Folliculitis decalvans: a case report of satisfactory recovery after implementing

ABSTRACT Introduction: Folliculitis decalvans is a rare skin disease characterized by the presence of painful papules and pustules with an underlying neutrophilic infiltrate, usually on the scalp. Its treatment is lengthy and challenging, and recurrence is relatively common. Although its etiology is unknown, several theories explaining its development have been proposed, including colonization by Staphylococcus aureus. Case description: This is the case of a 26-year-old male healthcare worker who visited the outpatient service after experiencing a 4-year history of painful pustules on the scalp; initially these lesions were located in the occipital region, but then also started to appear in the temporal and parietal regions. After being treated for bacterial folliculitis and having several recurrences, a skin biopsy was performed, which allowed diagnosing him with folliculitis decalvans. Once the diagnosis was made, isotretinoin (20mg) treatment was implemented for a year and a half, achieving complete remission of the lesions. Conclusion: Although this case has some limitations, such as the lack of histopathology images and some control laboratory tests, it clearly shows the difficulties faced when treating this type of skin disorders and presents an overview of the use of isotretinoin, evidencing that although this drug is well tolerated, possible adverse reactions from drug interactions with trimethoprim/sulfamethoxazole may arise. In addition, this case is of great importance since the possible presence of a familial cluster of folliculitis decalvans could be confirmed, if further genetic testing is performed.

RESUMEN Introducción. La folliculitis decalvans es una enfermedad dermatológica rara caracterizada por la presencia de pápulas y pústulas dolorosas que están acompañadas de un infiltrado de neutrófilos subyacente. Esta condición suele aparecer en el cuero cabelludo, su recurrencia es relativamente común y su tratamiento, largo y difícil. Aunque su etiología es desconocida, se han propuesto muchas teorías que intentan explicar su aparición, siendo la colonización por Staphylococcus aureus una de ellas. Presentación del caso. Hombre de 26 años que se desempeñaba como trabajador de la salud y consultó por un cuadro clínico de 4 años de evolución caracterizado por la aparición de pústulas dolorosas en la región occipital, las cuales posteriormente se extendieron a la región temporal y parietal. Después de tratarlo como una foliculitis infecciosa y tras múltiples recurrencias, se realizó una biopsia de las lesiones que permitió diagnosticarlo con folliculitis decalvans. Se instauró un tratamiento consistente de 20mg de isotretinoina al día por un año y medio, con el cual se logró la resolución de la folicutis. Sin embargo, dos años después tuvo un relapso, pero, según el paciente, esto pudo ocurrir por el consumo de derivados lácteos, ya que, según indicó, cuando suspende el consumo de esta clase de productos no aparecen más lesiones luego de 2-3 semanas. Conclusión. Aunque este caso tiene algunas limitaciones como la ausencia de imágenes histopatológicas y algunos laboratorios de control, muestra las dificultades para tratar este tipo de condiciones dermatológicas y presenta un panorama del uso de la isotretinoina, ya que evidencia que este medicamento tiene una buena tolerancia, pero presenta interacciones medicamentosas adversas con la trimetoprima/sulfametoxazol. Además, este caso es de gran importancia, ya que, si se realizan más pruebas genéticas, podría confirmarse la posible presencia de un grupo familiar de foliculitis decalvante.

Atypical pityriasis rosea in a young colombian woman. case report

ABSTRACT Introduction: Pityriasis rosea is an acute and self-limited exanthem first described by Gilbert in 1860. Its treatment is symptomatic, and although there is no conclusive evidence, it has been associated with the reactivation of the human herpesviruses 6 and 7 (HHV-6 and HHV-7). Case presentation: A 28-year-old woman, from Bogotá, Colombia, a health worker, attended the emergency room due to the onset of symptoms that began 20 days earlier with the appearance of punctiform lesions in the left arm that later spread to the thorax, abdomen, opposite arm, and thighs. The patient reported a history of bipolar II disorder and retinal detachment. After ruling out several infectious diseases, and due to the evolution of the symptoms, pityriasis rosea was suspected. Therefore, treatment was started with deflazacort 30mg for 21 days, obtaining a favorable outcome and improvement of symptoms after 2 months. At the time of writing this case report, the patient had not consulted for recurrence. Conclusion: Primary care physicians should have sufficient training in dermatology to recognize and treat dermatological diseases since many of them are diagnosed based on clinical findings. This is an atypical case, in which the patient did not present with some of the pathognomonic signs associated with pityriasis rosea.

RESUMEN Introducción. La pitiriasis rosada es un exantema agudo y autolimitado que fue descrito formalmente por Gilbert en 1860. Su tratamiento es sintomático y, aunque faltan pruebas concluyentes, su aparición se ha asociado a la reactivación de los herpevirus humanos 7 y 6 (HHV6 y HHV7). Presentación del caso. Mujer de 28 años procedente de Bogotá, Colombia, quien se desempeñaba como trabajadora de la salud y consultó al servicio de urgencias por un cuadro clínico de 20 días de evolución que inició con la aparición de lesiones punteadas en el brazo izquierdo que se expandieron posteriormente a tórax, abdomen, brazo contralateral y muslos. La paciente informó antecedente de trastorno bipolar tipo II y desprendimiento de retina. Después de descartar varias enfermedades infecciosas, y debido a la evolución del cuadro clínico, se sospechó pitiriasis rosada, por lo que se instauró tratamiento con 30mg de deflazacort por 21 días, con el cual se logró una evolución favorable y la mejoría total de los síntomas a los 2 meses. Hasta el momento de la elaboración del presente reporte de caso la joven no había consultado por recurrencia. Conclusión. Es indispensable que los médicos de atención primaria tengan una educación adecuada en dermatología para poder reconocer y tratar la pitiriasis rosada, pues su diagnóstico es eminentemente clínico y puede tener múltiples presentaciones atípicas, como en el caso aquí reportado donde la paciente no tuvo algunos de los signos patognomónicos característicos.

Envenomation by an arachnid (latrodectus or steatoda): case report involving a woman and her female dog

ABSTRACT Introduction: Accidents involving spiders bites usually cause mild medical reactions that lead to local symptoms and, less commonly, systemic effects. The most medically significant spiders belong to the genera Latrodectus and Loxosceles. This paper presents a possible case of steatodism in a young woman and her pet. Case description: 26-year-old female patient, who reports a clinical history characterized by paresthesia, malaise, fever, diarrhea and a painful papule in the left cheek after being bitten by a spider. Immediately after being bit, the patient hit the spider with the back of her hand and it fell to the ground, where her dog swallowed it. The dog presented with vomiting and general discomfort after ingestion. Symptomatic therapy was given for comfort, and neither the patient nor the dog required antivenin therapy. Both evolved favorably. Discussion: The relevance of this case is the involvement of two mammals (a human and her dog) due to the accidental contact with a spider, possibly of the genus Latrodectus or Steatoda. Conclusion: Two possible cases of steatodism are described. Since spider bites are a relatively frequent reason for medical consultation in Colombia, it is important to diagnose and manage them properly.

RESUMEN Introducción. Los accidentes producidos por arañas suelen ser eventos médicos poco severos. La mordedura provoca, por lo general, síntomas locales y, menos frecuente, efectos sistémicos. Las arañas más importantes desde el punto de vista médico pertenecen a los géneros Latrodectus y Loxosceles. Se reporta un posible caso de steatodismo en una mujer joven y su mascota. Presentación del caso. Paciente femenino de 26 años quien presenta cuadro clínico de 5 días de evolución caracterizado por parestesia, malestar general, fiebre, diarrea y una pápula dolorosa en la mejilla izquierda después de ser mordida por una araña. La joven golpea la araña inmediatamente con el dorso de la mano y esta cae al suelo, donde su perra la ingiere; esta última presenta vómito y malestar general después de la ingesta. Como tratamiento se administró terapia sintomática y ninguna de ellas requirió antiveneno. Ambas evolucionaron favorablemente. Discusión. Se presentan dos posibles casos de steatodismo, siendo el aspecto relevante del presente caso que tanto la paciente como su mascota presentaron síntomas debido al contacto accidental con una araña, posiblemente del género Latrodectus o Steatoda. Conclusión. Dado que los accidentes por mordedura de araña son relativamente frecuentes para la consulta médica en Colombia, es importante diagnosticarlos y manejarlos de forma adecuada.

Delusional infestation. ekbom's syndrome in a 53-year old woman. case report

ABSTRACT Introduction: Delusional infestation is a rare psychiatric disorder defined as a condition in which the patient has the unshakable belief and perception of being infested with parasites. Its treatment is difficult, and frequently includes antipsychotic medications (such as olanzapine or aripiprazole). Non-pharmacological treatment, particularly psychotherapy, can be used for less severe cases. Dermatologists and psychiatrists must take a multi-disciplinary approach (preferably in a psycodermatology dedicated clinic) since this type of patients sometimes refuse treatment. Case description: A 53-year-old female businesswoman describes a clinical history of five years of visual hallucinations, depressive symptoms, and generalized pruritus, along with the use of toxic substances to "clean" her skin and cloths. She reports similar symptoms in some relatives but they were not evaluated. Blood tests and analyses of the "specimen" brought by the patient were performed, yielding negative results. The patient had never been assessed by any specialist, and showed disoriented during the consultation. Follow-up was not possible due to the reluctance of the patient to follow the indications and seek psychiatric treatment. Moreover, the patient did not respond to further communication attempts. Discussion: Delusional infestation is an uncommon disease that endangers the patients and the people around them. Its treatment is difficult and long, and not conducting proper follow-up is a great risk. Its prevalence and incidence is variable and generally unknown. It can affect the patient, their next of kin, pets or the environment, and the "pathogen" can be a living organism or an inanimate object. Conclusion: This case is important as it shows the hardships of treatment, adequate follow-up and care, as well as the need to improve how these patients are approached. Additionally, both classical and uncommon signs and symptoms could be observed as the patient stated that her relatives were affected (possible delusional infestation by proxy).