Rapidly growing hemorrhagic papule on the cheek of a 54-year-old man

A 54-year-old man sought medical attention for a growth on his right cheek that had been present for three months. The growth began as a small, brown “pimple” that gradually increased in size over time. Physical examination revealed a 9 mm well-circumscribed erythematous nodule with a hemorrhagic crust. On dermoscopy, the lesion was completely vascular appearing, with no pigment visualized. A clinical diagnosis of pyogenic granuloma was made. The lesion was biopsied and histopathologic examination revealed a 2.8 mm thick, Clark level IV, ulcerated, amelanotic nodular melanoma. Because the literature contains reports of nodular melanoma mimicking the presentation of a pyogenic granuloma, all such lesions should be biopsied for histopathologic diagnosis.     

Hydroa vacciniforme persistent in a 60-year-old man.

Hydroa vacciniforme (HV) is an idiopathic photodermatosis with onset in childhood, a chronic-recurrent course, and spontaneous resolution in adolescence or early adulthood. We present a patient with typical HV in whom lesions began in childhood and continued until 60 years of age.     

Chronic pruritic papular dermatitis in adult men: a variant of prurigo.

Chronic recurrent pruritic papular eruptions in which a specific diagnosis cannot be established becomes a baffling experience to the dermatologist. We have met adult male patients with chronic recurrent pruritic papular eruptions, but their clinicopathological features are not described in English language textbooks. Our purpose was to study the clinical and histological features of this entity and review the various existing taxonomy. We conducted a study of 20 patients over a six year period by taking histories, performing skin biopsies, screening patch tests, and doing immunofluoresence studies. The eruptions occurred exclusively in male adults and had a predilection for the trunk and proximal extremities. The lesions were characterized by severely pruritic, nonfollicular, monomorphic, erythematous urticarial papules. There was no evidence of atopic diathesis or history of insect bite. Most patients had normal levels of serum eosinophils and IgE. The predominant histopathologic finding was a presence of perivascular infiltration of mononuclear cells with eosinophils. The patients followed a chronic course of at least six months with waxing and waning; systemic corticosteroids were the only effective treatment. Finally, all other pruritic erythematous papular dermatoses were ruled out. These cases comprise a distinct entity that has previously been mentioned in a few reports. Clear definition of this entity with an appropriate designation is in order to avoid confusion among dermatologists, and we propose the disease name "chronic papular dermatitis in adult men" as a variant of prurigo.     

Unknown: A warm, painful nodule on the back

A 67-year-old man presented with a complaint of a painful nodule on his back for approximately two months. On exam, a violaceous, firm, warm, indurated nodule measuring 3.5 x 2 cm was observed. Nine months prior to presentation, he was diagnosed with a moderately differentiated squamous cell carcinoma (SCC) of the left upper lobe (stage 1b), which was removed via video-assisted thoracoscopic wedge resection. Diagnosis of metastatic SCC secondary to traumatic seeding at a trocar port site was made. To our knowledge, this has not been previously described in the literature.     

Cheilitis: analysis of 75 cases referred to a contact dermatitis clinic.

BACKGROUND: Cheilitis is a common problem, the cause of which is often obscure. OBJECTIVE: Data on 75 cases of recalcitrant cheilitis were analyzed. These had been referred to a tertiary care center. METHODS: Each of the 75 patients had undergone a detailed history, physical examination, and patch tests. RESULTS: Of the patients, 53 were female (67%), and the age range was 9 to 79 years. Of the cases, 36% included irritant contact dermatitis (ICD), 25% included allergic contact dermatitis (ACD), 19% were attributed to atopic eczema, and in 9% the dermatitis was of unknown cause. Nine percent were noneczematous. The materials causing ACD were medicaments applied to the lips, lipstick ingredients, sunscreen agents, toothpaste ingredients, colophony in dental floss and toothpicks, nail varnish, cosmetics, and nickel in the mouthpiece of a flute. CONCLUSION: The most common cause of cheilitis was irritation, frequently caused by liplicking. About one quarter was caused by ACD. Medicaments, lipsticks, sunscreens, and toothpaste were the most common allergens. Atopic eczema is a commonly overlooked cause of cheilitis. However, there is a troublesome group of patients, 9% in this series, who are often severely affected, but the cause of their cheilitis remains obscure.     

Transgenic expression of interleukin-13 in the skin induces a pruritic dermatitis and skin remodeling

IL-13 has been implicated in the pathogenesis of allergic diseases, including atopic dermatitis (AD). However, a direct role of IL-13 in AD has not been established. We aimed to develop an inducible transgenic model in which IL-13 can be expressed in the skin and to define the resulting dermal phenotype and mechanisms involved. The keratin 5 promoter was used with a tetracycline-inducible system to target IL-13 to the skin. The clinical manifestations, dermal histology, cytokine gene regulation, and systemic immune responses in the transgenic mice were assessed. IL-13 was produced exclusively in the skin and caused a chronic inflammatory phenotype characterized by xerosis and pruritic eczematous lesions; dermal infiltration of CD4+ T cells, mast cells, eosinophils, macrophages, and Langerhans cells; upregulation of chemokine and cytokine genes, including thymic stromal lymphopoietin; and skin remodeling with fibrosis and increased vasculature. The dermal phenotype was accompanied by elevated serum total IgE and IgG1 and increased production of IL-4 and IL-13 by CD4+ cells from lymphoid tissues and peripheral blood mononuclear cells. IL-13 is a potent stimulator of dermal inflammation and remodeling and this transgenic model of AD is a good tool for investigating the underlying mechanisms in the pathogenesis of AD.