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Henna-induced hemolytic anemia and acute renal failure.

Henna is a traditional cosmetic agent and is used worldwide, especially in the Middle East. Its active agent is lawsone (2-hydroxy-1,4-naphthoquinone). Henna is not only applied to hands or hair as a cosmetic agent in traditional ceremonies, but is also applied to the body on lesions in the treatment of seborrheic dermatitis or fungal infections. However, its application over the body or in newborns is rare. Here we report a 27-day-old boy who developed hemolytic anemia and acute renal failure following topical application of henna to his abdomen, intertriginous region and legs to treat diaper rash.

Acute Kidney Injury↗

[Tinea faciei in a newborn].

Dermatophytosis in newborns and infants has been regarded as very unusual; a case recently observed of a 2-month-old child affected by tinea faciei is described. Twenty days before, localized erythematous infiltrated patches at the upper left eyelid and eyebrows with papules and pustules, were observed. Rarefaction of the eyebrows and partially loss of the eyelashes associated with scattered areas of erythematopapulous lesions on the face, were seen. Mycological examination was positive and trichophyton rubrum colonies grew. Tinea capitis is more common than tinea faciei in newborn and infants. Differential diagnosis includes: seborrheic dermatitis, atopic dermatitis with associated impetigo, candidiasis, bacterial folliculitis. The interhuman transmission by relatives is the most probable modality of trans-mission, as previously reported in the literature. A widespread of the dermatoses was due to previous application of topical corticosteroids. The lesions resolved completely after treatment with miconazole cream, applied twice daily for three weeks.

Age Factors↗

Cutaneous manifestations in HIV positive patients.

Cutaneous manifestations are common clinical findings among HIV positive patients. The causes may be bacteria, viruses, fungi and other non-infectious agents. This study was conducted at the Pramongkutklao Hospital skin clinic to determine the frequency distribution of cutaneous manifestations in HIV positive patients. A total of 147 patients with HIV seropositivity were recruited and divided into a retrospective group and a prospective study group. For the retrospective study, hospital records of 129 patients who attended from January 1995 to November 1998 were recruited. The prospective study was carried out from November 1998 to January 1999 and 18 patients were recruited. Cutaneous finding among patients in the two studies were evaluated. There were ten common cutaneous manifestations observed in the retrospective and prospective study including pruritic papular eruptions (PPE) (51.2%, 50%), oral candidiasis (16.7%, 21.7%), herpes zoster (10.9%, 5.6%), oral hairy leukoplakia (10%, 5.6%), unclassified eczema (9%, 11.1%), urticaria (5.6%, 3.1%), seborrheic dermatitis (4.7%, 16.7%), folliculitis (4.7%, 5.6%), prurigo simplex (4.7%, 5.6%), and Steven-Johnson syndrome (3.9%, 0%). However, the distribution of cutaneous manifestations in the two studies were not significantly different. These findings may be useful as baseline data for common cutaneous manifestations in HIV positive patients.

AIDS-Related Opportunistic Infections↗

Evaluation and treatment of itching in HIV-infected patients.

Itching is a common complaint among patients infected with HIV and may cause significant morbidity and embarrassment. Although idiopathic HIV-pruritus has been described, it is probably less common than was previously thought. In most patients, a careful history and physical examination will show that a dermatosis accounts for their pruritus. Dry skin, seborrheic dermatitis, eczema, psoriasis, pruritic papular eruption, staphylococcal folliculitis and prurigo nodularis are frequently encountered in these patients. These common dermatoses, drug eruptions, several rarer conditions and systemic causes of itching should be excluded before diagnosing idiopathic HIV-pruritus. Treatment should be directed to the underlying skin problem and may be supplemented with sedating antihistamines. Phototherapy is a safe and effective therapeutic modality for many pruritic dermatoses as well as for idiopathic pruritus.

AIDS-Related Opportunistic Infections↗

Psoriasis in infancy: therapy with calcipotriene ointment.

Psoriasis in infancy is often more therapeutically challenging than atopic and seborrheic dermatitis. The generalized nature of psoriasis and the intensity of inflammation often reduce the efficacy of topical corticosteroids. Furthermore, involvement of intertriginous skin and the presence of scalp disease limit the potency of the topical steroids that can be prescribed. We report on an infant treated with topical calcipotriene for infantile psoriasis who experienced greater benefit than he had with standard corticosteroid medications. Laboratory testing for calcium metabolism was normal during the course of therapy. We conclude that calcipotriene can be a safe and effective therapy for psoriasis in early infancy.

Calcitriol↗

Dermatological diseases and signs of HIV infection.

Therapy of HIV infection has undergone significant changes since the introduction of highly-active antiretroviral therapy (HAART). Mortality and the appearance of opportunistic infections have significantly been reduced. Diseases of the skin and adjacent mucous membranes often provide the first signs for HIV infection. The spectrum of dermatologic findings related to HIV includes a variety of cutaneous and mucocutaneous disorders. The most frequent diagnoses are oral candidiasis, mollusca contagiosa, oral hairy leuokoplakia, herpes zoster and herpes simplex, seborrheic dermatitis, and Kaposi's sarcoma. Incompatibility reactions to drugs are observed on a strikingly frequent basis in HIV infection. Such severe incompatibility reactions are much more frequent in HIV patients than in the normal population. Inducers often include sulfonamides, cotrimoxazole, tuberculostatics as well as nucleoside-type reverse transcriptase inhibitors.

Drug Eruptions↗

Effects of anabolic-androgenic steroids on the pilosebaceous unit.

Examination of skin biopsy specimens from persons using anabolic-androgenic steroids demonstrates dramatic hypertrophy of the sebaceous glands. High dosages of testosterone and anabolic-androgenic steroids, often self-administered by athletes, increase skin surface lipids, the cutaneous population of Propionibacteria acnes and the cholesterol and free fatty acids of the skin surface lipids. Acne, oily hair and skin, sebaceous cysts, hirsutism, androgenic alopecia, striae atrophicae, seborrheic dermatitis, and secondary infections including furunculosis may occur in persons using these drugs.

Acne Vulgaris↗

Four cases of dermatomycosis: superficial cutaneous infection by Alternaria or Bipolaris.

Invasive dermal infections in immunosuppressed patients by a wide variety of opportunistic fungi are well described in the literature; however, superficial infections (dermatomycosis) are more rarely described. We report 4 cases of dermatomycosis by Alternaria or Bipolaris species. All but one of the patients had predisposing conditions including topical corticosteroid use, atopic or seborrheic dermatitis, and nail dystrophy. All 4 patients were otherwise immunocompetent. These cases represent some of the very few reports of Bipolaris in a primary stratum corneum infection and the first report of Bipolaris in an otherwise healthy person. We also describe what may be the first report of Bipolaris onychomycosis. All of our patients responded to topical or oral imidazole antifungal therapy. We discuss the significance of Alternaria and Bipolaris as contaminants or irrelevant organisms grown in some cultures of skin scrapings.

Administration, Oral↗

Skin diseases in alcoholics.

Alcohol abuse is associated with many health problems, especially skin changes. As a small, water- and lipid-soluble molecule, alcohol reaches all tissues of the body and affects most vital functions. Cutaneous diseases are now emerging as useful markers of alcoholism detectable at an early and possibly reversible stage of the disease, thus being of substantial importance to dermatologists and general practitioners. The most common skin manifestations of alcoholism presented in this review article are urticarial reactions, porphyria cutanea tarda, flushing, cutaneous stigmata of cirrhosis, psoriasis, pruritus, seborrheic dermatitis, and rosacea.

Alcohol-Induced Disorders↗

[The scaly scalp].

Scaly scalp is a common problem in the pediatric and adult population. The possible causes range from the commonly seen tinea capitis, seborrheic dermatitis and psoriasis to rare diseases such as lupus erythematosus and lichen planus. In all cases a thorough history and physical examination are important first steps to successful diagnosis and treatment.

Humans↗

[Taxonomy of Malassezia furfur: state of the art].

Malassezia furfur is a lipophilic yeast considered as a normal component of the human skin flora. Apart from pityriasis versicolor, M. furfur has been linked to several skin diseases such as seborrheic dermatitis, folliculitis or atopic dermatitis. Moreover, these yeasts have been reported as agent of invasive human diseases including pneumonia, catheter-associated sepsis and peritonitis. The existence of morphological, serological, metabolical, biochemical and karyotipical differences has been described among isolates of these yeasts. These observations gave arguments for a possible intraspecific division, and this hypothesis has been confirmed by the existence of six species within the formerly called M. furfur (lipid-dependent Malassezia strains): M. furfur, Malassezia sympodialis, Malassezia globosa, Malassezia obtusa, Malassezia restricta and Malassezia slooffiae.

English Abstract↗

Management of sports-induced skin wounds.

Skin wounds are common in sports but are rarely documented by the certified athletic trainer. The literature is unclear about wound types, and none of the articles reviewed reported frequencies. The purpose of this paper is to discuss the frequency of common athletic skin wounds and their specific management. Management of skin wounds can sometimes be problematic. Hydrogen peroxide has been used on wounds since 1947, yet some researchers report that hydrogen peroxide and iodophor solution can delay or interfere with wound healing, or cause damage to the wounded area if use is intense and prolonged. Occlusive dressings have been reported to have considerable advantage in maintaining a moist wound bed and in decreasing healing time. Infection rates beneath occlusive dressings, however, are similar to those associated with other types of dressings. Complications to wounds, with or without the use of occlusive dressings, such as keloids and seborrheic dermatitis, occur in low frequencies. Due to a lack of specific information about sports-induced skin wounds and their management, we recommend that standardized documentation for common wounds be developed along with further study of techniques for management.

Journal Article↗

[Pyoderma vegetans as an early sign of HIV infection].

Skin and mucosal lesions are described in a 40-year-old man who suffered from HIV infection in the stage of secondary diseases. The diagnosis was supported by demonstration of antibodies to HIV in the immune blotting test. The clinical manifestations were reduced to steady fever, generalized lymphadenopathy, pyoderma vegetans and chancriform pyoderma, candidiasis of the oral cavity, and seborrheic dermatitis, HIV infection was diagnosed 4 years after the appearance of pyoderma which initially was amenable by external antibacterial agents and then became resistant to them. Eruptions of pyoderma vegetans simulating wide condylomas were located in inguinal folds, on the internal surface of the thighs and scrotum; the chancriform focus was located in the internal preputial layer. The treatment with azothymidine combined with antibacterial and antimycotic agents led to the improvement of the patient's general status and to the reduction of local lesions. However, on recommendations of an unknown witch doctor who started treating him with the aid of reflexotherapy, phytotherapy and bioenergetic actions the patient stopped receiving the treatment prescribed and did not report for control examinations. After 5 months he died of brain edema.

Acute Disease↗

[Immunohistochemical study for the localization of apolipoprotein AI, B100, and E in normal and psoriatic skin].

Recently many new knowledge about the LDL receptors and LDL-receptor mediated endocytosis of cholesterol have been reported (Goldstein et al. 1979). This phenomenon is also observed in keratinocyte. The use of low density lipoprotein-gold (LDL-gold) technique in electron microscopy demonstrated a reciprocal correlation between cell differentiation and LDL-receptor expression in normal and psoriatic skin which is characterized by keratotic disorder and epidermal hyperproliferation. (Mommaas-Kienhuis et al. 1987). In order to study the interaction between normal skin and lipid, and the affect of lipid to psoriatic skin, we investigated the localization of apolipoprotein AI, B100 and E in epidermis. Six normal skins, ten psoriatic skins and three skins of seborrheic dermatitis were obtained. In normal epidermis, apolipoprotein B100 was markedly detected intercellularly, and apolipoprotein E was observed intracellularly. In contrast, apolipoprotein AI was not detected in epidermis. This result showed that keratinocytes expressed B and E receptors on their surface membrane, connecting with apolipoprotein B100 and apolipoprotein E respectively. But this finding that positive reaction sites were found in all layer of epidermis also suggested that anti-apolipoprotein B100 antibody reacted extracellular cholesterol excreted outside from keratinocytes. In psoriatic skin, the basement membrane of dermo-epidermal junction, the vascular walls and perivascular regions in papillary dermis were stained positively by anti-apolipoprotein AI antibody. But the localization of apolipoprotein B100 and E were similar to normal skin, and they were also detected in the parakeratotic regions in horny layer. These results did not show the relationship between cell differentiation and B, E receptor expression on keratinocyte. And it is suggested that cholesterol metabolism in keratinocyte affected the pathogenesis of psoriasis.

Apolipoprotein A-I↗

Papulosquamous disorders associated with human immunodeficiency virus infection.

Papulosquamous eruptions are the most frequently seen cutaneous manifestations of human immunodeficiency virus (HIV) infection. Especially common and useful in making a diagnosis of HIV infection are seborrheic dermatitis, xerosis or ichthyosis, and a pruritic or papular eruption. There is some evidence from transgenic mice studies that the transactivating gene TAT and the HIV provirus may produce epidermal hyperplasia, either directly or through cytokine production, without associated immunodeficiency. The association of certain papulosquamous diseases, especially psoriasis, with HIV has opened up new avenues of research on pathogenesis of hyperproliferative skin disease.

HIV Infections↗

Cutaneous manifestations of HIV infection in children.

The vast majority of children with infection with the human immunodeficiency virus (HIV) develop some form of mucocutaneous disease during the course of their illness. Candidal, fungal, bacterial, and viral infections of the skin and mucous membranes tend to be more severe and less responsive to therapy than in the healthy child. Children with HIV infection are also at risk for drug eruptions, seborrheic dermatitis, and several other inflammatory disorders of the skin. An understanding of the cutaneous manifestations of HIV infection may aid in the early diagnosis and appropriate treatment of this disease.

Child↗

Human immunodeficiency virus infection and the skin.

The skin is commonly affected in the course of human immunodeficiency virus (HIV) infection. In many cases, skin findings may be the earliest sign of HIV disease or acquired immunodeficiency syndrome. When cutaneous diseases occur in unusual settings, such as zoster in a young individual, are increased in severity or fail to respond to routine therapy, the possibility of underlying immunodeficiency should be suspected. Skin diseases in HIV-infected hosts include primary infections, such as those caused by herpes simplex virus and molluscum contagiosum, as well as secondary involvement of systemic diseases, such as cryptococcosis and histoplasmosis. Noninfectious inflammatory processes, such as seborrheic dermatitis and psoriasis, as well as neoplasms, such as Kaposi's sarcoma and basal cell carcinoma, may all be seen in these patients. We review a number of these diseases and discuss their treatment. Clinicians must be aware of the cutaneous manifestations of HIV infection so that the disease will be recognized at an earlier point in time and therapy with zidovudine and prophylactic antibiotics will be instituted where appropriate.

HIV Infections↗