Tick Typhus
James H. S. Gear in CRC Handbook of Viral and Rickettsial Hemorrhagic Fevers, 2019
On the 3rd to the 5th day of illness, a maculopapular rash erupts first on the extremities and then on the trunk (Plate 6*). The rash appears in crops and new macules and papules may be noted each day for 1 to 3 days. The papules are relatively coarse and can be felt as small shotty nodules in the skin. At first they are pinkish, but later become darker. Characteristically, the rash involves the palms of the hands, the soles of the feet, and, to a lesser extent, the face. The profuseness of the rash is directly related to the severity of the illness. In mild cases only a few raised red papules, more evident on the limbs than on the trunk, may be seen. In severe cases, a profuse maculopapular rash covers the whole body, but tends to be centrifugal, being more marked peripherally than centrally, and the skin has a dusky cyanotic hue. In very severe cases, the rash may become hemorrhagic with bleeding into the elements of the rash, associated with numerous petechial hemorrhages in the skin which may become edematous. On recovery, especially after specific treatment, the rash rapidly resolves, but if it had become hemorrhagic, staining of the skin may be seen for some time in convalescence.
Infectious diseases
Giuseppe Micali, Francesco Lacarrubba in Dermatoscopy in Clinical Practice, 2018
Clinically, MC presents as an eruption of multiple papules. The morphology of an individual lesion is a dome-shaped, flesh colored, or pearly papule with an umbilicated center (Figures 10.1 –10.2). Lesions vary in size from 1–10 mm, although occasionally giant lesions are seen. The papules may be atypical in size, shape, and color, and signs of inflammation may occur spontaneously or after trauma. The lesions are often grouped in small areas but also may become widely disseminated. Any cutaneous surface may be involved, but favored sites include the axillae, the antecubital and popliteal fossae, and the crural folds in children. Autoinoculation is common. MC in adults affects the groin, genital area, thighs, and lower abdomen and is often acquired with sexual intercourse. Histologically, MC exhibits epidermal hyperplasia producing a crater filled with huge (up to 35 microns) eosinophilic to basophilic intracytoplasmatic inclusions that are called molluscum bodies or Henderson-Patterson bodies. MC is a self-limited disease, which if left untreated will eventually resolve in immunocompetent hosts but may persist in atopic and immunocompromised individuals.1–5
Benign lesions
Richard P. Usatine, Daniel L. Stulberg, Graham B. Colver in Cutaneous Cryosurgery, 2014
This is a common viral infection that produces umbilicated papules which appear stuck on to the skin. Children are chiefly affected, particularly those with atopic dermatitis. The number of lesions present may vary from one or two to several hundred and they can persist for months or years. It is important to remember that the sudden development of large numbers of these lesions, in an adult, should raise the possibility of HIV or another cause for impaired immunity. Liquid nitrogen is applied until the surface of the lesion is white (Figure 8.22). This takes only 3–5 seconds. The central dimple, so characteristic of molluscum, is highlighted. It is not necessary to freeze beyond the margin of the lesion. Over the next few days there may be temporary swelling then shrinkage and the papule falls off. Cryosurgery can rarely be used for children under the age of 6 years without the prior application of a topical anesthetic. After the first lesion is treated most children shrink away from any further attempts. EMLA may be applied at home or when the child first arrives at the office. For young children, less painful options include topical treatment with cantharidin, tretinoin, or imiquimod.
Two cases of lupus miliaris disseminatus faciei successfully treated with oral tofacitinib
Published in Journal of Dermatological Treatment, 2023
A 39-year-old female presented with a 6-month history of multiple reddish and yellowish papules on the face without systemic symptoms. Physical examination revealed symmetrically multiple monomorphic smooth reddish papules on her eyelids, cheeks, noses and chins. Skin biopsy results showed perifollicular epithelioid cell granulomas and lymphocytes infiltrating. Caseating granulomas were observed in the histopahtology of a biopsy specimen. A diagnosis of LMDF was made. She was treated with oral doxycycline at a dosage of 100 mg once daily plus hydroxychloroquine 200 mg twice daily with topical tacrolimus. However, there was no obvious improvement. We changed the therapeutic regimen to tofacitinib (Xeljanz) (5 mg twice daily) plus hydroxychloroquine for 2 months. At the 6-week follow-up, her lesions were improved greatly. Then she continued taking tofacitinib and these lesions improved gradually in the following 10 months (Figure 1).
An unusual presentation of eruptive syringomas on the neck
Published in Baylor University Medical Center Proceedings, 2021
Madeline R. Frizzell, Saadeddine S. Saad, Katherine H. Fiala
A healthy 11-year-old boy presented with a 5-year history of asymptomatic persistent papules on his neck. The papules became more prominent with heat and exercise but were neither pruritic nor bothersome. The patient’s medical history included seasonal allergies and myopia requiring glasses. He was recently examined by his ophthalmologist with no abnormal findings. The remainder of the skin was uninvolved. There were scattered 2 to 5 mm yellow-orange papules on a background of smaller, countless skin-colored papules arranged horizontally in a linear pattern, on the anterior neck and extending bilaterally (Figure 1a). A 3 mm punch biopsy of a larger papule on the anterolateral neck revealed comma-shaped epithelial structures consistent with syringoma, so a diagnosis of eruptive syringomas was made (Figure 1b). The patient’s clinical presentation warranted a concurrent diagnosis of juxtaclavicular beaded lines.
Transfollicular elimination of sebaceous glands in a patient with disseminate and recurrent infundibulofolliculitis
Published in Baylor University Medical Center Proceedings, 2021
Mahmud Alkul, Travis S. Dowdle, Jay Truitt, Michelle B. Tarbox
DRIF was originally described by Hitch and Lund in 1968 as a benign but bothersome condition affecting young men with darkly pigmented skin.1 There is no known etiology. DRIF is characterized by widespread, flesh-colored papules in stereotypical areas such as the trunk and extremities. Other less commonly reported presentations include a linear distribution of papules along neck creases.2 Histological examination revealing chronic perifollicular inflammation in association with typical papule distribution allows for a diagnosis of DRIF. Common symptoms include pruritus, which can be exacerbated in hot climates and may be significant to the degree of self-excoriation, but papules may also be asymptomatic. These papules are subject to relapse and remission, although our patient experienced persistent papules for an extended period of time.
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