Miliaria Scarlatinosa, A Peculiar and Rare Form of Scarlet Fever - A Case Report.

Scarlet fever typically presents with distinctive erythematous papular rash following pharyngitis. Atypical forms may develop, making the diagnosis difficult. We present the case of a girl with fever, and unusual vesicular skin eruption (miliaria scarlatinosa) preceded by a skin infection, without mucosal changes. Leukocyte count, C-reactive protein, and antistreptolysin O-titer were elevated. Bacteriological swabs of the skin injury revealed Streptococcus pyogenes. Histopathology was compatible with scarlet fever exanthema. Intramuscular penicillin and topical wound care induced complete remission. It is of great importance to be aware of uncommon clinical presentations of scarlet fever in order to establish a timely diagnosis and prevent potential complications.

The oldest new finding in atopic dermatitis: subclinical miliaria as an origin.

IMPORTANCE: In 1947, Sulzberger and colleagues published a micrograph of a blocked acrosyringium in a patient with atopic dermatitis (AD), believing that it had a large role in the disease process. Lacking appropriate probes, they could not confirm the finding. OBJECTIVE: To confirm the observations by Sulzberger et al on the blockage of sweat ducts in AD in pathologic specimens. DESIGN AND SETTING: Biopsy specimens diagnostic of various inflammatory diseases and with a secondary differential diagnosis of eczema were evaluated at an academic medical center. EXPOSURES: Evidence of ductal obstruction in each specimen was examined following staining with hematoxylin-eosin, periodic acid-Schiff, and Gram stain. MAIN OUTCOMES AND MEASURES: Comparison of biopsy specimens with control specimens and additional controls consisting of noninflamed skin. RESULTS: Using 36 biopsy specimens, this study confirmed the observations by Sulzberger et al on the blockage of sweat ducts in AD. Blocked acrosyringia were noted in each specimen on routine staining with hematoxylin-eosin. The study also confirmed the findings by earlier investigators about the blockage of sweat ducts in miliaria, showing eosinophilic material in the ducts that was positive for periodic acid-Schiff. Previous researchers also observed bacteria in the blockages, and this study demonstrated the same findings in AD, rather than miliaria. CONCLUSION AND RELEVANCE: Subclinical miliaria may be the earliest change in AD and likely initiates the process that causes intense pruritus.

Diaper dermatitis: a review and update.

PURPOSE OF REVIEW: Diaper dermatitis is the most common cutaneous diagnosis in infants. In this review, common causes of diaper dermatitis and similarly presenting conditions will be covered, as well as updates on treatments of common diaper dermatitides. RECENT FINDINGS: There have been recent advancements in the treatment of diaper dermatitis. In addition, there are many newly recognized causes of diaper dermatitis that clinicians should be aware of. SUMMARY: Irritant dermatitis is the most common cause of diaper dermatitis. However, there are multiple other common causes of diaper dermatitis and it is thus imperative that the clinician be aware of cutaneous mimickers of irritant diaper dermatitis as well as their treatments.

Miliaria rubra and thrombocytosis in pseudohypoaldosteronism: case report.

Pseudohypoaldosteronism type 1 (PHA1) is a disease involving a state of renal tubular unresponsiveness to the action of aldosterone and characterized by excessive salt loss in the urine, hyperkalemia, and metabolic acidosis. In kidney, PHA1 may occur primarily by mutations in the subunits of the sodium channel or in the mineralocorticoid receptors, and secondarily by several renal disorders. Miliaria rubra and thrombocytosis are reported in a 6-month-old girl with PHA1. In patients with PHA1, miliaria rubra-like cutaneous eruptions are suggested to occur due to obstruction of eccrine sweat glands through inflammation caused by excessive sodium excretion in sweat during hyponatremic crises. The presence of thrombocytosis in patients with PHA1 has not been previously reported. A hypothesis is proposed suggesting that sympathetic activation which provides vascular tonus during sodium excretion in sweat and salt-depletion crisis may play a role in the development of eruptions and thrombocytosis in patients with PHA1.

Xantomatosis perifolicular: hallazgo histológico clave en la enfermedad de Fox-Fordyce / Perifollicular xanthomatosis as a key histological finding in Fox-Fordyce disease

La enfermedad de Fox-Fordyce es una rara dermatosis caracterizada por la presencia de múltiples pápulas foliculares pruriginosas en áreas corporales con riqueza de glándulas apocrinas como axilas, areolas mamarias o región genital. Los hallazgos histopatológicos que definen la enfermedad de Fox-Fordyce son muy variados. Además de los hallazgos descritos como típicos de esta entidad, como la dilatación del infundíbulo y la hiperqueratosis y espongiosis del epitelio infundibular, se pueden observar otros muchos hallazgos histológicos. Presentamos el caso de una mujer de 21 años de edad afectada por esta enfermedad y recalcamos la importancia de la xantomatosis perinfundibular como hallazgo histológico clave en el diagnóstico de esta entidad (AU)

Fox-Fordyce disease is a rare skin condition characterized by the presence of multiple pruritic follicular papules in areas rich in apocrine glands, such as the axillae, mammary areolae, or genital regions. There is a high degree of variability in the histological findings seen in Fox-Fordyce disease. In addition to those described as typical of this entity, such as dilation of the infundibulum and hyperkeratosis and spongiosis of the infundibular epithelium, many other histological changes can be observed. We report the case of a 21-year-old woman with Fox-Fordyce disease and highlight the importance of perifollicular xanthomatosis as a key histological finding in the diagnosis of the disease (AU)

[Pustular miliaria rubra and systemic type 1b pseudohypoaldosteronism in a newborn]. / Miliaire rouge et pseudo hypoaldostéronémisme de type 1b de révélation néonatale.

BACKGROUND: The term "miliaria" is used to describe a group of highly transient skin disorders in the newborn characterized by eccrine duct obstruction and the passage of sweat into the epidermis and papillary dermis. This rash in the susceptible skin of the neonate is brought on by heat and confined environments. Our paper reports several episodes of pustular miliaria rubra associated with salt loss crises in a newborn with systemic pseudohypoaldosteronism type 1b (PHA). OBSERVATION: Since the first days of life, the child presented severe and diffuse miliaria comprising many disseminated pustules associated with salt loss syndrome. Pseudohypoaldosteronism type 1b was readily diagnosed on the basis of aldosterone, sodium and chloride levels in sweat, saliva and in feces. The course was characterized by chronicity and flares simultaneously with salt loss. DISCUSSION: Associated pseudohypoaldosteronism type 1b/red miliaria is not fortuitous with this in fact being the second case reported in the literature. Obstruction of the eccrine ducts and pustular exanthema were probably due to abnormal Na+ levels in sweat.

Basaloid follicular hamartoma with eruptive milia and hypohidrosis: is there a pathogenic relationship ?

We report a sporadic case of eruptive milia with histopathological features of basaloid follicular hamartoma which developed in an 8 year-old Japanese girl. Multiple milia and comedo-like eruptions were present at birth and gradually increased in number and spread over the extremities. Histopathologically, keratotic cysts with trichilemmal keratinization and features of basaloid follicular hamartoma were observed without any histological findings of basal cell epithelioma or trichoepithelioma. Reduced sweating was observed after iontophoretically applied acetylcholine on the forearm. Nevus of Ota and thyroid goiter were complications.

Pustular miliaria rubra: a specific cutaneous finding of type I pseudohypoaldosteronism.

Type I pseudohypoaldosteronism, an autosomal recessive, life-threatening disorder of mineralocorticoid resistance leads to excessive loss of sodium chloride through eccrine and other secretions. Recurrent episodes of pustular miliaria rubra are associated with salt-losing crises and clear spontaneously with stabilization. Inflammation of and around the damaged eccrine glands has been attributed to the deleterious effects of excessive eccrine gland salt exposure.

Multiple eruptive milia in a 15-year-old boy.

We present a 15-year-old boy with periorbital idiopathic multiple eruptive milia. He represents the youngest case to date of this unusual dermatosis.

[Multiple trichoepithelioma, cylindroma, miliaria and carcinomatous transformation]. / Trichoépithéliomes multiples, cylindromes, grains de milium, dégénérescence carcinomateuse.

We report a new case of multiple trichoepitheliomas, milia and cylindromas syndrome. This new case differed from the others in that it was complicated by the occurrence of a basal cell carcinoma presenting as an ulcus rodens affecting the nasal pyramid. In such cases, the main differential diagnosis to be excluded is basal cell naevomatosis.

Heat-related illnesses. When are they a true emergency?

During the hot, humid months of summer, heat-related illnesses are common. Many of these are minor and self-limited, but heatstroke is a true emergency because the body's cooling mechanisms have been overwhelmed. The condition must be recognized rapidly and treated immediately with fluid replacement and cooling. The most effective and accessible technique for cooling involves the use of cool mist and fans directed across the patient's body to promote rapid evaporation. With aggressive management, the effects of heatstroke are almost uniformly reversible. With proper precautions, its occurrence is universally preventable.

Atopic dermatitis. Clinical spectrum and approach to treatment.

The fact that atopic dermatitis is such a common medical problem underlies the need for better understanding of the basic disease processes and the development of new therapeutic approaches. Infection is now recognized as an important exacerbating factor, and the role of inflammatory and immunologic mediators is receiving scrutiny. The development of potent topical corticosteroids has provided a new component in the therapeutic armamentarium that previously included only cool soaks, menthol or phenol, tars, antihistamines, and combinations of these. Appropriate and aggressive therapy given early seems to offer the patient the best chance for recovery. Patient education is important in minimizing recurrent flares of disease.

Heat intolerance as a function of percent of body surface involved with miliaria rubra.

Twenty-four heat-acclimatized male volunteers were wrapped as previously described (Am. J. Physiol. 239 (Regulatory Integrative Comp. Physiol. 8): R226-R232, 1980) but to produce miliaria rubra (heat rash) in specific regions of the body. Three experimental rash groups were involved: 1) the torso (17% total skin surface rashed, n = 6), 2) torso and arms (38%, n = 8), or 3) legs (41%, n = 6), while four subjects served as controls. All subjects were reexposed to walking in the heat on the 7th day after unwrapping, and again 14, 21, and 28 days after unwrapping. When compared to responses for the last heat acclimatization day, tolerance time and sweat rate were lower and mean body temperature and delta heat storage significantly higher for experimental rash subjects contrasted to the controls for up to 21 days; however, no significant differences between the three rashed groups were found. The critical amount of surface area for heat intolerance from heat rash appears to be related to the specific region of the body and associated sweating responses; smaller rashed areas of the trunk, because they have greater potential for abundant sweating, may produce similar responses to heat stress as larger rashed areas of the limbs. Heat intolerance due to rash was not resolved until after 21 days.