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Common pediatric foot dermatoses.

The pediatric foot dermatoses known as tinea pedis, shoe dermatitis, and juvenile plantar dermatosis are seen commonly in clinical practice. A knowledge of the clinical presentations and causes of these disorders can help pediatric and family nurse practitioners identify, diagnose, and treat childhood rashes of the feet. The conventional view in pediatrics is that small children rarely have tinea pedis. However, a 1992 study disputes this claim. Any child who has an atypical or persistent foot rash will need a referral or consultation.

Child↗
PubMed1994

The efficacy of localized PUVA therapy for chronic hand and foot dermatoses.

The response to treatment of all patients enrolled over an 18-month period for localized oral or topical psoralen photochemotherapy (PUVA) of chronic hand and foot dermatoses was retrospectively reviewed. There were broadly similar success rates for the two groups for complete clearance: 61.5% (eight of 13 patients who completed therapy)--oral PUVA, 47.8% (11 of 23 patients who completed therapy)--topical PUVA, and for significant improvement: 23.1% (three of 13 patients)--oral PUVA, 30.4% (seven of 23 patients)--topical PUVA; there were no significant differences in response when diagnostic subgroupings of the hand dermatoses were taken into account. The mean number of treatments (22 for oral PUVA and 24 for topical), treatment durations (122 and 129 days), maximum UVA doses (11.2 and 12.3 J/cm2) and to a lesser extent cumulative UVA doses (189.3 and 237.0 J/cm2) for the therapies were similar in the two groups; adverse effects were minimal for both treatment protocols. However, at least five of the eight patients in the oral PUVA group and five of the 11 in the topical group who cleared completely relapsed after a mean 86 (range 19-245) and 174 (range 23-596) days, respectively. These findings are in broad agreement with those of previous studies. Therefore to avoid generalized photosensitivity and a higher likelihood of adverse effects with systemic therapy, as well as a possible slower relapse rate, topical therapy seems preferable.

Administration, Cutaneous↗
PubMed1988

Pustulosis palmoplantaris and chronic eczematous hand dermatitis. Treatment, epidermal Langerhans cells and association with thyroid disease.

Long-standing hand and foot dermatoses, e.g. pustulosis palmoplantaris (PPP) and chronic eczematous hand dermatitis, severely affect the patients' quality of life. The cause of PPP is unknown and the disease usually responds unsatisfactorily to treatment. The aims of the studies of PPP were to determine the prevalence of thyroid disease and to evaluate the relative merits of treatment with etretinate, psoralen photochemotherapy (PUVA), and a combination of the two. Furthermore, epidermal Langerhans cells (LC) were quantified in lesional skin before and after treatment. The prevalence of thyroid disease was significantly increased in a group of PPP patients compared to normal individuals and psoriasis patients. Both hypo and hyperthyroidism were found. In addition, circulating autoantibodies to thyroid antigens were more common in patients with PPP than in the control group. The thyroid status was further examined in a new and larger group of PPP patients, including a 4-year follow-up examination of those with thyroid antibodies or subclinical thyroid dysfunction. The increased prevalence of thyroid diseases was corroborated when this PPP group was compared to an age and sex-matched control population sample from the same city. Some patients also showed biochemical evidence of gastric autoimmunity. Ninetyfour percent of the PPP patients were smokers at the time of onset of the skin disease, compared to 33% of the subjects in a control group. Patients with treatment-resistant PPP were recruited for a randomised, double-blind and placebo-controlled trial. A combination of etretinate and PUVA was more effective than monotherapy with etretinate or PUVA. The latter were equally effective. Etretinate frequently provoked side effects. Follow-up examinations showed a high relapse rate. Epidermal LC were visualised with monoclonal antibodies to Leu 6 and HLA-DR antigens utilizing an immunoperoxidase technique. Their number was increased in lesional skin. The number of HLA-DR positive LC was decreased following etretinate, and normalised with etretinate + PUVA. Chronic eczematous hand dermatitis is a common clinical challenge. These studies aimed at an evaluation of PUVA and UVB phototherapy in patients with recalcitrant lesions and to enumerate epidermal LC before and after treatment. PUVA was a highly effective mode of treatment and cleared all treated hands. UVB was better than no treatment but the dermatitis did not clear in any patient. The number of epidermal LC was increased in lesional palmar skin in both allergic contact dermatitis, irritant contact dermatitis and hyperkeratotic dermatitis of the palms.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1997

Eccrine syringofibroadenoma in a patient with erosive palmoplantar lichen planus.

We report the case of an 82-year-old woman with a 6-year history of erosive palmoplantar lichen planus associated with eccrine syringofibroadenoma (ESFA). Examination revealed a well-demarcated patche writish of reticulated whitish papular lesions in skin of otherwise normal appearance at the border of erosive lichen planus plaques. These lesions had the histological appearance of ESFA. We suggest that these lesions are induced by the inflammatory remodelling associated with erosive lichen planus and propose to consider ESFA in the context of skin tissue remodelling as a new subtype of ESFA.

Adenoma, Sweat Gland↗
PubMed1998

Solar urticaria. A report of 25 cases and difficulties in phototesting.

BACKGROUND: Solar urticaria is a rare photosensitive disease, and its differential diagnosis with respect to polymorphous light eruption is sometimes difficult. We report our experience with 25 cases of solar urticaria and discuss the pitfalls in phototesting such patients. OBSERVATION: The most important locations in this patient series are the V of the neck and the arms, which are similar to those of polymorphous light eruption. In all of the patients, however, the lesions appeared within 30 minutes of sun exposure or phototesting and disappeared within 24 hours. Notably, 12 (48%) of the patients had a history of atopy. Phototesting helps confirm the diagnosis, but, in some patients, this was difficult. CONCLUSIONS: A negative phototest result from a single light source does not necessarily exclude a diagnosis of solar urticaria. In patients in whom phototesting elicits negative reactions, other light sources should be used, and, if the phototest result is still negative, a provocative test with natural sunlight should be done. Histamine1-receptor antihistamines are a useful first-line therapy, although more severely affected persons may require prophylactic courses of phototherapy or photochemotherapy. The main problem is maintenance treatment.

Adolescent↗
PubMed2006

Looking after the individual to reduce disease in the flock: a binomial mixed effects model investigating the impact of individual sheep management of footrot and interdigital dermatitis in a prospective longitudinal study on one farm.

A total of 160 ewes on one farm in England were studied for 18 months. The incidence of footrot and interdigital dermatitis in individually identified sheep and treatment and flock control measures were recorded. A binomial mixed effect model with the incidence of footrot or interdigital dermatitis as the outcome was used to investigate patterns of association between treatments, flock control measures and the incidence of footrot or interdigital dermatitis. In this one flock, the incidence of footrot and interdigital dermatitis was positively associated with the incidence of footrot and interdigital dermatitis and with trimming of feet and negatively associated with the use of parenteral antibiotics and topical antibiotic sprays in either the first and/or second 2-week period prior to the incidence of interest. These results provide two hypotheses: one that 'footrot and interdigital dermatitis are infectious diseases that can be controlled, in part, through the use of antibiotic therapy, which acts to reduce the infectious period of diseased sheep' and two, that 'routine trimming of diseased and healthy feet exacerbate disease, through environmental contamination and/or through increased susceptibility of sheep with recently trimmed feet'.

Animal Husbandry↗
PubMed2005

Bovine digital dermatitis and severe virulent ovine foot rot: a common spirochaetal pathogenesis.

A potential pathological role for spirochaetes in bovine digital dermatitis (bovine DD) and severe virulent ovine foot rot (SVOFR) has been considered and a treponeme isolate obtained from each disease in the UK. In this work, we have investigated the hypothesis that the two diseases may have a shared (common) spirochaetal aetiology. Experiments were designed to identify serological similarities and differences between the two spirochaetes; an enzyme-linked immunosorbent assay (ELISA) was developed to detect anti-treponeme antibodies in the sera of cows and sheep against the two-treponeme isolates. Sera were further tested for antigen reactivity by Western blotting. Cattle and sheep with bovine DD and SVOFR, respectively, had increased seropositivity rates to both treponeme isolates, with different patterns of reactivity between farms. In some cattle herds, significant correlations were shown between antibodies to bovine DD treponemes and SVOFR treponemes (P<0.001). In other herds, there was no apparent cross reaction, suggesting the presence of more than one treponeme in bovine DD on some farms. There was no significant correlation between the two treponeme isolates when ELISA-tested against 58 sheep sera from SVOFR cases (P>0.05); sheep showed strong evidence of reactivity to one or the other treponeme antigens, but never to both. Western blotting against both treponeme antigens showed that they frequently displayed different antigen epitopes, although some minor bands were common to both organisms. The data suggest that there are a number of spirochaetes in UK farms, which could be involved in the pathogenesis of either bovine DD or SVOFR.

Animals↗
PubMed2005

The occurrence of treponemes in contagious ovine digital dermatitis and the characterisation of associated Dichelobacter nodosus.

Contagious ovine digital dermatitis (CODD) is a recently recorded, apparently new infection of the ovine hoof, which differs clinically from footrot caused by Dichelobacter nodosus and which fails to respond well to accepted treatment practices for footrot. Despite the welfare implications of such an infection, very little research has been performed on CODD to date and the aetiology remains confused. Suggestions have been made that there is a potential role for treponemes in the pathogenesis of CODD but that D. nodosus is apparently not involved. Six farms were therefore targeted in this study to provide a more in-depth investigation into the bacterial flora of CODD lesions. Dark ground microscopy, culture and PCR techniques were used, concentrating on the presence of D. nodosus and spirochaetes, particularly those of the genus Treponema. The results demonstrated that isolates of D. nodosus were indeed present in a high percentage (74%) of CODD lesions compared with 31% of apparently healthy feet. The isolates were shown to be of similar virulence type to those reported previously in cases of footrot, and the range of serogroups was also found to be similar to footrot, with serogroup H being prevalent. Treponemes were present in 70% of CODD lesions and 38% of apparently healthy feet, supporting a possible association between CODD and treponemes. However, any further progress on the aetiology of CODD and the potential for novel, effective treatment will depend on an improved ability to culture these organisms routinely in the laboratory thereby enabling their complete characterisation.

Animals↗
PubMed1996

Common foot problems.

The foot is a complex region of the body that includes the vascular, neurologic, dermatologic, and musculoskeletal organ systems. This article addresses each of these systems and the common maladies that affect them, with a view toward common presentations, evaluation, differential diagnoses, treatment alternatives, and guidelines for proper referral. Finally, a section of the article is devoted to the prevention and treatment of lower extremity problems unique to patients with diabetes.

Diabetic Foot↗
PubMed1987

Cutaneous infection with Mycobacterium gordonae.

A case of cutaneous infection with Mycobacterium gordonae and other reports of extrapulmonary infection due to this organism are reviewed. This case confirms the pathogenic potential of M. gordonae which must now be included among the scotochromogens capable of causing cutaneous disease. Isolates of this organism should be tested against a full range of antimicrobial agents since traditional antituberculous therapy may be of limited efficacy. Pending the results of in vitro susceptibility testing, amikacin, ethambutol, rifampicin and co-trimoxazole are suggested as empirical therapy for infections caused by this organism.

Adult↗