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Rapid Development of Perifolliculitis Following Mesotherapy
CASE LETTER Rapid Development of Perifolliculitis Following Mesotherapy Weihuang Vivian Ning, MD; Sameer Bashey, MD; Gene H. Kim, MD patient received mesotherapy with an unknown substance PRACTICE POINTS for cosmetic rejuvenation; the rash was localized only to the injection sites.copy She did not note any fever, chills, • Mesotherapy—the delivery of vitamins, chemicals, and plant extracts directly into the dermis via nausea, vomiting, diarrhea, headache, arthralgia, or upper injections—is a common procedure performed respiratory tract symptoms. She further denied starting in both medical and nonmedical settings for any new medications, herbal products, or topical therapies cosmetic rejuvenation. apart from the procedure she had received 2 weeks prior. • Complications can occur from mesotherapy treatment. Thenot patient was found to be in no acute distress and • Patients should be advised to seek medical care with vital signs were stable. Laboratory testing was remarkable US Food and Drug Administration–approved cosmetic for elevations in alanine aminotransferase (62 U/L [refer- techniques and substances only. ence range, 10–40 U/L]) and aspartate aminotransferase (72 U/L [reference range 10–30 U/L]). Moreover, she had Doan absolute neutrophil count of 0.5×103 cells/µL (refer- ence range 1.8–8.0×103 cells/µL). An electrolyte panel, To the Editor: creatinine level, and urinalysis were normal. Physical Mesotherapy, also known as intradermotherapy, is a examination revealed numerous 4- to 5-mm erythematous cosmetic procedure in which multiple -
General Dermatology an Atlas of Diagnosis and Management 2007
An Atlas of Diagnosis and Management GENERAL DERMATOLOGY John SC English, FRCP Department of Dermatology Queen's Medical Centre Nottingham University Hospitals NHS Trust Nottingham, UK CLINICAL PUBLISHING OXFORD Clinical Publishing An imprint of Atlas Medical Publishing Ltd Oxford Centre for Innovation Mill Street, Oxford OX2 0JX, UK tel: +44 1865 811116 fax: +44 1865 251550 email: [email protected] web: www.clinicalpublishing.co.uk Distributed in USA and Canada by: Clinical Publishing 30 Amberwood Parkway Ashland OH 44805 USA tel: 800-247-6553 (toll free within US and Canada) fax: 419-281-6883 email: [email protected] Distributed in UK and Rest of World by: Marston Book Services Ltd PO Box 269 Abingdon Oxon OX14 4YN UK tel: +44 1235 465500 fax: +44 1235 465555 email: [email protected] © Atlas Medical Publishing Ltd 2007 First published 2007 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Clinical Publishing or Atlas Medical Publishing Ltd. Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention. A catalogue record of this book is available from the British Library ISBN-13 978 1 904392 76 7 Electronic ISBN 978 1 84692 568 9 The publisher makes no representation, express or implied, that the dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. -
Expert-Level Diagnosis of Nonpigmented Skin Cancer by Combined Convolutional Neural Networks
Supplementary Online Content Tschandl P, Rosendahl C, Akay BN, et al. Expert-level diagnosis of nonpigmented skin cancer by combined convolutional neural networks. JAMA Dermatol. Published online November 28, 2018. doi:10.1001/jamadermatol.2018.4378 eFigure. Sensitivities (Blue) and Specificities (Orange) at Different Threshold Cutoffs (Green) of the Combined Classifier Evaluated on the Validation Set eAppendix. Neural Network Training eTable 1. Complete List of Diagnoses and Their Frequencies Within the Test-Set eTable 2. Education of Users According to Their Experience Group eTable 3. Percent of Correct Prediction of the Malignancy Status for Specific Diagnoses of a CNN Using Either Close-up or Dermatoscopic Images This supplementary material has been provided by the authors to give readers additional information about their work. © 2018 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/25/2021 eFigure. Sensitivities (Blue) and Specificities (Orange) at Different Threshold Cutoffs (Green) of the Combined Classifier Evaluated on the Validation Set A threshold cut at 0.2 (black) is found for a minimum of 51.3% specificity. © 2018 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/25/2021 eAppendix. Neural Network Training We compared multiple architecture and training hyperparameter combinations in a grid-search fashion, and used only the single best performing network for dermoscopic and close-up images, based on validation accuracy, for further analyses. We trained four different CNN architectures (InceptionResNetV2, InceptionV3, Xception, ResNet50) and used model definitions and ImageNet pretrained weights as available in the Tensorflow (version 1.3.0)/ Keras (version 2.0.8) frameworks. -
NAIL CHANGES in RECENT and OLD LEPROSY PATIENTS José M
NAIL CHANGES IN RECENT AND OLD LEPROSY PATIENTS José M. Ramos,1 Francisco Reyes,2 Isabel Belinchón3 1. Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Spain; Associate Professor, Department of Medicine, Miguel Hernández University, Spain; Medical-coordinator, Gambo General Rural Hospital, Ethiopia 2. Medical Director, Gambo General Rural Hospital, Ethiopia 3. Department of Dermatology, Hospital General Universitario de Alicante, Alicante, Spain; Associate Professor, Department of Medicine, Miguel Hernández University, Spain Disclosure: No potential conflict of interest. Received: 27.09.13 Accepted: 21.10.13 Citation: EMJ Dermatol. 2013;1:44-52. ABSTRACT Nails are elements of skin that can often be omitted from the dermatological assessment of leprosy. However, there are common nail conditions that require special management. This article considers nail presentations in leprosy patients. General and specific conditions will be discussed. It also considers the common nail conditions seen in leprosy patients and provides a guide to diagnosis and management. Keywords: Leprosy, nails, neuropathy, multibacillary leprosy, paucibacillary leprosy, acro-osteolysis, bone atrophy, type 2 lepra reaction, anonychia, clofazimine, dapsone. INTRODUCTION Leprosy can cause damage to the nails, generally indirectly. There are few reviews about the Leprosy is a chronic granulomatous infection affectation of the nails due to leprosy. Nails are caused by Mycobacterium leprae, known keratin-based elements of the skin structure that since ancient times and with great historical are often omitted from the dermatological connotations.1 This infection is not fatal but affects assessment of leprosy. However, there are the skin and peripheral nerves. The disease causes common nail conditions that require diagnosis cutaneous lesions, skin lesions, and neuropathy, and management. -
Hair and Nail Disorders
Hair and Nail Disorders E.J. Mayeaux, Jr., M.D., FAAFP Professor of Family Medicine Professor of Obstetrics/Gynecology Louisiana State University Health Sciences Center Shreveport, LA Hair Classification • Terminal (large) hairs – Found on the head and beard – Larger diameters and roots that extend into sub q fat LSUCourtesy Health of SciencesDr. E.J. Mayeaux, Center Jr., – M.D.USA Hair Classification • Vellus hairs are smaller in length and diameter and have less pigment • Intermediate hairs have mixed characteristics CourtesyLSU Health of E.J. Sciences Mayeaux, Jr.,Center M.D. – USA Life cycle of a hair • Hair grows at 0.35 mm/day • Cycle is typically as follows: – Anagen phase (active growth) - 3 years – Catagen (transitional) - 2-3 weeks – Telogen (preshedding or rest) about 3 Mon. • > 85% of hairs of the scalp are in Anagen – Lose 75 – 100 hairs a day • Each hair follicle’s cycle is usually asynchronous with others around it LSU Health Sciences Center – USA Alopecia Definition • Defined as partial or complete loss of hair from where it would normally grow • Can be total, diffuse, patchy, or localized Courtesy of E.J. Mayeaux, Jr., M.D. CourtesyLSU of Healththe Color Sciences Atlas of Family Center Medicine – USA Classification of Alopecia Scarring Nonscarring Neoplastic Medications Nevoid Congenital Injury such as burns Infectious Systemic illnesses Genetic (male pattern) (LE) Toxic (arsenic) Congenital Nutritional Traumatic Endocrine Immunologic PhysiologicLSU Health Sciences Center – USA General Evaluation of Hair Loss • Hx is -
Pili Torti: a Feature of Numerous Congenital and Acquired Conditions
Journal of Clinical Medicine Review Pili Torti: A Feature of Numerous Congenital and Acquired Conditions Aleksandra Hoffmann 1 , Anna Wa´skiel-Burnat 1,*, Jakub Z˙ ółkiewicz 1 , Leszek Blicharz 1, Adriana Rakowska 1, Mohamad Goldust 2 , Małgorzata Olszewska 1 and Lidia Rudnicka 1 1 Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; [email protected] (A.H.); [email protected] (J.Z.);˙ [email protected] (L.B.); [email protected] (A.R.); [email protected] (M.O.); [email protected] (L.R.) 2 Department of Dermatology, University Medical Center of the Johannes Gutenberg University, 55122 Mainz, Germany; [email protected] * Correspondence: [email protected]; Tel.: +48-22-5021-324; Fax: +48-22-824-2200 Abstract: Pili torti is a rare condition characterized by the presence of the hair shaft, which is flattened at irregular intervals and twisted 180◦ along its long axis. It is a form of hair shaft disorder with increased fragility. The condition is classified into inherited and acquired. Inherited forms may be either isolated or associated with numerous genetic diseases or syndromes (e.g., Menkes disease, Björnstad syndrome, Netherton syndrome, and Bazex-Dupré-Christol syndrome). Moreover, pili torti may be a feature of various ectodermal dysplasias (such as Rapp-Hodgkin syndrome and Ankyloblepharon-ectodermal defects-cleft lip/palate syndrome). Acquired pili torti was described in numerous forms of alopecia (e.g., lichen planopilaris, discoid lupus erythematosus, dissecting Citation: Hoffmann, A.; cellulitis, folliculitis decalvans, alopecia areata) as well as neoplastic and systemic diseases (such Wa´skiel-Burnat,A.; Zółkiewicz,˙ J.; as cutaneous T-cell lymphoma, scalp metastasis of breast cancer, anorexia nervosa, malnutrition, Blicharz, L.; Rakowska, A.; Goldust, M.; Olszewska, M.; Rudnicka, L. -
New Approach in Combined Therapy of Perifolliculitis Capitis Abscedens Et Suffodiens
726 Letters to the Editor New Approach in Combined Therapy of Perifolliculitis Capitis Abscedens et Suffodiens Felix Jacobs, Gisela Metzler, Jakub Kubiak, Martin Röcken and Martin Schaller Department of Dermatology, Eberhard Karls University, DE-72076 Tuebingen, Germany. E-mail: [email protected] Accepted March 14, 2011. Perifolliculitis capitis abscedens et suffodiens (PCAS) tract. In the upper dermis there was a suppurative inflam- is a rare scalp disease seen mostly in young males of mation with abscess material and hair shaft fragments being discharged via a draining sinus. Periodic acid-Schiff (PAS) Afro-American descent. The disease is characterized by staining for fungi, as well as immunohistochemical staining perifollicular pustules, suppurative nodules and fluctua- with anti-Mycobacterium bovis (BCG) and for T. pallidum was ting abscesses, as well as by intercommunicating sinus negative. Direct immunofluorescence of the perilesional scalp tracts on the scalp. We report here an elderly Caucasian skin was negative. woman who fulfilled the clinical and histological criteria Microbiological examinations failed to identify pathogenic organisms. for diagnosis of PCAS. Following the diagnosis of a PCAS, the patient was treated The patient was treated with initial prednisolone, with 10 mg acitretin and 30 mg prednisolone daily as an inpa- systemic acitretin, topical tacrolimus and oral zinc. tient. The prednisolone was reduced to 5 mg per day during the After 6 months, her condition was stable. course of treatment. Because of the decreased level of zinc, 100 mg zinc aspartate was given daily. In addition, topical gluco- corticoids and tacrolimus 0.1% were alternated. CASE REPOrt This regimen produced almost total healing within 11 days (Fig. -
Proliferating Papules on Abdomen
Test your knowledge with multiple-choiceDERM cases C This month – 6 cases: ASE 1.Proliferating Papules on Abdomen 2.Yellowish Discolouration of Toenails 3.Asymptomatic Lip Papule p.23 Small Lumps on the Lower Eyelids p.24 4. AReddish,GrowingMass p.25 5. 6.AWomanwithBackHair p.26 Copyright© p.27 Case 1 p.28 Not for Sale or Commercial Distribution Unauthorised use prohibited. Authorised users can download, Proliferatingdisplay, view a Papulesnd print a single co onpy for Abdomenpersonal use A3-year-oldmalepresentswithproliferatingpapules on his abdomen. They are mildly pruritic. He has been feeling unwell recently. What is your diagnosis? a. Molluscum contagiosum b. Common warts c. Pemphigus vulgaris d. Xanthogranulomas e. Xanthomas Answer Molluscum contagiosum MCV-1 poxvirus, and it most(answer commonly a) affects young children, but it also affects sexuallyis active caused by the adults and immunosuppressed individuals (especially those with HIV). Lesions in adults are typically found in the groin and genital region. Individual lesions are smooth, firm, dome-shaped, are key, and treatment is not always necessary since skin-coloured papules measuring 2 to 5 mm, some of this is a self-resolving condition. If lesions are wide- which will show evidence of umbilication.There may spread and therapy is requested, treatment options be adjacent eczema in some cases, and secondary include liquid nitrogen cryotherapy (older children bacterial infection of excoriated molluscum papules and adults), cantharidin application, curettage, sali- may also be present. cylic acid, topical tretinoin, imiquimod cream, or oral It is a clinical diagnosis, although, occasionally a cimetidine. skin biopsy is required. Education and reassurance Benjamin Barankin, MD, FRCPC, is a Dermatologist practicing in Toronto, Ontario. -
Differential Diagnosis of the Scalp Hair Folliculitis
Acta Clin Croat 2011; 50:395-402 Review DIFFERENTIAL DIAGNOSIS OF THE SCALP HAIR FOLLICULITIS Liborija Lugović-Mihić1, Freja Barišić2, Vedrana Bulat1, Marija Buljan1, Mirna Šitum1, Lada Bradić1 and Josip Mihić3 1University Department of Dermatovenereology, 2University Department of Ophthalmology, Sestre milosrdnice University Hospital Center, Zagreb; 3Department of Neurosurgery, Dr Josip Benčević General Hospital, Slavonski Brod, Croatia SUMMARY – Scalp hair folliculitis is a relatively common condition in dermatological practice and a major diagnostic and therapeutic challenge due to the lack of exact guidelines. Generally, inflammatory diseases of the pilosebaceous follicle of the scalp most often manifest as folliculitis. There are numerous infective agents that may cause folliculitis, including bacteria, viruses and fungi, as well as many noninfective causes. Several noninfectious diseases may present as scalp hair folli- culitis, such as folliculitis decalvans capillitii, perifolliculitis capitis abscendens et suffodiens, erosive pustular dermatitis, lichen planopilaris, eosinophilic pustular folliculitis, etc. The classification of folliculitis is both confusing and controversial. There are many different forms of folliculitis and se- veral classifications. According to the considerable variability of histologic findings, there are three groups of folliculitis: infectious folliculitis, noninfectious folliculitis and perifolliculitis. The diagno- sis of folliculitis occasionally requires histologic confirmation and cannot be based -
Traction Folliculitis: an Underreported Entity
HIGHLIGHTING SKIN OF COLOR Traction Folliculitis: An Underreported Entity Gary N. Fox, MD; Julie M. Stausmire, MSN, CNS; Darius R. Mehregan, MD Traction folliculitis is a component of traction air and scalp diseases induced by traumatic alopecia syndrome and has received minimal hairstyling techniques, including the use of attention in primary source medical literature. Hchemical relaxers and permanent solutions, The popularity of hairstyles that produce hair hot combs, braids, hair extensions, and pomades, tend traction and the knowledge that early interven- to be underappreciated.1-4 The practice of these tech- tion improves prognosis amplify the importance niques and their sequelae are most common in black of recognizing this entity. Traction folliculitis individuals.1 We present an illustrative scenario of presents as perifollicular erythema and pustules trauma caused by hairstyling techniques in an infant on the scalp in areas where hairstyles produce and review the literature on traction folliculitis. We traction on the hair shaft. In addition to the trac- found no prior reports of traction folliculitis in infants tion, concurrent hair care practices may play a and no prior images of traction folliculitis in the facilitatory role in the development of traction primary source medical literature. folliculitis. Treatment involves immediate removal of traction on hair and temporary alteration of the Case Report facilitatory hair care practices. In more severe An 8-month-old black infant was brought in by his cases, topical or systemic antibacterial therapy mother for evaluation of “pus bumps” on the scalp and, occasionally, topical corticosteroid therapy of several weeks’ duration. The infant was otherwise may be necessary. -
The Dermatologist's Approach to Onychomycosis
J. Fungi 2015, 1, 173-184; doi:10.3390/jof1020173 OPEN ACCESS Journal of Fungi ISSN 2309-608X www.mdpi.com/journal/jof Review The Dermatologist’s Approach to Onychomycosis Jenna N. Queller 1 and Neal Bhatia 2,* 1 Dermatology Chief Resident at Harbor-UCLA Medical Center, Torrance, CA 90502, USA; E-Mail: [email protected] 2 Director of Clinical Dermatology, Therapeutics Clinical Research, San Diego, CA 92123, USA * Author to whom correspondence should be addressed; E-Mail: [email protected]; Tel.: +1-858-571-6800. Academic Editor: Theodore Rosen Received: 24 June 2015 / Accepted: 5 August 2015 / Published: 19 August 2015 Abstract: Onychomycosis is a fungal infection of the toenails or fingernails that can involve any component of the nail unit, including the matrix, bed, and plate. It is a common disorder that may be a reservoir for infection resulting in significant medical problems. Moreover, onychomycosis can have a substantial influence on one’s quality of life. An understanding of the disorder and updated management is important for all health care professionals. Aside from reducing quality of life, sequelae of the disease may include pain and disfigurement, possibly leading to more serious physical and occupational limitations. Dermatologists, Podiatrists, and other clinicians who treat onychomycosis are now entering a new era when considering treatment options—topical modalities are proving more effective than those of the past. The once sought after concept of viable, effective, well-tolerated, and still easy-to-use monotherapy alternatives to oral therapy treatments for onychomycosis is now within reach given recent study data. In addition, these therapies may also find a role in combination and maintenance therapy; in order to treat the entire disease the practitioner needs to optimize these topical agents as sustained therapy after initial clearance to reduce recurrence or re-infection given the nature of the disease. -
Global Development Assistance for Adolescent Health from 2003 to 2015
Supplementary Online Content Li Z, Li M, Patton GC, Lu C. Global development assistance for adolescent health from 2003 to 2015. JAMA Netw Open. 2018;1(4):e181072. doi:10.1001/jamanetworkopen.2018.1072 eTable 1. List of Donor Countries Included in the CRS eTable 2. 132 Recipients in the CRS (According to the World Health Organization Regions) eTable 3. Key Words to Identify the Related Age Group (Adolescence) in the Creditor Reporting System eTable 4. CRS Purpose Name and Respective Fractions Allocated to Adolescent Health eTable 5. Definitions of DAAH on the Leading Causes of DALYs of Adolescent Health eTable 6. Key Words Used to Search for Projects on Skin and Subcutaneous Diseases in the Creditor Reporting System eTable 7. Key Words Used to Search for Road Injury Projects in the Creditor Reporting System eTable 8. Key Words Used to Search for HIV/AIDS Projects in the Creditor Reporting System eTable 9. Key Words Used to Search for Projects on Iron-Deficiency Anemia in the Creditor Reporting System eTable 10. Key Words Used to Search for Self-Harm Projects in the Creditor Reporting System eTable 11. Key Words Used to Search for Projects on Interpersonal Violence in the Creditor Reporting System eTable 12. Key Words Used to Search for Projects on Depressive Disorders in the Creditor Reporting System eTable 13. Key Words Used to Search for Projects on Lower Back and Neck Pain in the Creditor Reporting System eTable 14. Key Words Used to Search for Diarrheal Projects in the Creditor Reporting System eTable 15. Key Words Used to Search for Tuberculosis Projects in the Creditor Reporting System eTable 16.