A Case of Congenital Folliculitis Caused by Pseudomonas aeruginosa in a Preterm Neonate

Intrauterine infections are associated with life-threatening neonatal conditions such as sepsis, intracranial hemorrhage, and chronic lung disease. Herein we present a case of generalized congenital folliculitis caused by Pseudomonas aeruginosa in a preterm neonate of 27 weeks gestational age successfully treated with antibiotics. Folliculitis is an important manifestation of intrauterine P. aeruginosa infection, and prompt, effective treatment is crucial to ensuring a good prognosis.

Seasonal leukotrichia in a German shepherd dog. A case report

Leukotrichia can be caused by a variety of metabolic and inflammatory diseases. Canine alopecia areata is a rare multifactorial benign non-scarring alopecia. This case report describes a seasonally recurrent leukotrichia associated with alopecia areata in a German shepherd dog. Important differential diagnoses were ruled out and histopathology finally confirmed the diagnosis of alopecia areata. Topical tacrolimus and hydrocortisone aceponate were ineffective. The cause for the seasonal character in this case remained undetermined.

Folliculitis in prurigo pigmentosa: a proposed pathogenesis based on clinical and pathological observation

BACKGROUND

Prurigo pigmentosa is a rare inflammatory dermatosis whose exact etiology is not understood yet. The purpose of this study was to provide evidence of hair follicle involvement in the pathogenesis by analyzing its clinicopathologic features.

METHODS

Patients who fulfilled both the clinical and histological diagnostic criteria of prurigo pigmentosa were recruited. Their histopathologic findings, clinical features and medical histories were analyzed.

RESULTS

A total of 32 confirmed patients were enrolled from 2002 to 2013. Their ages ranged from 11 to 79 years with a female predominance. Patient lesions were primarily reddish-brown and located on the back. A total of 25 patients (78%) had pathological involvement of hair follicles, either bacterial colonies in the hair follicles (21/32, 66%), folliculitis (8/32, 25%) or perifolliculitis (15/32, 47%). There was a significantly higher proportion of patients with hair follicle involvement compared with control groups with either noninflammatory (5/43, 12%, p < 0.001) or inflammatory skin diseases (12/32, 38%, p = 0.002) on the back. Minocycline was an effective antibiotic treatment either singly or in combination with steroids.

CONCLUSIONS

The frequent presence of bacterial colonies along with sequelae of inflammatory changes on biopsy provides new evidence to support the theory that prurigo pigmentosa is a reactive inflammation associated with bacterial folliculitis.

Cutaneous pythiosis in a donkey (Equus asinus) in Brazil

Our study describes the clinical, epidemiologic, pathologic, immunohistochemical, and molecular aspects PCR of a case of cutaneous pythiosis in a donkey (Equus asinus) from Brazil. During a dry period, the animal grazed for 4 months around a pond where the vegetation remained green. Skin lesions were nodular, multifocal, and disseminated, mainly involving the legs, ventral chest, and mammary gland. On cut surface, there were multifocal to coalescent discrete yellow foci, and occasional small cavitations with a few kunkers. Ulcerative nodular pyogranulomatous and eosinophilic dermatitis with folliculitis and furunculosis were observed histologically. Hyphae were observed in sections stained with Gomori methenamine silver. Immunohistochemistry with Pythium insidiosum antibodies yielded strong immunostaining of hyphae. P. insidiosum DNA was extracted from tissues in paraffin blocks by amplification of a fragment of 105 bp, which targets the 5.8S ribosomal gene. After the diagnosis of pythiosis, the larger skin lesions were excised and treated as second intention healing wounds, which were completely healed 30 days after resection. Small skin lesions regressed spontaneously in ~60 days. The granulomatous inflammation and outcome of the disease in this donkey were similar to cases of pythiosis in cattle.

Doxycycline for prevention of erlotinib-induced rash in patients with non-small-cell lung cancer (NSCLC) after failure of first-line chemotherapy: A randomized, open-label trial

BACKGROUND

Rash is a common epidermal growth factor receptor inhibitor-induced toxicity that can impair quality of life and treatment compliance.

OBJECTIVE

We sought to evaluate the efficacy of doxycycline in preventing erlotinib-induced rash (folliculitis) in patients with non-small-cell lung cancer.

METHODS

This open-label, randomized, prospective, phase II trial was conducted in 147 patients with locally advanced or metastatic non-small-cell lung cancer progressing after first-line chemotherapy, randomized for 4 months with erlotinib alone 150 mg/d per os (control arm) or combined with doxycycline 100 mg/d (doxycycline arm). Incidence and severity of rash, compliance, survival, and safety were assessed.

RESULTS

Baseline characteristics of the 147 patients were well balanced in the intent-to-treat population. Folliculitis occurred in 71% of patients in the doxycycline arm and 81% in the control arm (P = .175). The severity of folliculitis and other skin lesions was lower in the doxycycline arm compared with the control arm. Other adverse events were reported at a similar frequency across arms. There was no significant difference in survival between treatment arms.

LIMITATIONS

The open-label design of the study and the duration of the treatment with doxycycline are limitations.

CONCLUSION

Doxycycline did not reduce the incidence of erlotinib-induced folliculitis, but significantly reduced its severity.

Extreme Phenotype of Epidermal Growth Factor Receptor Inhibitor-induced Destructive Folliculitis

Due to the increasingly widespread use and side effect profile of epidermal growth factor receptor inhibitors (EGFRIs), cutaneous side effects of these drugs are frequently encountered. The EGFR is expressed on keratinocytes and fibroblasts. Inhibition of EGFR can produce a range of cutaneous adverse effects, the most frequent being a characteristic acneiform skin eruption. As the latter is associated with good anti-neoplastic responses, the onset of EGFRI-induced acneiform skin eruption is typically viewed as a positive sign by patients and physicians. It can usually be treated well with standard acne drugs, but in rare cases, the skin eruption can be so severe that systemic therapy and/or interruption of EGFRI treatment are required. One of the severest forms of EGFRI-induced skin eruption occurring on the head and neck area resembles folliculitis decalvans. Here, we discuss the management of such a case seen in our department. In addition, we present an analysis of tumor necrosis factor-α, interleukin-1β (IL-1β), and IL-17A expression based on immunohistochemical stains and qPCR.

Microlichus americanus acariasis in saffron finches (Sicalis flaveola) with dermatitis and feather loss

Over a 5-year period, 13 saffron finches (Sicalis flaveola) housed in mixed aviaries at the Bronx Zoo (Bronx, New York) were examined with feather loss and dermatitis, primarily affecting the nape, neck, and dorsum. Feather loss, hyperkeratosis, epidermal hyperplasia, and mixed granulocytic and mononuclear inflammation were identified in biopsies from live birds and tissue sections from postmortem specimens. In 10 of 13 cases, sections of arthropod parasites were seen histologically within feather follicles and along the surface of affected skin. Based on morphological characteristics, mites recovered from samples of formalin-fixed skin in 4 birds were identified as Microlichus americanus, an epidermoptid mite infrequently reported from wild birds and hippoboscid flies. Gross and histological lesions strongly implicate M. americanus as the cause of dermatitis affecting practically all saffron finches in the collection.

Case series of familial frontal fibrosing alopecia and a review of the literature

Frontal fibrosing alopecia (FFA) is a distinctive form of scarring alopecia presenting with partial eyebrow loss and frontal temporal parietal recession of the hairline. Its etiology remains unknown, and there is no definitive treatment. Information in familial cases of FFA is scarce. We conducted a retrospective cohort study describing the mean clinical findings, treatment, and also the mean differences between premenopausal and postmenopausal cases of familiar FFA. Data analysis from case was performed on eight patients with a familiar history and diagnosis of FFA seen at the Alicante Aesthetic Dermatology Centre between January 2009 and June 2014. All patients in this cohort were females. Mean age at onset was 65 year (range 60-75) in the postmenopausal patients and 39 year (range 33-47) in the premenopausal women. All menopausal patients were in an advanced stage when the disease had already developed in the frontal and/or temporal parietal hairline region. However, the daughters, all of them premenopausal age, attended the consultation with mild involvement of the eyebrows in all four cases and mild impairment of the frontal hairline in three of them. Specific clinical findings in familial FFA are poorly communicated until nowadays although the number of familial cases arises until 8% in the main case series published in recent years. Early diagnosis in premenopausal stage is frequent in our case series and allows us to begin the protocol treatment in the first stage of the disease, but long-term progression will remain uncertain until a definitive treatment could be established by multicenter randomized controlled trials.

Dose-response algorithms for water-borne Pseudomonas aeruginosa folliculitis

We developed two dose-response algorithms for P. aeruginosa pool folliculitis using bacterial and lesion density estimates, associated with undetectable, significant, and almost certain folliculitis. Literature data were fitted to Furumoto & Mickey's equations, developed for plant epidermis-invading pathogens: N l = A ln(1 + BC) (log-linear model); P inf = 1-e(-r c C) (exponential model), where A and B are 2.51644 × 107 lesions/m2 and 2.28011 × 10-11 c.f.u./ml P. aeruginosa, respectively; C = pathogen density (c.f.u./ml), N l = folliculitis lesions/m2, P inf = probability of infection, and r C = 4·3 × 10-7 c.f.u./ml P. aeruginosa. Outbreak data indicates these algorithms apply to exposure durations of 41 ± 25 min. Typical water quality benchmarks (≈10-2 c.f.u./ml) appear conservative but still useful as the literature indicated repeated detection likely implies unstable control barriers and bacterial bloom potential. In future, culture-based outbreak testing should be supplemented with quantitative polymerase chain reaction and organic carbon assays, and quantification of folliculitis aetiology to better understand P. aeruginosa risks.

Daily baseline skin care in the prevention, treatment, and supportive care of skin toxicity in oncology patients: recommendations from a multinational expert panel

Skin reactions due to radiotherapy and chemotherapy are a significant problem for an important number of cancer patients. While effective for treating cancer, they disturb cutaneous barrier function, causing a reaction soon after initiation of treatment that impacts patient quality of life. Managing these symptoms with cosmetics and nonpharmaceutical skin care products for camouflage or personal hygiene may be important for increasing patient self-esteem. However, inappropriate product choice or use could worsen side effects. Although recommendations exist for the pharmaceutical treatment of skin reactions, there are no recommendations for the choice or use of dermatologic skin care products for oncology patients. The present guidelines were developed by a board of European experts in dermatology and oncology to provide cancer care professionals with guidance for the appropriate use of non-pharmaceutical, dermocosmetic skin care management of cutaneous toxicities associated with radiotherapy and systemic chemotherapy, including epidermal growth factor inhibitors and monoclonal antibodies. The experts hope that these recommendations will improve the management of cutaneous side effects and hence quality of life for oncology patients.

Post waxing folliculitis: a clinicopathological evaluation

BACKGROUND

Epilation by waxing is one of the common methods of removing unwanted body hair, and follicular papules following this cosmetic procedure are not uncommon. However, this not so uncommon problem has not been clinically and histopathologically evaluated.

OBJECTIVE

To study the clinicopathological profile of folliculitis temporally developing after epilation by waxing.

SUBJECTS AND METHODS

Clinical and histopathological evaluation was done in 28 patients who developed follicular papules within a period of eight weeks following a history of epilation by waxing over the same area. The demographic profile and the method and frequency of waxing were noted. The symptoms associated with and the morphology and distribution of the follicular lesions were recorded. A punch biopsy was done from a representative follicular lesion to evaluate the pathological changes.

RESULTS

All the patients recruited were females (100%) with a mean age of 24.33 + 2.43 years. While all 28 patients had waxed their forearms, 25 had waxed their arms, 18 their legs, and 10 their thighs. The most common sites affected by folliculitis were arms (25; 100%) and forearms (15/28; 53.6%). Thighs, though least frequently waxed, were involved in seven (70%) subjects. Of these, seven (25%) women complained of itching. The lesions in all patients were erythematous to skin colored follicular papules, though two (7.1%) patients also had nodular lesions. A punch biopsy done showed features suggestive of pseudofolliculitis. A granulomatous reaction was seen in nine (32.1%) biopsies. A foreign body identified as a hair shaft was seen in seven (25%) biopsies and keratin in one biopsy.

CONCLUSIONS

Folliculitis following epilation by waxing is more frequent in proximal parts of the extremities than in distal parts, even though distal parts are more frequently waxed. In one-third of the cases, post-waxing folliculitis is due to foreign body reaction to hair shaft or keratin and resembles pseudofolliculitis. To know exact pathogenesis, additional biopsies with multiple step sections need to be taken to look for retained fragments of hair shaft and /or foreign body reaction.

Expanding the histologic findings in smallpox-related post-vaccinial non-viral folliculitis

Post-vaccinial non-viral folliculitis has been recognized in the past decade as a new adverse cutaneous reaction to smallpox vaccination. Contrary to more serious smallpox vaccine reactions, post-vaccinial non-viral folliculitis has a benign course and resolves spontaneously within approximately 7 days. We describe additional histopathologic findings associated with post-vaccinial non-viral folliculitis, which has only been described once previously. New findings include the presence of a neutrophilic or lymphohistiocytic infiltrate that is concentrated around the hair follicles. We compare our findings to the follicular nature of varicella and herpes zoster infections, generating the hypothesis of deposition of vaccinia protein within folliculosebaceous units as a potential pathophysiologic mechanism behind post-vaccinial non-viral folliculitis.

Photoletter to the editor: An erythematous folliculocentric papular lesion on the chest of a 60-year-old man: What is your diagnosis?

Folliculitis has many etiologies including bacterial, fungal, viral and parasitic. Therefore, an accurate determination of the cause is necessary to direct treatment. This is a case of a 60-year-old man who presented with an erythematous papule on his chest. Biopsy showed granulomatous inflammation, abscess formation, and the causative agent was Demodex.