Dermatitis artefacta: unusual appearance in an older woman.

Dermatitis artefacta is a rare and difficult condition for diagnosis and treatment, with the highest incidence of onset in late adolescence to early adult life. Most patients are young women who have a personality disorder; borderline features are common and the patient's denial of psychological distress makes management and treatment difficult. Patients use a variety of means to cause the skin changes. Clinical presentation of the skin lesions does not conform to those of known dermatoses and are located on easily reached parts of the skin. We report an unusual case of a 72-year-old woman with symmetrical changes under the breasts and in the right inguinal region. The lesions were composed partly of haemorrhagic round lesions and partly of scars. A skin biopsy was taken and consultations with the psychiatrist, internist and the patient's family led to the diagnosis of self-induced dermatitis. The skin lesions were covered by occlusion techniques and the lesions improved very rapidly. The patient was discharged from the hospital under psychiatric and family care.

Effect of infection with Trichophyton mentagrophytes varietas interdigitale on phagocytosis in humans.

BACKGROUND AND AIM: Phagocytosis by polymorphonuclear leucocytes (PMNLs) and macrophages is important in the defence of human organisms, especially in mycotic infections of the skin. The aim of this study was to examine the relationship between phagocytosis and a chronic type of infection with Trichophyton mentagrophytes varietas interdigitale (T. m. var. interdig.). MATERIALS AND METHODS: A group of 256 patients was investigated from 1990 to 2000. They were all treated with terbinafine. The parameters for phagocytosis were analysed by the Hersy method. RESULTS: The immunological status of all of the patients was altered. Ingestion, digestion and random mobility decreased significantly (P < 0.001). Out of 256 patients treated with terbinafine, 196 (76%) were cured completely and the values for phagocytosis became normal. CONCLUSION: This investigation confirms the defect in the function of phagocytes of patients chronically infected by T. m. var. interdig. Terbinafine was shown to be an effective antimycotic drug, both fungicidal and immunostimulative.

Itraconazole and terbinafine treatment of some nondermatophyte molds causing onychomycosis of the toes and a review of the literature.

BACKGROUND: Onychomycosis may be caused by dermatophytes (which form the majority of organisms), Candida species, and nondermatophyte molds. OBJECTIVE: To evaluate the efficacy and safety of itraconazole and terbinafine in the treatment of some nondermatophyte molds that cause toe onychomycosis and to review the literature on the treatment of nondermatophyte mold toe onychomycosis using the oral antifungal agents. PATIENTS AND METHODS: Patients with nondermatophyte mold toe onychomycosis were treated in an open, prospective manner with either itraconazole (pulse) or terbinafine therapy. In each instance, light microscopic examination was consistent with the diagnosis of a nondermatophyte mold. For each patient, mycological evaluation of the target nail resulted in 3 or more successive cultures yielding growth of the mold alone. RESULTS: All 15 patients had onychomycosis of the toes which was of the distal and lateral type. The patients were treated with itraconazole given as the standard 3 pulses with additional pulses administered depending upon the response exhibited by the toe onychomycosis in the patient. Similarly, terbinafine was given for 12 weeks with additional therapy administered as dictated by the response. Efficacy parameters were mycological cure (MC) and clinical cure (CC). Mycological cure was negative light microscopic examination (KOH) and culture. Clinical cure was the appearance of a completely normal-looking nail. At month 12 from the start of treatment, the response was as follows: Scopulariopsis brevicaulis: itraconazole (MC 4/4, CC 2/4) and terbinafine (MC 0/1, CC 0/1), Fusarium species: itraconazole (MC 1/1, CC 1/1) and terbinafine (MC 0/1, CC 0/1), Aspergillus species: itraconazole (MC 5/6, CC 3/6), Alternaria alternata: itraconazole (MC 0/1,CC 0/1), and Onychocola canadensis: itraconazole (MC 1/1, CC 0/1). There were no significant clinical or laboratory adverse effects. CONCLUSIONS: In the present series itraconazole demonstrated efficacy against onychomycosis of the toenails caused by S. brevicaulis and Aspergillus species. A review of the literature confirms our experience with itraconazole and further suggests that terbinafine may also demonstrate efficacy against cases of S. brevicaulis and Aspergillus toe onychomycosis. Additionally, reports in the literature suggest that pedal onychomycosis caused by Fusarium species may also show response to itraconazole and terbinafine. For the other species, there are fewer data, making it difficult to draw conclusions.

Syringoid eccrine carcinoma.

A rare case of a syringoid eccrine carcinoma in a 52-year-old male patient is described. During the first hospitalization, syringoma was diagnosed, both clinically and histologically, keeping in mind the possibility of its malignant alteration. Difficulties in making a diagnosis with histological and immunohistochemical examinations are reported. The possibility of differential diagnosis of primary breast carcinoma and methods of its exclusion are also described. Treatment of the patient was surgical with good results.

Efficacy of itraconazole, terbinafine, fluconazole, griseofulvin and ketoconazole in the treatment of Scopulariopsis brevicaulis causing onychomycosis of the toes.

BACKGROUND: Scopulariopsis brevicaulis is a common non-dermatophyte mould that can cause onychomycosis. OBJECTIVE: To evaluate the efficacy and safety of the oral antifungal agents griseofulvin, ketoconazole, itraconazole, fluconazole and terbinafine in the treatment of S. brevicaulis. PATIENTS AND METHODS: In a prospective, comparative, parallel-group, single-blinded, randomized, non-industry-sponsored study, patients with toe onychomycosis caused by S. brevicaulis sp. were randomized and treated with one of 5 oral antifungal agents, i.e. griseofulvin, ketoconazole, itraconazole (pulse), fluconazole or terbinafine. The treatment regimens were: griseofulvin 600 mg twice daily for 12 months, ketoconazole 200 mg daily for 4 months, itraconazole pulse therapy given for 3 pulses, with each pulse consisting of 200 mg twice daily for 1 week with 3 weeks off between successive pulses, terbinafine 250 mg daily for 12 weeks and fluconazole 150 mg daily for 12 weeks. RESULTS: There were 59 patients (48 males, 11 females, mean age 35.6 years, range 25-53 years). All patients had clinical evidence of distal and lateral onychomycosis, with moderate to severe disease of the target nail. Between the treatment groups there was no significant difference in the mean age of the patients or the mean area of involvement with onychomycosis at baseline. The efficacy parameters were clinical cure (CC) and mycological cure (MC). At month 12 after the start of treatment, the response was: griseofulvin, CC 3/11, MC 0/11, CC + MC 0/11; ketoconazole, CC 10/12, MC 8/12, CC + MC 8/12; itraconazole, CC 12/12, MC 12/12, CC + MC 12/12; terbinafine, CC 12/12, MC 11/12, CC + MC 11/12, and fluconazole, CC 8/12, MC 8/12, CC + MC 8/12. Adverse effects consisted of: griseofulvin, gastro-intestinal symptoms, allergic reaction, photodermatitis, hepatic and renal dysfunction in 11 patients with discontinuation of treatment in 3 patients; ketoconazole, hepatic dysfunction but no symptomatic changes in 2 patients; itraconazole, nausea and vomiting in 2 patients; terbinafine, taste disturbance in 2 patients, nausea in 3 patients, and fluconazole, severe gastro-intestinal events in 5 patients. None of the patients receiving ketoconazole, itraconazole, terbinafine or fluconazole discontinued treatment. CONCLUSIONS: Itraconazole and terbinafine demonstrate efficacy against some cases of S. brevicaulis toe onychomycosis. These agents also appear to be safe in the course of therapy for toe onychomycosis. Griseofulvin is ineffective against toe onychomycosis caused by S. brevicaulis. Ketoconazole is not recommended for toe onychomycosis given its potential for adverse effects, particularly with the availability of the newer antifungal agents.

[Therapy of onychomycosis]. / Terapijske mogucnosti u lijecenju onihomikoza.

The most important data about etiology, clinical signs, diagnostic methods and the most frequent therapeutic modalities in the field of onychomycoses are presented in the introduction. In a 6-month clinical study 141 patients with onychomycosis were registered. The data on 88 patients, divided into 4 groups according to clinical findings and therapeutic regimen, were evaluated. The best therapeutic results in the treatment of onychomycoses were obtained using antifungal agents such as amorolfine and terabinafine, especially combining systemic and local therapy.

Frequency of skin cancer and other ultraviolet radiation provoked skin lesions of eyelid and periocular region in the 1981-1992 period.

It is well known that the region of eyelids and periocular skin is exposed to ultraviolet radiation (UV rays), so it is the location of skin changes associated with the effects of this radiation. The analysis of basal cell carcinomas, keratoses, keratoacanthomas and cornu cutaneum of this regions covered a 12-year period. In the total of 1,398 skin biopsies from the Department of Ophthalmology, Sestre Milosrdnice University Hospital from Zagreb, the above mentioned lesions were found in 498 cases. Most frequent were basal cell carcinomas (BCC), found in 377 cases, followed by squamous cell carcinoma (SCC) in 64, keratoses in 37, cornu cutaneum in 8 and keratoacanthoma in 12 cases. As BCC was the most frequent finding in the bioptic material from this clinic, special emphasis was put on this tumor, its age and sex distribution, and localization. In the discussion and material analysis, particular reference is given to the causative relation with the effects of UV radiation. As a special contribution to the discussion on the connection of these changes with UV radiation, 3 cases with the occurrence of BCC and seborrheic keratoses in the same lesion and a patient with senile elastosis and BCC in the same segment of the skin of an eyelid are described.

Interferon reduces recurrences of basal cell and squamous cell cancers.

BACKGROUND: Interferon is considered to be an important curative agent for dermatologic diseases. We report the follow-up experience of patients with basal cell or squamous cell carcinomas treated with human natural leukocyte interferon (HNLI). RESULTS: Among 52 patients with basal cell carcinoma (BCC) treated with HNLI more than 10 years ago, and among 58 treated more than 5 years ago, only 2 recurrences were observed. There were no recurrences in 75 patients who had a complete response to HNLI treatment, nor were there any in 20 patients with either a partial or complete response to r.IFM alpha 2c treatment. Of 52 patients with squamous cell carcinoma (SCC), 31 had been treated more than 10 years earlier, two recurrences of the disease at the site of the original lesion were observed. CONCLUSION: Interferon treatment makes it possible to achieve a persistent cure in patients with BCC and SCC in a high proportion of cases. The potential advantage of nonsurgical treatment are an enhancement of cosmetic results through the prevention of destruction of important anatomic structures.

Pyoderma gangrenosum.

The authors summarize recent data on the etiopathogenesis and therapy of pyoderma gangrenosum and report on a 72-year-old patient for years suffering from recurring nodose lesions on his forelegs. The ulcerations first appeared a month before the patient's admission to author's Department. The course of the disease, patient's history and comprehensive clinical and laboratory findings pointed to the diagnosis of pyoderma gangrenosum. The patient was treated with systemic application of corticosteroids, and this therapy proved very effective.

Defective phagocytosis in chronic trichophytosis.

Chronic trichophytosis as a primary clinical entity (primary chronic trichophytosis, PCT) is increasingly encountered in the literature. Its prevalent cause in Croatia is the anthropophilic form of Trichophyton interdigitale. Chronicity of the disease may result from immunological defects of the patients. Thus, in 62 patients with PCT: skin testing, enumeration of T- and B-lymphocytes in the peripheral blood, quantitation of immunoglobulin classes, and phagocytosis (random mobility, ingestion, digestion and extracellular killing) by peripheral blood leukocytes was tested. The findings were compared to those in healthy persons. Defective phagocytosis (random mobility, ingestion and digestion) was found in patients with PCT (P < 0.001). All the other results were within the control range. Therefore, PCT seems to be associated with defective phagocytosis of peripheral blood leukocytes in affected persons.

[Usefulness and value of allergical tests in stomatology]. / Primjena i znacaj alergoloskih testova u stomatologiji.

A four year study was carried out on 52 patients with allergic changes of oral mucosa. The most frequent symptoms were oedema of mucosae, stomatitis and glossitis. In 35 patients, by use of allergic tests, we have found the cause of the disease, mostly in the group of nutritive, contact or inhalatory allergens. At 17 patients allergic tests were negative, but we have found the cause of changes at 8 patients. It was intestinal parasitosis or focalosis. At 9 patients all results of tests and clinical findings were normal, but they all had a good reaction on anti-allergic therapy with antihistamines. Collaboration between allergologist and stomatologist could improve our results on that field.