Syphilis: A Contemporary Clinicopathologic Assessment.

Syphilis is a sexually transmitted disease caused by the spirochetal bacterium Treponema pallidum that has been of public health concern for centuries. In the United States, it is currently a reportable disease and one which is recently generating increasing case numbers especially in at risk populations of immune deficiency and men who have sex with men. The present series examines biopsies from 13 patients collected over a 12-year period from a general hospital network in north suburban Cook County, Illinois. There were 13 patients (11 male: 2 female) with varied presentations, including primary ulcerated anogenital chancres, mucosal lesions, peculiar rashes, and alopecia. The reason(s) for biopsy were not clear from the clinical record, as a clinical consideration of syphilis was recorded in only 3 cases. Histologic examination of the mucocutaneous lesions encompassed a spectrum of findings including ulceration, psoriasiform hyperplasia, intense mixed band-like inflammation at the dermal-epidermal junction with a prominent plasma cell component. The contemporary availability of an effective immunostain is a valuable diagnostic adjunct. The organisms generally parallel the intensity of the inflammatory infiltrate but the distribution may vary and rarely, organisms may be absent despite serologic confirmation. Previous corkscrew morphology of the organism described ultrastructurally is reflected in the immunostained representation. Although the diagnosis of syphilis remains a clinical one in most cases, some patients will have unusual presentations and biopsies will be done. The awareness of the pathologist will facilitate prompt and effective treatment.

[Late onset dermatophytic disease]. / Maladie dermatophytique de revelation tardive.

Dermatophytic disease, described for the first time in 1959 by Hadida and Schousboe, is a chronic dermatophyte infection of the skin and viscera. It is a rare disease occurring mainly in Maghreb. Immunological studies have highlighted a deficit of cellular immunity with autosomal recessive transmission responsible for tolerance to dermatophyte. The first signs of this disease usually occur during childhood. Our patient suffered from pachyonychia affecting all his nails and erythematous, circinate, pruritic, scaly lesions occurring in all his seed coat from the age of 50 years. These disorders were gradually followed by alopecia and hair removal of all body hairy areas, palmoplantar keratoderma as well as bilateral axillary and inguinal adenopathies. Tricophyton violaceum was isolated from patient's nails. No immune deficiency was found or visceral involvement within the limits of the assessments made. The evolution was marked by transient improvements, resistance of adenopathies and skin appendage involvement as well as by multiple relapses despite griseofulvin therapy. Dermatophytic disease is a serious life-threatening disease due to its inexorable evolution toward visceral involvement. The improvement of patient's immune system associated with antifungal therapy may be the best treatment.

Leprosy on the scalp

Abstract Leprosy is a chronic infectious disease caused by Mycobacterium leprae. This bacillus has a high predilection for skin and peripheral nerves. The scalp’s anatomical properties do not favor the development of such mycobacterium. We report a case of leprosy with scalp involvement, a rare occurrence in our literature.

Leprosy on the scalp.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. This bacillus has a high predilection for skin and peripheral nerves. The scalp's anatomical properties do not favor the development of such mycobacterium. We report a case of leprosy with scalp involvement, a rare occurrence in our literature.

Alopecia: Kids are not just little people.

Alopecia is a disorder that affects all patients, young and old. Many diagnoses, particularly the scarring alopecias, are more common in adults; however, others, such as tinea capitis, are more common in children, and some, such as alopecia areata, often affect both age groups. The approach to, and evaluation of, an alopecia patient is thus highly dependent on his or her age. In adults with diffuse, non-scarring hair loss, a part-width examination can help detect pattern hair loss, the most common cause of diffuse loss in this age group. In children this is much less likely, and a careful evaluation for tinea capitis is in order. The same holds true for patchy alopecia in children, as well as scarring alopecia-tinea needs to always be considered. In adults, patchy alopecia is often due to alopecia areata and sometimes to one of the primary scarring alopecias. A laboratory evaluation, and especially a biopsy, would be a more appropriate undertaking for an adult than a child, and an adult would be more likely to tolerate certain therapeutic regimens such as intralesional injections. In a conversational manner, the authors discuss their individual approaches to the alopecia patient, highlighting the differences in diagnosis, workup, and management that depend on whether the affected individual is an adult or a child.

Alopecia syphilitica with detection of Treponema pallidum in the hair follicle.

Alopecia is one of the clinical manifestations of secondary syphilis. It is uncommon for hair loss to be the sole or predominant manifestation, as hair loss is the chief clinical and histologic differential diagnosis of alopecia areata. The main difference between these two entities is the detection of Treponema pallidum in syphilis. We present the case of a 24-year-old Hispanic man, human immunodeficiency virus seropositive in treatment, with tiny patches of non-cicatricial alopecia in the parieto-occipital regions of his scalp. The patient denied previous history of genital or other skin lesions. A biopsy from an alopecic patch was performed which showed an inflammatory non-scarring alopecia with a discrete lymphocytic type inflammatory infiltrate localized in the peribulbar region. There was lymphocyte exocytosis into the matrix, associated with vacuolar degeneration, and scattered apoptotic cells were observed. Plasma cells were scattered. Immunohistochemical studies showed the presence of T. pallidum limited to the peribulbar region and penetrating into the follicle matrix. To the authors' knowledge, this is the first time that spirochetes have been shown in the hair follicle in alopecia syphilitica, suggesting that the spirochetes may be pathogenetic and responsible for the alopecia.

A case of recurrent rash and leg numbness mimicking systemic rheumatic disease: the occurrence of leprosy in a nonendemic area.

Leprosy, a rare chronic granulomatous communicable disease caused by Mycobacterium leprae, is classically known to have cutaneous and neurologic sequelae. As a result of immigration, the disease, endemic in Brazil, India, Nepal, Madagascar, Myanmar, and Indonesia, has been recognized to be present in North America and the Caribbean. We describe a case of a woman presenting with a long history of a recurrent rash and leg numbness, initially diagnosed with systemic lupus, who was later proven to have lepromatous leprosy. It is a reminder that this underappreciated disease should still be considered in the differential diagnosis of skin rash and neuropathy, even in nonendemic regions.

Secondary syphilis clinically mimicking pseudolymphoma of the face.

Syphilis has been given titles such as the great imitator, the great mimic, and the great masquerader. It may lack pathognomonic signs and often presents similar to many other dermatological conditions. We present a case of a young woman who developed asymptomatic papulonodular lesions on the forehead; the lesions were clinically similar to pseudolymphoma but it was determined that she had secondary syphilis exhibiting prozone phenomenon. She also had alopecia of eyebrows. Both the alopecia as well as nodular lesions clinically resembling pseudolymphoma responded to and completely recovered with antisyphilitic treatment.

[Update on the diagnosis of dermatomycosis]. / Attualità sulla diagnosi delle dermatomicosi.

Dermatomycosis are mycotic diseases of skin caused by a few mycetes: dermatophytes, and some opportunistic fungi as Malassezia, Candida (not C. albicans), Trichosporon, Rhodutorula, Cryptococcus or Aspergillus, Geotrichum, Alternaria, etc. Dermatophytes are a group of closely related filamentous fungi that invade keratinized tissue (skin, hair, nails) of humans and other animals and produce infection called dermatophytosis or ringworm or "tinea". The etiological agents of dermatophytosis are classified in three genera: Microsporum, Trichophyton and Epidermophyton (Deuteromycetes). On the basis of their primary habitat dermatophytes are divided in Anthropophilic dermatophytes (parasitic organisms that infect humans), Zoophilic dermatophytes (parasitic organisms that infect animals, but also humans: agents of zoonosis) and Geophilic dermatophytes (saprobic fungi associated with keratinous materials in soil). In the soil there are also structure associated with contagion, ("spore", "arthroconidium", or "clamydospore") of anthropophilic and zoophilic dermatophytes that may persist for years, in the environment, in hair or skin scales. Since on the skin of animals there are many saprobic organisms (Malassezia) and many fungi may infect the fur, it is important to make an accurate diagnosis. Dermatophytosis are communicable diseases acquired from infected animals or from fomites. Infections caused by dermatophytes is a ringworm. These infections may range from mild and superficial, almost subclinical, to a few areas of scaling to a highly inflammatory reaction with extensive areas of scarring and alopecia. Granuloma formations (mycetoma-like) may occur especially in cats. Dermatophytes, as filamentous fungi, undergo radial fungi: collection of skin material is best made by collecting the scales near the edges of the rings. Hairs are best sampled by plucking; a scalpel may be used to scrape scales; brushes have also been used. Sample materials are best transported in dry packet. The Wood's light may be used to identify infected fluorescent hairs. Direct microscopy, although false negative up to 50% of cases, is a highly efficient screening technique. Scraping and hairs should mixed to 10-15% KOH. Culture is a valuable adjunct to direct microscopy and is essential to identify more dermatophytes. A medium selective against most nondermatophytic moulds and bacteria is used as a primary isolation medium. Many typical isolates of common dermatophytes can be identified directly from primary isolation media. Identification characters include: colony pigmentation, texture, morphological structure (macroconidia, microconidia, spirals, pectinate branches, etc). Nutritional requiment, growth in special media, "in vitro" perforation, mating studies are procedures used to identify atypical isolates. Serological approaches have revealed difficulties. Many kinds of molecular biologic techniques have been made available for clinical diagnosis recently; almost all of these techniques involve the polymerase chain reaction (PCR).

Micetomas por microsporum canis: caso clínico / Mycetomas by microsporum canis: report of one case

We report and eight years old boy presenting with a pyogenic granuloma of the scalp, generalized alopecia, descamative plates in the neck, trunk and limbs and nail involvement. Cultures for fungus of all these lesions disclosed Microspore canis. The patient was treated with oral griseofulvin, miconazole and topical tolnaftate. Five years later and after several incomplete treatments, the patient returns with a fistulous mass of 12 x 8 cm in the dorsal area whose culture revealed Microspore canis. The mass was excised and oral ketoconazole was indicated. After three months of follow up, the patient was lost from control

Scalp dermatitis, ectodermal dysplasia and cleft lip and palate: rapp-hodgkin or AEC syndrome.

A female infant with ectodermal dysplasia, bilateral cleft lip and palate and a recalcitrant scalp dermatitis is presented. She had features of both Rapp-Hodgkin syndrome and AEC syndrome. It has recently been suggested in the literature that these two syndrome are the same condition and this case report supports this viewpoint.