José Mazuecos

Long-term Involution of Unilateral Porokeratotic Eccrine Ostial and Dermal Duct Naevus

Sir, Porokeratotic eccrine ostial and dermal duct naevus (PEODDN) is a rare disorder of keratinization with eccrine involvement that histologically presents a cornoid lamella exclusively associated with eccrine ostia and the underlying sweat ducts (1). It is an expression of genetic mosaicism (2) and is characterized by asymptomatic grouped keratotic papules and plaques with a linear distribution, usually located on the acral portion of a limb (3). The lesions are congenital with a tendency to be stable and sometimes progressive.

Anaerobic bacteria in men with urethritis

Investigation of the urethral flora in men with urethritis, with particular reference to anaerobic bacteria.

A prevalence survey of dermatoses in the southwestern Spanish neonate

during periods with more intense physical activity. Another patient has taken 250 mg oxytetracycline per day continuously since mid-1992. This dose enables him to participate in long hikes as a boy scout, an activity in which he previously could not take part. One patient took sick leave during the months of May and June, 1992, due to severe blistering of the feet. After two weeks of treatment with 750 mg oxytetracycline per day, she was able to resume her job. Most patients stated that bulla formation decreased within the first week of treatment and that blistering recurred within a week of the cessation of therapy. For many generations, epidermolysis bullosa simplex has been a fact of life for some families on the Danish island of Lass0. In the 1950s a genetic study of the affected families carried out by N0rholmPetersen and Birch Nielsen disclosed 125 cases of epidermolysis bullosa simplex in three families [1]. Hauge [2] continued ihis research and found an autosomal pattern of inheritance. He concluded that a mutation which had occurred in the 1700s was the likely cause of the initial event on the island and that, in all three families, the disease had probably derived from this mutation. Six patients in the current study were from two families who have their origins on the island of Laes0. The patients from one of these families were aware of 11 cases of epidermolysis bullosa simplex in the family, while the patients from the other family were aware of !3 family members with the disease. Most of the patients described here have symptoms only or primarily during the warm summer months. The fact that treatment is necessary for only a few months of the year makes tetracycline an attractive therapy. The patients all stated that previous treatments had had little or no effect on their disease and that the marked improvement seen during oxytetracycline treatment greatly improved their quality of life. This treatment trial was initiated because bullous pemphigoid has been seen to respond to treatment with tetracycline [3,4] and because improvement was seen in two patients with dystrophic epidermolysis bullosa following treatment with minocycline [5], We chose oxytetracycline because this drug is routinely used in our clinic for the treatment of acne. There is probably no difference between the effect of this compound and tetracycline. As only limited conclusions can be drawn from an open study, we are currently conducting a properly controlled trial of the effect of oxytetracycline on epidermolysis bullosa simplex. We felt, however, that the striking results of this open study would be of interest to other clinicians.

Ofuji papuloerythroderma in an elderly woman with atopic erythroderma.

To the Editor A 9-year-old Caucasian girl was referred to our clinic for hyperpigmented macules on her face and body. Four years previously subcutaneous nodules that had appeared on her knees and the occipital area were diagnosed as Schwannomas histologically. The ‘brownish’ skin lesions on her face, legs and sacral area, present since birth, were thought to be café-au-lait macules and the diagnosis was neurofibromatosis. The nodules that were not excised had curiously disappeared over time. Later, her mother became concerned when more macular lesions appeared on her arms and legs and the girl was referred to us. When questioned, the child complained of bone pain, occasional pruritus and urticaria. Physical examination revealed light pinkish-brown macules with tiny telangiectatic vessels close to the periphery of the lesions, the biggest ones on the sacral and right preauricular area, measuring 8 cm and 5 cm in diameter, respectively (figs 1 and 2). These ‘congenital’ lesions were warmer than the adjacent normal skin and neither the normal (dermographism) nor the lesional (Darier’s sign) skin urticated on stroking. The lesions did fade slightly with diascopy. The newly appearing lesions were smaller tan macules with few or no telangiectasia and were not warm. There were two new subcutaneous lesions on the left elbow. The liver was slightly enlarged on palpation and ultrasonographically. There was no splenomegaly or lymphadenopathy. Serum levels of liver transaminases and alkaline phosphatase were slightly above normal limits. Two per cent basophilia was noted on the peripheral blood smear. The results of the other laboratory tests and imaging studies, including biochemical analyses, protein electrophoresis, blood coagulation tests, hepatitis serology, cranial magnetic resonance imaging, chest X-rays, bone scan, bone marrow aspiration and biopsy were within the normal limits. A 24-h urine collection for methylimidazoleacetic acid was within normal limits. Because of the lack of permission from the parents, bone and liver biopsies were not performed. Histopathological examination of the macule on the sacral area showed hyperpigmentation in the basal layer, superficial perivascular inflammatory infiltrate with scattered spindle-shaped mast cells and telangiectatic dermal vessels (figs 3 and 4). A diagnosis of telangiectasia macularis eruptiva perstans (TMEP) was suspected. The most frequent site of organ involvement of mastocytosis is the skin. TMEP is generally agreed to be cutaneous mastocytosis, an uncommon variant of urticaria pigmentosa. 1 It appears most frequently in adults and only rarely affects young children or infants. Systemic involvement is more common in adult forms of mastocytosis. 2 Systemic signs and symptoms depend on the specific organ system affected. Bone pain in the legs of our patient was the only complaint that can be considered a systemic manifestation of mastocytosis, and it is

Clinical efficacy of new quinolones for therapy of nongonococcal urethritis.

Ninety-five patients with nongonococcal urethritis were enrolled in a double-blind study and were randomly assigned to a one-week treatment with ciprofloxacin (500 mg twice daily) or ofloxacin (200 mg twice daily). Two weeks after treatment the results obtained for the 79 evaluated patients were as follows: 59 patients (75%) were clinically cured, and of the 54 patients with initial positive cultures, 39 (72%) remained culture-negative. We did not find any statistically significant differences between the results obtained with the two treatments. These results did not vary with the cause. Patient compliance with the regimens of two doses per day was excellent, and no serious adverse effects occurred with either drug.

Pubic trichotillomania in an adult man

Sir, Bowenoid papulosis is a disease presenting with fleshy, usually pigmented papules involving the genitalia of both sexes. In vulvar lesions, the term vulvar intraepithelial neoplasia (VIN3) is also used to describe the same condition. Histological examination reveals a picture consistent with carcinoma in situ, although the course of the disease appears to be benign. Association with oncogenic human papillomavirus (HPV 16, 18, 33) has been demonstrated. In the past, excisional surgery, electrocoagulation, cryotherapy and 5-fluorouracil have been used in the treatment of the condition with varying degrees of success. A 38-year-old woman was referred to our clinic with a 4-year history of pruritic skin lesions on her labia majora. She had previously been treated with podophyllin without any benefit. The molecular biological examination of the vaginal mucosa had been negative in terms of HPV typing (groups 6/11, 16/18, 31/33). However, HPV 31/33 was detected in the cervical smear (Hybrid Capture II test). Previous treatment with erbium laser, KTP 532 mm laser and podophyllin had been unsuccessful. On examination, erythema and numerous small papules were detectable on the labia minora and majora as well as in the clitoral and perianal area, each papule 1±3 mm in diameter (Fig. 1). The dermatohistopathological examination of several biopsies taken from these sites showed a uniform pattern with bowenoid epithelial changes, thus supporting the clinical diagnosis of bowenoid papulosis (Fig. 2). Treatment with imiquimod was initiated with a regimen different from that recommended for the treatment of genital warts. Imiquimod cream 5% was applied to affected areas on alternate days for 10 days until the skin became visibly irritated. The cream was now applied once daily for another 10 days, but washed off after 2 h each time. This treatment led towards complete clinical resolution within 8 weeks (Fig. 3). Histology performed 1 month, 6 months and 18 months after treatment demonstrated the absence of any precancerous epidermal changes (Fig. 4). The lympho histiocytic dermal infiltrate observed 1 month after treatment decreased in density in the control biopsies taken 6 and 18 months after treatment. Colposcopy performed 10 months after treatment showed minor acetic-white areas around the portio. No low-risk or high-risk HPV material was detected on the cervix (Hybrid Capture II test). More than 18 months after treatment the patient continues to be clinically clear. Imiquimod is a topical immune response modifier so far registered for the treatment of condylomata acuminata. Imiquimod directly induces antiviral and immunomodulating cytokines such as interferon-a, tumour necrosis factor-a and different interleukins from monocytes, macrophages and dendritic cells. Its effect on the innate immune response and the activation of Th1-immunity are responsible for its acute

Skin bridge on a nail plate caused by distal onychocryptosis

The formation of a skin bridge on the nail plate is a rare finding which is sometimes observed in newborns and infants.We present the case of a 22 year-old-male who 2 years ago underwent surgical nail avulsion to treat bilateral onychocryptosis of the toenail on the right great toe. Following the procedure, the patient once again developed a painful lateral and distal ingrown nail. Owing to the elevation of the pulp hallux, the nail plate pierced through the distal nail groove, producing a painless [...]