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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patients with venous insufficiency commonly develop complications which can result in significant morbidity and occasional mortality. Venous leg ulcers, the most prevalent type of lower extremity ulcer, are the most frequent sequela of venous insufficiency and negatively affect quality of life for the patient. Most have focused on venous ulceration, but other complications may arise including dermatitis, atrophie blanche, lipodermatosclerosis, and malignancy. Contact dermatitis is a common complication seen in the treatment of venous disease. Patients with venous insufficiency have a disrupted epidermal barrier, making them more susceptible than the general population to contact sensitization and subsequent dermatitis. Venous dermatitis is often the first manifestation of venous insufficiency and needs to be addressed promptly. Atrophie blanche, an end point of a variety of conditions, appears as atrophic plaques of ivory white skin with telangiectasias. Lipodermatosclerosis is an indurated plaque in the medial malleolus which can, at times, be quite tender and painful. Malignant degeneration is a rare but important complication of venous disease since tumors which develop in the setting of an ulcer tend to be more aggressive. Pain is a feature of venous disease often overlooked and commonly undertreated. Finally, psychosocial issues such as anxiety and depression are more common in patients with venous disease and should be adequately addressed. Recognizing these complications of chronic venous insufficiency is important as early intervention is the key to preventing unnecessary patient suffering and discomfort.
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PMID:Dermatologic complications of chronic venous disease: medical management and beyond. 1782 46

Corticosteroids have been used extensively since cortisone was first synthesized in the 1950s. Glucocorticoids are derived from cortisone and are used in treatments for inflammation, dermatitis, allergic reactions, asthma, hepatitis, lupus erythematosus, nausea, vomiting and inflammatory bowel diseases. In the setting of palliative care, glucocorticoids have many uses, including many symptoms of malignancy, nausea, vomiting, depression, fatigue, anorexia and cachexia.
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PMID:Role of corticosteroids in palliative care. 1803 21

The present series of experiments was designed to examine, in the anesthetized cat, the extent to which the synaptic efficacy of knee joint afferents is modified during the state of central sensitization produced by the injection of capsaicin into the hindlimb plantar cushion. We found that the intradermic injection of capsaicin increased the N2 and N3 components of the focal potentials produced by stimulation of intermediate and high threshold myelinated fibers in the posterior articular nerve (PAN), respectively. This facilitation lasted several hours, had about the same time course as the paw inflammation and was more evident for the N2 and N3 potentials recorded within the intermediate zone in the L6 than in the L7 spinal segments. The capsaicin-induced facilitation of the N2 focal potentials, which are assumed to be generated by activation of fibers signaling joint position, suggests that nociception may affect the processing of proprioceptive and somato-sensory information and, probably also, movement. In addition, the increased effectiveness of these afferents could activate, besides neurons in the intermediate region, neurons located in the more superficial layers of the dorsal horn. As a consequence, normal joint movements could produce pain representing a secondary hyperalgesia. The capsaicin-induced increased efficacy of the PAN afferents producing the N3 focal potentials, together with the reduced post-activation depression that follows high frequency autogenetic stimulation of these afferents, could further contribute to the pain sensation from non-inflamed joints during skin inflammation in humans. The persistence, after capsaicin, of the inhibitory effects produced by stimulation of cutaneous nerves innervating non-inflamed skin regions may account for the reported reduction of the articular pain sensations produced by trans-cutaneous stimulation.
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PMID:Changes in synaptic effectiveness of myelinated joint afferents during capsaicin-induced inflammation of the footpad in the anesthetized cat. 1825 Oct 18

Pellagra is associated with low levels of vitamin B3 (niacin) and/or tryptophan and often involves other other B vitamins. Since the time Gasper Casal first described the disease in 1972, it was observed that the patients with pellagra were all poor, subsisted mainly on maize, and rarely ate fresh meat. Subsequent occurrences have been in the form of epidemic outbreaks, consequent to either introduction to maize as a major food or increased consumption of other niacin-deficient diets like Jowar (Sorgum vulgare). The virtual disappearance of pellagra as an endemic health problem in recent years can be attributed to a rise in the standard of living of farmers and diversification of the diet globally. The clinical picture is a combination of multisystem alterations typically involving gastrointestinal, skin and central nervous system abnormalities. The cardinal manifestations have been popularly known as the three D's, which are dementia, dermatitis and diarrhea. Psychiatric manifestations are fairly common but are easily overlooked due to their non specific nature. These are commonly seen as irritability, poor concentration, anxiety, fatigue, restlessness, apathy and depression. The occurence of psychosis in pellagra is an uncommon finding, which is usually seen in advanced stages of pellagroid encephalopathy, commonly found in chronic alcoholics. Delusional parasitosis has been also reported in this condition, although the association is still controversial. We report a case of pellagra manifesting with delusional parasitosis in a man whose delusion resolved rapidly after he started niacin-augmentation therapy. This case may provide clues to the biological underpinnings of delusional parasitosis as well as niacin treatment as treatment option in similar cases.
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PMID:Rapid resolution of delusional parasitosis in pellagra with niacin augmentation therapy. 1906 87

There is a considerable degree of connection between psychiatry and dermatology. This connection is relevant both for diagnosis and management of dermatological pathology. This article summarises common psychiatric conditions seen in patients with skin disease, both primary psychiatric disorders and psychiatric disorders secondary to dermatological pathology. Diagnosis of relevant psychiatric conditions such as anxiety, depression, obsessive-compulsive disorder, delusional parasitosis and dermatitis artefacta, and psychiatric treatments are discussed. It gives an update of psychopharmacology relevant to the dermatologist including important interactions between psychotropic and dermatological agents.
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PMID:Psychiatric treatments in dermatology: an update. 1987 24

CASE DESCRIPTION-A 2-month-old female Nigerian Dwarf goat was evaluated for a generalized crusting dermatitis; signs of depression; and fever of 1 month's duration. CLINICAL FINDINGS-Histologic evaluation of skin biopsy specimens revealed subcorneal pustules and rafts of acantholytic cells. No etiologic agents were detected in the biopsy material, and bacterial culture of skin biopsy specimens yielded no growth of pathological organisms. A diagnosis of pemphigus foliaceus was made. TREATMENT AND OUTCOME-Remission was achieved with a combination of SC administration of dexamethasone and IM administration of gold sodium thiomalate. The goat remained free of clinical signs for at least 26 months after discontinuation of all medications. No clinically apparent adverse effects of treatment were evident. CLINICAL RELEVANCE-This report represents the first description of successful treatment of juvenile pemphigus foliaceus in a goat by use of a novel protocol involving dexamethasone and gold sodium thiomalate.
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PMID:Successful treatment of juvenile pemphigus foliaceus in a Nigerian Dwarf goat. 2022 83

Clostridial dermatitis of turkeys (CDT) has emerged as a major issue across most geographic regions of the United States. The prevalence and severity of dermatitis has increased over the last several years, since the time it was first reported in 1993. Cellulitis in poultry can be associated with Staphylococcus aureus or Escherichia coli, but the more recent field situation in turkeys is specifically associated with Clostridium spp. The prevalence of cellulitis is relatively low; however, the disease can be devastating in the individual flocks affected. Clostridium septicum, Clostridium perfringens, Clostridium sordelli, and S. aureus can cause cellulitis. Escherichia coli, Streptococcus spp., and other bacteria have occasionally been isolated from birds diagnosed with cellulitis. CDT appears as excessive mortality in older birds around 16-18 weeks of age. It has been reported from field experience as early as 7 wk of age. Clinical signs of CDT can range from sudden death to inappetence, depression, leg weakness, recumbency, and ataxia. The disease is characterized by reddish to dark or greenish discoloration of the skin around the thighs, abdomen, keel, tail region, back, and wings. The lesions can extend into the underlying muscles, and there can be gas bubbles under the skin which result in crepitation. Some cases present with dead birds having "bubbly tail," fluid-filled blisters associated with broken feather follicles around the base of the tail. Bubbly tail in breeder toms might not cause excessive mortality, but the lesions are so severe that the birds cannot be used for semen collection. Incidence of mortality from this condition can be severe and acute (i.e., rapid onset of high mortality). The dead birds decompose very quickly. Microscopically, there is necrosis, with or without inflammation of the skin, especially in the dermis and occasionally in the skeletal muscles, associated with large numbers of rod-shaped bacteria. Overcrowding, aggressive birds, poor-wet litter, decreased down time, a contaminated environment including feed and water, poor hygienic conditions, and contaminated vaccines and vaccine equipment, etc., can predispose birds for CDT. Preventative measures and treatment are discussed extensively in this review.
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PMID:Clostridial dermatitis and cellulitis: an emerging disease of turkeys. 2060 20

Nearly two thirds of patients with cancer will undergo radiation therapy as part of their treatment plan. Given the increased use of radiation therapy and the growing number of cancer survivors, family physicians will increasingly care for patients experiencing adverse effects of radiation. Selective serotonin reuptake inhibitors have been shown to significantly improve symptoms of depression in patients undergoing chemotherapy, although they have little effect on cancer-related fatigue. Radiation dermatitis is treated with topical steroids and emollient creams. Skin washing with a mild, unscented soap is acceptable. Cardiovascular disease is a well-established adverse effect in patients receiving radiation therapy, although there are no consensus recommendations for cardiovascular screening in this population. Radiation pneumonitis is treated with oral prednisone and pentoxifylline. Radiation esophagitis is treated with dietary modification, proton pump inhibitors, promotility agents, and viscous lidocaine. Radiation-induced emesis is ameliorated with 5-hydroxytryptamine3 receptor antagonists and steroids. Symptomatic treatments for chronic radiation cystitis include anticholinergic agents and phenazopyridine. Sexual dysfunction from radiation therapy includes erectile dysfunction and vaginal stenosis, which are treated with phosphodiesterase type 5 inhibitors and vaginal dilators, respectively.
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PMID:Managing the adverse effects of radiation therapy. 2070 69

Dermatitis artefacta is a disease characterized by self-inflicted skin lesions in fully aware patients. Mechanical and chemical devices are most commonly used to produce such injuries. Several psychological disorders like depression, obsessive compulsive disorders, hysteria, etc. are associated with this kind of disease. Most of the patients are young females aged between 15 and 30, but the diagnosis of dermatitis artefacta may even be made in pediatric patients or elderly people. Because of its rarity and the polymorphism of lesions, dermatitis artefacta is often a challenge for the clinicians. More difficulties might be due to the lack of cooperation in these patients, who usually refuse the dialogue with doctors and deny their primary role in damaging their skin. We present a case of an elderly woman who showed a peculiar pattern of deep excoriating lesions disseminated on the upper part of her body, with an evident state of depression. Diagnostic and therapeutic procedure, that is often long lasting and difficult in such cases, was made by teamwork of dermatologists, psychiatrists and psychologists, leading to steady control of impulses and full remission of cutaneous symptoms.
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PMID:Dermatitis artefacta in a patient affected by impulse control disorder: case report. 2148 63

The celiac disease is traditionally viewed as the children's disease with a typical form accompanied mainly by intestinal symptoms and malabsorption. This opinion is still generally accepted by the medical community. Findings based on the area-wide screening show that the prevalence has risen from the original 1 : 1 000-1 500 to 1 : 70-550. The average prevalence in the western countries is nearly 1 : 100. The prevalence of the celiac disease in the Czech republic is estimated to be approximately 1 : 200-250. It means that the number of people in the Czech republic who are likely to be affected is about 40,000-50,000 people. Currently only 10-15% of the total number of the ill people are diagnosed and monitored. Adult patients represent the main diagnostic problem because their clinical pictures are individual and the main symptoms are atypical (nonenteral). These are anaemia (mainly sideropnic), early/premature osteoporosis, herpetiformic (Duhring) dermatitis, polyneurititis, ataxia, depression, behavioural disorders, menstrual cycle disorders and infertility. Therefore our attention is currently focused on the screening of these groups of subjects. The purpose of our study was to check the frequency of the celiac disease with patients with diagnosed osteoporosis and osteopenia. In our study we have confirmed the assumption that the prevalence ofthe celiac disease in the group of subjects was 1 : 50, which means that 2.2% of patients with osteoporosis and osteopenia are affected by celiac sprue and therefore screening examination of these patients with the subsequent causal treatment (gluten-free diet) is recommended.
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PMID:[Screening of celiac disease in patients with osteoporosis and osteopenia]. 2227 32


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