The most important aspect of management in these cases is immediate withdrawal of the suspected agent, because small pustules in a localized patch may progress to a more generalized pustular rash. 5 Treatment is supportive, and because of the self-limiting nature of the disease, no specific treatments are usually needed. However, topical or systemic corticosteroids can be used to hasten resolution. 2 We discontinued enoxaparin for our patient, and prescribed topical corticosteroid (betamethasone) cream to be used twice daily. The pustules resolved rapidly over several days.In conclusion, we present a case of a woman with a cutaneous drug reaction consistent with ALEP that occurred after enoxaparin. This case highlights enoxaparin as a novel causative agent for this type of drug reaction.
Background. Educational videos improve patient knowledge of wound care and skin cancer. However, the effect of viewing an educational video at home before undergoing Mohs micrographic surgery (MMS) has not been demonstrated. Aim. To evaluate the use of an educational video to improve patient understanding of MMS. Methods. Patients scheduled to undergo MMS were randomized to receive standard patient education, or standard patient education with an additional video developed by the authors. The educational material was posted to patients along with the details of their MMS appointment. Both groups answered questionnaires to assess their knowledge of MMS, and to measure their anxiety and satisfaction. Results. Patients who watched the educational video scored higher on the knowledge questionnaire than did patients in the control group (0.8, 95% CI 0.3 to 1.4, P < 0.01), but were not statistically less anxious (À0.7, 95% CI À2.6 to 1.3, P = 0.50). Overall, patients undergoing MMS were satisfied. Conclusion. Home viewing of an educational video before MMS can improve patient understanding.
A 64-year-old man presented to the emergency department with a 3-week history of a single painful bleeding lesion on his left heel. The patient had been on a recent holiday to Mozambique, and the lesion appeared after his return.On physical examination, a single hyperkeratotic yellow nodule with a black punctum was seen on the patient's heel (Fig. 1a). Dermoscopic examination was undertaken (Fig. 1b). The lesion was punch excised under local anaesthetic in clinic, and the tissue was sent for histological evaluation.
Histopathological findingsOn histological examination, a cavity in the stratum corneum was seen, lined by a thick eosinophilic cuticle with spike-like projections (Fig. 2). Inside the cavity, there were multiple ring-like structures, as well as round and oval-shaped structures containing granules (Figs 3a,b).What is your diagnosis? (a) (b) Figure 1 (a) Painful hyperkeratotic nodule on the left heel; (b) dermatoscopic view of the hyperkeratotic nodule, showing punctum.
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