Superficial resection combined with photodynamic therapy for successful treatment of facial lupus vulgaris with squamous cell carcinoma.

Skin squamous cell carcinoma is the second most common non-melanoma skin tumor worldwide. Most skin squamous cell carcinoma patients have underlying diseases. Here, we report a 56 year-old patient diagnosed with skin squamous cell carcinoma and with a 30 year course of neglected lupus vulgaris, which was very rare. In this case, we adopted a treatment strategy involving a small wound: superficial resection combined with photodynamic therapy with a satisfied result.

Twenty-nine cases of lupus vulgaris.

UNLABELLED: Cutaneous tuberculosis (TB) is a rare presentation of extrapulmonary TB. Lupus vulgaris (LV) is a common presentation of cutaneous TB. OBJECTIVE: We aimed to describe the epidemiological, clinical, paraclinical, therapeutic, and outcome features of LV in the region of Sfax, Tunisia. PATIENTS AND METHODS: We conducted a retrospective and descriptive study of LV case patients observed at the dermatology department of the Hédi Chaker Hospital (Sfax) over a 34-year period. RESULTS: A total of 88 cutaneous TB case patients were identified during the study period, including 29 patients presenting with LV. All patients had clinical features of the most common presentation of LV. The results of skin biopsies indicated tuberculoid granulomas without caseous necrosis. Patients received TB treatment. LV progressed to squamous cell carcinoma in one patient. CONCLUSION: In Tunisia, endemic country for TB, LV should be considered in patients presenting with an old skin lesion.

Tropical and exotic dermatoses and ulcers.

BACKGROUND: Tropical dermatoses and ulcers, although essentially unique to tropical and subtropical areas, are occasionally seen in Australian general practice on returning travellers and migrants from endemic countries. OBJECTIVE: This article will discuss important causes of tropical and exotic ulcers occasionally seen in Australia. DISCUSSION: As tropical ulcers may mimic many other causes of skin ulceration and nodules, a history of recent travel should arouse clinical suspicion. The time frame since exposure to the causative organism is an important feature in the diagnostic process. For example, pyodermas and cutaneous larva migrans present a few days after contact with the causative agents, whereas leishmaniasis, cutaneous tuberculosis, atypical mycobacterial diseases (swimming pool granulomas) and tropical mycosis take weeks to months to appear.

From patient to discoverer--Niels Ryberg Finsen (1860­1904) --the founder of phototherapy in dermatology.

Niels Ryberg Finsen (1860­1904) developed a lamp based on electric carbon arcs (later known as the Finsen light) that was used for skin therapy a century ago. He became director of the Medical Light Institute in Copenhagen, later the Finsen Institute, where he developed this method of treatment. Within a few years, 40 Finsen Institutes were established in Europe and in the United States of America. In 1903, Finsen received the Nobel Prize in Medicine in recognition of his work on the treatment of diseases and, in particular, the treatment of lupus vulgaris by means of concentrated light rays. Finsen's scientific interests were greatly influenced by his health condition. Beginning in 1883, he began to experience symptoms of an illness that would be later diagnosed as Niemann-Pick disease. He spent the last years of his life confined to a wheelchair. Dermatology reaps the benefits of light treatment to this day.

Lupus neonatal, a propósito de un caso / No disponible

El lupus neonatal es una enfermedad de origen autoinmune causada por anticuerpostransplacentarios de tipo La y Ro, que se dirigen y afectan directamente al recién nacido,causando un amplio abanico clínico. Se presenta el caso de un niño de 1 mes de edad conhallazgos clínicos e histológicos característicos del lupus neonatal(AU)

Neonatal lupus is an autoimmune disease caused by transplacental La and Ro antibodiesthat address and affect directly to the newborn, causing diverse clinical manifestations. We presenta one month old infant, with clinical and histological characteristics of lupus disease(AU)

[Therapy-resistant "psoriasis vulgaris"]. / Therapierefraktäre "Psoriasis vulgaris".

A 61-year-old patient had a 25-year history of erythematous scaling lesions, diagnosed and treated as psoriasis vulgaris. He presented with a growing nodule within the erythematous plaque. Biopsy shows epithelioid cell granulomas with prominent Langhans giant cells. There was no sign of a squamous cell carcinoma. The tuberculin test was strongly positive and M. tuberculosis complex was detected in the biopsy material by PCR. He was diagnosed with lupus vulgaris, the most frequent form of cutaneous tuberculosis. Other types include tuberculosis verrucosa cutis, tuberculosis cutis orificialis and disseminated military tuberculosis. The patient was treated with rifampicin, isoniazid, pyrazinamide and ethambutol for two months, following a four month treatment with rifampicin and isoniazid. The skin lesions rapidly resolved under antituberculotic treatment.

Clinical and epidemiological study of cutaneous tuberculosis in Northern Ethiopia.

BACKGROUND: Tuberculosis is a major public health problem in Ethiopia but cutaneous tuberculosis (CT) has not been documented. OBJECTIVE: This study was conducted to determine its existence and its clinical pattern in Tigray, a northern region of Ethiopia. METHODS: We report 202 cases of CT who attended the Italian Dermatological Centre in the 34-month period between January 2005 and October 2007. The diagnosis was made on a clinical, cytological and histological basis. RESULTS: Clinically, 143 cases of scrofuloderma, 22 of lupus vulgaris, 18 of gumma, 11 of lichen scrofulosorum, 6 of tuberculosis verrucosa cutis and 2 of erythema induratum of Bazin were observed in our department. All patients were aged between 18 months and 69 years, and 49 were paediatric cases. Forty-five were HIV positive. CONCLUSION: The number of CT cases observed in the period of 34 months indicates a high incidence of the disease in the region also in the paediatric age. CT is still underdiagnosed due to the low number of dermatologists as well as the poor life conditions of the population and the traditional belief in magic medicine. The current study may therefore provide some indication about the epidemiology of CT in Ethiopia.

[Maximilian Mehl and the treatment with concentrated sunlight]. / Maximilian Mehl und die Behandlung mit konzentriertem Sonnenlicht.

In 1889, a chance observation made by Maximilian Mehl, an officer of the Berlin police force, lead him to develop a new method of treating Lupus Vulgaris with concentrated sunlight. Although first therapies proved the efficacy of this method, scientific medicine showed little interest. But Mehl found recognition among supporters of natural healing methods who saw their principles confirmed by his discovery. Mehl's tentative therapy was superseded by technological methods of sunlight treatment, as developed by the Danish doctor Niels Ryberg Finsen. In 1903 Finsen was awarded the Nobel Prize for his work while Mehl's discovery remained practically unknown. This episode in the history of medicine demonstrates how the recognition of a new method not only depends on criteria of its efficacy, but equally so on the degree of its conformity with preconceived notions and accepted standards.

[Lupus miliaris disseminatus faciei: 6 cases]. / Lupus miliaire disséminé de la face: 6 cas.

BACKGROUND: Lupus miliaris disseminatus faciei is recognized by all authors as a unique entity, despite many appellations for this disease. In fact, the real origin and the treatment of this affection are unknown. In this study we try to specify the major histological and clinical points of diagnosis, the evolution in the mid-term and the different possibilities of the treatment. PATIENTS AND METHODS: This is a retrospective study of the patients diagnosed with lupus miliaris and followed-up by one of us (P.M.) between 1990 and 2000. RESULTS: There were 6 patients in this study, 5 males and 1 female. The mean age was 37 years old at the time of diagnosis. The patients exhibited a facial eruption, notably in the middle of the face, eyelids and peri-oral area. All the patients had a polymorph eruption of inflammatory and smooth papules. Many of these papules progressed in several weeks to round scars with a perpendicular carved shape. Histologically and depending of the stage of evolution of the lesion, there were some epithelioid cell and giant cell granulomas organized around the necrosis. All of the trial treatments led to failure or semi-failure. Four of the patients followed-up for several years spontaneously recovered from this disease within 2 to 4 years. DISCUSSION: Based on the anatomical and clinical similarities observed in these 6 patients, our study confirms the authenticity of the "lupus miliaris". It did not correspond to a particular form of acne, rosacea, tuberculosis or sarcoidosis. The scars are pathognomonical of this type of eruption. No treatment seems to be efficient. However our study seems to confirm the general idea of spontaneous recovery with 2 to 4 years.