Cases reported "Facial Dermatoses"

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1/12. Treatment of cutaneous leishmaniasis with 20% paromomycin ointment.

    Cutaneous leishmaniasis is an infectious disease caused by flagellate protozoa of the genus Leishmania. In Mediterranean countries, the most common causative agents are Leishmania (L.) major, L. infantum and L. tropica. In croatia, cutaneous leishmaniasis is a rare disease, the last case being reported in 1988. Our patient was a 5-year-old boy with a left cheek skin lesion in the form of papule with central exulceration, hyperkeratotic crust and erythema of a 6-month duration. The diagnosis of cutaneous leishmaniasis was based on history data (stay in the southernmost region of croatia and multiple mosquito bites), light microscopic histology (dense infiltrates of large histiocytes with extracellular bodies), and positive montenegro (leishmanin) test. A new therapy with aminosidine (paromomycin), an aminoglycoside antibiotic, in the form of ointment at a concentration of 20%, was for the first time used in croatia. Four-week therapy resulted in complete regression of the skin lesions with residual hyperpigmentation. During therapy, no local or systemic side effects were observed. Thus, topical therapy with paromomycin could be considered an efficient therapeutic alternative in the management of cutaneous leishmaniasis.
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ranking = 1
keywords = leishmaniasis
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2/12. Cutaneous leishmaniasis.

    The incidence of leishmaniasis is increasing globally due to population and environmental changes. Ease of worldwide travel and immigrant populations means that the UK surgeon is more likely to encounter cutaneous lesions. Two cases are presented and treatment options discussed.
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ranking = 0.625
keywords = leishmaniasis
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3/12. Erythematous-edematous-infiltrative plaque on the face: cutaneous angio-lupoid leishmaniasis.

    The present report deals with an unusual clinical presentation of cutaneous leishmaniasis occurring in an atopic subject and discusses the possible pathogenetic mechanisms with particular attention to the role of nitric oxide in the immunological control against intracellular parasites. The altered balance between TH1 and TH2, typical of atopy, with consequent production of IL-4, might contribute to the high susceptibility to opportunistic infections and to the unusual clinical presentation. Moreover the laxity of the tissue and the great vascularization may enhance cutaneous expression of the Leishmania infestation, producing new aspects which add to the difficulty of diagnosis.
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ranking = 0.625
keywords = leishmaniasis
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4/12. Disseminated mucocutaneous leishmaniasis resulting from chronic use of corticosteroid.

    Mucocutaneous leishmaniasis is a granulomatous disease clinically characterized by ulcerated skin and mucosal lesions whose clinical manifestations can regress spontaneously, but with possible long subclinical evolution. The course of the disease is often related to the host immune response. The purpose of this article is to describe the clinical and microscopic findings of cutaneous and mucosal lesions of mucocutaneous leishmaniasis in a patient who presented an unusual form of the disease associated with an immunosuppressive state.
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ranking = 0.75
keywords = leishmaniasis
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5/12. A new rural focus of cutaneous leishmaniasis caused by leishmania tropica in kenya.

    We have identified a new rural focus of cutaneous leishmaniasis caused by leishmania tropica in Muruku sublocation, Salama location, Laikipia district, Rift Valley province, kenya. Based on a few available case histories, previous reports of L. tropica in kenya indicated a tentative geographical distribution. Recently 6 indigenous Kenyans from the new focus, who had never travelled outside kenya, developed cutaneous lesions on the face and/or extremities found to contain Leishmania by culture and smear. Most of the patients manifested the typical 'urban' dry sore which grew slowly into a nodule measuring 2 x 1 cm to 9.5 x 3 cm, and after some months formed a central crust surrounded by small satellite papules. After treatment with Pentostam (sodium stibogluconate), about 40% of the sores failed to heal completely, either scarring centrally with fulminating papules at the edges and spreading peripherally, or healing but then recrudescing at the edge of the scar. Stationary-phase promastigotes from culture isolates were analysed by cellulose acetate electrophoresis. Isoenzyme profiles of 6 isolates were compared with those of world health organization reference strains using 12 enzyme loci; they were indistinguishable from those of 2 L. tropica reference strains. All 6 case sites lay within a radius of 4 km. Several other suspected cases from the same area are being investigated.
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ranking = 0.625
keywords = leishmaniasis
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6/12. Disseminated cutaneous leishmaniasis.

    Disseminated cutaneous leishmaniasis DCL is a condition rarely seen in the middle east. We report a case of disseminated cutaneous leishmaniasis in a 60-years-old lady. The patient first presented 1996 with an initial lesion, which started on the butterfly area of the face and spread, probably due to immunosuppression, to involve the whole face. The lesions consisted of nodules, which did not ulcerate. The histology showed abundance of macrophages filled with amastigotes L-D bodies. The patient was started on oral zinc sulphate 10 mg/kg in 3 divided doses daily. The condition showed gradual improvement. Repeated biopsies showed upgrading of the histopathological picture. After 6-months of treatment there was complete clearance of the condition. The patient was followed up for 6-years with no recurrence. However, she presented with a new lesion on the butterfly area again in February 2003. The biopsy again showed abundance of macrophages filled with amastigotes L-D bodies. A 4-months course of zinc sulphate 10 mg/kg in 3 divided doses daily resulted in complete clearance of the lesions. zinc sulphate might represent a new treatment for this condition that has no adequate treatment until now.
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ranking = 0.75
keywords = leishmaniasis
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7/12. Mucocutaneous leishmaniasis presenting as facial cellulitis.

    We report a case of mucocutaneous leishmaniasis caused by Leishmania viannia braziliensis. Despite several courses of both oral and intravenous antibiotics no improvement was seen. This case highlights the importance of taking a thorough history, including details of recent travel, and considering rarer causes when no improvement with antibiotics is seen. Our patient was infected with a particularly virulent strain and destruction of the mucous membranes is not uncommon. Rapid diagnosis and treatment are therefore crucial.
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ranking = 0.625
keywords = leishmaniasis
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8/12. association of oral cysticercosis and post kala azar dermal leishmaniasis.

    Oral cysticercosis affecting the tongue in association with post kala azar dermal leishmaniasis in an adult man is presented. The features that helped to distinguish oral cysticercosis from other conditions endemic in that area are briefly discussed.
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ranking = 0.625
keywords = leishmaniasis
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9/12. Recurrent cutaneous leishmaniasis: successful treatment with sodium antimony gluconate.

    The case of a 15-year-old boy with recurrent cutaneous leishmaniasis is reported. Species identification was based on results of serotyping and isoenzyme analysis. The patient did not respond to rifampin combined with isoniazid or to ketoconazole. Subsequent therapy with systemic sodium antimony gluconate resulted in complete regression of the lesions.
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ranking = 0.625
keywords = leishmaniasis
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10/12. leishmaniasis presenting as a dermatomyositis-like eruption in AIDS.

    Three patients are described with leishmaniasis and AIDS, with cutaneous lesions mimicking dermatomyositis. Leishmania organisms were observed in great numbers in the dermis of lesional skin biopsy specimens. They were also present inside keratinocytes in all layers of the epidermis in one patient. skin cultures from all patients and bone marrow culture in patients 1 and 3 revealed leishmania infantum. Leishmania organisms were also found in nonlesional skin. The absence of proximal symmetric muscle weakness, elevated muscle enzymes, myopathic electromyograms, or characteristic histopathologic and immunologic features of dermatomyositis, and the rapid and complete clearance or marked improvement of the cutaneous lesions after treatment for leishmaniasis, make us consider true dermatomyositis unlikely. We suggest that leishmaniasis be included in the list of diseases capable of inducing a dermatomyositis-like eruption.
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ranking = 0.375
keywords = leishmaniasis
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