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Part 1 General Dermatology GENERAL DERMATOLOGY COPYRIGHTED MATERIAL Handbook of Dermatology: A Practical Manual, Second Edition. Margaret W. Mann and Daniel L. Popkin. © 2020 John Wiley & Sons Ltd. Published 2020 by John Wiley & Sons Ltd. 0004285348.INDD 1 7/31/2019 6:12:02 PM 0004285348.INDD 2 7/31/2019 6:12:02 PM COMMON WORK-UPS, SIGNS, AND MANAGEMENT Dermatologic Differential Algorithm Courtesy of Dr. Neel Patel 1. Is it a rash or growth? AND MANAGEMENT 2. If it is a rash, is it mainly epidermal, dermal, subcutaneous, or a combination? 3. If the rash is epidermal or a combination, try to define the SIGNS, COMMON WORK-UPS, characteristics of the rash. Is it mainly papulosquamous? Papulopustular? Blistering? After defining the characteristics, then think about causes of that type of rash: CITES MVA PITA: Congenital, Infections, Tumor, Endocrinologic, Solar related, Metabolic, Vascular, Allergic, Psychiatric, Latrogenic, Trauma, Autoimmune. When generating the differential, take the history and location of the rash into account. 4. If the rash is dermal or subcutaneous, then think of cells and substances that infiltrate and associated diseases (histiocytes, lymphocytes, mast cells, neutrophils, metastatic tumors, mucin, amyloid, immunoglobulin, etc.). 5. If the lesion is a growth, is it benign or malignant in appearance? Think of cells in the skin and their associated diseases (keratinocytes, fibroblasts, neurons, adipocytes, melanocytes, histiocytes, pericytes, endothelial cells, smooth muscle cells, follicular cells, sebocytes, eccrine -
The Frequency of Superficial Mycoses According to Agents Isolated During a Ten-Year Period (1999-2008) in Zagreb Area, Croatia
Acta Dermatovenerol Croat 2010;18(2):92-98 CLINICAL ARTICLE The Frequency of Superficial Mycoses According to Agents Isolated During a Ten-Year Period (1999-2008) in Zagreb Area, Croatia Paola Miklić, Mihael Skerlev, Dragomir Budimčić, Jasna Lipozenčić University Department of Dermatology and Venereology, Zagreb University Hospital Center and School of Medicine, Zagreb, Croatia Corresponding author: SUMMARY Fungal infections involving the skin, hair and nails represent Paola Miklić, MD one of the most common mucocutaneous infections. Significant changes in the epidemiology, etiology and clinical pattern of mycotic University Department of Dermatology infections have been observed during the last years. The aim of this and Venereology retrospective study was to determine the incidence and the etiologic Zagreb University Hospital Center factors of superficial fungal infections in Zagreb area, Croatia, over a and School of Medicine 10-year period (1999-2008). A total of 75828 samples obtained from 67 983 patients were analyzed. Dermatomycosis was verified by culture in Šalata 4 17410 (23%) samples obtained from 16086 patients. Female patients HR-10000 Zagreb were more commonly affected than male (59% vs. 41%). Dermatophytes Croatia were responsible for 63% of all superficial fungal infections, followed by yeasts (36%) and molds (1%). Trichophyton (T.) mentagrophytes [email protected] (both var. interdigitalis and var. granulosa) was the most frequent dermatophyte isolated in 58% of all samples, followed by Microsporum Received: November 10, 2009 (M). canis (29%) and T. rubrum (10%). The most common clinical forms of dermatomycosis were onychomycosis (41%), tinea corporis (17%) Accepted: April 20, 2010 and tinea pedis (12%). Candida spp. was mainly isolated from fingernail debris. -
Therapies for Common Cutaneous Fungal Infections
MedicineToday 2014; 15(6): 35-47 PEER REVIEWED FEATURE 2 CPD POINTS Therapies for common cutaneous fungal infections KENG-EE THAI MB BS(Hons), BMedSci(Hons), FACD Key points A practical approach to the diagnosis and treatment of common fungal • Fungal infection should infections of the skin and hair is provided. Topical antifungal therapies always be in the differential are effective and usually used as first-line therapy, with oral antifungals diagnosis of any scaly rash. being saved for recalcitrant infections. Treatment should be for several • Topical antifungal agents are typically adequate treatment weeks at least. for simple tinea. • Oral antifungal therapy may inea and yeast infections are among the dermatophytoses (tinea) and yeast infections be required for extensive most common diagnoses found in general and their differential diagnoses and treatments disease, fungal folliculitis and practice and dermatology. Although are then discussed (Table). tinea involving the face, hair- antifungal therapies are effective in these bearing areas, palms and T infections, an accurate diagnosis is required to ANTIFUNGAL THERAPIES soles. avoid misuse of these or other topical agents. Topical antifungal preparations are the most • Tinea should be suspected if Furthermore, subsequent active prevention is commonly prescribed agents for dermatomy- there is unilateral hand just as important as the initial treatment of the coses, with systemic agents being used for dermatitis and rash on both fungal infection. complex, widespread tinea or when topical agents feet – ‘one hand and two feet’ This article provides a practical approach fail for tinea or yeast infections. The pharmacol- involvement. to antifungal therapy for common fungal infec- ogy of the systemic agents is discussed first here. -
Tinea Incognito
TINEA INCOGNITO http://www.aocd.org Tinea incognito is a localized skin infection caused by fungus, just like tinea corporis (ringworm) and tinea capitis (scalp ringworm). It is a skin infectious process that looks very different from other fungal infections, both the shape and the degree of involvement. Topical corticosteroid use is the culprit for the difference. Fungal infection, most often caused by Trichophyton rubrum, presents initially as a flat, scaly rash that gradually becomes a circular lesion with a raised border and the border is scaly as it advances. While the lesion enlarges, the center becomes brown or less pigmented. These skin findings comprise of the ringworm we typically see on the body. Lesions can be large or small. At this stage of the disease, if a topical corticosteroid is applied to the lesion, the local inflammation from the fungal infection will be decreased, so to alter the clinical presentation of the typical infection. And this secondary appearance is called tinea incognito. The most common site for this clinical transformation is the face and the back of the hand. The hand is a popular site for a lot of skin diseases, which is why tinea incognito is hard to diagnose and be differentiated from the others. Altered clinical picture of tinea incognito could resemble eczema, psoriasis and other diseases. What makes the clarification important is the difference in treatment approach. Corticosteroid makes tinea worse but helps the other ones. The new appearance of tinea incognito is quite different from other fungal infections. Instead of a localized lesion, it becomes much more extensive and loses its original circular shape, which is one of the most important clinical clues to diagnose fungal infection. -
Tacrolimus-Induced Tinea Incognito
Tacrolimus-Induced Tinea Incognito Narendra Siddaiah, MD; Capt Quenby Erickson, USAF, MC; Gea Miller, MD; Dirk M. Elston, MD Tacrolimus and pimecrolimus represent a new class of topical nonsteroidal medications cur- rently used in the treatment of a variety of inflam- matory skin lesions. We report the case of a patient in whom topical tacrolimus therapy resulted in widespread lesions of tinea incognito. This case shows that partial treatment of derma- tophytosis with griseofulvin may obscure the diagnosis. It also suggests that topical tacro- limus appears capable of inducing widespread dermatophytosis. The clinical appearance in this case was similar to tinea incognito induced by a topical corticosteroid. Cutis. 2004;73:237-238. he term tinea incognito is generally used to describe a dermatophytic infection whose T appearance is modified by the use of cortico- steroids.1 Steroids suppress local immunity, thus pro- moting fungal growth. Lesions often lack the degree of inflammation associated with tinea, and diagnosis is often delayed. Tacrolimus is 1 of 2 topical macrolide calcineurin inhibitors with potent immunomodula- Figure 1. Annular erythematous and scaly patches on tory activity approved in the treatment of atopic the face. dermatitis. We describe the case of a patient with wide- spread tinea incognito secondary to topical tacrolimus. One year before presentation, the child and his Case Report 4-year-old brother were treated with a 6-week course A 9-year-old black male child presented to the der- of griseofulvin 12.5 mg/kg per day for tinea capitis, matology clinic with large erythematous and scaly and his mother was treated with topical antifungal patches on his face, neck, and trunk (Figures 1 and agents for tinea corporis. -
Pili Torti: a Feature of Numerous Congenital and Acquired Conditions
Journal of Clinical Medicine Review Pili Torti: A Feature of Numerous Congenital and Acquired Conditions Aleksandra Hoffmann 1 , Anna Wa´skiel-Burnat 1,*, Jakub Z˙ ółkiewicz 1 , Leszek Blicharz 1, Adriana Rakowska 1, Mohamad Goldust 2 , Małgorzata Olszewska 1 and Lidia Rudnicka 1 1 Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; [email protected] (A.H.); [email protected] (J.Z.);˙ [email protected] (L.B.); [email protected] (A.R.); [email protected] (M.O.); [email protected] (L.R.) 2 Department of Dermatology, University Medical Center of the Johannes Gutenberg University, 55122 Mainz, Germany; [email protected] * Correspondence: [email protected]; Tel.: +48-22-5021-324; Fax: +48-22-824-2200 Abstract: Pili torti is a rare condition characterized by the presence of the hair shaft, which is flattened at irregular intervals and twisted 180◦ along its long axis. It is a form of hair shaft disorder with increased fragility. The condition is classified into inherited and acquired. Inherited forms may be either isolated or associated with numerous genetic diseases or syndromes (e.g., Menkes disease, Björnstad syndrome, Netherton syndrome, and Bazex-Dupré-Christol syndrome). Moreover, pili torti may be a feature of various ectodermal dysplasias (such as Rapp-Hodgkin syndrome and Ankyloblepharon-ectodermal defects-cleft lip/palate syndrome). Acquired pili torti was described in numerous forms of alopecia (e.g., lichen planopilaris, discoid lupus erythematosus, dissecting Citation: Hoffmann, A.; cellulitis, folliculitis decalvans, alopecia areata) as well as neoplastic and systemic diseases (such Wa´skiel-Burnat,A.; Zółkiewicz,˙ J.; as cutaneous T-cell lymphoma, scalp metastasis of breast cancer, anorexia nervosa, malnutrition, Blicharz, L.; Rakowska, A.; Goldust, M.; Olszewska, M.; Rudnicka, L. -
Case Report a Case and Review of Congenital Leukonychia Akhilesh S
Volume 22 Number 10 October 2016 Case Report A case and review of congenital leukonychia Akhilesh S Pathipati1 BA, Justin M Ko2 MD MBA and John M Yost3 MD MPH Dermatology Online Journal 22 (10): 6 1 Stanford University School of Medicine, Stanford, CA 2 Stanford University School of Medicine, Department of Dermatology, Stanford, CA 3Stanford University School of Medicine, Department of Dermatology, Nail Disorders Clinic, Stanford, CA Correspondence Akhilesh S Pathipati 291 Campus Drive Stanford, CA 94305 Tel. (916)725-3900; Fax. (650)721-3464; Email: [email protected] Abstract Leukonychia refers to a white discoloration of the nails. Although several conditions may cause white nails, a rare, isolated, congenital form of the disease is hypothesized to stem from disordered keratinization of the nail plate. Herein, we report a case of a 41-year-old woman with congenital leukonychia and review prior cases. Keywords: Leukonychia, Nail disorders, Congenital nail disease Introduction Leukonychia is defined as a white or milky discoloration of the nail plate and has traditionally been subclassified into true and apparent variants. Apparent leukonychia derives from pathological changes in the nail bed (most commonly edema) resulting in tissue pallor visible through the nail plate, whereas true leukonychia stems from structural abnormalities of the nail plate itself owing to disordered keratinization occurring in the nail matrix [1]. In the latter, the white opacity of the nail plate derives from two separate histopathologic features: retained parakeratotic cells containing enlarged keratohyaline granules and disorganized keratin fibrils [2,3]. Both of these abnormalities affect and impede light diffraction through the nail plate, ultimately contributing to the characteristic white discoloration [1]. -
Incidence and Biodiversity of Yeasts, Dermatophytes and Non
Journal de Mycologie Médicale (2017) 27, 166—179 Available online at ScienceDirect www.sciencedirect.com ORIGINAL ARTICLE/ARTICLE ORIGINAL Incidence and biodiversity of yeasts, dermatophytes and non-dermatophytes in superficial skin infections in Assiut, Egypt Incidence et biodiversite´ des levures, des dermatophytes, et non dermatophytes, agents de mycoses superficielles dans le gouvernorat d’Assiout — ´Egypte A.H. Moubasher, M.A. Abdel-Sater *, Z. Soliman Department of Botany and Microbiology, Faculty of Science, Assiut University Mycological Centre, Assiut University, Assiut, Egypt Received 1st October 2016; received in revised form 28 December 2016; accepted 11 January 2017 Available online 7 February 2017 KEYWORDS Summary Skin infections; Objective. — The aim was to identify the incidence of the causal agents from dermatophytes, Yeasts; non-dermatophytes and yeasts in Assiut Governorate employing, beside the morphological and Dermatophytic; physiological techniques, the genotypic ones. Non-dermatophytic; Patients. — Samples from infected nails, skin and hair were taken from 125 patients. PCR Materials and methods. — Patients who presented with onychomycosis, tinea capitis, tinea corporis, tinea cruris and tinea pedis during the period from February 2012 to October 2015 were clinically examined and diagnosed by dermatologists and were guided to Assiut University Mycological Centre for direct microscopic examination, culturing and identification. Results. — Onychomycosis was the most common infecting (64.8% of the cases) followed by tinea capitis (17.6%). Direct microscopic preparations showed only 45 positive cases, while 96 cases showed positive cultures. Infections were more frequent in females than males. Fifty-one fungal species and 1 variety were obtained. Yeasts were the main agents being cultured from 46.02% of total cases. -
Pili Torti: Clinical Findings, Associated Disorders, and New Insights Into Mechanisms of Hair Twisting
CONTINUING MEDICAL EDUCATION Pili Torti: Clinical Findings, Associated Disorders, and New Insights Into Mechanisms of Hair Twisting Paradi Mirmirani, MD; Sara S. Samimi, MD; Eliot Mostow, MD, MPH RELEASERELEASE DATE:DATE: AugustSeptember 2009 2009 TERMINATIONTERMINATION DATE:DATE: AugustSeptember 2010 2010 TheThe estimatedestimated timetime toto completecomplete thisthis activityactivity isis 11 hour.hour. GGOALOAL ToTo understandunderstand primarypili torti tocutaneous better manage nodular patients amyloidosis with the(PCNA) condition to better manage patients with the condition LLEARNINGEARNING OBJOBJECTIECTIVVESES UponUpon completioncompletion ofof thisthis activity,activity, youyou willwill bebe ableable to:to: 1.1. RecognizeDistinguish thepili clinicaltorti from presentation other hair shaftof PCNA. disorders. 2.2. DiscussList conditions the pathophysiology frequently associated of PCNA. with pili torti. 3.3. DistinguishExplain the primarypathophysiologic systemic amyloidosismechanisms from that PCNAcan lead based to pili on torti. clinical and laboratory findings. IINTENDEDNTENDED AAUDIENCEUDIENCE ThisThis CMECME activityactivity isis designeddesigned forfor dermatologistsdermatologists andand generalgeneral practitioners.practitioners. CMECME TestTest andand InstructionsInstructions onon pagepage 107.148. ThisThis articlearticle hashas beenbeen peerpeer reviewedreviewed andand approvedapproved byby CollegeCollege ofof MedicineMedicine isis accreditedaccredited byby thethe ACCMEACCME toto provideprovide MichaelMichael Fisher,Fisher, -
Ectodermal Dysplasia (Generic Term)
Ectodermal Dysplasia (generic term) Authors: Doctor Kathleen Mortier1, Professor Georges Wackens1 Creation date: September 2004 Scientific Editor: Professor Antonella Tosti 1Department of stomatology and maxillofacial surgery, AZ VUB Brussels, Belgium [email protected] Definition Clinical classification of Ectodermal dysplasias References Definition Ectodermal dysplasias (EDs) are a heterogeneous group of disorders characterized by developmental dystrophies of ectodermal structures, such as hypohidrosis, hypotrichosis, onychodysplasia and hypodontia or anodontia. About 160 clinically and genetically distinct hereditery ectodermal dysplasias have been cataloged. In the early seventies there existed no definition and no classification. Freire-Maia and Pinheiro tried to put some order in the field of ectodermal dysplasias. Firstly, the group should be defined before an attempt was made to list its conditions. Secondly, the group was so large that it was necessary to split it into several subgroups. So they decided that an ED should present any two of the signs that affected the four structures widely mentioned by the authors who studied the classic EDs – hair, teeth, nails and sweat glands – with or without any other sign (see blow). The system is arbitrary without biological relevance to the pathogenesis and genetics of the specific disorder. However, classification based on clinical signs and symptoms is all that has been available until recently, since the pathogenesis and molecular genetics of the disorder are largely unknown. Clinical classification of Ectodermal dysplasias (Pinheiro and Freire-Maia, 1994) Unknown cause Conditions AD AR XL ? AD? AR? XL? Subgroup 1-2-3-4 1. Christ-Siemens-Touraine (CST) syndrome (MIM 305100; XR BDE 0333; POS 3208; FMP 1) 2. -
What Is Your Diagnosis?
PHOTO QUIZ What Is Your Diagnosis? IMAGE NOT IMAGE NOT AVAILABLE ONLINE AVAILABLE ONLINE A 4-year-old girl presented to the dermatology clinic for the treatment of bullous impetigo. Examination revealed resolving angular cheilitis with secondary impetiginization, as well as frizzy, blond, unkempt-appearing shoulder-length hair. The patient’s parents reported that the girl’s hair was difficult to comb and had been unmanageable since birth. The patient is the offspring of nonconsanguineous parents and was the product of a healthy pregnancy. She was born at 38 weeks’ gestation by uncomplicated vaginal delivery and had experienced healthy growth and development. There was no known family history of hair disease. PLEASE TURN TO PAGE 31 FOR DISCUSSION Heidi F. Anderson, MD, University of Virginia School of Medicine, Charlottesville. Cheryl L. Lonergan, MD, Department of Dermatology, University of Virginia. Hina S. Qureshi, MD, Department of Pathology, University of Virginia. Kelly M. Cordoro, MD, Department of Dermatology, University of Virginia. The authors report no conflict of interest. 20 CUTIS® Photo Quiz Discussion The Diagnosis: Uncombable Hair Syndrome irst described in 1973 by Dupre et al1 as cheveux incoiffables and also now known as spun glass F hair and pili trianguli et canaliculi, uncomb- able hair syndrome is characterized by dry, frizzy, silvery blond to light brown hair that does not lay flat on the head. Typically, the hair is noncompliant with attempts at management by a comb or brush.2 Uncombable hair syndrome presents in infancy or during adolescence in rare cases.3 Hair grows at a slow to average rate, and the syndrome is not associ- IMAGE NOT ated with any hair loss or fragility.4 Both inherited AVAILABLE ONLINE (autosomal dominant gene with incomplete pen- etrance) and sporadic forms have been described,5 though the genetic or biochemical changes underly- ing this condition have yet to be determined.6 The exact prevalence of uncombable hair syndrome is unknown. -
Tinea Infections: Changing Face Or Neglected?
American Journal of www.biomedgrid.com Biomedical Science & Research ISSN: 2642-1747 --------------------------------------------------------------------------------------------------------------------------------- Mini Review Copyright@ Atzori Laura Tinea Infections: Changing Face or Neglected? Laura Atzori*, Laura Pizzatti and Monica Pau Department of Medical Science and Public Health, University of Cagliari, Italy *Corresponding author: Atzori Laura, Dermatology Clinic, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy. To Cite This Article: Atzori Laura. Tinea Infections: Changing Face or Neglected?. Am J Biomed Sci & Res. 2019 - 4(4). AJBSR.MS.ID.000820. DOI: 10.34297/AJBSR.2019.04.000820 Received: August 05, 2019 | Published: August 13, 2019 Abstract Dermatophyte infections are of great importance in dermatology practice. The general impression from the literature retrieval is that we are is whether dermatophytes are changing their biological attitude or there is a tendency to neglect the diagnosis, because of the common use of topicalexperiencing mixed a antibiotic/antimycotic change in tinea infections, corticosteroid and these cream,changes delaying involves the epidemiology, assessment clinicaluntil no presentation, response and diagnosis evident andworsening. therapies. Following The question short worth global alert and address the need of reporting and execution of antifungal sensitity tests, which is not a routinely procedure. The adoption review encompass actual knowledge to provide matter of tough and auspicate generation of new studies. The menace of antifungal resistance is of all suspect the infection, even when clinical presentation is not obvious, and possibly perform a simple direct mycological examination after of innovative diagnostic techniques, such as MALDI-TOF and PCR identification are by the way, nevertheless, a trained dermatologist should first KHO clarification, which rapidly confirms the diagnosis.