Dermatologic clinics
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Dermatologic clinics · Apr 2010
ReviewSurgery of the hand in recessive dystrophic epidermolysis bullosa.
The underlying genetic abnormalities of epidermolysis bullosa (EB) cause destabilization at the dermo-epidermal junction. Patients with EB characteristically are subject to blistering following relatively minor trauma (the Nikolsky sign), and suffer from ulcers and erosions in all areas subject to persistent or repeated friction, such as the hand. Hand deformities occur in most patients with dystrophic EB (DEB), and include adduction contractures of the first web space, pseudosyndactyly, and flexion contractures of the interphalangeal, metacarpophalangeal, and wrist joints. ⋯ Recurrent deformity occurs within 2 to 5 years. Meticulous skin care and the use of well-fitted splints supervised within a multidisciplinary team setting are essential. To date there is no strong evidence base on which to plan surgical treatment of the hand in DEB.
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Nail abnormalities are a common feature in most subtypes of epidermolysis bullosa (EB), and they recently have been included among the criteria for scoring EB severity. Trauma undoubtedly contributes to the development of nail dystrophy, and for this reason the great toenails often are affected more severely. ⋯ The spectrum of clinical severity is large, and nail abnormalities may cause severe disability or just be a mild cosmetic problem. This article reviews the nail abnormalities observed in EB.
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Current aesthetic dermatology rejuvenation options offer minimally invasive, more affordable alternatives to traditional cosmetic surgery. Chemical peels and laser resurfacing can significantly improve the appearance of the skin and stimulate neocollagenesis; botulinum toxin reduces the appearance of dynamic facial lines; and dermal fillers can restore facial fullness. These nonsurgical procedures also carry potential risks. This article reviews potential complications of these procedures and best practices for clinical management to improve outcomes.
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Erythema induratum of Bazin is a chronic, nodular eruption that usually occurs on the lower legs of young women. It has been regarded as a manifestation of tuberculin hypersensitivity, a type of tuberculid occurring on the legs, whereas nodular vasculitis represents the nontuberculous counterpart. ⋯ The etiopathogenesis of erythema induratum of Bazin and its relation to tuberculosis are still controversial, because mycobacteria cannot be cultured from the skin lesions. Most authors currently consider erythema induratum of Bazin (nodular vasculitis) a multifactorial disorder with many different causes, tuberculosis being one of them.
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Paracoccidioidomycosis is a fungal infection that is relatively common in Brazil, Venezuela, Colombia, Ecuador, and Argentina. Sporadic cases can also be seen in some other countries. ⋯ Depending on the specific immunity of the host, the infection can assume many forms and affect single or multiple organs, eventually becoming a severe and even fatal disease. It is very important for dermatologists of all over the world to know about paracoccidioidomycosis because sometimes the disease only manifests many years after the individual has left the endemic area.