Clinical Appearance Of Tinea Corporis Resembles With Tinea Imbricata And Condyloma Acuminata Genital In A Reproductive Woman With HIV : A Case Report

Background: HIV (human immunodeficiency virus) is a virus that attacks the body’s immune system that can cause immunodeficiency. Immunodeficiency results in increased susceptibility to fungal infections. The other opportunistic infection, condyloma acuminate is prevalent in groups at high risk for HIV acquisition and in HIV-infected individuals. Case: There were ring-shaped reddish patches with scaly and itchy on the right back since 3 weeks ago. Patients often scratch it especially when sweating and hot weather. The itchy reddish patches with scaly were increased in number and size on the right back then spreading over the edge to form ring-like patches. Patient complained ring-shaped reddish patches getting more red, scaly, itchy, and wider. 6 months ago, there was a lump that sometime felt itchy in below part of vulva. Patient in reproductive age and not married yet, but sexually active. Patient had a sexual relation with male who HIV 2 years ago. Patient also suffered HIV and got ARV since 6 month ago. There was no protection (condom) during the sexual intercourse. Dermatologic state in right back with efflorescence is plaque erythema with annular concentric ring forms, scale, and blackish crust. Venereologycal state show vegetation in vulva with size 0,2 - 1,5 x 1 x 0,5 cm with verrucous surface. Acetowhite test is positive result. KOH 10% of skin scrapping show fungal element and fungal culture result is tricophyton rubrum. Patient was diagnosed tinea corporis (TC) and condyloma acuminata (CA) genital griseovulfin 900 mg, cetirizin 10 mg, ketokonazol 2% cream twice a day, tricholoroacetat 90% and showed good improvement.Discussion: Diagnosis tinea corporis and CA genital based on clinical findings and mycological examination. Early diagnosis and proper treatment are important in HIV patients in order to prevent severe infection. After 4 weeks treatment, show improvement on TC however CA lesion no reduced. Keywords: tinea corporis,condyloma acuminate, tinea imbricata, HIV, Reproductive age

Giant condyloma acuminate due human papilloma virus type 16 in an infant successfully treated with topical imiquimod therapy

Anogenital warts related to human papillomavirus (HPV) have been observed in children. Definition of the transmission mode, therapy, and follow-up for long term potential complications is important. A 27-month old girl was admitted with multiple pedunculated red-purple colored cauliflower-like lesions of 1.5 years duration. Clinical/histopathological and microbiological diagnosis was condyloma acuminate due to HPV type 16. After 12 weeks of imiquimod 5% cream application (pea-sized) overnight three times per week, the perianal warts had completely disappeared. The mode of transmission of HPV 16 in our case was probably horizontal, related to the sharing of common personal hygiene items in the women’s shelter. We report herein the case of an infant living in a women’s shelter with giant condyloma acuminata due to HPV 16, which was successfully treated with topical imiquimod therapy. This patient should be followed up for recurrence and potential malignant lesions related to HPV type 16.

Physiologic Skin Changes During Pregnancy.

Introduction: Approximately 90% pregnant women are associated with skin changes. The skin undergoes profound alterations during pregnancy as a result of endocrine, metabolic and immunologic changes. Some of these are trivial and chiefly cosmetic, producing no or minor symptoms, others can be distressing and/or of major medical importance. For the necessity of proper and complex care of the pregnant woman ,the knowledge about the changes are crucial. The ability of precise diagnosis of physiological skin changes allows specifying the suspected cases of pathologic etiology and referring them to the dermatological referral centers for in-depth diagnosis and eventual treatment. The aim of this study was to identify the incidence and types of dermatological changes in our population. Methods: Pregnant patients attending the antenatal clinic of the Gynecology department in Shree Birendra Hospital, and presenting to the outpatient clinic of the Department of Dermatology, Bir Hospital, for any dermatologic problem, were enrolled. The study spanned a period of 10months (January 2008 to October 2008). We evaluated 150 pregnant women to determine the pattern of pregnancy-induced physiologic skin changes in Nepalese community. Results: Majority of patient developed dermatological changes in second and third trimester. The commonest sign was hyper pigmentation of the skin followed by striae and edema. Fungal infections were the commonest infections observed,Tineacorporis accounting for 10 (6.66%) and tineaversicolarwas seen in Eight (5.33%) patients. Three (2%) patients had Scabies. A total of 3 patients had sexually transmitted disease. 2 (1.3%) had Condyloma acuminate and 1 (.006%) had syphilis. Conclusions: Hyperpigmentation was the commonest sign (87.33%) followed by striae (82%), edema (45.3%), vascular changes (17.3%) and melasma (8%). Varicosities of veins, spider nevi and palmar erythema are relatively less frequent in our population. Medical Journal of Shree Birendra Hospital; Jan-June 2012/vol.11/Issue1/42-45 DOI: http://dx.doi.org/10.3126/mjsbh.v11i1.7767