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The most recent Joint United Nations Programme on HIV/AIDS (UNAIDS) data inform us that approximately 2.3 million children were infected with HIV at the end of 2009. The greatest burden of this infection is thrust squarely on the most impoverished healthcare systems in the world. Sub-Saharan Africa is home to at least 68% of the global total of HIV infection of 22.5 million. Although a scale up of antiretrovirals has been one of the UNAIDS priorities, and access to services to prevent mother-to-child transmission has increased, an estimated 370,000 children were newly infected in 2009. Hence, infected mothers continue giving birth to HIV-infected children who require appropriate healthcare to diagnose and treat their underlying immunodeficiency and related disorders. Skin lesions are common in these children as they present with infections common in the general population, albeit more severe. Those lesions that are markers of HIV or AIDS are important signs heralding an improving or declining immune system and the success of antiretrovirals. Cutaneous manifestations of HIV/AIDS can be classified broadly as infections and infestations, inflammatory conditions, tumors, and antiretroviral related. This manuscript discusses the more common skin conditions seen in children infected with HIV so as to improve the diagnosis and therapy administered by healthcare professionals especially in sub-Saharan Africa.

Endocrine diseases in the dog commonly manifest with dermatological lesions. Hypothyroidism is the most common endocrinopathy and usually presents with alopecia in areas of wear, seborrhea, and recurrent infections. Common clinical signs associated with hyperadrenocorticism include polyuria, polydipsia, and polyphagia. The most common dermatological manifestation of hyperadrenocorticism is bilaterally symmetrical alopecia sparing the head and distal extremities. Pyoderma is a common finding associated with immunosuppression. Less commonly, calcinosus cutis may occur. Sex hormone excess, primarily hyperestrogenism and hyperandrogenism, may also be associated with dermatological signs. Usually, dogs are intact, and the excess production is due to testicular or ovarian neoplasia.

A 6-year-old cat was examined because of recurrence of a draining mass involving skin and subcutaneous tissues of the caudoventral aspect of the abdomen. Previous treatment included administration of antimicrobial drugs and corticosteroids and surgical excision. Atypical mycobacteria were seen during cytologic examination of biopsy specimens of the mass; Nocardia sp was cultured. While hospitalized, the cat developed hypercalcemia and was found to have high serum calcitriol concentrations. Treatment consisted of administration of ciprofloxacin and trimethoprim-sulfadiazine because of the infection and administration of sodium chloride solution, furosemide, and calcitonin because of the hypercalcemia. The cat recovered.

A 69-year-old man with recurrent eruptions of pyoderma gangrenosum for 4 years is described. The patient also suffered from paraproteinemia (increased IgA with M-component) and transient acantholytic dermatosis resembling pemphigus erythematosus. He had no intestinal symptoms.

The association between ulcerative colitis and various abnormalities of the skin, especially pyoderma gangrenosum, has been accepted for many years. The underlying aberrations in either of the organ systems, as well as the basis of their association, however, remain obscure. Several large series of ulcerative colitis patients are reviewed to emphasize the important concomitant cutaneous findings, and investigations into the pathogenesis of pyoderma gangrenosum are discussed.

The authors describe three cases of refractory anaemia with an excess of myeloblasts in the bone marrow (RAEM), associated with pyoderma gangrenosum (PG) and vasculitis. The first patient was an 85-year old man whose RAEM had begun in 1979. In 1985, he developed pyoderma gangrenosum in the popliteal fossa and on the right heel. Histology confirmed the diagnosis. A direct immunofluorescence test on the biopsy specimen was negative. Apart from the haematological syndrome, there were no laboratory abnormalities. The cutaneous lesions disappeared after 7 weeks of treatment with prednisolone 20 mg per day. The blood disease remained unchanged. The second patient was a 71-year old woman with RAEM since 1982. In 1984, she presented with lesions of cutaneous vasculitis located on the anterior aspect of the upper third of her left leg. There was neither arthralgia nor fever, and no history of drug toxicity or infection. Beside RAEM, polyclonal hyperglobulinaemia was present. Histological examination of the skin showed evidence of vasculitis with fibrinoid necrosis of vascular walls and perivascular lympho-histiocytic infiltrate with granulocytes and slight leucocytoclasia. Direct immunofluorescence testing of the skin demonstrated intravascular complement deposits. There were no circulating immune complexes; measurements of complement and complement fractions gave normal values; no cryoglobulin was found. The cutaneous lesions recurred on two occasions in 6 months, although no drug toxicity or infection could be elicited and the haematological syndrome was unaffected. The third patient was a 67-year old man with RAEM since 1982. In 1983, an ulcero-necrotic lesion spontaneously developed on his right leg.(ABSTRACT TRUNCATED AT 250 WORDS)

In this paper, two cases of chronic ulcerative colitis displaying systemic manifestations are discussed. Each case illustrates the refractoriness of the systemic manifestations to colectomy and the total resolution of the manifestations by additional proctectomy. The implications of these clinical observations in relationship to the aetiology and therapy of ulcerative colitis are discussed.

Since Sweet's initial description of eight patients, the concept of acute febrile neutrophilic dermatosis has evolved and changed. We have expanded it to include patients with bullous pyoderma gangrenosum, bowel-bypass syndrome with or without the bypass, the vesiculopustular eruption or ulcerative colitis, and possibly even typical pyoderma gangrenosum. A variant of acute febrile neutrophilic dermatosis in which acute myeloid leukemia is present has been reported and seems identical to bullous pyoderma gangrenosum. Although no clear pathogenesis has been demonstrated, studies of the bowel-bypass syndrome have implicated immune complex disease. Therapy with prednisone is usually effective, but numerous other anti-inflammatory agents have been used effectively.