Hourglass epidermoid inclusion cyst: an unusual clinical presentation

Although hourglass epidermoid inclusion cysts have been reported in the cranial region, they have not been reported elsewhere in the body. We report a case of an epidermoid inclusion cyst that was excised completely.

Investigation of skin diseases in non- domestic animals.

The skin is a readily accessible organ and dermatological disorders are commonly seen in a wide variety of species. In order to investigate skin diseases of non-domestic animals, the veterinarian must have some understanding of their varied biology and natural history. Sample- taking may require anaesthesia and techniques must be appropriate to the type of lesion and the species in question. Processing of samples is usually carried out in a similar way to those from domestic animals. Interpretation of the findings need caution. The establishment of databases will help in the progression of comparative dermatology in the West Indies and elsewhere.

Investigation of skin diseases in non- domestic animals.

The skin is a readily accessible organ and dermatological disorders are commonly seen in a wide variety of species. In order to investigate skin diseases of non-domestic animals, the veterinarian must have some understanding of their varied biology and natural history. Sample- taking may require anaesthesia and techniques must be appropriate to the type of lesion and the species in question. Processing of samples is usually carried out in a similar way to those from domestic animals. Interpretation of the findings need caution. The establishment of databases will help in the progression of comparative dermatology in the West Indies and elsewhere.

Chemical peeling of the dark skinned patient Fitzpatrick type IV, V & VI

Chemical peeling of the skin has been an important therapeutic tool for the treatment of many skin diseases and especially for eliminating effects of solar damage, postinflammatory hyperpigmentation and scarring. Its application is safest in the fair skin types (Fitzpatrick 1, 11 & 111). This study was aimed at determining the incidence of complications in 500 Dark Skinned patients Fitzpatrick (IV, V & VI) by using the technique of applying superficial peel to an entire anatomical unit followed by "small patch" medium and deep peels only to the most severely affected areas of skin. 70 percent glycolic acid was used for superficial peel. 70 percent glycolic acid with 35 percent Trichlorocetic Acid (TCA) for medium peel, and 70 percent glycolic acid with 50 percent TCA for deep peel. Five hundred patients were evaluated for possible various complications by two independent examiners. Clinically, the combination of glycolic acid and TCA was safe and effective in peeling the dark skin: Complications included:- Hyperpigmentation - 6.6 percent; Erythema - 1.8 percent; Scaring - 0.4 percent; Milia - 0.2 percent; Poor physician/patient relationship - 0.2 percent. The incidence of complication following chemical peels of the dark skinned patient is low when medium and deep peeling are done in small patches of skin (1 to 10cm patches) in areas that needed it most and not to entire anatomical units.(AU)

Is enough dermatology training given to primary health physicians?

Large numbers of patients with minor skin ailments are being referred by primary health physicians to skin clinics with little attempt at diagnosing and treating these cases. This study evaluated whether primary health physicians were exposed to enough dermatology in their training to diagnose and treat simple dermatoses. In this retrospective cross-sectional survey the diagnosis, treatment, source of referral of all patients seen between January and June 1997 in two health centres in East Trinidad, Sangre Grande (SG) and Arima (A), were reviewed. There werer 146 registered patients at Sangre Grande and 189 at Arima. The commonest skin disorder was eczema (SG 37 percent, A 38 percent). The ability to diagnose this condition was 25 percent in Arima and 7 percent in Sangre Grande. Atopic exzema was the commonest in childhood (A 16 percent, SG 13 percent). Fungal infections, which included tinea corpois (A 8 percent, SG 7 percent) and tinea capitis ( A 15 percent, SG 8 percent), were the next most common dermatoses seen. The diagnostic ability for tinea corpois was: A 13 percent SG 0 percent; but there was a higher diagnostic index for tinea capitis (A 52 percent, SG 50 percent). Psoriasis (A 21 percent, SG 7 percent), like tinea capitis, had a diagnosis index of 50 percent. The most common referring diagnosis was skin rash (43 percent, SG 45 percent) or fungal rash (A 38 percent, SG 36 percent). There were significant differences in gender (P <0.05) and ethnicity (P<0.001) in Arima. In conclusion, the commonest dermatoses seen in both centres, were the eczemas, fungal infections and psoriasis. Diagnostic ability was low for the eczemas and tinea corporis, the commonest skin disorders, but better for tinea capitis and psoriasis. Increase referrals fof common skin disorders leads to overcrowding, decreasing the time for the dermatologist to do procedures, to teach and to give earlier and more frequent appointments to needy patients. Cost of treatment of patients and to Government is lower when the diagnosis is made on the initial visit, and loss of school days for tinea capitis can be decreased by prompt and effective treatment.(AU)

Black Skin Disease in South East London

Skin disease in black patients can present a diagnostic challenge both because of variations in clinical appearance and because certain disorders appear unique to black skin. The majority of dermatology text books and atlases concentrate mainly on white skinned patients. Our hospital serves a cosmopolitan local community in whom 40 percent of the population is black. We recorded the diagnosis made in 461 consecutive black (African, Afro-Caribbean and mixed-race) patients who attended a general dermatology new patient clinic in South East London. The aim of the study was to document the spectrum of skin disease seen in black patients and to highlight these disorders. 187 children and 274 adults were studied. In the black children atopic eczema was diagnosed in 38 percent, tinea capitis 26.7 percent, pityriasis alba 3.7 percent, viral warts 3.2 percent, keloids 2.7 percent, others 25.7 percent. Diseases recorded which are not seen in the white children included Facial Afro-Caribbean Childhood Eruption (FACE) and infantile acropustulosis. Of the 274 adults assessed, acne was diagnosed in 14.6 percent, eczema 10.2 percent, psoriasis 5.1 percent, pityriasis versicolor 4.0 percent, alopecia areata 3.3 percent, dermatofibroma 2.9 percent, urticaria 1.8 percent, pityriasis rosea 1.8 percent, cutaneous sarcoid 1.5 percent, discoid lupus 1.1 percent. Diseases more commonly seen in black skin were acne nuchae keloidalis/scalp folliculitis 14.6 percent, keloids 4.4 percent, post inflammatory pigmentation 3.6 percent and traction alopecia 1.1 percent; other disorders were seen in 30 percent. Normal variants recorded were dermatosis papulosa nigra, linear nail pigmentation and palmar pits. As the UK population becomes increasingly cosmopolitan, familiarity with skin disorders in both black and white skin is increasingly relevant to our practice. (AU)

HTLV-I seroprevalence among patients with severe skin disorders at the University Hospital of the West Indies, Jamaica - abstract

This prospective study of seroprevalence of human T-lymphotropic virus Type I (HTLV_I) among patients with sever skin disorders at the University Hospital of the West Indies (UHWI) was undertaken because of the high prevalence of skin lesions in patients with adult T-cell lymphoma/leukaemia (ATL) both before and after diagnosis was made. Of 901 patients admitted to the dermatology ward between May 1989 and October 1996, 195 were found to be HTLV-I seropositive, giving a seroprevalence rate of 21.6 percent. The commonest disorders among the HTLV-I positive group were infected dermatitis (ID), ATL, crusted scabies and eczema other than ID. Skin disorders with the highest HTLV-I positive rates were ID (100 percent), ATL (85.7 percent) and crusted scabies (70 percent). Eczema other than ID, erythroderma and psoriasis also had a significantly higher HTLV-I positivity rate than the general Jamaican population but less than the first three mentioned. Seven patients were co-infected with HTLV-I and HIV-I, and the commonest skin disorder among this group was seborrhoeic dermatitis. There was 100 percent positivity among fifteen mothers of ID patients tested. The results confirm the hypothesis that there is a higher HTLV-I seroprevalence rate among patients with severe skin disorders than the general population in Jamaica. (AU)

Prevalence of paediatric skin diseases in rural Honduras

Although review of medical literature suggests that skin disease is a common cause of morbidity in developing countries, there have been few prospective primary care studies to document the prevalence of dermatologic conditions. The goal of this study was to determine the prevalence of paediatric skin diseases in rural Honduras. The study was conducted in October 1992, during a medical mission sponsored by the University of Cincinnati, Children's Hospital Medical Center (Cincinnati) and the Honduran Ministry of Health (AU)

Paediatric skin disease at Port-of-Spain general hospital, Trinidad - abstract

A one-year study was carried out on children in the age-group neonates to 12 years attending the Paediatric Skin Clinic at the Port-of-Spain General Hospital. Referrals to this clinic came from general practitioners, health offices from most of the north of Trinidad as well as the Outpatient Paediatric Clinics. The 340 new paediatric skin patients seen formed 20 percent of the total population of new cases seen in all skin clinics in the period under review. Atopic eczema (26 percent) was the commonest paediatric skin problem, and this together with tinea capitis (14 percent), scables (12 percent), papular urticaria (9 percent), seborrhoeic eczema (7 percent), viral warts (6 percent) comprised the six most common skin conditions in the age groups. Only the first four when severe tended to interfere with school attendance. The apparent preponderance of Afro-Trinidadians is consequential on geography and is therefore not significant (AU)

Primary idiopathic cutaneous amyloidosis: can coconut oil be a contributing factor? - abstract

Twenty patients who presented clinically with either macular or lichen amyloidosis at clinics at the Port of Spain General Hospital or the St. Joseph Health Centre had skin biopsies done. Two control groups of male and female patients were randomly selected. They presented with other unrelated skin conditions and either used coconut oil only occasionally or used other types of oil. Skin biopsies were stained with haematoxylin and eosin and congo red/methyl violet. The study group were all female Indo-Trinidadians who had daily applied coconut oil to the arms, legs and hair for an average period of 31 years (range 4 months - 40 years). In 15 patients, there was histological confirmation of amyloid. Seven patients had at least 1 family member with a similar skin condition. Papular and macular skin lesions were seen on the anterior aspect of the leg and the extensor aspect of the arm and scapular region. It is proposed that the common practice among female Indo-Trinidadians of daily application of coconut oil to arms, legs and hair is a risk factor in the development of primary cutaneous amyloidosis and that genetic and familial factors are also involved in this condition (AU)

Coexistence of porphyria cutanea tarda and systemic lupus erythematosus

The association of porphyria cutanea tarda with a well-documented case of systemic lupus erythematosus is reported. Renal histopathology is presented. Both conditions have been quiescent during the past year of follow-up (AU)

Incidence of skin disease in rural Jamaica

The incidence of skin disease in people seeking health care in rural Jamaica during the period January to December 1985 has been studied. Results indicate that of 14,179 clinic visits reviewed, 6 percent involved a primary dermatological diagnosis. Infectious and parasitic diseases predominated, with scabies, impetigo, and tinea being the most common diagnoses. Of these, scabies accounted for nearly one third of all dermatologic visits. Noninfectious skin disease accounted for less than 10 percent of dermatologic diagnosis, with unclassified eczema making up the majority. Undiagnosed skin conditions contributed one third of dermatologic visits, with an incidence inversely related to the incidence of scabies visits. This relationship suggests that many evaluations of skin conditions were based on the exclusion of scabies with no alternative diagnosis. (AU)

Amoebiasis presenting as an abdominal wall abscess (Amoeboma cutis)

A case of amoebic liver abscess which eroded the anterior abdominal wall and presented as an epigastric skin lesion is described. The diagnosis was established on finding trophozoites of Entamoeba histolytica in pus and tissue from the abscess wall. Treatment was carried out by incision and drainage, specific chemotherapy, and surgery, including closure of an associated gastro-cutaneous fistula (AU)