J Dermatol Case Rep
· 2013 Mar · PMID 23580908
·
Full text
BACKGROUND: Gardner-Diamond syndrome (GDS) is also known as psychogenic purpura, autoerythrocyte sensitization syndrome and painful bruising syndrome. MAIN OBSERVATION: This is a case report of 27-year-old woman who pres...BACKGROUND: Gardner-Diamond syndrome (GDS) is also known as psychogenic purpura, autoerythrocyte sensitization syndrome and painful bruising syndrome. MAIN OBSERVATION: This is a case report of 27-year-old woman who presented with unexplained bruising and intramuscular hematomas after a seven year history of complex regional pain syndrome. Her evaluation consisted of hematological studies, skin and muscle biopsy; it failed to reveal an underlying coagulopathy, vasculitis or other demonstrable cause. In the absence of any other etiology, she was diagnosed as Gardner-Diamond syndrome. CONCLUSIONS: This patient is unique because of intramuscular hematomas and the association of Complex regional pain syndrome with Gardner-Diamond syndrome.
Di Stefani A, Galluzzo M, Talamonti M
… +3 more, Chiricozzi A, Costanzo A, Chimenti S
J Dermatol Case Rep
· 2013 Mar · PMID 23580907
·
Full text
BACKGROUND: Pityriasis rubra pilaris is a rare, chronic erythematous squamous disorder of unknown etiology. The disease is characterized initially by small follicular papules that coalesce into yellowish pink scaly plaqu...BACKGROUND: Pityriasis rubra pilaris is a rare, chronic erythematous squamous disorder of unknown etiology. The disease is characterized initially by small follicular papules that coalesce into yellowish pink scaly plaques, palmoplantar keratoderma, diffuse furfuraceous scale of the scalp, and frequent progression to exfoliative erythroderma. Generally it is difficult to discern pityriasis rubra pilaris from other skin conditions but key-clinical features help in the diagnosis such as "islands" of spared skin within generalized erythroderma, follicular keratotic plugs, and an orange hue of the involved skin. Treatment options include topical vitamin D analogues, keratolytics, systemic acitretin, methotrexate, cyclosporine, azathioprine, fumaric acid esters, phototherapy, and anti-TNFα agents. Cases, of pityriasis rubra pilaris, successfully treated with a short-course ustekinumab therapy, have been reported. MAIN OBSERVATIONS: We report a 31-year-old man with pityriasis rubra pilaris, refractory to conventional treatments, successfully treated with ustekinumab monotherapy for over 64 weeks. After failing conventional systemic agents (cyclosporine, aciretin and methotrexate), ustekinumab 45 mg has been prescribed, with the same dosing regimen as in psoriasis. The patient improved dramatically within 4 weeks of the first injection, with markedly less erythema and pruritus. Long-term control of the disease of the disease was achieved (64 weeks of treatment). CONCLUSION: We report this case in order to show the striking and rapid efficacy of ustekinumab in reducing the signs and symptoms of the disease. Complete remission was achieved after the third injection, but also a long-term control of the disease. The therapy was well-tolerated in our patient and no adverse events occurred.
Di Costanzo L, Ayala F, Megna M
… +3 more, Gaudiello F, Patrì A, Balato N
J Dermatol Case Rep
· 2013 Mar · PMID 23580906
·
Full text
BACKGROUND: Tumor necrosis factor-α (TNF-α) inhibitors represent efficacious therapeutic agents in many chronic inflammatory diseases such as psoriasis and rheumatoid arthritis. However they have been connected with incr...BACKGROUND: Tumor necrosis factor-α (TNF-α) inhibitors represent efficacious therapeutic agents in many chronic inflammatory diseases such as psoriasis and rheumatoid arthritis. However they have been connected with increased risk of infection and reactivation of a variety of infectious agents, such as viruses. The reactivation of varicella zoster virus infection causes herpes zoster (HZ), a self-limiting, dermatomally localized, vesicular rash that can be accompanied by postherpetic neuralgia and severe neurological complications. MAIN OBSERVATIONS: Limited information has been published regarding HZ during therapy with TNF-α inhibitors especially for the occurrence of HZ during adalimumab treatment. We report the case of a 58-year-old immunocompetent man with a 18-year history of plaque psoriasis who develops ophthalmic HZ during treatment with adalimumab. CONCLUSION: We report this case to enrich the literature and to highlight the increased risk of HZ infections in patient on anti-TNF-α therapy (incidence of HZ is about 3-fold increased respect to general population). Clinically, these infections often have atypical presentations that may hamper prompt diagnosis. Therefore, it is very important to identify early signs and symptoms of herpes zoster in patients on biologic therapy in order to start prompt efficient antiviral treatment to prevent the development of severe complications.
J Dermatol Case Rep
· 2012 Dec · PMID 23329995
·
Full text
Benign fibrous histiocytomas of the skin sometimes extend into the deeper dermis with higher cellularity and show more aggressive clinical courses in comparison with typical dermatofibromas. They may occur either as a tr...Benign fibrous histiocytomas of the skin sometimes extend into the deeper dermis with higher cellularity and show more aggressive clinical courses in comparison with typical dermatofibromas. They may occur either as a true neoplasm or in a reactive process. We describe a case of fibrous histiocytoma which was triggered by tuberculin skin test.
J Dermatol Case Rep
· 2012 Dec · PMID 23329994
·
Full text
Proliferating pilomatricoma is a proliferative variant of pilomatricoma. Although it is considered as a benign tumor, local recurrence may occur. We report a case of a 49-year-old Japanese man with 3-year history of an a...Proliferating pilomatricoma is a proliferative variant of pilomatricoma. Although it is considered as a benign tumor, local recurrence may occur. We report a case of a 49-year-old Japanese man with 3-year history of an asymptomatic subcutaneous tumor in the nuchal area. Histological evaluation demonstrated a cystic lesion lined by a basaloid epithelium at the periphery and filled with eosinophilic cornified material containing shadow cells in upper part of the tumor, and multilobular proliferation of basaloid cells in association with small foci of shadow cells in the remaining part. Based on these findings, the diagnosis of proliferating pilomatricoma was made. No recurrence has been observed during a 3-year follow-up.
J Dermatol Case Rep
· 2012 Dec · PMID 23329993
·
Full text
Linear atrophoderma of Moulin is a rare acquired disorder arising most commonly during childhood or adolescence, occurring equally in both sexes and characterized by hyperpigmented atrophoderma in a unilateral bandlike d...Linear atrophoderma of Moulin is a rare acquired disorder arising most commonly during childhood or adolescence, occurring equally in both sexes and characterized by hyperpigmented atrophoderma in a unilateral bandlike distribution along the lines of Blaschko. Since Moulin et al described the condition in 1992, only a few dozen cases have been reported. It has been postulated that linear atrophoderma of Moulin may be due to mosaicism.A 66-year-old man pre-sen-ted with a 46-year his-to-ry of evol-ving tan soft atro-phic con-fluent plaques in a striking-ly Blasch-koid dis-tri-bu-tion, in-vol-ving the left up-per back, shoulder, up-per arm, chest and flank. Ini-tial on-set, at age 20, con-sis-ted of a single mildly pru-ritic pink patch on the left back that was un-res-pon-sive to topical anti-fun-gals. Each new le-sion arose simi-larly as a pink pru-ritic patch, sub-se-quent-ly be-co-ming de-pressed, hy-per-pig-men-ted, and asym-pto-ma-tic over se-ve-ral years. Le-sions were never scaly, firm, or indu-rated. Punch biopsy speci-mens were obtained. The clinical and histo-patho-lo-gi-cal features con-firmed the diagnosis of linear atrophoderma of moulin.Our present case has the characteristic clinical and histopathological features of linear atrophoderma of Moulin, but is the first reported case with mild pruritus at the onset of each new lesion and progressing slowly over 46 years. The lack of any systemic symptoms or other complications in our patient reaffirms the benign nature of this skin disease.
J Dermatol Case Rep
· 2012 Dec · PMID 23329992
·
Full text
BACKGROUND: Alopecia areata is an autoimmune disease that is affecting anagen hair follicles. The triggers of autoimmunity in patients with alopecia areata remain unknown. MAIN OBSERVATION: A 13-year-old boy developed mu...BACKGROUND: Alopecia areata is an autoimmune disease that is affecting anagen hair follicles. The triggers of autoimmunity in patients with alopecia areata remain unknown. MAIN OBSERVATION: A 13-year-old boy developed multiple hairless patches of focal hair loss with typical clinical and trichoscopy features of alopecia areata. Mycology examination of the scalp hair and epidermal scrapings reveled massive growth of Alternaria chlamydospora. CONCLUSION: We hypothesize that fungal antigens (e.g. antigens involved in fungal melanin synthesis) may be possible triggers, contributing to autoimmune reactions in patients with alopecia areata. We discuss research data, which may indirectly support this hypothesis, however the concept has yet to be verified.
Pastuszczak M, Lipko-Godlewska S, Jaworek AK
… +1 more, Wojas-Pelc A
J Dermatol Case Rep
· 2012 Dec · PMID 23329991
·
Full text
BACKGROUND: Linear immunoglobulin A (IgA) bullous dermatosis (LABD) is a rare autoimmune blistering disorder. The disease may be either idiopathic or druginduced. Over the past 30 years, approximately one hundred LABD ca...BACKGROUND: Linear immunoglobulin A (IgA) bullous dermatosis (LABD) is a rare autoimmune blistering disorder. The disease may be either idiopathic or druginduced. Over the past 30 years, approximately one hundred LABD cases have been described as induced by a wide range of drugs, chiefly antibiotics. MAIN OBSERVATIONS: We report the case of 37-year-old woman who developed pruritic bullous lesions spread all over the body three weeks after her last dose of cefuroxime axetil. Antibiotic therapy was started due to rhino-sinusitis. CONCLUSIONS: In most reported cases of drug-induced LABD, skin lesions occur within the time of drug administration. However, the onset of disease may be even after discontinuation of treatment. It seems that in such cases, other clinical conditions (like infection) act, as cofactors of immunologic response.
Picciani B, Silva-Junior G, Carneiro S
… +5 more, Sampaio AL, Goldemberg DC, Oliveira J, Porto LC, Dias EP
J Dermatol Case Rep
· 2012 Dec · PMID 23329990
·
Full text
BACKGROUND: Geographic stomatitis is an uncommon oral lesion that presents similar clinical, histopathological and genetic features as those of psoriasis. These findings suggest that this lesion may actually represent an...BACKGROUND: Geographic stomatitis is an uncommon oral lesion that presents similar clinical, histopathological and genetic features as those of psoriasis. These findings suggest that this lesion may actually represent an oral manifestation of psoriasis. We report one case of geographic stomatitis and discuss a possible connection between this condition and psoriasis. MAIN OBSERVATIONS: A 37-year-old woman presented with red patches, surrounded by a white border on the labial mucosa and a positive family history of psoriasis. Histopathological examination, immunohistochemical analysis with antibodies against CD4, CD8, CD20, CD68, CD31, and Ki-67 and HLA-A*, -B*, -C*, -DRB1*, -DQA1* and -DQB1* genotyping were performed. Histopathological examination revealed parakeratosis, marked elongation of rete ridges with acanthosis and clubbing, exocytosis, Munro microabscesses, pustule of Kogoj, dilated tortuous vessels at the tip of dermal papillae, and predominant superficial and perivascular lymphocytic chronic inflammatory cell infiltrate. Immunohistochemistry analysis revealed a predominant T-cell subepithelial infiltrate. Based on the referred clinicopathological findings and in the absence of cutaneous lesions, the diagnosis of geographic stomatitiswas confirmed. CONCLUSIONS: This case and theoretical data indicate that geographic stomatitis may be an oral manifestation of psoriasis. Moreover, to improve our understanding, psoriatic patients should routinely undergo a detailed oral examination and patients with geographic stomatitis should routinely be submitted to a cutaneous routine examination.
Goldsztajn KO, Moritz Trope B, Ribeiro Lenzi ME
… +2 more, Cuzzi T, Ramos-E-Silva M
J Dermatol Case Rep
· 2012 Dec · PMID 23329989
·
Full text
BACKGROUND: Granulomatous slack skin is a very rare subtype of T-cell cutaneous lymphoma, characterized by the slow development of cutaneous sagging, especially on flexural areas. Its behavior is indolent and the treatme...BACKGROUND: Granulomatous slack skin is a very rare subtype of T-cell cutaneous lymphoma, characterized by the slow development of cutaneous sagging, especially on flexural areas. Its behavior is indolent and the treatment, in the majority of cases, disappointing. MAIN OBSERVATION: We report a 54-year-old black patient with granulomatous slack skin, who at the beginning of the investigation showed intense xeroderma and generalized lymph node enlargement. The diagnosis was established based on histopathologic findings long before the disease's characteristic clinical presentation appeared. CONCLUSIONS: During the twelve years of follow-up, the clinical manifestation evolved to marked skin looseness, most predominant in flexural regions, illustrating the clinical hallmark of granulomatous slack skin, long after first histological abnormalities were observed.
Fotiadou C, Lazaridou E, Sotiriou E
… +1 more, Ioannides D
J Dermatol Case Rep
· 2012 Dec · PMID 23329988
·
Full text
BACKGROUND: Psoriasis affects a considerable proportion of women in their reproductive years. Limited published data exist about the possible negative impact of the disease itself in the prognosis of pregnancy. On this b...BACKGROUND: Psoriasis affects a considerable proportion of women in their reproductive years. Limited published data exist about the possible negative impact of the disease itself in the prognosis of pregnancy. On this background, the emergence of newer biologic agents for psoriasis treatment - such as ustekinumab - raises safety issues concerning the exposure to the drug during pregnancy. To our knowledge this is the first report in the literature describing a pregnancy outcome under ustekinumab treatment. OBSERVATION: We report a 35-year-old female psoriasis patient who was under treatment with ustekinumab for a year when she inadvertedly became pregnant. The drug was discontinued immediately and the patient did not opt for termination. During the 12th week of gestation she experienced a spontaneous abortion. CONCLUSION: Although the patient's profile fulfilled 2 general risk factors for spontaneous abortion - she was a smoker and this was her third pregnancy - one could not underestimate the possible role of the drug and of psoriasis per se in this adverse pregnancy outcome. Pregnancy registries and large prospective studies are needed in order to determine whether poorer pregnancies outcomes in psoriatic women are due to the disease itself, associated comorbidities or side-effects of new therapies such as ustekinumab.
Julian Y, Argenziano G, Moscarella E
… +4 more, de Paula Ramos Castro R, Longo C, Abeldaño A, Zalaudek I
J Dermatol Case Rep
· 2012 Dec · PMID 23329987
·
Full text
BACKGROUND: The clinical and dermoscopic diagnosis of cutaneous melanoma metastases may be challenging especially in patients with unknown primary melanoma. MAIN OBSERVATIONS: We observed repetitive dermoscopic patterns...BACKGROUND: The clinical and dermoscopic diagnosis of cutaneous melanoma metastases may be challenging especially in patients with unknown primary melanoma. MAIN OBSERVATIONS: We observed repetitive dermoscopic patterns of peripheral stellate telangiectasias in cutaneous melanoma metastases from 3 patients, of whom 2 had an unknown primary melanoma. CONCLUSIONS: Stellate telangiectasias surrounding bluish to purple or red nodules with recent onset may represent a clue for cutaneous melanoma metastases.
Lacarrubba F, Dall'oglio F, Dinotta F
… +1 more, Micali G
J Dermatol Case Rep
· 2012 Sep · PMID 23091591
·
Full text
The parallel ridge pattern, characterized by a parallel band-like pigmentation of the ridges of the surface skin markings, represents the most important dermoscopic feature of in situ acral melanoma. A case of a young gi...The parallel ridge pattern, characterized by a parallel band-like pigmentation of the ridges of the surface skin markings, represents the most important dermoscopic feature of in situ acral melanoma. A case of a young girl who showed a plantar pigmented brown macule likely due to prolonged contact with black rubber shoes, revealing a parallel ridge pattern on dermoscopy, is reported and discussed. Although parallel ridge pattern is highly suspicious of early melanoma, exogenous pigmentation should be considered as differential diagnosis in case of rapid onset acral pigmented macules.
Mir-Bonafé JM, Blanco-Barrios S, Romo-Melgar A
… +2 more, Santos-Briz A, Fernández-López E
J Dermatol Case Rep
· 2012 Sep · PMID 23091590
·
Full text
We present a male patient with polycythemia vera (PV) in whom pyoderma gangrenosum (PG) was induced by subcutaneous injections of interferon-α2beta (IFN-α2b).The patient presented with a 6 cm wide necrotic ulcer on the e...We present a male patient with polycythemia vera (PV) in whom pyoderma gangrenosum (PG) was induced by subcutaneous injections of interferon-α2beta (IFN-α2b).The patient presented with a 6 cm wide necrotic ulcer on the external aspect of his left thigh, which was surrounded by an erythematous and indurated plaque. He also had a simetrical but smaller 2 cm of size ulcer on the external aspect of the right thigh. Histopathological examination showed a massive perivascular and interstitial inflammatory infiltrate. It was vastly composed of neutrophils and secondary formation of interstitial neutrophilic microabscesses was also observed.To our knowledge only two cases of PG secondary to IFN-α2b injections have been reported, none of them in a patient with PV. Physicians should be aware of these IFN-α2b-related local adverse effects as they might become extremely severe. Immediate local discontinuation of drug administration is mandatory. In order to avoid these complications, alternating injection sites is highly advisable.
Merino de Paz N, Rodríguez-Martin M, Contreras Ferrer P
… +3 more, Pestana-Eliche M, Martin-Herrera A, Noda-Cabrera A
J Dermatol Case Rep
· 2012 Sep · PMID 23091589
·
Full text
Dyschromatosis universalis hereditaria (DUH) is a rare genodermatosis mainly described in asian subjects. Here, we report a case of a caucasian 11-year-old boy with DUH and an unaffected twin brother. Parents were not co...Dyschromatosis universalis hereditaria (DUH) is a rare genodermatosis mainly described in asian subjects. Here, we report a case of a caucasian 11-year-old boy with DUH and an unaffected twin brother. Parents were not consanguineous. A review of the main phenotical, clinical and hystological aspects of this rare entity is exhibited. Differential diagnose might be stablished with several pigmentary disorders, so Dermatologist might have this entity in mind to make a correct diagnose, specially in cases with no response to typical treatments.
J Dermatol Case Rep
· 2012 Sep · PMID 23091588
·
Full text
Hyperkeratosis lenticularis perstans also known as Flegel's disease is a keratinisation disorder characterized by small keratotic papules with horny scales. Most cases have been reported in Europe with age of presentatio...Hyperkeratosis lenticularis perstans also known as Flegel's disease is a keratinisation disorder characterized by small keratotic papules with horny scales. Most cases have been reported in Europe with age of presentation between 35 and 60 years. We report a case of a 25-year-old man, who presented with 1-5 mm multiple asymptomatic hyperkeratotic papules of 15 years duration on both legs and hand along with lichenified plaques with Koebner phenomenon in the axillary folds, anticubital and popliteal fossae. Similar lesions were present in the eyelids also. There was no involvement elsewhere. Similar illness was found in the younger brother aged 13 years with the duration of illness for the past 5 years. Histopathology confirmed the clinical diagnosis. Patient was treated with oral isotretinoin in a daily dose of 20 mg per day to which he responded immediately with clearing of the lesions in two weeks.
J Dermatol Case Rep
· 2012 Sep · PMID 23091587
·
Full text
Pityriasis rotunda is described as persistent, large, sharply defined circular patches of dry ichthyosiform scaling with no inflammatory changes. Pityriasis rotunda may be associated with systemic diseases (eg. hepatocel...Pityriasis rotunda is described as persistent, large, sharply defined circular patches of dry ichthyosiform scaling with no inflammatory changes. Pityriasis rotunda may be associated with systemic diseases (eg. hepatocellular carcinoma). We report a case of pityriasis rotunda in a 19-year-old, otherwise healthy male. The condition started one year prior to his referral. Lesions were distributed over the trunk and upper extremities. Histopathological examination revealed hyperkeratosis, absent granular layer, pigmented basal layer, pigmentary incontinence and perivascular lymphocytic infiltrate. PAS staining for fungi was negative. Treatment of pityriasis rotunda in this case was challenging. When there's an underlying disease, successful treatment of the original disease leads to clearance of pityriasis rotunda lesions.
Emadi SN, Babamahmoodi F, Poursaleh Z
… +6 more, Sayad-Noori SS, Soroush MR, Maleki AR, Izadi M, Khodaei-Ardakan MR, Emadi SE
J Dermatol Case Rep
· 2012 Sep · PMID 23091586
·
Full text
BACKGROUND: The relationship between compromised immune system and the development of malignancy, generalized dermatitis, and infection after sulfur mustard gas exposure has been established. MAIN OBSERVATION: We introdu...BACKGROUND: The relationship between compromised immune system and the development of malignancy, generalized dermatitis, and infection after sulfur mustard gas exposure has been established. MAIN OBSERVATION: We introduce a 58-year-old man with an abrupt, de novo and erythrodermic eruption in 2002 that was previously exposed to sulfur mustard during the Iran - Iraq war in 1987. Six weeks after the onset of diffuse eruption, he developed papules on the glans penis and generalized dermatophytosis. A biopsy of his eruption was consistent with cutaneous T-cell lymphoma/Sézary syndrome. A complete blood count demonstrated leukocytosis, eosinophilia and atypical lymphocytosis. Subsequently, Sézary syndrome was confirmed and T-cell count with increased CD4/CD8 in flow cytometry. The biopsy of his penile papules was consistent with Kaposi's sarcoma. CONCLUSION: These findings suggest a causative relationship between sulfur mustard gas exposure, cutaneous T cell lymphoma and immune compromised state with opportunistic infections.
Mauleón C, Valdivielso-Ramos M, Cabeza R
… +2 more, Rivera T, García I
J Dermatol Case Rep
· 2012 Sep · PMID 23091585
·
Full text
BACKGROUND: Kikuchi disease (Kikuchi-Fujimoto disease, histiocytic necrotizing lymphadenitis) is a systemic illness of unkown etiology. It is characterized by cervical lymphadenopathy and fever. The skin is the most freq...BACKGROUND: Kikuchi disease (Kikuchi-Fujimoto disease, histiocytic necrotizing lymphadenitis) is a systemic illness of unkown etiology. It is characterized by cervical lymphadenopathy and fever. The skin is the most frequently affected extranodal organ. Cuta-neous Kikuchi-Fujimoto disease can mimic both clinically and histolo-gically skin lesions in lupus erythema-tosus, a disorder with which it seems to be closely related. A close follow up is required as systemic lupus erythema-tosus develop-ment has been reported. MAIN OBSERVATION: We report a case of a 23-year-old woman, who was admitted to our depart-ment with high fever, skin lesions and arthralgia. Scaly and erythematous plaques were noted on both cheeks and earlobes. In pads of feet and hands and periungual area, multiple purple papules with a perilesional erythematous halo were evident. A thoraco-abdominal computed tomography scan revealed lateral cervical, mediastinal, paratracheal, subcarinal and submandi-bular lympha-denopathy. Excisional node biopsy was consisten with Kikuchi disease with skin involvement. CONCLUSION: It has to be kept in mind that Kikuchi disease is a differential diag-nosis in case of fever, lymphade-nopathy and lupus-like skin lesions. Skin lesions in this disease and may resemble clinically and histologically to those of subacute lupus erythema-tosus or systemic erythema-tosus lupus.