Facial involvement and the severity of psoriasis.

BACKGROUND: Psoriasis is a chronic, inflammatory skin disorder characterized by well-demarcated erythematous-scaly lesions, affecting 0-6.6% of the world population. Facial lesions are neglected in most descriptions in current literature, although some studies indicate that it could be a predictor of psoriasis severity. OBJECTIVE: To compare the severity of psoriasis, measured by the Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI), in patients with and without facial lesions. MATERIAL AND METHODS: This is a cross-sectional study, whose sample size was 63 individuals for each group. Subjects were included in the HUPES Complex Dermatology Service (Salvador/BA - Brazil) from April 2014 to January 2016. Demographic information was obtained using a prestructured form. Assessments of psoriasis severity and quality of life were done using PASI and DLQI, respectively. RESULTS: Facial lesions were detected on 63 (50.0%) of the 126 patients included. The pinna was the most frequently affected region (63.5%). Mean PASI in the group with facial involvement was 14.0 vs. 6.0, when facial involvement was absent. DLQI means for these groups were, respectively, 7.5 and 4.7. CONCLUSIONS: Facial involvement in a psoriasis patient was a marker of disease severity, and its identification should influence the therapeutic decision.

[Idiopathic facial aseptic granuloma: A case report]. / Granuloma aséptico facial idiopático: A propósito de un caso.

Idiopathic facial aseptic granuloma is a childhood condition characterized by asymptomatic erythematous-violaceous nodules, often confused with abscesses. Its pathogenesis is unknown, but some authors have postulated its relationship with infantile rosacea. We present a case of a patient with a clinical diagnosis of idiopathic facial aseptic granuloma, with ocular involvement and a good response to oral metronidazole treatment.

El granuloma aséptico facial idiopático (GAFI) es una afección de la infancia, que se caracteriza por nodulos faciales eritematovioláceos asintomáticos, usualmente confundidos con abscesos. Su patogénesis es desconocida, pero algunos autores han postulado su relación con la rosácea infantil. Se presenta el caso de un paciente con diagnóstico clínico de granuloma aséptico facial idiopático, con compromiso ocular y buena respuesta al tratamiento con metronidazol por vía oral.

Chromomycosis, an unusual cause of cicatricial ectropion: a case report.

Chromomycosis is a fungal infection that affects the epidermis, dermis, and subcutaneous tissue and is caused by dematiaceous fungal species that turn black on staining. We report the case of a 50-year-old male patient who was a rural worker and had been treated without success for three decades. Facial lesions progressed and caused severe cicatricial retraction. As the infection evolved, the left upper eyelid developed cicatricial ectropion. The surgical treatment was performed using skin obtained from the patient's own abdomen. Patient has developed a good postoperative appearance.

Chromomycosis, an unusual cause of cicatricial ectropion: a case report / Cromomicose como causa rara de ectrópio cicatricial: relato do caso

ABSTRACT Chromomycosis is a fungal infection that affects the epidermis, dermis, and subcutaneous tissue and is caused by dematiaceous fungal species that turn black on staining. We report the case of a 50-year-old male patient who was a rural worker and had been treated without success for three decades. Facial lesions progressed and caused severe cicatricial retraction. As the infection evolved, the left upper eyelid developed cicatricial ectropion. The surgical treatment was performed using skin obtained from the patient's own abdomen. Patient has developed a good postoperative appearance

RESUMO A cromomicose é uma infecção fúngica que afeta a epiderme, derme e tecido subcutâneo. A infecção é causada por espécies de fungo dematiáceos que se coram em preto. Nós relatamos o caso de um homen de 50 anos de idade, trabalhador da zona rural, que tinha sido tratado por três décadas sem êxito conclusivo. As lesões faciais progrediram causando retração cicatricial severa. Com a evolução do quadro, houve também retração também da pálpebra superior do olho esquerdo. O tratamento cirúrgico foi realizado utilizando pele abdominal do próprio paciente. O paciente apresentou uma boa aparência pós-operatória.

Low-dose oral isotretinoin for moderate to severe seborrhea and seborrheic dermatitis: a randomized comparative trial.

BACKGROUND: The efficacy of low-dose oral isotretinoin in the treatment of seborrhea and seborrheic dermatitis has been poorly investigated in randomized studies. OBJECTIVES: This study was designed to determine the efficacy and safety of low-dose oral isotretinoin in the treatment of moderate to severe seborrhea and seborrheic dermatitis on the scalp and/or face. METHODS: A randomized, comparative clinical trial, using two groups, was conducted over 6 months. Patients in Group ISO were treated with isotretinoin 10 mg every other day. In Group X, patients received antiseborrheic topical treatment. Patient opinion, investigator assessment, scalp pruritus, sebum production, and quality of life (QoL) comprised the efficacy outcomes. RESULTS: The intention-to-treat population comprised a total of 45 patients with mean ± standard deviation ages of 28.7 ± 5.8 years in Group ISO and 29.8 ± 6.5 years in Group X. The rate of sebum production significantly decreased in Group ISO. Patient opinion, investigator, and QoL assessments improved in both groups. CONCLUSIONS: Low-dose oral isotretinoin can be a therapeutic modality for moderate to severe seborrhea and seborrheic dermatitis.

Rosacea fulminans.

We review rosacea fulminans, a rare condition that may cause facial scarring and disfigurement. All physicians and health care professionals must be aware of this form of rosacea to treat or refer the patient. Early treatment of rosacea fulminans is essential to avoid scarring.

Acné fulminans: presentación de un caso / Acne fulminans: case review

Introducción: El acné fulminans fué descrito en 1959 y se considera una forma aguda y grave de acné, originalmente se denominó como acné colglobata ulcerativo febril agudo, la principal característica es el inicio súbito de las lesiones. Los hayazgos clínicos incluyen acné ulcero-costroso, fiebre, poliartritis, anormalidades en las pruebas de laboratorio y escasa respuesta al tratamiento antimicrobiano. afecta principalmente a adolescentes varones, pero tambien puede presentarse en mujeres; las lesiones son mas frecuentes en tórax y se han reportado pocos casos de localización facial o ambos. El tratamiento de elección son los corticoides orales y la isotretinoína oral. Presentación de caso: Se trata de paciente femenino de 19 años de edad que debuta súbitamente con placas costrosas supurativas, nódulos y quistes que forman trayectos localizados en cara. Acompañando al cuadro fiebre, mal estado general y altralgias; ademas con leucocitosis y aumento de la velocidad de eritrosedimentación. Se manejo con antibióticos sistémicos, esteroides y posteriormente con isotretinoína oral, con resolución del cuadro. Conclusión: El acné fulminans es una entidad poco frecuente, su diagnostico es fundamentalmente clínico y su manejo debe ser oportuno para evitar secuelas. Esta rara enfermedad responde pobremente a los antibióticos de amplio espectro, a los antiinflamatorios no esteroideos y al tratamiento tópico convencional del acné vulgar. El tratamiento de elección son los corticosteroides orales y la isotretinoína, lo cual demostramos con la presentación de este caso clínico...(AU)

Acné fulminans: presentación de un caso / Acne fulminans: case review

Introducción: El acné fulminans fué descrito en 1959 y se considera una forma aguda y grave de acné, originalmente se denominó como acné colglobata ulcerativo febril agudo, la principal característica es el inicio súbito de las lesiones. Los hayazgos clínicos incluyen acné ulcero-costroso, fiebre, poliartritis, anormalidades en las pruebas de laboratorio y escasa respuesta al tratamiento antimicrobiano. afecta principalmente a adolescentes varones, pero tambien puede presentarse en mujeres; las lesiones son mas frecuentes en tórax y se han reportado pocos casos de localización facial o ambos. El tratamiento de elección son los corticoides orales y la isotretinoína oral. Presentación de caso: Se trata de paciente femenino de 19 años de edad que debuta súbitamente con placas costrosas supurativas, nódulos y quistes que forman trayectos localizados en cara. Acompañando al cuadro fiebre, mal estado general y altralgias; ademas con leucocitosis y aumento de la velocidad de eritrosedimentación. Se manejo con antibióticos sistémicos, esteroides y posteriormente con isotretinoína oral, con resolución del cuadro. Conclusión: El acné fulminans es una entidad poco frecuente, su diagnostico es fundamentalmente clínico y su manejo debe ser oportuno para evitar secuelas. Esta rara enfermedad responde pobremente a los antibióticos de amplio espectro, a los antiinflamatorios no esteroideos y al tratamiento tópico convencional del acné vulgar. El tratamiento de elección son los corticosteroides orales y la isotretinoína, lo cual demostramos con la presentación de este caso clínico...

An open-label efficacy pilot study with pimecrolimus cream 1% in adults with facial seborrhoeic dermatitis infected with HIV.

BACKGROUND: Seborrhoeic dermatitis (SD) is a common dermatosis in human immunodeficiency virus (HIV)-positive patients, many of whom do not respond satisfactorily to conventional topical treatments such as corticosteroids and antifungals. OBJECTIVE: A pilot study to investigate the efficacy and tolerability of pimecrolimus cream 1% in HIV-positive patients with facial SD. METHODS: In a single-centre study, 21 HIV-infected patients with mild to severe SD were treated twice daily with pimecrolimus cream 1% for 14 days. Thereafter, treatment was discontinued and patients followed up for 5 weeks. Skin involvement at baseline and on days 7, 14, 21, 35 and 49 was assessed using a four-point clinical score and digital photography. MAIN OUTCOME MEASURES: Efficacy and safety of pimecrolimus cream 1% treatment and incidence of relapse in the follow-up phase. Results Marked improvement was seen in clinical parameters at day 7, with >or= 90% patients clear of symptoms at day 14. Relapse was observed at day 35 but signs were milder than at baseline. All patients responded to therapy, despite their immunological status. Pimecrolimus did not alter CD4(+) and CD8(+) T-cell counts or viral load during the treatment period. CONCLUSION: Pimecrolimus cream represents a new, effective therapeutic option for facial SD in HIV patients.

[Tinea capitis in an adult. Case report]. / Tiña de la cabeza en un adulto. A propósito de un caso.

A tinea capitis and tinea faciei case in an elderly female patient with diabetes mellitus type 2 is presented. Her dermatological illness began on her face and later disseminated to her scalp. She received multiple medications which aggravated her condition. The diagnosis was established by means of direct examination and the isolation of Trichophyton tonsurans in culture. Treatment with 200 mg daily dose of itraconazol for two months resulted in clinical and mycological cure.

Mucocutaneous histoplasmosis in AIDS.

A 36-year-old man, who was an intravenous drug abuser, developed thoracic herpes zoster, paronychia, oral candidosis, necrotizing gingivitis and bilateral parotid salivary gland swelling. Granulomatous oral lesions and ulceration on the nose were shown to be due to disseminated histoplasmosis.

[Bazex's para-neoplastic acrokeratosis. A clinical case with hyperpigmentation]. / Acroqueratosis paraneoplásica de Bazex. Un caso clínico con hiperpigmentación.

We studied a white skin type 3 male patient aged 68 years old with a paraneoplastic acrokeratosis of Bazex, suffering from an oesophagus neoplasm. Cutaneous manifestations preceded in months the cancer. Dermatosis affected fingers of hands and feet, soles, nose and helix. Black melanic hyperpigmentation was the first cutaneous sign and were followed by an hyperkeratosis, becoming the most clinical characteristic of the syndrome. The sequence of these signs induces us to suggest that hormonal factors elaborated by the tumoral cells are the ones responsible for the pigmentary changes since they appeared before the hyperkeratosis.

The Sweet syndrome in children.

Two children are described with the Sweet syndrome (acute febrile neutrophilic dermatosis), a rare skin disorder usually seen in middle-aged women. Typical features include spiking fever, neutrophilic leukocytosis, raised painful erythematous plaques and nodules reflecting a cutaneous dermal infiltrate composed of polymorphonuclear leukocytes and rapid resolution in response to systemically administered corticosteroid. The eruption is believed to represent a hypersensitivity reaction to antecedent infection or concurrent malignancy.