Eruptive lesions in a patient with bone marrow transplantation

A 41‐year‐old man with a diagnosis of chronic myeloid leukemia presented with several elevated, small, soft, yellow papules, disseminated over the face and upper trunk. The cutaneous lesions had developed 5 years after transplantation ( Fig. 1 ).

Figure 1 Open in figure viewer PowerPoint Sebaceous hyperplasia on the upper trunk presenting as yellowish, dome‐shaped, asymptomatic papules, 1–2 mm in diameter. The lesion is umbilicated, with individual lobules growing out from the center; lesions may occur individually or in groups     

Two cases of reactive perforating collagenosis arising at the site of healed herpes zoster.

Case 1 A 67‐year‐old South Korean woman presented with a painful eruption on the left trunk. Several groups of vesicles with an erythematous and edematous base were situated unilaterally within the distribution of the left T9 dermatome; they had been present for 7 days. A diagnosis of herpes zoster was made, and treatment with acyclovir, analgesics, tranquilizers, and wet dressings produced a moderate response. Two weeks after onset, the lesions appeared to have healed with a scar. Four months later, however, the patient noticed another eruption of papules in the postherpetic area ( Fig. 1A,B ).

Figure 1 Open in figure viewer PowerPoint Case 1. (A) Multiple erythematous papules on the left trunk along the T9 dermatome. (B) Multiple erythematous papules with a keratotic central plug     

Treatment with chemotherapy of scleredema associated with Ig A myeloma.

A 70‐year‐old woman was referred to the dermatology outpatient clinic in January 1999. During the previous 12 months she had developed a progressive induration and stiffness of the skin of her face, neck, shoulders, and upper aspect of her arms. There was no history of a preceding infection or of diabetes mellitus. An examination revealed that the skin of her face, back, shoulders, arms and chest was shiny, erythematous, and diffusely indurated, with a wooden consistency and decreased range of motion. Consistent firm pressure demonstrated a brawny edema. The face lacked expression, with minimal wrinkling ( Fig. 1 ). Lymphadenopathies were not found in any location.

Figure 1 Open in figure viewer PowerPoint Woody face with minimal wrinkling     

Treatment of localized epidermodysplasia verruciformis with tacalcitol ointment

A 69‐year‐old Japanese woman presented with multiple, erythematous, keratotic plaques distributed on her right breast, right shoulder, and left cubital fossa. The lesions varied in size from 5 mm to 6 cm. The patient had first noticed a small area of primary erythema on her left cubital fossa at the age of 18 years. The number and size of the lesions had increased for 50 years. A black nodule appeared on the plaque on the right breast 3 years ago and enlarged to 5 cm in diameter ( Fig. 1A ).

Figure 1 Open in figure viewer PowerPoint (a) Erythematous plaques varying in size distributed on both breasts. The biggest plaque contained hyperkeratotic tumor. The black nodule appeared on the plaque of the right breast. (b) Six months after black tumor removal, hypertrophic change was noted on the scar. Topical application of vitamin D3 analog caused regression in size and elevation of the largest keratotic plaque, and a decrease in hyperkeratosis of the other eruptions     

Lichenoid photodermatitis associated with nimesulide

An 81‐year‐old‐female patient presented with a 2 week history of erythematous to violaceous lichenoid papules and plaques exhibiting a reticulated pattern on the ‘‘V’' area of the chest and dorsal hands. Fine, whitish reticulated networks were present over the surface of many well developed papules. The lesions were sharply demarcated and moderately pruritic ( Fig. 1 ).

Figure 1 Open in figure viewer PowerPoint Violaceous lichenoid papules with reticular pattern located on the ‘‘V’' area of the chest     

The papulokeratotic type of solitary benign lichenoid keratosis

A 67‐year‐old housewife was referred to us for a papulonodular keratotic lesion on the left side of the left eyebrow ( Fig. 1 ). The lesion had started to develop 6 months earlier and had gradually reached a size of 2 cm in diameter. It was firm, nonitching, and painless on pressure.

Figure 1 Open in figure viewer PowerPoint Papulokeratotic lesion on the left eyebrow     

Granulomatous slack skin

A 32‐year‐old man presented with multiple subcutaneous swellings of 6 years' duration. A biopsy performed 6 years earlier, when the patient presented with papules and plaques, was reported as tuberculoid Hansen's disease. The patient received dapsone, but showed no improvement. The disease was progressive. The patient currently has bilateral parotid enlargement ( Fig. 1 ), enlarged submandibular, submental, and axillary lymph nodes, multiple subcutaneous swellings over the axillae and arms of cricket ball size, loose skin folds in the axillae ( Fig. 2 ) and groin, and dry, scaly, and ichthyotic skin all over the body. Clinical differential diagnoses of mycosis fungoides and cutis laxa were made. The patient was discharged on request and then was lost to follow‐up.

Figure 1 Open in figure viewer PowerPoint Patient with bilateral parotid enlargement     

Plaque-type blue nevus combined with nevus spilus and smooth muscle hyperplasia

A 31-year-old man presented with a large pigmented lesion, present since birth on his right upper aspect of his back. On examination, a speckled pigmented plaque measuring 9 × 5 cm was found on the right interscapular area. The plaque was composed of multiple dark-blue macules and papules with intervening areas of faint blue discoloration and brown patches overlapping the blue lesions ( Fig. 1 ). The lesion was slightly elevated, showing a gradual increase in height from its periphery toward its center. The lesion had enlarged as the patient grew, but there had been no change in color, size, or texture over the past few years. No other pigmentary changes were noted, and there was no family history of pigmentary disorders.

Figure 1 Open in figure viewer PowerPoint A large speckled plaque composed of an aggregation of many deep blue macules, papules and small brown patches with intervening areas of faint blue discoloration     

Skin eruption associated with Hymenolepis nana infection

A 56‐year‐old man presented with a recurrent cutaneous eruption of the trunk, associated with itching, which had lasted for several months. Antihistamines, such as cetirizine, loratadine, and fexofenadine, and topical steroids had been used with only temporary relief. Recently, the cutaneous manifestations had become continuous and very tedious and had not responded to local or systemic treatments. The patient was a doctor of medicine, was married, and had not been taking any medications. He had travelled for scientific purposes to different areas of Italy and The Netherlands in the last 12 months. He had no animals at home and no history of fever, sweats, arthralgia, cough, dyspnea, or allergic diseases. A history of gastritis and mild hyperglycemia was present. Skin examination showed large, erythematous, slightly edematous macules and pruritic, erythematous papules densely aggregated over scattered areas of the trunk, especially on both flanks, the abdomen, and the back ( Fig. 1 ). The patient appeared well and no lymphadenopathy was found.

Figure 1 Open in figure viewer PowerPoint Erythematous papules, isolated or densely aggregated over scattered areas of the trunk, associated with areas of erythema and edema     

Barraquer-Simons syndrome with benign infundibulocystic proliferation

A white man attended our outpatient clinic because of soft papules on the second finger of the left hand. They were livid red‐colored, warty surfaced cysts, 1–2 cm in diameter, arranged in an annular configuration ( Fig. 1 ). The patient showed prominent zygomatic bones and symmetric loss of buccal fat pads (Bichat's fats), leading to sunken cheeks ( Fig. 2 ). The history of the patient could not be taken because of his debility.

Figure 1 Open in figure viewer PowerPoint Soft papules on the second finger of the left hand     

Erythema annulare centrifugum and pregnancy

A 28‐year‐old woman came to our attention in the 33rd week of her first pregnancy with a 2‐week history of asymptomatic skin eruptions on the arms and legs. She was otherwise well and no other symptoms were present. She used only vitamin and iron supplements during pregnancy. The eruption began as erythematous papules before spreading peripherally while clearing centrally. This produced polycyclic plaques with indurated margins and trailing scales on the inner aspect of the advancing edge. The diameter of the lesions varied from a few to several centimeters ( Fig. 1 ).

Figure 1 Open in figure viewer PowerPoint Superficial erythema annulare centrifugum: a central clearing and “trailing scale” behind an advancing, annular, erythematous border     

T-cell chronic lymphocytic leukemia mimicking dermatomyositis

A 57‐year‐old man was diagnosed with chronic lymphocytic leukemia (CLL) during routine hematologic evaluation. Two months later, the patient developed a mildly pruritic periorbital eruption and erythematous plaques in a photosensitive distribution. A skin biopsy at an outside institution showed nonspecific histopathologic changes. The patient was diagnosed with amyopathic dermatomyositis and treated with prednisone 1 mg/kg/day with no improvement. The patient was subsequently admitted to our institution for CLL chemotherapy. Physical examination on admission revealed bilateral, violaceous, nonblanching periorbital plaques ( Fig. 1A )and symmetric erythematous plaques with mottled hypo‐ and hyperpigmentation on the shoulders, proximal arms ( Fig. 1B ), and upper chest ( Fig. 1C ). Periungual erythema was noted. Muscle strength was normal. Laboratory examination was significant for a white cell count of 33,700/mm³ with 78% lymphocytes, a hematocrit of 25.8%, and a platelet count of 25,000/mm^3. The lymphocytes were almost exclusively CD4 T cells expressing CD2, CD3, CD5, and CD7. Electrolytes, liver function tests, creatine kinase, aldolase, antinuclear antibodies, and anti‐Jo antibodies were normal or negative. Several biopsies of the plaques on the arms were obtained. Histopathology revealed leukemic infiltration of the skin with monoclonal T lymphocytes positive for CD2, CD3, CD4, CD5, and CD7 ( Fig. 2 ). Steroids were discontinued. The patient died a week later from toxic epidermal necrolysis secondary to allopurinol.

Figure 1 Open in figure viewer PowerPoint Clinical findings included periorbital violaceous plaques mimicking a heliotrope eruption (a) and poikilodermatous‐appearing plaques on the lateral arms (b) and upper chest (c)     

Systemic cryptococcosis with solitary cutaneous lesion in an immunocompetent patient

A 55-year-old white farmer from north-east Brazil presented with a 1-month history of headache and a solitary nodular lesion on his face. He was a smoker and had reported contact with pigeons. He did not complain of any other systemic symptom such as cough or pain. Physical examination of the skin lesion revealed a nodule measuring approximately 3 cm in diameter with central ulceration and overlying crust ( Fig. 1 ). The lesion clinically resembled a keratoacanthoma.

Figure 1 Open in figure viewer PowerPoint Nodular, single, keratoacanthoma-like lesion with a necrotic crust on the face     

Superficial cutaneous sporotrichosis in specific anergic patient.

A 25-year-old man from Coscomatepec, Veracruz (400 km south-east of Mexico City), and currently resident at this location, presented with dermatosis on the face, affecting the frontal region, dorsum of the nose, and malar region, composed of two nodular or verrucose plaques with an irregular diameter and form, with infiltrated borders, ulcerations, and bloody and honey crusts; the plaques developed over 4 years after trauma due to a horse kick ( Fig. 1a .)

Figure 1 Open in figure viewer PowerPoint (a) Initial appearance. (b) After 7 years of various treatments     

Bowen's disease: an uncommon presentation

A 60‐year‐old man presented with a lesion over the abdomen of 12–13 years’ duration. The lesion had been gradually progressing over the years and was asymptomatic. It had been treated by application of 5‐fluorouracil in 1993, which had resulted in partial regression; however, it started to grow again. A similar lesion had occurred over the left thigh, 2 years after the abdominal lesion appeared, and was excised. Past personal and family history was noncontributory. General and systemic examination revealed no abnormality. Dermatologic examination revealed a plaque, 18 cm × 15 cm in size, over the abdomen. It was well defined and erythematous. In places, hyperpigmented, verrucous, firm papules of various sizes were seen at the periphery and center of the lesion. There was no atrophy, ulceration, bleeding, and lymphadenopathy ( Fig. 1 ). A differential diagnosis of hyperkeratotic lupus vulgaris, Bowen's disease, pagetoid type of basal cell carcinoma, squamous cell carcinoma, and superficial spreading melanoma was considered.

Figure 1 Open in figure viewer PowerPoint Clinical photograph of lesion over the abdomen     

Purpuric pityriasis rosea

A 17‐year‐old young man presented with a 2‐week history of an asymptomatic widespread eruption affecting the trunk and arms. On physical examination we observed multiple, oval purpuric macules and papules, 1–3 cm in diameter, distributed in a “christmas tree” pattern on the trunk and arms ( Figs 1 and 2 ). There was no sign of a herald patch and mucosal examination was normal.

Figure 1 Open in figure viewer PowerPoint Lesions distributed in christmas tree pattern on the trunk     

Alopecia: a rare manifestation of lupus vulgaris

A 14‐year‐old girl presented with a 2‐year history of gradually developing, asymptomatic, reddish, raised lesions over the scalp, face, arms and trunk. The family history was significant for tuberculosis. Her grandmother was found to have pulmonary tuberculosis. Clinical examination revealed reddish‐brown, soft papules forming two large plaques by coalescence over the scalp and back ( Figs 1 and 2 ).

Figure 1 Open in figure viewer PowerPoint Lupus vulgaris, plaque form manifesting as alopecia     

Clenched fist syndrome with palmar lichen planus

A 16-year-old girl had a 4-year history of hyperkeratosis and fissures on the palm. The skin lesions had gradually progressed to thick hyperkeratosis with mild pruritus, diffusely covering the right palm, and leading to flexion contractures of the fingers with mild pain. There was no family history of similar lesions. Her father had died 4 years previously. Dermatologic examination revealed hyperkeratosis, scaling, a mild yellow color, fissures, and maceration on the palm and volar surface of the fingers of the right hand ( Fig. 1 ). There was an approximately 3 cm × 4 cm hyperkeratotic lesion on the palm of the left hand.

Figure 1 Open in figure viewer PowerPoint Hyperkeratosis with a mild yellow color, scaling, fissures, maceration on the palm and palmar surface of the fingers, and flexed fingers of the right hand     

Case of generalized lichen amyloidosis

A 23-year-old white female patient presented with a 3-year history of a pruritic rash on the trunk, extensor surfaces of the extremities, back, abdomen, and the glutea. There was no family history of any similar dermatological disease. Dermatological examination revealed generalized rough, mildly keratotic, symmetrical dome-shaped papules, involving dorsal and extensor surfaces of both the lower and upper extremities, abdomen, back and the glutea ( Fig. 1 ). Physical examination was normal.

Figure 1 Open in figure viewer PowerPoint Dome-shaped, lichenified papules, 4–5 mm in diameter, on the right lower extremity     

Lichen planus pemphigoides presenting with a strikingly unilateral distribution

A 44-year-old Pakistani woman presented with a unilateral eruption of 2 months’ duration. She was in her usual state of health when she awoke one morning with an acute blistering eruption in the right axilla. At that time she also began to experience “rough spots” on the buccal mucosa. Approximately 4 days later, lesions, including small blisters, appeared at multiple other sites, all in a right-sided distribution. The patient had an 8-year history of hypothyroidism and was treated with levothyroxine. Physical examination revealed a widely distributed and strikingly right-sided eruption. Dark brown macules and patches measuring 0.1–1.2 cm, some of which were confluent, were located in the right axillary area at the site of previous blister formation ( Fig. 1a ). Close inspection revealed that some of these lesions had a glistening and violaceous appearance at their periphery. Discrete, small, flat-topped papules with similar qualities were also present at this location. Lichenoid lesions were evident in multiple other

Figure 1 Open in figure viewer PowerPoint (a) Hyperpigmented macules and patches in the right axillary region. Some of these lesions had a glistening, violaceous, and raised quality at the periphery (white arrow) suggesting post-inflammatory hyperpigmentation secondary to lichen planus. (b) Lichenoid lesions in the intergluteal area and the right buttock