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PubMed2003

Canine granulocytic ehrlichiosis (CGE) in Italy.

Medical records of thirty-five consecutive cases of canine granulocytic ehrlichiosis (CGE) diagnosed cytologically in Central Italy in 1995-2000 were analysed retrospectively. Tick exposure was reported in 16 dogs (45.7%) and concurrent babesiosis in 19 dogs (54.3%). Ehrlichia-like inclusion bodies were found in neutrophils in a percentage varying from 0.5% to 11%. Frequently recorded clinical signs included anorexia (71.4%), lethargy (45.7%), conjunctivitis (31.4%), fever (25.7%), lameness (20%) and ataxia (20%). Among the 16 representative dogs in which protein, electrophoresis was performed, 10 (62.5%) showed high globulin levels and 6 (37.5%) had concurrent high total protein levels. During treatment with doxycycline, all associated symptoms, including those unusually described, such as pyoderma intertrigo, erythema, apparent blindness and oral papillomatosis, progressively disappeared in 31 (89%) out of 35 dogs. The efficacy of treatment was marked in dogs simultaneously treated twice with imidocarb dipropionate: among the 14 dogs in which a fast recovery was noted, 11 (80%) were concurrently affected by babesiosis and consequently treated with the specific medicament leading to excellent outcomes. The main conclusion is that CGE is present among dogs from Central Italy and should be included in the differential diagnosis of possible zoonotic agents affecting the canine population.

Animals↗
PubMed2002

Bacterial skin infections in the elderly: diagnosis and treatment.

Skin and soft tissue infections are quite common in elderly people. A number of special conditions and circumstances need to be considered in the diagnosis and therapy. It is important to try to establish the causative organism, exclude other cutaneous disorders and identify precipitating factors. Treatment modalities include antiseptics, topical and systemic antibacterials, dressings and biotherapy. Skin infections presenting with erythema, blisters, pustules, and ulcerations or in body folds are described in detail. Cellulitis and infected ulcers are the most commonly encountered cutaneous infections in the elderly. Accurate and quick diagnosis and treatment are imperative to prevent significant morbidity and mortality. Appropriate antibacterials, antiseptics and dressings are necessary depending on the severity of the clinical presentation and resistance patterns. Laboratory tests, such as skin swabs, to establish the exact pathogen take time and the results might represent colonisation rather than infection of the skin. Cellulitis should be clinically distinguished from erysipelas and necrotising fasciitis. The latter is a life-threatening condition, which in the majority of cases requires surgical debridement of the infected tissue. Blisters and honey-coloured crusts are typical features of impetigo. It is very contagious and close contacts should be examined. Folliculitis is a commonly seen skin infection, which often responds to the use of antiseptics and topical antibacterials. More severe pustular skin eruptions, such as furunculosis and carbunculosis, usually require treatment with systemic antibacterials. Intertrigo and erythrasma have a predilection for the body folds, especially the axillae and groin, and topical therapy is usually sufficient. Secondary skin infections are often the result of persistent pruritus associated with increasing dryness of the aging skin. Emollients and antihistamines are useful measures. Primary cutaneous disorders and systemic diseases should be excluded with the aid of appropriate investigations, such as blood tests and skin biopsy. Staphylococcus aureus and beta-haemolytic streptococci are the most common causative organisms of cutaneous infections.

Aged↗
PubMed2002

Management of cutaneous erythrasma.

Corynebacterium minutissimum is the bacteria that leads to cutaneous eruptions of erythrasma and is the most common cause of interdigital foot infections. It is found mostly in occluded intertriginous areas such as the axillae, inframammary areas, interspaces of the toes, intergluteal and crural folds, and is more common in individuals with diabetes mellitus than other clinical patients. This organism can be isolated from a cutaneous site along with a concurrent dermatophyte or Candida albicans infection. The differential diagnosis of erythrasma includes psoriasis, dermatophytosis, candidiasis and intertrigo, and methods for differentiating include Wood's light examination and bacterial and mycological cultures. Erythromycin 250mg four times daily for 14 days is the treatment of choice and other antibacterials include tetracycline and chloramphenicol; however, the use of chloramphenicol is limited by bone marrow suppression potentially leading to neutropenia, agranulocytosis and aplastic anaemia. Further studies are needed but clarithromycin may be an additional drug for use in the future. Where there is therapeutic failure or intertriginous involvement, topical solutions such as clindamycin, Whitfield's ointment, sodium fusidate ointment and antibacterial soaps may be required for both treatment and prophylaxis. Limited studies on the efficacy of these medications exist, however, systemic erythromycin demonstrates cure rates as high as 100%. Compared with tetracyclines, systemic erythromycin has greater efficacy in patients with involvement of the axillae and groin, and similar efficacy for interdigital infections. Whitfield's ointment has equal efficacy to systemic erythromycin in the axillae and groin, but shows greater efficacy in the interdigital areas and is comparable with 2% sodium fusidate ointment for treatment of all areas. Adverse drug effects and potential drug interactions need to be considered. No cost-effectiveness data are available but there are limited data on cost-related treatment issues. A guideline is proposed for the detection, evaluation, treatment and prophylaxis of this cutaneous eruption.

Administration, Oral↗
PubMed2002

Dermatological complications of obesity.

Obesity is a health problem of considerable magnitude in the Western world. Dermatological changes have been reported in patients with obesity, including: acanthosis nigricans and skin tags (due to insulin resistance); hyperandrogenism; striae due to over extension; stasis pigmentation due to peripheral vascular disease; lymphedema; pathologies associated with augmented folds; morphologic changes in the foot anatomy due to excess load; and complications that may arise from hospitalization. Acanthosis nigricans plaques can be managed by improved control of hyperinsulinemia; the vitamin D3 analog calcipitriol has also been shown to be effective. Skin tags can be removed by snipping with curved scissors, by cryotherapy or by electrodesiccation. Hyperandrogenism, a result of increased production of endogenous androgens due to increased volumes of adipose tissue (which synthesizes testosterone) and hyperinsulinemia (which increases the production of ovarian androgens) needs to be carefully assessed to ensure disorders such as virilizing tumors and congenital adrenal hyperplasia are treated appropriately. Treatment of hyperandrogenism should be centred on controlling insulin levels; weight loss, oral contraceptive and antiandrogenic therapies are also possible treatment options. The etiology of striae distensae, also known as stretch marks, is yet to be defined and treatment options are unsatisfactory at present; striae rubra and alba have been treated with a pulsed dye laser with marginal success. The relationship between obesity and varicose veins is controversial; symptoms are best prevented by the use of elastic stockings. Itching and inflammation associated with stasis pigmentation, the result of red blood cells escaping into the tissues, can be treated with corticosteroids. Lymphedema is associated with dilatation of tissue channels, reduced tissue oxygenation and provides a culture medium for bacterial growth. Lymphedema treatment is directed towards reducing the limb girth and weight, and the prevention of infection. Intertrigo is caused by friction between skin surfaces, combined with moisture and warmth, resulting in infection. This infection, most commonly candidiasis, is best treated with topical antifungal agents; systemic antifungal therapy may be required in some patients. Excess load on the feet can result in morphological changes that require careful diagnosis; insoles may offer some symptom relief while control of obesity is achieved. Obesity-related dermatoses associated with hospitalization, such as pressure ulcers, diminished wound healing, dermatoses secondary to respiratory conditions, and incontinence, must all be carefully managed with an emphasis on prevention where possible. Recognition and control of the dermatological complications of obesity play an important role in diminishing the morbidity of obesity.

Acanthosis Nigricans↗
PubMed2005

Dermatologic signs in patients with eating disorders.

Eating disorders are significant causes of morbidity and mortality in adolescent females and young women. They are associated with severe medical and psychological consequences, including death, osteoporosis, growth delay and developmental delay. Dermatologic symptoms are almost always detectable in patients with severe anorexia nervosa (AN) and bulimia nervosa (BN), and awareness of these may help in the early diagnosis of hidden AN or BN. Cutaneous manifestations are the expression of the medical consequences of starvation, vomiting, abuse of drugs (such as laxatives and diuretics), and of psychiatric morbidity. These manifestations include xerosis, lanugo-like body hair, telogen effluvium, carotenoderma, acne, hyperpigmentation, seborrheic dermatitis, acrocyanosis, perniosis, petechiae, livedo reticularis, interdigital intertrigo, paronychia, generalized pruritus, acquired striae distensae, slower wound healing, prurigo pigmentosa, edema, linear erythema craquele, acral coldness, pellagra, scurvy, and acrodermatitis enteropathica. The most characteristic cutaneous sign of vomiting is Russell's sign (knuckle calluses). Symptoms arising from laxative or diuretic abuse include adverse reactions to drugs. Symptoms arising from psychiatric morbidity (artefacta) include the consequences of self-induced trauma. The role of the dermatologist in the management of eating disorders is to make an early diagnosis of the 'hidden' signs of these disorders in patients who tend to minimize or deny their disorder, and to avoid over-treatment of conditions which are overemphasized by patients' distorted perception of skin appearance. Even though skin signs of eating disorders improve with weight gain, the dermatologist will be asked to treat the dermatological conditions mentioned above. Xerosis improves with moisturizing ointments and humidification of the environment. Acne may be treated with topical benzoyl peroxide, antibacterials or azaleic acid; these agents may be administered as monotherapy or in combinations. Combination antibacterials, such as erythromycin with zinc, are also recommended because of the possibility of zinc deficiency in patients with eating disorders. The antiandrogen cyproterone acetate combined with 35 microg ethinyl estradiol may improve acne in women with AN and should be given for 2-4 months. Cheilitis, angular stomatitis, and nail fragility appear to respond to topical tocopherol (vitamin E). Russell's sign may decrease in size following applications of ointments that contain urea. Regular dental treatment is required to avoid tooth loss.

Adolescent↗
PubMed2000

[Statistical surveillance of mucocutaneous candidiasis in Showa University Fujigaoka Hospital in the past 5 years].

We investigated the epidemiology of 618 patients of mucocutaneous candidiasis who visited our outpatient clinic between 1993 and 1997. Compared with previous reports in Japan, the incidence of candida intertrigo increased and that of erythema mycoticum infantile decreased. The incidence of "others", such as nail candidiasis and candidiasis developed under plaster increased. We identified the species of Candida from patients in 496 recent cases, and these species were cultured successfully in 79.2%. As reported by previous authors, a majority or our results were Candida albicans serotype A. We also investigated the risk factors such as diseases or conditions which might be related to immunodeficiency (neoplasm, AIDS) and that might force a patient to restrict himself to bed for a long period (neurological disease). The former was found in 22.7%, and the latter in 23.3% of patients.

Adolescent↗
PubMed2001

[1997 Epidemiological survey of dermatophytoses in Japan].

An epidemiological investigation on dermatophytoses in Japan for the year 1997 was carried out with the following results. The number of dermatomycoses patients visiting the fourteen cooperating institutes that year was 8,284. New outpatients with this condition accounted for 13.3% of all new outpatients in these institutes. Dermatophytoses patients numbered 7,314 and were composed of: tinea pedis 4,901 (63.8%), tinea unguium 1,592 (20.7%), tinea corporis 557 (7.2%), tinea cruris 395 (5.1%), tinea manuum 215 (2.8%), tinea capitis 12, kerion celsi 3, tinea barbae 1 and granuloma trichophyticum 1. Of these, 117 were children under 15 years of age. Species and incidences of the 2,273 strains isolated from the patients with dermatophytoses were as follows: Trichophyton (T.) rubrum 1,628 (71.6%), T. mentagrophytes 617 (27.2%), Epidermophyton floccosum 9 (0.4%), Microsporum (M.) canis 2, M. gypseum 2, T. glabrum 1, and 15 undetermined strains. Candidiasis was found in 714 individuals: intertrigo 302, erosio interdigitalis 108, erythema infantum 85, oral candidiasis 51, paronychia et onychia 51, genital candidiasis 50, onychomycosis 15 and other atypical forms of candidiasis 39. Patients with tinea versicolor numbered 242 and those with malassezia folliculitis 15. There were nine cases of deep dermal mycoses. The results of superficial dermatophytoses for the year 1997 differed from those of 1991-92 in the following points: tinea corporis and tinea cruris were lower in number, while tinea unguium had increased in ratio and number continuously. M. canis infection tended to decrease. In the age distribution of tinea, in every clinical form the peak of distribution curve gradually shifted to a more elderly age group.

Adolescent↗
PubMed2004

[Statistical study of dermatomycosis for 30 years (1968-1997) in sendai national hospital].

A statistical study on dermatomycoses for the 30 years from 1968 to 1997 in the dermatologic section of Sendai National Hospital was carried out with the following results. The total number of dermatomycosis patients was 14,259 and accounted for 9.59% of all new outpatients during this period. These cases of dermatomycoses were composed of the following: dermatophytoses 10,656, candidiasis 3,287, malassezia infection 566, sporothrichosis 20, aspergillosis 7, and chromomycosis 1. Annual changes in number of dermatophytoses varied in each clinical type: tinea corporis and tinea cruris had increased by the end of the 1970s, and there after decreased gradually until recent years. Tinea pedis and tinea unguium, on the contrary, increased after the 1980s. Age distribution of all clinical forms of dermatophytoses changed gradually, and its peak of the distribution curve shifted to an older site each year, while the number of younger generation patients decreased. Mycologically Trichophyton (T.) rubrum was mainly isolated from all types of dermatophytoses, and T. mentagrophytes followed. The ratio of these two species (R/M) in tinea pedis was 1.25, and the ratio of T. mentagrophytes was relatively high. Epidermophyton floccosum was continuously isolated, but its frequency in recent years has decreased. Microsporum canis infection increased from the middle period of this research, but after 1990 decreased gradually. The other dermatophytes were found sporadically. In recent years the species isolated have become more simplified. Among candidiasis, infantile candidiasis increased dramatically in the 1970s but soon decreased. Intertrigo type also increased in the same period and then decreased to an intermediate level. Paronychia, onychia and erosio interdigitale were constantly found in small numbers, while malassezia infection remained at a constant level and was found more in male patients.

Adolescent↗
PubMed2005

Superficial fungal infections seen at the National Skin Centre, Singapore.

UNLABELLED: Cutaneous fungal infections are common in Singapore. The National Skin Centre is a tertiary referral centre for dermatological diseases in the country, and sees more than 2,500 cases of superficial fungal infections annually. AIM: This study analyses data collated from the centre's medical record office as well as fungal culture results from the mycology laboratory. RESULTS: From 1999 to 2003, there were a total of 12,903 cases of superficial fungal infections seen at the centre. The majority of patients (n=9335) (72.3%) were males. The most common infection was tinea pedis (n=3516) (27.3%), followed by pityriasis versicolor (n=3249) (25.2%) and tinea cruris (n=1745) (13.5%). Candidal infections were also common (n=1430), the majority of which were cases of candidal intertrigo. There were very few cases of tinea capitis, which is uncommon in Singapore. The number of cases of onychomycosis has shown a rising trend over the past 5 years. Trichophyton rubrum was the most prevalent fungal pathogen isolated from all cases of superficial fungal infections of the skin, except for tinea pedis, where Trichophyton interdigitale was the most frequently isolated organism. Dermatophytes remain the most commonly isolated fungal pathogens isolated in toenail onychomycosis, whilst Candida species accounted for the majority of isolates in fingernail onychomycosis. CONCLUSION: Current epidemiologic trends of superficial fungal infections in Singapore show some similarities to recent studies from the United Kingdom and United States.

Candidiasis, Cutaneous↗
PubMed2006

[An epidemiological survey of dermatomycoses in Japan, 2002].

An epidemiological survey of dermatomycoses and the causative fungus flora of dermatophytoses in Japan for 2002 was made on a total number of 72,660 outpatients who visited 14 dermatological clinics throughout Japan. The results were as follows: 1) Dermatophytosis was the most prevalent cutaneous fungal infection (7,994 cases) seen in these clinics, followed by candidiasis (755 cases) and then Malassezia infections (220 cases). 2) Among dermatophytoses, tinea pedis was the most frequent (4,813 cases: male 2,439, female 2,374), then in decreasing order, tinea unguium (2,123 cases: male 1,093, female 1,030), tinea corporis (497 cases: male 281, female 216), tinea cruris (299 cases: male 249, female 50), tinea manuum (248 cases: male 144, female 104) and tinea capitis including kerion (14 cases, male 6, female 8). 3) Tinea pedis and tinea unguium are seen to increase in summer season, among the aged population and among males in each clinic. When compared to the previous surveys (1992 and 1997) by clinical form, t. unguium patients increased from 1.9% of total outpatients in 1992, to 2.0% in 1997, then to 2.9% in 2002. 4) As the causative dermatophyte species, Trichophyton rubrum was the most frequently isolated among all dermatophyte infections except tinea capitis. 5) T. rubrum was isolated from 63.3%(1,431/2,262) of tinea pedis lesions, followed by Trichophyton mentagrophytes (36.6%, 829/2,262), and also 88.8% (325/366) of t. corporis, 95.4% (185/194) of t. cruris and 85.6% (462/540) of t. unguium. 6) Cutaneous candidiasis was seen in 755 cases (1.0%) of 72,660 outpatients. Intertrigo (347 cases) was the most frequent clinical form, followed by erosio interdigitalis (103 cases) and diaper candidiasis (102 cases). It has a tendency to affect the aged being complicated with topical predisposing factors. 7) Cutaneous Malassezia infections and other superficial fungal infections are seen in 220 cases, without any characteristic features by gender or clinical form.

Adolescent↗
PubMed2006

[Statistical study of dermatomycosis - observations in Sendai National Hospital over a 30 year period].

A statistical 30-year study of dermatomycosis in Sendai National Hospital (1968-1997) revealed many changes in the prevalent diseases: Tinea pedis and tinea unguium constantly increased during this period, and the ratio of the former associated with nail infection finally reached 30% of all tinea pedis patients. On the contrary, tinea corporis and cruris showed a remarkable decreasing tendency. Patient age distribution of each disease also showed distinctive changes, generally increasing in the older generation and decreasing in the younger. The number of patients with tinea pedis and unguium gradually increased among the middle and older generations, with the peak of the age-distribution curve shifting upward year after year. On the other hand, cases of tinea cruris among the younger generation were few in the latest years, and middle-age patients remained at a low number. In the first stage of this study the kinds of atiologic dermatophytes consisted of multiple species, but after middle period the isolation of Epidermaphyton floccosum decreased. Microsporum canis appeared first in 1976 but in the recent several years has completely disappeared. In the last few years of the period studied Trichophyton rubrum and Trichophyton mentagrophytes were the only isolates found from among all types of dermatophytoses. Infantile candidiasis remarkably increased in 1970-1975 but thereafter decreased rapidlly. Candidial intertrigo also increased in the same period but did not decrease as much thereafter and continued at the same intermediate level. The number of other types of candidiases were not greatly changed throughout the 30-year period. Malassezia infection also showed no remarkable changes, and only 20 cases of sporothrichosis were found. One case of the deep seated form of cutaneous aspergillosis was found, and this was also true of chromomycosis caused by Fonceaea pedrosoi.

Arthrodermataceae↗
PubMed2001

Clinical outcomes in reduction mammaplasty: a systematic review and meta-analysis of published studies.

This systematic review and meta-analysis were undertaken to determine whether reduction mammaplasty improves measurable outcomes in women with breast hypertrophy. A systematic review of the literature in 5 languages from 1985 until March 1999 was performed, and data were compared for meta-analysis. Eligible studies were both experimental and observational and involved women with preoperative physical and/or psychosocial signs and symptoms who underwent reduction mammaplasty for breast hypertrophy. Outcomes assessed were postoperative physical signs and symptoms such as shoulder pain, shoulder (bra strap) grooving, and quality-of-life domains, such as physical and psychological functioning, and were expressed primarily as risk differences (RDs). Twenty-nine studies of 4173 patients met all eligibility criteria. Reduction mammaplasty was associated with a statistically significant improvement in physical signs and symptoms involving shoulder pain (RD, 0.71 [95% confidence interval (CI), 0.62-0.80]); shoulder grooving (RD, 0.69 [95% CI, 0.60-0.78]); upper/lower back pain (RD, 0.59 [95% CI, 0.48-0.70]); neck pain (RD, 0.50 [95% CI, 0.37-0.64]); intertrigo (RD, 0.44 [95% CI, 0.34-0.54]); breast pain (RD, 0.36 [95% CI, 0.17-0.55]); headache (RD, 0.28 [95% CI, 0.11-0.46]); and pain/numbness in the hands (RD, 0.11 [95% CI, 0.04-0.18]). The quality-of-life parameter of physical functioning was also statistically significant (RD, 0.58 [95% CI, 0.44-0.71]), while psychological functioning was not significant (RD, 0.46 [95% CI, 0.00-1.00]). The evidence suggests that women undergoing reduction mammaplasty for breast hypertrophy have significant postoperative improvement in preoperative signs and symptoms, quality of life, or both.

Adult↗
PubMed1999

[Candida in biological human samples].

Infections by Candida have been raising in the last decades, and risk factors, mainly immunosuppression and the appearance of Candida no albicans, are determinants in the prognosis of these mycoses. The purpose of this investigation was to identify and establish the prevalence of C. albicans and Candida spp. in candidiases, in patients to the Hospital Universitario de Maracaibo, whose biological samples were processed for both direct examination and cultures, needed for the proper identification. From October 1996 to October 1998, isolation and identification of yeasts of Candida were performed in 177 biological samples: 73 (41.24%) Candida albicans and 104 (58.75%) Candida spp. Both blastoconidias and pseudohyphae were found in 34 samples (19.21%), 24 of which (70.5%) were diagnosed as C. albicans and 10 (29.5%), as Candida spp. Blastoconidias identified by direct method were distributed as C. albicans 34.2% and Candida spp. 65.7%. C. albicans was found more often in intertrigo, sputum and in bronquial lavage samples. Candida spp. was more frequent in nails. Candidiasis is a frequently diagnosed mycosis in hospitals, mainly among immunossuppresed patients. It is very important to use direct microscopical evaluation and cultures, in order to establish the presence of blastoconidias and pseudohyphae, that will help to diagnose the aethiology and prevalence of candidiasis. It is also important to recognize subungueal candidiasis in hospital staff, that could spread the infection to inpatients.

Adult↗
PubMed2000

[1996 epidemiological survey of dermatophytoses in Japan. Epidemiological Investigation Committee for Human Mycoses in the Japanese Society for Medical Mycology].

An epidemiological investigation on dermatophytoses in Japan for the year 1996 was carried out with the following results. The number of dermatomycoses patients visiting the fifteen cooperating institutes that year was 8,402. New outpatients with this condition accounted for 13.1% of all new outpatients in these institutes. Dermatophytoses patients numbered 7,395 and were composed of: tinea pedis 4,764 (64.4%), tinea unguium 1,487 (20.1%), tinea corporis 558 (7.5%), tinea cruris 369 (5.0%), tinea manuum 195 (2.6%), tinea capitis 11, kerion Celsi 7, tinea barbae 1 and other forms 3. Of these, 113 were children under 15 years of age. Species and incidences of the 2,615 strains isolated from the patients with dermatophytoses were as follows: Trichophyton (T.) rubrum 1,828 (69. 9%), T. mentagrophytes 743 (28.4%) Epidermophyton floccosum 20 (0. 8%), Microsporum (M.) canis 13 (0.5%), M. gypseum 5, T. violaceum 2, and 4 undetermined strains. Candidiasis was found in 722 individuals: intertrigo 299, erosio interdigitalis 95, erythema infantum 89, oral candidiasis 63, paronychia et onychia 56, genital candidiasis 56, onychomycosis 24, chronic mucocutaneous candidiasis 1 and other atypical forms of candidiasis 39. Patients with tinea versicolor numbered 265 and those with Malassezia folliculitis 15. There were five cases of deep dermal mycoses: three of sporotrichosis, one of chromomycosis and one of aspergillosis. The results of superficial dermatophytoses for the year 1996 differed from those of 1991-92 in the following points: Tinea corporis and tinea cruris were lower in number, while tinea unguium had increased in ratio and number. M. canis infection tended to decrease gradually. In the age-distribution of tinea, in every clinical form the peak of distribution curve shifted to a more elderly age group.

Adolescent↗
PubMed2001

[Descriptive epidemiology and knowledge of erysipelas risk factors].

Few epidemiological data related to erysipelas or cellulitis is available in the literature. Descriptive data, such as incidence, has mainly been assessed in hospital settings, and exceptionally in the general population. In the only case-control study available, main risk factors for erysipelas of the leg were lymphoedema and the site of entry. Leg edema, venous insufficiency, and overweight were associated to erysipelas to a lesser extent. Given its high attributable risk, secondary prevention strategies targeted at toe-web intertrigo should be evaluated. Risk factors for severity are difficult to assess if they are transient - such as NSAIDs intake. A study on prognostic factors is needed before intervention strategies are tested in appropriate groups of patients.

Erysipelas↗
PubMed2002

[Paget's extramammary disease of the axillae and perineum].

INTRODUCTION: Paget's extramammary disease mostly affects genital, perianal and axillary regions. Whilst triple involvement has been described in Japanese patients, simultaneous lesions of both axillary regions and the inguinal area are exceptional among European patients. We report a case of triple Paget's extramammary disease in a Caucasian patient. CASE-REPORT: A 79-year-old male patient who developed a prostatic adenocarcinoma 3 years ago, was seen for an erythemato-squamous intertrigo of both axillary folds and the pubic area, present for 10 years, not diagnosed and resistant to topical treatments. Triple Paget's extramammary disease was confirmed by both histopathological and immunohistochemical investigations. No recurrence of the prostatic adenocarcinoma was observed. DISCUSSION: Since the first description of triple Paget's extramammary disease, 28 cases have been reported in Japan. To our knowledge, this is the first case observed in a Caucasian patient. The clinical features of axillary lesions are described as pigmented or depigmented plaques, sometimes lichenoid or erosive. For some Japanese authors, a biopsy is mandatory even in the absence of clinical lesions, since typical Paget cells can be found. Immunohistochemical studies reveal CK7 expression, the marker of choice for primary extramammary Paget's disease. CK7 - would suggest underlying regional internal malignancy as well as CK20 +. Despite the fact that the immunophenotype was CK7 +/CK20- the patient developed an evolving prostatic adenocarcinoma. Although various treatments are described in the literature, surgical excision remains the first line treatment whenever possible.

Aged↗
PubMed2002

["Banal dermatomycoses" that cannot be overlooked].

Two young adults presented an interdigital intertrigo and a dyschromic nail alteration, respectively. They were adept of intense sport swimming in pools. Lesions had been misdiagnosed as athlete's foot and onychomycosis, respectively. Several antifungal treatments had been tried without success. After many months of inadequate management, the dermatological examination revealed the presence of two malignant melanomas corresponding to the eroded acrolentiginous and nodular subungueal types, respectively.

Adult↗
PubMed1975

[Interdigital spinocellular epitheliomas of the foot].

The authors draw attention to the relative commonness of spinocellular epitheliomas located in the 4th and 3rd interdigital spaces of the feet. These epitheliomas, 22 cases in 19 patients, occur chiefly in women (12 cases) and in agricultural workers, secondary to lesions of intertrigo and of "soft corns" present for 2 to 20 years. The principal aetiological factor seems to be continual maceration due to the use of rubber boots, rather than trauma. With this in mind, particular attention should be paid to chronic interdigital lesions of the feet, with the use of wide deep biopsies.

Aged↗