Rola Dhaybi

Photoprotection in teenagers

Background: It is very common to apply a ‘template photoprotection’ without taking into consideration the background of a specific population. In Lebanon, so far, no preliminary survey has been conducted before launching an educational photoprotection campaign, revealing the need of the people according to their background.

Onychomycosis in Lebanon: a mycological survey of 772 patients

Accurate diagnosis of onychomycosis is based on clinical findings, direct microscopic investigation and mycological culture. If the diagnosis is not confirmed by culture and improvement does not occur, it is impossible to tell whether this represents treatment failure or an initial incorrect diagnosis. The aim of this study was to identify the major organisms involved in onychomycosis with emphasis on the importance of culture in treating onychomycosis. The study was performed at the Lebanese University, Beirut, Lebanon over a 5‐year period (2000–2004). Clinically suspected patients were referred to our mycology laboratory for KOH test and culture. The study included 772 patients (520 women, 252 men). Cultures were positive in 54.3% of cases (predominantly male). The ratio of onychomycosis in toenails/fingernails was 1.9. In toenails, dermatophytes were found in 77.1% of cases, Candida in 18.9% and moulds in 4%. In fingernails, Candida was found in 81% of cases, dermatophytes in 18.1% and moulds in 0.9%. The most commonly isolated dermatophytes were Trichophyton mentagrophytes (36%), T. rubrum (27.5%) and T. tonsurans (26%). Pathogens involved in onychomycosis change according to each geographical area. Therefore, treatments should be based on studies carried out in the same region.

Palmoplantar pustulosis should not be considered as a variant of psoriasis

1 Lawrence SH, Salkin D, Schwartz JA, Fortner HC. Rupture of abdominal wall through striae distensae during cortisone therapy. JAMA 1953; 152: 1526–1527. 2 Stroud JD, Van Dersarl JV. Striae. Arch Dermatol 1971; 103: 103–104. 3 Bordier C, Flechet E, Thomine E, Lauret PH. Rupture de Vergetures au cours d’un Psoriasis Pustuleux traité par Étrétinate (Tigason). Ann Dermatol Venereol 1984; 111: 929–931. 4 Bowman PH, Hogan DJ. Ulcerated atrophic striae from Etretinate. Cutis 2000; 65: 327–328. 5 Shuster S. The cause of striae distensae. Acta Derm Venereol Suppl (Stockh) 1979; 59: 105–108. 6 Peterson JL, McMarlin SL, Read SI. Edematous striae distensae. Arch Dermatol 1984; 120: 1097–1098. 7 Lee JH, Lee EK, Kim CW, Kim TY. A case of edematous stiae distensae in lupus nephritis. J Dermatol 1999; 26: 122–124. 8 Ashcroft GS, Mills SJ, Lei K et al. Estrogen modulates cutaneous wound healing by downregulating macrophage migration inhibitory factor. J Clin Invest 2003; 111: 1309– 1318. 9 Gilliver SC, Ashworth JJ, Mills SJ, Ashcroft GS. Androgens modulate the inflammatory response during acute wound healing. J Cell Sci 2006; 119: 722–732. 10 Mills SJ, Ashworth JJ, Gillver SC, Hardmann MJ, Ashcroft GS. The sex steroid precursor DHEA accelerates cutaneous wound healing via estrogens receptors. J Invest Dermatol 2005; 125: 1053–1062.

Angiolymphoid hyperplasia with eosinophilia: efficacy of isotretinoin?

BackgroundAngiolymphoid hyperplasia with eosinophilia (ALHE) is a benign but potentially disfiguring vascular lesion. It is usually characterized by dermal and subcutaneous nodules, primarily in the head and neck region. Spontaneous regression is common, but persistent or recurrent lesions may require treatment. Several treatments have been reported but surgery is the most efficient one.Methods and resultsWe report a 32-year-old man presenting with multiple nodules on the cheeks, preauricular region and the scalp and who received treatment with isotretinoin (0.5 mg/kg/day) for 1 year with complete resolution of one of his scalp nodules. The rest of the lesions remained stable and were treated with surgical excision without recurrence.ConclusionIsotretinoin may play a role in the treatment of ALHE due to its antiangiogenic properties via a reduction of vascular endothelial growth factor (VEGF) production by keratinocytes.

Myasthenia gravis with cutaneous polyarteritis nodosa

Cutaneous polyarteritis nodosa presents with typical cutaneous lesions of polyarteritis nodosa without visceral involvement at the time of diagnosis. We report a 32‐year‐old woman with a 12‐year history of myasthenia gravis under immunosuppressive treatment, who presented with tender, erythematous nodules 20 mm in diameter on her shins. A diagnosis of cutaneous polyarteritis nodosa was made, based on the clinical and histopathological findings. Myasthenia gravis, an antibody‐mediated disease, is occasionally accompanied by other autoimmune diseases, but we found no previous report in the literature associating it with polyarteritis nodosa.

Neutrophilic eccrine hidradenitis to acetaminophen

JJ Wu,*† DB Huang,‡¶ JE Murase,† GD Weinstein† †Department of Dermatology, University of California, Irvine, Irvine, CA, USA, ‡Division of Infectious Diseases, Department of Medicine and ¶University of Texas at Houston School of Public Health, University of Texas Health Science Center at Houston, TX, USA, *Corresponding author, C340, Medical Science I, University of California, Irvine, Irvine, CA 92697-2400, tel. (949) 824-7103; fax (949) 824-8954; E-mail: jjwu@uci.edu

Chikungunya associated with cutaneous ulcerations

Chikungunya is a viral infection commonly causing fever and arthralgias, sometimes accompanied with myalgias and rash. We report a 72‐year‐old woman presenting with a 3‐month history of painful cutaneous ulcerations on both legs, and discuss the cutaneous features associated with chikungunya.