Cutaneous granular bacteriosis, a rarely diagnosed infection of the head and the neck.

A young man presented with a large multilobulated and mutilating tumour of the scalp, which had been relapsing for years. Histological examination of a biopsy from the lesion revealed chronic inflammation with granulation tissue and presence of granules with eosinophilic periphery, which was positive for Gram, Grocott and periodic-acid-Schiff stains. A large excision was performed. Cultures grew Staphylococcus aureus. The patient was treated with penicillin G, but 4 weeks after the start of treatment, new small nodules appeared over the same area. All these new nodules disappeared within 2 weeks the addition of clindamycin and cotrimoxazole. This triple antibiotic treatment was carried on for 18 months, and the patient remained disease-free after a follow-up of 4 years. Although the lesions were clinically and histologically suggestive of actinomycosis, culture revealed that they were caused by a completely different organism. We suggest grouping such lesions under a single term "granular bacteriosis" and combining surgery with broad-spectrum antibiotics covering Actinomyces species and botryomycosis-causing organisms (mainly Staphylococcus).

[Profile of skin diseases observed in a department of dermatology (1995-2000)]. / Profil des pathologies cutanées observées en clinique dermatologique (1995-2000).

OBJECTIVE: The aim of this retrospective study was to determine the nature and frequency of skin diseases observed at the Dermatology Department (Hôtel-Dieu de France University Hospital) between January 1st, 1995 and December 31, 1999, and to compare them according to age and sex. PATIENTS AND METHODS: All the patients who presented to the consultation were enclosed in the study. Their file included sex, age, one or several diagnoses, the number of visits for each disease. Only new diagnoses were taken into account. Data were handled by Epilnfo program. RESULTS: 6822 patients (59.01% women, 40.99% men, average age 31 years) were seen with 8552 diagnoses. Fungal infections represent the most frequent disease (14.6%), followed by acne (14.1%), eczema (8.56%), viral infections (7.9%) and skin tumors (7.28%). Women consulted more often than men for acne, rosacea, eczema, hair loss, melasma and stretch marks; whereas men consulted more often for fungal and viral infections, and alopecia areata. DISCUSSION: The most frequent skin diseases (all ages merged), were fungal infections, acne and eczema. The same three diagnoses were found before as the most frequent in a previous Lebanese study. The profile of skin diseases in Lebanon turns out very close to observations made in developed countries, but it differs from the Western profile on two fundamental points: absence of leg ulcers and rarity of skin tumors. This profile seems, besides, very remote from the Middle-Eastern and Arabic context especially because of the absence of some endemic diseases such as tinea capitis, leprosy and leishmaniosis.

Ectopic contact dermatitis from ethyl cyanoacrylate instant adhesives.

Although allergic reactions to cyanoacrylate adhesives are extremely rare, they should not be considered impossible. We report a young hairdresser who developed an occupational allergic contact dermatitis to 2 "instant glues" used to attach false hair. The eczematous eruption involved the fingers and face slightly but mainly the eyelids. Patch test reactions were strongly positive to ethyl cyanoacrylate adhesives.

Patch testing with frullania during a 10-year period: hazards and complications.

Contact dermatitis from frullania mainly affects people living in the country. The 2 most frequent species in Europe, Frullania dilatata and Frullania tamarisci, do not cross-react: both species must be patch tested when frullania intolerance is suspected. Yet patch testing with frullania may be hazardous: 9 out of 37 cases recorded in Strasbourg correspond to active sensitization by the tests. Since routine testing is risky, only aimed testing can be recommended.

Systemic contact dermatitis from pseudoephedrine.

A patient with rhinitis developed systemic contact dermatitis when starting oral treatment with Rhinalair, containing pseudoephedrine hydrochloride. A few months later, another oral treatment Rinutan, containing norephedrine hydrochloride, provoked a more severe generalized eczema. Patch test reactions were strongly positive to ephedrine and pseudoephedrine, slightly positive to phenylephrine and negative to epinephrine. Norephedrine was not tested.

Allergic contact dermatitis from eosin.

Before 1960, eosin sensitivity was not rare and lipstick cheilitis was very common. We report 4 patients seen in 1988 and 1989 who were sensitized to eosin from topical bacteriostatic preparations. All 4 patients had positive patch tests to eosin. The allergen is probably an impurity rather than eosin itself.

Allergic contact dermatitis from topical corticosteroids.

22 cases of allergic contact dermatitis from topical corticosteroids were observed in Strasbourg and previously published. 7 further cases are reported here and the vehicle and concentration of corticosteroids for patch tests are discussed. A 0.1% concentration in petrolatum seemed adequate for testing the 4 molecules (triamcinolone acetonide, dexamethasone, desonide and amcinonide) responsible for the 7 new cases. In 1 case, several cross-reactions were seen. A corticosteroid screening series permits patch testing of the suspected molecule(s) in a selective way. Without this series, long delays are required to make the correct diagnosis by patch testing. We have reviewed more than 60 papers on corticosteroid allergy published up to now.

Mini-epidemic of contact dermatitis from ginkgo tree fruit (Ginkgo biloba L.).

3 cases of contact dermatitis from ginkgo fruit are reported. Swelling of the prepuce can be the only clinical sign of intolerance, as was observed in 1 case. Diagnosis of contact dermatitis to ginkgo fruit should be made in cities where female ginkgo trees grow, in Chinese, Japanese and South-East Asian subjects, who are aware of the ginkgo nut's culinary qualities within the fruit, as well as in children who play with the fallen fruits as "marbles".

Contact dermatitis after ultrasonography and electrocardiography.

We report 4 patients who developed allergic contact dermatitis after ultrasound investigations. Patch testing was positive with conducting gels, and in 2 cases with propylene glycol. Contact dermatitis to gels is also seen in electrographic practice and after transcutaneous electrical analgesia.