Complete Skin Examination Research Articles

Examining the scalp for melanoma? Try a blow dryer

CLINICAL CHALLENGE The incidence of scalp melanomas has been increasing with that of melanoma overall, and scalp melanomas carry a higher mortality rate than melanomas on other locations, including nearby areas of the head and neck. It has been suggested that the lower survival rates are a result of the inherent difficulties in identifying early-stage melanomas on the scalp. Although the importance of early detection of scalp melanomas cannot be overstated, the scalp examination itself is considered one of the most time-consuming elements of the complete skin examination.

The Prevalence of Bruising Among Infants in Pediatric Emergency Departments

Bruising can indicate abuse for infants. Bruise prevalence among infants in the pediatric emergency department (ED) setting is unknown. Our objective is to determine prevalence of bruising, associated chief complaints, and frequency of abuse evaluations in previously healthy infants presenting to pediatric EDs. We conducted a prospective, observational, multicenter study of infants aged 12 months or younger presenting to pediatric EDs. Structured sampling was used. Pediatric emergency medicine clinicians performed complete skin examinations to screen for bruising. Study investigators documented skin findings, date of visit, patient's age, chief complaint, and abuse evaluation. The primary outcome was prevalence of bruising. Secondary outcomes were prevalence of bruising based on chief complaint and frequency of abuse evaluation. Point estimates of bruise prevalence and differences in bruise prevalence between patient subgroups were calculated with 95% confidence intervals (CIs). Bruising was identified in 88 of 2,488 infants (3.5%; 95% CI 2.9% to 4.4%). Rates of bruising for infants 5 months and younger and older than 5 months were 1.3% and 6.4%, respectively (difference 5.1%; 95% CI 3.6% to 6.8%). For infants 5 months and younger, 83% of bruising was associated with a trauma chief complaint and only 0.2% of infants presenting with a medical chief complaint had bruising. Pediatric emergency medicine clinicians obtained abuse evaluations on 23% of infants with bruising, and that rate increased to 50% for infants 5 months and younger. Bruising prevalence in children 12 months and younger who were evaluated in pediatric EDs was low, increased within age strata, and was most often associated with a trauma chief complaint. Most bruised infants did not undergo an abuse evaluation.

Skin features in myotonic dystrophy type 1: An observational study

Poor data regarding skin involvement in Myotonic Dystrophy, also named Dystrophia Myotonica type 1, have been reported. This study aimed to investigate the prevalence and types of skin disorders in adult patients with Myotonic Dystrophy type 1.Fifty-five patients and one hundred age- and sex-matched healthy subjects were referred to a trained dermatologist for a complete skin examination to check for potential cutaneous hallmarks of disease. No difference in prevalence of preneoplastic, neoplastic, and cutaneous lesions was detected between the two groups. Among morphofunctional, proliferative and inflammatory lesions, focal hyperhidrosis (p < 0.0001), follicular hyperkeratosis (p = 0.0003), early androgenic alopecia (p = 0.01), nail pitting (p = 0.003), pedunculus fibromas (p = 0. 01), twisted hair (p = 0.01), seborrheic dermatitis (p = 0.02), macules of hyperpigmentation (p = 0.03) were significantly more frequent in patients compared with controls. In patients with Myotonic Dystrophy type 1 significant differences according to sex were found for: early androgenic alopecia, twisted hair and seborrheic dermatitis, whose prevalence was higher in males (p < 0.0001).Our preliminary results seem to rule out an increased prevalence of pre-neoplastic, and neoplastic skin lesions in Myotonic Dystrophy type 1. On the other hand, an increased prevalence of morphofunctional, inflammatory, and proliferative diseases involving adnexal structures seems to characterize adult patients with Myotonic Dystrophy type 1.

Dermatologic features of Smith-Magenis syndrome.

Smith-Magenis syndrome (SMS) is characterized by distinctive facial and skeletal features, developmental delay, cognitive impairment, and behavioral abnormalities, including self-injurious behaviors. We aimed to investigate whether cutaneous features are common in SMS. We performed a complete skin examination in 20 young SMS patients. Skin features secondary to self-injurious behavior, such as bites, abrasions, dystrophic scars, limited spots of hyperkeratosis, anomalies of the nails, and whitlows, were found in the majority of patients. Acral pachydermia and fissured plantar keratoderma were common. Xerosis was constant and associated with extensive keratosis pilaris in the majority of patients. Dermatofibromas were frequent in older patients. The hair was dense and shiny, with an unusual hairline. Eyelash trichomegaly and heavy brows were common, as well as folliculitis on the back. The skin features of SMS have rarely been reported in the literature. Some of these are the consequence of neurobehavioral features, but some cutaneous features and abnormalities of appendages have not been reported in other related syndromes. Skin manifestations of SMS are varied, sometimes induced by self-injurious behavior and sometimes more specific. It remains to be determined whether the combination of the two kinds of signs could contribute to early diagnosis of the syndrome.

Differential diagnosis and management of balanitis

Balanitis is a descriptive diagnosis for a heterogeneous group of infectious or inflammatory dermatoses which have to be differentiated from malignant conditions. Balanitis is caused not only by Candida spp. and bacterial infections, including anaerobic bacteria: viral infections, parasites and other sexually transmitted infections (STI) also have to be considered. Lichen planus, psoriasis and contact dermatitis can characteristically lead to inflammatory conditions of the glans penis. In addition to a complete skin examination, a thorough patient history with respect to topically applied products and sexual behavior is essential. Infections must be treated and the glans penis should be kept dry. It is important to ensure a balanced genital hygiene in patients. As a last resort therapeutic circumcision can be considered for most forms of chronic balanitis.

Implementing an educational initiative to promote sleep

reports 70,000 new diagnoses of skin cancer each year (themost frequent cancer in fact). Half of patients hospitalized with principal diagnosis “skin cancer” are 75 years and older. Usually, skin cancers early diagnosed can be cured, 70% are basal cell carcinomas, 20% squamous cell carcinoma, and 10% are melanomas (incidencehas tripledbetween1980and2005,due to sunexposurepractices). Factors of delayed diagnostic have been analyzed by the INCA: elderly widows, inequality in access to dermatologists consultations in France. In addition, general practitioners, that follow high-risk populations such as older people (that often cannot do self survey), recognize there is a lack of formation and not enough time to make a complete skin examination (including scalp, external genital organs and feet). The hospital stay is an opportunity to perform this skin examination during several nursing care. Objectives: Evaluate the feasibility of skin cancer screening by nurses during hospitalization in acute geriatric unit. Methods: Screening of risk factors and suspicious skin lesion (full examination including scalp, external genital organs, feet) has been realized one day in 2013, January. Inclusion criteria were patients hospitalized in 2 acute geriatric units in Caen hospital. Exclusion criteria were outgoing patients, palliative care, and dementia with psychobehavioral troubles. It has been performed by one referent nurse and one professional caregiver in each unit, who have received a brief training based on INCA nurse plug. Results: 32 patients were included in 40 hospitalized patients, mean age 87.2 years (±5), 53% female. Presence of each risk factor and number of cumulative risk factors has been recorded for each patient. Only 2 patients had no risk factor. There weremissing data for 8 patientswith cognitive impairment for «personal or family history ofmelanoma” and “history of sunburn” items; and for 3 of these 8 patients also missing data about “professional UV exposure”. Suspicious skin cancer lesions have been discovered in 3 patients who were addressed to a dermatologist (but 1 canceled because of 2 emergency re-hospitalizations, 1 lost to follow up, 1 suddenly died). Conclusion: ·The prevalence of skin cancer risk factors is high in elderly, for whom a regular screening is needed. In our acute geriatric units, skin cancer screening is not relevant for 1 patient/8 that has severe dementia or is in palliative care. This screening could be realized in other acute medicine units and geriatric rehabilitation centers. Complete skin examination is easy to perform during hospitalization to detect suspicious lesion, so we decided to plan it in routine care. The skin cancer screening is specified to the general practitioner in the hospital report. Further training is planned in June 2014, for our referent nurses and caregivers, and geriatricians. Organization of further dermatological consultation has to be improved. Reference: http://www.e-cancer.fr/depistage/cancers-de-la-peau/ espace-professionnels-de-sante Disclosure of interest: None declared.

Continuing professional training program in skin cancer screening in elderly

Introduction: INCA (French National Institute of Cancer) recommends skin cancer screening for any adult exposed to potential risk factors, without age-limit. Health professionals identified for screening are not only doctors, but also nurses, and physiotherapists. There is no national registry for skin cancer incidence. Hospital activity reports 70,000 new diagnoses of skin cancer each year (the most frequent cancer in fact). Half of patients hospitalized with principal diagnosis “skin cancer” are 75 years and older. Skin cancer with early diagnosis can often be cured, 70% are basal cell carcinomas, 20% squamous cell carcinoma, and 10% are melanomas (incidence has tripled between 1980 and 2005, due to sun exposure practices). Factors of delayed diagnostic have been identified by the INCA: elderly widows, inequality in access to dermatologist consultation in France. In addition, general practitioners, that follow high-risk populations such as older people, who cannot practice self-examination, recognize that there is a lack of training and not enough time to make a complete skin examination during themedical consultation (including scalp, external genital organs and feet). Objectives: Develop a continuing professional training (in French Developpement Professionnel Continu) for nurses, general practitioners and geriatricians, following elderly patients, living in community dwelling and nursing home. Methods: In Normandy, the program was suggested by mail in 2014 February, via private general practitioners' regional union, nurse coordinators and geriatricians in nursing homes. The first self-assessment was performed between March and May, one day, by a retrospective and randomized study of 20 patients medical journal among 75 years and older nursing home's residents, followed since at least one year. Patients receiving palliative care and dementia with severe behavioral troubles were excluded. There were 2 different questionnaires for nurses or doctors with filling guide for each. Use of data by sorting flat. Classroom training about skin cancer in elderly was organized with dermatologists in May 23. Feedback experience on skin cancer screening was organized in June 19, with elaboration of corrective action plan. The second self-assessment is planned at the end of 2014. Results: 8 geriatricians and only 1 nurse from different institutions performed the first self-assessment. For the nurse, there were negative answers for the 5 criteria in all patients. Concerning geriatricians, a complete skin examination has already been recorded for 27,5% of patients (but since more than one year for 80%). Skin cancer risk factors are never collected. None liberal general practitioners participated. Conclusion: We had expected more participants for this innovating continuing training program, involving both institution health professionals and private practitioners concerned by cancer screening in their patients. 2014 is the beginning of binding « Developpement Professionnel Continu » for private practitioners, and self-assessment method is still not well known. Further training program is planned in the next years, for health professionals, with better communication strategies. This first self-assessment revealed a lack of skin cancer examination in older patients, and of skin cancer risk factor collection, and also in dermatological monitoring. We hope our classroom training will improve the second selfassessment results. Reference: http://www.e-cancer.fr/depistage/cancers-de-la-peau/ espace-professionnels-de-sante. Disclosure of interest: None declared.

Melanoma screening by physicians: time for a policy change in the United States.

priority. What can be done to address the rising health care costs of diagnosing and treating melanoma and reduce the loss of productivity of patients? Melanoma screening by a physician is associated with detection of thinner melanomas, which results in decreased mortality. 2 A higher proportion of melanoma diagnosed at an earlier stage can be expected to lower costs for both years of productive life lost as well as disease treatment. Currently, 59.6% of primary care physicians (PCPs) routinely perform skin examinations, compared with 81.3% of dermatologists. Lack of reimbursement was cited by 43.3% of PCPs and 25.1% of dermatologists as one barrier to performing complete skin examination to screen patients for melanoma. Other barriers for PCPs are lack of time, lack of training, and their low confidence in their skills pertaining to pigmented lesion examinations. 3 In a 1-year pilot skin cancer-screening program in

Primary Gastric Melanoma: Wait, I Thought the Stomach Did Not Have Any Melanocytes!

Introduction: We report a case of a patient who presented with abdominal pain and decreased ability to tolerate food, and was found to have melanoma in the gastric mucosa. We highlight the difficulty of diagnosing primary gastric melanoma with certainty, given its rarity and theoretical implausibility, as normal gastric epithelium lacks melanocytes. We also briefly review several pathophysiologic and embryologic hypotheses for this phenomenon. A 50-year-old Hispanic male presented to our clinic with epigastric pain and decreased ability to tolerate food. An EGD revealed a large, irregular ulcerated gastric mass extending 1.5 to 2 cm from the gastroesophageal junction to the antrum. The mass was biopsied, and immunohistochemical stains showed the tumor cells were positive for melan-A, HMB45 and vimentin, confirming melanoma. A thorough search for another possible primary lesion, consisting of a complete skin examination and positron emission tomography (PET), did not identify a clear primary site of melanoma. The PET scan revealed uptake involving the gastric walls and lymph nodes in the perigastric, retroperitoneal and left supraclavicular regions. BRAF analysis was positive for a V600 mutation. The patient subsequently underwent palliative jejunostomy placement and was evaluated by medical oncology. Primary gastric melanoma is extremely rare (with only a handful of cases reported in the literature), likely due to the lack of melanocytes in normal gastric epithelium. Therefore, when melanoma is encountered in the stomach, it is crucial to search for a primary melanocytic lesion that may have metastasized to the stomach. While gastrointestinal involvement by melanoma has been found in up to 60% of autopsies of patients who have died with primary cutaneous melanoma, melanoma located primarily in the gastric mucosa is an uncommon occurrence. Several pathophysiologic mechanisms have been suggested. Ectopic migration of melanocyte precursors or differentiation of the APUD cells to melanocytes have been suggested as possible mechanisms. Spontaneous regression of primary melanoma has also been recognized, and it is possible that our patient’s gastric melanoma may have represented a metastasis from primary lesion that had spontaneously regressed. The median overall survival for primary melanoma of the GI tract is 17 months; for primary melanoma of the stomach, 5 months. There is little consensus on therapy for patients with primary GI melanoma, but treatment with complete excision may provide long-term disease-free survival. Vemurafenib, a BRAF kinase inhibitor, has been shown to improve both overall and progression-free survival in patients with metastatic melanoma with the BRAF V600E mutation

A new total body scanning system for automatic change detection in multiple pigmented skin lesions.

The detection of newly appearing and changing pigmented skin lesions (PSLs) is essential for timely diagnosis of cutaneous melanoma. Total body skin examination (TBSE) procedures, currently practiced for this purpose, can be extremely time-consuming for patients with numerous lesions. In addition, these procedures are prone to subjectivity when selecting PSLs for baseline image comparison, increasing the risk of missing a developing cancer. To address this issue, we propose a new photogrammetry-based total body scanning system allowing for skin surface image acquisition using cross-polarized light. Equipped with 21 high-resolution cameras and a turntable, this scanner automatically acquires a set of overlapping images, covering 85%-90% of the patient's skin surface. These images are used for the automated mapping of PSLs and their change estimation between explorations. The maps produced relate images of individual lesions with their locations on the patient's body, solving the body-to-image and image-to-image correspondence problem in TBSEs. Currently, the scanner is limited to patients with sparse body hair and, for a complete skin examination, the scalp, palms, soles and inner arms should be photographed manually. The initial tests of the scanner showed that it can be successfully applied for automated mapping and temporal monitoring of multiple lesions: PSLs relevant for follow-up were repeatedly mapped in several explorations. Moreover, during the baseline image comparison, all lesions with artificially induced changes were correctly identified as "evolved."

Prevalence of ectoparasites in owned dogs in Kerman city, southeast of Iran

The present study aimed to investigate the intensity and distribution of natural infestation of ectoparasites in owned dogs during June to November 2011 in Kerman city, southeast of Iran. One hundred two domestic dogs (63 males, 39 females) with age ranged between 45days to 13years were examined for ectoparasites infestation including (tick, lice, flea and mite) in Kerman city. Detailed questionnaire about grooming and bathing interval, keeping place (outdoor, indoor) and purpose of keeping were obtained from owners. After complete skin examination, animals hairs were combed and their skin rubbed with a piece of cotton soaked in alcohol to remove the ectoparasites in apparently normal cases, and deep skin scratching were prepared from all type of lesions in symptomatic dogs. A total number of 149 ectoparasites were collected. The most common ectoparasite was Rhipicephalus sanguineus tick, which infested 27 of the 102 dogs (26.47%). Ctenocephalides canis was identified on two dogs (1.96%) and 5 dogs infested with Hippobosca spp (4.9%)that the highest infestation rate was seen in September (14.2%). Studied samples were routinely checked for clinical symptoms. Itching and scratching lesions were the only reported signs which seen in flea infested dogs (6.4%) and other infested dogs (93.5%) had no clinical symptoms. Ectoparasites were significantly higher in outdoor dogs in compare with indoor group and the most tick infested location was ear (61.3%) (P<0.05).

Pizza makers' contact dermatitis.

Contact eczema to foods, spices, and food additives can occur in occupational and nonoccupational settings in those who grow, handle, prepare, or cook food. Pizza is one of the most eaten foods in every continent, and pizza making is a common work in many countries. We aimed to evaluate the occurrence and the causes of contact dermatitis in pizza makers in Naples. We performed an observational study in 45 pizza makers: all the enrolled subjects had to answer a questionnaire designed to detect personal history of respiratory or cutaneous allergy, atopy; work characteristics and timing were also investigated. Every subject attended the dermatology clinic for a complete skin examination, and when needed, patients were patch tested using the Italian baseline series of haptens integrated with an arbitrary pizza makers series. Our results reported that 13.3% of the enrolled pizza makers (6/45) presented hand eczema, and that 8.9% (4/45) were affected by occupational allergic contact dermatitis. Diallyl disulfide and ammonium persulfate were the responsible substances. Performing patch tests in pizza makers and food handlers affected by hand contact dermatitis is useful. We propose a specific series of haptens for this wide working category.

A medico-legal view on the importance of the external examination of the traumatized patient

Introduction. the correct registration of the external traumatic lesions is extremely important in the clinical management of the trauma, as well as in its forensic and judicial assessment. Nevertheless, the quantity and quality of the information registered in the observation charts may be suboptimal, thus significantly affecting the forensic assessment regarding the cause of death, the relationship between lesions and death, and therefore the judicial implications of the case. Material and method. We have conducted a study on a sample of 77 consecutive deaths by violence, all examined at the Institute of Legal Medicine in Iasi. A comparative analysis was conducted of the external lesions documentation in the observation chart and the forensic autopsy report, and a degree of consistency was established between the two. For each case a series of data was collected and then statistically analyzed in order to observe the existence of a correlation between the degree of accordance and of the two examinations and the registered parameters. Results. the present study has found 62.3% discordant cases. From the selected parameters, three were correlated to the degree of concordance, having the capacity to foretell whether an external lesion would be registered correctly in the observation chart: the biochemical analysis level - patients who received complete blood investigations were more frequently subject to complete skin examination in the clinic; the existence of a surgical intervention - concordance was higher in patients who suffered a surgical intervention during hospitalization; cause and context of death - patients who died as a result of burns or electrocution showed perfect concordance in 100 % of cases, while less than 3 % of patients who died in the context of aggression were recorded all types of injury. Conclusions. Better documentation of external injuries in hospital is many times essential for the medico-legal evaluation and the subsequent judicial implications. While there are factors that may explain the disregard of the registration of all traumatic marks, in the context of lack of time and the need for quick delivery of treatment, the importance of the observation sheet as a document of medico-legal and legal value must be recognized by all physicians.

Melanoma screening by means of complete skin examinations for all patients in a dermatology practice reduces the thickness of primary melanomas at diagnosis

Melanoma screening by means of complete skin examinations for all patients in a dermatology practice reduces the thickness of primary melanomas at diagnosis

Melanoma of Non-Sun Exposed Skin in a Man with Previous Prostate Cancer: Recognition of a Recently Confirmed Association

BackgroundThe association of an increased risk to develop melanoma in patients with prostate cancer has recently been confirmed.PurposeThe postulated etiologic relationship between prostate cancer and the subsequent occurrence of melanoma is discussed.MethodsA man with previous prostate cancer who developed melanoma on the plantar surface of his left great toe is described and the possibility of high levels of endogenous androgens promoting not only prostate cancer, but also increased risk of melanoma are reviewed.ResultsModification of the host immune response, alteration of chromosome telomere length, and/or imbalance of androgen level (presenting as severe teenage acne) are potential mechanisms whereby high levels of endogenous androgens may contribute to the association between prostate cancer and risk of melanoma.ConclusionsAn increased surveillance for melanoma should be considered in prostate cancer patients. Complete skin examination in men who have had prostate cancer—especially in those individuals diagnosed with prostate cancer prior to age 68 years—should regularly be performed.Electronic supplementary materialThe online version of this article (doi:10.1007/s13555-014-0045-2) contains supplementary material, which is available to authorized users.

Dermatologic manifestations of ataxia-telangiectasia syndrome

Previous reports on the cutaneous manifestations of ataxia-telangiectasia (A-T) have relied on data from small series, in patients not genetically tested for A-T. The aim of our study was to characterize the dermatologic manifestations in patients with A-T followed up at the national A-T clinic in Israel. This retrospective cross-sectional study included 32 patients followed up at a multidisciplinary A-T clinic from 2010 to 2012. Complete skin examination was done by a single dermatologist. Information about mutations and neurologic status was extracted from the patients' charts. Relevant demographic, clinical, and laboratory characteristics of all patients were collected and summarized. Of the 32 patients, 97% had ocular telangiectasia, the hallmark of the disease. Telangiectasia on other body parts was less frequent. Pigmentary anomalies included café-au-lait macules (84%), hypopigmented macules (44%), and melanocytic nevi (37%). A facial papulosquamous rash was found in 41% of cases. Other manifestations included hypertrichosis and birdlike facies. We did not observe premature hair graying or poliosis. No genotype-phenotype correlation was found in terms of skin manifestations. There was a modest sample size, because of the rarity of the disease. Recognition of the ocular and dermatologic manifestations of A-T can facilitate early diagnosis in a child with neurologic deterioration.

Primary Melanoma of the Cervical Spine with Cerebral Metastases: Case Report and Review of the Literature

Primary spinal melanoma is a very rare condition: to date < 60 cases have been reported in the literature. A 48-year-old man presented with a 6-month history of upper- and lower-extremity numbness. Spinal magnetic resonance imaging (MRI) revealed a space-occupying lesion at the C2-C6 level. This was confirmed as a melanoma by immunohistochemistry. Cerebral MRI showed multiple lesions with the same signal characteristics as those seen in the spinal lesion on MRI. Complete skin, mucosal and retinal examination failed to show any primary lesion, therefore a diagnosis of primary cervical melanoma with brain metastases was made. To our knowledge this is the first report of a primary melanoma of the cervical spine with cerebral metastases at the time of diagnosis. This article presents pertinent reported literature and discusses the aetiology, diagnosis, treatment and prognosis of this unusual condition.

Determining risk factors for developing systemic lupus erythematosus in patients with discoid lupus erythematosus

Up to 28% of patients with discoid lupus erythematosus (DLE) are susceptible to developing systemic lupus erythematosus (SLE). To better characterize patients with DLE who have a higher potential of developing SLE, we reviewed studies contrasting, firstly, DLE-only patients (i.e. patients with DLE without SLE) and SLE patients with DLE (i.e. patients who are diagnosed with SLE and DLE simultaneously, and patients with SLE who later develop DLE), and secondly, DLE-only patients and patients with DLE who progress to SLE. These studies have commonly identified various clinical and laboratory indicators, such as widespread DLE lesions, arthralgias/arthritis, nail changes, anaemia, leucopenia, high erythrocyte sedimentation rates (ESRs) and high titres of antinuclear antibodies (ANAs), which are associated with progression to SLE in patients with DLE, and SLE patients with DLE. Limitations of these studies include inadequate follow-up time, small numbers of patients with DLE converting to SLE, outdated criteria for SLE diagnosis and retrospective study designs. However, because of the risk of SLE development in patients with DLE, complete skin examinations, joint assessments and laboratory tests including ANA, ESR and full blood counts should be performed regularly for patients with DLE. A prospective study following patients with DLE who do or do not develop SLE is currently underway through the Cutaneous Lupus Registry at the University of Texas Southwestern Medical Center. It will seek to identify clinical features and biomarkers that improve our assessment of risk of systemic spread in these patients.

Occupational hand dermatitis among cement workers in Taiwan

Occupational dermatitis among cement workers is a major occupational health concern. The two most important occupational hazards for cement workers are irritant and allergic cement contact dermatitis. The objective of this study was to investigate the severity of occupational cement contact dermatitis and the common allergens among cement workers in Taiwan. A total of 97 cement workers from the Cement Workers' Association of Tainan City and County participated in this study. A structured questionnaire was used to evaluate the demographic data and work-related activities of these cement workers. A complete skin examination was conducted, and skin manifestations were assessed by a dermatologist. Allergens from European Standard Tray (Chemotechnique Diagnostic AB, Sweden) with a total of 25 substances were used for patch testing. Our results showed that 65 out of 97 cement workers were suffering from occupational cement hand contact dermatitis. The most affected skin area was the hand. Thickening of the dorsal surface of the hand, especially around the metacarpophalangeal joint area, and hyperkeratosis of the palm were the major skin manifestations. The results of the patch test showed that 24 out of 97 were allergic to potassium dichromate, nine were allergic to thiuram mix, nine were allergic to fragrance mix and seven were allergic to cobalt chloride. The final diagnosis, based on the results of the skin examination and the patch test, showed that 43 of 97 cement workers had irritant cement contact dermatitis and 22 had allergic cement contact dermatitis. We conclude that occupational cement hand dermatitis among cement workers is an important and severe issue in Taiwan, and the most common allergens among cement workers are potassium dichromate, thiuram mix, fragrance mix and cobalt chloride. The high positive rate of chromium hypersensitivity among cement workers reflects the urgency to regulate the addition of ferrous sulfate to cement in Taiwan.

Different patterns of dermatological presentations in patients co-infected with human immunodeficiency virus and hepatitis C virus (HCV), and those infected with HCV alone

Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) share the same transmission routes. About 30% of HIV-positive patients are co-infected with HCV. Of the various HCV-related extrahepatic events, those involving the skin may be the first sign of infection. To specify the skin presentations in patients co-infected with HIV and HCV (co-infected patients; CP) and compare them with those found in patients with HCV mono-infection (mono-infected patients; MP). This was a cross-sectional study, in which the studied population consisted of MP and CP from a tertiary hospital in the South of Brazil, who underwent complete skin examination and laboratory tests. In total, 201 patients were assessed, of whom 108 were CP, and 93 were MP. Pruritus tended to be more common in MP. MP also had significantly more dermatological conditions (mean of 5.2) than CP (mean of 4.5). In total, 104 different skin diseases were identified. There was a higher prevalence of infectious diseases and pigmentation disorders, such as verruca vulgaris and facial melasma, in CP, whereas trunk and facial telangiectasias, palmar erythema, and varicose veins were more common in MP. We found a high prevalence of skin conditions both in MP and in CP; however, the patterns of the dermatological conditions were different. CP were found to have significantly fewer skin lesions than MP, but had a higher prevalence of infectious and pigmentation disorders. By contrast, vascular conditions were more common in MP.