Association of eosinophilic fasciitis with morphea.

Eosinophilic fasciitis is a rare inflammatory disease of unknown etiology, described for the first time by Shulman in 1974. The disease presents with induration of the skin, connective tissue and the underlying muscle fascia, sometimes accompanied by myalgia, most commonly in the lower extremities. Unlike scleroderma, it presents with absence of visceral organ involvement and Raynaud's phenomenon. Hypergammaglobulinemia and eosinophilia have been reported. Eosinophilic fasciitis is often associated with hematological disorders--there are reports of combinations with other autoimmune diseases such as systemic sclerosis, systemic lupus erythematosus, Hashimoto thyroiditis, Sjogren syndrome, vitiligo, etc. Occurrence of morphea, in the course of eosinophil fasciitis is considered a rarity. We have observed such a case with the simultaneous presence of both types of lesions. A 20-year-old female patient is reported, wherein the clinical picture developed for 6 months. The initial erythematous edema and subsequently the livedo-like painful plaques in both lower legs gradually swell, thicken and hyperpigment. Almost simultaneously with these complaints small brown livid body plaques emerged. The patient was diagnosed based on history, clinical picture, peripheral eosinophilia and histological findings from the affected areas. There was no systemic involvement and accompanying hematologic or other disease. Therapeutic management and significant clinical improvement were achieved using systemic corticosteroid therapy combined with methotrexate.

A case of rheumatoid arthritis presenting with postherpetic neuralgia and abdominal-wall pseudohernia.

Postherpetic neuralgia is a common complication, while the postherpetic abdominal-wall pseudohernia (AWP) is a quite rare complication of herpes zoster (HZ). We report a patient >45 years of age with a history of rheumatoid arthritis (RA) who presented with two chronic HZ complications. A 75-year-old woman was admitted with neuralgia following cutaneous herpes zoster 6 weeks before. She was on long-term glucocorticoid, antimalarial and non-steroidal anti-inflammatory treatment. Confluent ulcers began to fill with granulation tissue, crusts, scars and skin discoloration in the area of the left T12-L2 dermatomes and reducible, painless swelling of the left flank, 20 × 20 cm, without palpable defect in abdominal-wall. There were typical joint deformity and positive rheumatoid factor. On neurological examination superficial abdominal reflexes were diminished in the left side, with hypesthesia of the overlying skin. Needle electromyography revealed denervational changes limited to the left-side muscles (on affected dermatomes T12-L2). Thoracoabdominal CT did not reveal the presence of existing hernia. There was an abdominal distension, the left abdominal-wall was thinner than the right side. The patient was treated with an oral preparation containing benfotiamine and vitamins B6 and B12, carbamazepine, amitriptyline, gabapentin, and local lidocaine. Skin rash left with scarring and pigmentary changes and the abdominal-wall swelling resolved within 8 months, however, the pain still persisted. To our best knowledge, this is the first observation of RA-associated postherpetic AWP. This rare motor complication appears to be self-limited with a good prognosis for recovery, while postherpetic neuralgia may require a combination of treatments for adequate pain relief. Older age, female sex, greater rash and acute pain severity are considered as risk factors associated with severe postherpetic neuralgia. In addition, patients with RA, mainly those treated with oral corticosteroids, are also at increased risk of HZ complications.

Treatment of Malassezia species associated seborrheic blepharitis with fluconazole.

UNLABELLED: The AIM of the present study was to evaluate the therapeutic effect of fluconazole (FungoIon) in patients with seborrheic blepharitis. PATIENTS AND METHODS: Four seborrheic blepharitis patients with Malassezia spp. positive cultures on Dixon's agar were treated with fluconazole (Fungolon) (0.200) weekly for 4 weeks. RESULTS: The therapeutic effect of the treatment was positive in all patients--the clinical symptoms withdrew and cultures became mycologically negative. CONCLUSION: The results indicate that antifungal agents are efficient in the treatment of seborrheic dermatitis.

Malassezia species and seborrheic dermatitis.

Malassezia spp. are medically important dimorphic, lipophilic yeasts that form part of the normal cutaneous microflora of human. Seborrheic dermatitis is a multifactor disease that needs endogenous and exogenous predisposing factors for its development. Presence of these factors leads to reproduction of the saprophytic opportunistic pathogen Malassezia spp. and development of a disease. The inflammatory reaction against the yeast Malassezia is considered basic in the etiology of the seborrheic dermatitis. The pathogenesis and exact mechanisms via which these yeasts cause inflammation are still not fully elucidated. They are rather complex and subject of controversy in literature. Most probably Malassezia spp. cause seborrheic dermatitis by involving and combining both nonummune and immune mechanisms (nonspecific and specific). Which of these mechanisms will dominate in any single case depends on the number and virulence of the yeasts as well as on the microorganism reactivity. In the recent years a great interest have been aroused by the epidemiological investigations. Depending on the geographical place of the countries different Malassezia species in seborrheic dermatitis dominate in the different countries. In view of the etiology and pathogenesis of the seborrheic dermatitis comprehensive antifungal preparations have been recently introduced and are nowadays the basic therapeutic resource in the treatment of this disease.

Topically applied vitamins and their cutaneous effects.

The number of cosmetic products which include vitamins as a constituent has increased three-fold since 1991. Vitamins are commonly used as ingredients of products designed to improve the appearance and health of the skin; for this reason the cutaneous benefits of such products are actively researched by dermatologists and chemists. The present study does a review of the action of topically applied vitamins for local use which improves the function of the skin. We specifically consider the biologic activity of topically applied vitamins, their stability and usefulness. Ways of stabilizing different kinds of vitamins, as well as their stability to oxygen, light, temperature, acids, and bases, are shown. The conclusion suggested by the review is that the efficiency of topically applied vitamins is dependent not only on their good stabilization and concentration but also on the clinical individual tests that can determine the best product for each particular patient.

Fluconazole (Fungolon) in the treatment of onychomycoses.

UNLABELLED: Onychomycoses are fungal infections of the hand and foot nails, caused by dermatophytes, yeasts and molds. These conditions are difficult to treat, spontaneous remissions are rare and recurrences are not infrequent. AIM: The present study aimed at establishing the efficacy of pulse fluconazole therapy (200 mg once weekly for 4 months) in cases of hand nails infections and 200 mg once weekly for 6 months in cases of feet nail infections. MATERIAL AND METHODS: The study comprised 36 patients--23 with hand onychomycosis and 13 with feet onychomycosis (patients' age ranging from 22 to 67 years). More than 25% of the nail bed was affected in all cases. Diagnosis was based on direct microscopy of KOH treated specimens and by culturing on Sabouraud medium. RESULTS: Treatment outcome was categorized as follows: clinical cure--in 91.3% of the cases with hand onychomycosis and improvement--in 8.7% of the cases; eradication of fungal infection--in 95.6% of the cases. Feet onychomycosis--clinical cure--61.5% of the patients, improvement--in 38.5% and eradication of fungal infection--in 69.2 % of the cases. Fluconazole (Fungolon) has only been recently used in the treatment of nail fungal infections. So far, no standard dosage has been established. CONCLUSIONS: On the basis of the accumulated evidence it is concluded that pulse fluconazole (Fungolon) therapy--200 mg once weekly is effective and safe. However, for better disease outcome, especially in cases of foot nail infections--dosage of 300 mg once weekly and 300-450 mg once weekly (if molds are the offending agents) is recommended.