PRURITIC RASH IN AN ELDERLY PATIENT WITH UNCONTROLLED DIABETES MELLITUS.

OBJECTIVE: Acquired reactive perforating collagenosis is an uncommon skin disease that belongs to a group of dermatologic disorders characterized by transepidermal elimination of dermal material. It is highly associated with systemic disease, primarily diabetes mellitus and dialysis-dependent chronic renal failure. METHODS: A 70-year-old female with 20 years of poorly controlled type 2 diabetes mellitus presented with a 6-month history of multiple pruritic erythematous papules and nodules with central hyperkeratosis, involving her right dorsal arm. Histologic examination was consistent with acquired reactive perforating collagenosis. In addition to topical treatment of the disease, the patient was referred to endocrinology for appropriate management of her underlying diabetes mellitus. RESULTS: Ideal treatment should involve both the endocrinologist and dermatologist. Control of the underlying systemic disease, in this case diabetes, as well topical or systemic medications can both help to improve this condition. Our patient re-established care with her endocrinologist who adjusted her medication regimen, resulting in improved hemoglobin A1c values. Our patient additionally benefited from topical betamethasone cream, ammonium lactate, and pimecrolimus application. The combined therapy led to resolution of her pruritic rash. CONCLUSION: This case highlights the importance of the skin exam by the endocrinologist, as he or she plays a unique role in identifying this rare and difficult-to-treat dermatologic disease. Early detection and prompt referral to a dermatologist are crucial in preventing progression of disease, treating the disease, and improving the patient's quality of life.

Categorical vowel perception enhances the effectiveness and generalization of auditory feedback in human-machine-interfaces.

Human-machine interface (HMI) designs offer the possibility of improving quality of life for patient populations as well as augmenting normal user function. Despite pragmatic benefits, utilizing auditory feedback for HMI control remains underutilized, in part due to observed limitations in effectiveness. The goal of this study was to determine the extent to which categorical speech perception could be used to improve an auditory HMI. Using surface electromyography, 24 healthy speakers of American English participated in 4 sessions to learn to control an HMI using auditory feedback (provided via vowel synthesis). Participants trained on 3 targets in sessions 1-3 and were tested on 3 novel targets in session 4. An "established categories with text cues" group of eight participants were trained and tested on auditory targets corresponding to standard American English vowels using auditory and text target cues. An "established categories without text cues" group of eight participants were trained and tested on the same targets using only auditory cuing of target vowel identity. A "new categories" group of eight participants were trained and tested on targets that corresponded to vowel-like sounds not part of American English. Analyses of user performance revealed significant effects of session and group (established categories groups and the new categories group), and a trend for an interaction between session and group. Results suggest that auditory feedback can be effectively used for HMI operation when paired with established categorical (native vowel) targets with an unambiguous cue.