Ramsay Hunt syndrome revisited.

Varicella-zoster infections commonly are seen in clinical practice; however, Ramsay Hunt syndrome caused by reactivation of latent varicella-zoster virus in the geniculate ganglion is rare. We report the case of a 30-year-old woman who developed Ramsay Hunt syndrome and also review the characteristic features of this disease.

Omphalith-associated relapsing umbilical cellulitis: recurrent omphalitis secondary to a hair-containing belly button bezoar.

We report an 18-year-old man with recurrent cellulitis of his umbilicus and surrounding skin. Thorough investigation revealed a foreign body as the source of his relapsing infection, a compact collection of terminal hair shafts. Spontaneously occurring stonelike foreign bodies resulting from the accumulation and concretion of keratinous and amorphous sebaceous material within the umbilicus are referred to as omphaliths. However, because the composition of our patient's foreign body is pilar in origin, we propose that the foreign body be designated as either an omphalotrich or trichomphalith. Alternatively, because the umbilicus and epithelium of the gastrointestinal tract are embryologically related, we suggest that our patient's hair-containing foreign body be referred to as a trichobezoar, which is used to describe exogenous foreign bodies composed of ingested hair in the gastrointestinal tract. The patient's cellulitis resolved without any subsequent episodes following the removal of his belly button bezoar.

Alopecia syphilitica-report of a patient with secondary syphilis presenting as moth-eaten alopecia and a review of its common mimickers.

Alopecia syphilitica is an uncommon manifestation of secondary syphilis, occurring in only 4 percent of these individuals. It is non-inflammatory and non-cicatricial hair loss that can present in a diffuse pattern, a moth-eaten pattern, or a combination of both. A 38-year-old, otherwise asymptomatic, homosexual man is described whose initial presentation of syphilis was patchy, moth-eaten, alopecia. In addition, differentiating features of alopecia syphilitica and other similar appearing non-cicatricial alopecias are reviewed. Conditions that mimic moth-eaten alopecia include other localized and non-cicatricial alopecias, such as alopecia areata, alopecia neoplastica, tinea capitis, and trichotillomania. The distinguishing clinical and laboratory features of alopecia syphilitica include other mucocutaneous changes associated with secondary syphilis, when present, and a positive serology for syphilis. The treatment of choice is a single intramuscular injection 2.4 million units of benzathine penicillin G for patients without immunocompromise; however, our patient was treated with three weekly doses because of concern about possible HIV positivity. The hair loss usually resolves within 3 months of treatment.