Sevki Ozdemir

Treatment of Confluent and Reticulated Papillomatosis with Azithromycin

Confluent and reticulated papillomatosis (CRP) is a relatively rare disorder of unknown origin, mostly affecting young female adults. We here present the case of a 21‐year‐old male patient with confluent and reticulated papillomatosis. Skin examination revealed brownish, verrucous, hyperkeratotic, 2 to 5 mm papules, which formed confluent patches and plaques with a reticulate network on the interscapular area. The patient was initially treated with ketoconazole cream for two weeks without improvement. The disease can be rather persistent and resistant to topical therapy. Our case showed a satisfactory response to treatment with azithromycin. Although this treatment is known to be effective in some cases, the action mechanism of azithromycin on CRP is not fully understood.

Prurigo pigmentosa in a patient with nickel sensitivity

© 2008 The Authors JEADV 2009, 23, 169–243 Journal compilation

Scrofuloderma: 30 years of experience from eastern Turkey.

Editor, Scrofuloderma is the most common form of cutaneous tuberculosis seen in many developing countries and in some European series. It is caused by the continuous propagation of infection from an underlying structure, most commonly a lymph node or bone. Children, young adults, and elderly patients are usually affected. An abscess will form by continuity or fistula formation from an underlying nidus with subsequent induration of surrounding areas, resulting in an ulcer surrounded by keloid tissue. Although scrofuloderma is one of the more frequent forms of cutaneous tuberculosis, it has not been evaluated extensively in Turkey. This study documents the clinical and laboratory findings of scrofuloderma in Erzurum, a major city in eastern Turkey, and its surrounding area. Between 1975 and 2005, 304,566 patients visited the outpatient clinics of Ataturk University Medical School Hospital. Of these, 168 (0.05%) patients diagnosed with cutaneous tuberculosis were analyzed retrospectively. Fifty-five of the 168 (32.7%) cutaneous tuberculosis patients had scrofuloderma. The mean age of the patients was 25.1 years (range: 1–70 years). The female : male ratio was 1.61. The localizations of the lesions were as follows: 30 (54.5%) were in the head and neck region; four (7.3%) were on the trunk; 14 (25.3%) were on the upper limbs; and seven (12.7%) were on the lower limbs. The mean duration of lesions was 2.72 years (range: 2 months to 30 years). Thirty-eight (69.1%) patients had a positive Mantoux test. Nine (16.4%) patients had positive culture results. Scrofuloderma is a form of cutaneous tuberculosis which arises in previously sensitized individuals with a high degree of tuberculin sensitivity. In Europe and the USA, scrofuloderma is rare but still presents as a common type of cutaneous tuberculosis, as it does in India and South Africa. The ratio of detected scrofuloderma varies greatly between different regions worldwide. The incidence of scrofuloderma in cutaneous tuberculosis has been reported to be 72% in Morocco, 26.9% in Hong Kong, 19.6% in Pakistan, and 53.3% in northern India. In our study, the incidence of scrofuloderma was 32.7%, which was similar to the findings in northern India. The most commonly affected areas in scrofuloderma are the neck, axillae, chest wall, and groin. The patient may have active pulmonary or pleural disease with systemic symptoms. In Europe, over 80% of lesions are on the head and neck, particularly on the nose and cheek. In a study from India, the most commonly involved nodes were cervical (76.3%), followed by nodes in the inguinal (28.9%), axillary (28.9%), and submandibular (10.5%) regions. In cervical nodes, bilateral involvement was seen in 30% of cases, and the upper deep cervical site was the most common location. The Mantoux test is positive in most cases of scrofuloderma. Rates of positive Mantoux skin tests in scrofuloderma have been reported as 82.8% in India, 81% in Morocco, and 94.7% in northern India. In our study, the incidence of positive Mantoux skin tests in scrofuloderma was 69.1%, which was lower than rates in previous studies. Cultures are negative in a significant number of cases of scrofuloderma and cutaneous tuberculosis. Cultures were positive in 16.7% and 9% of cases in studies conducted in Hong Kong and Morocco, respectively. In our study, 16.4% of cultures were positive, which accords with figures reported in the literature. In conclusion, tuberculosis is still an important health problem in underdeveloped and developing countries. Scrofuloderma is paucibacillary tuberculosis. It is commonly seen in persons who have high immunity, and it is usually localized to the head and neck region nodes.