Cases reported "Facial Dermatoses"

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1/130. The hyperkeratotic variant of disseminated superficial actinic porokeratosis (DSAP).

    A 78-year-old South Korean man was referred to us from the Medical intensive care Unit (MICU) for an opinion. He was comatose and was on ventilatory care due to aspiration pneumonia. Multiple tiny papules had developed 10 years previously and since then the number and size had been increasing gradually. He had been diabetic for the past 4 years, and had Parkinson's disease diagnosed 1 year previously. Laboratory examinations revealed an elevated level of white blood cells (WBCs) (25,000/microL) and decreased hemoglobin (8.8 g/dL). Other laboratory results were negative or within normal limits. skin examination showed multiple, discrete, crust-like, brownish papules over the erythematous base on the face, upper extremities, and lower extremities. With the clinical impressions of irritated verruca vulgaris, seborrheic keratosis, or cutaneous fungal infection, a skin biopsy was taken from a papule on the left shin, and histopathologic examination revealed several pronounced hyperkeratotic and parakeratotic columns, and characteristic cornoid lamellae in the stratum corneum. Beneath the cornoid lamellae, the granular layer was decreased. A number of round or oval, dyskeratotic, homogenized eosinophilic cells with pyknotic nuclei were scattered in the prickle cell layer below the cornoid lamellae. A mild lymphohistiocytic infiltrate was observed in the papillary dermis and around the blood vessels in the upper dermis. Also, actinic degeneration was present in the upper dermis.
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2/130. Chronic factitial ulcer of chin cured by endodontic (root-canal) surgery for underlying periapical abscess.

    In a determined search for the cause of a "factitial" ulcer of the jaw, consultation with 3 dentists was required before an underlying periapical abscess was discovered. Within 3 months of endodontic surgery, this ulcer of 12 years duration had completely healed and remains healed. Too often dental infection is neither suspected nor detected as a cause of skin disease.
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3/130. Facial orf.

    Orf is an occupational dermatosis caused by a poxvirus that infects sheep or goats. Human transmission typically occurs in people in contact with the infected animals or by handling contaminated animal products such as wool or meat. The infection in humans is classically characterized by a solitary papule on the fingers or hands. Involvement of the face or head has rarely been reported. We report orf in a young woman with multiple nodules on the face.
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4/130. Epstein-Barr virus-associated lymphoproliferative skin lesion with recurrent necrotic papulovesicles of the face.

    A 24-year-old man showed recurrent necrotic papulovesicles of the face. The cutaneous lesions started with erythema, followed by vesicles, necrosis, and crusting, and leaving depressed scars. light avoidance did not prevent the development of the lesions. Histologic examination revealed lymphoproliferative lesions confined to the skin. Latent Epstein-Barr virus (EBV) infection was detected in the lymphoid cells from the skin lesions by in situ hybridization. A moderate to high dosage of corticosteroids suppressed the development of new skin lesions, but relapses occurred when these systemic corticosteroids were tapered.
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5/130. Recalcitrant acne vulgaris secondary to a dental abscess.

    This case report describes a middle-aged man with acne that was recalcitrant to numerous medications, including three courses of isotretinoin. His condition cleared after an infected tooth was removed and recurred when another tooth became carious. acne vulgaris is associated with several immunologic responses including the production of antibodies against propionibacterium acnes, the gram-positive bacteria found in acne lesions. We believe that the presence of our patient's dental infections provoked a follicular inflammatory response resulting in his recalcitrant acne.
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6/130. Cervico-facial necrotising fasciitis occurring with facial paralysis: case report.

    Necrotising fasciitis is a soft tissue infection, usually polymicrobial, characterised by necrosis of fascia and subcutaneous tissue. It frequently involves the groin, abdomen and extremities, but rarely involves the cervico-facial region. A case is presented of a 70-year old man who, following a futile attempt to extract a lower left first molar, developed a cervico-facial necrotising faciitis with facial nerve paralysis. Bacteriological investigations revealed the presence of klebsiella spp and viridans streptococci. It is emphasized that early detection of this disease followed by aggressive surgical debridement and antibiotic therapy are most important.
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7/130. Pulsed dye laser therapy for viral warts.

    Twenty-eight patients with 103 recalcitrant and 20 simple viral warts were treated with the Cynosure PhotoGenica V pulsed dye laser at 585 nm, and fluencies of 6.0-9.0 J/cm(2). An eradication rate of 92% for recalcitrant warts after an average of 2.1 (range 1-7) treatments and 75% for simple warts after an average of 1.6 (range 1-2) treatments was achieved with a mean follow-up period of 7.2 (range 3-15) months. Mild hypopigmentation was noted in one patient and superficial infection in another. Unlike ablative treatment modalities, with pulsed dye laser therapy, no wound was created thus avoiding prolonged postoperative pain, disability and scarring. Treatment was well tolerated by patients, most of whom returned to work or normal activities immediately postoperatively. Pulsed dye laser is an effective treatment for both recalcitrant and simple warts. It is the treatment of choice for these lesions in cosmetically sensitive areas.
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8/130. Trichodysplasia spinulosa--a newly described folliculocentric viral infection in an immunocompromised host.

    This is a case report of an immunocompromised individual who presented with progressive alopecia, friable follicular spinous processes, and erythematous, indurated papules. Examination of skin biopsies using light microscopy and immunohistochemistry revealed pathologic changes of the follicular inner root sheath epithelium with dystrophic trichohyaline granules. Electron microscopy of thin sections of tissue revealed intracellular viral particles with a size and appearance consistent with those in the Papovaviridae family. Electron microscopy of negatively stained extract from a homogenized lesion also demonstrated icosahedral viruses with papovavirus morphology. We believe this is a previously unreported folliculocentric viral infection in an immunosuppressed human host and have termed this entity "trichodysplasia spinulosa".
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9/130. A case of adult T-cell lymphoma leukemia with hemophagocytic syndrome.

    A 62-year-old Japanese woman was admitted to our clinic with virus-associated hemophagocytic syndrome (VAHS) in subcutaneous adult T-cell lymphoma leukemia (ATLL). bone marrow aspiration showed hypocellularity, histiocytic hyperplasia, and hemophagocytosis. There was serological evidence of chronic cytomegalovirus (CMV) infection. The hemophagocytic syndrome (HPS) initially improved by some treatments, and the patient later experienced remission several times, but the CMV infection persisted. Most cases of non-tumorous HPS in adults are associated with viral or bacterial infection, and underlying diseases in non-tumorous HPS are mostly blood diseases, especially T-cell lymphoma (1, 2), but ATLL is a rare underlying disease in such cases.
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10/130. Facial and perioral molluscum contagiosum as a manifestation of hiv infection.

    molluscum contagiosum (MC) is a self-limiting viral disease of the skin and the mucous membranes. Facial and perioral MC is seen with increasing frequency in human immunodeficiency (hiv) infection, particularly in hiv infected homosexual men. The purpose of this study was to describe clinical observations of facial and perioral MC in hiv infected patients. One hundred and eighty hiv-positive individuals (160 males and 20 females) were examined over a period of five years. Fifty-eight were homosexual men and 19 were bisexual men. Fifty-one of 180 patients at the time of the first examination had CD 4 count < 200 cells/mm3 and another 63 presented loss of CD 4 cells in this level, during this period. Three hiv infected patients (two homosexual and one bisexual) were affected with facial and perioral MC. At the time of MC diagnosis the CD 4 count was less than 200 cells/mm3 for all three patients. One patient died nine months after MC diagnosis and the other two are still alive. It is remarkable that in this study no clinical lesions were observed on other sites of the skin.
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