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Cutaneous Candidiasis

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441. Uveitis, Classification (Overview)

macular edema) Delayed hypersensitivity skin testing for tuberculosis (purified protein derivative [PPD]), anergy for sarcoidosis ( Candida or mumps), and rarely histoplasmosis or coccidioidomycosis Electroretinogram (chloroquine toxicity, opaque media, birdshot choroidoretinopathy, retinitis pigmentosa, nonspecific) Electro-oculogram (diabetic retinopathy, siderosis retinae, vitiliginous maculopathy, shallow retinal pigment epithelial detachments) Vitrectomy (tumor, infection, antibody titer (...) assistance with cutaneous lesions) Rheumatology (diagnostic and therapeutic collaboration) Therapeutic tests See the list below: Tuberculosis systemic therapy Luetic systemic therapy Lyme disease systemic therapy Toxoplasmosis systemic therapy Antiviral systemic therapy Corticosteroid therapy (nonspecific) Diagnostic lens removal (phacoanaphylaxis) Invasive diagnostic testing See the list below: Diagnostic vitrectomy Aqueous paracentesis Vitreous tap Corneal biopsy Impression cytology Conjunctival biopsy

2014 eMedicine.com

442. Tinea Pedis (Overview)

rubrum , Trichophyton mentagrophytes, and Epidermophyton floccosum most commonly cause tinea pedis, with T rubrum being the most common cause worldwide. Trichophyton tonsurans has also been implicated in children. Nondermatophyte causes include Scytalidium dimidiatum , Scytalidium hyalinum , and, rarely, Candida species. Using enzymes called keratinases, dermatophyte fungi invade the superficial keratin of the skin, and the infection remains limited to this layer. Dermatophyte cell walls also contain (...) , which have no sebaceous glands. Host factors such as breaks in the skin and maceration of the skin may aid in dermatophyte invasion. The cutaneous presentation of tinea pedis is also dependent on the host's immune system and the infecting dermatophyte. Previous Next: Epidemiology Frequency Tinea pedis is thought to be the world's most common dermatophytosis. Reportedly, 70% of the population will be infected with tinea pedis at some time. Race Tinea pedis has no predilection for any racial or ethnic

2014 eMedicine.com

443. Benign Vulvar Lesions (Overview)

to a cutaneous hypersensitivity associated with defective cell-mediated immunity and immunoglobulin E overproduction. [ ] Although airborne and food allergens may generally play a role, because of their skin hypersensitivity, atopic individuals sometimes show vulvar symptoms as a result of irritation by personal hygiene products (eg, soaps, cleansers, lotions, perfumes, sanitary napkins). Seborrheic dermatitis The cause of seborrheic dermatitis is unknown. Seborrhea is evidently a substantial predisposing (...) mediated disorder. [ ] Some drugs have been found to induce lichen planus–type eruptions. [ ] Vulvar lesions may be more common than generally considered; a report found genital involvement in 51% of women with cutaneous disease. [ ] Involvement may sometimes be hypertrophic. [ ] Lupus erythematosus Lupus erythematosus is an idiopathic autoimmune disorder that can affect many organ systems. According to the degree of systemic involvement, the disease is classified into systemic, subacute, chronic

2014 eMedicine.com

444. Paraneoplastic Diseases (Follow-up)

differ Remote cutaneous manifestations should be specific to the tumor causing them Paraneoplastic syndromes should be uncommon relative to the prevalence of the cancer The paraneoplastic syndrome and the cancer should be demonstrably associated These criteria have remained valid but are perhaps overly stringent, because cancers are often difficult to detect and may exert subtle physiologic influence without their presence being known. Study of these syndromes has contributed to the understanding (...) of the effect of cancerous biology on the skin. [ ] This article focuses on cutaneous paraneoplastic syndromes caused by solid tumors. A wide range of cutaneous signs may be related to internal malignancy. These include the following: Metastasis - Eg, leukemia cutis, cutaneous T-cell lymphoma, and Paget disease of the breast Nonspecific metabolic effects related to inanition - Eg, wasting, alopecia, and xerosis Infections related to immunosuppression [ ] - Eg, herpes zoster Signs resulting from compromise

2014 eMedicine.com

445. Oral Manifestations of Systemic Diseases (Follow-up)

, 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

446. Oral Manifestations of Drug Reactions (Follow-up)

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

447. Paracoccidioidomycosis (Follow-up)

, ketoconazole) for oropharyngeal candidiasis prophylaxis in HIV-infected patients may aid in the reduction in disseminated paracoccidioidomycosis. AIDS is seen primarily in urban areas, whereas paracoccidioidomycosis is found mainly in rural areas, possibly contributing to the fact that the rate of paracoccidioidomycosis occurrence is lower than expected. The paracoccidioidin skin test is frequently negative in infected patients with AIDS. Supportive care Supportive care among patients (...) American blastomycosis) successfully treated with terbinafine: first case report. Br J Dermatol . 2000 Jul. 143(1):188-91. . Media Gallery Approximate distribution of paracoccidioidomycosis in North, Central, and South America, based on case reports. Granulomatous lesion involving the nose in patient with paracoccidioidomycosis; note the resemblance to cutaneous leishmaniasis. Potassium hydroxide (KOH) preparation from pus; note the multiple budding and variation in cell size with Paracoccidioides

2014 eMedicine.com

448. Ocular Manifestations of HIV (Follow-up)

in HIV-positive patients. Keratitis due to VZV usually is associated with herpes zoster ophthalmicus, with or without the presence of dermatitis. In HIV-infected patients, compared with the general population, VZV and HSV keratitis tend to reoccur more often, and they may be resistant to treatment. [ , ] Bacterial and fungal keratitis are not more frequent in HIV patients, but these infections tend to be more severe. The most common organism is Candida , especially in intravenous drug users (...) infection (ie, chickenpox) is spread by airborne respiratory droplets that contain the virus or by direct contact with cutaneous lesions. It is extremely contagious to susceptible individuals. VZV primary infection usually develops during childhood, and the disease tends to be mild and self-limited. VZV keratitis occurs in fewer than 5% of patients who are HIV positive, but it may cause permanent visual loss. The prevalence of VZV keratitis is higher in HIV-infected patients than in the general US

2014 eMedicine.com

449. Oral Examination (Follow-up)

can also be taken; however, more cost-effective diagnostic procedures are available. Bacterial cultures are of limited value. Fungal cultures Fungal cultures are not obtained routinely. A positive culture for Candida albicans (normally present in 20-30% of the population anyway) is indicative of carriage rather than candidal infection. [ ] As such, a fungal culture is usually not indicated for patients where a diagnosis of candidiasis has been already made clinically. Fungal culture (...) ; however, more cost-effective diagnostic procedures are available. Bacterial cultures are of limited value. Latex agglutination–based diagnostic tests for Candida albicans have been available for use in gynecology for several years. While not specifically marketed for use in the diagnosis of oral candidiasis, such tests have proven to be very accurate, easy to use, and cost effective. of 25 Tables Contributor Information and Disclosures Author Alessandro Villa, DDS, PhD, MPH Instructor, Department

2014 eMedicine.com

450. Onychomycosis (Follow-up)

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 (...) Dermatol . 2004 Jun. 140(6):696-701. . Tosti A, Piraccini BM, Lorenzi S. Onychomycosis caused by nondermatophytic molds: clinical features and response to treatment of 59 cases. J Am Acad Dermatol . 2000 Feb. 42(2 Pt 1):217-24. . Tosti A, Piraccini BM, Lorenzi S, Iorizzo M. Treatment of nondermatophyte mold and Candida onychomycosis. Dermatol Clin . 2003 Jul. 21(3):491-7, vii. . Tosti A, Piraccini BM, Stinchi C, Colombo MD. Relapses of onychomycosis after successful treatment with systemic antifungals

2014 eMedicine.com

451. Paronychia (Follow-up)

. J Hand Surg Am . 2013 Jun. 38(6):1189-93. . van Diepeningen AD, Feng P, Ahmed S, Sudhadham M, Bunyaratavej S, de Hoog GS. Spectrum of Fusarium infections in tropical dermatology evidenced by multilocus sequencing typing diagnostics. Mycoses . 2015 Jan. 58 (1):48-57. . Bahunuthula RK, Thappa DM, Kumari R, Singh R, Munisamy M, Parija SC. Evaluation of role of Candida in patients with chronic paronychia. Indian J Dermatol Venereol Leprol . 2015 Sep-Oct. 81 (5):485-90. . Masago K, Irie K, Fujita S (...) , Imamichi F, Okada Y, Katakami N, et al. Relationship between Paronychia and Drug Concentrations of Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors. Oncology . 2018. 95 (4):251-256. . Hamid RN, Ahn CS, Huang WW. Adverse Cutaneous Effects of Neratinib. J Dermatolog Treat . 2018 Oct 15. 1-8. . Tomková H, Kohoutek M, Zábojníková M, Pospísková M, Ostrízková L, Gharibyar M. Cetuximab-induced cutaneous toxicity. J Eur Acad Dermatol Venereol . 2010 Jun. 24(6):692-6. . Coquart N, Karam A, Metges JP

2014 eMedicine.com

452. Psoriasis, Plaque (Follow-up)

hypervascularity and an increase in the size of the dermal papillae occur. An activated CD3 + lymphocytic infiltrate is noted around blood vessels, with T cells expressing cutaneous lymphocyte–associated antigen, co-stimulatory molecules such as CD2, and lymphocyte function-associated antigen–1 (LFA-1) adhesion molecules. An aggregation of neutrophils in the dermis occurs that extends up into the epidermis. Previous Next: Overview of Treatment Plaque psoriasis is a chronic skin condition. Any approach (...) . Because of the expense of the home units, it is most suitable for patients who require long-term maintenance therapy. PUVA photochemotherapy, also known as PUVA, uses the photosensitizing drug methoxsalen (8-methoxypsoralen) in combination with UVA irradiation to treat patients with more extensive disease. UVA irradiation uses light with wavelengths of 320-400 nm. PUVA interferes with DNA synthesis, decreases cellular proliferation, and induces apoptosis of cutaneous lymphocytes, leading

2014 eMedicine.com

453. Psoriasis, Guttate (Follow-up)

attributed to them are not as frequent as those attributed to streptococci. Associated organisms include the following: Bacteria - Staphylococcus aureus Fungi - Malassezia, Candida Viruses – Human papillomavirus (HPV), varicella-zoster virus, [ ] retroviruses, human endogenous retroviruses (HERVs) [ ] Drug therapy, including biologic agents, may sometimes precipitate a guttate-type flare. The most commonly implicated medications include lithium, beta-blockers, antimalarial drugs, and nonsteroidal anti (...) response to PUVA via increased mast cell activation has been observed in guttate psoriasis and might underlie the mechanism of action behind UV-induced resolution of the lesions. However, considering the developments in photomedicine over the last several years, particularly regarding the clinical efficacy of narrowband UV-B phototherapy, versus the risk of cutaneous malignancies with PUVA, treatment with narrowband UV-B is favored over treatment with PUVA. Previous Next: Additional Therapies Vitamin D

2014 eMedicine.com

454. Intertrigo (Follow-up)

concepts. Pediatrics . 1980 Oct. 66(4):532-6. . English JC 3rd, Derdeyn AS, Wilson WM, Patterson JW. Axillary granular parakeratosis. J Cutan Med Surg . 2003 Jul-Aug. 7 (4):330-2. . Hahler B. An overview of dermatological conditions commonly associated with the obese patient. Ostomy Wound Manage . 2006 Jun. 52(6):34-6, 38, 40 passim. . American Academy of Family Physicians. Information from your family doctor. Intertrigo: what you should know. Am Fam Physician . 2005 Sep 1. 72(5):840. . Guitart J (...) dermatitis: a randomized, controlled study. J Eur Acad Dermatol Venereol . 2010 Sep. 24(9):1094-8. . Kalra MG, Higgins KE, Kinney BS. Intertrigo and secondary skin infections. Am Fam Physician . 2014 Apr 1. 89 (7):569-73. . Holdiness MR. Management of cutaneous erythrasma. Drugs . 2002. 62 (8):1131-41. . Dogan B, Karabudak O. Treatment of candidal intertrigo with a topical combination of isoconazole nitrate and diflucortolone valerate. Mycoses . 2008 Sep. 51 Suppl 4:42-3. . Martin Ezquerra G, Sanchez

2014 eMedicine.com

455. Kaposi Sarcoma (Follow-up)

in iatrogenically immunosuppressed patients. Indolent skin tumors in elderly white patients may not require specific therapy early in the course of the disease; however, systemic vinblastine (or other chemotherapy) attacks both cutaneous and visceral lesions. Localized nodular disease may respond well to surgical excision, radiotherapy, and intralesional and outpatient low-dose vinblastine chemotherapy. The latter combination of local and systemic regimens may be preferable. The authors usually inform patients (...) infection. [ ] Pegylated liposomal doxorubicin is now being used as a second-line therapy in the treatment of patients with advanced classic Kaposi sarcoma. [ ] Limited experience for classic and HIV-related cutaneous Kaposi sarcoma treated with 0.1% topical timolol gel has shown that it can be beneficial. [ ] Radiotherapy is an option for some Kaposi sarcoma patients. Radiotherapy often produces good therapeutic results with classic nodular Kaposi sarcoma but tends to be only palliative in patients

2014 eMedicine.com

456. Job Syndrome (Follow-up)

by the intravenous administration of antibiotics are used for cutaneous infections. Coverage is usually aimed at Staphylococcus and Haemophilus species. Acupuncture treatment has been reported to be of value for symptom management of patients with hyper-IgE syndrome, although further studies are required for confirmation. [ ] Job syndrome therapy is usually longer than typical treatment because the disease in these patients responds more slowly than that of patients without Job syndrome. Intravenous antibiotic (...) . [ ] Other patients treated with prophylactic antibiotics had both minor and major infections during therapy, often after several months of being infection free. Cases in patients with severe hyper-IgE syndrome whose disease was unresponsive to other therapeutic modalities are reported; these cases had a marked clinical response to cyclosporin A. Treatment included low-dose cyclosporin for 6 months or longer. Both cutaneous and pulmonary infections responded to this therapy, and no adverse effects were

2014 eMedicine.com

457. Laser Revision of Scars (Follow-up)

scarring can result. Although pigment and vascular alterations are often transient in nature, [ ] textural changes caused by collagen disruption can be permanent, particularly in the case of keloid scarring. [ ] The wound-healing process is divided into 3 sequential yet overlapping stages known as inflammation, granulation, and remodeling. [ ] The initial stage is characterized by a response to cutaneous injury involving inflammatory cells. [ ] Neutrophils are the first cells present in an injury (...) to arise in sites subjected to increased pressure or movement. [ ] Despite obvious tissue proliferation, hypertrophic scars remain within the confines of the original integumental injury, in distinction to keloid scars, which extend beyond the original cutaneous injury. [ ] Unlike keloids, which tend to persist indefinitely, hypertrophic scars may regress spontaneously. [ ] This pathologic scarring is more common than keloid scaring. Seethe image below. Erythematous and hypertrophic laceration scars

2014 eMedicine.com

458. Leukoplakia, Oral (Follow-up)

disorders of the oral mucosa. J Oral Pathol Med . 2007 Nov. 36(10):575-80. . Nico MM, Hammerschmidt M, Lourenço SV. Oral mucosal manifestations in some genodermatoses: correlation with cutaneous lesions. Eur J Dermatol . 2013 Sep-Oct. 23 (5):581-91. . Bouquot JE, Weiland LH, Kurland LT. Leukoplakia and carcinoma in situ synchronously associated with invasive oral/oropharyngeal carcinoma in Rochester, Minn., 1935-1984. Oral Surg Oral Med Oral Pathol . 1988 Feb. 65(2):199-207. . Napier SS, Speight PM (...) consumption high Alcohol consumption high Marijuana consumption mild/moderate UV light exposure high Early sexual debut Numerous lifetime sexual partners Medical History Clear Deficiencies of iron or vitamins A, C, or E Diabetes Discoid lupus erythematosus Dyskeratosis congenita Epidermolysis bullosa Fanconi anemia High-risk human papillomavirus infection Immune defects, including HIV/AIDS or chronic candidosis Medications: Immunosuppressants, antihypertensives Periodontitis, poor hygiene Plummer-Vinson

2014 eMedicine.com

459. Leukemia Cutis (Follow-up)

therapy can be used. However, in most of these cases, reinduction systemic chemotherapy must be added unless medically contraindicated by the patient's comorbidity. In general, most patients on chemotherapy should receive prophylaxis for common infectious agents, including herpes simplex virus (HSV), Candida species, and P carinii . They should also receive symptomatic treatment for mucocutaneous complications of chemotherapy. These treatments include ketoconazole troches (for thrush) and viscous (...) clinical outcome. Leukemia Research . 2004. 28:1007-1011. . Assaf C, Gellrich S, Whittaker S, Robson A, Cerroni L, Massone C, et al. CD56-positive haematological neoplasms of the skin: a multicentre study of the Cutaneous Lymphoma Project Group of the European Organisation for Research and Treatment of Cancer. J Clin Pathol . 2007 Sep. 60(9):981-9. . . Diaz-Cascajo C, Bloedern-Schlicht N. Cutaneous infiltrates of myelogenous leukemia in association with pre-existing skin diseases. J Cutan Pathol . 1998

2014 eMedicine.com

460. Herpes Simplex (Follow-up)

Bacterial and fungal superinfections Bacterial and fungal superinfections are not uncommon. can occur in an uncircumcised male as a result of bacterial infection of the herpetic ulcers. Candidal has been described in as many as 10% of women with primary genital herpes, particularly in women with diabetes. Care should be taken to confirm the diagnosis of candidiasis, as ulcerative herpetic disease can have whitish mucosal lesions that can be confused with . Ocular infections This complication (...) be associated with progressive scarring of the cornea. HSV has been the leading infectious cause of blindness in the United States. Skin infections Various cutaneous complications related to HSV can occur. : This occurs in individuals with underlying dermatitis and may be localized (which can be confused with herpes zoster) or disseminated. The process can also occur in patients with extensive skin breakdown as with burns, , or Sézary syndrome. Herpetic whitlow: HSV infections of the fingers occur

2014 eMedicine.com

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