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1.
Nat Med ; 26(6): 900-908, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32424212

RESUMO

Skin conditions affect 1.9 billion people. Because of a shortage of dermatologists, most cases are seen instead by general practitioners with lower diagnostic accuracy. We present a deep learning system (DLS) to provide a differential diagnosis of skin conditions using 16,114 de-identified cases (photographs and clinical data) from a teledermatology practice serving 17 sites. The DLS distinguishes between 26 common skin conditions, representing 80% of cases seen in primary care, while also providing a secondary prediction covering 419 skin conditions. On 963 validation cases, where a rotating panel of three board-certified dermatologists defined the reference standard, the DLS was non-inferior to six other dermatologists and superior to six primary care physicians (PCPs) and six nurse practitioners (NPs) (top-1 accuracy: 0.66 DLS, 0.63 dermatologists, 0.44 PCPs and 0.40 NPs). These results highlight the potential of the DLS to assist general practitioners in diagnosing skin conditions.


Assuntos
Aprendizado Profundo , Diagnóstico Diferencial , Dermatopatias/diagnóstico , Acne Vulgar/diagnóstico , Adulto , Afro-Americanos , Nativos do Alasca , Americanos Asiáticos , Carcinoma Basocelular/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Dermatite Seborreica/diagnóstico , Dermatologistas , Eczema/diagnóstico , Grupo com Ancestrais do Continente Europeu , Feminino , Foliculite/diagnóstico , Hispano-Americanos , Humanos , Índios Norte-Americanos , Ceratose Seborreica/diagnóstico , Masculino , Melanoma/diagnóstico , Pessoa de Meia-Idade , Profissionais de Enfermagem , Grupo com Ancestrais Oceânicos , Fotografação , Médicos de Atenção Primária , Psoríase/diagnóstico , Neoplasias Cutâneas/diagnóstico , Telemedicina , Verrugas/diagnóstico
3.
Dermatol Online J ; 26(2)2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-32239885

RESUMO

Background Folliculitis decalvans is a neutrophilic cicatricial alopecia whose etiology remains unknown. It is frequently associated with staphylococcal infections. We aimed to determine the rate of gram-negative infections in patients with folliculitis decalvans. Methods A retrospective chart review was performed of patients with biopsy-proven folliculitis decalvans seen at a tertiary hair referral center. The results of bacterial cultures were evaluated. Subjects were determined to have no infection, gram-positive infections, gram-negative infections, or mixed infections. Results Thirty-nine subjects were included in the study. Ninety-three cultures were performed. The majority of cultures were positive for staphylococci. Eleven patients (28%) had gram-negative infections of the scalp. Gram-negative infections comprised one-third of all cultures (33%). Conclusion We present the largest cohort of folliculitis decalvans patients with gram-negative infections, suggesting the need for routine bacterial cultures in patients who are not responsive to standard anti-staphylococcal antibiotics. Awareness of the incidence of these infections may lead to better therapeutic outcomes.


Assuntos
Foliculite/microbiologia , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/complicações , Dermatoses do Couro Cabeludo/microbiologia , Adulto , Idoso , Biópsia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Couro Cabeludo/microbiologia , Couro Cabeludo/patologia
5.
J Med Microbiol ; 69(3): 436-442, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32068525

RESUMO

Introduction. Malassezia folliculitis (MF) and pityriasis versicolor (PV) are common dermatoses caused by Malassezia species. Their molecular epidemiology, drug susceptibility and exoenzymes are rarely reported in China.Aim. To investigate the molecular epidemiology, drug susceptibility and enzymatic profile of Malassezia clinical isolates.Methodology. Malassezia strains were recovered from MF and PV patients and healthy subjects (HS) and identified by sequencing analysis. The minimum inhibitory concentrations (MICs) of nine antifungals (posaconazole, voriconazole, itraconazole, fluconazole, ketoconazole, miconazole, bifonazole, terbinafine and caspofungin) and tacrolimus, the interactions between three antifungals (itraconazole, ketoconazole and terbinafine) and tacrolimus, and the extracellular enzyme profile were evaluated using broth and checkerboard microdilution and the Api-Zym system, respectively.Results. Among 392 Malassezia isolates from 729 subjects (289 MF, 218 PV and 222 HS), Malassezia furfur and Malassezia globosa accounted for 67.86 and 18.88 %, respectively. M. furfur was the major species in MF and PV patients and HS. Among 60M. furfur and 50M. globosa strains, the MICs for itraconazole, posaconazole, voriconazole and ketoconazole were <1 µg ml-1. M. furfur was more susceptible to itraconazole, terbinafine and bifonazole but tolerant to miconazole compared with M. globosa (P<0.05). Synergistic effects between terbinafine and itraconazole or between tacrolimus and itraconazole, ketoconazole or terbinafine occurred in 6, 7, 6 and 9 out of 37 strains, respectively. Phosphatases, lipases and proteases were mainly secreted in 51 isolates.Conclusions. Itraconazole, posaconazole, voriconazole and ketoconazole are theagents against which there is greatest susceptibility. Synergistic effects between terbinafine and itraconazole or tacrolimas and antifungals may be irrelevant to clinical application. Overproduction of lipases could enhance the skin inhabitation of M. furfur.


Assuntos
Antifúngicos/farmacologia , Dermatomicoses/epidemiologia , Foliculite/epidemiologia , Malassezia/isolamento & purificação , Tinha Versicolor/epidemiologia , Azóis/farmacologia , China/epidemiologia , Dermatomicoses/microbiologia , Foliculite/microbiologia , Humanos , Lipase/metabolismo , Malassezia/efeitos dos fármacos , Malassezia/enzimologia , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Pele/microbiologia , Tacrolimo/farmacologia , Terbinafina , Tinha Versicolor/microbiologia
6.
Clin Exp Dermatol ; 45(6): 716-718, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31965609

RESUMO

Actinic folliculitis (AF) is a rare recurrent seasonal photodermatosis, relatively newly characterized by nonpruritic, monomorphic pustules and papules appearing 4-24 h after exposure to sunlight. Lesions usually affect the face but also appear on the upper chest and arms. Resolution normally occurs within 7-10 days with cessation of sunlight exposure. AF is resistant to standard treatments used for acne vulgaris and acne rosacea, with only oral retinoids previously being reported as effective. We report the first two cases, to our knowledge, of AF responding extremely effectively to a topical retinoid.


Assuntos
Adapaleno/administração & dosagem , Foliculite/patologia , Transtornos de Fotossensibilidade/patologia , Luz Solar/efeitos adversos , Administração Tópica , Adulto , Anti-Inflamatórios não Esteroides/administração & dosagem , Feminino , Foliculite/tratamento farmacológico , Foliculite/etiologia , Humanos , Isotretinoína/uso terapêutico , Transtornos de Fotossensibilidade/tratamento farmacológico , Transtornos de Fotossensibilidade/prevenção & controle , Dermatopatias Vesiculobolhosas/etiologia , Dermatopatias Vesiculobolhosas/patologia
7.
Clin Exp Dermatol ; 45(1): 63-72, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31017678

RESUMO

We present a series of 13 patients with clinical and histological features of both folliculitis decalvans (FD) and lichen planopilaris (LPP), either concomitantly, or sequentially as the clinical phenotype changed over time. This biphasic presentation of FD-LPP is not as uncommon as would be expected from the lack of description in the literature. We discuss current theories about the pathogenesis of both LPP and FD, and speculate how abnormal immune responses may either predispose to secondary bacterial infection or be influenced by dysbiosis of the skin/hair follicle microbiome, resulting in inflammation and permanent hair follicle damage.


Assuntos
Foliculite/complicações , Folículo Piloso/patologia , Líquen Plano/complicações , Adulto , Idoso , Feminino , Foliculite/patologia , Humanos , Líquen Plano/patologia , Masculino , Pessoa de Meia-Idade , Fenótipo
8.
Taiwan J Obstet Gynecol ; 58(6): 877-879, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31759547

RESUMO

OBJECTIVE: Dermatological problems after chemotherapy are often neglected with gynecological oncologists. Since paclitaxel is one of most popular agents for gynecology organ-related cancers, dermatologic change after paclitaxel treatment is seldom reported before. CASE REPORT: Two patients with gynecological organ malignancy who underwent the postoperative dose-dense weekly schedule of paclitaxel 80 mg/m2 plus carboplatin (area of curve 5) every three weeks had repeat dermatological problems (skull, facial and upper trunk areas) during the treatment. They included dermatitis, eczema, and folliculitis. Topical use of anti-fungal cream and oral anti-histamine agents stopped the disease progression and all had completed their chemotherapy without interruption. CONCLUSION: Clinicians should be aware of paclitaxel-induced skin toxicities, especially on the skull, face and upper trunk areas to minimize the occurrence of severe morbidity and to provide the better quality of life when cure is our primary priority in the management of gynecological organs-related malignancies.


Assuntos
Alopecia/induzido quimicamente , Foliculite/induzido quimicamente , Neoplasias Ovarianas/tratamento farmacológico , Paclitaxel/efeitos adversos , Pele/patologia , Neoplasias do Colo do Útero/tratamento farmacológico , Alopecia/diagnóstico , Antineoplásicos Fitogênicos/efeitos adversos , Antineoplásicos Fitogênicos/uso terapêutico , Feminino , Foliculite/diagnóstico , Humanos , Pessoa de Meia-Idade , Paclitaxel/uso terapêutico
9.
Dermatol Ther ; 32(6): e13103, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31583801

RESUMO

Bacterial folliculitis, rosacea, and other common skin conditions have been linked to infestation by Demodex mites (human demodicosis). Currently, there is little guidance for treatment of inflammatory conditions associated with demodicosis. Thus, the objective of this review is to evaluate the efficacy and safety of treatments utilized for Demodex infestation. PubMed (1946 to January 2019) and Embase (1947 to January 2019) were searched with the following term combinations: Demodex mites, Demodex folliculitis, demodicosis, Demodex folliculorum, or Demodex brevis and articles evaluating treatment of body surface colonization with Demodex mites were included. Common interventions used for Demodex infestation include metronidazole-based therapies, permethrin, benzoyl benzoate, crotamiton, lindane, and sulfur. Short courses of metronidazole taken orally have shown efficacy in reducing Demodex density. Additionally, topical administration of permethrin daily or twice daily was shown to be efficacious across multiple studies. Crotamiton and benzyl benzoate were also efficacious treatments. Several therapies were associated with mild-to-moderate skin irritation. Due to limited data, no standard of care can be identified at this time. Efficacious treatment options may include permethrin, crotamiton, benzyl benzoate, and oral metronidazole; however, long-term efficacy has not been established.


Assuntos
Infestações por Ácaros/tratamento farmacológico , Administração Tópica , Benzoatos/administração & dosagem , Foliculite/tratamento farmacológico , Humanos , Metronidazol/administração & dosagem , Permetrina/administração & dosagem , Rosácea/tratamento farmacológico , Toluidinas/administração & dosagem
10.
Dermatol Online J ; 25(8)2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31553869

RESUMO

Folliculitis decalvans is a rare scarring alopecia that presents with indurated, tender pustules and papules on the vertex and occipital scalp. Although systemic antibiotics with activity against Staphylococcus species provide some symptomatic improvement, folliculitis decalvans remains a significant management challenge and often exhibits a relapsing-and-remitting course. In this report, we posit the potential utility of medical grade honey as a safe and cost-effective adjuvant therapy in the treatment of folliculitis decalvans. We describe a patient with painful, boggy scalp pustules who achieved clearance of his scalp lesions with the addition of Manuka honey. To our knowledge, this report is the first to demonstrate the clinical use of honey in the management of folliculitis decalvans and may lend support to the role of Staphylococcus in the pathogenesis of this disease.


Assuntos
Alopecia/terapia , Foliculite/terapia , Mel , Dermatoses do Couro Cabeludo/terapia , Infecções Cutâneas Estafilocócicas/terapia , Alopecia/etiologia , Alopecia/patologia , Antibacterianos/uso terapêutico , Cefalexina/uso terapêutico , Foliculite/complicações , Foliculite/patologia , Glucocorticoides/uso terapêutico , Humanos , Injeções Intralesionais , Masculino , Dermatoses do Couro Cabeludo/complicações , Dermatoses do Couro Cabeludo/patologia , Infecções Cutâneas Estafilocócicas/complicações , Infecções Cutâneas Estafilocócicas/patologia , Falha de Tratamento , Adulto Jovem
11.
J Dermatol ; 46(11): 978-984, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31489692

RESUMO

Distinguishing between Malassezia folliculitis (Pityrosporum folliculitis [P. folliculitis]) and acneiform eruption, based on clinicopathological features, is challenging for clinicians. In the literature, the histopathological differences between P. folliculitis and acneiform eruption lesions have been poorly described. We aimed to determine the clinicopathologic distinctions between P. folliculitis and acneiform eruption by retrospectively analyzing the histology of hematoxylin and eosin stained tissue sections obtained from 52 patients diagnosed with these lesions. The presence of fungal spores in the follicular lumen was most consistent with a P. folliculitis diagnosis (P < 0.001). However, intrafollicular inflammation (P = 0.009), irregular patterns of keratin plugging (P = 0.008), and nuclear dust in the follicular lumen (P < 0.001) favored an acneiform eruption diagnosis. These intrafollicular characteristics and inflammatory differences are believed to be caused by necrotic keratinocytes that lead to vacuolar changes in the follicular wall (P = 0.013). We did not observe any difference between P. folliculitis and acneiform eruption lesions in terms of perifollicular inflammatory cell infiltration. Our study demonstrated that significant differences exist between P. folliculitis and acneiform eruption lesions relative to the presence of necrotic keratinocytes in the follicular wall, intrafollicular characteristics, and inflammatory cell infiltrations. Necrotic keratinocytes are believed to have a key role in these differences. These findings may contribute to an improved understanding of the pathogenesis and differential diagnosis of P. folliculitis and acneiform eruption.


Assuntos
Erupções Acneiformes/diagnóstico , Foliculite/diagnóstico , Foliculite/microbiologia , Malassezia/isolamento & purificação , Erupções Acneiformes/patologia , Adulto , Diagnóstico Diferencial , Feminino , Foliculite/patologia , Humanos , Masculino
13.
J Dermatol ; 46(7): 610-614, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31166031

RESUMO

Primary cicatricial alopecia (PCA) is a group of poorly understood mechanisms in which the destruction of hair follicles leads to permanent hair loss. Lichen planopilaris (LPP) is a type of lymphocytic PCA and it has been known for epidermal Langerhans cells (LC) to disappear in the scar of LPP. We also found that epidermal LC also disappeared in the scar of folliculitis decalvans (FD), a type of neutrophilic PCA. Of note was that epidermal LC did not disappear in the scar of discoid lupus erythematosus, another type of lymphocytic PCA, suggesting that LC disappearance in the scar was not always a common feature of PCA. We found that the expression of integrin (ITG)-αvß6 in scar epidermis was significantly diminished in LPP and FD, but not in other PCA and disorders accompanied with scar formation. We also found that exogenous interleukin-1ß and α-interferon downregulated ITG-αvß6 expression in normal human epidermal keratinocytes. These data suggest that downregulation of ITG-αvß6 may be one of the causes of LC disappearance in the scar of LPP and FD.


Assuntos
Alopecia/patologia , Antígenos de Neoplasias/metabolismo , Cicatriz/patologia , Foliculite/patologia , Integrinas/metabolismo , Células de Langerhans/imunologia , Líquen Plano/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Alopecia/imunologia , Antígenos de Neoplasias/imunologia , Cicatriz/imunologia , Regulação para Baixo , Células Epidérmicas/imunologia , Epiderme/imunologia , Epiderme/patologia , Feminino , Foliculite/imunologia , Folículo Piloso/imunologia , Folículo Piloso/patologia , Humanos , Integrinas/imunologia , Queratinócitos , Líquen Plano/imunologia , Masculino , Pessoa de Meia-Idade
17.
Dermatol Online J ; 25(4)2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-31046918

RESUMO

Squamous cell carcinomas (SCCs) often arise secondary to UV-induced DNA damage resulting in genetic mutations, but can also occur in the setting of prolonged inflammation. Folliculitis decalvans (FD) is a rare cicatricial alopecia with a complex, multifactorial pathogenesis that results in chronic inflammation and scarring. We present a patient with severe, chronic FD who developed metastatic squamous cell carcinoma of the scalp.


Assuntos
Carcinoma de Células Escamosas/secundário , Foliculite/complicações , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias Cutâneas/patologia , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/cirurgia , Doença Crônica , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Pescoço , Couro Cabeludo , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/cirurgia
19.
Hautarzt ; 70(8): 601-611, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31001659

RESUMO

Tinea barbae is a rare dermatomycocis, by definition follicular bound in the beard area of adult men. Manifestation usually starts with erythema accompanied by desquamation. Deeper distribution along terminal hairs leads to folliculitis with formation of pustules and nodes as well as abscesses; fixed adherent yellowish crusts may appear. Frequently there is locoregional swelling of the lymph nodes and occasionally a deterioration of general condition with (sub)febrile temperatures. Often this leads to the initial suspected diagnosis of a bacterial folliculitis barbae or impetigo contagiosa. Tinea barbae is mostly induced by species of the genus Trichophyton (T.). The pathogens are diverse and are mostly zoophilic, sometimes anthropophilic and rarely geophilic dermatophytes. With the help of a specific anamnesis and diagnostic procedure, including mycological examinations, histology and molecular detection of dermatophytes via polymerase chain reaction (PCR), tinea barbae-in our patient induced by T. mentagrophytes-can be rapidly diagnosed. Early initiation and adequate treatment duration lead to restitutio ad integrum.


Assuntos
Abscesso/diagnóstico , Face/microbiologia , Foliculite/microbiologia , Folículo Piloso/microbiologia , Tinha/diagnóstico , Trichophyton/isolamento & purificação , Abscesso/tratamento farmacológico , Adulto , Antifúngicos/uso terapêutico , Arthrodermataceae , DNA Fúngico/genética , Face/fisiopatologia , Dermatoses Faciais/microbiologia , Foliculite/diagnóstico , Foliculite/tratamento farmacológico , Humanos , Masculino , Reação em Cadeia da Polimerase , Tinha/microbiologia , Resultado do Tratamento , Trichophyton/classificação , Trichophyton/genética
20.
Acta Dermatovenerol Croat ; 27(1): 49-50, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31032795

RESUMO

Dear Editor, Folliculitis decalvans (FD) is a rare form of primary neutrophilic cicatricial alopecia. It is a highly distressing disease that affects young and middle-aged adults, with a slight male predominance (1). The most frequent clinical manifestations are follicular pustules and diffuse and perifollicular erythema that heal with centrifugal scarring. Follicular tufting, erosions, and hemorrhagic crusts can also be present, and this alopecia is most often located at the vertex and occipital area. Patients frequently complain about pain, itching, or burning sensations, and the involvement of other body areas is rare (2). The pathogenesis of this disease remains unclear. Staphylococcus aureus and other hair follicle bacteria can often be isolated from the pustules, suggesting the role of a bacterial infection in its etiology. A defect in the host's immune response can also be postulated by reports of familial cases and the appearance of FD in patients with immunity dysfunctions. Other mechanical factors have been suggested, such as structural abnormalities of the follicle or local inflammation (2). Management of this alopecia is difficult and its course is typically chronic and relapsing. The treatment aim is to stop inflammation and further irreversible destruction of hair follicles. Antibiotics remain the first-line therapy, due both to their anti-inflammatory and antimicrobial properties (1). Although topical fusidic acid is widely used as adjuvant treatment, there are few data regarding its oral use. We report a case of folliculitis decalvans successfully treated with oral fusidic acid. Our patient was a 41-year old Cape Verdean woman with a two month history of alopecia with painful, purulent discharge at the vertex of the scalp. The patient was diagnosed with human immunodeficiency virus type 1 (HIV-1) infection 5 years prior and was stable on her regimen of efavirenz, tenofovir, and emtricitabine, with undetectable viral load. She denied application of topical or capillary products. Dermatological examination revealed a patch of cicatricial alopecia with crusts and follicular pustules (Figure 1). Direct microscopic examination and mycological culture showed no fungal element. A diagnosis of folliculitis decalvans was established and the patient was started on oral fusidic acid at a dose of 500 mg three times a day. Betamethasone dipropionate 0.05% and salicylic acid 3% lotion as well as azelaic acid 5% lotion were also applied to the affected area once daily. After two months of treatment, the patient showed clinical improvement, with less erythema and suppuration of the affected scalp. A partial hair regrowth was noted, mainly at the periphery. Subsequently the patient maintained only topical therapy, and no recurrences were observed after 6-months of follow-up. Fusidic acid is useful in the treatment of skin and soft tissue infections, particularly those due to S. aureus, as shown by randomized controlled studies (3). The clinical efficacy of fusidic acid in the treatment of folliculitis decalvans has been reported previously. Bogg was the first to describe this useful effect (4). Sutter also reported good results with fusidic acid used both topically and orally (500 mg three times a day) (5). However, both failed to report the treatment duration or the outcome on discontinuation. Abeck described three patients that responded to a three week oral course of fusidic acid (500 mg three times a day) and to a maintenance treatment with zinc sulfate (4). During the following year, recurrence was observed in only one patient after ending zinc sulfate therapy. Oral antibiotics are frequently used to treat folliculitis decalvans. Tetracyclines and the combination of clindamycin with rifampicin are the most commonly used (2). However, the disease usually progresses when treatment is stopped. Fusidic acid is an anti-staphylococcal drug with few adverse effects. It is highly bioavailable orally, and has a long plasma half-life. Despite years of clinical use in numerous countries, resistance rates remain at low levels to date (6). Since clinical series or cases including ours have shown good results, this drug should not be forgotten when considering treatment options for folliculitis decalvans.


Assuntos
Alopecia/tratamento farmacológico , Antibacterianos/uso terapêutico , Foliculite/tratamento farmacológico , Ácido Fusídico/uso terapêutico , Adulto , Alopecia/etiologia , Alopecia/patologia , Feminino , Foliculite/etiologia , Foliculite/patologia , Humanos
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