Abstracts
Diaper Rash (1) - United Kingdom
Diaper Rash (1) - United Kingdom
Nappy rash accounts for 20% of dermatology consultations in childhood, but its causes are poorly understood.
Determined the incidence of nappy rash in the first 4 weeks of life. [87% response rate.]
14 highly significant possible causal factors emerged, of which 10 were retained in a logistic regression model: dirtying of nappy, contact with doctor about other problems, history of rashes in joints or skin creases, type of nappy worn, being fed cereal, taken to mother's bed when waking at night, history of cradle cap, general state of health, previous stomach upset, and being only breast-fed. However, the relative risks were generally small.
The likelihood of nappy rash increases with intercurrent illness and early introduction of cereals. Disposable nappies give little protection, and this finding helps to endorse a recently introduced hospital scheme arising from environmental concerns that encourages parents to use cotton nappies instead of disposables.
For many babies, however, the causes of nappy rash remain unknown.
Philipp R et al., Getting to the bottom of nappy rash. Avon Longitudinal Study of Pregnancy and Childhood. Br J Gen Pract, 1997 Aug, 47:421, 493-7.
Diaper Rash (2)
Diaper Rash (2)
The diaper-wearing population has expanded from infants and children to include adults, especially the elderly.
Nurses caring for patients over a wide age range are commonly asked for advice about diapering choices, and for guidance in evaluation, prophylaxis, and treatment of diaper rashes.
Disposables and reusables, and the advantages and disadvantages of each are discussed. A systematic approach is presented for the nursing evaluation of common diaper rashes and their differentiation from rarer skin eruptions of the groin and perineum in diaper-wearing persons.
Boiko S: Diapers and diaper rashes. Dermatol Nurs, 1997 Feb, 9:1, 33-9, 43-6; quiz 47-8.
Gulf War
Gulf War
Numerous questions have been raised about the health consequences to veterans of the Gulf War but most particularly to issues concerning women, who were deployed in unprecedented numbers. Little is known about the health consequences to women of wartime stressors, in general, or the environmental and job-related exposures specific to the theater of the Gulf War.
Women deployed to the theater reported significantly more general as well as gender-specific health problems than did women deployed elsewhere. A cluster of common health problems included: skin rash, cough, depression, unintentional weight loss, insomnia, and memory problems.
Pierce PF: Physical and emotional health of Gulf War veteran women. Aviat Space Environ Med, 1997 Apr, 68:4, 317-21.
Herpes Zoster
Herpes Zoster
Herpes zoster appears to have increased substantially over the last 40 years.
Determined whether the risk of complications of herpes zoster has changed during the last 40 years.
Trigeminal distribution of rash and the presence of certain conditions associated with immune compromise appeared to increase risk.
The apparent increase in the incidence of herpes zoster was not accompanied by a change in the risk of specific or overall complications in a population-based sample. Advanced age and other conditions associated with waning cellular immunity may confer an increased risk of experiencing a complicated course of herpes zoster.
Galil K et al., The sequelae of herpes zoster [see comments]. Arch Intern Med, 1997 Jun 9, 157:11, 1209-13.
Infants (Rash)
Infants
Skin disruptions account for 20% to 30% of pediatric primary care visits. These disruptions may result from skin infections, inflammatory responses, insect bites, and infestations.
The most common dermatoses in infancy are seborrheic dermatitis, (also known as cradle cap); diaper or primary contact dermatitis; and atopic dermatitis, more commonly referred to as eczema, an entity that has yet to be clearly defined.
Recognition and appropriate treatment of these common pediatric dermatoses must not just focus on the skin disruptions; it is important that the infant be assessed within the context of the family.
Singleton JK: Pediatric dermatoses: three common skin disruptions in infancy. Nurse Pract, 1997 Jun, 22:6, 32-3, 37, 43-4 passim.
Papaya Juice
Papaya Juice
Case report of a 55-year-old woman without a history of atopic disease, or drug allergy, who developed a maculopapular symmetric exanthematous rash about 2 days after taking throat lozenges containing papaya juice. Patch tests were positive for papaya juice.
Uniquely: systemic contact dermatitis to papaya without papain hypersensitivity.
Iliev D & Elsner P: Generalized drug reaction due to papaya juice in throat lozenges. Dermatology, 1997, 194:4, 364-6.
Parenteral Alimentation
Parenteral Alimentation
Total parenteral nutrition with lipids is a well-accepted modality of metabolic support in seriously ill trauma patients. Intolerance to lipid administration is unusual when dosage limits are not exceeded, and few hematologic disturbances have been recorded with modern fat emulsions.
Traumatic lesions, eosinophilia with or without leukocytopenia may develop.
Discontinuation of the nutritional regimen with lipids achieves normalization of the hematologic profile, suggesting that an acute or sub-acute allergic reaction was responsible. The appearance of skin rash on occasion reinforces this hypothesis.
It is concluded that blood cell aberrations are possible during intravenous feeding with lipids in trauma subjects, but tend to respond to suppression of the lipid-containing nutritional prescription.
Faintuch J et al., Hematologic disorders in trauma patients during parenteral alimentation with lipids. Rev Hosp Clin Fac Med S Paulo, 1996, 51:2, 60-4.
Scurvy (1)
Scurvy (1)
Various conditions can imitate cutaneous vasculitis. Scurvy is a less appreciated cause of rash that can resemble vasculitis.
Findings included a purpuric skin rash, myalgias, and malaise.
Patients had low vitamin C levels and findings on skin biopsy specimens indicative of scurvy.
Early recognition of scurvy is important because it can be treated specifically, and toxic treatment of vasculitis can be avoided.
Adelman H et al., Scurvy resembling cutaneous vasculitis. Cutis,1994, 54(2)111-4.
Scurvy (2)
Scurvy (2)
Case report of a 31-year-old male with weakness, gingival "pain" and a rash over the lower extremities. This person had a history of poor "nutritional" intake, did not consume "alcohol", and had a 13 pack per year history of "smoking".
Laboratory evaluation of "vitamin C" found a marked deficiency with a level less than .2 mg/Dl. A "skin" biopsy demonstrated chronic "lymphocytic" vasculitis. The patient received 500 mgs of vitamin C twice a day and within 3 days after discharge the pain had ceased and the rash had cleared.
He was instructed in diet and maintained on low dose "ascorbic acid" tablets. The authors state that vitamin C deficiency may be present in morbid states such as, "cigarette" smoking, "malnutrition", "liver disease", "rheumatoid arthritis" and "cancer". Signs of vitamin C deficiency may include a perifollicular purpuric rash, poor dental hygiene with gingival "inflammation" and "bleeding", complaints of arthralgias, weakness and "fatigue".
"Scurvy in a Nonalcoholic Person in the United States", Assi, Muneer E., et al, J of the American Osteopathic Association, Dec. 1992;92(12):1529-1531.
Zinc Deficiency (1)
Zinc Deficiency (1)
Case report of a 6-month female infant with a 3 to 4 week history of a scaly, "erythematous" perioral rash. The rash had been treated with topical hydrocortisone without improvement.
After discharge from the hospital the infant was maintained solely on breast milk. The differential diagnosis was impetigo, "candidiasis" or "zinc" deficiency. The child had a low "serum" zinc level of 40 ug/dl (normal range: 60 to 130).
Oral zinc "chloride" at .3 mg per kg every 24 hours and infant formula was added to the breast feeding. The child showed marked improvement after 2 days of therapy and nearly complete healing of the eruptions after 2 weeks.
"Acquired Zinc Deficiency in a Premature Breast-Fed Infant", Buehning, Laura, MD and Goltz, Robert W., MD, Journal of the American Academy of Dermatology, March 1993;28(3):499-501.
Zinc Deficiency (2)
Zinc Deficiency (2)
Report of 6 patients who developed skin eruptions while on total "parenteral" "nutrition". The eruptions typically presented as red papules in the perioral region, nasal area, scrotum and perianal area.
Occasionally there was blistering and hair loss. Spread to the scalp, peripalpebral areas and over "joints" was common. Resumption of oral feeding or supplementation with zinc resulted in the resolution of these symptoms.
Attention to trace metals in patients receiving intravenous hyperalimentation, especially with regards to zinc and "copper" status, should take place.
"Skin "Lesions" During Intravenous Hyperalimentation: Zinc Deficiency", Okada, Akira, MD, et al, Nutrition, January/February 1989;5(1):11-20.
"Newborn Chemical Exposure From Over-The-Counter Skin Care Products", (frequency of, toxicity of, bathing, shampoo, rash) Cetta, Frank, MD, et al, Clinical Pediatrics, May 1991;30(5):286- 289.
Zinc Deficiency (3)
Zinc Deficiency (3)
Case report of a premature infant with necrotizing enterocolitis who developed symptoms of zinc (Zn) deficiency after three to four weeks of total parenteral nutrition (TPN).
Clinical presentations included characteristic skin rash, alopecia, retarded growth, generalized edema and decreased serum alkaline phosphatase (ALP).
Immune function studies revealed impaired neutrophil adhesion and mitogen-induced lymphoproliferation, whereas phagocytosis, chemotaxis and lymphocyte subsets remained normal.
A high dose of elemental Zn (2.5 mg/kg/day), administered orally, improved the clinical symptoms and restored the immune function.
In patients with Zn deficiency, impaired neutrophil adhesion and lymphocyte function may contribute to immunodeficiency which can be reversed with adequate Zn supplementation.
Fan PC et al., Impaired immune function in a premature infant with zinc deficiency after total parenteral nutrition [see comments]. Acta Paediatr Sin, 1996 Sep-Oct, 37:5, 364-9.
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