RESUMO
Objective electronic monitoring systems have demonstrated poor adherence to topical therapies. We compared 5 clinical trials that measured adherence to topical therapy in patients with atopic dermatitis to identify characteristics of the study designs that affect patient adherence. Mean adherence among the trials ranged from 32% to 93%, and the length of time between baseline and first return visit was inversely proportional to adherence. The timing of the first return visit may be a practical tool to modify patient adherence.
Assuntos
Dermatite Atópica/tratamento farmacológico , Visita a Consultório Médico/estatística & dados numéricos , Cooperação do Paciente , Ensaios Clínicos como Assunto , Humanos , Fatores de Tempo , Resultado do TratamentoRESUMO
Squamous cell carcinoma (SCC), a malignancy of epidermal keratinocytes, is the second most common cause of skin cancer in the United States. Our case represents an unusual variant of this common tumor. We report a clinical presentation of a case of SCC occurring as cutaneous cystic lesions on the face of an 87-year-old white woman with a medical history of multiple SCCs.
Assuntos
Carcinoma de Células Escamosas/diagnóstico , Cisto Epidérmico/etiologia , Neoplasias Cutâneas/diagnóstico , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/cirurgia , Cisto Epidérmico/cirurgia , Feminino , Humanos , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/cirurgiaRESUMO
Leclercia adecarboxylata is a rare, gram-negative rod that has been infrequently reported in the literature. The organism has been documented to cause solitary infections in immunocompromised hosts and polymicrobial wound infections in the immunocompetent. We present a case of an 8-year-old boy with significant past medical history of acute lymphoblastic leukemia who developed cellulitis due to local infection by L. adecarboxylata. This case is presented to raise awareness of this rare organism's ability to cause common cutaneous disease, especially in the immunocompromised.
Assuntos
Celulite (Flegmão)/complicações , Celulite (Flegmão)/microbiologia , Infecções por Enterobacteriaceae/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Celulite (Flegmão)/patologia , Criança , Infecções por Enterobacteriaceae/patologia , Humanos , Masculino , Pele/microbiologia , Pele/patologiaRESUMO
Vancomycin is used in the treatment of infections caused by gram-positive bacteria resistant to beta-lactam antibiotics. It is also used in the treatment ofenterococci, although this use has been limited due to resistance. The authors report the clinical and pathological presentations of 5 different vancomycin hypersensitivity reactions, including morbilliform eruption, erythroderma, acute generalized exanthematous pustulosis, linear immunoglobulin A bullous dermatosis, and toxic epidermal necrolysis. With the increased prevalence of beta-lactam-resistant bacteria, reliance on vancomycin continues to increase; thus, the recognition of reactions to this drug will be helpful in caring for patients who require this medication in the future.
Assuntos
Antibacterianos/efeitos adversos , Toxidermias/patologia , Vancomicina/efeitos adversos , Pustulose Exantematosa Aguda Generalizada/induzido quimicamente , Adolescente , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Dermatite Esfoliativa/induzido quimicamente , Toxidermias/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dermatopatias Vesiculobolhosas/induzido quimicamente , Síndrome de Stevens-Johnson/etiologia , Vancomicina/uso terapêutico , Suspensão de TratamentoRESUMO
BACKGROUND: Alefacept has an established efficacy and safety profile for 12 weeks of treatment of severe chronic plaque type psoriasis. The effectiveness and safety of longer-term continuous use is not well characterized. METHODS: Fifteen subjects with moderate-to-severe chronic plaque type psoriasis were given weekly 15 mg alefacept injections for 16 consecutive weeks followed by monthly 15 mg injections for up to eight consecutive months, along with clobetasol propionate spray 0.05% twice daily for the first four weeks. Disease severity was measured using the Psoriasis Area and Severity Index (PASI) and the Investigator Global Assessment (IGA). RESULTS: Mean PASI scores improved 33 percent overall during the first month with combination treatment. There was an overall 21 percent worsening in PASI scores after the transition from weekly to monthly medication administration. Of the 15 initially enrolled patients, 27 percent achieved PASI 75 by end of study. No patients achieved an IGA of 0 or 1 by end of study. Two major adverse events were reported: low CD4 count and severe allergic dermatitis. CONCLUSION: Topical clobetasol propionate 0.05% was only partially effective at augmenting the early treatment effect of alefacept. The authors did not observe marked benefit or major side effects by continuing additional monthly alefacept treatments beyond 16 weeks of weekly treatment.