Climate change, human migration, and skin disease: is there a link?

Climate change, exemplified by higher average global temperatures resulting in more frequent extreme weather events, has the potential to significantly impact human migration patterns and health. The consequences of environmental catastrophes further destabilize regions with pre-existing states of conflict due to social, political, and/or economic unrest. Migrants may carry diseases from their place of origin to their destinations and once there may be susceptible to diseases in which they had not been previously exposed to. Skin diseases are among the most commonly observed health conditions observed in migrant populations. To improve awareness among dermatologists of the burden of skin diseases among migrants, the group searched the English language scientific literature to identify articles linking climate change, migration, and skin disease. Skin diseases associated with human migration fall into three major categories: (i) communicable diseases, (ii) noncommunicable diseases, and (iii) environmentally mediated diseases. Adopting comprehensive global strategies to improve the health of migrants requires urgent attention.

A global consensus statement on ashy dermatosis, erythema dyschromicum perstans, lichen planus pigmentosus, idiopathic eruptive macular pigmentation, and Riehl's melanosis.

Ashy dermatosis (AD), lichen planus pigmentosus (LPP), erythema dyschromicum perstans (EDP), and idiopathic eruptive macular pigmentation are several acquired macular hyperpigmentation disorders of uncertain etiology described in literature. Most of the published studies on these disorders are not exactly comparable, as there are no clear definitions and different regions in the world describe similar conditions under different names. A consensus on the terminology of various morphologies of acquired macular pigmentation of uncertain etiology was a long-felt need. Several meetings of pigmentary disorders experts were held to address this problem. A consensus was reached after several meetings and collation of e-mailed questionnaire responses and e-mail communications among the authors of publications on the above conditions. This was achieved by a global consensus forum on AD, LPP, and EDP, established after the 22nd International Pigment Cell Conference held in Singapore in 2014. Thirty-nine experts representing 18 countries participated in the deliberations. The main focus of the deliberations was terminology of the conditions; as such, we present here the consensus statement of the forum and briefly review the available literature on the subject. We have not attempted to discuss treatment modalities in detail.

Impact of climate change on dermatological conditions related to flooding: update from the International Society of Dermatology Climate Change Committee.

Climate change contributes to the increase in severity and frequency of flooding, which is the most frequent and deadly disaster worldwide. Flood-related damage can be very severe and include health effects. Among those health impacts, dermatological diseases are one of the most frequently encountered. Both infectious and noninfectious dermatological conditions are increasing after flooding. We searched PubMed using the search term climate change OR global warming OR rainfall OR flooding OR skin. Articles published in the English-language literature were included. We also searched the International Society of Dermatology website library on climate change for additional articles. There is an increased risk of trauma during the course of a natural disaster. The majority of post-tsunami wound infections were polymicrobial, but gram-negative bacteria were the leading causes. Infectious diseases with dermatological manifestations, such as impetigo, leptospirosis, measles, dengue fever, tinea corporis, malaria, and leishmaniasis, are important causes of morbidity among flood-afflicted individuals. Insect bites and stings, and parasite infestations such as scabies and cutaneous larva migrans are also frequently observed. Inflammatory conditions including irritant contact dermatitis are among the leading dermatological conditions. Dermatological conditions such as alopecia areata, vitiligo, psoriasis, and urticaria can be induced or exacerbated by psychological conditions post disaster. Prevention is essential in the management of skin diseases because of flooding. Avoiding exposure to contaminated environments, wearing protective devices, rapid provision of clean water and sanitation facilities, prompt vector controls, and education about disease risk and prevention are important.

Hypopigmented mycosis of fungoides in an eight-year-old girl managed with narrowband ultraviolet B therapy

Mycosis fungoides presenting with hypopigmented lesions is an uncommon variant, which is usually described among dark-skinned patients. We report a case of hypopigmented mycosis fungoides in an eight-year-old girl who has responded favorably to narrowband-ultraviolet B therapy. The disease mimics several benign inflammatory skin conditions, hence, a high clinical suspicion is warranted in patients presenting with widespread hypopigmentation.

The misadventures of a traveler: Penicilliosis in a Filipino with HIV-AIDS

We report a case of penicilliosis in a Filipino man with HIV-AIDS who presented with skin-colored and erythematous to hyperpigmented, umbilicated papules and nodules on the face, trunk, and extremities associated with fever, lymphadenopathy, and anemia. The diagnosis was made through skin biopsy and fungal culture, which showed characteristic paintbrush-like hyphae and conidiophores. The patient was treated with intravenous amphotericin B at 0.6 mg/kg/day for 14 days followed by oral itraconazole 200 mg twice daily for 10 weeks resulting to flattening of lesions with hyperpigmentation, and prevention of appearance of new lesions. Resolution of fever, lymphadenopathy and improvement of anemia were also noted. He was placed on maintenance regimen with itraconazole 200 mg once daily to prevent relapse. Early diagnosis and appropriate management is important because mortality of disseminated disease is high if diagnosis and treatment are delayed.

Cutaneous cytomegalovirus infection presenting as persistent plaque on the nose in an HIV-AIDS patient

Cytomegalovirus (CMV) rarely manifests as cutaneous lesions in immunocompromised patients. Only 25 cases have been reported since 1991. It causes latent infection among exposed individuals but reactivation may occur in immunocompromised patients causing encephalitis, pneumonitis, colitis, retinitis and congenital fetal infection. Cutaneous manifestations of CMV infection usually present with various skin lesions such as ulcers, erosions, erythematous morbilliform rash, vesicles and bullae. We report a case of cutaneous CMV infection in an HIV-AIDS patient presenting as a persistent ulcerated plaque on the nose. The lesion slowly evolved into a plaque which partially destroyed the right alar rim. Skin punch biopsy showed perivascular giant cells with large eosinophilic inclusions resembling an owl's eye consistent with CMV infection. He was subsequently diagnosed with CMV retinitis because of blurring of vision and findings of retinal necrosis on fundoscopy. Oral valganciclovir 1800mg/day was given for 21 days. Significant thinning and drying of the plaque with no further progression of ulceration of the alar rim were noted.

An unusual presentation of secondary syphilis in an 18-year-old man

INTRODUCTION: Secondary syphilis is a sexually transmitted infection characterized by localized or diffuse mucocutaneous lesions, often with generalized lymphadenopathy with laboratory evidence consistent with syphilis. Condolyma latum is one of the many forms of secondary syphilis and is noted to occur commonly on moist intertriginous areas of the body such as the axilla, web spaces of the toes, genital and perianal regions. CASE REPORT: An 18 year-old man presented with a four-month history of few erythematous pruritic plaques on the penile shaft and multiple moist plaques involving the scalp, face, anterior neck, nape, axilla,anterior abdomen, upper and lower extremities, and scrotum. There are few erythematous scaly patches noted on the palms and soles. Serologic testing confirmed a diagnosis of syphilis and the patient tested negative for human immunodeficiency virus infection. The patient was given a single dose of intramuscular benzathine penicillin G 2.4 million units, with noted flattening of all lesions upon follow-up three months later. CONCLUSION: Condylomata lata, although most commonly found on moist intriginous areas of the axilla, web spaces of the toes, genital and perianal regions, can also involve less commonly affected areas such as the scalp, face, anterior abdomen, and the extremities. A high index of suspicion therefore is warranted to differentiate it from other cutaneous diseases and to prevent progression of the disease by initiating appropriate antibacterial therapy.

Seabather's eruption in two triathletes at Samal Island, Davao, Philippines

Seabather's eruption (SBE) is characterized by pruritic erythematous papules on the covered areas of the body that appear within 24 hours after exposure to seawater. SBE is known to be caused by the planula of a thimble jellyfish (Linuche unguiculata) or a sea anemone (Edward siellalineata). We report cases of two adult male triathletes who developed pruritic erythematous papules on the chest and back after a swim training along the coastal waters of Samal island, Davao City. Examination of samples of the seawater revealed multiple planulae or larval forms of cnidarians. The histopathologic examination revealed moderately dense superficial and deep perivascular and periadnexal inflammatory infiltrates consisting predominantly of lymphocytes, few eosinophils and neutrophils. Treatment with a short course of systemic corticosteroids proved beneficial in both patients. A review of published literature regarding this interesting aquatic sports dermatosis was also conducted.

T-cell-rich angiomatoid polypoid pseudolymphoma of the skin: a clinicopathologic study of 17 cases and a proposed nomenclature.

BACKGROUND: We describe a series of previously unreported, distinctive, polypoid solitary T-cell-rich cutaneous pseudolymphomas. METHODS: The clinicopathologic features were examined in 17 cases. RESULTS: Patient ages ranged from 16 to 71 years (mean = 38.5) with a female predominance (female : male = 14 : 3). All lesions, clinically diagnosed most often as pyogenic granuloma, presented as a solitary, polypoid, erythematous, papule ranging in size from 2.5 to 7.5 mm (mean = 5.8). Most occurred on the head and neck (7) and trunk (6) with other sites including the thigh (1), shoulder (1) and knee (1). A dense dermal infiltrate composed of mildly atypical lymphocytes with variable numbers of admixed plasma cells and histiocytes was prototypical. Commonly, there was an associated epidermal collarette (16/17), Grenz zone (11/17) or admixed eosinophils (8/17). Prominent vessels lined by plump endothelial cells, reminiscent of high endothelial venules of lymph nodes, were universal and some degree of telangiectasia was also common (12/17). CD3-positive T-cells consisted of an admixture of CD4-positive and CD8-positive forms (15/16). Multiple studies suggested polyclonality (seven cases). No recurrences after lesional excision were noted in the 17 patients with a follow-up range from 24 to 120 months (mean = 46.6). CONCLUSION: Although these lesions share histopathologic features of the so-called acral pseudolymphomatous angiokeratoma of children (APACHE), they occur in a completely different clinical setting, present in solitary and polypoid fashion and are T-cell rich. We propose the diagnostic label T-cell-rich angiomatoid polypoid pseudolymphoma for this distinctive but presumably reactive lesion.

Mucinous hidradenoma: a report of three cases.

Mucinous cutaneous adnexal tumors are an uncommon occurrence. We describe three cases of mucinous hidradenoma characterized by diffuse and prominent mucinous cell proliferation and discuss the relevant literature. The patients (two men and one woman) ranged in age from 32 to 72 years. The lesions were completely excised, and all patients were alive without evidence of disease (follow-up interval 3-4 years). Case 1 presented as a 1.3-cm eyelid nodule and histology showed a mucinous apocrine hidradenoma with a proliferation of mucinous cells and apocrine glands. Case 2, from the shoulder of a 40-year-old man, was a 2.5-cm well-circumscribed nodule composed of hyperplastic villoglandular proliferation of mucinous cells with focal squamous whorls and focal columnar glandular cells showing decapitation secretion. The tumor was also interpretated as a mucinous hidradenoma, most likely of follicular-apocrine origin. Case 3 was a 3.0-cm scalp nodule. The histology showed a mucinous clear-cell hidradenoma composed of numerous mucinous glands amidst small squamous cells with clear cytoplasm and a hyalinized fibrovascular stroma.

Sarcomatoid eccrine porocarcinoma: report of two cases and a review of the literature.

Eccrine porocarcinoma is an uncommon sweat gland malignancy. To the best of our knowledge, there has been no report in the English literature of porocarcinoma with predominantly undifferentiated sarcomatous change. We present two cases of sarcomatoid eccrine porocarcinoma associated with a benign poroma. Case 1 pertained to an 82-year-old woman with an ulcerated chest wall tumor, and Case 2 was that of a 74-year-old woman who presented with an ulcerated plaque in the lower leg. Case 1 showed an unusual pseudo-angiosarcomatous morphology with spindle cells dissecting through collagen bundles and forming vascular like channels. Case 2 revealed high-grade malignant spindle cells with focal evidence of ductal differentiation. In both the cases, benign poromatous elements were histologically evident. Immunohistochemistry performed showed pancytokeratin positivity in spindle cells of both lesions. Epithelial membrane antigen and carcino-embryonic antigen positivity in the malignant ductal elements and focal smooth muscle actin staining of the spindle cells were demonstrated in Case 2. A brief review of relevant literature is presented.

Symplastic hemangioma: report of two cases.

Symplastic hemangioma is characterized by degenerative atypia of vascular smooth muscle and interstitial cells within a pre-existing vascular lesion with minimal endothelial cell atypia. We describe an additional two cases of this distinctive but poorly recognized entity. On histology, both lesions revealed a cirsoid aneurysm-type appearance with thick-walled and variably dilated blood vessels. The vascular endothelial cells showed mild nuclear hyperchromasia with no multilayering or mitoses. The atypical cells, either located within the vascular smooth muscle wall or within the interstitium, were spindle or epithelioid with varying degrees of hyperchromasia, nuclear enlargement, pleomorphism, and multinucleation. Perivascular hemorrhage, vascular thrombosis, and focal papillary endothelial hyperplasia were uniformly present. The variably fibrous to edematous stroma showed hemosiderin deposits and a mononuclear inflammatory infiltrate. Clusters of adipocytes were present within the superficial dermis. Rare atypical mitoses and occasional bizarre lipoblast-like stromal cells were identified in one tumor. Immunohistochemistry showed focal smooth muscle actin positivity in the pleomorphic cells of the vascular walls. CD68 and CD34 stained occasional stromal cells in the interstitial location. Both the cases showed no recurrence. The bizarre cytologic changes are interpreted as degenerative in nature and probably akin to that observed in ancient schwannoma and uterine symplastic leiomyoma.

Mycology in the Philippines, revisited.

The warm tropical climate of the Philippines and its interaction with cultural practices, occupation and immune responsiveness contribute to the increased susceptibility of Filipinos to fungal infections. An investigation to determine the prevalence of fungal infections in dermatology training institutions over a 4-year period was conducted. The results showed that fungal infections rank as the second leading cause of consultation with a prevalence of 12.98%. Pityriasis versicolor (25.34%), tinea corporis (22.63%), tinea cruris (16.7%) and tinea pedis (16.38%) were the most frequently encountered cases. Fungal culture yield is low and Candida sp. is the most common isolate, obtained predominantly from specimens taken from the oral mucosa and nails. Candidiasis is still the most common opportunistic infection followed by coccidioidomycosis, cryptococcosis and aspergillosis. Imidazoles are the most commonly prescribed systemic and topical treatment by Filipino dermatologists. Initial data collected would serve as reference for future research and may be used to compare with epidemiologic data obtained from other Asian countries.

A preliminary study on the mosquito repellent effect of tea tree (Melaleuca alternifolia) oil

BACKGROUND: Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF) are now considered as major health problems in the Philippines. N,N,-dietyl-3-toluamide (DEET) is recognized as the most effective against Aedes aegypti. However, the concern about its use have underscored the need to find a safer alternative repellent.OBJECTIVES: This study aims to determine and compare the repellent activity of tea tree (Melaleuca alternifolia) oil against Aedes aegypti with 7% DEET using a double-blind controlled experimental trialMETHODOLOGY: Twenty healthy subjects were allocated systematically by alternate assignment into three treatment groups (Control vs. Tea Tree oil, control vs. 7 percent DEET, Tea Tree oil vs DEET). All subjects were exposed to Aedes aegypti for 5 minutes every hour for 8 hours and the number of mosquitoes biting/landing were recorded and compared for each treatment groupRESULTS: Fifty percent tea tree oil has a repellent activity against Aedes aegypti and its efficacy is comparable to 7% DEET. Both treatments were equally effective in repelling mosquitoes for 7 hours. No cutaneous reactions to both repellents were notedCONCLUSION: The efficacy of tea tree oil is comparable to 7% DEET and is recommended as an alternative natural mosquito repellent.