Beard alopecia areata: a multicentre review of 55 patients.

BACKGROUND: Alopecia areata on the beard area (BAA) is a common clinical manifestation, but there are no studies about its characteristics. OBJECTIVE: To describe the epidemiology, comorbidities, clinical presentation, evolution, diagnostic findings and therapeutic choices in a series of patients with BAA. METHODS: This retrospective multicentre review included patients diagnosed with BAA as the first and unique clinical manifestation with at least 12 months of follow-up. Diagnosis was performed based on the typical clinical features. Extra-beard involvement was monitored in all cases. RESULTS: Overall, 55 male patients with a mean age of 39.1 years (range 20-74) were included. Twenty-five patients (45.5%) developed alopecia of the scalp during follow-up and more than 80% of cases appeared in the first 12.4 months. Clinical presentation of AA on the scalp was patchy AA (less than 5 patches) (52%), multifocal AA (28%), AA totalis (12%) and AA universalis (8%). Multivariate analysis revealed a trend of association between scalp involvement and family history of AA without statistical significance. CONCLUSIONS: According to this study, BAA may progress to scalp AA in a significant number of patients (45.5% of the patients with a follow-up interval of at least 12 months). In the group of patients who developed scalp AA, 80% of them did it within the first 12 months, so follow-up of patients with BAA is highly encouraged.

Unusual forms of alopecia areata in a Trichology Unit.

BACKGROUND: Alopecia areata (AA) occurs with the apparition of asyntomatic non inflamatory alopecia plaques without scars. We distinguish several variants which are divided into two groups: typical forms (AA in single or multiple plaques) and atypical forms (by its presentation, evolution or paradoxical regrowth). OBJETIVES AND METHODS: We describe the cases of AA treated in our Trichology Unit between January 2000 and December 2011. RESULTS: We obtained 488 cases of AA. 114 (23.36%) were unusual form of AA or had paradoxical regrowth. The most common unusual form of AA was sisaipho type (7.37%), followed by AA for black and blonde hair (5.32%), atypical diffuse forms (4.30%), androgenetic alopecia type and (3.89%) and AA rectangular occipital (0.68%). Furthermore, we found nine cases of paradoxical regrowth (1.84%). CONCLUSIONS: Atypical variants of AA in our series are less than 25% of all cases, although it should be noted that since it is a specialized unit, we may be making a selection bias to be more difficult to diagnose cases or poor outcome.

Dermatitis artefacta: a review.

Dermatitis artefacta is a rarely diagnosed disorder that is often a source of perplexity and anxiety for dermatologists because they know less about the cause of this self-inflicted condition than the patients themselves. It differs from other skin disorders in that diagnosis is made by exclusion rather than on the basis of histologic and biochemical findings and therefore involves a considerable investment of time and resources. Based on the findings of a study of 201 patients diagnosed with dermatitis artefacta between 1976 and 2006, we review the different clinical presentations of this skin disorder and discuss its diagnosis and treatment. The series analyzed comprised 152 women and 49 men (female to male ratio of 3.1:1) with a mean age of 31.2 years. The patients were mostly single and had a low educational level and few or no job qualifications or skills.

Three cases of Lipschutz vulval ulceration.

A Lipschütz ulcer or 'ulcus vulvae acutum' is an acute simple ulceration of the vulva or vagina of non-venereal origin which can be associated with lymphadenopathy. Three cases are described with accompanying clinical photographs. Two cases refer to adolescents, one an infant, all without any history of sexual contact. The cases serve to illustrate a little known but potentially important differential diagnosis of vulval ulceration.

Dermatitis artefacta of the breast: a retrospective analysis of 27 patients (1976-2006).

BACKGROUND: Dermatitis artefacta (DA) is defined as all dermatological, self-inflicted skin lesions, where the patient denies having produced the lesions. OBJECTIVES: The purpose of this study is to make a single-centre retrospective clinical review of patients diagnosed as DA of the breast. MATERIALS AND METHODS: During a 30-year period (1976-2006), patients diagnosed as DA of the breast, seen in the Department of Dermatology of the Virgen Macarena Hospital in Seville, were recorded. Clinical and epidemiological features are described. RESULTS: A total of 27 women with a mean age of 34.33 years were selected representing 13.43% of the total of DA patients recorded (n=201) in this period. The most frequent clinical forms were: excoriations (nine patients, 33.33%) and ulcers (nine patients, 33.33%), followed by burns (six patients, 22.22%), blisters (one patient, 3.70%), contact dermatitis (one patient, 3.70%) and haematomas (one patient, 3.70%). Ten of the cases were located exclusively on the breasts, whereas 17 had also other locations such as face in seven cases, arms in five cases, abdomen in five cases and the entire body in two cases. Cutaneous lesions were treated with occlusive bandages using zinc paste or plaster splint when necessary. CONCLUSION: To our knowledge, this is the major series of DA of the breast studied. This complicated psychodermatological condition requires a correct diagnosis, appropriate management and psychiatric assessment.

Single doses of ofloxacin in uncomplicated gonorrhoea.

The clinical efficacies of 2 different single-dose oral treatments of ofloxacin were evaluated in a double-blind, randomised study of 60 males with gonococcal urethritis. 30 patients received a single dose of ofloxacin 100mg and 30 received a single dose of ofloxacin 200mg. The minimal inhibitory concentrations of ofloxacin against all isolates were less than or equal to 0.25 mg/L. Neisseria gonorrhoeae was eradicated from all 50 patients evaluated and clinical cure was achieved in 84%. In total, 8 patients developed post-gonococcal urethritis, although there was a significantly (p less than 0.05) lower rate of post-gonococcal urethritis in the group treated with ofloxacin 200mg. In conclusion, a single oral dose of ofloxacin 100mg could be an alternative treatment for uncomplicated gonorrhoea.

Double-blind, randomized clinical trial on the effect of interferon-beta in the treatment of condylomata acuminata.

A randomized, double-blind, placebo-controlled trial was conducted to assess interferon-beta efficacy and safety in the treatment of anogenital condylomatous lesions. One hundred patients received a daily intramuscular injection of either interferon-beta (IFN-beta) (2 MIU/day) or placebo for 10 days. Of 94 evaluable patients, the complete response rate observed 8 weeks after treatment was significantly higher in the group receiving IFN-beta, as compared to the placebo-treated group (51% vs 28.9%, P < 0.05). After one year, 24 patients (100%) out of 24 complete responders to IFN-beta who attended for follow-up remained free of lesions. Twelve of 13 patients with complete response to placebo (92.3%) remained free of lesions after one year. Side effects were mild and no significant analytical changes were observed. In conclusion, interferon-beta is an effective and safe treatment for long-term eradication of anogenital condylomatous lesions.

Livedo reticularis and Raynaud's phenomenon associated with cryoglobulinaemia but not related to hepatitis C virus in an HIV-1-positive patient.

Symptomatic cryoglobulinaemia is infrequent in HIV-1-infected patients, but a few cases have been described [1-3], occasionally associated with hepatitis C virus (HCV) infection [1, 3]. These cases showed rheumatologic [1] or neurologic manifestations [2, 3], but until now no cutaneous symptoms associated with cryoglobulinaemia in HIV-infected patients have been described. We report what we believe to be the first case of cutaneous, symptomatic cryoglobulinaemia in an HIV-1-positive patient, who, in addition, was HCV-negative.

Alopecia areata, stress and psychiatric disorders: a review.

Although the results of some studies have proven negative, the influence of psychological factors in the development, evolution and therapeutic management of alopecia areata is, in general, well documented. Life events and intrapsychically generated stress can play an important role in triggering of some episodes. The comorbidity of psychiatric disorders, mainly generalized anxiety disorder, depression, and phobic states, is high. The role of treatment of concomitant psychopathological disorders is a vital one. Indeed this treatment can positively affect how the patient adapts to his/her alopecia and social setting and perhaps can even lead to a better dermatological evolution of the alopecia. Therefore, controlled studies analyzing the possible links between psychiatric symptoms, treatment with antidepressants or benzodiacepines, evolution of alopecia, medium term prognosis, and immune function are necessary. Basic psychotherapeutic support may prove to be of use in many cases and can be carried out by the dermatologist, although a subgroup of patients may need psychopharmacological or psychotherapeutic specialized treatments. Studies using operative diagnostic criteria and structured interviews are still scarce. Therefore, it seems necessary to design studies using modern psychiatric methodology. Controlled clinical trials to test the efficiency of psychoactive drugs and psychotherapy in the disease are also needed. By studying in depth these and other related aspects, we may improve the clinical management of our patients.

Chloracne caused by ingestion of olive oil contaminated with PCDDs and PCDFs.

1. All members of a Spanish family (father, mother and six children) developed chloracne. 2. The causative agent was found to be the family's stock of olive oil, which had become contaminated with polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), pentachlorophenol, and hexachlorobenzene. 3. The more highly chlorinated PCDDs, in particular octachlorodibenzo-p-dioxin, were the predominant congeners in the oil. 4. Three members of the family exhibited either an overt or a sub-clinical disturbance of kidney function. The father also had a chronic respiratory problem. These changes could not be unequivocally attributed to the PCDDs. 5. Experimental toxicity of the oil was limited to the development of an hepatic porphyria in mice. 6. A serum sample, taken 5 years after consumption of the oil ceased, contained high levels of the PCDDs and PCDFs. Extrapolation back to ingested dose was used to validate dosage estimates. 7. The use of toxicity equivalence factors (TEFs) provided estimates of cumulative dosage to produce chloracne as 0.13-0.31 micrograms 2378-TCDD kg-1 (using EPA TEFs) or 6.7-16 micrograms 2378-TCDD kg-1 (using Nordic/NATO TEFs). 8. This is the first incident in which human toxicity is related primarily to ingestion of PCDDs and for which estimates of dosage can be made.

[Incontinentia pigmenti. Study of 3 families]. / Incontinentia pigmenti. Etude de trois familles.

Ten cases of incontinentia pigmenti are reported. All patients, corresponding to three families, were female. In one case a Turner's syndrome phenotype (XO) with mosaicism 46 XX/46 X; i (Xq) was observed. This finding seems to confirm that the disease is transmitted through a dominant gene carried on the X chromosome. Dental alterations were the most frequent of associated abnormalities, being present in all 10 patients. We regard these abnormalities as important as they permit a retrospective diagnosis in adult patients after the skin lesions have disappeared. EEG alterations (essentially an increase in the slow component) were also observed in the majority of cases.

[Anogenital warts in children]. / Verrues ano-génitales chez les enfants.

Fourteen cases of anogenital warts in children are reported. Girls were more frequently affected than boys (9/5). Three children had been infected during birth; two had autoinfection from non-anogenital warts; two girls had apparently been sexually abused. In the remaining 7 cases the origin of the warts was unknown. The authors discuss the epidemiological, therapeutic and social implications of this little known but important paediatric pathology, pointing to the possibility of sexual transmission in cases of "apparently" unknown origin.

[De Sanctis-Cacchione syndrome. Apropos of 2 cases]. / Síndrome de De Sanctis-Cacchione. A propósito de dos observaciones.

We report two cases of xeroderma pigmentosum (XP), with neurologic alterations, representing a partial, although not complete form of the syndrome of De Sanctis-Cacchione. The clinical and aetiological features of the condition are discussed.

[Erosive plantar lichen planus with onycho-atrophy]. / Liquen plano erosivo plantar con onicoatrofia.

Four cases of lichen with atrophy of the nail are reported. Three of them had erosive lesions on the sole of the feet. They all had lichen planus of the mouth and some slight lesions of typical lichen planus of the skin too. One of them also had lichen sclerosus of the scalp, and two women had non-atrophic alopecia of the axillary and pubic hair. There were other heterogeneous associated clinical features in all the cases: diabetes in one case; "esophageal diverticula", xerophthalmia, low figures of C.4 and antinuclear antibodies in serum in another case; hyperuricaemia and hypertriglyceridemia a in another case; hepatic cirrhosis and ferropenic anaemia in the other case.

[Treatment of condylomata acuminata using liquid nitrogen]. / Tratamiento de condilomas acuminados con nitrógeno líquido.

We treated 105 patients with anogenital warts with cotton swabs soaked in liquid nitrogen. 90.1% of the patients were cured, but recurrences were observed in 19.5%. With this method we obtained better clinical results than those obtained with the cryoprobes system. Good results were obtained when the lesions were accessible for treatment, but neither the time of evolution nor the size influenced the cure.

[Congenital constrictive bands (report of an abdominally localized case)]. / Bridas constrictivas congénitas (observación de un caso de localización abdominal).

Having observed a case of congenital annular band located on the abdomen, the authors review the various pathogenic hypotheses and their associations.

[Bowenoid papulosis. Apropos of 2 cases]. / Papulosis bowenoide. A propósito de dos observaciones.

Two new cases of bowenoid papulosis are reported, one in a male with Behçet's syndrome, and the other in a young woman. The literature is reviewed, we consider the different etiopathogenic factors and we discuss its nature and nosology.

[Woolly hair. Apropos of 5 cases]. / "Woolly hair." A propósito de cinco observaciones.

Five cases of Woolly hair, three generalised, and two localised are reported. On the first two, we carried out trichogrammes which were studied with polarized light, and on all five, SEM (Scanning Electron Microscopy). The data obtained coincided with previous descriptions (Pseudomonilethrix images, Pili torti, Trichorrhexis nodosa, reduced hair diameter, oval section following transversal cut, and a wavy-line disposition), although we emphasize the smaller number of layers of cuticle cells following the transversal cut, and the presence of Trichonodosis, not previously refered.