Clinics in dermatology
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Paracoccidioidomycosis is an endemic systemic mycosis that predominates in southern Mexico, parts of Central America, and South America. It is caused by a dimorphic fungus and is generally acquired through the lungs, from where it disseminates. ⋯ Treatment includes sulfamethoxazole-trimethoprim for mild forms and itraconazole for moderate cases. Fluconazole and voriconazole can be used for meningeal involvement, and amphotericin B is indicated for severe disease.
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Sporotrichosis is the most common subcutaneous mycosis. It is usually acquired by traumatic inoculation, and it is caused by one of the species of the Sporothrix schenckii complex. More than 6 species, such as S schenckii sensu stricto, Sporothrix brasiliensis, Sporothrix globosa, Sporothrix mexicana, and Sporothrix albicans, have been identified by molecular techniques. ⋯ The diagnosis is suggested by biopsy specimen and confirmed by tissue culture. Itraconazole is considered the treatment of choice, although in some undeveloped countries potassium iodide is still used, owing to its safety and low cost. For systemic or disseminated cases, amphotericin B is the treatment of choice.
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Clinics in dermatology · May 2012
Abnormal epidermal barrier in the pathogenesis of contact dermatitis.
A crucial role of the epidermal permeability barrier is obvious in contact dermatitis. An intact skin barrier prevents the penetration of harmful substances into the skin. Irritants and allergens that stay on the skin surface and come into contact with the stratum corneum only do not harm the skin. ⋯ Treatments in contact dermatitis should restore the skin barrier to prevent relapse of the disease. Topical corticosteroids, most often used in treating contact dermatitis, reduce immunological reactions and inflammation but do not lead to a complete barrier repair. Skin barrier repair is more complete after treatment with calcineurin inhibitors and bland lipid-based emollient; therefore, these preparations should be preferred for long-term treatment of contact dermatitis.
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Although dermatology does not lead the list of specialties most commonly sued for malpractice, anyone who has been the recipient of a malpractice claim is often traumatized both personally and professionally. Every day dermatologists must address various ethical concerns that have legal implications. Herein, we chose to discuss the following such issues: (1) the ethical and legal necessity of submitting a clinically benign appearing lesion for dermatopathologic review; (2) the ethical and legal considerations regarding frequency of screening after a patient has been diagnosed with melanoma; (3) the multiple ethical and legal considerations involved with the misdiagnosis of a melanoma; (4) the complex ethical and legal considerations of a dermatologist making a clinical diagnosis in a nonprofessional social and public setting; and (5) the ethical and legal implications of sharing care of patients with other dermatologists and specialists.