Henoch-Sch nlein purpura is an acute, self-limited vasculitis syndrome which shows characteristic skin, joint, renal and gastrointestinal manifestations. It is common in childhood and may also occur in adults with fatal complications such as nephritis and gastrointestinal bleeding. We experienced a case of a 20-year-old woman who presented with palpable purpura and severe arthritis. The histopathologic examination of the skin revealed leukocytoclastic vasculitis with perivascular deposition of IgA and she was diagnosed with Henoch-Sch nlein purpura. Despite treatment with prednisolone for one month, she had more aggravated purpura and fatal gastrointestinal bleeding. The symptoms were improved shortly by cyclophosphamide pulse therapy with plasmapheresis but symptoms were aggravated and symmetric mononeuropathy of the ulnar nerve developed. She was treated with 400 mg/day of thalidomide and symptoms were improved. We herein report a case of Henoch-Sch nlein purpura successfully treated with thalidomide which was refractory to prednisolone, immunosuppressive drugs and plasmapheresis.
Adult ; Dermatologic Agents/*therapeutic use ; Female ; Human ; Purpura, Schoenlein-Henoch/*drug therapy ; Thalidomide/*therapeutic use

BACKGROUND: As the number of dermatologic surgical procedures increases, home care wound management is growing in frequency. OBJECTIVE: The aim of this study was to evaluate the efficacy and surgical site infection rate of home care wound management according to the use of oral antibiotics and the characteristics of the wound and of the patient. METHODS: Our study included 207 patients that had undergone a dermatologic surgical procedure and the subsequent management of their wounds in the home. We checked overall infection rate of home care wound management and compared the result according to the use of oral antibiotics. We evaluated surgical site infection rate after we classified each surgical wound based on age, sex, surgical method, site, size, and depth. In addition, we surveyed efficacy of home care wound management. RESULTS: Overall surgical site infection rate was 1.86%, and the infection rate was not significantly different between the group that utilized home care wound management without oral antibiotics and the group with oral antibiotics (p>0.05). There was no statistically significant difference of surgical site infection rate according to sex, age, wound's size and depth (p>0.05). However, patients with younger age, male sex, greater size, and depth of wounds showed a numerical increase in surgical site infection rate. Staged partial excision for nevus sebaceous in scalp showed significantly higher rate of surgical site infection (p<0.05). In our survey, most patients preferred home care wound management after dermatologic surgical procedures and patients were able to perform the wound care well. CONCLUSION: We expect to utilize home care wound management after dermatologic surgical procedures, provided that physicians appropriately educate patients and their caretakers on proper dressings.
Anti-Bacterial Agents ; Bandages ; Dermatologic Surgical Procedures ; Home Care Services ; Humans ; Male ; Nevus ; Scalp

Human ; Male ; Female ; Child ; Dermatitis, Atopic ; Dermatologic Agents ; Eczema ; Glucocorticoids ; Exanthema

Gangrenous skin disease is characterized by rapidly progressive necrosis of the subcutaneoua tissue. It is mainly caused by Group A b-hemolytic Streptococcus. We are now reporting three cases of gangrenous skin diseases including gangrene due to Vibrio vulnificus, streptococcal gangrene, and ecthyma gangrenosum. Their treatment was as follows: early surgical debridment, the correction of fluidelectrolyte depletion, and antibiotics. When fresh granulation tissues were seen on the wound base, we performed so called Island skin graft. 3 to 5 weeks later, there were good cosmetic and functional results. These results reveals that among several curative measures of gangrenous skin diseases early surgical debridment is the most important one. We belive many dermatologists should be concerned about skin surgery progressively.
Anti-Bacterial Agents ; Dermatologic Surgical Procedures ; Ecthyma ; Gangrene ; Granulation Tissue ; Necrosis ; Skin Diseases* ; Skin* ; Streptococcus ; Transplants* ; Vibrio vulnificus ; Wounds and Injuries

PURPOSE: To report a case of keratoconjunctival chemical injury caused by exposure to EMLA(R) 5% cream. CASE SUMMARY: A 51-year-old woman presented with ocular pain and decreased visual acuity in her left eye after an autologous fat injection for forehead lifting. At her initial visit, her best corrected visual acuity was 20/40 in the left eye. Slit-lamp examination showed a diffuse corneal epithelial defect and conjunctival injection. Based on history of inadvertent seepage of EMLA(R) 5% cream into the left eye and clinical findings consistent with chemical injury, the patient was treated with antibiotics, steroids, and artificial tears. Two weeks after treatment, several corneal erosions remained, and best corrected visual acuity improved to 20/20. After two months, the corneal and conjunctival epithelia were healed. CONCLUSIONS: EMLA(R) 5% cream is commonly used as topical anesthetic ointment for dermatologic surgery, including laser procedures. The cream is highly alkaline and can cause chemical injury to the eye, thus extreme caution should be used when applying the cream to the eyelid or face.
Anti-Bacterial Agents ; Dermatologic Surgical Procedures ; Eye ; Eyelids ; Female ; Forehead ; Humans ; Lifting ; Middle Aged ; Ophthalmic Solutions ; Steroids ; Visual Acuity

The significance of patient-reported outcomes (PROs) is increasingly being acknowledged and quality of life (QOL) has become an integral element of the assessment of overall burden of disease. Psoriasis has been known for its major impact on patients' QOL and various generic, dermatology-specific and psoriasis-specific self-administered psychometric instruments have been used over the years to assess the QOL of psoriasis patients. However, the Dermatology Life Quality Index (DLQI) is the most widely used QOL measure among these measures in psoriasis-related clinical trials. A number of topical and systemic treatments have been used in the management of psoriasis and lately biologics have emerged as a new and promising treatment modality for difficult-to-treat psoriasis. The evidence on the efficacy of these agents has been growing dramatically with QOL being used as one of the primary outcome measures in many clinical trials. The aim of this paper is to give an overview of the use of the DLQI as an outcome measure for assessing the QOL impact of biologics on psoriasis patients. Furthermore, the efficacy of five commonly used biologics has been compared in terms of their ability to improve the QOL assessed by the DLQI. This review has revealed that there is a variation in the efficacy of various biologics in terms of QOL improvement with the mean reduction in the DLQI scores being highest for ustekinumab 90 mg (mean DLQI score reduction=9.5), followed by infliximab (8.5), etanercept 50 mg, twice a week (7.7), adalimumab (6.3), and alefacept (4.0).
Biological Products ; therapeutic use ; Clinical Trials as Topic ; Dermatologic Agents ; therapeutic use ; Dermatology ; Humans ; Psoriasis ; drug therapy ; Quality of Life

The inclusion complex of isotretinoin was prepared by sealed-control temperature method and amylose was used as carrier. The formation of inclusion complex was confirmed by powder X-ray diffraction and DSC. The equation of enzymatically-controlled drug release was established by kinetic theory, and the release characteristic of drug was confirmed by using the kinetic equation. The results show that the drug release was attributed to first order reaction without alpha-amylase. However, with alpha-amylase, the drug release was an acceleration process by the effect of both dissociation and enzymatic hydrolysis simultaneously. The research indicates that drug release from the inclusion complex was modulated by the addition of alpha-amylase.
Amylose ; chemistry ; Calorimetry, Differential Scanning ; Dermatologic Agents ; chemistry ; Drug Carriers ; chemistry ; Hydrolysis ; Isotretinoin ; chemistry ; Kinetics ; Temperature ; X-Ray Diffraction ; alpha-Amylases ; chemistry

BACKGROUND: Narrow-band UVB and topical corticosteroids are treatments for vitiligo. The possible synergistic effect of these modalities has not yet been investigated.
OBJECTIVE: This study aims to compare the efficacy of combining narrow-band UVB (NB-UVB) and 0.05% clobetasol propionate ointment (CP) with that of NB-UVB and placebo in inducing initial and overall repigmentation and control of disease activity after 6 months of therapy. Moreover, it aims to assess the safety and determine the permanence ofrepigmentation within I year post-treatment in both regimens.
METHODS: Randomized, placebo-controlled, double-blind, left-right comparison was conducted on generalized vitiligo patients with 5-50% body surface area involvement, having at least 2 bilateral, comparative lesions. CP or placebo was applied once daily on either side of the body, each combined with NB-UVB thrice weekly for 6 months.
OUTCOME MEASURES: (1) number of exposures and cumulative dose (CD) of NB-UVB that induced initial repigmentation; (2) quantity of repigmentation after 6 months estimated by comparing pre- and post-treatment photographs; (3) effect on disease activity by comparing pre- and post-treatment VIDA (vitiligo disease activity) scores; and (4) permanence of repigmentation and development of new lesions within 1 year post-treatment documented by photographs.
ANALYSIS: Sample size was calculated using formula for testing two proportions at 0.05 level of significance and a power of 0.80. Data was analyzed with Student t test (paired), Exact test for symmetry and Wilcoxon signed rank test, depending on the data set involved.
RESULTS: Twenty-five patients were recruited, but only 20 were evaluable at the end of the study. Initial repigmentation was noted after a mean of 9.30 +/- 3.54 exposures (mean CD 1,887.8 +/- 1195.81 mJ/cm2) of NB-UVB on the CP-treated side, and after a mean of 15.85 +/- 5.61 exposures (mean CD 4,152.2 +/- 2231.9 mJ/cm2) on the placebo side. After 6 months, 55% (11/20) and 40%(8/20) of patients exhibited marked (>75 %) repigmentation in the NB-UVB with CP side, and NB-UVB with placebo side, respectively. Adverse events were minimal and transient. VIDA scores improved and repigmentation induced by both treatment regimens remained stable in majority within one year post-treatment.
CONCLUSIONS: Combination NB-UVB and CP induced repigmentation earlier, requiring significantly lower cumulative dose of NB-UVB than NB-UVB plus placebo. Over all quantity and permanence of repigmentation, as well as control of disease activity and safety, were comparable in the two regimens.

 

 

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Adrenal Cortex Hormones ; Clinical Protocols ; Clobetasol ; Dermatologic Agents ; Outcome Assessment (health Care) ; Ultraviolet Therapy ; Vitiligo

BACKGROUND: Clean dermatologic procedures create wounds with a low risk of infection (usually up to 5%). Whether the use of topical antibiotics is advocated, with regard to its efficacy and safety issues such as antibiotic resistance and sensitizing potential, is controversial. Fusidic acid, a topical antibiotic against gram-positive bacteria, is a rare sensitizer and commonly used in postprocedure care in Korea. OBJECTIVE: This is a retrospective study aimed at comparing the efficacy and safety between fusidic acid and petrolatum for the postprocedure care of clean dermatologic procedures. METHODS: Patients were treated with either fusidic acid or petrolatum ointment, applied on the wound created during clean dermatologic procedures such as biopsy of the punch, incisional, excisional, and shave types. The efficacy, adverse events, and subjective level of satisfaction were retrieved from medical records. RESULTS: A total of 414 patients with a total of 429 wounds were enrolled. The overall rate of adverse events was 0.9%, and the rates of adverse events in the fusidic acid group and the petrolatum group were 1.4% and 0.5%, respectively (p=0.370). There was no wound discharge, pain, tenderness, swelling, induration, or dehiscence in both groups. The patients' self-assessment of the wound was not significantly different between the two treatment groups. CONCLUSION: Our findings support the hypothesis that the routine prophylactic use of topical antibiotics is not indicated for clean dermatologic procedures. We recommend the use of petrolatum in the postoperative care of clean dermatologic procedures because of its equivalent efficacy and superior safety profiles.
Anti-Bacterial Agents ; Biopsy ; Dermatologic Surgical Procedures ; Drug Resistance, Microbial ; Fusidic Acid* ; Gram-Positive Bacteria ; Humans ; Korea ; Medical Records ; Petrolatum* ; Postoperative Care ; Retrospective Studies* ; Self-Assessment ; Wound Healing ; Wounds and Injuries

Fumaric acid esters (FAE), mainly dimethylfumarate (DMF), have been shown to be highly efficacious in the treatment of psoriasis. Among the potential side effects of FAE therapy, lymphocytopenia is sometimes observed. In order to address the question whether FAE may interfere with systems of the innate defense, the modulatory role of FAE on the generation of superoxide-anion by human monocytes and neutrophils was studied by measuring the reduction of cytochrome c. Various concentrations of DMF and its metabolite methylhydrogenfumarate (MHF) were used to observe their modulatory effect on superoxide-anion generation by monocytes and neutrophils in response to bacteria (S. aureus and E. coli) and candida (C. albicans). Dexamethasone (DXM, 1 x 10(-7) mol x L(-1)) was also studied at the same time. We found that DXM significantly inhibited superoxide-anion generation from monocytes in response to bacteria and C. albicans, whereas DMF and MHF (10-20 microg x mL(-1)) significantly increased the production of superoxide-anion in monocytes in response to the above mentioned bacteria. DXM, DMF and MHF did not affect superoxide-anion generation of neutrophils. Our data indicate that DMF and MHF enhance superoxide-anion generation in human monocytes as one of the important mechanisms of innate defense against microorganisms.
Candida albicans ; immunology ; Cells, Cultured ; Cytochrome c Group ; metabolism ; Dermatologic Agents ; pharmacology ; Dimethyl Fumarate ; Escherichia coli ; immunology ; Fumarates ; pharmacology ; Humans ; Phagocytes ; metabolism ; Staphylococcus aureus ; immunology ; Superoxides ; metabolism ; Zymosan ; immunology