RESUMEN
We describe a neonate with anemia, thrombocytopenia, and hyperbilirubinemia secondary to hemolytic disease of the newborn. After phototherapy for hyperbilirubinemia, the neonate developed a photodistributed eruption with high serum and urine porphyrin levels. This transient porphyrinemia resolved at 1 month.
Asunto(s)
Eritroblastosis Fetal/sangre , Porfirinas/sangre , Anemia Neonatal/complicaciones , Femenino , Humanos , Hiperbilirrubinemia/complicaciones , Hiperbilirrubinemia/terapia , Recién Nacido , Fototerapia/efectos adversos , Trombocitopenia/complicacionesRESUMEN
Distinguishing clinically similar dermatologic disorders can be challenging and the differential diagnosis of a blistering eruption in the newborn period can be extensive. Several genodermatosis, such as bullous congenital ichthyosiform erythroderma (BCIE) and epidermolysis bullosa simplex (EBS), autoimmune bullous disorders, infectious diseases, sucking blisters, and bullous mastocytosis must be considered. We present a case of BCIE misdiagnosed as EBS and review characteristic clinical and histopathological features of each disorder as well as the basic approach to treatment.
Asunto(s)
Errores Diagnósticos , Epidermólisis Ampollosa Simple/diagnóstico , Hiperqueratosis Epidermolítica/diagnóstico , Antibacterianos/uso terapéutico , Balneología , Biopsia , Trastornos de la Nutrición del Niño/complicaciones , Trastornos de la Nutrición del Niño/terapia , Preescolar , Terapia Combinada , Desinfección , Emolientes/uso terapéutico , Nutrición Enteral , Epidermólisis Ampollosa Simple/patología , Epidermólisis Ampollosa Simple/terapia , Insuficiencia de Crecimiento/etiología , Humanos , Hiperqueratosis Epidermolítica/patología , Filamentos Intermedios/ultraestructura , Masculino , Staphylococcus aureus Resistente a Meticilina , Microscopía Electrónica , Infecciones Cutáneas Estafilocócicas/complicaciones , Infecciones Cutáneas Estafilocócicas/tratamiento farmacológico , Infecciones Cutáneas Estafilocócicas/microbiología , Infecciones Cutáneas Estafilocócicas/terapiaRESUMEN
The use of antifungal/corticosteroid combinations as topical therapy for dermatophytoses has been criticized as being less effective, more expensive, and the cause of more adverse cutaneous reactions than antifungal monotherapy. The combination of clotrimazole and betamethasone diproprionate (Lotrisone) is a mix of an azole antifungal and a high-potency corticosteroid, and is one of the most widely prescribed of these combinations. Our objective was to describe the beneficial and deleterious effects of Lotrisone in the treatment of common cutaneous fungal infections and its relative cost-effectiveness. We did a literature review documenting clinical trial data and adverse reactions to Lotrisone and collected a cost analysis of topical antifungal prescribing data over a 2-month period from a large midwestern staff-model health maintenance organization (HMO). Lotrisone is approved by the U.S. Food and Drug Administration (FDA) for the treatment of tinea pedis, tinea cruris, and tinea corporis in adults and children more than 12 years of age. Treatment is limited to 2 weeks in the groin area and 4 weeks on the feet. The most concerning adverse effects of Lotrisone were reported in children and included treatment failure, striae distensae, hirsuitism, and growth retardation. This combination was also reported to have decreased efficacy in clearing candidal and Trichophyton infections as compared to single-agent antifungals. Lotrisone was considerably more expensive than clotrimazole alone and was found to account for more than 50% of topical antifungal expenditures as prescribed by primary care physicians, but only 7% of topical antifungals prescribed by dermatologists. We found that Lotrisone was shown to have the potential to induce many steroid-related side effects and to be less cost effective than antifungal monotherapy. This combination should be used judiciously in the treatment of cutaneous fungal infections and may not be appropriate for use in children.