It is a case study of a 62-yr-old female with crusted (Norwegian) scabies, which appeared during her treatment with systemic and topical corticosteroid therapy, under the diagnosis of erythroderma. In the same time, the patient had been suffered from hypothyoidism, and her skin changes were misdiagnosed, because it was thought that they are associated with her endocrine disorder. Suddenly, beside the erythema, her skin became hyperkeratotic, with widespread scaling over the trunk and limbs, and crusted lesions appeared on her scalp and ears. The microscopic examination of the skin scales with potassium hydroxide demonstrated numerous scabies mites and eggs. Repeated topical treatments with lindan, benzoyl benzoat and 10% precipitated sulphur ointment led to the complete resolution of her skin condition.
Temporary henna tattooing has been very popular during recent years. Henna (Lawsonia inermis) is a plant from the Lythraceae family. For henna tattooing, henna dye is used. It is a dark green powder, made from the leaves of the plant, used for hair dyeing and body tattooing. Very often, para-phenylenediamine (PPD) is added to henna dye to make color blacker and to speed up dyeing. PPD may be a very potent contact sensitizer. We report a 9-year-old boy with allergic contact dermatitis due to temporary henna tattooing. Patch testing showed a positive reaction to PPD. After the treatment with topical corticosteroid and oral antihistamines, the lesion cleared with discrete residual hypopigmentation.
Acrokeratosis paraneoplastica of Bazex is rare condition, characterized with scaly hyperkeratotic psoriasiform plaques on acral parts of body (helices, nose, and malar and acral surfaces), and in later stages propagation to the limbs and trunk.This syndrome is distinct marker for different neoplastic conditions, predominantly squamous cell carcinoma of the upper aerodigestive tract with possible cervical lymph node metastases.In this paper we present 56 years old male patient, with hyperkeratotic plaques on the skin of his palms, soles, ear lobes and apex of the nose. Detailed examination found tumorous swelling on the left side of his neck. Histopathologic examination revealed solid anaplastic metastatic tumor. Patient died before primary tumor could be found. Bazex syndrome can appear before the diagnosis of internal malignancies, and thus is important for dermatologists to recognize it in favor of early diagnosis of specific malignant process.
Epidemiology of atopic dermatitis Atopic dermatitis (AD) is a disease that usually presents in the early childhood (1). AD is one of the most common skin diseases and it affects approximately 20% of children and 1-3% of adults (2). In 60% of patients the first manifestations appear within the first year of life, and in 90% of patients before the age of five. In most patients manifestations of AD disappear before the adulthood, while in 25% of patients AD persists throughout life (2). Rarely, the first AD manifestations appear in adulthood (2). Approximately 25% of AD patients may develop some form of hand eczema during the life (3). Clinical presentations of AD The clinical presentations of AD vary depending on the age and course of the disease; the major manifestations include erythema, edema, xerosis, erosions/excoriation, oozing and crusting, and lichenification (1, 4, 5, 6, 7). Intense itching is common in AD resulting in excoriation, pruritic papules, lichenification and eczematous skin lesions (2, 3, 4). The itch is particularly pronounced at night causing sleep impairment, thus having significant negative impact on the quality of life of both patients and their families (2, 3, 5, 6). The disease may take an acute, subacute or chronic course. Acute lesions are characterized by intense pruritus, presence of papules and vesicles on erythematous skin, and are associated with excoriation, erosion and serous exudates. Subacute lesions manifest as erythematous, excoriated scaly papules, while typical skin thickening with pronounced skin markings (lichenification) and pruritic papules are distinctive for the chronic course of the disease. In infants and young children, AD commonly starts as an acute or subacute condition, whereas chronic forms are characteristic for older children and adults (5, 6, 7). These three distinct phases are often observed in the same patient (6, 7). Clinical presentations in children During the first month of life, the first signs of atopic dermatitis may present as pronounced yellowish scales on the scalp, commonly known as "cradle cap" or infantile seborrheic dermatitis (1). In infants, 3-6 months old, the predilection sites for eczematous changes on the face are cheeks, forehead and chin, whereas the central part of the face (nose, perioral region) and diaper area are often spared. Skin changes are acute or subacute, with unclear margins, and present with erythema, edema, papulovesicles, excoriations, often associated with oozing and crusting, while chronic changes are rare and manifest as erythematous papules and plaques with desquamation. In infants 8-10 months old, AD progresses to extensor surfaces of the extremities, and after the first year it may affect the upper trunk, where the changes manifest as nummular dermatitis (1, 5, 6, 7). After the age of 2 years, the clinical presentations change, that is, the disease takes a chronic course, or AD develops de novo. The symptoms include poorly marginated lichenified plaques with excoriations
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