Microneedling Radiofrequency for Acne Vulgaris and Post-Acne Scarring: A Case Report

Background: There are various therapeutic modalities for acne and post acne scarring, but the best option is to have a safe, effective with affordable cost such as monotherapy or combination therapy. One of the recommended combination therapy for acne vulgaris with atrophic acne scars is microneedling radiofrequency which can improve skin structure. Case report: A 25 year old male with moderate comedonal acne vulgaris and severe scarring. The patient came with complaints of uneven skin surface on both cheeks, forehead and chin which had been felt to increase since 3 years ago. The appearance of acne on the face has been felt since 12 years ago. The patient's parents and sister also had acne complaints. On dermatological examination, on the forehead, temples, cheeks, nose and chin found blackheads, whiteheads, papules, hyperpigmented macules, multiple atrophic acne scars. The treatment choice for this patient is microneedling radiofrequency in combination with topical therapy. Discussion: The combination of microneedling with radiofrequency is one of the therapeutic modalities for acne vulgaris and also post-acne scarring with minimal side effects. In the evaluation for 2 weeks after the procedure, this patient did not complaint of any adverse events.

A relapse of pemphigus vulgaris in pemphigus herpetiformis or a phenotypic “switch”

Sir, Pemphigus herpetiformis (PH) was originally described by Jablonska et al. in 1975. Clinically, PH presents itself as a herpetiform dermatitis with immunopathological characteristics of pemphigus [1,2]. We report an exceptional case of typical pemphigus vulgaris (PV) relapsing after 36 years in PH. A 65-year-old patient, followed for PV for 36 years and treated with corticosteroid therapy with a remission for more than thirty years, consulted for pruriginous lesions evolving for the previous eight months. A dermatological examination revealed urticariform pruriginous ring lesions surmounted by small peripheral vesicles spread throughout the body (Fig. 1), sparing the mucous membranes, and without Nikolsky’s sign. After two non-specific skin biopsies, the histological examination revealed an intraepidermal bubble with acantholytic cells and eosinophilic spongiosis (Figs. 2a and 2b). Direct immunofluorescence confirmed the diagnosis of pemphigus and indirect immunofluorescence was at the upper limit. The diagnosis of a PV relapse in PH was retained and a dapsone-based treatment was initiated at a dose of 150 mg/day and stopped seven days later when met with hemolytic anemia. Oral corticosteroid therapy involving prednisone at a dose of 1 mg/kg/day was initiated but, given the persistence of the pruritus, the decision was to combine methotrexate at a dose of 12.5 mg/week. A good evolution and a decline within eight months were observed. An improved pruritus and the disappearance of the skin lesions were achieved after one month of treatment. PV and PH are two different anatomical and clinical entities of the autoimmune disease pemphigus, with distinct clinical, histopathological, and immunopathological characteristics [1,2]. Our observation documents a complete phenotypic “switch” of pemphigus with a transition from PV to PH both clinically, histologically, and immunologically. Several rare cases of PV switching to superficial pemphigus (SP) (“phenotypic switch”) have, since 1991, been reported, with a higher frequency this direction than otherwise; the transition period varies from six months to twenty years [3]. To the best of our knowledge, no case has been described of a progression from PV to PH. Having observed one firsthand, we are first to describe the case of a complete phenotypic switch from PV to PH. The mechanism of such a transition remains poorly understood and is often observed during a relapse. Some authors suggest that the effect of immunosuppressants on the desmoglein DSG3 more marked than on DSG1 could explain the relapse of PS in PH [3,4]. Future studies on the immunological factors and predictors of PV relapses after the discontinuation of treatment would be useful to better understand the mechanisms of a relapse in pemphigus, with or without a phenotypic transition.

Ecthyma gangrenosum in a patient with febrile pancytopenia

Ecthyma gangrenosum (EG) is a cutaneous infection most commonly associated with Pseudomonas bacteremia and usually occurring in immunocompromised patients [1]. The infection progresses sequentially from a maculopapular rash to hemorrhagic bullae, then to necrotic ulcerations with surrounding erythema [2]. Herein, we report a case of ecthyma gangrenosum in an immunologically compromised patient. A 65-year-old female was admitted to the oncohematology department for febrile pancytopenia. Blood work revealed severe thrombocytopenia at 15,000/mm³), an absolute neutrophil count of 180 cells/mm³, and anemia. A sternal bone marrow puncture found 15% of plasma cells. Four days after the admission, the patient had a painful, quickly extending lesion on the abdomen. She described erythema that progressed to pustules, then ulcerations. On general clinical evaluation, the patient was feverish at 40°C. A dermatological examination revealed the presence of a 6 cm purpuric patch on the left flank with a central necrotic eschar (Fig. 1). The diagnosis of ecthyma gangrenosum was reached and the patient was treated with ceftazidime and vancomycin. Unfortunately, having gone into septic shock, the patient died one week later.

A case of lichen planopilaris associated with lichen planus following Blaschko lines successfully treated with topical corticosteroid

Lichen planopilaris (LPP) is characterized by erythematous, keratotic follicular papules and cicatricial alopecia. LPP, the most common cause of cicatricial alopecia, is usually seen in women and causes significant psychosocial morbidity. We describe here a 42-year-old woman with a 6-month history of hair loss accompanied by itching on the scalp. Dermatological examination revealed patchy cicatricial alopecia in the vertex and band-like purple flat patches and plaques following the Blaschko lines on the right half of the body, together with post-inflammatory hyperpigmentation. Histopathological examination of the scalp biopsy was consistent with LPP, while thigh biopsy was consistent with lichen planus. With the histopathological and clinical evidence, our patient was evaluated as LPP associated with LP and successfully treated with topical corticosteroid. A few LPP and LP cases following the Blaschko lines have previously been reported separately. However, LPP, together with LP following Blaschko lines, have not been reported in the same patient.

Viral Cutaneous Infections in Swimmers: A Preliminary Study

Molluscum contagiosum (MC) and warts are common viral infections of the skin. Data regarding the prevalence of MC and verruca in swimmers are very poor and lacking in the literature. The purpose of this study was to determine the incidence of Molluscum Contagiosum (MC) and warts cases among young competitive swimmers participating in Greek swimming clubs. Of 244 swimmers enrolled in this study, 12.3% reported MC and 43% warts, during their swimming career, diagnosed and treated by dermatologists. There was no difference between sexes for MC but diagnoses of warts were higher in females. Axillae and trunk were the most common sites of primary infection for MC but warts mainly appeared on the soles. The incidence of MC and warts in swimmers who use outdoor facilities was higher. In our study, the incidence of warts and MC in Greek swimmers is considered high. Moist walking surfaces, placing towels on locker room benches, and sharing equipment are behaviors that cause infections. An early diagnosis of warts and MC lesions must be implemented in every swimmer through dermatological examination. Taking proper measures for reducing the risk of warts and MC transmission in Greek swimmers is mandatory.

Pink plaque on the hypogastrium

Bowen’s disease is a type of intraepidermal squamous cell carcinoma usually affecting the elderly and occurring on sun-exposed areas, such as the face, scalp, and limbs. The development of Bowen’s disease in other locations such as the abdomen is rare. In these cases, dermoscopy proves to be a helpful tool in making the diagnosis [1]. A 65-year-old male with no previous medical history presented himself with a nonhealing asymptomatic lesion on the abdomen slowly growing for the last ten years. A dermatological examination revealed a 6-cm well-limited erythematous plaque on the hypogastrium with peripheral pigmentation (Fig. 1). Dermoscopy found central keratin as well as white shiny structures, including white shiny lines, white shiny areas, and rosettes (Fig. 2) as well as brown linear globules and dots on the periphery and looped vessels (Fig. 3). Bowen’s disease was the most likely diagnosis, which was confirmed by histopathology. The patient underwent surgery for excision of the lesion with 5-mm margins.

Isolated café-au-lait macules: Think of neurofibromatosis type V

Sir, Segmental neurofibromatosis (SNF) is a rare form of neurofibromatosis (NF) with a reported prevalence of 0.0014%–0.002%. It is included in Riccardi’s classification as type V NF [1]. It is characterized by café-au-lait macules and/or neurofibromas distributed in only one dermatome, less commonly in two or more dermatomes [2]. Roth et al. reclassified SNF into four subtypes: true SNF, localized SNF with deep involvement, hereditary SNF, and bilateral SNF. A limited number of cases of SNF have been reported with systemic involvement, such as visceral neurofibromas, skeletal abnormalities, and renal agenesis [1]. Laser therapy may be performed if an aesthetic demand arises. Herein, we report a case of SNF in a young boy with no systemic disease. An eleven-year-old male was sent by his pediatrician for skin spots that appeared at the age of four. The young patient came from a non-consanguineous marriage and had no family history of skin disease. A general physical examination revealed normal parameters, such as weight, size, intelligence, speech, auditory function, and visual acuity. A dermatological examination found unilateral café-au-lait macules with a ranging size of 1 to 5 mm in the right half of the trunk with no crossing of the midline (Figs. 1a and 1b). We thoroughly examined the boy and found no other features of neurofibromatosis, including neurofibromas, neurological deficits, or bone abnormalities. We assured the patient and his parents that this was a benign disease, so the risk of developing any disease-related complications was low. Annual monitoring was started. No therapy was proposed because the patient expressed no aesthetic demands.

Identification of Malassezia Species Isolated from Pityriasis Versicolor by CHROMagar-Medium

Background Pityriasis versicolor is a chronic superficial fungal infection seen worldwide, with high prevalence observed in hot and humid climates. Objectives The aim of this work was to isolate and identify Malassezia species from pityriasis versicolor using specific fast gtowth media; Chrom agar to obtain a better understanding of the role of each species in the etiology of disease. Patients and Methods This study was conducted on 70 patients with clinical diagnosis of pityriasis versicolor with positive KOH test. All of the participants were subjected to a well informed consents, full history taking including age, sex, site of the lesions and any previous treatment, full general and dermatological examination to determine site, color of the lesions and Wood's light examination. Results Our results reported 94.3% of studied patients yielded growth on culture while 5.7% did not show any growth. The predominant age group was ≥ 25 years old. Furthermore it was found that PV affected male subjects (62.90%) more than the females (37.1%). Conclusion Malassezia yeasts, although are considered a part of normal skin microbiome, is a known cause of pityriasis versicolor. PV was more common in males in the age group ≥ 25yrs. The most affected body site was the chest, the most common variant is hyperpigmented type, and the commonest isolate was M.furfur.

Cutaneous Larva Migrans in Urban Area: A Case Report

Cutaneous larva migrans (CLM) is a zoonotic skin disorder caused by the infestation of animal hookworm larvae, the most common being Ancylostoma braziliense. The larvae penetrate the skin surface and subsequently migrate to the epidermis, leaving a typical manifestation of linear or serpiginous erythematous burrow-like tracks, known as creeping eruption. This report presented a case of a young man with complaints of the serpiginous erupted lesion over the upper left thigh, following a recent history of beach travel. On dermatological examination, an erythematous serpiginous lesion and papules were found, portraying the clinical presentation of CLM. The administration of albendazole 400 mg was started, and the symptoms were completely resolved. Keywords: larva migrans, skin disease, creeping eruption, nematodes, albendazole.

Notoedric Mange in a Domestic Cat: Application of Ivermectin and Supportive Therapy

Feline scabies is a disease that is caused by Notoedres cati, a sarcoptic mite that injures the skin tissue. The present clinical case relates a notoedric scabies in a domestic cat, clinical observations, diagnostic test, and treatment. A 4-year-old male neutered domestic short haired cat was brought at a veterinary clinic. Alopecia, erythema, scales, crusts and hyperkeratosis were observed on the head, and pinnae and malodorous from lesions were observed in dermatological examination. Deep skin scrapings were collected. Microscopic examination revealed adult live mites presence. Based on the morphology, the mites isolated were identified as Notoedres cati. Ivermectin oral capsules (300µg/kg), repeat dose at 14 days. Bath with chlorhexidine and Benzoyl peroxide every 5 days for two months were applied. Moreover, multivitamin complexes were supplied daily, orally. An immunostimulant 1mL/10kg. IM, again applied two days. A clinical improvement in the cat was observed after administered this treatment. The present study reports notoedric mange in a domestic short haired cat in Colombia. The application of ivermectin with supportive therapy was useful in the treatment of notoedric scabies in this cat. The application of products other than ivermectin showed positive clinical observations in the recovery of this patient with feline scabies.