@torsha Many doctors learned in medical school that monkeypox is a mild disease that goes away on its own, and many people have said that about this outbreak as well. But the reality on the ground is a lot of people with this infection are really suffering, and some actually may be at risk for permanent damage and scarring
@sanghamitra In a study published July 21 in The New England Journal of Medicine, researchers reported clinical details and outcomes of 528 monkeypox infections across 16 countries. All the cases were diagnosed between April 27 and June 24, 2022. Ninety-five percent of the cases were suspected to have been transmitted through sexual activity, 98% of patients identified as gay or bisexual men, and 75% of the patients were White. The median age of patients in this case series was 38 years, and 90% of infections occurred in Europe. Forty-one percent of patients were HIV-positive, and 96% of these individuals were receiving antiretroviral therapy. Among patients whose HIV status was negative or unknown, 57% reported using preexposure prophylaxis against HIV. About 3 in 10 (29%) individuals tested positive for concurrent sexually transmitted infections.
@weston Atrophying tinea versicolor is a rare form that presents as atrophic, ivory-colored–to–erythematous lesions that are oval-to-round in shape. These lesions can have a wrinkled surface, and the atrophy is limited to the areas of skin affected by tinea versicolor.
Histologic features of these lesions include epidermal atrophy, vascular ectasia, and rarefaction of collagen and elastic fibers.
These lesions are often reported in patients who are either misdiagnosed or have a comorbid condition requiring an extended use of topical corticosteroids. However, cases of atrophying tinea versicolor have been described in patients who do not have a history of using topical corticosteroids.
Topical antifungals temporarily eradicate the condition, although treatment may need to be intermittently repeated to prevent recurrence. Oral therapy for tinea versicolor is convenient and effective, but it does not prevent recurrences. A once-monthly (for 6 mo) oral dose of fluconazole is a popular alternative.
Terbinafine topical (Lamisil)
Terbinafine topical inhibits squalene epoxidase, which decreases ergosterol synthesis, causing fungal cell death. Use this medication until symptoms significantly improve. The duration of treatment should be greater than 1 week but not greater than 4 weeks.
Clotrimazole topical (Mycelex, Lotrimin-AF)
Clotrimazole topical is a broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing fungal cell death. Reevaluate the diagnosis if no clinical improvement is seen after 4 weeks.
Ketoconazole topical (Extina, Ketozole)
Ketoconazole is an imidazole broad-spectrum antifungal agent. It inhibits the synthesis of ergosterol, causing cellular components to leak, resulting in fungal cell death. Ketoconazole achieves excellent skin levels with minimal oral dosing, but oral treatment with this agent for skin infections is contraindicated because of safety concerns. M furfur is eradicated by the presence of ketoconazole in outer skin layers.
Ciclopirox interferes with the synthesis of DNA, RNA, and protein by inhibiting the transport of essential elements in fungal cells.
Naftifine is a broad-spectrum antifungal agent and synthetic allylamine derivative; it may decrease the synthesis of ergosterol, which, in turn, inhibits fungal cell growth. If no clinical improvement is seen after 4 weeks, reevaluate the patient.
Econazole topical (Ecoza)
Econazole is effective in cutaneous infections. It interferes with RNA and protein synthesis and metabolism. It disrupts fungal cell wall membrane permeability, causing fungal cell death.
Oxiconazole damages the fungal cell wall membrane by inhibiting the biosynthesis of ergosterol. Membrane permeability is increased, causing nutrients to leak out and resulting in fungal cell death.
@inayka Oral therapy with other systemic antifungals is effective for tinea versicolor and is often preferred by patients because of convenience and oral administration is less time consuming than topical treatment. Of course, oral therapy can be used in consort with topical regimens. Fluconazole, and itraconazole are the preferred oral agents. Various dosing regimens have been used. Fluconazole has been offered as a single 150- to 300-mg weekly dose for 2-4 weeks and is the safest oral agent. Itraconazole is usually given at 200 mg/d for 7 days. Pramiconazole and sertaconazole have also been used in the management of tinea versicolor. [49, 50] A review suggested the following dosing regimens: 200 mg/d for 5 or 7 days of itraconazole, 300 mg/wk for 2 weeks of fluconazole, and 200 mg/d for 2 days of pramiconazole.
@hua While oral ketoconazole is contraindicated for the treatment of tinea versicolor, the topical foam may be useful in some patients. The risk of serious liver damage, adrenal gland problems, and harmful drug interactions with use of oral ketoconazole outweighs it benefit for fungal skin infections.
@princey The organism that causes tinea versicolor is localized to the stratum corneum. M furfur can be detected by hematoxylin and eosin (H&E) alone, although periodic acid-Schiff (PAS) or methenamine silver staining are more confirmatory. On rare occurrences, the organism can approach the stratum granulosum, and it can even be found inside keratinocytes. The epidermis reveals mild hyperkeratosis and acanthosis, and a mild perivascular infiltrate is present in the dermis. An acanthosis nigricans–like epidermal change is noted in the papular variety, with dilated blood vessels observed in erythematous lesions.
@luigi Most cases of tinea versicolor occur in healthy individuals with no immunologic deficiencies. Nevertheless, several factors predispose some people to develop this condition. These factors include genetic predisposition; warm, humid environments; immunosuppression; malnutrition; application of oily preparations; corticosteroid usage; and Cushing disease. The use of bath oils and skin lubricants may increase the risk of developing tinea versicolor
@aditi-1 Tinea versicolor is a benign skin disease that causes scaly macules or papules on the skin. As the name implies (versi means several), the condition can lead to discoloration of the skin, with colors ranging from white to red to brown. The condition is not considered contagious because the causative fungal pathogen is a normal inhabitant of the skin. Treatment leads to cessation of scaling within a few days, but discoloration may last for weeks to months. If scale cannot be provoked and new lesions are not developing, then there is no need to repeat treatment and the patient can be reassured that ongoing infection in unlikely.
Although tinea versicolor is recurrent for some patients and, therefore, a chronic disease, the condition remains treatable with the available remedies (see Medical Care and Medication). Thus, the prognosis is excellent and new treatments continue to be developed
@aparajita Although teenagers often have a high level of awareness of the risks of sun exposure, many adolescents feel better and feel they look healthier with a tan. In general, many adolescents tend to focus more on the here and now than on possible hypothetical risks that may or may not arise in the future. These perceptions have been evaluated in a small study of adolescent girls in England. The investigators concluded that the participants believed looking tanned in the short term was worth the risk of cosmetic and health consequences in the long term. For many adolescents, sun exposure is a constant positive reminder of leisure, vacations, and health, and the reactivation of positive experiences can enhance their mood.
@mohitpriya In 2013, SD-101 was granted breakthrough therapy designation by the US Food and Drug Administration for the treatment of patients with inherited epidermolysis bullosa. Such designation "is very unusual, but of course reflects the terrible issues we've had with this disorder," said Amy Paller, MD, from the Feinberg School of Medicine at Northwestern University in Chicago. The SD-101 6% concentration is now being tested in a larger phase 3 study, Dr Paller reported here at the American Academy of Dermatology 74th Annual Meeting.
@madhubani Mupirocin-susceptibility testing was performed at only some of the 13 participating centers. Of 15 patients whose cultures had recorded SA mupirocin-susceptibility testing, 11 had cultures positive for mupirocin-susceptible SA and 6 (40%) had mupirocin-resistant SA isolates (2 patients grew both). Of these six patients, half had isolates that were also methicillin-resistant. Mupirocin, a topical antibiotic, has been a cornerstone of decolonization regimens for MSSA and MRSA, but resistance has been demonstrated in other research as well and is not specific to EB, wrote Levin, Morel, and coauthors.