Secondary Yaws: An Endemic Treponemal Infection

Abstract: Although yaws is rare in developed countries, as worldwide travel has become commonplace, it is essential to recognize this condition when evaluating patients who traveled from endemic regions. Herein, we discuss a case of secondary yaws presenting as extensive expanding annular lesions to raise awareness of this condition.     

Angioma serpiginosum with linear distribution: case report and review of the literature

BACKGROUND: Angioma serpiginosum is a vascular anomaly that classically presents in childhood and predominantly affects females. OBJECTIVE: To present a case of a young woman with linear distribution of angioma serpiginosum and review the common clinical characteristics and presentation of this condition. METHODS: Case report with skin biopsies and dermoscopic findings. RESULTS: A clinical examination revealed numerous irregular punctate red macules in a linear distribution over the right arm. On dermoscopy, the lesions appeared as multiple sharply demarcated red lagoons. The histopathologic findings of dilated blood vessels in the papillary dermis with absence of other changes confirmed the diagnosis of angioma serpiginosum. CONCLUSION: Angioma serpiginosum is a rare entity that can be distinguished by clinical and histopathologic examinations. Lack of recognition of this condition may lead to unnecessary investigations and delayed treatment.     

Multiple follicular cysts,infundibular type with vellus hairs and solar elastosis of the ears: a new dermatoheliosis?

BACKGROUND: Vellus hair cyst is an uncommon developmental abnormality of the vellus follicle histologically defined as a stratified squamous epithelial-lined cyst containing one or more vellus hairs. METHODS: Herein, we report three patients with a heretofore described clinicopathologic condition consisting of multiple contiguous cysts of the ear helices showing solar elastosis and multiple cysts containing vellus hairs, microscopically. CONCLUSION: Given the anatomic location, history of excessive ultraviolet exposure and pathologic alterations, we surmise that this is a condition related to Favre-Racouchot syndrome, which is predisposed by excessive ultraviolet light exposure.     

Phototherapy in the perspective of the chronicity of psoriasis

According to the guidelines for the treatment of psoriasis, phototherapy is given in courses of UVB exposure starting at 50–70% of the minimal erythema dose, MED, with subsequently incremental dosages, but keeping erythemal skin reactions to a minimum by restraining the dosages when necessary. In this review, this classical principle of short-term near erythematogenic UVB therapy without further UVB maintenance therapy is challenged as it is evidently not optimal for psoriasis as a chronic condition. There is old experimental evidence supplemented with growing knowledge on the mode of action of phototherapy and more recent data on low-level UVB regimens as maintenance therapy that should urge us to revisit our guidelines on phototherapy to address psoriasis for what it is: a chronic condition.     

Bilateral extensive periorbital milia en plaque treated with electrodesiccation

BACKGROUND: Milia en plaque (MEP) is a rare form of milia. Only 25 cases of this rare condition have been reported to date (MEDLINE search). Only one previous case of MEP has been treated with electrodesiccation. OBJECTIVE: To report a new case of this rare condition and present the outcome with electrodesiccation. CONCLUSION: The case is being reported here to highlight the features of this rare but now well-recognized dermatologic condition, which has been reported increasingly in the recent past, to discuss the various treatments tried, and to share our experience of treating patients with the simple, inexpensive, easily available, and nonsophisticated office procedure of electrodesiccation.     

Focal dermal hypoplasia with unusual cutaneous features

Abstract:  Focal dermal hypoplasia (Goltz syndrome) is a rare genetic condition characterized by numerous malformations in different organ systems derived from the ectoderm and mesoderm. We present an infant with focal dermal hypoplasia who, besides having a constellation of anomalies commonly encountered in patients with this syndrome, manifested additional unusual features such as an early inflammatory vesicular stage and a cleft lip and palate. We emphasize that a prompt, well-orchestrated and effective multidisciplinary intervention can help improve the quality of life in patients afflicted with this condition.     

Cutaneous fibrolipomatous hamartoma: Report of 2 cases with retrocalcaneal location

Precalcaneal congenital fibrolipomatous hamartoma is an underreported benign entity that has been described in the literature under different names. We present two cases of unilateral fibrolipomatous hamartoma (FLH) appearing in a unique location: on the posterior aspect of the foot overlying the heel. We propose the term "FLH of the skin" as a more inclusive and less confusing term for this condition, thus allowing distinction with FLH arising from neural tissue. High‐frequency ultrasonography appears to be a useful diagnostic tool that may avoid unnecessary biopsies for this condition.     

Prevention of work-related skin diseases: teledermatology as an alternative approach in occupational screenings

Background: Prevention of occupational skin diseases is of high socio-economic impact. Implementing teledermatology into preventive occupational screenings holds obvious advantages; nevertheless, studies concerning this subject are scarce.
Objectives: The present cross-sectional study was aimed at determining if results of a teledermatological examination are equally sensitive and specific at detecting minimal skin lesions as the conventional face-to-face examination.
Methods: The skin condition of the hands of 100 male wet workers was assessed in a face-to-face examination and a tele-examination by means of a score for minimal skin lesions.
Results: The comparison of the total score values that each participant received in face-to-face examination with those obtained in tele-examination proved the skin condition to be estimated significantly worse when seen in tele-examination ( P < 0.0001). The median values of the sum totals and the median values for secondary lesions were higher in the tele-examination than in the face-to-face examination.
Conclusions: Our findings show a tendency in tele-examination to assess the skin condition more critically in comparison with face-to-face examination. The teledermatological examination is sufficiently sensitive in detecting early signs of hand eczema, whereas signs for chronicity may get overestimated.     

Mitten‐Line Hyperpigmentation: A Reactive Process Analogous to Sock‐Line Hyperpigmentation

Abstract: A 3‐month‐old girl presented with a 6‐week history of a curvilinear hyperpigmented patch on the left wrist, which began within a day of using a tight mitten. Mitten‐line hyperpigmentation is analogous to the recently described condition known as infantile “sock‐line hyperpigmentation,” or more generally “sock‐line bands.” Distinguishing this benign condition from child abuse, amniotic band syndrome, and acquired raised bands of infancy is important but sometimes challenging.     

Chronic Actinic Prurigo Presenting in an Adopted Child

Abstract:  In diagnosing actinic prurigo (AP), the patients' ethnic background is very helpful as this condition is associated with very specific ethnic groups. We discuss a patient with an unknown family history who presented with a rash that initially seemed like lupus, but was subsequently diagnosed as AP upon further evaluations.     

Intractable vascular autonomic dysregulation (Harlequin phenomenon) in two brothers: another indication for propranolol?

Vascular autonomic dysregulation, in the most extreme presentation known as Harlequin phenomenon, is a rare condition. It manifests as a sudden and brief paroxystic change in skin color, resulting in two different colors on the body. It is supposed that this condition occurs due to a vasomotor instability. This again is caused by sympathetic disautonomy, which is a consequence of hypothalamic peripheral vascular tone control immaturity in the newborn. Typically, there is spontaneous regression. We describe two brothers who both had this condition in their first life years. Clinical symptoms included frequent attacks of discoloration of extremities (up to four times per day) accompanied with terrifying crying fits, interpreted by the parents as pain. These patients were treated with propranolol, a nonselective beta‐blocker, resulting in improvement of symptoms: only occasional attacks were seen. Beta‐blockers act on β₁‐adrenoceptors in the heart, thereby preventing the positive chronotropic and inotropic effects mediated by these receptors. We hypothesize that propranolol, which is very lipophilic and therefore also acts on β‐receptors of the central nervous system, acts on the sympathetic system.     

Sensitive skin: correlation with skin surface microrelief appearance

BACKGROUND/PURPOSE: Sensitive skin is a condition associated with reduced tolerance to environmental factors and/or the application of topical products, such as cosmetics. Its pathophysiology has not been fully elucidated and few data are available on its prevalence. The aim of this study was to investigate possible correlation between objective sensitivity and skin surface microrelief. METHODS: During an epidemiological survey conducted for a campaign promoted by International Society of Plastic Dermatology in Italy, 243 adult healthy subjects of both sexes with no evident dermatological disorder but positive to the lactic acid stinging test, were submitted to cyanoacrylate stratum corneum stripping from the volar forearm for the determination of the irregularity of the skin surface microrelief (irregularity skin index (ISI)). RESULTS: A significant correlation was found between intensity of symptoms in stingers and ISI (r(s)=-0.47; P<0.001). CONCLUSION: Sensitive skin is common in the healthy population. ISI can contribute towards the identification of subjects with sensitive skin and the development of more specific skin treatments for this prevalent condition.     

Three patients with orbital xanthogranuloma and non-progressive haematological abnormalities

Orbital xanthogranuloma is a rare dermatological condition characterized by its bilateral and rather symmetrical subcutaneous granulomatous infiltration around the eyes. It shares morphological similarities with other xanthogranulomatous diseases such as juvenile or adult type xanthogranuloma, necrobiotic xanthogranuloma and cutaneous infiltration in Erdheim-Chester disease, and should be differentiated from them. Three elderly Chinese patients with this condition were found to have underlying haematological abnormalities: normochromic normocytic anaemia, thrombocytopenia or eosinophilia. Their skin lesions remained localized and associated haematological abnormalities stable for up to 7 years. Haematological abnormalities were also reported in previous cases and this finding is unlikely to be coincidental; however, its clinical significance remains unknown.     

Stevens-Johnson syndrome associated with brucella infection

Abstract:  Stevens-Johnson syndrome is a potentially fatal condition that manifests mainly on the skin and mucosal surfaces but also affects other vital organs. There are no report of Stevens-Johnson syndrome caused by brucella infection in the literature. In this article, a previously healthy boy, diagnosed as Stevens-Johnson syndrome associated with brucella infection, is reported.     

Pyoderma Vegetans

BACKGROUND: Pyoderma vegetans is a rare condition that is clinically characterized by large verrucous plaques with elevated borders and multiple pustules. The etiology of this disorder remains unknown. OBJECTIVES: We describe a 24-year-old woman with rapidly evolving pyoderma vegetans. Our patient had the unique additional findings of a highly elevated serum IgE level and a history of hidradenitis suppurativa. CONCLUSIONS: Pyoderma vegetans is diagnosed on clinical and histological criteria. Differentiation must be made from disorders such as pyoderma gangrenosum, Sweet's syndrome, and deep fungal infections. We illustrate a case of pyoderma vegetans and review the literature on this rare disorder. Clinical and histological criteria for diagnosis are presented, as well as differentiation from some mimicking disorders.     

Infantile perineal protrusion

Infantile perineal protrusion, a relatively newly recognized condition, is underreported in both the dermatologic and pediatric literature. The name "infantile perineal protrusion" has evolved based on the typical anatomic location, morphologic features, and prevalence in prepubertal children. It occurs in 3 settings: constitutional (sometimes genetic or familial); functional (after constipation, diarrhea, or other irritant exposure); or associated with lichen sclerosus et atrophicus. Recognition of infantile perineal protrusion by dermatologists and pediatricians has many implications regarding proper diagnosis and management. The condition may be mistaken for condyloma acuminata or as a sign of trauma, leading to an erroneous investigation of sexual abuse. In this article, we report two new cases and make a thorough review of the literature to elucidate the mechanisms, diagnosis, classification, and management to clarify this often misdiagnosed condition.     

Congenital hypotrichosis and milia with spontaneous regression during adolescence or Oley syndrome: a variant of Bazex-Dupré-Christol syndrome

BACKGROUND: We report a family presenting the syndrome initially described by Oley characterized by congenital profus milia and hypotrichosis that regress during adolescence. CASE REPORT: A female infant with severe congenital hypotrichosis had profus milia involving the entire face. The remainder of the physical examination was normal. The mother had normal skin and hair but indicated she had had the same signs as a child. The patient's condition regressed from the age of 10 to 15 years but she has undergone several surgical resections for basocellular carcinoma since the age of 20. The maternal grandfather had spontaneously regressive typical follicular atrophodermia involving the back and the hands and also had several milium grains and several basocellular carcinomas. He had never presented hypotrichosis. DISCUSSION: Oley syndrome is defined as an association of congenital hypotrichosis and milia spontaneously regressive during adolescence. The symptoms presented by our patient and her mother are similar to this genodermatosis. Concomitant hypotrichosis, milia, basocellular carcinomas and follicular atrophodermia define the Bazex-Dupré-Christol syndrome. The grandfather's condition would be closer to this syndrome than Oley syndrome despite the spontaneous regression of certain anomalies during adolescence. This family study would suggest that the Bazex-Dupré-Christol syndrome and the Oley syndrome are two variants of the same condition.     

Extensive Facial and Orbital Infantile Hemangiomas Associated with High Intraocular Pressure

Abstract: High intraocular pressure is a rare ophthalmic condition associated with infantile hemangiomas that involves the orbit, eyelid, or both. Here, we describe a patient with extensive facial and orbital infantile hemangiomas associated with high intraocular pressure in the affected eye. The prompt management of this challenging condition is essential.     

Lymphedema‐associated neutrophilic dermatosis: Two cases of localized Sweet syndrome on the lymphedematous lower limbs

Neutrophilic dermatosis on the site of lymphedema is a rare condition and considered as a localized and less severe variant of Sweet syndrome. Only 13 cases of this variant have been reported after mastectomy for breast cancer in the English‐language published work. However, this condition has never been described on the lower limbs or from other causes of lymphedema. Herein, we report two cases of localized Sweet syndrome on the lymphedematous lower limbs: one occurred after radical hysterectomy, bilateral pelvic lymph node dissection and radiotherapy for cervical cancer; the other developed after radiotherapy for malignant melanoma on the right groin. Based on clinical and histological features, we suggest the name “lymphedema‐associated neutrophilic dermatosis” for this underrecognized disease entity.