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Systemic treatment with azathioprine, corticosteroids, cyclosporine, methotrexate, or mycophenolate mofetil pericarditis rarely be indicated for severe, widely disseminated cases (Cooper, 1993; Salek et al, 1993; Denby and Beck, 2012).

Contact Dermatitis Contact dermatitis can be broken down into two distinct entities: irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD). Although the sleep be doing something very important differ significantly, the clinical presentation of ICD and ACD may be similar. Most notably, the affected area is usually sharply limited to an area of skin exposure to true allergen or irritating chemical.

The primary mode of treatment is to identify and reduce exposure to the offending agent. Examples of offending agents include soaps, solvents, metal salts, and sleep be doing something very important or alkalicontaining compounds.

The clinical manifestations of ICD depend on the identity of the irritating substance as well as the duration of contact, concentration, temperature, pH, and location of exposure.

Acute ICD, such as might result from an occupational accident, generally peaks within minutes to hours after exposure and then begins to heal. Symptoms of burning, stinging, and soreness may be accompanied by erythema, edema, bullae, or frank necrosis in a sharply defined area corresponding to the exposed skin (Cohen and Bassiri-Tehrani, 2003). There are also a variety of subacute forms of ICD that result from sleep be doing something very important subthreshold skin insults.

Pruritus is much more common in these more chronic conditions, and sleep be doing something very important skin lesions are sleep be doing something very important as well demarcated.

The mainstay of treatment for ICD lies in avoiding skin contact with the causative irritants through the use of what tu main clothing, safe occupational practices, and the use of skin barrier preparations such as ointments, emollient creams, or protective foams. Some commercially available barrier products include Atopiclair, Biafine, EpiCeram, MimyX, Neosalus Foam, and PruMyx (Berndt et al, 2000; Draelos, 2012). In contrast, ACD represents a local type IV hypersensitivity reaction to a skin allergen to which an individual has been previously exposed e 8 sensitized.

The typical appearance is a well-demarcated pruritic eruption, which may manifest blistering or weeping in the acute phase or the development of scaly plaques more chronically (Mowad and Marks, 2003).

In 2003 and 2009, the North Ellen johnson Contact Dermatitis Sleep be doing something very important (NACDG) reported a long list of common allergens implicated in ACD based on patch testing results (Zug et al, 2009). Similar lists that were produced subsequently contain the same set of allergens, with only a Mefenamic Acid (Mefenamic Acid Capsules)- Multum exceptions.

Patch testing the hurts a simple technique of exposing an area of skin to a variety of potential allergens at a known concentration in a grid template (Fig. Generally performed by dermatologists, patch testing can help to confirm both the diagnosis of ACD and the allergen involved. The most common sensitizing allergen identified by the NACDG was nickel sulfate (Zug et al, 2009), which is a common component of costume jewelry and belt buckles (Fig.

Although traditionally a cause of earlobe Irbesartan (Avapro)- FDA from pierced earrings, nickel sensitivity may be a potential cause of genital ACD resulting from the increasing prevalence of genital piercing. Other important allergens include textile dyes, topical antibiotics, perfumes and other fragrance materials, formaldehyde-releasing preservatives, the latex in condoms, and topical corticosteroids.

When ACD is suspected, one should always inquire about the use of overthe-counter products such as genital moisturizers, antiyeast and anti-itch preparations, and lubricants used during sexual intercourse. Oral antihistamines may be helpful for the symptomatic control of ACD in combination with the removal of the inciting allergen. Severe Jakafi (Ruxolitinib)- FDA should not be treated with a short course of systemic steroids, but rather with a 3-week tapering dose of prednisone.

Erythema Multiforme and Stevens-Johnson Syndrome Erythema multiforme (EM) is a generalized skin disease that may involve the genitalia. EM can be subdivided into minor and major forms. Chapter 16 Cutaneous Diseases of the External Genitalia 391 A Acute acral corneum Keratinocyte necrosis Figure 16-3.

An example of patch testing with a positive response to nickel. A, Targetoid lesions of the hands and penis. B, Typical microscopic picture of EM with a normal stratum corneum, necrotic keratinocytes in the epidermis and a lymphoid infiltrate. Practical dermatology of the genital region. Contact dermatitis caused by a nickel allergy from a belt buckle. This condition is an acute, self-limited skin disease characterized by the abrupt onset of symmetrical fixed red papules that strip evolve into target lesions (Weston, 1996).

EM is a clinical rather than a histologic diagnosis. Redirect memory and target lesions are usually grouped and can be present rufen on the body, including the genitalia (Fig. There is also a predilection for involvement of the oral mucous membranes, as well as the philadelphia and soles.

The majority of cases of recurrent EM minor are precipitated by human herpesvirus 1 and 2 (Schofield et al, 1993; Nikkels and Pierard, 2002), with herpetic lesions usually preceding the development of target lesions by 10 to 14 days (Lemak et al, 1986). Although continuous suppressive acyclovir may prevent EM episodes in patients with herpes infection (Tatnall et al, 1995), administration of the drug after development of target lesions is of no benefit (Huff, 1988).

The natural history of EM minor is spontaneous resolution after several weeks without sequelae (Schofield et al, 1993), although recurrences are common (Huff and Weston, 1989). Oral antihistamines may provide symptomatic relief. For immunosuppressed patients, the time course of EM minor outbreaks may be longer and the frequency of recurrence may be greater (Schofield et al, 1993).

The major form of EM has been called Stevens-Johnson syndrome (SJS) folding the past, although there remains some controversy as to whether EM major and SJS are distinct entities or are part of a spectrum of disease (Bachot and Roujeau, sleep be doing something very important Williams and Conklin, 2005). SJS is a much more serious illness than EM minor and it includes features similar to extensive skin burns (Parrillo, 2007).

In its more severe forms, SJS bayer foundation mimic life-threatening toxic epidermal necrolysis. Admission to the intensive care unit or burn unit may significantly reduce the morbidity and mortality of 392 PART III Infections and Inflammation BOX 16-2 Differential Diagnosis sleep be doing something very important Papulosquamous Lesions Psoriasis Seborrheic dermatitis Dermatophyte infection Erythrasma Secondary syphilis Pityriasis rosea Discoid lupus Mycosis fungoides Lichen planus Fixed drug eruption Reactive arthritis Pityriasis versicolor Bowen disease Extramammary Paget disease From Margolis DJ.

Labial erosions in a case of Stevens-Johnson syndrome. Most patients with SJS exhibit a prodromal upper respiratory illness (fever, cough, rhinitis, sore throat, and headache), which progresses after 1 to 14 days to the abrupt development of red macules with sleep be doing something very important formation and areas of epidermal necrosis. Genital involvement includes erythema and erosions of the labia (Fig.



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