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  Practising dermatology in the South Pacific - Figures

Figure 1: Tinea corporis often affected more than 20% of the body surface. Trichophyton rubrum was cultured from 17 of the 38 patients from whom skin scrapings were taken. (Because of the difficulty of growing these fungi from skin scrapings, only about 30%-50% of specimens are expected to be culture-positive.1,2) Tinea imbricata, a dermatophyte infection with a distinctive concentric annular scaling pattern, was seen in four Vanuatu patients and confirmed in one patient by culture of Trichophyton concentricum.

Figure 2: Tinea versicolor, an infection with the yeast Malassezia furfur, occurs worldwide. In temperate zones, the rash is usually confined to the torso, but in tropical areas it is often very extensive (as above). In our patients, the distinctive scaly, hypopigmented patches were often also evident on the face, neck and forearms and a source of cosmetic disability.

Figure 3: Tinea corporis (neck) and tinea versicolor (shoulders).

Figure 4: Chronic discoid lupus erythematosus presenting with striking skin depigmentation.

Figure 5: Hypertrophic plaques of psoriasis.

Figure 6: Epidermolytic hyperkeratosis, a rare autosomal dominant condition characterised by generalised foul-smelling, fissured hyperkeratotic skin, which leads to profound social isolation. This condition was diagnosed in three teenage girls, one in Samoa and two in Vanuatu. The treatment (oral retinoid) requires close monitoring, and its cost is beyond the means of these countries.

Figure 7: Tuberculoid leprosy in a 24-year-old Samoan woman with a seven-month history of expanding plaque on the cheek. Note the thickened accessory nerve coursing over the sternomastoid muscle. This was the only patient with undiagnosed leprosy. Two others were undergoing treatment for known leprosy.

Figure 8: Lichen amyloidosis, a distinctive chronic pruritic eruption of scaly pigmented papules on the legs, was diagnosed in 15 patients, all Polynesian Samoans. The cause of this condition is unknown, but racial factors are important. It has been described in South East Asians, who have the same racial origin as Polynesians.

©MJA 1998