Cutaneous protothecosis in a patient with previously undiagnosed HIV infection.

Protothecosis is an uncommon condition resulting from infection by achlorophyllous algae of the Prototheca species. Immunocompromised individuals are generally most susceptible to protothecal infection and tend to develop severe and disseminated disease. However, the association between protothecosis and HIV-induced immunosuppression is not clear, with only a handful of cases having been described to date. Here we report a case of cutaneous protothecosis in a Chinese man with previously undiagnosed HIV infection that responded well to oral itraconazole.

Atopic dirty neck or acquired atopic hyperpigmentation? An epidemiological and clinical study from the National Skin Centre in Singapore.

BACKGROUND: 'Atopic dirty neck' is a poorly understood acquired hyperpigmentation in patients with atopic dermatitis (AD). OBJECTIVE: To report a single-centre experience with synthesis of this entity's features. METHODS: All patients with AD with dirty neck seen over a 5-month period at the National Skin Centre were invited to participate. RESULTS: Out of 544 AD patients examined, 78 (14.3%) had acquired pigmentation of the neck. The majority had moderate-to-severe underlying eczema. Histopathology showed increased epidermal melanin and dermal melanophages, a thickened basement membrane and a dense superficial perivascular infiltrate. CONCLUSION: Acquired atopic hyperpigmentation has a high prevalence, particularly in adolescent Asian males. Clinico-pathological correlation suggests it results from both frictional melanosis and post-inflammatory hyperpigmentation. The rippled appearance and the onset in adolescence are probably due to accentuation of the juxta-clavicular beaded lines. Optimal control of eczema may improve and potentially prevent the development, which is of importance considering the psychosocial impact of the condition.

Contact dermatitis: a common adverse reaction to topical traditional Chinese medicine.

BACKGROUND: Over the past decade, there has been an increase in the use of topical traditional Chinese medicine (TTCM). The most common adverse event seen in the use of TTCM is contact dermatitis. This retrospective study was designed to determine the types of commonly used TTCM in Singapore causing contact dermatitis. METHODS: We retrospectively reviewed the case notes of 10 patients seen at the National Skin Centre over a 4-month period with a diagnosis of adverse cutaneous reactions to TTCMs. RESULTS: A total of 10 patients were diagnosed with contact dermatitis to TTCM at our institution over a 4-month period. The clinical manifestation ranged from eczematous lesions to urticarial plaques and blisters. Five of these patients were patch-tested to our standard series, our in-house TTCM series, as well as to the TTCM they had used. The other five patients declined patch testing. The results of patch testing confirmed the diagnosis of allergic contact dermatitis in three of the tested patients. Negative patch testing results inferred the diagnosis of irritant contact dermatitis to TTCM in the other two patients. Two of the patients with positive patch tests also had a positive reaction to balsam of peru and fragrance mix. The three positive patch tests were all caused by medicated oils. CONCLUSIONS: These results suggest it is likely that essential oils present as constituents of the medicated oils could be the possible allergen. The study also confirms that contact dermatitis is a common adverse event associated with the use of TTCM.