Rallis E, Korfitis C, Katoulis A
… +1 more, Katsarou A
J Dermatol Case Rep
· 2013 · PMID 24133561
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BACKGROUND: Psoriasis is a chronic, immune-mediated inflammatory disease estimated approximately in 2% of the European population. Drug abuse is reported in 3-5% of the global population. MAIN OBSERVATION: We present a 4...BACKGROUND: Psoriasis is a chronic, immune-mediated inflammatory disease estimated approximately in 2% of the European population. Drug abuse is reported in 3-5% of the global population. MAIN OBSERVATION: We present a 41-year-old, cocaine-addicted patient male with severe plaque-type psoriasis treated successfully with ustekinumab. The patient received ustekinumab at a dose of 45 mg subcutaneously at weeks 0, 4 and 16 and achieved PASI 75 at week 18. CONCLUSIONS: Although several drug-abusers experience psoriasis, literature is very poor regarding the outcome of systemic treatment in those patients. In our patient no adverse effects were seen during the administration period of ustekinumab and no interactions between cocaine and ustekinumab were noticed. Nevertheless, more individuals and further studies are needed to establish the efficacy and safety of ustekinumab in the treatment of psoriasis in drug-abusers.
Saunderson RB, Garsia R, Headley AP
… +3 more, McCaughan GW, O'Toole S, Strasser SI
J Dermatol Case Rep
· 2013 · PMID 24133560
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BACKGROUND: Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe drug reaction characterised by rash, eosinophilia and systemic involvement. MAIN OBSERVATIONS: We report a case of DRESS induced by pentox...BACKGROUND: Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe drug reaction characterised by rash, eosinophilia and systemic involvement. MAIN OBSERVATIONS: We report a case of DRESS induced by pentoxifylline used for the treatment of severe alcoholic hepatitis, in a patient with longstanding caffeine intolerance. A history of intolerance to caffeine and other methylxanthines is listed as a contraindication to the use of pentoxifylline, yet this precaution is not mentioned in alcoholic hepatitis treatment guidelines. CONCLUSIONS: Prescribers should always seek a history of intolerance to caffeine and related compounds prior to use of pentoxifylline, as severe life threatening reactions can occur.
J Dermatol Case Rep
· 2013 · PMID 24133559
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BACKGROUND: Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disorder characterized by multiple venous malformations of the skin and internal organs. Oral lesions are very common and occur in over half of the p...BACKGROUND: Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disorder characterized by multiple venous malformations of the skin and internal organs. Oral lesions are very common and occur in over half of the patients with this condition. Sclerotherapy is currently the first-line treatment modality of symptomatic cases due to its high efficacy and low rate of complications. MAIN OBSERVATIONS: We report the case of a 68-year-old male with BRBNS who presented with dysphagia and difficulty with speech due to prominent oral venous malformations. After the use of sclerotherapy with ethanolamine oleate to control his symptoms, the patient exhibited severe edema of the tongue and posterior pharyngeal wall which caused constriction of his airway. The patient was intubated, and remained so for 72 hours until his edema resolved. In addition to his oral lesions, the patient also exhibited other features of BRBNS including cutaneous, soft-tissue, gastrointestinal, and neurological manifestations of disease. CONCLUSION: Physicians should be aware of the potentially life-threatening complication of severe tongue and pharyngeal edema when using sclerotherapy for the treatment of oral vascular malformations. Additionally, dermatologists should be familiar with the many systemic manifestations which can be present in patients with BRBNS, as illustrated in this case.
J Dermatol Case Rep
· 2013 Jun · PMID 23858347
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Nevus lipomatosis superficialis is a rare, asymptomatic hamartoma of skin. We report 3 adult patients with NLS of Hoffmann - Zurhelle type, 2 males and a female. Two cases showed clinical peculiarities - ulceration or as...Nevus lipomatosis superficialis is a rare, asymptomatic hamartoma of skin. We report 3 adult patients with NLS of Hoffmann - Zurhelle type, 2 males and a female. Two cases showed clinical peculiarities - ulceration or association with ipsilateral gluteal hypertrophy. Reduction buttock lift was performed to improve body contour. In conclusion, nevus lipomatosis superficialis can become symptomatic. Although simple surgical excision leads to a complete cure in the majority of cases, sometimes more complex procedures become necessary.
Barreiros HM, Goulão J, Cunha H
… +1 more, Bártolo E
J Dermatol Case Rep
· 2013 Jun · PMID 23858346
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Calciphylaxis is an uncommon necrotizing dermal condition, most often related to end-stage renal disease, associated with secondary hyperparathyroidism. The incidence is 1-4% per year in dialyzed patients. The condition...Calciphylaxis is an uncommon necrotizing dermal condition, most often related to end-stage renal disease, associated with secondary hyperparathyroidism. The incidence is 1-4% per year in dialyzed patients. The condition is characterized by microcalcification of small and medium-sized blood vessels, causing cutaneous and soft tissue necrosis. The etiology of calciphylaxis is poorly understood, although many reports highlight the abnormal calcium-phosphate products as an important etiological factor. Calciphylaxis is associated with significant morbidity and mortality with estimated 5-year survival rates of less than 50%. Sepsis is the main cause of death. We report two patients of calciphylaxis treated with surgical debridement and excellent outcome in both cases.
J Dermatol Case Rep
· 2013 Jun · PMID 23858345
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BACKGROUND: Pyoderma gangrenosum is a rare neutrophilic dermatosis which leads to necrotic and painful skin ulceration. PG of the breast is extremely rare with 32 documented cases in the current literature. Delay in diag...BACKGROUND: Pyoderma gangrenosum is a rare neutrophilic dermatosis which leads to necrotic and painful skin ulceration. PG of the breast is extremely rare with 32 documented cases in the current literature. Delay in diagnosis worsens scarring as the ulcers are rapidly expanding, painful and usually slow to heal. CASE PRESENTATION: We present a case of pyoderma gangrenosum of the breast in a patient with associated rheumatoid arthritis which was initially diagnosed as an infected breast ulcer and later successfully treated with systemic steroids and intravenous immunoglobulin (IVIG). CONCLUSION: Even though PG of the breast has been gaining increased recognition over the past two decades, this has been more common in the post-surgical setting. This case highlights the need to consider PG as a differential diagnosis when faced with unsual cases of breast ulceration and the importance of multidisplinary approach for effective treatment of this condition.
J Dermatol Case Rep
· 2013 Jun · PMID 23858344
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BACKGROUND: Seborrheic keratoses are common, benign cutaneous growths, however in rare situations they can acutely erupt in large numbers. Eruptive seborrheic keratoses can be associated with internal malignancy (sign of...BACKGROUND: Seborrheic keratoses are common, benign cutaneous growths, however in rare situations they can acutely erupt in large numbers. Eruptive seborrheic keratoses can be associated with internal malignancy (sign of Leser-Trelat), but may also appear in conjunction with inflammatory dermatoses and adverse drug reactions. MAIN OBSERVATION: A 71-year-old Caucasian man presented with acute onset of a pruritic, burning papular erythematous rash on his chest, upper extremities and lower extremities after a routine adalimumab injection for rheumatoid arthritis. Two skin biopsies obtained showed findings diagnostic of seborrheic keratoses. Spontaneous resolution of the diffuse eruptive seborrheic keratoses was achieved within 3 months of discontinuing adalimumab therapy. CONCLUSIONS: We believe the development of eruptive seborrheic keratoses due to adalimumab therapy is rare, and because our patient responded promptly to discontinuation of the drug we suggest this should be the preferred course of action in future cases.
Souto MP, Matsushita Mde M, Matsushita Gde M
… +1 more, Souto LR
J Dermatol Case Rep
· 2013 Jun · PMID 23858343
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BACKGROUND: Pilomatrixoma (OMIM ID #132600) is a benign cutaneous tumor originating from the pilosebaceous follicle and characterized by the presence of subcutaneous nodules of up to 3.0 cm in diameter, usually on the he...BACKGROUND: Pilomatrixoma (OMIM ID #132600) is a benign cutaneous tumor originating from the pilosebaceous follicle and characterized by the presence of subcutaneous nodules of up to 3.0 cm in diameter, usually on the head, neck and upper extremities. It is most common in the first two decades of life and after the age of 60. MAIN OBSERVATIONS: An adult female patient was evaluated, presenting a solid tumoral lesion with erythematous surface and purplish tone, with approximately 7.5 x 5.0 cm in size, in the interscapulovertebral region. It was thought to be an epidermoid cyst, sarcoma, calcified hemangioma, giant dermatofibroma, or nodular basal cell carcinoma. The resection of the lesion was carried out and, at the histological examination, specific details were observed that led to the diagnosis of pilomatrixoma. CONCLUSION: Pilomatrixoma should be suspected in the differential diagnosis of giant adnexal tumors.
Mosel D, Harris L, Fisher E
… +2 more, Olasz E, Wilson B
J Dermatol Case Rep
· 2013 Jun · PMID 23858342
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BACKGROUND: Nocardia is an opportunistic pathogen that can cause disseminated infection in immunocompromised hosts. The most common type of skin lesion reported with disseminated Nocardia is a subcutaneous nodule; howeve...BACKGROUND: Nocardia is an opportunistic pathogen that can cause disseminated infection in immunocompromised hosts. The most common type of skin lesion reported with disseminated Nocardia is a subcutaneous nodule; however, there are reports with unusual cutaneous presentations. Long term corticosteroid treatment is one of the largest risk factors for developing disseminated Nocardia. Initial treatment is empiric as each strain has unique susceptibilities and it takes weeks to speciate and test sensitivities. MAIN OBSERVATIONS: A 66-year-old female on long term corticosteroids for systemic lupus erythematosus (SLE) and antiphospholipid syndrome presented with a polymorphous skin eruption and systemic symptoms concerning for infection. Especially concerning were areas of hemorrhagic pustules on the lower legs, and two ecthymatous lesions on the thigh. Tissue culture Gram stain revealed Gram positive branching filamentous rods concerning for Nocardia. The patient improved with empiric treatment. CONCLUSIONS: This case of Nocardiosis had unusual cutaneous findings that could have misguided the clinician, but the tissue culture and Gram stain proved to be useful for rapid diagnosis and proper treatment.
Boente Mdel C, Asial R, Primc NB
… +1 more, Happle R
J Dermatol Case Rep
· 2013 Jun · PMID 23858341
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BACKGROUND: The association of Blaschko lines with genetic mosaicism has lead to the concept that this pattern represents the manifestation of genetically abnormal skin tissue contrasting with the genetically normal skin...BACKGROUND: The association of Blaschko lines with genetic mosaicism has lead to the concept that this pattern represents the manifestation of genetically abnormal skin tissue contrasting with the genetically normal skin. Various mosaic defects affecting not only the skin but also extracutaneous tissues have lead to the description of different types of epidermal nevus syndromes. We present a further case of an unusual organoid epidermal nevus characterized by depigmented hypertrichosis. MAIN OBSERVATIONS: We describe a 2-year-old boy with a systematized angora hair nevus being characterized by bands covered with soft white hair arranged along Blaschko's lines, involving the scalp, face, and trunk. A biopsy obtained from a scalp lesion showed mild epidermal acanthosis and increased pigmentation of the basal layer. Trichoscopy the affected scalp hair demonstrated fine light coloured shafts. The boy had slight macrocephaly and body asymmetry, a sacral pit, and koilonychia of the big toes. CONCLUSIONS: The angora hair nevus is a peculiar type of organoid epidermal nevus, representing the cutaneous hallmark of a distinctive syndrome, the angora hair nevus syndrome (Schauder syndrome). In cases of epidermal nevi showing hypertrichosis, this unusual entity should be borne in mind for differential diagnosis.
J Dermatol Case Rep
· 2013 Jun · PMID 23858340
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BACKGROUND: Encephalocraniocutaneous lipomatosis (ECCL), also known as Haberland's Syndrome, is a sporadically occurring neurocutaneous syndrome with no gender or race predilection. ECCL patients present with a broad spe...BACKGROUND: Encephalocraniocutaneous lipomatosis (ECCL), also known as Haberland's Syndrome, is a sporadically occurring neurocutaneous syndrome with no gender or race predilection. ECCL patients present with a broad spectrum of clinical manifestations, often in a unilateral distribution. The hallmark of ECCL is the nevus psiloliparus, a soft, bulging, lipomatous scalp lesion, with associated alopecia. MAIN OBSERVATIONS: We describe a case of a 2-month-old Filipino male with a soft, ill-defined mass with associated alopecia on the fronto-parietal scalp. Biopsy revealed findings consistent with a nevus psiloliparus. The patient also presented with a lipomatous nodule on the right temple, as well as choristomas and a coloboma on the right eye. He had no history of seizures and development was at par with age. CONCLUSION: Recognition of ECCL is important in order to work-up the patient for concomitant problems, such as central nervous system and cardiac anomalies, and employ a multidisciplinary approach in the management of these patients.
J Dermatol Case Rep
· 2013 Jun · PMID 23858339
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BACKGROUND: Olmsted syndrome is a rare keratinization disorder characterized by a combination of periorificial keratotic plaques and bilateral palmoplantar transgredient keratoderma. Other clinical manifestations include...BACKGROUND: Olmsted syndrome is a rare keratinization disorder characterized by a combination of periorificial keratotic plaques and bilateral palmoplantar transgredient keratoderma. Other clinical manifestations include diffuse alopecia, leukokeratosis of the oral mucosa, onychodystrophy, hyperkeratotic linear streaks, follicular hyperkeratosis and constriction of digits. MAIN OBSERVATIONS: We report a case of Olmsted syndrome in a 5-year-old male presented by mutilating palmoplantar keratoderma, perioral keratoses and linear hyperkeratotic lower limb plaques. CONCLUSIONS: Olmsted syndrome is a rare genodermatosis with only 43 cases reported so far. We present another case of the disease.
Masmoudi A, Hariz W, Marrekchi S
… +2 more, Amouri M, Turki H
J Dermatol Case Rep
· 2013 Jun · PMID 23858338
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Cutaneous leishmaniasis is a major world health problem. Diagnosis is suspected on evocative clinical presentation in patients living in or coming from endemic areas. Several methods have been used. The smear is a simple...Cutaneous leishmaniasis is a major world health problem. Diagnosis is suspected on evocative clinical presentation in patients living in or coming from endemic areas. Several methods have been used. The smear is a simple investigation used in endemic regions. The culture enables to identify the specimen. PCR has a high sensitivity. Montenegro's reaction is used in the epidemiological study. Pentavalent antimony derivatives remain the mainstay of systemic treatment. Their efficiency is well established. Their toxicity should be researched. Other treatments can be utilized, such as miltefosine. Local therapy is used in uncomplicated lesions. Injections of the pentavalent antimony derivate, cryotherapy and paromomycin ointmentsis are important options and should be used more frequently in Old World leishmaniasis.
J Dermatol Case Rep
· 2013 Mar · PMID 23580915
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Botryomycosis is a chronic, granulomatous infection of the skin, soft tissue and viscera. It is uncommon and mainly occurs in immunocompromised patients. Splendore-Hoeppli phenomenon represents an immunological host reac...Botryomycosis is a chronic, granulomatous infection of the skin, soft tissue and viscera. It is uncommon and mainly occurs in immunocompromised patients. Splendore-Hoeppli phenomenon represents an immunological host reaction to antigens of infectious and non-infectious agents. We report a case of a 64-year-old immunocompetent woman presented at our department with a 2-month history of abdominal papules and discharging nodules. She was treated with several antibiotics with no success. Skin biopsy showed granular bodies in the dermis with a Splendore-Hoeppli phenomenon. Microbiologic study isolated a Staphylococcus aureus. Patient was successfully treated 4 weeks with oral clindamycin 300 mg bid. Lack of drug penetration into the "encapsulated-like" microcolonies could explain the therapeutic challenge of this case.
J Dermatol Case Rep
· 2013 Mar · PMID 23580914
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Dermatofibrosarcoma protuberans is an uncommon soft tissue neoplasm. In the vast majority of cases it presents as a nodule or a firm tumor that can reach massive dimensions producing the protuberant nodules for which it...Dermatofibrosarcoma protuberans is an uncommon soft tissue neoplasm. In the vast majority of cases it presents as a nodule or a firm tumor that can reach massive dimensions producing the protuberant nodules for which it is named. We report a case of a 34-year-old woman presented at our department with an 8-year history of a small and discretely erythematous supraclavicular atrophic plaque. Skin biopsy lead to the diagnosis of dermatofibrosarcoma protuberans and a wide local excision of the tumor was performed in collaboration with the Plastic Surgery department. In this clinical case we describe an uncommon variant of the disease with minimal clinical manifestation that can cause serious diagnostic difficulties. The small and discrete atrophic plaque of our patient could have been easily ignored with serious clinical and prognostic implications for the patient.
J Dermatol Case Rep
· 2013 Mar · PMID 23580913
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Histoplasmosis is a systemic fungal disease that may present in a variety of clinical manifestations. Involvment of the oral mucosa is very rare and may occur as part of disseminated histoplasmosis or as isolated involve...Histoplasmosis is a systemic fungal disease that may present in a variety of clinical manifestations. Involvment of the oral mucosa is very rare and may occur as part of disseminated histoplasmosis or as isolated involvement. We present a patient with disseminated histoplasmosis, in whom oral lesions were the initial manifestation of the disease.
J Dermatol Case Rep
· 2013 Mar · PMID 23580912
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Lichen planopilaris is a scarring alopecia resulting from a lymphocytic inflammatory process of unknown etiology. We report a case of a 46-year-old man, who presented with an asymptomatic papular eruption over the face....Lichen planopilaris is a scarring alopecia resulting from a lymphocytic inflammatory process of unknown etiology. We report a case of a 46-year-old man, who presented with an asymptomatic papular eruption over the face. Histologic examination was consistent with lichen planopilaris. This case is unusual because the disease affects the facial vellus hair only, without scalp involvement or other features of lichen planopilaris and its variants.
Lallas A, Apalla Z, Karteridou A
… +1 more, Lefaki I
J Dermatol Case Rep
· 2013 Mar · PMID 23580911
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Pityriasis rubra pilaris (PRP) is a relatively uncommon entity that often has to be clinically differentiated from other erythematosquamous skin diseases, such as psoriasis. Dermoscopy has already been shown to enhance c...Pityriasis rubra pilaris (PRP) is a relatively uncommon entity that often has to be clinically differentiated from other erythematosquamous skin diseases, such as psoriasis. Dermoscopy has already been shown to enhance clinical evaluation of inflammatory skin conditions and dermoscopic patterns of various diseases, including psoriasis, have been documented. In the current manuscript we present the dermoscopic findings observed in two patients suffering from PRP and psoriasis, respectively. The dermoscopic pattern of PRP consisted of round/oval yellowish areas surrounded by vessels of mixed morphology. The latter findings are clearly distinct from the dermoscopic features of psoriasis, which have been extensively investigated previously and are presented also in the psoriatic patient herein. This observation represents an initial indication that dermoscopy could be of value in differentiating between the two entities.
Pedrosa A, Nogueira A, Morais P
… +4 more, Duarte AF, Pardal J, Mota A, Azevedo F
J Dermatol Case Rep
· 2013 Mar · PMID 23580910
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Congenital atrichia (CA) is a rare form of irreversible alopecia with an autosomal recessive mode of inheritance, usually associated with a mutation in the human hairless (HR) gene located at chromosome 8. Papular lesion...Congenital atrichia (CA) is a rare form of irreversible alopecia with an autosomal recessive mode of inheritance, usually associated with a mutation in the human hairless (HR) gene located at chromosome 8. Papular lesions may develop as an additional phenotypic feature. Herein we describe a case of CA supported by trichoscopy, histology and genetic analysis. The patient's single brother had also universal alopecia. To our knowledge this is the second report of a specific pathogenic mutation (c.2818C>T) of the HR, which until now had only been identified in a family with CA and papular lesions, emphasizing the difficulty to establish a strict correlation between HR genotyping and the phenotype.
Scalvenzi M, Palmisano F, Ilardi G
… +2 more, Varricchio S, Costa C
J Dermatol Case Rep
· 2013 Mar · PMID 23580909
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BACKGROUND: Merkel cell carcinoma (MCC) is a rare and typically aggressive form of skin cancer. The benign appearance of the tumor usually on exposed skin parts, contrasting with its extensive microscopic invasion, can d...BACKGROUND: Merkel cell carcinoma (MCC) is a rare and typically aggressive form of skin cancer. The benign appearance of the tumor usually on exposed skin parts, contrasting with its extensive microscopic invasion, can delay timely diagnosis. MAIN OBSERVATIONS: We report a case of a 71-year-old man with a slowly progressive nodule on the left hand. CONCLUSION: At the dermoscopic examination, the presence of a polymorphous vascular pattern, including milky-red areas may constitute an additional clinical clue to accurately diagnose this rare tumor. Clinical, dermoscopic and histological features are discussed.