Cutis
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Bullous pemphigoid and rheumatoid arthritis are rarely found co-existent in one patient. We report a patient with severe rheumatoid arthritis who four years later showed bullous pemphigoid. This association is rare but may be more than coincidental.
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A 52-year-old woman who had had ulcerative colitis for more than ten years experienced a third relapse of pyoderma gangrenosum of her lower extremities. She was treated with topical disodium cromoglycate. The dosage of salicylazosulfapyridine and steroids she was taking, and by which the ulcerative colitis, but not the pyoderma gangrenosum could be controlled, was not increased. Because pyoderma gangrenosum is often very difficult to treat and may require an aggressive approach using drugs that can cause serious side effects, we believe that a topical therapy is worth trying.
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Capsaicin cream is the first of a class of neuropeptide active agents to be introduced into dermatologic therapy. Capsaicin's effects appear primarily related to its ability to deplete the neuropeptide substance P from local sensory terminals in the skin. The use of capsaicin cream in the treatment of postherpetic neuralgia and psoriasis is discussed. I believe that capsaicin and other neuropeptide active agents may become important therapeutic modalities for the dermatologist in the near future.
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Skin necrosis from extravasation of intravenous materials can result from nonphysiologic irritants, vasopressors, and chemotherapeutic agents. Careful handling of these materials is essential. ⋯ Early surgical excision and repair is recommended for chemotherapeutic infiltrations. General supportive care is recommended for all extravasations.
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Randomized Controlled Trial Clinical Trial
A comparison of clindamycin phosphate 1 percent topical lotion and placebo in the treatment of acne vulgaris.
The efficacy and skin tolerance of 1 percent clindamycin phosphate lotion were compared with those of the placebo for the lotion in a randomized, double-blind, 12-week study in forty-six patients with moderate to severe acne vulgaris. Patients using the 1 percent clindamycin lotion experienced reductions in numbers of pustules, papules, open comedones, and nodulocystic lesions. Papule counts were also reduced in placebo-treated patients. ⋯ Both regimens were well tolerated. Although diarrhea was reported by eight patients (three taking clindamycin, five receiving placebo), no patients discontinued the protocol because of diarrhea. This study demonstrated the efficacy of 1 percent clindamycin topical lotion in the treatment of moderate to severe acne vulgaris.