Is there a relation between risk groups or initial CD4 T cell counts and prevalence of seborrheic dermatitis in HIV-infected patients?

OBJECTIVES: (i) To investigate whether there is a difference in the prevalence of seborrheic dermatitis (SD) between homo- or bisexual HIV-infected patients and HIV-infected intravenous drug users, (ii) to study whether the initial CD4 T cell count at the first positive HIV test is of any significance for the prevalence of SD and furthermore to analyze whether (iii) antiretroviral treatment influences the prevalence and time course of SD. PATIENTS AND METHODS: Since 1992 we have been following, within the scope of the Swiss HIV Cohort Study, a group of individuals with proven HIV infection. In this study all HIV-infected patients belonging either to the risk group of homo- or bisexuals or that of intravenous drug users were included for further analysis. RESULTS: We included 226 men and 51 women. The ages ranged from 17 to 68 years (mean 30.1). One hundred and forty-four were homo- or bisexual men and 133 (82 men and 51 women) were intravenous drug users. Out of these 277 HIV-infected patients, 66 (23.8%) had SD at baseline and 7 (2.5%) developed SD during the observation period (male:female = 68:5). CONCLUSION: In our study we found that (i) the risk group influences the prevalence and time course of SD, yet that (ii) neither the initial CD4 T cell count nor (iii) antiretroviral treatment is of any significance.

Superciliary upsweep or tented eyebrows. A distinct mendelian trait.

Facial appearance is influenced by the anatomic relationship of the eyebrows and eyelids. Anatomic variants may characterize members of a pedigree and thus constitute a family mark. We studied three white families with circumscribed upward slanting eyebrows. In one pedigree the family mark was inherited over four generations, suggesting an autosomal dominant inheritance. In the other two families the eyebrow variation was documented in three members over two generations, compatible with an autosomal dominant mode of transmission. In two families the expression of the trait varied in the form of both bilateral and unilateral involvement. No diseases or malformations were associated with this eyebrow anomaly.

[Epidemiology of skin diseases in HIV-infected patients: a prospective cohort study]. / Epidemiologie von Hauterkrankungen bei HIV-infizierten Patienten: eine prospektive Kohortenstudie.

Along with the rising AIDS epidemic, the recognition of mucocutaneous lesions indicating HIV infection is important not only for dermatologists but also for general practitioners. During 36 months we prospectively followed 357 HIV-1-infected patients on a regular base, and all the dermatologic findings were evaluated statistically. Several skin problems such as seborrheic dermatitis, may occur early in HIV infection. Mollusca contagiosa, oral hairy leukoplakia and Kaposi's sarcoma are often clinical signs of marked disease progression with very low CD4-cell counts.

Oral manifestation of disseminated Mycobacterium kansasii infection in a patient with AIDS.

We report the case of a 46-year-old male patient with advanced HIV infection who developed an oral ulcer caused by Mycobacterium kansasii. It is the first description of an aphthous-like ulcer caused by this nontuberculous mycobacterium. As the AIDS epidemy is still growing, more cases might be observed and the current spectrum of differential diagnosis should be expanded.

Isolated lichen planus of the lip.

Oral lichen planus (LP) is a relatively common disorder of unknown aetiology. Oral LP occurs most often on the buccal mucosa, but the gingivae, tongue, floor of the mouth, retromalar pads and lips may also be affected. Usually, patients have multiple sites of involvement. We report a 44-year-old patient with a 3-year history of isolated swelling of the lower lip, erosions and crusting. Histology of a biopsy from the lip revealed features of LP. Oral treatment with acitretin and low-dose steroid led to complete resolution of the lesions within 10 weeks. This is the first well-documented case of isolated LP of the lip. Diagnostic difficulties and differential diagnosis are reviewed.

Molluscum contagiosum mimicking sebaceous nevus of Jadassohn, ecthyma and giant condylomata acuminata in HIV-infected patients.

We report on three HIV-infected homosexual male patients with atypical manifestations of mollusca contagiosa (MC). Their clinical presentation mimicked sebaceous nevus of Jadassohn, ecthyma and giant condylomata acuminata. HIV-infected patients feature MC with atypical morphology in about two thirds of the cases. The atypical aspects of MC concern the localization, morphology, growth pattern and size of the lesions. MC is a late manifestation of HIV infection and mirrors marked cellular immune deficiency. We conclude that in HIV-infected patients all tumorous lesions should be biopsied because the clinical characteristics are often not specific enough for a definite diagnosis.

Localized scleroderma associated with Borrelia burgdorferi infection. Clinical, histologic, and immunohistochemical observations.

BACKGROUND: Recent reports have implicated Borrelia burgdorferi infection as a possible cause of localized scleroderma (LS). OBJECTIVE: Our purpose was to describe the clinical, histologic, and immunopathologic features of patients with LS who had serum antibodies to B. burgdorferi. METHODS: Ten patients were examined clinically and by routine microscopy. Biopsy specimens from seven patients were studied immunohistochemically with monoclonal antibodies. The proliferative response of peripheral blood mononuclear cells to B. burgdorferi was investigated in seven patients by lymphocyte proliferation assay. RESULTS: Seven patients had plaque-type morphea, and three patients had linear scleroderma. Two patients had a history of previous erythema migrans. One patient had coexistent acrodermatitis chronica atrophicans, and in two patients lichen sclerosus et atrophicus was observed. Histologically, a prominent inflammatory phase with sclerosis of the connective tissue was shown in all patients. Immunohistochemical studies revealed that the inflammatory infiltrates consisted of both B and T lymphocytes, predominantly of the CD4+ subset. All 10 patients had strongly elevated serum antibodies to B. burgdorferi. Patients with LS showed significantly elevated lymphoproliferative responses to B. burgdorferi when compared with healthy control subjects. CONCLUSION: Our findings suggest that some cases of LS are linked to Borrelia infection.

Localized unilateral hyperhidrosis.

We describe a case of localized unilateral hyperhidrosis on the forehead in a 52-year-old woman. The pathophysiology of this unique clinical picture and its treatment are described.