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Afra TP, Daroach M, Mahajan R, De D, Handa S. Pustular lesions in the neonate: Focused diagnostic approach based on clinical clues. Indian J Dermatol Venereol Leprol 2022; 88:708-716. [DOI: 10.25259/ijdvl_209_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/01/2022] [Indexed: 11/04/2022]
Abstract
Pustules in a neonate can be due to various causes. Though the majority of conditions causing pustules in a neonate are benign, it is essential to clearly differentiate these from serious ones. A systematic approach based on detailed history and clinical examination of the neonate along with basic laboratory evaluation narrows down diagnostic possibilities and aids in the correct diagnosis. This review outlines a step-by-step approach so as to avoid clinical dilemmas and unnecessary intervention.
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Affiliation(s)
| | - Manju Daroach
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Rahul Mahajan
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Dipankar De
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sanjeev Handa
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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2
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Goodarzi H, Wu TT, Wang J, Teng JM. Neonatal Dermatology: The Normal, the Common, and the Serious. Neoreviews 2021; 22:e40-e51. [PMID: 33386313 DOI: 10.1542/neo.22-1-e40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The objective of this review is to help practitioners of neonatal and pediatric medicine become more familiar with diagnosing and managing neonatal skin conditions. This article will discuss normal neonatal skin care and benign and common rashes, as well as some of the serious dermatologic conditions that require specialists for further evaluation and/or treatment.
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Affiliation(s)
- Heidi Goodarzi
- Department of Dermatology, Stanford University, Palo Alto, CA
| | - Tiffany T Wu
- Department of Dermatology, Stanford University, Palo Alto, CA
| | - Jami Wang
- Department of Dermatology, Stanford University, Palo Alto, CA
| | - Joyce M Teng
- Department of Dermatology, Stanford University, Palo Alto, CA
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3
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Yang M, Zhou M, Wang H, Yang M, Gao Y, Jia Y. Lipidomics reveals the role of glycoceramide and phosphatidylethanolamine in infantile acne. J Cosmet Dermatol 2020; 20:947-954. [PMID: 33128854 DOI: 10.1111/jocd.13823] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Infantile acne refers to a skin disease that usually occurs on the face from 6 weeks to 1 year old, and the etiology of infantile acne is different from that of puberty acne. The change of skin surface lipid (SSL) is an important factor in the occurrence of acne. OBJECTIVES Comparison of facial skin lipid changes in healthy and acne-prone infants, screening for possible groupings of substances, to explore factors associated with the development of acne in infants, such as gender and frequency of face washing. METHODS A questionnaire was used to obtain information about the infant, facial lipids were affixed with adhesive tape, and the samples were analyzed using Ultraperformance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-QTOF-MS), with subsequent data analyzed by single-factor and multifactor analysis. RESULTS It was observed that some lipids followed the trend of lipid master classes, subclasses and were significantly different. Galactosylceramides, glycosylceramides and phosphatidylethanolamine were screened as the majority of differentiating lipid species. Additionally, it was emphasized that the frequency of face washing and parent's acne was independent with the severity of acne in infant by clinical characteristics, whereas the skin type and gender can affect the severity of acne statistically. CONCLUSIONS Facial lipids change significantly between infantile acne and healthy infants, suggesting that qualitative and quantitative changes in lipids are strongly associated with the development of acne and may exacerbate the environment in which acne occurs.
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Affiliation(s)
- Manli Yang
- Beijing Key Laboratory of Plant Resources Research and Development, College of Chemistry and Materials Engineering, Beijing Technology and Business University, Beijing, China.,Key Laboratory of Cosmetic of China National Light Industry, College of Chemistry and Materials Engineering, Beijing Technology and Business University, Beijing, China
| | - Mingyue Zhou
- Beijing Key Laboratory of Plant Resources Research and Development, College of Chemistry and Materials Engineering, Beijing Technology and Business University, Beijing, China.,Key Laboratory of Cosmetic of China National Light Industry, College of Chemistry and Materials Engineering, Beijing Technology and Business University, Beijing, China
| | - Hecong Wang
- Beijing Key Laboratory of Plant Resources Research and Development, College of Chemistry and Materials Engineering, Beijing Technology and Business University, Beijing, China.,Key Laboratory of Cosmetic of China National Light Industry, College of Chemistry and Materials Engineering, Beijing Technology and Business University, Beijing, China
| | - Ming Yang
- Children' Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Ying Gao
- Children' Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Yan Jia
- Beijing Key Laboratory of Plant Resources Research and Development, College of Chemistry and Materials Engineering, Beijing Technology and Business University, Beijing, China.,Key Laboratory of Cosmetic of China National Light Industry, College of Chemistry and Materials Engineering, Beijing Technology and Business University, Beijing, China
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4
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Abstract
Acne vulgaris presenting from birth to preadolescence can be confusing to diagnose and even more challenging to evaluate and manage. The differential diagnosis of acne varies by age and, in some cases (especially when it presents in midchildhood), deserves a thorough evaluation to rule out underlying systemic abnormalities. Acne management strategies, including factors affecting adherence to the treatment regimen, may be influenced by the patient's age. This article presents an overview of the clinical presentations of acne by age and our approach to evaluation and management of this common condition.
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Affiliation(s)
- Lidia Maroñas-Jiménez
- Department of Dermatology, Hospital Universitario 12 de Octubre, Medical School, Universidad Complutense, Institute i+12, Avenida de Córdoba s/n, Madrid 28041, Spain
| | - Andrew C Krakowski
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, 8010 Frost Street, Suite 602, San Diego, CA 92123, USA; DermOne, LLC, Four Tower Bridge, 200 Barr Harbor Drive, Suite 200, West Conshohocken, PA 19428, USA.
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5
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Abstract
Neonatal pustular eruption is a group of disorders characterized by various forms of pustulosis seen in first 4 weeks of life. Its presentation is often similar with some subtle differences, which can be further established by few simple laboratory aids, to arrive at a definite diagnosis. Given their ubiquitous presentation, it is sometimes difficult to differentiate among self-limiting, noninfectious, pustular dermatosis such as erythema toxicum neonatorum, transient neonatal pustular melanosis, miliaria pustulosa, etc., and potentially life threatening infections such as herpes simplex virus and varicella zoster virus infections. This review article tries to address the chronological, clinical, morphological, and histological differences among the various pustular eruptions in a newborn, in order to make it easier for a practicing dermatologist to diagnose and treat these similar looking but different entities of pustulation with a clear demarcation between the physiological benign pustular rashes and the infectious pustular lesions.
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Affiliation(s)
- Sangita Ghosh
- Department of Skin and VD, PGIMS, Rohtak, Haryana, India
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6
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Hulsmann AR, Oranje AP. Educational paper: neonatal skin lesions. Eur J Pediatr 2014; 173:557-66. [PMID: 23385854 DOI: 10.1007/s00431-013-1956-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 01/22/2013] [Indexed: 01/20/2023]
Abstract
Although most skin lesions in neonates are transient or benign, they may also be the presenting symptom of a life-threatening disease such as herpes neonatorum. In the present review, we present a short overview of neonatal skin lesions and a practical table to guide the general paediatrician in the diagnosis and management of neonatal skin lesions. Recent reviews are cited for further reading.
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Affiliation(s)
- Anthon R Hulsmann
- Department of Paediatrics, Amphia Ziekenhuis, Breda, the Netherlands,
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7
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Pilosebaceous Diseases. Dermatopathology (Basel) 2014. [DOI: 10.1007/978-1-4471-5448-8_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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8
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Admani S, Barrio VR. Evaluation and treatment of acne from infancy to preadolescence. Dermatol Ther 2013; 26:462-6. [DOI: 10.1111/dth.12108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Shehla Admani
- Rady Children's Hospital; San Diego California
- University of California, San Diego; La Jolla California
| | - Victoria R. Barrio
- Rady Children's Hospital; San Diego California
- University of California, San Diego; La Jolla California
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9
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Abstract
Hyper-IgE syndrome (HIES) is a primary immunodeficiency disorder characterized by atopic manifestations and susceptibility to infections with extracellular bacteria and fungi. Atopic manifestations include atopic dermatitis-like skin lesion and extremely high serum IgE levels. Most of the extracellular bacterial infections are caused by Staphylococcus aureus, which is associated with milder inflammation compared to normal. Recent studies have revealed that the most cases of the HIES are caused by dominant negative mutations in STAT3 gene. Cutaneous manifestations of HIES includes newborn rash, eczematoid dermatitis, cold abscesses, mucocutaneous candidiasis, and coarse texture of the facial skin. Impaired Th17 cell development due to the defective IL-6 signaling in T cells and impaired induced regulatory T (iTreg) cell generation due to defective IL-10 signaling in dendritic cells may, at least in part, account for the cutaneous pathology of HIES.
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Affiliation(s)
- Yoshiyuki Minegishi
- Department of Immune Regulation, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
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10
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Mancini AJ, Baldwin HE, Eichenfield LF, Friedlander SF, Yan AC. Acne Life Cycle: The Spectrum of Pediatric Disease. ACTA ACUST UNITED AC 2011; 30:S2-5. [DOI: 10.1016/j.sder.2011.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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12
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Antoniou C, Dessinioti C, Stratigos AJ, Katsambas AD. Clinical and therapeutic approach to childhood acne: an update. Pediatr Dermatol 2009; 26:373-80. [PMID: 19689511 DOI: 10.1111/j.1525-1470.2009.00932.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is a limited literature reporting on acne in childhood. Childhood acne can be classified in neonatal, infantile, mid-childhood, and prepubertal acne, depending on the age of onset. In this review we will present an update on the clinical approach and therapeutic options when facing prepubertal acne in a child. The use of tetracyclines is contraindicated in children younger than 8 years, and oral isotretinoin is not recommended in children younger than 12 years of age according to the FDA and the European Commission. Nevertheless, there are case reports of 10 patients successfully treated with oral isotretinoin for recalcitrant infantile acne with scarring. Further studies are needed to investigate whether isotretinoin may improve the long-term prognosis of infantile acne, which may be associated with more severe acne in adolescence.
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Affiliation(s)
- C Antoniou
- Department of Dermatology, Andreas Sygros Hospital, University of Athens, Athens, Greece.
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13
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Sethuraman G, Mancini AJ. Neonatal Skin Disorders and the Emergency Medicine Physician. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2008. [DOI: 10.1016/j.cpem.2008.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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14
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Tom WL, Friedlander SF. Acne through the ages: case-based observations through childhood and adolescence. Clin Pediatr (Phila) 2008; 47:639-51. [PMID: 18698096 DOI: 10.1177/0009922808315444] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acne vulgaris is a common disorder that affects more than 17 million individuals in the United States. Knowledge of the disease is an important part of clinical practice, particularly for the pediatric practitioner. Contrary to common belief, acne is not a disease limited to adolescents and young adults but can occur at any stage of life. This article is a case-based review of acne during childhood and adolescence. Workup is based on age and concurrent physical findings, whereas therapy depends on the type of skin lesions along with patient characteristics and preferences.
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Affiliation(s)
- Wynnis L Tom
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California 92123, USA
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15
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Zomorodain K, Mirhendi H, Tarazooie B, Kordbacheh P, Zeraati H, Nayeri F. Molecular analysis of Malassezia species isolated from hospitalized neonates. Pediatr Dermatol 2008; 25:312-6. [PMID: 18577034 DOI: 10.1111/j.1525-1470.2008.00673.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Malassezia species are a part of the skin microflora of neonates. Under certain circumstances, they can cause diseases ranging from simple pustulosis to lifethreatening fungemia in newborn infants. Little information is available about the epidemiology of Malassezia species in neonates. In the present study, we successfully isolated Malassezia yeasts from 68.7% of hospitalized neonates. Using the polymerase chain reaction-restriction fragment length polymorphism method (PCR-RFPL), M. furfur (88.06%) was identified as the most isolated species, followed in frequency by M. globosa (10.48%), M. obtusa (0.73%), and M. slooffiae (0.73%). Among the variables studied, only a longer stay in the ward resulted in a higher colonization rate. Using multiple logistic regression, only the type of hospital and ward had some effects on the colonization rate. Our results supported the hypothesis that neonates acquire Malassezia flora through direct contact with their mothers or hospital personnel.
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Affiliation(s)
- Kamiar Zomorodain
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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16
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Ayhan M, Sancak B, Karaduman A, Arikan S, Sahin S. Colonization of neonate skin by Malassezia species: relationship with neonatal cephalic pustulosis. J Am Acad Dermatol 2007; 57:1012-8. [PMID: 17889963 DOI: 10.1016/j.jaad.2007.02.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Revised: 02/20/2007] [Accepted: 02/20/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Colonization of neonate skin by Malassezia species and their causative role in neonatal cephalic pustulosis is unclear. OBJECTIVES We sought to determine the skin colonization by Malassezia in healthy newborns, and to investigate its association with neonatal cephalic pustulosis. METHODS Samples for Malassezia colonization were taken from cheeks and scalps of 104 neonates between 24 and 72 hours after birth, and again 2 or 4 weeks later. Pustules were sampled with concomitant nonlesional skin cultures if neonatal cephalic pustulosis was diagnosed. RESULTS Malassezia colonization increased significantly with age of the neonate (5% at the first week, 30% at 2-4 weeks). In all, 26 patients were given the diagnosis of neonatal cephalic pustulosis during follow-up. No correlation was found between the severity of the disease and Malassezia isolation. Skin colonization of patients with neonatal cephalic pustulosis (20.8%) was not higher than colonization of healthy newborns (37%). LIMITATIONS Not all of the neonates were examined by the authors at the second visit. CONCLUSIONS Malassezia colonization increases after the first week of life. No correlation was found between neonatal cephalic pustulosis and Malassezia.
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Affiliation(s)
- Meltem Ayhan
- Department of Dermatology, Hacettepe University, Ankara, Turkey
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17
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Abstract
As erupções vesicopustulosas neonatais compreendem um grupo de desordens que surgem nas primeiras quatro semanas de vida. Apresentam extensa relação de diagnósticos diferenciais e, na maioria das vezes, podem ser identificadas clinicamente ou mediante recursos laboratoriais simples. Os dermatologistas devem reconhecer esses quadros cutâneos e, sobretudo, saber diferenciá-los de outras dermatoses graves e potencialmente fatais.
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18
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Abstract
Acne is a disease that can be seen in the first year of life, early childhood, prepubertal age, and puberty. The purpose of this article is to review the clinical presentation and pathogenesis of the various forms of prepubertal acne and to propose guidelines regarding its evaluation and treatment. The early clinical recognition of the disease and prompt initiation of therapy in these age groups will help prevent the sequelae of emotional distress and severe scarring in both the child and parents.
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Abstract
Acne is a disease that can be seen in the first year of age, early childhood, prepubertal age and puberty. Neonatal acne is due mainly to considerable sebum excretion rate, and infantile acne because of high androgens of adrenal origin in girls and of adrenal and testes in boys. These pathogenic mechanisms are characteristic in these ages. Important factors like early onset of comedones and high serum levels of dehydroepiandrosterone sulfate are predictors of severe or long-standing acne in prepubertal age. Hereditary factors play an important role in acne. Neonatal, nodulocystic acne and conglobate acne has proven genetic influences. Postadolescent acne is related with a first-degree relative with the condition in 50% of the cases. Chromosomal abnormalities, HLA phenotypes, polymorphism of human cytochrome P-450 1A1 and MUC1 gene are involved in the pathogenesis of acne. Several other genes are being studied.
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Affiliation(s)
- Maria I Herane
- Department of Dermatology, West Unit Faculty of Medicine, Hospital San Juan de Dios, University of Chile, Santiago, Chile.
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20
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Abstract
We report a case of infantile acne. The lesion on the forehead resembled infantile acne clinically, but histologically it contained yeasts of Pityrosporum. The lesion was treated with topical ketoconazole cream and improved. We suggest that Pityrosporum is associated with infantile acne.
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Affiliation(s)
- Sook-Kyoung Kang
- Department of Dermatology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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21
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Abstract
The differential diagnosis for pustular skin disorders is extensive. The distribution of the lesions and the age of the patient are characteristics that may provide strong clues to the etiology of cutaneous pustular eruptions. In adults, generalized pustular dermatoses include pustular psoriasis, Reiter's disease and subcorneal pustular dermatosis. Medications can cause generalized pustular eruptions, such as in the case of acute generalized exanthematous pustulosis; or more localized reactions, such as acneiform drug eruptions, which usually involve the face, chest and back. Localized pustular eruptions are seen on the hands and feet in adults with pustulosis palmaris et plantaris and acrodermatitis continua (both of which may be variants of psoriasis); on the face in patients with acne vulgaris, rosacea, and perioral dermatitis; and on the trunk and/or extremities in patients with folliculitis. A separate condition known as eosinophilic folliculitis occurs in individuals with advanced human immunodeficiency disease. Severely pruritic, sterile, eosinophilic pustules are found on the chest, proximal extremities, head and neck. Elevated serum immunoglobulin E and eosinophilia are often concurrently found. In neonates, it is especially important to make the correct diagnosis with respect to pustular skin disorders, since pustules can be a manifestation of sepsis or other serious infectious diseases. Generalized pustular eruptions in neonates include erythema toxicum neonatorum and transient neonatal pustular melanosis, both of which are non-infectious. Pustules are seen in infants with congenital cutaneous candidiasis, which may or may not involve disseminated disease. Ofuji's syndrome is an uncommon generalized pustular dermatosis of infancy with associated eosinophilia. As in adults, neonates and infants may develop acne or scabies infestations. In this article, we review the most common pustular dermatoses and offer a systematic approach to making a diagnosis. We also report the most up-to-date information on the treatment of these various cutaneous pustular conditions.
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Affiliation(s)
- Yebabe M Mengesha
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Koyama T, Kanbe T, Kikuchi A, Tomita Y. Effects of topical vehicles on growth of the lipophilic Malassezia species. J Dermatol Sci 2002; 29:166-70. [PMID: 12234705 DOI: 10.1016/s0923-1811(02)00020-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In the present study, the abilities of major Malassezia species, M. sympodialis, M. globosa and M. furfur, to assimilate topical agents, which have been widely used as a material of ointment for skin diseases, were tested. Obvious growth of M. furfur on GYEP agar plate was noted in the presence of white petrolatum, purified white petrolatum, hydrophilic ointment and heparinoid in hydrophilic ointment, and also M. sympodialis showed similar growth when they were cultured with hydrophilic or heparinoid in hydrophilic ointment. In contrast, M. globosa did not grow on GYEP in the presence of the any topical agents tested. These results suggest that Malassezia species, especially M. furfur and M. sympodialis, assimilate several topical agents and showed the drug-depended cell growth.
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Affiliation(s)
- Tomoki Koyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya 466-8550, Japan.
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23
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Abstract
Malassezia species are members of the human cutaneous commensal flora, in addition to causing a wide range of cutaneous and systemic diseases in suitably predisposed individuals. Studies examining cellular and humoral immune responses specific to Malassezia species in patients with Malassezia-associated diseases and healthy controls have generally been unable to define significant differences in their immune response. The use of varied antigenic preparations and strains from different Malassezia classifications may partly be responsible for this, although these problems can now be overcome by using techniques based on recent work defining some important antigens and also a new taxonomy for the genus. The finding that the genus Malassezia is immunomodulatory is important in understanding its ability to cause disease. Stimulation of the reticuloendothelial system and activation of the complement cascade contrasts with its ability to suppress cytokine release and downregulate phagocytic uptake and killing. The lipid-rich layer around the yeast appears to be pivotal in this alteration of phenotype. Defining the nonspecific immune response to Malassezia species and the way in which the organisms modulate it may well be the key to understanding how Malassezia species can exist as both commensals and pathogens.
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Affiliation(s)
- H Ruth Ashbee
- Mycology Reference Centre, Division of Microbiology, University of Leeds and Leeds General Infirmary, Leeds, United Kingdom.
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24
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Pustular Diseases. Dermatology 2000. [DOI: 10.1007/978-3-642-97931-6_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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