The “gauntlet” of pellagra

A 48-year-old alcoholic Filipino man presented to the outpatient department with a 2-year history of an eruption in a photosensitive distribution and episodes of mild diarrhea. He was otherwise in good health. Dermatologic examination revealed a browny-red coloration, with a sharply demarcated erythematous border, affecting both hands and lower forearms, where it was striking in its symmetry ( Fig. 1 ). Around the neck, it was typical of a casal's necklace. The fronts and backs of the legs and the dorsa of the feet were also erythematous. The patient showed no evidence of mental confusion.

Figure 1 Open in figure viewer PowerPoint “Gauntlet” of pellagra, showing browny-red discoloration with sharply demarcated erythematous border     

Dimethylfumarat “nur” ein Anti‐Psoriatikum?

Fumaric acid esters have been used successfully in the therapy of psoriasis vulgaris since 1959. In the last 17 years, many of the underlying mechanisms of anti‐psoriatic action, such as a Th1/Th2 shift, a suppression of important leukocyte adhesion molecules, the induction of pro‐apoptotic pathways in T‐cells and recently anti‐angiogenic action, have been discovered. Based on the knowledge of these immunomodulatory characteristics, fumaric acid esters have been shown to be effective or potentially effective in a multitude of dermatological as well as non‐dermatological diseases. The range of new therapeutic targets reaches from multiple sclerosis to illnesses such as necrobiosis lipoidica, granuloma annulare and sarcoidosis. Experimental approaches offer promising, although preliminary, results on the treatment of cancer, malaria, chronic inflammatory lung diseases, and Huntington disease, to name but a few. This valued and well‐known drug mainly prescribed by dermatologists is now experiencing a renaissance far beyond dermatologic applications.     

A “seasonal bromoderma” in a farmer

Bromoderma is a rare skin disease caused by the ingestion, inhalation, or contact with products containing bromides. We report a case of bromoderma in a 36‐year‐old farmer, characterized by remission during the spring and exacerbation during the winter. The recognition of the use of products containing bromides during the winter helped us to understand the cause of the clinical condition.     

“Standard of reasonable care” in dermatopathology

Diagnoses in dermatopathology are capable of improvement. Clinical pictures should be evaluated along with skin biopsy specimens whenever possible.