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Kim BR, Kim MJ, Koo J, Choi HJ, Paik KH, Kwon SH, Choi HR, Huh CH, Shin JW, Park DS, Na JI. Artificial intelligence-based prescription of personalized scalp cosmetics improved the scalp condition: efficacy results from 100 participants. J DERMATOL TREAT 2024; 35:2337908. [PMID: 38616301 DOI: 10.1080/09546634.2024.2337908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/01/2023] [Indexed: 04/16/2024]
Abstract
Background: Scalp-related symptoms such as dandruff and itching are common with diverse underlying etiologies. We previously proposed a novel classification and scoring system for scalp conditions, called the scalp photographic index (SPI); it grades five scalp features using trichoscopic images with good reliability. However, it requires trained evaluators.Aim: To develop artificial intelligence (AI) algorithms for assessment of scalp conditions and to assess the feasibility of AI-based recommendations on personalized scalp cosmetics.Methods: Using EfficientNet, convolutional neural network (CNN) models (SPI-AI) ofeach scalp feature were established. 101,027 magnified scalp images graded according to the SPI scoring were used for training, validation, and testing the model Adults with scalp discomfort were prescribed shampoos and scalp serums personalized according to their SPI-AI-defined scalp types. Using the SPI, the scalp conditions were evaluated at baseline and at weeks 4, 8, and 12 of treatment.Results: The accuracies of the SPI-AI for dryness, oiliness, erythema, folliculitis, and dandruff were 91.3%, 90.5%, 89.6%, 87.3%, and 95.2%, respectively. Overall, 100 individuals completed the 4-week study; 43 of these participated in an extension study until week 12. The total SPI score decreased from 32.70 ± 7.40 at baseline to 15.97 ± 4.68 at week 4 (p < 0.001). The efficacy was maintained throughout 12 weeks.Conclusions: SPI-AI accurately assessed the scalp condition. AI-based prescription of tailored scalp cosmetics could significantly improve scalp health.
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Affiliation(s)
- Bo Ri Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Jae Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Jieun Koo
- Aram Huvis Co., Ltd, Seongnam, Korea
| | - Hwa-Jung Choi
- Department of Beauty Art, Youngsan University, Busan, South Korea
| | - Kyung Ho Paik
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Soon Hyo Kwon
- Department of Dermatology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Hye-Ryung Choi
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Hun Huh
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Won Shin
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | | | - Jung-Im Na
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
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Ibraheim MK, Storey L, North JP. Recurrent inverse necrotizing infundibular crystalline folliculitis. J Cutan Pathol 2024. [PMID: 38563487 DOI: 10.1111/cup.14617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/18/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
Necrotizing infundibular crystalline folliculitis (NICF) is a rare type of necrotizing folliculitis. The disease typically manifests as folliculocentric papules arising in a seborrheic distribution. Only 23 cases exist in the literature. Most reported cases have arisen spontaneously, but a small number of drug-induced cases in the setting of epidermal-derived growth factor, vascular endothelial-derived growth factor, or PD-1 inhibitor therapy have been reported. Colonization by bacteria and/or yeast occurs frequently. The etiology remains unknown, but some suggest a complex interplay with an aberrant microbiome, sebaceous gland dysfunction, and perturbed EGFR signaling in follicular infundibula. Histopathologic findings include rupture of follicular epithelium, neutrophilic inflammation, and nodular cup-shaped crystal deposits. We present a case of spontaneous, recurrent NICF in an inverse pattern in the inguinal region.
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Affiliation(s)
| | | | - Jeffrey P North
- Department of Dermatology and Pathology, University of California San Francisco, San Francisco, California, USA
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Ly S, Manjaly P, Kamal K, Theodosakis N, Charrow A, Mostaghimi A. Insurance coverage among the largest insurers per state for laser hair removal in the treatment of hidradenitis suppurativa. J Am Acad Dermatol 2024; 90:859-862. [PMID: 38128832 DOI: 10.1016/j.jaad.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Sophia Ly
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Priya Manjaly
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Kanika Kamal
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Nicholas Theodosakis
- Harvard Medical School, Harvard University, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Alexandra Charrow
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts.
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Altan Ferhatoğlu Z, Altinişik DD, Özdede A, Özkoca D, Güner S, Yildiz KA, Kutlubay Z, Seyahi E, Hamuryudan V. Folliculitis might be associated with pathergy-positivity in patients with Behçet syndrome. Medicine (Baltimore) 2024; 103:e37553. [PMID: 38518008 PMCID: PMC10957023 DOI: 10.1097/md.0000000000037553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/19/2024] [Indexed: 03/24/2024] Open
Abstract
Pathergy test indicates nonspecific hyper-reactivity of the skin to aseptic trauma in Behçet syndrome (BS) and is considered as an adjunctive diagnostic test with a good specificity albeit with low sensitivity. We tested the hypothesis that a relationship exists between active clinical manifestations of BS and the pathergy-positivity when performed simultaneously. Pathergy test and detailed dermatologic examination were done in 105 BS patients (60M/45F); who were seen consecutively at the multi-disciplinary BS outpatient clinic in a single tertiary center. Information regarding demographic and clinical characteristics, pathergy test results at diagnosis, and details about treatment were obtained from patient charts. Disease activity was assessed using Behçet Disease Current Activity Form. Among 105 patients, 27 (25.7%) were pathergy-positive at the time of the study visit whereas 40.9% were pathergy-positive at the time of the diagnosis. There was no relation between pathergy test and patient age or disease duration, either. Pathergy-positivity was significantly more common in patients with folliculitis compared to those without folliculitis (40.7% vs 19.2%; P = .026). The test was also positive in all 3 patients with leg ulcers due to venous stasis. We found that among all skin-mucosa lesions only the presence of folliculitis was associated with pathergy positivity with statistical significance. It was also remarkable that the current pathergy was positive in all 3 patients with active leg ulcers but this finding warrants further studies because of the low patient numbers.
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Affiliation(s)
- Zeynep Altan Ferhatoğlu
- Department of Dermatology Istanbul, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | | | - Ayşe Özdede
- Department of Internal Medicine, Division of Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Defne Özkoca
- Department of Dermatology, Koç University, School of Medicine, Istanbul, Turkey
| | - Sabriye Güner
- Department of Internal Medicine, Division of Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Kadir Atacan Yildiz
- Department of Dermatology Istanbul, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Zekayi Kutlubay
- Department of Dermatology Istanbul, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Emire Seyahi
- Department of Internal Medicine, Division of Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Vedat Hamuryudan
- Department of Internal Medicine, Division of Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Armillei MK, Lomakin IB, Del Rosso JQ, Grada A, Bunick CG. Scientific Rationale and Clinical Basis for Clindamycin Use in the Treatment of Dermatologic Disease. Antibiotics (Basel) 2024; 13:270. [PMID: 38534705 DOI: 10.3390/antibiotics13030270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
Clindamycin is a highly effective antibiotic of the lincosamide class. It has been widely used for decades to treat a range of skin and soft tissue infections in dermatology and medicine. Clindamycin is commonly prescribed for acne vulgaris, with current practice standards utilizing fixed-combination topicals containing clindamycin that prevent Cutibacterium acnes growth and reduce inflammation associated with acne lesion formation. Certain clinical presentations of folliculitis, rosacea, staphylococcal infections, and hidradenitis suppurativa are also responsive to clindamycin, demonstrating its suitability and versatility as a treatment option. This review describes the use of clindamycin in dermatological practice, the mechanism of protein synthesis inhibition by clindamycin at the level of the bacterial ribosome, and clindamycin's anti-inflammatory properties with a focus on its ability to ameliorate inflammation in acne. A comparison of the dermatologic indications for similarly utilized antibiotics, like the tetracycline class antibiotics, is also presented. Finally, this review addresses both the trends and mechanisms for clindamycin and antibiotic resistance, as well as the current clinical evidence in support of the continued, targeted use of clindamycin in dermatology.
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Affiliation(s)
- Maria K Armillei
- Program in Translational Biomedicine, Yale School of Medicine, Yale University, New Haven, CT 06511, USA
| | - Ivan B Lomakin
- Department of Dermatology, Yale University, New Haven, CT 06520, USA
| | - James Q Del Rosso
- College of Osteopathic Medicine, Touro University Nevada, Henderson, NV 89014, USA
- JDR Dermatology Research, Las Vegas, NV 89148, USA
- Clinical Research and Strategic Development, Advanced Dermatology and Cosmetic Surgery, Maitland, FL 32751, USA
| | - Ayman Grada
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Christopher G Bunick
- Program in Translational Biomedicine, Yale School of Medicine, Yale University, New Haven, CT 06511, USA
- Department of Dermatology, Yale University, New Haven, CT 06520, USA
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Fawzy MM, El-Enany G, Abdelraouf SMA, Abdelkader HA. Recurrent papulonodular herpes zoster, with syringitis, folliculitis, and vasculitis as clues to the diagnosis. J Cutan Pathol 2024; 51:205-208. [PMID: 38063075 DOI: 10.1111/cup.14566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 02/02/2024]
Abstract
Herpes zoster (HZ) may have atypical clinical presentations, particularly in immunosuppressed patients. Nodular HZ is an extremely rare condition. We report the first case of recurrent papulonodular HZ in an adult patient with inflammatory bowel disease (IBD) receiving biologic treatment. More interestingly, there was no epidermal involvement on histopathological examination, but the involvement of the adnexa and blood vessels was a clue to the diagnosis in view of the clinical context. We wish to raise awareness of this rare manifestation of HZ for early diagnosis and proper treatment.
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Affiliation(s)
- Marwa Mohamed Fawzy
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Galal El-Enany
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Wu CY, Parsiola R, Mitchell M, Mitchell M, Ramos S, Ravera I, Pucheu-Haston C. Evaluation of residual antibacterial effects on canine skin surface and hair following treatment with five commercial mousse products against Staphylococcus pseudintermedius. Vet Dermatol 2023; 34:495-504. [PMID: 37434336 DOI: 10.1111/vde.13190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/18/2023] [Accepted: 06/18/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Antibacterial effect studies of commercial antiseptics typically have evaluated hair and not the skin. OBJECTIVES To evaluate the antibacterial effects of mousse products on both canine skin and hair. ANIMALS Fifteen short-haired and eight long-haired dogs without skin disease. MATERIALS AND METHODS Five mousses were applied once: (1) 2% chlorhexidine and 2% miconazole; (2) 0.05% phytosphingosine; (3) 2% salicylic acid and 10% ethyl lactate; (4) 3% chlorhexidine and 0.5% climbazole; and (5) 2% chlorhexidine and 1% ketoconazole. Skin swabs and hair were collected from application sites before treatment, and at 1 h and at Day (D)2, D4, D8, D10 and D14 post-treatment. Skin swabs and hair were placed on Mueller-Hinton plates inoculated with Staphylococcus pseudintermedius inoculum suspension. Inhibition zones were measured after incubation. RESULTS Inhibition was not noted with mousses 2 and 3. In mousse 5, inhibition zone sizes produced by swabs from long- and short-haired dogs were not significantly different (p = 0.105), and all swabs and hair produced inhibition until D14, regardless of hair length. By contrast, in mousse 1, inhibition zones produced by swabs from long-haired dogs were smaller than those from short-haired dogs (p < 0.001), and swabs from long-haired dogs produced a shorter duration of bacterial inhibition than hair. CONCLUSIONS AND CLINICAL RELEVANCE The antibacterial effects of mousse 5 were not affected by hair length. Hair may be acceptable for evaluating effects on the skin in short-haired dogs. However, long hair may interfere with product distribution and duration of bacterial inhibition. Therefore, the evaluation of hair alone may overestimate clinically relevant antibacterial effects.
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Affiliation(s)
- Chi-Yen Wu
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | | | - Mark Mitchell
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Maria Mitchell
- Louisiana Animal Disease Diagnostic Laboratory, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Sara Ramos
- Capital Area Veterinary Specialists, Baton Rouge, Louisiana, USA
| | - Ivan Ravera
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Cherie Pucheu-Haston
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
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8
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Faccin M, Wiener DJ, Rech RR, Santoro D, Rodrigues Hoffmann A. Common superficial and deep cutaneous bacterial infections in domestic animals: A review. Vet Pathol 2023; 60:796-811. [PMID: 37264789 DOI: 10.1177/03009858231176558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The skin covers the external surface of animals, and it is constantly exposed to and inhabited by different microorganisms, including bacteria. Alterations in the skin barrier allow commensal and/or pathogenic bacteria to proliferate and penetrate deep into the lower layers of the skin. Being the first barrier to the external environment, the skin is prone to injuries, allowing the penetration of microorganisms that may lead to severe deep infections. Companion animals, especially dogs, are prone to bacterial infections, often secondary to allergic dermatitis. When environmental conditions are unfavorable, horses, cattle, sheep, and goats can develop superficial infections, such as those caused by Dermatophilus congolensis. Deep inflammation is commonly caused by Mycobacterium spp., which results in granulomatous to pyogranulomatous dermatitis and panniculitis. Likewise, bacteria such as Nocardia spp. and Actinomyces spp. can cause deep pyogranulomatous inflammation. Bacteria that lead to deep necrotizing lesions (eg, necrotizing fasciitis/flesh-eating bacteria) can be severe and even result in death. This review includes an overview of the most common cutaneous bacterial infections of domestic animals, highlighting the main features and histologic morphology of the bacteria, cutaneous structures involved, and the type of inflammatory infiltrates.
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Deo N, Isaq NA, Peters MS, Link J. Iatrogenic Demodex folliculitis: A case report. Int J Rheum Dis 2023; 26:2073-2075. [PMID: 37096969 DOI: 10.1111/1756-185x.14708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/10/2023] [Accepted: 04/09/2023] [Indexed: 04/26/2023]
Abstract
Demodex folliculorum is a commensal mite that inhabits the orifices of cutaneous pilosebaceous follicles. Overgrowth of these organisms can lead to Demodex folliculitis, which typically presents as papules and pustules predominantly involving the temples, cheeks, and occasionally the chest. We present a 51-year-old woman with iatrogenic Demodex folliculitis secondary to immunosuppressive treatment for an autoimmune connective tissue disease. Histopathological exam of a skin biopsy, which revealed follicular Demodex mites, confirmed the diagnosis. The eruption was treated with oral ivermectin and topical metronidazole gel, and the patient's immunosuppressive regimen was decreased, resulting in marked improvement in the eruption within 6 weeks and no worsening of her underlying autoimmune disorder. This case emphasizes the importance of considering Demodex folliculitis in the differential diagnosis of a new onset rash in the context of immunosuppressive treatment.
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Affiliation(s)
- Neha Deo
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Nasro A Isaq
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Margot S Peters
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jenny Link
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
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Assefa G. Acne Necrotica in Its Entirety: When It Starts, and After It Evolves. Int Med Case Rep J 2023; 16:467-471. [PMID: 37636990 PMCID: PMC10460170 DOI: 10.2147/imcrj.s421796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023] Open
Abstract
Acne necrotica is a rare disease, characterized by recurrent crops of inflammatory papules and papulo-pustules that rapidly become necrotic, leaving varioliform scars of varying extent. Here, I report the case of a 32-year-old male with early-stage disease and a 58-year-old male with late-stage acne necrotica. Both patients had a history of chronic, relapsing, umbilicated, and centrally necrotic erythematous papules and papulo-pustules involving the hairline and face. A diagnosis of acne necrotica was made based on the clinical presentation, and both patients started on topical mometasone furoate cream and doxycycline tablets and responded well. Herein I report this case to reappraise an under-recognized entity of acne necrotica.
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Affiliation(s)
- Girum Assefa
- Department of Dermatovenereology, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Elsaeed Eldeeb M, El Mulla K, Alshaer A, Ashraf HM, Omran EA. The effect of long-pulsed 1064 nm Nd:YAG laser-assisted hair removal on some skin flora and pathogens: an in vivo study. Indian J Dermatol Venereol Leprol 2023; 0:1-10. [PMID: 37609732 DOI: 10.25259/ijdvl_854_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/08/2023] [Indexed: 08/24/2023]
Abstract
Background The effect of NDYag on normal skin flora and pathogenic microbes has not been studied. Objectives Evaluation of immediate (before versus after each session) and delayed (pre-first session versus pre-fourth session) antimicrobial effect of Nd:YAG laser-assisted hair removal. Methods Thirty females scheduled for axillary Nd:YAG laser hair removal were included. Skin swabs were collected from the vault of the dominant axilla before and after each of the four sessions. Bacteriological cultures were performed to record the counts of total aerobes, total anaerobes, lipophilic bacteria, total staphylococci, Staphylococcus epidermidis (S. epidermidis), S. saprophyticus, S. hominis, and S. aureus. Reported changes in sweat odour and folliculitis (if present) were recorded. Results S.hominis was the predominant species in all subjects before and after all sessions. Counts of total aerobes, total anaerobes, lipophilic bacteria, total staphylococci, and S.hominis significantly decreased after all 4 sessions. A significant reduction was noted in the median colony counts before the fourth session as compared to the baseline count before the first session in total aerobes (278.9 versus 126.3 × 105 CFU/cm2, p = 0.003), total anaerobes (338.7 versus 103.7 × 105 CFU/cm2, p = 0.002) and total staphylococci (248.5 versus 105.0 × 105 CFU/cm2, p = 0.004). Most subjects reported worsened or unchanged axillary sweat odour. There was a statistically significant positive correlation between sweat odour and the counts of total aerobes (r = 0.433, p = 0.017), total anaerobes (r = 0.377, p = 0.040), total staphylococci (r = 0.383, p = 0.036) and S.hominis (r = 0.497, p = 0.005) ; lower counts were associated with a worsened odour. Limitations Small sample size; few laser sessions; short follow-up; subjective assessment of sweat odor and quantity. Conclusions Laser caused an immediate and delayed reduction in axillary aerobes, anaerobes, lipophilic bacteria, and staphylococci. This form of dysbiosis might lead to sweat odour changes.
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Affiliation(s)
- Marwa Elsaeed Eldeeb
- Department of Dermatology, Alexandria Faculty of Medicine, ElAzarita, Alexandria, Egypt
| | - Khaled El Mulla
- Department of Dermatology, Alexandria Faculty of Medicine, ElAzarita, Alexandria, Egypt
| | - Abeer Alshaer
- Department of Dermatology, Alexandria Faculty of Medicine, ElAzarita, Alexandria, Egypt
| | - Heba M Ashraf
- Department of Microbiology, High Institute of Public Health, Alexandria University, ElAzarita, Alexandria, Egypt
| | - Eman A Omran
- Department of Microbiology, High Institute of Public Health, Alexandria University, ElAzarita, Alexandria, Egypt
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Starace M, Yamagata JP, Cortez de Almeida RF, Frattini S, Bruni F, Alessandrini A, Iorizzo M, Melo DF, Neri I, Piraccini BM. A Practical Algorithm for the Management of Superficial Folliculitis of the Scalp: 10 Years of Clinical and Dermoscopy Experience. Dermatol Pract Concept 2023; 13:e2023131. [PMID: 37557142 PMCID: PMC10412046 DOI: 10.5826/dpc.1303a131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Superficial folliculitis of the scalp (SFS) is a common complaint in clinical practice, and initial presentation may be difficult to differentiate as they may appear very similar to each other. OBJECTIVES The aim of this thesis is to describe the pathologies that occur clinically as folliculitis of the scalp, identify their causes and characteristics and create a standardized classification. METHODS This is a retrospective clinical, dermoscopic and histopathological study over 10 years of dermatologic consultations. Only individuals with a confirmed diagnosis of SFS (updated diagnostic criteria or biopsy) were included. RESULTS In this review, we describe the various clinical features of different causes of SFS in ninety-nine cases and divided into infectious due to fungus, bacteria, or virus and inflammatory conditions such as rosacea, acneiform eruption and Ofuji syndrome. CONCLUSIONS The clinician must differentiate SFS from other underlying scarring disorders to prevent poorer outcomes. We created an algorithm to help the clinician reach a proper diagnosis.
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Affiliation(s)
- Michela Starace
- Dermatology - IRCCS Azianda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - João Paulo Yamagata
- Department of Dermatology, State University of Rio de Janeiro – UERJ, Rio de Janeiro – RJ, Brazil
| | | | - Simone Frattini
- Mental Health Department, Guelph General Hospital, Guelph, ON, Canada
| | - Francesca Bruni
- Dermatology - IRCCS Azianda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Aurora Alessandrini
- Dermatology - IRCCS Azianda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Matilde Iorizzo
- Private Dermatology Practice, Bellinzona/Lugano, Switzerland
| | - Daniel Fernandes Melo
- Department of Dermatology, State University of Rio de Janeiro – UERJ, Rio de Janeiro – RJ, Brazil
| | - Iria Neri
- Dermatology - IRCCS Azianda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- Dermatology - IRCCS Azianda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Navlani S, Mestha A. A Unique Case of Pili Multigemini Complicated by Folliculitis: Unveiling the Intricacies of a Rare Hair-Follicle Disorder. Cureus 2023; 15:e42280. [PMID: 37609080 PMCID: PMC10440396 DOI: 10.7759/cureus.42280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/24/2023] Open
Abstract
Pili multigemini is defined as the presence of two or more hair shafts in one hair follicle. It has mostly been reported to occur in the beard of men; however, it has been reported to occur uncommonly at other locations of the body as well. We present a rare case of a patient who presented with folliculitis on the abdomen which was incidentally detected as pili multigemini.
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Affiliation(s)
- Sahil Navlani
- General Practice, Dubai Academic Health Corporation, Dubai, ARE
| | - Akshata Mestha
- General Practice, Dubai Academic Health Corporation, Dubai, ARE
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14
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Al-Chaer RN, Bouazzi D, Jemec G, Mogensen M. Confocal microscopy and optical coherence tomography of inflammatory skin diseases in hairs and pilosebaceous units: A systematic review. Exp Dermatol 2023. [PMID: 37140216 DOI: 10.1111/exd.14830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/14/2023] [Accepted: 04/23/2023] [Indexed: 05/05/2023]
Abstract
Common skin disorders such as acne vulgaris, rosacea and folliculitis are bothersome prevalent inflammatory diseases of hair follicles that can easily be investigated bedside using optical coherence tomography (OCT) and reflectance confocal microscopy (RCM) with micrometre resolution, opening a novel era for high-resolution hair follicle diagnostics and quantitative treatment evaluation. EMBASE, PubMed and Web of Science were searched until 5 January 2023 to identify all studies imaging hair follicle characteristics by RCM and OCT for diagnosis and monitoring of treatment in hair follicle-based skin disorders. This study followed PRISMA guidelines. After inclusion of articles, methodological quality was assessed using the QUADAS-2 critical appraisal checklist. Thirty-nine in vivo studies (33 RCM and 12 OCT studies) were included. The studies focused on acne vulgaris, rosacea, alopecia areata, hidradenitis suppurativa, folliculitis, folliculitis decalvans, lichen planopilaris, discoid lupus erythemasus, frontal fibrosing alopecia and keratosis pilaris. Inter- and perifollicular morphology including number of demodex mites, hyperkeratinization, inflammation and vascular morphology could be assessed by RCM and OCT in all included skin disorders. Methodological study quality was low, and interstudy outcome variability was high. Quality assessment showed high or unclear risk of bias in 36 studies. Both RCM and OCT visualize quantitative features as size, shape, content and abnormalities of hair follicles, and have potential to support clinical diagnosis and evaluate treatment effects. However, larger studies with better methodological quality are needed to implement RCM and OCT directly into clinical practice.
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Affiliation(s)
- Rami Nabil Al-Chaer
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Dorra Bouazzi
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Gregor Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Mette Mogensen
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Clinical Medicine, The Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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15
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Rieger A, Just FT, Michelakaki E, Eddicks L, Gager AM, Schöl H, Gohl C, Steinmetz HW, Blutke AF, Denk D. Demodex carolliae in a colony of Seba's short-tailed bats (Carollia perspicillata): clinical, pathological and parasitological findings. J Comp Pathol 2023; 203:5-12. [PMID: 37119605 DOI: 10.1016/j.jcpa.2023.03.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/13/2023] [Accepted: 03/29/2023] [Indexed: 05/01/2023]
Abstract
Seba's short-tailed bats (Carollia perspicillata) are a frugivorous species native to Central and South America. Despite their importance as a reservoir for zoonotic pathogens and their popularity in zoological collection and as research models, there are relatively few reports on non-zoonotic diseases of bats. Mites of the genus Demodex are obligate commensals of the skin of a range of mammals, are highly host-specific and are not associated with clinical disease when present in low numbers. However, infestation with high numbers can result in severe or even fatal disease and substantially affect the well-being of the animals. The clinical, pathological and parasitological findings in 12 Seba's short-tailed bats with demodicosis from a colony kept at Munich Zoo Hellabrunn between 1992 and 2021 are described in this report. From 2002, skin lesions became apparent on the head, especially the periocular region, nose and ears, as well as the genital area of some animals. In advanced cases, skin changes were also present on the abdomen, back and extremities. Gross findings typically included alopecia and thickening of the skin, with the formation of papules, reflecting cystically dilated hair follicles containing myriads of demodecid mites. Histologically, lesions were characterized by a paucicellular lymphocytic dermatitis and folliculitis with perifollicular fibrosis, epidermal hyperplasia, orthokeratotic hyperkeratosis and disproportionately high numbers of intrafollicular arthropods. Demodex carolliae was identified morphologically by light, phase-contrast and electron microscopy. Further characterization was achieved by extraction of parasitic DNA and partial gene sequencing of two mitochondrial genes, 16S rDNA and cox1. This is the first clinicopathological description of generalized demodicosis in Seba's short-tailed bats and includes the first molecular characterization of D. carolliae with provision of a GenBank entry.
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Affiliation(s)
- Alexandra Rieger
- Institute of Veterinary Pathology, Center for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Veterinaerstr. 13, 80539 Munich, Germany
| | - Frank T Just
- Department for Pathology, Parasitology and Bee Diseases, Bavarian Health and Food Safety Authority, Veterinaerstrasse 2, 85764 Oberschleissheim, Germany
| | - Effrosyni Michelakaki
- Institute of Veterinary Pathology, Center for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Veterinaerstr. 13, 80539 Munich, Germany
| | - Lina Eddicks
- Institute of Veterinary Pathology, Center for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Veterinaerstr. 13, 80539 Munich, Germany
| | - Anna M Gager
- Institute of Veterinary Pathology, Center for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Veterinaerstr. 13, 80539 Munich, Germany
| | - Heidrun Schöl
- Institute of Veterinary Pathology, Center for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Veterinaerstr. 13, 80539 Munich, Germany
| | - Christine Gohl
- Münchener Tierpark Hellabrunn AG, Tierparkstr. 30, 81543 Munich, Germany
| | | | - Andreas F Blutke
- Institute of Veterinary Pathology, Center for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Veterinaerstr. 13, 80539 Munich, Germany
| | - Daniela Denk
- Institute of Veterinary Pathology, Center for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Veterinaerstr. 13, 80539 Munich, Germany.
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16
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Lim SS, Shin K, Mun JH. Dermoscopy for cutaneous fungal infections: A brief review. Health Sci Rep 2022; 5:e464. [PMID: 35024456 PMCID: PMC8733849 DOI: 10.1002/hsr2.464] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 01/22/2023] Open
Abstract
Background Fungal dermatological diseases are significant public health issues. Dermoscopy is a useful bedside assessment tool that helps clinicians diagnose various skin neoplasms and general dermatological diseases. Aim This brief review aims to update clinicians on the dermoscopic features of cutaneous fungal infections such as tinea capitis, tinea corporis, tinea incognito, onychomycosis, and pityrosporum folliculitis. Methods The PubMed database was searched using the terms “dermoscopy” or its synonyms, “tinea capitis”, “tinea corporis”, “tinea incognito”, “onychomycosis” and “pityrosporum folliculitis”. Results The diagnostic value of dermoscopy is well‐recognised in the evaluation of tinea capitis and onychomycosis. There are fewer studies investigating the dermoscopic features of tinea corporis, tinea incognito and pityrosporum folliculitis, but the current data suggest that dermoscopy can aid clinical evaluation of these diseases. Understanding dermoscopic features of cutaneous fungal infection has the potential to increase diagnostic accuracy. Conclusion Dermoscopy in the evaluation of fungal dermatological diseases has the potential to optimize diagnostic accuracy, reduce unnecessary testing, and, consequently, improve clinical practice.
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Affiliation(s)
| | - Kihyuk Shin
- Department of Dermatology, College of Medicine Pusan National University Busan South Korea.,Department of Dermatology Pusan National University Yangsan Hospital Yangsan South Korea.,Research Institute for Convergence of Biomedical Science and Technology Pusan National University Yangsan Hospital Yangsan South Korea
| | - Je-Ho Mun
- Department of Dermatology Seoul National University Hospital Seoul Republic of Korea.,Department of Dermatology Seoul National University College of Medicine Seoul Republic of Korea
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17
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Chen Y, Yang YP, Qiu F, Wang YJ, Fan YM. Immunophenotyping comparison of inflammatory cells between Malassezia folliculitis and pityriasis versicolor lesions. Med Mycol 2021; 60:6427365. [PMID: 34791431 DOI: 10.1093/mmy/myab073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 11/14/2022] Open
Abstract
Immunophenotyping of inflammatory dermal infiltrates in Malassezia folliculitis (MF) and pityriasis versicolor (PV) lesions is less reported. Immunohistochemistry was performed on 21 MF lesions, 10 PV lesions, and 10 control skin. CD3+, CD4+, CD8+, CD20+, CD68+, and CD117+ cells were increased in MF compared with PV and normal skin (P < 0.01-0.05), while CD3+, CD4+, and CD20+ cells were higher in PV than in normal skin (P < 0.05). Dermal CD1a+ cells were higher only in PV (P < 0.05). Although both cellular and humoral immune responses are involved in pathogenesis of MF and PV, their difference may contribute to clinicopathological discrepancy between two disorders. LAY SUMMARY Malassezia folliculitis and pityriasis versicolor are common Malassezia-induced superficial mycoses. Their clinicopathological discrepancy may be due to the difference of cellular and humoral immune responses.
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Affiliation(s)
- Yu Chen
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, 524001, China
| | - Yan-Ping Yang
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, 524001, China
| | - Fang Qiu
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, 524001, China
| | - Yu-Jie Wang
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, 524001, China
| | - Yi-Ming Fan
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, 524001, China
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18
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Abstract
Background: Pembrolizumab is a monoclonal antibody targeting PD-1. Folliculitis secondary to pembrolizumab has rarely been reported in the treatment of malignant melanoma. Case: A 49-year-old with a history of mild lower limb folliculitis developed metastatic malignant melanoma, and immunotherapy with pembrolizumab was initiated. Following 19 doses of pembrolizumab, a folliculocentric pustular eruption developed on the lower legs. Biopsy was consistent with folliculitis. Treatment with topical corticosteroids, high-dose prednisolone, lymecycline, clarithromycin, trimethoprim and clindamycin was unsuccessful. Pembrolizumab was stopped after 22 cycles, but the folliculitis persisted. Oral isotretinoin was required for disease control. Discussion: Drug-induced follicular eruptions have rarely been described with anti PD-1 therapy. Isotretinoin may be required to achieve remission.
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Affiliation(s)
- Cathal O'Connor
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, T12 X23H, Ireland
- University College Cork, Cork, T12 AK54, Ireland
| | - Derek Power
- Department of Oncology, Cork University Hospital, Cork, T12 EC8P, Ireland
| | - Catherine Gleeson
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, T12 X23H, Ireland
| | - Cynthia Heffron
- University College Cork, Cork, T12 AK54, Ireland
- Department of Pathology, Cork University Hospital, Cork, T12 EC8P, Ireland
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19
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Alkul M, Dowdle TS, Truitt J, Tarbox MB. Transfollicular elimination of sebaceous glands in a patient with disseminate and recurrent infundibulo folliculitis. Proc AMIA Symp 2021; 34:734-735. [PMID: 34733006 DOI: 10.1080/08998280.2021.1941581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Disseminate and recurrent infundibulofolliculitis (DRIF) is a rare form of folliculitis characterized by multiple papules widely distributed on the trunk and extremities. We present a 37-year-old man with confirmed DRIF complicated by transfollicular elimination of the sebaceous unit, an additional finding of DRIF that has rarely been reported.
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Affiliation(s)
- Mahmud Alkul
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Travis S Dowdle
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Jay Truitt
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Michelle B Tarbox
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas
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20
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Abstract
Down syndrome (DS) is the most common chromosomal condition and affects many organs including the skin. Dermatologists are an integral part of the DS care team. This is a review of both common and rare dermatologic conditions in DS. We provide practical strategies for a successful dermatology interview and examination. We explore the downstream effects of trisomy of chromosome 21, in particular on the immune system, and how these insights may enhance our pathophysiologic understanding of their cutaneous conditions.
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Affiliation(s)
- Chenin Ryan
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Kishore Vellody
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Leah Belazarian
- Departments of Pediatrics and Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jillian F Rork
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA.,Department of Dermatology, Dartmouth-Hitchcock Medical Center, Manchester, New Hampshire, USA
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21
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Soglia S, Maione V, Bugatti M, Vermi W, Calzavara-Pinton P, Venturini M. Adalimumab for interleukin-1β-mediated chronic non-scarring scalp folliculitis: Case report and literature review. J Dermatol 2021; 49:157-160. [PMID: 34472127 DOI: 10.1111/1346-8138.16106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/27/2021] [Accepted: 07/25/2021] [Indexed: 11/29/2022]
Abstract
Chronic non-scarring scalp folliculitis is a little-known entity included within the spectrum of scalp folliculitis, a group of diseases sharing clinical features but with heterogeneity in terms of residual scarring (always absent in chronic non-scarring scalp folliculitis), microbiology, and response to antibiotics. Chronic non-scarring scalp folliculitis is most likely an inflammatory disease within the group of neutrophilic dermatoses. The recognition of the inflammatory nature of this disease may pave the way for the use of new therapies, directly targeting pathogenic molecules. Herein, we report the first case of chronic non-scarring scalp folliculitis treated by adalimumab.
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Affiliation(s)
- Simone Soglia
- Department of Dermatology, University of Brescia, Brescia, Italy
| | - Vincenzo Maione
- Department of Dermatology, University of Brescia, Brescia, Italy
| | - Mattia Bugatti
- Department of Pathology, University of Brescia, Brescia, Italy
| | - William Vermi
- Department of Dermatology, University of Brescia, Brescia, Italy.,Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri, USA
| | | | - Marina Venturini
- Department of Dermatology, University of Brescia, Brescia, Italy
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22
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Frølunde AS, Olesen AB, Riber‐Hansen R, Pallesen KAU. Eosinophilic pustular folliculitis of infancy: A rare diagnosis in children. Clin Case Rep 2021; 9:e04167. [PMID: 34026179 PMCID: PMC8117823 DOI: 10.1002/ccr3.4167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 12/31/2022] Open
Abstract
Remember EPFI as a differential diagnosis in children with a rash on the scalp and no effect of antibiotic treatment.
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23
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Nakamizo S, Honda T, Sato T, Al Mamun M, Chow Z, Duan K, Lum J, Tan KJ, Tomari K, Sato R, Kitoh A, Tay ASL, Common JEA, Guan NL, Setou M, Ginhoux F, Kabashima K. High-fat diet induces a predisposition to follicular hyperkeratosis and neutrophilic folliculitis in mice. J Allergy Clin Immunol 2021; 148:473-485.e10. [PMID: 33713763 DOI: 10.1016/j.jaci.2021.02.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Neutrophilic folliculitis is an inflammatory condition of hair follicles. In some neutrophilic folliculitis, such as in patients with acne and hidradenitis suppurativa, follicular hyperkeratosis is also observed. Neutrophilic folliculitis is often induced and/or exacerbated by a high-fat diet (HFD). However, the molecular mechanisms by which an HFD affects neutrophilic folliculitis are not fully understood. OBJECTIVE Our aim was to elucidate how an HFD promotes the development of neutrophilic folliculitis. METHODS Mice were fed an HFD, and their skin was subjected to histologic, RNA sequencing, and imaging mass spectrometry analyses. To examine the effect of an HFD on neutrophil accumulation around the hair follicles, phorbol 12-myristate 13-acetate (PMA) was used as an irritant to the skin. RESULTS Histologic analysis revealed follicular hyperkeratosis in the skin of HFD-fed mice. RNA sequencing analysis showed that genes related to keratinization, especially in upper hair follicular keratinocytes, were significantly upregulated in HFD-fed mice. Application of PMA to the skin induced neutrophilic folliculitis in HFD-fed mice but not in mice fed a normal diet. Accumulation of neutrophils in the skin and around hair follicles was dependent on CXCR2 signaling, and CXCL1 (a CXCR2 ligand) was produced mainly by hair follicular keratinocytes. Imaging mass spectrometry analysis revealed an increase in fatty acids in the skin of HFD-fed mice. Application of these fatty acids to the skin induced follicular hyperkeratosis and caused PMA-induced neutrophilic folliculitis even in mice fed a normal diet. CONCLUSION An HFD can facilitate the development of neutrophilic folliculitis with the induction of hyperkeratosis of hair follicles and increased neutrophil infiltration around the hair follicles via CXCR2 signaling.
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Affiliation(s)
- Satoshi Nakamizo
- Singapore Immunology Network, Agency for Science, Technology and Research, Biopolis, Singapore; Skin Research Institute of Singapore, Agency for Science, Technology and Research, Biopolis, Singapore; Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tetsuya Honda
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Dermatology, School of Medicine, Hamamatsu University, Hamamatsu, Shizuoka, Japan.
| | - Tomohito Sato
- Department of Cellular and Molecular Anatomy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Md Al Mamun
- Department of Cellular and Molecular Anatomy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Zachary Chow
- Skin Research Institute of Singapore, Agency for Science, Technology and Research, Biopolis, Singapore
| | - Kaibo Duan
- Singapore Immunology Network, Agency for Science, Technology and Research, Biopolis, Singapore
| | - Josephine Lum
- Singapore Immunology Network, Agency for Science, Technology and Research, Biopolis, Singapore
| | - Kahbing Jasmine Tan
- Singapore Immunology Network, Agency for Science, Technology and Research, Biopolis, Singapore; Skin Research Institute of Singapore, Agency for Science, Technology and Research, Biopolis, Singapore
| | - Kaori Tomari
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Reiko Sato
- Singapore Immunology Network, Agency for Science, Technology and Research, Biopolis, Singapore; Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihiko Kitoh
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Angeline S L Tay
- Skin Research Institute of Singapore, Agency for Science, Technology and Research, Biopolis, Singapore
| | - John E A Common
- Skin Research Institute of Singapore, Agency for Science, Technology and Research, Biopolis, Singapore
| | - Ng Lai Guan
- Singapore Immunology Network, Agency for Science, Technology and Research, Biopolis, Singapore
| | - Mitsutoshi Setou
- Department of Cellular and Molecular Anatomy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Florent Ginhoux
- Singapore Immunology Network, Agency for Science, Technology and Research, Biopolis, Singapore; Skin Research Institute of Singapore, Agency for Science, Technology and Research, Biopolis, Singapore.
| | - Kenji Kabashima
- Singapore Immunology Network, Agency for Science, Technology and Research, Biopolis, Singapore; Skin Research Institute of Singapore, Agency for Science, Technology and Research, Biopolis, Singapore; Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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24
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Braun-Meyre G, Marbet C, Blickenstorfer M, Khani H. [An Itching Pleasure]. Praxis (Bern 1994) 2021; 110:108-110. [PMID: 33530778 DOI: 10.1024/1661-8157/a003426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
An Itching Pleasure Abstract. A 50-year-old female patient presents in the emergency department with an itchy, acneiform exanthema on the trunk and malaise for two days. Laboratory testing showed no abnormalities. After further questioning, the patient reported frequent use of her new whirlpool. Based on the medical history and the clinic we suspected a pseudomonas folliculitis. A bacterial culture of the pustules showed growth of Pseudomonas aeruginosa, which confirmed the diagnosis. Systemic antibiotics were not necessary in the absence of risk factors for severe progress or immunosuppression. The exanthema healed within a few days without any complications by using external disinfectants.
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Affiliation(s)
| | | | | | - Hamid Khani
- Klinik für Dermatologie, Universitätsspital Basel
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25
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Hashida Y, Higuchi T, Nakajima S, Nakajima K, Ujihara T, Kabashima K, Sano S, Daibata M. Human Polyomavirus 6 Detected in Cases of Eosinophilic Pustular Folliculitis. J Infect Dis 2020; 223:1724-1732. [PMID: 32989462 DOI: 10.1093/infdis/jiaa607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Human polyomaviruses (HPyVs) have been associated with several cutaneous inflammatory conditions. More investigation is needed to identify further presentations of cutaneous pathology associated with HPyVs. Our aim was to investigate the possible association of skin-tropic HPyVs with folliculitis, particularly eosinophilic pustular folliculitis (EPF). METHODS This study included 55 Japanese patients, comprising 13 patients with EPF and 42 patients with suppurative folliculitis. HPyV DNAs were detected by quantitative polymerase chain reaction. Expression of viral antigen and geographically related viral genotypes were also assessed. RESULTS Human polyomavirus 6 (HPyV6) DNA was found in 9 of 13 (69%) patients with EPF, a rate significantly higher than that found in suppurative folliculitis (1/42; 2%). Of the 7 HPyV6 DNA-positive EPF specimens analyzed, 4 were positive for HPyV6 small tumor antigen. All the HPyV6 strains detected in this study were of the Asian/Japanese genotype. CONCLUSIONS The predominant detection of HPyV6 DNA and the expression of viral antigen suggest a possible association between HPyV6 infection and EPF in a subset of patients. Worldwide studies are warranted to determine whether Asian/Japanese genotype HPyV6 is associated preferentially with the incidence and pathogenesis of this eosinophil-related skin disease that has an ethnic predilection for the East Asian population.
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Affiliation(s)
- Yumiko Hashida
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Kochi, Japan
| | - Tomonori Higuchi
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Kochi, Japan
| | - Saeko Nakajima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kimiko Nakajima
- Department of Dermatology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Takako Ujihara
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Kochi, Japan.,Science Research Center, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Singapore Immunology Network and Skin Research Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Shigetoshi Sano
- Department of Dermatology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Masanori Daibata
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Kochi, Japan
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26
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Matthews M, Vanlier C, de Montjoye L, Baeck M. A creeping holiday souvenir: about a misleading case of hookworm folliculitis†. J Travel Med 2020; 27:5862545. [PMID: 32584381 DOI: 10.1093/jtm/taaa101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/09/2020] [Accepted: 06/14/2020] [Indexed: 11/12/2022]
Abstract
Hookworm-related cutaneous larva migrans occurs in endemic areas but also amongst travelers. Although this disease usually presents as a single pruritic raised erythematous track, misleading clinical presentations are not uncommon. This particularly extensive, follicular presentation of larva migrans should warn clinicians about atypical forms of this emerging tropical disease.
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Affiliation(s)
- Marine Matthews
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Corentine Vanlier
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Laurence de Montjoye
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Marie Baeck
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200 Brussels, Belgium
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Abstract
Despite concerns about infection risks of floating tanks, outbreaks have rarely been reported. In May 2017, an outbreak of skin rash occurred among visitors of a floating tank open for the public in Norway. We assessed the extent and cause of the outbreak and the risk factors for infection in a retrospective cohort study among the visitors of the floating tank using a standardized web-based questionnaire. An environmental investigation was conducted including microbiological analysis of the floating tank water. Of the 46 respondents to the questionnaire (61 distributed), 22 reported symptoms, most commonly palmar and plantar rash, swollen lymph nodes, ear canal pain and itching. None of the investigated risk factors, such as sex, age, duration of bathing or use of the shower after bathing, were significantly associated with illness. The results of the environmental investigation indicated that the water was heavily contaminated by P. aeruginosa and heterotrophic bacteria. The outbreak investigation highlights the need to ensure adequate hygienic operation of floating tanks. Awareness about responsibilities should be raised among the operators of floating tanks and relevant operational parameters for floating tanks should be made available for local health authorities.
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Affiliation(s)
- Susanne Hyllestad
- University of Oslo, Faculty of Medicine, Institute of Health and Society, Oslo, Norway.,Norwegian Institute of Public Health, Department of Zoonotic, Food- and Waterborne Infections,, Oslo, Norway
| | - Heidi Lange
- Norwegian Institute of Public Health, Department of Zoonotic, Food- and Waterborne Infections,, Oslo, Norway
| | - Bernardo Guzman-Herrador
- Norwegian Institute of Public Health, Department of Zoonotic, Food- and Waterborne Infections,, Oslo, Norway
| | - Emily MacDonald
- Norwegian Institute of Public Health, Department of Zoonotic, Food- and Waterborne Infections,, Oslo, Norway
| | - Vidar Lund
- Norwegian Institute of Public Health, Department of Zoonotic, Food- and Waterborne Infections,, Oslo, Norway
| | - Preben Aavitsland
- University of Oslo, Faculty of Medicine, Institute of Health and Society, Oslo, Norway.,Norwegian Institute of Public Health, Department of Zoonotic, Food- and Waterborne Infections,, Oslo, Norway
| | - Line Vold
- Norwegian Institute of Public Health, Department of Zoonotic, Food- and Waterborne Infections,, Oslo, Norway
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Rork JF, McCormack L, Lal K, Wiss K, Belazarian L. Dermatologic conditions in Down syndrome: A single-center retrospective chart review. Pediatr Dermatol 2020; 37:811-816. [PMID: 32519435 DOI: 10.1111/pde.14214] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/22/2020] [Accepted: 05/05/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Current literature addressing dermatologic conditions associated with Down syndrome is limited, with emphasis on rare skin conditions and lack of consensus on the incidence of more common disorders. OBJECTIVE We sought to evaluate dermatologic conditions in patients with Down syndrome diagnosed and managed by dermatologists. METHODS This was a retrospective analysis of 101 pediatric and adult patients with Down syndrome seen by the University of Massachusetts Dermatology Department between 2008 and 2018. RESULTS Folliculitis was the most common diagnosis overall (30.7%), followed by seborrheic dermatitis (26.7%) and hidradenitis suppurativa (22.8%). Eczematous dermatitis, alopecia areata, and xerosis were the most common diagnoses observed in children aged 0-12 years; hidradenitis suppurativa, folliculitis, and seborrheic dermatitis in adolescents aged 13-17 years; and folliculitis, seborrheic dermatitis, and xerosis in adults 18 years and older. Other notable diagnoses present overall included onychomycosis (9.9%) and psoriasis (8.9%). Malignant cutaneous tumors were present in two patients, specifically basal cell carcinoma and malignant melanoma in situ. LIMITATIONS This was a retrospective, single-institution study. CONCLUSION Dermatologic conditions in patients with Down syndrome vary by age but are most often adnexal and eczematous disorders. Trisomy of chromosome 21 and the resulting downstream effects, specifically on the immune system, may account for these findings.
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Affiliation(s)
- Jillian F Rork
- Department of Dermatology, Dartmouth Medical School, Lebanon, NH, USA
| | | | - Karan Lal
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Karen Wiss
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
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29
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Schuler A, Veenstra J, Tisack A. Folliculitis Induced by Laser Hair Removal: Proposed Mechanism and Treatment. J Clin Aesthet Dermatol 2020; 13:34-36. [PMID: 32802254 PMCID: PMC7380697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The neodymium:aluminum garnet laser has emerged as a generally well-tolerated tool for hair removal; however, some patients develop a folliculitis after treatment, which can limit utility. To our knowledge, the literature is currently lacking an adequate description of the etiology of laser-induced folliculitis or strategies to prevent and manage it. We present the case of a 33-year-old Caucasian male patient who developed a robust laser-induced folliculitis. We discuss management strategies and the possible mechanism of onset, as well as hypothesize that the mechanism driving laser-induced folliculitis is similar to that seen with pseudofolliculitis barbae, as the nidus for the inflammatory response appeared to be the hairs undergoing extrusion through the skin. While laser-induced folliculitis is a self-limited complication, it might discourage patients from seeking laser hair removal. In patients known to develop this adverse effect or those with hair features potentially more prone to developing folliculitis (i.e. curly, coarse hair or pili multigemini), it might be reasonable to treat with prophylactic doxycycline and topical steroids along with gentle washing techniques to assist in depilation. As demonstrated in our case, this might help to decrease the severity and duration of laser-induced folliculitis.
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Affiliation(s)
- Andrew Schuler
- Dr. Schuler is with the University of Michigan Medical School in Ann Arbor, Michigan
- Drs. Veenstra and Tisack are with the Department of Dermatology, Henry Ford Health System in Detroit, Michigan
| | - Jesse Veenstra
- Dr. Schuler is with the University of Michigan Medical School in Ann Arbor, Michigan
- Drs. Veenstra and Tisack are with the Department of Dermatology, Henry Ford Health System in Detroit, Michigan
| | - Alison Tisack
- Dr. Schuler is with the University of Michigan Medical School in Ann Arbor, Michigan
- Drs. Veenstra and Tisack are with the Department of Dermatology, Henry Ford Health System in Detroit, Michigan
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30
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Li W, Zhang ZW, Luo Y, Liang N, Pi XX, Fan YM. Molecular epidemiology, in vitro susceptibility and exoenzyme screening of Malassezia clinical isolates. J Med Microbiol 2020; 69:436-442. [PMID: 32068525 DOI: 10.1099/jmm.0.001161] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction. Malassezia folliculitis (MF) and pityriasis versicolor (PV) are common dermatoses caused by Malassezia species. Their molecular epidemiology, drug susceptibility and exoenzymes are rarely reported in China.Aim. To investigate the molecular epidemiology, drug susceptibility and enzymatic profile of Malassezia clinical isolates.Methodology. Malassezia strains were recovered from MF and PV patients and healthy subjects (HS) and identified by sequencing analysis. The minimum inhibitory concentrations (MICs) of nine antifungals (posaconazole, voriconazole, itraconazole, fluconazole, ketoconazole, miconazole, bifonazole, terbinafine and caspofungin) and tacrolimus, the interactions between three antifungals (itraconazole, ketoconazole and terbinafine) and tacrolimus, and the extracellular enzyme profile were evaluated using broth and checkerboard microdilution and the Api-Zym system, respectively.Results. Among 392 Malassezia isolates from 729 subjects (289 MF, 218 PV and 222 HS), Malassezia furfur and Malassezia globosa accounted for 67.86 and 18.88 %, respectively. M. furfur was the major species in MF and PV patients and HS. Among 60M. furfur and 50M. globosa strains, the MICs for itraconazole, posaconazole, voriconazole and ketoconazole were <1 μg ml-1. M. furfur was more susceptible to itraconazole, terbinafine and bifonazole but tolerant to miconazole compared with M. globosa (P<0.05). Synergistic effects between terbinafine and itraconazole or between tacrolimus and itraconazole, ketoconazole or terbinafine occurred in 6, 7, 6 and 9 out of 37 strains, respectively. Phosphatases, lipases and proteases were mainly secreted in 51 isolates.Conclusions. Itraconazole, posaconazole, voriconazole and ketoconazole are theagents against which there is greatest susceptibility. Synergistic effects between terbinafine and itraconazole or tacrolimas and antifungals may be irrelevant to clinical application. Overproduction of lipases could enhance the skin inhabitation of M. furfur.
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Affiliation(s)
- Wei Li
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, PR China
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31
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Draelos ZD. Examining 15% Azelaic Acid Foam for the Treatment of Folliculitis: A Pilot Study. J Clin Aesthet Dermatol 2020; 13:36-38. [PMID: 33144909 PMCID: PMC7605388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND: Folliculitis is a frequently recurrent skin condition characterized by inflammatory papules and pustules on numerous body areas arising from follicular irritation induced by shaving or trauma but might also arise in the presence of bacterial or fungal organisms. Oral and topical antibiotics remain the mainstay of treatment, but the chronicity of the condition requires a safe maintenance therapy. OBJECTIVE: The objective of this study was to examine the off-label use of 15% azelaic acid foam in the treatment of folliculitis. DESIGN: Subjects received 15% azelaic acid foam for twice daily application to all areas of folliculitis for four weeks. PARTICIPANTS: Twenty-six male or female subjects with dermatologist diagnosed folliculitis participated in this research. MEASUREMENTS: Assessments consisted of the dermatologist investigator and subjects evaluating several parameters on a five-point scale (0=none, 1=minimal, 2=mild, 3=moderate, 4=severe) at baseline, Week 2, and Week 4. The dermatologist investigator evaluated lesional erythema, lesional inflammatory papule size, extent of inflammatory papules, lesional pus, lesional pustule size, extent of pustules, and overall folliculitis assessment. The subjects assessed itching associated with folliculitis, pain associated with folliculitis, lesional pus, lesional redness, extent of involvement, and overall folliculitis assessment. RESULTS: After four weeks of 15% azelaic acid foam treatment, the investigator noted a 67-percent reduction in lesional erythema, 73-percent reduction in lesional inflammatory papule size, 87-percent reduction in extent of pustules, and 78-percent reduction in overall folliculitis. The subjects reported a reduction of 60-percent in folliculitis itching, 67-percent reduction in pain, 73-percent reduction in lesional pus, 51-percent reduction in lesional redness, and 59-percent reduction in extent of folliculitis involvement. CONCLUSION: Azelaic acid 15% foam used off-label might be a useful treatment or adjunctive therapy for folliculitis.
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Affiliation(s)
- Zoe Diana Draelos
- Dr. Draelos is with Dermatology Consulting Services, PLLC in High Point, North Carolina
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32
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Saunte DML, Gaitanis G, Hay RJ. Malassezia-Associated Skin Diseases, the Use of Diagnostics and Treatment. Front Cell Infect Microbiol 2020; 10:112. [PMID: 32266163 PMCID: PMC7098993 DOI: 10.3389/fcimb.2020.00112] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/28/2020] [Indexed: 11/13/2022] Open
Abstract
Yeasts of the genus, Malassezia, formerly known as Pityrosporum, are lipophilic yeasts, which are a part of the normal skin flora (microbiome). Malassezia colonize the human skin after birth and must therefore, as commensals, be normally tolerated by the human immune system. The Malassezia yeasts also have a pathogenic potential where they can, under appropriate conditions, invade the stratum corneum and interact with the host immune system, both directly but also through chemical mediators. The species distribution on the skin and the pathogenetic potential of the yeast varies between different Malassezia related diseases such as head and neck dermatitis, seborrheic dermatitis, pityriasis versicolor, and Malassezia folliculitis. The diagnostic methods used to confirm the presence of Malassezia yeasts include direct microcopy, culture based methods (often a combination of morphological features of the isolate combined with biochemical test), molecular based methods such as Polymerase Chain Reaction techniques, and Matrix Assisted Laser Desorption/Ionization—Time Of Flight mass spectrometry and the chemical imprint method Raman spectroscopy. Skin diseases caused by Malassezia are usually treated with antifungal therapy and if there are associated inflammatory skin mechanisms this is often supplemented by anti-inflammatory therapy. The aim of this paper is to provide an overview of Malassezia related skin disease, diagnostic methods and treatment options.
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Affiliation(s)
- Ditte M L Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - George Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.,DELC Clinic, Biel/Bienne, Switzerland
| | - Roderick James Hay
- St. Johns Institute of Dermatology, Kings College London, London, United Kingdom
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33
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Bury K, Leavy JE, O'Connor A, Jancey J. Prevalence, Prevention and Treatment of Saddle Sores among Female Competitive Cyclists: A Scoping Review Protocol. Methods Protoc 2020; 3:E4. [PMID: 31935936 DOI: 10.3390/mps3010004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 11/17/2022] Open
Abstract
Female cyclists are prone to a variety of injuries and illnesses that occur as a result of prolonged contact with a bicycle saddle. Saddle sores are a range of skin ailments on the buttocks, genitals and inner thigh that result from a combination of friction, heat, pressure, moisture and bacteria in the saddle area. Whilst saddle sores are reportedly common, for some cyclists, the condition may cause only mild discomfort. However, for female competitive cyclists, the condition can be an ongoing source of pain and illness affecting participation and performance in the sport. Despite many online sources for health information and products for saddle sores, it is unknown what empirical evidence exists for the prevalence and severity of saddle sores, and for the effectiveness of prevention and treatment methods. This paper outlines the protocol for a scoping review, which aims to describe the empirical evidence for the prevalence, prevention and treatment of saddle sores among female competitive cyclists. Ethics approval has been obtained for this study from Curtin University's Human Research Ethics Committee no: HRE2019-0120. The findings from this study will contribute to the literature for injury in female sport.
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34
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Firsowicz M, Boyd M, Jacks SK. Follicular occlusion disorders in Down syndrome patients. Pediatr Dermatol 2020; 37:219-221. [PMID: 31626333 DOI: 10.1111/pde.14012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/24/2019] [Accepted: 08/31/2019] [Indexed: 12/11/2022]
Abstract
Disorders involving follicular occlusion, such as hidradenitis suppurativa, folliculitis, acneiform eruptions, and pilonidal cysts, have shown an increased prevalence in the Down syndrome (DS) population, but there are limited published data examining this association. We conducted a retrospective chart review of 243 DS patients presenting to a pediatric dermatology clinic to further examine the prevalence of disorders of follicular occlusion in DS patients. Our study showed high rates of disorders of follicular occlusion in DS patients, with prevalent disorders including folliculitis (21.0%), keratosis pilaris (17.3%), acne vulgaris (11.1%), hidradenitis suppurativa (7.0%), and furunculosis (4.5%), and overall prevalence of 44.9%. These findings add to a limited but growing body of evidence that documents an increased rate of disorders of follicular occlusion in pediatric DS patients.
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Affiliation(s)
- Maya Firsowicz
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - McKenna Boyd
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - Stephanie K Jacks
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
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35
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Cohen PR, Erickson C, Calame A. Malassezia (Pityrosporum) Folliculitis Incognito: Malessezia-associated Folliculitis Masked by Topical Corticosteroid Therapy. Cureus 2020; 12:e6531. [PMID: 32038889 PMCID: PMC6993079 DOI: 10.7759/cureus.6531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Malassezia (Pityrosporum) folliculitis usually appears as pruritic monomorphous papules and pustules on the upper back, chest, extensor arms and face. Acne vulgaris, bacterial folliculitis, eosinophilic folliculitis and systemic corticosteroid-induced acne can clinically mimic the fungal-caused acneiform condition. The designation incognito is used to describe tinea or scabies when the characteristic presentation is masqueraded by the application of topical corticosteroid treatment. Application of corticosteroid cream altered the morphology of the skin lesions in a man with Malassezia folliculitis. His cutaneous findings-localized areas of post-inflammatory hyperpigmentation with flattened or completely resolved follicular papules-raised the possibility of partially treated follicular eczema or follicular contact dermatitis. Pathognomonic findings from biopsies of the skin lesions established the diagnosis of Malassezia folliculitis; the condition completely resolved after treatment with topical antifungal shampoo and cream. Similar to tinea incognito and scabies incognito, folliculitis caused by Malassezia yeast in which the cutaneous morphology has been concealed by management with topical corticosteroids should be referred to as Malassezia (Pityrosporum) folliculitis incognito.
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Affiliation(s)
- Philip R Cohen
- Dermatology, San Diego Family Dermatology, San Diego, USA
| | | | - Antoanella Calame
- Dermatology/Dermatopathology, Compass Dermatopathology, Inc., San Diego, USA
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36
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Tohyama M, Hamada M, Harada D, Kozuki T, Nogami N, Monden N, Kajiwara T, Nishina T. Clinical features and treatment of epidermal growth factor inhibitor-related late-phase papulopustular rash. J Dermatol 2019; 47:121-127. [PMID: 31803963 DOI: 10.1111/1346-8138.15170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/04/2019] [Indexed: 11/29/2022]
Abstract
Papulopustular rash, an acneiform rash, appears on the seborrheic region during the first to second week of treatment with an epidermal growth factor receptor inhibitor (EGFRi). The rash gradually disappears after the fourth week; however, it persists or newly develops in other regions during EGFRi treatment. Because Staphylococcus aureus is frequently isolated from late-phase papulopustular rash, we assessed the incidence of bacterial infection and treatment outcomes of patients with late-phase papulopustular rash. Sixty-four cases treated with an EGFRi over 4 weeks who presented with papulopustular rash were assessed retrospectively. The median duration of EGFR inhibitor treatment was 5 months. Grade 2 and 3 papulopustular rash was observed in 47 and eight cases, respectively. Bacterial culture was performed in 51 cases, 50 of which yielded positive results: methicillin-sensitive S. aureus in 29, methicillin-resistant S. aureus in 14, Staphylococcus species in five, Pseudomonas aeruginosa in three, and other in four cases. Of the S. aureus isolates, 42% were resistant to minocycline and 40% to levofloxacin. After treatment with topical and/or oral antibiotics without topical corticosteroids, the papulopustular rash rapidly improved by an average of 2.9 ± 3.4 weeks. However, use of a combination of antibiotics and a topical corticosteroid prolonged the recovery period to an average of 18.9 ± 11.4 weeks. In conclusion, folliculitis that develops over 4 weeks after the initiation of EGFRi treatment is typically caused by staphylococcal infection. Bacterial culture is necessary due to the high rate of antibiotic resistance. It is important to distinguish late- from early-phase papulopustular rash and to treat using different approaches.
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Affiliation(s)
- Mikiko Tohyama
- Department of Dermatology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Makoto Hamada
- Department of Infectious Disease and Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Daijiro Harada
- Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Toshiyuki Kozuki
- Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Naoyuki Nogami
- Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Nobuya Monden
- Department of Head and Neck Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Takeshi Kajiwara
- Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Tomohiro Nishina
- Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
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Jacob S, VanDaele MA, Brown JN. Treatment of Demodex-associated inflammatory skin conditions: A systematic review. Dermatol Ther 2019; 32:e13103. [PMID: 31583801 DOI: 10.1111/dth.13103] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/16/2019] [Accepted: 09/25/2019] [Indexed: 12/20/2022]
Abstract
Bacterial folliculitis, rosacea, and other common skin conditions have been linked to infestation by Demodex mites (human demodicosis). Currently, there is little guidance for treatment of inflammatory conditions associated with demodicosis. Thus, the objective of this review is to evaluate the efficacy and safety of treatments utilized for Demodex infestation. PubMed (1946 to January 2019) and Embase (1947 to January 2019) were searched with the following term combinations: Demodex mites, Demodex folliculitis, demodicosis, Demodex folliculorum, or Demodex brevis and articles evaluating treatment of body surface colonization with Demodex mites were included. Common interventions used for Demodex infestation include metronidazole-based therapies, permethrin, benzoyl benzoate, crotamiton, lindane, and sulfur. Short courses of metronidazole taken orally have shown efficacy in reducing Demodex density. Additionally, topical administration of permethrin daily or twice daily was shown to be efficacious across multiple studies. Crotamiton and benzyl benzoate were also efficacious treatments. Several therapies were associated with mild-to-moderate skin irritation. Due to limited data, no standard of care can be identified at this time. Efficacious treatment options may include permethrin, crotamiton, benzyl benzoate, and oral metronidazole; however, long-term efficacy has not been established.
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Affiliation(s)
- Sherin Jacob
- Department of Pharmacy, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Madeline A VanDaele
- Department of Pharmacy, North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Jamie N Brown
- Pharmacy Service, Durham Veterans Affairs Health Care System, Durham, North Carolina
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39
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Sechi A, Guglielmo A, Patrizi A, Savoia F, Cocchi G, Leuzzi M, Chessa MA. Disseminate Recurrent Folliculitis and Hidradenitis Suppurativa Are Associated Conditions: Results From a Retrospective Study of 131 Patients With Down Syndrome and a Cohort of 12,351 Pediatric Controls. Dermatol Pract Concept 2019; 9:187-194. [PMID: 31384491 DOI: 10.5826/dpc.0903a03] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2019] [Indexed: 12/25/2022] Open
Abstract
Background Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent skin disease of the pilosebaceous unit characterized by protean manifestations. Several studies have found an increased incidence and earlier presentation of this disease in patients carrying trisomy 21. Patients with Down syndrome (DS) have a higher risk of developing a wide range of cutaneous manifestations, including HS and chronic folliculitis. Recently, disseminate recurrent folliculitis (DRF) has been reported as an atypical monosymptomatic feature of HS at its onset. Objective To assess the prevalence of HS and DRF by comparing a cohort of patients carrying trisomy 21 vs pediatric controls. Methods A retrospective 2-year monocentric clinical study was performed by collecting clinical data of 131 patients with DS, aged 4-36 years, followed at the Dermatology Unit and Down Syndrome Regional Center of Bologna University. Data were matched with those coming from 12,351 pediatric controls. Results In DS patients, DRF and HS showed a prevalence of, respectively, 6.8% and 24.4%, while 5.3% of patients presented both diseases. In the control group the prevalence for HS+ and DRF+ was 0.5% and 1.2%, respectively, with a 0.14% of overlap cases. The association between HS and DRF proved to be statistically significant in both groups (P < 0.05). In the DS cohort the mean age of symptoms onset was 15.67 (SD: 2.29) years for HS and 13.11 (SD: 4.93) years for DRF. Buttocks were the most frequently affected body area for DRF followed by the inguinocrural area, while in HS buttocks were less frequently involved than groins and upper thighs. Conclusions Because of the later onset of HS, patients with DRF at an early age should be monitored for the possible onset of HS in the apocrine-bearing areas.
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Affiliation(s)
- Andrea Sechi
- Division of Dermatology, Sant'Orsola-Malpighi Polyclinic, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Alba Guglielmo
- Division of Dermatology, Sant'Orsola-Malpighi Polyclinic, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Annalisa Patrizi
- Division of Dermatology, Sant'Orsola-Malpighi Polyclinic, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Francesco Savoia
- Division of Dermatology, Sant'Orsola-Malpighi Polyclinic, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Guido Cocchi
- Neonatology Unit, Sant'Orsola-Malpighi Polyclinic, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Miriam Leuzzi
- Division of Dermatology, Sant'Orsola-Malpighi Polyclinic, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Marco A Chessa
- Division of Dermatology, Sant'Orsola-Malpighi Polyclinic, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
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40
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Affiliation(s)
- Fatemeh Livani
- Infectious Disease Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Soodeh Kabir
- Dermatology Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Durdu M, Errichetti E, Eskiocak AH, Ilkit M. High accuracy of recognition of common forms of folliculitis by dermoscopy: An observational study. J Am Acad Dermatol 2019; 81:463-471. [PMID: 30914342 DOI: 10.1016/j.jaad.2019.03.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/18/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Clinical differentiation of folliculitis types is challenging. Dermoscopy supports the recognition of folliculitis etiology, but its diagnostic accuracy is not known. OBJECTIVE To assess the diagnostic accuracy of dermoscopy for folliculitis. METHODS This observational study included patients (N = 240) with folliculitis determined on the basis of clinical and dermoscopic assessments. A dermoscopic image of the most representative lesion was acquired for each patient. Etiology was determined on the basis of cytologic examination, culture, histologic examination, or manual hair removal (when ingrowing hair was detected) by dermatologist A. Dermoscopic images were evaluated according to predefined diagnostic criteria by dermatologist B, who was blinded to the clinical findings. Dermoscopic and definitive diagnoses were compared by dermatologist C. RESULTS Of the 240 folliculitis lesions examined, 90% were infections and 10% were noninfectious. Infectious folliculitis was caused by parasites (n = 71), fungi (n = 81), bacteria (n = 57), or 7 viruses (n = 7). Noninfectious folliculitis included pseudofolliculitis (n = 14), folliculitis decalvans (n = 7), and eosinophilic folliculitis (n = 3). The overall accuracy of dermoscopy was 73.7%. Dermoscopy showed good diagnostic accuracy for Demodex (88.1%), scabietic (89.7%), and dermatophytic folliculitis (100%), as well as for pseudofolliculitis (92.8%). LIMITATIONS The diagnostic value of dermoscopy was calculated only for common folliculitis. Diagnostic reliability could not be calculated. CONCLUSION Dermoscopy is a useful tool for assisting in the diagnosis of some forms of folliculitis.
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Affiliation(s)
- Murat Durdu
- Department of Dermatology, Başkent University Medical School, Adana Dr. Turgut Noyan Application and Research Center, Adana, Şırnak, Turkey.
| | - Enzo Errichetti
- Department of Dermatology, University Hospital Santa Maria della Misericordia, Udine, Italy
| | | | - Macit Ilkit
- Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, Adana, Turkey
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Haddad Junior V. Profile of skin diseases in a community of fishermen in the northern coast of the state of São Paulo: the expected and the unusual. An Bras Dermatol 2019; 94:24-28. [PMID: 30726459 PMCID: PMC6360980 DOI: 10.1590/abd1806-4841.20197174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 01/01/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The fishing colony of the Picinguaba neighborhood is located at the northern end of the coast of the state of São Paulo. It has about 300 residents, of which approximately 100 are professional fishermen. OBJECTIVES This study aimed to identify the main dermatoses of the community in comparison with other populations, and their frequency. METHODS The dermatoses were identified and tabulated for two years, in a prospective study carried out on monthly trips to the fishermen's colony in Picinguaba. RESULTS One hundred and eighteen patients were attended and followed up, which is equivalent to about 1/3 of the colony's inhabitants. Of these, 43 were children (under the age of 14) and 75 were adolescents and adults. The diseases observed were catalogued according to the age groups. Although most dermatoses in the community were similar with those observed in the general population, some specific cases could be seen, such as folliculitis on the legs of fishermen and an unexpected low frequency of actinic lesions in the colony, as well as dermatitis by aquatic animals. STUDY LIMITATIONS The limitations were monthly attendance and the spontaneous demand of the patients. CONCLUSIONS The finding of community-specific dermatoses and the low incidence of malignant and pre-malignant tumors associated with sun exposure needs further studies for better clarification.
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Affiliation(s)
- Vidal Haddad Junior
- Department of Dermatology, Faculdade de Medicina de Botucatu,
Universidade Estadual Paulista, Botucatu (SP), Brazil
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Affiliation(s)
- Cynthia Chen
- College of Physicians and Surgeons, Columbia University Medical Center, New York, New York
| | - Dmitriy Timerman
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Christine Y Finnin
- Department of Dermatology, Columbia University Medical Center, New York, New York
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Zaaroura H, Geffen Y, Bergman R, Avitan-Hersh E. Clinical and microbiological properties of Staphylococcus lugdunensis skin infections. J Dermatol 2018; 45:994-999. [PMID: 29897142 DOI: 10.1111/1346-8138.14496] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/07/2018] [Indexed: 11/29/2022]
Abstract
Staphylococcus lugdunensis is an emerging pathogen in skin and soft tissue infections that was previously considered a commensal. The aim of this study was to elucidate the characteristics of skin infections by S. lugdunensis and its appropriate management, in a tertiary referral medical center. The clinical files, bacterial cultures and histopathology reports of all S. lugdunensis isolates from skin infections over a period of 8 years (September 2009-September 2017) were reviewed. S. lugdunensis was isolated from 29 patients with skin infections, aged 7-89 years (mean 33.3 years). A state of immune suppression (drug-induced, malignancy or diabetes) was present in five patients (17%). Folliculitis and cutaneous pustulosis were the most common presentations (16 cases, 55%), followed by secondary infection of hidradenitis suppurativa (five cases, 17%). Other sources of isolation were infected molluscum contagiosum (two cases), folliculitis decalvans (one case), dissecting cellulitis (one case), abscess (one case), cyst (one case), impetigo (one case) and granuloma after trauma (one case). The in vitro antibiotic sensitivity tests showed susceptibility to most tested antibiotics, although a few isolates were resistant to gentamycin, penicillin and oxacillin. In 19 of 20 patients for whom follow ups were available, cutaneous manifestations improved or resolved with proper local and/or oral antibiotic therapy. S. lugdunensis may play a role as a primary or secondary pathogen in various skin infections, most commonly folliculitis and pustulosis. Proper antibiotic therapy may lead to improvement or resolution.
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Affiliation(s)
- Hiba Zaaroura
- Department of Dermatology, Rambam Health Care Campus, Technion, Haifa, Israel
| | - Yuval Geffen
- Clinical Microbiology Laboratory, Rambam Health Care Campus, Technion, Haifa, Israel
| | - Reuven Bergman
- Department of Dermatology, Rambam Health Care Campus, Technion, Haifa, Israel.,Department of Pathology, Rambam Health Care Campus, Technion, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Emily Avitan-Hersh
- Department of Dermatology, Rambam Health Care Campus, Technion, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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45
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Prindaville B, Belazarian L, Levin NA, Wiss K. Pityrosporum folliculitis: A retrospective review of 110 cases. J Am Acad Dermatol 2018; 78:511-514. [PMID: 29138059 DOI: 10.1016/j.jaad.2017.11.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/31/2017] [Accepted: 11/04/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pityrosporum folliculitis is an under-recognized eruption of the face and upper portion of the trunk that may be confused with, or occur simultaneously with, acne vulgaris. OBJECTIVE We sought to characterize risk factors for Pityrosporum folliculitis, its clinical presentation, and its response to treatment. METHODS A retrospective chart review was performed on all patients age 0 to 21 years seen at our facility from 2010 to 2015 with Pityrosporum folliculitis confirmed by a potassium hydroxide preparation. RESULTS Of 110 qualifying patients, more than 75% had acne that had recently been treated with antibiotics, and when recorded, 65% reported pruritus. Clinical examination demonstrated numerous 1- to 2-mm monomorphic papules and pustules that were typically on the forehead extending into the hairline and on the upper portion of the back. The most common treatment was ketoconazole shampoo, which led to improvement or resolution in most cases. Some patients required oral azole antifungals. LIMITATIONS This study was retrospective and relied on providers describing and interpreting the clinical findings and potassium hydroxide preparations. No standard grading system was used. CONCLUSION Unlike classic acne vulgaris, Pityrosporum folliculitis was more common after antibiotic use. It presented as fine monomorphic, pruritic papules and pustules along the hairline and on the upper portion of the back, and it improved with topical or oral azole antifungal therapy.
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Affiliation(s)
- Brea Prindaville
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Nikki A Levin
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Karen Wiss
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
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Johnson VE, Boyd AS. Primary cutaneous Rhizopus folliculitis in an immunocompetent woman. JAAD Case Rep 2018; 4:36-37. [PMID: 29296649 PMCID: PMC5739175 DOI: 10.1016/j.jdcr.2017.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Vanessa E Johnson
- Department of Medicine (Dermatology), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alan S Boyd
- Department of Medicine (Dermatology), Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
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Wei EY, Coghlin DT. Beyond Folliculitis: Recognizing Herpes Gladiatorum in Adolescent Athletes. J Pediatr 2017; 190:283. [PMID: 28728810 DOI: 10.1016/j.jpeds.2017.06.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/19/2017] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Elizabeth Y Wei
- Hasbro Children's Hospital The Warren Alpert Medical School of Brown University Providence, Rhode Island
| | - Daniel T Coghlin
- Hasbro Children's Hospital The Warren Alpert Medical School of Brown University Providence, Rhode Island
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Abstract
Because both acne vulgaris and folliculitis can present as inflammatory erythematous papules, pustules or nodules, they are often hard to distinguish. The importance to distinguish between these 2 shall be stressed as their pathogenesis and therapies are different and misdiagnosis or missed diagnosis may lead to improper treatment. We will introduce several special types of folliculitis that should be differentiated from acne to increase our knowledge of the disorders with an acne-like manifestation.
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Affiliation(s)
- Kai-Lv Sun
- Department of Dermatology, Beijing Hospital, National Center of Gerontology, Dongdan, Dongcheng District, Beijing, China
| | - Jian-Min Chang
- Department of Dermatology, Beijing Hospital, National Center of Gerontology, Dongdan, Dongcheng District, Beijing, China
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49
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Abstract
A multitude of infectious diseases of viral (genital herpes, herpes zoster, genital warts and molluscum contagiosum), bacterial (syphilis, chancroid, lymphogranuloma venereum, donovanosis, erysipelas, cellulitis and necrotising fasciitis, folliculitis, impetigo, bartholin gland abscess, trichomycosis and erythrasma), fungal (candidiasis and dermatophytosis) and parasitic (pediculosis pubis) origin may affect the vulvar area. Herein, we review the infections and their skin manifestations in the vulvar area.
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Affiliation(s)
- Freja Lærke Sand
- a Department of Dermatology , Bispebjerg Hospital , Copenhagen , Denmark
| | - Simon Francis Thomsen
- a Department of Dermatology , Bispebjerg Hospital , Copenhagen , Denmark.,b Department of Biomedical Sciences , University of Copenhagen , Copenhagen , Denmark
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50
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Rato M, Monteiro AF, Parente J, Aranha J, Tavares E. Birt-Hogg-Dubé Syndrome - report of two cases with two new mutations. J Dermatol Case Rep 2017; 11:12-15. [PMID: 28539984 DOI: 10.3315/jdcr.2017.1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 11/13/2016] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Birt-Hogg-Dubé syndrome (BHDS) is a rare autosomal dominant genodermatosis characterized by cutaneous fibrofolliculomas and/or trichodiscomas, lung cysts, spontaneous pneumothorax and renal tumors. However, its clinical expression is highly variable. This syndrome is caused by germline mutations in the folliculin gene (FLCN) on chromosome 17p11.2. MAIN OBSERVATIONS Two men, 60 and 39-year-old, presented with a several year history of asymptomatic whitish papules scattered over the face and neck. Skin biopsies revealed fibrofolliculomas. The clinical diagnosis of BHDS was corroborated by identification of new heterozygotic mutations in FLCN gene, in exon 6 (C.573_574delinsT) and in exon 9 (c.1015C>T), respectively. Computed tomography scan of the thorax and abdomen showed pulmonary cysts with no suspicious kidneys lesions, and, in the case of the second patient, a mass in left adrenal gland. Laparoscopic left adrenalectomy was performed and histopathological examination was compatible with a malignant perivascular epithelioid cell tumor. CONCLUSIONS The presence of multiple fibrofolliculomas should raise the suspicion of BHDS. Patients with this syndrome, regardless of the detected mutation, should be carefully monitored to ensure that potentially serious disease-related conditions can be detected early.
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Affiliation(s)
- Margarida Rato
- Dermatology Department of Hospital de Santarém EPE, Santarém, Portugal
| | | | - Joana Parente
- Dermatology Department of Hospital de Santarém EPE, Santarém, Portugal
| | - João Aranha
- Dermatology Department of Hospital de Santarém EPE, Santarém, Portugal
| | - Ermelindo Tavares
- Dermatology Department of Hospital de Santarém EPE, Santarém, Portugal
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