Aperito Journal of Dermatology

We report a 3-year-old Chinese girl who presented with an 18-month history of a localized asymptomatic triangular area of hair loss in the right frontotemporal area. There was no history of trauma. The parents were non consanguinous and there was no family history of a similar lesion. Her 42-year-old father had androgenic alopecia that was first noted 3 years ago. Physical examination revealed a patch of alopecia 3.5 x 4 cm over the right frontotemporal area, with its apex towards the vertex. The overlying skin was otherwise normal. In particular, there was no scaling, scarring, erythema, or induration in the alopecic area. Dermoscopy showed normal follicular openings with thin vellus hairs over the affected area and terminal hairs in the adjacent scalp. Based on the characteristic history and physical findings, a diagnosis of congenital triangular alopecia was made. Awareness of this condition is important so that it will not be overlooked or misdiagnosed. 

A 65-year-old male presented in the outpatient department with multiple painful ulcers and pustules on the whole trunk. The total duration of disease was 14-months. He was provisionally diagnosed as a case of pyoderma gangrenosum. He was initially treated with oral steroid but the condition worsens. The biopsy of the lesion was done which showed caseating granuloma. He was treated as a case of cutaneous scrofuloderma but no response was seen in two months. Then culture for mycobacterium was send and result was positive for atypical mycobacteria. The treatment direction was shifted towards the management of atypical mycobacterial infection with the addition of two second line drugs in first line antitubercular drugs and then he cured completely in 9-months.

We report on two homeless, HIV-infected patients with intravenous drug abuse developing a generalized rash composed of angiomatous papules. Based on the clinical manifestations, routine histology and sequencing of bacterial 16S rRNA the diagnosis of bacillary angiomatosis (BA) was established. In addition to treating the underlying HIV infection, the patients received azithromycin leading to complete regression of the cutaneous lesions. These cases highlight the clinical efficacy of azithromycin in the treatment of bacillary angiomatosis. Compared to the first line treatment of BA with erythromycin, azithromycin has a better tolerability, shows a more favorable drug-drug interaction profile and, most importantly, can be given once daily due to its superior pharmacological properties. Collectively, azithromycin poses an attractive alternative in the treatment of BA, especially in patient populations with low treatment adherence.

Digital mucous cysts are benign, cystic lesions of the digits typically located near the distal interphalangeal joints or near the proximal nail folds. The peak incidence rates are in the age group between 40 and 70 years. The male to female ratio is 2:1. Two types of digital mucous cysts have been described. The myxomatous (superficial) type presumably arises de novo from the metabolic derangement of dermal fibroblasts that leads to excess production of hyaluronic acid. The ganglionic (deep) type results from leakage of fluid from the distal interphalangeal joint. osteoarthritis and There may be coexisting osteophytes in the joint. Characteristically, a digital mucous cyst presents as an asymptomatic, slow-growing, solitary, circumscribed, semi-translucent, flesh colored, compressible, dome shaped, cystic Papulonodule measuring 1 to 10 mm in diameter on the finger. A watchful observation may be appropriate for asymptomatic patients. For symptomatic patients and those patients who prefer treatment, simple surgical excision of the cyst is the treatment of choice. Other treatment options include incision and drainage, repeated needling to induce scarification, cryotherapy, sclerotherapy, intralesional injections of corticosteroids or sclerosing agents, electrodessication, and carbon dioxide laser therapy. 

Tinea pedis, also known as "athlete foot", refers to a superficial fungal infection of the feet caused predominately by dermatophytes. Tinea pedis is most often caused by Trichphyton rubrum and T. interdigitale. It is estimated that 10 to 15% of the world population have tinea pedis. The prevalence is higher in adults than in children. The peak age incidence is between 16 and 45 years of age. Tinea pedis is more common among males than females. Human may become infected through close contact with infected persons, animals, fomites, or soil. The transmission of tinea pedis is facilitated by warm, moist environments and wearing of occlusive shoes. Three clinical forms of tinea pedis are recognized, namely, interdigital, moccasin, and vesicobullous. The diagnosis is often clinical, especially if the lesions are typical. If necessary, the diagnosis can be confirmed by potassium hydroxide wet-mount examination of skin scrapings of the active border of the lesion. Superficial or localized tinea pedis usually responds to topical antifungal therapy twice daily for 2 to 4 weeks. Systemic treatment is indicated if the lesions are extensive, chronic, recurrent or resistant to topical antifungal treatment or if the patient is immunocompromised, or there is evidence of concomitant nail involvement,