[Alopecia areata]

Alopecia areata is a frequent cause of hair loss. The origin of disease is not fully understood. However there are indications for a T-cell mediated autoimmune process. Genetic, immunologic and psychologic factors are important for the outbreak of disease. Most patients show localized patches of acute hair loss, where regrowth is observed spontaneously or with simple topical treatment within few months. In up to 15% of patients severe forms of disease can develop with total scalp (alopecia totalis) or scalp and body hair loss (alopecia universalis). There are only few known risk factors for development of a severe form. Although spontaneous remission is possible in these cases, it occurs rarely and treatment is difficult. Multifocal alopecia areata responds to intravenous high-dose corticosteroids. Topical immunotherapy with diphenylcyclopropenone (DPC) or PUVA therapy may be effective in longstanding and widespread disease. The unpredictable course of disease is a major handicap for clinical trials and treatment recommendations. Contact of patients with self-help organisations may be of help for coping with the disease.

Vulvodynia after CO2 laser treatment of the female genital mucosa

We have observed 3 cases of vulvodynia after CO2 laser (pulse or scan) treatment of condylomata acuminata (n = 1) or bowenoid papulosis (n = 2) of the female genital mucosa. Laser treatment was associated with a considerable delay in healing (3-4 months) and chronic pain. The histology of the treated areas showed a scar tissue and severe mucosal atrophy. The occurrence of painful scars following CO2 laser treatment could be related to an inadequate laser technique considering the morphology of the vagina.

Alopecia syphilitica: report of two cases in Geneva

Two patients with alopecia syphilitica are presented. Moth-eaten alopecia is the most typical look of secondary syphilis on the scalp. With the decrease in syphilis cases in western countries, this rarer clinical manifestation tends to be misdiagnosed.

Treatment of acyclovir-resistant herpetic ulceration with topical foscarnet and antiviral sensitivity analysis

BACKGROUND

Herpes simplex virus (HSV) can produce persistent mucocutaneous disease in patients with the acquired immunodeficiency syndrome (AIDS). In this case report, we evaluate the efficacy, safety and viral resistance after topical foscarnet in severe genital ulceration due to acyclovir-resistant HSV-2.

CASE REPORT

A 45-year-old African woman was known for an HIV infection with severe immunosuppression (CD4 <100/mm3). She had received a long-term prophylaxis with acyclovir (400 mg b.i.d.) for a recurrent genital herpes. Few weeks after stopping this prophylaxis, she developed large genital ulcerations progressing despite valacyclovir treatment (1,000 mg t.i.d.). Cultures were positive for HSV-2, resistance to acyclovir was shown by the plaque reduction assay and topical foscarnet was tried. Treatment consisted of a 20-min application of topical foscarnet 2.4% twice a day. Dramatic improvement was observed with rapid antalgia, and cicatrization of the genital ulcerations was observed after 50 days. HSV could not be detected on the mucosal surface. Initially, HSV-2 was resistant to acyclovir but sensitive to foscarnet. After 1 month of topical treatment, HSV-2 became sensitive to acyclovir and was still sensitive to foscarnet. Finally, after 6 weeks of treatment, no virus could be detected by culture.

CONCLUSION

Topical foscarnet (2.4%) is a convenient treatment for chronic genital herpes. Resistance to acyclovir disappears few weeks after stopping this drug and sensitivity to foscarnet persists during the 50 days of treatment.

[Vulvodynia and facticious urticaria]

BACKGROUND

The term vulvodynia describes a multifactorial syndrome of chronic vulvar discomfort with burning, itching, pain, and dyspareunia. Due to the paucity of clinical signs, this syndrome is often perceived as a predominantly psychiatric problem. A context of symptomatic dermographism has been reported in rare instances.

PATIENTS AND METHODS

In our interdisciplinary consultation of vulvar dermatology, we routinely look for the presence of facticious urticaria. In the last 17 months, we observed 14 patients with an association of facticious urticaria and vulvodynia.

RESULTS

The principal symptoms were itching and burning. Sexual intercourse, tight clothes, and stress were most often cited as aggravating factors. The efficacy of a systemic antihistaminic treatment observed in our patients suggests that certain cases of vulvodynia might be an expression of symptomatic dermographism.

DISCUSSION

Therefore, a check-up for chronic vulvar discomfort should comprise a test for the presence of facticious whealing. The prevalence of a causal relationship between chronic vulvar discomfort and facticious whealing remains to be established.

[Plica polonica in the 21st century]

We describe a young man presenting with dreadlocks. There are remarkable similarities with the so called plica polonica, that historically had been treated with long courses of mercury. Apparently very important in the 18th century, the interest for this hair-disorder appears to be lost in specialized medical literature. In contrast dreadlocks, a recent hairstyle are frequently encountered. Lack of other sources various websites provide dermatologists with answers to questions regarding complications. Fortunately a simply haircut is today treatment enough.

An overlap of Cowden's disease and Bannayan-Riley-Ruvalcaba syndrome in the same family

We describe a family with the unusual association of Cowden's disease and Bannayan-Riley-Ruvalcaba syndrome. The father has characteristic mucocutaneous features that are palmoplantar keratoses, multiple facial papules, oral papillomatoses, lipomas, and vitiligo with involvement of the thyroid and digestive tract. The son presents with pigmented macules of the penis, macrocephaly, and a lipoma that are typical for Bannaya-Riley-Ruvalcaba syndrome. Recent studies have demonstrated that these 2 diseases are allelic disorders at the PTEN locus on chromosome 10q.

[Papular-purpuric gloves and socks syndrome]

In 1990, we first described the papular-purpuric "gloves and socks" syndrome (PPGSS). It is characterized by an itching erythema and edema of the hands and feet together with oral mucosal lesions and fever. The skin lesions subsequently become purpuric and resolve spontaneously after a few days. In more than half of the patients, an acute parvovirus B 19 infection has been proven. In a few cases of PPGSS, other viral infections have been found, for example hepatitis B and measles. We report on a patient with PPGSS and review the literature.

[Therapy of acne vulgaris]

Acne is an eminently curable disease. If therapeutic intervention sets in timely, scar formation can be prevented. Therapeutic modalities include the topical agents that should always be combined, and systemic agents, of which Isotretionoin is of particular importance. Isotretinoin is the only agent that can induce a complete clearing of acne lesions in 60 to 80% of cases. Adjuvant therapies, such as local injections, incisions, and peelings, are valuable tools in everyday practice and may accelerate the clearing of acne lesions. The treatment of acne is a long term endeavour that needs to be individually tuned to each patients' needs.

Neutrophil eccrine hidradenitis in a patient with AIDS

Neutrophilic eccrine hidradenitis (NEH), first described as a rare, transient, and benign complication of various chemotherapy regimens for acute leukemia, has also been observed in other conditions, including three HIV-positive patients and even in otherwise healthy individuals (1-3). A similar histological pattern was described after intradermal bleomycin injections into normal human skin (4). We report the first case of NEH in a hemophilic HIV infected patient treated with stavudine, a new reverse transcriptase inhibitor.

Genetic studies in Medzev, an isolate in south-eastern Slovakia. 2. Distribution of blood group genetic markers

Phenotype and gene frequencies of three blood group, four serum protein and seven red cell enzyme polymorphisms were examined in 105 individuals from the population of Medzev, South-Eastern Slovakia. Locus and allele specific tests of homogeneity were calculated in order to obtain the pattern of variation. The results indicate considerable genetic differences between this population and another local population of this region (Chmelnica) as well as between the Medzev population and the total population of Slovakia. The possible reasons of the genetic heterogeneity within Slovakia are discussed.

[Atrophic polychondritis with multiple arterial occlusions]

A 68-years old patient with relapsing polychondritis of the ear developed stenosis and occlusion of hercarotid and femoropopliteal arteries. Relapsing polychondritis is a rare systemic disorder which may take a fetal course. We also review this rare, systemic disorder.

[Cutaneous manifestations of parvovirus B19 infection]

Parvovirus B19 can cause a wide range of cutaneous or extracutaneous diseases. There are three types of exanthemas, erythematous maculopapulous or vesicopapulous exanthema including erythema infectiosum, the less common maculoerythematous exanthemas and purpural exanthemas including vascular, thrombocytopenic or non-vascular or non-thrombopenic forms such as le socks and gloves syndrome. Reports of other manifestations have been more sporadic: generalized livedo, polymorphous rash, lupus-like rash and Kawasaki syndromes. The presence of unusual presentations and the risk of fetomaternal transmission are two reasons for better understanding this virus.

[Postmenopausal frontal fibrosing alopecia]

We report on two patients with postmenopausal frontal fibrosing alopecia. This recently described disease affects postmenopausal women and is characterized by progressive recession of the frontotemporal and parietal hair margins. It leads to a symmetrical band-like scarring area of alopecia 3-6 cm wide. Histological examination shows perifollicular fibrosis and lymphocytic inflammation concentrated around the isthmus and infundibular areas of the follicles. One of our two patients also had vulvar lichen sclerosus et atrophicus. An effective treatment for this type of postmenopausal alopecia is yet not known, but the course of the disease seems to be self-limited.

[Nail changes within the scope of reflex dystrophy]

We describe a 16-year-old boy with reflex sympathetic dystrophy after a fracture of the right hand. He had inflammation of the proximal nail folds and arrested nail growth of digits 3, 4 and 5 on the right hand. After 2 months lymphatic drainage treatment, the changes of the nails had disappeared.