[Conservative treatment of trophic ulcers of the leg].
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A 15-year-old female patient developed painful nodules in an anophthalmic socket that were exacerbated by treatment with steroids and narcotics. Although orbit biopsy showed chronic inflammation, the diagnosis of mastocytosis was confirmed with skin biopsy and urinary levels of histamine. The patient responded to excision of nodules and treatment for mastocytosis. Painful orbital lesions associated with mastocytosis have not been reported previously.
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The combination of different antipsoriatics or treatment regimens should increase the therapeutic effect and reduce the adverse reactions. The combination of dithranol and tar (cignolin-salicyl-vaseline + tar, CSVT) reduces dithranol erythema and increases the antipsoriatic effect. CSVT treatment is highly effective, but patients tend to accept it less than other treatment regimens. On the other hand, Goeckerman therapy (tar + UV irradiation) is more accepted but less effective. Combinations of dithranol with UV irradiation or with tar and UV irradiation (Ingram regimen) are not advantageous. Dithranol and Goeckerman therapy are relatively secure treatment regimens, as they have been applied for more than 50 years without knowledge of significant late defects. PUVA therapy, although highly effective, is not superior to dithranol therapy. Even though PUVA therapy is more easily accepted than dithranol treatment, PUVA therapy should be applied only in severe cases. The combinations of aromatic retinoid with (selective) UVB irradiation (ReSUP) or with PUVA therapy (RePUVA) are highly effective. Retinoids can reduce the UV doses and most likely limit the risk of late damage. For routine treatment, ReSUP is preferable to RePUVA therapy.
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All diseases related to chronic or intermittent hypoxaemia can be efficaciously treated with the conventional oxygen therapy. The effectiveness of alternative oxygen therapies (oxygen multistep therapy, intravenous oxygen insufflation, haematogen oxidation therapy and ultraviolet blood radiation) has not been proved for any of the alleged numerous indications. Hyperbaric oxygen therapy can be tried, in single cases, outside of its internationally recognized indications, for the treatment of acute hypoxy of the inner ear.
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Topical corticosteroids remain the most commonly used topical treatments for inflammatory dermatoses, including psoriasis and atopic dermatitis. Topical corticosteroids are available in a variety of vehicles-creams, ointments, lotions, gels, and, more recently, foam. The vehicle used can substantially affect the individual agent's clinical action, potency, and acceptability to the patient. Moreover, some vehicles are better suited for specific body areas. Selection of the appropriate product should be determined by area of usage, physician experience, cost, and patient preference, particularly regarding vehicle. Although topical corticosteroids are associated with several side effects, including skin atrophy, telangiectases, purpura, and striae formation, appropriate usage can minimize these occurrences. Judicious use includes short-term, appropriate application as initial monotherapy or in combination strategies with other therapeutic agents that ideally possess complementing mechanisms of action. Examples include pulsing with high-potency topical corticosteroids and combination regimens with other topical agents such as topical calcineurin inhibitors, calcipotriene, or tazarotene. Appropriate education of patients and caregivers alike will facilitate the optimal use of these medications.
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Three phototherapeutic regimens with photosensitization are now used in dermatology: PUVA (psoralen + UVA), TUV (crude coaltar + UV), PRT (phototherapy with hematoporphyrin derivative). The efficiency of PUVA and TUV is well known in several dermatoses. PRT is now being tested experimentally. For TUV, the lack of a standardized regimen does not allow a clear-cut evaluation of the therapy. For PUVA, late side-effects, particularly carcinogenicity have to be considered. To improve efficiency and minimize the side-effects of PUVA some procedures, such as association with retinoïds, pharmaco-kinetic studies for individual adaptation of the therapeutic regimen and the use of new less mutagenic psoralens are helpful. The persistent phototoxicity following treatments with hematoporphyrin derivative constitutes the major side-effect observed, for this phototherapy.