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Annular facial dermatoses in blacks are common. Although the diagnosis of these dermatoses is usually made without difficulty, occasionally problems are encountered. A patient with annular seborrheic dermatitis that closely resembled the annular lesions of secondary syphilis is presented. The differential diagnosis of annular facial lesions in the black patient is then briefly reviewed.
BACKGROUND: Chemical peeling is a skin-wounding procedure that may have some potentially undesirable side-effects. AIMS: The present study is directed towards safety concerns associated with superficial chemical peeling with salicylic acid in various facial dermatoses. METHODS: The study was a non-comparative and a prospective one. Two hundred and sixty-eight patients of either sex, aged between 10 to 60 years, undergoing superficial chemical peeling for various facial dermatoses (melasma, acne vulgaris, freckles, post-inflammatory scars/pigmentation, actinic keratoses, plane facial warts, etc.) were included in the study. Eight weekly peeling sessions were carried out in each patient. Tolerance to the procedure and any undesirable effects noted during these sessions were recorded. RESULTS: Almost all the patients tolerated the procedure well. Mild discomfort, burning, irritation and erythema were quite common but the incidence of major side-effects was very low and these too, were easily manageable. There was no significant difference in the incidence of side-effects between facial dermatoses (melasma, acne and other pigmentary disorders). CONCLUSION: Chemical peeling with salicylic acid is a well tolerated and safe treatment modality in many superficial facial dermatoses.
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In the present study, 40 patients with facial skin lesions and Demodex folliculorum (DF) mite density > 5/cm(2) by SSSB were evaluated for their immune response through counting T-cell subsets (CD3-CD4-CD8) and NK cells (CD16) numbers and IgG, M, D concentrations in peripheral blood in relation to DF mite density. They were 26 females and 14 males with overall mean age was 48.57+/-15.33 years. A control group of 40 healthy individuals without any skin diseases was enrolled. The mean DF mite density (MD) was 11.82+/-3.72/cm(2) in patients compared to 1.77+/-2.39 /cm(2) and a prevalence of 47.5% in controls. The difference was statistically significant. MD significantly correlated with age both in study and controls, but not with sex. A significant decrease in the absolute numbers of lymphocytes, T-cell subsets and NK cells was found in the study group in comparison with controls. Mean IgM level was significantly higher in patients. No significant correlation was observed between MD and the immune response. So, DF mites modulate the host cellular immune response to their advantage, as T-cell subsets and NK cells seem to be the target of immuno-suppression, favouring dermatosis development.
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Fifty-four patients taking minocycline for acne or rosacea were assessed for adverse effects. Their mean duration of treatment was 17 months, and their average cumulative dose was 47 g. No symptoms attributable to the therapy were reported. Biochemistry and haematology profiles were normal. There was no evidence of an adverse effect on thyroid function. Skin pigmentation was detected in eight patients (14.8%). Five patients had diffuse facial pigmentation, and three patients had localized pigmentation at the site of a scar or injury. Diffuse pigmentation occurred only in patients who had been on treatment for 3 years or more; 50% of such patients were affected. Age and solar damage may also have been factors in this type of pigmentation. Localized pigmentation occurred at sites of previous tissue damage, and was not directly related to the duration of therapy. Patients who receive long-term minocycline therapy should be regularly monitored for the development of pigmentation.
BACKGROUND: Tacrolimus ointment is increasingly used for anti-inflammatory treatment of sensitive areas such as the face, and recent observations indicate that the treatment is effective in steroid-aggravated rosacea and perioral dermatitis. We report on rosaceiform dermatitis as a complication of treatment with tacrolimus ointment. OBSERVATIONS: Six adult patients with inflammatory facial dermatoses were treated with tacrolimus ointment because of the ineffectiveness of standard treatments. Within 2 to 3 weeks of initially effective and well-tolerated treatment, 3 patients with a history of rosacea and 1 with a history of acne experienced sudden worsening with pustular rosaceiform lesions. Biopsy revealed an abundance of Demodex mites in 2 of these patients. In 1 patient with eyelid eczema, rosaceiform periocular dermatitis gradually appeared after 3 weeks of treatment. In 1 patient with atopic dermatitis, telangiectatic and papular rosacea insidiously appeared after 5 months of treatment. CONCLUSIONS: Our observations suggest that the spectrum of rosaceiform dermatitis as a complication of treatment with tacrolimus ointment is heterogeneous. A variety of factors, such as vasoactive properties of tacrolimus, proliferation of Demodex due to local immunosuppression, and the occlusive properties of the ointment, may be involved in the observed phenomena. Future studies are needed to identify individual risk factors.
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In hyperadrenocorticism in the dog, cutaneous lesions may include alopecia, thin, hypotonic skin, hyperpigmentation, comedones, calcinosis cutis, secondary bacterial and fungal infections, and demodicosis. Skin lesions affecting only the face have not been reported in reviews of hyperadrenocorticism, nor has the disease been included in the differential diagnoses of facial dermatoses. This report involves 4 dogs with hyperadrenocorticism in which cutaneous signs were limited to the face.
Two patients with Cowden disease, a syndrome consisting of cutaneous papules and nodules on the face, oral mucous membranes and dorsal aspects of the forearms and hands in association with tumours of the thyroid gland, breasts, gastro-intestinal tract, and female reproductive tract, are reported. This disease is important to the physician because recognition of these cutaneous lesions may allow early diagnosis of internal neoplasia.