MULTIPLE BASAL CELL CARCINOMA IN TROPICAL AUSTRALIA

No association between HLA DR1 and the development of multiple basal cell carcinomas (BCC) was found among patients who had lived at least two-thirds of their lives in the tropics. The percentage of patients with multiple BCCs increased with age; this was different from what has been found in people living in the temperate zone of Australia.     

Results of serological tests for syphilis among Gurkhas and other high risk groups.

Serological tests for syphilis gave more positive results in serving Gurkha (Nepali) soldiers from west Nepal than in those from east Nepal or in Gurkha recruits. The soldiers had served from four to 11 years. The source of their infection was not clear. Positive results were rather less common in black patients born in the tropics attending a genitourinary medicine in London and were similar to findings in blood donors in the West Indies. British born male patients attending a genitourinary medicine department in London had a much lower prevalence. Malay and Nepali women attending an antenatal clinic in Singapore had a higher prevalence of positive serological results than women attending an antenatal clinic in London. Nepalis, Malays, and black people born in the tropics continue to require serological screening.     

Hendersonula toruloidea infection of the nails in Caucasians

Hendersonula toruloidea is a member of the Sphaeropsidales, a subgroup of the Fungi Imperfecti. It has been noted to cause disease similar to foot and nail ringworm in natives of the tropics resident in temperate climates. We report four cases of the disease in Caucasians, presumably acquired during short trips abroad. As travel to the tropics becomes more common, this infection should be considered in the differential diagnosis of certain nail dystrophies. Unfortunately, Hendersonula toruloidea does not respond to currently available antifungal agents.
     

Pitted keratolysis: clinical manifestations in 53 cases

Pitted keratolysis (PK) has been reported to be more common among bare-footed people living in tropical regions. It is now known that the disease is not limited to the tropics but has a world-wide distribution. However, no study has previously been performed analysing the clinical manifestations of the disease in temperate countries. A survey of 53 patients revealed several distinctive clinical features. Hyperhidrosis is the most frequently observed symptom of this condition. Malodour and sliminess of the skin are also distinctive features, evident in 88.7% and 69.8% of the cases, respectively. The most common sites of onset of PK are the pressure-bearing areas, such as the ventral aspect of the toe, the ball of the foot and the heel. The next most common site is a friction area, the interface of the toes. Lesions are rarely seen on the non-pressure-bearing locations. Some of the primary lesions originate as a small defect along the plantar furrow, which gradually grows into the characteristic crateriform pit. Several clinical features are helpful in diagnosing PK.     

Prevalence of pityriasis versicolor in a group of Italian pregnant women

BACKGROUND: Although a predisposing role of pregnancy to Malassezia infections is referred, data on the prevalence of pityriasis versicolor (PV) in pregnant women are not available in literature. OBJECTIVE: To investigate the frequency of PV during pregnancy, 60 pregnant women were clinically and microscopically investigated during and after pregnancy. RESULTS: Fifty-two women completed all visits; three women were affected by PV at first or third trimester of pregnancy, and none at 6 months after delivery. Colonization due to Malassezia yeasts was very significantly (P < 0.01) or significantly increased (P < 0.05) at the third trimester and 6 months after delivery, respectively. No variation was observed between the end of pregnancy and the postpartum (P > 0.05). CONCLUSION: Frequency of PV during pregnancy (5.7%) does not seem different from that reported in general population living in temperate climates (2-5%). However, higher degree of colonization by Malassezia resulted at the end of pregnancy and postpartum.     

Quantitative evaluation of skin condition in an epidemiological survey of females living in northern versus southern Japan

Image analysis and biophysical methods were used to compare the skin condition of a group of females ranging in age from 5 to 65 years who had lived all of their lives in either Kagoshima (n=300), located in southern Japan, or Akita (n=302), located in northern Japan. Kagoshima annually receives approximately 1.5 times more solar UVB radiation than Akita. The methods used and corresponding skin parameters reported in this survey were: high resolution digital imaging followed by computer analysis of facial images for facial skin wrinkling and hyperpigmentation; silicone skin replicas followed by Moiré interferometry for facial skin surface roughness (texture); the Minolta Chromameter for skin color (L*a*b*) on sun-exposed (forehead) and sun-protected (upper inner arm) skin sites; the Corneometer for skin capacitance (hydration) on the cheek and ventral forearm; the Sebumeter for sebum excretion rate on the forehead; and the Minolta Spot Thermometer for skin temperature on the upper cheek. Compared with Japanese women living in Akita, Japanese women living in Kagoshima had significantly longer facial wrinkles, higher number of wrinkles, larger hyperpigmented spots, higher number of spots, rougher facial skin texture, more yellow foreheads and upper inner arms, darker foreheads, and less stratum corneum hydration in the cheeks and arms. When compared on an age-for-age basis, the average 40-year-old Kagoshima women has the same level of facial wrinkling as a 48-year-old Akita women, a delay of 8 years for living in the northern latitude. For facial hyperpigmentation, the delay is 16 years; the average 40-year-old Kagoshima women has the same level of facial hyperpigmentation as a 56-year-old Akita women. The results further testify to the skin damaging effects of sun exposure and may be useful in public health education to promote everyday sun protection.     

HIV treatment adherence and unprotected sex practices in people receiving antiretroviral therapy

BACKGROUND: Poor HIV treatment adherence can result in the development of drug resistant strains of HIV and HIV positive people may transmit drug resistant virus to their sex partners. OBJECTIVE: To examine the association between HIV treatment adherence and sexual risk behaviour practices in people living with HIV-AIDS. METHODS: Surveys and interviews with 255 men and women living with HIV and receiving antiretroviral therapy. RESULTS: People who were currently taking antiretroviral medications and missed at least one dose of their medications in the past week scored significantly higher on a hopelessness scale and reported more current use of marijuana. People who had been non-adherent also reported significantly more sex partners, greater rates of unprotected vaginal intercourse, and less protected sex behaviours including less protected sex with partners who were HIV negative or of unknown HIV status. CONCLUSIONS: Associations between HIV treatment adherence and sexual transmission risk behaviours indicate the need for comprehensive and integrated health behaviour interventions for people living with HIV-AIDS.     

Isolated scalp involvement with pityriasis versicolor alba (pityrias versicolor albus capitis) in a patient from a dry,temperate region

Pityriasis versicolor (tinea versicolor) is a common superficial fungal infection of the skin involving the hyphal (filamentous) form of Pityrosporum orbiculare. Clinical cutaneous infection is common in humid, tropical climates, but declines to less than 5 percent in temperate climates. Isolated face or scalp involvement is rare. We present a boy living in a temperate region who had sudden onset of scalp and hairline involvement with tinea versicolor.     

Naevi in schoolchildren in Scotland and Australia

Summary To test the hypothesis that children living in subtropical and tropical environments have more naevi than those of similar ethnicity living in temperate countries, a comparative study of melanocytic naevi in 111 schoolchildren from Brisbane, Australia, and 222 from Glasgow, Scotland, was carried out. All children were aged 13–15 years, of European ancestry, and had spent most of their lives at latitudes of less than 30°S (Australia) or greater than 30°N (Scotland), Using an identical protocol, all naevi of 2 mm or more in diameter occurring on the right arm were counted by either a highly experienced research nurse in Brisbane, or a dermatologist in Glasgow, Hair and eye colour, and facial freckling, were assessed by the examiner, and axillary skin colour of children in both cities was measured using the same reflectance spectrophotometer. Children in Brisbane had significantly more naevi than those in Glasgow (P<0–05), after adjusting for complexion variables. The difference in the geometric mean number of naevi on the arm was much greater among boys (7.7 vs, 4.4, in Brisbane and Glasgow, respectively) than among girls (7.3 vs, 6.7). This has parallels with the sex differences in melanoma at later ages in the two countries. Besides country of residence, freckles and innate skin colour were the most significant predictors of large numbers of naevi, whereas red hair had a significant protective effect. Overall, these data on prevalence of naevi in children from contrasting environments provide some evidence in support of the theory that naevus development is related to the level of sun exposure in childhood and adolescence.     

Chancroid,lymphogranuloma venereum,granuloma inguinale,genital herpes simplex infection,and molluscum contagiosum

Chancroid, lymphogranuloma venereum, and granuloma inguinale may be considered as tropical venereal diseases. These diseases were a major diagnostic and therapeutic challenge in past centuries. Currently, patients with these bacterial infections that are endemic to the tropics occasionally consult with dermatologists in temperate climates. Due to the increasing frequency of travel to the tropics for tourism and work, as well as the increasing number of immigrants from these areas, it is important for dermatologists practicing in temperate climates to be familiar with the dermatologic manifestations of such infections, to be prepared to diagnose these diseases, and to treat these patients. All three “tropical” infections respond well to prompt and appropriate antimicrobial treatment, although herpes progenitalis still cannot be cured, and the number of people infected keeps growing; moreover, genital herpes can be transmitted by viral shedding before and after the visual signs or symptoms. Acyclovir, valacyclovir, and famciclovir can shorten outbreaks and make them less severe or even stop them from happening. There is currently no etiologic treatment for molluscum contagiosum, and the majority of treatment options are mechanical, causing a certain degree of discomfort. The molluscum contagiosum virus, unlike the other infectious agents mentioned, does not invade the skin.     

HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South Africa

OBJECTIVES: A cornerstone of HIV prevention in South Africa is voluntary HIV antibody counselling and testing (VCT), but only one in five South Africans aware of VCT have been tested. This study examined the relation between HIV testing history, attitudes towards testing, and AIDS stigmas. METHODS: Men (n = 224) and women (n = 276) living in a black township in Cape Town completed venue intercept surveys; 98% were black, 74% age 35 or younger. RESULTS: 47% of participants had been tested for HIV. Risks for exposure to HIV were high and comparable among people tested and not tested. Comparisons on attitudes toward VCT, controlling for demographics and survey venue, showed that individuals who had not been tested for HIV and those tested but who did not know their results held significantly more negative testing attitudes than individuals who were tested, particularly people who knew their test results. Compared to people who had been tested, individuals who were not tested for HIV demonstrated significantly greater AIDS related stigmas; ascribing greater shame, guilt, and social disapproval to people living with HIV. Knowing test results among those tested was not related to stigmatising beliefs. CONCLUSIONS: Efforts to promote VCT in South Africa require education about the benefits of testing and, perhaps more important, reductions in stigmatising attitudes towards people living with AIDS. Structural and social marketing interventions that aim to reduce AIDS stigmas will probably decrease resistance to seeking VCT.     

Malignant Melanoma in World War II Veterans

ABSTRACT: In a consecutive series of 1,067 patient entered into the data base of the Melanoma Cooperative Croup at New York University School of Medicine between 1972 and 1980, 120 men were of draft age (18–31 years) during World War II (1941–1945). Questionnaires were sent to these 120 individuals; 89 responded. Simultaneously, a control (nonmelanoma) population of 65 men of similar age was queried. Each subject in both groups was asked whether he had served in the armed forces during World War It and, if so, what were his theaters of operation. Based on the response, 83% (74 of 89) of the melanoma group compared with 76% (49 of 65) of the control group had served in the armed forces during World War II; however, a significantly (p = 0.0002) greater percent of the melanoma patients 134%) served in the tropics than did the control subjects (6%). Further, overrepresented in the melanoma group that served in the tropics (compared with the melanoma group who served in the armed forces in nontropical theaters) were malignant melanomas that had their origin in nevocytic nevi. The findings suggest that Caucasian individuals heavily exposed to sunlight in the tropics for several years during early life may he at higher risk to the subsequent development of cutaneous malignant melanoma. In some individuals this may be a two-step phenomenon, in which the first step is the solar induction of nevocytic nevi and the second is malignant transformation within them.     

Separation of spouses due to travel and living apart raises HIV risk in Tanzanian couples

BACKGROUND: Persons with absent partners may be more vulnerable to risky sexual behavior and therefore HIV. Partner absence can be due to traveling (e.g., family visits or funerals) or to living apart (e.g., work-related or in polygamous marriages). We investigated to what extent partner absence leads to more risky sexual behavior in Tanzanian couples. METHODS: We compared 95 men and 85 women living apart with 283 men and 331 women living together. Only persons who were still married were included, either living apart or cohabiting at the time of the interview. Subjects were classified into 4 groups: coresidents being either nonmobile or mobile, and people living apart either frequently or infrequently seeing each other. RESULTS: Most people living apart were polygamously married. Men living apart did not report more extramarital sex than coresident men. However, among coresident men, extramarital sex was reported by 35% of those being mobile compared with 15% of those nonmobile. Among women, those living apart reported extramarital sex more often than coresidents (14% vs. 7%), and this was mainly due to women living apart who infrequently saw their husbands. CONCLUSIONS: Risky sexual behavior occurs more often in mobile coresident men, and in women living apart infrequently seeing their spouses. These groups are relatively easy to identify and need extra attention in HIV prevention campaigns.     

Recurrent genital herpes: clinical and virological features in men and women.

One hundred and forty eight patients (69 women and 79 men) with often recurring genital herpes were observed for two months. Men had 119 observed recurrences and women 104. The attacks were significantly longer in men than women (8.7 days v 6.6 days, p = 0.005). Significantly more women complained of symptoms, however, and when symptoms occurred they were more severe. Other significant differences between men and women included age (men were older than women); more men had previously had sexually transmitted diseases; more men had infected a sexual partner, but fewer knew the source of their infection; and men had more lesions at each attack. Positive viral culture results were shown to depend on the amount of erythema, the number of lesions, and the presence of vesicles.     

中国大陆当今男同／双性爱者心理卫生与相关状况调查

目的:了解中国当今男同/双性爱者的心理与行为,评估干预效果。方法:采用邮寄匿名调查问卷的方式,调查与本项目组建立通信联系并接受健康干预者。结果:共回收有效问卷950份,同性爱80.40%,双性爱19.60%。67.32%经常感到孤独,63.32%感到压抑,34.52%因性取向有过自杀念头,10.63%有过自杀行为。92.84%有口交史,83.47%有肛交史,80.6%最近一年内有吻肛行为,10.42%有拳交行为,37.53%参与过群交,48.42%曾与女性性交。干预后97.1%认为有助于促进心理卫生,94.55%认为有助于提高个人生活质量。结论:在当代中国,尽管学界对gay/Bi的观念有了很大改变,但其负性心理仍普遍存在,尤其是高比例的人存在自杀念头和行为。通过健康干预,能够改善该人群的生命质量。     

Comparison of women with cervical human papillomavirus infection and genital warts. I. Some behavioural factors and clinical findings.

OBJECTIVE--To determine if behavioural factors, other than sexual, differ between women with cervical human papillomavirus infection (CHPI) and those with genital warts (GW). DESIGN--A structured, personal in-depth interview which included details on sexual behaviour, hygiene, gynaecological complaints, and demographical characteristics and a gynaecological examination which included vaginal culture and human papillomavirus (HPV) typing with Southern blot. SUBJECTS--Women (n = 972) who had attended two family planning clinics and one youth clinic for contraceptive advice. RESULTS--Out of this female population 66 (6.8%) were found to have CHPI, 39 (4.0%) had genital warts (GW), and 30 (3.1%) women reported genital warts within the last two years. The women with CHPI had had significantly less education, were more often immigrants, had a vaginal flora change more frequently and were more often smokers than the women with GW. The women with GW reported lower abdominal pain significantly more often, had a leucocyte dominance in the vaginal secretion more often and favoured bathing in a bathtub more than the women with CHPI. After adjustment for sexual behavioural factors the significant difference between the two groups for bathing in a bathtub and lower abdominal pain remained. CONCLUSION--Although both conditions are caused by HPV, there are behavioural differences between women with CHPI and women with CA.     

A Case of Scabies Complicated by Acute Glomerulonephritis

A 21-year-old male patient with scabies complicated by acute glomerulonephritis was reported. In the literature, such patients are prevalent in the tropical and subtropical zones, but only sporadic in the temperate zone. The incidence of such patients and the cause of glomerulonephritis were discussed.     

Actinic lichen planus: a presentation,deviant from the conventional

Actinic lichen planus, a variant of lichen planus usually in people living in the tropics, presents as annular or discoid patches over the sun-exposed regions. We present here a case of actinic lichen planus with papules and plaques over the malar region and dorsum of nose- a rare presentation of this entity.     

Nontropical diabetic hand syndrome: A troubling new entity

The nontropical diabetic hand syndrome merits recognition as a serious hand infection and diabetic complication. Initially recognized in the tropics and called tropical diabetic hand syndrome, this entity has not been previously delineated in temperate regions. Due in part to its unremarkable initial presentation, nontropical diabetic hand syndrome is neglected in temperate zones of the world yet it can result in severe morbidity and mortality among diabetic patients. It is poorly understood, needs recognition, and mandates expedited treatment since its clinical presentation is often overlooked until serious consequences occur. Inner city diabetic patients with poor glycemic control appear to be particularly susceptible to developing nontropical diabetic hand syndrome. We review this new entity and differentiate it into three clinical presentations: (Stage I) superficial erosion and ulceration; (Stage II) cellulitis and necrosis; and (Stage III) gangrene. The treatment of this new diabetic syndrome involves aggressive glycemic control and possible surgical intervention. We stress the importance of recognizing the diabetic hand syndrome as a potentially disabling and life‐threatening disorder in diabetics worldwide.