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Cutaneous Candidiasis

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181. Vulvovaginitis (Diagnosis)

: Jill M Krapf, MD, FACOG; Chief Editor: Christine Isaacs, MD Share Email Print Feedback Close Sections Sections Vulvovaginitis Overview Practice Essentials Vulvovaginitis is a general term referring to many types of vaginal infection, although this article focuses on the following disorders, which affect the vulvar region: Vulvovaginal candidiasis Atrophic vaginitis Vulvar vestibulitis Contact dermatitis Signs and symptoms Acute vulvovaginal candidiasis Vulvar pruritus and burning - Primary symptoms (...) of the disease Erythema and edema of the vestibule and of the labia majora and minora Thrush patches - Usually found loosely adherent to the vulva Thick, white, curdlike vaginal discharge Chronic vulvovaginal candidiasis Marked edema and lichenification of the vulva with poorly defined margins Grayish sheen made up of epithelial cells and organism covering the area Severe pruritus and burning Irritation and pain Atrophic vaginitis Vaginal soreness Postcoital burning Dyspareunia Burning leukorrhea Occasional

2014 eMedicine.com

182. Acne Vulgaris (Follow-up)

, less drug-related adverse events were found with the 40-mg subantimicrobial dosing. Enteric-coated, delayed-release formulations of doxycycline can further reduce gastrointestinal adverse effects. [ ] Oral antibiotic use can lead to vaginal candidiasis; doxycycline can be associated with photosensitivity; and minocycline has been linked to pigment deposition of the skin, mucous membranes, and teeth. [ ] The emergence of antibiotic-resistant bacteria, other than C acnes (formerly P acnes (...) . Available at . December 14, 2017; Accessed: December 15, 2017. Sutcliffe S, Giovannucci E, Isaacs WB, Willett WC, Platz EA. Acne and risk of prostate cancer. Int J Cancer . 2007 Dec 15. 121 (12):2688-92. . Housman E, Reynolds RV. Polycystic ovary syndrome: a review for dermatologists: Part I. Diagnosis and manifestations. J Am Acad Dermatol . 2014 Nov. 71 (5):847.e1-847.e10; quiz 857-8. . Schmidt TH, Khanijow K, Cedars MI, Huddleston H, Pasch L, Wang ET, et al. Cutaneous Findings and Systemic

2014 eMedicine.com

183. Verrucous Carcinoma (Diagnosis)

, 2017 Author: Jennifer Shuley Ruth, MD; Chief Editor: William D James, MD Share Email Print Feedback Close Sections Sections Verrucous Carcinoma Overview Background Verrucous carcinoma is a relatively uncommon, locally aggressive, clinically exophytic, low-grade, slow-growing, well-differentiated with minimal metastatic potential. Verrucous carcinoma may involve the oral cavity, larynx, anogenital region, plantar surface of the foot, and, less commonly, other cutaneous sites. See the image below (...) . Verrucous carcinoma; an exophytic and hyperkeratotic mass that discharged malodorous debris through several sinus tracts. Courtesy of J García-Gavín, D González-Vilas, L Rodríguez-Pazos, D Sánchez-Aguilar, and J Toribio, via Wikimedia Commons. In 1948, Ackerman first described verrucous carcinoma in the oral cavity as a low-grade tumor that generally is considered a clinicopathologic variant of . [ ] Aird et al first described cutaneous verrucous carcinoma (carcinoma cuniculatum) in 1954

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2014 eMedicine.com

184. Filariasis (Diagnosis)

malayi, Brugia timori, Onchocerca volvulus, and Loa loa . All of these cause cutaneous manifestations. Filarial worms of the genus Dirofilaria and zoonotic Onchocerca species, normally parasitic in animals, occasionally enter a human host and undergo partial or aberrant development. These may cause cutaneous or subcutaneous manifestations. Another filarial nematode, Mansonella genus , is also a public health threat. Related Medscape articles include and . Next: Onchocerciasis Onchocerciasis is caused (...) , superficial ulceration, and secondary infection can occur (see the images below). Pruritus is most severe over the lower trunk, pelvis, buttocks, and thighs. Classically, it is confined to one anatomic quarter of the body. Bleeding on skin from scratching itchy skin of onchodermatitis. One anatomic quarter of body (leg) markedly affected by edema and papule formation of onchodermatitis. The most distinctive cutaneous finding is a firm, mobile, subcutaneous nodule termed an onchocercoma. They are typically

2014 eMedicine.com

185. Down Syndrome (Diagnosis)

from control subjects were pointed out in 1939. In 1959, a chromosomal abnormality was proven to cause Down syndrome. [ ] Cutaneous manifestations of Down syndrome include the following: Soft and velvety skin in early childhood Dry skin in late childhood - Xerosis (70%), atopic dermatitis (50%), palmoplantar hyperkeratosis (40-75%), and seborrheic dermatitis (31%) Premature wrinkling of the skin, cutis marmorata, and acrocyanosis Bacteria infections, fungal infections (tinea), and ectoparasitism (...) from tumors. Unusual forms of elastosis perforans serpiginosa are noted in patients with Down syndrome. The onset of skin lesions is during the second decade of life. Both sexes are affected, with an increased prevalence in males. The male-to-female ratio is 4:1. Cutaneous lesions are more extensive, and the duration of the condition is longer, 10 years or more versus 5 years in the idiopathic type. Keratotic papules often coalescence to form an arcuate or serpiginous pattern. Lesions heal

2014 eMedicine.com

186. Drug Eruptions (Diagnosis)

and who suddenly develops a symmetric cutaneous eruption. Morbilliform eruption localized to striae has been described with clindamycin. [ ] Morbilliform drug eruption. Signs and symptoms The first steps in the history are as follows: Review the patient’s complete medication list, including prescription and over-the-counter drugs Document any history of previous adverse reactions to drugs or foods Consider alternative etiologies (eg, viral exanthems and bacterial infections) Note any concurrent (...) and who suddenly develops a symmetric cutaneous eruption. Medications that are known for causing cutaneous reactions include antimicrobial agents, [ ] nonsteroidal anti-inflammatory drugs (NSAIDs), cytokines, chemotherapeutic agents, anticonvulsants, and psychotropic agents. Prompt identification and withdrawal of the offending agent may help limit the toxic effects associated with the drug. The decision to discontinue a potentially vital drug often presents a dilemma. Previous Next: Pathophysiology

2014 eMedicine.com

187. Dyshidrotic Eczema (Diagnosis)

of dyshidrotic eczema can range from self-limited to chronic, severe, or debilitating. The condition's unresponsiveness to treatment can be frustrating for the patient and physician (see the images below). Tense vesicles and bullae on the palm. Courtesy of Norman Minars, MD, University of Miami, Department of Dermatology & Cutaneous Surgery. Multiple tense vesicles on the palm. Some believe the terms pompholyx and dyshidrosis are obsolete and favor a new term, such as "acute and recurrent vesicular hand (...) leukocyte antigen–independent pathways, causing systemic allergic dermatitis in the form of dyshidrotic eczema. [ , ] Emotional stress [ ] and environmental factors (eg, seasonal changes, hot or cold temperatures, humidity) reportedly exacerbate dyshidrosis. Dyshidrosislike eczematous eruptions with the use of intravenous immunoglobulin (IVIG) infusions have been reported. A 2011 search of the literature identified pompholyx as one of the most important cutaneous adverse effects of IVIG, being present

2014 eMedicine.com

188. Epididymitis (Diagnosis)

. Go to for complete information on emergent management of epididymitis. Complications Complications associated with acute epididymitis and bacterial orchitis include the following: Scrotal abscess and pyocele Testicular infarction: Cord swelling can limit testicular artery blood flow Fertility problems Testicular atrophy Cutaneous fistulization from rupture of an abscess through the tunica vaginalis (seen especially in tuberculosis) Recurrence, chronic epididymitis, and orchialgia With regard (...) bacillus Calmette-Guérin (BCG) treatment for superficial bladder cancer (at a rate of 0.4%). Viral epididymitis is thought to be the predominant etiology of pediatric epididymitis. It is defined by the absence of pyuria. Although mumps is the most common viral cause of epididymitis, coxsackievirus A, varicella, and echoviral infections have also been identified. Other rare infections (eg, brucellosis, [ ] coccidioidomycosis, blastomycosis, cytomegalovirus [CMV], candidiasis, CMV in human

2014 eMedicine.com

189. Erythrasma (Diagnosis)

cutaneous barrier Obesity Diabetes mellitus Warm climate Poor hygiene Advanced age Other immunocompromised states Previous Next: Epidemiology Frequency The incidence of erythrasma is reported to be around 4%. This infection is observed all over the world; the widespread form is found more frequently in the subtropical and tropical areas than in other parts of the world. [ ] In a study conducted in Turkey, the rate of erythrasma was found to be 46.7% among 122 patients with interdigital foot lesions (...) catheter–related infections (2 cases), [ , ] endocarditis (2 cases), [ , ] pyelonephritis (2 cases), [ , ] cellulitis (1 case), [ ] endophthalmitis (1 case), [ ] arteriovenous fistula infection (1 case), cutaneous granuloma (1 case), [ ] and meningitis (1 case). [ ] The first case of postoperative intraabdominal infection caused by Corynebacterium minutissimum in an immunocompetent adult host was reported and has been successfully treated with intravenous amoxicillin/sulbactam. [ ] Previous Next

2014 eMedicine.com

190. Combined B-Cell and T-Cell Disorders (Diagnosis)

100,000; in Sweden, 2.43 of every 100,000 live births. [ ] Mortality/Morbidity SCID is a devastating disease with a high risk of early death in infancy or childhood: a large number of patients die during their first year of life, and most do not survive beyond their second year. The condition is notable for recurrent and common infections (eg otitis media, diarrhea, mucocutaneous candidiasis). Moreover, if infants are not diagnosed by age 6 months, opportunistic infections follow, especially (...) combined immunodeficiency. Medscape Reference. Updated August 21, 2006. . Bonilla FA, Geha RS. 2. Update on primary immunodeficiency diseases. J Allergy Clin Immunol . 2006 Feb. 117(2 suppl mini-primer):S435-41. . Cachafeiro T, Escobar G, Bakos L, Bakos R. Chronic cutaneous cytomegalovirus infection in a patient with severe combined immunodeficiency syndrome. Br J Dermatol . 2013 Sep 6. . Kwan A, Puck JM. History and current status of newborn screening for severe combined immunodeficiency. Semin

2014 eMedicine.com

191. Rhinocerebral Mucormycosis (Treatment)

posaconazole is superior to amphotericin B is still being studied. [ , ] Isavuconazole (Cresemba), another azole antifungal, has also been reported to be efficacious in the treatment of rhinocerebral mucormycosis that is refractory to amphotericin B and posaconazole. [ ] In March 2015, it was approved by the FDA for invasive mucormycosis infections caused by Mucorales fungi (eg, Rhizopus oryzae , Mucormycetes species). [ ] Although specifically approved for the treatment of aspergillosis and candidiasis (...) impaired aspergillosis and rare fungi. NLM identifier: NCT00634049. ClinicalTrials.gov. Available at . Accessed: April 2, 2015. Media Gallery Clinical view of the face of a patient with rhinocerebral mucormycosis. Notice the cutaneous hemorrhagic ulcer on the right anterior cheek resulting from perforation of the fungus through the sinus cavity. A cotton blue preparation of Rhizopus species. A tissue hematoxylin and eosin stain of Rhizopus species. The appearance of a culture slant of Rhizopus species

2014 eMedicine.com

192. Teratology and Drug Use During Pregnancy (Treatment)

, short maxillary bones) occurred in rabbits at the high dosage of 1 mg/kg/d, which was also maternally toxic. Fluconazole (Diflucan) Old categorization: Pregnancy category - C (single dose); D (multiple doses) Risk summary: Trimester of risk – First. Associated defects and complications - Craniofacial, skeletal, and cardiac effects Data: Available human data do not suggest an increased risk of congenital anomalies following a single maternal dose of 150 mg (Diflucan, Pfizer) for vaginal candidiasis

2014 eMedicine.com

193. Oral Manifestations of Systemic Diseases (Treatment)

, with resultant increased risk for candidiasis and periodontal disease. [ ] Histologic analysis reveals a lichenoid mucositis with an inflammatory infiltrate, primarily composed of T cells. [ ] The basement membrane zone has linear deposits of IgG and C3 visualized by direct immunofluorescence. [ ] A form of lupus known as discoid lupus erythematous is limited to the skin and mucous membranes. Oral manifestations appear with cutaneous lesions and are clinically and histologically similar to oral lichen planus (...) coincide with exacerbations of the colonic disease. Lesions in the colon consist of areas of hemorrhage and ulceration, along with abscesses. Cutaneous involvement consists of similar ulcerations that may arise on the buttocks, abdomen, thighs, and face, although in rare cases patients may develop pyoderma vegetans. [ , ] In the oral cavity, aphthous ulcers or angular stomatitis occurs in as many as 5-10% of patients, although hemorrhagic ulcers can occur. [ ] Rarely, patients can develop pyostomatitis

2014 eMedicine.com

194. Oral Manifestations of Drug Reactions (Treatment)

patients, especially those who also present with xerophthalmia (ie, dry eyes) or evidence of parotid swelling. Appropriate laboratory studies or biopsy of the labial minor salivary glands or parotid glands may be helpful in establishing or excluding an autoimmune etiology. Importantly, patients with xerostomia are also at increased risk for oral candidiasis, a superficial infection that may cause mucosal sensitivity or discomfort, as well as tooth decay that usually affects the cervical (gumline (...) ) and root surfaces. Cultures and oral cytologic tests can be useful in assessing possible cases of xerostomia-associated candidiasis. Meticulous oral hygiene, regular dental checkups, and the use of topical fluoride rinses are recommended to reduce the risk of dental decay. Previous Next: Swelling Several drugs can induce type I hypersensitivity reactions, or disease mediated by immunoglobulin E mast cells, that can range from isolated swelling of the oral tissues to full-blown anaphylaxis. Around

2014 eMedicine.com

195. Oral Examination (Treatment)

has been described in dry mouth or syndromic patients (e.g., ); however, the presence of fissuring is of no clinical significance in the vast majority of cases. Atrophy of the dorsal surface of the tongue can be secondary to nutritional deficiencies, some medications (e.g., hydroxyurea), erythematous candidiasis and other mucocutaneous diseases. In addition to discomfort, patients often report altered taste sensations. Foliate papillae are structures present on the posterolateral aspect (...) to the presence of cutaneous pigmentation; however, alveolar mucosa is rarely pigmented (see the third image below). The attached gingiva adjacent to the teeth is keratinized and tightly bound to bone. Healthy gingiva is stippled and resembles citrus rind (peau d' orange). The alveolar mucosa extends from the mucogingival junction to cover the mucobuccal fold. It is not keratinized and often appears darker than the alveolar mucosa. Persons of color frequently have intraoral pigmentation, including

2014 eMedicine.com

196. Onychomycosis (Treatment)

with chronic mucocutaneous candidiasis. Total onychomycosis and paronychia. Image courtesy of Dr Antonella Tosti. Dermoscopy of distal subungual onychomycosis showing irregular margin of the onycholytic area with spikes projecting into the proximal nail plate, reported as the "aurora borealis" pattern. Handyscope at 20X. of 6 Tables Contributor Information and Disclosures Author Antonella Tosti, MD Professor of Dermatology, Department of Dermatology and Cutaneous Surgery, University of Miami, Leonard M

2014 eMedicine.com

197. Sjogren Syndrome (Treatment)

irritation in patients with Sjögren syndrome. Brands include Biotene toothpaste, Biotene mouth rinse, Dental Care toothpaste, and Oral Balance gel. Watch for oral candidiasis and angular cheilitis and treat them with topical antifungal agents, such as nystatin troches. Oral fluconazole may occasionally be needed. Patients also need to be sure to disinfect their dentures. Sinusitis and sinus blockade should be treated because these problems may contribute to mouth breathing. Emphasize the use of isotonic (...) sodium chloride solution nasal sprays to avoid antihistamine use. Pilocarpine or cevimeline tablets are options. Some small studies suggest that interferon alfa may be a useful therapy in the future. Previous References Rischmueller M, Tieu J, Lester S. Primary Sjögren's syndrome. Best Pract Res Clin Rheumatol . 2016 Feb. 30 (1):189-220. . Kittridge A, Routhouska SB, Korman NJ. Dermatologic manifestations of Sjögren syndrome. J Cutan Med Surg . 2011 Jan-Feb. 15(1):8-14. . Vitali C, Bombardieri S

2014 eMedicine.com

198. Sjogren Syndrome (Treatment)

irritation in patients with Sjögren syndrome. Brands include Biotene toothpaste, Biotene mouth rinse, Dental Care toothpaste, and Oral Balance gel. Watch for oral candidiasis and angular cheilitis and treat them with topical antifungal agents, such as nystatin troches. Oral fluconazole may occasionally be needed. Patients also need to be sure to disinfect their dentures. Sinusitis and sinus blockade should be treated because these problems may contribute to mouth breathing. Emphasize the use of isotonic (...) sodium chloride solution nasal sprays to avoid antihistamine use. Pilocarpine or cevimeline tablets are options. Some small studies suggest that interferon alfa may be a useful therapy in the future. Previous References Rischmueller M, Tieu J, Lester S. Primary Sjögren's syndrome. Best Pract Res Clin Rheumatol . 2016 Feb. 30 (1):189-220. . Kittridge A, Routhouska SB, Korman NJ. Dermatologic manifestations of Sjögren syndrome. J Cutan Med Surg . 2011 Jan-Feb. 15(1):8-14. . Vitali C, Bombardieri S

2014 eMedicine.com

199. Severe Combined Immunodeficiency (Treatment)

a detailed search for infectious agents. Empiric broad-spectrum antibiotics should be administered parenterally during the wait for the results of cultures and body fluid analysis. Consider prophylactic treatment with nystatin to prevent mucocutaneous candidiasis. SCID is a pediatric emergency and must be addressed expeditiously. Intravenous immunoglobulin (IVIg) should be administered promptly, and evaluation for bone marrow transplantation (BMT) should be started. Patients with SCID who are treated (...) : , , , , and Disclosure: Nothing to disclose. Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose. Henry K Wong, MD, PhD Associate Professor of Dermatology, Ohio State University College of Medicine Henry K Wong, MD, PhD is a member of the following medical societies: , , International Society for Cutaneous Lymphomas, and Disclosure: Amgen Consulting fee Speaking and teaching; Centocor

2014 eMedicine.com

200. Severe Combined Immunodeficiency (Treatment)

a detailed search for infectious agents. Empiric broad-spectrum antibiotics should be administered parenterally during the wait for the results of cultures and body fluid analysis. Consider prophylactic treatment with nystatin to prevent mucocutaneous candidiasis. SCID is a pediatric emergency and must be addressed expeditiously. Intravenous immunoglobulin (IVIg) should be administered promptly, and evaluation for bone marrow transplantation (BMT) should be started. Patients with SCID who are treated (...) : , , , , and Disclosure: Nothing to disclose. Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose. Henry K Wong, MD, PhD Associate Professor of Dermatology, Ohio State University College of Medicine Henry K Wong, MD, PhD is a member of the following medical societies: , , International Society for Cutaneous Lymphomas, and Disclosure: Amgen Consulting fee Speaking and teaching; Centocor

2014 eMedicine.com

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