Seminars in dermatology最新文献

The skin is one of the most important organs involved in patients with HIV infection. Because it is the one most readily evaluated by inspection, it is essential that clinicians be expert in the recognition of skin disorders that herald the presence of HIV disease or a change in the immune status of one already known to be infected. In this article, the most important cutaneous disorders in patients with HIV infection are discussed with special emphasis on those that can be used to assess prognosis or detect the presence of an opportunistic infection.

This article will review the 1993 STD Treatment Guidelines of particular importance to dermatologic clinical practice. Topics include STD/HIV prevention, management of sexual partners, STD in persons with HIV co-infection, genital ulcer disease (GUD) including syphilis, herpes simplex virus (HSV) infection, lymphogranuloma venereum (LGV) and chancroid, therapy of nongonococcal (NGU) and chlamydial urethritis and cervicitis, gonococcal (GC) infections, HPV infection, hepatitis B virus (HBV) infection, pediculosis pubis, and scabies.

The political process is a decisive factor in determining how governmental funds are allocated for control of all diseases especially one as highly politicized as AIDS/HIV. This article discusses how this process works and how various community groups such as homosexual men, women, African-Americans, and the elderly are affected by the outcome.

Optimistic predictions about the extinction of syphilis have proven to be premature. During the beginning of the decade, the reported numbers of infectious syphilis cases were the highest in 40 years. Despite numerous publications about syphilis, the disease continues to challenge clinicians with its protean cutaneous and systemic manifestations. Co-infection with the human immunodeficiency virus does not appear to significantly influence the stage at presentation, clinical course or serologic positivity in most patients, but coinfected patients may be at risk of developing neurosyphilis and late complications even after administration of adequate treatment.

Genital herpes infections are a major source of morbidity. These infections are responsible for significant health problems, including direct physical discomfort associated with outbreaks, potential complications such as neonatal transmission, and the often devastating psychological effects of a chronic illness. In addition, herpes infections have been identified as a significant co-factor in the transmission of human immunodeficiency virus infection. Accurate and rapid diagnosis and treatment are important steps necessary to minimize these effects.

Although Sarcoptes scabii and Phthirus pubis infestations in humans are not always associated with the presence of other sexually transmitted diseases, usually they are. Therefore, patients presenting with scabies or P. pubis should be routinely tested for various sexually transmitted diseases. These very uncomfortable infestations are easily curable with proper therapy. Lindane 1% preparations effectively exterminate both vermin. We have not seen any resistant strains. Especially with P. pubis, all household contacts should be treated to avoid reinfestation.

On the vulva, the appearance of sexually transmitted diseases (STD) is modified for several reasons. Recognition of the special characteristics of vulvar epithelium facilitates diagnosis of both sexually transmitted diseases and vulvar dermatoses that may be mistaken for STDs. The first section will review examination techniques and anatomic considerations. The second section will describe distinctive manifestations of vulvar herpes, human papillomavirus (HPV), molluscum contagiosum, scabies, and syphilis. The final section will provide differential diagnoses for primary and secondary vulvar lesions including erythema, papules, plaques, pustules, bullae, erosions, and ulcers.

With the current resurgence of sexually transmitted diseases (STDs), familiarity with the clinical manifestations of STDs in neonates and infants is essential to minimize the tragic consequences. The recognized routes of transmission of the diseases include transplacental, intrapartum, and postpartum exposure. This discussion will be confined to infections caused by syphilis, herpes simplex virus, human papillomavirus, gonorrhea, and chlamydia emphasizing clinical aspects in this population.

Study of the epidemiology of mycosis fungoides has been hampered by methodologic issues. Mycosis fungoides does appear to be increasing in frequency more rapidly than lymphoma in general. There is substantial geographic variation, as well as variation by race and gender. Analytic studies have not demonstrated additional risk factors.