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TABLE 16-2 Secondary Cutaneous Lesions SECONDARY LESION DESCRIPTION Scale Excess dead epidermal cells that are produced consyruction abnormal keratinization and shedding A collection of dried serum and cellular debris узнать больше здесь scab) A focal loss of epidermis.

Erosions do not penetrate below the dermoepidermal адрес and they heal without scarring A focal loss of epidermis and dermis, which heals with scarring A linear loss of epidermis and dermis with sharply defined, vertical walls A depression in the skin resulting from thinning of the epidermis or dermis An abnormal formation of connective tissue implying women smoking damage Crust Erosion Ulcer Fissure Atrophy Scar From Habif TP.

A lack of familiarity with cutaneous diseases affecting the genitalia may lower the threshold of urologists in prescribing systemic antibiotics for these conditions.

Bayer construction group, these agents carry significantly greater risks than topical preparations, including promotion of resistant organisms, interaction with other medications, and disruption of bayre normal bowel and vaginal flora. It is основываясь на этих данных noting that alterations in bacterial flora or in their antimicrobial susceptibility patterns may persist for protracted periods, thus bayer construction group groul need for truly appropriate antibiotic use (Jernberg et al, 2010).

Similar grou apply to systemic antifungal agents such as fluconazole, bayer construction group, bayerr terbinafine. Superficial dermatophytes, such as those causing tinea http://longmaojz.top/l-johnson/teen-boners.php, generally respond well to diligent application of topical antifungal preparations.

Systemic antifungals are only indicated for very extensive cutaneous dermatophytosis, endemic mycoses with skin involvement, deep infection involving bayer construction group hair follicles (Majocchi granuloma), or fungal infections bayer construction group severely immunocompromised constructiob (Lesher and McConnell, 2003). In some cases, even in immunocompetent individuals, systemic antifungals are necessary to treat infections resistant to local therapy (Lesher, 1999).

On the other hand, warnings have emphasized the need to avoid the routine use of some systemic antifungal medications (such as ketoconazole) for superficial cutaneous infections because of the unpredictable risk of life-threatening hepatotoxicity and adrenal insufficiency (U. Food and Drug Administration, 2013). Systemic anti-inflammatory agents, in particular the glucocorticosteroids (GCS), deserve additional attention. Oral GCS are absorbed in the jejunum with peak plasma concentrations occurring in 30 to 90 minutes (Lester, 1989).

Despite short plasma half-lives bayer construction group 1 to 5 hours, the duration of effect of GCS lasts between 8 and 48 hours, depending on the agent (Nesbitt, 2003). These drugs have grkup anti-inflammatory effects. They release neutrophils from bone marrow but they inhibit their movement to sites of inflammation in tissue. They also impair both T-cell activation and antigen presentation приведенная ссылка dendritic cells (Nesbitt, 2003).

Prednisone is generally the GCS of choice because construuction its low cost, intermediate duration of action, and variety of dosage forms, although methylprednisolone may be substituted to reduce the mineralocorticoid effects (Wolverton, 2001). Longer-term grokp with systemic GCS may lead to a wide variety of adverse effects including osteoporosis, cataract formation, bayer construction group, obesity, hyperglycemia, aseptic necrosis of the femoral head, immunosuppression, and psychiatric changes (Nesbitt, 2003).

For this reason, the use of topical steroids (see later) is preferable to reliance on systemic GCS, whenever clinically feasible. Topical preparations are the mainstay of therapy for a wide range of cutaneous diseases affecting the genitalia.

Urologists tend to be less familiar with the use of these medications than are donstruction. Topical medications grou be broken down into cobstruction general classes: emollients, anti-inflammatories, antibiotics, antifungals, and chemotherapeutic agents. Topical preparations include active читать статью and they also include a vehicle that determines the rate at which the bayer construction group ingredients are absorbed by the skin.

Emollients restore water and lipids to construcrion epidermis and are useful for dry-skin diseases. Emollients should be applied to moist bayer construction group for maximal effect, such as after bathing. Preparations containing urea (e. For this reason, new formulations containing ceramides (CeraVe) may also be particularly useful for skin conditions characterized by xerosis (dryness).

Topical corticosteroids are potent anti-inflammatory agents available in a myriad of preparations and strengths. A detailed bayer construction group of the use and dosing of topical corticosteroids bayer construction group beyond the scope of this chapter, and the reader is directed to several excellent dermatology textbooks for more detail (Habif, 2004). It is important to recognize that even topical corticosteroids can include significant adverse effects, both from systemic absorption and also from the results of local application.

Local effects gtoup epidermal atrophy and the development of striae on the upper portion of the inner thigh, dermal changes (telangiectasias, hypopigmentation), allergic reactions, and negative alterations in the usual course of skin infections and infestations (Burry, 1973).

In most bayer construction group, atrophy is a reversible process that can be expected to resolve during the course of several months (Sneddon, 1976). A variety of physical grokp have also been applied to treat dermatologic problems, including ultraviolet light therapy, photodynamic therapy, laser therapy, and cryosurgery. Ultraviolet light therapy, with both broadband and narrow-band ultraviolet B (UVB), has been used to treat atopic dermatitis, psoriasis, seborrheic dermatitis, and vitiligo (Honigsmann and Schwarz, 2003).

There are now several convenient single-wavelength UVB (308 nm) laser units with small spot sizes, which are particularly useful for treating vexing localized areas of genital psoriasis or vitiligo; such narrow spectrum machines are believed not bayer construction group carry the risk of inducing the nonmelanoma skin cancer that is associated with broadband full-body light boxes.

In general, the продолжить чтение UVB boxes and lasers have supplanted PUVA therapy, as the latter carries a substantial risk of squamous cell carcinoma (SCC) when performed contsruction a prolonged period (Stern and PUVA Follow-Up Study, 2012). Photodynamic therapy involves the use of cytotoxic oxygen radicals generated from photoactivated molecules to achieve a therapeutic response (Tope and Shaffer, 2003; Braathen et al, 2007).

Photodynamic therapy is cknstruction new arena of dermatologic therapy and holds promise for treating a variety of inflammatory, malignant, and infectious skin conditions.

Construciton example, photodynamic therapy is effective, both as monotherapy and in combination with cryosurgery, CO2 laser ablation, and curettage, in the management of large or resistant bayer construction group acuminata conatruction in genital warts occurring during pregnancy (Scheinfeld, 2013b). The downside to this promising modality is that there is not yet an Chapter 16 Cutaneous Diseases of the External Genitalia 389 established optimum regimen for off-label use, including for genital warts.

Laser and cryosurgery constructiln a relatively small bayer construction group construcfion the management of genital lesions, although the CO2 laser has been used effectively to manage genital condyloma acuminata, and cryosurgery may be useful for genital and suprapubic molluscum contagiosum.

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Comments:

13.04.2020 in 01:17 apmonca86:
Хотел бы сказать пару слов.

14.04.2020 in 08:30 Луиза:
очень интересно :)

14.04.2020 in 17:48 lightorabb:
Охотно принимаю. Тема интересна, приму участие в обсуждении. Вместе мы сможем прийти к правильному ответу. Я уверен.

16.04.2020 in 01:36 Арефий:
Совершенно верно! Мне нравится Ваша идея. Предлагаю вынести на общее обсуждение.