A 57 year old Caucasian man presented with multiple asymptomatic spiny papules on the palms and soles that he had been shaving off with a razor for many years. He was otherwise healthy with no personal or family history of skin disease or malignancy. A diagnosis of spiny keratoderma of the palms and soles or "music box spine dermatosis" was made. The clinical, histologic, and electron microscopic features of spiny keratoderma are distinct. This entity previously had multiple classifications and it is important to distinguish it from other keratodermas as some keratodermas can be linked to cutaneous and internal malignancies and conditions: poly cystic kidney disease, liver cysts, Darier's disease, and hyperlipoproteinemia among others. Spiny keratodermas can have systemic associations and do not resolve spontaneously. Treatment is generally ineffective.
We present a crystallographic study that systematically investigates the effects of the n-alkyl side-chain length on the crystal packing in shape-persistent macrocycles. The solid-state packing of carbazole-ethynylene-containing macrocycles is sensitive to the alkyl-chain length. In macrocycles containing n-alkyl side chains up to nine carbons in length, face-on aromatic π interactions predominate, while the addition of one carbon leads to a completely different packing arrangement. Macrocycles with C(10) or C(11) chains exhibit a novel packing motif wherein the alkyl chains intercalate between macrocycles, leading in one case to continuous solvent-filled channels. When crystals of the C(10) macrocycle are bathed in solvent, the included molecules exchange with the external solvent, and the alkyl chain disorder changes in response to changes in the guest volume in order to retain crystallinity. Powder X-ray diffraction data indicate that alkyl-macrocycle interactions in the longer chains "emulate" the distances typical of face-to-face π interactions, leading to deceptive indicators of π stacking.
Hair loss, or alopecia, is a common patient complaint and a source of significant psychological and physical distress. The majority of common hair loss disorders can be accurately diagnosed in the outpatient setting with a systematic evaluation of the patient. This review will present a clinical approach to the patient with alopecia by describing the history, clinical findings, and diagnosis of various hair loss disorders.
Current literature documents the use of many pharmacologic agents in the management of acute sunburn. While numerous studies have been undertaken, there is no consensus on an algorithm for such treatment. We review the literature for an evidence-based approach to the management of sunburn. A MEDLINE search was conducted whereby all published articles related to sunburn or ultraviolet (UV)-induced erythema from 1966-2001 were evaluated. Studies and reviews were excluded if they were not conducted in human beings. The results of these studies are varying and often conflicting in terms of clinical effectiveness or feasibility. A total of 40 studies were reviewed. Fourteen out of the 40 studies addressed the actual treatment of sunburn (i.e. the application of a substance after the development of signs or symptoms). The majority concluded that either corticosteroids, NSAIDs, antioxidants, antihistamines or emollients were ineffective at decreasing recovery time. The remaining studies showed mild improvement with such treatments, but study designs or methods were flawed. Furthermore, regardless of the treatment modality, the damage to epidermal cells is the same. Given the lack of convincing data and consensus of opinion regarding sunburn management, the most effective and practical approach to acute sunburn is symptomatic treatment of UV light-induced symptoms, including erythema, pain and pruritus.
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