An intriguing case of lichen simplex chronicus in an elderly sub-Saharan African with longstanding scabies and sensory neuropathy.

Lichen Simplex Chronicus (LSC) is chronic dermatitis caused by repetitive scratching or rubbing of the skin. It presents as hyperpigmentation and thickening of the skin with variable scaling. Because LSC is a secondary lesion with a wide variety of causes, optimal management is contingent on identifying and managing its exact aetiology. We report an intriguing case of LSC in an elderly patient with longstanding scabies and sensory neuropathy.

Glucose Monitoring Dermopathy.

A 75-year-old man had been monitoring his glucose using a blood glucose monitoring system at the same body site for at least 20 years (>7300 needlesticks). The asymptomatic skin lesion had been present for many years. He used the same site because it hurt less than the fingers and bled well. His medical history was remarkable for diabetes mellitus, hypertension, coronary artery disease, and a pacemaker. His medications included glipizide, metformin, carvedilol, furosemide, lisinopril, amlodipine, clopidogrel, and aspirin. Physical examination revealed a brown, slightly raised, rough plaque with focal, punctate hemorrhagic crusts, on the distal area of the right thigh (Figure 1). The clinical differential diagnosis was more likely to be lichen simplex chronicus than pigmented Bowen's disease. A skin biopsy demonstrated an acanthotic epidermis with coarse collagen bundles in a thickened papillary dermis with extravasated erythrocytes, consistent with a dermal reparative reaction (Figure 2).

Vulvar Pruritus and Lichen Simplex Chronicus.

Vulvar pruritus and lichen simplex chronicus are common reasons for presentation to women's health practitioners, including gynecologists and dermatologists. Both conditions are multifactorial and are often confounded by other inflammatory, neoplastic, infectious, environmental, neuropathic, hormonal, and behavioral variables. Careful history taking and thorough physical examinations, including wet mount and potentially skin biopsy, are necessary for appropriate diagnosis. Treatment should focus on decreasing inflammation, reducing irritants, and providing symptomatic relief to achieve remission. Comprehensive treatment covering environmental, biological, and behavioral therapy can result in long-term cure for patients with these conditions.

Level of use and safety of botanical products for itching vulvar dermatoses. Are patch tests useful?

BACKGROUND: Topical remedies based on botanical ingredients are popular. OBJECTIVES: To assess: (i) the usage of botanical substances in subjects affected with itching and chronic vulvar complaints; (ii) the incidence of side-effects associated with their use and the frequency of contact allergy; (iii) the diagnostic usefulness of patch testing. METHODS: Sixty-six patients were provided with a questionnaire to assess the prevalence and type of topical botanical preparations used and the occurrence of adverse reactions. Patients were patch tested with (i) the Italian baseline series, (ii) a topical medicament series, and (iii) a botanical series. RESULTS: Forty-two patients (63.6%) reported the use of natural topical products on the vulva. Seven (16.7%) noted adverse reactions; 27 showed positive reactions with the baseline series; 14 (21.2%) had at least one relevant reaction, mainly to allergens in topical products and cosmetics; and 2 (3%) showed positive reactions to the botanical series. Of the 7 patients complaining of adverse effects of botanical products, 3 (42.8%) showed relevant sensitization. CONCLUSIONS: The use of natural topical products is widespread among women affected with itching vulvar diseases. Contact dermatitis is a possible adverse effect. Botanical series are of questionable usefulness, owing to the wide variety of botanical ingredients.

Cutaneous findings in children with intellectual disabilities.

The link between pediatric dermatology and intellectual disabilities (ID) is revised, according to the author's personal experience and the existing published work. Cutaneous manifestations in children with ID can be: (i) a key element to reach a diagnosis, as in neurodermatoses; (ii) a peculiar sign to define a complex syndrome; (iii) linked to behavioral features; (iv) iatrogenic, caused by drugs, as a side-effect; and (v) independent from ID.

Lichen simplex chronicus as a symptom of neuropathy.

BACKGROUND: The main cause of lichen simplex chronicus (LSC) is not known but there is evidence to suggest that neurological abnormalities may be implicated in its aetiology. AIM: To investigate neuropathy in patients with LSC on the limbs. METHODS: In total, 23 consecutive patients [15 women (65.2%) and 8 men (34.8%); mean +/- SD age 48.2 +/- 14.03 years, range 20-71] with LSC on the limbs were included in the study. Mean +/- SD duration of disease was 22.86 +/- 21.38 months (range 1-60). Radiography, magnetic resonance imaging (MRI) and electrophysiological studies were performed for all patients. RESULTS: In total, 8 patients (34.8%) had LSC on the arms and 15 patients (65.2%) had LSC on the legs; 3 (37.5%) of the 8 patients with LSC on the arms and 6 (40%) of the 15 patients with LSC on the legs had radiculopathy in the electrophysiological studies. The prevalence of radiculopathy in patients with LSC on the limbs was higher than in asymptomatic subjects in the electrophysiological studies. CONCLUSIONS: Damage to the peripheral nervous system, such as radiculopathy and neuropathy, can play a critical role in the aetiology of LSC on the limbs. Both nerve-root compression in MRI scans and radiculopathy in nerve-conduction studies are common findings in asymptomatic subjects, but they seem to be more common in patients with LSC on the limbs. Therefore, these patients should be evaluated for the possibility of underlying neuropathy.

[Atopy patch testing with aeroallergens and food]. / Atopie-Patch-Test mit Aeroallergenen und Nahrungsmitteln.

The atopy patch test (APT), a patch test employing allergens known to elicit IgE-mediated reactions which is assessed by evaluating eczematous skin lesions after 24 h to 72 h, was developed as a diagnostic tool for characterizing patients with aeroallergen-triggered atopic eczema (AE, atopic dermatitis). Positive APT reactions are associated with allergen-specific T-cell responses. The specificity of APT is higher than the specificity of skin prick tests or RAST. More studies for the standardization of APT methods are necessary, especially with regard to food APT.

Giant lichenification of the scalp.

Lichenification is characterized clinically by thickening of areas of skin as a result of the itch-scratch cycle and therefore is seen in conditions associated with chronic pruritus. The characteristic feature of giant lichenification is the occurrence of tumour-like growths with a warty cribriform surface. We describe a renal transplant patient presenting with giant lichenification of the scalp following an attack of herpes zoster at the same site. Chronic pruritus following scalp dysaethesia secondary to herpes zoster was considered the most likely explanation for the occurrence of these lesions.

[Effects of long-term exposure to street traffic exhaust on the development of skin and respiratory tract diseases in children]. / Auswirkungen langfristiger Expositionen gegenüber Strassenverkehrs-Immissionen auf die Entwicklung von Haut- und Atemwegserkrankungen bei Kindern.

The pathogenesis of allergies can be stimulated by adjuvant effects--i.e. air pollutants such as NOx and particles from diesel engines as well as noise--the latter especially during night-time. During sleep, noise signals which are associated with danger (i.e. lorry noise) have the potential to trigger stress reactions even if the noise level is low. Increases of cortisol in the first half of the night seem to play an important role.--In a blind interview study, the combined effects of chronic exposure to traffic related air pollution and noise, upon the risk of skin and respiratory diseases in children were studied. All children between 5-12 years, who had consulted one of two participating pediatricians were included in the study. The pediatricians' diagnoses of 400 children were analysed together with their parents answers on the density of road traffic on their street and several confounding factors. Multiple regression analyses resulted in relative risks of asthma, chronic bronchitis and neurodermitis, which increased significantly with increasing traffic load. A comparison with the literature on such effects caused by air pollution alone, showed that traffic noise during the night might have an adjuvant effect on the pathogenesis of the mentioned diseases.