Candida infections today--how big is the problem?

Thirty years ago, superficial fungal infections were common, but systemic fungal infections were not as frequent as today. Since that time incidence in both superficial and systemic fungal infection has been increasing. The reasons are many. Due to advances in medicine, human life span is extended and many people suffer from various immunodeficiencies. Transplantation of organs and tissues, wide application of parenteral feeding and parenteral administration of drugs, infection with human immunodeficiency virus (HIV), and long-term peroral administration of antibiotics are the main reasons for appearance of many immunologic dysfunctions and thereby systemic fungal infections. The most usual predisposing factors for systemic fungal infection are skin and mucosal damage, hypofunction of T-cell-mediated immunity, decreased function of neutrophiles, long-term administration of corticosteroids, as well as dysfunction of microbial flora. Systemic fungal infections are a great problem, because they are very difficult to prove and to treat. This is why prevention of systemic infections is extremely important today, including the removal of predisposing factors as well as rational drug administration.     

Which intercurrent infections are associated with maculopapular cutaneous drug reactions? A case‐control study

BACKGROUND: Patients with lymphotrophic viral infections are at increased risk for cutaneous drug reactions (CDRs). However, the association between other intercurrent infections and maculopapular CDRs has not been evaluated by epidemiologic methods. OBJECTIVE: We conducted a case-control study in order to evaluate the exposure to intercurrent infections in patients with maculopapular CDRs. METHODS: Data were obtained through assessment of files of 53 patients hospitalized for maculopapular CDRs in the Department of Dermatology and 159 control patients. Exposure to intercurrent infections was recorded in patients and controls. RESULTS: An intercurrent infectious disease was documented in 31/53 (58.5%) of patients with CDRs, as compared to 12/159 (7.5%) patients in the control group (OR 17.26, 95% CI: 7.24-42.00). Maculopapular CDRs were associated with respiratory tract infections (OR 20.53, 95% CI: 5.20-94.45), and urinary tract infections (OR 20.61, 95% CI: 2.36-465.99), but not with skin infections (OR 3.83, 95% CI: 0.85-17.87) or other infections. CONCLUSIONS: Our study implies that maculopapular CDRs are associated with respiratory tract infections as well as urinary tract infections. Further study is needed to evaluate the role of intercurrent infections in the pathogenesis of CDRs.     

A new cutaneous sign of mercury poisoning?

Chronic mercury poisoning is becoming a health concern because of extensive pollution of water and fish, and the increasing consumption of fish in the human diet. Mercury is extremely toxic to the body, especially the central nervous system, but diagnosis is difficult because of the lack of specific signs. A total of 11 patients were observed to have a nonpruritic or mildly pruritic discreet papular and papulovesicular eruption that correlated with high blood mercury levels. The mercury evidently came from increased seafood consumption. All of the patients improved when they were placed on either a seafood-free diet or chelation therapy. Physicians should suspect mercury poisoning in patients who eat a high-seafood diet who present with an asymptomatic or mildly pruritic papular or papulovesicular eruption.     

Primary cutaneous alveolar rhabdomyosarcoma in an adolescent – A challenging diagnosis

Primary cutaneous alveolar rhabdomyosarcoma is an extremely rare and highly aggressive soft tissue sarcoma that predominantly arises on the extremities and perineum of adolescents and young adults. Dermatologists should be aware of these tumors in order to promptly make the diagnosis and initiate treatment.     

Renal cell carcinoma and viral infections: A dangerous relationship?

Virus-related cancers in humans are widely recognized, but in the case of renal cancer, the link with the world of viruses is not clearly established in humans, despite being known in animal biology. In the present review, we aimed to explore the literature on renal cell carcinoma (RCC) for a possible role of viruses in human RCC tumorigenesis and immune homeostasis, hypothesizing the contribution of viruses to the immunogenicity of this tumor. A scientific literature search was conducted using the PubMed, Web of Science, and Google Scholar databases with the keywords “virus” or “viruses” or “viral infection” matched with (“AND”) “renal cell carcinoma” or “kidney cancer” or “renal cancer” or “renal carcinoma” or “renal tumor” or “RCC”. The retrieved findings evidenced two main aspects testifying to the relationship between RCC and viruses: The presence of viruses within the tumor, especially in non-clear cell RCC cases, and RCC occurrence in cases with pre-existing chronic viral infections. Some retrieved translational and clinical data suggest the possible contribution of viruses, particularly Epstein-Barr virus, to the marked immunogenicity of sarcomatoid RCC. In addition, it was revealed the possible role of endogenous retrovirus reactivation in RCC oncogenesis, introducing new fascinating hypotheses about this tumor’s immunogenicity and likeliness of response to immune checkpoint inhibitors.     

A foot tumour as late cutaneous Lyme borreliosis: a new entity?

Acrodermatitis chronica atrophicans (ACA) is the late cutaneous form of Lyme borreliosis. The early inflammatory phase manifests with a bluish‐red discoloration and doughy swelling of the skin. The atrophic phase represents a late‐phase process with red discoloration, and a thin and wrinkled appearance of the skin. We present a patient who exhibited a previously undescribed form of late cutaneous Lyme borreliosis (LCLB) with a foot tumour. A 64‐year‐old woman had a large tumorous lesion on the right sole. The tumour size and deformation of the feet made wearing shoes difficult. On skin histology, a granulomatous lymphohistiocytic infiltrate with plasma cells was noticed. In fact, the patient recalled tick bites 2 or 3 years before. Borrelia burgdorferi (Bb) serology was highly positive and a polymerase chain reaction analysis on the skin biopsy detected Bb sensu lato, genospecies B. afzelii. We diagnosed LCLB and antibiotics were prescribed. On the more recent examination, the tumour had totally disappeared; the skin was atrophic and dry with only few scales. We report an atypical case of European LCLB, suggesting that ACA is not the only possible presentation of LCLB. The diagnosis of ACA is often clinically missed for months or years, and may be mistaken at the inflammation phase for vascular disorders, erysipelas or bursitis/arthritis, and at the atrophic phase for lichen sclerosus atrophicus, morphoea or anetoderma. To our knowledge, no such tumorous LCLB has previously been described.     

Multiple progressive annular telangiectasias: A clinicopathological variant of cutaneous collagenous vasculopathy?

Telangiectasias are the clinical manifestation of diverse processes affecting blood vessels. Herein we report the case of a 60‐year‐old man presenting long‐standing asymptomatic annular telangiectatic lesions with whitish centers. The histopathologic examination revealed thickened blood dermal vessel walls in the superficial dermis showing reduplication of the basement membrane resembling cutaneous collagenous vasculopathy (CCV). We suggest that this atypical clinicopathological presentation may represent either a localized annular variant of CCV or a previously unreported clinical form of multiple cutaneous telangiectasias.     

Increased incidence of cutaneous Staphylococcus aureus infections after the 2010 floods in the Var department of France: Rumour or reality?

BackgroundNatural disasters are typically associated with the emergence of infectious diseases. On 15 June 2010, severe storms caused flooding in the Var department (France). A rumour about increased risk of Staphylococcus aureus skin infections after bathing in the sea began to circulate on Internet a few days after the floods. The aim of this study was to compare the rumour with the true incidence of cases of infection.MethodsSince 1999, we have been conducting a prospective survey of S. aureus skin infections in our hospital to study their clinical, laboratory and epidemiologic features. We compared data on cases of Staphylococcus skin infection recorded in our institution from 2008 to 2012.ResultsWe found that there was no increase in S. aureus skin infections after the floods compared to the previous and subsequent years.ConclusionWe had a unique opportunity to check the rumoured increase in incidence of infectious disease with the true incidence. In our study, the fear of S. aureus skin infections following flooding proved to be unfounded.     

The role of human herpesvirus-6, Epstein–Barr virus and cytomegalovirus infections in the etiopathogenesis of different types of cutaneous drug reactions

Background Recently, it has been recognized that drug‐induced hypersensitivity syndrome (DIHS) is associated with reactivation of human herpesvirus‐6 (HHV‐6), Epstein–Barr virus (EBV) and cytomegalovirus (CMV). However, whether those viruses have a role in the development of cutaneous drug reactions (CDRs) other than DIHS is not known. Objective To investigate the role of HHV‐6, EBV and CMV infections in the etiopathogenesis of different types of CDRs. Methods Eighteen patients with diagnosis of CDR according to the clinical and histopathological findings were evaluated. Real‐time polymerase chain reaction (PCR) was used for the detection of EBV, CMV, and HHV‐6 DNA in lesional skin biopsy specimens; EBV and CMV DNA in serum samples; and HHV‐6 DNA in peripheral blood mononuclear cells. Results The genome of HHV‐6 was detected only in the lesional skin of two patients with DIHS. Epstein–Barr virus and CMV DNA in the skin lesions, EBV and CMV genomes in the serum samples, and HHV‐6 DNA in the peripheral blood mononuclear cells were negative in all patients. Limitations The patient population was small and did not include all types of CDRs. Also, we had only two patients with DIHS. We had not been able to measure the increase in anti‐viral IgG titers in serial serum samples. Conclusion Epstein–Barr virus and CMV infections do not seem to have a role in the etiopathogenesis of CDRs including DIHS. The association between HHV‐6 infection and CDRs is likely to be limited to DIHS.     

Omalizumab—A Review

Omalizumab is a recombinant, humanized, monoclonal antibody against human immunoglobulin E (IgE). The US FDA has approved this molecule for chronic urticaria.     

Does mountaineering increase the incidence of cutaneous melanoma? A hypothesis based on cancer registry data

Exposure to ultraviolet radiation is considered a major risk factor for the development of cutaneous melanoma. In white populations in Australia or the USA, the melanoma incidence increases with the vicinity of residence to the equator. In Europe decreasing incidence rates towards southern countries may be due to the darker pigmentation of the Mediterranean population. The comparison of age-standardized incidence rates (world standard population) in Europe shows that Swiss cancer registries and the Austrian Tyrol registry have much higher incidence rates for cutaneous melanoma than other Central European cancer registries. The excess of Swiss/Austrian incidence rates is even more pronounced when head localization is analysed separately. Due to the altitude-related increase in UV radiation two possible explanations for the Swiss/Austrian excess rates may be considered: firstly, as a result of the altitude of residence, higher UV exposure is generally present in these countries; secondly, mountaineering activities may additionally increase UV exposure.