The decubitus ulcer: many questions but few definitive answers.

Decubitus ulcers appear to be associated with insidious trauma. Differential diagnosis can be tricky, and etiology is controversial with sustained localized pressure which plays a significant role. Sustained pressure can stretch soft tissues and blood vessels, causing multiple microthrombi around the point of maximum compression. This leads to prolonged ischemia and produces a plaque of dead tissue surrounded by microthrombi. Prevention often includes regular movement or supports that move the patient. Good nutrition is important, but the adverse effects of fever should not be overlooked. Anti-thrombotic agents should be considered. Occlusive dressings can be used for existing ulcers, while traditional treatments are less appropriate. Pressure and other stresses theoretically should be relieved.

The treatment of acne vulgaris with low dosage doxycycline.

Doxycycline hyclate 20 mg bid is an effective maintenance dosage in patients with inflammatory acne. Twelve subjects aged 14 to 36, both men and women, completed a 16-week study to demonstrate the effectiveness of submicrobial dosing of doxycycline hyclate. Seventeen subjects were screened, and three withdrew before receiving any medication. The subjects received doxycycline hyclate 100 mg daily for eight weeks. One subject withdrew due to unrelated side effects. Eleven subjects had a 50% reduction of lesions at eight weeks, which qualified them to enter the second eight-week phase of the study. This group received either doxycycline hyclate 20 mg bid or placebo. The six subjects receiving doxycycline hyclate 20 mg bid maintained their improvement, while the placebo group did not.

The assessment of acne: an evaluation of grading and lesion counting in the measurement of acne.

The basic morphology of acne--comedones, papules, pustules, and nodules--and the extent of involvement do not permit simple evaluation due to the number of variables involved. Because these acne lesions may vary in number during the natural course of the disease, various measurements have been developed, based on clinical examination and photographic documentation. These range from global assessments to lesion counting, with the latter providing more objective data.

Controversies about the decubitus ulcer.

Knowledge of the decubitus ulcer has made great progress in recent decades. No longer is the diagnosis of a bedsore, as it was in the iron lung days, almost a death warrant. One cannot cause to heal a patient who is in organ failure, nor can one necessarily prevent ulcers in a new spinal cord-injured patient. Reflecting on the common cold, one realizes that prevention is limited to covering the face when sneezing, and treatment is symptomatic. There is no way of eradicating the virus of the common cold, nor is there an appropriate treatment. The decubitus ulcer should be conceived of in a similar vein, until understanding is more complete and specific treatments are available.

Traumatic purpuric penile ulcer.

A 33-year-old man presented with a history of a penile ulcer of four days' duration. He was immediately treated with 2.4 million IU of benzathine penicillin IM and tested for syphilis, but subsequently proved non-reactive. He was already receiving doxycycline BID from another physician for this nonspecific genital ulcer and minocycline for acne. Past medical history revealed periodic flares of hidradenitis suppurativa, limited to the buttocks and inguinal region; acne, involving the face and back; and angiokeratoma of the scrotum. He had no known drug allergies, nor had he admitted to taking any other medicaments. Examination revealed an 8 x 15 mm irregularly shaped, shallow, tender ulcer over a larger purpuric base and involving part of the corona and the distal portion of the shaft. No inguinal adenopathy or buboes could be found on palpation. The patient was placed on a cream containing 3% iodochlorhydroxyquin 1% hydrocortisone. By the end of two weeks of therapy, the lesion had healed with no residual discoloration. Subsequently, the patient revealed that he masturbated daily, rubbing his penis back and forth on the bed sheet while lying prone on the bed. Eleven months later, he consulted us again for a new purpuric penile ulcer, because he had begun to masturbate in his usual fashion. The ulcer healed within several days, and there were no sequellae.

Cutaneous reactions to antibacterial agents.

Antibacterial agents may cause a variety of untoward reactions. Some range from transient, mild erythema to toxic epidermal necrolysis, often resulting in disability and death. Both in vivo and in vitro tests are becoming useful for the diagnosis of the causative agent in drug eruptions. The drug hypersensitivity syndrome may be associated with thyroid abnormalities often occurring months after the drug has been withdrawn. Symmetrical small joint polyarthritis, fever, and malaise may be the presenting findings in a patient with drug-induced lupus erythematosus. Exanthematous drug eruptions without high fever, mucosal involvement, or joint symptoms often resolve without discontinuation of the drug. The differential diagnosis of Stevens-Johnson syndrome and toxic epidermal necrolysis depends on the percentage of epidermal detachment.

Dermatologic manifestations of complementary therapy.

The dermatologic manifestations of complementary therapy include reactions to herbs used orally and topically for treating skin disease, cutaneous reactions to drugs used orally and topically for treating other diseases, and reactions to alternative interventions. The safety of alternative medicine is in question. Unlike approved drugs, the quality, efficacy, and safety of herbal medicines is not regulated. Herbal medicines may be misidentified and contaminated with a variety of substances. The following review identifies and categorizes therapies according to their common uses with their adverse reactions.