Successful Treatment of Idiopathic Onychodystrophy With 300 Microsecond 1064 nm Nd:YAG Laser.

Onychodystrophy is the temporary or permanent change in the nail structures. It can be secondary to an inflammatory condition or infectious disease, however many cases of onychodystrophy are idiopathic in nature. In secondary onychodystrophy the treatment is directed towards the underlying process, with subsequent improvement in the appearance of the affected nails depending on the etiology. Dystrophy secondary to onychomycosis is particularly difficult to treat. In permanent idiopathic nail dystrophy, treatment is often unsatisfactory. Destructive nail changes are not only cosmetically displeasing, but also at times physically painful and socially embarrassing. The literature on the treatment of purely idiopathic nail dystrophy is extremely scarce. To our knowledge there exists only one report of two cases of idiopathic onychodystrophy successfully treated with fractional carbon dioxide laser and topical corticosteroids. In this report, we present the first cases of idiopathic onychodystrophy successfully treated with a 1064 nm neodymium-doped yttrium aluminum garnet laser.

Factors influencing the yield of mesenteric angiography in lower gastrointestinal bleed.

AIM: To assess if certain triaging rules could be established to optimize the yield of mesenteric angiography. METHODS: Medical records of 101 patients were retrospectively reviewed and parameters relating to age, gender, pulse rate, blood pressure, serum hemoglobin, intensive care unit (ICU) admission, and the number of packed red blood cells (PRBC) transfused in the 12 and 24 h prior to the angiography were tabulated in two groups with positive and negative angiography results. RESULTS: We found no correlation between gender, pulse rate, blood pressure or serum hemoglobin and positivity of the mesenteric angiogram. But patients with positive angiogram were found to be on average 7 years older (73.2 years vs 65.9 years old) (P = 0.02). Angiogram was positive in 39.3 % (11/28) of patients admitted in ICU vs 23.2% (17/73) who were admitted elsewhere in the hospital (P = 0.03). In the 12 and 24 h prior to angiography, patients with a positive angiogram received a mean of 2.7 ± 2.3 and 3.3 ± 2.6 units of PRBC s respectively, while patients with a negative angiogram had a mean of 1.6 ± 1.9 (P = 0.02) and 2.1 ± 2.6 units (P = 0.04) received respectively in the same period. CONCLUSION: Older age, ICU admission, having received at least 4 units PRBC over 12 h or 5 units over 24 h prior to angiogram are leading indicators for a positive study.

Atypical presentation of congenital yellow nail syndrome in a 2-year-old female.

BACKGROUND: Yellow nail syndrome (YNS) is a rare clinical entity of unknown etiology that is characterized by a triad of yellow nails, respiratory manifestations, and lymphedema. The condition appears in the mid- to later years of life and only rarely in childhood. We describe a rare case of YNS with an atypical clinical presentation consisting of only yellow and dystrophic nails in a 2-year-old female since birth. OBJECTIVE: A case of congenital YNS with only dystrophic and yellow nails is reported. METHODS AND RESULTS: A 2-year-old female presented with yellow nails since birth. There was no positive family history. Physical examination revealed 20 thickened, dystrophic, yellow nails with onycholysis. There was no evidence of respiratory manifestations or lymphedema. CONCLUSION: Although rare, YNS can present as a congenital clinical entity and persist after birth. Pediatric patients with YNS show different clinical manifestations than the classic adult patient. The presence of yellow and dystrophic nails in the absence of respiratory and lymphatic manifestations may be the only sign of pathology and warrants close monitoring as progression to more serious complications can occur.

Dynaclose tape: a practical alternative to punch biopsy site closure.

BACKGROUND: A punch biopsy is a common therapeutic and diagnostic procedure that is routinely performed by dermatologists. A thin cylinder of tissue is removed with a biopsy punch, which creates a full-thickness wound. Sutures are used for primary closure as part of standard practice and are removed in follow-up 5 to 14 days later. The biopsy site heals with a small linear scar. In the past, punch biopsies were often left to heal by secondary intention, but given the extended healing time, this has fallen out of practice among dermatologists. OBJECTIVE: The purpose of this case report is to introduce a new quick and cost-effective approach to accelerate secondary intention healing following punch biopsies in busy dermatology clinics. RESULTS/CONCLUSION: We present a case where Dynaclose tape (Canica Design Inc, Almonte, ON) was used as an alternative to sutures for biopsy site closure. Dynaclose tape is a strip with adhesive ends and a clear center composed of silicone elastomer. The silicone elastomer promotes wound closure by pulling the opposing margins together. The tape maintains excellent adhesion and follows the natural shape of the skin to maximize patient comfort and mobility.

Comparative study of IQ-ultra and Finn Chambers test methodologies in detecting 10 common standard allergens that cause allergic contact dermatitis.

BACKGROUND: Patch testing is routinely used in contact dermatitis clinics because it is the gold standard for the evaluation of potential allergic contact dermatitis. OBJECTIVE: The study was undertaken to evaluate possible differences in reactivity between the Finn Chamber and IQ-Ultra patch-testing methodologies. METHODS: Patients were patch-tested simultaneously with the Finn Chamber and IQ-Ultra patch tests. Ten standard allergens set by the North American Contact Dermatitis Group were used for both techniques. RESULTS: Both patch tests had a significant agreement in detecting all of the allergens. An "almost perfect agreement" was noted for ethylenediamine dihydrochloride, quaternium-15, mercapto mix, black rubber mix, balsam of Peru, and nickel sulfate; "substantial agreement" for formaldehyde, bisphenol A epoxy resin, and 4-tert-butylphenol formaldehyde resin; and "moderate agreement" for potassium dichromate. CONCLUSION: The Finn Chamber and IQ-Ultra patch tests had a good agreement in the detection of the 10 standard allergens that were tested.

Allergic contact dermatitis from dimethyl fumarate after contact with a Chinese sofa.

BACKGROUND: Dimethyl fumarate has been successfully used in the treatment of psoriasis in the past. Despite its clinical use, cutaneous contact with this molecule may cause contact dermatitis. OBJECTIVE: We report a case in which skin exposure to a synthetic fabric sofa containing dimethyl fumarate made by a Chinese furniture manufacturer resulted in a severe, pruritic, papulovesicular, eczematous dermatitis to the sites of contact with the sofa. METHODS: The patient was patch-tested with serial dilutions of dimethyl fumarate. RESULTS: Patch testing results revealed strong positive reactions to dimethyl fumarate at different concentrations. CONCLUSION: Dimethyl fumarate is a potent contact sensitizer and is commonly found in sachets inside furniture and footwear boxes.

Erratum to: The Wide-Awake Approach to Dupuytren's Disease: Fasciectomy under Local Anesthetic with Epinephrine.

[This corrects the article DOI: 10.1007/s11552-009-9239-y.].