Sign of Leser-Trélat associated with adenocarcinoma of the rectum

The acute onset and/or rapid increase in size and number of multiple seborrheic keratoses associated with internal malignancy is called sign of Leser-Trélat. Although some authors reject its existence, there are more than 80 well-documented case reports in the literature. Here, we report a 75-year-old man who presented with abrupt appearance of multiple seborrheic keratoses without any suspicious symptom of cancer. The screening for malignant neoplasms let us detect a rectal adenocarcinoma that was in a curative stage. This case-report illustrates a true sign of Leser-Trélat, and proves that these patients must be appropriately investigated for underlying malignancy.     

Detection of the K?bner phenomenon of the skeleton of patients with psoriasis]

Psoriasis is a humorally controlled systemic disease. The degree of "eruptive strength" of manifestation results from hereditary factors (disposition) and environmental factors (provocation). We were able to demonstrate that the well-known K?bner phenomenon of the skin also occurs on the skeleton of patients suffering from psoriasis. We analysed 83 patients in whom bone scans were carried out. Our results indicate that provocation factors such as bacterial foci and/or trauma correlate with a significantly higher number of pathological scintigraphic findings, ranging up to "hot spots". Furthermore, not only did bone fractures remained scintigraphically positive for an unusually long time, traumas of the end phalanx could be demonstrated in 70% of psoriatic patients compared with 21% of a control group. Obviously, one factor alone or a combination of factors triggers the involvement of the skeleton as a "deep K?bner phenomenon". In psoriatic patients the response of bone metabolism to disturbance differs from that of non-psoriatic patients in that there is a long-lasting dysregulation. This explains the high correlation between skin and skeletal manifestation in psoriatics. Therefore the manifestation of psoriatic disease is due not to a single-stranded linear causal interrelation but to a multicausal "network pathogenesis". Bone scintigraphy is the diagnostic method of choice in patients with psoriatic osteoarthropathy and allows an objective evaluation of therapeutic success.     

Evidence of the importance of specialist nursing care dealing with patients with feet at risk of tissue damage. Possible implications for reforms of NHS hospital care?

Recent media attention has highlighted recommendations from ‘Future hospital: caring for medical patients’ about specialist medical care being less ward-based. This article gives evidence of the value of specialist nursing in a particular patient group.Here we present data regarding foot care for patients on vascular surgical wards. Ward B recently started to regularly care for vascular patients prior to this study, whereas ward A was previously the only specialised vascular ward in the hospital. All patients on the wards were surveyed on 3 occasions and it was recorded whether each patient's feet were touching the bed footplate. 52% of patients on ward B vs. 23% of patients on ward A had their feet touching the end of the bed (p = 0.03, n = 57). After an intervention of targeted training, alterations to routine manual handling training, and monitoring by matrons, repeat data collection took place. Only 18% of patients on ward B had their feet touching the end of the bed post intervention (p = 0.03). There was no statistical difference between wards post intervention.While looking at a simple, but nonetheless important, aspect of patient care; this audit provides evidence of the importance that nursing staff are familiar with the challenges posed by a particular patient group. If plans for specialised medical care to work across the hospital come to fruition, some patients may be nursed by staff less familiar with their needs. Vigilance and training interventions are likely to be needed for developing problems.     

Flare-up of pustular psoriasis with fluoxetine: possibility of a serotoninergic influence?

In this article, we report two cases of pustular psoriasis flaring up after fluoxetine administration. A 21-year-old male patient with localized pustular psoriasis became erythrodermic following commencement of fluoxetine. Even though the lesions were unresponsive to cyclosporine A (Cyc A) treatment, dramatic resolution was observed with discontinuation of fluoxetine. A 44-year-old female patient with pustular psoriasis who was on Cyc A and acitretin therapy was given fluoxetine for her psychiatric symptoms. In the following 5 days, her lesions flared. Owing to previous experience, fluoxetine was stopped. Her lesions improved dramatically in the following 3 days. Exacerbation of psoriasis with antidepressant therapy has been rarely described. An extensive review of the literature revealed four such cases, all of which were seen after the use of selective serotonin reuptake inhibitors (SSRI). A serotoninergic influence in the etiopathogenesis of psoriasis may be possible together with a pharmacogenetic difference in the drug metabolism of these patients. Considering the two patients we presented and the patients previously reported in the literature, aggravation of pustular psoriasis by SSRI should be borne in mind.     

Report of a Turkish child with Sjören-Larsson syndrome associated with peripheral nerve involvement

Sjögren‐Larsson syndrome is a rare hereditary neurocutaneous disorder characterized by ichthyosis, spastic di‐ or tetra‐plegia, and mild to moderate mental retardation. In this article, we present a nine‐year‐old girl with the classical features of the syndrome associated with peripheral nerve involvement because of its rare presentation. To the best of our knowledge, only three cases of Sjögren‐Larsson syndrome with peripheral nerve involvement have been previously reported in the literature. We assume that Sjögren‐Larsson syndrome involves extensive disorders of the ectodermal tissues, including the peripheral nerves as well as the skin and the central nervous system.     

Unsuitability of organ donation from a patient with a history of melanoma?

A 52-year-old man with a history of melanoma presented to the emergency department with a massive intracranial hemorrhage. The patient deteriorated rapidly and was being considered as a potential organ donor. Three years before presentation, the patient had undergone wide excision of a 3.75-mm melanoma from his back with sentinel lymph node biopsy, which yielded negative findings. He had been well until the day of presentation. Although there are no specific guidelines for candidacy of organ donation from patients with a history of melanoma, there are several reports of donor-derived melanoma in organ transplant recipients, most with grave consequences. The literature relevant to this case is reviewed and discussed.     

Open-label study of the efficacy and safety of topical treatment with TDT 067 (terbinafine in Transfersome®) in patients with onychomycosis

Background Alopecia areata (AA) is the second most common cause of hair loss in humans, and has a genetically complex inheritance. The hypothesis that AA is autoimmune in nature is supported by previous studies. These report an association with specific HLA alleles, as well as genetic variants of other genes implicated in autoimmunity, such as various cytokine genes. However, these cannot yet be considered proven susceptibility loci, as many of these association findings were derived from small patient samples. Objectives To investigate the association between AA and selected cytokine genes using a sample of 768 patients with AA and 658 controls of Central European origin. Methods Eleven single‐nucleotide polymorphisms (SNPs) from cytokine genes implicated in previous AA studies were genotyped. These genes were IL1B, IL1A, IL1RN, MIF, IFNG and the TNF/LTA gene region. We also genotyped 15 SNPs selected from cytokine genes that have shown significant association with other autoimmune diseases. These genes were IL10, IL36RN, IL12B, IL6, IL2, IL23, IL2RA and IL4R. Results Significant association was found for two variants within both IL2RA and TNF/LTA. In the overall sample, the most significant results were obtained for the IL2RA variant rs706778 (P = 0·00038) and the TNF/LTA locus variant rs1800629 (P = 0·0017). In subgroup analyses, according to severity, age at onset and family history these effects were stronger in the severely affected patients, with the lowest P‐values being obtained for rs706778 (P = 3·8 × 10^?6). Conclusions Our results point to the involvement of IL2RA and the TNF/LTA region in the aetiology of AA, in particular severe AA, and provide further support for the hypothesis that AA is autoimmune in nature.