Journal of the American Academy of Dermatology
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J. Am. Acad. Dermatol. · Nov 2000
Case ReportsNeutrophilic dermatosis of the dorsal hands: pustular vasculitis revisited.
An entity termed "pustular vasculitis of the hands" was recently described. Patients with this condition presented with low-grade fevers and erythematous plaques, pustules, and bullae limited to the dorsal hands and fingers, which were characterized histologically by a dense neutrophilic infiltrate and leukocytoclastic vasculitis. We describe patients with a similar clinical presentation, but who lacked vasculitis on biopsy findings. ⋯ Our 3 patients had clinical lesions similar to those termed pustular vasculitis of the hands, but which lacked leukocytoclastic vasculitis on biopsy findings. Because of histologic findings and a therapeutic response more characteristic of Sweet's syndrome, we propose the term neutrophilic dermatosis of the dorsal hands. In addition, low-dose dapsone is proposed as a possible first-line therapy in this condition, especially in those with recurrent disease.
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J. Am. Acad. Dermatol. · Nov 2000
A comparison of hourly block appointments with sequential patient scheduling in a dermatology practice.
There is significant demand for dermatologic care, and manpower is limited. Increasing patient encounters stress office processes. Analyses of the effects of schedule manipulation in a high-volume dermatology office have not been described. ⋯ Within the parameters of this study, block scheduling did not significantly affect patient waiting times. Block scheduling created more patient-free time for the physician and clinical staff than did sequential scheduling. Block scheduling increased the quality of the practice environment from the perspective of the physician and the staff.
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J. Am. Acad. Dermatol. · Oct 2000
The use of interferon alfa as adjuvant therapy for advanced cutaneous melanoma: the need for more evidence.
Interferon alfa is rapidly gaining acceptance as the standard of care for patients with advanced but nonmetastatic cutaneous malignant melanoma. The randomized trials of interferons for melanoma are reviewed with attention to any survival benefits demonstrated by these studies. Because none of these studies are placebo controlled, questions regarding the placebo effects interferons may possess are addressed, as is an analogous clinical scenario in which interferons appeared to be beneficial in nonplacebo controlled trials but were shown to be ineffective in placebo-controlled trials. Moreover, given the significant toxicities and financial costs of interferons, the argument is advanced that interferon alfa should not become the standard of care for melanomas until the results of randomized, placebo-controlled trials evaluating the survival advantages of interferon alfa for melanoma become available.
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J. Am. Acad. Dermatol. · Aug 2000
Case ReportsThe sign of Leser-Trélat in a case of adenocarcinoma of the lung.
This is what we believe to be the first report of the sign of Leser-Trélat in association with occult adenocarcinoma of the lung. The sign of Leser-Trélat is proposed as a sign of possible occult malignancy, despite various suggestions to the contrary. ⋯ In addition, we suggest a refinement of the definition of the sign of Leser-Trélat and discuss the use of "sign of Leser-Trélat" and "syndrome of Leser-Trélat" in relation to physical findings. All patients with the sign of Leser-Trélat should undergo a thorough evaluation for occult malignancy.
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J. Am. Acad. Dermatol. · Aug 2000
Case ReportsAll-trans-retinoic acid-induced scrotal ulcerations in a patient with acute promyelocytic leukemia.
Induction therapy with all-trans -retinoic acid has been shown to improve the outcome of patients with acute promyelocytic leukemia, although some side effects occur. Dry skin and lips are among the most common cutaneous side effects. We report a case of scrotal ulcerations induced by all-trans -retinoic acid in an American patient; to our knowledge this is the first such case reported.