Report of 2 Novel Presentations of Subcutaneous Fat Necrosis of the Newborn.

Subcutaneous fat necrosis of the newborn (SCFNN) is a rare form of panniculitis classically affecting healthy full-term infants. There are a number of predisposing factors including perinatal asphyxia. The condition generally has a benign course with spontaneous resolution, but monitoring for metabolic complications, in particular the potentially life-threatening complication of hypercalcaemia, is critical. The authors report 2 cases of preterm infants with perinatal asphyxia with atypical presentations of SCFNN: the first with bony involvement resembling Langerhans cell histiocytosis and with follicular pseudocarcinomatous hyperplasia on histology; and the second presenting with a huge haematoma requiring surgical debridement. Both cases were initially erroneously diagnosed as pyogenic infections.

Skin conditions in a South African tuberculosis hospital: Prevalence, description, and possible associations.

BACKGROUND: The current pandemic of tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection, the modern era of antiretroviral therapy, and the rising incidence of multidrug-resistant TB have led to a broader spectrum of skin conditions in patients hospitalized with TB. These factors also influence investigations into possible causal relationships with TB. OBJECTIVES: The aim of this study was to describe mucocutaneous conditions found in patients hospitalized with TB and to report associated factors. METHODS: A cross-sectional observational study examining the spectrum of skin manifestations found in 105 patients hospitalized with TB was conducted. All relevant demographic and clinical data were collected. Possible associations were evaluated by making use of statistical analysis. RESULTS: Seventy-four (70%) of the investigated population were HIV-positive, and 46 (44%) patients were being treated for drug-resistant TB. The most prevalent dermatosis was xerosis (n = 83, 79%), followed by oral candidiasis (n = 33, 31%) and scars (n = 33, 31%), finger clubbing (n = 31, 29%), leukonychia (n = 29, 28%), striae (n = 25, 24%), and facial hyperpigmentation (n = 22, 21%). Anemia was detected in 90 (86%) patients, and 75 (71%) were classified as being underweight. Three patients were diagnosed with cutaneous TB. CONCLUSIONS: Patients hospitalized with TB have on average four different dermatoses, but xerosis remains the leading dermatological finding, irrespective of HIV status or TB drug sensitivity. Anemia and malnutrition are associated with numerous skin conditions found in this population. The prevalence of cutaneous TB among patients hospitalized with TB remains low, despite the high rate of TB and HIV co-infection.

A Review and Proposed Approach to the Neutrophilic Dermatoses of Childhood.

Neutrophilic dermatoses (NDs) are inflammatory skin conditions that are not associated with infection. The classification and clinical approach to these conditions in children is poorly described. This review classifies these conditions into five nosological subtypes: Sweet's syndrome, pyoderma gangrenosum, aseptic pustules, neutrophilic urticarial dermatoses, and Marshall's syndrome. In addition, we review the various secondary diseases that need to be excluded in the clinical management of the NDs of childhood, with a focus on the autoinflammatory conditions that the reader may not be familiar with. We propose a practical clinical approach to these disorders.

Fine-needle aspiration cytology of subcutaneous fat necrosis of the newborn: the cytology spectrum with review of the literature.

Subcutaneous fat necrosis of the newborn is a rare, transient panniculitis of full-term infants. Diagnosis is usually made clinically; however, a biopsy is sometimes required. Fine-needle aspiration biopsy (FNAB) offers an alternative to biopsy. The cytology shows a spectrum of changes ranging from clumped lobules of fat with opaque cytoplasm to necrotic aspirates with dispersed fat cells with opaque cytoplasm, foamy macrophages, multinucleated giant cells, lymphocytes, and neutrophils. Radially orientated, refractile, needle-shaped crystals are visible in the cytoplasm of the fat cells and loose lying in the necrotic background. FNAB offers an alternative to biopsy with good results.

Acne guideline 2005 update.

OBJECTIVE: The guidelines on the management of acne vulgaris have been developed in an attempt to improve the outcomes of acne treatment in South Africa. This extremely common condition has a major impact on the quality of life of South African young people and it is expected that if implemented, these guidelines will play a role in improving this situation. RECOMMENDATIONS: All health care workers involved in the management of acne should take note of these guidelines and endeavour to implement them in clinical practice. All treatment methods and procedures not substantiated by evidence from the literature should be discontinued and avoided to decrease the financial burden of acne treatment. VALIDATION: These guidelines were developed through general consensus by a group of about 40 internationally recognised experts in the field of acne treatment (the Global Alliance to Improve Outcomes in Acne, see details below) and further refined for South African circumstances by the majority of South African dermatologists who attended a series of six discussions held in the major centres of South Africa during 2004. GUIDELINE SPONSOR: The meetings of the Global Alliance to Improve Outcomes in Acne as well as the South African discussion meetings were sponsored by Galderma.