Milia en plaque of the nose: report of a case and successful treatment with topical tretinoin.

Milia are benign, superficial keratinaceous cysts that present as fine, small white papules. Milia en plaque is a rare, challenging-to-treat variant most often seen in the posterior auricular region. A total of 9 cases of milia en plaque have been reported in the pediatric literature to date. We report a case of milia en plaque of the nose in a 7-year-old boy, a novel site of involvement in the pediatric population, and successful treatment with the use of topical tretinoin. Topical retinoids offer an effective treatment option for the management of milia en plaque in the pediatric population.

Multiple eruptive milia.

Multiple eruptive milia (MEM) is a rare skin condition characterized by sudden onset of multiple milia occurring mainly on the head, neck, and trunk. Milia are small, benign, 1- to 4-mm, white keratinous cysts. The lesions generally are asymptomatic and may arise spontaneously or secondary to a number of processes. Multiple eruptive milia are cosmetically troublesome and difficult to treat. We report the case of a 40-year-old man with an abrupt onset of MEM on the face.

Skin conditions: common skin rashes in infants.

Infants exhibit many skin rashes. Erythema toxicum neonatorum presents as erythematous macules, papules, and pustules on the face, trunk, and extremities; it typically resolves spontaneously within 1 week. Neonatal acne presents as comedones or erythematous papules on the face, scalp, chest, and back. Infantile acne is similar but starts after the neonatal period. Both conditions typically resolve spontaneously; failure to resolve within 1 year warrants evaluation for androgen excess. Neonatal cephalic pustulosis is an acne variant caused by hypersensitivity to Malassezia furfur. It is typically self-limited, but severe cases are managed with topical ketoconazole. Miliaria and milia are caused by sweat retention and present as tiny vesicles or papules; they resolve spontaneously. Contact diaper dermatitis is managed by keeping the diaper area clean and with open air exposure. Diaper dermatitis due to Candida albicans is managed with topical antifungals. Seborrheic dermatitis causes scaling on the scalp. Management involves shampooing and removing scales with a soft brush after applying mineral oil or petrolatum; severe cases are managed with tar or ketoconazole shampoo. Atopic dermatitis is related to food allergy in approximately one-third of children. Food allergy can be confirmed with oral food challenges or skin prick tests. Management includes elimination of irritants and triggers and use of low-potency topical steroids.

Miliarial-type perifollicular B-cell pseudolymphoma (lymphocytoma cutis): a misleading eruption in two women.

Disseminated miliarial-type lymphocytoma cutis is a rare clinicopathologic subtype of lymphocytoma, characterized by numerous translucent micropapules and located on the head and neck. We describe here the clinical, histological and immunological features of miliarial-type perifollicular B-cell pseudolymphoma in two women aged 32 and 49 years presenting with numerous 1-2 mm translucent papules on the head and neck. Microscopic examination revealed features typical of a miniature lymphocytoma cutis with a superficial nodular infiltrate housing small well-circumscribed germinal centers containing tingible body macrophages and surrounded by a distinct mantle zone. The immunohistological profile was also typical of lymphocytoma cutis, and polymerase chain reaction analysis of the IgH gene rearrangement did not show any clonal B-cell population. The lesions resolved spontaneously in one case and improved after treatment with hydroxychloroquine in the second patient. The presentation of this subtype of lymphocytoma is a formidable clinical diagnostic challenge. Rosacea, sarcoidosis, democidiosis, lupus miliaris disseminatus faciei and steroid acne are easy to exclude on the basis of histological profile. However, the miliarial form of primary cutaneous center lymphoma is difficult to rule out. Dermatologists and dermatopathologists should be aware of this unusual form of lymphocytoma cutis, which can be misleading during clinical diagnosis.

La Verbena azul en el tratamiento del niño con salpullido / The blue Verbena to treat the child with rash

Introducción: la miliaria es una enfermedad inflamatoria de la piel, usualmente conocida como salpullido, es muy frecuente en niños pequeños sobre todo en los meses de verano. Objetivo: valorar la eficacia de la infusión de Verbena azul en el control de la miliaria común. Métodos: se realizó un ensayo clínico fase II, a partir de la preparación de una infusión de hojas frescas o secas molidas, que se vertieron en 12 litros de agua hirviente, se tapó y se separó del fuego después de añádirle la planta, se dejó reposar y se coló. Fue aplicada tibia en todo el cuerpo durante 21 días, en dos secciones, al levantarse, y en la tarde luego del baño diario. El estudio se realizó en 30 lactantes de raza blanca, que acudieron con esta patología a la consulta de Medicina Natural y Tradicional, en el consultorio 6 del poblado de Altagracia, en el periodo entre junio del 2004 y junio del 2005, los cuales pertenecían al Policlínico Comunitario Docente Carlos J. Finlay de la Ciudad de Camagüey. Los datos se recogieron mediante una encuesta, confeccionada de acuerdo con los objetivos planteados en la investigación. Resultados: el grupo más afectado fue el de 3 a 6 meses, todos los pacientes fueron blancos, no se encontraron diferencias significativas en cuanto al sexo. La variedad clínica más frecuente fue la cristalina, y los meses en que más se presentó fueron entre junio y agosto. Conclusiones: este tratamiento presentó una alta eficacia en el control de la sintomatología de la miliaria común; se curaron 9 de cada 10 pacientes

Introduction: miliaria is an skin inflammatory disease known as rash and is very frequent in small children mainly during summer months. Objective: assessing the efficacy of the infusion of blue Verbena in controlling common heat rash. Methods: a phase II clinical trial was conducted from the preparation of an infusion of fresh leaves or dry grinded poured out in 12 liters of boiling water, was covered and removed from fire after adding the plant, it was doughed and strained. It was applied warm in whole body for 21 days in t wo sessions, to stand up and at evening after daily bath. A study was conducted in 30 white infants presenting with this pathology who came to the Natural and Traditional Medicine Service in the No.6 consulting room of the Altagracia settlement from June, 2004 to June, 2005 of Carlos J. Finlay Teaching Community polyclinic of the Camagüey city. Data were collected by survey, designed according to the objectives proposed in research. Results: the more involved group was that aged 3-6 months, all patients were white; there were not significant differences as regards sex. The more frequent clinical variety was the crystalline one and more prevalent months were June and August. Conclusions: present treatment was highly effective in the control of symptomatology of the common miliaria; nine of ten patients were cured

La Verbena azul en el tratamiento del niño con salpullido / The blue Verbena to treat the child with rash

Introducción: la miliaria es una enfermedad inflamatoria de la piel, usualmente conocida como salpullido, es muy frecuente en niños pequeños sobre todo en los meses de verano. Objetivo: valorar la eficacia de la infusión de Verbena azul en el control de la miliaria común. Métodos: se realizó un ensayo clínico fase II, a partir de la preparación de una infusión de hojas frescas o secas molidas, que se vertieron en 12 litros de agua hirviente, se tapó y se separó del fuego después de añádirle la planta, se dejó reposar y se coló. Fue aplicada tibia en todo el cuerpo durante 21 días, en dos secciones, al levantarse, y en la tarde luego del baño diario. El estudio se realizó en 30 lactantes de raza blanca, que acudieron con esta patología a la consulta de Medicina Natural y Tradicional, en el consultorio 6 del poblado de Altagracia, en el periodo entre junio del 2004 y junio del 2005, los cuales pertenecían al Policlínico Comunitario Docente Carlos J. Finlay de la Ciudad de Camagüey. Los datos se recogieron mediante una encuesta, confeccionada de acuerdo con los objetivos planteados en la investigación. Resultados: el grupo más afectado fue el de 3 a 6 meses, todos los pacientes fueron blancos, no se encontraron diferencias significativas en cuanto al sexo. La variedad clínica más frecuente fue la cristalina, y los meses en que más se presentó fueron entre junio y agosto. Conclusiones: este tratamiento presentó una alta eficacia en el control de la sintomatología de la miliaria común; se curaron 9 de cada 10 pacientes(AU)

Introduction: miliaria is an skin inflammatory disease known as rash and is very frequent in small children mainly during summer months. Objective: assessing the efficacy of the infusion of blue Verbena in controlling common heat rash. Methods: a phase II clinical trial was conducted from the preparation of an infusion of fresh leaves or dry grinded poured out in 12 liters of boiling water, was covered and removed from fire after adding the plant, it was doughed and strained. It was applied warm in whole body for 21 days in t wo sessions, to stand up and at evening after daily bath. A study was conducted in 30 white infants presenting with this pathology who came to the Natural and Traditional Medicine Service in the No.6 consulting room of the Altagracia settlement from June, 2004 to June, 2005 of Carlos J. Finlay Teaching Community polyclinic of the Camagüey city. Data were collected by survey, designed according to the objectives proposed in research. Results: the more involved group was that aged 3-6 months, all patients were white; there were not significant differences as regards sex. The more frequent clinical variety was the crystalline one and more prevalent months were June and August. Conclusions: present treatment was highly effective in the control of symptomatology of the common miliaria; nine of ten patients were cured(AU)

Miliaria rubra and thrombocytosis in pseudohypoaldosteronism: case report.

Pseudohypoaldosteronism type 1 (PHA1) is a disease involving a state of renal tubular unresponsiveness to the action of aldosterone and characterized by excessive salt loss in the urine, hyperkalemia, and metabolic acidosis. In kidney, PHA1 may occur primarily by mutations in the subunits of the sodium channel or in the mineralocorticoid receptors, and secondarily by several renal disorders. Miliaria rubra and thrombocytosis are reported in a 6-month-old girl with PHA1. In patients with PHA1, miliaria rubra-like cutaneous eruptions are suggested to occur due to obstruction of eccrine sweat glands through inflammation caused by excessive sodium excretion in sweat during hyponatremic crises. The presence of thrombocytosis in patients with PHA1 has not been previously reported. A hypothesis is proposed suggesting that sympathetic activation which provides vascular tonus during sodium excretion in sweat and salt-depletion crisis may play a role in the development of eruptions and thrombocytosis in patients with PHA1.

Milia en plaque: a new site.

A 35-year-old Kuwaiti field worker presented with a history of an asymptomatic, erythematous plaque on the right side of the nasal bridge. It soon extended to the malar area, being studded with multiple yellowish papules (Fig. 1). He denied any history of photosensitivity, drug intake, local trauma, topical applications, or ionizing radiations to that area. Examination revealed an erythematous, 1.5 x 3 cm plaque on the right nasal fold, extending to the malar area, overlain by a group of tiny yellowish papules (15-20 in number). He also had a few discrete milia on the right cheek. The histology (Fig. 2) revealed multiple keratin-filled cysts, surrounded by a dense lymphocytic infiltrate, findings consistent with milia; 0.05% tretinoin was prescribed twice daily for 1 month without improvement; minocycline, 100 mg daily, was then employed, and at 1 month of follow-up there was a significant decrease in erythema and milia count.

[Dermatologic indications for anti-androgenic treatment]. / Dermatologische Indikationsstellung zur antiandrogenen Behandlung.

In spite of remarkable therapeutic results obtained by gestagens with antiandrogenic activity, usually combined with estrogen, in oily seborrhea, acne, Fox-Fordyce disease, androgenetic alopecia and hirsutism many dermatologist still hesitate to treat the named disorders by hormones. The reason for their hesitation appears to be the erroneous belief, that the named disturbances represent hormonal disorders the treatment of which does not belong to dermatology. After a survey on the mechanism of action of antiandrogens the basic difference between androgen dependent skin disorders and endocrinopathies with manifestation on the skin and its appendages is explained. Androgen dependent skin disorders, like oily seborrhea and most cases of acne are not the result of endocrine disturbances in the sense of an pathologically increased or decreased production of sexual hormons. Administering sexual hormons the physician takes advantage of the sebosuppressive effect of female sexual hormons as he does of the antiallergic activity of the hormon cortisol (and related compounds) in the treatment of eczemas. The antiandrogenic treatment of androgenetic alopecia, hirsutism and androgenetic acne--with their underlying hormonal disturbance, consisting in an increased production of androgens, represents an quasi etiological therapy. As in these cases the hormonal disturbances finds its expression mainly or exclusively in disorders of the skin or hair growth, the dermatologist, preferentially in cooperation with endocrinogists and/or gynacologists remains entitled to take over the treatment. The available drugs are discussed and suggestions are made for their appropriate use.