Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:40

Interstitial Lung Diseases Intertrigo 845

Absolute: diarrhea

Relative: prior allergic reaction or diarrhea

follow-up

During Treatment

■Assess complications and benefits:

➣CBC and LFT monthly (azathioprine)

➣UA monthly (cyclophosphamide)

➣BP, weight, glucose, bone density (prednisone)

➣Symptoms, 6-min walk test

➣Radiograph and CT

➣Pulmonary function including lung volume and diffusing capac-

ity

➣Prednisone benefit usually apparent in 1–3 mo; azathioprine or

cyclophosphamide usually require 3–6 mo

complications and prognosis

Complications

■Acute exacerbation after prior insidious course

■Progressive respiratory impairment and death

■Cor pulmonale

■Pulmonary embolism

■Lung cancer in up to 10% of IPF patients, independent of smoking

risk

■Pulmonary infection

Prognosis

■Depends on disease and reversible features such as exposure cessa-

tion

■IPF invariably progressive: 50% mortality 2.8 y after diagnosis; objec-

tive improvement in less than 20%

■Better prognosis for nonspecific interstitial pneumonia and respira-

tory bronchiolitis/ILD

Intertrigo..........................................

JEFFREY P. CALLEN, MD

history & physical

History

■Irritant dermatitis of intertriginous folds

■Caused by maceration and rubbing