Childhood cutaneous tuberculosis: a 20-year retrospective study in Tunis

Despite prevention programs, tuberculosis is still endemic in developing countries. We assessed the epidemiologic and clinical profiles of childhood cutaneous tuberculosis in our dermatology department from 1981 to 2000 and compared it to previous Tunisian reports and to the relevant literature. This is a retrospective study over a 20-year period (1981-2000) in a large teaching hospital of the capital. Patients included were below age 15 years. Diagnosis was based upon clinical examination, tuberculin reaction, histopathology and response to antitubercular therapy. There were 26 patients with cutaneous tuberculosis, 0.1 percent of the total number of dermatology outpatients for that time period. Of these 26, seven (27 %) were immunocompetent. There were four boys and three girls and the mean age was 9.5 years. Three patients had lupus vulgaris, three had scrofuloderma, and one child had orificial tuberculosis. Six out of seven children were BCG vaccinated. There was no family history of tuberculosis. The Mantoux reaction was positive in six children. There was no systemic organ involvement in all cases. All patients were treated successfully with triple or quadruple anti-tubercular drugs for 4-11 months. Compared to a previous Tunisian report conducted over an 8-year period in the seventies, the incidence of childhood cutaneous tuberculosis has decreased. In that report, scrofuloderma was the most frequent form. Currently the incidence of lupus vulgaris has reached that of scrofuloderma, demonstrating the increase of the clinical pattern associated with strong immunity. All children had localized disease and responded to antimycobcterial chemotherapy.     

Childhood cutaneous tuberculosis: a study over 25 years from northern India

AIMS: We undertook this study to analyse the pattern of childhood cutaneous tuberculosis prevailing in northern India over the past 25 years and to highlight differences from and similarities to adult tuberculosis. MATERIALS AND METHODS: Clinical records of children with cutaneous tuberculosis who attended the Nehru Hospital attached to the Postgraduate Institute of Medical Education and Research, Chandigarh, India, between January 1975 to December 1999 were analysed. RESULTS: Four hundred and two patients with cutaneous tuberculosis were examined during the 25-year period of observation. These patients formed 0.1% of the total dermatology outpatients. Seventy-five (18.7%) of these 402 cases were children ( 10 mm). Histopathologic reports were available for evaluation in all 75 children. Out of 30 cases of LV, 24 (80%) showed classical tuberculous histology. In contrast, out of 40 cases with SFD, only 19 (47.5%) showed classical histology. Classical tuberculous histology was noted in all 3 (100%) cases of TVC and 1 (100%) case each with tuberculids and gumma. Tubercle bacilli could be demonstrated in 4/30 (13.3%) cases with LV and 9/40 (22.5%) cases with SFD. Systemic involvement was seen in 16 (21.3%) children, of whom 3 (18.8%) had LV and 13 (81.3%) SFD. The lungs were the most common organs involved in 8 (50.0%) children followed by bone(s) in 4 (25.0%), abdomen in 2 (12.5%), and both lung and bone in 1 (6.3%) child. In contrast to adults, girls outnumbered boys in the childhood series; SFD was a common form of presentation in contrast to LV and TVC, tuberculous gumma and tuberculids were noted less often. In both children and adults, Mantoux reactivity did not correlate with the extent of the disease; patients with disseminated disease were found to be less often vaccinated with BCG and regional lymphadenopathy was noted more often in patients with disseminated disease. CONCLUSIONS: In the whole spectrum of cutaneous tuberculosis, there is a proportion of patients with dissemination (systemic involvement) who are of great epidemiological significance as they require a change in the standard therapeutic regimens recommended for cutaneous tuberculosis.     

Epidemiology of acquired bullous diseases in Eastern Croatia: a retrospective prewar to postwar study

The purpose of this study was to evaluate the epidemiology of bullous diseases (BD) in eastern Croatia during a ten-year period (1986-1990/1992-1996), and to estimate the effect of prolonged exposure to traumatic events during the war in Croatia on the prevalence and incidence of acquired BD. The files of all BD patients hospitalized at Department of Dermatology and Venereology, Osijek University Hospital, during the periods from January 1986 to December 1990 and from January 1992 to December 1996 were collected and analyzed with regard to personal data, history of the disease including age, sex and onset of symptoms, clinical diagnosis, laboratory findings, and associated illness. Forty-five patients were newly diagnosed with BD over the ten-year period. During the 1986-1990 period, 19 patients with BD represented 0.89% of 2133 patients admitted to our Department. During the 1992-1996 period, 26 newly diagnosed patients with BD represented 1.27% of 2050 patients treated at our Department. Females were more affected than males. The most common clinical variant was pemphigus vulgaris, occurring frequently in the middle-aged population. All our patients were exposed to prolonged stressful war conditions during the 1992-1996 period, therefore, we speculate that extended emotional stress may have triggered the onset of the disease.     

Combination antimalarials in the treatment of cutaneous dermatomyositis: a retrospective study

OBJECTIVE: To observe whether the use of antimalarials in combination resulted in significant improvement in the cutaneous signs and symptoms of patients with dermatomyositis who did not otherwise respond to the use of single-agent antimalarial therapy. DESIGN: Retrospective case series of 17 patients treated between January 1, 1991, and December 31, 2002. SETTING: An ambulatory medical dermatology clinic in an academic center.Patients Patients had adult-onset dermatomyositis with predominantly cutaneous symptoms and a follow-up period at our clinic of at least 6 months. Cases in which it was not possible to assess the effect of treatment on cutaneous symptoms were not included.Intervention Treatment regimens varied and included the use of antimalarials, prednisone, methotrexate, and other medications. MAIN OUTCOME MEASURES: Physician-observed and patient-reported improvement based on erythema, pruritus, and extent of affected skin. RESULTS: Seven of 17 patients experienced at least near clearance in cutaneous symptoms with the use of antimalarial therapy alone: 4 of these patients required combination therapy (hydroxychloroquine sulfate-quinacrine hydrochloride or chloroquine phosphate-quinacrine), while 3 of them responded well to antimalarial monotherapy. The median time required to reach the response milestones on the final working therapeutic regimen was 3 months (mean, 4.8 months; range, 2-14 months). Six patients did not respond significantly to any type of therapy, including nonantimalarials. CONCLUSION: Our experience suggests that a significant subgroup of patients whose skin lesions have been unresponsive to a single antimalarial benefit from combination therapy with hydroxychloroquine and quinacrine or chloroquine and quinacrine, but controlled clinical trials are warranted to assess the extent of benefit.     

The microbial flora of clinically infected cutaneous metastases: a retrospective study

Symptomatic cutaneous metastases are associated with discharge, malodour, pruritus and pain, all of which may negatively impact quality of life and cutaneous health. We conducted a retrospective chart review of patients referred to the Dermatology Service at Memorial Sloan Kettering Cancer Center between August 2006 and June 2015, and characterized the microbial flora and antimicrobial management of cutaneous metastases in 64 patients. We detected pathogenic and/or opportunistic bacteria in 50% of skin lesions. The most commonly isolated organisms were Staphylococcus aureus and Pseudomonas aeruginosa. Patients treated with oral antibiotics, alone or in combination with topical agents, had a statistically significant better improvement in infectious symptoms than those treated without oral antibiotics. Our findings suggest that the normal skin microbial flora is disrupted in patients with symptomatic skin metastases. Oral antibiotics may provide benefit when used as first-line therapy for infected skin lesions in patients with symptomatic cutaneous metastases.     

Clinicopathologic characteristics of cutaneous chronic graft-versus-host diseases: a retrospective study in Korean patients

Background Chronic graft‐versus‐host disease (cGVHD) is a major complication in long‐term survivors of hematopoietic stem cell transplantation (HSCT). Cutaneous manifestations are frequently the presenting features; therefore, the dermatologist needs to be aware of the wide spectrum of cutaneous cGVHD. Methods We retrospectively evaluated patients’ characteristics, clinical, and histological features of cutaneous cGVHD and analyzed factors influencing the severity of cutaneous cGVHD in 100 Korean HSCT recipients between January 1, 1995, and December 31, 2007. Results Clinical manifestations of cutaneous cGVHD mainly presented as lichenoid (60.0%), sclerodermoid (12.0%), or erythematous maculopapular (22.0%) patterns. Other less common findings included xerosis, dyspigmentation, acquired ichthyosis, eczema, exfoliative dermatitis, alopecia, erythema multiforme‐like or keratosis pilaris‐like eruption. Among 100 patients, 46 patients were investigated for nail involvement, and 29 (63.0%) of them were accompanied with nail abnormalities. Histologically, characteristic lichenoid lesions were observed in 53%, sclerodermoid in 9%, and acute/chronic overlap syndrome in 28% of patients. We also discovered that HSCT from female donors to male recipients increased the severity of cutaneous cGVHD. Conclusions We report a large study about cutaneous cGVHD in Asian patients. Cutaneous cGVHD presented with a wide spectrum of clinical and histological manifestations.     

Epidemiology of contact dermatitis from pesticides in Japan

An epidemiological study was made of 216 patients with contact dermatitis from pesticides in Japanese rural regions from 1968 to 1970. They were analyzed according to conditions of use, sex, age, occupation, exposure, and season. The pesticides most often responsible were captafol (Difolatan) (28.7%), sulfurs (18.5%), highly and moderately toxic organic phosphates (18.1%), and chlorinated hydrocarbons (9.7%). Complications, sites of dermatitis, prognosis and factors contributing to onset of dermatitis are discussed.     

疣状皮肤结核继发糜烂溃疡一例

患者,男,60岁。臀部、腹股沟红斑丘疹、溃疡7个月余。多次在我科门诊就诊,诊断为湿疹、传染性湿疹样皮炎、皮肤溃疡等,治疗效果差。后收住院诊治,组织病理提示上皮样细胞肉芽肿及干酪样坏死,PPD试验阳性,TSPOT阳性,诊断：疣状皮肤结核继发细菌感染。给予异烟肼、利福平及盐酸乙胺丁醇三联口服治疗后皮疹消退。     

Epidemiology of pemphigus in Macedonia: a 15-year retrospective study (1990-2004)

BACKGROUND: Pemphigus is an autoimmune blistering skin disease mediated by auto-antibodies directed against desmoglein proteins. There are only a few epidemiological studies on pemphigus. Our objective was to determine the epidemiological features of pemphigus in Macedonia, and to compare the results with those reported elsewhere. METHODS: Diagnosis in all cases was confirmed by histopathology and direct immunofluorescence. Binomial distribution testing and Fisher's exact-test at the 0.01 level of significance were used to determine if particular demographic groups were over-/ under-represented among the pemphigus patients. RESULTS: One hundred and thirty-three new pemphigus cases were diagnosed in Macedonia from 1990-2004. The average annual incidence was 0.44/100,000 inhabitants (SD = 0.17). The incidence doubled to 0.89 in 2001 during the local armed unrest. The disease did not affect either gender to a greater extent. The average annual incidence was 0.51 for ethnic Macedonians. Roma (Gypsies) had a statistically significantly higher incidence of pemphigus at 2.4 cases/100,000 individuals. Ethnic Albanians had statistically significantly lower incidence of 0.1 cases/100,000 individuals. The most common variant was pemphigus vulgaris (77.4%). CONCLUSIONS: The annual incidence for pemphigus in Macedonia is 0.44 cases/100,000 inhabitants. Most common form was pemphigus vulgaris. An epidemiological peak occurred in 2001 during the local armed conflict. Macedonian Roma had a sixfold higher incidence of pemphigus compared with the overall population; ethnic Albanians had a fourfold lower incidence.