Position statement: Recommendations on the diagnosis and treatment of Malassezia folliculitis.

Malassezia is a lipophilic yeast that is a part of the human mycobiome. Malassezia folliculitis appears when the benign colonization of the hair follicles, by the Malassezia yeasts, becomes symptomatic with pruritic papules and pustules. Although Malassezia folliculitis is common in hospital departments, diagnosing and treating it varies among dermatologists and countries. The European Academy of Dermatology and Venereology Mycology Task Force Malassezia folliculitis working group has, therefore, sought to develop these recommendations for the diagnosis and management of Malassezia folliculitis. Recommendations comprise methods for diagnosing Malassezia folliculitis, required positive findings before starting therapies and specific treatment algorithms for individuals who are immunocompetent, immunocompromised or who have compromised liver function. In conclusion, this study provides a clinical strategy for diagnosing and managing Malassezia folliculitis.

Emerging antifungal treatment failure of dermatophytosis in Europe: take care or it may become endemic.

BACKGROUND: Dermatophytosis is a world-wide distributed common infection. Antifungal drug resistance in dermatophytosis used to be rare, but unfortunately the current Indian epidemic of atypical widespread recalcitrant and terbinafine-resistant dermatophytosis is spreading and has sporadically been reported in Europe. OBJECTIVES: To explore the occurrence of clinical and mycological proven antifungal drug resistance in dermatophytes in Europe. METHODS: A standardized questionnaire was distributed through the EADV Task Force of Mycology network to dermatologists in Europe. RESULTS: Representatives from 20 countries completed the questionnaires of which 17 (85 %) had observed clinical and/or mycological confirmed antifungal resistance, two countries published cases of antifungal resistance and one country had no known cases. CONCLUSIONS: This pilot study confirms that both clinical and mycological antifungal resistance exist in Europe.

Paediatric nail consultation in an academic centre in Belgium: a 10-year retrospective study.

BACKGROUND: Very few studies have been conducted to establish the nature and prevalence of nail disorders in children. OBJECTIVES: To determine the frequency of various nail conditions in the paediatric setting and to report their management and follow-up. METHODS: This was a retrospective study between 2007 and 2017 of children under 18. All the patients were evaluated in our paediatric nail clinic at the dermatology department of Queen Fabiola Children's University Hospital. The data were synthesized from information obtained through medical records as well as from photographs taken during consultation. Follow-up was completed by phone interview. RESULTS: Three hundred and one patients were included. The majority of nail abnormalities involved the toenails (57.6%). The most common clinical signs were, in descending order, Beau's lines, pachyonychia, subungual hyperkeratosis and onycholysis. The most frequent diagnoses were fever-related Beau's lines or onychomadesis (9.7%), trachyonychia (8.4%), longitudinal melanonychia (8.1%) and congenital malalignment of the great toenail (8.1%). The main diagnoses by age group were as follows: congenital hypertrophy of the lateral nail folds (21.4%) [0-2 years old]; fever-related Beau's lines or onychomadesis (21%) [2-6 years old]; trachyonychia (22%) [6-12 years old]; and juvenile ingrown nail (21.4%) [12-18 years old]. Management included clinical observation for 119 patients and specific advices for 108 patients. A treatment was prescribed for 134 patients, topical in 76.5% of cases. Follow-up demonstrated complete healing in 50.6% of patients and improvement in 19.7%. CONCLUSION: The most frequent nail disorders are benign, and their distribution varies with age. Management mainly involves conservative care, and the prognosis is favourable in the majority.

A survey among dermatologists: diagnostics of superficial fungal infections - what is used and what is needed to initiate therapy and assess efficacy?

BACKGROUND: Superficial fungal infections are common. It is important to confirm the clinical diagnosis by mycological laboratory methods before initiating systemic antifungal treatment, especially as antifungal sensitivity and in vitro susceptibility may differ between different genera and species. For many years, the gold standard for diagnosis of superficial fungal infections has been direct fungal detection in the clinical specimen (microscopy) supplemented by culturing. Lately, newer molecular based methods for fungal identification have been developed. OBJECTIVE: This study was initiated to focus on the current usage of mycological diagnostics for superficial fungal infections by dermatologists. It was designed to investigate whether it was necessary to differentiate between initial diagnostic tests and those used at treatment follow-up in specific superficial fungal infections. METHODS: An online questionnaire was distributed among members of the EADV mycology Task Force and other dermatologists with a special interest in mycology and nail disease. RESULTS: The survey was distributed to 62 dermatologists of whom 38 (61%) completed the whole survey, 7 (11%) partially completed and 17 (27%) did not respond. Nearly, all respondents (82-100%) said that ideally they would use the result of direct microscopy (or histology) combined with a genus/species directed treatment of onychomycosis, dermatophytosis, Candida- and Malassezia-related infections. The majority of the dermatologists used a combination of clinical assessment and direct microscopy for treatment assessment and the viability of the fungus was considered more important at this visit than when initiating the treatment. Molecular based methods were not available for all responders. CONCLUSION: The available diagnostic methods are heterogeneous and their usage differs between different practices as well as between countries. The survey confirmed that dermatologists find it important to make a mycological diagnosis, particularly prior to starting oral antifungal treatment in order to confirm the diagnose and target the therapy according to genus and species.

Onychopapillomas: a 68-case series to determine best surgical procedure and histologic sectioning.

BACKGROUND: Onychopapilloma (OP) is a benign longitudinal nail bed tumour usually presenting as longitudinal erythronychia. Evidence-based recommendations for proper histologic sectioning and definitive surgical management are not available. OBJECTIVES: The aim of this study was threefold. The first was to review the clinical and histopathological features of all OP diagnosed in our department. The second was to identify the most accurate histological technique. The third aim was to determine the most effective surgical procedures by examining recurrence rates and complications over the long term. METHODS: This retrospective analysis collected all patients with OP in the dermatology department of Saint-Pierre - Brugmann University Hospital (Brussels, Belgium) between January 2007 and March 2017. Clinical findings and type of surgery performed were recorded from medical files and iconographic documents. All slides were reviewed by a dermatopathologist with expertise in nail disease. Longitudinal follow-up was performed. RESULTS: A total of 68 patients were included (42 women, 26 men) with a median age of 46 years. Two children were 9 and 11. The histological interpretation was more difficult for the transverse sections than for the longitudinal ones (29.4% vs. 2.2%). The pathological diagnosis of OP was typical in 30.6%, suggestive in 51.6%, slightly suggestive in 12.9% and not contributive in 4.8%. 50 patients had a mean follow-up of 50 months. 38% recovered completely and 20% recurred. 42% had mild to moderate sequelae. CONCLUSIONS: We report herein the first two paediatric cases. Classical longitudinal excision with careful removal of the lesion from the inferior face of the nail plate seems to be the most accurate surgical technique. In the pathology laboratory, longitudinal sections should be recommended. In our series, a recurrence rate of 20% was observed. This was more frequent when a tangential longitudinal excision was performed.

How to diagnose and treat symptomatic anterior cervical osteophytes?

INTRODUCTION: Forestier disease, a cervical anterior form of diffuse idiopathic skeletal hyperostosis (DISH) is electively diagnosed in the elderly population. ENT symptoms are likely prevalent (dysphagia, and less frequently dysphonia, dyspnea, etc.), but diagnosis and the relation between symptoms and anterior longitudinal ligament ossification can be difficult to demonstrate. Starting from two clinical cases and a review of the literature, the authors propose a diagnostic and therapeutic course of action. MATERIALS AND METHODS: A typical description of Forestier disease is related based on the cases of two 80- and 79-year-old men referred with gradually worsening swallowing problems leading to dysphagia. Both underwent surgical resection of cervical osteophytes via a lateral cervical approach after failure of the medical treatments. DISCUSSION: Based on the clinical presentations and the analysis of the literature, the authors describe the clinical features of the cervical anterior form of DISH presenting with ENT symptoms. The diagnosis and conservative therapeutic, and surgical management of anterior cervical hyperostosis based on ongoing gradual solutions are described.

[Risk factors for home deaths due to pneumonia among low socioeconomic level Chilean children, Santiago de Chile (1994)]. / Factores de riesgo de fallecer en domicilio por neumonía, de niños chilenos de estratos socioeconómicos bajos, Santiago de Chile (1990-1994).

BACKGROUND: Pneumonia is the main cause of late infant mortality in Chile. Over 60% of these deaths occur at home. The lack of hospital beds and the inadequate outpatient management are contributing factors. AIM: To assess risk factors for home deaths due to pneumonia in Chilean children. PATIENTS AND METHODS: The clinical and environmental histories of 53 (39 male) children that died due to pneumonia in their homes were analyzed. The cause of death was confirmed by necropsy with histopathological studies in all cases. These cases were compared with 88 control children of similar age, gender, socioeconomic status and living in the same geographical area of Metropolitan Santiago. RESULTS: Fifty four percent of deceased children were of less than 3 months of age and only 3 cases and their controls were above 1 year old. Identified risk factors for death were malnutrition with an odds ratio of 30.6 (CI 3.9-64.8, p < 0.001), low birth weight with an odds ratio of 5 (CI 1.8-14.1, p < 0.001), previous admissions to hospitals with an odds ratio of 5.79 (CI 2-17.1, p < 0.001), congenital malformations (mainly cardiac) with an odds ratio of 8.4 (CI 2-39.9, p = 0.001) and a history of bronchial obstruction with an odds ratio of 5.68 (p < 0.001). Identified maternal risk factors were smoking with an odds ratio of 4.13 (CI 1.6-10.7 p < 0.001) and being a teenager with an odds ratio of 4.3 (CI 1.7-11, p < 0.001). Malnutrition, low birth weight, history of previous hospital admissions and having a teenager or smoker mother were considered as independent risk factors using a stepwise analysis. CONCLUSIONS: Chilean low income children have identifiable risk factors for death at their homes due to pneumonia, that can be preventively managed.