ISOLATION OF BACTERIA CAUSING SECONDARY BACTERIAL INFECTION IN THE LESIONS OF CUTANEOUS LEISHMANIASIS

Background:

Cutaneous Leishmaniasis (CL) is a parasitic disease characterized by single or multiple ulcerations. Secondary bacterial infection is one of the complications of the disease that can increase the tissue destruction and the resulting scar.

Objective:

To effectively determine the incidence of real secondary bacteria infection in cutaneous leishmaniasis, we designed the current study.

Methods and Materials:

This was a cross-sectional study performed in Skin Diseases and Leishmaniasis Research Centre, Isfahan, Iran. In this study, 854 patients with confirmed CL were enrolled. Samples were taken from all the patients. Sterile swaps were achieved for the ulcer exudates and scraping was used for nonulcerated lesions. All the samples were transferred to tryptic soy broth medium. After 24 h of incubation in 37°C, they were transferred to eosin methylene blue agar (EBM) and blood agar. Laboratory tests were used to determine the species of bacteria. All of the collected data were analyzed by SPSS software and chi-square.

Results:

Among 854 patients with confirmed cutaneous leishmaniasis, 177 patients (20.7%) had positive cultures for secondary bacterial infection. Bacteria isolated from the lesions were as follows: Staphylococcus aureus - 123 cases (69.4%), coagulase negative Staphylococcus - 41 cases (23.1%), E. coil - 7 cases (3.9%), Proteus - 3 cases (1.7%) and Klebsiella - 3 cases (1.7%).

Conclusions:

The incidence of secondary bacterial infection in lesions of CL was 20.7%. The most common isolated pathogen was Staphylococcus aureus. The incidence of secondary bacterial infection was significantly more in the ulcerated lesions as compared with nonulcerated lesions (P = 0.00001).     

Herpes zoster: a clinical study in 205 patients

Background:

Even though herpes zoster is a common condition its incidence and pattern of occurrence in the era of HIV disease is significant.

Aim:

To analyze the incidence, pattern of occurrence and evolution of herpes zoster with special attention to provocative factors if any.

Materials and Method:

This was an analytical study conducted for 2 years based on a preformed proforma containing preliminary information, a detailed clinical evaluation regarding the segment of involvement, morphology, pattern of lesions, complications, disseminations etc. and investigations to establish provocative factors if any.

Results:

Incidence of herpes zoster was mainly in the fourth and third decades of life. A definite history of chicken pox was present in only 63.4% cases. In the majority (70%) herpes zoster occurred spontaneously. In 30% cases, immunosuppression due to chemotherapy, malignancy, HIV infection, diabetes mellitus were observed. The commonest segment affected was thoracic (42.4%) followed by cranial (28.2%) and cervical (12.1%). Majority resolved in 7–14 days except immunosuppressed. 34.6% of the patients had complications such as secondary bacterial infection, post herpetic neuralgia, and motor weakness. Ten patients had HIV infection as a provocative factor.

Conclusion:

The results of incidence and clinical pattern of herpes zoster is almost parallel to the previous studies. Any factors of immunosuppression should be checked, especially HIV, particularly in disseminated and long-lasting cases.     

Comparison of intralesional two percent zinc sulfate and glucantime injection in treatment of acute cutaneous leishmaniasis

Introduction:

Cutaneous leishmaniasis is an endemic disease in developing countries caused by different species of leishmania parasite, and if left untreated, it will result in a deformed scar after a relatively long period. Although various systemic and topical treatments have been proposed for leishmaniasis, pentavalent Antimony compounds remain the first-line treatment for it. Considering the cases with treatment failure, potential side effects and reluctance of patients to receive the drug, there are continuing efforts to find better treatment alternatives.

Aim:

Comparison of the effect of intralesional 2% zinc sulfate injection with Glucantime in treatment of acute cutaneous leishmaniasis.

Materials and Methods:

In this clinical trial, 45 patients with clinical diagnosis of cutaneous leishmaniasis and positive direct smear for leishman body were treated by intralesional injection of either 2% zinc sulfate or Glucantime. After simple randomization, in one group the patients were treated with 2 bouts of intralesional 2% zinc sulfate with a 2-week interval, and in the other group they were treated with 6 weekly bouts of intralesional Glucantime. The patients were monitored in two week intervals for 8 weeks. Healing of the lesions was evaluated clinically and by direct smear, and the data were analyzed using SPSS (11.5) software, t-Student, Mann-Whitney and Analysis of covariance (ANCOVA) statistical tests.

Findings:

In the end of study, 34 patients completed the study, 10 of whom received intralesional Glucantime and 24 of whom received intralesional 2% zinc sulfate. The healing rate after 8 weeks was 80% in the group receiving intralesional Glucantime and 33.3% in the one receiving 2% zinc sulfate (P=0.009).

Conclusion:

Based on the results of this study, intralesional injection of 2% zinc sulfate was less effective in treatment of cutaneous leishmaniasis than intralesional Glucantime.     

The Spectrum of Cutaneous Infection in Diabetic Patients with Hepatitis C Virus Infection: A Single-Center Study from Egypt

Context:

Hepatitis-C virus (HCV) infection and diabetes mellitus (DM) have a significant association with skin disorders. Aims: The aim of this study was to assess the impact of HCV infection on the pattern of cutaneous infections among diabetic patients. Methods and Material: A prospective study included diabetic patients who attended Al-Hussein University hospital, Cairo during the period from 2008 to 2010. Patients were examined for skin infections, and investigated for HCV infection.

Statistical Analysis Used:

SPSS (version 11.5).

Results:

The study included 163 patients (102 males and 61 females) with a mean age of 46.2 ± 4.83 years. Ninety five patients (58.3%) were HCV+ve (group A) while 68 patients (41.8%) were HCV-ve (group B). Skin infections in group A included fungal (48.4%), viral (26.3%), bacterial (22.1%) and parasitic (3.2%) while in group B, the spectrum included bacterial (41.2%), fungal (39.7%), viral (11.7%) and parasitic (7.4%). Onychomycosis was the commonest infection in group A (25.2%) compared with folliculitis in group B (19.1%). Cutaneous infections in HCV+ patients were more characterized by increased severity, aggressive course, resistance to treatment and rapid relapse.

Conclusions:

HCV infection has a significant impact in increasing and changing the spectrum of skin infections in diabetic patients. Severe and resistant infections in diabetics could be an important sign of HCV infection.     

FAMILIAL REACTIVE PERFORATING COLLAGENOSIS

Background:

Reactive perforating collagenosis (RPC) is one of the rare forms of transepidermal elimination in which genetically altered collagen is extruded from the epidermis. This disease usually starts in early childhood as asymptomatic umbilicated papules on extremities, and the lesions become more conspicuous with age.

Aims:

The objective of our study was to determine the clinico-pathological features of RPC and the response to various treatment modalities.

Methods:

Ten patients of RPC, belonging to five different families, were studied clinically. Various laboratory investigations were carried out and diagnosis was made by histopathology of the lesions. Patients were given various topical and oral treatments.

Results:

RPC is familial in most cases without any definite inheritance pattern. It begins in childhood and the lesions are usually recurrent and become profuse and large with age. Systemic diseases have no role in the onset of lesions.

Conclusion:

Oral and topical retinoids in combination with emollients is the best treatment option.     

Human Papillomavirus Deoxyribonucleic Acid may not be Detected in Non-genital Benign Papillomatous Skin Lesions by Polymerase Chain Reaction

Background:

Papillomatosis is a known histopathologic pattern usually seen in human papillomavirus (HPV) infection and verruca vulgaris is the typical example. This pattern is also detected in some other benign cutaneous lesions such as nevus sebaceous (NS), seborrheic keratosis (SK), trichilemmoma (TL) and inverted follicular keratosis (IFK). The association between papillomatous lesions and HPV infection is questionable.

Objective:

The objective of this study was to investigate the presence of HPV deoxyribonucleic acid (DNA) in non-genital benign papillomatous skin lesions (NS, SK, TL and IFK) by polymerase chain reaction (PCR).

Materials and Methods:

A total of 100 specimens of non-genital NS, SK, TL and IFK were retrieved from archives of Dermatopathology Department of Razi Hospital, between 2003 and 2010. The conventional PCR using consensus GP5+/GP6+ primer and hydroxymethylbilane synthase gene as inner control was performed.

Results:

PCR for HPV DNA revealed no positive results in any of 28 seborrheic keratosis (SK), 28 nevus sebaceous (NS), 28 inverted follicular keratosis (IFK) and 13 trichilemmoma (TL) studied specimens.

Conclusion:

Papillomatosis is usually a characteristic pattern of HPV infection. However, we found no association between HPV infection and non-genital benign papillomatous lesions.     

Evaluation of Organelle Changes in Promastigotes of Unresponsive Leishmania Tropica to Meglumine Antimoniate in Comparison with Sensitive and Standard Isolates by Electron Microscopy

Background:

The control of leishmaniasis faces serious challenges because of resistance to the first-line antimonial drugs. We aimed to evaluate the differences in organelle changes of cultivated promastigotes obtained from skin lesions of sensitive and unresponsive isolates to meglumine antimoniate (Glucantime) by electron microscopy.

Material and Methods:

This study was done in Bam city, southeastern Iran, in which the incidence of disease has sharply increased since the earthquake in 2003. The samples were taken from 66 patients who were referred to the cutaneous leishmaniasis (CL) treatment center in Bam. A questionnaire was completed for each individual, recording their demographic characteristics and CL status. The scraping smears provided from the edge of active lesions with sterile blades were fixed with methanol, stained by Giemsa, and examined under a compound light microscope for amastigote form simultaneously. To prepare the specimens for transmission electron imaging, promastigotes were centrifuged and resuspened.

Results:

Transmission electron microscopic study of the cultivated promastigotes revealed that there were alterations in the organelles and structures of sensitive isolates compared with unresponsive and standard ones. Organelles and structures such as mitochondria, kinetoplast, microtubules, cytoplasmic vacuoles, plasma membrane and vesicles were studied. The alterations such as disintegration of kinetoplast into thin filaments and condensation of kinetoplast DNA core, changes in size, number and location of vesicles and microtubules were observed. We noted intense cytoplasmic vacuolization, and considerable swelling of mitochondria.

Conclusion:

The significance and relevance of these changes might help understand drug resistance patterns and help localize the best target site for inactivating the organism.     

White Lesions in the Oral Cavity: A Clinicopathological Study from a Tertiary Care Dermatology Centre in Kerala,India

Context:

White lesions in the oral cavity may be benign, pre-malignant or malignant. There are no signs and symptoms which can reliably predict whether a leukoplakia will undergo malignant change or not. Many systemic conditions appear initially in the oral cavity and prompt diagnosis and management can help in minimizing disease progression and organ destruction.

Aim:

The aim of the paper was to study the clinical and histopathological patterns of white lesions in the oral cavity presented at the study setting and to study the factors associated with the histopathological patterns of the lesions.

Settings and Design:

A hospital based cross-sectional study of patients with white lesions in the oral cavity attending the Department of Dermatology and Venereology, Medical College, Thiruvananthapuram was done.

Materials and Methods:

After taking a detailed history, microscopic examination of Potassium hydroxide smear and an oral biopsy with histopathologial examination was done.

Results:

Out of the 50 patients in the study, clinically the diagnoses made were Lichen planus (32 patients; 64%), Frictional Keratosis (4;8%), Dysplasia (2;4%), Oral Hairy Leukoplakia (1;2%), Pemphigus Vulgaris (2;4%), Cutaneous Lupus Erythematosus (1;2%), Oral Submucous fibrosis (3;6%) and Oral Candidiasis alone (5;10%). Out of the 45 patients who had undergone biopsy, 25 (55.6%) had Lichen planus, 9 (20%) had Frictional Keratosis and mild Dysplasia was found in 4 (8.9%) patients.

Conclusion:

The measure of agreement between the clinical and pathological diagnosis was only 32%. Older age, difficulty in opening the mouth, consumption of non-smoked tobacco, site of the lesion (gingival, floor of mouth or lingual vestibule) and presence of tenderness on the lesion were significantly associated with Dysplasia.     

A Clinico-Bacteriological Study of Pyodermas at a Tertiary Health Center in Southwest Rajasthan

Background:

The spectrum of pyoderma changes constantly, and so does the antibiotic susceptibility pattern.

Aims:

This study was done to assess the magnitude and clinical patterns of pyodermas, their causative micro-organisms, and the antibiotic susceptibility patterns.

Materials and Methods:

Five hundred consecutive, clinically diagnosed and untreated cases of pyoderma, attending the Dermatology OPD of RNT Medical College and MB Government Hospital, Udaipur, from October 2010 to September 2011 were the subjects of this study. A detailed clinical examination, and relevant investigations including bacterial culture and sensitivity, were carried out and recorded.

Statistical Analysis:

For statistical analysis of data, the software ‘EPI-INFO Version 6’ was used, and Chi-square (χ²) test was applied.

Results:

Of 19576 cases attending skin OPD during the study period, pyoderma was seen in 500 patients; the incidence being 2.55%. Males outnumbered females. The highest number of cases (109; 21.8%) was observed in 1st decade. Lower extremities were the commonest site of predilection. Primary pyodermas outnumbered secondary pyodermas. Furuncle (136; 27.2%) and infectious eczematoid dermatitis (62; 12.4%) were the commonest entities among primary and secondary pyoderma respectively. Staphylococcus aureus was the commonest causative agent in both primary and secondary pyoderma. It showed high susceptibility to amoxycillin + sulbactam, aminoglycosides and cefoperazone, moderate susceptibility to linezolid, while low susceptibility to fluoroquinolones and cephalexin.

Conclusion:

Such studies help to assess the changing trend of bacterial infections, their causative organisms and antibiotic susceptibility pattern.     

Cutaneous manifestations of internal malignancy

Background:

Many malignancies affecting the internal organs display cutaneous manifestations which may be either specific (tumor metastases) or nonspecific lesions.

Aims:

The study is aimed at determining the frequency and significance of cutaneous manifestations among patients with internal malignancy.

Materials and Methods:

750 cases of proven internal malignancy, who attended a cancer chemotherapy center in South India, were studied. Specific infiltrates were confirmed by histopathology, fine needle aspiration cytology (FNAC) and marker studies.

Results:

Out of the 750 patients with internal malignancy, skin changes were seen in a total of 52 (6.93%) patients.

Conclusion:

Cutaneous metastases (specific lesions) were seen in 20 patients (2.66%): contiguous in 6 (0.8%), and non-contiguous in 14 (1.86%). Nonspecific skin changes were seen in 32 patients (4.26%). None of our patients presented with more than one type of skin lesions. Herpes zoster was the most common nonspecific lesion noticed in our patients, followed by generalized pruritus, multiple eruptive seborrheic keratoses, bullous disorder, erythroderma, flushing, purpura, pyoderma gangrenosum, insect bite allergy and lichenoid dermatitis.     

Assessing the autoantibody levels in relation to disease severity and therapy response in pemphigus patients

Background:

In pemphigus, autoantibodies are directed against adhesion molecules, which make the junctions between keratinocytes, and thus determining their level can reflect the disease activity.

Aim:

The purpose of this study is to determine the clinical significance of the autoantibody levels in pemphigus management.

Materials and Methods:

The clinical features of 47 pemphigus vulgaris patients were assessed and patients′ sera were investigated by indirect immunofluorescence using monkey esophagus as a substrate for autoantibody levels.

Results:

We found a significant correlation between antibody titers and mucosal severity scores. Initial antibody titers of the patients with at least one mucosal lesion at the end of the first month of the therapy were found significantly higher than the patients who had no mucosal lesion. With the therapy, lesions resolved earlier than the antibody titers.

Conclusion:

In patients with pemphigus, especially in cases who were not treated before, sera antibody levels are a valuable tool in evaluating disease severity and choosing initial treatment. In patients who had been taking any systemic treatment, it is difficult to make a relationship between antibody levels and disease severity, because therapy improves disease earlier than the antibody titers. However, estimating antibody levels can be helpful for clinicians in disease management, in reducing or ceasing treatment dosage and anticipating recurrence.     

Plantar warts treated with topical adapalene

Background:

Treatment of plantar warts caused by human papilloma virus (HPV) strain types 1, 2 and 4 is often difficult and a challenging problem. Various therapeutic modalities available for treating this problem have not been uniformly successful.

Purpose:

The purpose of present study is to evaluate the efficacy of adapalene applied locally with occlusion in plantar warts.

Materials and Methods:

A total of 10 patient with 118 plantar warts were included in an open study. All were treated by applying adapalene gel 0.1% after paring of warts if needed followed by occlusive dressing with polythene paper in each patient. The effects of the treatment were evaluated every week till the clearance of all warts.

Findings:

Adapalene was used in 10 patient having 118 plantar warts. All the warts cleared in 39±15.07 days. There was no side effects like scar formation, irritation, erythema or infection with adapalene.

Conclusion:

Adapalene clears the plantar warts faster compared to other modalities available.

Limitation:

Need trial with large number of patients.     

CHILDHOOD VITILIGO: RESPONSE TO METHYLPREDNISOLONE ORAL MINIPULSE THERAPY AND TOPICAL FLUTICASONE COMBINATION

Background:

Childhood vitiligo is always a challenge to treat, especially when the disease is progressing rapidly in such a patient. Oral minipulse with betamethasone has been tried in childhood vitiligo and also in some other immune mediated skin disorders with good results.

Aims:

The aim of the present study was to see the overall efficacy of methylprednisolone oral minipulse therapy in combination with topical fluticasone in progressive childhood vitiligo. The combination was tried to achieve a significant amount of repigmentation of vitiligo lesions already present at the initial visit.

Materials and Methods:

Four hundred children with progressive vitiligo were enrolled for this study and were prescribed oral methylprednisolone on two consecutive days every week in a minipulse form for a period of six months. In addition, the patients were instructed to apply fluticasone ointment topically once a day on their vitiligo lesions. The patients were assessed for the remission achieved as well as the extent of repigmentation of their already existent lesions.

Results:

More than 90% of patients went into complete remission after the start of the therapy. Moreover, about 65% (two-thirds) of patients achieved good to excellent repigmentation of lesions at the end of six months of therapy. The therapy was also well tolerated and the side effects seen were almost negligible.

Conclusions:

Oral minipulse treatment with methylprednisolone is an effective treatment option for controlling the disease spread in childhood vitiligo and with the addition of topical fluticasone the extent of repigmentation achieved is also quite significant.     

Cutaneous manifestations of deep mycosis: an experience in a tropical pathology laboratory

Background:

Cutaneous manifestations of deep mycotic infection are fraught with delayed or misdiagnosis from mainly cutaneous neoplastic lesions.

Aim:

This study is designed to present our experience of these mycoses in a pathology laboratory in the tropics.

Materials and Methods:

A clinicopathologic analysis of deep mycotic infections was conducted over a 15 years period Formalin fixed and paraffin wax processed biopsies were stained with hematoxylin and eosin, periodic acid Schiff (PAS), and Grocott''s methenamine silver (GMS) for the identification of fungus specie. Patients’ bio-data and clinical information were obtained from records.

Results:

Twenty males and seven females presented with 6 months to 6 years histories of varying symptoms of slow growing facial swellings, nodules, subcutaneous frontal skull swelling, proptosis, nasal blockage, epistaxis, discharging leg sinuses, flank mass, convulsion and pain. Of the 27 patients, four gave antecedent history of trauma, two had recurrent lesions which necessitated maxilectomy, two presented with convulsion without motor dysfunction while one had associated erosion of the small bones of the foot. None of the patients had debilitating illnesses such as diabetes mellitus, tuberculosis, and HIV infection. Tissue histology revealed histoplasmosis (10), mycetoma (9), subcutaneous phycomycosis (6), and phaeohyphomycosis (2).

Conclusion:

Deep mycoses may present primarily as cutaneous lesions in immunocompetent persons and often elicit distinct histologic inflammatory response characterized by granuloma formation. Diagnosis in resource constraint setting can be achieved with tissue stained with PAS and GMS which identifies implicated fungus. Clinical recognition and adequate knowledge of the pathology of these mycoses may reduce attendant patient morbidity.     

Erythromycin as a Safe and Effective Treatment Option for Erythema Annulare Centrifugum

Background:

Erythema annulare centrifugum (EAC) is an inflammatory dermatosis with unknown etiology. It is usually self-limited, but chronic disease may be difficult to treat. We observed incidentally the therapeutic effect of erythromycin for EAC among patients taking erythromycin for other diseases.

Aim:

To evaluate the treatment response of erythromycin for EAC.

Materials and Methods:

During the study period, from July 2007 to February 2011, all patients with EAC were assigned to erythromycin stearate tablet 1000 mg per day for two weeks. EAC was diagnosed by a constellation of clinical and pathological findings. The efficacy (before and after the treatment) was assessed clinically by one dermatologist and photographically by two blinded dermatologists. Secondary outcomes included adverse drug effects and recurrence.

Results:

Eight patients were enrolled in this study. Most patients had chronic relapsing disease with poor response to previous treatment. All the patients showed rapid response with profound reduction in the size of lesion and erythema two weeks after initiation of erythromycin treatment. The response was so obvious and complete that a coincidental response was less likely. Three patients had recurrence of disease and they tended to have more extensive lesions. Readministration of erythromycin was effective. All patients tolerated the treatment well.

Conclusion:

Our study documented erythromycin as a safe and cost-effective treatment for EAC.     

PITYRIASIS VERSICOLOR: A CLINICOMYCOLOGICAL AND EPIDEMIOLOGICAL STUDY FROM A TERTIARY CARE HOSPITAL

Background:

Pityriasis versicolor is a mild, chronic, usually asymptomatic superficial fungal infection of the stratum corneum, caused by Malassezia yeasts. The purpose of the present study is to assess the clinical profile of a group of patients with pityriasis versicolor and to find out the epidemiological characteristics in this part of India as well as any association, if any, with other diseases.

Materials and Methods:

For this purpose, 110 consecutive patients of pityriasis versicolor were evaluated clinically and diagnosis was confirmed mycologically at a tertiary care hospital in Kolkata. All data were recorded in a predesigned, pretested semi-structured schedule. The total duration of study period was 12 months.

Results:

Majority of the patients were young adults. Most of the patients were asymptomatic. There is prominent seasonal variation of the patients with a peak in August and September months. Most of the lesions were hypopigmented scaly macules and were KOH positive. Most commonly involved sites were chest, face and back. Seborrheic dermatitis sometimes coexisted with pityriasis versicolor and a number of patients also had diabetes mellitus and immunosuppressive conditions.

Conclusions:

Overall, the clinicomycological and epidemiological profile of pityriasis versicolor infection as observed in a tertiary care setting in eastern India does not differ significantly from those observed by previous workers elsewhere.     

Bacteriological Study of Pyodermas in a Tertiary Care Dermatological Center

Background:

Bacterial skin infection especially Pyoderma, commonly caused by Staphylococcus aureus and group A Streptococci, is quite common in Indian dermatology clinics. Despite a number of new antibiotics, the incidence of bacterial resistance is rising.

Aim:

To find out causative organisms and their latest antibiotic susceptibility patterns in pyodermas.

Materials and Methods:

All in-patients admitted in the Dermatology wards in Government Medical College, Amritsar were screened over 18 months and those with erosive skin lesions and/or purulent discharge were included in the study and swabs were sent for culture and sensitivity.

Results:

Majority 49/61 cases (80.33%) comprised of secondary pyodermas while primary pyodermas constituted only 12/61 cases (19.67%). Single organism was isolated in 49 cases (80.33%). More than one type of organism was isolated in 3 cases (4.92%) while none could be isolated from 9 (14.75%) cases. Staphylococcus aureus spp. was the commonest organism isolated in 36 (59.01%) cases and out of these, coagulase positive strains were found to be highly susceptible to amikacin (21cases-100%). Coagulase negative strains were sensitive to amikacin (7 cases-77.7%) and gentamycin (6 cases-66.6%) respectively.

Conclusion:

This study gives an indication of the present pattern of bacteriological profile of pyodermas in a tertiary care hospital in north-west India. In-vitro testing is essential as knowledge of the causative organisms and resistance patterns can help us select appropriate antibiotics without wasting time in using resistant drugs.     

Limits of fine-needle aspiration cytology in diagnosing pilomatrixoma: a series of 25 cases with clinico-pathologic correlations

Background:

Pilomatrixoma (PMX) is a benign, quite uncommon, skin neoplasm, which is frequently misdiagnosed by clinicians.

Aim:

We have analyzed 25 PMX to determine the agreement between clinical diagnosis, preoperative FNA characteristics, and corresponding histopathological specimens; moreover, reliable cytologic criteria for PMX and the differential diagnosis to avoid cytological pitfalls have been emphasized.

Materials and Methods:

By fine-needle aspiration (FNA) cytology a series of consecutive cases of PMX collected during last 5 years were studied. Smears were stained by Papanicolau and May-Grünwald-Giemsa.

Results:

Patients affected by PMX were 11 males, 14 females (ratio 1:1.27); the mean age was 32.72 years with age range 3-78 years, being 72% (18/25) of patients 40 years or less. PMX was mainly distributed in the head-neck region (52%), scalp (16%), upper/lower arms (28%), and chest (4%). The observed diagnostic cytological features were represented by clusters of basaloid epithelial cells, shadow or ghost cells, inflammatory background, calcification, and giant cells. Unfortunately, not all these morphological aspects were always disclosed in smears, thus making the cytological preoperative diagnosis questionable and problematic.

Conclusions:

The experience of a well-trained cytopathologist should distinguish the relevant FNA features in terms of smear background, architecture, and cell morphology. The most dangerous mistake in FNA diagnosis of PMX regards a diagnosis of primary malignant or metastatic cutaneous lesions.     

BACTERIAL RESISTANCE TO ANTIBIOTICS IN ACNE VULGARIS: AN IN VITRO STUDY

Background:

Acne vulgaris is one of the most common skin disorders in youth especially during the puberty.

Objective:

This in vitro study was performed to determine the antibiotic resistance and sensitivity in acne vulgaris.

Materials and Methods:

Samples were collected from normal skin and nodulocystic and pustular skin lesions of one hundred youngsters (64 girls, 36 boys) among college students in the age range of 18-24 years old. The specimens were cultured individually on blood agar and Muller-Hinton media. The cultures were then incubated under both aerobic and anaerobic conditions for 2 to 7 days. Bacteria were identified and their resistance to common antibiotics was evaluated according to the standard procedures.

Results:

In aerobic culture of pustular and nodulocystic skin lesions, Staphylococcus aureus was present in 41% of subjects, Staphylococcus epidermidis in 53% and Micrococcus spp in 45% of subjucts. In anaerobic bacterial culture of pustular and nodulocystic skin lesions, Staphylococcus aureus was present in 39%, Propionibacterium acne in 33% and Staphylococcus epidermidis in 21% of subjects. The results of present study revealed that clindamycin and erythromycin were the least effective antibiotics for Propionibacterium acne while tetracycline was the least effective for Staphylococcus aureus in vitro. A synergic effect of benzoyl peroxide, erythromycin or clindamycin was noticed. Rifampin was the most effective antibiotic in vitro.

Conclusion:

Our results showed that rifampin was the most sensitive antibiotic in vitro for acne vulgaris. To achieve a better treatment, a combination of rifampin with other antibiotics may be more efficient. We suggest in vivo studies for better evaluation and treatment of acne patients with rifampin.