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Tropical disease may not figure highly in the differential diagnosis of a facial swelling in the United Kingdom but should be considered in those who have been in a tropical area. This case history documents details of the presentation and investigation of a case of leishmaniasis that appeared as a facial swelling in a 4-year-old boy who had recently returned from the Middle East.
Facial and perioral molluscum contagiosum is a common and often disfiguring condition in patients with HIV infection. The purpose of this study was to report on the clinical aspects of eight HIV-positive patients with facial molluscum contagiosum. Also we describe the histopathologic and electron microscopic findings and discuss the treatment modalities for this unusual disease.
We have identified a new rural focus of cutaneous leishmaniasis caused by Leishmania tropica in Muruku sublocation, Salama location, Laikipia district, Rift Valley province, Kenya. Based on a few available case histories, previous reports of L. tropica in Kenya indicated a tentative geographical distribution. Recently 6 indigenous Kenyans from the new focus, who had never travelled outside Kenya, developed cutaneous lesions on the face and/or extremities found to contain Leishmania by culture and smear. Most of the patients manifested the typical 'urban' dry sore which grew slowly into a nodule measuring 2 x 1 cm to 9.5 x 3 cm, and after some months formed a central crust surrounded by small satellite papules. After treatment with Pentostam (sodium stibogluconate), about 40% of the sores failed to heal completely, either scarring centrally with fulminating papules at the edges and spreading peripherally, or healing but then recrudescing at the edge of the scar. Stationary-phase promastigotes from culture isolates were analysed by cellulose acetate electrophoresis. Isoenzyme profiles of 6 isolates were compared with those of World Health Organization reference strains using 12 enzyme loci; they were indistinguishable from those of 2 L. tropica reference strains. All 6 case sites lay within a radius of 4 km. Several other suspected cases from the same area are being investigated.
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The first episode of herpes simplex virus (HSV) infection of the hand can occur in association with infection at another site, such as primary HSV-1 gingivostomatitis. Autoinoculation is the likely route of transmission. The attacks are usually solitary and last about 14 days. A first episode that results from exogenous inoculation may be severely inflammatory and may last up to 28 days. The majority of cases are recurrent infections and most often occur in adults with HSV-2 infection.
A questionnaire about skin rashes and their symptoms was sent to 3877 randomly selected office employees with different degrees of exposure to video display units (participation rate 96.6%). From this group 809 randomly selected persons were examined and interviewed. Itching and burning sensations with few visible signs were more common among persons who were highly exposed than among those in the nonexposed category. Objective facial signs were not significantly more common among persons in the highly exposed category. No dose-response effect was observed regarding the amount of video display unit exposure and objective skin signs. Unilateral skin rashes and skin malignancies were found in the same frequency in both highly exposed and the nonexposed persons. This study does not provide support for the hypothesis that video display unit work induces any recognized type of facial skin disease.
Twenty women had similar symptoms and clinical findings related to the use of tartar control toothpaste. Each had burning and itching around the corners of the mouth, followed by pruritic perioral patches of erythema 4 to 14 days later. All patients had begun using tartar control toothpaste 1 to 2 weeks before onset and had brushed their teeth at least three times per day. The typical findings included a moderately severe perioral erythema with fissuring of the angles of the mouth; scaling erythematous patches, separated by normal skin lateral to the initial erythema, were also present. No vesiculation or crusting was noted, and involvement of the gingiva and buccal mucosa was noted in only one case. On discontinuation of the tartar control toothpaste, marked improvement was seen within 1 to 6 weeks with, in most instances, either no treatment or 1% hydrocortisone cream.
One hundred patients with facial seborrheic dermatitis and 42 control subjects were studied. The number of periodic acid-Schiff-positive Pityosporum ovale yeast cells in skin scrapings per high-power field were counted and designated 1 + to 4 +. Our data indicate a correlation between the density of P. ovale and the clinical severity of seborrheic dermatitis, both before and after therapy with a precipitated sulfur/salicyclic acid shampoo. The data support the concept that yeast contributes to the pathogenesis of seborrheic dermatitis.
The case of a 60-year-old Japanese man with unique multiple keratoacanthomas is reported. The lesions were located in the perioral area, grew peripherally, and healed centrally. Although individual lesions spontaneously regressed, prompt recurrence was observed after excision. Biopsy specimens taken from early proliferative, fully developed, and regressing stages revealed keratoacanthoma. Involucrin was demonstrated in the lesions during development and resolution. The early stage showed homogeneous staining of moderate intensity in the tumor cells at the suprabasal layers, and the staining became slightly irregular and intense when the lesions were fully developed. During resolution the intensity was markedly diminished. These results suggest that preterminal squamous differentiation accelerated during development of the tumors.
Keratoacanthomas infrequently are treated by radiotherapy. However, keratoacanthomas that are recurrent after surgical excision or whose resection would result in cosmetic deformity may benefit from radiotherapy. Between January 1970 and June 1988, 29 such keratoacanthomas in 18 patients were irradiated. Doses ranged from 3500 cGy in 15 fractions to 5600 cGy in 28 fractions. Measured end points of therapy were (1) initial response, (2) freedom from recurrence, and (3) quality of the subsequent cosmetic appearance (scored as good, fair, or poor). No lesion progressed and all eventually regressed completely. Cosmetic results generally were considered good by both the patient and the referring dermatologist; none of the results was considered poor. Our results demonstrate that radiation is an effective means of treating keratoacanthomas.
Multiple keratoacanthomas developed on the face of a woman after radiation therapy to the nasal sinuses. Treatment with isotretinoin appeared to shorten her recovery period.
Allergic contact dermatitis developed on the hands and/or face of two patients after exposure to latex examination gloves. Both patients were patch test negative to the usual rubber allergens, but both had a positive patch test reaction to 4,4'-thiobis(6-tert-butyl-m-cresol) (Lowinox 44S36). Patient 2 was also patch test positive to butylhydroxyanisole. The patients were tested with other gloves, to find gloves that they could safely use. Glove manufacturers were queried to ascertain the occurrence of Lowinox 44S36 and butylhydroxyanisole in different brands of latex and vinyl examination gloves. A list of gloves and their associated allergens was generated and is provided to assist dermatologists in helping patients choose gloves free of specific allergens.
In a double-blind, randomized, within-patient comparative study, the efficacy and tolerability of Ro 14-9706 (an arotinoid methyl sulfone) in the treatment of actinic keratoses was compared with that of tretinoin (all-trans-retinoic acid). A total of 25 patients with more than three lesions on each side of the face completed the study. All patients applied each agent twice daily for 16 weeks as a 0.05% cream to opposite sides of the face. The number of actinic keratoses in each treatment area was counted before treatment and at weekly intervals. The mean percent decrease in the number of actinic keratoses was 37.8% for areas treated with Ro 14-9706 and 30.3% for areas treated with tretinoin. Each of these decreases was significantly different from baseline (p less than 0.01), but not from each other. Ro 14-9706 was better tolerated; local inflammation was slight or absent in most patients, whereas tretinoin caused severe erythema in 50% and severe scaling in 23% of patients.
Herpes simplex virus DNA was identified by the polymerase chain reaction with primers specific for the herpes DNA polymerase gene. A herpes-specific amplimer was detected in two of three cases in which the clinical and histologic features were inconclusive.
Sixty-eight typical cases were studied to define the course of Pityrosporum folliculitis in a tropical setting. Contrary to reports in the literature, we found Pityrosporum folliculitis to be polymorphic. The "molluscoid" comedopapule was the most characteristic and common lesion, and it yielded consistently high spore counts. The face was commonly involved. To establish the diagnosis, we used direct microscopy of potassium hydroxide/Parker blue-black ink mounts of the lower poles of comedonal plugs. Pityrosporum folliculitis is common in the Philippines, although our adult controls had a low incidence of skin carriage of Pityrosporum orbiculare on the face compared with those reported in the West. Pityrosporum folliculitis coexisted with acne vulgaris in 56% of patients, and the addition of antimycotics to the acne regimen produced dramatic clearing of lesions.
This double-blind, vehicle-controlled, multicenter study evaluated the efficacy and safety of a new topical antineoplastic agent, masoprocol, in the treatment of actinic keratoses of the head and neck. Of the 113 patients who applied topical masoprocol twice a day for 14 to 28 days, there was a mean decrease in actinic keratoses from 15.0 to 5.4 and a median percent reduction from baseline actinic keratosis count of 71.4% at the 1-month follow-up visit. Comparable numbers for the vehicle-treated group were 13.4 to 11.1 actinic keratoses and 4.3% median percent reduction. Irritation, as manifested by erythema or flaking, occurred in 61.5% of topical masoprocol-treated patients versus 26.7% of those treated with vehicle and did not correlate with clinical response. Topical masoprocol appears to be useful in the treatment of actinic keratoses.