Skin lesions as the first manifestation of the hypereosinophilic syndrome

An unusual case of the hypereosinophilic syndrome (HES) is described in which lesions have been confined to the skin after a 2-year period of follow-up. The pathogenesis of the HES remains unsolved. A hypersensitivity phenomenon might be involved, although in this case no immunological abnormalities could be detected. The role of the eosinophilic granulocyte, however, seems to be a secondary one.     

Glaucoma following the application of corticosteroid to the skin of the eyelids

A case is reported of intractable glaucoma presumed to be associated with the long-term use of a corticosteroid-containing dermatological preparation on the skin of the eyelids for the control of eczema.     

Guidelines for the presentation of contact allergy case reports

Case reports constitute a classic publication format that is being increasingly appreciated, for example because of its educational value. In the field of contact dermatitis research, case reports often serve as sentinel publications concerning new allergens, or new exposures to known allergens, or regarding other conditions leading to contact dermatitis. The CARE guideline published in 2013 addresses standardized and complete reporting of case reports in all fields of medicine. The present article takes up the CARE suggestions, and further specifies these in terms of application to case reports in the field of contact dermatitis. The objective of this structured guidance is to provide junior or inexperienced doctors and researchers with an annotated list, against which the fulfilment of essential or optional items of a complete, high‐quality case report to be submitted to Contact Dermatitis or other journals can be checked.     

ACE Inhibitor in the Treatment of Cutaneous and Lymphatic Sarcoidosis

Angiotensin-converting enzyme is used as a marker for sarcoid activity. We describe a case of remission of cutaneous and lymphatic sarcoidosis in a patient treated with an ACE inhibitor for congestive heart failure and hypertension; the remission has continued over 4 years of follow-up. Because this is a report of only one case, there is a possibility of sampling error. Whether the patient's remission in this case was a serendipitous spontaneous remission that happened to occur during ACE inhibitor therapy or whether ACE inhibitor therapy can play a role in the treatment of sarcoidosis needs to be determined in a large clinical trial.     

Atypical primary carcinoid tumour of the skin

Abstract:  We present a new case of a primary carcinoid tumour of the skin. The mitotic index (4/10 HPF) warrants classification of this case as atypical. The patient was a 58-year-old woman with a 1-year history of a mass on the scalp. Literature review showed this to be only the seventh case of primary carcinoid tumour of the skin. Importantly, the evolution has been favourable in all seven tumours, with a mean follow-up of 2.5 years for the previous six cases. Although the number of cases is too small to draw definitive conclusions, information to date suggests that this type of tumour can be expected to have a benign behaviour, despite the presence in some cases of criteria suggestive of uncertainty, such as the presence of mitosis.     

Acantholytic dermatosis of the vagina: the diagnostic challenge of acantholytic disease in the genital region

We report the case of a 24‐year‐old woman with an 8‐month history of deep pelvic pain and postcoital bleeding. Examination revealed desquamation of the vaginal epithelium with tender fissured plaques in the vagina, initially thought to be vaginal intraepithelial neoplasia. Histology showed squamous mucosa with suprabasal acantholysis and hyperkeratosis, and no evidence of viral infection, dysplasia or malignancy. These findings were consistent with acantholytic dermatosis (AD), a rare lesion that resembles Hailey–Hailey and Darier disease histopathologically, but can be distinguished on a clinical basis. Vulval cases of AD are well recognized, but to our knowledge, this is the first reported case involving the vaginal epithelium alone.     

Dermatomyositis in association with transitional cell carcinoma of the bladder

We report a case of dermatomyositis occurring in association with transitional cell carcinoma of the bladder. The case illustrates the importance of a thorough search for neoplasms in elderly patients with dermatomyositis and is a reminder that bladder cancer may be a rare cause of dermatomyositis. The case also shows that successful treatment of an underlying tumour may lead to resolution of paraneoplastic dermatomyositis, and relapse of cutaneous and muscle symptoms and signs may indicate recurrence of tumour.     

Tuberculosis of the vulva masquerading as a sexually transmitted disease

Tuberculosis of the vulva is a rare condition usually seen by a gynecologist. We report a case of chronic ulcer on the vulva of four months duration, which, on detailed investigation, turned out to be a case of primary inoculation tuberculosis. The patient was subsequently put on antitubercular therapy with a good the therapeutic response. The rarity of this presentation in dermato-venereology is emphasized.     

Tuberculosis verrucosa cutis on the sole of the foot

We report an unusual case of tuberculosis verrucosa cutis on the plantar aspect of the foot that had been present for more than 40 years in a 62-year-old Indian man. He had a grade IV positive Heaf test and a normal chest radiograph. Mycobacterium tuberculosis was successfully cultured from the third biopsy taken from the lesion. This case demonstrates the indolent nature of the lesion and stresses the importance of taking adequate biopsies for microbiological culture when there is a high index of suspicion for M. tuberculosis. The diagnosis of tuberculosis verrucosa cutis should be based on history and evolution of the disease, cardinal morphological features and histopathological characteristics. Response to anti-tuberculosis drugs may be of assistance.     

Squamous Cell Carcinoma of the Skin Associated with Sarcoid Reactions in the Regional Lymph Nodes

Sarcoid reactions in lymph nodes with or without metastasis from a primary malignant neoplasm are well-known. However, it is extremely rare to find these reactions associated with cutaneous solid tumors; only one such case has appeared in the literature. Here we describe a case of an 83-year-old man with cutaneous squamous cell carcinoma accompanied by sarcoid reactions and metastatic foci in the regional lymph nodes. The possibilities of systemic sarcoidosis and tuberculosis were excluded after extensive examinations specific for these diseases. Some authors regard the sarcoid reaction to be a sign of a good prognosis on the basis of studies of a few patients with solid tumors. In our case, however, the patient died of pulmonary metastasis with pleuritis carcinomatosa shortly after surgery. Systematic analysis of a sufficient number of cases should be carried out to evaluate the clinical significance of this type of reaction.     

Eruptive histiocytoma and xanthoma disseminatum as manifestations of the same disease?

Xanthoma disseminatum, generalized eruptive histiocytoma, juvenile xanthogranuloma and Hand-Schüller-Christian disease are considered to be separate nosologic entities, but it can be difficult to differentiate them and establish the correct diagnosis in a given case. In this paper, the case of a young man is presented who showed lesions resembling those of generalized eruptive histiocytoma early in the course of disease while the lesions later showed typical signs of xanthoma disseminatum.     

Giant folliculosebaceous cystic hamartoma of the upper extremity

BACKGROUND: Folliculosebaceous cystic hamartoma (FSCH) is a rare cutaneous hamartoma consisting of dilated folliculosebaceous units invested in mesenchymal elements. These lesions have a striking predilection for the central face and scalp of adults. The vast majority of lesions present as 0.5-1.5-cm papules or exophytic nodules. A single case of giant FSCH has been reported on the upper back. METHODS: A 32-year-old woman presented with a (15 cm in greatest dimension) plaque-like, multinodular lesion on her left upper arm for several years. The lesion was clinically suspected to be a nevus sebaceus. RESULTS: The skin excision showed numerous dermal and subcutaneous dilated follicular structures with peripherally radiating sebaceous lobules, hair follicles, and surrounding mesenchymal elements consistent with FSCH. CONCLUSION: To our knowledge, this is the second case of giant FSCH. Our case is unique for its larger size, more plaque-like growth, and location on an extremity when compared to the seminal case of giant FSCH.     

Congenital onychodysplasia of the index fingers. An abnormal grip theory

Congenital onychodysplasia of the index fingers, a condition characterized by hypoplasias and dysplasias of the nails peculiarly restricted to the index fingers, is assumed to be related to a peculiar grip of the thumbs leading to ischemia of the index fingers while the baby is in utero. This is based on our observation of a case two days after birth. Major characteristics of this condition, including index finger involvement and radial-prone involvement of the nails, can be well explained by this hypothesis, as can exceptional cases of middle finger involvement. A case of acquired polyonychia is presented which also appears to favor the ischemia theory for this condition.     

Phakomatous choristoma of the eyelid: a report of a case

Phakomatous choristoma is a rare congenital hamartoma of lens tissue. It presents in newborns or young infants as a subcutaneous mass in the medial lower eyelid. We present a case of phakomatous choristoma recently identified among old consultation files at Children's Hospital in Boston. Our case illustrates unique histological features of this entity which has to be included in differential diagnosis of skin lesions of the inferonasal eyelid.     

A survey of case reports and case series of therapeutic interventions in the Archives of Dermatology

Background  Case reports and case series are often the first line of clinical evidence in the medical literature and, until stronger evidence becomes available, are the only guidance to new therapies.
Aim  To determine how case reports and case series are reported, what kind of information is provided, and what the authors conclude.
Methods  All case reports and series ( n  ≤ 10 patients) that described new or innovative therapies were selected from the online version of the Archives of Dermatology published from January 1998 to June 2001. Data were extracted according to a predefined protocol.
Results  Sixty-two case reports and 38 case series were identified. Four of the 100 articles reported treatment failure; 25 reports (40%) and 19 series (50%) concluded that the treatment was efficacious or useful. Systemic treatment was used in 28 reports (45%) and 19 series (50%). Twelve series (32%) reported treatment of consecutive patients. Follow-up could not be assessed in seven case reports (11%). Sixteen reports (26%) and 15 series (39%) reported patients' experiences; 14 reports (23%) and 10 series (26%) indicated some consent.
Conclusions  This small survey confirms a strong publication bias that favors positive results, exaggerated claims of efficacy and safety, underreporting of patient-centered outcomes, and inadequate reporting of consent. We hope to stimulate a discussion of the quality standards for reporting single cases and case series, and of how information from case reports can be used best to improve patient care.     

Nodular fasciitis of the cheek

Nodular fasciitis is a benign, fibrohistiocytic tumor most commonly arising on the trunk. Histopathologically it can be misdiagnosed as fibrosarcoma. We present a case report and review of the literature. Local excision to completely remove the tumor proved curative at 1 year of follow-up. We concluded that nodular fasciitis can be encountered on the cheek and should be regarded as a benign tumor.     

Factitious lymphedema of the hand: a diagnostic challenge

A case of factitious lymphedema of the hand is presented. Attention is drawn to this entity and its differential diagnosis. Delayed detection in our case resulted in prolonged and costly hospitalization with some loss of hand function. Treatment should be left to those skilled in psychotherapy.     

A solitary crateriform ulcer of the lower lip: a case report with review of literature

Keratoacanthoma (KA) is a relatively common skin lesion. We report a case of KA-mimicking squamous cell carcinoma in a 40-year old smoker, who was also having speckeled leukoplakia on the buccal mucosa. The present case highlights the importance of histopathological diagnosis, as the treatment in latter case is aggressive, which is unnecessary if attempted with KA. Moreover, the present report provides an overview of such lesions, which could be encountered in clinical situations for which definitive diagnosis is of paramount importance before the starting of treatment plan.     

Syringomatous adenoma of the nipple occurring within a supernumerary breast: a case report

Originally described by Rosen in 1983, syringomatous nipple adenoma (SAN) is a tumor of disputed histogenesis, which can be problematic both diagnostically and therapeutically. ¹ It is a benign primary tumor of breast epithelium with histology similar to that of the syringoma. In the current case, we describe a 40-year-old female with this lesion occurring within a supernumerary breast. This case represents, to our knowledge, the first such reported case, and represents a significant finding as its presence could lend some confusion as to whether or not this represents a benign primary process of breast or a potentially infiltrative tumor of the skin.