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This Month in Archives of Dermatology
October 2006

This Month in Archives of Dermatology

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Copyright 2006 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2006

Arch Dermatol. 2006;142(10):1265. doi:10.1001/archderm.142.10.1265
Factors Influencing Coexistence of Toenail Onychomycosis With Tinea Pedis and Other Dermatomycoses

Onychomycosis is the most frequent nail disease, accounting for half of all nail abnormalities and 1/3 of all fungal infections of the skin. In this prospective survey of 2761 patients with toenail onychomycosis, Szepietowski et al observed concurrent tinea pedis in 1/3 of patients. Other fungal skin infections were relatively common as well. These data suggest that effective therapy of onychomycosis is essential not only to treat lesional nails but also to prevent dermatophyte infection from spreading to other sites of the skin.

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Skin and Soft Tissue Infections Due to Rapidly Growing Mycobacteria

Mycobacterium fortuitum, Mycobacterium chelonae, and Mycobacterium abscessus are environmental mycobacteria that can cause chronic infections of the skin, soft tissues, and lungs. These organisms are characterized by rapid growth on standard media and by lack of pigmentation. In this retrospective case series, Uslan et al compared the demographics, clinical features, bacterial susceptibility patterns, and treatment for 63 patients with skin and soft tissue infections due to these rapidly growing mycobacteria. In general, patients infected with M chelonae or M abscessus were older and had significant comorbidities and immunosuppression, while patients infected with M fortuitum were more likely to have experienced trauma or to have had a surgical procedure at the site.

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African Tick Bite Fever

African tick bite fever is an acute, flulike illness characterized by fever, regional lymphadenopathy, and inoculation eschars. The causative agent is Rickettsia africae, an intracellular gram-negative bacillus classified in the spotted fever group of rickettsial bacteria. In this case report, Owen et al highlight the clinical features of this illness as well as preventive strategies, appropriate diagnostic testing, and therapy. With the increased mobility of the population, it is important to recognize the signs of diseases localized to particular geographic areas. African tick bite fever was virtually unknown outside of endemic regions a decade ago, but is now considered the most important rickettsial infection among international travelers, with an incidence estimated at 5.3% of international travelers in endemic regions. Risk factors include game hunting, safari tourism, rainy season travel, and travel to southern Africa.

Image not available

Inoculation eschar measuring 3.5 × 2.0 cm lateral to left inguinal region. The central eschar is surrounded by a slightly raised erythematous rim.

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Successful Treatment of Recalcitrant Chronic Idiopathic Urticaria With Sulfasalazine

Chronic idiopathic urticaria (CIU) is characterized by the occurrence of daily wheals and pruritus for at least 6 weeks without obvious cause. In the United States, there is a lifetime CIU prevalence of 0.5%. The cause has been theorized to be either infectious or autoimmune. Functional autoantibodies directed against the α chain of the high-affinity IgE receptor have been isolated from the serum of patients with CIU. Antihistamines remain the standard treatment, and the potential role of an autoimmune mechanism has led to additional therapies focusing on immunomodulation. Despite these advances, many patients still have therapy-resistant CIU. In this retrospective case series, McGirt et al describe the safe and successful use of sulfasalazine in the treatment of recalcitrant CIU, either as monotherapy or as a steroid-sparing agent.

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Aesthetic and Functional Efficacy of Subcuticular Running Epidermal Closures of the Trunk and Extremity

Among the factors that affect the outcomes of elliptical excisions are the choice of suture type and suturing technique. Few clinical trials compare the functional and aesthetic outcomes associated with different excision closure techniques. In this randomized controlled trial, Alam et al demonstrate that superficial subcuticular sutures of polyglactin 910 left in place appear to be the superior choice for bilayered trunk and extremity closures from a functional and aesthetic standpoint. In addition, overall procedure cost may be diminished.

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