Charles Zugerman

Dermatitis from transcutaneous electric nerve stimulation

Transcutaneous electric nerve stimulation (TENS) is an effective treatment modality for chronic pain. Electrical impulses produced by a portable stimulator are transmitted by cable to electrodes which are attached to specific areas of the body by tape or adhesive. A conductive electrolyte jelly is utilized in order to make good electrical contact with the skin. Several dermatologic complications have been associated with the use of this technic, including allergic and irritant contact dermatitis and micropunctate burns caused by the improper use of poorly conductive lubricant jellies. A patient is reported herein who developed allergic contact dermatitis to propylene glycol in a conductive jelly (Neuromod TENS gel). In an attempt to continue therapy, the patient changed to a poorly conductive surgical lubricant jelly which caused irritation and micropunctate burns. Subsequently, electrodes not utilizing conductive jelly were applied, with excellent results.

Iatrogenic hyperadrenocorticism during topical steroid therapy: Assessment of systemic effects by metabolic criteria

Systemic absorption of topically applied glucocorticoids in quantities sufficient to replace endogenous production is not uncommon. However, iatrogenic Cushings syndrome resulting from the use of topical corticosteroids is very rare. Thus the possibility that systemic absorption may cause hyperglucocorticism has been deemphasized and examined only sporadically. We have studied changes in carbohydrate metabolism induced by topical glucocorticoids in a psoriatic patient who had developed Cushings syndrome from topical desoximetasone (Topicort). The results indicated that (1) fasting hyperglycemia and increased insulin-glucose ratios could be induced within 24 hours of administration of topical glucocorticoids, (2) insulin resistance accompanied abnormal carbohydrate tolerance, and (3) fluctuations in circulating leukocytes paralleled the changes in carbohydrate metabolism. The findings suggest that metabolic indexes of glucocorticoid action action may provide useful parameters for assessing systemic absorption of topical glucocorticoids. glucose relationship as one such index to assess the risk of treatment of extensive chronic skin disease with potent topical glucocorticoids.