André Bourlond

Double-blind Comparison of Itraconazole With Griseofulvin in the Treatment of Tinea Corporis and Tinea Cruris

Seventy‐eight patients with tinea corporis or tinea cruris participated in a double‐blind study with either 100 mg itraconazole or 500 mg ultramicromized griseofulvin for 15 consicutive days. Clinical outcome was significantly in favor of itraconazole at completion of treatment (72% responce rate vs. 51%) and at the follow‐up visit(91% response vs. 64%). The most important difference berween both treatment was the mycologic outcome, for which itraconazole showed a cure rate oc 87% compared to 57% for griseofulvin 2 weeks after comparison of therapy. It is suggested that 100 mg of itraconazole orally daily is significantly more effective than 500 mg of griseofulvin once daily for 15 days in the treatment of glabrous skin infections. Both drugs were well tolerated.

Dermal Alternariasis in a Kidney-transplant Recipient

Dermal alternariasis represents one of the new infectious diseases related to immunodepression, especially in kidney recipients. Periodic acid-Schiff and Grocott stains of paraffin sections and mycological cultures must be resorted to in order to establish the diagnosis. Ketoconazole should be the best treatment.

Mycobacterium simiae disseminated infection in a patient with acquired immunodeficiency syndrome

SummaryMycobacterium simiae is commonly found in nature and its role as a pathogen has been controversial. A case of disseminatedM. simiae infection with blood, pulmonary and cutaneous localization is reported here. The pathogenic role ofM. simiae was clearly demonstrated as it was the only organism isolated from sputum, broncho-alveolar lavage fluid, as well as blood and skin tissue. Identification ofM. simiae by conventional testing may be difficult. Analysis of fatty and mycolic acid patterns, as performed in this case, is necessary to confirm its identification.ZusammenfassungMycobacterium simiae ist ein Bakterium, das in der Natur häufig zu finden und in seiner Pathogenität umstritten ist. Wir berichten über einen Fall vonM. simiae-Infektion mit Erregernachweis im Blut und Krankheitsmanifestationen in der Lunge und an der Haut. Die pathogenetische Bedeutung vonM. simiae war in diesem Fall eindeutig zu beweisen, da es der einzige aus Sputum, Bronchoalveolarlavageflüssigkeit, Blut und Haut angezüchtete Keim war. Die Identifizierung vonM. simiae bereitet bei Verwendung konventioneller Methoden Schwierigkeiten. Um die Identifizierung zu bestätigen, muß, wie im vorliegenden Fall, eine Analyse der Fettsäure- und Mycolsäure-Muster durchgeführt werden.Mycobacterium simiae is commonly found in nature and its role as a pathogen has been controversial. A case of disseminatedM. simiae infection with blood, pulmonary and cutaneous localization is reported here. The pathogenic role ofM. simiae was clearly demonstrated as it was the only organism isolated from sputum, broncho-alveolar lavage fluid, as well as blood and skin tissue. Identification ofM. simiae by conventional testing may be difficult. Analysis of fatty and mycolic acid patterns, as performed in this case, is necessary to confirm its identification. Mycobacterium simiae ist ein Bakterium, das in der Natur häufig zu finden und in seiner Pathogenität umstritten ist. Wir berichten über einen Fall vonM. simiae-Infektion mit Erregernachweis im Blut und Krankheitsmanifestationen in der Lunge und an der Haut. Die pathogenetische Bedeutung vonM. simiae war in diesem Fall eindeutig zu beweisen, da es der einzige aus Sputum, Bronchoalveolarlavageflüssigkeit, Blut und Haut angezüchtete Keim war. Die Identifizierung vonM. simiae bereitet bei Verwendung konventioneller Methoden Schwierigkeiten. Um die Identifizierung zu bestätigen, muß, wie im vorliegenden Fall, eine Analyse der Fettsäure- und Mycolsäure-Muster durchgeführt werden.

Management of Nonstaphylococcal Toxic Epidermal Necrolysis

A. Bourlond, Ch. Pirard, Department of Dermatology, Faculty of Medicine, Catholic University of Louvain, 52, avenue E. Mounier (Tour Vésale), B–1200 Brussels (Belgium) We were interested to read the paper of Tegelberg-Stassen et al. [1], and we adhere without restriction to their conclusions. As a matter of fact, at the Department of Dermatology, we have treated all our cases of toxic epidermal necrolysis (excluded of course the cases of staphylococcal scalded skin syndrome) in the same way, i.e. reserved barrier nursing, control of fluid balance, timely antibiotics and overall high doses of corticosteroids. From our experience, we would like to add some comments: High doses of corticosteroid must be resorted to as soon as possible in order to control the intensity of the eruption. The treatment does not prevent the shedding of the epidermis already severely aggressed, but it minimizes the oozing. Improvement must be achieved in a few days only; if delayed for more than 7 days, prognosis gets much worse, and infections multiply unavoidably. The comfort of patients and the rapidity of recovery are definitively enhanced. 238 Letters to the Editor Reference In Reply 1 Tegelberg-Stassen MJAM, Vloten WA van, Baart de la Faille H Management of nonstaphylococcal toxic epidermal necrolysis Follow-up study of 16 case histories. Dermatologica 1990; 180 124-129. Chronic Vulvar Purpura Sir, In a recent issue of Dermatologica, Kato et al. [1] described a chronic vulvar purpura in a 56year-old Japanese woman. The purpuric lesion was persistent during a follow-up time of 8 years and has been related by the authors to an abdominal ptosis. A cause of persistent purpuric lesions with hemosiderin deposits in the vestibulum vaginae is the plasma cell vulvitis of Zoon (vulvitis cir-cumscripta plasmacellularis). This circumscribed chronic vulvitis is usually located around the posterior circumference of the introitus vaginae or on the inner side of the labia minora; most often it presents as a dark red colored smooth lesion or a slightly erosive inflammatory erythroplasia [2]. The main histologic hallmarks are: atrophy of the epithelium, dense lymphoplasmocytic infiltration of the upper corium with invasion of the lower epithelial layers and extravasation of erythrocytes leading to a less or more dense deposition of hemosiderin [3]. Persistent lesions heavily laden with hemosiderin look clinically dark pigmented. In histologic specimens of older

About two cases of Mycobacterium simiae infection in AIDS: review of the pathogenicity.

Mycobacterium simiae is an ubiquitous species rarely involved as a cause of human infection. Its pathogenicity remains therefore unclear and controversial. Disseminated infections with M. simiae occur rarely and only 7 cases have been reported in patients with acquired immunodeficiency syndrome (AIDS). At least, two were mixed infections caused by M. simiae and M. avium-intracellulare. We report the case of two AIDS patients presenting with pure M. simiae infections: one was a disseminated infection and the other a pulmonary infection. Epidemiology and pathogenicity of M. simiae in pulmonary, extra-pulmonary and disseminated infections are reviewed.

Hypertrichosis induced by diazoxide in idiopathic hypoglycemia of infancy.

C. Rousseau, D. Willocx, A. Bourlond, J.P. Buts, M. Maes, A. Lopez, Service de Dermatologie des, Cliniques universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200 Bruxelles (Belgium) Case Report C... Laura, the product of an uneventful pregnancy, was born on February 8. 1988. She weighed 4.2 kg and looked healthy. However, during the first days of life, she developed severe hypoglycemia, responsive only to continuous intravenous glucose and glucagon infusion. High plasma insulin, inappropriate for the low blood glucose levels, was found. On day 20, diazoxide treatment was started (20 mg/kg/day p.o.). Five weeks later, hypertrichosis developed on the forehead, cheeks, back and extensor aspect of the limbs. There was not only vellus hair hypertrophy or hypertrichosis lanugosa but also true hair, 2 cm long, rather thick, brown-black (fig. 1). The hyperinsulinemia persisted in spite of the therapy, and it proved impossible to withdraw glucagon; diazoxide was stopped in mid-april and an 85% pancreatectomy was performed on August 24, 1988. The histology of the pancreas showed the presence of several hyperplastic foci of B cells. After withdrawal of diazoxide, hypertrichosis faded slowly; 6 months later, the skin looked almost normal. Before, during and after the treatment, the secondary sexual characters remained quite normal; hirsutism ‚ external genitalia hyperplasia and breast development were not observed at any time; urinary 17-ketoand 17-hydroxysteroids fell within the range of normal values. Comment Diffuse hypertrichosis is now well recognized as a side effect of diazoxide treatment [1 ‚ 2]; it occurs more frequently in idiopathic hypoglycemia than in hypertension where the overall incidence is lower than 1% [1,2]. Hypertrichosis develops very rapidly, a few weeks only after initiation of the treatment, and becomes more and more impressive with time. Fortunately, when the drug is withdrawn, hypertrichosis fades progressively with restitutio ad integrum within 6 months. Histology reveals a high proportion of anagen hair follicles [3, 4]. Clear-cut etiopathogeny escapes present knowledge ‚ but is has been hypothesized that vasodilatation increases cutaneous perfusion and promotes hair growth; a rich vascular network around hair follicles was recognized under the microscope [1,2,4];

Syndrome de Stewart-Treves

A Stewart-Treves angiosarcoma (Stewart-Treves syndrome) developed 14 years after mammectomy (Halsted) and radiotherapy for breast cancer in a woman now 56 years old. Limited excision, graft and comple

[Histiocytosis-X cutanée de l’adulte]

2 cases of histiocytosis-X of the adult are reported. Localization in the axillary and inguinal folds and longitudinal shallow ulcerations look rather typical.

Xanthogranulome nécrobiotique et myélome

Necrobiotic xanthogranuloma represents a very peculiar dermatosis with distinctive microscopic features. It is associated with paraproteinemia and quite often with myeloma : it is a good marker of med

Etat poïkilodermique et tolamolol

Long-term ingestion of tolamolol led to severe poikiloderma with microscopic features similar to those of premycosis.