Tiña de la cabeza en un adulto. A propósito de un caso

A tinea capitis and tinea faciei case in an elderly female patient with diabetes mellitus type 2 is presented. Her dermatological illness began on her face and later disseminated to her scalp. She received multiple medications which aggravated her condition. The diagnosis was established by means of direct examination and the isolation of Trichophyton tonsurans in culture. Treatment with 200 mg daily dose of itraconazol for two months resulted in clinical and mycological cure.

A Case of Cutaneous Paecilomyces lilacinus Infection on the Face

A 74-year-old woman presented in April, 2003, with cutaneous lesions of the face by Paecilomyces lilacinus infection. The patient had received predonisolone and azathioprine for 20 months for treatment of autoimmune hemolytic anemia. The lesion first developed on the right lateral eyelid 1.5 years earlier, and gradually enlarged. Physical examination revealed a dark reddish or brownish plaque and scattered papules and abscesses around the plaque on right lateral and lower eyelids, and the cheek. She noted mild tenderness on pressure. Cultures obtained from pus and biopsy specimen showed moulds, and those were identified as Paecilomyces lilacinus. Griseofulvin, 500 mg per day, was not effective for the lesion, so itraconazole, 200-300 mg per day, was administered orally for 11 weeks. Since culture from pus still yielded P. lilacinus despite clinical effectiveness, itraconazole pulse therapy (400 mg daily, 7 days a month) was started. The lesion cleared after three cycles of the pulse therapy.

Molecular Analysis of Malassezia Species Isolated from Three Cases of Akatsuki Disease (Pomade Crust)

Malassezia spp. which normally colonize on the skin surface, are known as being either the cause or an exacerbating factor in a variety of skin conditions, including pityriasis versicolor, folliculitis, seborrheic dermatitis and atopic dermatitis. We report here three cases of Akatsuki disease (pomade crust). Scales and crusts were collected from the lesional skin and analyzed using a PCR-based non-culture method. Malassezia microflora in Akatsuki disease was compared to that of healthy subjects and atopic dermatitis patients. Samples were collected from upper and lower eyelids (Case 1), an operation scar (Case 2) and parietal scalp (Case 3). DNA was extracted from the scales and nested PCR was performed using specific primers for each species. Our analysis detected only M. obtusa and M. slooffiae in Cases 1 and 3 and only M. slooffiae in Case 2. Our previous data indicated that while M. globosa, M. restricta and M. sympodialis were common in healthy subjects, the two aforementioned species were rare, suggesting that the presence of M. obtusa and M. slooffiae in the subjects in the present study is correlated to the pathogenesis of Akatsuki disease.

Comparison of five antimicrobial regimens for treatment of mild to moderate inflammatory facial acne vulgaris in the community: randomised controlled trial

BACKGROUND

We investigated the efficacy and cost-effectiveness of five antimicrobial regimens for mild to moderate facial acne and whether propionibacterial antibiotic resistance affects treatment response.

METHODS

In this randomised, observer-masked trial, 649 community participants were allocated one of five antibacterial regimens. Primary outcomes were patients' self-assessed improvement and reduction in inflamed lesions at 18 weeks. Analyses were by intention to treat.

FINDINGS

Moderate or greater improvement at 18 weeks was reported in 72 (55%) of 131 participants assigned oral oxytetracycline plus topical placebo, 70 (54%) of 130 assigned oral minocycline plus topical placebo, 78 (60%) of 130 assigned topical benzoyl peroxide plus oral placebo, 84 (66%) of 127 assigned topical erythromycin and benzoyl peroxide in a combined formulation plus oral placebo, and 82 (63%) of 131 assigned topical erythromycin and benzoyl peroxide separately plus oral placebo. Most improvement occurred in the first 6 weeks. Treatment differences for the proportion of people with at least moderate improvement were: minocycline versus oxytetracycline -1.2% (unadjusted 95% CI -13.3 to 10.9); combined erythromycin and benzoyl peroxide versus oxytetracycline 11.1% (-0.7 to 22.9) and versus minocycline 12.3% (0.4 to 24.2); erythromycin and benzoyl peroxide separately versus combined formulation -3.5% (-15.2 to 8.2); benzoyl peroxide versus oxytetracycline 5.0% (-7.0 to 17.0), versus minocycline 6.2% (-5.8 to 18.2), and versus combined formulation -6.1% (-17.9 to 5.7). Benzoyl peroxide was the most cost-effective treatment. Efficacy of both tetracyclines was reduced by pre-existing tetracycline resistance.

INTERPRETATION

Topical benzoyl peroxide and benzoyl peroxide/erythromycin combinations are similar in efficacy to oral oxytetracycline and minocycline and are not affected by propionibacterial antibiotic resistance.

[Clinical-epidemiological aspects of pityriasis versicolor (PV) in a fishing community of the semiarid region in Falcon State, Venezuela]

Between August 2001 and May 2002, the prevalence and several epidemiological and clinical characteristics of pityriasis versicolor (PV) were studied in 902 individuals aged two months- 60 years, 426 females and 476 males, from a fishery community of Río Seco, a semiarid region in the state of Falcon, north-western Venezuela. The overall prevalence of the disease was 15.52% (140/902). The frequency of infection was higher in females (65.7% vs. 34.3%), children under one year of age and adolescents (27.9% y 32.1%, respectively), and dark skin (67.9%). The most commonly affected anatomical areas were the face (57.9%) and thorax (27.1%). The most important clinical features of the disease were: hypochromic (91.4%), multicentric (73.6%), pruritic (92.9%), fine scaled (80.7%) and irregularly shaped borders (91.4%). On the basis of these results, the possible risk factors on transmission dynamic and maintenance of the disease endemically is discussed.

Cutaneous sporotrichosis: an unusual clinico-pathologic and therapeutic presentation

This report presents a number of unusual clinico-histopathologic and therapeutic features in a culture proven case of cutaneous sporotrichosis. These include lymphocutaneous sporotrichosis involving face; its dissemination in an otherwise healthy patient; its histology mimicking cutaneous cryptococcosis; two episodes of severe purulent inflammatory reaction bordering the lesion during therapy with saturated solution of potassium iodide; no therapeutic response to potassium iodide therapy and rapid healing of lesion with high-dose of fluconazole.

[Facial localizations of Buruli ulcers: two cases]

We report the first two published cases of a facial localization of Mycobacterium ulcerans ulcer (Buruli ulcer). M. ulcerans is the third most common mycobacteriosis, after leprosy and tuberculosis. Clinical manifestations involve large necrotic ulcerations with protruding edges, mainly localized on the limbs. Both of our patients, 9 and 45-year-old females, resided in endemic areas of Buruli ulcer in the Ivory Coast. The ulcers were located on the left zygomatic malar region in one patient and the submental region in the other. Treatment involved resection of the ulcer followed by total skin graft. Ulcer healing was observed after two months hospitalization in one patient. The other patient died.

Branched filaments no fungus, ovoid bodies no bacteria: Two unusual cases of mycetoma

We describe a 58-year-old man presenting with necrotizing panniculitis of the lower right leg and a 64-year-old woman with a clinically similar lesion combined with pustular eruptions and subsequent ulceration on the forehead. In the first patient, Giemsa staining showed small ovoid bodies and Grocott staining revealed hyphae. Histology from the process on the forehead showed branched filaments in the periodic acid-Schiff (PAS) staining. In the first case, Madurella mycetomatis, a fungus, was the pathogenic agent, whereas in the other case white colonies of filamentous organisms resembling fungi could be cultivated that turned out to be the bacterium Nocardia brasiliensis. Since the initial clinical appearance of these two forms of mycetoma were almost identical and histopathologic findings were inconclusive, only sophisticated microbiologic work-up of material from lesional skin led to the correct diagnosis. In times of global tourism, these unusual cases impressively document the necessity to become more familiar with mycetoma to make accurate therapeutic decisions with effective results, possibly saving a limb.

Subcutaneous phaeohyphomycosis on face caused by Cladophialophora bantiana

We report the case of a patient suffering from subcutaneous phaeohyphomycosis caused by Cladophialophora bantiana. The face of the upper site was involved with small, stellate, pyogranulomatous foci and low inflammation. The patient was treated by topical and systemic corticosteriod and amphotericin B. After 3 months of treatment, the patient showed good response.

A case of Trichosporon cutaneum folliculitis and septicaemia

Trichosporon cutaneum, a saprophytic fungal organism normally found in the soil, has been increasingly recognized as a cause of life-threatening systemic illness in immunosuppressed patients including those with leukaemia. Cutaneous involvement occurs in about 30% of patients with T. cutaneum septicaemia although disseminated folliculitis has not been described to our knowledge. We now describe a case of T. cutaneum follicultis due to fungaemia in a neutropenic patient.

Fatal bacteria granuloma after trauma: a new entity

In the past 20 years, more than 20 cases of a type of granulomatous disease have been noticed by dermatologists in different areas of China. The patients had these features in common: (i) the lesions followed a slight trauma to the face; (ii) they were spreading dark-red plaques without pus or ulceration; (iii) new lesions appeared near to or far from the original lesion; (iv) histopathology showed histiocytic granuloma; (v) the patients had severe headache and clouding of consciousness during the later stages of the disease; (vi) all patients died within 1.5-4 years; (vii) treatment with prednisone led to some healing of the lesions but accelerated death; and (viii) all patients were from rural areas. We examined the tissues from two similar patients by electron microscopy and identified two kinds of bacteria as a possible cause of the disease. One was an anaerobic actinomycete, the other was Staphylococcus capitis. The anaerobic actinomycete was sensitive to lincomycin (a forerunner of clindamycin). After a 5-month therapy with lincomycin, one patient survived. We infer that the cause of death is the unknown anaerobic actinomycete. Because the disease is very severe, we suggest the name 'fatal bacteria granuloma after trauma' to draw attention.

Facial cellulitis in childhood: a changing spectrum

BACKGROUND

Before conjugated Haemophilus influenzae type b (Hib) vaccination, a syndrome known as buccal cellulitis, usually caused by Hib and often accompanied by bacteremia, was seen. We investigated the incidence and cause of facial cellulitis at our hospital during the 10 years before and the 10 years after introduction of the vaccine.

METHODS

Records of patients discharged with a diagnosis of facial cellulitis or infections of the oral cavity were reviewed. Fisher's exact test was used to compare rates of cellulitis during the two decades.

RESULTS

Trauma was the most common antecedent to facial cellulitis in both eras. Buccal cellulitis accounted for 7/25 (28%) of cases before Hib vaccination and 0/19 cases since. Pneumococcal buccal cellulitis was not seen in either decade.

CONCLUSIONS

Buccal cellulitis due to Hib is a disappearing disease. Eighty-nine percent of recent inpatient cases of childhood facial cellulitis were related to trauma, tooth problems, or severe sinusitis. Facial cellulitis due to S pneumoniae is rare.

Pyoderma faciale: gram-negative recovery by means of needle aspiration

Pyoderma faciale is an inflammatory disease that until now was believed to occur only in women. Bacterial pathogens have not been found in most cases, and those found included only gram-positive microorganisms. We present 2 cases consistent with pyoderma faciale--one of them a 17-year-old adolescent boy--in which gram-negative bacteria were found. Enterobacter cloacae was found in one patient, and Klebsiella oxytoca was found in the other. Needle aspiration is the technique of choice in looking for pathogens in this disease.

Tuberculosis of the maxillary sinus manifesting as a facial abscess

Tuberculosis of the maxillary sinus is rare. Likewise, an acute onset that necessitates incision and drainage is also very uncommon. We report the case of a 15-year-old girl who came to us with an abscess on the left side of her face. She was found to have tuberculosis of the left maxillary antrum.

Skin colonization by Malassezia species in neonates: a prospective study and relationship with neonatal cephalic pustulosis

OBJECTIVES

To assess skin colonization by Malassezia species in full-term healthy newborns, to investigate factors associated with colonization, and to look at acnelike cephalic pustulosis associated with this carriage.

DESIGN

Samples were obtained from neonates and their mothers 0 to 5 days after birth and again 3 weeks later. Clinical patterns of common acnelike pustulosis were reported as mild (<10 papulopustules), moderate (> or =10 papulopustules), or absent. Direct examination and culture of sample. Identification of yeasts was based on microscopic and physiologic criteria.

SETTING

A maternity hospital and the pediatric dermatology unit of a university hospital.

PARTICIPANTS

Consecutive series of 102 neonates and their mothers.

MAIN OUTCOME MEASURES

Incidence of skin colonization and type of Malassezia species found in neonates and correlation with neonatal cephalic pustulosis (neonatal acne).

RESULTS

At the first visit, 11 neonates and 36 mothers had cultures positive for Malassezia. Malassezia sympodialis and Malassezia globosa were preferentially cultured. At 3 weeks, 29 (52%) of 56 neonates and 18 (32%) of 56 mothers had cultures positive for only M sympodialis and M globosa. Breastfeeding was not associated with a higher prevalence of Malassezia carriage in neonates. Malassezia colonization was higher when pustulosis was more severe and M sympodialis was found in pustules.

CONCLUSIONS

Malassezia colonization begins at birth and increases in the first weeks of life. A high prevalence of M sympodialis in neonates is noted from birth. Its association with neonatal acne is confirmed. Further investigation is needed to study the role of sebum secretion rate and quality in the neonatal period.

Chromobacterium violaceum infection: A rare but frequently fatal disease

The authors report a rare case of Chromobacterium violaceum infection in a 2-month-old child. She presented with an apparently localized abscess, which appeared to respond well to therapy. However, the infection recurred later with a fulminant course. The organism frequently is dismissed as a contaminant or not identified properly, and the fatality rates are high. A high degree of awareness about this infection needs to be created, especially among pediatricians and pediatric surgeons, because children appear to be infected more commonly than adults, and aggressive therapy is needed to save these patients.

Acquired immunodeficiency syndrome-related blastomycosis in an unusual geographic location

Blastomycosis is a fungal infection acquired via inhalation of Blastomyces dermatitidis. The majority of cases occur in central, southeastern, and mid-Atlantic areas of the United States. We report the case of a 42-year-old veteran infected with the human immunodeficiency virus who presented in E1 Paso, Texas, with a dry cough, fever, and recent weight loss. We review the clinical and epidemiologic features of blastomycosis. Diagnostic criteria and pharmacologic management are discussed. Active duty personnel are at high risk of exposure to B. dermatitidis. Military providers should maintain an index of suspicion for blastomycosis in endemic and nonendemic regions.

[A case of Folliculitis barbae Candidomycetica]

A 71-year-old man was referred to our department on January 30, 1998 with hard red papules that had developed on the philtrum in mid-January. On January 2, the patient had received high-dose steroid therapy (pulse therapy) for cluster asthma attacks and antibiotics at the Department of Internal Medicine of our hospital. Infiltrative, protruding reddish plaques were observed on the philtrum, which contained a number of small pustules at sites corresponding to hair follicles. There was partial opacity and slight irregularity of the nail plates on the first and second toes of the right foot. Fungal elements were detected from a lesion on the mustache and the nail. Histological examination of the lesion on the philtrum revealed infiltration of inflammatory cells comprising neutrophils, lymphocytes, and macrophages around the hair follicles. Beard hair and nail cultures revealed Candida albicans A, indicating that the patient had candidal sycosis and candidal onychia. He was treated with oral fluconazole (100 mg/day). The lesion was clinically improved within 50-days. Recently, extensive use of steroids and antibiotics has produced an increase in reports of patients with Folliculitis barbae Candidomycetica. We believe that the present case was also induced by high-dose steroid therapy and antibiotics.