Varicela, afectación palmo-plantar y neumonía / Varicella, palmoplantar involvement and pneumonia

La varicela es una enfermedad propia de la infancia; su presentación en adultos es muy poco frecuente y suele asociarse a cuadros de mayor gravedad y afectación sistémica. Se presenta como un exantema generalizado de diseminación centrípeta, pruriginoso y pleomórfico, de predominio facial y troncular, que respeta las extremidades. La neumonía es la complicación extracutánea más frecuente y la principal causa de hospitalización en este grupo etario. La afectación palmo-plantar es excepcional y suele estar asociada a enfermedad diseminada en pacientes con importante comorbilidad o algún tipo inmunosupresión. Presentamos el caso de un paciente de 71 años que presenta enfermedad varicelosa diseminada, caracterizada por neumonía y afectación palmo-plantar, en el contexto de tratamiento con corticoides

Varicella is a childhood disease; it occurs very rarely in adults, usually associated with more severe cases and systemic involvement. It presents as a generalized rash of centripetal spread, pruritic and pleomorphic, occurring in the face and trunk but not in the limbs. Pneumonia is the most frequent extracutaneous complication and the leading cause of hospitalization among this age group. Palmoplantar involvement is uncommon, usually associated with disseminated disease in patients with significant comorbidity or some kind of immunosuppression. We present the case of a 71-year-old patient with disseminated varicella infection, characterized by pneumonia and palmoplantar involvement, and treated with corticosteroids

Increase in vesicular hand eczema after house dust mite inhalation provocation: a double-blind, placebo-controlled, cross-over study.

BACKGROUND: It is unclear whether the respiratory tract is involved in eliciting or aggravating eczematous lesions in patients with vesicular hand eczema. Objectives. To investigate the effect of inhalation of house dust mite (HDM) on vesicular hand eczema. METHODS: Eighteen patients with vesicular hand eczema and HDM allergy received inhalation challenges with four concentrations of HDM in a randomized, double-blind, placebo-controlled, cross-over study. Early asthmatic reactions and late asthmatic reactions were defined as a placebo-corrected fall of 15% or more from baseline of forced expiratory volume in 1 second. Hand eczema was scored according to the Dyshidrotic Eczema Area and Severity Index (DASI) at baseline, and 1, 6, 24 and 48 hr. RESULTS: The median DASI increased significantly as compared with baseline at 6 and 48 hr after HDM inhalation. This increase was significantly different between the provocations at 6 hr. The median vesicles score increased significantly from baseline at 24 and 48 hr. Patients with a placebo-corrected increase in the number of vesicles at 24 hr and 48 hr had significantly more often late asthmatic reactions than those without an increase in the number of vesicles. Patients with a placebo-corrected increase of the DASI score at 24 hours had as a group a higher mean total IgE level than those without an increase of the DASI score. CONCLUSION: Hand eczema increased significantly more after HDM provocation than after placebo provocation. An increase in the number of vesicles was preceded by late asthmatic reactions. The group patients with an increase of hand eczema tended to have a higher mean total IgE level.

A case of acquired Zinc deficiency.

We report a case of adult-onset acquired zinc deficiency after bariatric surgery. Zinc deficiency may be inherited in the form of acrodermatitis enteropathica or acquired by low nutritional intake, malabsorption, excessive loss of zinc, or a combination of these factors.

[Pompholyx-like reactions occurring early in treatment of severe atopic dermatitis in children and adolescence].

BACKGROUND: Pompholyx-like reactions may develop for aggressive atopic dermatitis treatments in the incipient phase despite of improvement of other skin symptoms. METHODS: Eighty-nine patients admitted to National Center for Child Health and Development for treatment of atopic dermatitis between April 2007 and March 2009 were recruited. RESULTS: Pompholyx-like reactions were seen in thirteen out of eighty-nine patients between 4 and 32 (mean 16.7±10.4) days following admission. The mean age of patients with these reactions was 6.2±6.1 years (range of 3 months to 23 years). At the time of admission, practical issues of scoring atopic dermatitis: the SCORAD was assessed. The values of SCORAD index with pompholyx were ranging from 16-91 (mean 50.8±17.9), and the index except under one-year old were significantly higher than unaffected patients. These patients were evaluated into their medical record, for evidence of Pompholyx-like lesions: a bilateral vesicular eruption confined to the skin of the palms, soles, or sides of the fingers. Topical corticosteroids are used to treat Pompholyx-like reactions, all them achieved remission between 4 and 50 days (mean 18.5±12.0). In general, pompholyx is more common in summer. However, it seems that there were no significant differences in the pompholyx-like reactions incidence between in summer and in winter. CONCLUSION: The factor for the occurrence of pompholyx-like lesions remains unexplained. Although the original symptoms of eczema were improved, pompholyx-like eczema breakout, therefore, patients often feel uneasy. We should be aware of this clinical condition.

Pompholyx: a review of clinical features, differential diagnosis, and management.

Pompholyx is a vesicobullous disorder of the palms and soles. The condition is hard to treat because of the peculiarities of the affected skin, namely the thick horny layer and richness of the sweat glands. In this article, we review the available therapies, and score the treatments according to the level of evidence. The cornerstones of topical therapy are corticosteroids, although calcineurin inhibitors also seem to be effective. Topical photochemotherapy with methoxsalen (8-methoxypsoralen) is as effective as systemic photochemotherapy or high-dose UVA-1 irradiation. Systemic therapy is often necessary in bullous pompholyx. Corticosteroids are commonly used although no controlled study has been published to date. For recalcitrant cases, corticosteroids are combined with immunosuppressants. Alitretinoin has efficacy in chronic hand dermatitis including pompholyx. Another evolving treatment seems to be the intradermal injection of botulinum toxin. Radiotherapy might be an option for selected patients not responding to conventional treatment. In practice, patients benefit most from a combination of treatments.

Pústulas palmoplantares en un paciente con dolor esternoclavicular / Palmar-plantar pustules in a patient with sternoclavicular pain

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Low-cobalt diet for dyshidrotic eczema patients.

BACKGROUND: Dyshidrotic eczema is a type of chronic intermittent dermatitis characterized by vesicles, dystrophic fingernail changes, and rarely bullae that affects the hands and feet. Many exogenous factors may trigger a flare including dermatophyte infections, contact irritants, and metal hypersensitivity. Although metal hypersensitivity does not play a role in all cases of dyshidrotic eczema, high oral ingestion of nickel and/or cobalt should be considered, regardless of patch test results. OBJECTIVE: We updated and simplified existing published guidelines for low-cobalt diets. A recent review of the literature showed that dietary cobalt restriction, a safe yet burdensome treatment option for dyshidrosis, is referenced to dated sources. METHODS: We have analysed current data for the cobalt content in common food items. CONCLUSION: We propose a revised, point-based diet that will eliminate much of the dietary cobalt (and nickel) and reduce dyshidrotic eczema flares.

A 3-year causative study of pompholyx in 120 patients.

OBJECTIVE: To assess the relative frequency of the different causes of pompholyx evoked in the literature. DESIGN: Prospective survey. SETTING: Clinical outpatient setting. PATIENTS: A total of 120 consecutive patients with pompholyx referred to our department from 2000 through 2003. MAIN OUTCOME MEASURES: Systematic investigation of different causes of pompholyx: fungal intertrigo, hyperhidrosis, atopy, contact eczema, and internal reactions with systematic provocation tests to metals, balsam of Peru, and food allergen when suspected. RESULTS: The present study found the following causes of pompholyx in the 120 patients: mycosis (10.0%); allergic contact pompholyx (67.5%), with cosmetic and hygiene products as the main factor (31.7%), followed by metals (16.7%); and internal reactivation from drug, food, or haptenic (nickel) origin (6.7%). The remaining 15.0% of patients were classified as idiopathic patients, but all were atopic. (Percentages do not total 100 because of rounding.) CONCLUSIONS: Our data confirm the existence of reactional pompholyx to interdigital-plantar intertrigos and endogenous reactions to metals or other allergens, but they mainly point at the unexpected importance of a so-called contact pompholyx in which cosmetic and hygiene products play a preponderant role compared with metals. The great frequency of atopic conditions, even if idiopathic pompholyx is not inferred as an equivalent of atopy, should lead to further causative investigations before undertaking more expensive or extensive treatments of refractory pompholyx.

[Pompholyx of the infant possibly induced by systemic metal allergy to chromium in mother's milk].

A seven month-old boy had been suffering from recalcitrant pompholyx of both soles in spite of the treatment with corticosteroid ointment for three months. Because patch test of chromium was positive at 48 and 96 hr reading, we advised to his mother that the infant must avoid to touch and to take the chromium-containing goods. His lactating mother had been taking high amounts of chocolate and cocoa every day, both of which contain considerable amounts of chromium. The pompholyx disappeared within 2 weeks, after his mother stopped eating chocolate and cocoa. Oral provocation test with chocolate and cocoa to the patient's lactating mother resulted in the development of pompholyx in the baby within two days. We diagnosed the infant as systemic metal allergy to chromium which was possibly transferred from his mother's milk. This is the first report of systemic metal allergy which is provoked by mother's milk which is from the person who takes a lot of metal-containing foods.

[Factors associated with palmoplantar or plantar pompholyx: a case-control study]. / Facteurs associés à la dysidrose palmo-plantaire ou plantaire: étude cas-témoins.

BACKGROUND: Disydrosis or pompholyx is a chronic and recurrent form of dermatosis that poses a number of therapeutic issues. The etiopathology of the condition is unclear. The aim of this study was to identify factors associated with the palmoplantar and plantar dysidrosis. PATIENTS AND METHODS: This was a prospective case-control study conducted between June 2001 and February 2004 at the University Hospital of Lome (Togo). Each case (palmoplantar or plantar pompholyx) was matched for age (+/- 5 years) and sex with two controls. Examination for tinea pedis was performed in all participants (patients and controls) but mycologic culture alone was done in patients with interdigital-plantar intertrigo. RESULTS: One hundred patients with pompholyx were matched with 200 controls. Mean age was 32.8 +/- 14.8 years in the patient group and 31.4 +/- 14.8 years in the control group. For univariate analysis, the main factors associated with pompholyx were: personal atopy (OR = 12.6; CI95%: 6.4 - 25.1) and familial atopy (OR = 5.8; CI95%: 3.2 - 10.5); history of eczema (OR = 5.4; CI95%: 2.6 - 11.4); hyperhidrosis (OR=4.5; CI 95%: 5.5 - 40.7), sport (OR = 8.8; CI 95%: 3.9 - 20.8); tinea pedis (OR = 15.6; CI 95%: 7.5 - 32.9). In multivariate analysis, atopy (OR = 10.5; CI95%: 8.4 - 20.8) and tinea pedis (OR = 18; CI95%: 10.5 - 25.2) were the only factors associated with pompholyx. Trichophyton rubrum was the most common etiology of tinea pedis in both patients and controls. DISCUSSION: The results of this study show atopy and tinea pedis as factors statistically associated with palmoplantar or plantar pompholyx. However, only cohort studies can determine the precise causal relationship between tinea pedis and pompholyx.