Management of nail psoriasisDe Berker, D.
doi: 10.1046/j.1365-2230.2000.00663.xpmid: 11012585
Nail psoriasis is often difficult to cure, but may respond to a range of different approaches used alone or together. As with treatment of psoriasis affecting skin, relapse is common and therapies may need to be maintained or repeated. The exact benefits of many of these treatments are not well documented in the literature. Basic nail care is important and topical therapies represent the main modality of treatment for the majority of cases. In severe nail disease, where there is a hypertrophic element, injection therapy with triamcinolone may be helpful. PUVA and other forms of radiation may be of benefit, but as with systemic therapy, they are usually useful in the context of treatment of psoriasis elsewhere on the body.
Cutaneous leishmaniasisHepburn, N. C.
doi: 10.1046/j.1365-2230.2000.00664.xpmid: 11012586
Leishmaniasis is a major World health problem, which is increasing in incidence. In Northern Europe it is seen in travellers returning from endemic areas. The protozoa is transmitted by sandflies and may produce a variety of clinical syndromes varying from a simple ulcer to fatal systemic disease. This review considers the management of simple cutaneous leishmaniasis. Patients usually have a single ulcer which may heal spontaneously, requiring only topical, or no treatment at all. Lesions caused by Leishmania braziliensis may evolve into the mucocutaneous form, ‘espundia’, and should be treated with systemic antimony. Sodium stiboglucoante 20 mg/kg/day i.v. for 20 days is the appropriate first line treatment in these cases. Although it may cause transient bone marrow suppression, liver damage, a chemical pancreatitis, and disturbances in the electrocardiogram, it appears to be safe. The success of treatment should be assessed 6 weeks after it has been completed and patients should be followed up for 6 months.
General Practitioner referral guidelines for dermatology: do they improve the quality of referrals?Hill, V. A.; Wong, E.; Hart, C. J.
doi: 10.1046/j.1365-2230.2000.00665.xpmid: 11012587
Guidelines have proliferated in recent years in all areas of medicine, sometimes with little evaluation of their effect. Referral guidelines for dermatology were compiled by the dermatologist at the Royal Surrey County Hospital in consultation with local general practitioners. An audit was undertaken to assess how appropriate referrals were just before and after distribution of the guidelines and was repeated 2 years later to determine whether they had made any significant impact. The results revealed a 40% increase in the number of appropriate referrals immediately after introduction of the guidelines, but this was not sustained 2 years later. Five common conditions accounted for two‐thirds of inappropriate referrals before and after the guidelines were sent. The need for continued general practitioner education in dermatology to reinforce referral guidelines is demonstrated.
Erythema nodosum in SingaporeTay, Y. K.
doi: 10.1046/j.1365-2230.2000.00667.xpmid: 11012588
A retrospective study was carried out of all patients presenting with erythema nodosum over a 3‐year period (1994–1997) at the National Skin Centre, Singapore. There were 75 patients, aged 4–70 years with a peak (40%) in the 21–30‐year‐old age group; 65 were female and 10 were male, giving a female to male ratio of 6.5 : 1. Precipitating factors included viral respiratory tract infections and streptococcal pharyngitis in 20 cases (26%), tuberculosis in two cases (3%), pregnancy in three cases (4%) and miscellaneous conditions: Behcet's syndrome (two cases), gonorrhoea (one case), varicella (one case) and cat‐scratch disease (one case). The cause was unknown in 45 cases (60%). The pattern of erythema nodosum in Singapore is similar to that reported in the Western literature except that sarcoidosis and inflammatory bowel disease are uncommon associations.
Chemotherapy‐induced acral erythema: report of a case and immunohistochemical findingsTsuruta, D.; Mochida, K.; Hamada, T.; Ishii, M.; Wakasa, K.; Hashimoto, S.; Takekawa, K. E.
doi: 10.1046/j.1365-2230.2000.00670.xpmid: 11012591
Chemotherapy‐induced acral erythema (CAE) is an uncommon and distinct reaction seen in patients receiving high‐dose chemotherapy. The exact pathogenic mechanisms of this disorder are still unknown. We report a 27‐year‐old woman who presented with red, swollen and painful macules on both palms, clinically consistent with this disease. Histological examination demonstrated vacuolar degeneration of the basal cell layer and spongiotic blisters in the epidermis, especially in the atrophied eccrine ducts and papillary oedema with mild perivascular infiltration of mononuclear and hypersegmented neutrophils. Immunohistochemistry showed that the infiltrating mononuclear cells were CD3–CD16+CD56+ leucocyte function antigen‐1+, possibly natural killer cells. The eccrine ducts expressed HLA‐DR and intracellular adhesion molecule‐1 (ICAM‐1). Our findings suggest that cell‐to‐cell interaction between NK cells and keratinocytes in the eccrine apparatus may induce CAE and may be involved in the pathogenesis of the skin reaction in our patient and possibly in this disease.
Calciphylaxis in the absence of renal failurePollock, B.; Cunliffe, W. J.; Merchant, W. J.
doi: 10.1046/j.1365-2230.2000.00671.xpmid: 11012592
We report a patient with severe bilateral leg ulceration that was resistant to treatment. A biopsy confirmed the cause as calciphylaxis. Calciphylaxis refers to a syndrome of calcium deposition in the small and intermediate dermal vasculature which can lead to epidermal ischaemia, ulceration and necrosis. Most cases occur in those with chronic renal failure and secondary hyperparathyroidism. We describe the rare presentation of calciphylaxis in a patient with normal renal function and primary hyperparathyroidism who had many classical features. Unfortunately she developed gangrene, sepsis and died.