Perineal Dermatitis Research Articles

Perineal dermatitis in the elderly. A critical review of the literature.

The review of literature revealed a significant lack of research on the pathogenesis of perineal dermatitis in the elderly. The majority of what is known about this condition stems from the pediatric population. The differences between TEWL and skin surface pH levels in pediatric and geriatric skin raises questions about the further generalizability of the pediatric studies. There appears to be some controversy in the literature regarding whether baseline TEWL is increased or decreased in cutaneous aging. The literature did reveal some data indicating that skin surface pH increases with age; however, no data on the perineum was found. No studies examining the role of TEWL and skin surface pH and its association in the development of perineal dermatitis in the elderly were found. Additionally, no studies were found that examine the nursing variables identified in the literature search. The paucity of scientific data on this serious and costly condition warrants additional research in this area.

Complications of absorbable pelvic mesh slings following surgery for rectal carcinoma.

To evaluate the intraoperative, postoperative, and long-term complications of an absorbable pelvic mesh sling after surgery for rectal carcinoma. A retrospective review of medical records from April 8, 1991, through April 8, 1996. Twenty patients with a mean age of 57 (range, 37-79) years underwent pelvic mesh sling placement. The tumor stages were as follows: Stage I, 5; Stage II, 2; Stage III, 11; and Stage IV, 1. A recurrent perianal basal cell carcinoma was not included in the staging group. Surgery consisted of 18 abdominoperineal resections, 1 total proctocolectomy, and one Hartmann's procedure. Mean follow-up was 18 (range, 2-49) months. There were no intraoperative complications related to mesh placement. Twenty-nine complications occurred in 14 patients during the immediate postoperative period. Five were possibly mesh-related and included a pelvic abscess, perineal seroma, toxic perineal wound, pulmonary embolus, and lower extremity deep venous thrombosis, respectively. A mild postoperative ileus developed in 17 patients (85 percent), and a diet was initiated at a mean of seven (range, 4-24) days. Fourteen patients received postoperative radiotherapy with a mean dose of 5,339 (range, 2,500-7,020) cGy delivered in 180-cGy fractions. There were 14 immediate complications caused by radiotherapy in 11 patients, but only two patients required delays in treatment. Two patients had diarrhea alone, six developed perineal dermatitis alone, and three patients had both diarrhea and perineal dermatitis. All patients with diarrhea had received chemoradiation. One patient developed a partial small-bowel obstruction following radiation. Absorbable pelvic mesh sling placement can be performed with minimum morbidity and is recommended following surgery for rectal cancer when radiation is anticipated as part of multimodality therapy.

Iatrogenic Urogenital Fistulae

Nineteen patients with iatrogenic urogenital fistulae were treated between 1985 and 1989. All resulted from obstetric and gynaecological surgery. Major symptoms were leakage of urine through the vagina, menouria and perineal dermatitis. The fistulae formed after treatment for benign conditions in 18 patients. Fistulae complicating cancer surgery were uncommon. All patients with uretero-vaginal fistulae underwent preliminary percutaneous nephrostomy. Twelve patients underwent reconstruction using either the Boari-Ockerblad flap (5), uretero-neocystostomy (4) or other techniques (3), all with excellent results. Most of the remaining patients had treatment elsewhere. We consider that preliminary diversion, followed by delayed reconstruction, is a valuable option in the management of uretero-vaginal fistulae.

STRUCTURED SKIN CARE REGIMEN TO PREVENT PERINEAL DERMATITIS IN THE ELDERLY

A preliminary investigation was conducted to determine the efficacy of a structured skin care regimen to prevent perineal dermatitis in incontinent geriatric psychiatry patients. A 10-week, prospective, clinical trial was conducted (n = 15). Four weeks (weeks 2 to 5) were devoted to monitoring the unstructured pretreatment nursing skin care practice and to determining the incidence of perineal dermatitis in incontinent patients. Four weeks (weeks 7 to 10) were also spent implementing and observing the structured nursing skin care regimen. The study revealed that 33% (three) of the subjects in the unstructured skin care group and 33% (two) of the subjects in the structured skin care group had perineal dermatitis. In subjects with a combination of urine and stool incontinence perineal dermatitis developed within 2 days. The findings suggest that perineal dermatitis occurs quickly in the presence of urine and stool incontinence. Further research is needed to validate the efficacy of a structured skin care regimen to prevent perineal dermatitis.

Feasibility of non-surgical definitive management of anal canal carcinoma

The management of anal canal carcinoma has evolved over the last decade, with the combination of radiotherapy (RT) and chemotherapy (CT) offering a definitive alternative to surgery or RT alone. Twenty-two patients with basaloid/cloacogenic/squamous cell carcinoma of the anal canal (13 with T3–T4 lesions), were treated with synchronous RT (30.00 to 45.00 Gy in 3 1 2 to 5 weeks) and CT × 2 courses (Mitomycin C 15 mg/m2 LV. bolus + 96 hours 5FU infusion). This regimen differed from the conventional Nigro regimen in that higher doses of RT and 2 courses of Mitomycin C were used and both CT courses were given synchronously with RT. Three patients with residual disease were salvaged with an additional course of CT and local RT, without surgery. Acute side effects including perineal dermatitis, diarrhea, leukopenia, and thrombocytopenia were reversible or transient. Twenty patients are alive and free of disease 17 to 62 months (median 45 months) following initiation of treatment. Two patients died at 7 months without evidence of disease at autopsy. These results compare favorably with other series employing RT alone, AP resection alone, and to those employing similar CT-RT regimens as well, in terms of disease-free survival rate (100%), complete response rate ( 19 22 or 86%), salvage rate without surgery ( 3 3 ), and acceptable morbidity. These results may be attributed to an optimal balance of RT and CT doses and refinements in RT technique which are detailed in our report.

Sanitary Napkin Dermatitis due to the Perfume

Deodorant sanitary napkins are being used with increasing frequency. This is a case report of a patient with a puzzling vulvar dermatitis, which was due to the perfume in the deodorant sanitary napkin. Report of a Case A 38-year-old woman sought treatment in September 1977 with a perineal dermatitis that had been present for six months. She had been treated with many topical preparations without benefit. On examination she had a well-demarcated area of dermatitis on the labia, extending onto the anal area. Patch testing to the routine North American Contact Dermatitis seriesshowed positive results (Table 1). All patch tests were applied for 48 hours, using an occlusive technique with aluminum patch test strips. 1 Further questioning showed that she was worse during her menstrual period. Just prior to the onset of the dermatitis, she had begun using deodorized tampons and deodorized sanitary napkins. Patch testing results with the

Public Life and Private Information

ABSTRACT To the Editor:— As one who was concerned by the publication of Lord Moran's book, my reaction did not arise from failing to notice Churchill's unsteady walk and slurred speech. Until I read Dr. Robitscher's communication (202: 398, 1967) I had forgotten about Churchill's address to the Conservative Party in 1953. My reaction arose from wondering what Moran and his publishers thought they achieved in 1966. The idea that a delay in publication might affect the sales was also hard to dispel.Because nursemaids write about prominent families does not mean that doctors should. They should have different standards.Dr. Jean-Paul Marat spent most of the day in a bathtub on account of scrotal and perineal dermatitis— allegedly acquired by hiding in sewers. So his physician made no revelation at all in his case report. In 1822, a year after Napoleon Bonaparte's death, pigeons were the fastest means of communication.