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Cutaneous Candidiasis

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161. Nonneoplastic Epithelial Disorders of the Vulva (Overview)

eczema, or dry skin and is related 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 (...) , but evidence suggests that it is an immunologically 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

2014 eMedicine.com

162. Oral Examination (Overview)

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

163. Onychomycosis (Overview)

with marked periungual inflammation Features of EO are as follows: Milky white discoloration of the nail plate No evidence of subungual hyperkeratosis or onycholysis Features of candidal onychomycosis are as follows: Develops in patients with chronic mucocutaneous candidiasis or immunodepression Affects several or all digits Total onychomycosis associated with periungual inflammation The digits often take on a bulbous or drumstick appearance See for more detail. Diagnosis Direct microscopy of a 20 (...) to T rubrum infection is typical of immunosuppressed patients . Additionally, Proximal subungual onychomycosis with periungual inflammation is usually caused by molds White superficial onychomycosis is usually caused by T mentagrophytes; nondermatophyte molds cause deep white superficial onychomycosis. Candida albicans nail infection is observed in premature children, in immunocompromised patients, and in persons with chronic mucocutaneous candidiasis. Risk factors for onychomycosis include family

2014 eMedicine.com

164. Erythrasma (Overview)

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

165. Epididymitis (Overview)

. 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

166. Benign Vulvar Lesions (Follow-up)

eczema, or dry skin and is related 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 (...) , but evidence suggests that it is an immunologically 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

2014 eMedicine.com

167. Decubitus Ulcers (Follow-up)

, the wound care specialist must be alert to detect signs of antibiotic resistance, and he or she must be attentive to the results of the laboratory data, especially culture and sensitivity results. Patients who are immunocompromised or have impaired chemotaxis resulting in bacterial overgrowth or candidiasis need concomitant treatment with selected antimycotic or antifungal agents. Other considerations in prescribing an antibiotic include the patient’s length of hospital stay, the availability of home (...) paddle is harvested 10 cm in width and designed over muscle along axis from anterior superior iliac spine to lateral tibial condyle. The inferior limit of the cutaneous territory can be extended to 6 cm above the knee and 25-35 cm in length (see the image below). The lateral femoral circumflex artery can be found approximately 6-8 cm inferior to the ASIS. In patients with lumbar lesions, a sensate TFL flap can be designed to include the T12 dermatome by fashioning the flap to include the area 6 cm

2014 eMedicine Surgery

168. Severe Combined Immunodeficiency (Follow-up)

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 Pediatrics

169. Hemorrhagic Cystitis (Diagnosis)

products are inadvertently placed in the urethra. Gentian violet douching to treat candidiasis has resulted in hemorrhagic cystitis when the drug has been misplaced in the urethra, but this hemorrhagic cystitis has resolved spontaneously with cessation of treatment. [ , , ] Accidental urethral placement of contraceptive suppositories has also caused hemorrhagic cystitis in several patients. In this case, the bladder irritation was thought to be caused by contact of the acidic compound nonoxynol-9 (pH (...) cystitis in systemic lupus erythematosus. Pediatr Nephrol . 1998 Nov. 12(9):788-9. . Sarnak MJ, Long J, King AJ. Intravesicular formaldehyde instillation and renal complications. Clin Nephrol . 1999 Feb. 51(2):122-5. . Vicente J, Rios G, Caffaratti J. Intravesical formalin for the treatment of massive hemorrhagic cystitis: retrospective review of 25 cases. Eur Urol . 1990. 18(3):204-6. . Redman JF, Kletzel M. Cutaneous vesicostomy with direct intravesical application of formalin: management of severe

2014 eMedicine Pediatrics

170. 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 Pediatrics

171. Fungal Infections in Preterm Infants (Diagnosis)

infants (~10%); treatment should be for 7-14 days. For affected term infants, discussing the need for evaluation of the infant's immune system for a primary immunodeficiency may be indicated. Congenital cutaneous candidiasis An example of congenital cutaneous candidiasis is shown in the image below. Congenital cutaneous candidiasis in a 26-week-old infant. This usually manifests as an erythematous papulopustular rash. A diffuse, burnlike, erythematous, macular dermatitis with skin exfoliation is more (...) likely to manifest with blood, urine, or cerebrospinal fluid (CSF) involvement than with a papulopustular rash in patients of any gestational age. [ ] Extremely low birth weight (ELBW) infants (< 1000 g) with congenital cutaneous candidiasis are at greater risk of developing invasive fungal infection (66%) than LBW (33% in those 1000-2500 g) or term infants (11%). For this reason, all should be treated with systemic antifungal therapy. Mucocutaneous candidiasis: This manifests postnatally

2014 eMedicine Pediatrics

172. Diaper Dermatitis (Diagnosis)

Ointment in Neonates and Infants with Moderate to Severe Diaper Dermatitis Complicated by Cutaneous Candidiasis. Pediatr Dermatol . 2013 May 16. . Farahani LA, Ghobadzadeh M, Yousefi P. Comparison of the Effect of Human Milk and Topical Hydrocortisone 1% on Diaper Dermatitis. Pediatr Dermatol . 2013 Apr 22. . Martin E. Weisse Stephen C. Aronoff. Candida. Kliegman. Nelson Textbook of Pediatrics . 18th ed. Saunders; 2007. 231. Media Gallery A 3-week-old female infant with diaper rash. Satellite lesions (...) enzyme found in the stratum corneum liberates ammonia from cutaneous bacteria. Urease has a mild irritant effect on nonintact skin. Lipases and proteases in feces mix with urine on nonintact skin and cause an alkaline surface pH, adding to the irritation. (Feces in breastfed infants have a lower pH, and breastfed infants are less susceptible to diaper dermatitis.) [ ] The bile salts in the stools enhance the activity of fecal enzymes, adding to the effect. has been identified as another contributing

2014 eMedicine Pediatrics

174. Severe Combined Immunodeficiency (Follow-up)

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

175. Severe Combined Immunodeficiency (Follow-up)

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

176. Sjogren Syndrome (Follow-up)

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

177. Sjogren Syndrome (Follow-up)

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

178. Dermatologic Diseases of the Male Genitalia: Nonmalignant (Diagnosis)

Dermatologic Diseases of the Male Genitalia: Nonmalignant (Diagnosis) Nonmalignant Dermatologic Diseases of the Male Genitalia: Introduction, Definition of Terms, and Anatomy, Trichomycosis and Folliculitis, Balanoposthitis, Balanitis, and Candidiasis Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do (...) by urologists. For most of these conditions, the diagnosis can be ascertained through clinical history and presentation, but, on occasion, biopsy may be necessary. This review focuses on cutaneous diseases that are either specific to the male genitalia or frequently involve this body region. Topics in this article are divided into groups based on their initial clinical presentation and most common clinical appearance. The discussion focuses on diagnosis, treatment, and clinical outcome. Attempts are made

2014 eMedicine.com

179. Dermatologic Manifestations of Renal Disease (Diagnosis)

=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTA5NDg0Ni1vdmVydmlldw== processing > Dermatologic Manifestations of Renal Disease Updated: May 14, 2018 Author: Julia R Nunley, MD; Chief Editor: Dirk M Elston, MD Share Email Print Feedback Close Sections Sections Dermatologic Manifestations of Renal Disease Overview Overview Dermatologic manifestations of renal disease are not uncommon findings in patients with end-stage renal disease (ESRD). Cutaneous examination of patients with ESRD has shown that 50-100% of patients have at least 1 dermatologic condition (...) . A high prevalence of cutaneous disorders is expected, because most patients with ESRD have an underlying disease process with cutaneous manifestations. In addition, uremia and conditions associated with renal replacement therapy are fraught with numerous and, often, relatively unique cutaneous disorders. Consequently, dermatologic manifestations of renal disease may be divided into 3 general categories including: (1) dermatologic manifestations of diseases associated with the development of ESRD, (2

2014 eMedicine.com

180. Benign Vulvar Lesions (Diagnosis)

eczema, or dry skin and is related 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 (...) , but evidence suggests that it is an immunologically 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

2014 eMedicine.com

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