Erysipelas: a common potentially dangerous infection.

Erysipelas is an acute superficial cutaneous cellulitis that commonly occurs not only in elderly and immunocompromised persons, but also in neonates and small children subsequent to bacterial inoculation through a break in the skin barrier. Group A Beta-hemolytic streptococcus (GABHS, Streptoccocus pyogenes) is the usual etiologic agent. Factors that predispose pediatric patients to the development of erysipelas include very young age, diabetes mellitus, an immunocompromised state, and nephrotic syndrome. Patients typically have a well-demarcated, erythematous, indurated, rapidly spreading patch with a palpable advancing border on the face or extremities. Fever with chills and general malaise may be prominent symptoms. Antibiotics are usually effective. Patients handled in a timely manner tend to recover without problems. However, potential complications include abscess formation, necrotizing fasciitis, septicemia, recurrent infection, and lymphedema.

Neonatal scabies.

A case of scabies infestation in a ten-week-old infant is described. Infestation in a neonate presents a clinical picture quite different from that found in older children and adults. Therapeutic options can be limited in infants. Current concepts and treatment modalities are discussed.

Epidermolytic hyperkeratosis treated with etretinate.

Epidermolytic hyperkeratosis is an unusual type of ichthyosis that may be characterized in extreme cases by massive cutaneous involvement resembling a porcupine. We present such a patient who had a remarkable response to treatment with oral etretinate.

Necrotizing fasciitis: a deadly infection.

Necrotizing fasciitis (NF) is a life-threatening condition, consisting of a soft-tissue infection with rapidly progressive, widespread fascial necrosis. NF may be caused by a wide variety of microbes. Indeed, NF may be an infection of one species of bacteria or may be polymicrobial. Prompt diagnosis and treatment are essential. Surgical debridement and antibiotic therapy are the primary treatment options.

Scabies.

Scabies is highly contagious and is usually transmitted by direct personal contact. It typically presents as an intensely pruritic eruption. Atypical presentations are common in Norwegian scabies and in childhood scabies. Infestation is documented by visualizing the mite, its eggs or scybala on low-power microscopy. The treatment of choice is 5 percent permethrin cream, used in a single application at bedtime and removed the next morning.

Pseudoporphyria: an atypical variant resembling toxic epidermal necrolysis.

BACKGROUND: Pseudoporphyria has been attributed to both medication usage and chronic hemodialysis. Histologically, it is identical to porphyria cutanea tarda. It is most commonly seen as localized bullae on sun-exposed skin, often on the dorsum of the hands and fingers. OBJECTIVES: We describe a 31-year-old man with rapidly evolving bullae which became denuded, clinically suggestive of toxic epidermal necrolysis. Pseudoporphyria was proven histologically. However, our patient's eruption was not localized as small bullae but was widespread, with large bullae evolving into large, cutaneous, denuded erosions. CONCLUSIONS: We describe a previously unreported, generalized variant of pseudoporphyria that resembles toxic epidermal necrolysis. We provide a review of pseudoporphyria and compare our variant to toxic epidermal necrolysis and mimicking disorders.