Barriers to Treatment of Tinea Capitis in Children Living in the Jane Finch Community of Toronto.

BACKGROUND: Tinea capitis is a common fungal infection of the scalp. If left untreated, tinea capitis infection can cause severe inflammatory reactions and the development of kerion. Tinea capitis is effectively treated with oral antifungals, but at present these are not covered under government assistance programs. OBJECTIVE: To assess the potential impact of a limited use code for antifungal therapy in the treatment of childhood tinea capitis. METHOD: Fourteen family physicians practicing in the Jane Finch area were surveyed on their experience treating tinea capitis in this community. RESULTS: Seventy-one percent of surveyed family physicians felt that cost impedes the treatment of tinea capitis in their practice, and 100% felt that a limited use code would have a positive impact on their patients. CONCLUSION: A limited use code for oral antifungal treatments of tinea capitis may provide a simple, cost-effective solution to a major problem impacting children in the Jane Finch area.

Pityriasis rotunda diagnosed in Canada: case presentation and review of the literature.

BACKGROUND: Pityriasis rotunda is a rare cutaneous disorder characterized by scaly, circular, well-demarcated, hypo- or hyperpigmented, fine plaques over the trunk and extremities. OBJECTIVE: We present a case of pityriasis rotunda in a 44-year-old African-Canadian woman who presented to a community dermatology practice in Toronto. RESULTS: Pityriasis rotunda has been well described in Japan, Italy, and South Africa. It is extremely rare in North America, with nine reported cases to date, the majority of which were diagnosed in the United States. CONCLUSION: Pityriasis rotunda is a rare cutaneous disorder associated with systemic disease. To the best of our knowledge, this is the second report of pityriasis rotunda diagnosed in Canada.

Toxic effects of skin-lightening products in Canadian immigrants.

BACKGROUND: The cultural practice of skin bleaching is highly prevalent in Africa. Most reported cases of toxic effects of skin-lightening products occur in this region. OBJECTIVE: To describe cases of misuse of over-the-counter (OTC) cosmetic skin-lightening products occurring in Canadian immigrants. METHODS: Two cases of Canadian immigrants with severe complications from OTC skin-bleaching agents were identified in a community-based dermatology practice in Toronto. The case histories were reviewed and analyzed. RESULTS: A 28-year-old African-Canadian woman developed extensive striae from long-term use of a topical cream containing clobetasol that she had purchased in a Caribbean health food store. A 55-year-old African-Canadian woman developed exogenous ochronosis from the use of a topical bleaching agent she had purchased in Ghana. CONCLUSION: Cosmetic skin lightening with unregulated topical products occurs in Canada. Dermatologists working in Canada need to be aware of this practice to provide appropriate directive care.

HIV dermatology in Canada: cutaneous disease burden and demographic characteristics of a specialized urban practice.

BACKGROUND: The introduction of antiretroviral therapies has changed the pattern of cutaneous disease in individuals infected with human immunodeficiency virus (HIV). OBJECTIVE: To assess demographic characteristics, severity of immunosuppression, and frequency of dermatologic disorders in patients presenting to a Canadian specialized HIV dermatology practice. METHODS: A cross-sectional study was performed of 183 consecutive outpatient and inpatient consultations to a single HIV dermatology practice from January 2007 to December 2008. RESULTS: One hundred sixty-three (88%) patients were male, with an average age of 45. Forty-six patients were not on antiretroviral therapy. Verruca was the most common diagnosis, seen in 29 patients, followed by dermatophyte infection, seen in 27. Patients with a low CD4 count (p  =  .0001) and a high viral load (p  =  .0043) were more likely to present with an HIV-specific dermatosis. CONCLUSION: Cutaneous infections were the most common diagnoses in this cross section. Classic HIV dermatoses were seen more frequently in those with more advanced disease owing to HIV infection.

A review of adverse cutaneous drug reactions resulting from the use of interferon and ribavirin.

Drug-induced cutaneous eruptions are named among the most common side effects of many medications. Thus, cutaneous drug eruptions are a common cause of morbidity and mortality, especially in hospital settings. The present article reviews different presentations of drug-induced cutaneous eruptions, with a focus on eruptions reported secondary to the use of interferon and ribavirin. Presentations include injection site reactions, psoriasis, eczematous drug reactions, alopecia, sarcoidosis, lupus, fixed drug eruptions, pigmentary changes and lichenoid eruptions. Also reviewed are findings regarding life-threatening systemic drug reactions.

Pulmonary site bioprostheses: morphologic findings in 40 cases.

CONTEXT: From January 1995 to June 2003, there were 514 patients who underwent pulmonary valve replacements at either the Hospital for Sick Children or Toronto General Hospital. Fifty-four (10.5%) of these adults returned for replacement of their prostheses because of failure. Forty (74.1%) of the 54 explants were bioprostheses, and 14 (25.9%) were homografts. OBJECTIVE: To present the morphologic findings from this consecutive series of 40 pulmonary-site bioprostheses. DESIGN: Data were obtained by review of pathologic, clinical, and surgical records for all 40 patients with bioprosthetic pulmonary valves explanted from 1995 to June of 2003. RESULTS: The mean duration of valve implantation was 14.3 +/- 5.2 years (2-26 years). Median age at implantation was 16.7 +/- 10.3 years (range, 3 months to 53 years). Structural valve deterioration was found in 39 (97.5%) of the valves. Morphologic evidence of stenosis was found in all valves, whereas incompetence was found in 28 (70.0%). Calcification was present in 32 (80.0%) of the valves and was severe and diffuse in 22 (55.0%). Host tissue overgrowth, or pannus, was present on 39 (97.5%) of the valves and was severe in 35 (87.5%). Tears were present in 19 (47.5%) of the valves. CONCLUSIONS: Explanted bioprostheses showed a high degree of calcification and pannus, which together led to stenosis. Cusp immobilization, involving all 3 cusps, was frequent and was more common in patients younger than 30 years of age at explantation (P < .001). Host-tissue overgrowth is a significant problem with bioprostheses, and pulmonary-site bioprostheses are no exception.

Hypertrophic obstructive cardiomyopathy: comparison of outcomes after myectomy or alcohol ablation adjusted by propensity score.

OBJECTIVE: In November 1998, our center began offering alcohol ablation as an alternative to surgical myectomy for patients with hypertrophic obstructive cardiomyopathy. Patients with concomitant lesions were referred for surgical intervention, and the others were offered either treatment option. We sought to review the early outcomes for both protocols. METHODS: One hundred fifty patients had intervention for hypertrophic obstructive cardiomyopathy to June 30, 2003. Sixty patients elected to have alcohol ablation, and 5 crossed over to surgical intervention. A total of 95 patients had a myectomy. Patients having an isolated myectomy (n = 48) are compared with those who had an ablation. Hospital records were reviewed, and follow-up contact (mean, 2.2 years) with the patient or referring cardiologist and recent echocardiographic reports were obtained. Differences in clinical and hemodynamic outcomes between achieved treatment groups were compared after adjustment for differing baseline patient characteristics, including use of a propensity score, to adjust for the non-randomization. RESULTS: The patients undergoing alcohol ablation (n = 60) were older (58 vs 48 years) and had fewer associated lesions (1 vs 39 patients), lower pressure gradients (67 vs 73 mm Hg), and similar symptomatic status and degrees of mitral regurgitation compared with those in the myectomy group. Alcohol ablation was abandoned in 6 patients, 5 of whom underwent myectomy. Among the completed alcohol ablations, there were 5 late deaths, and 1 other patient was referred for myectomy. One late death occurred after myectomy. At latest follow-up, 3-year survival is 97%, and 92% of the patients are in New York Heart Association class II or I. Adjusted comparisons showed significantly lower postintervention left ventricular outflow gradients at rest in the myectomy group (5 vs 15 mm Hg), with provocation (14 vs 42 mm Hg), mitral systolic anterior motion (67% vs 29%), and New York Heart Association class. No significant difference was present in postintervention septal thickness or freedom from postintervention pacing, although in time-related analysis, the 3-year freedom from pacing is 88% versus 59% (P = .02), favoring myectomy. CONCLUSION: Either alcohol ablation or myectomy offers substantial clinical improvement for patients with hypertrophic obstructive cardiomyopathy. Hemodynamic resolution of the obstruction and its sequelae is more complete with myectomy. Residual lesions after alcohol ablation might affect longer-term outcomes.