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Habronemosis, also known as habronemiasis or habronematidosis, is a parasitic disease of equids caused by the larval stages of Habronematidae nematodes (Habronema muscae, Habronema microstoma, and Draschia megastoma) that are transmitted by muscid flies. The presence of aberrant infective larvae in the cutaneous and conjunctival tissues of these hosts results in granulomatous, exudative, and ulcerated lesions, also known as "summer sores." In this study, we present a retrospective analysis of habronemosis cases in horses from the municipality of Lages, located on the Santa Catarina Plateau, a region with high altitudes and a temperate climate that differs from regions of Brazil where such parasitosis usually occurs. The equids were examined from 2008 to 2020 at the Veterinary Hospital of Santa Catarina State University. Sixteen patients were diagnosed and treated using macrocyclic lactones and wound cleaning. Most cases were recorded in autumn in horses (10/16, 62.5%) over 15 years of age (11/16, 68.8%), and the lesions were more frequently located in the conjunctiva (11/16, 68.8%). In scientific dissemination media, this is the first report of habronemosis on the Santa Catarina Plateau, Brazil. This information will contribute to the diagnosis, treatment and prevention of skin diseases in horses in this region.

Cutaneous amebiasis is a rare clinical entity caused by the invasive protozoan parasite Entamoeba histolytica that can be readily diagnosed with skin biopsy if suspected. It presents as a rapidly progressive and destructive ulceration with necrosis. A man in his 40s with metastatic rectal cancer who underwent palliative abdominal perineal resection with end colostomy in his left lower quadrant and on systemic chemotherapy developed progressive breakdown of his peristomal skin unresponsive to antibiotics that was then diagnosed to be cutaneous amebiasis. It is important to be aware of cutaneous amebiasis and include it in the differential diagnosis when peristomal wounds do not respond to treatment., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Dermoscopy is an essential in vivo diagnostic technique in the clinical evaluation of skin tumors. Currently, the same can also be said about its implications when approaching different clinical situations in Dermatology. A growing number of reports on dermatological scenarios and diseases have been published, in which dermoscopy has been of great diagnostic help. The term "entomodermoscopy" was coined to describe dermoscopic findings in skin infestations and also in dermatoses of infectious etiology. In part I of this article, the main dermoscopic descriptions of zoodermatoses and bacterial infections will be addressed. In many of them, such as scabies, pediculosis, myiasis, and tungiasis, it is possible to identify the pathogen and, consequently, attain the diagnosis more quickly and use the technique to follow-up therapeutic effectiveness. In other situations that will be described, dermoscopy can allow the observation of clinical findings with greater detail, rule out differential diagnoses, and increase the level of confidence in a clinical suspicion., (Copyright © 2021 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U. All rights reserved.)

Increased migration, the omnipresent desire to travel, climate change and a globally more mobile population enhance the risk of spreading infectious, tropical pathogens across international borders. In addition to diarrhea and fever, skin diseases present one of the most common reasons for a medical consultation upon return among travelers. These diseases are often caused by parasites. Detailed data on infectious travel diseases is scarce. However, demographic, endemic and travel-related information represent the basic requirements for physicians to choose appropriate diagnostics and adequate treatment for affected patients. This article gives an overview of common parasitic travel dermatoses, their specific diagnostic workup, treatment and preventive measures.

Cysticercosis is a neglected tropical disease set as health priority by WHO. Most of the reported cases included isolated types of cysticercosis affecting the skin, the eyes or the brain . Disseminated types, however, are rare. We here report a case of disseminated cysticercosis affecting the brain, the eyes and the skin in a Senegalese female patient aged 66 years admitted with headaches and chronic seizures. Clinical examination showed cerebellar syndrome associated with generalized and painless nodular subcutaneous lesions. Diagnosis was confirmed based on histopathological examination of skin biopsy which showed cysticerci. Patient's outcome was good under albendazole therapy., Competing Interests: Les auteurs ne déclarent aucun conflit d’intérêts., (Copyright: Bruce Shinga Wembulua et al.)

General Purpose: To provide information about infection with cutaneous larva migrans (CLM)., Target Audience: This continuing education activity is intended for physicians, physician assistants, NPs, and nurses with an interest in skin and wound care., Learning Objectives/outcomes: After participating in this educational activity, the participant will:1. Distinguish the clinical features, diagnosis, and management of CLM.2. Explain the epidemiology of CLM., Abstract: Cutaneous larva migrans is a hookworm infection and one of the most common skin diseases of tourists in tropical countries. Most commonly, the infection is transmitted by contact with feces of dogs and cats containing hookworm eggs. This case-based review explores the epidemiology, diagnosis, clinical features, and management of cutaneous larva migrans infection.

Toxocariosis is a parasitic disease caused by the larvae from genus Toxocara sp. There are two classic syndromes described for this entity: visceral larva migrans and ocular larva migrans, depending on larvae localization. Human being behaves as an accidental host in which Toxocara sp. does not become an adult worm. This infection is generally asymptomatic but clinical manifestations can be diverse, and they vary according to number and localization of entrenched larvae and host's immune system. In the last years it has been studied a relation between Toxocara sp. and some cutaneous manifestations. We describe the case of a 19-month infant with visceral larva migrans and cutaneous manifestations from vasculitis, explaining its form of presentation, evolution, diagnose and treatment., Competing Interests: None, (Sociedad Argentina de Pediatría.)

Cutaneous larva migrans (CLM) also termed as "creeping eruption," is a parasitic infestation produced by burrowing of the larva of Ancylostoma braziliense. The larva enters intact or abraded skin following exposure with soil contaminated with faeces. Solitary tracts involving feet, hands, buttocks, and genitalia are usually encountered. Although CLM is an endemic tropical disease, in this era of global migration, physicians worldwide should promptly diagnose and treat the condition., (Copyright © 2020 Elsevier Inc. All rights reserved.)

We present a case of subcutaneous dirofilariasis, a vector-borne zoonotic disease, in a young woman from Austria. The diagnosis was confirmed by ultrasound and histology of the excised subcutaneous nodule. The parasite species was identified as Dirofilaria repens by polymerase chain reaction. We expect to see more cases of human dirofilariasis also due to climate change and associated increase of the spectrum of suitable mosquito vectors.

Proliferative sparganosis is one of the most bizarre and mysterious parasitic diseases ever described. The causative parasite is Sparganum proliferum, which is a pseudophyllidean cestode distinct from Spirometra tapeworms. Here we overview this rare but fascinating disease with the all original case reports on human patients published in the last 115 years. Proliferative sparganosis is clearly divided into two disease types, cutaneous and internal proliferative sparganosis. Cutaneous type starts with a skin eruption caused by the dermal invasion of a sparganum. Skin lesion progresses to larger areas of the body if left untreated. Various internal organs and body wall can be eventually affected. The clinical symptoms of patients in this group are very similar to each other. Molecular data suggest that cutaneous proliferative sparganosis is caused by S. proliferum of which genetic variation is limited, regardless of the time or localities of the emergence of patients. Internal proliferative sparganosis, on the other hand, is much more heterogeneous. Some cases show aggressive infection in internal organs, while others show only restricted lesions. Some of the cases that had been cited as proliferative sparganosis in the past literature were removed from the list, because they were judged as cyclophyllidean tapeworm infections. DNA sequencing is mandatory for the definite diagnosis of proliferative sparganosis. The Venezuelan strain of S. proliferum is maintained in experimental mice in Japan, which is fully prepared for the experimental study with advanced technologies in modern molecular biology., (Copyright © 2019 The Author(s). Published by Elsevier B.V. All rights reserved.)

Purpose of Review: The aim of the article is to review the most recent evidence concerning parasitic skin infections., Recent Findings: Parasitic skin infections are increasingly reported worldwide. Special at-risk categories are migrants, returning travelers, and immunocompromised individuals, who are at higher risk to present disseminated disease. The number of reported cases is growing even outside the endemic areas as a consequence of international travels, migration flows, increasing immunocompromised population, climate change, and natural disasters., Summary: Skin parasitoses are neglected infections. Funding assigned to prevent and treat them is limited, even if they affect millions of persons worldwide. Diagnosis could be a challenge for clinicians of high-income countries who are facing an increasing number of such infections related to great epidemiological events.

These are cutaneous diseases caused by insects, worms, protozoa, or coelenterates which may or may not have a parasitic life. In this review the main ethological agents, clinical aspects, laboratory exams, and treatments of these dermatological diseases will be studied., (Copyright © 2020 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U. All rights reserved.)

Myiasis represents a group of neglected tropical diseases caused by the infestation of vertebrate tissues by dipterous larvae. We herein report an imported case of foruncular myasis caused by Dermatobia hominis in Mexico City. The species was confirmed by DNA sequencing and phylogenetic reconstruction analysis.

Enterobiasis is the most common parasite infestation in children; it is often asymptomatic and may rarely be a cause of skin eruption. We present the case of a 7-year-old boy with sudden onset of pruritic erythemato-squamous confluent papules and plaques on UV-exposed skin, caused by proven enterobiasis. To our understanding, this is the first case of photodermatosis-like dermatitis caused by enterobiasis reported in the literature.

Background: Potassium hydroxide preparations (KOH) and tissue examinations for ova and parasites (O&P) are cost-effective office-based tests. No studies have quantified their utilization and economic impact., Methods: The objective is to determine the billing patterns and costs of office-based diagnostic procedures in the Medicare population. We conducted a cross sectional study using the Part B National Summary Data File (2000-2016) and the Physician and Other Supplier Public Use File (2012-2015) released by the Centers for Medicare & Medicaid Services., Results: In 2016, the total number of claims among all providers was 28,432 (KOH) and 52,182 (O&P), representing a decrease since 2000 (KOH, -41.8%; O&P, -43.4%). The total claims for in-office procedures by dermatologists per 10,000 beneficiaries decreased between 2012 and 2015 (KOH, -18.8%; O&P, -26.6%). Fewer dermatologists submitted claims for the tests (KOH, -11.3%; O&P, -16.6%). The total single (SB) and multiple (MB) biopsy claims by dermatologists per 10,000 beneficiaries decreased between 2012 and 2015 (SB, -1.8%; MB, -2.7%). The 2016 aggregate payments (% change since 2000) for KOH and O&P were $163,127.75 (-60.4%) and $299,074.18 (-61.6%), respectively; for SB and MB, they were $240,047,487.98 (+142.3%) and $38,214,117.22 (+79.2%), respectively., Conclusion: Fewer dermatologists submit claims for KOH and O&P each year. Future studies should evaluate whether this is due to a loss of cost-efficacy, and secondly, if it is related to decreased reimbursement, burdensome in-office laboratory regulations, or changing provider preferences., (© 2019 The International Society of Dermatology.)

Swimmer's itch, or cercarial dermatitis, is a waterborne non-communicable skin condition caused by schistosome cercariae released by aquatic snails. Cercarial dermatitis appears worldwide, but may be caused by different trematode species. The itchy maculopapular rash develops on exposed areas of the skin and typically resolves within 1-3 weeks. Shedding of infective larvae from snails is temperature dependent, and high temperatures and sunshine increase the risk of encountering the parasite and becoming infected. The unusually warm spring and summer of 2018 led to an increasing number of reports of the condition in Denmark and established a collaboration between the Department of Dermatology and the Faculty of Health and Medical Sciences, Department of Veterinary and Animal Sciences. This study explored the clinical picture of the disease, and demonstrated the occurrence of infected fresh water snail species in selected Danish water bodies. In conclusion, a risk of swimmer's itch in Denmark was confirmed.

Background: Chagas disease (CD) is caused by the protozoan parasite Trypanosoma cruzi and is transmitted by triatomine insects. Clinical manifestations vary according to the phase of the disease. Cutaneous manifestations are usually observed in the acute phase (chagoma and Romaña's sign) or after reactivation of the chronic phase by immunosuppression; however, a disseminated infection in the acute phase without immunosuppression has not been reported for CD. Here, we report an unusual case of disseminated cutaneous infection during the acute phase of CD in a Mexican woman., Methods: Evaluation of the patient included a complete clinical history, a physical exam, and an exhaustive evaluation by laboratory tests, including ELISA, Western blot and PCR., Results: Skin biopsies of a 50-year-old female revealed intracellular parasites affecting the lower extremities with lymphangitic spread in both legs. The PCR tests evaluated biopsy samples obtained from the lesions and blood samples, which showed a positive diagnosis for T. cruzi. Partial sequencing of the small subunit ribosomal DNA correlated with the genetic variant DTU II; however, serological tests were negative., Conclusions: We present a case of CD with disseminated skin lesions that was detected by PCR and showed negative serological results. In Mexico, an endemic CD area, there are no records of this type of manifestation, which demonstrates the ability of the parasite to initiate and maintain infections in atypical tissues .

Ticks are well-documented human parasites and vectors of infectious disease. The larval ("seed") stage is 1 of 3 motile life stages, and larval ticks have been known to attack in droves, causing diffuse pruritic erythematous papules and pustules. In the absence of close examination, larval tick infestation can easily be missed in the wide differential for this clinical presentation. We present 2 cases of larval tick infestation occurring during the summer within the same month at a single institution. Our purpose is to encourage physicians to include larval tick infestation when generating a differential diagnosis for diffuse pruritic erythematous papules and pustules.

Background: The polymorphic clinical presentations of schistosomiasis and leishmaniasis allow their inclusion in the differential diagnoses of several conditions. Although an overlap in distribution of these diseases has been reported in endemic areas, coinfection with cutaneous schistosomiasis and cutaneous leishmaniasis in the same patient is rare., Objectives: We report an unusual case of concomitant cutaneous schistosomiasis and cutaneous leishmaniasis. Actions for the management and diagnosis were proposed., Methods: A patient presented with cutaneous lesions on the abdomen and left elbow. The presence of degenerated ova of Schistosoma mansoni in the skin biopsy led to perform a complementary investigation with immunohistochemical techniques, rectal biopsy and abdominal ultrasonography. After the left elbow lesions had failed to improve after several weeks of standard treatment, a new biopsy was performed and led to diagnosis of another infection., Results: The patient lived in an endemic area for two infectious diseases (schistosomiasis and leishmaniasis). Biopsies revealed chronic granulomatous dermatitis. Degenerated S. mansoni eggs were found in the abdominal lesion and in a rectal biopsy specimen. Ultrasonography revealed hepatic involvement. Despite combination treatment with oxamniquine and praziquantel, a cutaneous lesion persisted on the left elbow; a new biopsy revealed amastigote forms of Leishmania. The patient was successfully treated with intramuscular and intralesional meglumine antimoniate., Conclusions: The presence of a similar granulomatous infiltrate in lesions caused by the two different infectious agents led to a delay in the diagnosis of cutaneous leishmaniasis. This report serves as a warning of the unusual possibility of cutaneous schistosomiasis and leishmaniasis coinfection in an endemic area., (© 2019 European Academy of Dermatology and Venereology.)

Cutaneous gnathostomiasis (CG) is a disease caused by ingestion of third-stage Gnathostoma larva in raw snakes, freshwater fish or frogs. The common causative organisms of CG in Japan include G. nipponicum, G. spinigerum, G. doloresi, G. binucleatum and G. hispidum. We report two cases of CG after eating many raw Japanese icefishes (Salangichthys microdon). In both cases, linear itchy eruptions on the trunk developed after eating many S. microdon. We performed genetic analysis in the first case, which revealed G. nipponicum. Of note, this is the first case of CG diagnosed based on genetic analysis in Japan. In Japan, eating whole small raw freshwater fish is common. The most popular types of raw small freshwater fish consumed in Japan are S. microdon (shirauo in Japanese) and Leucopsarion petersii (shirouo in Japanese). Usually, S. microdon are born in rivers, but live in both the sea and rivers. They feed on small fish and freshwater water fleas and spawn in rivers in the spring. On the other hand, L. petersii are born in rivers, but move to the sea soon after hatching. They feed on plankton such as copepod in the sea. They do not feed on anything when they return to rivers to spawn in the spring. Therefore, we hypothesize that S. microdon are more easily parasitized by G. nipponicum., (© 2019 Japanese Dermatological Association.)

Myiasis is a common travel-associated dermatosis. We describe a 52-year-old Italian man who acquired Dermatobia hominis when bitten by a mosquito during a visit to Argentina. He had a painful nodular lesion on the left cheek that had been present for about 3 weeks. The complete removal of the larva is the goal of medical treatment. Prescription of antibiotics to avoid secondary infections is not recommended. For psychological reasons and due to the failure of previous therapies, the lesion was excised. Travelers to endemic areas should be informed of preventive measures to reduce mosquito bites and transmission of the infestation., (© 2019 Wiley Periodicals, Inc.)

An-eighteen months (one and half years) old heifer was presented with a progressive loss of weight leading to cachexia and was attended to by a team of doctors from the ambulatory clinic of the School of Animal Science and Veterinary Medicine, University of Rwanda. Clinical examination revealed scleroderma of both sides of the neck and pinpoint cysts in the sclera and conjunctiva as well as corneal opacity of the left eye. Histological examination of skin biopsy showed a mononuclear dermatitis with several cysts of 100-300 μm filled up with bradyzoites in the subcutis and dermis. These lesions are consistent with bovine besnoitiosis, a disease caused by Besnoitia besnoiti in cattle. To the best of our knowledge, this is the first confirmed case of bovine besnoitiosis in Rwanda., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Introduction: Onchocerciasis is caused by Onchocerca volvulus and mainly leads to pruritus and skin and visual disorders, including blindness. Seventeen million people are infected in 38 countries; 31 of these are in sub-Saharan Africa, six in Latin America and one on the Arabian Peninsula. More than 99% of cases occur in sub-Saharan Africa where 120 million people are at risk of infection. Eye disorders have been well-documented; however, skin disorders have not been described accurately. The objective of our study was to describe the epidemiology, main skin manifestations and treatment of imported onchocerciasis., Material and Methods: A retrospective study was thus conducted by analysing the main demographic, clinical and treatment data regarding a cohort of 400 patients attending a reference clinical unit over a 17-year period., Results: Most patients were female (55%) with mean age 37.5±16.7 years. All the migrants came from sub-Saharan countries. The most frequently occurring dermatological symptom was pruritus. Ivermectin had been used as first-line therapy and adverse reactions had been described in 11 patients (3.2%)., Conclusions: The results indicate the fact that there should be a clinical suspicion of onchocerciasis regarding immigrants from endemic areas having skin lesions compatible with the disease's profile or asymptomatic patients having eosinophilia or unexplained high IgE. Moreover, skin snips from the buttocks region were very fruitful and treatment with ivermectin was seen to be safe. This is the largest case series regarding imported onchocerciasis described up to the present time., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Common household insects can be confused with ectoparasites. Understanding the basic identification and monitoring techniques of clothes moths will help the clinician identify if a patient has an infestation of the household versus his/her body. Clothes moth larvae are not parasites but are found on infested clothing and can be confused with myiasis.

The aim of this study was to determine the epidemiological and clinical profile of cutaneous parasitosis in Lomé, Togo. Of the 71422 patients seen in 3 dermatology departments during the study period, 1217 (1.7%) had cutaneous parasitosis, 98% of them ectoparasitosis.

This article aimed to gather male genital dermatoses that may lead to consult a urologist, except pre-neoplastic or neoplastic lesion., Method: This review is based on a research on Pubmed and EM-consult database, in English and in French, using the following key terms "male genital dermatoses", "male genital lesions", "balanitis", "balanoposthitis", "dermatoses des organes génitaux externes masculines", "lésions des organes génitaux externes de l'homme", "balanoposthites"., Results: It highlights normal morphological aspects, acute balanoposthitis (nonspecific, infectious, allergic, irritative and traumatic), common skin disease localized to male genital and male genital specific dermatoses., Conclusion: Any suspicious, fixed, must lead to a skin biopsy., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Gnathostomiasis is a parasitic infection caused by the third larval stage of nematodes of the genus Gnathostoma. The disease is endemic in some countries around the world. In the American continent, the majority of cases is concentrated in Mexico, Ecuador, and Peru. However, due to increasing traveling either at the intercontinental or intracontinental level, the disease is seen each time more frequently in tourists. Furthermore, countries, such as Brazil, that have never been considered endemic are reporting autochthonous cases. The disease usually presents as a deep-seated or slightly superficial migratory nodule in patients with history of eating raw fish, in the form of ceviche, sushi, or sashimi. Along with the clinical presentation, diagnostic criteria include either blood or tissue eosinophilia. In most instances, these criteria are enough for the attending physician to institute therapy. Chances of finding the parasite are low, unless the biopsy is taken from a very specific area that develops after antiparasitic treatment is started. The potential of other organ involvement with more serious consequences should always be kept in mind.

Skin abscesses are commonly seen by primary care physicians in the outpatient setting. The majority of these soft tissue infections arise from penetration wounds by inanimate objects, but rarely, a living organism may present as a contributing factor. We present a case of an 11-year-old boy with an unusual skin abscess containing a chequered periwinkle marine snail ( Littorina scutulata ). The unique characteristics of this intertidal mollusk appear to have enabled it to survive in the subcutaneous tissue for a week, despite the hostile environment of a skin abscess. This case emphasises adherence to current professional guidelines that recommend incision and drainage of suspected skin abscesses and encourages clinicians to take a careful history of present illness which may aid in identification of subsequent cases of marine snails, or other living organisms, residing in skin abscesses., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Cutaneous infections and infestations are common among children and adolescents. Ectoparasitic infestations affect individuals across the globe. Head lice, body lice, scabies, and infestations with bed bugs are seen in individuals who reside in both resource poor areas and in developed countries. Superficial cutaneous and mucosal candida infections occur throughout the life cycle. Dermatophyte infections of keratin-containing skin and skin structures result in tinea capitis (scalp), tinea corporis (body), tinea pedis (foot), and tinea unguium (nails). Less frequent endemic fungal infections such as blastomycosis, coccidiodomycosis, and histoplasmosis may present with skin findings. This article will describe the epidemiology and transmission of these conditions as well as their clinical manifestations. The approach to diagnosis will be addressed as well as primary prevention and current therapies., (Copyright © 2018 Mosby, Inc. All rights reserved.)

Cutaneous myiasis is the infestation of the skin or mucous membranes by larvae of the order Diptera. Wound myiasis affect the skin with a previous lesion, and it may consume both dead and living tissue. Finger infestation is rarely a cause of death, but it may provoke considerable morbidity. Prompt wound exploration and careful total larvae removal is essential to achieve healing. In the reported case, the patient was presented in an advanced stage of the infestation, with a large area of finger necrosis and amputation, associated with cellulitis extending from the finger's base to the hand. This diagnosis helped uncover a familiar history of severe abuse and neglect. The accurate understanding and management of such injuries are important not only for the orthopaedic treatment but also for the acknowledgment of their social and forensic implications., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Dirofilariasis is a worldwide zoonotic infection that rarely affects humans and is caused by filarial nematodes of the genus Diroflaria transmitted by mosquitoes. Cutaneous dirofilariasis, due to D. repens, presents as inflammatory lesions that develop into subcutaneous nodules. These clinical symptoms may be consistent with Wells' cellulitis. Diagnosis of dirofilariasis involves demonstration of the presence of the nematode during skin biopsy and identification of the worm through macroscopic, histological and PCR analysis. Surgical resection of the nodule remains the gold standard treatment. The number of cases of human cutaneous dirofilariasis has increased in the recent years and the disease must not be misdiagnosed., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

A 39-year-old man who was returning from the Amazon Jungle and had no medical history presented with a furuncular lesion on his right parietal scalp. Despite receiving appropriate antimicrobial treatment, his lesion did not heal. After surgical intervention, a Dermatobia hominis larva was extracted. The human botfly D. hominis is the most common causative agent of furuncular myiasis among travelers returning from Central and South America. Surgery is the main treatment option, and secondary bacterial infection should be kept in mind.

Patients with delusional infestation frequently bring specimens and examining these specimens is important in establishing a therapeutic relationship. The minute brown scavenger beetle is a member of the family Latridiidae. It is found in moist environments and feeds on mold. It poses no threat to humans, but it is important that dermatologists recognize it because it may be contained in specimens brought by patients.