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PubMed2001

Skin signs in anorexia nervosa.

BACKGROUND: Eating disorders are becoming an epidemic in Europe, particularly among young women, but European studies concerning this topic are few. In eating disorders, significant medical complications occur in all of the primary human organ systems, including the skin. OBJECTIVE: The purpose of this study was to improve the knowledge of skin signs in anorexia nervosa (AN) and verify whether cutaneous differences exist between the restrictive type and the bulimic type. METHODS: A noncontrolled clinical study was performed in 24 consecutive patients with the restrictive and the bulimic types of AN in order to verify whether the cutaneous signs are different in the two types. The dermatological examination included the entire skin, oral cavity, hair and nails, with attention to skin pathologies prior to the development of AN. RESULTS: In all the patients, the most frequent skin manifestations were xerosis (58.3%), hair effluvium (50%), nail changes (45.8%), cheilitis (41.6%), acne (41.6%), gingivitis (33.3%), acrocyanosis (29%), diffuse hypertrichosis (25%), carotenoderma (20.8%), generalized pruritus (16.6%), hyperpigmentation (12.5%), striae distensae (12.5%), factitial dermatitis, seborrheic dermatitis (8.3%), poor wound healing, melasma and Russell's sign (4.1%). In the patients with the bulimic type of AN, hair effluvium, acne, gingivitis, nail changes and generalized pruritus were more frequent than in the patients with the restrictive type. Russell's sign and seborrheic dermatitis were exclusively detected in the bulimic type. Hyperpigmentation, striae distensae, factitial dermatitis, poor wound healing and melasma were exclusively observed in the restrictive type. Cheilitis, diffuse hypertrichosis and carotenoderma were more represented in the restrictive type. Two patients with restrictive type of AN were followed up for a period of 3 years. In both, xerosis, cheilitis, acrocyanosis, hyperpigmentation and acne improved in relation to the increase in BMI. Hair effluvium and diffuse hypertrichosis appeared not to be linked to this parameter. CONCLUSION: Skin changes are prevalent among patients with AN. Some changes seem to depend on the type of AN or to be linked to the BMI.

Adolescent↗
PubMed2005

[Genetic polymorphism of Malassezia spp. yeast isolates from individuals with and without dermatological lesions].

INTRODUCTION: Malassezia spp. yeasts are opportunistic and newly emergent diseases. One or more species have been isolated in association with dermatological pathology and systemic disease. Their pathological role has not been fully elucidated since Malassezia spp. are common in normal skin flora. OBJECTIVE: In the current study, a search was undertaken for genetic markers in the Malassezia spp. isolates that correlate with each type of dermatologic lesion. MATERIALS AND METHODS: A total of 103 strains of Malassezia spp were isolated from patients with pytiriasis versicolor, seborrheic dermatitis, seborrheic dermatitis HIV (+), and atopic dermatitis, as well as from healthy individuals. Eight isolates from CBS Centraalbureau voor Schimmelcultures (Netherlands) were used as controls. Fingerprinting was done using random amplification of polymorphic DNA technique (RAPD) with three primers (OPA2, OPA4, OPA13). The data were analyzed with Diversity Database and SYN-TAX-PC programs. RESULTS: Intraspecies genetic heterogeneity in M. furfur, M. globosa, M. restricta, M. slooffiae, M. obtusa was observed, whereas M. sympodialis showed the greatest homogeneity. CONCLUSION: The dermatological disease caused by these different species was not associated with distinctive RAPD fingerprints.

Case-Control Studies↗
PubMed2002

[Inflammatory skin diseases. An assortment of clinically relevant disease conditions].

In the following a short overview on inflammatory dermatoses which are frequently diagnosed in clinical dermatology is presented. These include allergic contact dermatitis, dyshidrotic dermatitis, nummular dermatitis, seborrheic dermatitis, atopic dermatitis, lichen planus and psoriasis. Special emphasis is laid on the evolutionary stages in the development of lesions, clinically as well as histologically. The abovementioned dermatoses have a special pathological reaction pattern in common: the epidermis, papillary dermis and superficial capillary-venular plexus react together in these conditions and have therefore been termed the superficial cutaneous reactive unit.

Dermatitis↗
PubMed1999

[Cutaneous immune and inflammatory reactions to Malassezia furfur].

Initiation and aggravation of several inflammatory skin diseases are associated with Malassezia furfur. These are divided into at least two groups. In one group including tinea versicolor and Malassezia folliculitis, the growth of Malassezia furfur directly triggers the development of the cutaneous lesions. In another group including atopic dermatitis, seborrheic dermatitis, and psoriasis, cutaneous lesions already developed by other mechanisms are aggravated by the growth of Malassezia furfur. Recent progress of molecular biology techniques revealed that Malassezia furfur is divided into at least seven species. Since their clinical and histological findings are quite diverse, their differences cannot be explained solely by the difference in antigenicity of each Malassezia. Instead, the cutaneous defense mechanisms against Malassezia furfur must be considered. In this article, we reviewed the mechanisms at three levels: 1) barrier functions of the uppermost layer of the skin, the stratum corneum, 2) cytokine production by epidermal keratinocytes, and 3) immune and inflammatory responses by infiltrating neutrophils and T cells.

Dermatomycoses↗
PubMed2001

[Diagnosis of eczema. Can you recognize what your patient's symptom?].

The term eczema is applied to specific non-infectious inflammatory reactions of the skin, and covers a number of etiologically highly heterogeneous conditions which, however, demonstrate common features in terms of clinical presentation and pathogenesis. Eczematous disorders account for approximately 20% of the dermatological disturbances. They include allergic, contact and irritant contact dermatitis, atopic dermatitis, seborrheic dermatitis, nummular-microbial and dyshidrotic eczema, and stasis eczema. They have a high individual and socio-economic impact, and are dependent on individual predisposition.

Dermatitis, Atopic↗
PubMed1987

A survey of skin problems and skin care regimens in the elderly.

In an attempt to provide clinically relevant data regarding both dermatologic disease and skin care needs in the elderly, 68 noninstitutionalized volunteers, aged 50 to 91 years (average age, 74 years), were enrolled in a study consisting of a 33-item questionnaire and a total cutaneous examination. Two thirds of the entire group and 83% of the 23 octogenarians reported medical concerns regarding their skin, with pruritus as the most frequent complaint. On examination, all subjects had at least one cutaneous abnormality, and symptomatic and/or medically significant disorders were present in 64.7%. In decreasing order of prevalence, disorders for which dermatologic therapy was judged desirable included actinic keratoses, tinea pedis, contact dermatitis, seborrheic dermatitis, stasis dermatitis, and skin cancer. Overall, there was rather poor correlation between the subjects' complaints and perceptions and objective physical findings. Further, despite a high prevalence and long average duration of dermatologic concerns, very few subjects had consulted a physician for these problems, and no complaints other than "rashes" and pruritus had ever been discussed with any health care professional. Review of skin care regimens revealed substantial limitations with regard to bathing, shampooing, and nail care, particularly for subjects aged 80 years or older. Despite a small sample size and possibility of selection bias among the subjects, these data strongly suggest that skin problems are common among the elderly and that at present their dermatologic needs are largely unmet.

Aged↗
PubMed1986

Seborrheic-like dermatitis of acquired immunodeficiency syndrome. A clinicopathologic study.

We studied twenty-five skin biopsies from twenty-one patients with acquired immunodeficiency syndrome or its prodrome who presented with the "seborrheic dermatitis" associated with acquired immunodeficiency syndrome and compared them with an equal number of biopsies from patients with seborrheic dermatitis who had neither acquired immunodeficiency syndrome nor its risk factors. We found that although the eruption in acquired immunodeficiency syndrome closely resembles seborrheic dermatitis, histologically it is distinctive because it shows spotty keratinocytic necrosis, leukoexocytosis, and a superficial perivascular infiltrate of plasma cells and, frequently, neutrophils that show occasional leukocytoclasis. In long-standing lesions, hyperkeratosis is often present. None of these histologic features are commonly encountered in seborrheic dermatitis, psoriasis, or other eruptions known to us.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Nongenital dermatologic disease in HIV-infected women.

BACKGROUND: Dermatologic disease in HIV-infected women has not been adequately characterized. OBJECTIVE: The main purposes of this study were to characterize nongenital dermatologic disease in HIV-infected women and correlate these diagnoses with CD4 lymphocyte count to compare these findings with those in published reports of men. METHODS: This study was a retrospective chart review of female patients with dermatologic diagnoses followed up at an HIV clinic in New York City, seen by either a dermatologist (49 patients) and/or a primary care practitioner (114 patients). CD4 lymphocyte count was recorded if available within 6 months of diagnosis; mean CD4 count was calculated for all disorders with 5 or more diagnoses. RESULTS: Oropharyngeal candidiasis, drug eruption, dermatophytosis, rash (not otherwise specified), nongenital herpes simplex, herpes zoster, and seborrheic dermatitis were the most prevalent diagnoses made by primary care providers. Itchy red bump disease, acne, atopic dermatitis, xerosis, seborrheic dermatitis, nongenital warts, and molluscum contagiosum were the most prevalent diagnoses made by the dermatologist. Mean CD4 lymphocyte count was lowest in itchy red bump disease, nongenital warts, nongenital herpes simplex, xerosis, and drug eruptions. CONCLUSION: There appears to be no appreciable difference in the spectrum or prevalence of dermatologic disease in HIV-infected women versus HIV-infected men, except for a lower prevalence of Kaposi's sarcoma, oral hairy leukoplakia, and possibly onychomycosis in women. The degree of immunosuppression associated with various dermatoses in HIV-infected women is similar to that in men, except perhaps for molluscum contagiosum, which may appear earlier in women.

Adult↗
PubMed1979

[Histological differential diagnosis of psoriasis vulgaris and seborrheic eczema of the scalp].

The clinical differential diagnosis between seborrheic dermatitis and psoriasis vulgaris of the scalp can be difficult. We, therefore, tried to elaborate histopathological criteria for a differentiation of the two dermatoses. Forty excisional biopsies were analysed without knowing the clinical diagnosis. The histopathological substrate within the epidermis is characterized in psoriasis by dermatitis-like and in seborrheic dermatitis by psoriasis-like alterations. Therefore, in some cases a definite histopathological diagnosis could not be made. Strong criteria favouring psoriasis are: moderate condensed hyperkeratosis with alternating parakeratosis, PAS-reactive serum inclusions and Munro abscesses within the horny layer, spongiform pustles and neutrophilic leukocytes within the epidermis. Strong criteria for seborrheic dermatitis are: irregular acanthosis with relatively thin condensed orthoor parakeratotic horny layer, spongiosis and spongiotic vesicles, exocytosis of lymphocytes and the lack of any hard criterias for psoriasis. The results may suggest that seborrheic dermatitis of the scalp may transform into psoriasis in patients with a genetical disposition ("psoriatic diathesis", "latent psoriasis") via a Köbner reaction. The existence of the seborrheic dermatitis (Morbus Unna) is not doubted by these investigations.

Biopsy↗
PubMed2005

A novel T cell receptor transgenic animal model of seborrheic dermatitis-like skin disease.

We have characterized a novel animal model of the common inflammatory skin disease seborrheic dermatitis (SD) that involves the expression of the self-specific 2C transgenic T cell receptor on the DBA/2 genetic background. Opportunistic fungal pathogens are present in the primary histological lesions and severe disease can be mitigated by the administration of fluconazole, demonstrating a role for infection in disease pathogenesis. Spontaneous disease convalescence occurs at 70-90 d of age and is preceded by an expansion of CD4+ T cells that partially restores the T cell lymphopenia that occurs in these animals. The adoptive transfer of syngeneic CD4+ T cells into pre-diseased DBA/2 2C mice completely abrogates the development of cutaneous disease. The pattern of disease inheritance in DBA/2 backcrosses suggests that one, or a closely linked group of genes, may control disease penetrance. Bone marrow reconstitution experiments demonstrated that the DBA/2 susceptibility factor(s) governing disease penetrance is likely non-hematopoietic since bone marrow from disease-resistant 2C mice can adoptively transfer the full disease phenotype to non-transgenic DBA/2 animals. This model implicates fungal organisms and CD4+ T cell lymphopenia in the development of a SD-like condition and, as such, may mimic the development of SD in acquired immunodeficiency syndrome.

Adoptive Transfer↗
PubMedDate not supplied

Seborrheic dermatitis-like tinea faciei.

We report a 10-year-old Caucasian child who had erythema and abundant scaling on the nasolabial folds, the upper lip, and on the nose. Both the abundant scaling and the localization on the central part of the face led us to suspect seborrheic dermatitis. Direct microscopic examination of some scales removed from the lesions showed septate and ramified ectothrix hyphae. Cultural examination on Sabouraud medium led to the identification of the Trichophyton mentagrophytes species. We described this patient to highlight the importance of considering tinea faciei in the differential diagnosis of all facial eruptions and the value of mycologic examination.

Antifungal Agents↗
PubMed1987

[Dandruff--an atopic sign?].

Dandruff is a sign of low specificity but high sensitivity for atopic constitution. Of 32 (40%) patients consulting the clinic for other reasons than dandruff, atopic dermatitis, or seborrheic dermatitis, 13 had raised IgE PRIST values of greater than 120 IU/ml. In only 6 (19%) of these patients was screening for atopy completely negative (family and personal history, total and specific IgG, prick test).

Adult↗
PubMed2005

Videocapillaroscopic alterations in erythematotelangiectatic rosacea.

BACKGROUND: Rosacea is a common chronic dermatosis that involves the cutaneous microvasculature of the face. There are no objective measures for assessing the severity of erythematotelangiectatic rosacea. OBJECTIVE: Our purpose was to characterize and provide objective measures of vessel changes in erythematotelangiectatic rosacea by videocapillaroscopy. METHODS: We compared 30 patients with erythematotelangiectatic rosacea with 30 age- and sex-matched patients with facial seborrheic dermatitis and 30 healthy control subjects. Videocapillaroscopy was performed both on the cheeks and on the nailfold region. The analyzed parameters of the face were morphological (background color, vessel irregularities) and quantitative (polygonal net perimeter, telangiectasia, and vessel diameters). RESULTS: Characteristic alterations of skin vessels were observed in facial rosacea, with a pattern distinct from that of facial seborrheic dermatitis. In particular, rosacea showed neoangiogenesis and significantly larger polygons (13.21 +/- 3 vs 7.8 +/- 3 mm; mean +/- standard deviation, P < .001), more prominent telangiectases (267.8 +/- 108 vs 118.2 +/- 35 microm; P < .001) and larger mean vessel diameter (46.71 +/- 9 vs 24 +/- 10 microm; P < .001) compared with seborrheic dermatitis. Seborrheic dermatitis displayed more polygon irregularities and vessel tortuosity. In contrast, no differences were found in the nailfold region. LIMITATIONS: Vessel irregularities and overall erythema may be difficult to quantify. CONCLUSIONS: Videocapillaroscopy may represent a valid adjunctive method in the early diagnosis and measurement of erythematotelangiectatic rosacea.

Adult↗
PubMed1991

Carcinogenesis in porokeratosis. Evidence for a role relating to chronic growth activation of keratinocytes.

Porokeratoses are known to give rise to squamous and basal cell carcinomas. In this study, we examined 15 lesions of porokeratosis immunohistochemically for evidence of aberrant keratinization using several markers of keratinocyte (KC) maturation and differentiation, including involucrin, filaggrin, cytokeratins, and the growth activation marker psi-3. The staining patterns obtained were compared with several non-premalignant parakeratotic skin lesions including psoriasis, pityriasis rosea, pityriasis rubra pilaris, irritated seborrheic keratosis, atopic dermatitis, seborrheic dermatitis, and verruca vulgaris. The centers of porokeratoses stained in a pattern identical to that observed in other premalignant keratinocytic lesions including actinic keratoses, recessive dystrophic epidermolysis bullosa, and nonhealing wounds. KCs beneath the cornoid lamella (CL) stained in a pattern similar to that observed in squamous cell carcinomas. KCs peripheral to the CL in the epidermis showed a normal staining pattern. The control non-premalignant parakeratotic lesions displayed a variety of staining patterns, but none showed a pattern identical to that observed in porokeratosis. The failure of KCs in porokeratoses to mature and differentiate normally may be related to the increased incidence of carcinomas associated with these lesions.

Epidermis↗
PubMed1998

Association of cutaneous and oral diseases in HIV-infected men.

OBJECTIVES: Mucocutaneous diseases are common in patients infected with human immunodeficiency virus (HIV). To identify cutaneous diseases for which HIV-infected people are at high risk, we sought those that are strongly associated with specific HIV-related oral lesions and with progression of HIV disease. DESIGN: A cross-sectional study of HIV-positive outpatients referred to a university stomatology clinic for diagnosis and treatment of oral diseases. Each subject underwent both complete oral and cutaneous examinations. RESULTS: Among 55 men, with a median age of 41 years and a median CD4 cell count of 125/microliter (range 0-950/microliter), 93% had active oral diseases or conditions, including candidiasis, hairy leukoplakia, ulcers, Kaposi's sarcoma (KS), and xerostomia, and 95% had skin conditions, including onychomycosis, dermatophytosis, seborrheic dermatitis, KS, folliculitis, xerosis, and molluscum contagiosum. Seborrheic dermatitis, xerosis, skin KS, and molluscum contagiosum were associated with oral HIV-sentinel lesions (oral candidiasis, hairy leukoplakia, and KS), with low CD4 cell counts, and with AIDS. CONCLUSION: Our results suggest that xerosis and seborrheic dermatitis may be early harbingers of HIV disease progression. Their roles as predictors warrant further study, based on their associations with low CD4 cell counts and AIDS and strong co-prevalence with one of the most common HIV-related oral lesions, oral candidiasis.

AIDS-Related Opportunistic Infections↗