Manual Pocket Guide for Cutaneous Medicine and Surgery

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Editorial Board: Jack L. Lesher, Loretta S. Davis, David E. Kent, David J. Cohen Pocket Guide for Cutaneous Medicine and Surgery is written for dermatology residents and clerkship students. It contains up-to-date and easily accesible medical and surgical information. It is a quick reference on a wide range of dermatologic diseases including concise clinical information on diagnostic features, lab findings and practical management as well as key surgical anatomy and pearls on lasers, basic science and pharmacology.

In all, this book provides a comprehensive collection of dermatology and dermatopathology signs and concise guidance on their significance, associated clinical and laboratory findings, as well as an extensive compilation of board review essentials. Wie bewerten Sie den Artikel? Details zum Adobe-DRM. Sixty days of treatment is recommended when infection is associated with bioterrorism, because concomitant inhalation may have occurred.

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Until results of susceptibility tests are available, ciprofloxacin is rational empirical therapy B-III , especially with the possibility of genetically altered B. Other fluoroquinolones, such as levofloxacin, gatifloxacin, or moxifloxacin, are also likely to be effective.

Excisional Biopsy

Initiation of intravenous versus oral therapy depends on the severity of the illness, particularly the degree of edema. Some have suggested systemic corticosteroid therapy for patients who develop malignant edema, especially of the head and neck, but studies supporting this recommendation are lacking. Airway compromise requiring intubation or trachostomy may occur with malignant edema.

Cat-scratch disease and bacillary angiomatosis. Bartonella henselae causes most cases of cat-scratch disease in immunocompetent hosts. Bacillary angiomatosis, seen in immunocompromised patients, especially with AIDS, can occur from either B. In classic cat-scratch disease, a papule or pustule develops 3—30 days after a scratch or a bite. The disease course varies, but lymphadenopathy generally resolves within 1—6 months. Cutaneous bacillary angiomatosis has 2 clinical appearances. The second form is a painful subcutaneous nodule with overlying skin having a normal or dusky hue.

Definitive confirmation of Bartonella infections may be difficult, because these fastidious organisms infrequently grow from pus or nodal tissue. Serologic testing supports the diagnosis. However, cross-reactivity occurs between B.

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PCR, although mainly a research tool, is also a diagnostic option. Routine histologic examination of a node, coupled with the clinical findings, may strongly suggest the diagnosis. Histologic examination in conjunction with a Wharthin-Starry silver stain is helpful but does not differentiate the species of Bartonella.

Aspiration of fluctuant nodes may exclude other causes of purulent lymphadenopathy and sometimes is appropriate to relieve pain.

Pocket Guide to Cutaneous Medicine and Surgery, 1e (Companion)

Treatment of cat-scratch disease with antimicrobial agents has had variable, but rarely dramatic, results. A single, double-blind, placebo-controlled study involved 29 patients, 14 of whom received azithromycin [ ]. Cutaneous bacillary angiomatosis therapy has not been systematically examined. On the basis of results of case reports and small series, either erythromycin mg 4 times per day or doxycycline mg twice per day appear to be effective B-III. The duration of initial therapy, although not standardized, should be at least 4 weeks. With relapses, retreatment with prolonged therapy lasting several months should be entertained until immunocompetence returns.

Other antimicrobials with some efficacy are rifampin, trimethoprim-sulfamethoxazole, and ciprofloxacin [ ]. Erysipeloid is a cutaneous infection caused by the thin, pleomorphic, non—spore-forming gram-positive rod E. It is a zoonosis seen in persons who handle fish, marine animals, swine, or poultry. Between 1 and 7 days after exposure, a red maculopapular lesion develops, usually on the fingers or hands. Erythema spreads centrifugally with central clearing.

A blue ring with a peripheral red halo may appear, giving the lesion a target appearance. A severe, generalized cutaneous infection also occurs. However, systemic symptoms and leukocytosis are unusual. Untreated erysipeloid resolves during a period of 3—4 weeks, but treatment probably hastens healing and perhaps reduces systemic complications.

Most of the literature concerning therapy relates to endocarditis, in which high-dose penicillin is generally used. On the basis of in vitro susceptibilities and anecdotal statements, penicillin is appropriate B-III , although the optimum duration of therapy is unknown.

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For cutaneous infection, penicillin mg orally 4 times per day or amoxicillin mg 3 times per day for 7—10 days seems to be rational. For patients who are intolerant of penicillins, treatment with cephalosporins, clindamycin, or fluoroquinolones should be effective. Glanders, caused by the aerobic gram-negative rod Burkholderia mallei , is mainly a disease of solipeds e.

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Humans become accidental hosts either by inhalation or skin contact. Although other organs may be involved, pustular skin lesions and lymphadenopathy with suppurative nodes can be a prominent feature. Almost all glanders infections preceded the antibiotic era. Results of in vitro susceptibility tests suggest that ceftazidime, gentamicin, imipenem, doxycycline, and ciprofloxacin should be effective. A recent laboratory-acquired case was successfully treated with imipenem and doxycycline for 2 weeks, followed by azithromycin and doxycycline for an additional 6 months [ ].

Bubonic plague. Plague results from infection with Y. It primarily affects rodents, being maintained in nature by several species of fleas that feed on them. Three plague syndromes occur in humans: septicemic, pneumonic, and bubonic. Bubonic plague, the most common and classic form, develops when humans are bitten by infected fleas or have a breach in the skin when handling infected animals.

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  7. Domestic cat scratches or bites may also transmit bubonic plague. Patients usually develop fever, headache, chills, and tender regional lymphadenopathy 2—6 days after contact with the organism. A skin lesion at the portal of entry is sometimes present. Patients with bubonic plague may develop septicemia and secondary plague pneumonia, the latter permitting person-to-person transmission.

    Diagnosis can be made by blood cultures and by aspirating lymph nodes for staining and culture. PCR and other more sophisticated tests are generally available only at reference laboratories. Results of serologic tests may provide retrospective confirmation. No controlled comparative trials of therapy for plague exist. Streptomycin has been the drug of choice B-III , although tetracycline and chloramphenicol are also considered to be appropriate therapy table 7. Although there have been no recent reports of treatment of any sizable numbers of cases of plague, studies from the Vietnam War period showed that most patients actually received streptomycin plus either tetracycline or chloramphenicol. Some patients have been successfully treated with kanamycin. Gentamicin has been suggested as a substitute for streptomycin, but its use in humans has been limited. On the basis of in vitro susceptibilities and murine models, fluoroquinolones are another option. A multidrug-resistant strain of Y. Unless introduced into the rodent population, however, Y.