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Authors describe two cases of computer operators (female subjects) which experienced face skin disorders in connection with computer's terminal staffing. The first case was concerned with acute worsening of seborrheic dermatitis, the second one with photosensitive reaction complicated partially by psychogenic erythema.
Nearly all patients infected with the human immunodeficiency virus (HIV) will develop cutaneous or mucous membrane manifestations. Oral cavity lesions associated with HIV disease include candidiasis, hairy leukoplakia and Kaposi's sarcoma. Skin infections such as herpes simplex, herpes zoster, molluscum contagiosum, Staphylococcus aureus folliculitis and warts are often more severe than usual and may be refractory to therapy. Seborrheic dermatitis is the most common cutaneous eruption. The appearance of Kaposi's sarcoma in a patient younger than 60 years of age or in any individual with laboratory evidence of HIV infection is diagnostic of acquired immunodeficiency syndrome. Serious drug reactions may occur, despite the depressed cellular immunity associated with HIV infection.
Plasma levels of vitamin E (vit E) and polyunsatured fatty acids of phospholipids (PUFA-PL) as well as erythrocyte glutathione peroxidase (GSH-Px) activity are significantly lower (p less than 0.001) in patients HIV sero-positive (AIDS and ARC cases) both affected and not affected with seborrheic dermatitis and in 32% of HIV sero-negative intravenous drug abusers (IVDA, A subgroup) than in controls. The deficiency of PUFA-PL (mainly C20:3 n-6, C20:4 n-6 and C22:6 n-3) which is associated with a significant increase (p less than 0.001) of saturated palmitic and stearic acids and monounsaturated oleic acid, cannot be correlated to an active lipoperoxidative process. In fact the levels of thiobarbituric acid-reactive materials (TBA-RM) are not increased in the plasma of HIV sero-positive patients and A subgroup of IVDA. It is likely that the reduction of PUFA-PL is due to an inhibition of hepatic microsomal desaturase enzymes (delta 6 desaturase, delta 5 desaturase, delta 4 desaturase) which are involved in both n-6 and n-3 pathways. Since IVDA represent, and not only in Italy, a major risk category for HIV infection, we suggest that reduced blood levels of vit E, GSH-Px and particularly PUFA-PL may be added to the list of risk factors favouring the onset and the development of AIDS.
Coal tar has been used in dermatology for over a hundred years. It was the main therapeutic agent for the treatment of various skin orders before the introduction of topical steroid. Since the advent of topical steroid the use of coal tar has reduced considerably. It is still being used a lot in the treatment of psoriasis. In this paper I will describe how I use coal tar not only in psoriasis, which is well known, but also in acne, folliculitis, eczema and seborrheic dermatitis and vitiligo, which are less well known.
The occurrence of chronic esophagitis, considered a precursor condition for esophageal cancer, among persons 15 to 26 yr of age and risk factors for the disease were investigated in Huixian, Henan Province, a high-risk area for esophageal cancer in the People's Republic of China. The 538 study subjects underwent an esophagoscopy with guided biopsies and cytology, a physical examination, an interview with a questionnaire including known and suspected risk factors for esophageal lesions, and collection of a 10-ml blood sample and overnight urine. One-third of the subjects was selected from households with a case of esophageal cancer in the past 6 yr and two-thirds came from control households. Histologically confirmed very mild, mild, and moderate esophagitis was observed in 31.6%, 10.7%, and 1.1% of 354 male and 30.4%, 4.3%, and 1.1% of 184 female subjects, respectively. In the multivariate case-control analysis of mile and moderate esophagitis compared with very mild esophagitis and normal subjects, the prevalence of mild and moderate disease was found to be positively associated with the consumption of burning hot beverages [odds ratio (OR) = 4.7], the prevalence of esophagitis among siblings (OR = 4.4), and family history of esophageal cancer (OR = 1.8) and negatively associated with the frequent consumption of fresh fruits (OR = 0.3) and wheat flour products (OR = 0.4). Weaker associations were seen for cigarette smoking and the use of cottonseed oil as the main cooking oil. Univariate associations seen with a clinical diagnosis of oral leukoplakia (OR = 2.7) and seborrheic dermatitis (OR = 3.7) are probably due to common risk factors such as smoking and nutritional deficiency. The present findings suggest that exposures early in life to environmental risk factors and nutritional deficiency may be responsible for inflammation and a weakened esophageal epithelium, resulting in a condition possibly more favorable for the development of esophageal cancer.
Pityrosporum ovale has been implicated in the pathogenesis of seborrheic dermatitis, a dermatosis occurring with high prevalence in symptomatic HIV-infected individuals. Quantitative cultures for P. ovale were taken in 12 HIV-seropositive patients and in 12 HIV-seronegative controls. Sera were analysed for antibodies to P. ovale. In HIV-seropositive patients, lymphocyte subsets were analysed. The mean number of P. ovale/cm2, the mean serum antibody titres against this yeast and the occurrence of cutaneous disorders did not differ significantly between the two studied groups. No correlation was found between the number of P. ovale/cm2 and the immune status of the HIV-seropositive subjects. The absence of more serious immunological deterioration in the studied HIV-seropositive men may explain the results of this study.
A new method for quantitative culture of Pityrosporum yeasts, the 'tape-method', is presented. Samples for culture were taken from the skin by stripping with 1 cm2 of tape, whereafter the tapes were placed over a drop of sterile olive oil which was pipetted on a Sabouraud medium. Plates were incubated at 37 degrees C, and after 7 days the numbers of Pityrosporum colonies growing under the tapes were counted. With this method a difference in numbers of Pityrosporum colonies between seborrheic dermatitis and normal skin could be discerned. This difference was significant. It appeared that two successive strippings were sufficient for quantitative culture. The 'tape-method' appeared to be a reliable and inexpensive diagnostic tool.
A 6-month-old infant with acquired immunodeficiency syndrome (AIDS) and typical scabies subsequently developed Norwegian scabies, with deterioration of clinical status. The infestation spread to several health care workers who were in close contact with the patient, despite standard isolation precautions. In the rapidly growing hospitalized pediatric AIDS population, Norwegian scabies should be considered in the differential diagnosis of eczematous or seborrheic dermatitis.
New data have shown that sebum secretion is highest in young adults and then declines steadily throughout life in both men and women. This parallels the decline in androgen levels, but this cannot be the sole factor because there is so much overlap in sebaceous gland activity between men and women. The increased occurrence of dry skin in the elderly has been shown to be unrelated to the sebum secretion rate. This is not unexpected, as children, with even less sebum, rarely have this problem. Seborrheic dermatitis, which is also much more common in the elderly, is also unrelated to sebum secretion rate.
We examined and interviewed 809 randomly selected individuals (56% women and 44% men, mean age 44 years) from 4 Swedish cities; 1.7% had the sun-reactive skin type I, 26.2% type II, 61.3% type III and 10.7% type IV. Some variations in the distribution of skin types were found between the cities. One hundred subjects (12.4%), mostly women (p less than 0.001), had a history of polymorphous light eruption. People with skin type IV had significantly fewer facial skin problems than the rest of the subjects (p less than 0.05). The majority of subjects with atopic eczema, acne vulgaris or seborrheic dermatitis experienced improvement after exposure to sunlight. Individuals with rosacea also experienced improvement more often than impairment from exposure to sunlight. Facial telangiectases occurred in 57% of the subjects, unilaterally in 8.5% of the cases. The occurrence of telangiectases increased with increasing age (p less than 0.001), increasing sunbathing (p less than 0.01) and poor pigmentation ability (p less than 0.05).
Dermatitis, the inflammatory response of the skin to various factors, may present in a variety of forms. Atopic dermatitis, contact dermatitis, nummular eczema, seborrhea, and stasis dermatitis, conditions with which the patient may present to the emergency department, either in the acute stage or with exacerbation of a chronic condition, are reviewed in this article.
A topical clinical trial with preparations containing urea and sodium pyruvate has been made. It was used for diverse hyperkeratotic skin conditions (psoriasis, xerosis, pityriasis rubra pilaris, stuccokeratosis, seborrheic dermatitis, stasis dermatitis, pityriasis lichenoides chronica). A month later a clinical improvement was evident in all cases except in pityriasis lichenoides.
We report 31 cases of AIDS-Kaposi's sarcoma (KS) studied at the Hôpital Saint-Louis, Paris, France, from January 1983 to January 1986. Twenty-nine cases were cutaneous KS and 2 were lymph-node KS. Twenty-eight patients were homosexual or bisexual males, 1 was a woman with transfusion-AIDS and 1 was an intravenous drug-addict; one male had no known risk factor. Thirty were male and 1 female, mean age 35.5 years (+/- 8.4). All were Caucasian and positive for LAV antibodies (Elavia). 17/30 (56.6 p. 100) had a history of syphilis, 16/30 (53.3 p. 100) had a positive TPHA test, 12/30 (40 p. 100) had a history of urethral discharge, 26/31 (87 p. 100) had a history of sexually transmitted disease. 27/30 had antibodies against HBs or HBc. 14/31 (45 p. 100) presented with mild symptoms (fever, loss of weight). 10/28 (36 p. 100) had lymph node enlargement before the first cutaneous lesions of KS developed. Initial involvement included the trunk (32 p. 100), the legs (25 p. 100), the face (21 p. 100) and the lower limbs (11 p. 100). Seventy-one p. 100 of the patients had more than 10 lesions at the initial assessment. The palate was involved in 50 p. 100 of patients, the lymph nodes in 74 p. 100, the stomach in 38 p. 100, the colon in 31 p. 100. In 8 cases pulmonary involvement was present. Altogether, 55 p. 100 of the patients had visceral involvement. Enlargement of the spleen (16 p. 100) and liver (13 p. 100) was also noted. Nineteen p. 100 of the patients had chronic dermatophytic cutaneous infection, 39 p. 100 had oral candidiasis, 32 p. 100 had seborrheic dermatitis, 6 p. 100 had oral hairy leukoplakia and 26 p. 100 had trimethoprim-sulfamethoxazole eruption. Fifty-five p. 100 developed opportunistic infection (OI) (Pneumocystis carinii 8 cases, intestinal cryptosporidiosis 6 cases, cerebral toxoplasmosis 4 cases, CMV pulmonary infection 3 cases). In 14 cases KS preceded OI and in 3 cases OI preceded KS. Biological results are shown in tables II and III. Main findings were: mild inflammatory syndrome (ESR 33 +/- 24 mm, first hour), polyclonal hypergammaglobulinemia (18.6 g/l +/- 5.8), elevation of plasma factor VIII related antigen (191 +/- 66 U/dl), elevation of serum activity of angiotensin-converting enzyme (23.8 +/- 5 nmol/ml/min), low plasmatic cholesterol (3.77 +/- 1.1 mmol/l).(ABSTRACT TRUNCATED AT 400 WORDS)
Pseudohypoaldosteronism is a rare syndrome occurring during early infancy, which is mainly characterized by salt-depletion crises. Sodium chloride is lost via the kidneys resulting in a reduced sodium level and raised potassium level in the serum, leading to life-threatening disturbances of water and acid-base concentration. The excessive sodium loss seems to be caused by an unresponsiveness of the renal tubules to endogenous and exogenous mineralocorticoids. The colon, salivary and sweat glands, which are also involved in sodium reabsorption, may likewise be affected by the disease. We describe skin changes in two siblings suffering from pseudohypoaldosteronism, who developed seborrheic dermatitis, folliculitis or miliaria rubra-like lesions during salt-depletion crises. Biochemical analysis revealed a highly increased sodium-chloride concentration in the sweat, saliva, urine and stool of both patients. Destructive inflammatory reactions could be demonstrated histologically within and around the dermal sweat glands, thus indicating the important role of the sweat system in the pathogenesis of skin lesions in pseudohypoaldosteronism.
Over the last twelve years, only three cases of a dissiminated form of histiocytosis X, in infancy, have been treated at the Institute for Mother and Child Health Care in Novi Sad. The clinical picture exhibits a very characteristic, prolonged (from two to nine months) first stage of the illness. Its general symptoms are: fever, general decline of the infant, seborrheic dermatitis, coughing and recurrent purulent otitis. In the second stage the symptoms are even more pronounced but they depend on localization and the functional deterioration of the organs involved: the lungs, liver, pancreas, skin, bone marrow and lymph nodes. The article underlines the importance of hematological, cytological and histiopathological analyses in diagnosis, and it gives the results for the cases in question. Particular emphasis is placed on the importance of a cytological analysis of the skin scarificate. Two of the patients in question were treated with antibiotics and corticosteroids, while the third received antibiotics, corticosteroids and cytostatics, yet the outcome of all three cases was fatal. This is attributed, in part, to the late beginning of treatment and, in part, to the early age of the patients.
The systemic complications of therapy with lithium are well known, but toxidermia has only been recognised since 1968. The carbonate (Teralithe) is the lithium salt which is mainly responsible, leading to minor dermatoses: oedema, pruritus, alopecia, urticaria, purpura, allergic vasculitis, pretibial ulceration. Some more specific conditions have been individualised by their severity and rarity: acne form eruptions, seborrheic dermatitis, follicular keratoses and psoriasis-like dermatosis as well as true psoriasis induced or aggravated by lithium. The authors review the literature and discuss the pathogenesis of these toxidermias. The cause of some dermatoses can be explained, especially the allergic vasculitis and psoriasis lesions. The underlying mechanism of most of these conditions remains unknown, but excessive tissue concentrations of the drug probably play an important role in inducing these complications.
When used properly in controlled situations, topical corticosteroids provide dramatic relief in distressing disorders such as eczema, psoriasis and seborrheic dermatitis. The fluorinated preparations are associated with a variety of side effects, including acne, striae, premature aging of the skin, hypertrichosis, perioral dermatitis, glaucoma and even adrenal suppression. Except for the severe, acute dermatoses, a nonfluorinated steroid is the better choice because of the relative lack of side effects and lower cost.
In 20 patients with rosacea and rosacea-like eruptions Demodex folliculorum mites were found in high numbers within lesional skin. In one patient Demodex folliculorum could be demonstrated in pits and burrows in the epidermis of the scalp. In other instances the mouth parts of the mites were closely related to the follicular epithelium. Recent parasitologic findings showed that in spite of their name (Demodex = "sebaceous worm") the mites derive their nutritive requirements from cellular proteins obtained by epithelial destruction. To clarify the pathogenetic significance of hair follicle mites in man as suggested by these histological findings as well as their known ability to form organisational centers of foreign body granulomas, further epidemiologic and immunologic studies are needed. Topical antiparasitic agents did not offer any therapeutic advantage over traditional preparations used for rosacea and seborrheic dermatitis.