Spectrum Of Skin Diseases Research Articles

Pathological diagnosis of 400 cases of clinically diagnosed eczema: a retrospective analysis

Objective To analyze the pathological diagnosis of patients with clinically diagnosed eczema,to describe the spectrum of skin diseases tending to be misdiagnosed as eczema,and to investigate factors associated with their misdiagnosis.Methods A retrospective study was performed on 400 patients who were clinically diagnosed as eczema and received pathological examination at the dermatology clinic of Peking University Third Hospital from August 2006 to April 2013.Skin biopsy specimens were re-reviewed for these patients,and pathological diagnosis was made in combination with clinical presentations.Results Of the 400 outpatients with clinically diagnosed eczema,110 (27.5％) were finally diagnosed as non-eczema skin diseases pathologically,including 16 cases of psoriasis,13 bullous pemphigoid (BP),11 lichen planus (LP),9 cutaneous amyloidosis,8 mycosis fungoides (MF),14 skin malignancies,and 39 other skin diseases.The highest misdiagnosis rate was observed in people aged 60 to 79 years (33.9％) and lesions at the genital sites (46.2％).Conclusions Many conditions tend to be misdiagnosed as eczema in clinic,including psoriasis,BP,LP,cutaneous amyloidosis,MF and skin malignancies.Misdiagnosis is rather frequent in elderly people and eczematous lesions in genital areas,and pathological examination should be taken actively for uncertain cases. Key words: Eczema; Diagnostic errors; Case-control studies

The spectrum of skin diseases in a black population in Durban, KwaZulu-Natal, South Africa.

Precise knowledge of the prevalence and spectrum of skin diseases in a population allows for effective planning for provision of dermatology services and distribution of resources. There are no published data on the epidemiology of skin disorders in Durban, KwaZulu-Natal. We investigated the prevalence of skin diseases in black African patients attending a predominantly black private healthcare facility and profiled the patients. Clinical charts of all black African patients seen between January 2003 and December 2010 in a private practice in Durban were reviewed. The diseases seen were described and the prevalence calculated. A total of 6664 patient charts were reviewed. The five most common conditions were acne, eczemas, dyschromias, infections, and hair disorders. These data agree with reports from other parts of the world. Selection bias was presented by a single private practice, thus data may not be fully representative of our population. Acne, eczemas, dyschromias, infections, and hair disorders are, in that order, the five most common disorders encountered.

Skin disorders encountered in a Swiss pediatric emergency department

While skin disorders are commonly seen in paediatric emergency departments (PED), the exact frequency of the various dermatological conditions is unknown. Our aim was to evaluate the occurrence and spectrum of skin disorders in an urban PED and the need for a dermatological opinion. The medical records of patients attending the PED during 120 days over a 1-year period were analysed. The dermatological findings were evaluated as to incidence, demographic details, frequency of dermatological review and treatment. A questionnaire assessed the need for dermatological support. Skin findings were recorded in 1,572 (17.4%) of the 9,041 attendances. The skin problem was the primary cause of the PED visit or related to the primary complaint in 853 (54.3%) and 335 (21.3%) cases respectively. In 373 patients (23.8%) a diagnosis was only suspected or remained unknown. Inflammatory and allergic disorders were most commonly encountered (42.9%), followed by skin infections (31.8%), physically induced skin lesions (11.9%), varia/unknown (11.1%) and congenital disorders (2.3%). Viral and parainfectious exanthema was the most common diagnosis (17.6%), followed by anogenital dermatitis (7.7%), gingivostomatitis (7.1%), petechiae (6.4%), burns (6.0%), urticaria (5.0%) and insect bite reactions (5.0%). 81 (5.2%) of the patients with skin conditions were hospitalised. The PED doctors expressed the wish for a dermatological opinion in 25% of the patients with skin findings. We identified a high frequency, broad spectrum and diagnostic difficulties of paediatric skin conditions. Our data highlight the need for educational measures and close collaboration between the two specialities to improve management of these children.

Human T‐lymphotropic Virus 1 (HTLV‐1) infection – dermatological implications

Human T-lymphotropic virus type 1 (HTLV-1) is a type C retrovirus primarily endemic to Japan, Central and South America, the Middle East, regions of Africa, and the Caribbean. Currently, an estimated 10-20 million people worldwide are infected with this virus. Although the majority of infected individuals remain asymptomatic, HTLV-1 is the causative agent of a number of disorders, notably adult T-cell leukemia/lymphoma (ATLL) and a progressive demyelinating neurological disorder, HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). In addition to ATLL and HAM/TSP, HTLV-1 has been associated with a spectrum of skin disorders, such as infective dermatitis associated with HTLV-1, crusted scabies, and leprosy. The understanding of the interaction between virus and host response has improved markedly, but there are still few treatment options.

Pediatric dermatology in practice: spectrum of skin diseases and approach to patients at a Turkish pediatric dermatology center

Purpose: The aim of this study was to determine the real spectrum of skin diseases in Turkish children and how they were managed.Methods: Data on a total of 6000 consecutive patients aged 0–18 years attending the pediatric dermatology clinic were analyzed for diagnosis, disease group, diagnostic pattern, treatment modality, and referral and hospitalization frequency.Results: Allergic skin diseases (49.9%) were the leading group of dermatoses, which were followed by infectious diseases (20.5%), and disorders of skin appendages (10.2%). Atopic dermatitis was the most common dermatose, which was followed by papular urticaria and unclassified eczema. Most of the patients (92.0%) had diagnosis on clinical basis, whereas skin biopsy was performed in 3.7% and laboratory investigation in 4.4% of the patients. The hospitalization rate was 0.3%, and Henoch–Schönlein purpura was the most frequent dermatose for which hospitalization was required. Local treatment was prescribed in 56.0% of the patients, local treatment and systemic treatment together in 26.4%, and systemic treatment in 6.2%. Viral warts followed by viral exanthems caused by enteroviruses and acquired melanocytic nevi were the most frequently referred skin problems. Further investigation and treatment for systemic or related diseases was the most common reason for referrals (2.1%), and pediatrics was the department to which most of the referrals were made (1.8%).Conclusion: This study provided important data on the spectrum of skin diseases encountered in the pediatric age groups and general approach to patients in a pediatric dermatology clinic in Turkey.

Prevalencia y características de las dermatosis relacionadas con la infección por VIH en la actualidad

Introduction The introduction of highly active antiretroviral therapy has produced a substantial change in the natural history of human immunodeficiency virus (HIV) infection. The frequency of opportunistic infections and AIDS-related cancers has fallen, though new health problems have developed. Likewise, there has been a change in the spectrum of skin diseases now observed in these patients. Objective To analyze the prevalence and characteristics of skin disease in a group of HIV-infected outpatients. Methods A cross-sectional, observational study was performed. All patients who attended the day care unit of the infectious diseases department over a 6-month period (May–October, 2003) were offered the possibility of complete dermatologic examination. Epidemiologic and clinical variables were recorded in all participants, together with the findings on examination of the skin. A comparative study was performed, grouping the patients according to CD4-lymphocyte count and antiretroviral treatment. Results The prevalence of dermatoses in the study patients was 98.3%. The most common conditions were xerosis (114 patients, 37.6%), seborrheic dermatitis (94 patients, 31%), distal subungual onychomycosis (80 patients, 26.4%), and viral warts (65 patients, 21.4%). Grouped by etiology, infectious diseases were the most common (68.6%), followed by inflammatory diseases (47.5%). Conclusion Mucocutaneous lesions continue to be very common in HIV-infected patients, although there has been a qualitative change in the conditions that these patients present.

Current Prevalence and Characteristics of Dermatoses Associated with Human Immunodeficiency Virus Infection

Introduction The introduction of highly active antiretroviral therapy has produced a substantial change in the natural history of human immunodeficiency virus (HIV) infection. The frequency of opportunistic infections and AIDS-related cancers has fallen, though new health problems have developed. Likewise, there has been a change in the spectrum of skin diseases now observed in these patients. Objective To analyze the prevalence and characteristics of skin disease in a group of HIVinfected outpatients. Methods A cross-sectional, observational study was performed. All patients who attended the day care unit of the infectious diseases department over a 6-month period (May-October, 2003) were offered the possibility of complete dermatologic examination. Epidemiologic and clinical variables were recorded in all participants, together with the findings on examination of the skin. A comparative study was performed, grouping the patients according to CD4-lymphocyte count and antiretroviral treatment. Results The prevalence of dermatoses in the study patients was 98.3%. The most common conditions were xerosis (114 patients, 37.6%), seborrheic dermatitis (94 patients, 31%), distal subungual onychomycosis (80 patients, 26.4%), and viral warts (65 patients, 21.4%). Grouped by etiology, infectious diseases were the most common (68.6%), followed by inflammatory diseases (47.5%). Conclusion Mucocutaneous lesions continue to be very common in HIV-infected patients, although there has been a qualitative change in the conditions that these patients present.

The Spectrum of Skin Disease Among Indian Children

The Spectrum of Skin Disease Among Indian Children

Paediatric HIV-related skin diseases

Mucocutaneous lesions are a frequent manifestation of human immunodeficiency virus (HIV) infection and/or the acquired immunodeficiency syndrome (AIDS) in adult and paediatric patients alike. These include a wide variety of infective disorders, inflammatory dermatoses and adverse drug reactions. Although there is considerable overlap in the spectrum of skin disease in both groups, significant differences exist. Oral candidiasis, which implies marked immune deficiency in adults with AIDS, may occur without severe CD4+ T-cell depletion in children. Infective and inflammatory disorders such as oral hairy leucoplakia, bacillary angiomatosis and HIV-associated eosinophilic pustular folliculitis are exceedingly uncommon in children. Kaposi sarcoma is encountered far less frequently in children, and non-Hodgkin lymphoma in mucocutaneous sites is rarely seen. Stigmata of concomitant nutritional deficiencies are often observed in children. This review gives an overview of this spectrum of disease. The paucity of literature on the immune reconstitution inflammatory syndrome in the paediatric context is emphasized.

The Spectrum of Skin Disease Among Indian Children

Skin diseases in children are encountered frequently and their characterization is essential for the preparation of academic, research and health plans. A retrospective study was designed to evaluate the epidemiologic features of pediatric dermatoses in India. The setting was a tertiary care referral center in India (Kalawati Saran Children's Hospital, New Delhi) during January 1997 to December 2003. A total of 30,078 children less than 12 years of age with 32,341 new dermatoses were recorded, with a male to female ratio of 1.07:1. Most of the disease was seen in the 1- to 5-year age group (44.94%). The most common skin diseases were infections and infestations (47.15%) consisting of bacterial infections (58.09%) and scabies (21.54%), followed by eczemas (26.95%), infantile seborrheic dermatitis, scabies, and pityriasis alba. Other unique dermatoses in our settings were papular uticaria (3.59%), miliaria (5.46%), postinflammatory pigmentary abnormalities (1.68%), and nutritional deficiency dermatoses (0.45%). A majority of patients were diagnosed clinically and special diagnostic tests were conducted in 2.6% of patients. The most common diagnostic test used was KOH mount (59.2%), followed by skin biopsy (39%). Nearly 90% of patients were seen without any referral and in the remaining, a majority were referred by pediatricians (75%). A majority of patients were diagnosed to have infection followed by dermatitis in our setting.

Spectrum of skin disorders in human immunodeficiency virus‐infected patients in Singapore and the relationship to CD4 lymphocyte counts

Skin disorders are extremely common and cause significant morbidity in human immunodeficiency virus (HIV)-infected individuals. There are few data on their prevalence and association with CD4 counts in Asians. To evaluate the prevalence of skin disorders in ambulatory HIV-infected individuals attending a specialized skin clinic in Singapore and the association with the degree of immunosuppression. A cross-sectional study on skin disorders in HIV-positive outpatients in the Communicable Disease Centre of Singapore was performed. The association between skin disease prevalence and CD4 count was evaluated using logistic regression. Ninety-six patients (male : female, 8 : 1) were enrolled. The most common mode of HIV transmission was heterosexual (75%), followed by homosexual/bisexual contacts (22%), and intravenous drug abuse (3%). The distribution of patients in terms of current CD4 cell counts was as follows: 38.5% with less than 50 x 10(6)/L, 25% with between 50 and 199/microL, and 36.5% with at least 200 x 10(6)/L. The most common skin disorder was pruritic papular eruption (PPE) of HIV infection (31 cases), followed by psoriasis (24), seborrheic dermatitis (18), xerosis (17), herpes simplex (17), and adverse drug eruptions (17). A CD4 cell count of less than 200 x 10(6)/L was significantly associated with a higher number of skin disorders (P = 0.002) and the development of psoriasis [odds ratio (OR), 8.97; 95% confidence interval (CI), 1.70-47.16; P = 0.010], PPE (OR, 3.40; 95% CI, 1.21-9.53; P = 0.020), and adverse drug eruption (OR, 5.83; 95% CI, 1.21-28.00; P = 0.028). A preponderance of inflammatory dermatoses and an absence of skin tumors characterized this study. A low CD4 cell count was associated with a higher number of skin disorders and an increased incidence of PPE, psoriasis, and adverse drug eruptions.

Otophyma: a case report

We report a rare case of otophyma. A case report of otophyma and a review of the current literature concerning otophyma and the more common rhinophyma, are presented. A 46-year-old male presented with slow growing fleshy growths on both auricles which were excised. A diagnosis of otophyma was made. Although rosacea is more common, otophyma and other 'phymas' are thought to be the end stage of the rosacea spectrum of skin disease. However, unlike rhinophyma, otophyma is rarely seen and as a result there is little in the English language literature regarding it. Consequently, the management of otophyma is largely based on previous experiences with rhinophyma. To our knowledge this is the first case report of otophyma in the otolaryngology literature and only the second described in the English language literature. This case demonstrates the difficulties faced in diagnosing this rare condition and our successful management of this case.

Emerging Dermatologic Issues in the Oncology Patient

The spectrum of skin diseases that occurs in the oncology patient differs somewhat from that seen in other immunosuppressed populations. We review the cutaneous manifestations of invasive mold infections in the leukemia/lymphoma population. Aspergillus mold infections are now the leading infectious cause of death in this population. We also review the pustular eruption caused by a new class of chemotherapy for solid malignancies. An update on cutaneous graft-versus-host disease appears elsewhere in this journal. Cutaneous squamous cell carcinomas and basal cell carcinomas occur more frequently in the chronic lymphocytic leukemia and non-Hodgkin's lymphoma population; this is discussed, as is the more aggressive clinical course of these tumors.

HIV-associated pruritus: etiology and management.

With the advent of highly active antiretroviral therapy (HAART), life-threatening opportunistic infection has become less common in patients with HIV infection and longevity has increased dramatically. With increased longevity, the problems of living with a chronic disease have become more prominent in this patient population. Disorders such as fat redistribution and metabolic abnormalities can result from antiviral medications and from HIV disease itself. Pruritus is one of the most common symptoms encountered in patients with HIV. The spectrum of skin diseases in such patients encompasses dermatoses of diverse etiologies; a few are peculiar to patients with HIV while others are not. Some of these conditions may cause severe and sometimes intractable pruritus that provokes scratching, picking, disfigurement, sleep loss, and significant psychological stress. Moreover, the expense of ongoing medical treatments can be daunting. Skin rash can sometimes be the initial presentation of HIV infection or serve as a harbinger of disease progression. Causes of pruritus include skin infections, infestations, papulosquamous disorders, photodermatitis, xerosis, drug reactions, and occasionally lymphoproliferative disorders. Drug eruptions are particularly common in patients who are HIV positive, presumably as a result of immune dysregulation, altered drug metabolism, and polypharmacy. Itching can also result from systemic diseases such as chronic renal failure, liver disease, or systemic lymphoma. Workup of pruritus should include a careful examination of the skin, hair, nails, and mucous membranes to establish a primary dermatologic diagnosis. If no dermatologic cause is found, a systemic cause or medication-related etiology should be sought. Idiopathic HIV pruritus is a diagnosis of exclusion and should only be considered when a specific diagnosis cannot be established. The management of HIV-associated pruritus should be directed at the underlying condition. Phototherapy has been found to be useful in the treatment of several HIV-associated dermatoses and idiopathic pruritus as well. Unfortunately, some of the treatments that have been suggested for patients with HIV are anecdotal or based on small uncontrolled studies. The last decade has seen a surge in the utilization of HAART which, to some degree, reconstitutes the immune system and ameliorates some dermatologic diseases. On the other hand, some skin diseases flare temporarily when HAART is started. Unless frank drug allergy is suspected, HAART does not need to be stopped.

The spectrum of skin disorders in abdominal stoma patients.

Skin integrity is essential for the normal usage of a stoma appliance. However, there is little published on the prevalence, nature or management of stoma-related skin disorders. Objectives To document stoma-related skin disorders in a large cohort of patients. We sent a postal questionnaire to all surviving patients who had had abdominal stoma surgery at Hope Hospital, Salford, U.K. in the 10 years from 1 January 1989. Those reporting skin disease were invited to attend a clinic run by a dermatologist and a stoma-care specialist nurse. All lesions were categorized and swabs taken for microbiological examination. Of 525 surviving patients, 325 (62%) replied to the questionnaire. Of these, 73% reported a skin problem that had affected normal stoma bag use. Dermatoses included irritant reactions, particularly from leakage of urine or faeces (42%); pre-existing skin diseases, principally psoriasis, seborrhoeic dermatitis and eczema (20%); infections (6%); allergic contact dermatitis (0.7%) and pyoderma gangrenosum (0.6% annual incidence). A further 15% of patients with skin problems had persistent or recurrent dermatitis not explained by allergy, frank infection or faecal irritation. This responded to short-term treatment with topical corticosteroids. Further investigation is under way into its pathogenesis. Skin disorders are common in stoma patients, and various patterns can be recognized and effectively treated.

HIV infected patients: correlation of cutaneous disease with degree of immunosuppression.

The AIDS epidemic has become a world-wide health problem since the disease was identified ten years ago. An HIV-dermatology outpatient clinic was established at the Albion Street Centre in Sydney to manage patients with cutaneous manifestations of AIDS. This study reviews the spectrum of skin disorders seen, and attempts to correlate skin disease with the degree of immunosuppression as reflected by CD4 or T helper lymphocyte counts, whereas previous reports have attempted to correlate skin disease with clinical signs and symptoms. Brief summaries of HIV disease and the cutaneous manifestations of AIDS are given.

Common and Uncommon Dermatologic Diseases Related to Sports Activities

The athlete is exposed to a whole spectrum of skin diseases that may or may not be unique to the particular sport or activity. Although the athlete is usually a healthy young adult and sports-related skin diseases are often minor, it is important for these disorders to be recognized by physicians, nurses, coaches, and trainers. Prevention, early diagnosis, and treatment will enable the athlete to resume participation as early as medically possible.

Practical Pediatric Dermatology

This well-structured and organized text, written by a single, highly qualified author whose first edition (1979) has had a successful reception, provides the reader with a most usable teaching aid. Not meant to be an encyclopedic treatise, this readable volume provides a wealth of information about the diagnosis, treatment, and management of the broad spectrum of skin disorders seen from the newborn through the adolescent periods. Such a book should prove useful to medical students on their clinical rotations through pediatrics and family practice. Similarly, pediatric house staff, or nondermatologists who deal with pediatric patients, will also value this guide through the maze of the multiple dermatological problems that beset the young. Black-and-white photographs in general do not do justice to dermatological lesions, and those in this text, although plentiful, are not an exception to this rule. Consequently, some are of variable quality and limited usefulness. Why the marginal photomicrograph