Facial Dermatoses Research Articles

Demodex folliculorum infestations in common facial dermatoses: acne vulgaris, rosacea, seborrheic dermatitis

BackgroundDemodex mites are found on the skin of many healthy individuals. Demodex mites in high densities are considered to play a pathogenic role. ObjectiveTo investigate the association between Demodex infestation and the three most common facial dermatoses: acne vulgaris, rosacea and seborrheic dermatitis. MethodsThis prospective, observational case-control study included 127 patients (43 with acne vulgaris, 43 with rosacea and 41 with seborrheic dermatitis) and 77 healthy controls. The presence of demodicosis was evaluated by standardized skin surface biopsy in both the patient and control groups. ResultsIn terms of gender and age, no significant difference was found between the patients and controls (p>0.05). Demodex infestation rates were significantly higher in patients than in controls (p=0.001). Demodex infestation rates were significantly higher in the rosacea group than acne vulgaris and seborrheic dermatitis groups and controls (p=0.001; p=0.024; p=0.001, respectively). Demodex infestation was found to be significantly higher in the acne vulgaris and seborrheic dermatitis groups than in controls (p=0.001 and p=0.001, respectively). No difference was observed between the acne vulgaris and seborrheic dermatitis groups in terms of demodicosis (p=0.294). Study limitationsSmall sample size is a limitation of the study. The lack of an objective scoring system in the diagnosis of Demodex infestation is another limitation. ConclusionThe findings of the present study emphasize that acne vulgaris, rosacea and seborrheic dermatitis are significantly associated with Demodex infestation. Standardized skin surface biopsy is a practical tool in the determination of Demodex infestation.

Impact of Abuse of Topical Corticosteroids and Counterfeit Cosmetic Products for the Face: Prospective Demographic Study in Basrah City, Iraq.

Topical corticosteroids are highly effective compounds that are now widely used in dermatology for the treatment of various autoimmune and inflammatory disorders. Many corticosteroids are misused for diverse indications such as pigmentation, acne, pruritus, fungal or bacterial infections, rashes, and numerous other conditions. These products contain various constituents, most of which have hazards or toxic elements. The aim is to raise awareness among individuals in the city of Basrah, Iraq about the uses and abuses of applying fake products to the face to inform the consumers about potential harmful adverse effects. This study was a prospective multi-center clinic questionnaire of a demographic that involved the outpatient dermatology departments at the Al-Basrah teaching hospital and the Abu Al-Khaseeb hospital as well as the private clinics of two dermatology specialists in Basrah. A total of 235 patients with facial dermatoses secondary to the application of topical corticosteroids and counterfeit products or, a mixed formulation, for cosmetic purposes were recruited. Most enrolled patients were female with 10-20 years aged group. The majority applied these products due to friends or pharmacy encouragement. Motivations for the use of these products included: skin fairness, lightening, and general cosmetic. Interestingly, acne and erythema were common whilst, atrophy, dryness, telangiectasia, and hirsutism appear on long- term use only. The abuse of counterfeit cosmetic products and topical corticosteroids is in progress and they have adverse health events. There are many causes behind the abuse but the lack of education, lack of restriction, profitable for sellers and low prices are the main.

Study of Clinical Profile of Patients Presenting with Topical Steroid-Induced Facial Dermatosis to a Tertiary Care Hospital.

Background:Topical corticosteroids (TCs) are widely used for various indications in dermatology. However, these can cause a plethora of symptoms if overused or abused. Topical steroid damaged face is a relatively new entity which was described in 2008. TC abuse cause a myriad of side effects viz, erythema, telangiectasia, acne, acneiform eruption, hyper/hypopigmentation, rosacea, and photosensitivity when used inappropriately.Aim:The aim of the study was to ascertain the prevalence, demographics, and clinical presentations of TC abuse on faceamong our population.Materials and Methods:This was a cross-sectional study performed at dermatology department of a tertiary care teaching hospitallocated in eastern India for 1 year. All patients with facial dermatoses attending the outpatient department were asked about use of TC in recent past and those with positive history were included. A detailed clinical evaluation was undertaken and various demographic and clinical data were recorded.Results:A total of 316 patients (53 males, 263 females) presented with topical steroid-induced facial dermatoses during the entire study period. Majority of them used these agents on suggestion of close friends and relatives, pharmacists, television commercials, and doctors. Mometasone in the form “No-Scar” preparation was the most commonly abused topical steroid in our study. The most common side effects encountered were steroid-induced acne (45.2%) or flare of pre-existing acne followed by erythema and telangiectasia (21.2%), hypertrichosis (6.6%), rosacea (2.2%), and atrophy (1.5%). The most common reason for abusing TC was to get a fairer skin tone.Conclusion:Our study reports the clinical patterns of TC abused facial dermatoses. The fantasy to get a fairer skin among the people of our country has led to the abuse of topical corticosteroids. We conducted this study to create awareness among these patients about the dreadful effects of steroid misuse.

Face Mask-induced Itch: A Self-questionnaire Study of 2,315 Responders During the COVID-19 Pandemic.

Little is known about itch related to the use of face masks. This internet survey study investigated the prevalence, intensity and clinical characteristics of itch related to the use of face masks by the general public during the COVID-19 pandemic. A total of 2,315 replies were received, of which 2,307 were included in the final analysis. Of the respondents, 1,393 (60.4%) reported using face masks during the previous week, and, of these, 273 (19.6%) participants reported having itch. Subjects who reported sensitive skin and atopic predisposition, and those with facial dermatoses (acne, atopic dermatitis or seborrhoeic dermatitis) were at significantly higher risk of itch development. The highest rating of itch for the whole group on the Itch Numeral Rating Scale was 4.07±2.06 (itch of moderate intensity). Responders who wore masks for longer periods more frequently reported itch. Almost 30% of itchy subjects reported scratching their face without removing the mask, or after removing the mask and then scratching. Wearing face masks is linked to development of itch, and scratching can lead to incorrect use of face masks, resulting in reduced protection.

Orofacial pigmentary lesions in the pediatric age group: A descriptive observational study

Background: Pigmentary disorders on the face are frequently encountered in all age groups and both genders but are more common in pediatric patients. These lesions can be isolated incidental findings or indicative of a congenital or acquired systemic or genetic disorder. Aims and Objectives: The aim and objective of this study is to study the frequency and pattern of pigmented orofacial lesions in the pediatric age group and to describe the underlying associated condition if any. Materials and Methods: A descriptive study was conducted over a period of 6 months (June–November 2018) in the dermatology department of a tertiary care hospital in Eastern Uttar Pradesh. All the children from 2 to 14 years of age who reported to us with complaints of pigmentary lesions on the face or oral cavity were included, and attempt was made to find out if any underlying conditions. Results: A total of 207 children were included in the study. Pityriasis alba was the most common pigmentary disorder on the face in the study population in 146 (70.5%) children, while pityriasis versicolor was noted in 21 (10.1%). Other facial dermatoses noted were vitiligo, congenital melanocytic nevus, and postinflammatory hypopigmentation and hyperpigmentation. Eight (3.8%) children had associated underlying diseases such as xeroderma pigmentosum, dyskeratosis congenita, Vitamin B12 deficiency, Laugier–Hunziker syndrome, and juvenile dermatomyositis. Conclusions: Pigmentary disorders of the face and oral cavity are frequently seen in children which forms a major part of dermatology consultation. Although most of these disorders are of cosmetic concerns, few conditions are associated with systemic conditions. A thorough investigation and management are the keys to manage such cases.

Study of Facial Dermatoses in Adult Patients in Tertiary Care Hospital

Study of Facial Dermatoses in Adult Patients in Tertiary Care Hospital

Clinico-epidemiological study of facial dermatoses among adolescents

<p class="abstract"><strong>Background:</strong> The obsession of getting a flawless skin is more for adolescents than in any other age group. But these problems are seldom given enough importance. Very common problem like acne vulgaris can cause serious psychological impact in them.</p><p class="abstract"><strong>Methods:</strong> Four hundred consecutive adolescent (10-19 years) patients with facial dermatoses presenting to skin department, VIMS, Ballari were selected for the study. Study design was descriptional and cross sectional, conducted from January 2013 to December 2013.<strong></strong></p><p class="abstract"><strong>Results:</strong> Eighty seven percentage of the study population was students and the rest were either labourers or drivers. Acne vulgaris was the diagnosis in 304 (76%) of cases. Second most common condition was seborrheic dermatitis accounting for 24 (6%) of cases.</p><p class="abstract"><strong>Conclusions:</strong> Facial dermatoses are common among the adolescents. These dermatoses are of a major cosmetic concern in this age group. Early diagnosis and proper management with education of patients is important to prevent late disfiguring complications and psychological sequelae.</p>

Topical corticosteroid abuse over face: A clinical study

Topical corticosteroid abuse over face: A clinical study - IJCED- Print ISSN No: - 2581-4710 Online ISSN No:- 2581-4729 Article DOI No:- 10.18231/j.ijced.2019.063, IP Indian Journal of Clinical and Experimental Dermatology-IP Indian J Clin Exp Dermatol

Vichy mineralizing water with hyaluronic acid is effective and well tolerated as an adjunct to the management of various dermatoses and after esthetic procedures.

M89, containing 89% of Vichy mineralizing water and hyaluronic acid, has been developed to reinforce the skin barrier and to improve skin quality. To assess efficacy and tolerability of M89. Observational survey of subjects with facial dermatoses or after esthetic procedures. M89 served as adjunct to conventional therapy. Clinician assessments of erythema, desquamation, irritation and patient-reported dryness, burning, itching, and stinging/tingling were conducted at baseline and 4weeks. At 1week and 4weeks, patient assessed tolerance and satisfaction with M89. A total of 1630 subjects participated; 92.5% were females. Mean age was 41.1±11.3years. Dermatological indications accounted for 32.5%, procedures for 67.5%. At 4weeks, in subjects with dermatoses, erythema had resolved or improved in 68.0%, desquamation in 83.4%, and irritation in 93.3%. Dryness, burning, itching, and stinging/tingling scores had decreased by 63.8%, 81.8%, 70.9%, and 85.2%, respectively (all P≤.0001); 75.7% considered that their skin was sufficiently hydrated. In the procedure group, erythema had resolved or improved in 72.5%, desquamation in 75.2%, and irritation in 88.1%. Dryness, burning, itching, and stinging/tingling scores had decreased by 62.1%, 78.8%, 70.0%, and 84.2%, respectively (all P≤.0001); 74.1% considered that their skin was sufficiently hydrated. Almost all subjects reported soothed skin and satisfaction with product texture. Subject and investigator satisfaction was very high. M89 significantly improves skin signs and symptoms after 4weeks of continued use with no tolerance issues in subjects with dermatological indications. Moreover, subjects who have had recently undergone esthetic procedures M89 allowed a satisfying skin recovery.

Dermoscopy of Inflammatory Dermatoses (Inflammoscopy): An Up-to-Date Overview.

In addition to its use in pigmented and nonpigmented skin tumors, dermoscopy is gaining appreciation in assisting the diagnosis of nonneoplastic diseases, especially inflammatory dermatoses (inflammoscopy). In this field, dermoscopic examination should be considered as the second step of a "2-step procedure," always preceded by the establishment of a differential diagnosis on the basis of clinical examination. In this paper, we sought to provide an up-to-date overview on the use of dermoscopy in common inflammatory dermatoses based on the available literature data. For practical purposes, the analyzed dermatoses are grouped according to the clinical presentation pattern, in line with the 2-step procedure principle: erythematous-desquamative and papulosquamous dermatoses, papulokeratotic dermatoses, erythematous facial dermatoses, sclero-atrophic dermatoses, and miscellaneous.

Erythematotelangiectatic rosacea may be associated with a subclinical stage of demodicosis: a case-control study.

Facial densities of Demodex mites have been observed to be greater in patients with demodicosis and papulopustular rosacea than in healthy control patients. In patients with erythematotelangiectatic rosacea (ETR), this density has been observed to be similar to or greater than that of healthy controls. Erythema and telangiectasia, characteristics of ETR, are often observed among patients with pityriasis folliculorum, a discreet demodicosis, suggesting a possible link between these conditions. To compare the facial Demodex densities of patients with clinical ETR and patients with healthy skin, demodicosis, rosacea with papulopustules, and other facial dermatoses. In this retrospective study, we recorded Demodex densities measured using two consecutive standardized skin surface biopsies (SSSB1 and SSSB2) in 23 patients with ETR, 20 healthy control patients, 590 patients with demodicosis, 254 with rosacea with papulopustules and 180 with other facial dermatoses. Patients with ETR had higher Demodex densities (D cm-2 ) than did the healthy controls (mean ± SEM; SSSB1: 15·7 ± 6·3 vs. 1·8 ± 1·1 D cm-2 , P = 0·042; SSSB2: 38·0 ± 13·7 vs. 5·1 ± 2·1 D cm-2 , P = 0·026) and patients with other dermatoses (SSSB1: 0·4 ± 0·1 D cm-2 , P = 0·004; SSSB2: 1·3 ± 0·3 D cm-2 , P = 0·004), but lower densities than patients with demodicosis (SSSB1: 82·7 ± 4·2 D cm-2 , P = 0·008; SSSB2: 172·2 ± 7·7 D cm-2 , P = 0·001) or rosacea with papulopustules (SSSB1: 86·6 ± 7·3 D cm-2 , P = 0·027; SSSB2: 197·0 ± 12·1 D cm-2 , P = 0·002). ETR may be associated with nonvisible Demodex proliferation, possibly corresponding to a subclinical stage of demodicosis. Dermatologists should be aware of this potential association and look for subclinical demodicosis in patients with ETR, so that topical acaricidal treatment can be offered if Demodex density is high.

Interventions for rosacea based on the phenotype approach: an updated systematic review including GRADE assessments.

SummaryBackgroundRosacea is a common chronic facial dermatosis. Classification of rosacea has evolved from subtyping to phenotyping.ObjectivesTo update our systematic review on interventions for rosacea.MethodsWe searched CENTRAL, MEDLINE, Embase, LILACS, Science Citation Index and ongoing trials registers (March 2018) for randomized controlled trials. Study selection, data extraction, risk‐of‐bias assessment and analyses were carried out independently by two authors. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to assess certainty of evidence.ResultsWe included 152 studies (46 were new), comprising 20 944 participants. Topical interventions included brimonidine, oxymetazoline, metronidazole, azelaic acid, ivermectin and other topical treatments. Systemic interventions included oral antibiotics, combinations with topical treatments or other systemic treatments. Several studies evaluated laser or light‐based treatment. We present the most current evidence for rosacea management based on a phenotype‐led approach.ConclusionsFor reducing temporarily persistent erythema there was high‐certainty evidence for topical brimonidine and moderate certainty for topical oxymetazoline; for erythema and mainly telangiectasia there was low‐to‐moderate‐certainty evidence for laser and intense pulsed light therapy. For reducing papules/pustules there was high‐certainty evidence for topical azelaic acid and topical ivermectin; moderate‐to‐high‐certainty evidence for doxycycline 40 mg modified release (MR) and isotretinoin; and moderate‐certainty evidence for topical metronidazole, and topical minocycline and oral minocycline being equally effective as doxycycline 40 mg MR. There was low‐certainty evidence for tetracycline and low‐dose minocycline. For ocular rosacea, there was moderate‐certainty evidence that oral omega‐3 fatty acids were effective and low‐certainty evidence for ciclosporin ophthalmic emulsion and doxycycline.

A clinical study of facial dermatoses

<p class="abstract"><strong>Background:</strong> The attractiveness of the human body has always been an important issue in the fields of sociology, psychology, psychiatry and also in the field of dermatology. Because in most societies the face is usually a body part that is visible, imperfections of its skin is also visible, therefore its flawed appearance bears the potential to become a source of misery to some. The objective of the study was to study the various dermatological conditions affecting the face.</p><p class="abstract"><strong>Methods:</strong> A cross-sectional study was conducted among 200 patients with facial dermatoses during the period Dec-2014 to May-2016. Patients belonging to age group 12 years and above and both sexes were randomly selected and included in the study after taking their consent.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of the facial dermatoses, 75 patients had infections of the face comprising 37% of the total facial dermatoses with tinea faciei being the most common individual facial skin condition comprising 18%. Skin tumors and cysts and miscellaneous conditions of the face comprised 15% each of the total facial dermatoses. This was followed by contact dermatitis (9%), photodermatoses (8.5%), Rosacea in 5.5% of patients, Nevi in 5% of patients and pigmentary disorders being the least common facial dermatoses comprising 4.5%.</p><p class="abstract"><strong>Conclusions:</strong> It is worthwhile to take note of the special nature of facial skin and the disorders that affect it.</p>

A study of topical steroid induced facial dermatosis in Andaman and Nicobar Islands and to analyse the role of Demodex mite in its pathogenicity

<p class="abstract"><strong>Background:</strong> Topical corticosteroids (TCs) are widely abused all over our country due to its short term benefits and effortless over the counter availability. The rate of its abuse is more so in Andaman & Nicobar Islands (A&N). Henceforth we conducted a study<strong> </strong>to evaluate the topical steroid induced facial dermatosis (TSFD) in A&N and to analyse the role of demodex mite in its pathogenicity.</p><p class="abstract"><strong>Methods:</strong> 58 patients with TSFD participated in this study. Details such as demography of patient, topical steroid used, duration of usage, reason behind its usage and facial dermatosis of the TSDF developed were collected. Following this, standardized surface skin biopsy (SSSB) was performed to assess the density of demodex mite. The details were statistically analysed.<strong></strong></p><p class="abstract"><strong>Results:</strong> TSFD were predominantly seen in female of age group between 20 and 30 years. It was commonly misused to get rid of acne, pigmentation, tinea faciei and as a fairness cream. The commonly misused TCs were betamethasone cream followed by mometasone. It was commonly advised by pharmacists, friends, relatives, beauticians and GPs. Papules, pustules, photosensitivity and erythema were the commonly encountered adverse events. Microscopic examination of SSSB was negative in all the patients.</p><p class="abstract"><strong>Conclusions:</strong> The study depicts rampant and irrational use of TCs in our population. Though the demodex mites were absent in the patients studied, further studies with larger sample size and in different ethnicity needs to be done to affirm its role in the pathogenicity of TSFD.</p>

Incidence and density of Demodex folliculorum and Demodex brevis (Acari: Demodicidae) in patients with acne in the province of Erzincan, Turkey

ABSTRACTThe present study was carried out to determine the incidence and density of Demodex folliculorum (Simon, 1842) and Demodex brevis Akbulutova, 1963 in patients with acne. The study included 210 patients diagnosed with acne during clinical examination, and 150 healthy controls without any facial dermatoses. In the study, samples were taken from the right cheek, left cheek, nasolabial area, and chin of the participants using the Standard Superficial Skin Biopsy technique. Samples were examined under a light microscope, and Demodex species were identified and counted. Demodex positivity (≥5 mites) was detected in 62.4% of the patients and 16.7% of the controls in the study (p < 0.001). A total of 3325 (mean: 25.4/cm2) mites were isolated from Demodex-positive patients. A total of 2015 (mean: 19.2/cm2) mites were isolated from patients infested with D. folliculorum only, 52 (mean: 7.4/cm2) mites were isolated from patients infested with D. brevis only, and 1058 (mean: 65.2/cm2) mites were isolated from patients infested with both species. The mean density of both mites (co-infection D. folliculorum and D. brevis) was detected as 21.0, 43.5, and 117.1/cm2 respectively, in patients with mild, moderate, and severe acne. In the controls who was Demodex positive, only D. folliculorum or co-infection with both mites were detected, not D. brevis alone. A total of 167 (mean: 6.7/cm2) mites were isolated from these controls. As a result, Demodex mites were found to be very common and intense in patients with acne in Erzincan, Turkey. It was also concluded that there was a positive correlation between Demodex mites and degree of acne, and that the co-infection of D. folliculorum and D. brevis aggravated the clinical picture in patients with acne. It may be helpful to consider these findings in clinical assessments of patients with acne.

A clinicopathological study of facial granulomatous dermatoses: A hospital-based study

Background: Granulomatous dermatoses of various types, etiologies, and clinical features frequently present with similar clinicopathological features which create a dilemma and diagnostic challenge for experts. Early diagnosis of facial lesions is of prime concern due to potential social stigma and psychological stress because of cosmetic disfigurement. Objective: To study the epidemiological and clinicopathological features of various granulomatous facial skin lesions and their concordance rate. Materials and Methods: A retrospective, hospital-based study was carried out at the Department of Dermatology, College of Medical Sciences, Bharatpur, over a period of 5 years (January 2013–January 2018). All clinically suspected cases of facial granulomatous dermatoses were included, their clinical and histological findings were recorded and analyzed according to the standard protocol, and a clinicopathological correlation was ascertained. Results: Among 850 skin biopsies performed during the study, 30 cases were clinically suspected as facial granulomatous dermatoses. There was female predominance (n = 22, 73.33%), and the mean age of patients was 41.7 years. Majority of cases (n = 29, 96.66%) were of infectious origin with leprosy as predominant cause (n = 25, 83.33%), followed by cutaneous tuberculosis (n = 4, 13.33%). Histologically, epithelioid cell granulomas (n = 26, 86.67%) and histiocytic granuloma (n = 3, 10%) were observed. Fite Faraco stain was positive in 6 (20%) cases of leprosy. An overall concordance rate of 80% was observed in facial granulomatous dermatoses in our study. Conclusion: In our study, infectious etiology is the most common cause of facial granulomatous dermatoses. Among infections, leprosy is the most common.

Development of Rifampicin-Indocyanine Green-Loaded Perfluorocarbon Nanodroplets for Photo-Chemo-Probiotic Antimicrobial Therapy.

Acne vulgaris, generally resulted from overgrowth of Propionibacterium acnes (P. acnes), is one of the most difficult-to-treat facial dermatoses and more than 90% of adolescents experienced the disease worldwide. Because the innate non-lymphoid immune system cannot effectively eliminate excessive P. acnes from the skin surface, so far the therapy of acne vulgaris is still mainly dependent on antibiotic treatment. However, long-term or overdose of antibiotics may initiate microbial drug resistance and/or generate unexpected side effects that seriously hamper the use of antibiotics in the clinic. To overcome the aforementioned challenges, the novel rifampicin (RIF)-indocyanine green (ICG)-loaded perfluorocarbon (PFC) nanodroplets (RIPNDs) that may offer combined photo-, chemo-, and probiotic efficacies to P. acnes eradication were developed in this study. The RIPND was first characterized as a sphere-like nanoparticle with surface charge of −20.9 ± 2.40 mV and size of 240.7 ± 6.73 nm, in which the encapsulation efficiencies of RIF and ICG were 54.0 ± 10.5% and 95.0 ± 4.84%, respectively. In comparison to the freely dissolved ICG, the RIPNDs conferred an enhanced thermal stability to the entrapped ICG, and were able to provide a comparable hyperthermia effect and markedly increased production of singlet oxygen under near infrared (NIR; 808 nm, 6 W/cm2) exposure. Furthermore, the RIPNDs were able to induce fermentation of S. epidermidis but not P. acnes, indicating that the RIPNDs may serve as a selective fermentation initiator for the target probiotics. Based on the microbial population index analyses, P. acnes with 1 × 106 cells/mL can be completely eradicated by 12-h co-culture with S. epidermidis fermentation products followed by treatment of RIPNDs (≥20-μM ICG/3.8-μM RIF) + NIR for 5 min, whereby the resulted microbial mortality was even higher than that caused by using 16-fold enhanced amount of loaded RIF alone. Overall these efforts show that the RIPNDs were able to provide improved ICG stability, selective fermentability to S. epidermidis, and enhanced antimicrobial efficacy compared to equal dosage of free RIF and/or ICG, indicating that the developed nanodroplets are highly potential for use in the clinical anti-P. acne treatment with reduced chemotoxicity.

The role of PCR for Mycobacterium leprae in patients with facial granulomatoses: A pilot study

Background: Granulomatous pathology is seen in several facial dermatoses, which are diagnosed based on their characteristic clinical features. However, data on their etiology is sparse. Aims &amp; objectives: To determine the prevalence of Mycobacterium leprae (M. leprae) antigen in patients with facial granulomatous pathology by polymerase chain reaction (PCR) and to put forward postulates for this association. Methods: A 3-year retrospective analysis was done for patients presenting with facial granulomatoses between January 2014 &amp; December 2016. The analysed parameters included clinical manifestations, results of investigations including PCR for M. leprae and the outcome of multidrug anti-leprosy therapy in patients who were PCR positive for M. leprae. Results: A total of nine patients (eight females and one male) were included. Mean age was 34 years (range 6–49 years). The average duration of symptoms was 56 (range 3–168) months. Orofacial granulomatosis (OFG)/granulomatous cheilitis was the most common clinical diagnosis seen in 5/9 (56%) patients. Of the remaining four patients, three (33%) presented with a solitary indurated plaque on the face and one patient (11%) had a nodular swelling with a faint hypopigmented rim over the cheek. There were no skin lesions elsewhere in any of the patients. Gum hypertrophy and palatal nodules were seen in 3/5 (60%) patients, each in patients with OFG. Seven patients (78%) were identified to be positive for M. leprae DNA, using PCR targeting the Rlep gene. All seven patients were initiated on anti-leprosy multidrug regimen for 6–12 months with or without steroids. One patient was lost to follow up after 4 months of therapy. The mean duration of follow up in the remaining six patients was 27 (range 12–40) months. Five patients (83%) showed minimal decrease in the swelling at 3 months, but after the end of the therapy there was worsening of the lesions in 3/6 (50%) patients. The patients with smaller lesions showed resolution whereas none of the patients with OFG benefited from the therapy on short term or extended follow up. Limitations: The main limitations of the current study were its retrospective design, small sample size, short follow up period, and no objective clinical assessment. Conclusion: M. leprae was demonstrable by PCR in 78% (7/9) of patients tested, suggesting that it may have a role in the pathogenesis of facial granulomatous disorders in patients living in endemic areas. Treatment with anti-leprosy MDT does lead to sustained improvement in facial granulomatous lesions other than OFG which are positive to M. leprae on PCR, however, the response in OFG is disappointing; it would be advisable to treat them so as to eradicate the pathogen.

Topical Application of 5-Fluorouracil Associated with Distant Seborrheic Dermatitis-like Eruption: Case Report and Review of Seborrheic Dermatitis Cutaneous Reactions after Systemic or Topical Treatment with 5-Fluorouracil.

Introduction5-Fluorouracil is a fluoropyrimidine antineoplastic medication that is used to topically treat actinic keratoses. Although local adverse effects to the drug are common and anticipated, distant skin reactions are rare and unexpected. In this case report, we describe a patient who developed seborrheic dermatitis-like eruption at a distant site after topical application of 5-fluorouracil to his arms.Case reportA 63-year-old man with actinic keratoses on his arms developed a facial seborrheic dermatitis-like reaction after topically applying 5-fluorouracil 5% cream twice daily to actinic keratoses on his forearms for 7 days. The facial dermatosis resolved shortly after discontinuation of the 5-fluorouracil; upon rechallenge of topical 5-fluorouracil on his arms, the facial seborrheic dermatitis recurred.DiscussionSeveral case reports have been published which describe exacerbations of preexisting seborrheic dermatitis with local topical 5-fluorouracil. Additionally, one case series describes the development of scrotal dermatitis in two patients after distant treatment with 5-fluorouracil. The pathogenesis that causes this distant reaction is unclear.ConclusionWe describe a patient with a seborrheic dermatitis eruption after topical application of 5-fluorouracil at a distant site. The etiologic association between the drug and adverse effect was confirmed with multiple cycles of application and discontinuation of the offending agent.

Recalcitrant psoriasiform dermatosis of the face: Is it related to pityriasis rubra pilaris?

There are patients with recalcitrant psoriasiform plaques that do not fit into conventional categories of facial dermatoses. Our study aims to describe the clinicopathological characteristics of several patients with a unique presentation of persistent psoriasiform facial rashes. This retrospective cross-sectional study analyzed clinical and histological data of known cases of recalcitrant psoriasiform dermatosis of the face diagnosed at National Skin Centre, Singapore, over 10 years. There were 8 Chinese patients with mean age at onset of 29 years. Majority had pink to pink-orange well-defined plaques with dry scale (n = 6, 75%), distributed mostly on the cheeks (100%) and chin (n = 7, 88%). Hyperkeratosis, parakeratosis, preserved granular layer and psoriasiform hyperplasia were showed in all biopsies. Other common findings included subtle subcorneal acantholysis, "checkerboard" alternating ortho-/parakeratosis, vacuolated keratinocytes and follicular plugging. All patients showed little treatment response. One patient eventually developed features of type II pityriasis rubra pilaris (PRP). Our study was limited by its small sample size and lack of a pre-existing diagnostic code. This recalcitrant psoriasiform facial dermatosis seems to be a distinct entity, with consistent and reproducible clinical features and a PRP-like histology, bearing some resemblance to the recently described condition-facial discoid dermatosis.