Dermatologic conditions

Monobasic aluminum acetate is dispensed as a 7% aqueous solution for the topical treatment of certain dermatological conditions, where a combination of detergent, antiseptic, astringent, and heat-dispersant effects are needed (12). The solution, diluted with 20—40 parts water, is appHed topically to the skin and mucous membranes as a wet dressing (13). Burrow s solution, prepared from aluminum subacetate solution by the addition of a specific amount of acetic acid, is also used as a topical wet dressing. Standards of purity and concentration have been estabHshed for both pharmaceutical aluminum acetate solutions (13). Each 100 mL of aluminum subacetate solution yields 2.30—2.60 g of aluminum oxide and 5.43—6.13 g of acetic acid upon hydrolysis. For the Burow s solution, each 100 mL yields 1.20—1.45 g of aluminum oxide and 4.25—5.12 g of acetic acid. Both solutions may be stabilized to hydrolysis by the addition of boric acid in amounts not to exceed 0.9% and 0.6% for the subacetate and Burow s solutions, respectively (13). 

The ghicocorticoids are used as replacement therapy for adrenocortical insufficiency, to treat allergic reactions, collagen diseases (eg, systemic lupus erythematosus), dermatologic conditions, rheumatic disorders, shock, and other conditions (see Display 50-1). The anti-inflammatory activity of these hormones make them valuable as anti-inflammatories and as immunosuppressants to suppress inflammation and modify the immune response... 

Contact dermatitis is a common reason for dermatology referrals and constitutes up to 90% of all workers compensation claims for dermatologic conditions. Although most often seen in adulthood, contact dermatitis can affect all age groups, with females at slightly greater risk than males.28... 

NIOSH. Proposed national strategy for the prevention of leading work-related diseases and injuries — Dermatological conditions (DHHS Publication [NIOSH] 89-136) Cincinnati NIOSH, 1988. 

Hj antihistamines are clinically used in the treatment of histamine-mediated allergic conditions. Specifically, these indications may include allergic rhinitis, allergic conjunctivitis, allergic dermatological conditions (contact dermatitis), pruritus (atopic dermatitis, insect... 

Injections for local effect in dermatologic conditions Avoid injection of sufficient material to cause blanching, since this may be followed by a small slough. One to 4 injections are usually employed. 

ALA-proto-porphyrin IX Levulan (DUSA) 635 (5000) 0.56 60 50-150 500-1500 Skin cancers, dermatological conditions (psoriasis) No skin phototoxicity Can be used topically with blue light for skin disorders (Approved, actinic keratoses)... 

A number of drugs used primarily for other conditions also find use as oral therapeutic agents for dermatologic conditions. A few such preparations are listed in Table 61-4. 

Table 61-4 Miscellaneous Medications and the Dermatologic Conditions in Which They Are Used. ...

Recessive X-linked ichthyosis (RXLI) is a dermatological condition that is caused by steroid sulfatase deficiency (STSD), although the mechanism by which the deficiency causes the characteristic scaly skin has not been adequately explained. RXLI is the most common genetic disorder of steroid metabolism, affecting about 1 2000 males. Epstein and workers [16] first demonstrated that serum cholesterol sulfate was elevated in the condition, and this compound has become the preferred analyte for diagnosis. The serum level is more than tenfold greater than normal in the condition. 

Keane FM, Munn SE, du Vivier AW, Taylor NF, Higgins EM. Analysis of Chinese herbal creams prescribed for dermatological conditions. BMJ 1999 318(7183) 563 1. 

Not surprisingly, the cutaneous microbiome has been studied for its potential role in dermatologic conditions such as psoriasis, atopic dermatitis, and acne. Psoriasis, a chronic idiopathic inflammatory disease of the skin (170), has been associated with an overrepresentation of Firmicutes and underrepresentation of Actinobacteria when compared to both the unaffected skin of psoriatic patients and the skin of normal controls (171). Additionally, Pro-teobacteria were detected less frequently in psoriatic lesions compared to skin of healthy controls (171). Subsequent studies using pyrosequencing techniques confirmed that Actinobacteria were more abundant in controls compared to patients with psoriasis however, Proteobacteria were significantly higher in trunk skin samples from psoriatic patients compared to controls (172). 

Additionally, Propionibacterium acnes, which thrives in the pilosebaceous glands of the skin, secretes enzymes that cause local skin irritation and inflammation, and is generally accepted to play a role in the dermatologic condition, acne (178). The role of other microbiota in the development of acne, however, is still under investigation. 

These include atypical or subtle manifestations of dermatologic conditions such as seborrheic dermatitis, rosacea, psoriasis, atopic dermatitis, and ichthyosis. Classic manifestations of such diseases are diagnosed with relative ease. However, diagnostic difficulty arises in the presence of atypical morphology, lesions masked by topical therapy (e.g., corticosteroids), or exacerbations due to other topical agents (e.g., skin care products).2,10... 

Pesticides include a broad range of substances most commonly used to control insects, weeds, and fungi. Insecticides are often subclassified by chemical type as organophosphates, organochlorines, carbamates, and pyrethroids [110]. Some studies have indicated that pesticide exposure is associated with chronic health problems or health symptoms such as respiratory problems, memory disorders, dermatologic conditions, cancer, depression, neurologic deficits, miscarriages, and birth defects [111]. 

Skin diseases including essential fatty acid deficiency and ichthyosis may also affect the transdermal delivery of a compound. Studies have shown that the epidermal barrier function is altered by abnormal lipid composition in noneczematous atopic dry skin. Numerous other dermatologic conditions affect the anatomical structure and function of skin, which may impact on the nature of the toxic responses seen. 

Jablecki, J., Norton, S., Keller, R., DeGraw, C., Ratard, R., Straif-Bourgeois, S., et al. (2005). Infectious disease and dermatologic conditions in evacuees and rescue workers after Hurricane Katrina—multiple states, August-September, 2005. Morbidity and Mortality Weekly Report, 54(38), 961-964. 

Smith, K.J. (1999). The prevention and treatment of cutaneous injury secondary to chemical warfare agents. Application of these finding to other dermatologic conditions and wound healing. Dermatol. Clin. 17(1) 41-60. 

Blepharitis is a broad term that refers to a collection of lid margin inflammatory disorders that cause changes in adjacent or surrounding structures and often includes, or is associated with, dermatologic conditions such as seborrhea and rosacea. The etiology remains poorly understood despite a strikingly high prevalence in the population it has been reported that approximately 590,000 patients per year seek care due to blepharitis, and it is estimated that 20 million people suffer from this disorder worldwide. 

Infections blepharitis is thought to be caused by a direct infection from bacteria that are either foimd in greater qnantity, are more virulent in nature, or are pathogenic in certain individnals. It has also been postnlated that patients with atopy or other dermatologic conditions (e.g., rosacea) are more likely to have blepharitis and are more prone to staphylococcal infections. Cnrrently S. aureus remains the primary suspect in bacterial and mixed variety blepharitis, although the exact mechanism remains a mystery. 

Dermatologic disease and its related ocular complications are commonly encoimtered entities in general ophthalmic practice. The conjimctiva frequently is affected with ocular involvement. Although numerous dermatologic conditions can affect the eye, this section focuses on the three conditions that are most often encountered acne rosacea, psoriasis, and atopic dermatitis. 

The etiology of rosacea, which is a comparatively common dermatologic condition, remains obscure. The disorder typically presents between the third and fifth decades and is more frequently seen in women than in men. However, men are typically more severely affected. Specific trigger factors have been associated with rosacea, including trauma. An ethnic predisposition has been noted. Use of alcohol was once considered a factor, but this is no longer believed to be true. 

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