[How to cope with tinea capitis?]. / Comment gérer les teignes du cuir chevelu?

In Brussels, as in the other European cities with a high rate of immigration, the cases of anthropophilic tinea capitis have risen. Their clinical aspect is more discrete than in zoophilic cases, and you could be easily fooled. This explains why, in 2001-2002, we had some epidemics in schools and creches. Griseofulvin, the gold treatment, was withdrawn from the Belgian market in 1997. The identification of the pathogen when using the new antifungals (fluconazole, itraconazole and terbinafine) is mandatory, dermatophytes showing a different sensitivity to these drugs. The management of an anthropophilic tinea capitis needs some good planning and the cooperation of the family and the school. We describe our procedures in this article.

Two hundred ninety-six cases of onychomycosis in children and teenagers: a 10-year laboratory survey.

There is still little data available about the epidemiology of childhood onychomycosis. Looking at our laboratory figures over a 10-year period provided us with some useful information. Nail keratin samples were taken by dermatologists from 21,557 patients with nail conditions, mainly in the Brussels region. The specimens were examined by direct microscopy and/or histology, and cultured on Sabouraud medium agar. Only patients less than 17 years of age were considered as children. Clinical information was gathered about age, sex, and the location of the infected nail. Nine hundred sixty-three of the samples were from children, and 296 of those children had proven onychomycosis. More than three-fourths of the cases were found in children more than 6 years old, and boys were more frequently affected than girls. Toenails were the predominant location of infection. Trichophyton rubrum was the main pathogen, followed by Candida spp. and Trichophyton interdigitale. One case was caused by Scopulariopsis spp. As in adults, onychomycosis is probably the main nail disease in children. After the age of 6 years, the presentation is very similar to that in adults: toenails are mostly involved, and T. rubrum, the main pathogen, is responsible for distal and lateral subungual onychomycosis.

[Dermatophytoses due to domestic animals]. / Les dermatophytoses dues aux animaux domestiques.

Dermatophytoses are superficial skin infections due to dermatophytes which are filamentous fungi. Some dermatophytes can be hosted by domestic animals. In Belgium, Microsporum canis, Trichophyton (T.) mentagrophytes variety mentagrophytes, T. verrucosum and T. equinum are zoophilic species capable of infecting humans. Animals, clinical aspects in humans and the investigations needed will be reviewed. Treatment should target animal and patient but also limit the spread of the infection. Topical therapy is sufficient in cases restricted to the skin. When hair is involved, systemic treatment becomes mandatory. The withdrawal of griseofulvin from the Belgian market more than two years ago has made it necessary to introduce the mode of use of the newer antifungals such as fluconazole, Itraconazole and terbinafine.

Acropathia ulcero-mutilans acquisita of the upper limbs.

We report an 80-year-old woman with a bilateral mutilating acro-osteolysis of the fingers progressing over a period of 3 years. As the patient refused nerve or muscle biopsies, our diagnosis of acropathia ulcero-mutilans acquisita or Bureau-Barrière syndrome, characterized by osteolysis, remains hypothetical. Sporadic sensory mutilating acropathy of the upper limbs is rare, and we discuss the differential diagnosis.

Tinea capitis in two black african adults with HIV infection.

Tinea capitis is rare in adults, although a few cases have been described in HIV-infected patients. We present two cases in black African adults who were HIV positive. In one, the condition led to the diagnosis of HIV infection. It is possible that the rarity of tinea capitis in HIV-positive adults could be related to increased colonization of their scalp by Pityrosporum (Malassezia) spp. In patients well controlled with an antiviral therapy, the treatment of tinea capitis seems no more difficult than in non-immunosuppressed patients. There is possibly a relation between clinical presentation and degree of immunodeficiency.

An unusual case of squamous cell carcinoma of the nose.

A 49-year-old man presented with a tumoral lesion of the tip of the nose which had been manifest for 2 months. Within a few weeks, the tumour increased in size and became infiltrated. The biopsy showed a squamous cell carcinoma. Treatment consisted of a radical surgical excision.