Scott A. Norton

Cutaneous Leishmaniasis Acquired During Military Service in the Middle East

BACKGROUNDnCutaneous leishmaniasis is endemic in much of the Middle East. Personnel from more than 55 nations are currently participating in Middle East peacekeeping and military activities.nnnOBSERVATIONSnTwenty-three Fijian members of a military observational force in Sinai, Egypt, acquired cutaneous leishmaniasis. They were treated successfully with 1-month courses of ketoconazole.nnnCONCLUSIONSnSoldiers who acquire cutaneous leishmaniasis may return home to nations where cutaneous leishmaniasis is unknown or rarely diagnosed. Cutaneous leishmaniasis, caused by Leishmania major, may be treated with ketoconazole rather than antimonials.

Military Aeromedical Evacuations From Central and Southwest Asia for Ill-Defined Dermatologic Diseases

OBJECTIVESnTo determine the diagnoses of US military patients medically evacuated from Central and Southwest Asia for ill-defined dermatologic diseases, to compare these diagnoses with data from earlier military conflicts, and to identify ways to reduce the number of dermatologic evacuations of military personnel from the combat zone.nnnDESIGNnWe evaluated the preevacuation and postevacuation diagnoses of military personnel who were evacuated from Central and Southwest Asia for ill-defined dermatologic conditions. Outside the combat zone, these individuals were examined by dermatologists who provided a diagnosis regarded as correct for the purposes of this study. We excluded patients with precise preevacuation diagnoses, battle-related cutaneous injuries, and incomplete identifying data.nnnSETTINGnThe geographic area of responsibility for the US Central Command, including Iraq and Afghanistan. Data from January 1, 2003, through December 31, 2006, were obtained from aeromedical evacuation records and the militarys electronic medical records system.nnnPATIENTSnA total of 170 patients evacuated from the combat zone for ill-defined dermatologic diseases, such as skin disorder, not otherwise specified (International Classification of Diseases, Ninth Revision, Clinical Modification code 709.9).nnnMAIN OUTCOME MEASURESnThe postevacuation diagnosis assigned, in nearly all cases, by a board-certified dermatologist.nnnRESULTSnDermatitis, benign melanocytic nevus, malignant neoplasms, benign neoplasms, urticaria, and a group of nonspecific diagnoses were the most common postevacuation diagnoses.nnnCONCLUSIONSnWe propose that thorough predeployment identification of individuals with chronic skin diseases, emphasis of preventive measures, and development of treatment plans will reduce the number of dermatologic evacuations. Improving diagnostic accuracy and treatment plans via teledermatology may also reduce evacuations. The most common dermatologic diseases leading to evacuations are similar to those from 20th century wars.

Solitary Violaceous Nodule on the Face

REPORT OF A CASEnA 77-year-old man had an asymptomatic preauricular papule for several years. He had no prior skin cancers. The lesion was a solitary, smooth, well-circumscribed, plum-colored dermal nodule, 1.5 cm in diameter (Fig 1). He also had prominent midfacial sebaceous hyperplasia. No lymphadenopathy was noted, and the examination of his ears, nose, and throat was unremarkable. A shave biopsy was performed and the specimen submitted for routine (Figs 2 and 3) and special stains. What is your diagnosis?nnnDIAGNOSISnDermal cylindroma (also known as cylindroma, dermal eccrine cylindroma, Spieglers tumor, turban tumor, and tomato tumor).nnnCOMMENTnThis distinctive but uncommon skin tumor was first described by Ancell in 18421 and given the name cylindrom (cylindroma) by Billroth in 1859.2 The qualifier dermal cylindroma distinguishes this tumor from adenoid cystic carcinoma of the salivary glands, also called cylindroma. Cylindromas are usually firm, smooth, pink-to-red dermal.

Traditional Gingival Tattooing of Maxillary Denture

larvae feed over a period of several days and detach from the host and molt to 8-legged nymphs. The nymphs require another blood meal from a host to transform into sexually mature adults. The 8-legged female adults lay eggs on the ground after feeding and digesting a blood meal from a host. However, Ixodidae spend most of their life unattached from the host living in open environments such as meadows or forests. They are usually seasonally active, seeking their hosts when environmental conditions are suitable. A few reports of tick larvae bites cases were found in a PubMed search (Table). The causative organisms were Amblyomma americanum, Amblyomma testudinarium and Ixodes ricinus. The larvae bites were commonly observed on the covered area, including lower abdomen and genital areas. Some larvae were found on the conjunctiva. A tick might wander around on the host for several hours before feeding and commence feeding at a most suitable location. The pruritus after tick bites was explained by various substances produced by the salivary glands. In all previous reports and our case, the clinical manifestations of larval tick bites were treated by removing the larvae from the skin with or without topical application such as permethrin or -hexachlorocyclohexane. No patients with larval tick bites presented systemic symptoms. The 6-legged larvae can also bite and produce primary skin disorders. Although tick larvae bites are seldom reported and not well recognized, it is suggested that tick larvae bites should be kept in mind in patients with multiple arthropod bites, especially in periods of high tick activity.