The extrathyroid manifestations of Graves disease (GD) include thyroid orbitopathy, dermopathy, and acropachy. Thyroid dermopathy (TD), also known as pretibial myxedema, classically presents as nonpitting edema or plaquelike lesions on the pretibial region, while thyroid acropachy (TA) is seen in cases of severe TD, characterized by soft tissue swelling and clubbing of fingers and toes, as well as a periosteal reaction of the bones of the hands and feet. Both TD and TA are rare manifestations of thyroid disease and uncommonly reported in pediatric patients. Our aim was to increase awareness of dermatological manifestations associated with pediatric GD and review the literature of pediatric thyroid dermopathy as well as report a case of acropachy in a child.
Background and Objectives We evaluated if oxymetazoline therapy combined with 595‐nm pulsed dye laser (PDL) will be more beneficial than topical oxymetazoline alone for the improvement of erythematotelangiectatic rosacea. Study Design/Materials and Methods This was a randomized, controlled, prospective clinical trial approved by an independent Institutional Review Board, which enrolled 34 patients with moderate to severe clinical erythema (CEA) into a two‐arm study of PDL with concomitant oxymetazoline cream (Arm 1) and oxymetazoline cream alone (Arm 2). Patients in Arm 1 were treated with 3 monthly laser sessions, which were started after 1 month of topical oxymetazoline cream. Thirty subjects continued with the study, and 25 subjects (Arm 1: 14, Arm 2: 11) completed the 6‐month follow‐up. With photographic comparison to baseline images, efficacy endpoints were based on clinical on‐site grading by both the investigator and the patient, using the grading tools for CEA, Global Aesthetic Improvement (GAI) assessment, vessel size improvement, and subject self‐assessment. These scales were assessed at baseline and/or at each clinical follow‐up at 1, 2, 3, and 6 months. Subject satisfaction as well as post‐treatment immediate response and treatment‐associated pain scores were also evaluated. Results Statistically significant improvement in CEA was seen in both arms at the 1‐, 2‐, and 3‐month post‐baseline visits (P < 0.01). Only Arm 1 presented statistically significant improvement in CEA (P < 0.001) at 6 months post baseline with a mean score of 1.6 (almost clear‐mild) compared with 3.2 at baseline. Arm 1 showed significantly greater mean vessel size improvement at 3 months (P < 0.01) and 6 months (P < 0.05) post baseline compared to Arm 2. Significantly greater improvement (P < 0.05) in the investigator GAI score was reported at the 2‐ and 6‐month follow‐ups compared with Arm 2. Subject GAI scores showed statistically significant greater improvement in Arm 1 compared with Arm 2 at both the 3‐ and 6‐month follow‐ups (P < 0.01). There were no complications or long‐term effects associated with PDL or topical oxymetazoline treatments. Conclusion The prospective trial verifies a safe, enhanced clinical outcome with the combination of PDL therapy and topical oxymetazoline for the treatment of erythematotelangiectatic rosacea patients. Lasers Surg. Med. © 2021 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.
This is the first reported case in which a corneal injury occurring during blepharoplasty with a heat-producing instrument did not result in postoperative vision loss. Furthermore, it exemplifies how pain and other complaints experienced by the patient during the procedure must be recognized by the surgeon. Moreover, if corneal lacerations occur, the cornea should immediately be irrigated with saline to minimize thermal injury. Therapeutic contact lenses should be available in the operating room during eyelid surgeries to be used in cases of corneal injuries. However, we believe this complication could have been prevented by the use of corneal shields during surgery, and therefore, we suggest the use of plastic and nonconductive corneal shields during all radiofrequency-assisted eyelid surgeries.
functioning as expected. In comparison, of the 5 patients with negative patch test results, 3 patients kept their devices, which demonstrated that the negative patch test result had important diagnostic value. The remaining patients had their devices extracted prior to testing, and reimplantation was not indicated.Discussion | This study included 11 patients who underwent cardiac implant patch testing. The majority of patients had history of erythema at the implant site. Concern for infection was common, and more than half of patients had devices extracted prior to presentation. Culture results, with 2 exceptions, were negative.More than half of the patients had relevant positive patch test results, and the most common allergens were metals, rubber accelerators, and silicone. Cardiac device allergy to metals, silicone-based components, and thiuram rubber accelerators has been published previously. 5 To our knowledge, there are previous reports of allergy to carbamate rubber accelerators, diphenylguanidine rubber accelerators, and lidocaine, though not in the setting of cardiac devices. The majority of patients with relevant positive patch test reactions underwent device extraction and successful reimplantation. In a majority of cases, electrophysiologists were able to avoid allergens. For those patients in which we have follow-up data, new cardiac devices were functioning well.One limitation of this study is the lack follow-up data for 2 subjects. In addition, the duration of follow-up was limited to a maximum of 36 months. Cardiac device allergy should be considered when there is clinical concern for infection, history of device extraction, history of erythema at the implant site, or negative culture results. When cases are identified, positive outcomes may be obtained when allergen-guided reimplantation is performed. Contact allergy to cardiac devices is an uncommon but important phenomenon.
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