Unilateral acne after facial palsy

Abstract: We describe a case of unilateral acne which appeared after an episode of facial nerve palsy. An 18-year-old female patient presented with papules and pustules predominantly located on the side where the facial paralysis occurred. The patient suffered right facial paralysis, which was treated with prednisone and kinesiotherapy with massages, electrostimulation, and infrared light. Two weeks later, acne lesions appeared in the area affected by the paralysis. As suggested in other cases of paralysis, including cases of Parkinson's disease and spinal cord injury, an increased sebum excretion rate and the immobility of the affected area are most likely what caused the unilateral acne lesions.

Histiocitosis de células de Langerhans: el "camaleón" de la dermatopediatría / Langerhans cell histiocytosis

La Histiocitosis de Células de Langerhans (HCL) es una neoplasia mieloide de las células dendríticas Langerhans (CDL), caracterizada por acúmulos de células dendríticas mieloides CD207+. Corresponden a un espectro de enfermedades, desde sólo cutáneas a variantes multiorgánicas. El objetivo de este reporte es describir el caso clínico de un paciente pediátrico, con diagnóstico de Histiocitosis de Células de Langerhans, enfatizando el algoritmo clínico. Paciente masculino de 1 año y 5 meses, con antecedentes de otorrea persistente, refractaria a tratamiento, de un año de evolución. Consulta en policlínico de dermatología por "dermatitis severa" desde hace 1 año. Al examen físico se constatan lesiones tipo dermatitis seborreica generalizadas en tronco y cuero cabelludo, intertrigo fisurado, pápulas eritemato-costrosas plantares con petequias y pus en conducto auditivo externo bilateral. Presenta Hemoglobina 9,5 mg/dl, Hematocrito31,9%, leucocitos 12.400, linfocitos 33,3%, plaquetas 920.000, VHS 27. Subpoblaciones linfocitarias: CD3: 34,7%, C4: 22,7%, CD8: 9,7%, CD19:47,8%. HTLV negativo, VIH negativo. Acaro-test negativo. Dermatopatología: Denso infiltrado de células linfomonocíticas en dermis papilar, con ensanchamiento de estas y gran epidermotropismo, con abundante citoplasma eosinófilo con núcleos arriñonados, CD1a y langerina positivo. Recomendamos elevar la sospecha diagnóstica ante un cuadro de dermatitis seborreica generalizada que esta fuera del rango etario característico y en casos de dermatitis refractarias, donde a pesar de un adecuado tratamiento médico, el paciente persiste comprometido.

Langerhans Cell Histiocytosis (HCL) is a myeloid neoplasm of Langerhans dendritic cells (CDL), characterized by accumulations of myeloid dendritic cells CD207 +. They correspond to a spectrum of diseases, from cutaneous to multi-organ variants. The objective of this report is to describe the clinical case of a pediatric patient with diagnosis of, emphasizing the clinical algorithm. Male patient,1 year and 5 months old, with a history of refractory persistent otorrhea, consulted because of long term severe dermatitis. Physical examination revealed generalized seborrheic dermatitis lesions on the trunk and scalp, cleft intertrigo, plantar erythematous-crusted papules with petechiae, and pus in the external auditory canal. Laboratory findings showed: Hemoglobin 9.5 mg / dl, Hematocrit: 31.9%, leukocytes: 12,400, lymphocytes 33.3%, platelets: 920,000, HSV 27. Lymphocyte subpopulations: CD3: 34.7%, C4: 22.7%, CD8: 9.7%, CD19: 47.8%. HTLV negative, HIV negative. Scabies Negative. Dermatopathology: Dense infiltrate of lymphomonocytic cells in the papillary dermis with widening of the papilla and large epidermotropism, cells show abundant eosinophilic cytoplasm with "kidney nuclei", CD1a and langerin were positive. We recommend elevating the diagnostic suspicion in the face of a generalized seborrheic dermatitis that is outside the characteristic age range and in cases of refractory dermatitis, where the patient persists compromised.

Manifestações dermatológicas em pacientes infectados pelo HIV: um estudo de prevalência / Dermatological manifestations in HIV-infected patients: a prevalence study

Na infecção pelo HIV, a pele pode ser tanto um indicador precoce de doença quanto de gravidade. Este estudo analisou a frequência e a apresentação clínica de manifestações dermatológicas em pacientes portadores de HIV, destacando as lesões mais encontradas, e correlacionou suas características com o estado imunológico. Foram encontradas 129 lesões mucocutâneas dentre os 57 pacientes portadores de HIV examinados, havendo em média 2,25 lesões por paciente. As dermatoses mais comuns, em ordem decrescente de frequência, foram candidíase oral, onicomicose e dermatite seborreica. As lesões oportunistas mostraram relação significativa com deficiência imunológica, e as afecções de pele mais encontradas mostraram-se bons indicadores do estado imunológico do paciente e da progressão da doença.

In the HIV infection the skin can be either an early indicator of disease and severity. This study examined the frequency and clinical presentation of skin manifestations in patients with HIV, highlighting the most frequent injuries, and correlated their characteristics with the immune status. We found 129 mucocutaneous lesions among 57 patients with HIV, with an average of 2.25 lesions per patient. The most common skin diseases in descending order of frequency were oral candidiasis, onychomycosis and seborrheic dermatitis. Opportunistic lesions showed significant relationship with immune deficiency and the most frequent skin diseases proved to be good indicators of the immune status of the patient and disease progression.

Manifestaciones dermatológicas asociadas a la infección por VIH/SIDA / Dermatologic manifestations associated with HIV/AIDS

The ongoing human immunodeficiency virus (HIV) infection epidemic coupled with more efficacious and available treatments has led to a larger number of patients living with HIV or AIDS. As a result, skin manifestations related to HIV/AIDS or its therapy have become increasingly more common and are reported to occur in as many as 95% of patients. Herein, we review the most common HIV/AIDS related cutaneous pathologies and classify them into inflammatory, HAART-associated, neoplastic, and infectious manifestations. Cutaneous manifestations should be promptly recognized and treated by physicians and health care personnel in order to provide optimal care.

La epidemia del virus de la inmunodeficiencia humana (VIH) sumado al mayor acceso a terapias antiretrovirales (TARV) han llevado a un aumento del número y la sobrevida de pacientes que viven con esta infección crónica. Se estima que hasta 95% de los pacientes con infección por VIH/SIDA presentarán alguna manifestación cutánea, por lo cual, debemos conocerlas. En la presente revisión se estudiarán las manifestaciones cutáneas de la infección por el VIH/SIDA clasificadas como: manifestaciones inflamatorias, manifestaciones asociadas a la TARV, manifestaciones neoplásicas y manifestaciones infecciosas asociadas a infección por VIH/SIDA (bacterianas, virales, fúngicas y parasitarias). Estas manifestaciones deben ser reconocidas por los médicos y el personal de salud a cargo del tratamiento y control de los pacientes con esta patología crónica.

Dermatite seborreica / Seborrheic dermatitis

A dermatite seborreica é uma doença eritêmato-escamativa de caráter crônico-recidivante que acomete entre 1 e 3 por cento da população geral dos Estados Unidos. Possui dois picos de incidência - o primeiro, durante os três primeiros meses de vida, e o segundo, a partir da puberdade, atingindo seu ápice entre os 40 e 60 anos de idade. Os indivíduos HIV positivos têm maior prevalência da doença, que apresenta maior intensidade e tendência à refratariedade ao tratamento. Doenças neurológicas e outras doenças crônicas também estão associadas ao desenvolvimento da dermatite seborreica. Como mecanismo fisiopatogênico, reconhece-se que o fungo Malassezia sp., presente na pele de indivíduos suscetíveis, leve a uma irritação não-imunogênica a partir da produção de metabólitos à base de ácidos graxos insaturados deixados na superfície cutânea. Este artigo faz uma revisão da literatura sobre dermatite seborreica, com ênfase nos aspectos imunogenéticos, formas clínicas e tratamento.

Seborrheic dermatitis is a chronic relapsing erythematous scaly skin disease, the prevalence of which is around 1 to 3 percent of the general population in the United States. It has two incidence peaks, the first in the first three months of life and the second beginning at puberty and reaching its apex at 40 to 60 years of age. The prevalence of seborrheic dermatitis is higher in HIV-positive individuals and the condition tends to be more intense and refractory to treatment in these patients. Neurological disorders and other chronic diseases are also associated with the onset of seborrheic dermatitis. The currently accepted theory on the pathogenesis of this disease advocates that yeast of Malassezia spp., present on the skin surface of susceptible individuals, leads to a non-immunogenic irritation due to the production of unsaturated fatty acids deposited on the skin surface. This article provides a review of the literature on seborrheic dermatitis, focusing on immunogenetics, the clinical forms of the disease and its treatment.

Biotinidase deficiency.

A three month old baby presented with refractory seizures, dermatosis and persistent metabolic acidosis. Biotinidase deficiency was diagnosed on enzyme assay. Patient responded dramatically to biotin supplementation.

Selective screening for biotinidase deficiency

Biotinidase deficiency is characterized by neurological and cutaneous manifestations that can be prevented or ameliorated by oral biotin therapy. The present work aims to establish the prevalence of biotinidase deficiency in a targeted group of infants and children presenting with neurological and cutaneous problems or isolated cutaneous symptoms, during a two year period. We measured biotinidase activity and obtained medical histories and examinations of probands, as well as of available parents and siblings. Among 13 children presenting with neurological symptoms associated with intractable seborrheic dermatitis and/or alopecia, we identified 6 patients with profound biotinidase deficiency [activity<10% of mean normal activity] and one patient with partial biotinidase deficiency [activity between l0%-30% of mean normal activity]. Among 40 infants presenting with isolated intractable seborrheic dermatitis, we identified one infant with profound biotinidase deficiency and another with partial biotinidase deficiency. Normal healthy controls had biotinidase activities within normal ranges, Biotinidase activity in 5 parents and 3 siblings was intermediate between those of probands and those of normal individuals. We identified one asymptomatic sibling with biotinidase activity in the partial activity range. Among the most common neurological findings on presentation were developmental delay or regression in 66.6%, hypotonia in 66.6%, seizures in 55.5%, neurosensory hearing loss in 33.3%, ataxia in 22.2% and optic atrophy in 22.2% of patients. One patient presented with a spontaneous episode of metabolic acidosis. Age of onset was between 1 and 3 months of age in 66.6% of patients. Two patients presented later than the usual age of onset. There was no clear relationship between age of onset and either severity or type of deficiency. All patients showed resolution of skin problems and marked improvement in neurological symptoms on oral biotin treatment. Detection of 9 cases of biotinidase deficiency during a two year period at a single metabolic unit indicates that biotinidase deficiency is not rare in Egypt. We suggest that biotinidase deficiency be considered in all children with neurological symptoms particularly those associated with cutaneous manifestations. Biotinidase deficiency should be considered in the differential diagnosis of intractable seborrheic dermatitis. The high incidence of biotinidase deficiency, the low cost of screening test, and the inexpensive therapy cost increase the importance of neonatal screening for biotinidase deficiency in Egypt. This would prevent permanent neurological damage or death in future children with biotinidase deficiency

role of distribution of malasezia furfur serovars, propionibacteria and micrococcaceae in the pathogenesis of tinea versicolor and seborrhoeic dermatitis

This study was designed to compare the distribution of M. Furfur serovars [A, B and C], Propionibacteria and Micrococcaceae on the chest, face, back and scalp of 40 patients with tinea versicolor [TV] and ten matched controls and 40 patients with seborrhoeic dermatitis [SD] and ten matched controls. The patients and controls were sampled from the mentioned sites and cultured aerobically for Micrococcaceae and M. furfur and anaerobically for Propionibacteria. Serotyping of M. Furfur was carried out to identify the three serovars A, B and C. There was no difference in either the Micrococcaceae or Propionibacteria results in patients groups compared with control skin. Regarding the results of M. furfur, serovar A predominated in the back lesions in both patients groups when compared with the control. Serovar A was also predominant in the face lesions but only in seborrhoeic dermatitis patients, serovar C predominated in all sites [in both patient groups] and serovar B predominated in all lesions of TV patients and in the back, face and neck in SD patients

Etiopatogenia da dermatite seborréica: estado atual / Etiopathogenic of seborrheic dermatitis: actual state

Dermatite seborréica (DS) é dermatose extremamente comum; os aspectos etiopatogênicos ainda säo, no entanto, controversos. Alguns autores acreditam que a Malassezia furfur seja o organismo causal, porém o fungo é isolado da maioria dos indivíduos normais o que contraria essa teoria. Parece que a DS é decorrente de um processo inflamatório que leva à hiperproliferaçäo de queratinócitos e alteraçäo na composiçäo dos lipídios com aumento do colesterol e triglicérides e diminuiçäo de ácidos graxos. Essa alteraçäo aumenta o pH da pele e favorece a supercolonizaçäo pela Malassezia furfur. A populaçäo aumentada de M. furfur, por meio de seus metabólitos, ativa o complemento levando à liberaçäo de fatores quimiotáticos que perpetuam o processo inflamatório. Fatores constitucionais, fisiológicos e ambientais säo relevantes na etiopatogenia da DS, que é considerada multifatorial. O tratamento inclui cuidados gerais, principalmente na DS infantil, exposiçäo a raios ultravioleta e terapêutica tópica e/ou sistêmica.

Pytirosporum ovale en dermatitis seborreica. Estudio en 26 pacientes con SIDA y 21 controles / Pytirosporum ovale in seborrheic dermatitis. a study of 26 patients with AIDS and 21 controls

La dermatitis seborreica (DS) ha sido informada como una entidad frecuente en pacientes con SIDA. En este estudio evaluamos 26 pacientes con SIDA para conocer la prevalencia de DS y su relación con la cuenta de Pytirosporum ovale mediante tinción de Gram y cinta adhesiva transparente, en comparación con controles hospitalizados por enfermedad no relacionadas con el SIDA ni neurológicas. Los resultados fueron semejantes en ambos grupos: la cuenta de P. ovale correlacionó con la forma clínica de la DS; no hubo diferencia entre pacientes con SIDA y controles, ni en los que tomaban ketoconazol. La cuenta de P. ovale fue semejante en las áreas corporales en que se tomaron las muestras. Las técnicas de Gram y cinta adhesiva transparente fueron comparables para cuenta de P. ovale. Conclusiones. En nuestro medio, la DS no es un hallazgo frecuente en población general ni en pacientes con SIDA, y no hay diferencias en el número de P. ovale encontrado en comparación con controles; estos resultados pueden sugerir que la DS, para expresarse, requiere de factores raciales y que se trata de una entidad diferente en la que el P. ovale no es un factor importante en la fisiopatogenia de la enfermedad

Dermatitis seborréica: informe de 60 casos / Seborrheic dermatitis: report of 60 cases

El presente trabajo da a conocer 60 csos de Dermatitis Seborréica vista en 80 de pacientes del sexo masculino y 20 del femenino, encontrándose que el área más afectada fue la piel cabelluda 98 y en el 46 de los casos además de la piel cabelluda se afectó conjuntamente la cara. El tipo de Dermatitis Seborréica más frecuentemente visto fue la pitiriasis seca (67.8) y en cara la región centrofacial (89.28). Esta es una dermatosis benigna permanente a la que no se le da importancia, sin embargo es importante dar a conocer su frecuencia en nuestro medio

Mycological study of seborrheic dermatitis

The relationship between the Pityrosporum yeast and seborrheic dermatitis was studied. Seborrheic dermatitis is a chronic disease as 72.6% of cases had duration more than 10 years. The familial tendency and obesity were significantly important predisposing factors with more severity in winter. Direct microscopy was not a predictive method for fungal diagnosis as it gave only 13.6% positive smears. Dixon's modified medium was a good culture for rapid recovery of P. ovale, while SDCA medium was effective when the period of cultivation was prolonged. A trial to suppress P. ovale was performed with an antimycotic shampoo

Hiperandrogenismo cutâneo (síndrome SAHA na mulher) - Terapêutica com antiandrógenos / Cutaneous hyperandrogynism (sha) syndrome) treatment with antiandrogens

A síndrome SAHA ( seborréia, acne, hirsutismo e alopecia) é observada na mulher com todos ou alguns destes elementos. Depende da atuaçäo dos andrógenos nos receptores específicos da unidade pilossebácia andrógena-dependente, em áreas geneticamente definidas. Etiopatogenicamente envolve fatores hormonais isolados ou associados entre si, e que säo os seguintes: aumento da secreçäo glandular (ovários, supra-renais); elevaçäo da testosterona livre e biologicamente ativa pela reduçäo da SHBG; sensibilidade aumentada dos receptores androgênicos, e/ou conversäo maior da testosterona em dihidrotestosterona nos tecidos por um aumento da 5alfa-redutase. Fundamentos nestes dados, avanços significativos surgiram nos últimos anos com a identificaçäo de substâncias, cuja capacidade de bloquear a açäo dos andrógenos na pele tem demonstrado resultados favoráveis na terapêutica da síndrome SAHA, como o acetato de ciproterona e a espironolactona. Outros medicamentos estäo em estudo com a flutamida, finasteride e inocoterone

Estudio comparativo de la eficacia de cuatro principios activos anticaspa / A comparative study of the eficacy of four anti-dandruff active principles

Al considerara el grave problema estético y social que constituye la caspa, así como su elevada frecuencia entre la población, se decidió estudiar cuatro principios activos anticaspa, contra placebo. Se consideraron los parámetros clínicos más importantes: número de corneocitos, estudio micológico directo, cultivo, cutirreacción, prurito, irritación del cuero cabelludo y caida del cabello. Los resultados mostraron claramente que el disulfuro de selenio solo y en su presentación con acondicionador, fueron las sustancias más eficaces para combatir el problema

Relación entre dermatitis seborréica del cuero cabelludo y la composición metálica del agua / Relationship between seborrheic dermatitis of the scalp and metallic composition of water

El uso de agua de mar destilada para bebida y aseo se ha impuesto en los buques pesqueros en los últimos 15 años. Se estudió la composición metálica del agua en 19 buques durante la faena en tres puntos del sistema de distribución (destiladora, bebederos y duchas). Se escogieron dos buques según los resultados obtenidos para comparar en sus tripulaciones la incidencia de dermatitis seborréica del cuero cabelludo con la de la tripulación de un buque que consume agua del puerto. Se encontró relación estadísticamente significativa entre la composición metálica del agua en las duchas y la presencia de la enfermedad. La salinidad resultó el factor más influyente. Se sugiere la implantación de un sistema de vigilancia periódica de la calidad del agua en los buques

Papel patógeno de pytirosporum ovale en la dermatitis seborreica y pitiriasis ersicolor / Pathogenic role of Pytitosporum ovale in seborrhic dermatitis and pityriasis versicolor

En un estudio que comprendió pacientes con pitiriasis versicolor y dermatitis seborreica y dos grupos testigos (seborreicos sanos y sanos no seborreicos), se llegó a la conclusión de que Pityrosporum ovale actúa de dos maneras diferentes como agente patógeno de la piel. En la pitiriasis versicolor constituye el paráisto responsable de esta micosis, mientras que en la dermatitis seborreica actúa como un organismo saprofito que sensibiliza la piel y produce la reacción eccematoidea propia de esta dermatosis. La sensibilización por P. ovale fue explorada por medio de la cutirreacción con pitirosporina; la cual se mostró positiva en los pacientes con dermatitis seborreica y negativa en los pacientes con pitiriasis versicolor y en los grupos testigos. Desde el punto de vista terapêutico se encontró que el Ketoconazol por vía oral es efectivo en el tratamiento de ambas dermatosis