Nicholas F. Logemann

Botulinum toxin: An effective treatment for prosthesis-related hyperhidrosis in patients with traumatic amputations.

Hyperhidrosis-related to prosthesis use in patients who have suffered a traumatic limb amputation presents itself as a barrier to comfort, prosthesis use and overall quality of life. This review intends to encourage dermatologists to consider the use of botulinum toxin A or B for the treatment of hyperhidrosis in the residual limb and may serve as a stimulus for a modern, in-depth, and more comprehensive study. A review of the literature was conducted using the PubMed database, focusing on hyperhidrosis treatment after traumatic limb amputation. Articles discussing hyperhidrosis treatment for amputations secondary to chronic medical conditions were excluded. Seven case studies published over the last 12 years have demonstrated positive outcomes of this treatment strategy. Overall, there is little data examining this topic and current publications focus primarily on small case series. A larger, double-blind, placebo-controlled study would likely benefit veterans, service members, and civilians.

Recommendations for Counseling and Education of Service Members on Endemic African Cutaneous Kaposi Sarcoma: A Case Study

We report a case of Endemic African Cutaneous Kaposi Sarcoma (EACKS) on the lower extremity of an immunocompetent 31-yr-old male service member from Cameroon. Diagnosis was made using clinical and histologic findings. The service member was treated with local radiation therapy with resolution of his tumor.The goal of this article is to educate practitioners to counsel susceptible service members and leadership on the risk of developing EACKS when traveling to Sub-Saharan Africa, monitor for disease development, and guide in the diagnosis and treatment of patients with this rare disease.

A Localized Macular Rash in an Immunocompromised Patient with Pneumonia and Necrotizing Enterocolitis

A 21-year-old male with T-cell acute lymphoblastic leukemia (ALL) was admitted for fever and neutropenia. Despite 72 h of antibiotic therapy, he remained febrile and developed new abdominal and pleuritic chest pain. His antimicrobial regimen was broadened to meropenem and voriconazole. On hospital day 5, a new asymptomatic rash appeared on his left face consisting of erythematous macules that blanched with pressure Within 24 h, the skin lesions expanded and developed a central, non-blanching violaceous hue. Liposomal amphotericin B was added and a biopsy of the rash was obtained. Mucor spp was confirmed by skin culture. Repeat imaging showed interval development of diffusely scattered and innumerable hypodense lesions throughout the liver and spleen, as well as diffuse myositis and lesions within the brain and spine. Care was withdrawn and the patient expired on hospital day 11. Risk factors for developing invasive aspergillosis and mucormycosis are similar. This case illustrates similarities in their clinical presentations, highlights potential gaps in coverage by antifungal agents that are commonly used for empiric coverage, and reviews treatment options.

Nodular Skin Lesions in an Immunocompromised Patient

Diagnosis: Disseminated amebiasis (Acanthamoeba species). Our patient was an immunocompromised individual who died after developing a progressive meningoencephalitis with associated brain lesions (Figure 1) and concurrent nodular skin lesions (Figure 2). Histopathology from the cutaneous lesions revealed numerous cysts and trophozoites (Figure 3), which were pathologically consistent with free-living amoebae (either Balamuthia species or Acanthamoeba species). Indirect immunofluorescence testing was performed by the Centers for Disease Control and Prevention (CDC), and was positive for Acanthamoeba species and negative for Balamuthia mandrillaris. Cultures of the cerebrospinal fluid (CSF) were without growth; however, after the pathology findings from the skin biopsy, remaining CSF was sent to the CDC and found to be positive by polymerase chain reaction (PCR) for Acanthamoeba species. These findings are consistent with a diagnosis of disseminated acanthamebiasis. The most common clinical presentation of Acanthamoeba species is a nonopportunistic keratitis, usually in contact lens wearers. Other human infections with this free-living amoeba are rare and include sinus infections, skin manifestations, and central nervous system (CNS) involvement, most often granulomatous amoebic encephalitis (GAE). Typically, these syndromes affect the immunocompromised host, often patients with human immunodeficiency virus/AIDS or transplant recipients. Cutaneous acanthamebiasis can present as either ulcerative or nodular, and is often a reflection of disseminated disease [1]. GAE is a slowly progressive meningoencephalitis, and is fatal with few exceptions. Symptoms are typical for meningoencephalitis and include alteration in mental status, meningismus, headache, seizure, and photophobia [2]. Figure 1. A 3-cm hypodense lesion in the left temporal lobe. Figure 2. Several discrete 2to 3-cm erythematous nodules are present in a linear arrangement over the left thigh.

Patient Preferences Comparing Linear Versus Purse String Closures in Dermatologic Surgery Utilizing a Novel Simulator-Based Educational Tool.

BACKGROUND Patients often query in regard to cosmetic outcomes after cutaneous surgery. This study provides information on this topic by surveying preference on 2 skin closure methods, purse and linear. The authors used a novel method to poll opinions by incorporating simulated skin within the context of the survey. OBJECTIVE To determine patients preference for linear or purse string closure. Additional outcomes were to survey patients opinions regarding which scar characteristics have the highest cosmetic impact, the cosmetic importance of a scar, and the utility of simulators, and patient photographs as methods of understanding closure techniques. MATERIALS AND METHODS Participants were prospectively recruited to complete a survey. Data outcomes were analyzed using descriptive statistics and the chi-square test of association. RESULTS About half of the participants (54.7%) preferred linear closure. Preference was independent of gender (p = .90) or having a prior linear or purse string closure (p = .17). Patient photographs were the most influential for determining preference according to 86.2% of participants; however, 88% of the participants found simulator devices useful for educational purposes. CONCLUSION The methods in this survey may represent a venue for educating patients and incorporating their preferences into the choices they will make regarding dermatologic procedures, which they will undergo.