- Diagnostic Indicators of Rosacea and Demodicosis. [Journal Article]
- ADActa Derm Venereol 2018 Sep 18
- Papulopustular rosacea and demodicosis are characterized by non-specific symptoms, which can make clinical diagnosis difficult. This retrospective study of 844 patients assessed the diagnostic import...
Papulopustular rosacea and demodicosis are characterized by non-specific symptoms, which can make clinical diagnosis difficult. This retrospective study of 844 patients assessed the diagnostic importance of clinical signs and symptoms that are poorly recognized as being associated with these conditions. In addition to well-known signs (vascular signs (present in 80% of patients), papules (39%), pustules (22%) and ocular involvement (21%)), other signs and symptoms (discreet follicular scales (93%), scalp symptoms (pruritus, dandruff or folliculitis; 38%) and pruritus (15%)) may also suggest a diagnosis not only of demodicosis, but also of papulopustular rosacea. Facial Demodex densities (measured by 2 consecutive standardized skin biopsies) were higher when ocular or scalp involvement was present, suggesting more advanced disease, but further investigations are needed to confirm this hypothesis. Recognition of these clinical signs and symptoms should encourage dermatologists to perform a Demodex density test, thus enabling appropriate diagnosis to be made.
- Occurrence, Chronicity and Intensity of Itch in a Clinical Consecutive Sample of Patients with Skin Diseases: a Multi-centre Study in 13 European Countries. [Journal Article]
- ADActa Derm Venereol 2018 Sep 18
- Itch is an unpleasant symptom, affecting many dermatological patients. Studies investigating the occurrence and intensity of itch in dermatological patients often focus on a single skin disease and o...
Itch is an unpleasant symptom, affecting many dermatological patients. Studies investigating the occurrence and intensity of itch in dermatological patients often focus on a single skin disease and omit a control group with healthy skin. The aim of this multi-centre study was to assess the occurrence, chronicity and intensity (visual analogue scale 0-10) of itch in patients with different skin diseases and healthy-skin controls. Out of 3,530 dermatological patients, 54.3% reported itch (mean ± standard deviation itch intensity 5.5 ± 2.5), while out of 1,094 healthy-skin controls 8% had itch (3.6 ± 2.3). Chronic itch was reported by 36.9% of the patients and 4.7% of the healthy-skin controls. Itch was most frequent (occurrence rates higher than 80%) in patients with unclassified pruritus, prurigo and related conditions, atopic dermatitis and hand eczema. However, many patients with psychodermatological conditions and naevi also reported itch (occurrence rates higher than 19%).
- The effect of an ex vivo boosted immune cell therapy on canine atopic dermatitis: an open, uncontrolled pilot study. [Journal Article]
- VDVet Dermatol 2018 Sep 18
- CONCLUSIONS: EBIC therapy is a safe and efficient treatment for cAD. This therapy could correct the immunological imbalance in dogs with AD by infusing activated T lymphocytes.
- Type IV allergy to antimalarials can mimic cutaneous manifestations of lupus erythematosus. [Journal Article]
- JEJ Eur Acad Dermatol Venereol 2018 Sep 17
- The antimalarials chloroquine and hydroxychloroquine are key medications in the long-term therapy of systemic and cutaneous lupus erythematosus, a disease characterized by a plethora of potential cut...
The antimalarials chloroquine and hydroxychloroquine are key medications in the long-term therapy of systemic and cutaneous lupus erythematosus, a disease characterized by a plethora of potential cutaneous manifestations. Reports on the frequency and type of dermatologic side effects of antimalarials are sparse and heterogenous, ranging from 0.1% to more than 10% of treated patients and including the very general term "cutaneous eruption" as well as dyspigmentation, alopecia, hair bleaching, pruritus, polymorphous light eruption, Stevens-Johnson syndrome and toxic epidermal necrolysis. This article is protected by copyright. All rights reserved.
- Angioedema and emergency medicine: From pathophysiology to diagnosis and treatment. [Review]
- EJEur J Intern Med 2018 Sep 13
- Angioedema is a self-limiting edema of the subcutaneous or submucosal tissues due to localised increase of microvascular permeability whose mediator may be histamine or bradykinin. Patients present t...
Angioedema is a self-limiting edema of the subcutaneous or submucosal tissues due to localised increase of microvascular permeability whose mediator may be histamine or bradykinin. Patients present to emergency department when angioedema involves oral cavity and larynx (life-threatening conditions) or gut (mimicking an acute abdomen). After initial evaluation of consciousness and vital signs to manage breathing and to support circulation if necessary, a simple approach can be applied for a correct diagnosis and treatment. Forms of edema such as anasarca, myxedema, superior vena cava syndrome and acute dermatitis should be ruled out. Then, effort should be done to differentiate histaminergic from non-histaminergic angioedema. Concomitant urticaria and pruritus suggest a histaminergic origin. Exposure to allergens and drugs (mainly ACE inhibitors and non steroidal anti-inflammatory drugs) should be investigated as well as a family history of similar symptoms. Allergic histaminergic angioedema has a rapid course (minutes) whereas non histaminergic angioedema is slower (hours). Since frequently the intervention needs to be immediate, the initial diagnosis is only clinical. However, laboratory tests can be subsequently confirmatory. Allergic angioedema is sensitive to standard therapies such as epinephrine, glucocorticoids and antihistamines whereas non histaminergic angioedema is often resistant to these drugs. Therapeutic options for angioedema due C1-inhibitor deficiencies are C1-inhibitor concentrates, icatibant and ecallantide. If these drugs are not available, fresh frozen plasma can be considered. All these medications have been used also in ACE inhibitor-induced angioedema with variable results thus they are not currently recommended whereas experts agree on the discontinuation of the causative drug.
- Periocular contact dermatitis with use of topical voriconazole 1% in mycotic keratitis. [Journal Article]
- BCBMJ Case Rep 2018 Sep 15; 2018
- We present two cases of culture-proven fungal keratitis on natamycin treatment which developed periocular erythema, oedema, burning sensation and pruritus within 48 hours of the addition of topical v...
We present two cases of culture-proven fungal keratitis on natamycin treatment which developed periocular erythema, oedema, burning sensation and pruritus within 48 hours of the addition of topical voriconazole. On clinical examination, periocular erythema with induration was noted. A diagnosis of orbital cellulitis was suspected, but the absence of pain and tenderness refuted the diagnosis on clinical grounds. A dermatology consultation was sought, and a diagnosis of periocular contact dermatitis with voriconazole was made. A skin patch test was performed with the same medication; however, it was negative. Topical voriconazole therapy was withdrawn, and the patient was prescribed cold compresses and oral antihistamine medication, to which they responded well.
- [Combined spinal-epidural block for labor analgesia. Comparative study with continuous epidural block]. [Journal Article]
- RBRev Bras Anestesiol 2018 Sep 12
- CONCLUSIONS: The combined blockade proved to be effective with better quality of analgesia and greater comfort for pregnant women, constituting a good option for the practice of obstetric analgesia.
- Association between itch and cancer in 16,925 pruritus patients: Experience at a tertiary care center. [Journal Article]
- JAJ Am Acad Dermatol 2018 Sep 11
- CONCLUSIONS: Cross-sectional design precludes analysis of the temporal association between pruritus and malignancy. The study is limited to a single tertiary care center.Pruritus is most strongly associated with cancers of the liver, skin, and hematopoietic system. Black patients with pruritus have a higher likelihood of skin, soft tissue, and hematological malignancies than whites, while whites have higher likelihood of liver, respiratory, GI, and gynecological malignancies.
- Oral supplements in atopic dermatitis. [Journal Article]
- CDClin Dermatol 2018 Sep - Oct; 36(5):653-658
- Atopic dermatitis (AD) is the most common chronic inflammatory skin disorder. The disease is typified by chronic pruritus, a series of signs and symptoms associated with immune dysfunction (eg, incre...
Atopic dermatitis (AD) is the most common chronic inflammatory skin disorder. The disease is typified by chronic pruritus, a series of signs and symptoms associated with immune dysfunction (eg, increased immunoglobulin E mediated allergies), and abnormal skin barrier dysfunction (eg, increased response to irritants). Due to the chronic itch and reactivity, patients and parents of affected children will seek therapy. Therapies range from emollients to topical medicaments, including topical corticosteroids, and immunosuppressive agents. Due to concerns about the side effects of the available agents, patients and their loved ones will often seek "natural" agents as therapy. Oral agents that have been tried in (AD) include probiotics, vitamins, oils, and such traditional therapeutics as Chinese herbals and Ayurvedic agents. At this time probiotics may be promising, but there are inadequate data to determine their efficacy. In addition, there are significant concerns for the risks associated with Chinese herbals, which may be associated with liver failure and death, and Ayurvedic agents, which may be tainted with heavy metals. The safest and most effective natural agents are topically applied emollients.
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- Novel therapies in the treatment of atopic dermatitis. [Journal Article]
- SCSemin Cutan Med Surg 2018; 37(3):190-197
- Atopic dermatitis (AD) is a common cutaneous condition characterized by epidermal barrier disruption, severe skin inflammation, and pruritus. As a result of our growing understanding of disease patho...
Atopic dermatitis (AD) is a common cutaneous condition characterized by epidermal barrier disruption, severe skin inflammation, and pruritus. As a result of our growing understanding of disease pathogenesis, the therapeutic armamentarium to manage AD is rapidly expanding. Moving beyond broadly immunosuppressive agents, newer therapies for AD offer more targeted immunomodulation in the forms of phosphodiesterase 4 inhibitors, Janus kinase inhibitors, and anticytokine monoclonal antibodies. While such therapies are generally considered safer than traditional immunosuppressive agents that have been used off label for AD for decades, they are not without risk entirely. In some cases, potential side effects may be difficult to manage. This review summarizes current views on AD pathogenesis and discusses these novel and emerging therapies, including a discussion of the mechanisms of action, potential side effects, and limitations of current clinical trials for each drug. While the rapid and prolific expansion of therapies to treat AD is encouraging, additional studies are needed to adequately evaluate the long-term safety, efficacy, and generalizability among different age groups and disease subtypes.