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Onycholysis caused by chryseomonas luteola
Letter to the Editor/J.
Eur. Acad. Dermatol. Venereal. 4 (1995) 110-114
Podophyllotoxin versus podophyllin in the treatment of genital warts To the Editor: I would like to add my voice to the discussion on podophyllotoxin versus podophyllin in the treatment of genital warts [l]. In both our studies [2,3], we have found significantly better response with shorter duration of treatment in the podophyllotoxin vs podophyllin group. I would like to stress one more advantage of this therapy. For several years, after we completed our trials, I have been studying the histology of the lesions treated by podophyllin and podophyllotoxin, and I have found, not infrequently, slight to moderate dysplastic changes in podophyllin-treated patients, but none in cases treated with podophyllotoxin. I believe that this is also an important factor to be taken into consideration. I agree with Dr. R.D. Maw that podophyllotoxin is not an ideal drug for genital warts, and we must look for more successful therapy. However, of the present available modalities, podophyllotoxin appears to me superior to podophyllin. Since the motion: “Podophyllotoxin is superior to
Onycholysis caused by chryseomonas luteola To the Editor: In September 1993 we observed two African brothers, ten and eleven years old, who had just arrived from Somaliland. Both boys presented onycholysis in some fingernails, which were warped, yellowish-white in colour and separated from the plate, up to the deformation of the proximal nail folds. The disturbance was thought to be onychomycosis, but diret microscopic examination (KOH) failed to show hyphae and spores. We prescribed Sulconazole 1% lotion three times a day while awaiting the culture of a nail fragment. The laboratory culture grew Chryseomonas Luteola (CL), a Gram neg., aerobe, Pseudomonas comparable. We prescribed 0.1% Gentamicin ointment under night occlusion and 3% Chlortetracycline ointment by day. This method of treatment was commenced 20 days ago, with good results on the shape of the nails and the deformation of the proximal folds (we did not prescribe any oral antibiotic therapy because of the
podophyllin in the treatment of genital warts” was defeated in a democratic way at the clinical debate in Dublin, I take the liberty to express an opposite view which you of course can ignore, especially so since the debate took place almost two years ago. [l] Fraser PA, Lacey CJN, Maw RD. Motion: podophyllotoxin is superior to podophyllin in the treatment of genital warts. J Em Acad Dermatol Venereol 1993;2:328-334. [2] Mazurkiewicz W, Jablonska S. Vergleichende Untersuchungen zwischen 0.5% Podophyllotoxin-Praparaten (Condyline) und 20% Podophyllin, gel&t in Alkohol, hei der Therapie van spitzen Kondylomen. Z Hautkr 1986;61:1387-1395. [3] Mazurkiewicz W, Jablonska S. Clinical efficacy of Condyline (0.5% podophyllotoxin) solution and cream versus podophyllin in the treatment of external condylomata acuminata J Dermato1 Treat 1990;1:129-157. S. Jabtonska * Klinika Dermatologiczna saw. Poland
A.M., ul.Kos.zykswa 824 02-008 War-
* Tel: 0482 6215180; Fax: 0482 622 57 87 SSDZ 0926-9959(94)00091-3
evident malnutrition of both the patients; but we believe that only systemic treatment will lead to complete recovery). CL is rarely found in cultures from human tissues; it is an opportunistic organism associated with prosthetic valve endocarditis, sub-diafragmatic abscess and peritonitis in subjects undergoing continuous dialysis [ll. In our patients’ cases the nail infection originated in Africa, and was due to poor hygienic conditions, malnutrition, lack of care and probably to trauma 121 caused by digging for edible roots. It was possible to distinguish some initial foci of onycholysis in the center of the nail bed, as though the infection had arisen on the sites of nail fracture. Like Pseudomonas aeruginosu [3,4]. CL might play a role in onycholysis: the proteolytic enzymes produced by the bacterium act on the horny nail plate-nail bed attachment, effecting the separation. Unlike Pseudomonasaeruginosa, no green-bluish pigmentation was noted, CL not being able to produce pigments Ill.
Letter to the Editor/J.
Eur. Acad. Dermatol. Venereol. 4 (1995) 110-I 14
[l] Gilardi GL. Pseudomonas and related genera In: Manual of Clinical Microbiology, Balows A, Hansler W Jr et al. eds., American Society for Microbiology, Washington, 1991, chap. 41, pp 437-38. [2] Zaias N, Norton LA. Onycholysis In: Clinical Dermatology, Demis J, Dobson N, McGuire J eds., Harper & Row, Philadelphia, 1982, Vol. 1, unit 3-6, p. 1. [3] Chernosky ME, Dukes CD. Green nails. Arch Dermatol 1963;88:548-53. [4] Stone OJ, Mullins JF. The role of Pseudomonas aeruginosa in nail disease. J Invest Dermatol 1963;41:25-6.
Stevens-Johnson syndrome in a patient with systemic lupus erythematosus To the Editor: Stevens-Johnsonsyndrome (SJS) is characterized by severe mucocutaneouslesions and multiple organ involvement [ 1,2]. Hypersensitivity and immune mechanismshave been attributed with being a cause of this syndrome [2]. To our knowledge, however, there have been only few reports of the simultaneous occurrence of SJS and systemic lupus erythematosus(SLE) [3,4].
Baldari Montini
Urban0 p, *, Antonio b
Ascari
Raccagni ‘, Giuseppe
’ Department of Dermatology, G.B. Morgagni Hospital, Piazza S. Solieri 1, 47100 Fork, Italy b Department of Microbiology, L. Pierantoni Hospital, Fork, I&y
* Corresponding author. SSDI 0926-9959(94)00092-l
A 48-year-old woman was admitted to hospital for polyarthralgia and edema of the lower legs. Laboratory examination revealed a white cell count of 3.8 X 109/1 (15% lymphocytes), hemoglobin 95 g/l, platelet 1.2 X lO”/l, albumin 25 g/l, creatinine 212 pmol/l (nl < 106 pmol/l). Her urine protein was 7 g/day. Positive data included antinuclear antibody, anti-DNA antibody and anti-Sm antibody. C3 was 0.32 g/l (nl 1.2-0.5). Renal biopsy showed typical findings of lupus nephritis. After treatment with methylprednisolone (MPSL) (1 g for
Fig. 1. Cutaneous and oral involvement in a patient with Stevens-Johnson syndrome accompanied by systemic lupus erythematosus.
Eur. Acad. Dermatol. Venereal. 4 (1995) 110-114
Podophyllotoxin versus podophyllin in the treatment of genital warts To the Editor: I would like to add my voice to the discussion on podophyllotoxin versus podophyllin in the treatment of genital warts [l]. In both our studies [2,3], we have found significantly better response with shorter duration of treatment in the podophyllotoxin vs podophyllin group. I would like to stress one more advantage of this therapy. For several years, after we completed our trials, I have been studying the histology of the lesions treated by podophyllin and podophyllotoxin, and I have found, not infrequently, slight to moderate dysplastic changes in podophyllin-treated patients, but none in cases treated with podophyllotoxin. I believe that this is also an important factor to be taken into consideration. I agree with Dr. R.D. Maw that podophyllotoxin is not an ideal drug for genital warts, and we must look for more successful therapy. However, of the present available modalities, podophyllotoxin appears to me superior to podophyllin. Since the motion: “Podophyllotoxin is superior to
Onycholysis caused by chryseomonas luteola To the Editor: In September 1993 we observed two African brothers, ten and eleven years old, who had just arrived from Somaliland. Both boys presented onycholysis in some fingernails, which were warped, yellowish-white in colour and separated from the plate, up to the deformation of the proximal nail folds. The disturbance was thought to be onychomycosis, but diret microscopic examination (KOH) failed to show hyphae and spores. We prescribed Sulconazole 1% lotion three times a day while awaiting the culture of a nail fragment. The laboratory culture grew Chryseomonas Luteola (CL), a Gram neg., aerobe, Pseudomonas comparable. We prescribed 0.1% Gentamicin ointment under night occlusion and 3% Chlortetracycline ointment by day. This method of treatment was commenced 20 days ago, with good results on the shape of the nails and the deformation of the proximal folds (we did not prescribe any oral antibiotic therapy because of the
podophyllin in the treatment of genital warts” was defeated in a democratic way at the clinical debate in Dublin, I take the liberty to express an opposite view which you of course can ignore, especially so since the debate took place almost two years ago. [l] Fraser PA, Lacey CJN, Maw RD. Motion: podophyllotoxin is superior to podophyllin in the treatment of genital warts. J Em Acad Dermatol Venereol 1993;2:328-334. [2] Mazurkiewicz W, Jablonska S. Vergleichende Untersuchungen zwischen 0.5% Podophyllotoxin-Praparaten (Condyline) und 20% Podophyllin, gel&t in Alkohol, hei der Therapie van spitzen Kondylomen. Z Hautkr 1986;61:1387-1395. [3] Mazurkiewicz W, Jablonska S. Clinical efficacy of Condyline (0.5% podophyllotoxin) solution and cream versus podophyllin in the treatment of external condylomata acuminata J Dermato1 Treat 1990;1:129-157. S. Jabtonska * Klinika Dermatologiczna saw. Poland
A.M., ul.Kos.zykswa 824 02-008 War-
* Tel: 0482 6215180; Fax: 0482 622 57 87 SSDZ 0926-9959(94)00091-3
evident malnutrition of both the patients; but we believe that only systemic treatment will lead to complete recovery). CL is rarely found in cultures from human tissues; it is an opportunistic organism associated with prosthetic valve endocarditis, sub-diafragmatic abscess and peritonitis in subjects undergoing continuous dialysis [ll. In our patients’ cases the nail infection originated in Africa, and was due to poor hygienic conditions, malnutrition, lack of care and probably to trauma 121 caused by digging for edible roots. It was possible to distinguish some initial foci of onycholysis in the center of the nail bed, as though the infection had arisen on the sites of nail fracture. Like Pseudomonas aeruginosu [3,4]. CL might play a role in onycholysis: the proteolytic enzymes produced by the bacterium act on the horny nail plate-nail bed attachment, effecting the separation. Unlike Pseudomonasaeruginosa, no green-bluish pigmentation was noted, CL not being able to produce pigments Ill.
Letter to the Editor/J.
Eur. Acad. Dermatol. Venereol. 4 (1995) 110-I 14
[l] Gilardi GL. Pseudomonas and related genera In: Manual of Clinical Microbiology, Balows A, Hansler W Jr et al. eds., American Society for Microbiology, Washington, 1991, chap. 41, pp 437-38. [2] Zaias N, Norton LA. Onycholysis In: Clinical Dermatology, Demis J, Dobson N, McGuire J eds., Harper & Row, Philadelphia, 1982, Vol. 1, unit 3-6, p. 1. [3] Chernosky ME, Dukes CD. Green nails. Arch Dermatol 1963;88:548-53. [4] Stone OJ, Mullins JF. The role of Pseudomonas aeruginosa in nail disease. J Invest Dermatol 1963;41:25-6.
Stevens-Johnson syndrome in a patient with systemic lupus erythematosus To the Editor: Stevens-Johnsonsyndrome (SJS) is characterized by severe mucocutaneouslesions and multiple organ involvement [ 1,2]. Hypersensitivity and immune mechanismshave been attributed with being a cause of this syndrome [2]. To our knowledge, however, there have been only few reports of the simultaneous occurrence of SJS and systemic lupus erythematosus(SLE) [3,4].
Baldari Montini
Urban0 p, *, Antonio b
Ascari
Raccagni ‘, Giuseppe
’ Department of Dermatology, G.B. Morgagni Hospital, Piazza S. Solieri 1, 47100 Fork, Italy b Department of Microbiology, L. Pierantoni Hospital, Fork, I&y
* Corresponding author. SSDI 0926-9959(94)00092-l
A 48-year-old woman was admitted to hospital for polyarthralgia and edema of the lower legs. Laboratory examination revealed a white cell count of 3.8 X 109/1 (15% lymphocytes), hemoglobin 95 g/l, platelet 1.2 X lO”/l, albumin 25 g/l, creatinine 212 pmol/l (nl < 106 pmol/l). Her urine protein was 7 g/day. Positive data included antinuclear antibody, anti-DNA antibody and anti-Sm antibody. C3 was 0.32 g/l (nl 1.2-0.5). Renal biopsy showed typical findings of lupus nephritis. After treatment with methylprednisolone (MPSL) (1 g for
Fig. 1. Cutaneous and oral involvement in a patient with Stevens-Johnson syndrome accompanied by systemic lupus erythematosus.