[Tinea barbae profunda due to Trichophyton mentagrophytes : Case report and review]

Tinea barbae is a rare dermatomycocis, by definition follicular bound in the beard area of adult men. Manifestation usually starts with erythema accompanied by desquamation. Deeper distribution along terminal hairs leads to folliculitis with formation of pustules and nodes as well as abscesses; fixed adherent yellowish crusts may appear. Frequently there is locoregional swelling of the lymph nodes and occasionally a deterioration of general condition with (sub)febrile temperatures. Often this leads to the initial suspected diagnosis of a bacterial folliculitis barbae or impetigo contagiosa. Tinea barbae is mostly induced by species of the genus Trichophyton (T.). The pathogens are diverse and are mostly zoophilic, sometimes anthropophilic and rarely geophilic dermatophytes. With the help of a specific anamnesis and diagnostic procedure, including mycological examinations, histology and molecular detection of dermatophytes via polymerase chain reaction (PCR), tinea barbae-in our patient induced by T. mentagrophytes-can be rapidly diagnosed. Early initiation and adequate treatment duration lead to restitutio ad integrum.

Pityrosporum folliculitis: A retrospective review of 110 cases

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.

Hydroxychloroquine-induced fatal toxic epidermal necrolysis complicated by angioinvasive rhizopus

The majority of toxic epidermal necrolysis (TEN) cases are provoked by "high risk" medications (e.g. allopurinol, aromatic anticonvulsants, nevirapine, oxicam non-steroidal anti-inflammatory agents, and sulfonamides). TEN usually occurs 1 to 8 weeks after initial administration of the offending agent, but re-administration can evoke TEN within hours to days. Hydroxychloroquine has rarely been associated with TEN, with one case proving fatal. Herein, we report a case of hydroxychloroquine-induced fatal TEN complicated by angioinvasive Rhizopus. To our knowledge, this is the first case report of angioinvasive Rhizopus in a TEN patient. Initial misidentification of the offending agent causing TEN also serves as an important teaching point worth highlighting.

Orofacial tubercular lesions

AIM

The aim of this study was to evaluate the clinical characteristics of orofacial lesions like ulcer, swelling, discharge (with or without fistulae), nodules (tubercles), granulomatous growth, induration, diffuse inflammation, and extraction socket involvement in an Indian population through the case reports and review of literature.

MATERIAL AND METHODS

Four case reports are presented of patients who had orofacial lesions which turned out to be tuberculous. The diagnosis of tuberculosis was possible because it was kept high on the list of differential diagnosis of orofacial lesions. In our study, we used the following clinical criteria: 1) Suspicious lymph nodes should be biopsied. 2) Excision of non-healing, fistulous, or non-responsive lesions should be considered for biopsy. 3) Histopathological evidence of granulomatous inflammation with epithelioid cells and Langhan's giant cells or acid-fast bacilli should on Ziehl-Neelsen staining. 4) The patients' medical records were reviewed for details relating to presenting signs and symptoms, site and appearance of the lesions, chest x-ray findings, and sputum smear and tuberculosis culture results.

RESULTS

In all cases, the patients were prescribed antituberculosis therapy (ATT) by the physician. Strict follow-up was done to ensure completion of intensive phase therapy and both oral as well as pulmonary lesions were resolved.

CONCLUSION

Dentists and physicians treating orofacial lesions should be alert to the possibility of orofacial tuberculosis. Medical history should be taken very carefully and lymph node biopsy as well as other radiological and microbiological investigations should be carried out to rule out oral tuberculosis. Antituberculous therapy leads to successful resolution of the orofacial lesions.

Tinea Barbae (Tinea Sycosis): Experience with Nine Cases

Tinea barbae is a rare dermatophytosis that affects the hair and hair follicles of the beard and mustache. This paper presents 9 cases of tinea barbae observed over an 18-year period of time and classified as follows: 1 was superficial and 8 were deep (6 folliculitis-like and 2 kerion-like). Most of the cases (4) were associated with topical steroid therapy, others with pet contact (3 cases) and one with diabetes. The causal agents isolated were: Trichophyton rubrum in 3; Microsporum canis in 3; Trichophyton mentagrophytes in 2; and Trichophyton tonsurans in one. The involvement of the hair was observed and classified in all cases. The trichophytin skin reaction was positive in all 9 patients. All the patients were treated with systemic antimycotics, 3 cases with griseofulvin, 1 with ketoconazole, 3 with itraconazole, and 2 with terbinafine. Clinical and mycologic cures were achieved at 6 to 8 weeks of treatment at the usual doses.

The Clinical Importance ofDemodex folliculorumPresenting with Nonspecific Facial Signs and Symptoms

Demodex folliculorum (D. folliculorum), found in the pilosebaceous unit, is the most common ectoparasite of humans. Various clinical forms such as pustular folliculitis, papulopustular scalp eruptions, perioral dermatitis, and blepharitis have been defined, although in general, the disease has been classified into three main groups as "pityriasis folliculitis", "rosacea-like demodicidosis", and granulomatous rosacea-like "demodicidosis gravis". Our aim was to test for the presence of D. folliculorum in pathogenic numbers in patients who came to our clinic with non-specific symptoms such as facial itching with or without erythema, seborrheic dermatitis-like or perioral dermatitis-like lesions, papulopustular lesions, and an acneiform clinical appearance without telengiectasia or flushing. Twenty-eight (87.5%) female and 4 male (12.5%), patients and 33 age-and-sex matched healthy subjects enrolled in this study. D. folliculorum was sought in the lesion sites using the non-invasive method known as the Standardised Skin Surface Biopsy (SSSB). The discovery of more than five parasites in an area of 1 cm2, was evaluated as pathogenic. For treatment, 5% permethrine cream was applied twice daily for 15 to 30 days. The clinical symptoms of the patients were classified into clinical groups and evaluated as facial itching in 2 (6.3%), nonspecific erythema and itching in 21 (65.6%), erythema and pityriasiform squamous lesions in 3 (9.4%), acneiform in 3 (9.4%), papulopustular lesions in 1 (3.1%), granulomatous rosacea-like in 1 (3.1%), and perioral dermatitis-like symptoms in 1 (3.3%), D. folliculorum density was determined as 5>D/cm2 in all clinical lesions. A significant clinical healing and density of D. folliculorum at <=5 D/cm2 was determined in all but two patients after treatment. We consider that D. folliculorum presentation with different symptoms and signs than classical forms is not rare. For this reason, we suggest that it is useful to test for D. folliculorum in patients with non-classical presentations like facial itching, itching accompanied by non-specific erythema, itching and non-specific pityriasiform squamous lesions, and acneiform lesions.

[Primary cutaneous coccidioidomycosis in an infant]

Coccidioidomycosis is a systemic granulomatosis caused by dimorphic fungi Coccidioides immitis, which are endemic of the San Joaquin Valley in California, USA, and C. posadasii found in the southwestern desert of the USA, Mexico, and South America. The primary cutaneous form is extremely infrequent. There have been 25 reported cases in literature, all of them in adults. This is the first case in an infant.

[Rhinofacial conidiobolomycosis associated with cervical, thoracic and brachial localizations: one clinical case in Nigeria]

We report here the clinical case of a Nigerian adult patient who received medical care during October 2010, at the Center for Diagnosis and Treatment of Buruli ulcer in Pobè (Benin). He presented a massive facial tumor associated with several subcutaneous (cervical, thoracic and upper limbs) nodules, evolving since several years. Tissue samples collected at Pobè medical center were addressed to the mycology and histology laboratories of Angers University Hospital (France), according to the medical exchange agreement between the two institutions about the diagnosis and treatment of Buruli ulcer disease. Histological examination showed a Splendore-Hoeppli phenomenon, consisting of a granulomatous reaction made of eosinophilic polynuclear cells surrounding rare, large and irregular, non-septate hyphae. A filamentous fungus was isolated by cultivation of the clinical samples, which was identified as Conidiobolus coronatus. The patient was treated orally with daily doses of ketoconazole (400 mg per day). After 4 months of treatment, a marked regression of the facial lesion was obtained. A first constructive facial surgery was achieved, but the patient did not attend the second step. This case report allows us to remind the mycological diagnosis of this exotic mycosis, but also to emphasize the main difficulties encountered in medical management in the developing countries.

Acrodermatitis chronica atrophicans of the face: a case report and a brief review of the literature

Acrodermatitis chronica atrophicans is a rare late manifestation of tick-borne Borrelia burgdorferi infection, manifesting as inflammatory and atrophic lesions on acral skin. We describe the case of a 73-year-old woman with skin changes progressed to marked atrophy on her left hand and an edematous inflammatory involvement of the face. The diagnosis of acrodermatitis chronica atrophicans was made on the basis of clinical appearance, serological and histopathological findings, and the lesional detection of B. burgdorferi-specific gene segments by polymerase chain reaction. This unusual case illustrates that acrodermatitis chronica atrophicans affects not only the extremities but also the face. The clinical and histological finding of the lesions occurring on acral skin showed a prominent atrophic appearance, while the ones occurring on the face showed a prominent inflammatory appearance.

Lupus Vulgaris Erythematoides: report of a patient initially misdiagnosed as dermatitis

A small percentage of patients with tuberculosis present with cutaneous findings, which may be difficult to diagnose. We present a patient diagnosed with a rare, non-scarring form of cutaneous tuberculosis (CTB), classically termed as lupus vulgaris erythematoides.

Hitting the target: Lyme or STARI?

Erythema migrans (EM) is a characteristic rash most commonly associated with Lyme disease (LD) in the northeastern and north central United States. EM rash found in the southeastern United States is usually classified as Southern Tick-Associated Rash Illness (STARI). Here we describe an EM rash in a 3-year-old female from central Louisiana, whose laboratory and clinical findings were suspicious for LD. This case report highlights the importance of distinguishing STARI from LD, as LD left untreated can lead to long-term complications.

A facial swelling with multiple discharging sinuses: a diagnostic conundrum

BACKGROUND

Many disease processes can present with facial swelling and multiple discharging sinuses. A differential diagnosis would include actinomycosis, tuberculosis and osteomyelitis, but tinea barbae is a relatively uncommon presentation.

CASE REPORT

The following case report describes a 48-year-old jockey who was diagnosed with tinea barbae. It chronicles the investigations that were performed to determine the offending pathogen and the difficulty in achieving a diagnosis.

DISCUSSION

The investigations and the pathophysiology of dermatophytic infections and their management in a maxillofacial/oral medicine environment are discussed.

Fusarium skin infection: a case report

A 65-year-old man presented with an irregular ulcer with a black eschar on his forehead associated with severe headache. A subcutaneous nodule with a necrotic center was present on the left knee. The diagnosis of Fusarium infection was made and confirmed by biopsy and culture. The patient had a history of bronchial asthma for which he was on inhalational steroids for 5 years. It is unclear if this treatment was related to the disseminated Fusarium infection. The patient received oral itraconazole for 3 months with good improvement but met with an unexpected sudden death.

Verrucous plaque on the face: what is your diagnosis?

A 46-year-old male patient presented with hyperpigmented verrucous plaques and papules mainly on the left cheek and malar region that had evolved over a 7 month period. Histopathology demonstrated the presence of a large number of classical copper penny bodies or muriform bodies and a predominantly neutrophilic dermal infiltrate that confirmed the diagnosis of chromoblastomycosis.

[Cutaneous histoplasmosis due to Histoplasma capsulatum variety duboisii in an immune competent child. About one case in Abidjan, Côte d'Ivoire]

Histoplasmosis is a subcutaneous mycosis caused by dimorphic fungus which is to be found in two types: the capsulatum and duboisii types. The capsulatum type has had an increasing incidence with the HIV-AIDS epidemics but it is not demonstrated that the duboisii one has had the same upward incidence. Signs in children and immunocompetent patient are rarely described during this disease. The diagnosis is often late in the child as it looks like Molluscum contagiosum lesions. We report a case of skin histoplasmosis of duboisii type non associated with HIV infection in a child. Diagnosis has been confirmed by a histopathological test of a nodule biopsy. Medical treatment was successfully based on itraconazol.

Sycosiform tinea barbae caused by Trichophyton rubrum

Tinea barbae is an uncommon superficial dermatophyte infection of the beard and moustache areas. It was more frequently observed in the past, before single-use razors became available. In most cases, the zoophilic ectothrix Trichophyton mentagrophytes and Trichophyton verrucosum are responsible for this type of infection. Its clinical presentation is variable; it can mimic many other skin disorders such as sycosis, iododerma, contact dermatitis, perioral dermatitis, and actinomycosis. We report a case of tinea barbae caused by an uncommon agent Trichophyton rubrum, misdiagnosed as sycosis, and review the approach and management of the disease.

Treatment of moderate to severe facial seborrheic dermatitis with itraconazole: an open non-comparative study

BACKGROUND

Seborrheic dermatitis is a common chronic disease. Malassezia yeasts have been implicated in the pathogenesis of this disease. Antifungal agents are known to be effective in the treatment of Malassezia yeast infections.

OBJECTIVES

To evaluate the efficacy of itraconazole in the treatment of mild to severe facial seborrheic dermatitis.

METHODS

Sixty patients with moderate to severe seborrheic dermatitis were evaluated in an open non-comparative study. Patients were treated with oral itraconazole, initially 200 mg/day for a week, followed by a maintenance therapy of a single dose of 200 mg every 2 weeks. Four clinical parameters (erythema, scaling, burning, itching) were assessed using a 0-3 score. Mycological evaluation determined the presence of Malassezia spores in the scales using a direct smear.

RESULTS

At the end of the initial treatment significant improvement was reported in three clinical parameters: erythema, scaling, itching. Maintenance therapy led to only slight further improvement. Burning sensation was only mildly improved during the treatment. The quantity of Malassezia spores present in the direct smear decreased throughout the treatment period. No blood test abnormalities were found during the treatment.

CONCLUSIONS

In this study initial treatment with itraconazole was beneficial in patients with moderate to severe seborrheic dermatitis.

Sudden onset of verrucous plaques to the face and trunk: a case of cutaneous histoplasmosis in the setting of HIV

A 66-year-old Columbian man presented with a 15-day history of generalized weakness, cough, fever, and verrucous, ulcerating plaques of the face, upper chest and back, and arms. The patient proved to be HIV positive. Histopathologic examination showed a diffuse lymphocytic infiltrate coupled with a striking number of yeast forms within macrophages. The clinical presentation and histopathologic alterations are consistent with the diagnosis disseminated Histoplasma capsulatum. This case emphasizes the importance of increasing awareness of histoplasmosis in nonendemic areas as a result of the large subgroup of immunocompromised patients at risk. Disseminated histoplasmosis can be a treatable HIV complication if recognized early, though is unfortunately a harbinger for an overall poor prognosis.

[Conidiobolomycosis, a rare fungal tumor: a case report in Ouagadougou, Burkina Faso]

Conidiobolomycosis is a deep, rare mycosis, due to Conidiobolus coronatus which is a saprophyte of vegetation in decomposition. We report one case in Burkina Faso. A 17 years old man, shepherd, consulted for tumefactions on the face. It could date back insidiously to a traumatism, one year before. A month later some painless tumefactions appeared on the cheekbone, the right eyelid, the nose with epistaxis. The upper lip then the lower one had swollen. Dermatological exam revealed multiple, painless, hard, sub-cutaneous swellings, affecting the cheekbone, the eyelids, the root and the ala of the nose. This tumefaction sometimes adhered to underlying tissues and to the overlying skin, sometimes mobile; painless and hard swelling of the two lips was also noted. ENT exam showed an inflammation of the nasal mucous without ulceration and the permeability of the nasal tracts was subnormal. The cephalic tomodensitometry showed a thickness of the soft tissues of the lips and the nose with an infectious feature associated to a pansinusitis without bone lesion. Histology was in favour of conidiobolomycosis. The patient was treated with fluconazole and the swelling progressively disappeared. Conidiobolomycosis is a disease generally reported in some humid tropical countries. It begins in the nasal cavities leading then to a nasal obstruction. This case was singular by the fact it happened in a dry Sudano-Sahelian climate and by its clinical features.

[Disseminated cutaneous histoplasmosis due to Histoplasma capsulatum var. duboisii associated with AIDS. A case report in Abidjan, Côte d'Ivoire]

Histoplasmosis is a deep mycosis whose capsulatum variety is recognized as being an AIDS-defining infection. However AIDS associated with Histoplasma capsulatum var. duboisii is rarely reported. We report a case of cutaneous duboisii histoplasmosis associated with AIDS which has been mistaken for molluscum contagiosum for many months. The diagnosis has been confirmed by means of a biopsy of a nodule followed by an anatomo-pathological examination. The medical treatment was successfully based on combination Triomune (stavudine + lamividine + nevirapine) and itraconazole.

Acute rise in methicillin-resistant Staphylococcus aureus infections in a coastal community

OBJECTIVE

Describe the incidence of head and neck community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections over a 5-year period at a coastal tertiary medical center.

STUDY DESIGN

Retrospective chart review.

SUBJECTS AND METHODS

All patients presenting to the otolaryngology service with cultures taken from head and neck infections between 1999 and 2004 were eligible for inclusion. Statistical analysis was used to determine significance of the changing incidence of isolated organisms over the study period.

RESULTS

CA-MRSA infections rose from 21% to 64% over the 5-year period. The increasing trend in CA-MRSA infections reached statistical significance from 2003 to 2004. All CA-MRSA isolates were resistant to cefazolin and penicillin, but most were sensitive to clindamycin.

CONCLUSIONS

Our data demonstrates a striking increase in the incidence of CA-MRSA. We have tailored our treatment of cutaneous head and neck infections to include empiric treatment for CA-MRSA using clindamycin. Awareness and monitoring of this trend will be important for all practitioners involved in the care of these patients.

Sudden onset of verrucous plaques to the face and trunk: a case of reactivation cutaneous histoplasmosis in the setting of HIV

A 66-year-old Columbian man presented with a 15-day history of generalized weakness, cough, fever, and verrucous, ulcerating plaques of the face, upper chest, upper back, and arms. The patient proved to be HIV positive. Histopathologic examination showed a diffuse lymphocytic infiltrate coupled with a striking number of yeast forms within macrophages. The clinical presentation and histopathologic alterations are consistent with the diagnosis disseminated Histoplasma capsulatum. This case emphasizes the importance of increasing awareness of histoplasmosis in nonendemic areas as a result of the large subgroup of immunocompromised patients at risk. Disseminated histoplasmosis can be a treatable HIV complication if recognized early, although is unfortunately a harbinger for an overall poor prognosis.

Tinea faciei: a report on four cases

Four cases of tinea faciei that were observed at the Department of Dermatology of Charles Nicolle Hospital in Tunis are reported. All patients were females, ages 54 (patient 1), 38 (patient 2), 30 (patient 3), and 50 (patient 4). The lesions lasted 1 year, 2 months, 4 months, and 1 month, respectively. Tinea faciei was initially suspected in three patients, whereas for the second patient eczema was initially suspected. She was first treated topically with corticosteroids leading to exacerbation. Through mycological examination, Trichophyton rubrum was isolated in three patients, but was negative in patient 2. Three patients recovered completely after one month of griseofulvin associated with topical terbinafine. Patient 3 was topically treated because she was pregnant. Erythematous lesions of the face must be checked for fungi.

Majocchi's granuloma of the face in an immunocompetent patient

Majocchi's granuloma is a condition with chronic erythematous and indurated plaques that is a result of the rupture of a dermatophyte-infected infundibulum as a result of trauma. It is frequently seen on the anterior aspect of the legs of women. Herein, we present a case of Majocchi's granuloma of face, a site rarely involved, in an immunocompetent patient. Diagnosis was confirmed by histological and mycological examination. Histological examination revealed hyphae and arthrospores in the hair follicles and in the dermis with a diffuse dermal infiltrate consisting of lymphoplasmacytic cells, and focal collections of epithelioid cells, neutrophils and mild interstitial edema. Mycological examination confirmed the presence of fungus, Trichophyton rubrum, and the diagnosis of Majocchi's granuloma of the face was made. No concrete predisposing factor was found to be associated with the occurrence of the lesions on the face. However, the history of prolonged veiling of the face by a cloth by the patient, perhaps contributing to the occurrence of lesions on face, is a point of dubious significance.

Colonization of neonate skin by Malassezia species: relationship with neonatal cephalic pustulosis

BACKGROUND

Colonization of neonate skin by Malassezia species and their causative role in neonatal cephalic pustulosis is unclear.

OBJECTIVES

We sought to determine the skin colonization by Malassezia in healthy newborns, and to investigate its association with neonatal cephalic pustulosis.

METHODS

Samples for Malassezia colonization were taken from cheeks and scalps of 104 neonates between 24 and 72 hours after birth, and again 2 or 4 weeks later. Pustules were sampled with concomitant nonlesional skin cultures if neonatal cephalic pustulosis was diagnosed.

RESULTS

Malassezia colonization increased significantly with age of the neonate (5% at the first week, 30% at 2-4 weeks). In all, 26 patients were given the diagnosis of neonatal cephalic pustulosis during follow-up. No correlation was found between the severity of the disease and Malassezia isolation. Skin colonization of patients with neonatal cephalic pustulosis (20.8%) was not higher than colonization of healthy newborns (37%).

LIMITATIONS

Not all of the neonates were examined by the authors at the second visit.

CONCLUSIONS

Malassezia colonization increases after the first week of life. No correlation was found between neonatal cephalic pustulosis and Malassezia.

Methicillin-resistant Ascending Facial and Orbital Cellulitis in an Operation Iraqi Freedom Troop Population

PURPOSE

To present a descriptive case series of methicillin-resistant ascending facial and orbital cellulitis in an Operation Iraqi Freedom troop population.

METHODS

A physician's transfer records of patients cared for and or transferred from the 31st and 86th Combat Support Hospitals during Operation Iraqi Freedom between September 2004 and March 2005 were reviewed. Cases of facial and orbital cellulitis caused by a nasal mucosal source were included in the case series.

RESULTS

Five cases of ascending facial and/or orbital cellulitis caused by an aggressive nasal source are reported. All nasal microabscess cultures demonstrated methicillin-resistant Staphylococcus aureus species. None of the patients complained of nasal pain as the chief complaint, and all patients overlooked the follicular abscess at or inside the nares.

CONCLUSIONS

Occult nasal infections with methicillin-resistant Staphylococcus aureus can be the source of an aggressive ascending facial and orbital cellulitis. The nasal source can be overlooked because of the distracting presentation of the orbital and systemic findings. With the increasing prevalence of community-acquired methicillin-resistant Staphylococcus aureus infections, a nasal examination and nasal culture can greatly assist in the diagnosis and management of patients presenting with orbital cellulitis without a clear source of infection.

Mite-related bacterial antigens stimulate inflammatory cells in rosacea

BACKGROUND

Patients with papulopustular rosacea have a higher density of Demodex folliculorum mites on their faces than normal subjects but the role, if any, of their mites in initiating inflammation is disputed. Selective antibiotics are effective in reducing the inflammatory changes of papulopustular rosacea, but their mode of action is unknown.

OBJECTIVES

To investigate whether a D. folliculorum-related bacterium was capable of expressing antigens that could stimulate an inflammatory immune response in patients with rosacea.

METHODS

A bacterium (Bacillus oleronius) was isolated from a D. folliculorum mite extracted from the face of a patient with papulopustular rosacea, and was investigated further.

RESULTS

This bacterium produced antigens capable of stimulating peripheral blood mononuclear cells proliferation in 16 of 22 (73%) patients with rosacea but only five of 17 (29%) control subjects (P = 0.0105). This antigenic preparation was fractionated into 70 subfractions and the proteins in each fraction were visualized by sodium dodecyl sulphate-polyacrylamide gel electrophoresis. Western blot analysis revealed the presence of two antigenic proteins of size 62 and 83 kDa in fractions when probing with sera from patients with rosacea. No immunoreactivity to these proteins was recorded when probing with sera from control patients. Two-dimensional electrophoretic separation was used to isolate these proteins and matrix-assisted laser desorption/ionization time-of-flight analysis was employed to identify the relevant peptides. The 62-kDa immunoreactive protein shared amino acid sequence homology with an enzyme involved in carbohydrate metabolism and signal transduction while the 83-kDa protein was similar to bacterial heat shock proteins.

CONCLUSIONS

Antigenic proteins related to a bacterium (B. oleronius), isolated from a D. folliculorum mite, have the potential to stimulate an inflammatory response in patients with papulopustular rosacea.