Tinea on a Tattoo.

In the last twenty years, the prevalence of individuals with tattoos in the general population has increased in Europe (1) as well as in Australia (2) and the United States of America (3). A series of complications such as acute inflammatory reactions, allergic contact dermatitis (4,5), photoinduced, lichenoid, and granulomatous reactions (6, 7), pseudolymphoma (8), pseudoepitheliomatous hyperplasia (9), skin infections (6), and skin cancers (10) may occur on tattoos. Infectious complications on tattoos include bacterial infections (pyoderma, leprosy, syphilis, cutaneous tuberculosis, mycobacteriosis) (11-14), viral infections (molluscum contagiosum, warts, herpes simplex, hepatitis B and C) (15-17), and fungal infections (sporotrichosis, dermatophytosis) (18,19). We present the case of a 29-year-old immunocompetent female patient who was consulted for the development of an erythematous-squamous placard that appeared on a tattoo about 18 days after tattooing. Dermatological examination revealed a circular, erythematous, scaly plaque, with centrifugal growth and central resolution, presenting an active, raised, erythematous, vesiculopustular edge, giving the appearance of tinea corporis. The lesion's starting point was on the tattoo in two colors located on the middle third of the left calf and subsequently evolved to beyond the surface of tattoo (Figure 1). No other skin, scalp, or nail lesions were observed. Mycological examination of the material obtained by scraping of the scales and the vesicles from the edges and the surface of the plaque revealed numerous hyphae on direct microscopy examination, and white, flat colonies with a cottony surface and radial grooves developed in Sabouraud dextrose agar culture (Figure 2). Spindle-shaped, thick-walled macroconidia and a few pyriform microconidia were observed on microscopic examinations of the colonies. Based on macroscopic and microscopic characteristics, Microsporum canis was identified. Gram stain and bacterial culture results were negative. Patient history revealed the presence of a pet dog that was diagnosed with mycosis, the etiologic agent being M. canis. After 21 days of treatment with oral terbinafine (250 mg/day) and topical application of terbinafine 1% cream once a day, the lesion disappeared and mycological examination (direct microscopy and culture) was negative. In the case of tattoos, cutaneous inoculation of a dermatophyte may occur after 1-3 weeks of tattooing, corresponding to the healing phase of the tattoo application. Dermatophyte inoculation can be done by direct contact with an infected person or animal or, exceptionally, by telluric contamination. Despite the increasing number of tattooed people, there are only a few published cases of dermatophytosis arising on tattoos (19,20). Ammirati reported dermatophyte infection caused by Trichophyton tonsurans that occurred two weeks after tattooing, clinically presenting as concentric annular lesions with active vesiculopustular edges which progressively included the entire tattoo (19). Similarly, in our case the infection with M. canis occurred during the healing phase, the dermatophyte lesion occurring after 18 days from tattoo application by direct contact with the dog parasitized with M. canis. In conclusion, dermatophyte infection of tattoos remains possible, although rare.

Prevalence and antifungal susceptibility patterns of dermatophytes isolated from patients with neoplastic diseases: a case control study.

Patients with neoplasia who are severely immunocompromised have a higher risk of fungal infections. There are limited data in the literature regarding the frequency of dermatophyte infections and efficacy of antifungals in patients with malignancies. Objective was assessment of the incidence of dermatophyte infections and antifungal susceptibility, determination of dermatophyte species isolated from patients with neoplastic diseases. 138 patients diagnosed with various malignancies and 160 immunocompetent patients who were referred to the Department of Dermatology in Brasov, Romania, for suspicion of dermatophyte infections were included in the study. Nail clippings or skin scrapings were examined by direct microscopy and cultures in Sabouraud agar medium. Susceptibility tests for antifungals were conducted in vitro using a method of broth microdilution. Infections with dermatophytes were identified in 30.4% of patients with neoplastic diseases and in 29.37% in the control group. There was a significantly higher frequency of dermatophyte infections in patients with hematologic malignancies (52%) compared to those with solid cancers (25.66%) (P=0.01). The clinical aspects of dermatophyte infections in patients with neoplastic diseases were not different from those of patients without cancer; though in some cases the infections were more extensive. There were no statistically significant differences between mean values of minimum inhibitory concentration of antifungals compared with controls. Terbinafine had the highest antidermatophyte activity for all tested dermatophyte species isolated from patients with neoplastic diseases. There were no differences in frequency of dermatophyte infections and antifungal susceptibility to dermatophytes between patients with neoplastic diseases and immunocompetent patients.

Cardiovascular risk factors in patients with chronic plaque psoriasis: a case-control study on the Brasov County population.

Many studies have suggested that cardiovascular risk factors seem to be more common in patients with psoriasis than in the general population. In this study we aimed to determine the prevalence of cardiovascular risk factors in patients with chronic plaque psoriasis depending on the severity of disease. We conducted a prospective study in Brasov County (Romania) including 142 patients with chronic plaque psoriasis and disease duration of at least six months and 167 controls without psoriasis. The severity of psoriasis was assessed using the psoriasis area and severity index (PASI) score. Along with a thorough medical history and physical examination, serum lipid profile and fasting plasma glucose tests were carried out. The 10-year Framingham risk score (FRS) for general cardiovascular disease, which includes age, gender, total cholesterol, HDL-cholesterol, systolic blood pressure, smoking status, and diabetes mellitus, was applied. The severity of chronic plaque psoriasis was mild in 32 patients (22.53%) and moderate to severe in 110 patients (77.47%). We found a significant higher prevalence of metabolic syndrome in the patient group compared to controls. Individual components of metabolic syndrome like waist circumference, elevated triglycerides, reduced HDL-C, impaired fasting plasma glucose, and arterial hypertension were also more prevalent in patients than in controls. Mean triglycerides, total cholesterol, LDL-cholesterol and HDL-cholesterol levels were significantly raised in patients with psoriasis when compared to controls. The 10-year FRS was significantly higher in patients with psoriasis than in controls (8.36±5.75 vs. 6.61±4.13; P<0.001). FRS was higher in men (P=0.012) and in patients older than 50 years (P=0.008). According to the severity of psoriasis, FRS increases significantly from mild to moderate-to-severe psoriasis (6.82±4.48 to 8.8±6.71; P=0.003). Psoriasis, and especially moderate to severe psoriasis, seems to represent a risk factor for cardiovascular disease. Patients with psoriasis should be risk-assessed for cardiovascular diseases, and comorbidities should be actively managed.

Type-specific prevalence of human papillomavirus by cervical cytology among women in Brasov, Romania.

The oncogenic role of human papillomavirus (HPV) in triggering cervical cancer, the second most common cancer in women worldwide, is well established. Romania ranks in first place in Europe in terms of the incidence of cervical cancer. Geographical widespread data on HPV type-distribution are essential for estimating the impact of HPV vaccines and cervical cancer screening programmes. In this study we aimed to identify the prevalence of HPV genotypes and to establish correlations with abnormal cervical cytology among the female population of Brasov County, Romania. A total of 1,000 women aged 17.3-57 years, attending routine cervical examination in the Obstetrics and Gynecology Hospital of Brasov, Romania, and undergoing both cytological examination and HPV genotyping were screened. Infection with 35 different HPV genotypes was detected in 39.6% of cytological specimens. Overall HPV infections were highest in young women under 25 years (p<0.0001), in which cervical cytological abnormalities also reached the highest prevalence. Patients infected by HPV-16 or HPV-18 showed the highest prevalence of cervical cytological abnormalities. Some 48.2% of women with abnormal cytology were infected with high-risk HPV types whereas less than 3% of them were infected only with low-risk HPV types. Our study showed that the prevalence of high-risk HPV infection among Romanian women is higher compared to other studies in other geographic areas. Thus, we consider that in areas where there is an increased prevalence of high-risk HPV infections, HPV genotyping should be performed in all women aged between 18 and 45 years, and Pap test should be performed every 6 months in women with high-risk HPV infection, even those with previous normal cervical cytology.

In vitro susceptibility of dermatophytes isolated from patients with end-stage renal disease: a case-control study.

Although the therapeutic efficacy of antifungals is well known for dermatophytosis in general population, limited data exist for patients with chronic kidney disease. The objectives of this study were to determine the dermatophyte species causing infection in patients with end-stage renal disease (ESRD) and in vitro susceptibility of isolated dermatophytes to antifungals. A total of 87 patients with ESRD who undergoing haemodialysis and 105 patients with normal renal function suspected with dermatophytosis were included. Skin scrapings or nail clippings were examined by direct microscopy and cultured on Sabouraud agar. In vitro antifungal susceptibility tests were performed using a broth microdilution method. Dermatophyte infections were identified in 32.2% of haemodialysis patients and in 29.5% of controls (P > 0.05). In both groups, Trichophyton rubrum was the most frequently isolated. Mean MIC values of the all studied antifungals for all of isolated dermatophyte strains from patients with ESRD were similar to those obtained in control group (P > 0.05). Terbinafine (TBF) had the lowest mean MIC values for all tested dermatophytes in both groups. We consider that TBF should be the treatment of choice for dermatophytosis in patients with chronic kidney disease, but the dose should be adjusted according to creatinine clearance and should be monitored for side effects.

Syphilitic balanitis of Follmann.

BACKGROUND: Syphilitic balanitis of Follmann (SBF) is a rare condition that is considered as manifestation of primary syphilis. MATERIALS AND METHODS: A 28-year-old heterosexual male patient was consulted for a diffuse indurated dark red erythema of the glans penis accompanied by bilateral inguinal lymphadenopathy. Serological tests for syphilis were found positive. Treatment consisting of a single intramuscular administration of 2.4 million units of benzathine-penicillin was followed by complete disappearance of erythema and induration of the glans within two weeks. RESULTS: Syphilitic balanitis of Follmann presents with variable clinical appearances, and primary chancre may be absent, associated with, or occur after the balanitis. Usually the inguinal lymphadenopathy is present, and syphilitic serology is positive or is going to become positive. Treatment is identical to that of primary syphilis. CONCLUSION: The recrudescence of syphilitic infection requires exclusion of SBF from the diagnosis of balanitis.