Gyrate erythema in the setting of tinea pedis.

Gyrate erythema, which also is known as erythemaannulare centrifugum (EAC), is a reactive dermatitisthat is thought to occur in response to an underlyingtrigger. The superficial form is characterized bythe typical, centrifugally-expanding, annular,erythematous patches or plaques with a distincttrailing scale. The deep form also is a centrifugallyexpanding,erythematous plaque but with induratedborders and absence of scale. These cutaneousfindings are thought to be reactive, most often inresponse to infections or drugs and, less likely, tounderlying malignant conditions.

Clinical and pharmacogenetic predictors of circulating atorvastatin and rosuvastatin concentrations in routine clinical care.

BACKGROUND: A barrier to statin therapy is myopathy associated with elevated systemic drug exposure. Our objective was to examine the association between clinical and pharmacogenetic variables and statin concentrations in patients. METHODS AND RESULTS: In total, 299 patients taking atorvastatin or rosuvastatin were prospectively recruited at an outpatient referral center. The contribution of clinical variables and transporter gene polymorphisms to statin concentration was assessed using multiple linear regression. We observed 45-fold variation in statin concentration among patients taking the same dose. After adjustment for sex, age, body mass index, ethnicity, dose, and time from last dose, SLCO1B1 c.521T>C (P<0.001) and ABCG2 c.421C>A (P<0.01) were important to rosuvastatin concentration (adjusted R(2)=0.56 for the final model). Atorvastatin concentration was associated with SLCO1B1 c.388A>G (P<0.01) and c.521T>C (P<0.05) and 4ß-hydroxycholesterol, a CYP3A activity marker (adjusted R(2)=0.47). A second cohort of 579 patients from primary and specialty care databases were retrospectively genotyped. In this cohort, genotypes associated with statin concentration were not differently distributed among dosing groups, implying providers had not yet optimized each patient's risk-benefit ratio. Nearly 50% of patients in routine practice taking the highest doses were predicted to have statin concentrations greater than the 90th percentile. CONCLUSIONS: Interindividual variability in statin exposure in patients is associated with uptake and efflux transporter polymorphisms. An algorithm incorporating genomic and clinical variables to avoid high atorvastatin and rosuvastatin levels is described; further study will determine whether this approach reduces incidence of statin myopathy.

Peripheral arterial disease: application of the chronic care model.

Management of chronic diseases is one of the greatest challenges facing health care professionals globally. With the aging population increasing worldwide, the number of patients afflicted with chronic diseases will increase. Peripheral Arterial Disease (PAD) is a common, chronic atherosclerotic vascular disease that is associated with a high risk of stroke, myocardial infarction and cardiovascular death. The objective of this study was to determine if a multidisciplinary Vascular Risk Management Clinic (VRMC) would improve risk factor management and health outcomes for patients with PAD with poorly-controlled risk factors. A multidisciplinary VRMC was established utilizing a novel application of the Chronic Care Model to meet the needs of PAD patients. Interventions included optimization of medical therapy, investigations for undiagnosed atherosclerosis in other vascular distributions, smoking cessation therapy, dietary assessment and counseling, and active involvement of patients in evaluating progress towards their risk factor target goals. Assessment of risk factor control was done at each clinic visit and included measures of symptom severity, blood pressure, fasting blood sugar (FBS), lipid profile, body mass index (BMI), and smoking status. Analysis of risk factors was performed for the first 103 patients followed in the clinic. Average follow-up time was 528 days, and statistically significant improvements were seen in blood pressure, LDL, HDL, total cholesterol (TC), and TC/HDL ratio, while BMI, FBS, and triglycerides remained stable. Participation in a specialized vascular risk management clinic resulted in significant improvement in risk factors for disease progression compared to baseline status.