George W. Turiansky

Continuing medical educationCutaneous myiasis

UNLABELLED Myiasis is the infestation of living tissue by the larvae of flies in the order Diptera. Cutaneous involvement is the most common type of myiasis. Cutaneous myiasis can be subdivided into furuncular, migratory, and wound myiasis. Each subtype is reviewed with discussion of the larvae involved, presenting signs and symptoms, clinical differential diagnoses, and treatment. Preventive measures are also described. LEARNING OBJECTIVES At the conclusion of this learning activity, participants should be familiar with the causal agents, clinical manifestations, and treatment of human cutaneous myiasis.

Hyaluronidase enhances the therapeutic effect of vinblastine in intralesional treatment of Kaposi's sarcoma

BACKGROUND Although intralesional vinblastine has been used with some success in the treatment of cutaneous lesions of Kaposis sarcoma (KS), lesions commonly recur. When large lesions are treated, frequently there is considerable discomfort and, in some cases, secondary ulceration. Hyaluronidase has been used to increase dispersion of drugs administered by local injection. OBJECTIVE Our purpose was to determine whether intralesional hyaluronidase administered before intralesional vinblastine increases the dispersion of vinblastine and decreases toxicity. METHODS We treated six patients who had multiple cutaneous plaque lesions and tumors of KS with intralesional vinblastine, intralesional vinblastine preceded by intralesional hyaluronidase, or intralesional hyaluronidase alone. RESULTS Both intralesional vinblastine and intralesional vinblastine preceded by intralesional hyaluronidase caused clinical regression of lesions of KS; however, the combination of hyaluronidase and vinblastine was more effective in treating tumor nodules. In addition, lesions treated with hyaluronidase and vinblastine recurred less often than those treated with vinblastine alone and showed no evidence of residual KS in two patients undergoing biopsy between 4 and 6 months after therapy. CONCLUSION Intralesional hyaluronidase enhances vinblastine in the treatment of cutaneous lesions of KS without adding to the systemic toxicity.