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Papular pruritic eruption of Demodex folliculitis in patients with acquired immunodeficiency syndrome
Brief communications Papular pruritic eruption of Demodex folliculitis in patients with acquired immunodeficiency syndrome R. J. Ashack, M D , MS, M. L. Frost, M D , and A. L. Norins, M D Indianapolis, Indiana
As m a n y as 50% to 80% of the patients with acquired immunodeficiency syndrome ( A I D S ) and AIDS-related complex develop dermatologic problems. One of the most common is a relentless, noncoalescing, papular, pruritic eruption that occurs predominantly on the head, neck, upper part of the trunk, and extremities. James and Redfield I postulated that this papular pruritic eruption is a result of an abnormal host-cellular i m m u n e response to an infective process. Duvic 2 stated that this eruption m a y be due to a variety of infective agents: scabies, demodex or Staphylococcus aureus. A case of this papular pruritic eruption of A I D S is presented.
Case report. A 45-year-old white bisexual man tested From the Department of Dermatology, Regenstrief Health Center, Suite 524, Indiana University Medical Center. Reprint requests: Richard J. Ashaek, MD, MS, Department of Dermatology, Regenstrief Health Center, Suite 524, Indiana University Medical Center, Indianapolis, IN 46223.
positive for the human immunodeficiency virus (HIV) antibody in November t987. When the patient initially was seen in December 1987, he reported weight loss, diarrhea, night sweats, increasing fatigue and a progressive shortness of breath, nonproductive cough, and pleuritic chest pain. After admission to our hospital a follicular papular erythematous eruption was noted on the trunk and upper extremities (Fig. 1). The patient was thought to have folliculitis and was treated with 250 mg dicloxacillin four times daily for 2 weeks; in follow-up outpatient visits, it was noted that the pruritic eruption was progressing, causing increasing discomfort. Because the patient had not responded to systemic antibiotics, it was thought that the eruption represented Pityrosporurn folliculitis, and an empiric trial of ketoconazole, 200 mg daily, was given for 1 week. When the patient returned for follow-up 1 week later, the eruption was unchanged, and he was referred to the dermatology department. A few pustules were opened, and the contents were examined under a light microscope. Numerous Demodex mites were noted on each slide. The patient was treated with a single overnight application of 1% lindane lotion. A follow-up examination 2 weeks later revealed complete resolution.
Discussion. Demodex folliculorum, a cigar-shaped mite, is commonly seen in normal human hair follicles. More recently this organism has been implicated in inflammatory disorders in patients with altered immunity. In veterinary medicine it has been shown that in dogs, the presence of the mite Demodex canis has been
Fig, 1. Papular pruritic eruption before overnight treatment with 1% lindane lotion.
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correlated with immunodeficiency for which appropriate therapy consists of Iindane or other pesticides? Because this patient had such a proliferation of mites, an empiric trial of 1% lindane lotion proved efficacious. Current maintenance therapy consists of 10% crotamiton lotion applied topically. O u r observations support the previous findings of Duvic I that the Demodex mite m a y play an important etiologic role in the papular pruritic eruption of AIDS.
REFERENCES 1. James WD, Redfield RR. Human irnmunodeficiency virus infection and skin disease. J Assoc Milit Dermatologists 1987;2:7-12. 2. Duvie M. Staphylococcal infections and the pruritus of AIDS-related complex. Arch Dermatol 1987;123:1599. 3. Kirk RW. Small animal practices. Philadelphia: WB Saunders 1980:437. (Current veterinary therapy; vol 8).
Liposuction surgery for a buffalo h u m p c a u s e d by Cushing's disease Rhoda S. Narins, M D White Plains, New York
Case report. The patient, a 49-year-old woman, had a pituitary adenoma with pituitary-mediated adrenal cortical hyperplasia, causing Cushing's disease. The tumor was removed transsphenoidally 2 years before the patient's initial visit to me, and she had been well since that time. The buffalo hump that developed from the patient's Cushing's disease did not change after the pituitary surgery and caused her great embarrassment (Fig. 1). From White Plains Hospital Medical Center. Reprint requests: Rhoda S. Narins MD, 33 Davis Ave., White Plains, NY 10605.
Fig. 2. N o r m a l contour to patient's back after liposuction surgery.
The area to be suctioned was marked with an indetib[e pen. With the use of local anesthesia, 3 to 4 rrma incisions in three different areas were made so that the tunnels made by the cannula would criss-cross to give a smoother result. A No. 4-0 blunt-tipped steel cannula with three openings was used, and 400 ce of fat was removed. A Hexiplast (Medicalex, Paris, France) dressing was applied and was left in place for 1 week? "s Immediate postoperative photos revealed a normal contour to the patient's back (Fig. 2). The buffalo hump has not recurred, and the patient's back contour is normal. REFERENCES 1. Field L, Narins R. Liposuction surgery. In: Epstein, Epstein, eds., Skin surgery. Philadelphia: WB Saunders, 1987:370-8. 2. Illouz Y. Surgical remodeling of the silhouette by aspiration lipolysis or selective lipectomy. Aesth Hast Surg 1985;9( 1):7-21. 3. Illouz Y. My technique of lipolysis or selective lipectomy. Hast Reconstr Surg 1983;72:5911-7.
Actinic reticuloid: Response to eyelosporine Paul G. Norris, M R C P , Richard D. R. Camp, Phi), M R C P , and John L. M. Hawk, F R A C P
London, England We read with interest the recent report by Kingston et aL l of a black man with actinic reticuloid successfully treated with azathioprine and the subsequent correspon-
Fig. 1. Buffalo hump caused by Cushing's disease.
From the Institute or Dermatology, St, Thomas's Hospital, London, United Kingdom, Reprints not available.
As m a n y as 50% to 80% of the patients with acquired immunodeficiency syndrome ( A I D S ) and AIDS-related complex develop dermatologic problems. One of the most common is a relentless, noncoalescing, papular, pruritic eruption that occurs predominantly on the head, neck, upper part of the trunk, and extremities. James and Redfield I postulated that this papular pruritic eruption is a result of an abnormal host-cellular i m m u n e response to an infective process. Duvic 2 stated that this eruption m a y be due to a variety of infective agents: scabies, demodex or Staphylococcus aureus. A case of this papular pruritic eruption of A I D S is presented.
Case report. A 45-year-old white bisexual man tested From the Department of Dermatology, Regenstrief Health Center, Suite 524, Indiana University Medical Center. Reprint requests: Richard J. Ashaek, MD, MS, Department of Dermatology, Regenstrief Health Center, Suite 524, Indiana University Medical Center, Indianapolis, IN 46223.
positive for the human immunodeficiency virus (HIV) antibody in November t987. When the patient initially was seen in December 1987, he reported weight loss, diarrhea, night sweats, increasing fatigue and a progressive shortness of breath, nonproductive cough, and pleuritic chest pain. After admission to our hospital a follicular papular erythematous eruption was noted on the trunk and upper extremities (Fig. 1). The patient was thought to have folliculitis and was treated with 250 mg dicloxacillin four times daily for 2 weeks; in follow-up outpatient visits, it was noted that the pruritic eruption was progressing, causing increasing discomfort. Because the patient had not responded to systemic antibiotics, it was thought that the eruption represented Pityrosporurn folliculitis, and an empiric trial of ketoconazole, 200 mg daily, was given for 1 week. When the patient returned for follow-up 1 week later, the eruption was unchanged, and he was referred to the dermatology department. A few pustules were opened, and the contents were examined under a light microscope. Numerous Demodex mites were noted on each slide. The patient was treated with a single overnight application of 1% lindane lotion. A follow-up examination 2 weeks later revealed complete resolution.
Discussion. Demodex folliculorum, a cigar-shaped mite, is commonly seen in normal human hair follicles. More recently this organism has been implicated in inflammatory disorders in patients with altered immunity. In veterinary medicine it has been shown that in dogs, the presence of the mite Demodex canis has been
Fig, 1. Papular pruritic eruption before overnight treatment with 1% lindane lotion.
306
Volume 21 Number 2, Part 1 August 1989
Brief communications
307
correlated with immunodeficiency for which appropriate therapy consists of Iindane or other pesticides? Because this patient had such a proliferation of mites, an empiric trial of 1% lindane lotion proved efficacious. Current maintenance therapy consists of 10% crotamiton lotion applied topically. O u r observations support the previous findings of Duvic I that the Demodex mite m a y play an important etiologic role in the papular pruritic eruption of AIDS.
REFERENCES 1. James WD, Redfield RR. Human irnmunodeficiency virus infection and skin disease. J Assoc Milit Dermatologists 1987;2:7-12. 2. Duvie M. Staphylococcal infections and the pruritus of AIDS-related complex. Arch Dermatol 1987;123:1599. 3. Kirk RW. Small animal practices. Philadelphia: WB Saunders 1980:437. (Current veterinary therapy; vol 8).
Liposuction surgery for a buffalo h u m p c a u s e d by Cushing's disease Rhoda S. Narins, M D White Plains, New York
Case report. The patient, a 49-year-old woman, had a pituitary adenoma with pituitary-mediated adrenal cortical hyperplasia, causing Cushing's disease. The tumor was removed transsphenoidally 2 years before the patient's initial visit to me, and she had been well since that time. The buffalo hump that developed from the patient's Cushing's disease did not change after the pituitary surgery and caused her great embarrassment (Fig. 1). From White Plains Hospital Medical Center. Reprint requests: Rhoda S. Narins MD, 33 Davis Ave., White Plains, NY 10605.
Fig. 2. N o r m a l contour to patient's back after liposuction surgery.
The area to be suctioned was marked with an indetib[e pen. With the use of local anesthesia, 3 to 4 rrma incisions in three different areas were made so that the tunnels made by the cannula would criss-cross to give a smoother result. A No. 4-0 blunt-tipped steel cannula with three openings was used, and 400 ce of fat was removed. A Hexiplast (Medicalex, Paris, France) dressing was applied and was left in place for 1 week? "s Immediate postoperative photos revealed a normal contour to the patient's back (Fig. 2). The buffalo hump has not recurred, and the patient's back contour is normal. REFERENCES 1. Field L, Narins R. Liposuction surgery. In: Epstein, Epstein, eds., Skin surgery. Philadelphia: WB Saunders, 1987:370-8. 2. Illouz Y. Surgical remodeling of the silhouette by aspiration lipolysis or selective lipectomy. Aesth Hast Surg 1985;9( 1):7-21. 3. Illouz Y. My technique of lipolysis or selective lipectomy. Hast Reconstr Surg 1983;72:5911-7.
Actinic reticuloid: Response to eyelosporine Paul G. Norris, M R C P , Richard D. R. Camp, Phi), M R C P , and John L. M. Hawk, F R A C P
London, England We read with interest the recent report by Kingston et aL l of a black man with actinic reticuloid successfully treated with azathioprine and the subsequent correspon-
Fig. 1. Buffalo hump caused by Cushing's disease.
From the Institute or Dermatology, St, Thomas's Hospital, London, United Kingdom, Reprints not available.