Pruritic manifestations of corticosteroid-responsive dermatoses

Papular urticaria is characterized by chronic or recurrent eruptions of intensely pruritic papules, vesicles, and wheals caused by a hypersensitivity reaction to insect bites. 7 The lesions are usually grouped in linear clusters on exposed skin, but spare the genital, perianal, and axillary regions. Although the condition can occur in all age groups, it predominantly affects children. Intense pruritus and excoriations may be present. The rash of papular urticaria resolves much sooner than that of Gianotti-Crosti syndrome. Papular urticaria is diagnosed in patients of appropriate age with symmetrically distributed lesions, a history of hypersensitivity, and exposure to animals or insects. 7

Occlusive Dressing Technique

Occlusive dressings may be used for the management of psoriasis or other recalcitrant rub a small amount of cream into the lesion until it disappears. Reapply the preparation leaving a thin coating on the lesion, cover with pliable nonporous film, and seal the edges. If needed, additional moisture may be provided by covering the lesion with a dampened clean cotton cloth before the nonporous film is applied or by briefly wetting the affected area with water immediately prior to applying the medication. The frequency of changing dressings is best determined on an individual basis. It may be convenient to apply Triamcinolone acetonide cream under an occlusive dressing in the evening and to remove the dressing in the morning (., 12-hour occlusion). When utilizing the12-hour occlusion regimen, additional cream should be applied, without occlusion, during the day. Reapplication is essential at each dressing change. If an infection develops, the use of occlusive dressings should be discontinued and appropriate antimicrobial therapy instituted.

Burkholderia (formerly Pseudomonas ) pseudomallei is a gram-negative bacillus isolated from soil, stagnant streams, ponds, rice paddies, and market produce in endemic areas and can cause epizootics in sheep, goats, swine, horses, and seals.[4,33,43,45,77] Humans contract disease from contamination of abrasions with soil but may also ingest or inhale organisms.[4,45] Melioidosis is endemic to southeast Asia and northern Australia, but it may occur anywhere between 20 degrees north and south latitudes.[4,45] It is most widespread in Thailand where it accounts for 19% of hospitalizations and 40% of deaths from community-acquired septicemia.[4] Mild or subclinical infections are common; 80% of Thai children are seropositive by age five years.[4]

Although the concurrent presence of the characteristic rash provides suggestive clinical evidence, biopsy is the most definitive method to diagnose GVHD of the liver. However, this may not be feasible because of the possibility of acute bleeding due to severe thrombocytopenia soon after HCT. A transjugular hepatic biopsy may be preferred if an adequate amount of tissue can be obtained. The primary histologic finding is extensive bile duct damage (eg, bile duct atypia and degeneration, epithelial cell dropout, lymphocytic infiltration of small bile ducts), leading to occasionally severe cholestasis [ 26,31-33 ].

Pruritic manifestations of corticosteroid-responsive dermatoses

pruritic manifestations of corticosteroid-responsive dermatoses

Although the concurrent presence of the characteristic rash provides suggestive clinical evidence, biopsy is the most definitive method to diagnose GVHD of the liver. However, this may not be feasible because of the possibility of acute bleeding due to severe thrombocytopenia soon after HCT. A transjugular hepatic biopsy may be preferred if an adequate amount of tissue can be obtained. The primary histologic finding is extensive bile duct damage (eg, bile duct atypia and degeneration, epithelial cell dropout, lymphocytic infiltration of small bile ducts), leading to occasionally severe cholestasis [ 26,31-33 ].

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