Pitted keratolysis commonly affects young male patients wearing protective shoes for professional reasons, inducing a moist and warm environment. Hyperhidrosis, an unpleasant smell, and pain are the main clinical complaints.
Background: New advances in bioengineering have provided commercially available devices for measuring the mechanical properties of skin in vivo. Reproducibility of data and methodological approaches have not yet been thoroughly studied. Objective: To study the reproducibility and the influence of the area of the test site on the values of biomechanical variables yielded in a normal population. Method: A 500-mbar suction was transmitted to the skin through Cutometer® probes equipped with a 2- or 8-mm opening. Results: The best reproducibility was obtained for the maximum distension of skin and for the biological elasticity. The values of the standard biomechanical ratios were almost the same for both probes. Linear correlations were found between parameters of elasticity. Conclusion: The Cutometer is a reliable device. A high degree of correlation exists between biomechanical variables related to elasticity. Under a suction of 500 mbar, both the 2- and 8-mm probes give results which correlate statistically in a large population. However, the two probes do not measure precisely the same aspect of skin mechanics. The 2-mm probe measures the capacity of superficial skin folding, and the 8-mm probe explores the biomechanical properties of the dermis itself and of its slipping mobility on the hypodermis. The biomechanical parameters which appear the most clinically relevant for a normal-looking skin are the maximum distension and the biological elasticity.
Photodynamic therapy (PDT) and topical imiquimod immunotherapy (TII) are two recently introduced treatment modalities for certain types of basal cell carcinomas (BCC). We present a review of the relevant literature and report our own findings regarding the efficacy and tolerance of PDT and TII in the treatment of BCCs. According to published studies, the cure rates range from 75-95% for PDT and 42-100% for TII, depending on treatment modalities and BCC type. In our observations, 13 patients with nodular or superficial BCCs were treated by PDT using two courses of 3-hour topical application of methyl aminolevulinate, followed by 8 minutes illumination (lambda = 634 nm, e = 37J/cm2). Biopsies were taken before and one month after PDT. Side effects including pain and crusting were assessed. Eight patients with superficial BCC were treated by TII using 3 monthly courses each consisting of 3 weekly applications for 3 weeks followed by one week out of treatment. Biopsies were taken before and after 3 months of TII. Adverse reactions including erythema, oozing, ulceration, and crusting were recorded. Clinico-histological cure was obtained in 12/13 PDT cases as assessed after 1 month, and in 6/8 TII cases after 3 months. Minimal pain during illumination and crust formation were observed in 7/13 and 3/13 PDT cases, respectively. Variable erythema, oozing, ulceration, and crusting were observed in all TII-treated lesions. It is concluded that PDT represents an active and well tolerated alternative treatment for both nodular and superficial BCCs. TII also shows activity, although the tolerance may be poor and cure needs a longer time to be obtained. The final cosmetic appearance was fine following both PDT and TII procedures. Both PDT and TII may leave intact neoplastic aggregates inside the skin. They cannot be clinically perceived, leading to unexpected recurrences. It is stressed that the currently available efficacy information about PDT and TII deals with short term follow-up periods. A 5-year follow-up must be awaited before drawing firm conclusions.
There are no demographic data published on those with viral infections of the pubis (VIPs). We conducted a two-year prospective study to collect demographic information on patients with VIPs. Data were gathered on age, sex, diagnosis, low (≤10) or high (>10) lesion number, symptoms, how the patient discovered the lesions, localization, lesions beyond the pubis, risk factors, shaving habits, human papillomavirus (HPV) vaccination status and treatment. In a total of 61 patients, molluscum contagiosum (MC) was identified in 71%, condylomata acuminata (CA) in 11%, concomitant MC and CA infections in 11% and herpes simplex virus (HSV) infection in 4.8%. Shaving represented a risk factor for a high lesion number, but not for the extension beyond the pubis. MC, CA and HSV infections affecting the pubis are uncommon and often asymptomatic. As they may represent a hidden source of infection we recommend thorough inspection of the pubis during routine skin examination.
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