ESSENCES

Deep dermatophytosis: rare infections or common, butunrecognised, complications of lymphatic spread?

Hay RJ, Baran R. Curr Opin Infect Dis 2004; 17:77-79

This review article discusses deep dermatophytosisand the possible link with lymphatic spread. The mech-anisms limiting spread of dermatophyte fungi, undernormal circumstances, to the epidermis remain elusive.The hypothesis linking a specific clinical form of der-matophyte nail infection with lymphatic spread needsverification. In particular, it is important to clarify whe-ther viable dermatophytes can be detected outside theepidermis or nail plate and whether they will then remainviable and provide a source of endogenous re-infection.There is still some doubt as to whether the mysteriousarrival of dermatophytes in the proximal nail fold, par-ticularly in immunosuppressed patients, is a sign oflymphatic dissemination or whether we should besearching for another portal of entry.

Fatal cases of Rocky Mountain spotted fever in familyclusters–Three states, 2003

Levy C, Burnside J, Tso T, et al. MMWR 2004; 53:407-410

Rocky Mountain spotted fever (RMSF) is a tickborneinfection caused by Rickettsia rickettsii and characterizedby a rash. It has a case-fatality rate as high as 30% incertain untreated patients. Even with treatment, hospi-talization rates of 72% and case-fatality rates of 4% havebeen reported. This article summarizes the clinicalcourse of 3 fatal cases of RMSF in children and relatedillness in family members during the summer of 2003.These cases underscore the importance of prompt diag-nosis and appropriate antimicrobial therapy in patientswith RMSF to prevent deaths. They also emphasizeconsideration of RMSF as a diagnosis in family membersand contacts who have febrile illness and share environ-mental exposures with the patient.

The safety and efcacy of daptomycin for the treatment ofcomplicated skin and skin-structure infections

Arbeit RD, Maki D, Tally FP, et al. Clin Infect Dis 2004;38:1673-1681

Daptomycin, 4 mg/kg intravenously (IV) every 24 hfor 7-14 days, was compared with penicillinase-resistantpenicillins, 4-12 g IV per day or vancomycin (Vancocin),1 g IV every 12 h, in 2 randomized, international trialsthat included 1, 092 patients with complicated skin andskin-structure infections. Among 902 clinically evaluablepatients, clinical success rates were 83.4% and 84.2% forthe daptomycin- and comparator-treated groups,respectively. Among patients successfully treated with IVdaptomycin, 63% required only 4-7 days of therapy,compared with 33% of comparator-treated patients (p <0.0001). The frequency and distribution of adverse eventswas similar among both treatment groups. The studyshowed the safety and efficacy of daptomycin werecomparable with conventional therapy.

Cutaneous warts in patients with lupus erythematosus

Korkmaz C, Urer SM. Rheumatol Int 2004; 24:137-140

This study evaluated the freqency of cutaneous warts(CW) in patients with lupus erythematosus (LE) andassessed the effect of immunosuppressants on theappearance of CW. Fifty-eight patients with LE, 74 withrheumatoid arthritis (RA), and 105 healthy individualswere interviewed and examined for the presence of CW.All were questioned to find out whether their CWdeveloped before or after onset of the disease or duringtreatment. CW occurred considerably more often inpatients with LE than in healthy control and RA patients(p < 0.003 and p < 0.04, respectively). The presence ofCW did not correlate with the taking of im-munosuppressive drugs. The study findings suggest thatthe high prevalence of CW in patients with LE is prob-ably due to defects in some immune mechanisms, in-dependently of immunosuppressive drugs.

Online publication: 12 May 2005

5. HIV and Infectious Diseases

DOI: 10.1007/s10227-005-6005-9

Bedbug bites: a review

Thomas I, Kihiczak GG, Schwartz RA. Int J Dermatol 2004;43:430-433

This review article discusses bedbugs, reddish-browninsects that require blood meals tos survive and that feedon humans and other warm-blooded mammals and birds.They usually come out to feed at night and tend to hideduring the daytime. Adults are resistant and can survivefor up to a year without a meal. This makes it difficult toeradicate them other than with the use of insecticides.Reactions can range from localized urticaria to bullousreactions to anaphylaxis in rare cases. They are a par-ticular concern in Africa and the tropics as they may bevectors for endemic infectious diseases such as Americantrypanosomiasis, also known as Chagas� disease. Thearticle discusses diagnosis, differential diagnosis, deter-rence, and prevention.

Tinea imbricata or Tokelau

Bonifaz A, Archer-Dubon C, Saul A. Int J Dermatol 2004;43:506-510

This article discusses tinea imbricata or Tokelau, asuperficial mycosis caused by Trichophyton concentri-cum, an anthropophilic dermatophyte. It is endemic insome islands of the South Pacific (Polynesia), SoutheastAsia, Central and South America, and Mexico. It is mostoften seen in individuals living in primitive and isolatedconditions. Skin lesions are characteristically concentricand lamellar plaques of scale. Predisposing conditionsinclude humidity, inheritance, and immunologic factors.Diagnosis is usually made on clinical grounds, supportedby skin scrapings and culture. Tokelau is a chronic andhighly relapsing disease, and best results are obtainedwith oral griseofulvin and terbinafine (Lamisil) and atopical combination of keratolytic ointments, such asWhitfield�s.

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