ABSTRACT
Using potassium hydroxide (KOH) preparations in the diagnosis of superficial fungal infections is a technique that has been handed down from teacher to apprentice for more than 100 years. The technique is simple, accurate, and inexpensive; however, there is reason to believe it is falling to the wayside in favor of empiric treatment, especially in primary care settings. To continue the use of this valuable diagnostic aid, a system of teaching the KOH preparation to the next generation of physicians (ie, medical students, residents) is proposed with emphasis on facilitating the process by storing viable skin samples infected with dermatophytes for long periods of time. This technique obviates the need to find suitably infected patients before each teaching laboratory. This technique also is appropriate to refresh the skills of practicing physicians as they prepare for point-of-care testing assessments.
Subject(s)
Arthrodermataceae/isolation & purification , Dermatomycoses/diagnosis , Hydroxides/chemistry , Indicators and Reagents/chemistry , Potassium Compounds/chemistry , Dermatology/education , Education, Medical , Humans , Students, MedicalABSTRACT
Papillon-Lefèvre syndrome (PLS) is a rare inherited palmoplantar keratoderma (PPK) that is associated with progressive gingivitis and recurrent pyodermas. We present a case exhibiting classic features of this autosomal-recessive condition and review the current understanding of its pathophysiology, diagnosis, and treatment. Additionally, a review of pertinent transgredient PPKs is undertaken, with key and distinguishing features of each syndrome highlighted.
Subject(s)
Gingivitis/etiology , Papillon-Lefevre Disease/physiopathology , Pyoderma/etiology , Adult , Cathepsin C/genetics , Disease Progression , Female , Gingivitis/drug therapy , Gingivitis/pathology , Humans , Mutation , Papillon-Lefevre Disease/drug therapy , Papillon-Lefevre Disease/genetics , Pyoderma/pathology , RecurrenceABSTRACT
Chronic granulomatous disease (CGD) is a rare, inherited disorder, in which phagocytic cells, through an enzyme defect, are unable to produce microbicidal oxidants; affected individuals are thereby unduly susceptible to certain life-threatening bacterial and fungal infections and require lifelong antibiotic and antifungal prophylaxis. We present the case of an adolescent CGD patient whose recalcitrant acne vulgaris and subsequent recurrent facial abscesses were successfully treated with isotretinoin; swift resolution of this and similar patients' acne lesions is paramount, as these lesions may serve as a portal of entry for systemic infections and may pose a significant risk for scarring. Isotretinoin is associated with an increased rate of cutaneous Staphylococcus aureus carriage as well as exuberant granulation responses, both of theoretical concern in CGD patients. The therapeutic outcome of isotretinoin in treatment-resistant cases of acne in CGD patients has not been reported in the literature; we present this case to advocate an underreported use of isotretinoin in the prevention of acne, its subsequent cyst formation, and scarring patients with CGD.
