Crystal deodorant dermatitis: irritant dermatitis to alum-containing deodorant.

Two patients developed an irritant dermatitis of the axillae shortly after using an over-the-counter "natural deodorant crystal" product containing alum. We discuss this previously unreported, untoward reaction to alum, an ancient agent with newfound popularity as an alternative health product.     

Amelanotic lentigo maligna melanoma manifesting as a dermatitislike plaque

A 72-year-old man with a previous history of an amelanotic melanoma on his left forearm had an erythematous plaque excised from his right shoulder. Although the clinical impression was a dermatitis, a biopsy specimen revealed an amelanotic lentigo maligna melanoma. To our knowledge, this is the first patient described with an amelanotic lentigo maligna melanoma as a second primary tumor to an apparent previous amelanotic melanoma, manifesting as a dermatitislike plaque.     

Epidermolysis Bullosa Acquisita in an 8-year-old Girl

Epidermolysis bullosa acquisita is an autoimmune blistering disease with the distinct feature of having an autoantibody directed against an antigen located below the basement membrane of human skin and mucous membrane. We identified this disease in an 8-year-old girl, the youngest patient documented by immunoelectron microscopy.     

A surreptitious sinister sarcoma

Angiosarcoma is an exceedingly rare endothelial-derived sarcoma that, when seen, usually presents as an expanding bruise-like patch or violaceous papule/nodule on the head of an elderly patient. Herein, we present the histologic features of an unusual case that defied initial diagnosis.     

Leg ulcers secondary to drug reactions

Drug reactions are due to allergic or non-allergic mechanisms. Pencillin anaphylaxis is the prototype of an allergic drug reaction, whereas necrosis from eoumadin is an example of a non-allergic reaction. Drugs are simple chemical structures of low molecular weight that require covalent or other types of chemical bonding to proteins in order to initiate an immune response and an allergic reaction. Toxic drug reactions do not require binding to protein carriers. Their ill effects relate to an intrinsic ability to disrupt aspects of cutaneous functions.     

Type I hypersensitivity in an asthmatic child allergic to peanuts: was soy lecithin to blame?

BACKGROUND: Soy lecithin is widely used as an emulsifier, not only in topical skin care products but also in various drugs administered either topically, orally, or intravenously or by inhalation. Patients strongly allergic to soy and/or peanuts can develop an anaphylactic reaction when exposed to soy lecithin. METHOD: We report a 3-year-old asthmatic boy, allergic to peanuts, who was treated at the emergency department for an exacerbation of asthma following an upper respiratory tract infection. Within an hour after receiving the second of two inhalations of an ipratropium bromide (Atrovent) metered dose inhaler, he developed respiratory distress and generalized urticaria, an adverse event that regressed within 48 hours of withdrawal of the suspected drug. Soy lecithin, contained as an excipient in the metered dose inhaler, was strongly suspected of being responsible for this reaction. CONCLUSION: Drug products containing soy lecithin can cause severe allergic reactions in patients allergic to peanuts or soy. Physicians should be aware that adverse drug reactions can be due to both the active medical component and the excipient ingredients.     

Unresponsive eczematous dermatitis: a case of pancreatic cancer masquerading as cutaneous T cell lymphoma.

Skin diseases may be the presenting sign of malignancy, but strict criteria are required to make the diagnosis of a paraneoplastic syndrome. Common dermatoses may also herald an underlying malignancy without meeting these criteria. We report the case of an elderly man with an unresponsive eczematous dermatitis whose evaluation eventually revealed a pancreatic carcinoma. This case is presented to alert the clinician that a common dermatosis may be the first sign of an occult malignancy, especially if it behaves in an atypical or aggressive manner or is recalcitrant to standard therapies.     

Beiträge zur klinischen Kenntnis der Lentigines

Zusammenfassung Eingehende Untersuchungen an 364 Personen mit fast 8500 Lentigines ergaben, daß auf den Erwachsenen durchschnittlich mindestens 30 Lentigines kommen; davon sind etwa zwei Drittel klinisch als erhaben zu betrachten. Die Ziffern sind sehr viel höher als die bisher von anderen Untersuchern angegebenen. Zwischen den beiden Geschlechtern besteht kein Unterschied in der Lentigobehaftung.Die Entstehung der pigmentierten Lentigines erfolgt kontinuierlich; ihre Zahl steigt bis zum 9. Lebensjahr rasch an, von da ab bis zum 16. etwas langsamer, vom 16. oder 20. an kaum mehr wesentlich.Die meisten Lentigines sitzen an den Armen und am Stamm, fast ebensoviel am Kopf, wesentlich weniger an Hals und Beinen. Da am Kopf hinten nur wenige vorhanden sind, weist das Gesicht besonders reichliche Lentigines auf. Die Vorderseite überwiegt an Kopf und Beinen, die Hinterseite an Stamm und Armen. Zwischen rechter und linker Körperseite besteht kein Unterschied.Mit 4 Tabellen.     

Keratoacanthoma Arising in an Organoid Nevus During Childhood: Case Report and Literature Review

We report an 11-year-old girl with an organoid nevus of the cheek. She represents the first report of a keratoacanthoma arising within an organoid nevus in childhood.     

Allergic contact dermatitis to an expired moisturiser

A 64-year-old man developed an allergic contact dermatitis while using an expired sorbolene cream. Patch tests to the product ingredients were all negative. Repeated open application test to the expired product produced a strong reaction while an identical-brand non-expired product did not elicit a reaction, suggesting the presence of an unidentified degradation product or compound, acting as an allergen in the expired product. This case is intriguing in that it contrasts the ubiquitous use of over-the-counter topical agents with the exceedingly low incidence of contact dermatitis to expired topical products.     

Pustular allergic contact dermatitis to isoconazole nitrate

The topical imidazole antimycotics are widely used and are an infrequent cause of contact allergy. We report on a woman, who developed an unusual clinical picture of allergic contact dermatitis, namely papulopustular reaction, evoked by an isoconazole nitrate-containing cream. The histopathologic changes included subcorneal pustules, spongiosis, and an inflammatory infiltrate composed mainly of lymphocytes and some eosinophils and neutrophils. The patient demonstrated a severe vesicular reaction to isoconzole nitrate as is and at an imidazoles concentration of 0.5%. No cross-reactivity with other imidazole antimycotics was noted.     

Medicolegal issues for the dermatologist

Medicolegal issues for the dermatologist cannot be ignored. Appropriate legal advice from an attorney with such expertise may represent an unwanted office expense. However, the value of this advice in an increasingly hostile health care environment cannot be underestimated. Legal consultation, an insurance policy against the vagaries of health care law, has become a necessity in our litigious society.     

Carcinoma espinocelular agresivo con presentación atípica

—A 50-year-old man farmer consulted about the appearance on the thumb finger of the right hand of an inflammatory non ulcerated lesion that rememberd us an antrax; a first biopsy was inespecific, and a second one showed an invasive squamous cell carcinoma. We want to point out the existence of atypical clinical forms of squamous cell carcinoma and the need of an early diagnosis and treatment.     

Case for diagnosis. Infraorbital schwannoma

We report a 40-year-old man, with an unremarkable personal and family history, who presented for evaluation of an asymptomatic papule located on his right cheek. Histopathology revealed an encapsulated neoplasm within the dermis; composed by narrow, elongated, and wavy cells with an ill-defined cytoplasm, dense chromatin and tapered ends interspersed with collagen fibers. Pathologic findings were consistent with tissue of Antoni B pattern. The diagnosis was an infraorbital schwannoma. The incidental finding of rare tumors like this, should make clinicians consider a greater spectrum of differential diagnoses for a unilateral skin-colored papule on the cheek of patients.     

Innocuous-looking skin scab over an arteriovenous fistula: Case report and literature review

Little is written on the management of an innocuous-looking skin scab over an autogenous arteriovenous fistula (AVF) used for haemodialysis. The seriousness of the underlying pathology can be under-estimated, and this may lead to early loss of the AVF, and major-life-threatening haemorrhage. We describe the management of a 78-year-old patient presenting with an innocuous-looking scab over an AVF and review the pertinent literature on this subject.     

Cutaneous necrosis induced by acenocoumarol

Cutaneous necrosis is an infrequent but well-documented complication of oral anticoagulants. In the pathogenesis of cutaneous necrosis induced by oral anticoagulants recent hypotheses favour the combined role of local factors and a transient unbalance of coagulation mechanisms leading to an hypercoagulable state. There exists a genetic factor that determines a decreased level of two vitamin-K dependent glycoproteins, namely protein C and protein S. We present the case of an obese woman that developed an extensive cutaneous necrosis while receiving acenocoumarol for a deep venous thrombosis. She had an heterozygous deficit for protein C. The histopathologic findings of vessel thrombi and red blood cell extravasation were consistent with the clinical picture. A biopsy specimen taken from an initial lesion disclosed images of leucocytoclastic vasculitis. We reviewed the literature focusing on the pathogenesis and the histopathology of the disease.     

Malignant syphilis in an immunocompetent female patient

Malignant syphilis is an uncommon manifestation of secondary syphilis, in which necrotic lesions may be associated with systemic signs and symptoms. Generally it occurs in an immunosuppressed patient, mainly HIV-infected, but might be observed on those who have normal immune response. Since there is an exponential increase in the number of syphilis cases, more diagnoses of malignant syphilis must be expected. We report a case in an immunocompetent female patient.     

Challenge reactions in atopic dermatitis after percutaneous entry of mite antigen

We succeeded in reproducing an eczematous lesion on the apparently normal skin of a patient with atopic dermatitis by scratching and continuous application of an ointment containing ferritin-labelled mite antigen. Percutaneous entry of mite antigen was demonstrated in skin biopsies by Fe-staining. Scratched skin first showed an urticarial reaction typical of type I allergy which later changed into an eczematous reaction typical of type IV allergy. This change was also shown histologically.     

Early leprosy with perineural proliferation

A 62-year-old woman, who lived in an area of the United States nonendemic for leprosy, was seen for an enlarging anesthetic lesion that involved the entire left breast. Microscopic examination of skin biopsy specimens taken from the edge of the lesion disclosed chronic perineural inflammation and neural proliferation, with an acid-fast bacillus demonstrable in one nerve. Granulomas, giant cells, epithelioid cells, nerve abscesses, or other characteristics of tuberculoid leprosy were not seen. This woman had a skin lesion of leprosy in an atypical site. It appeared to be indeterminate on pathologic examination and was accompanied by an unusual degree of neural proliferation.     

A case of mosquito hypersensitivity showing abnormality of peripheral monocyte function

We report here an 11-year-old, Japanese girl with an ulcer-forming type of mosquito hypersensitivity. Since the lesions might have arisen from an Arthus type of hypersensitivity, we used a phorbol myristate acetate (PMA)-triggered chemiluminescence method to investigate the function of her peripheral monocytes, which should play an important role in any Arthus reaction in association with polymorphonuclear leucocytes (PMNs). The chemiluminescence of the patient's monocytes was significantly reduced from that of the normal control. To our best knowledge, no such functional abnormality of the monocytes has been seen previously in patients with an ulcer-forming type of mosquito hypersensitivity.