Dermatologic aspects of HIV infection

We report on the clinical course, the staging, and the theories regarding the etiopathogenesis and possible prognostic factors of Kaposi's sarcoma. In addition, we refer to the significance of viral, mycotic, and bacterial infections in HIV infection.     

Dermatologic aspects of anorexia and bulimia nervosa

Anorexia and bulimia nervosa are common in western civilized countries. They are frequently associated with disorders of the skin. Up to now, no dermatological studies of large numbers of patients with eating disorders have been published. We examined 145 patients with eating disorders (65 anorexia nervosa, 80 bulimia nervosa) regarding skin alterations. Simultaneously we controlled the moisture content and the superficial lipids of the skin. Several symptoms relevant to dermatology were found. In detail we report on: xerosis, hair changes, nail disorders, pathognomonic hand lesions, sialadenosis, lesions of the oral mucosa and the teeth, peripheral oedema, acrocyanosis, petechiae and artefacts.     

Dermatologic aspects of HIV in dermatology nursing.

Dermatology nurses are playing an increasing role in the assessment and care of HIV-infected patients. Recognition and proper care of the cutaneous manifestations of HIV disease are vital for improving the patient's health and comfort.     

Physiology of the oral cavity : Dermatologic aspects

The oral cavity is the first part of the digestive tract and, thus, the natural entry of food and fluids into the body. Further, it is permanently colonized by bacteria as are all other body surfaces. Humans have two sets of teeth: the deciduous dentition with 20 teeth and the permanent dentition with 32 teeth. Our teeth are unique solid bodies which penetrate the lining surface of the mouth. Thus special defense mechanisms are required to prevent the invasion of microorganisms into connective tissue and bone through the gap between the tooth surface and the gingiva. The host response is observed clinically as inflammation (gingivitis). In the conflict of microbiological exposure and host response this defense mechanism will derail in some individuals early and in most individuals later in life. The host's line of defense will yield to the microorganisms and the body will destroy the connective tissue and bone of the periodontal structures as part of its struggle against bacteria. Halitosis may indicate a particular medical problem (e.g. periodontitis). Contrary to common belief, in most cases halitosis is not due to gastric problems but is caused primarily by bacteria of the oral cavity.     

Dermatologic therapy of chronic genital disease

ABSTRACT:  The adaptation of dermatology for the genital area requires several modifications of standard therapy. This unique area produces issues of both psychological sensitivity and unique environmental factors of constant moisture, warmth, and friction. These issues become far more important when symptoms are chronic. Recognition of normal variants, the multifactorial nature of many genital symptoms, and the avoidance of creating secondary iatrogenic disease are all important.     

Dermatologic radiotherapy and thyroid cancer. Dose measurements and risk quantification

Thyroid doses for various dermatologic radiation techniques were measured with thermoluminescent dosimeters and ionization rate meters in an Alderson-Rando anthropomorphic phantom. The effects of changes in radiation quality and of the use or nonuse of treatment cones and thyroid shields were evaluated in detail. The results indicate that the potential risk of radiogenic thyroid cancer is very small when proper radiation protection measures are used. The probability of radiogenic thyroid cancer developing and the potential mortality risk were assessed quantitatively for each measurement. The quantification of radiation risks allows comparisons with risks of other therapeutic modalities and the common hazards of daily life.     

Dermatologic disease accounts for a large number of hospital admissions annually

BACKGROUND: Severe skin disease uncommonly requires hospitalization. The number of patients hospitalized for skin disease annually in the United States has never been reported. OBJECTIVE: We evaluated the number of patients admitted for skin disorders. METHOD: Using data from 2 national databases, the Healthcare Cost and Utilization Project-3 Nationwide Inpatient Sample (HCUP-3 NIS) 1992-1994 and Medicare Provider Analysis and Review (MEDPAR) 1990-1996 file, we evaluated the total discharges, total charges, and reimbursement of the dermatology-specific (272, 273, 283, and 284) and -related (263, 264, 265, 266, 271, 277, 278, and 279) diagnosis-related groups (DRGs). RESULTS: In 1994, the HCUP-3 NIS data showed that a total of 468,014 discharges were classified under Dermatology DRGs, whereas in 1996 MEDPAR data gave a figure of 183,310 discharges with a total Medicare reimbursement of $892 million. In both data sets, dermatology-specific DRGs show a decrease over time, although dermatology-related DRGs generally showed an opposite increasing pattern. The top 10 states reimbursed by Medicare in 1996 for the discharges grouped under the DRGs mentioned above were New York, California, Pennsylvania, Florida, Texas, Ohio, Illinois, Michigan, New Jersey, and Massachusetts. CONCLUSION: Many patients are admitted annually for skin disease. The minority are admitted by dermatologists.     

Dermatologic infestations

Head lice are transmitted by head to head contact. Optimal therapy includes malathion lotion 0.5% repeated in one week left on for 30 minutes to 8 hours. Spinosad topical suspension 0.9% repeated in one week left on for 10 minutes is another option. Scabies is transmitted mainly by direct contact but also via heavily infested fomites due to crusted scabies. Permethrin 5% cream to the body repeated in four days is often sufficient; however, scalp treatment with malathion lotion 0.5% is helpful in crusted scabies and in infested children. Oral ivermectin 200 mcg/kg is another option, repeated in four days. For scabies more than lice, fomites should be placed in a drier at 60 °C for 10 minutes to kill the arthropods. Treatment of close contacts in both cases will control outbreaks and repeated infestations. Both have been associated with methicillin-resistant Staphylococcus aureus infection. Bed bugs are a common cause for papular urticaria. Identification of the insect in the mattress or bedding confirms the diagnosis. Prevention involves encasing the mattress in a sealed plastic cover and extermination. Delusions of parasitosis is a diagnosis of exclusion that is best treated with an antipsychotic.     

Dermatologic signs

BACKGROUND: Dermatology signs serve as important clues to primary skin disorders and internal conditions. OBJECTIVE AND METHODS: To highlight major cutaneous signs based on a MEDLINE literature search from 1966 to March 2006. RESULTS AND CONCLUSIONS: A multitude of signs exist in dermatology. Appreciation and knowledge of cutaneous signs will enhance the care of patients with dermatologic manifestations.     

Dermatologic radiotherapy

Dermatologic radiotherapy is based on the standard physical and radiobiological parameters. The radiation quality most often used in dermatology lies between 10 and 50 kV. Another important parameter is the half-value depth which should correspond to the depth of the tumor below the skin surface. In this way the skin is not over-exposed to radiation treatment. Indications for radiotherapy of malignant skin tumors include basal cell carcinoma, squamous cell carcinoma, severe actinic keratoses, lentigo maligna, lentigo maligna melanoma, Merkel cell carcinoma, and Kaposi sarcoma, as well as T- and B-cell lymphomas. Most patients with malignant skin tumors require life-long monitoring after radiotherapy. The most common benign lesions where radiotherapy may be indicated are eczemas, psoriasis, and keloids, but its use should be carefully weighed in these settings.