are rich in ß-carotene and other carotenoids, along with several phenolic acids that may provide oxidant defense and photoprotection to the skin. The objectives of this study are to investigate the effects of Ataulfo mango intake on the development of facial wrinkles and erythema. A randomized two-group parallel-arm study was conducted to assess 16 weeks of either 85 g or 250 g of mango intake in healthy postmenopausal women with Fitzpatrick skin type II or III. Facial photographs were captured at weeks 0, 8, and 16, and wrinkles at the lateral canthi and erythema at the cheeks were quantified. Skin carotenoid values were measured with reflection spectroscopy. Deep wrinkle severity decreased significantly in the 85 g group after 8 (p = 0.007) and 16 (p = 0.03) weeks compared to baseline measures. In contrast, those in the 250 g group showed an increase after 16 weeks in average wrinkle severity (p = 0.049), average wrinkle length (p = 0.007), fine wrinkle severity (p = 0.02), and emerging wrinkle severity (p = 0.02). Erythema in the cheeks increased with 85 g of mango intake (p = 0.04). The intake of 85 g of mangos reduced wrinkles in fair-skinned postmenopausal women, while an intake of 250 g showed the opposite effect. Further studies feeding 85 g of mangos are warranted.
Assuntos
Eritema/fisiopatologia , Comportamento Alimentar , Frutas/química , Mangifera/química , Pós-Menopausa/fisiologia , Envelhecimento da Pele/fisiologia , Idoso , Pressão Sanguínea , Carotenoides/metabolismo , Ingestão de Alimentos , Eritema/sangue , Feminino , Humanos , Lipídeos/sangue , Pessoa de Meia-Idade , Estudos Prospectivos , Pele/metabolismoRESUMO
As the coronavirus epidemic continues, a host of new cutaneous complications is seen on the faces of frontline healthcare workers wearing personal protective equipment on a daily basis. To minimize the risk of COVID-19 infection, healthcare workers wear tight-fitting masks that lead to an excessive amount of pressure on the facial skin. Mechanical pressure, mask materials, and perspiration can all lead to various types of cutaneous lesions such as indentations of the face, skin tears, post-inflammatory hyperpigmentation, ulceration, crusting, erythema, and infection. The objective of this article is to provide effective and straightforward recommendations to those health care providers using facial masks in order to prevent skin-related complications. J Drugs Dermatol. 2020;19(9):858-864. doi:10.36849/JDD.2020.5259.
Assuntos
Infecções por Coronavirus/prevenção & controle , Dermatoses Faciais/etiologia , Traumatismos Faciais/etiologia , Máscaras/efeitos adversos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/efeitos adversos , Pneumonia Viral/prevenção & controle , COVID-19 , Infecções por Coronavirus/epidemiologia , Eritema/etiologia , Eritema/fisiopatologia , Exantema/etiologia , Exantema/fisiopatologia , Dermatoses Faciais/fisiopatologia , Traumatismos Faciais/epidemiologia , Traumatismos Faciais/fisiopatologia , Feminino , Saúde Global , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Exposição Ocupacional/prevenção & controle , Saúde Ocupacional , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Medição de RiscoRESUMO
OBJECTIVE: to detect, analyze and discuss the different ear nose throat (ENT) manifestations those were reported in COVID19 positive patients in the reviewed and published literatures. METHODS: We performed a search in the PubMed databases, Web of Science, LILACS, MEDLINE, SciELO, and Cochrane Library using the keywords; COVID-19, Novel coronavirus, corona, 2019-nCoV, SARS-CoV-2, ENT, ear, nose, throat, otorhinolaryngology, ORL, pharynx, ORL, smell, larynx, different ENT related symptoms. We reviewed published and peer reviewed studies that reported the ENT manifestations in COVID-19 laboratory-confirmed positive patients. RESULTS: within the included 1773 COVID-19 laboratory-confirmed positive patients, the most common ENT manifestations of COVID-19 were sore throat (11.3%) and headache (10.7%). While the other reported ENT manifestations were pharyngeal erythema (5.3%), nasal congestion (4.1%), runny nose or rhinorrhea (2.1%), upper respiratory tract infection (URTI) (1.9%), and tonsil enlargement (1.3%). CONCLUSION: ENT manifestations for COVID-19 are not common as fever and cough. But, a universal questionnaire using well-defined COVID-19 manifestations is needed to make the COVID-19 data precisely defined, complete and homogenous.
Assuntos
Infecções por Coronavirus/fisiopatologia , Transtornos do Olfato/fisiopatologia , Faringite/fisiopatologia , Pneumonia Viral/fisiopatologia , Tonsila Faríngea , Betacoronavirus , COVID-19 , Tosse/fisiopatologia , Diarreia/fisiopatologia , Dispneia/fisiopatologia , Eritema/fisiopatologia , Fadiga/fisiopatologia , Febre/fisiopatologia , Cefaleia/fisiopatologia , Humanos , Mialgia/fisiopatologia , Obstrução Nasal/fisiopatologia , Otorrinolaringopatias/fisiopatologia , Tonsila Palatina , Pandemias , Infecções Respiratórias/fisiopatologia , SARS-CoV-2RESUMO
BACKGROUND: Flushing and erythema are frequent skin symptoms in rosacea. Because their adequate treatment remains a clinical challenge, new treatment options are explored, such as oral ß-blockers. OBJECTIVES: To evaluate the efficacy of oral ß-blockers for rosacea-associated facial flushing and erythema. METHODS: PubMed, Embase, Web of Science, and Cochrane Library were systematically searched, including studies providing original data on the efficacy of oral ß-blockers in rosacea patients with facial flushing and/or persistent erythema. Risk of bias was assessed using the Cochrane Risk of Bias tool, Newcastle-Ottawa scale, and Quality in Prognosis Studies tool. RESULTS: Nine studies evaluating the use of carvedilol, propranolol, nadolol, and ß-blockers in general were included. Articles studying carvedilol and propranolol showed a large reduction of erythema and flushing during treatment with a rapid onset of symptom control. Bradycardia and hypotension were the most commonly described adverse events. LIMITATIONS: Most studies had a retrospective design with a small sample size, and outcome measurement was often subjective. CONCLUSIONS: Oral ß-blockers could be an effective treatment option for patients with rosacea with facial erythema and flushing that does not respond to conventional therapy. Larger prospective trials with objective outcome assessment are needed to validate the promising results of these studies.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Eritema/tratamento farmacológico , Dermatoses Faciais/tratamento farmacológico , Rubor/tratamento farmacológico , Rosácea/tratamento farmacológico , Administração Oral , Antagonistas Adrenérgicos beta/administração & dosagem , Antagonistas Adrenérgicos beta/efeitos adversos , Bradicardia/induzido quimicamente , Carvedilol/uso terapêutico , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/efeitos adversos , Avaliação de Medicamentos , Eritema/fisiopatologia , Dermatoses Faciais/fisiopatologia , Rubor/etiologia , Rubor/fisiopatologia , Humanos , Hipotensão/induzido quimicamente , Nadolol/uso terapêutico , Propranolol/uso terapêutico , Estudos Retrospectivos , Rosácea/complicações , Rosácea/fisiopatologia , Resultado do TratamentoRESUMO
Skin manifestations of systemic disease and malignancy are extremely polymorphous. Clinicians should be familiarized with paraneoplastic dermatoses in order to perform an early diagnosis of the underlying neoplasm. Lack of familiarity with cutaneous clues of internal malignancy may delay diagnosis and treatment of cancer. In this review, we described several paraneoplastic dermatoses and discussed extensively two paradigmatic ones, namely paraneoplastic pemphigus and paraneoplastic dermatomyositis.
Assuntos
Dermatomiosite/fisiopatologia , Neoplasias/diagnóstico , Síndromes Paraneoplásicas/diagnóstico , Pênfigo/fisiopatologia , Pele/patologia , Citocinas/metabolismo , Dermatomiosite/metabolismo , Dermatomiosite/patologia , Eritema/metabolismo , Eritema/patologia , Eritema/fisiopatologia , Humanos , Neoplasias/metabolismo , Neoplasias/fisiopatologia , Síndromes Paraneoplásicas/metabolismo , Síndromes Paraneoplásicas/fisiopatologia , Pênfigo/metabolismo , Pênfigo/patologia , Pioderma Gangrenoso/metabolismo , Pioderma Gangrenoso/patologia , Pioderma Gangrenoso/fisiopatologia , Pele/metabolismo , Dermatopatias/metabolismo , Dermatopatias/patologia , Dermatopatias/fisiopatologia , Síndrome de Sweet/metabolismo , Síndrome de Sweet/patologia , Síndrome de Sweet/fisiopatologiaRESUMO
Recurrence of breast cancer is a predominant fear for patients who were treated for breast cancer. Acute and late dermatologic effects of radiotherapy are not uncommon and could have similar characteristics to breast cancer recurrence. Thus, it is important to highlight key differences between the clinical and histologic presentations of radiation effects and recurrence. Herein, we present two patients who presented with late dermatologic effects of radiotherapy months to years after treatment, neither of whom had workup consistent with cancer recurrence. We provide clinical and microscopic descriptions of each case and provide a review to differentiate various dermatologic conditions. This report aims to outline potential late dermatologic effects of radiation treatment and emphasise that changes in the breast do not always signal breast cancer recurrence.
Assuntos
Neoplasias da Mama/fisiopatologia , Neoplasias da Mama/radioterapia , Eritema/etiologia , Eritema/fisiopatologia , Recidiva Local de Neoplasia/fisiopatologia , Lesões por Radiação/fisiopatologia , Radioterapia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/epidemiologia , Eritema/epidemiologia , Eritema/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Lesões por Radiação/epidemiologia , Lesões por Radiação/terapia , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: To establish a diagnostic tree analysis (DTA) model based on ultrasonography (US) findings and clinical characteristics for differential diagnosis of common causes of cervical lymphadenopathy in children. METHODS: A total of 242 patients (131 boys, 111 girls; mean age, 11.2 ± 0.3 years; range, 1 month-18 years) with pathologically confirmed Kikuchi disease (n = 127), reactive hyperplasia (n = 64), lymphoma (n = 24), or suppurative lymphadenitis (n = 27) who underwent neck US were included. US images were retrospectively reviewed to assess lymph node (LN) characteristics, and clinical information was collected from patient records. DTA models were created using a classification and regression tree algorithm on the basis of US imaging and clinical findings. The patients were randomly divided into training (70%, 170/242) and validation (30%, 72/242) datasets to assess the diagnostic performance of the DTA models. RESULTS: In the DTA model based on all predictors, perinodal fat hyperechogenicity, LN echogenicity, and short diameter of the largest LN were significant predictors for differential diagnosis of cervical lymphadenopathy (overall accuracy, 85.3% and 83.3% in the training and validation datasets). In the model based on categorical parameters alone, perinodal fat hyperechogenicity, LN echogenicity, and loss of fatty hilum were significant predictors (overall accuracy, 84.7% and 86.1% in the training and validation datasets). CONCLUSIONS: Perinodal fat hyperechogenicity, heterogeneous echotexture, short diameter of the largest LN, and loss of fatty hilum were significant US findings in the DTA for differential diagnosis of cervical lymphadenopathy in children. KEY POINTS: ⢠Diagnostic tree analysis model based on ultrasonography and clinical findings would be helpful in differential diagnosis of pediatric cervical lymphadenopathy. ⢠Significant predictors were perinodal fat hyperechogenicity, heterogeneous echotexture, short diameter of the largest LN, and loss of fatty hilum.
Assuntos
Algoritmos , Diagnóstico Diferencial , Linfadenite Histiocítica Necrosante/diagnóstico por imagem , Linfadenopatia/diagnóstico por imagem , Linfoma/diagnóstico por imagem , Pseudolinfoma/diagnóstico por imagem , Adolescente , Biópsia por Agulha Fina , Biópsia com Agulha de Grande Calibre , Criança , Pré-Escolar , Eritema/fisiopatologia , Feminino , Febre/fisiopatologia , Linfadenite Histiocítica Necrosante/patologia , Linfadenite Histiocítica Necrosante/fisiopatologia , Humanos , Processamento de Imagem Assistida por Computador , Lactente , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfadenite/diagnóstico por imagem , Linfadenite/patologia , Linfadenite/fisiopatologia , Linfadenopatia/patologia , Linfadenopatia/fisiopatologia , Linfoma/patologia , Linfoma/fisiopatologia , Masculino , Pescoço , Pseudolinfoma/patologia , Pseudolinfoma/fisiopatologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Ultrassonografia , Ultrassonografia Doppler em CoresRESUMO
BACKGROUND: Hereditary angioedema (HAE) with C1-inhibitor deficiency (C1-INH-HAE) is characterized by recurrent episodes of subcutaneous/submucosal edema, which may be preceded by erythema marginatum (EM) as a prodromal symptom. Our aim was to analyze the changes occurring in the parameters of the coagulation system during the development of EM and HAE attacks. MATERIALS AND METHODS: Eight C1-INH-HAE patients (1 male, 7 females, median age: 41.7 years) were studied. Blood samples were obtained from all patients (during symptom-free periods, EM, and HAE attacks), as well as from 20 sex- and age-matched healthy controls. Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer, Factor V, Factor VII, Factor X, Factor XI, and Factor XII levels were measured. RESULTS: D-dimer levels were significantly lower, whereas aPTT was significantly prolonged in healthy controls vs. the values measured during the symptom-free period (p = 0.0497; p = 0.0043), in the presence of EM (p = 0.002; p = 0.0002), or during HAE attacks (p < 0.0001; p = 0.0002). We observed the following differences between samples taken during HAE attacks vs. in symptom-free periods: D-dimer levels were significantly elevated (p = 0.0391), while aPTT was significantly shorter during HAE attacks (p = 0.0159). D-dimer levels were significantly higher during EM than in symptom-free periods (p = 0.0078). Comparing the samples drawn during EM or during HAE attacks, there were no significant differences in the study parameters. CONCLUSIONS: D-dimer levels were elevated during EM and this suggests that EM may be part of the HAE attack. Nevertheless, further research into the complement and kinin-kallikrein systems is needed in more patients for a better understanding of the pathomechanism of EM.
Assuntos
Angioedemas Hereditários/fisiopatologia , Biomarcadores/metabolismo , Proteína Inibidora do Complemento C1/metabolismo , Eritema/fisiopatologia , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Adulto , Angioedemas Hereditários/diagnóstico , Coagulação Sanguínea , Proteína Inibidora do Complemento C1/genética , Progressão da Doença , Eritema/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tempo de Tromboplastina Parcial , Estudos ProspectivosRESUMO
BACKGROUND: In addition to pressure itself, microclimate factors are gaining more attention in the understanding of the development of pressure ulcers. While there are already various products to reduce pressure on sore-prone areas to prevent pressure ulcers, there are only a few mattresses/hospital beds that actively influence skin microclimate. In this study, we investigated if microclimate management capable mattresses/hospital beds can influence skin hydration and skin redness/erythema. METHODS: We included 25 healthy subjects in our study. Measurements were made using Courage & Khazaka Multi Probe Adapter MPA with Corneometer CM825 and Mexameter MX18 to determine skin hydration of the stratum corneum and skin redness/erythema before and after the subjects were lying in conventional (Viskolastic® Plus, Wulff Med Tec GmbH, Fedderingen, Germany and Duo™ 2 mattress, Hill-Rom GmbH Essen, Germany) or microclimate management capable mattresses/hospital beds (ClinActiv + MCM™ and PEARLS AFT, Hill-Rom GmbH Essen, Germany). RESULTS: While there was no difference in skin redness/erythema on the different mattresses/hospital beds, skin hydration of the stratum corneum decreased significantly in an air fluidized bed compared to baseline values and values measured on standard mattress/Viskolastic® Plus. CONCLUSION: Air-fluidized therapy reduces skin hydration and therefore could contribute to prevent moisture associated ulcers. Changes in skin hydration as one important factor of skin microclimate can be detected after a short time of incubation and even before an erythema appears.
Assuntos
Roupas de Cama, Mesa e Banho , Eritema/fisiopatologia , Úlcera por Pressão/fisiopatologia , Fenômenos Fisiológicos da Pele , Adolescente , Adulto , Desenho de Equipamento , Equipamentos e Provisões Hospitalares , Feminino , Voluntários Saudáveis , Humanos , Masculino , Microclima , Adulto JovemRESUMO
SETTING: Breast tuberculosis (TB) is rare in Western Europe, and its diagnosis may be delayed through lack of awareness of presenting features. Our institution serves a large East London population with a high incidence of TB. OBJECTIVE: To characterize presenting features and avoidable diagnostic delay in breast TB patients. DESIGN: We conducted a 13-year retrospective study of breast TB patients treated at our institution including demographic, clinical, microbiology, and pathology data. RESULTS: Forty-seven cases were included; 44 (94%) were female, with a median age of 33 years (IQR 28.5-39.5). The main presenting feature was a breast lump in 41 cases (87%); which were predominantly solitary unilateral lesions (25, 61%) and frequently located in the upper outer quadrant (28, 68%). Where performed, Mycobacterium tuberculosis was cultured in 15/36 (42%) cases. Granulomata were present on biopsy or aspirate in 21 (47%) and 17 (36%) cases, respectively. The median duration between symptom onset and treatment was 20 weeks (IQR 15-30). Forty-six (98%) completed treatment successfully and one relapsed. CONCLUSION: A high index of suspicion for TB is required for individuals presenting with breast symptoms from countries where TB is endemic. Development of standardized pathways may improve detection and management of breast TB may reduce diagnostic delay.
Assuntos
Doenças Mamárias/diagnóstico , Tuberculose/diagnóstico , Adulto , Antituberculosos/uso terapêutico , Axila , Doenças Mamárias/tratamento farmacológico , Doenças Mamárias/patologia , Doenças Mamárias/fisiopatologia , Técnicas de Cultura , Duração da Terapia , Eritema/fisiopatologia , Feminino , Humanos , Lactação , Londres , Linfadenopatia/fisiopatologia , Masculino , Mamografia , Mastodinia/fisiopatologia , Derrame Papilar , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/patologia , Complicações Infecciosas na Gravidez/fisiopatologia , Estudos Retrospectivos , Tuberculose/tratamento farmacológico , Tuberculose/patologia , Tuberculose/fisiopatologia , Ultrassonografia MamáriaRESUMO
Two months of treatment with doxycycline provided no improvement. A biopsy of the patient's cheek led to a proper diagnosis.
Assuntos
Antibacterianos/uso terapêutico , Bochecha/fisiopatologia , Doxiciclina/uso terapêutico , Eritema/diagnóstico , Eritema/tratamento farmacológico , Exantema/tratamento farmacológico , Dermatoses Faciais/tratamento farmacológico , Eritema/fisiopatologia , Exantema/diagnóstico , Exantema/fisiopatologia , Dermatoses Faciais/diagnóstico , Dermatoses Faciais/fisiopatologia , HumanosRESUMO
BACKGROUND: Necrotising fasciitis is a rapidly progressing soft-tissue infection with a low incidence that carries a relevant risk of morbidity and mortality. Although necrotising fasciitis is often fatal in adults, its case fatality rate seems to be lower in children. A highly variable clinical presentation makes the diagnosis challenging, which often results in misdiagnosis and time-delay to therapy. METHODS: We conducted a protocol-based systematic review to identify specific features of necrotising fasciitis in children aged one month to 17 years. We searched 'PubMed', 'Web of Science' and 'SCOPUS' for relevant literature. Primary outcomes were incidence and case fatality rates in population-based studies, and skin symptoms on presentation. We also assessed signs of systemic illness, causative organisms, predisposing factors, and reconstructive procedures as secondary outcomes. RESULTS: We included five studies reporting incidence and case fatality rates, two case-control studies, and 298 cases from 195 reports. Incidence rates varied between 0.022 and 0.843 per 100,000 children per year with a case-fatality rate ranging from 0% to 14.3%. The most frequent skin symptoms were erythema (58.7%; 175/298) and swelling (48%; 143/298), whereas all other symptoms occurred in less than 50% of cases. The majority of cases had fever (76.7%; 188/245), but other signs of systemic illness were present in less than half of the cohort. Group-A streptococci accounted for 44.8% (132/298) followed by Gram-negative rods in 29.8% (88/295), while polymicrobial infections occurred in 17.3% (51/295). Extremities were affected in 45.6% (136/298), of which 73.5% (100/136) occurred in the lower extremities. Skin grafts were necessary in 51.6% (84/162) of the pooled cases, while flaps were seldom used (10.5%; 17/162). The vast majority of included reports originate from developed countries. CONCLUSIONS: Clinical suspicion remains the key to diagnose necrotising fasciitis. A combination of swelling, pain, erythema, and a systemic inflammatory response syndrome might indicate necrotising fasciitis. Incidence and case-fatality rates in children are much smaller than in adults, although there seems to be a relevant risk of morbidity indicated by the high percentage of skin grafts. Systematic multi-institutional research efforts are necessary to improve early diagnosis on necrotising fasciits.