Calum C. Lyon

The spectrum of skin disorders in abdominal stoma patients

Background Skin integrity is essential for the normal usage of a stoma appliance. However, there is little published on the prevalence, nature or management of stoma‐related skin disorders.

Topical tacrolimus in the management of peristomal pyoderma gangrenosum

BACKGROUND: Peristomal pyoderma gangrenosum (PPG) is a potentially disabling disease in stoma patients. Topical tacrolimus has been shown to be effective in the management of pyoderma gangrenosum. Unfortunately, greasy topical treatments may be impractical for PPG because of impaired appliance adhesion. OBJECTIVE: The purpose of this open study was to evaluate the therapeutic effectiveness of topical tacrolimus 0.3% formulated in carmellose sodium paste compared with topical corticosteroid preparations in the management of PPG. RESULTS: A total of 11 patients with PPG received treatment with topical tacrolimus 0.3% in OrabaseÂand 13 with topical clobetasol propionate 0.05% as monotherapy in each case. Seven of the tacrolimus-treated group healed completely (mean time to healing: 5.1 weeks) compared with five of the clobetasol propionate-treated group (mean time to healing: 6.5 weeks). Topical tacrolimus was significantly more effective than clobetasol propionate in managing larger PPG lesions (ulcer diameter > 2 cm). In six patients, who had failed to respond adequately to multiple systemic and topical treatments for PPG, the addition of topical tacrolimus was associated with healing of PPG within 6 weeks. CONCLUSION: These results suggest that topical tacrolimus 0.3% in OrabaseÂis a more effective and expeditious treatment than clobetasol propionate 0.05% for PPG. It is significantly more effective than clobetasol propionate 0.05% in managing lesions larger than 2 cm in diameter. Topical tacrolimus may be highly effective when other systemic or topical treatments have been unsuccessful. ( J Dermatol Treat (2001) 12: 13-17)

Topical sucralfate in the management of peristomal skin disease: an open study

Dermatoses affecting the skin around stoma sites are common and difficult to treat. We have investigated the effectiveness of topical sucralfate in the management of peristomal dermatoses in adults using an open study design. Apart from forming a physical barrier to further irritation, sucralfate binds to basic fibroblast growth factor preventing its degradation and thereby promotes healing. In eight out of nine patients with faecal or urine erosions, daily, topical sucralfate treatment was associated with healing within 4 weeks. There was limited or no response to treatment in a further nine patients with traumatic ulcers, excoriated dermatitis or pyoderma gangrenosum. Topical sucralfate represents a safe, inexpensive and effective therapeutic intervention, particularly for those patients with high output or short stomas where repeated stoma leakage may be unavoidable.

Abdominal stomas and their skin disorders

Abdominal stomas and their skin disorders : , Abdominal stomas and their skin disorders : , کتابخانه دیجیتال جندی شاپور اهواز

Folliculitis-perifolliculitis related to erlotinib therapy spares previously irradiated skin

Erlotinib, a specific epidermal growth factor receptor tyrosine kinase inhibitor, is used to treat various metastatic cancers. It is known to cause an acneiform rash. Herein, we report a case where the rash spared the previous radiotherapy field. A limitation of this study is that it is an anecdotal case report. Further research into the pathologic process of the rash is warranted to understand the reason for its absence in the irradiated skin.

The use of folic acid supplementation in psoriasis patients receiving methotrexate: a survey in the United Kingdom

There is little literature on the use of folic acid supplementation in psoriasis patients being treated with methotrexate. Under the auspices of the British Association of Dermatologists we surveyed, using a questionnaire, the use of folic acid supplementation with methotrexate therapy for psoriasis by dermatologists in the UK. Six‐hundred and fifteen questionnaires were sent and 153 responses were received (25%). One‐hundred and fourteen of the responders (75%) used folic acid supplementation with methotrexate in psoriasis patients. Thirty (26%) of these used folic acid supplementation in all patients taking methotrexate and 84 (74%) used folic acid only under certain circumstances, the most common of which was an elevated erythrocyte mean corpuscular volume. Forty‐six per cent of respondents believed that folic acid supplementation reduced nausea and 60% believed that folic acid did not interfere with the efficacy of methotrexate. A wide variety of dosing regimens were used for folic acid supplementation. In the absence of guidelines and controlled trials, there is great variation in the indication for use, dosing regimens used and beliefs regarding methotrexate supplementation for psoriasis. Randomized controlled trials are necessary to address these questions.

A painful spot on the nose

after intravenous cytotoxics. Skin biopsy and repeated blood cultures showed P acnes. In the third case, an otherwise healthy patient suffered recurrent, non-tender, follicular, pustules on the scalp containing P acnes. These resolved with a course of oral tetracycline. We believe that the cutaneous infection in our patient was caused by P acnes because the morphology and natural history could not be explained by other causes; P acnes was isolated in pure culture as well as being present in far greater numbers in the lesion than would be expected in normal facial skin; granulomatous histology has been described in P acnes infection; and after 9 weeks of continuous progression, resolution was achieved with systemic penicillin. P acnes infection should be suspected in otherwise unexplained skin lesions, particularly on the head and neck, in immunocompromised individuals. This may be of increasing relevance given the emergence of antibiotic-resistant strains of this organism.