Familial papular epidermal nevus with “skyline” basal cell layer

Papular epidermal nevus with “skyline” basal cell layer is a variant of keratinocytic nevus that usually occurs sporadically but may affect different family members. We report on the fourth family with papular epidermal nevus with “skyline” basal cell layer affecting a 3‐month‐old girl and her father.     

Multicenter study „Medical‐Occupational Rehabilitation Procedure Skin – optimizing and quality assurance of inpatient‐management (ROQ)”

Scientifically based prevention and patient management concepts in occupational dermatology have substantially improved during recent years. Currently the public statutory employers' liability insurance bodies fund a multi‐step intervention approach designed to provide quick preventive help for all levels of severity of occupational dermatoses. An administrative guideline (hierarchical multi‐step intervention procedure for occupational skin diseases –“Stufenverfahren Haut”) insures professional support and optimal patient orientation by the statutory insurers' representatives. For secondary prevention, the so‐called dermatologist's procedure (“Hautarztverfahren”) was recently updated in order to provide more rapid dermatologic consultations which are covered for by the public statutory employers' liability insurance bodies. Additionally, combined outpatient dermatologic and health‐educational intervention seminars (“secondary individual prevention”[SIP]) are offered to affected employees in a nationwide scheme. For those cases of occupational dermatoses in which these outpatient prevention measures are not successful, interdisciplinary inpatient rehabilitation measures have been developed (“tertiary individual prevention”[TIP]). TIP requires 3 weeks inpatient treatment including intensive health care instruction and psychological counseling, followed by outpatient treatment by the local dermatologist. In 2005, a German prospective cohort multicenter study (“Medical‐Occupational Rehabilitation Procedure Skin – optimizing and quality assurance of inpatient‐management”–“Medizinisch‐Berufliches Rehabilitationsverfahren Haut – Optimierung und Qualitätssicherung des Heilverfahrens”[ROQ]) started which will further standardize TIP and evaluate scientific sustainability in depth (3‐year dermatological follow‐up of 1,000 patients). The study is being funded by the German Statutory Accident Insurance (Deutsche Gesetzliche Unfallversicherung [DGUV]).     

Never perform laser treatment of skin tumors with clinical “EFG” criteria

Laser treatment is a common procedure for the treatment of cosmetically troubling skin lesions but has the limitation that histopathologic diagnosis is usually not obtained prior to treatment. Laser treatment of melanomas with benign clinical features may delay or make more difficult the correct diagnosis of such tumors. A helpful tool to identify clinically innocent appearing melanomas is the “EFG” rule, summarizing the common clinical features as “elevated, firm skin lesions showing continuous growth”. We report a 42‐year‐old woman who presented with a recurrent and metastatic melanoma after laser treatment of a tumor which was apparently clinically innocent and highlight the clinical features of such benign‐looking melanomas.     

“Slime” dermatitis,a fad‐associated chronic hand dermatitis

“Slime” is the colloquial name for a non‐Newtonian viscoelastic putty‐like substance that is currently a popular plaything among pre‐teens and adolescents. Several ingredients in homemade slime recipes may cause irritant or allergic contact dermatitis. We report two children who developed slime‐associated chronic hand dermatitis, more prominently on their dominant hand. We review the potential for irritant and allergic contact dermatoses as the causes of dermatitis associated with homemade slime.     

“Chemical” surgery in treating basal cell carcinoma in elderly

The incidence of basal cell carcinoma (BCC) has been increasing in the last decades due to population aging and precise diagnosis. The difficulty that physicians face frequently is related to the treatment decision for BCC; when treating BCC, correct and personalized choices must be taken into consideration by selecting from a large variety of therapeutic options such as: surgical excision (“the golden standard therapy”), electrodessication, cryosurgery, radiation therapy, laser, photodynamic therapy, curettage, topical treatment (imiquimod, 5‐fluorouracil, vismodegib), or combining different treatments. The present authors present series of cases of patients diagnosed with BCC, highlighting that “chemical surgery” using 70% trichloroacetic acid could be a valuable option in the treatment of nonaggressive BCC of the face.     

An unusual presentation of early congenital syphilis with annular configuration of blisters resembling “string‐of‐pearls”

Skin lesions in early congenital syphilis can show considerable variability. A 35‐day‐old infant presented with rhinitis, desquamation of palms and soles, pseudoparalysis of the right upper limb, and annular lesions with peripheral blistering over the chest and abdomen, resembling a “string‐of‐pearls.” A diagnosis of congenital syphilis was made on the basis of radiologic evaluation and reactive Venereal Disease Research Laboratory (VDRL) in both mother and child. We report this case to highlight the unusual presentation of congenital syphilis with annular configuration of blisters, mimicking a “string‐of‐pearls."     

Supportive Immunglobulingabe beim metastasierten Melanom unter Polychemoimmuntherapie nach dem „Legha‐Protokoll”

Summary: Background and Objective: Metastatic malignant melanoma as one of the most aggressive tumors has got a new and promising therapy option with the polychemoimmunotherapy according to “Legha's protocol” (5 – 7). Facing the relatively high toxicity of this therapy, especially the high rate of infections of 49 % ( 8 ), we decided to perform a supportive treatment with intravenous IgM‐enriched immunoglobulins in order to avoid infections.
Patients/Methods: From 1998 to 2002 we treated 34 patients with metastatic malignant melanoma with the polychemoimmunotherapy according to “Legha's protocol”. Four days after each course (except the first one) patients intravenously got IgM‐enriched immunoglobulins (5 ml/kg, i. e. 250 mg /kg).
Results: Out of 34 patients three patients suffered from different infections during the polychemoimmunotherapy: One patient developed a labial herpes infection after each course, another one a subcutaneous abscess on her forearm after the third course and the third patient had a gluteal abscess after the first course, that means before getting immunoglobulins. In comparison with the infection rate of 49 % given in the literature our observed infection rate as a side effect of Legha's therapy is very low (8,8 %) when combined with supportive immunoglobulins.
Conclusions: The supportive treatment with IgM‐enriched immunoglobulins during the polychemoimmunotherapy according to “Legha's protocol” can significantly reduce the rate of opportunistic infections in these secundarily immunosuppressed patients.     

The “Heart Sign”: An Early Indicator of Dose‐Dependent Doxycycline‐Induced Phototoxicity

Oral doxycycline is an antibiotic commonly used for the treatment of inflammatory acne in adolescents. Dose‐dependent phototoxicity, unrelated to dose duration, is a well‐known complication of its use. We present three adolescents who developed bilateral phototoxic rashes on the dorsal thenar spaces of their hands while taking doxycycline for their acne. Identification of the “heart sign” rash as a specific doxycycline‐related phototoxic reaction should alert clinicians to the need for prompt intervention, including sun protection counseling and a possible change in antibiotics, in the uniquely vulnerable adolescent population. Early recognition may allow patients to avoid future, more widespread phototoxic drug reactions.     

“Slime” contact dermatitis: Case report and review of relevant allergens

Homemade “slime” is currently a popular childhood hobby that can cause allergic and irritant contact dermatitis. We describe a case of hand dermatitis due to homemade “slime” with a positive patch test to methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) and MI. The most common potential allergens in “slime” collected from a review of “slime” recipes found on the Internet are reviewed.     

“Dots and lines”: A melanonychia striata in regression: Report of a case

A 2‐year‐old Caucasian boy with melanonychia striata with multiple striking pits on the nail plate of one fingernail is described. Nail disorders often pose diagnostic and therapeutic challenges for clinicians, especially melanonychia striata, because of the fear of a subungual melanoma. Only a few childhood cases of melanonychia striata have been described, and the multiple pits are even less common. Dots distributed along melanotic lines is a finding referred to as “dots and lines” and can be a sign of regression of melanonychia in childeren.     

Adolescent “Saxophone Penis” Secondary to Crohn's Disease: Misdiagnosed as Being Posttraumatic

We describe a patient with a “saxophone penis” mistakenly diagnosed as having posttraumatic changes. A careful history and attention to blood tests at presentation may have alerted clinicians that there was a nontraumatic cause for our patient's disease. It is essential that clinicians consider “metastatic” anogenital Crohn's disease as a possible cause of “saxophone penis”.     

“EB,or Not EB?” Neonatal Desquamative Impetigo in a Degloving Pattern

We present the case of a 7‐day‐old boy with significant, rapidly spreading blistering and desquamation in a “degloving” pattern on the hands that mimicked epidermolysis bullosa but was ultimately diagnosed as bullous impetigo caused by a clinically aggressive strain of Staphylococcus aureus. Bullous impetigo is a desquamating condition caused by local release of S. aureus exfoliative toxin A and is more commonly seen in children. This case highlights the fragility of newborn skin and reviews the major diagnoses that should be considered in an infant with significant blistering.     

Multifocal congenital hemangioma: Expanding the pathogenesis of “neonatal hemangiomatosis”

Congenital hemangiomas are benign vascular tumors, categorized by their postnatal behavior as rapidly involuting, non‐involuting, or partially involuting. They are typically solitary, with a predilection for the head or limbs near a joint. We present two infants with small, multifocal congenital nonprogressive hemangiomas of the skin, one associated with hepatic and intracranial lesions, and another with an in utero intracranial hemorrhage and hydrocephalus. These cases further extend the differential diagnosis of congenital multifocal vascular lesions or “hemangiomatosis.”     

Familial papular epidermal nevus with “skyline” basal cell layer and multiple pilomatricomas: A new association?

Papular epidermal nevus with “skyline” basal cell layer is a newly described keratinocytic nevus. Recently, papular epidermal nevus with “skyline” basal cell layer has been reported in association with extracutaneous involvement, and the term papular epidermal nevus with “skyline” basal cell layer syndrome is used to indicate a neurocutaneous syndrome characterized by the presence of papular epidermal nevus with “skyline” basal cell layer and different neurologic symptoms that seem to improve during infancy and adolescence. Multiple pilomatricomas have been reported in association with various syndromes. We report herein papular epidermal nevus with “skyline” basal cell layer associated with multiple pilomatricomas in two members of a family with the aim of drawing attention to this peculiar epidermal nevus to improve our knowledge of the syndrome.     

„Neue” Techniken für eine sensitivere Epikutantestung?

The patch test is the mainstay of diagnosis in allergic contact dermatitis. In its nearly 120‐year‐long history, numerous efforts to standardize several methodical aspects proved successful. The aim was always to enhance the validity and reliability of patch testing. This article reviews modifications of the basic patch test technique for enhancing test sensitivity. We expand on the recently validated strip patch test, which is a modification that involves affixing tape strips to the skin and removing them prior to patch testing. Although it was first described in 1953, we proposed the first protocol for standardized performance of the “strip patch test.” The protocol was then tested in studies. As a result, test sensitivity of standardized strip patch test versus patch test was increased. The protocol produced a uniform reduction in the thickness of the stratum corneum and a good inter‐rater agreement. Additionally, there was evidence of a non‐specific stimulation of the inflammatory epidermal system. With regard to patient history, the standardized strip patch test showed a vastly better sensitivity than the patch test with only marginally lower specificity. As a complementary measure to patch testing diagnostic accuracy could be improved significantly by performing the standardized strip patch test. Further studies are needed on the reproducibility of the standardized strip patch test.     

UV‐induced occupational skin cancer: possibilities of secondary individual prevention in the “Dermatologist's Procedure”

Invasive squamous cell carcinoma (SCC) as a “quasi occupational disease” according to §9 Section 2 of the German Social Code Book (SGB) VII typically develops on chronically UV‐damaged skin from actinic keratoses. After the Medical Scientific Committee of the Federal Ministry of Labor and Social Affairs has confirmed the legal criteria for acknowledging UV‐induced SCC as an occupational disease, it is expected that the condition will be added to the official list of occupational diseases issued by the Federal Government in the near future. The Social Accident Insurance is required by law (§3 Occupational Disease Regulation) to prevent these tumors by “ all appropriate means“. There are excellent therapeutic and preventive measures for the management of actinic keratoses to avoid the development of SCC. The “ Dermatologist's Procedure“ according to §§ 41–43 of the agreement between the Social Accident Insurance and the Federal Medical Association was established in Germany in 1972 to take preventive measures in insured persons with skin lesions possibly developing into an occupational disease, or worsening it, or leading to a recurrence of it This procedure proved to be very successful in the prevention of severe and/or recurring skin diseases forcing a worker to leave his job. On the basis of this agreement, the Social Accident Insurance has the instruments to independently provide preventive measures for the new occupational skin disease SCC induced by natural UV light according to §9 Section 2 of the German Social Code Book (SGB) VII.     

Barbed sutures “lunch time” lifting: evidence‐based efficacy

There is a growing trend nowadays for patients to seek the least invasive treatments possible with less risk of complications and downtime to correct rhytides and ptosis characteristic of aging. Nonsurgical face and neck rejuvenation has been attempted with various types of interventions. Suture suspension of the face, although not a new idea, has gained prominence with the advent of the so called “lunch‐time” face‐lift. Although some have embraced this technique, many more express doubts about its safety and efficacy limiting its widespread adoption. The present review aims to evaluate several clinical parameters pertaining to thread suspensions such as longevity of results of various types of polypropylene barbed sutures, their clinical efficacy and safety, and the risk of serious adverse events associated with such sutures. Early results of barbed suture suspension remain inconclusive. Adverse events do occur though mostly minor, self‐limited, and of short duration. Less clear are the data on the extent of the peak correction and the longevity of effect, and the long‐term effects of the sutures themselves. The popularity of barbed suture lifting has waned for the time being. Certainly, it should not be presented as an alternative to a face‐lift.     

“Drug‐resistant granuloma faciale”: treatment with carbon dioxide‐GaAs laser

Granuloma faciale (GF), also known as “eosinophilic granuloma,” is a rare benign leukocytoclastic vasculitis which most commonly occurs on the face of middle‐aged Caucasian males. Clinically, GF appears as single or multiple, slowly growing, reddish‐brown papules, nodules or plaques which may be cosmetically unpleasant. Its pathogenesis is unknown and GF is notoriously resistant to treatments. Both medical (dapsone, colchicine, gold injections, isoniazid, clofazimine, corticosteroids, psoralen ultraviolet radiation, and topical tacrolimus) and surgical therapies (excision, graft, dermabrasion, argon laser, carbon dioxide laser, pulsed dye laser, cryotherapy, and electrosurgery) have been used for GF but no effective treatment has yet been found. Furthermore, the typical facial location of GF requires an acceptable cosmetic result. We report two cases of drug‐resistant GF which were successfully treated with laser vaporization combining two different wavelengths: carbon dioxide (CO₂) 10,600 nm and GaAs 1540 nm.     

Bibbidi bobbidi bald: Two “hairowing” tales of Princess Package hairstyles

We present cases of localized alopecia on the vertex scalp of two girls after elaborate professional hairstyling marketed as the “Princess Package” at a major U.S. theme park. Localized alopecia followed pain, erythema, and delayed crusting due to necrosis of the scalp. The majority of the affected alopecic areas had evidence of regrowth at interval follow‐up, but small areas of scarring alopecia remained. We propose that these cases represent a type of alopecia caused by a combination of pressure ischemia and acute traction alopecia.