Asunto(s)
Liquen Escleroso y Atrófico/terapia , Adolescente , Adulto , Cuidados Posteriores , Anciano , Biopsia/métodos , Niño , Preescolar , Cicatriz/etiología , Fármacos Dermatológicos/uso terapéutico , Femenino , Enfermedades Urogenitales Femeninas/terapia , Humanos , Lactante , Recién Nacido , Liquen Escleroso y Atrófico/diagnóstico , Liquen Escleroso y Atrófico/etiología , Masculino , Enfermedades Urogenitales Masculinas/terapia , Persona de Mediana Edad , Pomadas , Evaluación de Resultado en la Atención de Salud , Trastornos de la Sensación/etiología , Neoplasias Cutáneas/etiología , Insuficiencia del Tratamiento , Adulto JovenAsunto(s)
Liquen Escleroso y Atrófico/terapia , Adulto , Niño , Medicina Basada en la Evidencia , Femenino , Enfermedades de los Genitales Femeninos/diagnóstico , Enfermedades de los Genitales Femeninos/terapia , Enfermedades de los Genitales Masculinos/diagnóstico , Enfermedades de los Genitales Masculinos/terapia , Humanos , Liquen Escleroso y Atrófico/complicaciones , Liquen Escleroso y Atrófico/diagnóstico , Cuidados a Largo Plazo/métodos , Masculino , Testosterona/uso terapéuticoRESUMEN
In-vivo studies suggest that chlorine-releasing antiseptic agents inhibit wound healing. Studies which have used cell culture systems to evaluate cytotoxicity have generated conflicting results for the toxicity of free-chlorine agents relative to other antiseptics. Here we examine the following three factors which may influence the toxicity of individual agents within a cell culture assay: (1) cell number; (2) duration of exposure; and (3) the nature of the antiseptic diluent. Three agents (sodium hypochlorite, chlorhexidine and hydrogen peroxide) were tested on transformed human keratinocytes (SVK 14 cells). It was found that increasing cell number, and using serum or medium as a diluent, reduced the toxicity of all agents but had the greatest effect on sodium hypochlorite. In contrast, increasing the duration of exposure increased the toxicity of all agents but had the greatest effect on hydrogen peroxide. These observations may explain the high toxicity of hydrogen peroxide and relatively low toxicity of sodium hypochlorite which have been observed in vitro and are the reverse of in-vivo findings. Culture systems in which high cell numbers are coupled with an agent diluted in serum or medium, and a long exposure time, seem likely to decrease the toxicity of chlorine-releasing agents relative to hydrogen peroxide.
Asunto(s)
Clorhexidina/farmacología , Peróxido de Hidrógeno/farmacología , Queratinocitos/efectos de los fármacos , Hipoclorito de Sodio/farmacología , Recuento de Células , Línea Celular Transformada , Recuento de Colonia Microbiana , Medios de Cultivo , Relación Dosis-Respuesta a Droga , Factores de TiempoRESUMEN
We report the combination of hemifacial microsomia, external auditory canal atresia, deafness and acro-osteolysis in several members of a highly consanguineous Asian family. In addition Mullerian anomalies have been found in two female members of the family. The external auditory canal stenosis and Mullerian anomalies in this family are similar to those reported by Winter et al. [(1968) J Pediatr 72 : 88-93] and overlap with those found in Goldenhar syndrome and Mullerian duct/renal aplasia/cervicothoracic somite dysplasia (MURCS), CHARGE and VATER associations. However, to the authors' knowledge, acro-osteolysis has not been reported in patients with any of these conditions. Overall, the findings in this family appear to be unique and the presence of consanguinity suggests an autosomal recessive condition with variable expression.
Asunto(s)
Anomalías Múltiples/patología , Acroosteólisis/patología , Sordera/patología , Conducto Auditivo Externo/anomalías , Cara/anomalías , Genes Recesivos , Conductos Paramesonéfricos/anomalías , Anomalías Múltiples/diagnóstico , Anomalías Múltiples/genética , Acroosteólisis/genética , Adolescente , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , LinajeAsunto(s)
Enfermedad de Darier/complicaciones , Tiña/complicaciones , Femenino , Humanos , MasculinoAsunto(s)
Azatioprina/efectos adversos , Queratodermia Palmoplantar/inducido químicamente , Prednisolona/efectos adversos , Biopsia , Humanos , Tolerancia Inmunológica , Queratodermia Palmoplantar/inmunología , Queratodermia Palmoplantar/patología , Masculino , Persona de Mediana Edad , Piel/patologíaAsunto(s)
Queilitis/etiología , Enfermedad de Crohn/complicaciones , Enfermedad Granulomatosa Crónica/etiología , Enfermedades de la Piel/etiología , Adolescente , Biopsia , Queilitis/patología , Enfermedad de Crohn/patología , Enfermedad Granulomatosa Crónica/patología , Humanos , Masculino , Enfermedades de la Piel/patologíaRESUMEN
Very large solitary trichoepitheliomas which arose in the perianal region in three patients are described. Although these tumours showed a striking histological similarity to classical multiple or solitary trichoepitheliomas of the face, they differed in their massive size, unusual location and by their involvement of deeper tissue. We suggest that giant solitary trichoepitheliomas is a distinct variant of trichoepithelioma that may have a predilection for the perianal region. At this site this rare tumour must be distinguished from basal cell carcinoma of the perineum and from malignant basaloid (cloacogenic) carcinoma of the anal canal.
Asunto(s)
Neoplasias del Ano/patología , Neoplasias Cutáneas/patología , Anciano , Neoplasias del Ano/cirugía , Femenino , Humanos , Masculino , Neoplasias Cutáneas/cirugíaRESUMEN
We present a patient with multiple leiomyomas confined to the left cheek, giving rise to an unusual clinical presentation of this condition. The lesions were cosmetically disfiguring and, because of their exposed location, were particularly painful in the winter months. The treatment of this condition is discussed.
Asunto(s)
Neoplasias Faciales/tratamiento farmacológico , Leiomioma/tratamiento farmacológico , Adulto , Neoplasias Faciales/patología , Humanos , Leiomioma/patología , Masculino , Nifedipino/uso terapéuticoRESUMEN
Cutaneous non-Hodgkin's lymphoma developed within a leg affected by chronic lymphoedema. The lymphoedema had followed radiotherapy to bony metastases from a carcinoma of the prostate. Eighteen months after the development of the cutaneous tumours, extracutaneous involvement by the lymphoma became apparent. This is the second report of a non-Hodgkin's lymphoma appearing within a lymphoedematous limb. The possible reasons for such an unusual localization are discussed. Our case report illustrates that cutaneous tumours other than lymphangiosarcomas may localize to a lymphoedematous limb and clinically simulate the Stewart-Treves syndrome.
Asunto(s)
Linfedema/complicaciones , Linfoma/complicaciones , Neoplasias Cutáneas/complicaciones , Anciano , Neoplasias Óseas/radioterapia , Neoplasias Óseas/secundario , Enfermedad Crónica , Humanos , Pierna , Linfedema/etiología , Linfoma/patología , Masculino , Radioterapia/efectos adversosRESUMEN
Recurrent erythema multiforme is an uncommon disorder. We have reviewed the clinical features and treatment of 65 patients with this condition. The mean number of attacks per year was six (range 2-24), and the mean duration of the disease was 9.5 years (range 2-36) reflecting its chronicity. The majority of patients had oral mucous membrane involvement (69%). In 46 patients (71%) the condition was precipitated by a preceding herpes simplex virus infection. Acyclovir was found to be the most useful first-line treatment, with 55% of patients deriving benefit from either continuous oral acyclovir or a patient-initiated 5-day oral course at the onset of herpes simplex virus infection. Of those failing to respond to acyclovir, a small proportion responded to dapsone. The most resistant patients (11) were treated with azathioprine, with complete disease suppression in all cases.
Asunto(s)
Aciclovir/administración & dosificación , Eritema Multiforme/tratamiento farmacológico , Administración Oral , Adolescente , Adulto , Anciano , Azatioprina/administración & dosificación , Niño , Preescolar , Enfermedad Crónica , Dapsona/administración & dosificación , Esquema de Medicación , Eritema Multiforme/complicaciones , Femenino , Herpes Simple/complicaciones , Humanos , Inmunización Pasiva , Inmunoglobulinas/administración & dosificación , Lactante , Masculino , Persona de Mediana Edad , RecurrenciaRESUMEN
Twenty patients who suffered from more than four attacks of erythema multiforme (EM) per year were enrolled in a 6-month double-blind, placebo-controlled trial of acyclovir 400 mg twice daily. Fifteen patients had disease precipitated by recurrent herpes simplex. In the acyclovir-treated group the median number of EM attacks during the treatment period was zero, compared with three in the placebo-treated group (P < 0.0005, Wilcoxon rank sum test). Seven of the 11 patients treated with continuous acyclovir did not have any attacks of EM while taking the drug, and one showed almost complete disease suppression. Following treatment with acyclovir, two patients went into complete remission, whereas all individuals in the placebo group continued to have attacks. In the acyclovir-treated group nine of the 11 patients had herpes simplex-precipitated disease. One of the two patients with idiopathic disease showed complete disease suppression while on acyclovir, lending support to the view that idiopathic recurrent EM may be related to subclinical herpetic infection. In this study, we have shown that continuous acyclovir therapy can completely suppress attacks of recurrent EM and, in some cases, may induce disease remission.
Asunto(s)
Aciclovir/uso terapéutico , Eritema Multiforme/tratamiento farmacológico , Adulto , Anciano , Método Doble Ciego , Eritema Multiforme/complicaciones , Femenino , Herpes Simple/complicaciones , Humanos , Masculino , Persona de Mediana Edad , RecurrenciaRESUMEN
A case of the congenital self-healing reticulohistiocytosis variant of Langerhans cell histiocytosis is described. The child was born with a widespread blistering eruption, which rapidly resolved leaving papules and erosions. These ultimately healed leaving anetoderma. Congenital self-healing reticulohistiocytosis should be considered in the differential diagnosis of blistering eruptions present at birth.
Asunto(s)
Histiocitosis de Células de Langerhans/congénito , Femenino , Histiocitosis de Células de Langerhans/patología , Humanos , Recién NacidoRESUMEN
Involvement in pemphigus vulgaris of the female genital tract including the vulva, vagina and cervix has previously been described. In all these cases other cutaneous and mucosal sites have also been affected at some time. We describe a case of pemphigus vulgaris which only involved the vaginal mucosa. The patient presented with a persistent vaginal discharge and examination showed extensive vaginal erosions. Histology of vaginal biopsies was non-diagnostic. The recognition that the vaginal changes may represent an immunobullous disease led to further vaginal biopsies on which direct immunofluorescence studies were performed. These biopsies showed IgG and C3 in the intercellular epidermis, suggesting a diagnosis of pemphigus vulgaris. During the 3-year period that the patient has been under review there have never been any other cutaneous or mucosal lesions. To our knowledge, this is the first case of pemphigus vulgaris localized exclusively to the vaginal mucosa. There was considerable delay in diagnosis and this case highlights how important it is to recognize that chronic mucosal lesions at genital sites may be caused by immunobullous diseases such as cicatricial pemphigoid and pemphigus, and to institute appropriate investigations.
Asunto(s)
Pénfigo/complicaciones , Vagina/patología , Excreción Vaginal/etiología , Antiinflamatorios/uso terapéutico , Enfermedad Crónica , Femenino , Humanos , Persona de Mediana Edad , Membrana Mucosa/patología , Pénfigo/tratamiento farmacológico , Pénfigo/patología , Prednisolona/uso terapéutico , Excreción Vaginal/tratamiento farmacológicoRESUMEN
These guidelines for the management of lichen sclerosus have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.
Asunto(s)
Liquen Escleroso y Atrófico/terapia , Medicina Basada en la Evidencia , Femenino , Humanos , Liquen Escleroso y Atrófico/complicaciones , Liquen Escleroso y Atrófico/diagnóstico , Cuidados a Largo Plazo/métodos , Masculino , Insuficiencia del TratamientoRESUMEN
The cytotoxic effects of a range of antiseptic agents were examined on cultured human fibroblasts and basal keratinocytes and compared to those on a transformed keratinocyte line (SVK 14 cells). Cells were exposed to chlorhexidine, hydrogen peroxide and sodium hypochlorite for 15 min and cell viability was assessed 24 h later with a colorimetric assay which utilizes the tetrazolium salt 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT). At concentrations recommended for wound cleansing all agents produced 100% killing of all cell types. The results show that fibroblasts and keratinocytes, cells which are fundamental to the wound healing process are equally sensitive to the effects of the antiseptic agents tested, and are highly susceptible to the effects of free-chlorine containing agents. These observations are of particular importance to the use of cultured keratinocytes (culture grafts) to enhance wound healing; the application of antiseptics to such wounds is contraindicated. All three cell types tested showed similar susceptibilities to the agents tested. These findings suggest that the transformed cell line, which has the advantage of immortality and ready availability, can replace fibroblasts and keratinocytes in studies designed to investigate the adverse effects of antiseptic agents in vitro. Comparison of the ED50 concentration for each agent on all cell types to the standard use concentration produced a ranking order of toxicity which showed chlorhexidine to be the least toxic agent and sodium hypochlorite the most.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Clorhexidina/farmacología , Fibroblastos/efectos de los fármacos , Peróxido de Hidrógeno/farmacología , Queratinocitos/efectos de los fármacos , Hipoclorito de Sodio/farmacología , Línea Celular Transformada , Células Cultivadas , Relación Dosis-Respuesta a Droga , HumanosRESUMEN
We present two siblings with congenital and progressive encephalopathy associated with systemic lupus erythematosus. The two brothers presented soon after birth with an encephalopathy associated with intracranial calcification (=2), intrauterine growth retardation (= 2), hepatitis (= 1) and thrombocytopenia (= 1), mimicking a congenital virus infection. Within the first year of life both children developed hypocomplementaemia and systemic lupus erythematosus (SLE), the main features of which were a discoid lupus-like rash on the hands and feet and the progressive production of high levels of autoantibodies. Both children were severely handicapped and died in early childhood from streptococcal infections. There are many causes of congenital encephalopathy with intracranial calcification. The early development of systemic lupus in these children suggested that their cerebral disease formed part of an autoimmune process. Complement levels and autoantibody profiles should be considered part of the investigation of a child with congenital infection-like syndrome, particularly when there are progressive dermatological complications.
Asunto(s)
Encefalopatías/congénito , Encefalopatías/complicaciones , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/genética , Infecciones Neumocócicas/congénito , Infecciones Neumocócicas/complicaciones , Antígenos CD/inmunología , Autoanticuerpos/inmunología , Encefalopatías/diagnóstico , Calcinosis/complicaciones , Calcinosis/congénito , Preescolar , Resultado Fatal , Humanos , Lactante , Lupus Eritematoso Sistémico/inmunología , Masculino , Síndrome , Tomografía Computarizada por Rayos XRESUMEN
Infection with herpes simplex virus (HSV) is a common worldwide problem. Primary infection with HSV-1 rarely causes significant problems although widespread involvement in atopic eczema can be life-threatening as may associated encephalitis. Keratoconjunctivitis, pharyngitis and hepatitis can also complicate primary infection. Twenty to 40% of the population at some stage have recurrent orolabial infections with HSV although in only 1% of these cases is this recurrence severe. Recurrent erythema multiforme appears to be associated with HSV-65% of patients are thought to have preceding herpes labialis. Many primary and recurrent infections with HSV-1 require little more than topical antiseptic therapy to control secondary infection. Systemic acyclovir, however, is indicated in various situations including complicated primary infection, infection in neonates, eczema herpeticum, HSV infections in the immunocompromised, and recurrent erythema multiforme. In the latter, prophylactic treatment with 6 months acyclovir appears to be effective.