onychomycosis due to other Candida species have also been reported. 3 C. tropicalis is often isolated from fungus-infected nails in Brazil, but there have been no reports of onychomycosis caused by C. tropicalis in Japan. 4 The risk factors of candidal onychomycosis include congenital mucocutaneous candidiasis, HIV infection, immunosuppressive therapy, peripheral vascular disease and diabetes mellitus. 2 Trauma during farming or hobby gardening may contribute to the onset of finger onychomycosis, whereas no significant risk factor was identified in the patient in the present case. The association of chronic paronychia suggests the involvement of Candida; however, candidal infections are difficult to diagnose in cases without swelling of the nail fold. Although a fungal culture is the gold standard for identifying the causative organism, this examination requires several weeks of incubation and sometimes produces a false-negative result. In addition, several strains of Candida species demonstrate resistance to terbinafine. 5 Therefore, azoles, including itraconazole and fosravuconazole, which exhibit remarkable antifungal activity against Candida species, should be preferentially prescribed to patients with finger onychomycosis.
Palmoplantar pustulosis (PPP) is a chronic skin inflammatory disease characterized by sterile pustules on the palms and soles. Pustulotic arthro‐osteitis (PAO) is a major comorbidity of PPP, frequently affecting the anterior chest wall. PPP and PAO are thought to be closely associated with focal infection. We report a female in her 40s who developed pustules on her palms and soles with tenderness of both sternoclavicular and left sacroiliac joints, which were not improved with non‐steroidal anti‐inflammatory drugs. Of note, she showed a great response to amoxicillin, resulting in the almost complete resolution of her skin lesions and arthralgia. We also reviewed previous reports to learn more about the potential therapeutic options of antibiotics for PAO.
users (63Á7%). ET (55Á45%) and EPT (51Á5%) users lived in areas with the highest ambient UV exposure more often than 'never ' HT users (47Á0%).We found no association between current ET (HR 1Á36, 95% CI 0Á96-1Á94) or EPT (HR 1Á11, 95% CI 0Á91-1Á36) use and CM risk (Table 1). No significant interaction was observed between naevi and current ET/EPT use overall (P interaction = 0Á075), but among those with naevi, the association with melanoma risk was significantly higher (P = 0Á023) for ET users (HR 1Á63, 95% CI 0Á84-3Á17) than EPT users (HR 0Á64, 95% CI 0Á37-1Á13) (Table 1).In a sensitivity analysis stratified by inclusion before or after results from the Women's Health Initiative were published (i.e. before 2005 or from 2005 onwards), the estimates for current ET and EPT in the two strata were similar. In another sensitivity analysis stratified by healthcare utilization via the proxy measure 'rural/nonrural area of residence', current ET and EPT estimates were similar.Our estimates for ET and EPT are in good agreement with a recent meta-analysis [ET: pooled relative risk (RR) 1Á32, 95% CI 1Á17-1Á49; EPT: RR 1Á12, 95% CI 0Á93-1Á35]. 1 Increasing number of naevi has been associated with higher levels of oestradiol. 8 The indication of a higher CM risk in women with naevi who use ET is in line with this finding.Major strengths of this study include the representative, nationwide population-based prospective design with up to 25 years of follow-up and complete outcome information. The main limitation of the study is the use of self-reported, although validated, exposure information 7 and self-reported covariates. This research letter reports for the first time associations between ET, EPT and melanoma risk stratified by naevi. Unfortunately, the number of exposed cases in the two strata was low and further research is needed.In conclusion, ET and EPT were not associated with CM risk in this nationwide cohort study, and the estimates were in line with recent meta-analyses.
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