Aseptic Pustulosis of the Folds Successfully Treated with Methotrexate.

An otherwise healthy 47-year-old woman presented with confluent pustular lesions on the scalp for 5 months and asymptomatic pustular lesions on the trunk and extremities for 2 weeks. She did not have systemic clinical manifestations and was treated with oral antifungals and antibiotics (amoxicillin, and clavulanic acid and flucloxacillin), with no effect. The lesions were unrelated to her menstrual cycle, and she had no history of dermatosis, including acne, psoriasis, or folliculitis. (SKINmed. 2022;20:466-468).

Langerhans Cell Histiocytosis-A Benign Presentation Heralding a Serious Disease.

A 3-year old White boy was referred to our dermatology department with a papular disseminated eruption, evolving for 7 months. Several topical antibiotics and corticosteroids were used without improvement. The dermatosis was locally asymptomatic, and systemic symptoms were absent. Examination revealed multiple, skin-colored to pinkish monomorphic papules with a generalized distribution involving the face, trunk, and limbs (Figure 1). The lesions spared the scalp, palms, and soles. Cervical, axillary, and inguinal lymphatic nodes were not palpable. Cutaneous biopsy of one of the abdominal lesions revealed an unremarkable epidermis but a reticular dermis with clusters of histiocytic, lymphocytic, and rare eosinophil cells. In the immunohistochemical study, expression of CD1a was observed in the histiocytic cells and S100 in the antigen-presenting cells of the dermal infiltrate (Figures 2 and 3). Taking into account the clinical presentation and the histopathologic result, a diagnosis of Langerhans cell histiocytosis (LCH) was established.

Case for diagnosis. Suppurative nodule or something deeper?

The authors report the case of a 62-year-old man with a history of total left hip arthroplasty nine years previously presenting with a large infiltrated plaque on the posterior area of the left thigh with three months of evolution without systemic symptoms or elevated inflammatory markers. Computed tomography of the left lower limb revealed a 12-centimeter linear extension of the lesion to the posterior part of the left proximal femur. Prosthesis joint infection, although rare, is a surgical complication to be taken into account, even if the surgery was performed many years before.

Awareness, knowledge, and practice patterns of general practitioner residents and specialists toward hidradenitis suppurativa: a survey study.

INTRODUCTION: Hidradenitis suppurativa (HS) is an unrecognized chronic inflammatory and debilitating disease with severe consequences for patients' quality of life. METHODS: A survey was performed among general practitioner (GP) residents and consultants in order to determine awareness, knowledge, and attitudes about HS. RESULTS: Among 372 respondents, 74% were GP residents in the first 2 years, 22% GP residents in the 3rd and 4th year, and 4% consultants. For a patient with boils and/or recurrent abscesses in folds, 90% considered a diagnosis of HS with no significant difference according to years of experience. These patients were referred to dermatology by 273 residents (80%) and eight consultants (53%), and this difference is statistically significant (p < 0.05). Regarding acute treatment, 84% prescribed topical antibiotics and 76% oral antibiotics. Respecting therapeutic approach, we observed that treatment with non-steroidal anti-inflammatory drugs is higher among older residents (51%) compared to younger ones (36%, p < 0.02) and the prescription of oral clindamycin is higher among consultants (31%) compared to residents (12%, p < 0.04). CONCLUSIONS: Our survey demonstrates that knowledge of HS is lacking among primary care physicians. Communication channels between GPs and dermatologists are often hampered, and so we recommend incorporating medical education into GP residency programs on how to treat mild HS, when to refer, and how to approach HS.

Case for diagnosis. Suppurative nodule or something deeper?

Abstract: The authors report the case of a 62-year-old man with a history of total left hip arthroplasty nine years previously presenting with a large infiltrated plaque on the posterior area of the left thigh with three months of evolution without systemic symptoms or elevated inflammatory markers. Computed tomography of the left lower limb revealed a 12-centimeter linear extension of the lesion to the posterior part of the left proximal femur. Prosthesis joint infection, although rare, is a surgical complication to be taken into account, even if the surgery was performed many years before.

Medication-Related Osteonecrosis of the Jaw in a Patient with Nonuremic Calciphylaxis.

A 62-year-old man was referred to the emergency department of our hospital with pain and swelling in the left mandibular region that had evolved over the previous 2 months (Figure 1). His medical history included nonuremic calciphylaxis and systemic sclerosis (Figure 2). Since the diagnosis of the nonuremic calciphylaxis 5 years before, the patient had been treated with intravenous (IV) sodium pamidronate 60 mg per week for 11 months, without improvement, followed by IV sodium thiosulfate 25 mg twice a week for 18 month. During year 3 of treatment, the calciphylaxis lesions reappeared, and IV sodium pamidronate 60 mg per week was reintroduced to the patient's treatment. The patient remained with double treatment for the next 2 years, but 3 months before the patient's presentation, the IV treatment had been suspended due to an absence of peripheral venous access.

Mycobacterium abscessus infection in a spa worker.

Mycobacterium abscessus (M. abscessus) is a non-tuberculous mycobacterium widely present in the natural environment and is now being increasingly identified as a cause of human disease. However, it can cause skin and soft tissue infection following trauma or surgery. We report a case of a skin ulcer associated with M. abscessus in a spa worker. Frequently, contamination with atypical mycobacteria occurs through tap water. However, in most outbreaks the infection source remains unknown. For an early diagnosis, it is important to perform biopsies and mycobacterium cultures. No specific treatment for skin infection with M. abscessus has been established; it depends on the immune status of the host and the extent of disease. Although it is rare, non-tuberculous mycobacterial infection should be part of the differential diagnosis of cutaneous ulcers, especially on trauma-prone areas.

Nonuremic Calciphylaxis: Four Cases Associated with Autoimmune Diseases.

Calciphylaxis is a rare and severe syndrome of vascular calcification with unclear pathogenesis. This disease mainly affects patients with end-stage renal disease; however, it also has been described in nonuremic patients. We report four cases of nonuremic calciphylaxis (NUC) with ulcerated lesions associated with autoimmune disease. These cases support the literature suggesting that bisphosphonates and sodium thiosulfate are effective drugs in the treatment of calciphylaxis regardless of renal function.

Dermatoscopy of flat pigmented facial lesions-evolution of lentigo maligna diagnostic criteria.

Recognition of facial lentigo maligna (LM) is often difficult, particularly at early stages. Algorithms and multivariate diagnostic models have recently been elaborated on the attempt to improve the diagnostic accuracy. We conducted a cross-sectional and retrospective study to evaluate dermatoscopic criteria aiding in diagnosis of flat pigmented facial lesions (FPFL). We examined 46 FPFL in 42 Caucasian patients and found that 4 of 20 dermatoscopic criteria reached the significance level required for features indicating malignancy namely, hyperpigmented follicular openings, obliterated follicular opening, annular-granular structures, and pigment rhomboids. Concomitant presence of at least 2 or 3 of the 4 mentioned criteria was significantly more frequent in LM than in pigmented actinic keratosis (PAK). However, despite more frequently seen in LM, these features were also displayed in some of the PAK and other FPFL, so we found them not specific for LM. Although dermatoscopy enhances the diagnostic accuracy in evaluating FPFL, histopathology remains the gold standard for correct diagnosis, making evident the need for improvements in early noninvasive diagnosis of LM.

Anogenital warts in children: Analysis of a cohort of 34 prepubertal children.

Anogenital warts are caused by infection with the human papillomavirus. We reviewed the clinical data of 34 children younger than 13 with anogenital warts referred to the department of dermatovenereology of a tertiary care hospital. Suspicion of sexual abuse was raised in 11 (32.4%). Human papilloma virus testing and genotyping was performed in 19 (55.9%) children, and human papilloma virus type 16 was found in 4, which raises the question regarding what type of follow-up is required for children infected with high-risk oncogenic HPV types. Although the diagnosis of anogenital warts in children raises concerns regarding sexual abuse, our study supports that pediatric anogenital warts can be associated with nonsexual transmission.

Psoriasis and comorbidities: general practitioners' awareness.

INTRODUCTION: Systemic inflammatory diseases such as psoriasis, systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA) are associated with an increased prevalence of cardiovascular diseases (CVD) and other comorbidities. The primary aim of this study was to assess the screening practices of general practitioners (GPs) with regard to the most frequent comorbidities in patients with psoriasis. METHODS: We adapted, with permission, a questionnaire that was used by Parsi et al. in 2012, which was then distributed to GP residents and consultants. RESULTS: Overall, 372 questionnaires were collected. Significantly more physicians screen for CV risk factors in patients with RA and SLE than in patients with psoriasis. There was no statistically significant difference between GP residents in the initial and final phase of residency, or between GP residents and consultants regarding awareness of increased prevalence of CVD in psoriasis or comorbidity screening practices in psoriasis patients. CONCLUSIONS: Most GP residents and consultants that participated in this study are not aware of an increased CV risk in patients with psoriasis and assign greater importance regarding this risk to other inflammatory diseases such as RA and SLE.

Cutaneous Morbidity Among Inflammatory Bowel Disease Patients: A Cohort Study.

BACKGROUND AND AIMS: Patients with inflammatory bowel diseases are prone to cutaneous manifestations. The aim of this study was to investigate their prevalence, type and association to demographic and clinical factors. METHODS: This was a cross-sectional study. Information relative to patients of a central Portuguese hospital with a definitive diagnosis of an inflammatory bowel disease, who were prospectively recruited, was collected. RESULTS: The final cohort included 342 patients, 62% of whom had Crohn's disease and 38% had ulcerative colitis. Cutaneous extraintestinal manifestations were present in 44.4% of all patients; this prevalence was lower [14.9%] when excluding cutaneous manifestations secondary to nutrition deficiency or drugs. These skin lesions were classified as granulomatous [0.3%], reactive [4.4%], immunologically associated [10.5%] and secondary to nutritional deficiencies [6.4%] or to bowel-related therapy [29.5%]. Excluding those secondary to nutrition or drugs, cutaneous manifestations were significantly associated with females (odds ratio [OR] 3.210 [1.625-6.340], p = 0.001) and younger patients (OR 0.954 [0.924-0.985], p = 0.004). Additionally, their occurrence was related to patients up to 16 years (OR 13.875 [1.332-144.484], p = 0.028) among the Crohn's disease sub-cohort, whereas in the ulcerative colitis sub-cohort they were more likely to occur in patients with extensive colitis (OR 5.317 [1.552-18.214], p = 0.008). CONCLUSIONS: Nearly half of the patients analysed had at least one cutaneous extraintestinal manifestation. The fact that certain lesions tend to be more common among patients with defined characteristics should alert the physicians and allow an early diagnosis and, when pertinent, a reference to dermatology.

Cross-sectional study of Treponema pallidum PCR in diagnosis of primary and secondary syphilis.

BACKGROUND: Syphilis remains a major challenge and a complex diagnosis. We aim to evaluate the role of polymerase chain reaction (PCR) in Treponema pallidum (Tp) detection in various types of biological samples in the diagnosis of early syphilis. METHODS: We conducted a cross-sectional study including all attendees of the STI clinic with clinical suspicion of early syphilis. One or more specimens for the detection of Tp by PCR testing were collected. RESULTS: The overall sensitivity of Tp PCR test was 82.61% (95% CI: 68.6-92.2%). Tp PCR test had sensitivity of 84.6% (95% CI: 54.6-98.1%) in primary syphilis cases and 81.8% (95% CI: 64.5-93%) in secondary syphilis cases. PCR test performance was independent of HIV status. CONCLUSION: Tp PCR test is a fast and reliable method for the detection of Tp in skin lesions of early syphilis, and it is a powerful tool in clinical settings.

Anogenital warts in pediatric population.

The approach to children with anogenital warts in the context of sexual abuse is a challenge in clinical practice. This study aims to review the current knowledge of anogenital warts in children, the forms of transmission, and the association with sexual abuse and to propose a cross-sectional approach involving all medical specialties. A systematic review of the literature was conducted in Portuguese and English from January 2000 to June 2016 using the ISI Web of Knowledge and PubMed databases. Children aged 12 years or younger were included. The ethical and legal aspects were consulted in the Declaration and Convention on the Rights of Children and in the World Health Organization. Non-sexual and sexual transmission events of human papillomavirus in children have been well documented. The possibility of sexual transmission appears to be greater in children older than 4 years. In the case of anogenital warts in children younger than 4 years of age, the possibility of non-sexual transmission should be strongly considered in the absence of another sexually transmitted infection, clinical indicators, or history of sexual abuse. The importance of human papillomavirus genotyping in the evaluation of sexual abuse is controversial. A detailed medical history and physical examination of both the child and caregivers are critical during the course of the investigation. The likelihood of an association between human papillomavirus infection and sexual abuse increases directly with age. A multidisciplinary clinical approach improves the ability to identify sexual abuse in children with anogenital warts.