N. Aste

Tinea capitis in children in the district of Cagliari, Italy

Summary. Between 1986 and 1995, 4104 children were observed in the Clinic of Dermatology in Cagliari, Italy. Three hundred and thirty‐six children (8.2%), 188 boys and 148 girls, aged 1 month to 13 years, were affected by tinea capitis. Microsporum canis was detected in 278 cases (82.7%) and Trichophyton mentagrophytes in 58 cases (17.3%). Systemic treatment with 20–25 mg kg‐1 day‐1 griseofulvin led to complete recovery in 30–40 days. None of the patients relapsed. The epidemiology of the infection was analysed according to age, sex and seasonal progression. Microsporum canis was the preponderant aetiological agent of tinea capitis in children in the district of Cagliari, Italy.

Cutaneous adverse drug reactions to allopurinol: 10 year observational survey of the dermatology department – Cagliari University (Italy)

Background  Allopurinol is extensively prescribed for conditions associated with urate excess, despite being responsible for severe cutaneous adverse drug reactions (ADR).

Clinical efficacy and tolerability of terbinafine in patients with pityriasis versicolor

Summary. The antifungal efficacy and tolerability of 1% terbinafine cream vs. 1% bifonazole cream were assessed in a single blind randomized trial in patients with pityriasis versicolor. Terbinafine, a drug of the allylamines group, a new class of antimycotic agents, blocks sterol biosynthesis in the pathogen through inhibition of squalene epoxidase and consequent squalene accumulation, a primarily fungicidal process. Forty pityriasis versicolor patients, (18 M, 22 F; mean age 32.4 years; min. 16, max. 65), used 1% terbinafine cream or 1% bifonazole cream for a maximum of 4 weeks. All patients were followed‐up weekly both clinically and my‐cologically. Clinical cures, defined as negativization of each clinical parameter, were recorded for 20 terbinafine patients (100%) and 19 bifonazole patients (95%), with routine microscopy and Woods light tests both negative. By the 2nd week of treatment, 2 terbinafine patients were mycologically cured (10%). By the 3rd week, 14 terbinafine patients (70%) and 5 bifonazole patients (25%) were mycologically cured. The present controlled clinical trial consequently demonstrates that terbinafine is rapidly effective and well tolerated for treatment of pityriasis versicolor.

Tinea pedis observed in Cagliari, Italy, between 1996 and 2000.

Summary The aim of this study was to verify the incidence of tinea pedis in patients observed in the Department of Dermatology of the University of Cagliari, Italy, in the period from 1996 to 2000. We examined 722 patients, 536 with lesions and 186 without lesions of the feet and in 169 of them (23.4%) we diagnosed tinea pedis. All patients suffering from tinea pedis belonged to the group with lesions. In the 536 patients with clinical manifestations which were evident to a certain degree, microscope and cultural examination gave positive results for dermatophytes in 169 cases (31.5%). The most frequently isolated dermatophyte was Trichophyton mentagrophytes (51.5%), followed by Trichophyton rubrum (45.2%) and Epidermophyton floccosum (3.3%). In the 186 patients without lesions, direct microscope examination was consistently negative while cultural examination showed the growth of sparse colonies of Candida albicans in two cases (1.1%) We analysed distribution by sex, age, residence, occupation and clinical manifestations. Stressing the high frequency of tinea pedis in this region, the discovery of a dermatophytic infection of the feet with an absence of signs and symptoms is an exceptional event.

Pityriasis rotunda: A Survey of 42 Cases Observed in Sardinia, Italy

BACKGROUND Pityriasis rotunda (PR) is an uncommon dermatosis characterized by multiple, round or oval, sharply demarcated scaling patches that are dyschromic and asymptomatic. It has been described in Japanese and in blacks, usually in association with certain infective or malignant systemic diseases. OBJECTIVE The aim of this study is to further clarify this rare entity which in Italy seems to be confined to the island of Sardinia. METHODS We studied 42 Sardinian patients, 22 males and 20 females, in an age range of 3-32 years. In 29 cases, the disease involved more than one family member. The patients were observed in Cagliari, the capital city of Sardinia. RESULTS Bacterial, viral and fungal investigation yielded negative results. Haematochemical and immunological examination and thyroid, hypophyseal and adrenal hormones did not reveal any alterations. No systemic pathologies were found associated with the disease. CONCLUSIONS The cases studied by us and those previously reported seem to indicate the presence of two distinct types of PR with significant prognostic differences.

Primary cutaneous cryptococcosis in an immunocompetent host.

We report a case of primary cutaneous cryptococcosis in an immunocompetent host. Several nodules, isolated or sometimes joint to form plaques, affected the right arm. The arm was paralytic and hypoplastic, and a history of numerous abrasions picking firewood up preceded the onset of the eruption. Histology on skin biopsy documented a dermal infiltrate constituted of histiocytes, lymphocytes, fibroblasts and rare giant cells. Numerous rounded periodic acid‐Schiff (PAS) bodies were also present. Cryptococcus neoformans var. neoformans grew upon culture. Complete blood, biochemical and instrumental examinations resulted in findings within normal range. Treatment with itraconazole 200 mg daily for 4 months led to complete recovery. During a 2‐year follow‐up, the patient did not present any relapse or dissemination to other organs.

Cutaneous Crohn Disease in a Child

Abstract:  Cutaneous Crohn disease refers to granulomatous skin manifestations not contiguous with gastrointestinal affected areas. It is a very rare condition, especially in children, and is easily misdiagnosed when characteristic gastrointestinal symptoms are absent. We report a 10‐year‐old Caucasian girl with a 6‐month history of erythematous, firm tumescence of the left labium majus pudendi and moist vegetations circumscribing the anal ostium. Histologic analysis of skin biopsy specimens from both types of lesions showed a characteristic granulomatous noncaseating infiltrate throughout the dermis. Endoscopic examination and a colon biopsy specimen showed chronic granulomatous inflammation consistent with Crohn disease. Treatment with prednisolone 20 mg daily, metronidazole 250 mg three times daily, topical corticosteroids, and mupirocin ointment produced marked improvement of the vulvar edema, whereas the perianal lesion had a relapsing course. Early recognition of extra‐intestinal manifestations of Crohn disease, which are extremely rare in children, may be difficult. Coexistence of contiguous and noncontiguous lesions, representing the very first signs of the disease, are further peculiarities in our patient.

Kerion Celsi: a clinical epidemiological study

Summary. We present a case record of patients with kerion Celsi observed in the Clinic of Dermatology, University of Cagliari (Italy) from 1981 to 1995. Altogether, 31 children (18 male and 13 female) with an age range of 40 days to 12 years were studied. In all cases the lesions were confined to the scalp. In 10 cases the disease developed as such, while in 21 patients it represented the inflammatory evolution of tinea capitis secondary to incongruous topical treatment. Microsporum canis was isolated in 22 cases and Trichophyton mentagrophytes in nine cases. Systemic treatment was carried out in 20 patients with griseofulvin, in six with ketcconazole and in five with terbinafine. Complete recovery was obtained in 25–30 days. No cases of relapse were observed. The authors stress the importance of an early diagnosis followed by timely and effective treatment to prevent scarring and permanent hair loss.

Dermatophyte infections mimicking other skin diseases: a 154-person case survey of tinea atypica in the district of Cagliari (Italy)

Background  Although usually simple, the diagnosis of dermatophyte infection is sometimes neglected. An observational study has been realized to evaluate the role of corticosteroid exposure (tinea incognito) and of other primary characteristics of the dermatophytosis that from onset mimic other diseases and mislead an unexperienced physician.

Leishmaniasis of the lip in a patient with Down's syndrome

Cutaneous leishmaniasis is an endemic protozoan infection in Sardinia, one of the major islands of the Mediterranean Basin. The main causative strain in this country is Leishmania infantum, which rarely involves mucocutaneous areas, but has the potential to cause visceral leishmaniasis. An atypical leishmaniasis involving the inferior lip of a 57‐year‐old female with Downs syndrome was observed at the Dermatology Department of Cagliari (italy). The diagnosis was mainly based upon histopathological examination, revealing intra‐ and extra‐cellular leishmania amastigotes. The leishmania infantum zymodeme MON‐111 was identified by isoenzymatic characterization. Laboratory investigations revealed a normal complete blood count and biochemistry profile, except for an inverted CD4/CD8 ratio. Treatment with meglumine antimoniate 60 mg/kg/day (Glucantime®) intramuscularly for 15 days, followed by intralesional administration 1 ml weekly for 4 weeks led to complete recovery. No relapses were observed at 6‐month follow‐up. The unusual localization is likely to be a reflection of the uncommon site of inoculation of the protozoa, transmitted by bites from flying vectors. Nevertheless, the presence of Downs syndrome in our patient may have contributed to the atypical presentation by traumatic exacerbation of the lesion, due to repeated auto‐induced microtraumas of the inferior lip accompanied by subclinical immunodeficiency. In fact, the specific immune response to Leishmania infection depends on a host‐cell‐mediated immune response, reported as defective in Downs syndrome patients. Differential diagnosis and early detection of the infection are necessary in order to start effective treatment and prevent more serious complications.