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Fungal Infections
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Uwe Wollina, Pietro Nenoff, Shyam Verma, Uta-Christina Hipler
Chromoblastomycosis or chromomycosis is a chronic polymorphic fungal infection of the skin and subcutaneous tissue. It is caused by several species of melanized or dematiaceous fungi, which produce a dark pigment. The fungus penetrates the skin through a skin injury. About 4–8 weeks later, a papule develops that progresses to a slow-growing warty nodule.
Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
A 65-year-old woman was treated for chromomycosis due to Phialophora verrucosa with systemic antifungal treatment supplemented with topical luliconazole 1% cream. Two days later, itchy erythema and papules appeared at the application site. Patch testing showed a positive reaction to luliconazole 1% pet. at D2 (++) and D3 (++). Since the patient also reported a history of contact dermatitis from lanoconazole cream used for the treatment of tinea pedis, she was patch tested with lanoconazole 1% and 10% pet. and a battery of other antimycotic creams, which yielded ++ reactions to both concentrations of lanoconazole only. Because luliconazole and lanoconazole have a similar chemical structure, the patient was considered to have been sensitized with lanoconazole and to have cross- reacted with luliconazole, resulting in the allergic contact dermatitis. The authors suggest that the dithioacetal structure was essential for inducing contact allergy to luliconazole and lanoconazole (2).
Ketoconazole
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissues caused by dematiaceous fungi (most commonly Fonsecaea pedrosoi, Philaophora verrucosa, Cladosporium carrionii), which are found in soil and decomposing vegetation and innoculated into skin by trauma. It is generally difficult to treat. Most infections caused by dematiaceous fungi require both surgical and medical treatment. Ketoconazole (200–400 mg daily) therapy for several months produced a moderate improvement in 30% of patients with mild disease. It is not effective in those with extensive disease (Restrepo, 1994). Cutaneous chromomycosis due to F. pedrosoi was reported in a renal transplant patient who required multiple excision biopsies and ketoconazole to effectively control her disease. Although residual skin lesions regressed over several months of treatment, they did not disappear, and recurrent lessions developed while she was taking ketoconazole 200 mg daily. New crops of lesions were excised and the patient remained free of disease for 1 year on continued ketoconazole (Wackym et al., 1985). Successful treatment with ketoconazole and flucytosine in combination has also been reported (Silber et al., 1983). At present, itraconazole is considered to be the drug of choice (Queiroz-Telles et al., 1992). Other medical therapeutic options include 5-flucytosine, terbinafine, fluconazole, thiabendazole, and amphotericin B (Martinez and Mendez Tovar, 2007).
Evaluation of Ultrasound Biomicroscopy Combined with Color Doppler Flow Imaging in the Diagnosis of Primary Lacrimal Canaliculitis
Published in Ocular Immunology and Inflammation, 2021
Qian Chen, Ruiqi Ma, Xiuqian Yi, Lu Gan, Yun Cheng, Rui Zhang, Jiang Qian, Yifei Yuan
In the present study, patients with primary canaliculitis were mostly middle-aged and elderly women. This propensity, which is consistent with previous reports, may be attributed to low tear-drainage velocity in the female population and decreased punctal depth at an older age.3,8,9 Besides, our study reported a predominant laterality (right eye) and location (lower canaliculus) in primary canaliculitis. This finding is comparable to some previous studies but still lack of consensus.10 Another finding is high misdiagnosis rates and long time-lapse to accurate diagnosis in both canaliculitis and non-canaliculitis groups. Inaccurate diagnosis may lead to insufficient or improper treatments and may even result in an unfavorable outcome. For instance, in a recent case report, a patient with canaliculitis was misdiagnosed as conjunctivitis and suffered corneal perforation due to infection spread.11 In our series, four non-canaliculitis cases were previously misdiagnosed as canaliculitis and underwent unnecessary invasive interventions (e.g. Case 4). These treatments can cause iatrogenic injury to the lacrimal system and result in impaired pump activity.12 Some researchers advocated microbiologic study to diagnose canaliculitis, whereas the successful culture rate was quite unstable, varying from 11.1% to 80.0%.3,13 The most common isolated microorganism is considered to be Actinomyces, but some recent studies demonstrated greater rates of infection with Streptococcal and Staphylococcal.14 The incongruent results may be attributed to a high rate of polymicrobial infection (31% in our case series) and the difficulties in isolating Actinomyces by virtue of its fastidious nature. Some researchers improved culturing techniques to increase the yield rate, while others proposed a histopathologic study to confirm the presence of Actinomyces.15 In the present study, Actinomyces was successfully cultured in 3 cases, and 10 more cases were identified based on staining results. Histopathologic analysis is more sensitive to discover pathogens, but this method may be misleading owing to the similar appearance of Actinomyces, Fusobacterium, Nocardiosis, Chromomycosis, and Botryomycosis on staining. Clinicians need a more convenient and reliable ancillary test to assist the diagnosis of primary canaliculitis.