The diagnosis and management of perniosis (chilblains)

Perniosis (chilblains) is an abnormal reaction to cold that occurs most frequently in women, children, and the elderly. Chilblains may be idiopathic and self-limited, or associated with systemic diseases. This article discusses the approach to the diagnosis and treatment perniosis and explains the concepts of acrocyanosis and erythrocyanosis. South African Family Practice Vol. 49 (6) 2007: pp. 28-2

Acute febrile neutrophilic dermatosis (Sweet's syndrome). A report of 2 cases

CITATION: Jordaan, H.F., De Goede, F.H. & Sandler, M. 1989. Acute febrile neutrophilic dermatosis (Sweet's syndrome). A report of 2 cases . S Afr Med J, 75(4):336-338.The original publication is available at http://www.samj.org.zaENGLISH ABSTRACT: Two cases of Sweet's syndrome are described. The diagnostic criteria, clinical spectrum, complications, pertinent differential diagnoses and treatment modalities of this relatively rare clinical condition are described. The association of Sweet's syndrome with underlying haematological malignant disease is stressed.Publisher’s versio

Calcific uraemic arteriolopathy (calciphylaxis) in patients on renal replacement therapy

Background. Calcific uraemic arteriolopathy (calciphylaxis) is an unusual and potentially fatal condition characterised by small-vessel calcification and ischaemic skin necrosis. It mainly affects patients with end-stage renal disease (ESRD) on haemodialysis, but may rarely occur in the absence of ESRD in conditions such as primary hyperparathyroidism, malignancy, alcoholic liver disease and connective tissue disease.Methods. We reviewed the records of all patients diagnosed with calciphylaxis while on renal replacement therapy at Tygerberg Hospital, Cape Town, South Africa, between 1990 and 2014, to describe its presentation, course and final outcome.Results. Nineteen patients developed calciphylaxis over this period. Their median age was 34 years and 13 (68.4%) were female. Fifteen (78.9%) had received a kidney transplant. All patients had painful skin lesions that rapidly progressed to infarction. Small-vessel calcification was seen on skin biopsy in 13 patients. Twelve patients had hyperparathyroidism. Several of the transplanted patients had been treated for graft rejection in the year preceding the diagnosis. Treatment consisted of good wound care and efforts to normalise serum calcium and phosphate levels. Five patients received an urgent parathyroidectomy. The outcome was fatal in 17 patients, with sepsis being the main cause of death.Conclusions. In our patients, calciphylaxis carried a worse prognosis than previously reported internationally. It should always be considered in the differential diagnosis of painful skin lesions in the dialysis or transplant patient

Regional clinical registry data show increased incidence of cutaneous melanoma in Cape Town

Cutaneous melanoma is a skin tumour that continues to result in a high mortality rate, particularly in the case of thick tumours and those that are deeply invasive histologically. It occurs in all populations but is most common in fair-skinned individuals, especially those with skin types 1 and 2 that tan poorly or not at all. There is epidemiological evidence for the pathogenetic role of ultraviolet light, particularly intense childhood exposure, although the relationship is complex. Genetic factors also play a role, as exemplified by families with both atypical naevi and melanoma. The rising incidence of melanoma, noted initially in countries with high levels of UV light, appears to be levelling off or decreasing in some areas. The pattern of these trends is inconsistent, with even European countries showing great variation. An epidemiological study performed in Cape Town from 1990 to 1995 demonstrated an incidence of melanoma of 24.4 per 100 000 white people per annum. We conducted a methodologically identical study in the same geographical area after a 10-year interval, to identify whether there is a trend in the incidence of melanoma in this area

Education and specialist referral of patients with atopic dermatitis

Educating patients with atopic dermatitis is an essential and necessary part of therapy and particularly important when young children are involved. Quality of life is seriously impaired if patients or their carers do not understand the chronic and relapsing nature of the disease and how it can be treated.

Do Multinational enterprises push up wages of domestic firms in the Italian Manufacturing sector?

This paper analyzes the effects of foreign direct investment on wages paid by domestic firms in the Italian manufacturing sector over the period 2002–2007. In particular, the authors investigate the im-pact of multinational enterprises on wages paid by local firms which operate in the same industry, known and horizontal wage spillovers, or have linkages with multinational enterprises in both downstream and upstream industries, known as vertical wage spillovers. By using a large panel dataset, consisting of 551,000 observations, the authors find evidence of wage spillovers only at inter-industry level and, more specifically, for those firms who supply their goods to multinational enterprises, described as backward wage spillovers. Moreover, findings suggest that the wage spillover effect is strongly affected by the technological gap between local and foreign firms: only workers employed in domestic firms with a low-medium technological absorptive capacity seem to benefit from the presence of multinational enterprises in terms of higher wages

Clinical and pathological features of acral melanoma in a South African population: A retrospective study

Background. Acral melanoma (AM) is a rare subtype of cutaneous melanoma (CM) that disproportionately affects skin of colour and carries a poorer prognosis than other melanoma subtypes. The poor prognosis is attributed to late diagnosis and subsequent relatively high Breslow thickness, but also to an intrinsic biological aggressiveness. Scientific data on AM from the developing world are limited and a need exists to characterise the disease further in the South African (SA) population.Objectives. To describe the clinical and pathological features of AM in an SA population.Methodology. A retrospective chart review characterised the demographics, clinical features and histological data of 66 patients diagnosed with AM between January 2010 and June 2016 at Tygerberg Academic Hospital, Cape Town, SA.Results. Sixty-six patients with AM were identified from 335 patients diagnosed with CM during the set time frame. The mean age (standard deviation (SD)) was 61.5 (12.5) years. Forty-two (63.6%) of the patients were female (male/female ratio 1:1.75). The majority of patients diagnosed with AM were black (48.5%), and the proportion of AM in black patients with CM was 80.0%. Fifty-six AMs (84.8%) were located on the foot and 10 (15.2%) on the hand. The median duration of the lesion before diagnosis was 10 months (range 2 - 84) and the mean (SD) tumour size was 3.8 (2.2) cm at diagnosis. The mean Breslow thickness of all AMs at diagnosis was 5.2 mm (median 4.2  mm, range 0 - 22). Stage of disease was known in 41 patients, 23 (56.1%) of whom had at least stage III disease at diagnosis. Mean Breslow thickness for foot and hand melanomas was 4.9 mm (range 0 - 22) and 6.9 mm (range 0 - 13.3), respectively (p=0.2552). The mean Breslow thickness in the black population was 6.3 mm compared with 4.2 mm and 4.3 mm, respectively, in the white and coloured populations (p=0.178). Patients from outside the Western Cape Province (WC) presented with a mean Breslow thickness of 6.6 mm (range 0 - 14.5) and patients from the WC with a mean Breslow thickness of 4.9 mm (range 0 - 22) (p=0.3602).Conclusions. AMs accounted for a significant proportion of all CMs diagnosed. Patients presented with an advanced stage of disease at diagnosis, and further studies are needed to further investigate the reasons for delayed diagnosis.