Klebsiella-induced acute infectious purpura fulminans in a Thai woman: Case report and review of literature.

Purpura fulminans (PF) is an uncommon syndrome of acute purplish skin eruption characterized by coagulation of the microvasculature, which leads to purplish lesions and skin necrosis. There are three subtypes; idiopathic PF, neonatal PF and, the most common subtype, acute infectious PF (AIPF). Acute infectious PF is related to the thrombotic subtype of disseminated intravascular coagulation (DIC) and usually is superimposed on sepsis. This can rapidly lead to multi-organ failure from thrombotic occlusion of small and medium-sized blood vessels. We report a case of Klebsiella-induced AIPF in a 78-year-old Thai woman and also review other published cases.

Primary cutaneous adenoid cystic carcinoma of the scalp: A case report, immunohistochemistry and review of the literature.

Primary cutaneous adenoid cystic carcinoma (PCACC) is an uncommon adnexal skin tumour with fewer than 200 cases studied in detail in the English literature. We describe the diagnosis and treatment of a few Southeast Asian cases of PCACC on the scalp of a 70-year-old Thai female. She presented with a slow-growing, painless, solid to cystic, skin-coloured tumour on her scalp. When excisional biopsy was done, histopathological findings showed dermal tumour that had a classic histologic appearance composed of basaloid cells arranged in a cribriform pattern with 'punched-out' pseudocysts filled with mucin (swiss cheese pattern) and had perineural invasion. The clinical and histopathological findings, and complete investigations confirmed the diagnosis of PCACC. Our case illustrates that PCACC, is an important histopathological differential diagnosis to bear in mind due to its locally aggressive nature and tendency to recur due to perineural invasion. A wide local excision with at least 2 cm of tumour-free margins was performed, which revealed no residual carcinoma. The patient remained disease-free for 16 months after diagnosis. PCACC is usually located on the head or neck of people in their sixth decade of life, with a female predominance. The aetiology of PCACC is unclear. The majority of PCACCs have the MYB-NFIB fusion gene or show overexpression of MYB by immunohistochemistry. Diagnosis of PCACC is primarily based on the characteristic histological appearance, as there are no distinguishing clinical features. The diagnosis of PCACC requires careful exclusion of infiltration or metastasis from other primary lesions. Treatment of this rare tumour is wide surgical excision with at least 2 cm of tumour-free margins to reduce the risk of local recurrence, and long-term follow-up for possible recurrence of PCACC is recommended. This case emphasizes the importance of careful inspection for the diagnosis of PCACC after initial surgery and pathological evaluation of the mass lesion for appropriate diagnosis and therapy.

Nitrogen plasma skin regeneration for the treatment of mild-to-moderate periorbital wrinkles: A prospective, randomized, controlled evaluator-blinded trial.

BACKGROUND: Nitrogen plasma skin regeneration is a novel device that produces heat to the skin, resulting in the production of new collagen. Because of lower energy with safer skin damage and lesser adverse effects who have high Fitzpatrick's skin type especially Thais, this technique is very interesting for clinical application for skin esthetic treatment. However, this treatment has yet been empirically studied as the treatment for mild-to-moderate periorbital wrinkles. OBJECTIVES: This study aimed to evaluate clinical efficacy of nitrogen plasma for the treatment of mild-to-moderate periorbital wrinkles. METHODS: Eighteen volunteers were enrolled. Each volunteer was randomized to receive nitrogen plasma treatment on one side of periorbital wrinkles with three sessions at a three-week interval and compared with contralateral side without treatment. Photographic examination, skin wrinkle (SEw) score, melanin index, patients' satisfaction score, side effect, and pain score were reported. RESULTS: At over fourteen weeks, all volunteers completed the study. Treatment with nitrogen plasma group had significantly better improvement for periorbital wrinkles score by Lemperle scale, skin wrinkle (SEw) score by Visioscan® VC 98, and the melanin index by Mexameter® than the control groups (P = 0.004, P < 0.001, P < 0.001, respectively). This study also showed significantly greater satisfaction score to favor the nitrogen plasma treatment group than the control group (P < 0.001). The short-term adverse effects included erythema, scaling, temporary hyperpigmentation, pruritus, and dryness. CONCLUSION: Nitrogen plasma skin regeneration is effective and safe for the treatment of mild-to-moderate periorbital wrinkles and darkening.