Cristina Birsan

Skin necrosis caused by prallethrin—A worldwide used insecticide

We report a case of necrosis caused by the use of prallethrin (mosquito repellent) on the skin in a 67-year-old diabetic female patient suffering from delusions of parasitosis. Cutaneous toxicity due to pyrethroids is less known or reported, despite well-documented pyrethroid poisoning involving the gastrointestinal, respiratory, cardiac, and nervous systems. Skin irritation has been described after acute accidental exposure but, as far as we know, no data have been published on the effects of pyrethroids when applied directly to the skin.

Cutaneous factitia in elderly patients: alarm signal for psychiatric disorders

Background The factitious disorders, more commonly known in daily practice as pathomimia, are expressed in dermatology units by skin lesions induced voluntarily by the patient, in order to draw attention of the medical staff and/or the family members. The disorder is often challenging to diagnose and even more difficult to document in front of the patient or relatives. It represents a challenge for the physician, and any attempt at treatment may be followed by recurrence of the self-mutilation. This paper describes two cases of pathomimia diagnosed by dermatologists and treated in a psychiatry unit, highlighting the importance of collaboration in these situations. Patients and methods Two case reports, describing old female patients with pathomimia, hospitalized in a department of dermatology for bizarre skin lesions. Results The first case was a 77-year-old female with unknown psychiatric problems and atrophic skin lesions on the face, self-induced for many months, with multiple hospitalizations in dermatology units, with no response to different therapeutic patterns, and full recovery after psychiatric treatment for a major depressive syndrome. The second case was a 61-year-old female patient with disseminated atrophic scars on the face, trunk, and limbs. She raised our interest because of possible psychiatric issues, as she had attempted to commit suicide. The prescription of antidepressants led to a significant clinical improvement. Conclusion These cases indicate that a real psychiatric disease may be recorded in patients suffering from pathomimia. Therefore, complete psychiatric evaluation in order to choose the proper therapy is mandatory for all these cases. Dermatologists and all physicians who take care of old patients must recognize the disorder in order to provide optimum care for this chronic condition. We emphasize therefore the importance of psychiatric evaluation and treatment to avoid the major risk of suicide. Skin lesions must be regarded as an alarm signal in critical cases, especially in senior people.

Pragmatic management of (suspected allergic) diaper dermatitis

Dear Sir, So-called diaper dermatitis covers a large spectrum of diseases, mostly comprising irritant contact dermatitis, allergic contact dermatitis, intertrigo, psoriasis, atopic dermatitis, and seborrheic dermatitis (1). We present a case of diaper dermatitis in a 4-month-old female child, diagnosed as allergic contact dermatitis on the basis of clinical features, long evolution, and the lack of response to all measures, that resolved only after the diaper had been replaced with a cotton product. Upon presentation, a large erythematous area, slightly desquamated, on the lower part of the abdomen, the sacral area and the diaper area was noted, without involvement of skin folds (Fig. 1a–c). The mother was very well trained in taking care of the child, and had never used alcohol-containing products for cleaning of the skin, but only superabsorbent disposable diapers, since the birth of the child. The child was healthy, breast-feeding, and normally developed according to her age, and was closely monitored by a paediatrician. One week after delivery, skin problems in the diaper area started in terms of erythema and slight oedema, but there was no oozing or crusting, and no maceration. Different diagnoses were made and different treatments were prescribed, including ointments, topical corticosteroids, antifungals, topical antibiotics, and calcineurin inhibitors, administered

Pityriasis Versicolor on the Face-Wrong First Diagnosis of Vitiligo

Pityriasis versicolor is a superficial infection of the stratum corneum caused by Malassezia yeasts. It is reported in a high incidence especially in warm and humid areas; clinical manifestations include scaly hypopigmented or hyperpigmented macules in characteristic areas of the body: chest, back, abdomen and proximal extremities. We describe a case of Pityriasis versicolor (hypopigmented) localized only on the face in a 10-year-old boy. The first diagnosis was vitiligo, the child underwent detailed and investigations about wide range in the Pediatric Hospital, the family was very anxious and the treatment proposed (phototherapy type UVB short wave (20 seances of UVB), emollients and topical steroids) was unsuccessful.