Skin scrapings versus standardized skin surface biopsy to detect Demodex mites in patients with facial erythema of uncertain cause – a comparative study.

Background: Standardized skin surface biopsy (SSSB) is considered to be the gold standard technique to evaluate the density of Demodex mites for the diagnosis of demodicidosis. Potassium hydroxide (KOH) preparation of skin scrapings is a much simpler procedure that can be used to detect pathogens in the superfi cial skin. Objective: To evaluate the reliability of potassium hydroxide preparation of skin scrapings as compared to the standard skin biopsy technique with regard to capacity to detect Demodex mites, time consumed and technician satisfaction. Methods: One hundred outpatients presenting with facial erythema of uncertain cause were enrolled. Standardized skin surface biopsy and potassium hydroxide preparation of skin scrapings were undertaken in adjacent areas on the patients’ right cheek. Limitation: Patients with normal facial skin were excluded from the study. Results: The accuracy of Demodex mite detection by potassium hydroxide preparation of skin-scrapings when compared to the standard procedure is 82%. The sensitivity, specifi city, positive and negative predictive values of this method are 75%, 84.2%, 60% and 91.43%, respectively. There was no statistically signifi cant difference between the standard and skin scraping techniques (P = 0.238) with regard to mite detection. Mean preparation time while using the skin scraping technique was 6 times less than that of the standard technique. For interpretation also, skin scraping technique (3.6 min) consumed much less time than the biopsy technique (9.8 min). Moreover, experienced technicians were more satisfi ed with skin scraping. Conclusion: Potassium hydroxide preparation of skin scrapings is an effective, time saving and practical technique to detect Demodex mites with accuracy comparable to the standard biopsy method.

Benign symmetric lipomatosis (madelung’s disease): A case report of new variant.

Benign symmetric lipomatosis (BSL) is characterized by the presentation of numerous symmetric non-tender fatty tumors in the neck, suboccipital region, proximal extremities and upper parts of the trunk, typically noted as a “pseudoathletic” appearance. The etiology of BSL remains unknown but mitochondrial mutations have been found in some patients. The mitochondrial cytopathy was suggested to be studied in all BSL patients especially those with neuropathy. We have presented a case of BSL with reverse fat distribution, which we named the “Pop-eye” appearance in which the fatty tumor was distributed at both the distal part of the upper extremities and the proximal part of the lower extremities. A study of the mitochondrial tRNA lysine gene did not reveal mutation at position 8344.

Primary cutaneous anaplastic large cell lymphoma presenting as multiple keratoacanthoma-like lesions.

Primary cutaneous anaplastic large cell lymphoma (C-ALCL) is categorized as primary cutaneous CD30+ lymphoproliferative disorders, according to the recent WHO-EORTC classification of cutaneous lymphomas. This group includes primary C-ALCL, lymphomatoid papulosis (LyP). Most patients of C-ALCL present with solitary or localized nodules or papules, and often show ulceration. Multiple keratoacanthoma-like lesions are unusual. As far as we know, there are five reported cases. Currently, there is no universally accepted standard therapeutic approach for cases of multifocal C-ALCL. The combination chemotherapy is considered the most appropriate first-line treatment. We present a rare case of C-ALCL with multifocal keratoacathoma-like tumors with a challenging treatment regimen. A 56-year-old Thai woman developed multiple asymptomatic ulcerated nodules on her trunk, and extremities for 5 months. The provisional diagnosis was keratoacanthoma but histopathology and immunohistochemical studies revealed CD30+ ALCL. She received many regimens of chemotherapy, but responded well to the ESHAP (etoposide, methylprednisolone, cisplatin, cytosar) regimen.

Prevalence of onychomycosis in patients with autoimmune diseases.

BACKGROUND: Onychomycosis is the most common nail disorder in adults. Many studies reported a higher prevalence of onychomycosis among particular patients, such as those with diabetes, poor peripheral circulation or immunosuppression. However, studies of the prevalence of onychomycosis in autoimmune patients who carry many of these predisposing factors have been limited OBJECTIVE: Study the prevalence of onychomycosis in autoimmune compared to non-autoimmune female patients. MATERIAL AND METHOD: A cross-sectional study of the prevalence of onychomycosis in autoimmune patients and non-autoimmune female patients visiting a dermatology clinic over a period of 18 months. One hundred and sixty-five female autoimmune patients were enrolled. RESULTS: The prevalence of onychomycosis in autoimmune patients was 10.2% (95%CI 6.5%, 15.9%) compared to 6.7% (95%CI 3.8%, 11.6%), in non-autoimmune patients (p > 0.05, 2-sided). Of vesiculobullous patients, mainly presenting with pemphigus and who were mostly on immunosuppressive medication, 24% had onychomycosis [p = 0.013; OR 4.39 (95%CI 1.27, 14.89)]. CONCLUSION: Exposure to humid microenvironments was an important factor in the occurrence of onychomycosis (p < 0.05, 2-sided). However, the number of patients with each individual disease was too small to conclude a prevalence of onychomycosis in conjunction with these individual cutaneous autoimmune diseases.

Chronic arsenicism and multiple skin cancers.

Abstract : We report a case of skin cancer who presented with an ulcerated nodule at left arm and finger. The patient was previously diagnosed Bowenûs disease at left calf one year ago, skin cancer at hand and foot nine years ago. He also received herbal medicine every month for 1 year since 50 years ago for herpes treatment. Multiple skin cancers were suspected to be induced by chronic arsenicism. High level of arsenic was identified from nails. Bowenûs disease at finger was treated with CO2 laser and squamous cell carcinoma at left arm was removed by surgical excision. Chronic arsenicism was treated by supportive care.

Clinical characteristics and mycology of onychomycosis in autoimmune patients.

Onychomycosis is the most common nail disorder in adults. Predisposing factors are immunosuppression, poor peripheral circulation, diabetes mellitus, increasing age, nail trauma, and tinea pedis. Autoimmune patients, who carry many of these predisposing factors, have never been studied. Autoimmune patients, with underlying autoimmune skin diseases; pemphigus, systemic lupus erythematosus (SLE), mixed connective tissue disease (MCTD), scleroderma, dermatomyositis and cutaneous vasculitis, as well as having abnormal-appearing nail(s) with suspicion of fungal nail infection were included. Clinical information was obtained. The causative organisms were identified by potassium hydroxide preparation and cultured. Duration of onychomycosis in autoimmune patients was twice longer than in non-autoimmune patients. Of those with mycological proven onychomycosis, the autoimmune patients had significantly more affected nails (p < 0.05; chi2, two-sided) compared to the non-autoimmune patients but there was no difference in the affected fingernails or toenails and clinical type of onychomycosis. Candida spp was the most frequently found in autoimmune subjects compared to dermatophytes, Trichophyton rubrum. However, dermatophytes especially Trichophyton rubrum was the most common causative organism in non-autoimmune samples, followed by Candida spp. The causative organisms were more frequently discovered in autoimmune patients, whether by potassium hydroxide (KOH) or culture, than in non-autoimmune patients (p < 0.05; chi2, two-sided).

Can aloe vera treat or protect from sunburn.

Aloe vera gel continues to be an ingredient in a wide variety of topical products, including sunscreen and after-sun products, even though there has been little scientific evidence to support its use. Evidence does exist to support the use of Aloe vera as a therapeutic modality in the treatment of thermal burns and radiodermatitis. We investigated the efficacy of topic Aloe vera gel in the treatment and prevention of cutaneous erythema following ultraviolet B. Ten healthy Thai volunteers were irradiated on control-untreated, pre-and post-Aloe vera-treated areas with UVB doses ranging 25 to 300 mJ/cm2. The threshold doses of UVB which induced a well-defined border erythema (MED) of the three areas were determined and compared. There were no statistically significant differences in MEDs in pre-, post-Aloe vera treated areas compared with those in untreated control sites (p>0.468). Our results suggest that topically applied of Aloe vera gel both before and after UVB-irradiation dose not affect UVB erythema.

Etiologic agents of cutaneous infectious granuloma: 2 year-experience from granuloma clinic, Siriraj Hospital.

Etiological diagnosis of cutaneous infectious granuloma is difficult to achieve and leads to difficult in patient management. We proposed to search for etiologic agents by special stain of histologic sections, cultural method and PCR technique for tuberculous and non-tuberculous mycobacteria. The skin biopsy specimens were obtained from dermatologic patients who attended Granuloma Clinic, Siriraj Hospital from January 1994 to December 1996. Sixty-nine cases of mixed cell granuloma were found during the 2-year-period. The causative agents had been found in 45 cases (65.22%). Mycobacterial infections were documented in 25 cases. Five cases of tuberculous infection were diagnosed by PCR method. Non-tuberculous mycobacterial infections were diagnosed by cultural method in 14 cases and the other 6 cases were diagnosed by acid-fast stain in histologic section alone. Actinomycotic mycetoma were diagnosed in 4cases. Fungal infections were documented in 16 cases, which caused by hyaline fungi 7 cases and dematiaceous fungi 9 cases. About one-third of all cases (24 cases) the etiologic agent could not be identified.