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Bacterial, Mycobacterial, and Spirochetal (Nonvenereal) Infections
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Management: Combination antimicrobial therapy for prolonged periods is needed to eliminate the organism. For treatment of superficial papules, monotherapy with the following antibiotics is appropriate: clarithromycin 500 mg twice daily, minocycline 100 mg twice daily, and doxycycline 100 mg twice daily. In deeper infections, combination therapy is needed, such as clarithromycin 500 mg twice daily and rifampicin 600 mg once a day. Treatment duration is generally 3 to 4 months.
Acne, rosacea and similar disorders
Published in Ronald Marks, Richard Motley, Common Skin Diseases, 2019
Superimposed on this persistent background of erythema are episodes of swelling and papules, which develop for no very obvious reason (Fig. 12.15). The papules are a dull red, dome shaped and non-tender, in contrast to acne, in which they tend to be irregular and tender. Pustules also occur, but are less frequent than in acne; blackheads, cysts and scars do not occur in rosacea.
Tick Typhus
Published in James H. S. Gear, CRC Handbook of Viral and Rickettsial Hemorrhagic Fevers, 2019
On the 3rd to the 5th day of illness, a maculopapular rash erupts first on the extremities and then on the trunk (Plate 6*). The rash appears in crops and new macules and papules may be noted each day for 1 to 3 days. The papules are relatively coarse and can be felt as small shotty nodules in the skin. At first they are pinkish, but later become darker. Characteristically, the rash involves the palms of the hands, the soles of the feet, and, to a lesser extent, the face. The profuseness of the rash is directly related to the severity of the illness. In mild cases only a few raised red papules, more evident on the limbs than on the trunk, may be seen. In severe cases, a profuse maculopapular rash covers the whole body, but tends to be centrifugal, being more marked peripherally than centrally, and the skin has a dusky cyanotic hue. In very severe cases, the rash may become hemorrhagic with bleeding into the elements of the rash, associated with numerous petechial hemorrhages in the skin which may become edematous. On recovery, especially after specific treatment, the rash rapidly resolves, but if it had become hemorrhagic, staining of the skin may be seen for some time in convalescence.
Two cases of lupus miliaris disseminatus faciei successfully treated with oral tofacitinib
Published in Journal of Dermatological Treatment, 2023
A 39-year-old female presented with a 6-month history of multiple reddish and yellowish papules on the face without systemic symptoms. Physical examination revealed symmetrically multiple monomorphic smooth reddish papules on her eyelids, cheeks, noses and chins. Skin biopsy results showed perifollicular epithelioid cell granulomas and lymphocytes infiltrating. Caseating granulomas were observed in the histopahtology of a biopsy specimen. A diagnosis of LMDF was made. She was treated with oral doxycycline at a dosage of 100 mg once daily plus hydroxychloroquine 200 mg twice daily with topical tacrolimus. However, there was no obvious improvement. We changed the therapeutic regimen to tofacitinib (Xeljanz) (5 mg twice daily) plus hydroxychloroquine for 2 months. At the 6-week follow-up, her lesions were improved greatly. Then she continued taking tofacitinib and these lesions improved gradually in the following 10 months (Figure 1).
Transfollicular elimination of sebaceous glands in a patient with disseminate and recurrent infundibulofolliculitis
Published in Baylor University Medical Center Proceedings, 2021
Mahmud Alkul, Travis S. Dowdle, Jay Truitt, Michelle B. Tarbox
DRIF was originally described by Hitch and Lund in 1968 as a benign but bothersome condition affecting young men with darkly pigmented skin.1 There is no known etiology. DRIF is characterized by widespread, flesh-colored papules in stereotypical areas such as the trunk and extremities. Other less commonly reported presentations include a linear distribution of papules along neck creases.2 Histological examination revealing chronic perifollicular inflammation in association with typical papule distribution allows for a diagnosis of DRIF. Common symptoms include pruritus, which can be exacerbated in hot climates and may be significant to the degree of self-excoriation, but papules may also be asymptomatic. These papules are subject to relapse and remission, although our patient experienced persistent papules for an extended period of time.
Stevens-Johnson syndrome with a recall-like reaction within a donor graft site
Published in Baylor University Medical Center Proceedings, 2021
Maleka Najmi, Leigha Sharp, Michelle Tarbox, Cloyce Stetson
A 69-year-old white man with a history of a left forearm sarcoma resection treated with a split-thickness skin graft and radiotherapy several months earlier presented to the emergency department with cellulitis of the left forearm. A 2-week course of TMP/SMX was prescribed for treatment. Ten days later, he presented with flu-like symptoms and a rash. Vital signs were within normal range without fever. The patient denied a history of herpes simplex virus infection and confirmed that TMP/SMX was the only new medication in the past 2 months. Laboratory evaluation revealed leukocytosis and mildly elevated glucose, urea, and creatinine levels. Physical exam revealed dusky erythematous papules coalescing into plaques on the trunk, face, and extremities with mild ocular, oral, and genital mucosal involvement. Epidermal detachment was noted with erosions and blisters on these areas, with a unique rectangular accentuation on the left upper thigh, the patient’s previous donor graft site (detachment <10% of total body surface area) (Figure 1). A punch biopsy from the donor split-thickness skin graft site on the patient’s left upper thigh revealed orthokeratosis overlying a mildly acanthotic epidermis with a subepidermal split accompanied by necrotic keratinocytes up to the level of the mid-epidermis. Within the dermis, there was a somewhat brisk superficial perivascular lymphocytic inflammatory infiltrate (Figure 2). A clinicopathologic diagnosis of SJS was made.