Secondary cutaneous peripheral T-cell lymphoma, unspecified, with generalized benign-looking dermatitis: a possibly distinct peripheral T-cell lymphoma

Abstract

Background

Cutaneous lymphomas are a heterogeneous group of tumors with various clinical manifestations, histological features, and prognoses.

Methods

Among 425 cases of cutaneous lymphoma, we describe eight cases of peripheral T-cell lymphoma, unspecified, presenting with generalized benign-looking dermatitis.

Results

Our case series included eight cases of secondary cutaneous peripheral T-cell lymphoma, unspecified. The observed clinical morphology features included drug eruption-like generalized morbilliform maculopatches in two cases, generalized folliculitis-like papules in two cases, and generalized eczematous dermatitis-like papules and patches in four cases. Histopathological examination demonstrated tumor cell infiltrates of mainly atypical, small-to-medium lymphoid cells that were perivascularly or periadnexally distributed throughout the dermis. Immunohistochemical staining results for CD2, CD3, CD4, and CD8 revealed that the tumor cells were T-cells.

Conclusion

This collection of cases and literature review emphasizes the need for clinical suspicion of peripheral T-cell lymphoma, unspecified, in the differential diagnosis of adult patients with refractory eczematous or benign-looking skin lesions.

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Tacrolimus 0.1% ointment applied under occlusion using cling film clears chronic actinic dermatitis resistant to systemic treatment

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Silk textile with antimicrobial AEM5772/5 (Dermasilk): a pilot study with positive influence on acne vulgaris on the back

Abstract

Background

The use of special silk textiles (Dermasilk) has shown positive effects on chronic inflammatory diseases like lichen sclerosus et atrophicus, atopic dermatitis, diabetic ulcerations, and vulvovaginal candidiasis.

Objective

Wearing T-shirts of this particular fabric could be useful in the management of patients with acne vulgaris on the back and trunk.

Material and Methods

Dermasilk T-shirts were given to 14 patients with acne vulgaris papulopustulosa on the back. The patients wore these shirts every night for 6 weeks, and their acne lesions were monitored. Dermasilk represents a polymerisate of fibroin, a silk protein, and antimicrobial AEM5772/5, an unsoluble colorless, odorless ammonium with antifungal and antibacterial ability.

Results

Photographic documentation before and after 6 weeks showed a clinically significant reduction in acne lesions on the back without any concomitant treatment or change in lifestyle and living conditions.

Discussion

The use of Dermasilk textiles in other subacute-chronic inflammatory skin diseases has shown positive effects. This is the first report on their safe and effective use in the management of acne vulgaris papulopustulosa corporis.

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Actinic prurigo as a hypersensitivity reaction type 4

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Melasma: systematic review of the systemic treatments

Abstract

Currently available treatment options for melasma include prevention of UV radiation, topical lightening agents, chemical peels, and light-based and laser therapies. However, none have shown effective and sustained results, with incomplete clearance and frequent recurrences. There has been increasing interest recently in oral medications and dietary supplements in improving melasma. We sought to evaluate the efficacy and safety/tolerability of oral medications and dietary supplements for the treatment of melasma. Multiple databases were systematically searched for randomized clinical trials (RCTs) evaluating the use of oral medication for treatment of melasma alone or in combination with other treatments. A total of eight RCTs met inclusion criteria. Oral medications and dietary supplements evaluated include tranexamic acid, Polypodium leucotomos extract, beta-carotenoid, melatonin, and procyanidin. These agents appear to have a beneficial effect on melasma improvement. In conclusion, oral medications have a role in melasma treatment and have been shown to be efficacious and tolerable with a minimal number and severity of adverse events. Therefore, dermatologists should keep oral medications and dietary supplements in their armamentarium for the treatment of melasma.

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Treatment of pyoderma gangrenosum, acne, suppurative hidradenitis (PASH) with weight-based anakinra dosing in a Hepatitis B carrier

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Pilot study on HPV-related cancer awareness and HPV vaccination in Ukrainian students

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Are genital ulcers always sexually transmitted? First report of scrotal ulcer caused by Serratia marcescens infection

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Epidemiology of rosacea in Colombia

Abstract

Background

Prevalence of rosacea has been estimated around the world in the range of 0–22%. In Colombia, the prevalence of rosacea remains unknown. The aim of this study was to determine the prevalence of rosacea and the frequencies of its subtypes in Colombia.

Methods

This cross-sectional, multicenter study was conducted in six outpatient dermatology clinics across Colombia. A total of 33 dermatologists conducted a comprehensive medical history and physical examination for all rosacea patients seen at their offices over the course of 2 months. All patients who accepted to participate were encouraged to answer a survey about the history of their illness.

Results

Of 10,204 outpatients evaluated for rosacea between July and August 2014, 291 rosacea patients were included in this study. The prevalence of rosacea subtypes in this cohort was: 45.3% erythematotelangiectatic (ETR) (n = 132), 48.7% papulopustular (PPR) (n = 142), 4.8% phymatous (n = 14), and 1% ocular (n = 3).

Conclusions

Overall, the prevalence in Colombia was 2.85%. Our data represent an important first step to understanding the current state of rosacea in Colombia. The prevalence of rosacea in Colombia is the highest in Latin America among a few reports published, which might be explained by geographic features. However, contrary to our expectations, the prevalence is lower than that in some European countries. We postulate that this finding may be due to methodological differences.

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Spectrum and clinical variants of giant cell elastolytic granuloma

Abstract

Background

Giant cell elastolytic granuloma, also known as annular elastolytic giant cell granuloma or actinic granuloma, is histologically characterized by elastophagocytosis. Recent studies have revealed various clinical presentations in both sun-exposed and non-sun-exposed areas.

Objectives

To clarify clinical characteristics based on case series observation.

Methods

We retrospectively reviewed patients who fulfilled the pathological diagnosis criteria for giant cell elastolytic granuloma seen at Mackay Memorial Hospital from 2000 to 2014. Patient characteristics, clinical presentation, duration, associated diseases, treatment, and prognosis were analyzed.

Results

A total of 22 patients were analyzed and categorized into three major variants. Eight patients with the "annular form" showed large annular lesions, which were usually associated with sun exposure. Six patients with the "papular form" presented with small papules. Eight patients in the "mixed form" group exhibited both papules and smaller annular plaques. The papular form had the youngest age of onset and shortest disease duration. The known consequences in 19 patients were resolved in seven, improved in three, recurred in four, and persisted in five patients.

Conclusions

The term "giant cell elastolytic granuloma" is more appropriate because these were not completely related to actinic changes and may be nonannular. The papular form is not easily recognizable without a biopsy.

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Herpes compuctorum: a cutaneous infection related to permanent tattoo

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Management of digital mucous cysts: a systematic review and treatment algorithm

Abstract

Digital mucous cysts (DMC) are benign, highly recurrent lesions of the digits. To date, there is still no treatment agreement on the treatment of DMC. Herein, we review available data on treatment modalities, including both surgical and nonsurgical techniques, and to provide a practical algorithm for the management of DMC. A systematic review was conducted using MEDLINE, EMBASE, and Cochrane databases. Articles studying the management of DMC were included in this review. A total of 40 articles were included in the review. The five most frequently used treatments for DMC were surgery (n = 849), expression of cyst content (n = 132), sclerotherapy (n = 119), corticosteroid injection (n = 108), and cryotherapy (n = 103). Surgery yielded the highest cure rate among all treatment modalities (95%) compared to sclerotherapy (77%), cryotherapy (72%), corticosteroid injection (61%), and expression of cyst content (39%) (P < 0.001). Surgery should be considered as the first-line treatment for DMC. Second-line treatments include sclerotherapy and cryotherapy. Third-line treatments include corticosteroid injections, expression of cyst content, and less-studied modalities. Surgery showed the highest cure rates. Future adequately designed randomized controlled trials are warranted to compare different treatment modalities.

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Molecular prevalence of Merkel cell polyomavirus in nonmelanoma skin cancer in a Brazilian population

Summary

Background

Merkel cell polyomavirus (MCPyV), a newly described oncogenic virus, has been found in association with tumours other than Merkel cell carcinoma (MCC). As yet, little is known about the involvement or influence of MCPyV on the development of these tumours and its prevalence in various populations.

Aim

To assess the prevalence of MCPyV DNA in cases of nonmelanoma skin cancer (NMSC).

Methods

The prevalence of MCPyV DNA was assessed in 96 cases of NMSC in a Brazilian population comprising 76 subjects, and these results were correlated with epidemiological and demographical data.

Results

MCPyV DNA was detected in 23 of 69 (33.3%) basal cell carcinomas, in 2 of 11 (18%) squamous cell carcinomas, 2 of 4 Bowen disease case, 0 of 1 MCC and 4 of 11 other skin disorders.

Conclusion

Despite the frequent detection of MCPyV DNA in NMSC, its possible role in the development of NMSC still needs further investigation.

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Successful treatment of refractory palmoplantar pustulosis with apremilast

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Multiple, spontaneous, noninflammatory cutaneous atrophic pits on the extremities

Click here for the corresponding questions to this CME article.

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Ecthyma gangrenosum without bacteraemia: evidence in favour of a broader definition

Summary

Ecthyma gangrenosum (EG) is often defined as a cutaneous manifestation of Pseudomonas aeruginosa septicaemia, typically secondary to neutropenia. There is increasing recognition that a broader definition is warranted, as numerous causative organisms and predisposing conditions have been reported. We describe two cases of EG that occurred without bacteraemia. In this atypical subset of cases, the skin is thought to represent the primary inoculation site from which haematogenous spread can occur.

The first case occurred in the context of human immunodeficiency virus (HIV) infection, a rarely reported association. The evidence base guiding clinicians on management of EG is very limited, particularly in relation to patients with HIV, in whom recurrence risk may be higher than normal. Recurrent EG is described in our second case, in an individual with Good syndrome, a rare association of thymoma and immunodeficiency.

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Calendar of Events

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Editorial Board/Reviewing Committee

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Palmar fasciitis and polyarthritis, a rare paraneoplastic syndrome related to ovarian cancer

Summary

Palmar fasciitis and polyarthritis syndrome (PFPAS) is an uncommon disorder characterized by diffuse inflammation of the palmar fascia, tendon sheaths, and joints of the fingers and wrists, which rapidly progresses to flexion contracture of the hands. This paraneoplastic syndrome, originally linked to ovarian carcinoma, has also been associated with multiple different malignancies. As PFPAS usually precedes the detection of cancer, its symptoms should raise the suspicion of an underlying malignancy and should be thoroughly investigated.

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‘Scaly’ tattoo reactions: is treatment mandatory?

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Cutaneous leishmaniasis associated with anti-tumour necrosis factor-α drugs: an emerging disease

Summary

Leishmaniasis is endemic in several geographic areas of the world. In each of these areas, particular species of Leishmania with differing aggressiveness to humans predominate. In the European Mediterranean basin, cutaneous leishmaniasis usually presents with discrete, self-healing skin lesions. Although it is known that tumour necrosis factor (TNF) inhibitors may increase the risk of developing infections such as tuberculosis, there is scarce literature on Leishmania infections in patients treated with these drugs. In recent months, we have observed three patients resident in the Catalan coast of Spain who were treated with TNF inhibitors for Crohn disease, and who developed unusually large and persistent cutaneous lesions of leishmaniasis. These lesions responded only to treatment with intravenous liposomal amphotericin B. In countries with a high incidence of infection by aggressive species of Leishmania, serological screening may be indicated to detect a possible latent leishmanial infection before prescription of TNF inhibitors.

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Mutations in AAGAB underlie autosomal dominant punctate palmoplantar keratoderma

Summary

Punctate palmoplantar keratoderma type 1 (PPPK1) is a rare autosomal dominant inherited skin disease, characterized by multiple hyperkeratotic lesions on the palms and soles. The causative gene for PPPK1 has been identified as AAGAB, which encodes α- and γ-adaptin-binding protein p34. We describe the clinical features in three unrelated families with PPPK1, and report three recurrent causative mutations in AAGAB.

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Cutaneous leucocytoclastic vasculitis with anti-EJ autoantibodies: mere coincidence or a manifestation of antisynthetase syndrome?

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Antibacterial and anti-biofilm effects of sodium hypochlorite against Staphylococcus aureus isolates derived from patients with atopic dermatitis

Abstract

Introduction

Atopic dermatitis (AD) is characterised by an increased susceptibility for skin infections. Staphylococcus aureus is reported to dominate in AD lesions and reports have revealed the presence of staphylococcal biofilms. These infections contribute to aggravating the eczema. Sodium hypochlorite is known to reduce bacterial load of skin lesions as well as disease severity in AD patients but the effect on biofilms is unknown.

Objectives

The aim of this study was to investigate the antimicrobial and anti-biofilm effects of sodium hypochlorite against S. aureus isolates derived from patients with AD.

Materials and Methods

Skin biopsy derived from infected AD patient was examined by scanning electron microscopy (SEM). Using radial diffusion assays, biofilm assays and confocal laser scanning microscopy, we assessed the effect of sodium hypochlorite on S. aureus isolates derived from lesional skin of AD patients.

Results

SEM revealed clusters of coccoid bacteria embedded in fibrin and extracellular substances at the skin of a patient with infected AD. At concentrations of 0.01-0.08%, sodium hypochlorite showed antibacterial effects against planktonic cells. Eradication of S. aureus biofilms in vitro was observed in concentrations ranging from 0.01% to 0.16%. Confocal laser scanning microscopy confirmed these results. Finally, when human AD skin was subjected to sodium hypochlorite in an ex vivo model, a dose of 0.04% reduced the bacteria derived from AD skin.

Conclusions

Sodium hypochlorite has antimicrobial and anti-biofilm effects against clinical S. aureus isolates. Our findings suggest usage of a higher concentration than currently used in bleach baths of skin-infected AD patients.

This article is protected by copyright. All rights reserved.

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Pediatric tuberculosis-human immunodeficiency virus co-infection in the United Kingdom highlights the need for better therapy monitoring tools: a case report

Tuberculosis is an infection that requires at least 6 months of chemotherapy in order to clear the bacteria from the patient's lungs. Usually, therapeutic monitoring is dependent on smear microscopy where a de...

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Computed tomography and anatomical measurements of critical sites for endosseous implants in the pterygomaxillary region: a cadaveric study

The aim of this study was to obtain computed tomography (CT) and physical measurements of the pterygomaxillary region to determine the anatomical and radiographic landmarks that clinicians need for pterygoid implant placement. Seventy-eight hemi-heads with an atrophic posterior maxilla from 46 cadaveric samples were measured using CT. Twenty-one hemi-heads were selected randomly for physical measurements. CT measurements showed that the mean and minimum distance between the maxillary tuberosity point (MT) and the most lateral lowest point of the pterygomaxillary fissure (PF) were 18.7mm and 10.0mm, respectively.

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Use of maxillofacial laboratory materials to construct a tissue-equivalent head phantom with removable titanium implantable devices for use in verification of the dose of intensity-modulated radiotherapy

The dose of radiotherapy is often verified by measuring the dose of radiation at specific points within a phantom. The presence of high-density implant materials such as titanium, however, may cause complications both during calculation and delivery of the dose. Numerous studies have reported photon/electron backscatter and alteration of the dose by high-density implants, but we know of no evidence of a dosimetry phantom that incorporates high density implants or fixtures. The aim of the study was to design and manufacture a tissue-equivalent head phantom for use in verification of the dose in radiotherapy using a combination of traditional laboratory materials and techniques and 3-dimensional technology that can incorporate titanium maxillofacial devices.

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Comparison of the clinical effects of treatment of osteochondroma by two types of vertical ramus osteotomy

The purpose of this retrospective study was to evaluate 10 patients with osteochondroma of the mandibular condyle who were treated by vertical ramus osteotomy. Three patients had resection of the condyle and reconstruction with free vertical ramus osteotomy grafts (free graft group) and seven had pedicled vertical sliding ramus osteotomy grafts (pedicled graft group). The mean (range) observation period was 30 months. All patients had satisfactory clinical outcomes, and facial symmetry and good occlusion were achieved during the first 10 months.

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Secondary bone grafting of alveolar clefts: a review of outcome at two centres in Australia and the UK

Secondary alveolar bone grafting is a key procedure in comprehensive cleft services, the main objective of which is to allow the canine to erupt through the bone. We have assessed the outcomes of the procedure at two units, one in Australia and one in the UK. Success was measured using standardised indexes for radiological assessment (Bergland and Kindelan) and clinically by noting eruption of canines through the grafted sites. The two-year review indicated that the two units had comparably high success rates.

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Propylene Glycol Toxicity in Adolescent with Refractory Myoclonic Status Epilepticus

Propylene glycol (PG) is a solvent commonly used in medications that, while benign at low doses, may cause toxicity in adults and children at high doses. We describe a case and the physiologic sequelae of propylene glycol toxicity manifested in a critically ill adolescent male with refractory myoclonic status epilepticus aggressively treated with multiple PG-containing medications (lorazepam, phenobarbital, and pentobarbital)—all within accepted dosing guidelines and a total daily PG exposure previously recognized to be safe. Hemodynamic measurements by bedside echocardiography during clinical toxicity are also reported. Clinicians should have a high index of suspicion for propylene glycol toxicity in patients treated with PG-containing medications even when the total PG exposure is lower than currently accepted limits.

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Clinical markers of vitiligo activity

Current modalities of understanding disease state (active/stable) are limited when considering treatment of vitiligo.

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Facial Asymmetry in a Crying Newborn: A Comparison of Two Cases and Review of Literature

Facial asymmetry in a crying newborn can be due to a variety of different causes. Neonatal asymmetric crying facies (NACF) is a specific phenotype, which is often underrecognized. It is defined as asymmetry of the mouth and lips with grimacing or smiling, but a symmetric appearance at rest. NACF needs to be differentiated from complete facial palsy in a newborn, which can occur due to traumatic or developmental etiologies. Developmental causes can be present in isolation or may be a part of a recognized syndrome. While asymmetric lower lip depression may be seen in both conditions, complete facial palsy is also associated with upper and mid face deformities. We present a case of NACF and compare it to a case of facial palsy due to perinatal trauma. The purpose of this case series is to clarify some of the confusing nomenclatures and highlight the differences in the physical exam findings, diagnosis, and eventual prognosis of these cases.

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