Erythema ab igne (EAI) is a reticulated, erythematous, or hyperpigmented dermatosis that is caused by chronic exposure to infrared radiation. Chronic lesions of EAI have significant potential for malignant transformation. We report a case of poorly differentiated carcinoma arising within a patch of long-standing EAI on the lower extremity of a 92-year-old female. This case highlights the importance of recognizing EAI early and counseling patients to avoid further exposure to the offending infrared source to reduce the risk of malignant transformation. EAI has been associated with several different types of cutaneous neoplasms including the Merkel cell carcinoma, squamous cell carcinoma, and cutaneous marginal zone lymphoma.
Background: Common belief holds that as topical glucocorticoids are used over time the less effective they become, a phenomenon called tolerance or tachyphylaxis. Objective:To determine what evidence supports the concept of tachyphylaxis to glucocorticoids. Methods:We searched Medline and Google Scholar for articles on tachyphylaxis to glucocorticoids published through October 2012.Results: Rapid tolerance, tachyphylaxis, to non-clinical effects of glucocorticoids has been reported in literature. However, clinically significant tolerance to topical glucocorticoids has not been identified in clinical trials. We did not identify any evidence that clinical efficacy of glucocorticoids in inflammatory skin diseases significantly diminishes during long term continuous use.Limitations: Tachyphylaxis or tolerance to clinical effects of topical glucocorticoids in inflammatory skin diseases is not fully characterized or well studied. Conclusion:Based on available data in literature, there is no clinical trial supporting the concept that topical glucocorticoids lose effectiveness over time, nor that intermittent use of topical glucocorticoids is more effective than continuous use. BackgroundTopical glucocorticoids are the foundation of dermatological treatment, with potent anti-inflammatory properties. Glucocorticoids act on a wide range of cells and have a wide range of mechanisms of action. Most of the effects of glucocorticoids on cells are mediated via the glucocorticoid receptor [1][2][3]. Glucocorticoids inhibit phospholipase A2, reducing the amount of arachidonic acid, decrease the release of interleukin (IL)-1α and IL-2, inhibit leucocyte migration to sites of inflammation, and interfere with the functions of endothelial cells, granulocytes, mast cells and fibroblasts [4][5][6][7][8][9][10]. Glucocorticoids also reduce T cell proliferation and increase T cell apoptosis, increase monocyte apoptosis, deplete the number of Langerhans cells, decrease histamine content of mast cells, and suppress eosinophil maturation, recruitment, and survival [11,12]. Topical glucocorticoids reduce protein synthesis
Background: Although topical corticosteroid ointments were once viewed as the best vehicle for treating inflammatory skin diseases, the recognition of the problem of poor compliance and patients' preferences for other vehicles has led to the development of corticosteroid products in alternative formulations.Objective: To describe patterns of use of newer vehicle formulations including foams, shampoos, sprays, and lotions for the treatment of psoriasis and other dermatoses. Methods:The use of non-traditional vehicles was identified using visit with diagnoses for psoriasis and other dermatoses from the National Ambulatory Medical Care Survey 2000-2010 data. Trends in corticosteroid vehicles mentions were evaluated over the study period to determine how the use of non-traditional vehicles has changed. The odds ratios of being prescribed a nontraditional vehicle were reported for patient and office-based characteristics of visits.Results: Approximately 2.3% and 1.9% of visits mentioned foam and other non-traditional vehicles (shampoo, lotion, spray), respectively. The use of corticosteroids in shampoo, lotion, or spray preparations increased by 0.5% annually (p=0.008) but did not significantly change for corticosteroids in a foam preparation (p=0.10). Psoriasis and seborrheic dermatitis were the leading diagnoses at visits prescribed corticosteroids in nontraditional vehicles. Dermatologists were more likely than non-dermatologists to prescribe foam products [OR: 8.4 (3.6, 19.9)] or clobetasol in another non-traditional vehicle [OR: 49.7 (10.3, 240.5)].Limitations: Product vehicle was not specified for all corticosteroids. Conclusion:Although there was increasing use of non-traditional vehicles, the rate of use has remained low. Dermatologists appear to have greater familiarity with the use of these newer vehicle formulations than do physicians in other specialties.
origin, but no constant organism has yet been demonstrated. The treatment has not been very satisfactory. Arsenic, mercury, iodids and other remedies have been employed with variable degrees of success. At the present time we are only able to mitigate the symptoms or lesions of the disease without, probably, exerting much influence upon its course. External applications should be of a sedative and anti-pruritic character. DISCUSSION. Dr. Duhring-Nine cases out or ten are fatal. The diagnosis of the early stage is often very difficult even to an expert. The disease is more common than is generally supposed. The early lesions simulate other diseases very closely, and particularly the erythematous form of eczema. I recall one case which was treated for eczema and within two years the patient died. So it is of great importance to be able to diagnose a case before the fungoid condition makes its appearance, after which it is fatal. I remember a case which was almost clinically like Dr. Shoemaker's, with the exception of the face lesions. The patient was treated with thyroid extract for three or four weeks and the lesions had largely disappeared. The family physician said that the patient had been able to follow his occupation (carpenter) up to two months ago and the main tumors had almost all disappeared. Then the patient suddenly became worse, the tumors increased in size, especially on the neck, axilla and chest, and within one month he sank very rapidly. There was extreme languor and the patient would not leave the bed, after which death occurred in two or three days. There is no hesitation in classing this affection as a distinct disease. I have seen two cases of sarcoma which were generalized and there was no suspicion of their being mycosis fungoides. Both cases died within three months. Dr. Gottheil-I had a very similar case and all forms of treatment were useless. The pruritus was so obstinate that the patient almost became insane. There were pinkish elevated plaques which itched very much and spread all over the body. The characteristic tumors appeared later. Numbers of previous cases had been diagnosed as eczema, psoriasis, tumors, etc. Every case of an intractable itching cutaneous disease should be suspected as a mycosis fungoides. Dr. Allen-More attention ought to be paid to the premycotic stage. Sometimes the earlier leaions would be like a
come under my observation, I have been led to present these thoughts for the consideration of this Section.There must be a widety disseminated convic¬ tion of the truths upon which our Boards of Health are founded before we can hope to elevate the status of the health of our communities to the
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