A ROSACEA-LIKE ERUPTION OF CHILDREN

Eleven children have shown similar changes on the facial skin. A bright malar flush was accompanied at times by small superficial papules, pustules and scaling. The clinical picture was variable, sometimes closely resembling rosacea and sometimes peri-oral dermatitis, taking an average of 1 year to clear. Seven of the 11 children had a family history of atopy, and 2 had a family history of rosacea. Potent topical corticosteroids may have played a role in the cause of these children's rash and, on withdrawal, there was sometimes a pustular exacerbation. The relationship to rosacea and peri-oral dermatitis is discussed.     

A case of childhood generalized pustular psoriasis treated with dapsone

Acute generalized pustular psoriasis (GPP) is a rare, sometimes fatal, exudative form of psoriasis characterized by acute febrile pustular psoriasis. Unlike the adult forms, GPP in childhood tends to undergo a more benign course. It may resolve spontaneously with only supportive treatment, but may sometimes be life threatening and resistant to therapy. We report a case of GPP in 7-year-old girl treated successfully with dapsone.     

Secondary longitudinal melanonychia secondary to onychophagia

BACKGROUND: Melanonychia of the toenails sometimes results from repeated trauma. This etiology is rarely put forward in lesions affecting the fingernails. CASE REPORT: A 44-year-old woman developed melanonychia affecting 9 fingernails. Genetic predisposition and drug, hormonal or infectious causes were ruled out and we postulated that the lesions were induced by nail biting. DISCUSSION: Nail biting is known to lead to several types of lesions, including melanonychia. The lesions may sometimes disappear several months after stopping this habit.     

Multicentric reticulo-histiocytosis; review of recent literature (since 1969)]

The review of recent literature (since 1969) shows 35 cases of multicentric reticulo-histiocytosis. This entity was first described as a dermatological disease, then as a dermatoarthritis. It is in fact a systemic disease which can involve many organs but is sometimes monosymptomatic. Its fatal outcome is, sometimes, the result of a disseminated neoplasia or a lymphoma. Its clinical and microscopic features allow to distinguish it from solitary reticulo-histiocytoma, generalized eruptive histiocytoma, congenital reticulo-histiocytosis of Hashimoto and Pritzker and familial histiocytic dermato-arthritis of Zayid.     

Atypical clinical presentation of pigmented purpuric dermatosis

The term pigmented purpuric dermatosis (PPD) is used for a group of mainly asymptomatic, sometimes pruritic dermatoses that are clinically characterized by an eruption of pinpoint purpuric lesions along with yellow, orange, red and/or brown, often patchy pigmented areas. Traditionally five subtypes have been distinguished, but atypical clinical patterns may also occur. Because of the variable clinical spectrum and the similar histopathologic findings, a strict nosological classification is sometimes difficult or even impossible to achieve. We report a case of PPD with atypical clinical features in a young woman, underlining the difficulties in the clinical classification of this spectrum of diseases.     

Case for diagnosis. Acrokeratoelastoidosis

Acrokeratoelastoidosis is a type of palmoplantar keratoderma first described by Oswaldo Gon?alves Costa, a Brazilian Dermatologist from the state of Minas Gerais. It is a rare autosomal-dominant genodermatosis; however it may occur sporadically. The disease is not congenital; rather, its onset occurs in childhood or adolescence. Clinically, the condition is characterized by multiple yellowish papules, sometimes glossy and keratotic, measuring approximately 2-4 mm in diameter, sometimes umbilicated, and located symmetrically on the sides of the hands and feet, symmetry being the most typical sign. The most common histopathological findings are hyperkeratosis, mild acanthosis and elastorrhexis, as revealed by orcein staining.     

Therapy of nontuberculous mycobacterial infections

Mycobacterial infections are increasing in incidence worldwide, partly as a result of the increase in immunocompromised individuals. They cause a large number of cutaneous infections with a broad array of manifestations. Because of their diverse manifestations and sometimes fastidious nature, infections with mycobacteria are often misdiagnosed, leading to delay in and sometimes failure of therapy. In addition, many mycobacteria display both in vitro and in vivo drug resistance to antimicrobial agents. Early recognition of affected patients, initiation of appropriate antimicrobial therapy based on current guidelines, and tailoring of therapy after susceptibility testing is available are therefore essential to the successful treatment of mycobacterial infections.     

Foamy cell angiosarcoma: a rare and deceptively bland variant of cutaneous angiosarcoma

Cutaneous angiosarcoma can sometimes mimic other benign and malignant lesions, thereby presenting a difficult differential diagnosis. In the two cases of cutaneous angiosarcoma presented herein, extensive foamy cell alteration of tumor cells resembled a reactive xanthogranulomatous process. Foamy cell angiosarcoma is an unusual and deceptively benign morphologic variant of cutaneous angiosarcoma. Critical features for diagnosis include the presence of a deep, permeative, sometimes ‘scaffolding’ growth pattern and subtle areas of vascular formation. Tatsas AD, Keedy VL, Florell SR, Simpson JF, Coffin CM, Kelley MC, Cates JMM. Foamy cell angiosarcoma: a rare and deceptively bland variant of cutaneous angiosarcoma.     

Skin variations in blacks

There are several skin variations normally found in blacks. These variations include Voigt's or Futcher's lines, midline hypopigmentation, pigmentation of the nails, oral pigmentation, plantar hyperpigmented macules, leukoedema of the oral mucosa, pearly penile papules, punctate pits and keratoses of the palms. It is important for health care providers in general and dermatologists in particular to recognize these variations in black skin. In the past, these skin variations have been viewed by physicians and sometimes patients as being abnormal and/or pathologic. Recognition of these benign variations in black skin will aid in correct identification and avoidance of sometimes unnecessary treatment.     

GENERALISED ERUPTIVE SYRINGOMA-A PAPULAR DERMATOSIS

Generalized eruptive syringoma is a rare condition characterised by multiple papules over the anterior trunk, sometimes extending on to the flexural aspects of the arms and thighs. A 22 year old Ethiopian woman with this disorder is presented.     

Sweet's syndrome associated with ovarian carcinoma

Sweet's syndrome is sometimes associated with haematological malignancies and less frequently with solid tumors. We report a new case of association of a Sweet's syndrome with an ovarian carcinoma.     

Contact allergy to corticosteroids in asthma/rhinitis patients

Patients with asthma and/or rhinitis, when using inhalers or nasal sprays containing corticosteroids, may experience mucosal symptoms, such as congestion of the nose, itching, nose bleeding and worsening of rhinitis, but also eczema of the face sometimes spreading to flexures, and sometimes the corticosteroid simply does not help. Few patients with such symptoms have been found to be allergic to their inhaled corticosteroids (1), and no report on whether contact allergy to corticosteroids could explain treatment failures is available. This issue was investigated in 2 ways: (i) by testing asthma/rhinitis patients for corticosteroid allergy, (ii) by looking at the prevalence of tixocortol pivalate allergy among dermatitis patients with and without asthma/rhinitis, respectively.     

Diffuse dermal angiomatosis of the breast: an emerging entity in the setting of cutaneous reactive angiomatoses

New and emerging types of cutaneous vascular (capillary) proliferations have been described or better categorized in the last few years. They include reactive angioendotheliomatosis, acroangiodermatitis (pseudo-Kaposi sarcoma), diffuse dermal angiomatosis, intravascular histiocytosis, glomeruloid angioendotheliomatosis, and angiopericytomatosis (angiomatosis with cryoproteins). Clinically, they are characterized by multiple, red violaceous, and purpuric patches and plaques, sometimes evolving toward necrosis and ulceration with a wide distribution but a propensity to involve the extremities. Histologically, they are characterized by different patterns of intravascular or extravascular lobular or diffuse hyperplasia of endothelial cells, pericytes, and sometimes histiocytes. Although these angioproliferations can histologically have a pseudoangiosarcomatous pattern, they are reactive in that they originate from the (sub)occlusion of vascular lumina by different localized or systemic disorders. The vascular proliferation stops after the inducing hypoxic stimulus has been withdrawn. Among them, diffuse dermal angiomatosis of the breast is a variant of diffuse dermal angiomatosis involving middle-aged women with macromastia, obesity, smoking, and vasculopathic disorders, considered a distinct disorder in the spectrum of cutaneous reactive angiomatoses. It presents with reticulated erythematous to purple patches with sometimes a tendency to ulcerate and bleeding, appearing on large, pendulous breasts. The pathogenesis is related to tissue hypoxemia resulting from subclinical torsion, compression, and increased venous hydrostatic pressure due to the macromastia, aggravated by the associated ischemic conditions such as hypertension and diabetes. There is no evidence-based therapy, but reduction mammoplasty is a viable treatment option. This should be evaluated in all patients who fail conservative therapy.     

Reticulate acropigmentation of dohi: a case report with insight into genodermatoses with mottled pigmentation

Reticulate acropigmentation of Dohi also called dyschromatosis symmetrica hereditaria or symmetrical dyschromatosis of the extremities is an autosomal dominant inherited disorder. It is characterized by mottled pigmentation with patchy depigmentation commonly over the back of the hands and feet and sometimes on the arms and legs.     

Chikungunya associated with cutaneous ulcerations

Chikungunya is a viral infection commonly causing fever and arthralgias, sometimes accompanied with myalgias and rash. We report a 72-year-old woman presenting with a 3-month history of painful cutaneous ulcerations on both legs, and discuss the cutaneous features associated with chikungunya.     

Perioral dermatitis

The cause of perioral dermatitis remains unclear. It is not due to the application of fluorinated corticosteroids. For therapy Locoid cream and tetracycline are recommended. There are some cases which are not influenced by any therapy. In these cases psychotherapy is sometimes effective.     

Nephrogenic Fibrosing Dermopathy

Nephrogenic fibrosing dermopathy (NFD) is an acquired, idiopathic, chronic, progressive eruption of the skin sometimes accompanied by systemic fibrosis that occurs in the context of renal failure. The age of patients with NFD ranges from 8 to 87 years at the time of onset, with a mean age of 46.4 years. Most cases have been reported in the US and Europe, but recently cases have also been reported in India. About 175 cases have been noted in a registry established for NFD patients. Even in the setting of renal disease, NFD still occurs rarely and its cause is unknown. Patients present with hard, indurated, sometimes peau d'orange plaques. They often show a distinctive physical appearance, with elbows and knees angled inward, and most patients complain of a loss of range of motion. Histology demonstrates thickened collagen bundles with surrounding clefts, mucin, and a proliferation of fibroblasts and elastic fibers, sometimes with reticular, dermal, large epithelioid or stellate spindle cells. Fibrosis of NFD can affect the internal organs and thus the term nephrogenic systemic fibrosis has been used by some analysts to describe this fibrosing process. The fibrosis of NFD appears to be due to the effects of a cell referred to as the circulating fibrocyte. Rare cases of partial-to-complete spontaneous resolution have been reported in the absence of specific therapy. Treatments yield inconsistent results and include restoration of renal function, extracorporeal photopheresis, photodynamic therapy, high-dose intravenous immunoglobulin, and other immunosuppressive therapies.     

Plate-like sebaceous hyperplasia overlying dermatofibroma

Epidermal hyperplasia, sometimes with primitive hair follicle-like differentiation, is a characteristic finding overlying dermatofibroma. We here report plate-like sebaceous hyperplasia overlying a dermatofibroma. Such changes are interpreted as a result of inductive epithelial effect by the dermatofibroma on the overlying epidermis.     

Langerhans cells in granulomatous syphilis

In a case of granulomatous syphilis (transitional state between early and late syphilis), several Langerhans cells (LC) were present in the basal and medial part of the epidermis. Evidence of LC activation was given by the presence of many Langerhans granules, vesicles, a large Golgi apparatus and, sometimes, Golgi complexes. In some LC, signs of degeneration were visible. Langerhans granules surrounded by cytoplasmic material were present in the intercellular space of the epidermis. Apposition of lymphocytes to LC in the dermal space supports the role of LC in immunologic mechanisms. This was further confirmed by signs of phagocytosis in LC. The interaction of LC with intra-epidermal microorganisms (as, for instance, the Treponema pallidum) might be important in the development of the epidermotropic infiltration. This mainly consists of lymphocytes, which sometimes form a pseudolymphoma. A correlation between LC and granuloma formation is suggested.     

A simple method for the detection of formaldehyde

The commonly used chromotropic acid method for the determination of formaldehyde sometimes produces a masking discolouration. We have therefore evaluated a complementary method in which acetylacetone is used as the reagent. By a combination of the 2 methods, formaldehyde can be traced in most products.