Reasonable Accommodation and Disparate Impact: Clean Shave Policy Discrimination in Today's Workplace.

This article examines Bey v. City of New York - a recent Second Circuit case where four Black firefights suffering from Pseudofolliculitis Barbae (a skin condition causing irritation when shaving which mostly affects Black men) challenged the New York City Fire Department's Clean Shave Policy - with an intersectional approach utilizing legal theories of racial, disability, and religious discrimination.

Suppressive therapy using azithromycin in 2 rare cases of recurrent staphylococcal infections.

Recurrent staphylococcal skin and soft tissue infections may recur despite decontamination and multiple courses of antibiotic therapy and may dramatically impair the patient's quality of life. We report successful use of long-term azithromycin prophylaxis in a recurrent laryngitis and a scalp folliculitis due to methicillin-susceptible Staphylococcus aureus.

Eczema herpeticum with herpetic folliculitis after bone marrow transplant under prophylactic acyclovir: are patients with underlying dermatologic disorders at higher risk?

We present an unreported coexistence: eczema herpeticum (EH) with histopathological findings of herpetic folliculitis (HF) after allogeneic bone marrow transplantation (BMT). A patient with atopic dermatitis (AD) underwent allogeneic BMT for idiopathic acquired aplastic anemia. She had been receiving cyclosporine (150 mg/12 h) and acyclovir (400 mg/12 h) for 6 months. A facial rash was observed, composed of monotonous erythematous, umbilicated papulo-vesicles and papulo-crusts <4 mm in size. The histopathological study showed herpetic cytopathic changes within the epidermis that extended into the hair follicle epithelium. Interestingly, microscopic HF has not previously been associated with post-transplant patients or EH. However, it is reasonable to hypothesize that the coexistence of these herpes simplex virus-related events may be underreported in the literature. Although further studies are necessary, we suggest that the prophylactic antiviral dose after BMT be enhanced in patients with underlying dermatologic diseases, especially in those with AD.

Nódulo centrofacial de reciente aparición / A Midfacial Nodule of Recent Onset

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Folliculitis induced by EGFR inhibitors, preventive and curative efficacy of tetracyclines in the management and incidence rates according to the type of EGFR inhibitor administered: a systematic literature review.

INTRODUCTION: Folliculitis is the most common side effect of epidermal growth factor receptor (EGFR) inhibitors (EGFRIs). It is often apparent, altering patients' quality of life and possibly impacting compliance. Variations in terms of the treatment-related incidence and intensity have not been fully elucidated. Tetracyclines have been recommended for the prophylaxis and treatment of folliculitis but their efficacy is yet to be established. MATERIALS AND METHODS: We carried out two systematic literature reviews. The first assessed the preventive and curative efficacy of tetracyclines. The second assessed the incidence of grade 3-4 folliculitis in the main clinical studies published. RESULTS: In four randomized studies, preventive tetracycline treatment was associated with a significantly lower incidence of grade 2-3 folliculitis and a better quality of life in three of the four studies. In curative terms, tetracycline efficacy was not evaluated in any randomized study, but an improvement in grade ≥2 folliculitis was reported in case series. The frequency and severity of folliculitis seem to be greater with the antibodies than with the tyrosine kinase inhibitors. Analysis restricted to lung cancer studies showed a statistically greater incidence in terms of grade 3-4 folliculitis with cetuximab (9%) and erlotinib (8%) than with gefitinib (2%) (p < .0001). CONCLUSION: Unless contraindicated, a tetracycline should be routinely prescribed prophylactically for patients treated with an EGFRI (level of evidence, B2). In curative therapy, the level of evidence for tetracycline efficacy is low (level of evidence, D). The incidence of grade 3-4 folliculitis induced by EGFRIs appears to be lower with gefitinib.

Incontinence in the aged: contact dermatitis and other cutaneous consequences.

Urinary and faecal incontinence affects a significant portion of the elderly population. The increase in the incidence of incontinence is not only dependent on age but also on the onset of concomitant ageing issues such as infection, polypharmacy, and decreased cognitive function. If incontinence is left untreated, a host of dermatological complications can occur, including incontinence dermatitis, dermatological infections, intertrigo, vulvar folliculitis, and pruritus ani. The presence of chronic incontinence can produce a vicious cycle of skin damage and inflammation because of the loss of cutaneous integrity. Minimizing skin damage caused by incontinence is dependent on successful control of excess hydration, maintenance of proper pH, minimization of interaction between urine and faeces, and prevention of secondary infection. Even though incontinence is common in the aged, it is not an inevitable consequence of ageing but a disorder that can and should be treated. Appropriate clinical management of incontinence can help seniors continue to lead vital active lives as well as avoid the cutaneous sequelae of incontinence.

Pseudofolliculitis barbae: review and update on new treatment modalities.

Pseudofolliculits barbae, PFB, is a common cutaneous disease encountered frequently in medical practice. PFB represents a chronic inflammatory condition of the hair follicle caused by ingrown hairs producing an inflammatory foreign body reaction. The pathogenesis of PFB is multifactorial. Factors such as hair type and direction of hair growth play a role in the initial inflammatory reaction. In the armed forces, PFB represents a real challenge for both the physician and the patient. The combat environment, with the recent threat of biological and chemical weapons, requires the servicemen to be clean-shaven for appropriate gas mask fitting around the face. This article will review the etiology, pathogenesis, classification, and newer treatment modalities in the management of PFB.

A double-blind trial of colchicine in Behçet's syndrome.

OBJECTIVE: Colchicine is a widely used treatment for Behçet's syndrome, even though in a previous 6-month controlled study, it was shown to be effective only in controlling erythema nodosum and arthralgias. We reassessed the effect of colchicine in Behçet's syndrome in a study conducted among a larger group of patients for 2 years. METHODS: We randomized 116 patients with Behçet's syndrome (60 male/56 female), who had active mucocutaneous disease without eye or major organ involvement, to receive either placebo or colchicine (1-2 mg/day, adjusted to body weight) in a double-blind trial for 2 years. The primary outcome measure was the sustained absence of any lesions during treatment (complete response). The secondary outcome measure was the difference in the number of mucocutaneous lesions or arthritic joints between the active drug and placebo arms. Women and men were analyzed separately. RESULTS: Eighty-four patients (72%; 45 male, 39 female) completed the 24-month study. Kaplan-Meier analyses showed significantly more complete responses in the colchicine treatment group in terms of reduced occurrence of genital ulcers (P = 0.004), erythema nodosum (P = 0.004), and arthritis (P = 0.033) among the women, and reduced occurrence of arthritis (P = 0.012) among the men. The mean numbers of genital ulcers (P = 0.001), erythema nodosum lesions (P = 0.002), and arthritic joints (P = 0.014) among the women were less in the colchicine group, and the mean number of arthritic joints (P = 0.026) among the men was less in the colchicine group. Adverse effects were similar in both groups. CONCLUSION: Colchicine may be useful for treating some of the manifestations of Behçet's syndrome, especially among women. This might be a reflection of less severe disease among the women.

Dermatosis bacterianas en el medio laboral / Bacterial dermatosis in the occupational environment

Dentro de los distintos grupos profesionales, las infecciones bacterianas se dan con mayor frecuencia en aquellos trabajadores que se exponen a animales o a sus productos, manejan utensilios cortantes, trabajan al aire libre o están en contacto con parásitos o insectos. Se revisan inicialmente las infecciones cutáneas producidas por estafilococos y estreptococos, que son las más frecuentes. Después se exponen las enfermedades relacionadas con el contacto con animales o sus productos (carbunco, brucelosis, erisipeloide de Rosenbach, muermo y fiebre por mordedura de rata). Dentro de las infecciones asociadas a un contacto casual con animales se comentan la tularemia, la leptospirosis y la infección por Pasteurella multocida, y también la tuberculosis verrugosa cutánea, las infecciones por Mycobacterium marinum, Salmonella dubtin, Pseudomona aeruginosa, así como por Corynebacterium spp. Por último se repasan las normas preventivas para evitar estas dermatosis (AU)

Hot tub dermatitis: a familial outbreak of Pseudomonas folliculitis.

Pseudomonas folliculitis resulting from the use of spa pools, whirlpools, and hot tubs is a newly described disease that typically develops 8 to 48 hours after exposure in a contaminated facility. The eruption consists of pruritic papules, papulopustules, nodules, and urticarial lesions on the trunk and extremities. A family of three and a neighbor developed Pseudomonas folliculitis after using a home hot tub from which P. aeruginosa was cultured. Skin biopsies showed an acute, suppurative folliculitis and dermal abscess formation. Although the eruption usually resolves spontaneously within 7 to 10 days, proper maintenance of equipment and adequate disinfectant levels are necessary to prevent its recurrence.

Methods for preventing pseudomonas folliculitis.

This outbreak highlights a number of significant factors related to most pseudomonas folliculitis outbreaks. The bath water had not been changed in more than four weeks which led to a build-up of high levels of organic carbon. There was an extended interval of six days between subsequent OTD chlorine residual tests, allowing the chlorine residual to decrease to low levels between tests. It should also be noted that the OTD test, by design, measures both the active free chlorine and the inactive combined chlorine residual. Therefore OTD residual readings in the low normal range may actually represent below normal free active chlorine residual levels. The following measures are suggested to reduce the growth of pseudomonads in hot tubs and whirlpool baths and to prevent subsequent cases of pseudomonas folliculitis: 1. The OTD chlorine residual should be checked every day. The residual should be well above the minimum level suggested for the bath. Or, preferably, an automatic chlorinator should be installed. This device measures the free chlorine residual and automatically adds chlorine to keep the residual in the desired range. 2. The water in the bath should be changed at least every eight weeks in order to reduce the total organic carbon level. The water should be changed more frequently if the bath is used by a large number of persons. 3. If an outbreak of pseudomonas folliculitis is associated with a bath, the water should be changed and the bath washed with a chlorine-based solution. Also, the method of keeping the chlorine residual in the operating range should be re-evaluated.

Pseudofolliculitis barbae. No 'pseudoproblem'.

Pseudofolliculitis barbae possibly affects 45% of all black servicemen and is a source of much misunderstanding and social unrest in the military. A recent study of 96 cases of pseudofolliculitis barbae has elucidated a successful shaving technique. It employs a 30-day period of beard regrowth to eliminate ingrown hairs, twice-daily use of a new polyester skin-cleansing pad, and use of solely electric hair clippers for facial hair removal. Ninety-six percent of those using this technique could thereafter conform to the Air Force grooming code.