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[Chronic lupoid leishmaniasis. A rare differential diagnosis in Germany for erythematous infiltrative facial plaques].
Lupoid leishmaniasis is a unique form of cutaneous leishmaniasis characterized by unusual clinical features and a chronic relapsing course. Clinically and histologically it is similar to lupus vulgaris, which is thus the most important differential diagnostic consideration. All patients with granulomatous facial lesions coming from endemic areas or with a positive travel history should be suspected of having leishmaniasis. We describe a 59-year-old woman with facial lupoid leishmaniasis.
[Juvenile verrucae planae: treatment with imiquimod 5% cream].
A 6 year old girl presented with flat-topped, skin-colored, partly grouped papules with slightly roughened surface on the left side of the forehead and around the left orbit. In an off-label use imiquimod 5% cream was applied twice a week before bedtime and was rinsed off in the morning. After four weeks of treatment the lesions had vanished completely. We suggest imiquimod 5% cream as a treatment option for juvenile plane warts even in children and in the face.
[Extrafacial granuloma eosinophilicum].
Three patients with a rare extrafacial granuloma eosinophilicum are presented. Lesions were localized on the scalp, the upper back or the upper arm. Only one patient had a typical facial granuloma eosinophilicum at the same time. Diagnosis was established by histopathology. The histopathological findings vary with the age of the lesion. Early lesions are characterized by a vasculitis with many eosinophils separated by a Grenz zone from epidermis and follicular structures. With time the inflammation changes and hyalin fibrosis takes place.
[Unilateral cervicofacial emphysema after dental treatment. Case report].
Subcutaneous emphysema is characterized by the presence of air or other gases in the subcutis after a spontaenous or traumatic interruption in a air-carrying structure. We describe a patient who developed unilateral facial swelling after dental treatment. Considering the history, differential diagnostic possibilities and the physical examination, we diagnosed cervicofacial emphysema.
[Combination of antimalarial drugs mepacrine and chloroquine in therapy refractory cutaneous lupus erythematosus].
Antimalarials represent the first line in treatment of cutaneous lupus erythematosus (LE). However, some patients show no improvement on monotherapy with chloroquine or hydroxychloroquine. A 30-year-old female patient had treatment-resistant cutaneous LE exhibiting features of both LE tumidus and subacute cutaneous LE. Previously, the patient had been unsuccessfully treated with chloroquine, hydroxychloroquine, dapsone, and azathioprine, each in combination with variable doses of prednisolone. However, the LE lesions increased during these therapeutic regimens. A combination of chloroquine and mepacrine therapy led to improvement and then total clearing after 4 months of treatment.
[Tubero-pustular demodicosis].
A 38-year-old female patient suddenly developed an unusual tuberous, pustular tumor on her chin. On the basis of clinical pattern, histological and microbiological investigations the diagnosis of demodicosis was established. Histological investigation revealed follicular cysts and a chronic granulomatous perifolliculitis with many of Demodex folliculorum. A large number of mites could be also identified by microscopy of smears from pustules. No cellular or humoral immunological defects, tumours nor systemic disorders were found. After oral therapy with steroids and metronidazole, the lesions improved rapidly.
[Idiopathic pustular and bullous variants of Sweet syndrome].
We report on the case of a 62-year-old patient with disseminated pustular plaques affecting especially his face and hands. These lesions exhibited severe blistering later in the course. The diagnosis of an unusual variant of an acute febrile neutrophilic dermatosis (Sweet's syndrome) was histologically confirmed. Pustular lesions are known to occur in Sweet's syndrome. Secondary development into bullous lesions, however, has not previously been described. No associated disease has so far been detected.
[Facial eosinophilic granuloma. Healing with cryosurgical therapy].
A case of eosinophilic granuloma facial is presented in which the lesions have been successfully treated by cryotherapy, healing with slight pigmentation. Since this disease appears to be difficult to treat, a great many forms of therapy have been proposed in the literature. These will be discussed with the results presented.
[Sites, types of manifestations and micromanifestations of atopic dermatitis in young adults. A personal follow-up 20 years after diagnosis in childhood].
A follow-up study of 47 patients who had suffered from atopic dermatitis in infancy (< 2 years aged old) was conducted by means of a questionnaire and personal interview/examination at the mean age of 23 years. It was found that 72.3% of them were still suffering from atopic dermatitis. The atopic eczema was mostly localized on the fingers (67.6%), on the head, e.g. forehead, eyelids and scalp (32% each), neck (35%) and chest (32%). Different localizations from the juvenile and adolescence phase were observed. In 73.5% the lichenoid type of atopic eczema was seen, in 67.6% the eczematic form of reaction, and in 28.4% the follicular form, the latter having decreased significantly in frequency since the adolescent phase. The pruriginous form with prurigo papules was observed only in the 8.8% of the patients who had been suffering from a chronic form of the disease since childhood. Nummular reactions were not observed. In 66% of the patients micromanifestations were present, most frequently perlèches (40.4%), retroauricular intertrigo (34%), atopic eyelid eczema (21%) and 21.3% "pulpite sèche" (tylotic, rhagadiform fingerpad eczema) (21.3%). In 14.9% of all patients these minimal forms of atopic dermatitis were present exclusively.
[Lupus vulgaris vegetans by auto-inoculation in open pulmonary tuberculosis].
Lupus vulgaris is now a rare dermatological disease. However, in view of the increase in risk factors (immigration from areas endemic for tuberculosis, multiply drug-resistant strains of Mycobacterium tuberculosis, HIV), cutaneous tuberculosis should always be considered in the differential diagnosis. We report on a case of lupus vulgaris vegetans of the nose, which developed by way of autoinoculation of the patient with Mycobacterium tuberculosis from reactivated, pulmonary tuberculosis and responded well to tuberculostatic therapy.
[Successful topical treatment of chronic cutaneous leishmaniasis with paromomycin sulfate (15%) and methylbenzethonium chloride (12%)].
A 19-year-old male patient with chronic cutaneous leishmania is was treated topically with paromomycin sulphate (15%) and methylbenzethonium chloride (12%) in petrolatum album. After application twice daily for two periods of 32 and 44 days the lesions were completely healed. Previous treatment for 9 months with ketoconazole (400 mg/day) together with the topical application of thiabendazole (2.5%) in base had been unsuccessful. No major side effects were observed after paromomycin sulphate application.
[Localized Sweet syndrome].
A 73-year-old women developed an inflammatory tumor on her right cheek within 3 weeks. The lesion measured more than 7 cm in diameter, contained a central crateriform depression and was studded with several sterile pustules. Histology showed a dense dermal infiltration of neutrophils, but no leukocytoclasia or destruction of dermal tissue. There was no associated leukocytosis or fever, but the patient suffered from recurrent chronic bronchitis. Because the acute inflammation was progressive under treatment with antibiotics, high-dose corticosteroids were given systemically. The tumor regressed quickly and resolved without scarring. Although this localized Sweet's syndrome is unusual, it fulfills several major and minor criteria of Sweet's syndrome and thus represents a rare form of this disease.
[Positive tuberculin reaction in sarcoidosis].
Scar sarcoidosis is one of the rare cutaneous manifestations of sarcoidosis. Apart from the clinical picture, suppression of the cell-mediated immunity can often be determined when tuberculin tests and testing for recall antigens are carried out. In the present case of a 68-year-old woman patient scar sarcoidosis and pulmonary sarcoidosis were detected. Remarkably, a strongly positive tuberculin reaction was found, while acute tuberculosis and former BCG vaccination were excluded. Both references in the literature and the case presented demonstrate that a positive tuberculin test, while very unusual in sarcoidosis, does not however, preclude the diagnosis. On the basis of some case reports in the literature, our patient was treated with allopurinol; impressive improvement of both the skin and the pulmonary manifestations was noted. Despite the well-known phenomenon of spontaneous regression in sarcoidosis, we recommend a clinical trial with allopurinol as this substance is well tolerated.
[Hamartoma of the sebaceous follicle. An immunohistologic analysis with cytokeratins].
A 62-year-old man presented with a nodule 2 cm in diameter on his left cheek, which he had had since childhood. Histological examination showed a circumscribed dermal nodule composed of sebaceous lobules attached to sebaceous ducts and to an infundibular cyst-like structure connected to the epidermis. The wall was lined with squamous epithelium with a stratum granulosum. This structure was reminiscent of a sebaceous follicle. In addition, a melanocytic naevus of the compound type was found. Immunohistological investigations of the tumour with various cytokeratins revealed a pattern of expression characteristic for the mature sebaceous follicle.
[Unusual radiation reaction after soft roentgen radiotherapy in a patient with pemphigus vulgaris].
A 71-year-old woman suffered from pronounced erosion of her nose after soft X-ray therapy (total dose 28 Gy, half dose depth 10.5-11.5 mm). 5 weeks after the end of the irradiation no healing tendency was observed. This unusual clinical course was caused by a simultaneously existing pemphigus vulgaris that worsened after radiotherapy, presumably as a consequence of the release of epidermal antigens. In this case it is improbable that the pemphigus was induced by the radiotherapy, as has been reported on several occasions in the literature. However, this possibility cannot be entirely excluded.
[Treatment of naevi flammei in adulthood with a flashlamp pumped pulsed dye laser].
Since 1993 almost 400 patients with port wine stains have been treated with the flashlamp pumped pulsed dye laser. The therapeutic effect on 61 adult patients was evaluated. After a mean of 2.16 treatments the colour lightened by between 33% and 100% in 70% of these patients. The best results were obtained in patients with plain pink port wine stains. In this kind of port wine stains the argon laser has proved to be far less successful. The rate of adverse effects amounted to only 5%. The results are expected to be improved by further laser sessions. The flashlamp pumped pulsed dye laser is an important advance in the treatment of port wine stains.
[Dermatomyositis-like skin changes with long-term hydroxyurea (Litalir) therapy].
We report on dermatomyositis-like adverse cutaneous reactions following long-term maintenance therapy with hydroxyurea in two patients suffering from chronic myelogenous leukaemia (CML). In addition to non-specific side effects, such as xerosis, pruritus and hyperpigmentation, both patients presented with more specific skin changes, i.e. erythematous lesions, scaling, and partially atrophic areas distributed in a linear fashion on the dorsal aspects of the hands and fingers. In addition, teleangiectatic erythema of the face was present in both patients, and this was associated with oedema of the eyelids in one patient. Despite these dermatomyositis-like features there were no clinical signs of muscular involvement, and muscle-specific enzymes were within normal ranges. Skin biopsy specimens revealed an interface dermatitis characterized by a lichenoid cell infiltrate, vacuolar alteration of basal cells, necrotic keratinocytes within the spinous zone, focal hypergranulosis, ortho-hyperkeratosis and telangiectases in the upper part of the dermis. Analogous histopathological findings have been documented in lichen planus-like skin changes on the hands following hydroxyurea therapy. It seems doubtful whether there are actually any major differences between those skin changes described as dermatomyositis-like and those interpreted as lichen planus-like in patients receiving long-term hydroxyurea therapy.