Delusional infestations: case series, differential diagnoses, and management strategies.

Physicians are not infrequently consulted by distraught patients with delusions of infestation who believe that they are infested with external or internal parasites and describe a crawling sensation of bugs or worms on or under their skin. Internet search engines were queried with the keywords as search terms to examine the latest articles on delusional infestations in order to describe presenting manifestations, differential diagnoses, and effective management strategies. The demographic and behavioral features of delusional infestations have remained constant and include: (1) onset in well-educated, middle-aged adults who are pet owners; (2) production of purported specimens of causative parasites; (3) pesticide overtreatment of themselves, their households, and pets; (4) excessive cleaning or vacuuming of households; (5) intense anger and resentment directed at physicians failing to confirm their self-diagnoses; and (6) sharing delusional symptoms with spouses or relatives. Although some reports have suggested that cases of delusional infestation are increasing today in the tropics, most studies have confirmed a stable incidence over time and similar disorder demographics worldwide. However, management strategies for delusional infestations have changed significantly over time with second generation, atypical antipsychotics offering safer adverse effect profiles and better prognoses than earlier therapies with first generation, typical antipsychotics. The most effective management strategies for delusional infestations include empathetic history-taking and active listening to the patient, careful exclusion of true parasitoses, and a therapeutic regimen that includes a second generation neuroleptic agent.

Sun exposure behavior and protection: recommendations for travelers.

BACKGROUND: Although there have been recent advances in the development of photoprotective clothing and broad-spectrum sunscreens, few peer-reviewed publications have focused on photoprotection recommendations for travelers. METHODS: In order to describe the adverse health effects of excessive ultraviolet (UV) radiation exposures; review recent studies of public perceptions regarding photoprotection and sun exposure behaviors; identify special populations at increased risks of drug-induced photosensitivity reactions and UV-induced skin cancers; and recommend several effective photoprotection strategies for travelers, Internet search engines were queried with the key words as search terms to examine the latest references on photoprotection and the epidemiology of UV-associated skin cancers. RESULTS: Observational studies have demonstrated that the public knows little about proper sunscreen protection, selection, and use, and often abuses sunscreens for intentional UV overexposures. Cohort studies have identified special populations at increased risks of UV-associated skin cancers without the proper use of sunscreens and photoprotective clothing including children, fair-skinned persons, patients taking photosensitizing drugs, and organ transplant recipients (OTRs). Clinical investigations support the regular use of broad-spectrum sunscreens to prevent the development of premalignant actinic keratoses (AK) in all sun-exposed subjects, especially OTRs; to prevent the development of squamous cell carcinomas from new AK in sun-exposed subjects, especially OTRs; to possibly prevent the development of cutaneous malignant melanomas in children and adults; and to possibly prevent the development of basal cell carcinomas in OTRs. CONCLUSIONS: Recommended photoprotection strategies for travelers should include avoiding intense sunlight, wearing photoprotective clothing, wearing sunglasses, and selecting the right sunscreen for their skin type. Travel medicine practitioners should counsel travelers about photoprotection and encourage travelers to take advantage of recent advances in the development of more effective broad-spectrum sunscreens and photoprotective clothing for themselves and their children.

A patient with coexistent bullous pemphigoid and primary membranous glomerulonephropathy.

Bullous pemphigoid has been rarely described in association with renal abnormalities, including membranous glomerulonephropathy, and it has been approximately 20 years since this association was last reported. We describe a case of a male patient with a concurrent onset of bullous pemphigoid and membranous glomerulonephropathy and discuss this rare association. A definite common immunologic mechanism that links the two disorders remains elusive.

Galli-Galli disease: A case report with review of the literature.

Galli-Galli disease is a rare variant of the genodermatosis Dowling-Degos disease with the histologic finding of acantholysis. We present the case of a patient who presented with reticulated pigmentary changes in the flexures as well as a pruritic papular eruption and histologic features consistent with Galli-Galli disease. A literature search revealed 3 previous case reports of Galli-Galli disease. These case reports were reviewed and summarized, and the clinical and histologic presentations were compared with those of our patient. In addition, another case report of patients with similar clinical manifestations was found and is presented herein. The differential diagnosis of Galli-Galli disease includes classic Dowling-Degos disease, transient acantholytic dermatosis, Darier's disease, and epidermolysis bullosa with mottled pigmentation. Galli-Galli disease is best considered a subtype of Dowling-Degos disease with clinical and histologic features similar to transient acantholytic dermatosis.

Update on the dermatologic use of systemic glucocorticosteroids.

Systemic glucocorticosteroids (GCS) remain a first-line therapy for a variety of dermatologic diseases. The purpose of this article is to review the major pharmacologic properties and drug interactions of GCS, as well as the mechanisms of action, dosing and delivery options, and major adverse effects. In addition, the present authors will discuss the major indications and practical suggestions for the use of systemic GCS in dermatology.

A middle-aged man with newly diagnosed HIV infection and rash.

TEN is a rare cutaneous drug reaction associated with high morbidity and mortality. The underlying pathogenic mechanisms are poorly understood. Development of an effective treatment algorithm has been hampered by the low incidence of this disorder, incomplete knowledge of the mechanisms of epidermal death, and lack of large controlled trials to evaluate therapeutic interventions.

Cutaneous sarcoidosis presenting as leonine facies.

Cutaneous sarcoidosis often masquerades as many other disease entities. We describe the case of a 56-year-old African American man with a 1-year history of progressively enlarging nodules and plaques of the face resulting in a leonine appearance and madarosis. The diagnosis of cutaneous sarcoidosis was made after skin biopsy results revealed noncaseating granulomas without evidence of foreign body, mycobacteria, or deep fungal infection. A thorough systemic workup was void of other comorbidities. The reports of tumoral sarcoidosis or sarcoidosis presenting with leonine facies are rare, and those cases that have been reported have been linked to other systemic findings.