[A patient with perfectly aligned itching papules of the back after hijama therapy]. / Een patiënte met huidafwijkingen na hijama-therapie.

A 31-year-old woman was seen at our clinic with itching papules of the back after hijama treatments. Hijama treatments consist of superficially cutting the skin followed by cupping and are applied for a diversity of complaints, including pain. Our patient initially presented with sensitive and burning sensations at the cutting sites, but recently, the cutting sites started to itch as well. At physical examination, we saw perfectly aligned papules with a sign of Wickham's striae on her back where the skin had been cut. Further examination revealed comparable, solitary papules on the inside of her wrist, flank and chest. A skin biopsy confirmed the diagnosis lichen planus. The patient was prescribed betamethasone cream and we advised against further hijama treatments.

[Skin disorder as an indication of viral infection]. / Huidafwijking als aanwijzing voor virusinfectie.

BACKGROUND: Gianotti-Crosti syndrome (GCS) is a dermatosis primarily affecting children between 2 and 6 years of age. It is characterized by multiple, itching, monomorphous, pink to red-brown papules or papulovesicles between 1 and 5 mm in size. GCS is associated with viral infections such as hepatitis B virus and Epstein-Barr virus (EBV). It is often accompanied by fever, hepatosplenomegaly and lymphadenopathy. The syndrome is self-limiting and disappears within 2 months. No treatment is therefore required. CASE DESCRIPTION: We report a case of a 16-year-old female who presented with itching papulovesicles on the extremities and on the buttocks. She was diagnosed with GCS because of the clinical findings, histopathological tests and positive EBV serology. CONCLUSION: GCS can also affect patients older than 6 years of age. Moreover, this syndrome may be a first sign of infection with Epstein-Barr virus, hepatitis B virus, HIV or other viral infections.

The proactive wet-wrap method with diluted corticosteroids versus emollients in children with atopic dermatitis: a prospective, randomized, double-blind, placebo-controlled trial.

BACKGROUND: Wet-wrap treatment (WWT) has been advocated as a relatively effective treatment in children with severe atopic dermatitis (AD). WWT often serves as crisis intervention for AD. OBJECTIVES: We sought to evaluate the use of WWT with diluted corticosteroids in comparison with emollient in children with severe AD during 4 weeks in a proactive schedule during which the frequency of corticosteroid applications was tapered. METHODS: A randomized, double-blind, placebo-controlled study was performed in children aged 6 months to 10 years with severe AD (objective SCORAD at least 40 ± 5), comparing WWT with diluted corticosteroids (1:3 mometasone furoate 0.1% ointment and for the face 1:19 mometasone furoate 0.1% ointment under a mask) with emollient (petrolatum 20% in cetomacrogol cream). The primary outcome was improvement of the objective SCORAD; secondary outcomes included Patient-Oriented Eczema Measure and quality-of-life index. RESULTS: WWT with diluted corticosteroids acted faster and was more efficacious than WWT with emollients. Best results were obtained in age groups 6 to 9 years and 0 to 3 years. The difference in efficacy evaluated by objective SCORAD was significant at all measuring points. This also applied to the quality-of-life index. LIMITATIONS: The study group was relatively small. CONCLUSIONS: WWT for severe AD is an effective therapy option for at least a period of 4 weeks.

[A few milestones in the history of syphilis]. / Enkele mijlpalen uit de geschiedenis van syfilis.

The history of syphilis is complex and has left its mark throughout medicine. The origin of syphilis is an important historical and scientific issue in the history of medicine. The Columbian hypothesis which assumes that syphilis originated in the New World ('America') and that Columbus and his crew imported the disease after his voyages of discovery in 1493 to the Old World ('Europe') is the most accepted theory. Misinterpretations of unethical experiments into the causes of syphilis and gonorrhoea from the 17th century to the early decades of the 19th century led to nosological misconceptions. In the late 19th century and 20th century came the great breakthroughs in the fields of microbiology, diagnosis and therapy.

[A woman with cayenne pepper spots]. / Een vrouw met roestbruine plekjes op de vulva.

A 52-year-old female with dyspareunia presented with red-brown maculae at the vulva.Biopsy revealed an inflammatory cell infiltrate mostly consisting of plasma cells, and the diagnosis 'vulvitis circumscripta plasmacellularis' was established.A biopsy is mandatory to confirm this rare benign inflammatory disorder of the vulva.

[Granulomatous secondary syphilis; an uncommon presentation of a polymorphic disease]. / Granulomateuze secundaire syfilis: een zeldzame uiting van een polymorf ziektebeeld.

BACKGROUND: Due to a great diversity of clinical presentations secondary syphilis can mimic various skin diseases, which means that the diagnosis of this sexually transmitted condition can be missed. Occurrence of a granulomatous inflammatory reaction in secondary syphilis is rare and may be confused with other granulomatous dermatoses. CASE DESCRIPTION: We present a 37-year-old homosexual male with a granulomatous dermatitis due to secondary syphilis. The differential diagnosis based on clinical and histopathological findings was lengthy and the initial syphilitic serology results were negative, resulting in delayed diagnosis. After revision of the histopathology and repeated serological testing secondary syphilis could be diagnosed. CONCLUSION: Not only the clinical, but also the histopathological presentation of secondary syphilis is variable. To prevent transmission, treatment delay and complications, we recommend repeating syphilitic serology following negative results if there is clinical or histopathological suspicion of this disease, especially in patients displaying high-risk behaviour. Syphilis should be also excluded in granulomatous dermatoses with plasma cells.

[A woman with red, swollen lower legs]. / Een vrouw met rode, gezwollen onderbenen.

A 32-year old female patient with Graves' disease was diagnosed with pretibial myxedema. It is part of the triad of extrathyreoidal manifestations of Graves' disease: exophthalmia, pretibial myxedema, and acropachy. The patient was successfully treated with topical corticosteroids.

Relevance and consequences of erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis in gynecology.

BACKGROUND: Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) can be distinguished by location, morphology and extent of cutaneous and mucosal lesions. EM has minimal effects on pregnancy and the genital tract. SJS and TEN on the other hand are related with premature labor and vaginal scarring that can lead to long-term painful lesions, stenosis, vaginal adenosis and telangiectasia. CASE: A 33-year-old G3P2 with a medical history of SJS has multiple recurrences during pregnancy of what seems to be EM instead of SJS with a favorable outcome. CONCLUSION: Differentiation between EM, SJS and TEN is important in gynecology to predict the effects of the diseases on the genital tract and on pregnancy.