Variegate Porphyria Triggered by Acute Hepatitis A Infection.

BACKGROUND: Variegate porphyria (VP) is a rare disorder of haem biosynthesis. We report a novel association with hepatitis A infection. PATIENT AND METHODS: A 31-year-old man was diagnosed with acute hepatitis A infection. During recovery, he presented with abdominal pain and a photoaggravated blistering skin eruption. RESULTS: Urine porphyrin precursors were markedly raised with high coproporphyrin III isomer levels. Faecal protoporphyrin levels were markedly increased and a maximum plasma fluorescence emission at 629 nm was noted. DISCUSSION: Acute hepatitis A infection, and the associated metabolic stress exerted on the haem biosynthetic pathway, induced overt presentation of latent VP. LEARNING POINTS: There should be a high index of suspicion for an acute cutaneous porphyria when a photosensitive rash is accompanied by neurovisceral symptoms.Latent porphyria may be overtly manifested after appropriate triggers which stress the metabolic haem biosynthetic pathway. One such trigger demonstrated by this case presentation is acute hepatitis A infection.The diagnostic approach to the investigation of a suspected acute cutaneous porphyria is initially with light-protected samples for urinary porphyrin precursors and plasma for fluorescence scanning. These should be sampled ideally during symptomatic periods. Further specialist analysis with fractionation of urinary and faecal porphyrins is necessary to distinguish between the two different acute cutaneous porphyrias.

The Antibiotic Susceptibility Profile of Cutibacterium Acnes in Maltese Patients with Acne.

BACKGROUND: Antibiotics have been widely used for the management of acne vulgaris, which has led to increased resistance of Cutibacterium acnes (C. acnes). OBJECTIVES: We sought to determine the susceptibility profile of C. acnes, isolated from patients with acne, to different prescribed antibiotics and compare our findings with global data. The relationship between antibiotic resistance and sex, age, acne severity, presence of any affected siblings, disease duration, and previous antimicrobial treatment was also investigated. METHODS: Samples were collected from randomly selected pustular acne lesions of patients attending the Dermatology Outpatients Clinic at Sir Paul Boffa Hospital in Floriana, Malta. Samples were inoculated and incubated in anaerobic conditions until 100 cultured C. acnes samples were obtained. Antibiotic susceptibility testing was then performed using azithromycin, clindamycin, doxycycline, minocycline, tetracycline, and trimethoprim/sulfamethoxazole using the agar dilution method. RESULTS: The highest resistance was observed to azithromycin (18%) followed by clindamycin (16%). Resistance to doxycycline and tetracycline was only found in two percent of the isolates and there was no resistance to trimethoprim/sulfamethoxazole and minocycline. Resistance to azithromycin and clindamycin was associated with acne severity (p=0.01 and p=0.03). Resistance to clindamycin was also statistically significantly higher in patients with a history of antibiotic therapy or concurrent antibiotic therapy during the study (p=0.04). CONCLUSION: To our knowledge, this is the first study documenting the susceptibility of C. acnes isolates to different antibiotics in Malta. Future research is needed to determine the clinical significance of antibiotic resistance of C. acnes.

Superficial and medium-depth chemical peels.

The use of chemicals for facial rejuvenation has been explored since ancient times. A sound knowledge of skin anatomy and wound healing is important for understanding the principles of chemical peeling. Chemical peels are classified according to the depth of skin resurfacing produced. The main clinical indications in the cosmetic field are photoaging, dyschromias, and acne scars, which are classified according to the histologic depth of the clinical changes. Proper patient selection, skin priming, and postpeel care are of utmost importance in ensuring a satisfactory outcome. Chemical peels are combined with other rejuvenating treatments for best results in photoaging.

Characteristics of superficial mycoses in Malta.

BACKGROUND: A study was conducted to determine the chief agents of superficial mycoses in Malta. Data were collected over a 5-year period from mycologic investigations carried out on all dermatologic specimens sent to the Mycology Laboratory at St. Luke's Hospital in Malta. METHODS: In the period between January 1995 and December 1999, a total of 1271 specimens from skin, nails, or hair were collected from 1200 clinically suspected cases of dermatomycoses. RESULTS: The fungi cultivated included dermatophytes (n = 371), yeasts (n = 33), and nondermatophyte filamentous fungi (n = 12). Trichophyton rubrum (n = 121) was the most prevalent, followed by Microsporum canis (n = 109), T. mentagrophytes (n = 80), M. gypseum (n = 27), Epidermophyton floccosum (n = 17), T. soudanense (n = 10), T. tonsurans (n = 2), T. verrucosum (n = 2), M. persicolor (n = 1), and T. violaceum (n = 1). Candida species were also cultivated, with C. parapsilosis (n = 14) being the most common, followed by C. albicans (n = 12) and C. tropicalis (n = 6). Nondermatophyte filamentous fungi were isolated from nail specimens only. CONCLUSIONS: In this study, superficial fungal infections were reported more commonly in female (n = 207) than in male (n = 182) patients. M. canis was the chief agent of tinea capitis and tinea corporis, whilst T. rubrum was the main causative agent of tinea pedis, tinea manuum, and tinea unguium. Onychomycosis due to Candida species was more common in female than in male patients.