Complete Cutaneous Examination Research Articles

A clinical and epidemiological study of non-venereal genital dermatoses: A cross-sectional, hospital-based study from Nepal

Background: Non-venereal genital dermatoses are the conditions of the genitalia that are not transmitted sexually. They may be confused with venereal diseases and be responsible for concerns among patients as well as diagnostic dilemmas for physicians. This study was conducted to determine the prevalence and describe the patterns of non-venereal genital conditions. Methods: This was a hospital-based, cross-sectional, prospective study conducted in a tertiary center in Kathmandu, Nepal, over a period of one year. Non-probability purposive sampling was employed to select the samples. Two hundred patients were enrolled in the study. Ethical approval was taken prior to the study. Detailed history taking along with a complete cutaneous examination were conducted for all patients and recorded in a preformed proforma. Results: Among 21366 patients, two hundred patients had non-venereal genital dermatoses. The prevalence of non-venereal dermatoses was 0.93 %. The mean age of the patient was 29.5 ± 15 years, ranging from 2 months to 81 years. The male-to-female ratio was 2.7:1. Itching was the most common presentation (46%). Fifty-four different types of non-venereal diseases were encountered and classified into inflammatory lesions (n = 84; 42%), infections and infestations (n = 43; 21.5%), normal variants and benign abnormalities (n = 41; 20.5%), and miscellaneous (n = 21; 10.5%). The most common were, among inflammatory dermatoses, drug reactions (11.5%) and eczema (6.5%) and, among infections and infestations, scabies (9.5%) and fungal infections (7.5%). Conclusion: Non-venereal genital dermatoses are important yet less common dermatological conditions. A number of patients have misconceptions about them as venereal. A comprehensive study of non-venereal dermatological genital conditions is required for careful management to minimize morbidity.

Different patterns of cutaneous manifestation of diabetes mellitus type-2 observed in tertiary care centre of South West Rajasthan

Diabetes mellitus (DM) is a common endocrinal disorder caused by complex interaction of genetics and environmental factors. Various dermatological features are known to be cutaneous markers of diabetes mellitus like diabetic dermatopathy, acrochordons, acanthosis nigricans and bullous diabeticorum, etc.An observational cross-sectional study on a total of 400 patients of Diabetes Mellitus Type-2. A complete cutaneous examination was done in all cases to observe for the presence of any specific or nonspecific dermatosis. All the statistical tests were two sided and P-value <0.05 was considered as significant level.This study showed that in specific cutaneous disorders, Acrochordon 138(34.5%) was the most common manifestation which was followed by, Bacterial Infections 93(23.5%), Dermatophytosis 77(19.2%), Candidiasis 76(19%), Acanthosis nigricans 50(12.5%) and Onychomycosis 33(8.25%) in decreasing order. Xerosis 259(64.7%) was the commonest manifestation in non-specific cutaneous disorders followed by, Generalized pruritus 200(50%), Seborrheic keratosis 35(8.75%) in decreasing order.Cutaneous manifestations are quite common in uncontrolled (HbA1c>7gm) type 2 diabetes mellitus as compare to controlled group. Uncontrolled group is more prone to develop diabetic complication like hypertension, diabetic retinopathy and peripheral neuropathy etc. It is concluded that, Diabetes mellitus Type-2 involves the skin quite often and whenever patients present with multiple skin manifestation and then diabetic statusshould be checked and controlled.

Cutaneous manifestations in COVID-19 patients in a district COVID care centre

<p class="abstract"><strong>Background:</strong> COVID-19, initially started as respiratory illness and evolved to involve various systems. Skin has been the least targeted organ with manifestations limited to case reports and series in a foreign scenario. Here, we tried to understand a same in an Indian scenario.</p><p class="abstract"><strong>Methods:</strong> This was cross-sectional study done in district COVID centre among patients with a confirmed diagnosis of COVID-19 with cutaneous manifestations for 3 months. A detailed history, complete cutaneous examination was carried out. Timing in relation to other symptoms and severity was assessed.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among the 1603 patients, 39 (2.4%) had skin manifestations. Urticaria (20.5%), petechiae/purpura (17.9%), pruritis (15.4%) were the most common followed by maculo-papular rash (7.7%), manifestations secondary to drugs (7.7%), diffuse hair fall (7.7%), pseudo-chilblains (5.1%), vesicular eruptions (5.1%), infections (5.1%), cellulitis, gangrene and livedoid vasculitis. Timing of skin lesions ranged from 2 days before (10.3%) onset of COVID-19 symptoms or diagnosis to 10 days after (69.2%). Urticaria, petechiae, maculopapular rash were seen more commonly in patients with fever and respiratory symptoms. Asymptomatic cases showed urticaria, petechiae and pseudo-chilblains. Majority were in mild and moderate disease and livedoid vasculitis patient had severe disease.</p><p class="abstract"><strong>Conclusions:</strong> Skin manifestations in COVID-19 are relatively uncommon in Indian scenario. However, few of the manifestations give a hint of infection while some correlate with the severity of disease.</p>

Prevalence of Venereophobia among Patients of Non-Venereal Genital Conditions- a Cross-Sectional Hospital Based Study from Nepal

Background
 Venereophobia is the fear of getting venereal diseases or sexually transmitted diseases. This study was carried out to determine the prevalence and describe the varying clinical pattern of dermatoses among patients with venereophobia in non-venereal genital conditions.
 Materials and Methods
 This was a hospital-based, prospective, cross-sectional observational study conducted in a tertiary center in Kathmandu, Nepal, over a period of one year. A nonprobability purposive convenient sampling technique was used to select the samples. Two hundred patients were enrolled in the study. Ethical approval was taken prior to the study. A detailed history along with a complete cutaneous examination was carried out in all patients and recorded in preformed proforma. Patients with symptoms and clinical signs of sexually transmitted infections were excluded from the study.
 Results
 The prevalence of venereophobia among non-venereal dermatosis was 18%. The mean age of the patient with non-venereal genital dermatosis was 29.5 ± 15 years. The male to female ratio was 17:2. About 72% of the total patients were married. The most common symptoms of patients with venereophobia were genital itching, whereas about 44% were asymptomatic. The common dermatological disorders associated with venereophobia were pearly penile papules, genital vitiligo, irritant contact dermatitis. Three fourth of the patient with venereophobia had multiple sexual exposures.
 Conclusions
 Venereophobia is an important issue to be focused on patients with genital dermatosis and a significant number of patients might have venereophobia even in non-venereal genital dermatoses. A proper genital and psychiatric evaluation might prevent misdiagnosis and complications.

Cutaneous manifestation of polycystic ovary syndrome.

The aim of this cross-sectional study, that included 146 polycystic ovary syndrome (PCOS) patients, was to evaluate the prevalence, severity and pattern of cutaneous manifestation in Jordanian women with PCOS, as well as their correlation with hormonal abnormalities. A thorough complete cutaneous examination, hormonal assays (Luteinizing hormone [LH], follicle stimulating hormone [FSH], prolactin, total testosterone, free testosterone, dehydroepiandrosterone sulfate) and pelvic ultrasonography were done. The most common cutaneous features of PCOS were acne vulgaris (75.3%) followed by hirsutism (59.6%) then seborrhea (43.2%) and androgenetic alopecia (42.5%). Patients who had acne vulgaris presented at a younger age than patients who did not. Patients who had androgenetic alopecia and stria were older than patients with no such features. Moreover, all cutaneous manifestations of PCOS, except for acne, were associated with higher body mass index (BMI). Elevated LH:FSH ratio of more than 2:1 was the most common hormonal abnormality, followed by increased LH and total testosterone. Acne, hirsutism, androgenetic alopecia, seborrhea, acanthosis nigricans and skin tags are common cutaneous manifestations among Jordanian patients with PCOS. The existence of one or more of these features, especially in overweight and obese patients, should alert the physician towards the possibility of having PCOS.

Impact of Chronic Urticaria on Quality of Life in a Tertiary Level Hospital in Nepal

Introduction: Most healthcare providers recognize that urticaria is frequently difficult to treat but many do not realize the substantial negative impact, chronic urticarial (CU) has on patient’s quality of life (QoL). The questionnaire specifically developed to measure health related quality of life in chronic urticaria is the Chronic Urticaria Quality of Life (CU-Q2oL) questionnaire. This questionnaire has helped to define the effects and impact on patients.
 Objective: To assess the impact of chronic urticaria on quality of life at tertiary level hospital in Nepal.
 Materials and Methods: This was a hospital based cross-sectional study conducted in the Department of Dermatology and Venereology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal, over a period of one year involving 230 patients in the study. A detailed history along with the complete cutaneous examination was carried out in all patients.
 Results: All the 230 patients (100%) had symptoms of wheals and pruritus while eye swelling and lip swelling was present only in 20% and 25% respectively. Highest Mean scores were seen of pruritus (4.34) and wheals (4.29). Highest mean score was achieved by domain of pruritus (4.31) followed by domain of sleep (2.31), life activities (2.22), limits (2.05), looks (1.76) and swelling (1.4).
 Conclusion: Chronic Urticaria impacts the quality of life by affecting various aspects in patient’s life. CU-Q2oL questionnaire could reveal the involvement of various such aspects, which were seldom realized by the patients themselves. Patients had worst quality of life with symptoms of pruritus and wheals.

Serum TWEAK: A cutoff between segmental and nonsegmental vitiligo.

TWEAK/Fn14 is expressed in many tissues including the skin, playing an important role in many inflammatory, autoimmune, and neoplastic cutaneous disorders. To assess the serum levels of tumor necrosis factor-like weak inducer of apoptosis (TWEAK) in vitiligo patients. This case-control study included 100 subjects (50 vitiligo patients and 50 control subjects) recruited from Dermatology Outpatient Clinic, Benha University. All patients were subjected to complete cutaneous examination, to evaluate the clinical type, distribution and severity of vitiligo using the Vitiligo Area Scoring Index (VASI). TWEAK serum levels were significantly higher in patients than in the control subjects (644.76±688.93 vs 282.75±125.67, respectively). Serum levels were significantly elevated in segmental versus nonsegmental vitiligo. Receiver operating characteristic (ROC) analysis revealed that TWEAK shows 80% sensitivity and 56.67% specificity in diagnosing vitiligo and 100% sensitivity and 80.09% specificity in differentiating segmental from nonsegmental vitiligo. TWEAK may play a role in vitiligo pathogenesis. It may be used in the differentiation between segmental and nonsegmental vitiligo and represent a promising therapeutic target in vitiligo.

Dermatological Conditions Associated with Pregnancy: A Hospital Based Study

Background: Pregnancy Changes can be both physiologic and pathologic, affecting commonly the skin, nails, and hair shafts. Pregnancy has immunologic, endocrine, metabolic and vascular changes, which leads to changes of skin and its appendages and can affect every organ of pregnant women including the skin. Pregnancy also modifies the course of a number of preexisting dermatological conditions. The aim of our study was to study the common skin manifestation
 Objectives: during pregnancy.
 Material and Method: Hundred pregnant women were enrolled in the study. This is a hospital- based prospective cross- sectional descriptive study, conducted in the out-patient department (OPD) of Department of Dermatology and Venereology and Department and Obstetrics and Gynecology at Nepalgunj Medical College Teaching Hospital Kohalpur, Banke Nepal, conducted over a period of two year, June 2016 to May 2018. A detailed history along with complete cutaneous examination was carried out in all patients. Relevant investigations were done wherever necessary.
 Result: A total of 100 pregnant women were recruited in our study from June2016 to May 2018. Out of these, 65(65%) were primigravidas and 35(35%) were multi gravidas. Their age range was 18 to 37 years with the mean of 24. Most of them presented in the third trimester. Pruritus was the commonest symptom accounting for 28(28%)cases. Physiological changes were seen in 75(75%) cases and 10 (10%) cases of specific dermatoses of pregnancy were seen.
 Conclusion: Skin manifestations are quite common in pregnancy and physiological changes were frequently seen. This study emphasizes the need for a scrupulous and meticulous search for dermatological and sexually transmitted diseases instead of a casual cursory examination and clinicians need to distinguish between physiological skin changes and specific dermatoses of pregnancy for better patient care.

Cutaneous findings in Bardet-Biedl syndrome.

Bardet-Biedl syndrome (BBS) is a rare, pleiotropic syndrome and member of a diverse group of disorders known as ciliopathies. Improved understanding of dermatoses in BBS will further understanding of the syndrome and will help define the role of dermatologists in providing care for patients with BBS. The purpose of this study was to describe the cutaneous phenotype of BBS in patients attending a large, multispecialty BBS clinic. All patients attending the multispecialty BBS Clinic at the Marshfield Medical Center over a 12-month period were invited to participate. Complete cutaneous examinations were performed by a board-certified dermatologist, and comprehensive physical examinations were performed by clinic physicians. Molecular genetic results were obtained when available. Comprehensive laboratory studies were performed in each patient including fasting blood sugar and thyroid and renal function. Thirty-one individuals ranging in age between 2 and 69 years (median age, 12 years) participated in the study. Cutaneous findings were present in all subjects. Keratosis pilaris was present in 80.6% of subjects, and seborrheic dermatitis was present in 19.3%. Obesity, a cardinal feature of BBS, was present in the majority of subjects (90.3%) and was accompanied by known obesity-related dermatologic disorders. Cutaneous disorders are common in BBS and suggest disturbance of keratinization and keratinocyte function as well as systemic consequences of BBS on skin health. Increased prevalence of skin barrier dysfunction in this ciliopathy demonstrates the importance of dermatologist contribution to health care in BBS.

Scabies Surrepticius: Scabies Masquerading as Pityriasis Rosea

Scabies, a mite infestation caused by 'Sarcoptes scabiei', most commonly presents as pruritic linear burrows where the mite has invaded the skin. Scabies variant such as bullous, crusted, hidden, incognito, nodular and scalp-mimic the other conditions. In addition, atypical presentations of scabies can masquerade as dermatitis herpetiformis, ecchymosis, Langerhans cell histiocytosis, systemic lupus erythematosus, urticaria, and urticaria pigmentosa. A 59-year-old male presented with non-pruritic papulosquamous plaques on his chest, abdomen, and back resembling lesions of pityriasis rosea in morphology and distribution. The complete cutaneous examination also demonstrated burrows on his finger webs. A mineral oil preparation of skin scrapings showed scabies mites, ova, and scybala. His infestation resolved after the treatment with topical permethrin 5% cream and oral ivermectin 15 mg on days one and eight. In conclusion, scabies surrepticius is a term that has recently been established to unify not only the numerous variants but also the atypical presentations of scabies. The inaccurate diagnosis of scabies infestation can lead to increased medical costs and the side effects of unnecessary tests and the treatment. Pityriasis rosea-like scabies can be added to the list of atypical presentations that are included under the unifying designation scabies surrepticius.

Male genital lichen sclerosus and hepatitis C

Funding sources: Skin Treatment and Research Trust (START) and Sir John Fisher Foundation. Conflicts of interest: none declared. Madam, Male genital lichen sclerosus (MGLSc) is an acquired cutaneous disease of uncertain aetiology. It causes acute and chronic balanoposthitis and scarring that can result in significant sexual and urinary dysfunction and has been associated with squamous carcinoma of the penis. The aetiopathogenesis of MGLSc is unknown. Prior postulated pathogenic factors in GLSc include genetic and environmental influences, exposure to the irritant effects of urine and infections such as Borrelia and human papillomavirus. A relationship with hepatitis C virus (HCV) has been suggested by case reports of extragenital and genital LSc.1–3 We have therefore screened for HCV seropositivity in a cohort of patients with MGLSc. This work was approved by the local Research Ethics Committee (REC 09/H0607/58). We studied 61 men attending the Male Genital Dermatoses Clinics at Chelsea and Westminster (CWH) and University College Hospitals (UCH), London. All had clinical and histology findings consistent with the diagnosis of GLSc. None of the patients had extragenital LSc upon complete cutaneous examination. The age range was 22–72 years. Patients had blood samples taken for HCV antibody titre and conventional liver function tests (LFTs).

Methicillin‐Resistant Staphylococcus aureus Colonization in Children with Atopic Dermaitis

Children with atopic dermatitis are more frequently colonized with Staphylococcus aureus than children without atopic dermatitis. However, little epidemiological data exist regarding the prevalence of methicillin-resistant S. aureus among children with atopic dermatitis. Recent studies have revealed an increasing prevalence of community-associated methicillin-resistant S. aureus among patients presenting to hospitals with serious bacterial infections, particularly those with cutaneous and soft tissue infections. As many atopic dermatitis patients are treated empirically with antibiotics for secondary skin infections, an understanding of the epidemiology of bacterial colonization and superinfection is essential for directing proper treatment in the atopic patient population. This study investigates the prevalence of risk factors for community-associated, methicillin-resistant S. aureus colonization among pediatric atopic dermatitis patients encountered at an academic pediatric dermatology clinic. An observational cross-sectional study was conducted at the Children's Hospital of Philadelphia in which 54 patients previously diagnosed with atopic dermatitis were enrolled. A detailed patient questionnaire, a complete cutaneous examination, and an evaluation of eczema severity according to the Eczema Area and Severity Index were completed at the time of enrollment. Bacterial cultures from the skin and nares were obtained to determine the frequency of colonization with either methicillin-sensitive S. aureus or methicillin-resistant S. aureus. Although most atopic dermatitis patients studied were colonized with S. aureus (43/54 [80%]), methicillin-resistant S. aureus was isolated from only seven atopic dermatitis patients (7/43 [16%]). Patients colonized with S. aureus were more likely to be male, to have been previously hospitalized, to have used a topical calcineurin inhibitor in combination with a topical steroid, and less likely to have used topical antibiotics. Bivariable analysis, however, revealed that only previous hospitalization was independently associated with an increased risk of methicillin-resistant S. aureus colonization. We observed that 80% of atopic dermatitis patients were colonized with S. aureus, and that of these patients, 16% of colonized patients were colonized with a methicillin-resistant strain. Methicillin-resistant S. aureus colonization was found to be significantly associated with previous hospitalization. Evidence also indicates that topical calcineurin inhibitors used in conjunction with topical steroids is associated with increased S. aureus colonization, while topical antibiotic use appears to decrease S. aureus colonization.

Dysplastic naevi with moderate to severe histological dysplasia: a risk factor for melanoma

The risk of malignant melanoma associated with histologically dysplastic naevi (HDN) has not been defined. While clinically atypical naevi appear to confer an independent risk of melanoma, no study has evaluated the extent to which HDN are predictive of melanoma. To estimate the risk of melanoma associated with HDN. Secondarily, the risk associated with number of naevi and large naevi is estimated. We enrolled 80 patients with newly diagnosed melanoma along with 80 spousal controls. After obtaining information on melanoma risk factors and performing a complete cutaneous examination, the most clinically atypical naevus was biopsied in both cases and controls. Histological dysplasia was then assessed independently by 13 dermatopathologists (0, no dysplasia; 1, mild dysplasia; 2, moderate dysplasia; 3, severe dysplasia). The dermatopathologists were blinded as to whether the naevi were from melanoma subjects or controls. Multivariate analyses were performed to determine if there was an independent association between the degree of histological dysplasia in naevi and a personal history of melanoma. In persons with naevi receiving an average score of > 1 (i.e. naevi considered to have greater than mild histological dysplasia), there was an increased risk of melanoma [odds ratio (OR) 2.60, 95% confidence interval (CI) 0.99-6.86] which persisted after adjustment for confounders (OR 3.99, 95% CI 1.02-15.71). Very few dermatopathologists reliably graded naevi of subjects with melanoma as being more dysplastic than naevi of control subjects. Among the entire group, the interobserver reliability associated with grading histological dysplasia in naevi was poor (weighted kappa 0.28). HDN do appear to confer an independent risk of melanoma. However, this result may add more to our biological understanding of melanoma risk than to clinical assessment of risk, because HDN assessed by a single pathologist generally cannot be used to assess risk of melanoma. Future studies should be directed at establishing reproducible, predictive criteria for grading naevi.

The prevalence and descriptive epidemiology of atopic dermatitis in Singapore school children.

Atopic dermatitis is a common disease that appears to be increasing in frequency during recent decades. Most of the studies are based on the Western population, and there are few data in the Asian population. To determine the prevalence and descriptive epidemiology of atopic dermatitis among school children in the general community in Singapore. This is a questionnaire study of 12 323 students done over a 1-year period, comprising 7 year olds (4605), 12 year olds (3940) and 16 year olds (3778) from 19 primary and 17 secondary schools randomly selected in Singapore. All children had a complete cutaneous examination. The diagnosis of atopic dermatitis was based on the U.K. Working Party diagnostic criteria. The questionnaire was translated into Chinese and both the English and Chinese versions were issued simultaneously to the students. The 1-year period prevalence of atopic dermatitis was 20.8%. Atopic dermatitis was present in 22.7% of 7 year olds, 17.9% of 12 year olds and 21.5% of 16 year olds. The overall sex ratio was equal. There were slightly more boys with atopic dermatitis among the younger children (6 and 12 year olds, 1.18 : 1 and 1.19 : 1, respectively) but more girls were affected (1.57 : 1) among the 16 year olds. Atopic dermatitis was more common among the Chinese (21.6%) and Malays (19.8%) compared with the Indians (16%) and other races (14%). The onset of the disease occurred before the age of 10 years in 49.5% of the 16 year olds. "Pure" atopic dermatitis without concomitant respiratory allergies was noted in 788 respondents (30.7%); 1775 (69.3%) suffered from a "mixed" type, with 34.3% having allergic rhinitis, 9.5% having asthma and 25.5% having both asthma and allergic rhinitis. More boys had atopic dermatitis and concomitant respiratory allergies whereas more girls were affected with "pure" atopic dermatitis alone (1.4 : 1). At least one first-degree family member with atopy was noted in 1435 children (56%): atopic dermatitis (70%), asthma (62%) and allergic rhinitis (68%). Among siblings with one parent with atopic dermatitis, 37% had either a father or a mother with atopic dermatitis. Common aggravating factors reported included exercise, heat and sweating, grass intolerance, thick clothing and stress. Pityriasis alba was noted in 25% of the study population, keratosis pilaris in 13% and ichthyosis vulgaris in 8%. Most respondents had mild to moderate atopic dermatitis that could be controlled with a fairly simple regimen of moisturizers, topical steroids, antihistamines and antibiotics. The high prevalence of atopic dermatitis in Singapore is similar to that observed in developed countries, suggesting that environmental factors may be important in determining the expression of the disease.

Axillary basal cell carcinoma.

Basal cell carcinoma (BCC) rarely occurs in the axilla. Only 18 cases have been reported in the world literature. To report our institution's 11-year experience with axillary BCC. A review of patient charts and biopsy specimens is given. We report 14 patients with 15 axillary BCCs. The average patient age was 65.6. The average lesion size was 10.8 mm. Nine patients had a personal history of skin cancer at sun-exposed sites. One patient had basal cell nevus syndrome. A history of ionizing radiation and severe sunburn involving the axilla was each seen in separate patients. No other predisposing factors for developing BCC were identified, such as immune suppression or a history of other malignancies. Histologic subtypes of all tumors were considered less aggressive, and only one tumor recurred. Axillary BCC is rare. Factors other than ultraviolet radiation likely contribute to the development of BCC, especially at sun-protected sites. Performing a periodic and complete cutaneous examination that includes sun-protected sites is important, especially in patients who have a history of skin cancer.

Clinical characteristics of malignant melanomas developing in persons with dysplastic nevi

A total of 452 patients with dysplastic nevi (DN) were followed prospectively by repetitive, complete cutaneous examinations in order to determine the clinical features of early malignant melanomas (MM) arising in them. Sixteen patients (3.5%) developed 18 newly diagnosed MM during an average follow-up period of 27 months. Twelve of the 18 MM were in situ and all of the primary invasive MM diagnosed prospectively in this follow-up were less than 0.89 mm in Breslow thickness, implying an excellent prognosis. The principal clinical clue to the diagnosis of MM was change in a preexisting pigmented lesion. Total-body photographs were very useful in helping to identify the early MM in these patients.

Dysplastic nevi. Markers for increased risk for melanoma.

A total of 452 white patients, classified into four dysplastic nevi groups, were followed prospectively by repetitive, complete cutaneous examinations using total-body photographs taken on entry into the study. Sixteen patients (3.5%) developed 18 newly diagnosed malignant melanomas (MM) during an average follow-up period of 27 months. Twelve of the 18 MM were in situ, and all of the six primary invasive MM diagnosed prospectively in this follow-up were less than 0.89 mm in Breslow thickness, implying an excellent prognosis. Compared with reference populations, the number of MM detected significantly exceeded the number estimated to occur in the comparable age-matched control groups. These data support the concept of repetitive follow-ups of all groups of patients with dysplastic nevi.

Prevalence of cutaneous disease in patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex

Ninety adult patients with acquired immunodeficiency syndrome (AIDS) and 27 with AIDS-related complex were seen consecutively, when available, either as inpatients or in AIDS clinics and given complete cutaneous examinations. Skin disease was common both in patients with AIDS and in those with AIDS-related complex. The most common cutaneous findings were candidiasis in 55 patients (47.0%), dermatophytosis in 35 (30%), herpes simplex infections in 26 (22%), molluscum contagiosum in 11 (9%), seborrheic dermatitis in 37 (32%), and acquired ichthyosis or xerosis in 36 (30%). Several cutaneous conditions previously reported in association with AIDS were infrequently seen: Psoriasis was seen in only one patient, and deep fungal infections and basal and squamous cell carcinomas were seen in none. No significant differences were noted in the prevalence of skin disease between patients with AIDS and those with AIDS-related complex, although xerosis and ichthyosiform skin changes tended to be more common in those with AIDS. The yellow nail syndrome and “a papular eruption” associated with AIDS were seen. Skin diseases also tended to be widespread and severe in the patients studied.

Importance of complete cutaneous examination for the detection of malignant melanoma

With the rate of melanoma increasing 1,000% in the past 50 years, the early detection of the disease is becoming more important. Data from 2,239 persons seen at the Manhattan Melanoma/Skin Cancer Detection Screening Program were analyzed to determine if a complete cutaneous examination would significantly increase the chance of detecting melanoma. Thirteen of the fourteen melanomas detected were on anatomic sites normally covered by clothing. Patients having complete skin examinations were 6.4 times more likely to have a melanoma detected than those having partial examinations (p = 0.025). These findings reinforce the importance of complete skin examination for the early detection of malignant melanoma.

Frictional Dermatitis of Onan

<h3>To the Editor.—</h3> We wish to report a heretofore unlabelled condition that we believe to be a not rare male affliction. Five men, aged 22 to 40 years, were seen at the dermatology clinic at the University of Texas Medical Branch, Galveston, over a four-month period in late 1982 with a distinctive penile dermatitis that we attributed to masturbation. In each case, patients complained of a pruritic penile eruption of one to three weeks' duration. Physical examinations disclosed subacute to chronic eczema on the penile corona and, in one patient, shaft. A linear distribution of lesions suggested an exogenous origin for the dermatitis. In more chronic cases, lichenification and hyperpigmentation were appreciated. Evaluation included exclusion by history of causes of penile allergic contact dermatitis,¹potassium hydroxide preparation to exclude candidosis, Gram's stain to exclude bacterial infection, and a VDRL test. History and complete cutaneous examination did not support diagnoses