Disulfiram and low nickel diet in the management of hand eczema: a clinical study.
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BACKGROUND: Hand eczema due to nickel sensitivity is a challenging task for the dermatologist. The average human diet provides sufficient amount of nickel, which acts as a provocating factor in nickel-sensitive individuals. When such patients are treated with steroid or other immunosuppressives, only short-term remission is obtained. This is because unless the dietary intake of nickel is minimized and the existing amount of nickel in the body of the sensitized individual is depleted, long-term remission is unlikely. AIM: To evaluate the efficacy of oral disulfiram, a nickel-chelating agent and low nickel diet (LND) in reducing the clinical symptoms and preventing frequent relapse of hand eczema in nickel-sensitive individuals. METHODS: A total of 21 patients with chronic vesicular hand eczema with nickel sensitivity were taken for this study. Patients were randomly divided into two groups: (a) Study group consisting of 11 patients (8 females and 3 males). They were prescribed disulfiram orally for a period of 4 weeks; they started LND 2 weeks prior to initiation of disulfiram therapy and continued till the end of follow-up period. (b) Control (placebo) group consisting of 10 patients (7 females and 3 males). They were allowed to continue with normal diet. Each of them received lactose tablet daily as placebo for 4 weeks. It was a comparative study and participants were not aware if they belonged to study group or control group (single blind trial). RESULTS: Hand eczema healed completely in 10 (90.9%) out of 11 patients treated with disulfiram and LND during the treatment period in the study group, compared with 1 out 10 patients in control (placebo) group (non significant). Mild relapse was noted in 5 patients in between 2-12 weeks of follow-up period. CONCLUSION: Low nickel diet and short course of oral disulfiram therapy can be considered a good option for the control of chronic hand eczema in nickel-sensitive individuals. (+info)
Persistent post-occupational dermatitis: report of five cases.
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Persistent post-occupational dermatitis is a phenomenon that is well-recognized by occupational dermatologists, but there have been few studies on it. In view of this, we proposed to assess the prevalence of this phenomenon in an English setting and ascertain the characteristics of the patients affected. Using modified criteria adapted from previous studies, details of 1100 patients seen in a contact dermatitis clinic were screened. Persistent post-occupational dermatitis was diagnosed in 5 patients out of 1100 seen over a 35-month period in a contact clinic (4 women, 1 man; age of onset 19-52 years). All had hand dermatitis that persisted despite removal of the apparent causative agents. Four patients were nickel-allergic on patch testing, though nickel was thought to be a potential causative agent in only one case and 2 patients were allergic to thiuram-mix on patch testing, and in both thiuram had a possible causative role. In all 5 cases, irritant exposure seemed important, with allergic factors contributing in 3 cases. Two patients had had eczema in childhood. Persistent post-occupational dermatitis is uncommon, affecting less than 0.5% of patients seen in a contact dermatitis clinic, but when diagnosed it has major implications for the future employment prospects of the individuals concerned. (+info)
Papular-purpuric "gloves and socks" syndrome caused by parvovirus B19 infection in Brazil: a case report.
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Papular-purpuric "gloves and socks" syndrome (PPGSS) is a novel, rare, self-limiting dermatosis caused by human parvovirus B19. It consists of pruritic edema and erythema of the hands and feet in a gloves-and-socks distribution, and it is associated with oral lesions and fever. We present a case of PPGSS in a 22-year-old Brazilian woman. Clinical and laboratory evaluation, including serological tests, PCR and gene sequencing, confirmed the presence of human parvovirus B19. (+info)
Tuberous sclerosis complex associated with dyschromatosis universalis hereditaria.
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Tuberous sclerosis is an autosomal dominant disease due to mutations in two genetic loci, characterized by hamartoma formation in the skin, nervous system, heart, kidney and other organs. Dyschromatosis universalis hereditaria is an autosomal dominant genodermatosis, characterized by small hyperpigmented and hypopigmented macules, uniformly distributed over the entire body. The face is rarely involved and the palms, soles and mucous membranes are usually spared. We report a case of tuberous sclerosis with dyschromatosis universalis hereditaria, with hyperpigmented and hypopigmented macules affecting the palms, soles and oral mucosa. To our knowledge, this is the first reported case of such an association. (+info)
Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit linked to onychomycosis in a healthcare worker.
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OBJECTIVE: To describe an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit. METHODS: After the identification of the first cases, the situation was regarded as an outbreak, and basic preventive measures against nosocomial infections were strictly enforced, and possible sources of dissemination were investigated. RESULTS: The outbreak lasted for 6 months and affected 36 newborn infants, causing seven infections and 29 colonizations. In the first stage of the outbreak, patients developed infection, but in the second stage, they were asymptomatic and were only identified by surveillance cultures. The outbreak was controlled after the identification and treatment of the healthcare worker who had been diagnosed with onychomycosis and whose hands were contaminated with extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. CONCLUSIONS: The detection and control of occult dissemination of this multiresistant bacterium among low-risk newborn infants prevented its endemic dissemination in the neonatal unit, as well as the exposure of critically ill and susceptible patients to the infection. (+info)
Palmar-plantar erythema associated with combination chemotherapy.
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We report three cases of a distinctive palmar-plantar erythema associated with the treatment of non-Hodgkin's lymphoma and acute myeloid leukaemia. The rash is characterized by a painful, sharply demarcated, intense erythema of the palms and/or soles followed by bulla formation, desquamation and healing. The eruption is self limiting in nature and did not adversely affect prognosis. Treatment need be neither altered nor stopped; only symptomatic measures are required. (+info)
A new sampler to assess dermal exposure during wet working.
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In the UK, approximately 30% of cases of dermatitis reported to the national surveillance scheme are associated with wet working or exposure to aqueous mixtures. There is evidence that the duration and frequency that hands are wet are key determinants of risk, but there are no objective methods to measure these exposure factors. This research aimed to develop a practical tool to measure the duration and the number of occasions hands are wet. We developed an electronic sensor that is worn on the finger, which detects wetness from evaporative cooling. The output signal is recorded in electronic memory and the frequency and duration of exposure calculated using a simple data processing algorithm. The device has been tested in a variety of environmental conditions and for a standardized wet-work task. Wetting events were detectable in all the standardized tests, with the proportion of time the hands were wet ranging from 15 to 49% (mean 30%). The electronic sensor is slightly affected by abrupt changes in air temperature and rapid air movements, but these do not seem to impose any practical limitations. This IOM Wet-Work sampler has the potential to provide reliable measurements of exposure that may be used to assess the risk of contact dermatitis. (+info)
Successful outcome of haemodialysis-induced pseudoporphyria after short-term oral N-acetylcysteine and switch to high-flux technique dialysis.
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Pseudoporphyria is a blistering disease with skin fragility and shallow scarring that clinically and histopathologically closely resembles porphyria cutanea tarda. The two conditions can be distinguished by porphyrin levels that typically are elevated in porphyria cutanea tarda, but not or only slightly in pseudoporphyria. Pseudoporphyria can be induced by various medications (e.g. non-steroidal anti-inflammatory drugs, antibiotics, diuretics, retinoids), intense UV(A) exposure, or haemodialysis. Treatment of haemodialysis-associated pseudoporphyria is not yet standardized. We report here a 65-year-old male patient with chronic renal failure due to Waldenstrom's macroglobulinaemia who was treated with conventional 3 times/week haemodialysis. He developed blistering skin changes on both hands, which were diagnosed as pseudoporphyria based on clinical, histopathological, and laboratory findings, and could be successfully managed with initial oral N-acetylcysteine and a switch from low-flux to high-flux membrane haemodialysis. The beneficial effect of the high-flux membrane technique in haemodialysis-associated pseudoporphyria has not been previously reported. (+info)