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Resumen Introducción: La histoplasmosis es una micosis sistémica en pacientes inmunodeprimidos y su epidemiología es desconocida en el país. Objetivo: Describir los datos demográficos y clínicos de pacientes con infección por VIH (IpVIH) e histoplasmosis diagnosticadas en el Laboratorio Central de Salud Pública, Asunción-Paraguay. Pacientes yMétodos: Estudio retrospectivo y transversal de pacientes con muestras positivas a Histoplasma capsulatum diagnosticados en el período 1993-2017. Resultados: Fueron diagnosticados 162 pacientes con IpVIH e histoplasmosis. El origen de los pacientes en orden de prevalencia fue: la capital Asunción, Central, Cordillera y San Pedro. La relación hombre/mujer fue 4:1 y la edad media 34,1 ± 7,7 años con un rango de 18 a 61 años. La fiebre, las lesiones en piel y las úlceras en mucosa fueron los síntomas y manifestaciones más frecuentes. Los métodos para diagnósticos más utilizados fueron las escarificaciones de piel, úlceras muco-cutáneas y las punciones de médula ósea. Conclusión: Por ser el primer reporte nacional de histoplasmosis en pacientes con IpVIH, consideramos este trabajo relevante para la base de otros estudios de micosis profunda.
Abstract Background: Histoplasmosis is a systemic mycosis in immunosuppressed patients and its epidemiology is unknown in the country. Aim: To describe the demographic and clinical data of patients with HIV infection and histoplasmosis diagnosed in the Central Public Health Laboratory, Asunción-Paraguay. Methods: Retrospective and cross-sectional study of patients with Histoplasma capsulatum positive samples diagnosed in the period 1993-2017. Results: 162 patients with HIV infection were diagnosed as histoplasmosis. The origin of the patients in order of prevalence were the capital Asunción, Central, Cordillera and San Pedro departments. The male/female ratio was 4: 1 and the mean age was 34.1 ± 7.7 years with a range of18 to 61 years. Fever, skin lesions and mucosal ulcers were the most frequent symptoms and manifestations. The most widely used diagnostic methods were scarification of skin, mucocutaneous ulcers and bone marrow punctures. Conclusion: As it is the first national report of histoplasmosis in patients with HIV infection, we consider this work relevant for the basis of other studies of deep mycosis.
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A retrospective study of poxvirus infections diagnosed in cattle from Goiás state (GO), Brazil, from 2010 to 2018, was performed. All cases have been investigated by the GO Official Veterinary Service (Agrodefesa), from which technical forms and protocols of veterinary diagnosis laboratories were reviewed. In most cases, samples of oral or cutaneous tissues and/or swabs were submitted for virological diagnosis by polymerase chain reaction (PCR) and/or virus isolation. Thirty seven outbreaks/cases of vesicular disease were notified in cattle of 25 counties; in 33 cases the animals presented lesions clinically compatible with poxviruses. The etiology of 25 out of 33 outbreaks/cases was confirmed as poxviruses by PCR and/or viral isolation: 13 as bovine vaccinia virus (VACV), six as pseudocowpox virus (PCPV), five as bovine papular stomatitis virus (BPSV) and one coinfection (VACV and an Orf virus-like parapoxvirus). The laboratory confirmed that cases occurred mainly in dairy cattle (19/25) and during the dry season (22/25). In adult cattle, gross changes were observed mainly in the teats and udder and included vesicles, ulcers, crusts, papules and scars and varied of type, severity and affected region, depending on the poxvirus species. In calves, the main lesions were ulcers in the mouth and muzzle. Zoonotic lesions compatible with poxvirus infections were observed for all diagnosed poxviruses, affecting especially the hands of milkers and other farm workers. Our data demonstrate the sanitary and economic relevance of these diseases and the wide circulation of different poxviruses in cattle from GO.(AU)
Foi realizado um estudo retrospectivo das infecções por poxvírus diagnosticadas em bovinos do estado de Goiás (GO), entre 2010 e 2018. Todos os casos foram investigados pela Agência Goiana de Defesa Agropecuária (Agrodefesa). Foram revisados formulários técnicos e protocolos de laboratórios de diagnóstico veterinário. Na maioria dos casos, amostras de tecidos orais ou cutâneos e/ou swabs foram encaminhadas para diagnóstico virológico. Foram notificados 37 surtos/casos de doença vesicular em bovinos em 25 municípios; em 33 casos os animais apresentavam lesões clinicamente compatíveis com poxvírus. A etiologia de 25 de 33 surtos/casos foi confirmada como poxvírus por PCR e/ou isolamento viral: 13 como vírus vaccínia (VACV), seis como vírus pseudocowpox (PCPV), cinco como vírus da estomatite papular bovina (BPSV) e um caso de coinfecção (VACV e um parapoxvírus semelhante ao Orf vírus). Os casos confirmados laboratorialmente ocorreram principalmente em bovinos leiteiros (19/25) e durante a estação seca (22/25). Em bovinos adultos, alterações macroscópicas foram observadas principalmente nas tetas e úbere e incluíram vesículas, úlceras, crostas, pápulas e cicatrizes e variaram quanto ao tipo, gravidade e região afetada, dependendo da espécie do poxvírus. Em bezerros, as principais lesões foram úlceras na boca e focinho. Lesões zoonóticas compatíveis com infecção por poxvírus foram observadas em todas as poxviroses diagnosticadas, afetando principalmente as mãos dos ordenhadores e outros trabalhadores rurais. Nossos dados demonstram a relevância sanitária e econômica dessas doenças e a ampla circulação de diferentes poxvírus em bovinos de GO.(AU)
Subject(s)
Humans , Animals , Cattle , Vaccinia virus/isolation & purification , Parapoxvirus/isolation & purification , Pseudocowpox Virus/isolation & purification , Poxviridae Infections/diagnosis , Poxviridae Infections/pathology , Poxviridae Infections/epidemiology , Coinfection/veterinary , Viral ZoonosesABSTRACT
A retrospective study of poxvirus infections diagnosed in cattle from Goiás state (GO), Brazil, from 2010 to 2018, was performed. All cases have been investigated by the GO Official Veterinary Service (Agrodefesa), from which technical forms and protocols of veterinary diagnosis laboratories were reviewed. In most cases, samples of oral or cutaneous tissues and/or swabs were submitted for virological diagnosis by polymerase chain reaction (PCR) and/or virus isolation. Thirty seven outbreaks/cases of vesicular disease were notified in cattle of 25 counties; in 33 cases the animals presented lesions clinically compatible with poxviruses. The etiology of 25 out of 33 outbreaks/cases was confirmed as poxviruses by PCR and/or viral isolation: 13 as bovine vaccinia virus (VACV), six as pseudocowpox virus (PCPV), five as bovine papular stomatitis virus (BPSV) and one coinfection (VACV and an Orf virus-like parapoxvirus). The laboratory confirmed that cases occurred mainly in dairy cattle (19/25) and during the dry season (22/25). In adult cattle, gross changes were observed mainly in the teats and udder and included vesicles, ulcers, crusts, papules and scars and varied of type, severity and affected region, depending on the poxvirus species. In calves, the main lesions were ulcers in the mouth and muzzle. Zoonotic lesions compatible with poxvirus infections were observed for all diagnosed poxviruses, affecting especially the hands of milkers and other farm workers. Our data demonstrate the sanitary and economic relevance of these diseases and the wide circulation of different poxviruses in cattle from GO.
Foi realizado um estudo retrospectivo das infecções por poxvírus diagnosticadas em bovinos do estado de Goiás (GO), entre 2010 e 2018. Todos os casos foram investigados pela Agência Goiana de Defesa Agropecuária (Agrodefesa). Foram revisados formulários técnicos e protocolos de laboratórios de diagnóstico veterinário. Na maioria dos casos, amostras de tecidos orais ou cutâneos e/ou swabs foram encaminhadas para diagnóstico virológico. Foram notificados 37 surtos/casos de doença vesicular em bovinos em 25 municípios; em 33 casos os animais apresentavam lesões clinicamente compatíveis com poxvírus. A etiologia de 25 de 33 surtos/casos foi confirmada como poxvírus por PCR e/ou isolamento viral: 13 como vírus vaccínia (VACV), seis como vírus pseudocowpox (PCPV), cinco como vírus da estomatite papular bovina (BPSV) e um caso de coinfecção (VACV e um parapoxvírus semelhante ao Orf vírus). Os casos confirmados laboratorialmente ocorreram principalmente em bovinos leiteiros (19/25) e durante a estação seca (22/25). Em bovinos adultos, alterações macroscópicas foram observadas principalmente nas tetas e úbere e incluíram vesículas, úlceras, crostas, pápulas e cicatrizes e variaram quanto ao tipo, gravidade e região afetada, dependendo da espécie do poxvírus. Em bezerros, as principais lesões foram úlceras na boca e focinho. Lesões zoonóticas compatíveis com infecção por poxvírus foram observadas em todas as poxviroses diagnosticadas, afetando principalmente as mãos dos ordenhadores e outros trabalhadores rurais. Nossos dados demonstram a relevância sanitária e econômica dessas doenças e a ampla circulação de diferentes poxvírus em bovinos de GO.
Subject(s)
Humans , Animals , Cattle , Poxviridae Infections/diagnosis , Poxviridae Infections/epidemiology , Poxviridae Infections/pathology , Parapoxvirus/isolation & purification , Vaccinia virus/isolation & purification , Pseudocowpox Virus/isolation & purification , Coinfection/veterinary , Viral ZoonosesABSTRACT
La acroqueratoelastoidosis de Costa es una genodermatosisde herencia autosónimica dominante con penetrancia incompleta. Es un trastorno de las fibras elásticas exclusivamente cutáneo y a nivel acral. Se caracteriza por la presencia de pápulas eritematosas, amarillentas o del color de la piel normal en la cara marginal de los dedos de las manos o de los pies, que se agrupan, forman placas con aspecto de empedrado y se extienden de forma simétrica al dorso, las palmas y las plantas. El hallazgo histológico patognomónico es la elastorrexis. Se presenta el caso de un niño de 7 años con una acroqueratoelastoidosis que comprometía las manos y los pies, asociada a prurito.
Acrokeratoelastoidosis of Costa is a genodermatosis of autosomal dominant inheritance with incomplete penetrance.It is a cutaneous disorder of the elastic fibers at the acral level.The clinical feature is the presence of erythematous, yellowish or normal skin-colored papules on the marginal aspect of the fingers and/or toes, which agminate to form cobblestone-like plaques and extend symmetrically to the dorsum and palms and soles. The pathognomonic histologic finding is elastorrhexis. We present a 7-year-old boy with acrokeratoelastoidosis involving hands and feet, associated with pruritus.
Subject(s)
Humans , Male , Child , Skin Diseases, Genetic/diagnosis , Skin Diseases, Genetic/pathology , Keratoderma, Palmoplantar , Elastic Tissue/abnormalitiesABSTRACT
Resumen Los exantemas virales en la infancia,son motivo deconsulta frecuente, en los Servicios de Dermatología, Pediatría, y Urgencias. Usualmente, son autolimitados y pueden ser difíciles de diagnosticar. Es importante reconocerlos y diferenciarlos de otras enfermedades severas que requieran un tratamiento inmediato. El síndrome de Gianotti-Crosti, también conocido como acrodermatitispapulosa de la infancia, es un exantema poco frecuente, secundario a la respuesta inmune del huésped frente a infecciones, especialmente virales o luego de inmunizaciones. La primera asociación descrita fue con la infección por el virus de hepatitis B, sin embargo, con la introducción de la vacuna contra este virus, aumentó la incidencia de otros virus relacionados con este síndrome. Presentamos el caso de un paciente de 4 años de edad con diagnóstico clínico de síndrome de Gianotti-Crosti.
Abstract Viralexanthemsin childhood are a frequent consultation both outpatient and in emergency services. They are usually self-limited and can be difficult to diagnose. It's important to recognize and differentiate them from other severe diseases that require immediate treatment. GianottiCrosti syndrome, also known as papularacrodermatitis of childhood, is an infrequent exanthema secondary to the host's immune response to infections, especially viral, or vaccines. The first association described was with hepatitis B virus infection, however, with the introduction of the vaccine against this virus,the incidence of other viruses related to this syndrome has increased. We present the case of a 4-year-old patient with a clinical diagnosis of GianottiCrosti syndrome.
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Objective To analyze clinical and pathological features of papular elastorrhexis.Methods Clinical data were collected from 22 patients with confirmed papular elastorrhexis in Hospital for Skin Diseases,Chinese Academy of Medical Sciences and Pekin Union Medical College from September 2006 to May 2018.Clinical manifestations,pathological findings and follow-up results were retrospectively analyzed.Results The average age of onset of the 22 patients was 5.7 years (range:1-10 years),and the male to female ratio was 4.5:1.The average duration from the occurrence of disease to the confirmation of diagnosis was 1.5 years,and no definite etiology was found.The patients had no itching or pain sensation.Skin lesions were soft,slightly elevated,well-circumscribed,round,oval or polygonal-shaped,white papules with diameters of 1-10 mm,and wrinkles appeared on the surface of the papule when the papule was pushed towards its center.Among the 22 patients,16 (73％) presented with scattered lesions,13 (59％)had less than 5 papules,and lesions were located in the trunk in 21 (95％).Histopathological examination of skin lesions in 8 patients showed no obvious increase of collagen fibers in the superficial and middle dermis,which were normally arranged with slightly widened spaces between them.Elastic fiber staining showed that elastic fibers disappeared or were dissociated focally in the superficial and middle dermis.After confirmed diagnosis,the 22 patients received no treatment.In 18 patients,skin lesions did not continue to expand after onset,and no new skin lesions occurred.Skin lesions were slightly enlarged,but remained steady thereafter in 4 patients.Sixteen patients achieved partial remission.Conclusions Papular elastorrhexis is a rare skin disorder of elastic fibers that occurs predominantly during childhood and adolescence,and its diagnosis relies on clinical manifestations combined with histopathological findings.No special treatment is needed and the prognosis is good.
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Objective@#To analyze clinical and pathological features of papular elastorrhexis.@*Methods@#Clinical data were collected from 22 patients with confirmed papular elastorrhexis in Hospital for Skin Diseases, Chinese Academy of Medical Sciences and Pekin Union Medical College from September 2006 to May 2018. Clinical manifestations, pathological findings and follow-up results were retrospectively analyzed.@*Results@#The average age of onset of the 22 patients was 5.7 years (range: 1 - 10 years) , and the male to female ratio was 4.5∶1. The average duration from the occurrence of disease to the confirmation of diagnosis was 1.5 years, and no definite etiology was found. The patients had no itching or pain sensation. Skin lesions were soft, slightly elevated, well-circumscribed, round, oval or polygonal-shaped, white papules with diameters of 1 - 10 mm, and wrinkles appeared on the surface of the papule when the papule was pushed towards its center. Among the 22 patients, 16 (73%) presented with scattered lesions, 13 (59%) had less than 5 papules, and lesions were located in the trunk in 21 (95%) . Histopathological examination of skin lesions in 8 patients showed no obvious increase of collagen fibers in the superficial and middle dermis, which were normally arranged with slightly widened spaces between them. Elastic fiber staining showed that elastic fibers disappeared or were dissociated focally in the superficial and middle dermis. After confirmed diagnosis, the 22 patients received no treatment. In 18 patients, skin lesions did not continue to expand after onset, and no new skin lesions occurred. Skin lesions were slightly enlarged, but remained steady thereafter in 4 patients. Sixteen patients achieved partial remission.@*Conclusions@#Papular elastorrhexis is a rare skin disorder of elastic fibers that occurs predominantly during childhood and adolescence, and its diagnosis relies on clinical manifestations combined with histopathological findings. No special treatment is needed and the prognosis is good.
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Papular elastorrhexis is a rare entity, possibly a form of connective tissue nevi, characterized by asymptomatic white papules on the trunk and extremities first appearing during childhood or adolescence. Histopathologically, the elastic fibers are decreased and may appear in thin and fragmented forms. This rare condition has clinical and histological findings that overlap with those of other connective tissue nevi, making diagnosis a challenge for dermatologists. Herein we report the case of a 27-year-old Korean female presenting with asymptomatic 2~5 mm sized whitish papules on both extremities and showing histopathologic findings of increased layers of collagen fibers and decreased and fragmented elastic fibers in the dermis.
Subject(s)
Adolescent , Adult , Female , Humans , Collagen , Connective Tissue , Dermis , Diagnosis , Diagnosis, Differential , Elastic Tissue , Extremities , NevusABSTRACT
Papular acantholytic dyskeratosis is a collection of papular skin lesions that occur in the intertriginous and genital area. They show a characteristic histology of focal suprabasal acantholysis that distinguishes it from Hailey-Hailey disease or Darier disease. We describe a 50-year-old man with an asymptomatic papular eruption on the perianal area for several years. Histologically, a biopsy specimen showed diffuse hyperkeratosis and irregular acantholysis throughout the epidermis. We used carbon dioxide laser therapy as a therapeutic option. Despite causing a long and painful healing process, a considerable reduction of the symptoms was achieved. Although we do not know the precise nature or the incidence of this disease, papular acantholytic dyskeratosis should be included in the differential diagnosis of verrucous papules in perineal or perianal areas and carbon dioxide laser may represent a good therapeutic option.
Subject(s)
Humans , Middle Aged , Acantholysis , Biopsy , Carbon Dioxide , Carbon , Darier Disease , Diagnosis, Differential , Epidermis , Incidence , Lasers, Gas , Pemphigus, Benign Familial , SkinABSTRACT
Introduction: DRESS is an uncommon severe cutaneous adverse drug reaction, which is under recognized. In this review, we aim to study the clinical characteristics of patients with DRESS that presented to our hospital. Methods: We conducted a retrospective analysis on the data of all the patients with DRESS from January 2006 to December 2012 in Selayang Hospital. Results: Twenty-one patients were included with median age of 33 and male to female ratio of 1:1. Allopurinol was the most frequent causative drug followed by anti-tuberculous drugs. The mean latency period was 28.6 days. All patients had macula-papular rash of which 6 progressed to erythroderma. Liver was the most frequent extra cutaneous organ involvement with median peak alanine transaminase of 746 iu/l, (range 45-3677) and median peak aspartate transaminase of 632 iu/l (range 30-3136). Six patients (28.5%) had acute liver failure. The mainstay of treatment was systemic corticosteroid. Mortality rate was 23.8%. Conclusion: DRESS is a severe cutaneous adverse drug reaction with a myriad of clinical presentation and is associated with mortality. Our series has higher mortality compared to most other reported studies, most probably due to referral bias. Early recognition is crucial.
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Background: HIV infection is associated with numerous cutaneous changes even before the onset of immunologic dysfunction and AIDS. We all know that as search for reliable clinical indicators for management of human immunodeficiency syndrome in resource poor settings continues, cutaneous disorder can be a good clinical marker of HIV infection, underlying immune status and the disease progression. Aim and objectives: To study occurrence of various cutaneous manifestations in a patients infected with HIV. Materials and methods: 120 HIV positive patients above 14 year old with definite cutaneous manifestations attending dermatology OPD in Department of Skin, STD and Leprosy, in a tertiary care centre Dehradun were studied from December 2013 to January 2016. Results: Among 120 HIV positive patients in our cross-sectional study highest number of patients belonged to 31-40 years age group. Male to female ratio was 1.9: 1 and heterosexual route was the most common route of transmission. Among all cutaneous manifestations pruritic papular eruption, cutaneous drug reactions, molluscum contagiosum, seborrheic dermatitis were common. 14.17% had more than one cutaneous disorder and they had advanced stage of the disease. Conclusion: Early recognition of the cutaneous manifestation can help in better management of HIV infection in resource poor setting as it can indicate progression of the disease and underlying immune status
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BACKGROUND: Papular elastorrhexis (PE), eruptive collagenoma (EC), and nevus anelasticus (NA) are described as multiple small papules with decrease, fragmentation, or lack of dermal elastic fibers. These diseases are suggested to be the same entity. The change of collagen fibers in the conditions has not been addressed to date. OBJECTIVE: We compared the clinical features of the 3 diseases and investigated changes in the collagen fibers involved. METHODS: Twenty-four cases of PE, 12 cases of EC, and 2 cases of NA found in PubMed and the Korean database were reviewed. Changes in dermal collagen fibers in 10 cases with histological figures were investigated. RESULTS: There were significant similarities between the 3 entities in terms of their clinical features. Four patients with PE and 2 with EC with fine, dense collagen fibers were women who had multiple white to hypopigmented, slightly indurated to firm, millimeter-size papules on the trunk and/or extremities that progressed gradually after developing in the patients' first to third decades. CONCLUSION: The 3 conditions are the same clinical entity in our opinion; such cases with fine, dense collagen manifest typical features.
Subject(s)
Female , Humans , Collagen , Elastic Tissue , Extremities , NevusABSTRACT
BACKGROUND: Papular elastorrhexis (PE), eruptive collagenoma (EC), and nevus anelasticus (NA) are described as multiple small papules with decrease, fragmentation, or lack of dermal elastic fibers. These diseases are suggested to be the same entity. The change of collagen fibers in the conditions has not been addressed to date. OBJECTIVE: We compared the clinical features of the 3 diseases and investigated changes in the collagen fibers involved. METHODS: Twenty-four cases of PE, 12 cases of EC, and 2 cases of NA found in PubMed and the Korean database were reviewed. Changes in dermal collagen fibers in 10 cases with histological figures were investigated. RESULTS: There were significant similarities between the 3 entities in terms of their clinical features. Four patients with PE and 2 with EC with fine, dense collagen fibers were women who had multiple white to hypopigmented, slightly indurated to firm, millimeter-size papules on the trunk and/or extremities that progressed gradually after developing in the patients' first to third decades. CONCLUSION: The 3 conditions are the same clinical entity in our opinion; such cases with fine, dense collagen manifest typical features.
Subject(s)
Female , Humans , Collagen , Elastic Tissue , Extremities , NevusABSTRACT
Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis are two forms of a life-threatening skin condition, in which cell death causes the epidermis to separate from the dermis. The syndrome is thought to be a hypersensitivity complex that affects the skin and the mucous membranes. The most well-known causes are certain medications, but it can also be due to infections, or more rarely, cancers. SJS usually begins with fever, sore throat, and fatigue, which is commonly misdiagnosed and therefore treated with antimicrobials. Ulcers and other lesions begin to appear in the mucous membranes, almost always in the mouth and lips, but also in the genital and anal regions. Conjunctivitis of the eyes occurs in about 30% of children who develop SJS. A rash of round lesions about an inch across arises on the face, trunk, arms and legs, and soles of the feet, but usually not the scalp. SJS is a medical emergency that usually requires hospitalization. Treatment focuses on eliminating the underlying cause, controlling symptoms and minimizing complications. Recovery after SJS can take weeks to months, depending on the severity of the condition. If it was caused by a medication, then the medication and others closely related to it has to be avoided permanently. An 18-month-old male child was admitted to a private health setup in Kolar with the complaints of peeling and discoloration of the skin, ulcerations in the oral cavity, eyelids, and genitalia. The parents gave the history of cefotaxime injection being administered to the child for treating typhoid 20 days back. Seven days after the administration of cefotaxime, the child had developed maculo-papular lesions all over the body. Later on there was peeling and discoloration of the skin. Itching was present. Ulcerations in the oral cavity, eyelids and genitalia were also noticed by the parents, who then brought the child to the health care center. According to the Naranjo’s adverse drug reaction probability scale, there is a possible relation between this adverse drug reaction (SJS) and cefotaxime.
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Focal acral hyperkeratosis is a rare skin disorder, initially described by Dowd et al., which is sporadic or inherited in an autosomal dominant way. Clinically, the condition presents with small yellowish to white papules located on lateral aspects of the hands and feet. Histopathological alterations are limited to the epidermis and there are no changes in the elastic fibers of the dermis. In this case report, a 14-year-old girl had a two-year history of persistent, asymptomatic, multiple papules along the border of the hands and feet. A histologic section of papules from the left hand and foot showed marked hyperkeratosis and hypergranulosis of epidermis.
Subject(s)
Adolescent , Female , Humans , Dermis , Elastic Tissue , Epidermis , Foot , Hand , SkinABSTRACT
A 25-year-old girl self-administered tab fluconazole for vulvovaginal candidiasis and developed fever, myalgia and erythematous papular eruptions with itching at both upper and lower lip, mucous membrane of the mouth, vaginal region, which subsequently changed into blister and multiple ulcers. She also had difficulty in swallowing due to painful erosions of the mouth and oropharynx and severe burning pain at vulval and vaginal region. There was bilateral conjunctival hemorrhage. Investigation report revealed leukocytosis and elevated C-reactive protein, which was suggesting the diagnosis of Stevens-Johnson syndrome. She was treated mainly by corticosteroids, antihistamines and antimicrobials and improved. Time taken for resolution of the lesion was 14 days. Rechallenge with the offending drug was not done in the interest of the patient and due to ethical constraints.
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Papular xanthoma is a rare normolipemic xanthomatous skin disease that primarily occurs in adults. While this rare disorder has been documented in children before, all but one case reported in the literature involved a normal lipid profile. The skin lesions of adult papular xanthoma appear to be persistent, whereas in children they generally self-heal within 1~5 years. Here, we describe a typical case of papular xanthoma in a 22-month-old boy who presented with numerous reddish-yellow papulonodules, 2~8 mm in diameter, mainly on the face, but also on the upper and lower extremities, and trunk, for 15 months. The lipid profile was normal, and histological studies showed a diffuse monomorphous infiltrate of foamy cells, with some Touton giant cells, in the dermis. The foamy cells stained positive for Cluster of Differentiation (CD) 68, and the Periodic Acid Schiff (PAS) stain was negative. These findings are consistent with the diagnosis of papular xanthoma.
Subject(s)
Adult , Child , Humans , Infant , Male , Dermis , Diagnosis , Giant Cells , Lower Extremity , Periodic Acid , Skin , Skin Diseases , XanthomatosisABSTRACT
Insects are a class of living creatures within the arthropods. Insect bite reactions are commonly seen in clinical practice. The present review touches upon the medically important insects and their places in the classification, the sparse literature on the epidemiology of insect bites in India, and different variables influencing the susceptibility of an individual to insect bites. Clinical features of mosquito bites, hypersensitivity to mosquito bites Epstein-Barr virus NK (HMB-EBV-NK) disease, eruptive pseudoangiomatosis, Skeeter syndrome, papular pruritic eruption of HIV/AIDS, and clinical features produced by bed bugs, Mexican chicken bugs, assassin bugs, kissing bugs, fleas, black flies, Blandford flies, louse flies, tsetse flies, midges, and thrips are discussed. Brief account is presented of the immunogenic components of mosquito and bed bug saliva. Papular urticaria is discussed including its epidemiology, the 5 stages of skin reaction, the SCRATCH principle as an aid in diagnosis, and the recent evidence supporting participation of types I, III, and IV hypersensitivity reactions in its causation is summarized. Recent developments in the treatment of pediculosis capitis including spinosad 0.9% suspension, benzyl alcohol 5% lotion, dimethicone 4% lotion, isopropyl myristate 50% rinse, and other suffocants are discussed within the context of evidence derived from randomized controlled trials and key findings of a recent systematic review. We also touch upon a non-chemical treatment of head lice and the ineffectiveness of egg-loosening products. Knockdown resistance (kdr) as the genetic mechanism making the lice nerves insensitive to permethrin is discussed along with the surprising contrary clinical evidence from Europe about efficacy of permethrin in children with head lice carrying kdr-like gene. The review also presents a brief account of insects as vectors of diseases and ends with discussion of prevention of insect bites and some serious adverse effects of mosquito coil smoke.