Non-dermatophyte Dermatoses Mimicking Dermatophytoses in Humans.

Human dermatophytic cutaneous infections usually present as single or multiple slowly progressing annular erythemato-squamous lesions with a tendency to central healing on the hairless skin. In the intertriginous regions (feet, inguinal, axillar, submammary), dermatophytic colonisations and infections manifest as whitish, slightly hyperkeratotic, pruritic and sometimes fissurated lesions. On the scalp, dermatophytic infections commonly lead to single or multiple more or less inflammatory and alopecic lesions. On the plantar and palmar aspects of the feet and hand, dermatophytosis presents as an eczema-like chronic dermatosis. Abscess-like lesions may occur due to zoophilic dermatomycosis. Dermatophytic infections of the nails reveal ill-defined whitish-yellowish colorations of the distal end or the lateral aspects of the nails, sometimes combined with partial nail embrittlement or even complete destruction. Despite the ubiquity of dermatophytic skin infections and their usually highly typical clinical features, a differential diagnosis has to be considered, in particular when treatment is not efficient or when treatment resistance occurs. This review presents the differential diagnosis in terms of frequency as well as the diagnostic methods permitting the distinction of annular, intertriginous, alopecic, palmoplantar, abscess-like and onychodystrophic lesions.

[Rosacea]. / La rosacea.

Rosacea is a common centro-facial dermatosis with a high socio-esthetic impact. Different subtypes are distinguished, classified into grades according to their severity. This classification is essential for therapeutic management. In general, rosacea remains difficult to treat as its pathophysiology is still not entirely understood. Future research is needed for a better understanding of this disease and the development of targeted treatments.

Satellite lesions accompanying herpes zoster: a new prognostic sign for high-risk zoster.

BACKGROUND: The incidence, clinical relevance and pathogenesis of single, isolated, varicella-like skin lesions occurring far beyond the primary herpes zoster (HZ)-affected dermatome remain unclear. OBJECTIVES: To search prospectively for these satellite lesions in 120 patients with HZ and to correlate their presence with a series of clinical, histological and virological data. METHODS: Relevant clinical data were recorded from 109 patients with proven HZ using immunohistochemistry on Tzanck smears. Furthermore, skin biopsies and blood samples were obtained from a subgroup of patients presenting with primary HZ with and without satellite lesions for histology, immunohistology, serology and real-time polymerase chain reaction. RESULTS: This study identified satellite lesions in 21·1% of the patients with HZ. Their presence conveyed a statistically significant relative risk (RR) for severe (RR 3·27, P < 0·001), multidermatomal (RR 10·6, P < 0·001) and multistage HZ (RR 3·30, P < 0·001); systemic signs (RR 2·08, P = 0·0031); immunosuppression (RR 2·38, P = 0·0014) and hospitalization (RR 2·94, P < 0·001). Varicella zoster virus (VZV) viraemia was higher (mean 4075 copies mL(-1) ) in patients with HZ with satellite lesions than in those without (mean 1466 copies mL(-1) ). In contrast to HZ lesions, satellite lesions often presented positive VZV immunostaining in endothelial cells, suggesting a similar pathogenesis to varicella. A limitation of this study is the centre-linked overrepresentation of immunocompromised patients. CONCLUSIONS: Total-body examination searching for satellite lesions is a rapid, simple and reliable tool for identifying patients with high-risk HZ.

Viral infections of the pubis.

There are no demographic data published on those with viral infections of the pubis (VIPs). We conducted a two-year prospective study to collect demographic information on patients with VIPs. Data were gathered on age, sex, diagnosis, low (≤10) or high (>10) lesion number, symptoms, how the patient discovered the lesions, localization, lesions beyond the pubis, risk factors, shaving habits, human papillomavirus (HPV) vaccination status and treatment. In a total of 61 patients, molluscum contagiosum (MC) was identified in 71%, condylomata acuminata (CA) in 11%, concomitant MC and CA infections in 11% and herpes simplex virus (HSV) infection in 4.8%. Shaving represented a risk factor for a high lesion number, but not for the extension beyond the pubis. MC, CA and HSV infections affecting the pubis are uncommon and often asymptomatic. As they may represent a hidden source of infection we recommend thorough inspection of the pubis during routine skin examination.

Photodynamic therapy and imiquimod immunotherapy for basal cell carcinomas.

Photodynamic therapy (PDT) and topical imiquimod immunotherapy (TII) are two recently introduced treatment modalities for certain types of basal cell carcinomas (BCC). We present a review of the relevant literature and report our own findings regarding the efficacy and tolerance of PDT and TII in the treatment of BCCs. According to published studies, the cure rates range from 75-95% for PDT and 42-100% for TII, depending on treatment modalities and BCC type. In our observations, 13 patients with nodular or superficial BCCs were treated by PDT using two courses of 3-hour topical application of methyl aminolevulinate, followed by 8 minutes illumination (lambda = 634 nm, e = 37J/cm2). Biopsies were taken before and one month after PDT. Side effects including pain and crusting were assessed. Eight patients with superficial BCC were treated by TII using 3 monthly courses each consisting of 3 weekly applications for 3 weeks followed by one week out of treatment. Biopsies were taken before and after 3 months of TII. Adverse reactions including erythema, oozing, ulceration, and crusting were recorded. Clinico-histological cure was obtained in 12/13 PDT cases as assessed after 1 month, and in 6/8 TII cases after 3 months. Minimal pain during illumination and crust formation were observed in 7/13 and 3/13 PDT cases, respectively. Variable erythema, oozing, ulceration, and crusting were observed in all TII-treated lesions. It is concluded that PDT represents an active and well tolerated alternative treatment for both nodular and superficial BCCs. TII also shows activity, although the tolerance may be poor and cure needs a longer time to be obtained. The final cosmetic appearance was fine following both PDT and TII procedures. Both PDT and TII may leave intact neoplastic aggregates inside the skin. They cannot be clinically perceived, leading to unexpected recurrences. It is stressed that the currently available efficacy information about PDT and TII deals with short term follow-up periods. A 5-year follow-up must be awaited before drawing firm conclusions.

Skin cancer screening campaign in the German speaking Community of Belgium.

The incidence of primary malignant melanoma (MM) and skin carcinomas, including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), is progressively raising. As long as their diagnosis and therapeutic managements are initiated early, their prognosis remains favorable. This underlines the importance of early recognition of skin cancers. Furthermore, it has been demonstrated that skin cancer screening programs are efficacious in increasing the population awareness of the early signs of skin cancer and of the dangers of UV - exposure. A skin cancer screening campaign was organised by dermatologists of the German-speaking Community of Belgium in cooperation with the Department of Family, Health, and Social Affairs of the Regional Ministry of the German-speaking Community of Belgium. In order to increase the screening selectivity, two risk populations were targeted; patients presenting 30 or more moles, and patients over 50 years of age presenting recent skin changes of the head and neck area. A media campaign using radio, television and daily press was started to increase the population awareness of the dangers of UV exposure and of the early signs of skin cancer. During 2 screening days, three-hour sessions were organised in 2 health centers located in Eupen and St Vith. A total of 148 patients were examined. A total of 124/148 patients met the selection criteria predefined during the media announcement. The simultaneous presence of 4 dermatologists during the screening sessions allowed a second opinion for warning lesions. Four BBCs as well as 23 patients pesenting dysplastic nevi were clinically diagnosed. During the 2 months following the screening campaign 5 MMs were identified by the same dermatologists in their routine practice. In conclusion, this skin cancer screening campaign led to the diagnosis of 4 carcinomas. The campaign furthermore increased the patient awareness, permitting the diagnosis of 5 MMs during the 2 following months. This figure represents about 30% of all MMs diagnosed yearly in this region of Belgium.

[Relativity of the management of skin cancers. A plea for synergy between general practitioners and the dermatologist-oncologist]. / Relativité de la prise en charge des cancers cutanés. Plaidoyer pour la synergie entre le médecin généraliste et le dermatologue-oncologue.

The clinical diagnosis and treatment of cutaneous cancers represent a frequent situation in cancerology. About one third of all human cancers take their origin from the skin. The general practitioner and the dermatologist-oncologist play the key role in that field of health care.

[Cutaneous melanomas, a spectrum of emerging cancers in women of Wallonia. Outlook by the Mosan Study Group of Pigmented Neoplasms]. / Les mélanomes cutanés, un spectre de cancers émergents chez la femme en région Wallonne. Un regard porté par le Groupe Mosan d'Etude des Tumeurs Pigmentaires.

The Mosan Study Group of Pigmented Neoplasms was founded about 15 years ago. It has collected more than 20,000 cutaneous malignancies including melanomas and basal and squamous cell carcinomas. The incidence of these cancers is on the rise in Wallonia. In particular, malignant melanomas represent a spectrum of emerging cancers characterized by a proteiform biological outcome. They mostly affect young women. The major risk factor appears to be iterative and unwise ultraviolet exposures. The prevention of melanomas is basically founded on such a dogma and accordingly relies on sunscreens. However, controversies about their beneficial effects are rife and fueled by axiomas and contradictory sophisms. At the exception of surgery, the therapeutic options for the diverse types of melanomas do not yet fulfill the scope of evidence-based medicine.

Breaking the relentless course of Hallopeau's acrodermatitis by dapsone.

We report the case of a 74-year-old man who suffered for four years from recurrent generalized pustular eruptions associated with acrodermatitis continua of Hallopeau (ACH). Initial therapy using topical corticosteroids, tars and PUVA failed to improve the acral lesions. The disease was also unresponsive to systemic therapy using corticosteroids, methotrexate, etretinate, acitretine and cyclosporin A. Serious side-effects were experienced with these drugs. A marked improvement of the generalized pustules was observed under treatment combining etretinate and methotrexate, without having any effect on the acropustulosis. During hospitalization, a topical tar therapy cleared the pustular rash. Again no effect was observed on the acral lesions. Disulone (DDS) therapy, initiated at a dose of 200 mg/day, completely cleared ACH after 4 weeks. The disease relapsed when the dose was reduced to 100 mg/day. Increasing the DDS to 150 mg/day was rapidly followed by a new clearance of the acral lesions. After a 3-month treatment, the patient has remained lesion free and no DDS-related side-effects have occurred. In conclusion, sulfones may be considered as an alternative therapeutic option in drug-resistant ACH.

Subclinical skin stiffening in adults suffering from type 1 diabetes mellitus. A comparison with Raynaud's syndrome.

Acral skin of patients suffering from either type 1 diabetes mellitus or Raynaud's syndrome may become stiffer than normal. Such changes have not yet been thoroughly assessed using biometrological methods. The purpose of this study was to compare the mechanical properties of skin in these two conditions. Subclinical alterations were looked for on the back of the hands. We used an in vivo suction device equipped with two probes measuring skin extensibility and elasticity of the superficial and deep layers of the skin, respectively. A total of 58 middle aged adults with type 1 diabetes, 26 patients suffering from Raynaud's syndrome and 50 sex- and age-matched healthy volunteers participated in the study. There is evidence that both diseases affect the biomechanical properties of the dermis and of the underlying tissues. The dual changes are apparently opposite, corresponding to a superficial dermal laxity while the deep dermo-hypodermal tissues show some stiffening. From a biomechanical point of view, type 1 diabetes aggravates skin ageing and is also responsible for a subclinical skin stiffening in many patients. Raynaud's syndrome shows similar changes although the skin ageing effect is less prominent and the skin stiffening more frequent.

Dermo-epidermal stimulation elicited by a beta-lipohydroxyacid: a comparison with salicylic acid and all-trans-retinoic acid.

Although ageing has been thought to be irreversible, studies made during the last decade have shown that a few topical compounds may limit or improve the age-related skin damages. The efficacy of tretinoin (all-trans-retinoic acid) in treating photoageing is well established. Identifying other compounds with similar effect and improved tolerance would be greatly valued. In this double-blind study, a new beta-lipohydroxyacid compound was evaluated. To address a comparison between products, 6 volunteers completed a 4-week study using twice daily 0.025% tretinoin, 5% salicylic acid, 1.5% beta-lipohydroxyacid or vehicle. Immunohistochemistry and computerized image analysis were performed on skin sections from biopsies taken after treatment. We searched for changes in epidermal renewal (Ki-67 labeling), modifications in cytokeratin (56-65 kD) and filaggrin patterns, and in tumor necrosis factor alpha (TNF-alpha), Ulex europaeus and factor XIIIa expressively. The vehicle- and salicylic-acid-treated areas had an aspect similar to untreated control sites. Both beta-lipohydroxyacid and tretinoin induced enhanced epidermal proliferation and thickness with activation of factor XIIIa+dendrocytes. The effects were more pronounced at the tretinoin-treated site. We speculate that TNF-alpha might mediate some of the dermal effects. The beta-lipohydroxyacid mimics some of the stimulatory effects of tretinoin on the epidermis and dermis. This new compound should be listed among topical products boosting the skin tissues affected by ageing.

Naevocyte triggering by recombinant human growth hormone.

The influence of growth hormone and insulin-like growth factor I on human melanocytes is being increasingly recognized. Clinical evidence has shown that when recombinant human growth hormone (hGH) is administered to children of short stature, the growth of melanocytic naevi is boosted. This study was conducted on 56 hGH-triggered naevi and nine similar lesions excised before or after hGH therapy for hypopituitarism and Turner's syndrome. A series of 40 naevi excised from age-matched healthy children served as controls. Atypicality of naevocytes was investigated using image analysis, AgNOR counts, immunohistochemistry (HMB-45, NKI-C3, Ki-67, anti-bcl-2-oncoprotein), and DNA flow cytometry. The data associate hGH treatment with anisokaryosis and increased AgNOR and Ki-67 counts in naevocytes. The same cells also show abnormal patterns of HMB-45 immunolabelling. These indications of naevocyte activation were not suggestive of malignant transformation. hGH-triggered melanocytomas should be added to the list of atypical melanocytic naevi. The long-term evolution of these lesions remains unknown and the potential risk of malignant transformation awaits careful evaluation.

Computerized evaluation of skin stiffening in scleroderma.

Modern non-invasive biometrological methods have proven to be helpful in monitoring some skin disorders. The present study was designed to evaluate the mechanical properties of skin in systemic scleroderma. The Cutometer SM 474 was used to measure the rheological properties of the skin in 33 patients suffering from scleroderma. The most prominent abnormality consisted in a marked reduction in skin extensibility. Changes occurring in time objectivate the evolution of the disease. Measuring the mechanical properties of skin in patients with scleroderma may be useful in monitoring the disease and its treatment.

Mechanical properties of the diabetic waxy skin.

BACKGROUND: In some diabetic patients, the skin of the hands has a waxy appearance. OBJECTIVE: To study subclinical skin stiffening in diabetic patients using a noninvasive, in vivo suction device measuring skin extensibility and elasticity. Skin thickness was also measured by high-resolution ultrasonography. METHODS: Evaluations were made on the dorsum of the hands and on the volar aspect of the forearms. RESULTS: In type 1 diabetic patients, the extensibility of skin was decreased while values of thickness and elasticity were increased. These alterations were most prominent on the hands. Similar modifications, although less pronounced, were also found in type 2 diabetic subjects. CONCLUSION: The reported biomechanical changes indicate the presence of subclinical skin stiffening in many patients with diabetes mellitus. Such noninvasive biometrological evaluations could be used for monitoring, rating and correlating some diabetes-associated disorders.

Influence of the test area on the mechanical properties of skin.

BACKGROUND: New advances in bioengineering have provided commercially available devices for measuring the mechanical properties of skin in vivo. Reproducibility of data and methodological approaches have not yet been thoroughly studied. OBJECTIVE: To study the reproducibility and the influence of the area of the test site on the values of biomechanical variables yielded in a normal population. METHOD: A 500-mbar suction was transmitted to the skin through Cutometer probes equipped with a 2- or 8-mm opening. RESULTS: The best reproducibility was obtained for the maximum distension of skin and for the biological elasticity. The values of the standard biomechanical ratios were almost the same for both probes. Linear correlations were found between parameters of elasticity. CONCLUSION: The Cutometer is a reliable device. A high degree of correlation exists between biomechanical variables related to elasticity. Under a suction of 500 mbar, both the 2- and 8-mm probes give results which correlate statistically in a large population. However, the two probes do not measure precisely the same aspect of skin mechanics. The 2-mm probe measures the capacity of superficial skin folding, and the 8-mm probe explores the biomechanical properties of the dermis itself and of its slipping mobility on the hypodermis. The biomechanical parameters which appear the most clinically relevant for a normal-looking skin are the maximum distension and the biological elasticity.

Optical profilometry of nail dystrophies.

Optical profilometry after nail shadowing is introduced as a new technique to quantify nail surface alterations. Objective evaluations can be performed in vivo as well as on nail clippings and silicone rubber replicas. Trachyonychia, pittings, grooves and any other type of onychodystrophy are conveniently defined by 3 profilometric parameters: the mean roughness, the mean depth of roughness and the number of peaks or crests.

Karyometry of malignant melanoma cells present in skin strippings.

BACKGROUND/AIMS: Skin strippings harvest the malignant melanoma cells eliminated through the stratum corneum. In this study, morphometry was applied to such non-invasive samplings in order to derive objective information about nuclear atypia. METHOD: Cyanoacrylate skin surface strippings were collected from 140 malignant melanomas. Karyometry was performed to quantify the size and shape of malignant cell nuclei. RESULTS: Anisokaryosis was prominent although the outline of nuclei were rather smooth. CONCLUSION: Image analysis of skin strippings harvested from malignant melanomas shows that anisokaryosis is the major cytologic feature of malignant melanoma cells in transit in the stratum corneum.