Fluticasone in mild to moderate atopic dermatitis relapse: A randomized controlled trial.

BACKGROUND: The long-term efficacy of corticosteroids to prevent atopic dermatitis (AD) relapses has partially been addressed in children. This study compared an intermittent dosing regimen of fluticasone propionate (FP) cream 0.05% with its vehicle base in reducing the risk of relapse in children with stabilized AD. METHODS: A randomized controlled, multicentric, double-blind trial was conducted. Children (2-10 years) with mild/moderate AD (exclusion criteria: >30% affected body surface area and/or head) were enrolled into an Open-label Stabilization Phase (OSP) of up to 2 weeks on twice daily FP. Those who achieved treatment success entered the Double-blind Maintenance Phase (DMP). They were randomly allocated to receive FP or vehicle twice-weekly on consecutive days for 16 weeks. The primary study endpoint was relapse rate; time to relapse and severity of disease were also studied. Kaplan-Meier estimates were calculated. RESULTS: Fifty-four patients (29 girls) entered the OSP (23 mild AD) and 49 (26 girls) continued into the DMP. Mean age was 5.5 (SD: 2.8) and 5.1 (SD: 2.3) yrs for FP and vehicle groups, respectively. Four patients withdrew from the DMP (two in every group). Patients treated with FP twice weekly had a 2.7 fold lower risk of experiencing a relapse than patients treated with vehicle (relative risk 2.72, SD: 1.28; p=0.034). FP was also superior to vehicle for delaying time to relapse. Both treatment therapies were well tolerated. CONCLUSION: This long-term study shows that twice weekly FP provides an effective maintenance treatment to control the risk of relapse in children with AD.

Syphilitic alopecia: a report of 5 cases and a review of the literature.

Syphilitic alopecia occurs in only 4% of patients with syphilis. We present 5 cases of this uncommon manifestation and review the corresponding literature. All of the patients in our series were men aged between 31 and 46 years. The lesions, which were located mainly in the parieto-occipital area of the scalp, manifested as multiple, irregular, nonscarring patches of alopecia that adopted a characteristic patchy moth-eaten pattern. One patient initially presented diffuse alopecia with multiple erythematous scaling lesions. Immunohistochemical staining revealed the presence of numerous spirochetes in the hair follicles in the 2 patients in whom skin biopsy was performed. The lesions improved with treatment in all the patients who attended follow-up. Dermatologists should maintain a high level of clinical suspicion for this uncommon manifestation of syphilis, particularly when it is the only symptom.

Erythroderma. A clinicopathological study of 56 cases.

BACKGROUND AND DESIGN: Erythroderma may be the result of many different causes. There are several publications on this subject, most of them from England, the United States, and the Scandinavian countries reporting a different incidence of each etiologic group. Our objective has been to determine the frequency of erythroderma in our environment, its cause, and patient evolution. We reviewed the clinical, laboratory, and biopsy material of 56 patients diagnosed with erythroderma who were treated in our department in the last 8 years (1984 through 1991). Patients were followed up to know the evolution of the erythroderma. RESULTS: The male-female ratio was 4:1. The mean age at diagnosis was 57 years. Dermatoses were the most frequent cause of erythroderma (62.5%), followed by topical or systemic drug reactions (16%), and cutaneous T-cell lymphomas (12.5%). Follow-up information was obtained from 42 patients (66%). Eight patients died (19%), but only in three cases was death directly related to erythroderma (7.14%). The group associated with the best prognosis was that related to drugs. The best clinicohistologic correlation was found in cutaneous T-cell lymphoma-related erythroderma. CONCLUSIONS: Erythroderma of unknown cause and protracted course may be secondary to senile atopic dermatitis, intake of drugs overlooked by the patients, and patients who are in slow progression to cutaneous T-cell lymphoma. Close follow-up of erythrodermas of unknown cause by repeating cutaneous biopsies will in time allow an early diagnosis in patients in the latter group.

[Tinea capitis by Microsporum audouinii]. / Tinea capitis por Microsporum audouinii.

We report the case of a four year-old girl from Equatorial Guinea who had been living in Spain for the last month. She presented several alopecic patches on the scalp. The direct study of the hair with 40% KOH showed an ectothrix infection and the mycological study revealed the etiologic agent was Microsporum audouinii. We present this case because of its rarity in our country and we point out the increasing interest of the imported tineas due to immigration from African countries.

[Rickettsia conorii: a new cause of erythema nodosum]. / Rickettsia conorii: una nueva causa de eritema nodoso.

A case of 26 year old male with an infection caused by Rickettsia conorii (RC) associated to erythema nodosum (EN) is presented. The patient had EN together with a high temperature and toxic symptoms 2 weeks after camping in the mountains. The diagnosis was made by ascertaining IgM titers positive to RC by indirect immunofluorescence (IIF). The disease disappeared 24 hours after the initiation of treatment with doxiciclin. Based on this observation, we consider RC to be an etiologic agent which should be taken into account in the differential diagnosis of EN.

[Sarcoidosis of the paranasal sinuses]. / Sarcoidosis nasosinusal.

Nasosinusal Sarcoidosis is an uncommon entity setting forth diagnostical and therapeutical questions to be answered. The AA. report a case of the sort with simultaneous pathological involvement of the skin, without systemic manifestations. The disease showed as a mucopurulent scaly rhinitis. The maxillary sinus was stuffed with sarcoid tissue. Both topical and systemic treatment with corticoid drugs failed to bring nasal and sinusal lesions to lessening. The skin changes unfolded favourably.

[Adquired epidermolysis bullosa. Immunopathological and ultrastructural studies]. / Epidermólisis ampollosa adquirida. Estudio inmunopatológico y ultraestructural.

A case of epidermolysis bullosa acquisita (EBA) in a 64 year old man is reported. The direct immunofluorescence showed a positive lineal anti IgG basement membrane on the affected skin (blisters and provocation tests) and on the univolved healthy skin. The electron microscopic studies showed a "dermolysis". In this patient it was not possible to find any pathological association. The EBA is usually associated with different processus but, sometimes, it could be isolated. Probably this clinicopathological field includes diverse badly delimited entities.

[Oral hairy leukoplakia. A study of 5 cases]. / Leucoplasia vellosa oral. Estudio de cinco casos.

Oral hairy leukoplakia (HL) is a newly described lesion (1984) in human immunodeficiency virus infected patients. Patients with HL show a high probability of developing an acquired immunodeficiency syndrome (AIDS). The results of histopathological, microbiological, immunological and ultrastructural studies in five patients with HL and AIDS are reported. The histopathological exam revealed in all cases acanthosis, parakeratosis, koilocytosis and keratin projections on the surface. Dermis was normal. Herpes type virus were seen in four cases and in one of them papilloma virus was also present in electron microscopic examination. There was immunocytochemical evidence of papilloma virus in one lesion. Candida albicans was found in 5 lesions by culture but only in two ones by periodic acid Schiff stain. Virus cultures for herpes virus were negative. Immunocytochemical search of Langerhans cells (S-100, HLA-DR, OKT4, OKT6) showed nearly absence of these cells in HL lesions. These results favour the viral etiology hypothesis of hairy leukoplakia.

Sensitization in early age to food allergens in children with atopic dermatitis.

BACKGROUND: Clinical and laboratory evidence increasingly supports the notion that food allergy plays a role in the pathogenesis of atopic dermatitis (AD). However, the prevalence of clinically significant food hypersensitivity among children with AD remains an unanswered question. OBJECTIVE: To prospectively determine the prevalence of IgE-mediated food hypersensitivity among patients referred to a dermatology department for evaluation of AD, and to analyze the clinical relevance of these sensitizations in AD. METHODS: We studied 44 infants of both sexes, aged less than 12 months old, who attended the dermatology department with symptoms of AD. Compliance with Hanifin-Rajka criteria was confirmed and the severity of AD was evaluated using the SCORAD index. IgE-mediated sensitization to cow's milk, alpha-lactalbumin, beta-lactoglobulin, casein, egg-white, egg-albumin, ovomucoid and foods introduced into the diet was studied using the skin prick test (SPT) and measurement of specific serum IgE (sIgE) by CAP System fluorescein-enzyme immunoassay. Cow's milk, as well as suspected foods from the clinical history or those with a positive SPT and/or sIgE, were withdrawn from the diet to evaluate improvement in AD, and an open controlled challenge test was carried out. RESULTS: Of the 44 patients studied, sensitization to foods was detected in 27 (61 %). No changes were observed in AD during the elimination diet or when the eliminated foods were subsequently reintroduced into the diet. The results of open controlled food challenges were positive in 12 patients (27 %). CONCLUSIONS: A high prevalence of food sensitization was found in infants with AD. The most frequent sensitization observed was to egg, although with little clinical relevance since this food had not been introduced into the diet. In the sample studied, the clinical relevance of the observed food hypersensitivities was confirmed in relation to AD. Further studies are required to confirm these results.

Sinus histiocytosis confined to the skin. Case report and review of the literature.

Sinus histiocytosis with massive lymphadenopathy is an uncommon disease affecting individuals of either sex and of all ages and ethnic backgrounds. We present a case of sinus histiocytosis confined to the skin in a 65-year-old woman whose diagnosis was coincident with herpes simplex virus infection and polybacterial urinary infection, both asymptomatic. The polymerase chain reaction for herpes simplex virus and human herpesvirus-6 from involved skin was negative. We review previously published cases of sinus histiocytosis limited to the skin.