Analysis of trichoscopic signs observed in 24 patients presenting tinea capitis: Hypotheses based on physiopathology and proposed new classification.

INTRODUCTION: Trichoscopy (hair dermoscopy) is a non-invasive and very useful technique for the diagnosis and follow-up of hair and scalp disorders. In tinea capitis, specific aspects of the hair shaft have been described, with the main ones being: comma hair, corkscrew hair, bar code-like hair (BCH) and zigzag hair (ZZH). METHOD: Herein we report on a retrospective study of 24 patients with tinea capitis (TC). All patients underwent trichoscopic examination and mycological culture. RESULTS: Trichoscopy was abnormal in all 24 patients showing hair-shaft abnormalities. We observed three types of images depending on the nature and the mechanism of infection and discuss the different trichoscopic aspects of the hair shaft (comma hair, corkscrew hair, bar code-like hair, zigzag hair, broken hair and black dots) resulting from 3 mechanisms of penetration of the fungus in the hair shaft (endothrix, ectothrix and ectothrix-endothrix). All patients had positive mycological cultures: 15 with trichophytic TC (8 with Trichophyton tonsurans, 5 with T. soudanense and 2 with T. verrucosum) and 9 microsporic TC (7 with Microsporum audouini, and 2 with M. canis). DISCUSSION: We propose for the first time, to our knowledge, a classification of trichoscopic signs of TC. This classification will enable rapid diagnosis and prediction of the nature of the fungus before mycological culture. CONCLUSION: Our study shows the importance of trichoscopy in the diagnosis and monitoring of TC as well as its very good correlation with mycological culture. We propose a new classification of trichoscopic signs dependent on the nature of the mycological agent and the mechanism of infection. Further prospective studies with more patients are needed to confirm this classification.

[Two new trichoscopic signs in alopecic and aseptic nodules of the scalp: "Eastern pancake sign" and comedo-like structures]. / Deux nouveaux signes trichoscopiques dans les nodules alopéciques et aseptiques du cuir chevelu : le « signe de la crêpe orientale ¼ et les structures comédoniennes.

BACKGROUND: The purpose of this study is to describe two new trichoscopic signs, "Eastern pancake sign" and "comedo-like structures", not previously reported to our knowledge and seen in 5 patients with alopecic and aseptic nodules of scalp (AANS). PATIENTS AND METHODS: We report on 5 patients presenting AANS. Demographic and ethnic characteristics, disease duration, clinical description, treatment and evolution were noted. Trichoscopy was performed for all patients. RESULTS: In all cases of NAAS, trichoscopy revealed 2 signs: "Eastern pancake sign" resulting in heterogeneous dilated follicular orifices without trichoscopic signs of alopecia areata, and "comedo-like structures" resembling comedones. DISCUSSION: To our knowledge, there have been no previous reports in the literature of the 2 new trichoscopic signs of AANS described herein: "Eastern pancake sign" and "comedo-like structures". The trichoscopic feature of comedo-like structures suggests the potential role of follicular occlusion in this disease. We consider that follicular occlusion may be a triggering factor in AANS.

Anal human papillomavirus DNA screening by Hybrid Capture II in human immunodeficiency virus-positive patients with or without anal intercourse.

High risk human papillomaviruses (HPVs) have emerged as risk factors for anal carcinoma, of which incidence is higher in HIV-positive patients than in the general population. The aim of our study was to investigate the prevalence and risk factors for anal HPV infections in HIV-positive patients with or without history of anal intercourse. Fifty HIV 1-infected patients (36 men and 14 women) were tested at entry and followed-up every 3 months for one year for the presence of anal HPV DNA by the Hybrid Capture II trade mark assay. A series of 50 HIV-negative subjects matched for age and sex served as controls. At enrollment, anal HPV DNA was present in 29/50 HIV-positive patients (58 %) and in 3/50 control subjects (6 %). High risk (HR) HPV genotypes were detected in 20/50 HIV-positive patients (40 %) with no difference in homosexual men and other HIV-positive patients. Risk factors for HPV infection were CD4 + cell counts less than 500/microL (RR: 2.13 [95 % CI: 1.0-4.7]) and history of anogenital warts (RR: 2.36 [95 % CI: 1.2-4.6]). The HPV load was higher in patients with CD4+ < or = 500/microL than in patients with CD4 + > 500/microL (p < 0.04). During the follow-up, anal HR HPV DNA was repeatedly identified at high levels in 5 HIV-positive patients. There is some convincing evidence that HIV-positive patients with low CD4+ cells, whatever the routes of HIV transmission, have a high rate of anal HPV infection and might be at increased risk of developing anal neoplastic lesions. Identifying HR HPV infection might be warranted in immunosuppressed patients.

Highly active antiretroviral treatment initiated early in the course of symptomatic primary HIV-1 infection: results of the ANRS 053 trial.

Highly active antiretroviral treatment (HAART) was given early to 64 patients with symptomatic primary human immunodeficiency virus (HIV)-1 infection. At the time of analysis, patients had been followed up for 9-21 months. No patient had died or developed an AIDS-defining event. Survival analysis showed that by month 21 the proportion of patients with plasma HIV-1 RNA <50 copies/mL was 72% (95% confidence interval, 58%-95%) in intention-to-treat analysis. After 18 months of treatment, 50% of the patients with undetectable plasma HIV-1 RNA also had undetectable HIV-1 RNA in peripheral blood mononuclear cells (PBMC). Only 1 of 3 patients had undetectable HIV-1 RNA in lymphoid tissue, while all patients had quantifiable HIV-1 DNA both in PBMC and lymphoid tissue. The median CD4 lymphocyte increase from baseline was 230 cells/microL. These preliminary results support the use of HAART in patients with primary HIV-1 infection.

Eosinophilic pustular folliculitis in infancy: report of two affected brothers.

We describe two brothers with eosinophilic pustular folliculitis. Both had recurrent crops of papules and pustules, primarily affecting the scalp. The eruption began in the neonatal period. Both children had a leucocytosis with eosinophilia. Histology revealed folliculitis, with an infiltrate in which eosinophils were predominant. Bacteriological and fungal cultures of pustules were negative. There was a good clinical response to treatment with a topical corticosteroid and dapsone. We review the 28 previously reported cases of eosinophilic pustular folliculitis in infancy. The occurrence of this disorder in brothers suggests that an inherited or contagious factor may be involved in its aetiology.