Acanthosis nigricans-like diaper dermatitis

Diaper dermatitis is a common designation for a variety of inflammatory disorders that occur in infants in the area covered by a diaper. Most commonly this disorder results from the effects of occlusion and chafing; microorganisms, especially Candida albicans, but also bacteria can play a role. The disease is represented by inflamed lesions circumscribed to convex surfaces of the pubic region, genitalia, buttocks, and upper part of the thighs or by erythema of the intertriginous areas. Tiny pustules at the periphery of the lesions are also a common sign; fully evolved or ulcerated papules or nodules or red-brown dark tumoral lesions are more rarely seen. We report three infants affected by a curious form of diaper dermatitis characterized by an acanthosis nigricans-like appearance involving the inguinal and sovrapubic folds. Histology performed in one case revealed hyperkeratosis with parakeratosis and bacteria (Enterococcus faecalis) invading the outer part of the epidermis. Lesions disappeared in all cases in a time variable from a few days to a few months with a mild topical treatment. This variety of diaper dermatitis, to our knowledge, has never been described so far

Coliti gravi ad insorgenza acuta. Metodologia diagnostica e trattamento

The aim of this paper is to define diagnostic criteria and treatment guidelines for acute colitis at first attack. This clinical syndrome begins with not-specific signs and symptoms (diarrhea, abdominal pain, fever, dehydration, weight loss and so on). In such cases a diagnosis of colitis was not previously made; the severity of the disease is widely variable and prognosis is not foreseeable before a correct etiologic diagnosis. Relaps of previously diagnosed inflammatory bowel diseases are ruled out. Early etiologic diagnosis is essential to program appropriate medical treatment and to avert the possible evolution to severe acute colitis. The Authors assess the value of several means for diagnosis and decision making (clinical features, stool examination, microbiologic and serologic findings, endoscopy, radiology, histologic findings and clinical course). Closed clinical monitoring in Intensive Care Unit of critically ill patients is recommended. A series of 43 patients operated on for persistently severe or complicated acute colitis since 1975 to 1988 is afterwards presented. Twenty-eight patients suffered from acute colitis at first attack, whereas 15 patients had relapses of chronic colitis. Significant differences between the two groups arose for the following parameters: age, operative mortality, rate of subsequent restoration of the intestinal continuity after urgent colectomy. Analysis of these data suggest a better clinical course for patients with severe acute colitis at first attack in comparison to patients affected from acute severe relapse of chronic colitis, provided the etiologic diagnosis is early and exact