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Thirty-four infants and children were prescribed bifonazole 1% shampoo as a treatment for lesions of scalp seborrheic dermatitis. All but one were cured or showed improvement within a short period. No serious side effects were observed. We conclude that bifonazole 1% shampoo is an effective and safe treatment for lesions of scalp seborrheic dermatitis in infants and young children.
During a 6-month-period, 150 patients infected with Human Immunodeficiency Virus (HIV) were repeatedly examined by dermatologists and dentists for lesions of skin and oral mucosa. The most frequently encountered diseases were: oral hairy leukoplakia (21%), dermatophytosis (including tinea unguium/tinea pedis et inguinalis) (20%), seborrheic dermatitis (19%), viral infections (10%), oral candidiasis (7%), acne vulgaris (6%), and folliculitis (5%). A variety of other manifestations were seen, with frequencies less than 5%. Herpes zoster was seen in 3% of the patients, indicating a rate of 60/1,000 per annum. The presence of seborrheic dermatitis was statistically associated with low T-helper lymphocyte count. Patients with low T-helper lymphocyte count had on average twice as many mucocutaneous lesions as patients with a normal or moderately decreased count. Any one of the manifestations seborrheic dermatitis, oral candidiasis or oral hairy leukoplakia was associated with a greater average number of additional mucocutaneous changes than seen in patients exhibiting none of these three conditions. The high proportion of HIV-infected patients with cutaneous and oral lesions underlines the importance of referring the patients to dermatologists and dentists for examination. Prospective examinations of the study population remain to elucidate the prognostic significance of mucocutaneous manifestations of HIV-infected patients.
Fifty-four unrelated Japanese patients with psoriasis vulgaris were tissue typed using the Sixth International Histocompatibility Workshop antisera. Two control groups were included in this study: Thirty-one pustulosis palmaris et plantaris and 17 seborrheic dermatitis as a disease control and 66 normal, healthy, unrelated Japanses as a reference. HLA-Al (P = 0.0065) from the A locus and HLA-BW37 (P = 0.0164) from the B locus were found to occur with increased frequency in patients with psoriasis vulgaris. No significant difference in antigen frequencies in pustulosis palmaris et plantaris was found, however, HLA-AW30 and/or AW31 and HLA-B12 occurred with increased frequency in seborrheic dermatitis. No linkage between psoriasis and HLA was observed in eight families. Therefore our findings in Japanese do not confirm the previous observation made in Caucasians of an association between psoriasis vulgaris and HLA-B13 or BW17.
INTRODUCTION: Several skin diseases are associated with human immunodeficiency virus (HIV) infection. In Africa, due to the difficult access to medical care and complementary examinations, certain diseases are of particular importance. In the present work, we report the skin manifestations observed in a dermatology unit of a large city in Africa over a 3 year period and which were the revealing signs of HIV infection. PATIENTS AND METHODS: All adult subjects (>15 years) with a positive HIV serology (confirmed by Western blot) that had been revealed by a skin disease seen at the Marchoux Institute at Bamako between June 1991 and September 1994 were included in the study. RESULTS: Two hundred sixty-three skin diseases revealed 233 cases of HIV infection. Diseases observed were: zoster (n = 71), seborrheic dermatitis (n = 43), Kaposi's sarcoma (n = 34), prurigo (n = 31), sexually transmitted diseases (n = 27), extensive dermatophytosis (n = 12), psoriasis (n = 12), molluscum contagiosum (n = 8), acquired ichthyosis (n = 3), cutaneous leishmaniasis (n = 2) and other skin diseases (n = 10). More than one disease were associated in 28 patients. Certain particular features were noted (superinfection of zoster, papular margin in dermatophytosis). DISCUSSION: In Africa, certain skin diseases often reveal HIV infection and some diseases have a high positive predictive value for HIV infection (zoster, seborrheic dermatitis, prurigo, Kaposi's sarcoma, extensive dermatophytotis). For prognosis, frequently associated diseases are signs of AIDS (Kaposi's disease, prurigo, molluscum contagiosum).
OBJECTIVE: The in vitro antifungal activity of lithium succinate has been evaluated against 46 different Malassezia furfur strains, isolated from patients suffering from dandruff, seborrheic dermatitis, and pityriasis versicolor. METHODS: Minimum inhibitory concentrations of lithium succinate were measured by the agar dilution technique. RESULTS: Lithium succinate was found to be able to inhibit growth of all investigated M. furfur isolates in vitro but at much higher concentrations than those which are normally used for susceptibility testing. Minimum inhibitory concentrations between 1,250 and 10,000 micrograms/ml were determined. When compared to the 8% lithium succinate ointment, the investigated concentrations are even far below this 8% value. CONCLUSIONS: It is suggested that the effect of lithium succinate ointment in seborrheic dermatitis therapy in vivo may be at least partly due to an antifungal activity of the agent.
BACKGROUND AND OBJECTIVES: The stratum corneum of some of the scaly (parakeratotic) diseases was examined with light and scanning electron microscopy (SEM) with the purpose to reveal the importance of this layer in the diagnosis of some of the diseases associated with the formation of scales. MATERIALS AND METHODS: Two biopsies of the skin surface were taken: one, obtained from 80 patients with various parakeratotic scaly diseases and from 25 control subjects, was processed for light microscopy; the other biopsy for SEM was taken from 10 control subjects and 25 patients. The diagnoses of these patients were: psoriasis (5 patients), erythrodermic psoriasis (2 subjects), parapsoriasis (5 patients), pityriasis rubra pilaris (5 subjects), pityriasis rosea (3 subjects), and seborrheic dermatitis (5 subjects). RESULTS: The light microscopic studies showed that normal corneocytes are of polygonal shape with their largest diameter measuring 42 microns; these cells lacked nuclei. All parakeratotic cells appeared bizarre in shape, smaller than normal, and the cells contained a nucleus. With SEM, normal cells appeared relatively regular in size and shape, trabeculated, and had a flat surface. Cells examined in all the diseases revealed various sizes, outlines, and trabeculae. Specific surface patterns (print) of diseased cells were: "fish-scale" in psoriasis; "marbled" in parapsoriasis, "rocky stone" in pityriasis rubra pilaris; "heart-shaped" in seborrheic dermatitis, and semicrystalloid in pityriasis rosea. CONCLUSIONS: Parakeratosis is characterized not only by the retention of the nucleus in keratinocytes, but is also characterized by a cell of smaller size. The specific print of a disease helps in the diagnosis. The print will change with different stages of a disease.
For the past 20 years, the author has been treating recurrent chronic seborrheic dermatitis with a suspension of human cerumen in glycerine. The cerumen is obtained from healthy children and young adults in which there is an over-production which requires removal. If the cerumen contains debris it is not used. The collected cerumen is suspended in 50% glycerine and left for several weeks to sterilize. It is then strained through a fine filter having been heated so that its is workable. The material is dispensed to the patient in a small dropper bottle and the patient is instructed to place two drops in the external ear canal once a week. The chronicity of seborrheic dermatitis must be explained carefully to the patient and the necessity for avoiding water, cosmetics and other materials must be stressed. The patient must be made aware that the cause of the condition is unknown and that periodic inspection of the ear canal is necessary in addition to the topical application of the cerumen suspension.
A population of 549 HIV-positive intravenous drug users, 140 of whom were women, recruited between June 1985 and June 1991, were studied to determine the usefulness of minor clinical signs and biological parameters in predicting progression to AIDS at different CD4+ levels. Ninety-eight subjects developed AIDS during a median follow-up of 4 years. Oral thrush was predictive of progression to AIDS independently of the CD4+ level at enrollment; seborrheic dermatitis was predictive of disease progression only in those with CD4+ under 500 cells/mm3. Regarding the predictive value of the biologic parameters examined, similar IgA levels among HIV-seropositive intravenous drug users with CD4+ > 500 cells/mm3 and HIV-negative intravenous drug users were observed, while higher median levels were found among HIV-positive participants with CD4+ level under 500 cells/mm3. Among intravenous drug users with CD4+ < 500 cells/mm3, a level of IgA higher than 200 mg/dl at enrollment was predictive of faster progression to AIDS. Among participants with CD4+ [corrected] over 500 cells/mm3, an IgA level above 400 mg/dl was still predictive of faster progression, but the sensitivity tended to be low. These findings suggest that an elevated level of IgA and presence of oral thrush may be important early markers of disease progression in HIV-infected intravenous drug users. Seborrheic dermatitis is also predictive, but only in later stages.
The aim of this study was to determine the in vitro fungicidal and growth inhibitory activity of ciclopirox olamine alone (1% and 1.5%) or in association with 1% zinc pyrithione compared to 2% ketoconazole, against Malassezia species particularly involved in the pathogenesis of seborrheic dermatitis. Experiments were performed on Malassezia globosa IP 2387.96 and M. restricta IP 2392.96 strains. Growth inhibitory activity of the active compounds in solution was evaluated by measuring minimal inhibitory concentrations using a broth micro-method and their fungicidal activity by a filtration method after contact times between solutions and yeasts ranging from 3-5 to 30 min. Concerning the determination of minimal inhibitory concentration of ciclopirox olamine/zinc pyrithione, it revealed the marked synergistic inhibitory effect of the association, leading to a higher efficacy compared to ketoconazole. As to the fungicidal activity of ciclopirox olamine, it significantly increased with the contact time. After 15-30 min of contact between 1.5% ciclopirox olamine and Malassezia strains, a 2-log reduction of Malassezia counts was observed. The 1.5% ciclopirox olamine/1% zinc pyrithione association was characterized by a steady fungicidal efficacy whereas the 2% ketoconazole solution did not express any fungicidal effect. In conclusion, this study demonstrates the in vitro inhibitory and fungicidal efficacy of the ciclopirox olamine/zinc pyrithione association against Malassezia species and underscores its potential interest in the treatment of seborrheic dermatitis.
BACKGROUND: Atopic dermatitis of the head and neck (HNAD) has been recognized as a separate entity. Malassezia furfur, a lipophilic yeast, is considered to be a pathogenic allergen in this form of atopic dermatitis. OBJECTIVE: The purpose of this study was to determine the level of IgE anti-M.-furfur antibodies and their relation to the severity of the disease. METHODS: IgE anti-M.-furfur antibodies were assayed in 106 patients with HNAD. Controls included 25 patients with non-HNAD, 20 with nonatopic dermatitis and 16 with seborrheic dermatitis (including 4 with AIDS). RESULTS: There was a highly significant correlation between the level of anti-M.-furfur IgE and clinical severity. Furthermore, there was a significant but smaller correlation between total IgE and clinical severity. In patients with HNAD, total IgE was higher amongst men. CONCLUSION: IgE anti-M.-furfur antibodies are a good and specific marker for HNAD. IgE M. furfur levels are strongly correlated with the severity of the disease.
Interferon-gamma-induced protein 10 is a 10-kd protein produced by human keratinocytes following an exposure to interferon gamma. Keratinocytes within psoriatic plaques and within delayed-type hypersensitivity reactions have been shown to stain strongly with an affinity-purified rabbit antibody prepared against interferon-gamma-induced protein 10, suggesting a possible role for interferon gamma in the production of the lesions. A psoriasiform eruption has been seen in patients with acquired immunodeficiency syndrome (AIDS). Its severity appears to correlate with the degree of immunodeficiency in the early stages of AIDS. We stained 10 lesions of psoriasiform dermatitis of AIDS with the anti-interferon-gamma-induced protein 10 antibody using immunoperoxidase techniques. As controls, we studied 10 lesions of non-AIDS psoriasis, six lesions of seborrheic dermatitis with psoriasiform hyperplasia, one lesion of lichen simplex chronicus, and four biopsy specimens of normal skin from patients with AIDS. In addition, normal skin specimens taken from patients with AIDS and human immunodeficiency virus-negative patients at time of autopsy were examined. An identical, strong and diffuse staining pattern was seen in all cases of psoriasiform dermatitis of AIDS, non-AIDS psoriasis, seborrheic dermatitis, and lichen simplex chronicus. The specimens of normal skin showed only weak basal layer staining with anti-interferon-gamma-induced protein 10. Thus, the presence of interferon-gamma-induced protein 10 in keratinocytes was associated with psoriasiform hyperplasia and could be detected in both AIDS-associated and classic psoriasis.
BACKGROUND: Eyelids can be affected by various types of dermatitis that are often difficult to diagnose. OBJECTIVE: The aim of the study was to establish some guidelines for a correct diagnosis. METHODS: A total of 447 patients treated at 12 research units for eczema or other inflammatory dermatitis located on the eyelids were invited to complete a questionnaire. When necessary, patch tests with haptens of the standard series from Gruppo Italiano di Ricerca sulle Dermatiti da Contatto e Ambientali della Società Italiana di Dermatologia e Venereologia (SIDEV-GIRDCA) were performed. RESULTS: Of the subjects studied, 50.2 % were diagnosed with allergic contact dermatitis (ACD); 20.9% were affected by irritant contact dermatitis (ICD), 13.5% by atopic dermatitis, 6.3% by seborrheic dermatitis, 6.5% by aspecific xerotic dermatitis, and 2.3% by psoriasis. Approximately 91% of all subjects reported an absence of familial atopy. A significant statistical association between diagnosis type and a personal history of atopy was evident (p <.000001, chi-square test). The results of gradual logistic regression models showed four-eyelid involvement as the main risk factor for ACD (odds ratio [OR] = 3.0; 95% CI, 1.1-8.1); with ICD, the main risk factor was the onset of symptoms at between 2 and 6 months (OR = 2.1; 95% CI, 1.1-4.0), whereas for atopic dermatitis, the main risk factors were the onset of symptoms later than 6 months and a personal history of atopy (OR = 4.9 and 3.6, respectively). CONCLUSION: Results suggest that many characteristics of the patients examined can be used for the differential diagnosis of palpebral eczematous dermatitis.
Infective dermatitis associated with HTLV-I (IDH) is a chronic, infected childhood eczema. Two adult-onset cases of IDH were studied, one of which was associated with HAM/TSP. The patients were submitted to dermatological, neurological and pathological examination. Immunohistochemical studies were made using CD3, CD4, CD8, CD20, CD79a, and CD57 antibodies. Cytotoxic granules were investigated using granzyme B, perforin, and TIA. The patients presented infected erythematous, scaly lesions with mild itching and a good response to sulfamethoxazole/ trimethoprim. A differential diagnosis with atopic dermatitis (AD) and seborrheic dermatitis (SD) was made, based on: the distinctive morphology and distribution of the lesions, presence of exudative and infected lesions, and mild pruritus. The inflammatory infiltrate was composed predominantly of CD8+ lymphocytes that did not present cytotoxic granules. We concluded that IDH can begin in adulthood and may be associated with HAM/TSP. The immunohistochemical findings were different from those observed in AD and SD.
The most often seen perianal dermatitis is the eczema, which is caused symptomatically by haemorrhoids, fissures, fistulas, proctitis, contact allergies, the funnel shaped anus and intensified folding of the perianal skin. Before treatment of the eczema all these causes have to be eliminated. Differential diagnosis of the perianal dermatitis are psoriasis, seborrheic dermatitis, endogenous eczema, intertrigo, proctitis and skin cancer.
BACKGROUND: The relationship between infantile seborrheic dermatitis (ISD) and infantile atopic dermatitis (IAD) is controversial. METHODS: Ninety-six children aged 2-12 months diagnosed with atopic dermatitis and a comparable control group of healthy children were evaluated. Demographic data, personal history of ISD and personal or family history of atopy was considered in both groups. RESULTS: A personal history of ISD was found in 49% of IAD cases and in 17% of controls (P < 0.05). CONCLUSIONS: Our result and those of the literature do not demonstrate a relationship between ISD and IAD. However, a number of cases of AD have an ISD-like clinical picture. It is probable that ISD is a syndrome and not a disease.
Ciclopirox is a broad-spectrum antifungal agent that also exhibits anti-inflammatory and antibacterial activity. The lotion and cream formulations of ciclopirox are effective in many types of infection, including tinea corporis/cruris, tinea pedis, cutaneous candidiasis, pityriasis (tinea) versicolor, and seborrheic dermatitis. The new ciclopirox gel 0.77% formulation is also indicated for the treatment of seborrheic dermatitis of the scalp, interdigital tinea pedis and tinea corporis.
OBJECTIVE: Human T-cell lymphotropic virus type I (HTLV-I) infection in childhood is believed to play an important role in risk for adult T-cell leukemia/lymphoma. Although HTLV-I is known to be associated with infective dermatitis in childhood, other HTLV-I-associated morbidity in children has not been well studied. We sought to determine the HTLV-I-associated health effects in Jamaican children. METHODS: We compared incidence rates of several health outcomes in 28 HTLV-I-infected and 280 uninfected children clinically followed from age 6 weeks to a maximum of 10 years. Cox proportional hazards regression analysis was used to analyze these prospectively collected data, adjusting for confounding effects of other variables as necessary. RESULTS: HTLV-I-infected children had significantly higher incidence rates of seborrheic dermatitis (rate ratio [RR] = 4.8, 95% confidence interval [CI] = 1.9-12.5), eczema (RR = 3.1, CI = 1.2-7.9) and persistent hyperreflexia (RR = 3.7, CI = 1.6-8.2). Additionally, HTLV-I infected children had increased rates of severe anemia (RR = 2.5, CI = 0.8-7.9) and abnormal lymphocytes (RR = 2.4, CI = 0.8-7.6) that were of borderline statistical significance. CONCLUSIONS: Our study suggests that HTLV-I-associated skin diseases of childhood may include seborrheic dermatitis and eczema. Additionally, these data suggest that persistent hyperreflexia of the lower limbs may be an early sign of HTLV-I-associated neurologic involvement in children. Expansion and continued clinical observation of this cohort would be valuable.
Ciclopirox (Loprox) is a broad-spectrum antifungal medication that also has antibacterial and anti-inflammatory properties. Its main mode of action is thought to be its high affinity for trivalent cations, which inhibit essential co-factors in enzymes. Clinical trials have shown that ciclopirox gel is a successful treatment for seborrheic dermatitis of the scalp as well as for tinea pedis. Adverse effects are generally mild and include a skin-burning sensation, contact dermatitis, and pruritus. Ciclopirox is indicated in the US for the treatment of tinea pedis, tinea corporis, pityriasis versicolor, seborrheic dermatitis, and cutaneous candidiasis.