A diagnostic challenge: a case of acrodermatitis enteropathica without hypozincemia and with maternal milk of low zinc level.

Acrodermatitis enteropathica is a rare and distinct form of zinc deficiency with a requirement of life-long zinc supplementation and inherited in a recessive manner. Transient nutritional zinc deficiency is also a well known condition mimicking acrodermatitis enteropathica like skin changes in preterm and term infants who are generally breastfed with a low level of zinc containing milk. Here, a 4-month-old male, term and fully breastfed acrodermatitis enteropathica case without hypozincemia and with maternal milk of low zinc level is presented.

Hyperhomocysteinemia in patients with stasis dermatitis and ulcer: a novel finding with important therapeutic implications.

BACKGROUND: Although homocysteine (Hcy) has profound effects concerning vascular lesions and thrombosis, it has not previously been investigated in patients with stasis dermatitis and ulcer. OBJECTIVE: To evaluate plasma Hcy levels in patients with stasis dermatitis and ulcer. METHODS: A total of 25 patients (17 male, eight female; mean age of 36 +/- 5.97 years) with stasis dermatitis, 40 patients with stasis ulcer (27 male, 13 female; mean age of 38.5 +/- 7.96 years) and 35 healthy control individuals (25 male, 10 female; mean age of 36.9 +/- 6.49 years) were included in this study. Patients taking vitamin supplements or patients with folic acid or vitamin B12 deficiency, diabetes mellitus, chronic hepatitis, renal failure and chronic alcoholism which might affect Hcy levels were excluded from the study. RESULTS: Hcy levels were found to be elevated in patients with stasis dermatitis (p = 0.00) and stasis ulcer (p = 0.00) compared to healthy controls with a median (range) of 19.1 micromol/l (15-28), 18.98 micromol/l (15-29), and 8.1 micromol/l (5-12.2), respectively. There was no statistically significant difference in Hcy level in patients with stasis dermatitis and ulcer (p = 0.877). CONCLUSION: As hyperhomocysteinemia can be treated by selected vitamin supplementation even in patients with normal serum vitamin concentrations, ulcer formation might be prevented by lowering Hcy in the clinical stage of stasis dermatitis.

Treatment of acrodermatitis continua with topical 8-methoxypsoralen plus local narrowband ultraviolet B phototherapy.

Treatment of acrodermatitis continua of Hallopeau (ACH) is known to be difficult. A 24-year-old man presented with an 11-year history of recurrent flares of painful pustular and scaly lesions on the distal portion of his fingers and toes, with persistent nail dystrophy. Based on the clinical and histopathological findings, ACH was diagnosed. The patient was treated with topical 8-methoxypsoralen (8-MOP) without occlusion, plus local narrowband ultraviolet B (NB-UVB) phototherapy. The patient did not use any other medication between sessions except topical emollients. Ten weeks later, when the patient had received 20 sessions, almost all the lesions had cleared. We report the first case of ACH which successfully responded to treatment with 8-MOP/NB-UVB.

Is facial involvement a sign of severe psoriasis?

Facial involvement in psoriasis receives little attention in standard descriptions of the disease. To our knowledge there has been only one comparison study on the severe of psoriasis between patients with and without facial involvement. The purpose of this study was to define the prevalence and characteristics of facial involvement, and to compare the severity of psoriasis between patients with and without facial involvement. A total of 120 consecutive patients with psoriasis seen in our polyclinic between January 2005 and May 2005 were enrolled in this study. They were categorized into patients with and without facial psoriasis. The age of onset, family history, nail and joint involvement, associated skin or systemic disease, history of phototherapy or systemic therapy, extent of involvement, the effect of external factors and Psoriasis Area and Severity Index (PASI) scores were recorded. Patients who had PASI score lower than 5 were excluded from the study. Patients with facial psoriasis frequently report early onset, or long duration, and tend to have more extensive disease and more intensive treatment. The patients with facial psoriasis have more positive family histories and Koebner responses. The nail, joint involvement and pruritus did not appear to influence the presence of facial psoriasis. Facial involvement in psoriasis is much more common than generally appreciated. This study demonstrates the significance of facial involvement in psoriasis. In view of its significance as a marker of severe disease, extra care must be taken during treatment to ensure clearance from this site.