Search

Impetigo herpetiformis is a rare variant of generalized pustular psoriasis that occurs during pregnancy or is triggered by pregnancy, often in association with hypocalcemia. This condition is associated with increased maternal and fetal morbidity and mortality. We report a 29-year-old pregnant woman who presented to hospital at the gestational age of 20 weeks with widespread erythema covered with pustules that coalesced to form lakes of pus. She did not respond to corticosteroids, immunosuppressants, or phototherapy. Finally, intra-amniotic injection of ethacridine lactate was administered to terminate the pregnancy, and the patient showed complete recovery in 3 months. Insight from this case report may facilitate optimal management of this relatively rare entity.

Malassezia (Pityrosporum) folliculitis usually appears as pruritic monomorphous papules and pustules on the upper back, chest, extensor arms and face. Acne vulgaris, bacterial folliculitis, eosinophilic folliculitis and systemic corticosteroid-induced acne can clinically mimic the fungal-caused acneiform condition. The designation incognito is used to describe tinea or scabies when the characteristic presentation is masqueraded by the application of topical corticosteroid treatment. Application of corticosteroid cream altered the morphology of the skin lesions in a man with Malassezia folliculitis. His cutaneous findings-localized areas of post-inflammatory hyperpigmentation with flattened or completely resolved follicular papules-raised the possibility of partially treated follicular eczema or follicular contact dermatitis. Pathognomonic findings from biopsies of the skin lesions established the diagnosis of Malassezia folliculitis; the condition completely resolved after treatment with topical antifungal shampoo and cream. Similar to tinea incognito and scabies incognito, folliculitis caused by Malassezia yeast in which the cutaneous morphology has been concealed by management with topical corticosteroids should be referred to as Malassezia (Pityrosporum) folliculitis incognito.

ZhiQiang Yin,1,* LiWen Ma,1,* JiaLi Xu,2,* JiPing Xia,1 Dan Luo1 1Department of Dermatology, 2Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Jiangsu, People's Republic of China*These authors contributed equally to this work Abstract: Panax notoginseng saponins (PNS) are a patented product in the People's Republic of China, and have extensive effects on the cardiovascular system. Here we report on four elderly patients (one male and three female) with drug eruption induced by PNS injection. All developed a sudden skin rash with pruritus from head to foot, and subsequently accepted hospitalization. In each case, PNS had been used for less than 1 week before appearance of the rash. No specific short-term medications or changes in diet or exposure to environmental factors immediately prior to appearance of the rash were identified. These four patients had some interesting features in common, ie, pustules, fever, and elevated circulating neutrophil counts, which required high-dose, long-term glucocorticoid therapy. To our knowledge, this is the first report of pustular drug eruption induced by PNS and provides a useful reference and warning for clinicians. Keywords: pustule, drug eruption, acute generalized exanthematous pustulosis, Panax notoginseng saponins

Epidermal growth factor receptor inhibitors are recent antineoplastic treatments used for the treatment of some non-cutaneous tumours, which aberrantly express EGFR. Because of their specificity, these drugs have low systemic toxicity, but frequent undesired cutaneous effects, the most common of which is an acneiform eruption, occurring after 1-3 weeks of treatment. Management of this rash is not well standardized.We evaluated efficacy, tolerability and impact on quality of life of a clindamycin phosphate 1.2%-benzoyl peroxide 5% gel in 12 male adults who developed acneiform eruption during treatment with cetuximab for metastatic colorectal cancer.Patients applied the clindamycin phosphate-benzoyl peroxide gel once daily, at evening, for 8 weeks. The Skin-Score was used to evaluate reduction of erythema, papules, pustules and pruritus, the Dermatology Life Quality Index questionnaire to evaluate the improvements of health-related quality of life.Significant clinical improvements occurred after 2 weeks of treatment and were even more evident after 8 weeks (mean Skin-Score 20.54 ± 7.83, p = 1.37 × 10(-6) vs. second week visit, p = 1.26 × 10(-7) vs. before treatment). Accordingly, DLQI values decreased from 13.64 ± 2.01 before treatment to 6.45 ± 1.37 after 8 weeks (p = 1.12 × 10(-5)).A clindamycin phosphate-benzoyl peroxide gel may be an effective and safe option in the treatment of cetuximab-associated acneiform eruptions.

Pyoderma vegetans (PV) is a chronic, vegetating pustular disorder characterized clinically by erythematous vesiculopustular vegetating cutaneous plaques. Marked epidermal hyperplasia, intraepidermal and subepidermal neutrophilic microabscesses and a dermal inflammatory infiltrate are the prominent histopathological findings. We describe a patient with PV associated with ulcerative colitis and mammary Paget's disease. Pustular eruptions associated with ulcerative colitis are reviewed.

İmpetigo herpetiformis (İH), yüksek fetal morbidite ve mortaliteye sahip, bazen gebeliğin sonlandırılmasını gerektirebilen bir hastalıktır. Etkili olduğu belirtilen farklı tedavi seçenekleri bulunmaktadır. Yirmi üç yaşında, psoriazis öyküsü olan 25 hafta lık gebe olgu, ani başlangıçlı jeneralize püstüler döküntülerle başvurdu. Klinik bulgular ve histopatolojik değerlendirme ile İH tanısı konuldu. Sistemik prednizolon (2 mg/kg/gün) üç hafta süreyle uygulandı. Yanıt olmadığı için siklosporin A (3mg/kg/gün) ilave edildi. İki hafta siklosporin A ve sistemik prednizolon kombine kullanılmasına rağmen deri bulguları gerilemedi. Tedavilere ek olarak 30. gebelik haftasında intravenöz immunglobulin (IVIG) (0,3 gr/kg/gün, 6 gün) uygulaması ile deri belirtilerinde azalma gözlendi. 33. gebel ik haftasında reaktivasyon olduğu için IVIG (0,7g/kg/gün, 3 gün) tekrar verildi. Püstüler lezyonlar geriledi. 34. gebelik haftasında doğum yapan olgunun sağlıklı bir bebeği oldu. Bu olgu sunumu ile İH’de gebeliğin devam etmesi ve fetusun sağlıklı gelişimini sağlamas ı amacıyla IVIG tedavisine dikkat çekilmektedir. Impetigo herpetiformis (IH), if left untreated, is associated with a high rate of perinatal morbidity and mortality and may lead to the decision of termination of pregnancy. There are various and effective therapeutic agents available for the treatment of the disease. A 23-year-old woman with a history of plaque psoriasis presented with a sudden generalized pustular eruption on the 25th week of her first gestation. The diagnosis was made based on the clinical and histopathological findings. The patient was treated with systemic prednisolone (2 mg/kg/d) first and, cyclosporine A (3 mg/kg/d) was added to the treatment after two weeks because prednisolone was not effective alone. The lesions did not regress despite four weeks of combined treatment with prednisolone and cyclosporine. Intravenous immunoglobuline (IVIG) (0.3 g/kg/d, 6 days) was added on the 30th week of gestation and resulted in regression of cutaneous rashes. On the 33rd week of gestation, IVIG (0.7 g/kg/d, 3 days) was repeated due to reactivation of pustules, and an improvement was observed. In this case report, we called attention to IVIG therapy in IH, for having the pregnancy continued enough for the fetal maturation before the delivery.

Amaç: Hafif ve orta dereceli akne vulgariste en çok kullanılan topikal antibiyotikler klindamisin ve eritromisindir. Topikal antibiyotiklerin benzoil peroksit ile kombinasyonu etkinliği artırır ve Propionibacterium acnes’e karşı gelişen antibiyotik direncini azaltır. Sodyum sulfasetamid sülfonamid grubu bir antibiyotiktir. Uzun yıllardır bilindiği halde akne tedavisinde fazlaca yer almamaktadır. Ancak son zamanlarda kullanımı tekrar gündeme gelmiştir. Çalışmamızda hafif ve orta derecedeki akne vulgariste sodyum sulfasetamidin etkinliğini klindamisin ve eritromisin ile karşılaştırmalı olarak değerlendirmeyi amaçladık. Gereç ve Yöntem: Karşılaştırmalı çalışmamızda akne vulgarisli 60 hasta, birinci grup sodyum sulfasetamid %10 losyon, ikinci grup klindamisin %1 losyon ve üçüncü grup eritromisin %2 jel 12 hafta süre ile günde iki kez uygulamak üzere, randomize olarak 3 gruba ayrıldı. Her grupta 20 olgu yer aldı. Tedavi tüm hastalarda benzoil peroksit %5 losyon ile kombine edildi. Hastalar başlangıçta, 4, 8 ve 12. haftalarda noninflamatuvar (açık ve kapalı komedo) ve inflamatuvar (papül ve püstül) lezyon sayıları açısından değerlendirildi ve yan etkiler kaydedildi. Bulgular: Gruplar arasında yaş, cinsiyet ve akne süresi yönünden anlamlı fark yoktu (p0,05). Çalışma sonunda her 3 tedavi yöntemi ile de istatistiksel olarak anlamlı azalma saptandı (p0,05). Noninflamatuvar lezyon sayısı ve total lezyon sayısındaki azalma açısından 4, 8 ve 12. haftalarda her 3 grup arasında anlamlı fark saptanmazken inflamatuvar lezyon sayısındaki azalma açısından 8. haftada klindamisin diğer tedavilere göre daha üstün bulundu (p0,05). Yan etki görülme oranları açısından da her 3 grup arasında anlamlı fark saptanmadı (p0,05). Sonuç: Bu çalışmada topikal sodyum sulfasetamidin, hafif ve orta şiddette akne vulgarisin tedavisinde, benzoil peroksitle kombine kullanıldığında klindamisin ve eritromisin gibi etkili ve güvenilir olduğu sonucuna varılmıştır. Bu sonuç daha geniş olgu sayılı çalışmalarla desteklenmelidir. (Türkderm 2012; 46: 33-8) Background and Design: Clindamycin and erythromycin are the most widely used topical antibiotics in the treatment of mild to moderate acne vulgaris. The combination of topical antibiotics with benzoyl peroxide increases the efficacy of the treatment and reduces antibiotic resistance of Propionibacterium acnes. Sodium sulfacetamide is a sulfonamide antibiotic. Although it has been known for many years, it is not widely used in acne treatment. However, it has recently acquired currency again. In this study, we aimed to assess the efficacy of sodium sulfacetamide in the treatment of mild to moderate acne vulgaris and to compare with the other widely used topical antibiotics. Material and Method: In our comparative study, 60 patients with acne vulgaris were randomly assigned into 3 groups, wherein the 1st, 2nd, and 3rd groups were applied sodium sulfacetamide 10% lotion, clindamycin 1% lotion, and erythromycin 2% gel, respectively, twice daily for 12 weeks. Each group consisted of 20 subjects. The treatment was combined with benzoyl peroxide in all groups. The patients were assessed for noninflammatory (open and closed comedones) and inflammatory (papules and pustules) lesion counts at 4, 8, and 12 weeks and, adverse events were recorded. Results: There was no significant difference between the groups for age, sex and acne duration (p>0.05). Statistically significant decrease was obtained with all 3 treatment regimens at the end of the study (p0.05). Conclusion: In this study, topical sodium sulfacetamide was found to be as effective and safe as erythromycin and clindamycin when combined with benzoyl peroxide in the treatment of mild to moderate acne vulgaris. These results should be supported by studies with larger cohorts. (Turkderm 2012; 46: 33-8)

Background Behcet's disease (BD) is usually diagnosed between the second and fourth decades. Onset after 50 years of age is extremely rare. We aimed to analyze the clinical features of late-onset patients with BD. Method The study was conducted from 439 patients diagnosed as BD according to criteria of the International Study Group for BD. Clinical features of patients who were asymptomatic or suffered from only recurrent aphthous stomatitis (RAS) until 50 years of age but fulfilled the diagnostic criteria of BD after this age were reviewed. Results The age-of-onset was more than 50 years in nine patients (1.56%). Two patients developed erythema nodosum, two developed pathergy positivity, one developed papulopustules, pathergy positivity and ocular symptoms, one developed papulopustules and pathergy positivity, one developed ocular symptoms, one developed papulopustules and ocular symptoms, and one developed erythema nodosum and pathergy positivity as well as oral aphthae and genital ulcerations after the age of 50 years. The neurologic system was involved in two patients. Mucocutaneous symptoms of two patients worsened after interruption of therapy. Two patients with neurologic and ocular involvement flared during the follow up. Conclusion Since the course of the disease is regarded to be relatively mild in mature patients, it is noteworthy that systemic manifestations such as ocular and neurologic involvement and acute flares developed after the age of 50 years in the limited number of patients with late-onset BD in our series.

Demodex folliculorum and Demodex brevis are normal inhabi-tants of the human pilosebaceous duct and sebaceousglands, respectively, with a predilection to colonize facialskin. 1 Parasitism is usually asymptomatic, but Demodex mites have been implicated as a pathogenic agent for somesuppurative or granulomatous dermatological conditionsresembling suppurative folliculitis of face and scalp inimmunocompetent and immunocompromised patients. Demodex infestation is usually associated with pruritus,erythema, papules, pustules, nodules or scales with apredilection for the face, especially the nose and nasolabialfolds in an immunocompetent patient.2–6 We describe herethe case of a 40-year-old man with acute onset papules,pustules and abscess-like conglomerates associated withheavy infestation of Demodex mites on his face.