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Small clear vesicles stud the skin at the sides of the fingers and on the palms or soles They look like the grains in tapioca They may be associated with intense itching Later, the vesicles dry and the area becomes scaly and fissured



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Smallpox and vaccinia are to be distinguished from generalized varicella zoster virus infection or generalized herpes simplex The latter two viral infections are not associated with a severe febrile prodrome Lesions are at various stages at each anatomic site Varicella usually appears in waves or crops Multiple palm and sole lesions are common in variola and uncommon in generalized varicellazoster and herpes simplex infection Direct fluorescent antibody testing for HSV and varicella zoster virus are the first-line diagnostic tests to differentiate varicella zoster virus, HSV, vaccinia, and variola Until the diagnosis is confirmed, strict isolation of the patient is indicated Similar fluorescent testing for variola can be performed in special laboratories

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Unroofing the vesicles and examining the blister roof with a KOH preparation will reveal hyphae in cases of bullous tinea Patients with inflammatory tinea pedis may have a vesicular dermatophytid of the palms Always examine the feet of a patient with a hand eruption Nonsteroidal antiinflammatory drugs (NSAIDs) may produce an eruption very similar to that of dyshidrosis on the hands

The female RJ-45 jacks in these wall outlets also have CAT ratings You must buy CAT-rated jacks for wall outlets to go along with the CAT rating of the cabling in your network In fact, many network connector manufacturers use the same connectors in the wall outlets that they use on the patch panels These modular outlets significantly increase ease of installation Make sure you label the outlet to show the job of each connector (Figure 6-20) A good outlet will also have some form of label that identifies its position on the patch panel Proper documentation of your outlets will save you an incredible amount of work later

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Topical and systemic corticosteroids help some patients dramatically Since this is a chronic problem, systemic corticosteroids are generally not appropriate therapy A high-potency topical corticosteroid used early in the attack may help abort the flare and ameliorate pruritus Topical corticosteroids are also important in treating the scaling and fissuring that are seen after the vesicular phase It is

There is no specific and proven antiviral therapy for vaccinia or variola Vaccinia immune globulin is used to treat eczema vaccinatum and progressive vaccinia Cidofovir may have some activity against these poxviruses

essential that patients avoid anything that irritates the skin; they should wear cotton gloves inside vinyl gloves when doing dishes or other wet chores, use long-handled brushes instead of sponges, and use a hand cream after washing the hands Patients respond to PUVA therapy and injection of botulinum toxin into the palms as for hyperhidrosis

Although the lesions are triggered by sun exposure, the wavelength of light triggering the lesions is beyond that absorbed by sunscreens, which for that reason are ineffective Barrier sun protection with clothing is required

For most patients, the disease is an inconvenience For some, vesiculobullous hand eczema can be incapacitating

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Ogden S et al Recalcitrant hand pompholyx: variable response to etanercept Clin Exp Dermatol 2006 Jan;31(1):145 6 [PMID: 16309517]

The last step is connecting the PC to the wall outlet Here again, most folks use a patch cable Its stranded cabling stands up to the abuse caused by moving PCs, not to mention the occasional kick You ll recall from 5, Modern Ethernet, that 10/100/1000BaseT networks specify a limit of 100 meters between a hub or switch and a node Interestingly, though, the TIA/EIA 568 specification only allows UTP cable lengths of 90 meters What s with the missing 10 meters Have you figured it out Hint: the answer lies in the discussion we ve just been having Ding! Time s up! The answer is the patch cables! Patch cables add extra distance between the hub and the PC, so TIA/EIA compensates by reducing the horizontal cabling length The work area may be the simplest part of the structured cabling system, but it is also the source of most network failures When a user can t access the network and you suspect a broken cable, the first place to look is the work area

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