Ulcerating papulosquamous eruption and constipation in a 75-year-old man.
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There are two types of hair cast. The common type is found frequently in association with parakeratotic scalp disorders. They have features allowing specific identification. They occur in children and adults of either sex. It is suggested they be called parakeratotic hair casts, as this name reflects the cause and composition of the casts. The uncommon type has specific features that are different from the common type. They are not usually associated with diseases of the scalp and have only been reported in female subjects. It is suggested they be called peripilar keratin casts, as this is the name frequently used for them. The proposed nomenclature should avoid confusion between two distinct types of hair casts that have often inappropriately been regarded as the same disorder, and which have not been previously differentiated by specific names.
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BACKGROUND: Trichosporonosis is a potentially life-threatening disseminated infection with Trichosporon beigelii, the causative agent of the white piedra. Systemic infection by this fungus has been most frequently described in immunocompromised hosts with neutropenia, but one case has been reported in the acquired immunodeficiency syndrome setting. We report a second case of trichosporonosis in a patient with acquired immunodeficiency syndrome and review the clinical and histologic characteristics of cutaneous involvement with this opportunistic fungal pathogen. OBSERVATIONS: Trichosporonosis occurs most commonly in neutropenic patients receiving chemotherapy. We describe the second case developing in the acquired immunodeficiency syndrome setting. Cutaneous involvement occurred in approximately 30% of patients and most frequently presented as purpuric papules and nodules with central necrosis or ulceration. Biopsy specimens of these lesions revealed dermal invasion by fungal elements, and culture was positive in greater than 90% of the cases. CONCLUSIONS: Disseminated infection with T beigelii can occur in immunosuppressed patients, including those with acquired immunodeficiency syndrome particularly if associated with neutropenia. Cutaneous involvement is common, presenting as purpuric papules and nodules. Biopsy and culture of cutaneous findings can help establish an accurate diagnosis resulting in rapid and appropriate treatment.
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OBJECTIVE: To determine the efficacy of excision with primary closure in the treatment of extensive and refractory acne keloidalis nuchae (AKN). DESIGN: Intervention before-after trial. Duration of follow-up ranged from 1 to 5 years. SETTING: University-based ambulatory outpatient dermatologic surgery unit. PATIENTS: Referred sample of 25 patients with extensive AKN that was refractory to medical management. All patients were healthy, young black men who had no medical problems and were not taking any medications. No other eligible patients refused to be included in the study. All 25 patients completed the study. INTERVENTIONS: All 25 patients underwent surgical excision of AKN. Twenty of the 25 underwent excision with layered closure in 1 stage. Four patients underwent 2-stage excisions with layered closure. One patient underwent excision with second-intention healing. MAIN OUTCOME MEASURE: A test of the following hypothesis: excision with primary closure is a successful treatment modality with little risk of recurrence for extensive cases of AKN. RESULTS: The author and all 25 patients rated the cosmetic result of surgery as good to excellent. No patients experienced complete recurrence of their acne keloids. Fifteen patients developed tiny pustules and papules within the surgical scar. Five patients developed hypertrophic scars. Papules, pustules, and hypertrophic scars were all successfully treated with high-potency topical and intralesional steroids. CONCLUSIONS: Excision with primary closure is an excellent surgical treatment modality for the management of extensive cases of AKN. Extremely large lesions should be excised in multiple stages. The surgeon should carefully assess each patient to determine whether AKN should be excised in 1 or multiple stages.
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BACKGROUND: Androgenetic alopecia is characterized by a defined area of progressive nonscarring alopecia. The clinical and histological findings in 15 women and 4 men with progressive scarring alopecia in a pattern distribution were studied. The results were evaluated and compared with clinicopathologic entities that feature scarring of the central scalp area, specifically, lichen planopilaris, pseudopelade, and follicular degeneration syndrome. OBSERVATIONS: Patients developed progressive fibrosing alopecia of the central scalp, without the multifocal areas of involvement typical of lichen planopilaris and pseudopelade. Perifollicular erythema, follicular keratosis, and loss of follicular orifices were limited to a patterned area of involvement. Biopsy specimens of early lesions demonstrated hair follicle miniaturization and a lichenoid inflammatory infiltrate targeting the upper follicle region. Advanced lesions showed perifollicular lamellar fibrosis and completely fibrosed follicular tracts indistinguishable from end-stage lichen planopilaris, pseudopelade, or follicular degeneration syndrome. CONCLUSIONS: Some patients with androgenetic alopecia might have additional clinical and histological features of inflammation and fibrosis limited to the area of androgenetic hair loss. In these patients, the histological findings of early lesions are identical to those seen in lichen planopilaris. The lichenoid tissue reaction leading to follicular destruction in these patients might be pathogenetically related to the events underlying androgenetic alopecia.
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OBJECTIVE: To compare the pediculicidal activity of 5 head lice products available in the United States on head lice from south Florida. DESIGN: In vitro pediculicidal product comparison. SETTING: Lice Source Services, Inc, located in Plantation, Fla, a clinic for the treatment and grooming of individuals with pediculosis capitis. PARTICIPANTS: Head lice were collected from healthy clients with Pediculus capitis that came to Lice Source Services, Inc, to seek their services. INTERVENTIONS: Within 2 to 6 hours of capture, lice were placed in continuous direct contact with the pediculicide products and observed at regular intervals. Results were compared with findings of a recent study of a treatment-sensitive population of head lice conducted in Panama. MAIN OUTCOME MEASURE: Percentage of lice dead at regular observation intervals between 5 minutes and 3 hours of continuous exposure to the pediculicides. RESULTS: Two prescription products, Ovide lotion (0.5% malathion) and 1% lindane shampoo, were ranked in the same order as in 2 previous studies (first and last, respectively). The order of effectiveness from most to least effective was as follows: Ovide lotion, A-200 shampoo (a natural pyrethrin product synergized with piperonyl butoxide), undiluted Nix (1% permethrin), diluted Nix, RID (a natural pyrethrin product synergized with piperonyl butoxide), and 1% lindane shampoo. CONCLUSIONS: There were statistically significant differences in the efficacy of all the products when compared with the results found in the recent study in Panama, except for Ovide lotion. Of those tested, Ovide was the only pediculicide in the United States that had not become less effective. The difference in efficacy of 1% lindane, Nix, and pyrethrins between the Panama and Florida studies supports the argument that some head lice in the United States have become resistant to these treatments.