Probable primary cutaneous histoplasmosis in a patient infected with HIV.

Histoplasmosis is a fungal infection caused by a dimorphic fungus, Histoplasma capsulatum. Most infections occur after inhalation of fungal spores. A wide variety of clinical manifestations can occur depending on the host response and the extent of inoculation. We report a case of probable cutaneous histoplasmosis after trauma in a 26-year-old man from Paraguay who was also infected with the human immunodeficiency virus. Diagnosis was based on histological and mycological examination. No systemic involvement was found.

Correlation between dermoscopy and direct microscopy in Tineabarbae.

Tineabarbae is a rare form of dermatophytosis that affects hair follicles of the beard and moustache. Dermoscopy could prove useful to identify parasitism of hair of the beard, just as it has proven useful in the diagnosis of Tineacapitis. We present the first fully documented case series of T. barbae with clinical, dermoscopic and mycological features.

[Cutis marmorata telangiectatica congenita. Review of 33 cases]. / Cutis marmorata telangiectásica congénita. Revisión de 33 casos.

INTRODUCTION: Cutis marmorata telangiectatica congenita (CMTC) is an uncommon congenital vascular malformation characterized by the presence of a localized or generalized pattern, frequently asymmetrical, with reticulated, erythematous or violaceous macules, present at birth or shortly thereafter. PATIENTS AND METHOD: Retrospective study of 33 cases of CMTC diagnosed between 1994 and 2007 in our hospital. Clinical and follow-up data were recorded in all cases. In some patients additional tests were performed. RESULTS: Most of the patients (51.5%) were female. In 87.9% of the cases lesions were observed at birth. All the cases were sporadic. CMTC was localized in 72.7% of the patients, being distributed mainly over the lower limbs. Associated anomalies were noted in 60.6%, with predominance of skin alterations (14 cases). Extracutaneous anomalies were present in 11 patients, most commonly atrophy and hypertrophy in the involved limbs. In none of the cases were there ocular or neurological manifestations. The average follow-up time was 14 months. Improvement of the lesions was observed in 45%, and in one case there was complete resolution. CONCLUSIONS: CMTC is a malformative disease which is frequently associated with other abnormalities. An appropriate assessment and follow-up of these patients is advisable. Performing a thorough medical history, including full physical examination is necessary. If the head is affected, ocular and neurological examination should be performed. The prognosis is generally good, with a tendency to improvement or disappearance in most cases.

[SEIP-AEPAP-SEPEAP consensus document on the aetiology, diagnosis and treatment of bacterial skin infections in out-patients]. / Documento de consenso SEIP-AEPAP-SEPEAP sobre la etiología, el diagnóstico y el tratamiento de las infecciones cutáneas bacterianas de manejo ambulatorio.

Skin infections are a common cause for dermatological consultations in the paediatric setting. A review is presented of the clinical manifestations, diagnosis and treatment of the main bacterial skin infections, as well as the diagnosis and treatment of super-infected puncture and bite wounds. The most prevalent bacteria in skin infections are Staphylococcus aureus and Streptococcus pyogenes. Treatment is usually empirical, since microbiological studies are only recommended under certain circumstances or lack of improvement with common therapies. Superficial skin infections can be treated with local antiseptics or antibiotics (mupirocin or fusidic acid). Systemic treatment is usually reserved for patients with extensive or severe disease or with other risk factors. Systemic treatment depends on the suspected infecting bacteria, with penicillin, amoxicillin, amoxicillin-clavulanic acid and first or second generation cephalosporin being the most frequently used drugs. Due to the low incidence of community-acquired methicillin-resistant infection by S. aureus in Spain, the use of clindamycin or co-trimoxazole is only recommended after severe disease, relapses or a clear epidemiological background.

[Isolation and identification of Malassezia spp. In pytiriasis versicolor, seborrheic dermatitis and healthy skin.]. / Aislamiento e identificación de Malassezia spp. en pitiriasis versicolor, dermatitis seborreica y piel sana.

The taxonomy of the genus Malassezia has been recently revised and enlarged to include seven distinct species. The aim of the study was to analyse the prevalence of these species in the cutaneous lesions of pityriasis versicolor and dermatitis seborrhoeica, as well as in the normal skin. Seventy-five patients with pityriasis versicolor, 75 of dermatitis seborrhoeica, and 150 samples of normal skin (75 from the forehead and 75 from the shoulders) were studied. A direct microscopy with KOH + Parker ink was carried out in the pityriasis versicolor and dermatitis seborrhoeica samples. All the samples were inoculated in plates containing modified Dixon medium and incubated at 31 degrees C. The yeasts isolated were identified by its morphological and physiological characteristics, upon the scheme published by Guillot et al. In pityriasis versicolor, Malassezia globosa was found in 84% of cases, alone or associated with Malassezia sympodialis, which was by far the commonest species in normal skin (91.7% of isolates, predominating in the trunk skin). In dermatitis seborrhoeica, Malassezia restricta was the commonest species (63.9%), often associated with M. globosa and/or Malassezia sympodialis. M. globosa was also very common in this disease (54.4%), where Malassezia slooffiae and Malassezia furfur could be detected in less than 5% of the samples. These results support that M. globosa, in its mycelial phase, plays a predominant role in the aetiology of pityriasis versicolor. In dermatitis seborrhoeica, the significance of the presence of different species, mainly M. restricta and M. globosa in its yeast phase, remains unclear. Further studies are needed to establish appropriately the pathogenicity of the lipophilic skin mycoflora.

[Dermatomyositis as paraneoplastic syndrome of bladder tumor]. / Dermatomiositis como síndrome paraneoplásico de tumor vesical.

The dermatomyositis is a connective tissue disease characterized by changes affecting both the skin and the muscle, appearing most frequently around the fifth and sixth decades and which association to a vesical tumour is very rare. This paper contributes one case of paraneoplastic dermatomyositis associated to infiltrant vesical tumour, presenting erythematous damage in face, nape of the neck and upper thorax, as well as periorbital heliotrope erythema and fingernails base and sides telangiectasia, all of which are typical signs of dermatomyositis.

Do Malassezia species play a role in exacerbation of scalp psoriasis?

INTRODUCTION: Clinical expression of psoriasis is in part dependent on external factors, such as drugs, microorganisms or stress. However convincing evidence of the role of Malassezia species in the pathogenesis of the psoriasis is still lacking. PATIENTS AND METHODS: Samples taken from scalp skin of 40 psoriatic patients and the same number of healthy individuals were observed under direct microsocopic examination and cultured on modified Dixon agar. RESULTS: Direct microscopy examination of psoriatic scalp scales was positive in 30 (75%) patients; while it was positive in only 12 (30%) healthy subjects (P=0.003). Half of the cultures from healthy subjects showed no growth of colonies, but only 8 (15%) of psoriatic patients were negative. When an exacerbation has occurred in the previous weeks, pseudohyphaes were observed in 12 (40%) patients, Malassezia globosa was isolated in 18 (45%) patients and Malassezia restricta was isolated in 12 (30%) patients. In the group of patients having stable lesion, without any exacerbation in the previous weeks, no pseudohypahes were observed, M. globosa was not isolated, M. restricta was isolated in 4 (10%), and cultures were negative in 6 of them (15%). CONCLUSIONS: Malassezia species form an integral part of normal cutaneous microflora in humans, however we found that during the episodes of exacerbation of the disease the presence of these yeasts, and particularly M. globosa, was increased.

Documento de consenso SEIP-AEPAP-SEPEAP sobre la etiología, el diagnóstico y el tratamiento de las infecciones cutáneas bacterianas de manejo ambulatorio / SEIP-AEPAP-SEPEAP consensus document on the aetiology, diagnosis and treatment of bacterial skin infections in out-patients

Las infecciones cutáneas constituyen un motivo de consulta frecuente en dermatología pediátrica. Se revisan las manifestaciones clínicas, el diagnóstico y el tratamiento de los principales cuadros infecciosos bacterianos de la piel, así como de la sobreinfección de las heridas punzantes y por mordedura. Las bacterias más prevalentes en las infecciones cutáneas son Staphylococcus aureus (S. aureus) y Streptococcus pyogenes. El tratamiento es generalmente empírico y solo ante determinadas circunstancias o mala evolución clínica se recomienda el estudio microbiológico. Las infecciones cutáneas superficiales pueden tratarse con antisépticos y antibióticos tópicos (mupirocina o ácido fusídico). El tratamiento sistémico se reserva para formas extensas, graves o con otros factores de riesgo del huésped. En estos casos, el antibiótico de elección dependerá, entre otros factores, de los patógenos sospechados; los más utilizados son penicilina, amoxicilina, amoxicilina-ácido clavulánico y cefalosporinas de primera o segunda generación. Considerando la baja incidencia de S. aureus resistente a la meticilina de adquisición comunitaria en nuestro país, no se recomienda modificar el tratamiento empírico salvo en circunstancias de especial gravedad, recurrencia o antecedente epidemiológico, en cuyo caso el tratamiento recomendado es clindamicina o trimetoprima-sulfametoxazol

Skin infections are a common cause for dermatological consultations in the paediatric setting. A review is presented of the clinical manifestations, diagnosis and treatment of the main bacterial skin infections, as well as the diagnosis and treatment of super-infected puncture and bite wounds. The most prevalent bacteria in skin infections are Staphylococcus aureusand Streptococcus pyogenes. Treatment is usually empirical, since microbiological studies are only recommended under certain circumstances or lack of improvement with common therapies. Superficial skin infections can be treated with local antiseptics or antibiotics (mupirocin or fusidic acid). Systemic treatment is usually reserved for patients with extensive or severe disease or with other risk factors. Systemic treatment depends on the suspected infecting bacteria, with penicillin, amoxicillin, amoxicillin-clavulanic acid and first or second generation cephalosporin being the most frequently used drugs. Due to the low incidence of community-acquired methicillin-resistant infection by S. aureus in Spain, the use of clindamycin or co-trimoxazole is only recommended after severe disease, relapses or a clear epidemiological background

¿Son realmente útiles los anti-TNFα en vasculitis sistémicas? Experiencia en panarteritis nodosa / Are anti-TNF-α agents really useful in systemic vasculitis? Experience in polyarteritis nodosa

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