High prevalence and correlates of human herpesvirus-6A in nevocytic nevus and seborrheic diseases: Implication from a pilot study of skin patient tissues in Shanghai.

Skin disorders vary greatly in symptom and severity, and the causes of these disorders are largely unknown. Human herpesvirus (HHV) has been shown to cause many diseases. However, the prevalence and correlation of each HHV infection with different skin disorders remains obscure. To reveal the potential link of a certain type of skin disease with herpesvirus infection, a total of 272 patient tissues with inflammatory or neoplastic skin diseases including 7 subtypes in Shanghai, China, were investigated. We found that the overall prevalence of HHV-6A in inflammatory or neoplastic skin tissues is the most common (40.3%), followed by Epstein-Barr virus (17.6%), Kaposi's sarcoma-associated herpesvirus (KSHV; 9.2%), HHV-6B (4.4%), human cytomegalovirus (1.1%), and varicella-zoster virus (0.7%); albeit the co-infection of HHV-6A, Epstein-Barr virus, and KSHV presents to a less extent and none of HSV-1, HSV-2, or HHV-7 were detected. Moreover, HHV-6A infection is highly associated with nevocytic nevus and seborrheic dermatitis/keratosis diseases, which mainly occur in the head and the neck or the lower limb. Despite no significant difference among the HHV infections in different age groups of skin patient tissues, the distribution of KSHV infection was exclusively and significantly higher (~3.7-fold) in male skin patients.

Mucocutaneous manifestations in human immunodeficiency virus (HIV)-infected patients in Nouakchott, Mauritania.

BACKGROUND: Mucocutaneous manifestations are one of the first clinical signs in patients infected with human immunodeficiency virus (HIV). To the best of our knowledge, there has been no previous study describing dermatologic manifestations in Mauritanians infected with HIV. The aim of the present study was to determine the profiles of mucocutaneous manifestations in relation to CD4 T cell count in HIV-positive Mauritanian patients. METHODS: A total of 86 adult patients aged > 18 years old attending the Ambulatory Treatment Center of the National Hospital of Nouakchott, Mauritania, with newly diagnosed HIV and who were not under antiretroviral treatment were included in the study in 2015. Dermatologic manifestations were documented before initiating antiretroviral treatment. RESULTS: Most of the included patients were in clinical stage 3 of the World Health Organization classification at initial diagnosis, with the mean CD4 T cell count (± SD) of 514 ± 319 cells/mm3 (range, 2-1328 cells/mm3 ), and 19 of 86 (22.1%) patients had CD4 T cell counts below 200 cells/mm3 . More than half (64%) of newly diagnosed HIV-infected patients had dermatoses, including the following: pruritic papular eruption (44.2%), seborrheic dermatitis (4.7%), Kaposi's sarcoma (3.5%), extensive xerosis cutis (2.3%), drug-induced skin reactions (1.2%), and various infectious dermatoses (dermatophyte infections [16.3%], oral candidiasis [11.6%], herpes zoster [8.1%], and scabies [2.3%]). A low CD4 T cell count (< 200 cells/mm3 ) was significantly correlated (P < 0.05) with the presence of following dermatoses: dermatophytosis, oral candidiasis, Kaposi's sarcoma, seborrheic dermatitis, and extensive xerosis cutis. CONCLUSION: Mucocutaneous lesions occur throughout the course of HIV infection, and dermatologic findings in Mauritanian HIV-positive patients are similar to those of patients in other countries. Early detection of skin disorders in some patients may help establish the diagnosis of HIV and management of HIV-associated diseases, limiting the cost of care in low-resource countries.

High Staphylococcus epidermidis Colonization and Impaired Permeability Barrier in Facial Seborrheic Dermatitis.

BACKGROUND: Seborrheic dermatitis (SD) is a common inflammatory skin condition. The etiology is unclear, although overgrowth of Malassezia on the skin has been suggested to cause SD. This study investigated whether colonization with Staphylococcus plays a role in facial SD, which was not well addressed previously. METHODS: The study was conducted from September 1, 2011 to February 20, 2012 in the First Hospital of China Medical University. In the first phase, the study evaluated the level of transepidermal water loss (TEWL) and the number of colony-forming units (CFU) of Staphylococcus in defined skin areas of SD patients who were human immunodeficiency virus (HIV) seropositive (HIV [+] SD [+] group, n = 13), classical SD (HIV [-] SD [+] group, n = 24) patients, HIV seropositive-non-SD (HIV [+] SD [-] group, n = 16) patients, and healthy volunteers (HIV [-] SD [-] group, n = 16). In the second phase, we enrolled another cohort of HIV (-) SD (+) patients who applied topical fusidic acid (n = 15), tacrolimus (n = 16), or moisturizer (n = 12). Changes in the Seborrheic Dermatitis Area Severity Index (SDASI), TEWL, and Staphylococcus density were evaluated 2 weeks later. Comparisons of each index were performed using analysis of variance (ANOVA) and least significant difference method. RESULTS: The level of TEWL was greater through lesional sites in the HIV (+) SD (+) group than that in HIV (+) SD (-) and HIV (-) SD (-) groups (95% confidence interval [CI]: 18.873-47.071, P < 0.001 and 95% CI: 28.755-55.936, P < 0.001, respectively). The number of CFU of Staphylococcus was greater in the HIV (+) SD (+) group than that in HIV (+) SD (-) and HIV (-) SD (-) groups (95% CI: 37.487-142.744, P = 0.001 and 95% CI: 54.936-156.400, P < 0.001, respectively). TEWL was significantly more improved in patients treated with tacrolimus and fusidic acid than that in those treated with moisturizers (95% CI: 7.560-38.987, P = 0.004 and 95% CI: 4.659-37.619, P = 0.011, respectively). Topical tacrolimus and fusidic acid were significantly associated with decreased SDASI as compared with moisturizer (95% CI: 0.03-0.432, P = 0.025 and 95% CI: 0.033-0.44, P = 0.024, respectively). CONCLUSIONS: High colonization with Staphylococcus epidermidis, along with impaired skin permeability barrier function, contributes to the occurrence of SD.

Dermatological manifestations of individuals infected with human T cell lymphotropic virus type I (HTLV-I).

BACKGROUND: Human T cell lymphotropic virus type I (HTLV-I) is associated with specific manifestations such as adult T cell lymphoma/leukemia (ATLL), HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), HTLV-I-associated uveitis, and infective dermatitis associated with HTLV-I (IDH). Although ATLL and IDH are considered specific manifestations of HTLV-I infection, several dermatological manifestations have been described in HTLV-I seropositive patients. OBJECTIVES: This study was conducted to determine the prevalences of skin lesions in patients infected with HTLV-I in an area of Brazil endemic for HTLV-I infection and to compare these prevalences with those in seronegative individuals in the same region. METHODS: A prevalence study was conducted between 2008 and 2010 with two groups of individuals comprising, respectively, 179 HTLV-I seropositive (positive enzyme-linked immunosorbent assay [ELISA] and positive Western blot analysis) and 193 HTLV-I seronegative individuals (ELISA-negative). The subjects were selected on a random basis and evaluated using a questionnaire to obtain epidemiological and clinical data. A physical examination was performed to verify the presence of skin lesions. RESULTS: Superficial mycoses were found in 54 (30.2%) seropositive subjects and in 26 (13.5%) of the seronegative group (P < 0.001). Xerosis was found in 39.1% of HTLV-I infected subjects and in 9.3% of seronegative controls (P < 0.001). Ichthyosis was diagnosed in nine (5.0%) HTLV-I seropositive subjects but in none of the control group (P = 0.001). A diagnosis of seborrheic dermatitis was made in 43 (24.0%) HTLV-I infected subjects and in 24 (12.4%) seronegative controls (P = 0.004). Furthermore, dermatological manifestations were more intense in the HTLV-I seropositive group. CONCLUSIONS: Several dermatological manifestations are more common and more severe in HTLV-I seropositive subjects. The presence of these manifestations in an area endemic for HTLV-I infection may provide some clues in the investigation of this infection.

Seborrheic dermatitis - an early and common skin manifestation in HIV patients.

Seborrheic dermatitis is a common dermatosis occurring on the scalp, face and chest. In the general population, the prevalence of seborrheic dermatitis varies between 3% and 5%, while in HIV positive patients there is an increased prevalence of seborrheic dermatitis ranging between 30% and 83%. Seborrheic dermatitis occurs early in the course of HIV disease and may be an initial clinical marker of HIV infection.

Genotyping by RAPD-PCR analyses of Malassezia furfur strains from pityriasis versicolor and seborrhoeic dermatitis patients.

Malassezia furfur is lypophilic yeast commonly associate with dermatological disorders. In the present work, we described the isolation of 47 M. furfur strains from three groups of patients: pityriasis versicolor (21 isolates), seborrhoeic dermatitis (15 isolates) and seborrhoeic dermatitis of the HIV positive patients (11 isolates). To investigate the identity of the strains at molecular level, DNA genomic of M. furfur strains were prepared and used to RAPD-PCR analyses. RAPD assay were carried out using two decamer primers and bands pattern generated were analyzed by an Unweighted Pair-Group Method (UPGMA). Dendrogram established a distinct differentiation between M. furfur isolates from pityriasis versicolor and seborrhoeic dermatitis patients with or without AIDS. We concluded that RAPD typing presented a high discriminatory power between strains studied in this work and can be applied in epidemiological investigation of skin disease causing by M. furfur.

Dermatologic lesions in asymptomatic blood donors seropositive for human T cell lymphotropic virus type-1.

Dermatologic manifestations are quite common in patients with adult T cell leukemia/lymphoma and myelopathy/tropical spastic paraparesis associated with infection with human T cell lymphotropic virus type-1 (HTLV-1). In this study, we evaluated the dermatologic lesions of eligible blood donors in the state of Minas Gerais in Brazil who were seropositive but asymptomatic for infection with HTLV-1. The study population was composed of 128 HTLV-1-seropositive individuals and 108 seronegative controls. All individuals underwent a dermatologic evaluation. Biopsy specimens were obtained from abnormal and normal skin samples of seropositive individuals in an attempt to detect HTLV-1 in tissue samples by a polymerase chain reaction. Dermatologic alterations were observed more frequently in the seropositive group (adjusted odds ratio [OR] = 8.77, 95% confidence interval [CI] = 4.11-18.71). The most common skin diseases were dermatophytoses (adjusted OR = 3.32, 95% CI = 1.50-7.35), seborrheic dermatitis (OR = 3.53, 95% CI = 0.67-24.66), and acquired ichthyosis (P = 0.001). Virus was detected more frequently in abnormal skin samples. Dermatologic lesions probably related to HTLV-1 infection were diagnosed in eligible blood donors who were infected with this virus, who were previously considered to be asymptomatic carriers of HTLV-1.

Herpesvirus-like DNA sequences in non-Kaposi's sarcoma skin lesions of transplant patients.

Herpesvirus-like DNA sequences (KSHV) have been reported to be associated with various forms of Kaposi's sarcoma (KS). To determine if KSHV was associated with other proliferative skin lesions from non-AIDS immunocompromised patients, 33 skin lesions (basal cell carcinomas, squamous cell carcinomas, actinic keratoses, verruca vulgaris, atypical squamous proliferations, and seborrhoeic keratosis) from 4 organ-transplant patients receiving immunosuppressive therapy were tested for KSHV by PCR. KSHV sequences were detected in 82% of these skin lesions. Our results suggest that KSHV is associated with lesions other than KS in non-AIDS immunocompromised patients, and may also be involved in the pathogenesis of the various forms of proliferative skin lesions from organ-transplant patients.