Anca Chiriac, Adriana Diaconeasa, Cristian Podoleanu and Simona Stolnicu
Background: Also known as papulopustular dermatitis (chronic form), rosacea-like dermatitis, periorificial dermatitis, or airhostess’ dermatitis, perioral dermatitis is a commonly encountered dermatological disease, especially in adult women and less frequently in children. Its diagnosis and treatment are a challenge especially in small children.
Case report: We present the case of a 2-year-old girl referred to the dermatologist for widespread erythematous papules, vesicles, and pustules on the perioral area, nasolabial folds, and on the outer region of the lower eyelids. Several diagnoses had been established during the previous months: impetigo, atopic dermatitis, seborrheic dermatitis, allergic contact dermatitis, childhood rosacea, demodecidosis, infantile acne, and variable therapeutic approaches had been tried, with no clinical improvement. Clarithromycin 250 mg/day orally associated with the application of 2% erythromycin solution were successfully used.
Conclusion: This case highlights the importance of the clinical diagnosis of perioral dermatitis in young children, of excluding other diagnoses and worthless treatments, and also the chronic evolution of the disease and its individualized treatment.
Anca E. Chiriac, Adrian Naznean, Cristian Podoleanu, Simona Stolnicu and Anca Chiriac
Superficial venous malformations can be clinically diagnosed since birth as localized, bluish or purple lesions, especially on the lower extremity, but deep venous malformations are difficult to diagnose only by clinical appearance. The diagnostic algorithm for superficial venous malformations in newborns includes clinical examination and Duplex ultrasonography. The latter allows differentiating tumors (hemangiomas) from vascular malformations and evaluating flow characteristics as well as localizing the site of the malformation.
Anca Chiriac, Piotr Brzezinski, Anca E. Chiriac, Marius Florin Coroș, Cosmin Moldovan, Cristian Podoleanu and Simona Stolnicu
Introduction: The aim of this presentation is to highlight the usefulness of high-frequency ultrasound (18 MHz) in localized morphea for: identification of the lesion, guided skin biopsy, quantification of skin thickness, evaluating the severity by measuring total echogenicity.
Case presentation: A 62-year-old Caucasian woman was referred to the Dermatology Department for a well-circumscribed indurate plaque localized on the right side of the abdominal wall and thigh. On clinical examination, a large well-delimited, indurate plaque, silvery in the center and surrounded by a purplish-red halo (lilac ring) was noticed on the right side of the abdomen and thigh. An ultrasound-guided punch biopsy was carried out and the microscopic examination of the biopsy revealed moderate interstitial inflammatory infiltrate together with abundant collagen bundles in the dermis and subcutis and a diagnosis of localized morphea (scleroderma) was established. Ultrasonography was performed and skin thickness was measured using high-frequency US (18 MHz) and was found to be 3.1 mm to 3.9 mm.
Conclusion: high frequency ultrasound is an inexpensive, easy to perform, noninvasive method, replacing surgical biopsy and offering a valuable quantification of skin fibrosis.
Anca Chiriac, Piotr Brzezinski, Liliana Foia, Horațiu Moldovan, Cristian Podoleanu, Adrian Năznean and Simona Stolnicu
Granuloma annulare (GA) is a granulomatous skin condition that can present with a diversity of clinical manifestations and locations, with an unknown etiology and diagnosed on clinical-pathological grounds/correlations. Although many trigger factors have been described and several pathogenic mechanisms proposed, the etiology of GA remains unknown. We report a case of work-related, isolated, unilateral GA localized on the right palmar area of a young worker, possibly induced by work-related direct trauma.
Anca E. Chiriac, Doina Azoicai, Anca Chiriac, Adrian Naznean, Francesca Larese Filon, Simona Roxana Georgescu, Liliana Foia, Cristian Podoleanu and Simona Stolnicu
Occupational skin diseases have an unknown prevalence in Romania, although they are considered the most frequent occupational diseases reported in Western European countries. Self-reported hand eczema among healthcare providers by questionnaire aims to estimate the prevalence of work-related hand eczema and associated risk factors in hospitals and outpatient units in Romania. The aim of this study is to discuss and to validate a questionnaire for surveying work-related skin diseases and exposure among healthcare providers.
Rareş Georgescu, Orsolya Bauer, Marius Coroş, Rareş Barbat, Daniela Podeanu, Adela Oprea, Andreea Păscutoi, Adrian Naznean and Simona Stolnicu
Introduction: Sentinel node biopsy is the gold standard for axillary assessment of patients with breast cancer without axillary metastases on clinical and radiological examination. Internationally accepted biopsy methods currently use a radioactive tracer (Te) or different variations of vital stain, or the combination of the two. Due to the high cost of technical and organizational difficulty related to the radioactive material, as well as the disadvantages of using the vital stain method, great effort is being made to find alternative solutions. The aim of this study was to determine the effectiveness of the exclusive use of vital stain versus the radioactive isotope, and the need to use the combined method. A second goal was the comparative analysis of the radioactive method and intraoperative assessment of suspicious (non-sentinel) lymph nodes.
Materials and methods: This article is based on a prospective nonrandomized study conducted on 69 patients with early breast cancer in whom the combined method was used (injection of radionuclide and methylene blue vital stain). The comparatively monitored parameters were the following: the total and mean number of excised sentinel lymph nodes, the number of metastatic ganglia revealed by the 2 methods, and the risk of understaging in case only one technique was used.
Results: We excised 153 sentinel nodes identified by the radioisotope method. Of these only 56 were stained with methylene blue (p <0.0001). We could also identify a significantly higher number of metastatic nodes with the aid of the radioactive method (p = 0.0049). Most importantly, a significant number of patients (57.14%) who would have been declared node-negative using vital staining could only be properly staged using the radionuclide or the combined method. On microscopic examination of 35 non-sentinel lymph nodes, we found 3 lymph nodes with metastases, and in 1 case the metastases were found only in the non-sentinel lymph node.
Conclusions: Given the risk of understaging, exclusive use of the vital stain method is not recommended, especially under the ASGO Z 00011 Protocol, since the more accurate determination of the number of metastatic sentinel lymph nodes in a patient influences the decision whether to perform lymphadenectomy or not. Using the combined method confers benefits only during the learning curve, in our database we found no stained nodes which were not radioactive. It is very important that the intraoperative stage uses the radioactive method and the intraoperative assessment of suspicious lymph nodes, because 35 non-sentinel lymph nodes were identified in our study, 3 of which had metastases, while in 1 case the metastases were in the non-sentinel lymph node.
Călin Molnar, Alexandru Vizitiu, Karoly Deak, Cristian Russu, Adrian Tudor, Bogdan Suciu, Simona Stolnicu, Marius Hulub and Claudiu Molnar
Hydatid cyst involving the spleen is a rare clinical condition (0.5-4%). We report a case of multi-parasitic infection in a 62 year old female (hydatid cyst and ascaris lumbricoides infestation), confirmed during surgery. The purpose of the paper is to emphasize on the rare association of the two parasitic infections, affecting two different organs (spleen and jejunum). The combined symptomatology of the two parasites could mimic an acute surgical abdomen.