Successful Management of Folliculitis Decalvans

Folliculitis decalvans (FD) is a rare disease that causes inflammation on the scalp, leading to scarring alopecia. It commonly affects young and middle-aged men and is characterized by pustules, papules, scarring, hemorrhagic crusts, and erosions. The exact cause of FD is not fully understood, but it is believed that Staphylococcus aureus may play a role in its development. The condition is thought to be influenced by a combination of genetic, allergic, infectious, and immunological factors. This report describes a 20-year-old male patient who experienced painful pustules on his scalp for six months. The pustules first appeared on the occipital region and then spread to the crown. The patient was diagnosed with FD after a thorough clinical and pus culture examination. Treatment involved a month-long prescription of doxycycline (100 mg BD) and topical ozenoxacin (2%), which led to successful remission of the lesions.

Hypoglycaemia in a Patient Taking Tetracyclines

Hypoglycaemia with tetracycline use is a very rare and unknown side effect of the antibiotic. The case highlights the importance of recognizing and managing this potential adverse effect. We present a case of an adolescent male with acne vulgaris who developed hypoglycaemic episodes after initiating tetracycline treatment and was referred by his General Practitioner to the Endocrinology clinic. The hypoglycaemia symptoms settled once tetracyclines were stopped. Acne vulgaris is a prevalent skin condition among adolescents, and antibiotics such as doxycycline and tetracycline are commonly used to treat severe cases of acne. While generally well-tolerated, rare side effects on glucose metabolism have been reported. Antibiotics are not well known to cause hypoglycaemic spells on their own. It is mostly when these antibiotics are started in patients taking other regular medications that the interaction between these medications causes hypoglycaemia.

Management of Chronic Symptoms of Lyme Disease With Intravenous Ceftriaxone

Lyme disease is a vector-borne illness of North America and Europe transmitted by Borrelia burgdorferi, over 30,000 cases are reported in the United States yearly. Patients typically present having early localized disease with fevers, headaches, myalgias, and a single erythema migrans. Usually, oral doxycycline is administered with a good disease prognosis but we report the case of a 58-year-old male who presented with Lyme disease diagnosed by immunoassay; he was treated with doxycycline but was refractory and saw an improvement in his symptoms with IV ceftriaxone.

Acne Lesion Extraction versus Oral Doxycycline for Moderate Acne Vulgaris: A Randomized Clinical Trial

CLINICAL TRIAL ID

NCT04206631.

BACKGROUND

Acne vulgaris is a polymorphic skin condition comprising inflamed and noninflamed lesions. In addition to topical retinoids, systemic antibiotics play a role as a main therapy for acne with inflamed papules and cysts. However, due to the increasing tendency for bacterial resistance, alternatives to antibiotics are needed.

OBJECTIVE

The aim of this study was to evaluate the effectiveness of acne lesion extraction compared to oral doxycycline for moderate acne vulgaris and to explore the impact of both treatments on Hypoxia-inducible factor (HIF)-1 alpha.

METHODS

This randomized clinical trial was conducted in two teaching hospitals in 2016. Subjects with moderate acne vulgaris (N=140) were divided into two groups. Each subject in both groups received 0.05% tretinoin cream, applied to the entire face each night, and 2.5% benzoyl peroxide gel, applied to the acne lesions in the morning and afternoon. One group was also treated with oral doxycycline 100mg once daily and the other was treated with acne lesion extraction performed on all facial lesions every two weeks; the patients were evaluated via patient-reported self-assessment and lesion counts every two weeks for six weeks. HIF-1 alpha expression of the biopsied lessions was examined via immunohistochemistry.

RESULTS

128 subjects completed the study. Among these 128 subjects there was a prominent decrease in inflamed lesions at Week 6 in the lesion extraction group compared to the oral doxycycline group (p<0.05). HIF-1 alpha expression of the biopsied lesions was found in 7 of 9 samples taken from the oral doxycycline group, while 3 of 4 samples in the lesion extraction group were found negative.

CONCLUSION

According to our results, acne lesion extraction appeared to be more effective than oral doxycycline in treating this sample of patients with moderate acne vulgaris. Additionally, HIF-1 alpha expression appeared to be decreased after acne lesion extraction.

Postoperative Tropheryma whipplei endophthalmitis - a case report highlighting the additive value of molecular testing

Introduction.Tropheryma whipplei is the causative agent of Whipple’s disease. Gastrointestinal and lymphatic tissues are affected in the majority of cases, resulting in diarrhoea, malabsorption and fever. Here, we report a rare case of ocular manifestation in a patient lacking the typical Whipple symptoms.

Case presentation. A 74-year-old Caucasian female presented with blurred vision in the right eye over a period of 1–2 months, accompanied by stinging pain and conjunctival hyperaemia for the last 2 days. Upon admission, visual acuity was hand motion in the affected eye. Ophthalmological examination showed typical signs of intraocular inflammation. Diagnostic and therapeutic pars plana vitrectomy including vitreous biopsy and intravitreal instillation of vancomycin and amikacin was performed within hours of initial presentation. Both microscopic analysis and microbial cultures of the vitreous biopsy remained negative for bacteria and fungi. The postoperative antibiotic regime included intravenous administration of ceftriaxone in combination with topical tobramycin and ofloxacin. Due to the empirical therapy the inflammation ceased and the patient was discharged after 5 days with cefpodoxime orally and local antibiotic and steroidal therapy. Meanwhile, the vitreous body had undergone testing by PCR for the eubacterial 16S rRNA gene, which was found to be positive. Analysis of the PCR product revealed a specific sequence of T. whipplei.

Conclusion. In our patient, endophthalmitis was the first and only symptom of Morbus Whipple, while most patients with Whipple’s disease suffer from severe gastrointestinal symptoms. 16S rDNA PCR should be considered for any intraocular infection when microscopy and standard culture methods remain negative.