Nevus depigmentosus: review of a mark of distinction

Abstract

Nevus depigmentosus (ND), also known as nevus achromicus or achromic nevus, is an uncommon congenital hypomelanosis of the skin that is often characterized as being nonprogressive and having serrated borders. It needs to be distinguished from other hypopigmented skin conditions such as nevus anemicus, hypomelanosis of Ito, Fitzpatrick patches (ash leaf spots) of tuberous sclerosis, vitiligo, indeterminate leprosy, and pigment demarcation lines. Treatment may be desired for aesthetic and possible psychosocial considerations. We review and update knowledge about ND and its simulants.

https://ift.tt/2H34R0J

Unusual case of rosacea fulminans after topical metronidazole application

https://ift.tt/2ty5JST

Low dose acitretin versus methotrexate in the treatment of palmoplantar psoriasis: a case series

Abstract

Palmoplantar psoriasis (PP) is a localized form of psoriasis presenting with thick and scaly plaques commonly with painful and bleeding fissures involving the palms and soles (1‐3). The treatment of PP is generally challenging because of resistance to treatments (4). Methotrexate and acitretin have been compared in the treatment of PP, with a superiority of methotrexate at week 12 (5).

This article is protected by copyright. All rights reserved.

https://ift.tt/2STz4Xa

Effects of Particulate matter on Healthy Human Skin: A panel study using a smartphone application measuring daily skin condition

Abstract

Background

The influence of particulate matter (PM) on human health has recently attracted attention. However, most previous studies have been limited to diseased skin.

Objectives

To evaluate the effects of PM on healthy skin.

Methods

The study enrolled 188 healthy volunteers without any skin disease during winter and early spring. Every day for 14 days, they recorded their skin states using a smartphone application, which automatically scored facial skin condition in terms of wrinkle, brown‐spot, and trouble indexes based on a selfie. Subjects recorded information about their personal life styles such as sleeping time, outdoor activity, etc. Air pollution and meteorological information were collected during the same period as well. We analyzed the correlation between daily skin condition and environmental factors.

Results

Overall, 2,625 person‐days were obtained for three months from February to April. Among the various factors analyzed in this study, temperature and PM showed statistically significant relationships with the daily condition. Multivariable analysis showed a cumulative effect, as PM_2.5 from eight to three days prior to when daily skin condition was checked had a negative correlation with wrinkle index (p<0.05).

Conclusions

Inadequate outdoor temperature can immediately impinge on the skin state of even healthy people. PM_2.5 may contribute to skin aging gradually rather than immediately.

This article is protected by copyright. All rights reserved.

https://ift.tt/2SUoy1J

Cutaneous schistosomiasis and leishmaniasis coinfection: a case report

Abstract

Background

The polymorphic clinical presentations of schistosomiasis and leishmaniasis allow their inclusion in the differential diagnoses of several conditions. Although an overlap in distribution of these diseases has been reported in endemic areas, coinfection with cutaneous schistosomiasis and cutaneous leishmaniasis in the same patient is rare.

Objectives

We report an unusual case of concomitant cutaneous schistosomiasis and cutaneous leishmaniasis. Actions for the management and diagnosis were proposed.

Methods

A patient presented with cutaneous lesions on the abdomen and left elbow. The presence of degenerated ova of S. mansoni in the skin biopsy led to perform a complementary investigation with immunohistochemical techniques, rectal biopsy and abdominal ultrasonography. After the left elbow lesions had failed to improve after several weeks of standard treatment, a new biopsy was performed, and led to diagnosis of another infection.

Results

The patient lived in an endemic area for two infectious diseases (schistosomiasis and leishmaniasis). Biopsies revealed chronic granulomatous dermatitis. Degenerated S. mansoni eggs were found in the abdominal lesion and in a rectal biopsy specimen. Ultrasonography revealed hepatic involvement. Despite combination treatment with oxamniquine and praziquantel, a cutaneous lesion persisted on the left elbow; a new biopsy revealed amastigote forms of Leishmania. The patient was successfully treated with intramuscular and intralesional meglumine antimoniate.

Conclusions

The presence of a similar granulomatous infiltrate in lesions caused by the two different infectious agents led to a delay in the diagnosis of cutaneous leishmaniasis. This report serves as a warning of the unusual possibility of cutaneous schistosomiasis and leishmaniasis coinfection in an endemic area.

This article is protected by copyright. All rights reserved.

https://ift.tt/2IyGNFb

Rosacea fulminans ‐ coincidence of the disease with inflammatory bowel disease

Abstract

Rosacea fulminans is characterised by indurated erythematous plaques, papules, pustules, nodules, typically occurring on the face. Forehead, nasal bridge, cheeks and chin are most severely affected. Scarring is unfortunately very common and expected often in poorly managed patients.

This article is protected by copyright. All rights reserved.

https://ift.tt/2EaKiMO

Reliability assessment and validation of the Dermal Pigmentation Area and Severity Index (DPASI): A new scoring method for Acquired Dermal Macular Hyperpigmentation

Abstract

Background

Dermal pigmentation area and severity score (DPASI), is a recently proposed scoring system for acquired dermal macular hyperpigmentation (ADMH)

Objective

To determine the reliability and validity of DPASI.

Methods

After standardized training, three researchers independently rated 55 patients with ADMH on two consecutive days within one week, to determine intra‐rater and inter‐rater reliability. Validation was performed by comparing DPASI with the physician global assessment score.

Results

Test‐retest reliability of individual raters tested by Pearson's r showed good correlation for all three raters (r= 0.984, p<0.0001; r = 0.983, p < 0.000 and r=0.970, p<0.0001). Inter‐rater agreement computed by intra‐class correlation coefficient also showed good correlation (ICC=0.997, p<0.0001). Internal consistency as measured by Cronbach's alpha was 0.997. The score faired well in face and content validity (I‐CVI of 0.87). On usability assessment, the scale had a median score of 4 on a scale from 1‐5. The meantime taken to score the patients were 307.2±83, 308.9±84.4, 350.15±91.8 seconds by 3 observers respectively.

Conclusion

The DPASI is a reliable measure of ADMH severity. The use of dermoscopy decreases inter and intra‐observer variation resulting in a more objective score.

This article is protected by copyright. All rights reserved.

https://ift.tt/2E9lcxJ