Dermatophytosis and Sjögren-Larsson syndrome: foe or friend?

We report the patchy normalization of lamellar ichthyotic skin in Sjögren-Larsson syndrome (SLS) following a cutaneous Trichophyton rubrum infection. The dermatophytosis was pruritic and pustular, requiring treatment which was followed by the return of the lamellar ichthyosis. We discuss the possible mechanism of this clinical observation, which in turn may direct future therapy for difficult to treat ichthyotic skin seen in conditions such as SLS.

Staphylococcus epidermidis: a possible role in the pustules of rosacea.

BACKGROUND: Rosacea is a common skin and ocular disease. Cutaneous rosacea is characterized by facial flushing, telangiectasia, papules, and pustules. It is generally regarded as inflammatory in nature. We believed that the role of bacteria as a contributory factor in pustular and ocular rosacea needed to be revisited. OBJECTIVES: We sought to ascertain whether there is an increase in the bacteria isolated from the (1) pustules of rosacea; and (2) eyelid margins of persons with cutaneous pustular rosacea. METHODS: Bacterial swabs were taken and cultured from an incised rosacea pustule, the ipsilateral cheek skin, and the eyelid margin of 15 patients with pustular rosacea. Swabs were also taken from the cheek skin and ipsilateral eyelid margin of 15 matched control subjects. RESULTS: A pure growth of Staphylococcus epidermidis was isolated from a pustule of 9 of 15 patients with pustular rosacea, and no pure growth of S epidermidis was isolated from their ipsilateral cheek skin. This was a highly statistically significant increase (P = .0003). A pure growth of S epidermidis was isolated from the eyelid margins of 4 of 15 patients with pustular rosacea, and no pure growth was isolated from the eyelids of age- and sex-matched control subjects. This was a statistically significant increase (P = .05). LIMITATIONS: This study focuses on the microbial basis of rosacea. CONCLUSION: Our findings suggest S epidermidis may play a role in pustular and ocular rosacea.

Frontal fibrosing alopecia associated with generalized hair loss.

We present six cases of frontal fibrosing alopecia, in which generalized hair loss is a feature. Although this variant of lichen planopilaris has been reported clinically in a number of patients, there is very little histological evidence that the condition exists in peripheral sites. We believe this pattern of involvement may be more common than is reported, and have provided histological evidence of lichen planopilaris being present at sites beyond the scalp and eyebrows.

Diagnosis of type I cryoglobulinaemia made through identifying crystals in the blood smear.

We report a case of type I cryoglobulinaemia in a 52-year-old man who presented with widespread cutaneous necrosis. The diagnosis could not be established early on, as repeated testing for cryoglobulin was negative despite a careful collection method. The diagnosis was made 1 year later, on an incidental full blood smear that revealed crystals, which is an uncommon way to diagnose this condition. We discuss the difficulties we faced in establishing the diagnosis and emphasise the need for repeat cryoglobulin testing in this clinical setting. In such cases, examination of a blood smear should be considered.

Invasive squamous cell carcinoma arising in refractory perianal Bowen's disease in a HIV-positive individual.

A 54-year-old HIV-positive homosexual man presented with erythematous and pigmented plaques on background erythema in the perianal region, histologically consistent with Bowen's disease. Perianal Bowen's disease represents high-grade anal intraepithelial neoplasia, which is considered a precursor lesion of invasive anal squamous cell carcinoma. This patient's anal intraepithelial neoplasia was unresponsive to multiple treatment modalities including cryotherapy, serial curettage and cautery, topical 5-fluorouracil and 5-aminolaevulinic acid photodynamic therapy. He progressed to develop a poorly differentiated squamous cell carcinoma of the anus three and a half years after the Bowen's disease was diagnosed. The squamous cell carcinoma was treated with combined chemoradiation. A recurrence of high-grade anal intraepithelial neoplasia was noted 6 months after completion of chemoradiation.