Botulinum toxin A appears to be a safe therapeutic option for patients with notalgia paresthetica. However, data currently available come from small patient series, making it difficult to draw definitive conclusions regarding the true efficacy and long-term effects of this treatment.

The vast majority of mastocytosis appear in childhood, urticaria pigmentosa (UP) and mastocytomas being the most common types. Terms such as "xanthelasmoid mastocytosis", "pseudoxanthomatous mastocytosis" or "nodular mastocytosis" have been introduced in the literature to describe the presence of yellowish papular or nodular lesions. We describe two children with cutaneous mastocytosis showing yellowish lesions in combination with other skin lesions. A 10-year-old girl presented with asymptomatic lesions in her vulva at birth, and developed brownish macules on her trunk years after. An eight-year-old boy presented with multiple yellowish papular lesions on his trunk, neck and limbs coexisting with a few clinically anetodermic lesions. No systemic involvement was found and the skin biopsy confirmed a cutaneous mastocytosis in both cases. The two patients are currently asymptomatic and are being periodically followed up. Mastocytoses may show a variety of clinical lesions, sometimes leading to misdiagnosis. Although there are previous reports, involvement of the mucosae and secondary anetoderma are not common findings in cutaneous mastocytoses. We consider that cutaneous manifestations of mastocytoses compose a clinical spectrum, thus explaining the coexistence of different clinical lesions and the development of uncommon presentations.

No abstract

A case of keratoacanthoma centrifugum marginatum is reported. The case is characterized by its size and its association with epidermolysis bullosa dystrophica.

No abstract

No abstract

No dermatophytic hyphae was found. Culture of these specimens yielded no dermatophytic growth. A local mycology laboratory confirmed our findings. His complete blood picture, fasting glucose, and liver and renal function tests were normal. Human immunodeficiency virus antibodies and HBsAg were negative.Our provisional diagnosis was M. furfur infection affecting his trunk, palms and fingernails. We prescribed oral itraconazole 200 mg daily for 1 week. The patient attended follow-up 3 weeks after completion of such therapy. Little remission of his cutaneous and nail lesions and no improvement in his pruritus were noted.We prescribed oral itraconazole 200 mg daily for one more week. Almost total ablation of pruritus, truncal and palmar lesions was noted another 3 weeks later. Fingernail dystrophies became more distal, with fresh nail plates noted from the matrix end.Our case and other reports 1-3 substantiate that M. furfur can cause onychomycosis. Whether M. furfur is the pathogenic culprit or merely an innocent bystanding coloniser remains debatable, as keratolytic properties of this pathogen were not well established. However, distal subungual dermatophytic onychomycosis involves the nail bed only in the initial phase. 4 The absence of keratolytic properties therefore does not preclude M. furfur from causing onychomycosis.For non-dermatophytic filamentous fungi, a 'simple association' evaluation criterion -Wood's light fluorescence, positive microscopic results for hyphae and spores and negative dermatophytic culture -incurs high specificity in determining their pathogenic significance. 5 More stringent criteria also exists for onychomycosis caused by non-dermatophytic moulds. 6,7 The applicability of these criteria to Malassezia spp. onychomycosis in our case is unknown.From a study on 500 patients with PV reported by one of us (VZ), 8 many patients had onychomycosis demonstrating goldenyellow fluorescence under Wood's light. Their nail clippings yielded no dermatophytic growth. Cutaneous and nail lesions responded to systemic ketoconazole (itraconazole was not available then). Two patients had palmar Wood's light fluorescence. Cutaneous PV and palmar fluorescence disappeared after systemic treatments. 8 Persisting nail fungal reservoirs account for treatment failures for dermatophytic cutaneous infections. Longer courses of systemic terbinafine or itraconazole pulses are effective for treating these patients. Treatment failures for PV frequently occur despite systemic itraconazole. 8 We thus postulate that severe pruritus in widespread M. furfur infection may cause frequent scratching, leading to M. furfur onychomycosis. M. furfur nail reservoirs might then cause treatment failures. We therefore advocate open case-control studies, and subsequent double-blind randomised trials, to investigate whether longer treatment courses or pulse therapy can cure patients with PV and M. furfur onychomycosis. Onychomycosis: a critical study of techniques and criteria for confirming the etiologic significance of nondermatop...