[Paget's disease of the nipple]. / Pagets sykdom i brystvorten.

BACKGROUND: Paget's disease of the nipple comprises approximately 1 % of all breast cancers, and presents with unilateral eczematoid changes to the nipple, areola or surrounding skin. Symptoms can be pain, itching or stinging in the area. CASE PRESENTATION: A female patient in her sixties presented to the skin clinic 18 months after initial detection of a rash surrounding her left nipple. Earlier ultrasound and mammography had not indicated pathology. Clinical suspicion and punch biopsies revealed a ductal carcinoma in situ. Surgical excision had to be repeated three times before the underlying malignancy was totally removed. INTERPRETATION: Eczematoid changes in the nipple area are associated with underlying ductal carcinoma or a carcinoma in situ, and biopsies should be taken.

Treatment with a barrier-strengthening moisturizer prevents relapse of hand-eczema. An open, randomized, prospective, parallel group study.

Hand eczema influences the quality of life. Management strategies include the use of moisturizers. In the present study the time to relapse of eczema during treatment with a barrier-strengthening moisturizer (5% urea) was compared with no treatment (no medical or non-medicated preparations) in 53 randomized patients with successfully treated hand eczema. The median time to relapse was 20 days in the moisturizer group compared with 2 days in the no treatment group (p = 0.04). Eczema relapsed in 90% of the patients within 26 weeks. No difference in severity was noted between the groups at relapse. Dermatology Life Quality Index (DLQI) increased significantly in both groups; from 4.7 to 7.1 in the moisturizer group and from 4.1 to 7.8 in the no treatment group (p < 0.01) at the time of relapse. Hence, the application of moisturizers seems to prolong the disease-free interval in patients with controlled hand eczema. Whether the data is applic-able to moisturizers without barrier-strengthening properties remains to be elucidated.

[Cutaneous drug reactions]. / Kutane legemiddelreaksjoner.

BACKGROUND: Adverse cutaneous reactions to drugs are frequent in general practice. This article is a review of current knowledge of the pathogenesis, differential diagnosis and practical management of this wide spectrum of cutaneous manifestations. MATERIAL AND METHODS: Recent studies, guidelines and textbooks are reviewed. The literature was identified on PubMed and supplemented by clinical experience from two university hospitals in Oslo, Norway. RESULTS AND INTERPRETATION: Adverse cutaneous reactions to drugs are frequent, though most reactions are mild and self-limiting. Drug reactions in the skin may be difficult to distinguish from viral exanthemas and other skin diseases. Serious reactions are potentially life-threatening and in need of treatment in intensive-care units. Of the 1350 drugs registered in Norway, the most frequent drugs involved in serious drug reactions are antibiotics, non-steroidal anti-inflammatory drugs, and anticonvulsants. Cutaneous drug reactions can be markers of underlying disease, such as HIV infection or lymphoproliferative diseases. Withdrawal of the suspected drug is essential for prognosis. It is also important to perform a causality assessment of the suspected drug reaction so that it can be avoided in the future, as well as to put emphasis on patient education.