ABSTRACT
Pediatric fasciitides are rare benign lesions that may clinically mimic a malignant sarcoma. Nodular fasciitis, the most common of these fasciitides, rarely occurs in children younger than 5 years of age. Often there is a history of preceding trauma. Herein, we report the case of a 5-month-old boy diagnosed with nodular fasciitis in the setting of nonaccidental trauma.
Subject(s)
Child Abuse/diagnosis , Fasciitis/diagnosis , Biopsy, Needle , Diagnosis, Differential , Fractures, Bone/diagnosis , Humans , Infant , Magnetic Resonance Imaging , Male , Sarcoma/diagnosis , ShoulderABSTRACT
Alternaria species are a group of dematiaceous fungi that are ubiquitous in nature and are becoming an increasingly important cause of disease in immunocompromised patients. We present a case of a 70 year old renal transplant recipient with multiple areas of cutaneous Alternaria infections likely introduced during local trauma. Treatment has required a combination of systemic therapy and surgical excision. This case illustrates the importance of recognizing fungal infections with cutaneous manifestations, such as alternariosis, in immunosuppressed patients.
Subject(s)
Alternariosis/therapy , Antifungal Agents/therapeutic use , Immunocompromised Host , Kidney Transplantation , Aged , Alternariosis/diagnosis , Alternariosis/immunology , Biopsy , Dermatologic Surgical Procedures/methods , Diagnosis, Differential , Humans , Male , Skin/pathologyABSTRACT
The first report of spinous follicular lichen nitidus with perifollicular granulomas was by Madhok and Winkelmann in 1988. Since this report, a few cases of follicular or periappendageal lichen nitidus have been described, in a more localized form or without perifollicular granulomas. We describe a 5-year-old girl with the rare generalized spinous follicular variant of lichen nitidus with perifollicular granulomas.
Subject(s)
Facial Dermatoses/pathology , Granuloma/pathology , Lichen Nitidus/pathology , Skin/pathology , Child, Preschool , Female , HumansSubject(s)
Facial Neoplasms , Immunosuppressive Agents/administration & dosage , Kidney Transplantation/immunology , Melanoma , Skin Neoplasms , Adult , Facial Neoplasms/diagnosis , Facial Neoplasms/surgery , Female , Humans , Melanoma/diagnosis , Melanoma/surgery , Skin Neoplasms/diagnosis , Skin Neoplasms/surgery , Time FactorsABSTRACT
BACKGROUND: Nonadherence to prescribed medications is a common problem in dermatology, and assessing adherence can be difficult. Electronic monitors are not always practical, but self-report measures may be less reliable. PURPOSE: To review the literature for self-report instruments and electronic monitors used to measure medication adherence in patients with chronic disease. METHODS: A PubMed literature search was conducted using the terms 'scale,''measure,''self-report,''electronic,' and 'medication adherence.' Relevant articles were reviewed and selected if they addressed self-report or electronic measures of adherence in chronic disease. RESULTS: Eleven self-report instruments for the measurement of adherence were identified. Four were validated using electronic monitors. All produced an estimate of adherence that correlated with actual behavior, although this correlation was not strong for any of the measures. None of the scales was tested in patients who had dermatologic disease and/or used topical medications. Several electronic monitoring systems were identified, including pill counts, pharmacy refill logs, and the Medication Event Monitoring System (MEMS). Validity was higher among electronic monitoring systems compared with self-report measures. CONCLUSION: While several self-report measures of adherence have been validated in chronic disease populations, their relevance in dermatology patients has not been studied. A dermatology-specific instrument for the measurement of adherence would contribute to improved outcomes; until such a tool exists, researchers and clinicians should consider nonadherence as a possible factor in skin disease that is not responsive to treatment. Electronic monitoring provides the most reliable means of measuring adherence, and may provide additional clues to identify barriers to adherence.
