RESUMO
Lichen nitidus is a generally asymptomatic disease identified by shiny, flesh-colored papules that are often limited to the trunk, upper limbs, and genitalia. Here, we describe a generalized presentation of lichen nitidus in a 6-year-old girl with Down syndrome. Lichen nitidus shares a known association with Down syndrome, and several case studies document patients with Down syndrome developing generalized lichen nitidus. The extensive nature of our patient's lichen nitidus, as well as the uncommon distribution, particularly on the face, adds to the currently limited primary literature on this subject.
RESUMO
Seborrheic dermatitis is a common multifactorial skin disorder favoring the scalp, ears, face, and central chest. We present a case of an elderly woman with new-onset severe seborrheic dermatitis with massive facial hyperkeratosis mimicking ichthyosis. Clinicians should be aware of rare presentations of common conditions and should screen for associated medical comorbidities in new-onset severe skin conditions.
RESUMO
Ixekizumab is an injectable monoclonal antibody against IL-17A approved by the US Food and Drug Administration for the treatment of plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis. We present what we believe is the first case of herpes zoster (shingles) in a patient 12 weeks after starting ixekizumab for presumed erythrodermic psoriasis. It is important to be aware of potential side effects of immunomodulatory medications, particularly those that are new to the market.
RESUMO
OBJECTIVE: This study aims to evaluate changes in topical antibiotic prescribing trends for acne. METHODS: We retrospectively reviewed the National Ambulatory Medical Care Survey data from 1993 to 2012 for all visits in which acne vulgaris was the primary diagnosis. RESULTS: Acne vulgaris represented an estimated 94.5 million (92.3, 96.8) visits during the 20-year study period. Bivariate analysis showed that over time erythromycin use declined (p < 0.001) and clindamycin use rose (p = 0.10). Multivariate analysis showed that the likelihood of erythromycin use declined to near zero (p < 0.001), whereas clindamycin utilization increased (p < 0.05). PubMed searches of "erythromycin AND resistance" and "clindamycin AND resistance" demonstrated increasing publication frequency by year, fit with sigmoidal functions (erythromycin: R2 = 0.93 and clindamycin: R2 = 0.94). Yearly publications consistently exceeded 100 papers for erythromycin and clindamycin resistance in 1983 and 2003, respectively, roughly corresponding to the interval between reports of their utility in acne. CONCLUSIONS: Our findings suggest topical erythromycin use for acne has essentially ceased. By contrast, clindamycin use is increasing. Current recommendations discourage topical antibiotic monotherapy in favor of combination therapy with benzoyl peroxide and topical retinoids. Our group's previous work demonstrated that this trend is indeed occurring.
