Subject(s)
Antifungal Agents/pharmacology , Antifungal Agents/therapeutic use , Arthrodermataceae/drug effects , Hand Dermatoses/drug therapy , Onychomycosis/drug therapy , Tertiary Care Centers , Arthrodermataceae/physiology , Hand Dermatoses/diagnosis , Hand Dermatoses/epidemiology , Humans , India/epidemiology , Microbial Sensitivity Tests/methods , Onychomycosis/diagnosis , Onychomycosis/epidemiologySubject(s)
Hand Dermatoses/diagnosis , Leprostatic Agents/therapeutic use , Leprosy, Tuberculoid/diagnosis , Adult , Dapsone/therapeutic use , Drug Therapy, Combination , Female , Hand/pathology , Hand Dermatoses/drug therapy , Humans , Hyperpigmentation/etiology , Hypesthesia/etiology , Leprosy, Tuberculoid/complications , Leprosy, Tuberculoid/drug therapy , Rifampin/therapeutic useSubject(s)
Acquired Immunodeficiency Syndrome/diagnosis , Anti-Retroviral Agents/administration & dosage , Foot Dermatoses/diagnosis , Hand Dermatoses/diagnosis , Onychomycosis/diagnosis , Talaromyces/isolation & purification , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/drug therapy , Adult , Drug Therapy, Combination , Foot Dermatoses/complications , Foot Dermatoses/drug therapy , Hand Dermatoses/complications , Hand Dermatoses/drug therapy , Humans , Male , Onychomycosis/complications , Onychomycosis/drug therapySubject(s)
Hand Dermatoses/diagnosis , Hand Dermatoses/drug therapy , Iontophoresis , Psoriasis/diagnosis , Psoriasis/drug therapy , Tretinoin/administration & dosage , Administration, Topical , Adult , Antineoplastic Agents/administration & dosage , Disease Management , Drug Compounding , Female , Hand/pathology , Humans , Male , Middle AgedSubject(s)
Anti-Inflammatory Agents/therapeutic use , Azathioprine/therapeutic use , Clobetasol/therapeutic use , Eczema/drug therapy , Hand Dermatoses/drug therapy , Immunosuppressive Agents/therapeutic use , Adult , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Treatment OutcomeSubject(s)
Antineoplastic Agents/adverse effects , Drug Eruptions/pathology , Hand Dermatoses/chemically induced , Hand Dermatoses/pathology , Hydroxyurea/adverse effects , Adrenal Cortex Hormones/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Drug Eruptions/drug therapy , Female , Hand Dermatoses/drug therapy , Humans , Middle AgedSubject(s)
Fibroma/diagnosis , Foot Dermatoses/diagnosis , Hand Dermatoses/diagnosis , Skin Neoplasms/diagnosis , Adolescent , Female , Fibroma/complications , Fibroma/drug therapy , Foot Dermatoses/complications , Foot Dermatoses/drug therapy , Glucocorticoids/therapeutic use , Hand Dermatoses/complications , Hand Dermatoses/drug therapy , Humans , Nails, Malformed/etiology , Skin Neoplasms/complications , Skin Neoplasms/drug therapy , Triamcinolone/therapeutic useABSTRACT
Onychomycosis is a common nail ailment associated with significant physical and psychological morbidity. Increased prevalence in the recent years is attributed to enhanced longevity, comorbid conditions such as diabetes, avid sports participation, and emergence of HIV. Dermatophytes are the most commonly implicated etiologic agents, particularly Trichophyton rubrum and Trichophyton mentagrophytes var. interdigitale, followed by Candida species and non dermatophytic molds (NDMs). Several clinical variants have been recognized. Candida onychomycosis affects fingernails more often and is accompanied by paronychia. NDM molds should be suspected in patients with history of trauma and associated periungual inflammation. Diagnosis is primarily based upon KOH examination, culture and histopathological examinations of nail clippings and nail biopsy. Adequate and appropriate sample collection is vital to pinpoint the exact etiological fungus. Various improvisations have been adopted to improve the fungal isolation. Culture is the gold standard, while histopathology is often performed to diagnose and differentiate onychomycosis from other nail disorders such as psoriasis and lichen planus. Though rarely used, DNA-based methods are effective for identifying mixed infections and quantification of fungal load. Various treatment modalities including topical, systemic and surgical have been used.Topically, drugs (ciclopirox and amorolfine nail lacquers) are delivered through specialized transungual drug delivery systems ensuring high concentration and prolonged contact. Commonly used oral therapeutic agents include terbinafine, fluconazole, and itraconazole. Terbinafine and itraconazole are given as continuous as well as intermittent regimes. Continuous terbinafine appears to be the most effective regime for dermatophyte onychomycosis. Despite good therapeutic response to newer modalities, long-term outcome is unsatisfactory due to therapeutic failure, relapse, and reinfection. To combat the poor response, newer strategies such as combination, sequential, and supplementary therapies have been suggested. In the end, treatment of special populations such as diabetic, elderly, and children is outlined.
Subject(s)
Antifungal Agents/therapeutic use , Foot Dermatoses/diagnosis , Hand Dermatoses/diagnosis , Onychomycosis/diagnosis , Drug Therapy, Combination , Foot Dermatoses/drug therapy , Foot Dermatoses/microbiology , Foot Dermatoses/surgery , Hand Dermatoses/drug therapy , Hand Dermatoses/microbiology , Hand Dermatoses/surgery , Humans , Onychomycosis/drug therapy , Onychomycosis/microbiology , Onychomycosis/surgery , Paronychia/complications , Paronychia/microbiologySubject(s)
Enoxaparin/administration & dosage , Keratoderma, Palmoplantar/drug therapy , Lichen Planus/drug therapy , Dose-Response Relationship, Drug , Drug Administration Schedule , Fibrinolytic Agents/administration & dosage , Follow-Up Studies , Foot Dermatoses/diagnosis , Foot Dermatoses/drug therapy , Hand Dermatoses/diagnosis , Hand Dermatoses/drug therapy , Humans , Injections, Subcutaneous , Keratoderma, Palmoplantar/diagnosis , Lichen Planus/diagnosis , Male , Middle Aged , Treatment Outcome , Young AdultSubject(s)
Immunoglobulin G/therapeutic use , Immunosuppressive Agents/therapeutic use , Nail Diseases/drug therapy , Psoriasis/drug therapy , Receptors, Tumor Necrosis Factor/therapeutic use , Administration, Oral , Adult , Dose-Response Relationship, Drug , Drug Administration Schedule , Etanercept , Follow-Up Studies , Hand Dermatoses/diagnosis , Hand Dermatoses/drug therapy , Humans , Male , Middle Aged , Nail Diseases/diagnosis , Psoriasis/diagnosis , Severity of Illness Index , Treatment OutcomeSubject(s)
Hand Dermatoses/microbiology , Onychomycosis/microbiology , Trichosporon/isolation & purification , Adult , Antifungal Agents/therapeutic use , Follow-Up Studies , Hand Dermatoses/diagnosis , Hand Dermatoses/drug therapy , Humans , Male , Onychomycosis/diagnosis , Onychomycosis/drug therapy , Rare Diseases , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
Psoriasis is a common, chronic, inflammatory disease with a wide range of clinical presentations. The disease severity ranges from mild to severe. Plaque type of psoriasis is the most common. A number of factors like previous treatment history and comorbid conditions influence the treatment of psoriasis in an individual patient. Location of the lesions is also an important consideration. Psoriasis localized to certain areas of the body like scalp, nails, palms and soles remains difficult to treat. These sites have been referred to as the difficult locations in literature. This article covers the management of psoriasis limited to these special areas.
Subject(s)
Dermatologic Agents/administration & dosage , Phototherapy/trends , Psoriasis/drug therapy , Psoriasis/pathology , Administration, Topical , Animals , Disease Management , Foot Dermatoses/drug therapy , Foot Dermatoses/pathology , Hand Dermatoses/drug therapy , Hand Dermatoses/pathology , Humans , Nail Diseases/drug therapy , Nail Diseases/pathology , Phototherapy/methods , Scalp Dermatoses/drug therapy , Scalp Dermatoses/pathologyABSTRACT
BACKGROUND: Annular elastolytic giant-cell granuloma (AEGCG) is a rare form of granulomatous dermatosis characterized by annular plaques with central atrophy and raised erythematous margins and is usually located on the facial and neck areas. It is characterized histologically by loss of elastic fibre and elastophagocytosis. We report a case of AEGCG. CASE REPORT: A 72-year-old man consulted for annular plaques, some of which were atrophic, and papules that had been present for 2 years. The lesions involved sun-exposed and non-sun-exposed skin. The biopsies showed granulomatous infiltrates and discrete elastophagocytosis. After ruling out various differential clinical and histological diagnoses, the patient was diagnosed with AEGCG. DISCUSSION: We report a case of AEGCG. Diagnosis was not easy. The differential diagnoses of this entity were discussed and we ruled out actinic granuloma, sarcoidosis, leprosy, and granuloma annulare. Our patient presented the classical annular variant combined with a papular variant. We report the first case involving response to isotretinoin.
Subject(s)
Elastic Tissue/pathology , Granuloma Annulare/diagnosis , Granuloma, Giant Cell/diagnosis , Aged , Elastin/metabolism , Facial Dermatoses/diagnosis , Facial Dermatoses/drug therapy , Facial Dermatoses/pathology , Granuloma Annulare/drug therapy , Granuloma Annulare/pathology , Granuloma, Giant Cell/drug therapy , Granuloma, Giant Cell/pathology , Hand Dermatoses/diagnosis , Hand Dermatoses/drug therapy , Hand Dermatoses/pathology , Humans , Isotretinoin/therapeutic use , Male , Models, Biological , Phagocytosis , Remission InductionSubject(s)
Leprosy, Tuberculoid/diagnosis , Pregnancy Complications, Infectious/microbiology , Brazil/ethnology , Dapsone/therapeutic use , Delayed Diagnosis , Facial Dermatoses/diagnosis , Facial Dermatoses/drug therapy , Facial Dermatoses/immunology , Facial Dermatoses/microbiology , Female , Foot Dermatoses/diagnosis , Foot Dermatoses/drug therapy , Foot Dermatoses/immunology , Foot Dermatoses/microbiology , Hand Dermatoses/diagnosis , Hand Dermatoses/drug therapy , Hand Dermatoses/immunology , Hand Dermatoses/microbiology , Humans , Hypesthesia/etiology , Immunity, Cellular , Leprosy, Tuberculoid/drug therapy , Leprosy, Tuberculoid/immunology , Leprosy, Tuberculoid/microbiology , Occupational Exposure , Prednisone/therapeutic use , Pregnancy , Pregnancy Complications, Infectious/immunology , Rifampin/therapeutic use , SpainABSTRACT
Neutrophilic dermatosis of the dorsal hands, a localized form of Sweet's syndrome, was recently described, and can be associated with several diseases including infections. Chronic hepatitis C virus infection has been proposed as a possible triggering factor. The authors present a case in which the clinical and laboratory workup diagnosis only revealed positive serology for hepatitis C virus. Although a cause-effect relation could not be proved, it might be advisable to include serology for this virus in the initial evaluation of patients with neutrophilic dermatosis.
Subject(s)
Hand Dermatoses/diagnosis , Hepatitis C, Chronic/diagnosis , Sweet Syndrome/diagnosis , Adult , Hand Dermatoses/complications , Hand Dermatoses/drug therapy , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/drug therapy , Humans , Male , Prednisolone/therapeutic use , Sweet Syndrome/complications , Sweet Syndrome/drug therapyABSTRACT
BACKGROUND: Onychomycosis is a fungal infection of nails caused by dermatophytes, yeasts and molds. AIMS: To study the efficacy and safety of oral terbinafine pulse as a monotherapy and in combination with topical ciclopirox olamine 8% or topical amorolfine hydrochloride 5% in onychomycosis. METHODS: A clinical comparative study was undertaken on 96 Patients of onychomycosis during the period between August 2005 to July 2006. Forty-eight patients were randomly assigned in group A to receive oral terbinafine 250 mg, one tablet twice daily for seven days every month (pulse therapy); 24 patients in group B to receive oral terbinafine pulse therapy plus topical ciclopirox olamine 8% to be applied once daily at night on all affected nails; and 24 patients in group C to receive oral terbinafine pulse therapy plus topical amorolfine hydrochloride 5% to be applied once weekly at night on all the affected nails. The treatment was continued for four months. The patients were evaluated at four weekly intervals till sixteen weeks and then at 24 and 36 weeks. RESULTS: We observed clinical cure in 71.73, 82.60 and 73.91% patients in groups A, B and C, respectively; Mycological cure rates against dematophytes were 88.9, 88.9 and 85.7 in groups A, B and C, respectively. The yeast mycological cure rates were 66.7, 100 and 50 in groups A, B and C, respectively. In the case of nondermatophytes, the overall response was poor: one out of two cases (50%) responded in group A, while one case each in group B and group C did not respond at all. CONCLUSION: Terbinafine pulse therapy is effective and safe alternative in treatment of onychomycosis due to dermatophytes; and combination therapy with topical ciclopirox or amorolfine do not show any significant difference in efficacy in comparison to monotherapy with oral terbinafine.