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Matthew J Zirwas

Publications and source records attributed to Matthew J Zirwas.

15 recordsLinked to original sources
PubMed2006

Role of protective gloves in the causation and treatment of occupational irritant contact dermatitis.

Irritant contact dermatitis of the hands is a significant occupational problem. Management primarily involves cessation of exposure to hazardous substances. Protective gloves can reduce or eliminate exposure of the hands to hazardous substances if used correctly, but if not selected and used correctly, protective gloves can actually cause or worsen irritant contact dermatitis of the hands by increasing exposure of the hands to hazardous chemicals. We present two cases of occupational irritant contact dermatitis of the hands caused by incorrect use of protective gloves. Glove failure can occur by penetration, permeation, or contamination, and all 3 mechanisms were operative in these cases. These cases demonstrate that correct use of gloves is at least as important as selection of gloves made of the appropriate material. By understanding mechanisms of glove failure, clinicians can make more appropriate recommendations for the selection and use of protective gloves in the workplace.

Adult↗
PubMed2006

The flushing patient: differential diagnosis, workup, and treatment.

UNLABELLED: Cutaneous flushing-a common presenting complaint to dermatologists, allergists, internists, and family practitioners-results from changes in cutaneous blood flow triggered by multiple conditions. Most cases are caused by very common, benign diseases, such as rosacea or climacterum, that are readily apparent after a thorough taking of history and physical examination. However, in some cases, accurate diagnosis requires further laboratory, radiologic, or histopathologic studies to differentiate several important clinicopathologic entities. In particular, the serious diagnoses of carcinoid syndrome, pheochromocytoma, mastocytosis, and anaphylaxis need to be excluded by laboratory studies. If this work-up is unrevealing, rare causes, such as medullary carcinoma of the thyroid, pancreatic cell tumor, renal carcinoma, and others, should be considered. LEARNING OBJECTIVE: At the completion of this learning activity, participants should be familiar with the mechanisms of flushing, its clinical differential diagnosis, the approach to establish a definitive diagnosis, and management of various conditions that produce flushing.

Alcohol Drinking↗
PubMed2006

Acquired ichthyosis.

Acquired ichthyosis (AI) is a nonhereditary cutaneous disorder characterized by dry, rough skin with prominent scaling that involves significant portions of the body. It has been associated with malignancies; autoimmune/inflammatory, metabolic, endocrine, and infectious diseases; and medication use. Most microscopic studies of AI exhibit hyperkeratosis with a reduced or absent granular layer. Because AI has been linked to a variety of conditions, the workup of a patient presenting with this finding can be complex. We present an update on AI to provide clinicians with direction regarding the assessment and treatment of patients presenting with AI. An algorithm for the evaluation of patients presenting with AI is provided.

Algorithms↗
PubMed2006

Cutaneous B-cell pseudolymphoma due to paraphenylenediamine.

Lymphomatoid contact dermatitis is a form of pseudolymphoma that was first described in 1976 by Orbaneja et al. Since that initial report, a number of allergens have been reported to cause this type of pseudolymphoma. Most cases involve hyperplasia of T cells. We describe a case of cutaneous B-cell pseudolymphoma due to paraphenylenediamine. This report underscores the importance of thorough history and observation when assessing patients with suspected lymphoproliferative processes.

Aged↗
PubMed2006

Allergic contact dermatitis to chloroxylenol.

Chloroxylenol, also known as p-chloro-m-xylenol (PCMX), is a compound that has been used as a preservative in cosmetics and as an active agent in antimicrobial soaps. We present two patients with allergic contact dermatitis from PCMX, confirmed by positive (+++) patch-test reactions at 48 and 72 hours, identification of PCMX in a soap and in a hand cream used by the patients, and improvement following withdrawal of the incriminating products. The mechanism of action, structure, antimicrobial activity, and dangers of PCMX are reviewed.

Adult↗
PubMed2006

Triclosan.

Triclosan is a common antibacterial chemical currently in widespread use in household and health care-related products. Triclosan was first introduced in 1965 and has been marketed as cloxifenol, Irgasan CH 3565, and Irgasan DP 300. Its most common use is in antimicrobial hand soaps, but in the United States it can also be found in consumer products such as liquid dishwashing soaps, deodorants, and toothpastes. The concentrations used in products in the United States typically range from 0.15 to 0.3%. While allergy to triclosan-based products is uncommon, several cases of contact dermatitis secondary to triclosan have been reported.

Anti-Infective Agents, Local↗
PubMed2005

Diffuse gingival enlargement.

Diffuse gingival enlargement is defined as an excessive growth of periodontal tissue. It can be considered a relatively common finding, as thousands of patients have been described in the literature. Patients may seek medical attention because of pain, tenderness, interference with speech and/or mastication, halitosis, or unsightly appearance, or gingival enlargement may be an unexpected finding on routine physical examination. Diffuse gingival enlargement has numerous causes, including poor dental hygiene, medications, serious systemic illnesses, genetic conditions, other specific physiologic states, or it may be idiopathic. Given the large number of possible underlying conditions, the work-up of a patient presenting with diffuse gingival enlargement may seem daunting. We present a systemic review of diffuse gingival enlargement, including an algorithm that can be used to direct the work-up of patients presenting with this condition.

Algorithms↗
PubMed2005

Livedo reticularis: an update.

Livedo reticularis (LR) is a well-known, relatively common physical finding consisting of macular, violaceous, connecting rings that form a netlike pattern (Fig 1). In most cases, it is a completely benign finding related to cold exposure. However, there are many potential causes (Table I), and this can make the evaluation of a patient presenting with this finding very difficult. An excellent review of the topic by Fleischer and Resnick was published in 1990. We have endeavored to update the literature and provide clinicians with guidance regarding the evaluation and treatment of patients presenting with LR.

Algorithms↗
PubMed2005

Clubbing: an update on diagnosis, differential diagnosis, pathophysiology, and clinical relevance.

Finger clubbing can be a striking physical finding. At other times, the presence of clubbing is difficult to establish by subjective examination alone and the profile angle or distal phalangeal to interphalangeal depth ratio are needed to confirm the finding. Most microscopic and imaging studies of clubbed fingers reveal hypervascularization of the distal digits. Recent research shows that when platelet precursors fail to become fragmented into platelets within the pulmonary circulation, they are easily trapped in the peripheral vasculature, releasing platelet-derived growth factor and vascular endothelial growth factor, promoters of vascularity and, ultimately, clubbing. Clinically, clubbing is associated with a number of neoplastic, pulmonary, cardiac, gastrointestinal, infectious, endocrine, psychiatric, and multisystem diseases. In narrowing the differential diagnosis, we recommend a detailed history and physical examination accompanied by focused laboratory and imaging studies. An algorithm for the evaluation of newly diagnosed clubbing is suggested.

Algorithms↗
PubMed2003

Immunofluorescence findings in granuloma faciale: report of two cases.

BACKGROUND: Immunofluorescence findings in granuloma faciale have been infrequently described. Reported findings include granular IgA, IgG, IgM, and C3 deposits in the dermoepidermal junction, in blood vessel walls, and on connective tissue fibers; IgG in the basement membrane zone, and IgG around blood vessels. OBSERVATIONS: We report two cases of granuloma faciale in which biopsy specimens were sent for routine pathology as well as immunofluorescence. Additional work-up included serologic testing for markers of lupus erythematosus (LE). Immunofluorescence in both cases revealed granular IgA, IgG, IgM, C3, and C5-9 deposits along the dermoepidermal junction only. Blood vessel walls and connective tissue fibers were spared. Serologic studies for markers of LE were negative. CONCLUSION: Immunofluorescence findings were essentially identical to those which would be expected in cutaneous LE; however, the combination of negative serologic studies for LE, histopathologic findings typical of granuloma faciale, and clinical findings most consistent with granuloma faciale allowed the diagnosis of granuloma faciale to be rendered with certainty. Interpretation of results of direct immunofluorescence of skin should be correlated with clinical presentation, histopathological findings and other laboratory results in order to render final diagnosis of a given patient.

Cytoplasmic Granules↗