Piotr Brzezinski

Chloronychia: green nail syndrome caused by Pseudomonas aeruginosa in elderly persons

Green nails, also known as chloronychia or green nail syndrome, are characterized by green discoloration of the nail plate (greenish-yellow, greenish-brown, greenish-black), proximal chronic non-tender paronychia, and distolateral onycholysis. The cause is Pseudomonas aeruginosa infection of the nail plate in persons whose hands are constantly exposed to water, soaps, and detergents or are subject to mechanical trauma, especially in the elderly. Green or black coloration of the nails should raise suspicion for Pseudomonas infection and be treated with an oral quinolone (ciprofloxacin), particularly in aged patients. We present three cases of green nails in elderly persons.

Aplasia cutis congenita of the scalp- what are the steps to be followed? Case report and review of the literature

Aplasia cutis congenita is a rare malformation characterized by localized congenital absence of the skin. It rarely occurs on the trunk and limbs, and can occur in isolation or as part of a heterogeneous group of syndromes. We report a case of a 4-day-old boy with a 5.6-cm- diameter tumor, with a central crust, non-indurate and no inflammatory rim; localized on the scalp and a small, atrophic hairless scar appeared 6 months later (approximately 5cm in length) at the site of the previous tumor.

Adverse effects of isotretinoin: A large, retrospective review

Acne is a very common and disfiguring disease that affects mostly adolescents and, to some extent, adults. The objective of our study was to estimate the adverse effects after isotretinoin by treatment of 3,525 patients due to acne vulgaris in a 5‐year observation. Retrospective, comparative study was carried out in Poland and Romania from January 2012 to August 2016. Inclusion criteria into this study were moderate, severe, and nodulocystic inflammatory acne vulgaris. Exclusion criteria were mild acne, pregnant, and lactating women. Statistical analysis was carried out using T test and Chi square. All patients were treated with oral isotretinoin. Patient age ranged from 13‐35 years. Dry lips was the most commonly reported adverse effect, affecting 100% of users, followed by xerosis (94.97%) and facial erythema (66.21%). Of all adverse effects, psychiatric symptoms accounted for 25.16%; eye lesions accounted for 8.96%. In lab investigations an increase in the level of total cholesterol and serum triglycerides was observed. This study documents the adverse effect profile of isotretinoin in a large number of patients collected over a period of 4 years. Side effects were mild and well tolerated and did not necessitate stopping the treatment. However, it is important to educate patients about this potential consequence.

Common psychocutaneous disorders in children.

The prevalence of psychosomatic disorders among dermatological patients is high but frequently unreported because of difficulties in diagnosing and treating this patient group. Psychiatric and psychological factors may play different roles in the pathogenic mechanism of some skin diseases. The mainstay of diagnosis and treatment is the differentiation between skin disorders associated with psychiatric illness and those of a purely psychiatric nature. Dermatologists and psychiatrists should be aware of this pathology and work together as a team to resolve difficult cases, especially in children. The present paper highlights the psychocutaneous diseases most frequently seen by dermatologists in pediatric population.

DERMATOLOGY EPONYMS - SIGN - LEXICON - (I)

Eponyms are used almost daily in the clinical practice of dermatology. And yet, information about the person behind the eponyms is difficult to find. Indeed, who is? What is this person’s nationality? Is this person alive or dead? How can one find the paper in which this person first described the disease? Eponyms are used to describe not only disease, but also clinical signs, surgical procedures, staining techniques, pharmacological formulations, and even pieces of equipment. In this article we present the symptoms starting with (N) and other. The symptoms and their synonyms, and those who have described this symptom or phenomenon.

Eosinophilia – A rare possible adverse reaction during anti-tumor necrosis factor-alpha therapy for psoriasis

Abstract The current use of tumor necrosis factor (TNF)-alpha inhibitors in rheumatological, dermatological and gastroenterological diseases has increased considerably in recent years. Different reports have been communicated regarding specific risks and side effects during treatment with TNF-alpha inhibitors. Eosinophilia has been linked to TNF-alpha inhibitors by several recent reports, although it is not listed as a possible adverse reaction in the product information of the drug. The aim of the present study was to evaluate the eosinophil count in patients diagnosed with psoriasis and treated with adalimumab. Based on the results of the present study, eosinophilia remains a rare adverse reaction during psoriasis treatment with TNF-alpha antagonists.

Topical malic acid in combination with citric acid: an option to treat recalcitrant warts.

A 42-year old man, construction worker, in good health state, seeks for dermatological advice and treatment, for numerous cutaneous warts distributed on dorsal aspects of both hands. The first lesion was observed 2 years before present consultation. Over time the number of warts has increased despite many attempts of therapy: salicilic acid, cryotherapy, surgical curretage, 5% imiquimod cream, and homeotherapy (FIG. 1). On clinical examination, on the dorsal aspect of both hands and digits more than 30 warts of different size were noticed, accompanied by pain and functional impairment. Usual lab investigations, HIV and serology for hepatitis B and C were all within normal limits. A topical treatment of combination of malic and citric acid in equal parts (10 g/10 ml) applied on each wart twice daily in occlusive dressing was recommended for 10 days (FIG. 1). An intense irritative reaction was achieved, followed in the next 2 weeks by intense desquamation and elimination of the warts. No scars, no hyperpigmentation, no recurrence, only minor erythematous changes were observed 1 month later (FIG. 2). Emollients and close follow-up were recommended. The patient has been seen monthly for the following 6 months, no recurrences, but minor xerosis was noticed on both hands.

Radiator-induced erythema ab igne in 8-year-old girl

The cutaneous lesion of erythema ab Igne are characterized by a reticulate erythema, hyperpigmentation, fine scaling, epidermal atrophy and telangiectasias, and reticulated erythema. We report a case of erythema ab igne on the hands of a 8-year-old girl, induced by classic homemade radiator.

Ingrown toenails (unguis incarnatus): Nail braces/bracing treatment.

Nail bracing is a safe, simple, and inexpensive treatment option that avoids surgery, requires no anesthetic, requires no recovery period, allows wearing the existing shoes, offers immediate relief from pain, and allows the practice of daily activities. Braces can be used for prolonged periods of times. If recurrence occurs, reapplication of bracing is usually required.

Ulcerated Hemangioma - Surveillance Only

Abstract Infantile hemangiomas are reported in 10-12% of children less than 1 year of age, with ulceration in about 5-13% of cases. Little is known about the mechanism of this disease and explanations are still being looked for. We present a 4-month-old female infant with haemangioma on the left buttock; the hemangioma was noticed at 2 weeks of age, progressively enlarging and ulcerated.