A 75-year-old man presented with lesions on his right leg and on the dorsum of the penis, which had appeared 5 years ago following long distance travel. His right leg was swollen, and there was a dark-violet-colored, slightly elevated lesion extending to the thigh and penis. Histologic examination revealed thickening of the arteriolar walls and diffuse proliferation of the vascular structures surrounding the arterioles and dissecting the dermal collagen fibers. Immunohistochemical staining for Factor VIII R-A reacted positively with arteriolar endothelium, but was negative on thin-walled vascular spaces. Femoral angiography showed multiple fine arteriovenous (A-V) shunts especially at the one-third distal lower region of the right leg.
A 55‐year‐old man, a farmer, was referred to our dermatology department in June 1993 with inflammatory and infiltrated nodular lesions on his left cheek and neck. These nodular lesions had appeared about a month previously and had enlarged quickly. He was unaware of any antecedent trauma. Physical examination revealed a painless, slightly erythematous, soft, fluctuant plaque which measured 8 cm in diameter. It consisted of follicular papules and pustules and was partially covered with brown‐black crusts (Fig. 1), Two similar plaques, 3 cm in diameter, were also detected on the neck. The regional lymph nodes were not palpable. The hair on the lesions was easily removed with a pair of forceps without causing pain. The patient had not previously had any skin disease. Laboratory investigations, including full blood count, erythrocyte sedimentation rate, serum concentrations of sodium, potassium, chloride, transaminases, alkaline phosphatase, sugar, cortisol, and renal function tests, were all normal. No fluorescence was seen on Wood's light examination. Direct microscopic examination with 15% potassium hydroxide solution revealed yeast cells and hyphae in three consecutive scrapings of the lesions. Candida albicans was isolated from the mycologic cultures; but no growth was observed in mycologic cultures of oral and anogenital mucosae swabs. Bacteriologic cultures of the lesions were also negative. A skin biopsy was performed for histologic confirmation. Examination of the biopsy specimen revealed dermal oedema and PAS(‐I‐) yeast cells among the infiltration of lymphocytes and plasma cells (Fig. 2). The patient was started on a regimen with fluconazole 100 mg once a day orally for a week, after which the dosage was decreased to 100 mg once every other day for a month. Also, the hair on the lesions was depilated. We noted a significant clinical improvement at the fifth week of the therapy (Fig. 3). Repeated mycologic examinations of the lesions were all negative even 1 month after the end of the therapy
The efficacy, safety, required duration of treatment, and patient preference for oral fluconazole 150 mg/week in the treatment of 521 patients with cutaneous candidosis, tinea corporis, tinea cruris or tinea pedis were assessed in an open, multicentre, noncomparative trial. Patients received weekly doses of fluconazole 150mg for an average of 4.65 weeks. Cultures were examined microscopically at baseline, at 2-week intervals, at study end, and at long term follow-up (4 to 6 weeks after the last dose). All adverse events were recorded and rated; patients with laboratory findings outside normal values were monitored. Forms regarding patient preference for oral or topical medication type were assessed from 19 centres at study end. Clinical evaluation demonstrated an overall success rate (cure plus improvement) of 96% at the end of therapy, and 92% overall success rate at long term follow-up. Eradication of pathogens based on culture was equally high, with 92% eradicated at the end of therapy and 89% eradicated at long term follow-up. Patient tolerability was good; only 7 patients (1.3%) discontinued therapy because of adverse events, in 2 cases because of laboratory abnormalities. These findings suggest that oral fluconazole therapy is safe. This study demonstrated that weekly oral doses of fluconazole 150mg were effective in the treatment of tinea corporis, tinea cruris, tinea pedis and cutaneous candidosis. Furthermore, there was a high patient preference for oral fluconazole over previous topical therapy.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.