P6636Tinea pedis: A variant of eczema

Kristin Hudacek, MD, Drexel Dermatology, Philadelphia, PA, United States;Carrie Cusack, MD, Drexel Dermatology, Philadelphia, PA, United States; HerbertAllen, MD, Drexel Dermatology, Philadelphia, PA, United States

We believe that tinea pedis very likely is a variant of eczema. There are many lines ofevidence to support this concept: the first that we encountered was 90% (18/20) ofpatients with the disease treated with a ceramide-containing moisturizer had theirclinical presentations and their cultures clear with just the use of that moisturizer.Further, there was no zone of inhibition when the cream was placed on a cultureplate of T rubrum indicating the cream has no antifungal effect. The next evidencewas finding staphylococci capable of producing biofilms in routine culturesbetween the toes. The ability to make biofilms was confirmed on XTT assays,Congo red cultures, and PCR for gene analysis of the biofilm-forming icad and AAPgenes. The impact of the biofilms was most prominent in eccrine ductal occlusionthat was noted on H+E and PAS stains (PAS stains the biofilm [extracellularpolysaccharide substance] positively). Toll-like receptor 2 activity was found in thestratum corneum proximal to the sweat ducts and not in its control location in thebasal zone. We have previously shown all these findings to be present in the moretypical presentations of eczema. We believe that the strateum corneum becomesaltered by the fungus instead of by the filaggrin gene (first hit); and, the sweat ductsbecome occluded by biofilm-producing staphylococci that cause activation of theTLR2s leading to activation of the innate immune system (second hit). Further,treatment with the cream helps restore the strateum corneum while the fungalcultures become negative.

APRIL 20

cial support: None identified.

Commer

P6506Treatment of pityriasis versicolor with photodynamic therapy

Luciana Abreu, MD, Prof. Rubem David Azulay Institute of Dermatology, SantaCasa de Miseric�ordia do Rio de Janeiro, Rio de Janeiro, Brazil; Andr�e RicardoAdriano, MD, postgraduate student at Prof. Rubem David Azulay Institute ofDermatology, Santa Casa de Miseric�ordia do Rio de Janeiro, Rio de Janeiro, Brazil;Bruna F�elix Bravo, MD, Prof. Rubem David Azulay Institute of Dermatology, SantaCasa de Miseric�ordia do Rio de Janeiro, Rio de Janeiro, Brazil; Luna Azulay-Abulafia, PhD, Prof. Rubem David Azulay Institute of Dermatology, Santa Casa deMiseric�ordia do Rio de Janeiro, Rio de Janeiro, Brazil; Patr�ıcia Makino Rezende,MD, postgraduate student, Prof. Rubem David Azulay Institute of Dermatology,Santa Casa de Miseric�ordia do Rio de Janeiro, Rio de Janeiro, Brazil; Regina CaszSchechtman, PhD, Prof. Rubem David Azulay Institute of Dermatology, SantaCasa de Miseric�ordia do Rio de Janeiro, Rio de Janeiro, Brazil

Background: Pityriasis versicolor (PV), a superficial fungal infection caused byMalassezia spp. is known for its recurrent character and normally treated withoral/topical antifungal drugs. However, rates of relapses, drug resistance, or adverseeffects like hepatotoxicity have been gradually frequent. Recent studies suggestphotodynamic therapy (PDT) as a helpful alternative option due to its antifungaleffect. Few studies exist regarding the therapeutic use of PDT in onychomycosis,among other superficial mycoses; but there are only 2 reports about its use in PV.

Objective: To investigate the efficacy of methyl 5-amino-levulinic acid (MAL)-PDT forPV treatment.

Methods: A pilot study enrolled a 42-year-old woman presenting a 2-year history ofasymptomatic PV lesions on the superior trunk and on the anterior neck wassubmitted to MAL cream application under 4-hour occlusion. Illumination wasperformed immediately after with non-coherent red light (light-emitting diodes,average wavelength 630 nm, light dose 70 J/cm2) for 14 minutes. Patient underwentrepeated sessions in the trunk lesion, because mycologic control examinationremained positive after 4 weeks. Afterward, 2 sessions of MAL-PDT at 4-weekinterval was performed just in the topography that have shown positive mycologictest after first PDT session, which was the trunk lesion; and only 1 PDT session wasperformed in the cervical area. Patient had returned monthly to the hospital andunderwent to mycologic control examinations and was photographed.

Results: One month after first session of MAL-PDT, both lesions had the mycologicexaminations that were negative. However, the second month evaluation had apositive result on the trunk lesion, therefore, a second session of MAL-PDTwas doneat this site. After 2 and 3 months from the beginning, the neck returned to positivefindings and only the superior trunk area (which underwent 2 PDT sessions)remained with negative mycologic control examination after 3 months ofobservation.

Conclusion: MAL-PDT could be an efficient alternative treatment option for patientswith recalcitrant PV. Though, the number of sessions must be individual andrepeated until the mycological tests remained negatives for more than 2 months; wesuggest a minimum of 2 or 3 sessions of MAL-PDT for each area. Lastly, data onantifungal MAL-PDT are limited, and further trials must be required to verify andimprove the results of this pilot study.

cial support: None identified.

Commer

13

P6850Typical case of cutaneous-lymphatic sporotrichosis with good evolutionafter treatment

Felipe Nazareth Carvalho, Federal University of Rio de Janeiro, Rio de Janeiro,Brazil; Andreia Sanches, Federal University of Rio de Janeiro, Rio de Janeiro,Brazil; David Rubem Azulay, Federal University of Rio de Janeiro, Rio de Janeiro,Brazil; I. Lyn Chan, MD, Federal University of Rio de Janeiro, Rio de Janeiro,Brazil; Nathalia Freire, MD, Rocinha Emergency Unit, Rio de Janeiro, Brazil; StellaRamos-e-Silva, MD, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

Sporotrichosis is a disease caused by Sporothrix schenckii, a dimorphic fungus mostfrequently found in regions of tropical and subtropical climate. This disease is foundin urban and rural areas, once closely associated with people who worked withplants, specially as gardeners. However, today it is observed among Brazilianpatients a significant increase in cases related to infected cats, who are an importantlink in the epidemiologic chain of this disease. A 21-year-old female patientpreviously healthy, native and dwelling in Rio de Janeiro, Brazil, presented withan ulcerated mildly painful and swollen lesion on the lateral border of the third rightfinger. Then hardened erythematous nodules appered on the ipsilateral upper limbfollowing a linear path, suggesting disease of the lymphatic vessels. Collection ofmaterial was held on the lesion of the third finger and sent for mycology. Directmycologic examination showed no presence of fungal structure. However, at theculture growth colonieswith a membranous aspect andwhite at the beginning wereobserved. Later it turned into blackish colonies, strongly suggesting the diagnosis ofsporotrichosis. Then, the patient was treated with potassium iodide. The forms ofsporotrichosis are: cutaneous, lymphatic, fixed cutaneous (cutaneous or localized),located mucosa, extracutaneous and visceral. Besides the clinic, it is very importantto show the growth of S schenckii culture, which confirms the diagnosis. Thisgrowth occurs quickly, from 3 to 5 days. Various forms of treatment for this diseaseare described. Potassium iodide, itraconazole, fluconazole and amphotericin B aredescribed in the literature to treat this illness. Despite reports of treatment-resistantcases, a saturated solution of potassium iodide remains the first option in thetreatment of sporotrichosis in Brazil because of its low cost. The optimal patientresponse to treatment, showing that the usation of this drug is still possible. Itshould be emphasized the importance of breaking the epidemiologic chain, madebehind the treatment of sick cats and burning of their bodies when death off theinfected cat occurs. Burying sick cats favors the propagation of the fungus in the soil,because this fungus can infect another cat or a human being.

cial support: None identified.

Commer

INFECTION—VIRAL

P6816Observation: A case of Merkel cell carcinoma infected by Merkel cellpolyomavirus DNA

Marigdalia Ramirez-Fort, MD, Center for Clinical Studies, Houston, TX, UnitedStates; Farhan Khan, MD, MBA, Center for Clinical Studies, Houston, TX, UnitedStates; Harrison Nguyen, Baylor College of Medicine, Houston, TX, United States;Julia Kauffman, MD, Department of Dermatology, The University of Texas HealthScience Center at Houston, Houston, TX, United States; Peter Rady, MD, PhD,Department of Dermatology, The University of Texas Health Science Center atHouston, Houston, TX, United States; Ronald Rapini, MD, Department ofDermatology, The University of Texas Health Science Center at Houston,Houston, TX, United States; Stephen Tyring, MD, PhD, Center for ClinicalStudies, Houston, TX, United States

A 61-year-old man presented to our clinic for evaluation of an erythematous scalypapule on his left lower lip that had been present for a few months. The patient isFitzpatrick skin type II and reported a moderate amount of daily sun exposure. Hehas a personal history of actinic keratosis, but he denied a personal or family historyof skin cancer. A shave biopsy of the lesion was performed. Histopathology showeda small cell malignancy in the dermis. Immunostaining demonstrated perinuclearstaining with CK20 and was also positive for synaptophysin. Staining for CD20 andchromogranin was negative. A diagnosis of Merkel cell carcinoma (MCC) was made.PCR analysis for the presence of Merkel cell polyomavirus (MCPyV) DNA in tumortissue and normal tissue from the same patient was performed. PCR resultsdemonstrated the presence of MCPyV DNA in the tumor tissue, but viral DNA wasnot found in the normal skin biopsy. Our finding supports previous reportssuggesting the role of MCV in the pathogenesis of MCC. Studies on identifyinglarge T antigen (LT) mutation, integration, and LTprotein expression will furthersupport the active role of MCPyV in our case presentation of MCC.

cial support: None identified.

Commer

J AM ACAD DERMATOL AB131