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PubMed1998

Systematic cutaneous examination in hepatitis C virus infected patients.

The purpose of this study was to evaluate the frequency of skin changes among 100 patients from the Hepatogastroenterology Department of the University Hospital, Strasbourg, France who were hepatitis C virus-positive (HCV) and HIV-negative. Their clinical data were compared to those of 50 HCV-, and HIV-negative patients from the same Department, who suffered from various liver diseases. Psoriasis, rosacea, seborrheic dermatitis, cherry angiomas, spider nevus and skin cancers were noted in similar proportions in the two groups. In 15% of HCV-positive patients vs. 4% of controls, chronic pruritus was noted (p < 0.05). In 9 HCV-positive patients, pruritus was not related to itching dermatosis, and only 2 of these patients had mild cholestasis. Four cases of lichen planus vs. 0 in the control group were recorded. The virological data of patients with pruritus or lichen planus were not different than those of the rest of the group. Our findings indicate that systematic skin check-up in HCV-positive patients is valuable.

Adult↗

PubMed1986

Tinea capitis among children of Ethiopian immigrants.

The incidence, clinical appearance and causative agent of tinea capitis among children of Ethiopian immigrants, was studied. Out of 124 children examined, 36 had scalp lesions and 32 cases were confirmed as scalp-ringworm on direct microscopy. Culture showed the dermatophyte to be Trichophyton violaceum. The clinical presentation, resembling seborrheic dermatitis, without clinically apparent hair invasion, was atypical.

Child↗

PubMedDate not supplied

Characterization of the lipase activity of Malassezia furfur.

Enzymes capable of metabolizing lipids are essential for the growth of Malassezia furfur in vitro and in vivo. We designed a series of experiments to characterize the lipolytic system in this yeast. The optimal pH of the lipase system was 7.5 Lipase activity was detected in soluble and insoluble saline cell extracts and in supernatant from the cultures. Esterase activity screened in samples separated by native polyacrylamide gels showed that it was restricted to one band of low mobility. An FPLC analysis of the soluble saline extract demonstrated that the lipase activity was present in three major peaks with different protein composition as revealed by SDS-PAGE. The enzymatic activity and cell growth were first induced and later inhibited by increasing concentrations of polyethylene-sorbitan-monooleate (Tween-80). The characterization of the lipolytic system (e.g. its induction by substrate and the effect of pH and/or different cations) could help to explain the increment in the number of M. furfur infections related to alterations of surface lipids in the skin such as seborrheic dermatitis.

Chromatography, Liquid↗

PubMed2006

Dermatological findings in 3 generations of a family with a high prevalence of human T cell lymphotropic virus type 1 infection in Brazil.

BACKGROUND: Dermatologic manifestations are quite common in patients with adult T cell leukemia and lymphoma and patients with myelopathy and/or tropical spastic paraparesis associated with human T cell lymphotropic virus type 1 (HTLV-1). The aim of this study was to investigate dermatological findings presented by 30 members of a Brazilian family, half of whom are infected with HTLV-1 (as confirmed by enzyme-linked immunosorbent assay and Western blot). METHODS: The subjects underwent dermatologic examination and laboratory assessment, which included the search for the HTLV-1 genome in peripheral blood mononuclear cells (PBMCs) by qualitative and semiquantitative polymerase chain reaction (PCR) and in skin samples by nested qualitative PCR and immunofluorescence assay. RESULTS: We found that cases of xerotic dermatological alterations, including 3 cases of acquired ichthyosis, were more frequent among the infected patients (7 cases vs. none among the uninfected individuals; P=.0063). Other lesions observed in this group included impetigo, scabies, epidermal nevus, herpes zoster scar, rosacea, and juvenile acne. One HTLV-1-infected individual presented with concurrently acquired ichthyosis, impetigo, scabies, dermatophytosis, and seborrheic dermatitis. The PCR performed on PBMCs and skin samples from 24 patients confirmed the serological results in all cases. Additionally, the HTLV-1 proviral load was higher in patients with >1 skin lesion. Finally, HTLV-1 could be identified in the skin by immunofluorescence assay, which, by use of PCR as the gold standard, showed a sensitivity and specificity of 61.5% and 100%, respectively. CONCLUSIONS: Altogether, these clinical and laboratory findings point to an HTLV-1 tropism toward the skin, even in HTLV-1 carriers without adult T cell leukemia/lymphoma or HTLV-1-associated myelopathy and/or tropical spastic paraparesis.

Adult↗

PubMed1993

Cutaneous disorders and viral gene expression in HIV-1 transgenic mice.

Patients infected with HIV-1 experience several hyperproliferative skin disorders, including seborrheic dermatitis, ichthyosis, and psoriasis. Transgenic mice carrying a subgenomic HIV-1 proviral construct lacking the gag and pol genes were found to develop proliferative epidermal lesions, manifested as diffuse epidermal hyperplasia in homozygous transgenic mice and benign papillomas in heterozygous transgenic mice. Nonpapillomatous skin from both homozygotes and heterozygotes expressed viral RNA, and the viral envelope protein gp120 was localized to the suprabasal keratinocyte. Papillomas contained increased amounts of both viral mRNA and envelope glycoprotein. Exposure of transgenic mice to doses of ultraviolet B (UV-B) irradiation that induced cutaneous injury increased viral gene expression and resulted in the development of papillomas within 14-21 days. Cutaneous injury induced by phenol and liquid nitrogen had similar effects. These data support a role for HIV-1 gene products in the pathogenesis of proliferative epidermal disorders associated with HIV-1 infection. Further, they suggest that the process of wound repair increases HIV-1 gene expression in this transgenic mouse model.

Animals↗

PubMed1996

Common superficial fungal infections in patients with AIDS.

Superficial mycotic infections such as seborrheic dermatitis, tinea pedis, tinea corporis, and onychomycosis are common in patients infected with human immunodeficiency virus (HIV). In communities where HIV infections are frequent, some of these clinical presentations serve as markers of the stage of HIV infection. The diagnosis of superficial fungal infection in HIV-positive patients may be difficult because of atypical clinical manifestations. Therefore, to ensure a correct diagnosis, skin scrapings should be collected for potassium hydroxide preparations and cultures. Most forms of dermatophytosis in HIV-positive patients respond well to many topical antifungal agents, such as azoles, terbinafine, and ciclopirox olamine. If the disease is chronic and extensive, then ketoconazole, fluconazole, and itraconazole are each effective.

AIDS-Related Opportunistic Infections↗

PubMedDate not supplied

Empiric therapy for bacterial infections: the historical perspective.

The term empiric is defined, and its implications in the treatment of infectious diseases and the selection of beta-lactam antibiotics are discussed. Some changes in the choice of empiric therapy during the last half-century are brought out by a discussion of therapy for selected infections. For some infections the changes (if any) have been only minor; for others, however, the changes have resulted in a progressive decline in mortality, a shortening of the course of the disease, and the reduction or elimination of complications. Among the diseases discussed are seborrheic dermatitis, malaria, syphilis, typhoid fever, pneumonia, bacterial endocarditis, and bacterial meningitis.

Bacterial Infections↗

PubMed1996

Treatment of fungal infection in AIDS.

Fungal infections affect virtually all patients with the Acquired Immunodeficiency Syndrome (AIDS). Superficial infection (seborrheic dermatitis, tinea capitis, tinea corporis and tinea cruris) is more common than in the general population and can be difficult to eradicate. Mucosal disease (oropharyngeal, oesophageal and vaginal candidosis) is very common and often recurs. In advanced AIDS, patients usually fail to respond to topical therapy and often to systemic therapy and isolates of Candida spp. from these patients are frequently resistant in vitro to fluconazole and other azoles. Systemic fungal infection is less common but life threatening. The commonest such infection is Pneumocystis carinii pneumonia (PCP) although prophylaxis is usually successful in preventing either the first episode or recurrent episodes. Histoplasmosis, coccidioidomycosis and Penicillium marneffei infections are common in endemic areas. Cryptococcal meningitis and invasive aspergillosis occur worldwide. The prophylaxis and treatment of all these except PCP are discussed and reviewed.

AIDS-Related Opportunistic Infections↗

PubMed2000

Histopathology of psoriasis treated with zinc pyrithione.

Psoriasis is still a relatively poorly understood inflammatory dermatosis that is resistant to many therapies. Because the pathogenesis is poorly understood, rational treatment is elusive. Until recently, the North American public was able to achieve successful resolution with an over-the-counter topical preparation marketed for dandruff and seborrheic dermatitis called SkinCap, which has now been withdrawn from the market. The purpose of this study was to examine the histologic changes induced by this preparation in a well-developed psoriatic plaque. Serial punch biopsies were taken over a 2-week period during which time SkinCap was applied topically twice daily. The biopsies were examined histologically, and features were evaluated semiquantitatively. The classic histologic features of psoriasis resolved completely over 2 weeks, with the reversal beginning with disappearance of neutrophils and the most striking finding being prominent apoptosis at 48 hours. The mechanism of this normalization is unknown. Hypotheses include blockage of cytokine and growth factor effect at some level and induction of apoptosis.

Humans↗

PubMed1998

The Western Australian HIV Cohort Study, Perth, Australia.

The efficacy of primary prophylactic treatment for opportunistic infections can be estimated in an observational cohort study by adjusting for clinical and laboratory markers of the immunodeficiency (e.g., oral candidiasis, CD4%, lymphocyte cell counts) as time-dependent co-variates (providing that the treatment does not directly alter the markers). However, the CD4 cell count provides an incomplete measure of the protective immune response, and the efficacy of treatment may be underestimated if there is inadequate adjustment for the severity of immunodeficiency. Unlike prophylactic therapies, the efficacy of which remains relatively constant over time, antiretroviral therapy may produce only transient or time-limited benefits. This problem can be minimized by allowing the effect of antiretroviral therapy to vary over time in Cox proportional hazards models (i.e., to allow the antiretroviral therapy coefficient to change over time). Another difficulty is that CD4 cell counts may underestimate the degree of immunodeficiency after prolonged zidovudine (AZT) monotherapy. If post-antiretroviral therapy CD4 cell counts are used to adjust for the stage of immunodeficiency, it may therefore be helpful to adjust for the duration of antiretroviral therapy with the CD4 cell count at the time of starting antiretroviral therapy. It is interesting to consider statistical models of progressive HIV-induced immunodeficiency in the context of the evolution of host immunity. HIV infection results in the loss of the relatively recently evolved adaptive CD4 T cell-mediated immunity to intracellular parasites. The infected host may compensate for this by making greater use of phylogenetically ancient, more innate protective responses. Because these compensatory responses are polymorphic, this results in the appearance of differences between individuals in the immune response to HIV as the disease progresses. Data from the Western Australia HIV Cohort Study support a two-stage model of immunopathology. The first stage of this model involves a loss of mucosal immunity and occurs at a variable CD4 cell count (of between 400 cells/mm3 and zero), and is marked by a loss of cutaneous delayed-type hypersensitivity responses and oral candidiasis, seborrheic dermatitis, and Pneumocystis carinii pneumonia. The second stage of the model involves a loss of systemic immunity and requires profound CD4 T-cell lymphopenia (CD4 cell count <50 cells/mm3), and is marked by infections such as cytomegalovirus and disseminated Mycobacterium avium infection. The influence of HLA type on the risk for such opportunistic infections becomes apparent during this late phase.

AIDS-Related Opportunistic Infections↗

PubMed1995

Alopecia areata in Korea (1982-1994).

I clinically studied 905 patients with alopecia areata (AA) who visited the Department of Dermatology, College of Medicine, Chung Ang University, from January of 1982 to February of 1994. The purpose of the study was to evaluate the clinical manifestations and compare the effects of treatment with intralesional injection of triamcinolone acetonide suspension and immunotherapy with dinitrochlorobenzene (DNCB) or diphenylcyclopropenone (DPCP). The results were as follows: 1) The incidence of AA among all out-patients (59,970) was 1.5% (905 cases), and the ratio of males to females was 1.3:1 (512:393). 2) The age distribution showed high incidences in the third (41.8%) and fourth decades (20.0%). 3) The family history was contributory in 104 cases (11.5%). 4) The relapse rate was 17.5% (158 cases). 5) Almost half of the patients had a solitary lesion (408 cases, 46.7%). 6) The most common site of predilection was the occipital region of the scalp in both male and female patients. 7) Associated diseases were seborrheic dermatitis, atopic dermatitis, hepatitis, hypertension, open heart surgery, thyroid disease, pulmonary disease, and vitiligo in order of frequency. 8) The effect of treatment on the patients who had bald patches less than 50 cm2 was not significantly statistically different between intralesional injection of triamcinolone acetonide and immunotherapy with DNCB or DPCP. 9) In cases with bald areas more than 50 cm2, including alopecia totalis and universalis, DNCB or DPCP immunotherapy showed better therapeutic effects than did intralesional injection of triamcinolone acetonide.

Adolescent↗

PubMed1998

Pruritic skin diseases in the elderly.

A total of 149 elderly men and women with pruritic skin problems were selected for study at the dermatological clinic in the Department of Medicine, Rajavithi General Hospital, Bangkok, Thailand, from 26 November 1996 to 10 January 1997. There were 62 men (41.6%) and 87 women (58.4%). The average age was seventy years. Among these elderly patients, pruritic skin disease was the most common problem, found in about 41%. Xerosis (senile pruritus) was the most common problem at 38.9%. Other pruritic skin diseases found were inflammatory eczema (22.8%), lichen simplex chronicus (12.1%), skin infections (11.4%), psoriasis vulgaris (6.7%), urticaria (4.7%), drug rash (2%), insect bite (0.7%), and anogenital pruritus (0.7%). Xerosis usually occurred with increased bathing frequency and use of strong soaps and detergents. The causes of inflammatory eczema were seborrheic dermatitis, allergic contact dermatitis, dyshidrosis, and stasis dermatitis. Statistical analysis of xerosis and inflammatory eczema by gender showed no difference, but there was more inflammatory eczema among females.

Age Distribution↗

PubMed2000

Keratosis lichenoides chronica: marked response to calcipotriol ointment.

Keratosis lichenoides chronica (KCL) is a rare dermatosis characterized by a distinctive seborrheic dermatitis-like facial eruption, together with violaceous, papular, and nodular lesions on the extremities and trunk, typically arranged in a linear and reticulate pattern. KLC is resistant to therapy, although spontaneous remission has been reported. We describe a 35-year-old woman with KLC who had the typical features of widespread violaceous, reticulate, and striae-like eruptions with a prominent keratotic component over a nine-year period and who responded well to treatment with calcipotriol ointment. The immunohistochemical profiles are presented in addition to typical histopathologic features.

Administration, Cutaneous↗

PubMed2000

A retrospective survey of mucocutaneous manifestations of HIV infection in Malaysia: analysis of 182 cases.

A retrospective analysis of 182 HIV positive Malaysians was done in two centers, the University Hospital Kuala Lumpur (UHKL) and the General Hospital Kuala Lumpur (GHKL) from March 1997 to February 1998. Demographic and clinical data were analyzed. The analysis showed that 130 out of 182 patients had mucocutaneous disorders (71.4%). In the study there were 125 males (96.2%) and 5 females (3.8%). The majority of the patients were in the age group from 20 to 50 years. The patients who presented with mucocutaneous disease also had low CD4+ T lymphocyte counts, and most of them had AIDS defining illnesses. The number of cases with generalized hyperpigmentation was very high (35.7%), followed by papular eruptions (29.1%) and xerosis (27.5%). Seborrheic dermatitis was seen in 19.2% of the cases and psoriasis in 7.7%. The most common infections were oral candida 35.7%, tinea corporis and onychomycosis 9.9%, and herpes infection 4.3%. However, mucocutaneous manifestations of Kaposi's sarcoma were rare. The results suggested that mucocutaneous findings are useful clinical predictors of HIV infection or a sign of the presence of advanced HIV infection.

Adult↗

PubMed2006

Androgenetic alopecia in adolescents: a report of 43 cases.

Androgenetic alopecia (AGA) is the most common type of hair loss in adults, but it also occurs in adolescents, though its prevalence among this younger population is not well established. The purpose of this study was to evaluate the clinical manifestations and endocrine status of adolescent patients with AGA in Korea. This 5-year (January 2001-August 2005) clinical study involved 43 adolescent patients with AGA. Testosterone and dehydroepiandrosterone sulfate (DHEA-S) laboratory studies were undertaken to investigate androgenic hormonal effects. Hair loss severity was categorized using the Hamilton-Norwood and Ludwig classifications. Gender ratio showed a male predominance (M : F, 35:8), and a mean age at onset of 16.8 years. These adolescent patients showed milder symptoms than adults, and a family history of alopecia was found in 72.1%, which is greater than that reported in adults, which ranges 30.9-64.5%. Seborrheic dermatitis (27.9%) was the condition most commonly associated with AGA among our study subjects, followed in descending order by acne vulgaris and atopic dermatitis. Serum levels of testosterone and DHEA-S were within normal limits, except in one subject. Our study shows the clinical characteristics of AGA in Korean adolescents.

Adolescent↗

PubMed1993

Clinical and laboratory evaluation of AIDS trichopathy.

BACKGROUND: The present study reports the incidence of trichocutaneous disorders studied in 500 patients infected with HIV 1 in a large university-based setting. Correlation of these findings with immunologic function at the time of diagnosis is presented. Unusual presentations and therapeutic interventions are discussed. Prognosis as related to various trichocutaneous disorders is elaborated. METHODS: All patients in this study were HIV 1 positive by Western blot assay. T-cell subsets were evaluated by monoclonal antibodies against T-cell surface markers. Hair disorders were analyzed by means of light hair pull test, hair mount, polarizing microscopy, trichogram, scalp biopsy, and cultures for bacteria, fungi, and mycobacteria as indicated. Trichologic manifestations were classified based upon immunologic correlation of absolute level of helper T cells/mm3. RESULTS: The majority of hair disorders in the study population occurred with helper T cell numbers of less than 150/mm3. Papulosquamous problems including seborrheic dermatitis and psoriasis were most commonly noted followed by disorders of cell growth cycle regulation and trichokeratinization, i.e., telogen effluvium and loose anagen syndrome. CONCLUSIONS: Multiple trichocutaneous disorders occur in the setting of retroviral infection. Most of these disorders occur in the setting of progressive immunoincompetence. The awareness of the disorders described here will aid the clinician in both the recognition and management of pilar aberrations in the appropriate clinical setting.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Prevalence of dermatological disorders in Thai HIV-infected patients correlated with different CD4 lymphocyte count statuses: a note on 120 cases.

BACKGROUND: Skin disease is one health problem among human immunodeficiency virus (HIV)-seropositive patients. Several dermatological findings in HIV-infected patients have been investigated. In this study, the skin lesions of 120 HIV-infected patients with different CD4 count statuses in Bangkok, Thailand, are studied. METHODS: This study was performed as a cross-sectional descriptive study. All subjects had a complete physical examination to detect their dermatological disorders and carried out the necessary diagnostic procedures by consultation with the dermatologist. RESULTS: Eighty percent of all patients were observed to have one or more skin disorders. Xerosis (73.33%) and oral candidiasis (54.17%) were the most common skin disorders, followed by seborrheic dermatitis (46.67%), pruritic papular eruption (36.67%), oral hairy leucoplakia (12.50%), folliculitis (11.67%), herpes zoster (9.17%), and alopecia (6.67%). CONCLUSION: Although the pattern of cutaneous lesions was comparable with previous reports, the strikingly lower prevalence of skin tumor and drug eruption was reviewed. Patients with advanced HIV infection were found to have significantly more skin disorders than those with early stage HIV.

AIDS-Related Opportunistic Infections↗

PubMed2004

Seasonal variation of dermatologic disease in the USA: a study of office visits from 1990 to 1998.

BACKGROUND: Seasonal variation has been demonstrated in many diseases, including certain skin diseases. OBJECTIVE: To determine whether there is seasonal variation in dermatologic office visits in the USA. METHODS: Data on dermatologic office visits were obtained from representative visits to outpatient physicians in the USA from the National Ambulatory Medical Care Survey from 1990 to 1998. Office visit seasonality was examined for all skin conditions, and individually for the 15 most commonly diagnosed conditions. RESULTS: Office visits for skin conditions were seasonal (P = 0.002). The magnitude of variation can be roughly expressed by the following scheme: actinic keratosis (P = 0.0001) > acne (P = 0.0001) > folliculitis (P = 0.002) > dyschromia (P = 0.01) > seborrheic keratosis (P = 0.04) > psoriasis (P = 0.07) > seborrheic dermatitis (P = 0.09). Visits for skin cancer, not otherwise specified (skin cancer NOS), atopic dermatitis, cysts, common wart, wart, not otherwise specified (wart NOS), rosacea, contact dermatitis, and benign tumors showed no significant seasonal variations or trends. CONCLUSIONS: Dermatologic office visits are seasonal, with visits for individual diseases varying in their magnitude of seasonality. This seasonal variation may be a result of biological and nonbiological variables.

Humans↗