Wells syndrome (eosinophilic cellulitis): a clinical imitator of bacterial cellulitis.

OBJECTIVE: To report a case of Wells syndrome (eosinophilic cellulitis) in a patient who was previously hospitalized twice and received several antibiotic treatments. SETTING: Inpatient hospital consultation. PARTICIPANT: One patient diagnosed with Wells Syndrome based on supporting clinical history, histopathological examination, and other laboratory data. MEASUREMENT: Change in signs and symptoms over time. RESULTS: Improvement of skin lesions after administration of corticosteroids. CONCLUSION: Wells syndrome is a clinical condition that mimics bacterial cellulitis. It is characterized as an erythematous, edematous tender plaque with predilection for the lower extremity. The authors report this case to warn clinicians about other primary dermatological disorders that resemble infectious cellulitis in order to avoid misdiagnoses and delayed treatment.

Synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome complicated by seven pulmonary emboli in a 15-year old patient.

SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome represents a spectrum of various dermatologic and musculoskeletal conditions. Thromboses have infrequently been reported in SAPHO syndrome, most often in the subclavian vein. There have been no reported cases of pulmonary emboli associated with SAPHO. We report a case of a young patient with SAPHO syndrome who later presented with extensive iliofemoral deep vein thromboses and seven pulmonary emboli.

A Medicare cost comparison of minor cutaneous procedures by surgical setting.

BACKGROUND: Regulations that cause minor cutaneous procedures to be moved from the physician's office to an ambulatory surgery center (ASC) or hospital may have the potential to unnecessarily increase the costs of these procedures from the Medicare perspective. OBJECTIVE: To investigate whether minor cutaneous procedures that could reasonably be performed in the office are being done in more intense settings (ASCs or hospitals), who is performing these procedures in alternative settings, and the cost of higher intensity settings. METHODS: Medicare claims data on a number of minor cutaneous surgery procedures performed by various medical disciplines, the location in which the procedures were performed, and the ratio of minor procedures done in each surgical setting by specialty were obtained using the 1992-2000 Medicare Current Beneficiary Survey (MCBS). We used Medicare reimbursements as a measure of the cost of the procedure. RESULTS: When compared by surgical setting, the mean charges for each minor cutaneous procedure were greatest when the procedure was performed in the hospital setting and least when performed in the office setting. Owing to surgical setting, dermatologists were the most cost-effective specialists for the performance of minor cutaneous procedures. CONCLUSIONS: Regulations that discourage office-based surgery could significantly increase medical care costs.

Tinea capitis among children in the Columbus area, Ohio, USA.

Tinea capitis is a fungal infection of the hair follicles of the scalp. In the US, the most common organisms have traditionally been Trichophyton tonsurans, and occasionally Microsporum canis. This study was designed to examine patterns of organisms causing tinea capitis and determine factors associated with infection. A retrospective database analysis was conducted to locate records of patients with tinea capitis from May 2001 to May 2006 at Nationwide Children's Hospital in Columbus, OH. Descriptive statistics, frequency analysis, chi-squared test, and Student's t-test were performed to evaluate types of causative organisms and associated patient characteristics. One hundred and eighty-nine charts of patients with a positive scalp culture for tinea capitis were located. Trichophyton tonsurans (88.9%) was the foremost causative agent followed by Trichophyton violaceum (4.2%). Tinea capitis was more prevalent among African Americans and was more common in urban areas (P < 0.05). Children of African descent inhabiting urban settings were most vulnerable to tinea capitis. The most common organism isolated in this retrospective study was T. tonsurans. Trichophyton violaceum and Trichophyton soudanense were also isolated, which are not commonly reported causes of tinea capitis in the US.

Cantharidin use among pediatric dermatologists in the treatment of molluscum contagiosum.

Cantharidin is cited often in the dermatology and pediatric literature as a valuable treatment option for molluscum contagiosum (MC). However, there have been no prospective, randomized, vehicle-controlled trials that have been able to quantify cantharidin's efficacy in MC. The purpose of this study was to determine the breadth of usage of cantharidin, most frequently used protocols, and common side effects seen with use of cantharidin. An eighteen question survey was administered to the Society of Pediatric Dermatology. The survey sought to evaluate treatments used in MC and experiences with cantharidin including: protocol, side effects, specific products used, and satisfaction with cantharidin. A total of 300 surveys were distributed via email, 101 surveys were initiated, and 95 (94%) of these were completed. Cantharidin, imiquimod, benign neglect, curettage, cryotherapy, and retinoids were the most common approaches to pediatric MC reported by respondents. Ninety-two percent of respondents reported satisfaction with cantharidin's efficacy, but 79% reported side effects, with discomfort/pain and blistering being the most common. Cantharidin is a common modality in the treatment of MC among pediatric dermatologists. While efficacy data is still lacking, subjective satisfaction with cantharidin is reported. Cantharidin remains a viable treatment option for children with MC.

Bullous pemphigoid precipitated by galantamine hydrobromide.

Bullous pemphigoid (BP) is an acquired autoimmune disease commonly attributed as idiopathic, especially in elderly patients, characterized by subepidermal vesicles and bullae with linear deposits of IgG autoantibodies and complement along the epidermal basement membrane. It also is now commonly accepted that BP can be caused by or associated with drug therapy. We report a case of drug-induced BP (DIBP) likely due to galantamine hydrobromide, a competitive and reversible acetylcholinesterase inhibitor used in the treatment of mild to moderate Alzheimer dementia.

Allergens in corticosteroid vehicles.

BACKGROUND: Whereas allergy to vehicle ingredients (ie, excipients and preservatives) in topical steroid vehicles is well recognized, there are no data regarding which vehicle ingredients are in common use or on which vehicles and active molecules are associated with which ingredients. OBJECTIVE: To produce descriptive data on the use of allergenic vehicle ingredients in prescription topical corticosteroids. METHODS: The package insert for every steroid in widespread use in the United States was obtained from the manufacturer and used to generate an ingredient list for the product. RESULTS: There are seven vehicle ingredients that are commonly used in topical corticosteroid vehicles that are well-known allergens: propylene glycol, sorbitan sesquioleate, formaldehyde-releasing preservatives, parabens, methylchloroisothiazolinone/methylisothiazolinone, lanolin, and fragrance. Of 166 topical corticosteroids, 128 (including all creams) had at least one of these vehicle ingredients. More generic products were free of allergens than were branded products. Solutions and ointments were the least allergenic vehicles. The most commonly present potential allergens were propylene glycol and sorbitan sesquioleate. CONCLUSIONS: Most prescription topical corticosteroids have the potential to cause allergic contact dermatitis owing to vehicle ingredients. Dermatologists should be aware of this possibility and should consider prescribing agents that do not contain potentially allergenic vehicle ingredients.