Atypical exanthems: morphology and laboratory investigations may lead to an aetiological diagnosis in about 70% of cases.

BACKGROUND: Besides the six classical exanthems, other exanthems may occur, differing in morphology and causative agent (atypical exanthems). Their aetiological diagnosis is difficult but crucial for both the patient and community concerning issues such as time off school, immunizations, and risks for pregnant women and immunocompromised patients. OBJECTIVES: To investigate whether morphology, associated symptoms and laboratory results can help to determine the aetiology of atypical exanthems. METHODS: We studied 112 consecutive out-patients attending two university dermatology departments. Peripheral blood mononuclear cells (PBMC) and throat, rectal and vaginal swabs were studied to identify viral and bacterial growth. Nested polymerase chain reaction was performed on PBMC and plasma using specific primers for herpesviruses. Serology for common viruses was investigated. RESULTS: We classified the exanthems into seven morphological patterns: macular erythema (32 patients), papular erythema (eight), maculopapular erythema (42), maculopapular erythema with petechiae (seven), erythema with vesiculation (11), erythema with pustules (five) and urticaria (seven). On the basis of morphology, in concert with the associated symptoms and laboratory results, we found a causal relationship in 76 patients (68%): 25 cases due to drugs, 32 to viruses, 16 to bacteria and three to parasites. A good correspondence between morphology and aetiology was found. The erythematous-vesicular pattern was exclusive to viral infections and was often accompanied by enanthema. The erythemato-pustular and papular patterns were found only in drug-related cases and in some undiagnosed cases. In contrast, the macular and maculopapular patterns were almost evenly distributed among the various aetiologies, although their colour was duskier in the drug-related exanthems. Severe pruritus was associated with drug-related exanthems. CONCLUSIONS: This is the largest series of consecutive patients with atypical exanthems reported. Their morphology and their association with pruritus or constitutional symptoms proved to be important diagnostic clues.

Assessing hair shedding in children.

BACKGROUND: The wash test is currently used to assess hair shedding, though it lacks a cut-off point of normality and any evidence of being reliable. The aim of this study is to provide data to fulfil those needs. METHODS: The wash test was employed in a standardized way on 31 children aged 3-11 years. RESULTS: The test yielded 10.68 +/- 3.91 hairs, a figure which may be considered as 'normal' for children of that age. The chi(2) test granted the validity of the method. The number of shed hairs counted in the washing basin increased with the age of the subjects. COMMENT: The wash test proved to be reliable and to be a useful tool for monitoring hair shedding. The increasing trend with age may suggest a possible prepubertal onset of androgenetic alopecia.

Argon laser treatment of cutaneous multiple angiokeratomas.

BACKGROUND: Angiokeratomas are cutaneous vascular lesions with common clinical and histological features: dark red to black papules and ectasia of upper dermis vessels, respectively. Multiple angiokeratomas are difficult to treat because they are often too extensive for surgery and cautery, procedures frequently leading to hemorrhage and scarring. OBJECTIVE: Our report is designed to evaluate the efficacy of argon laser photocoagulation in the treatment of multiple angiokeratomas. METHODS: Two male patients affected by angiokeratoma circumscriptum and angiokeratoma of Fordyce, respectively, were treated using an argon laser under local anesthesia. The laser beam was used as a hemostyptic and to flatten vascular papules by photocoagulation. RESULTS: The cosmetic results of argon laser treatment were good. Posttreatment crusting lasted 2 weeks; 4 months later there was excellent healing without scarring. CONCLUSION: Angiokeratomas respond favorably to argon laser photocoagulation since vascular ectasias are localized in the papillary dermis. Thus, the argon laser offers significant advantages over traditional methods and produces no side effects.

[Splash rash dermatitis. A case]. / Follicolite da idromassagio ("splash rash dermatitis"). Un caso.

The Authors report a case of a folliculitis developed in a woman who used a spa with hydrojet circulation. This dermatitis is due to Pseudomonas aeruginosa, which can colonizes the closed-cycle water systems.

Falsely elevated urinary level of vanillylmandelic acid induced by griseofulvin.

A 6-year-old girl with mild hepatitis was found to have an elevated urinary level of vanillylmandelic acid (VMA), but no cause for the elevation was found. The patient was receiving griseofulvin for treatment of tinea capitis, and this drug was suspected of causing a falsely elevated urinary VMA level. Four other patients receiving griseofulvin were also found to have elevated urinary VMA levels. In one patient, urinary VMA level determined by an alternate method was normal.

Recurrent digital fibromatosis of childhood. An ultrastructural and immunohistochemical study of two cases.

Two cases of recurrent digital fibromatosis of childhood were studied by electron microscopy and immunohistochemistry, using rabbit anti-actin antisera. The tumor cells were typical myofibroblasts, containing inclusion bodies and bundles of microfilaments. Immunohistochemistry showed the presence of actin in these cells, thus proving the myofibroblastic nature of the tumors. Inclusions were negative or showed a weak annular positivity. A possible explanation of these findings is discussed.