P1132Clinical efficacies of topical agents for the treatment of seborrheicdermatitis on the scalp

Hee Chul Eun, MD, Seoul National University, College of Medicine, Seoul, SouthKorea

Previous studies have shown that topical steroids and shampoo containing zincpyrithione provide clinical benefits for treatment of scalp seborrheic dermatitis. Butthe clinical efficacy of topical tacrolimus, a newly developed calcineurin inhibitor,on seborrheic dermatitis is not well investigated. We wanted to compare the clinicalefficacy of topical tacrolimus with that of conventional treatment (zinc pyrithioneshampoo and topical betamethasone) for the treatment of seborrheic dermatitis onthe scalp. Patients with seborrheic dermatitis on the scalp were randomly allocatedto receive topical betametasone, topical tacrolimus, or zinc pyrithione shampoo.Some patients were instructed to continue the treatments for 8 weeks and the othersto discontinue the treatments at week 4. We have evaluated the efficacy usingclinical severity score, dandruff score, and sebum secretion at baseline and weeks 4and 8. All treatment groups showed significant improvements respectively inclinical assessment after 4 weeks. After cessation of the treatment, the patients whowere treated with betamethasone lotion or tacrolimus ointment were aggravatedclinically. The patients treated by zinc pyrithione improved continuously even aftercessation of the treatment. Topical tacrolimus was as effective as topical betameth-asone, and showed more prolonged remission than topical betamethasone. To treatseborrheic dermatitis on the scalp, we think the combination therapy of topicalsteroid and zinc pyrithione is recommended. Although topical tacrolimus is aseffective as topical steroid, its vehicle should be modified for the treatment on thescalp.

Commercial support: None identified.

P1130A case of autochthonous cutaneous larva migrans in Spain

Juan Luis Santiago, MBChB, Ramon y Cajal Hospital, Alcala de Henares University,Madrid, Spain; Lorea Bagazgoitia, MD, Ramon y Cajal Hospital, Alcala de HenaresUniversity, Madrid, Spain; Pedro Jaen, PhD, Ramon y Cajal Hospital, Alcala deHenares University, Madrid, Spain; Sonia Bea, MD, Ramon y Cajal Hospital, Alcalade Henares University, Madrid, Spain

Introduction: Cutaneous larva migrans results from the migration of hookwormlarvae in the skin of dead-end human host. The disease mainly occurs in resource-poor communities in tropical areas, but it also reported sporadically in high-incomecountries and in tourists who had visited the tropics. Autochthonous cutaneouslarva migrans syndrome is rare in Spain and other temperate countries. However,one case of this syndrome was diagnosed in a patient from Madrid, Spain, in thesummer of 2007.

Case report: A 31-year-old femalen developed multiple erythematous, serpiginouspruritic tracts moving 1- to 2-cm per day over and existing cutaneous plaque on thebuttocks. Exposure to the infective larvae in endemic areas and close contact withanimals were excluded. She had visited Pirineos mountains and took a bath in a river,lying on the soil after the bath. Diagnosis was made clinically in the presence ofserpiginous and moving skin tracts associated with intense itching on exposedcutaneos areas of buttocks and legs. She was treated with systemic albendazole, witha good and rapid response.

Discussion: This case demonstrates that the conditions leading to the developmentof cutaneous larva migrans are rarely found simultaneously in temperate zones ofEurope. Rapid diagnosis and treatment with systemic albendazole may control theinfestation and improve the symptoms.

Commercial support: None identified.

P1131Psychologic aspects of women who underwent cellulite treatments:Pilot study

Doris Hexsel, PhD, Brazilian Center for Studies in Dermatology, Porto Alegre, RS,Brazil; Cristiano Brum, MD, Brazilian Center for Studies in Dermatology, PortoAlegre, RS, Brazil; Rosemarie Mazzuco, MD, Brazilian Center for Studies inDermatology, Porto Alegre, RS, Brazil; Ticiana Costa Rodrigues, MD, PhD,Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil

Background: Cellulite is a clinical condition that affects more than 80% of womenworldwide. It was noted that those suffering from cellulite experience some day-to-day restrictions, included wearing some clothing and sexual activity, among others.These suggest the great social impact of this condition in their lives. There are noreferences in the medical literature to psychological aspects of women thatunderwent cosmetic treatments for cellulite, especially those concerning depres-sion, anxiety, and body shape symptoms and eating behavior disturbances.

Objective: The aim of this pilot study was to investigate the psychological andpsychiatry aspects concerning women that underwent cellulite treatments.

Methods: The study was conducted in accordance with Good Clinical Practice(GCP/ICH) in one research center in Brazil. All the volunteers had signed theconsent form. The study sample was composed by 20 healthy female volunteerswith ages ranged from 18 to 55 years. Patients answered a questionnaire withquestions related to symptoms of eating disorders, body image concerns, anxietyand depression, social functioning, previous psychiatry treatments, time and moneyspent with cellulite treatment, and point of view from other people concerning theircellulite, including their partners.

Results: Eighty percent of the patients reported that their partner did not payattention to their cellulite, but 10% stated that they received pressure from theirpartners to undergo cellulite treatment and to lose weight. They also reported thatthey compare themselves to remind themselves that they are not the only one withthis problem. When the body is exposed, they reported an increase in depressiveand anxious symptoms, leading to an avoidance of these situations, although nocriteria for major depressive disorder or general anxiety disorder were found in thesample. None seem to have eating disorders. One volunteer suffer from bipolardisorder and takes mood stabilizers and antipsychotic medication.

Conclusions: Considering that cellulite causes psychological suffering, the results ofthis pilot study can be useful to a better understanding and support to thepsychological and social aspects of the affected patients. A larger sample of patientsis currently being studied to support and improve these results, concerning theprevalence of eating disorders, anxiety, depression, body image disturbances, andobsessive traits.

Commercial support: None identified.

P1133An unsuspected case of leprosy

Paul F. Lizzul, University of California Davis, Sacramento, CA, United States; DavidM. Scollard, MD, PhD, National Hansen’s Disease Program, Baton Rouge, LA,United States; Jeffrey Newman, MD, PhD, University of California Davis,Sacramento, CA, United States; Maxwell A. Fung, MD, University of CaliforniaDavis, Sacramento, CA, United States

Leprosy is caused by Mycobacterium leprae. Because of the wide spectrum ofpresentations, recognition of leprosy may be delayed. A 22-year-old Filipino malepresented with a several-week history of a waxing and waning ‘‘rash’’ withassociated myalgias, arthralgias, and fever, initially diagnosed by another physicianas cellulitis and treated with cephalexin. A physical examination revealed general-ized, symmetrically distributed, well demarcated tender violaceous macules andplaques with dusky grey centers that resembled erythema multiforme. A biopsydemonstrated neutrophils and ‘‘foamy’’ histiocytes with perineural involvementconsistent with borderline lepromatous leprosy with features of erythema nodosumleprosum. Initial Fite stain revealed only rare acid-fast bacilli, but subsequent Fitestain performed by a referral laboratory revealed large numbers of organisms. Thiscase illustrates the importance of considering the diagnosis of leprosy in a patientfrom endemic regions and the possibility of having erythema nodosum leprosum inthe absence of previous treatment regimens.

Commercial support: None identified.

MARCH 2009 J AM ACAD DERMATOL AB47