Incidence of leukocytoclastic vasculitis in chronic idiopathic urticaria. Study of 100 cases

One hundred cases of chronic idiopathic urticaria (CIU) were studied to determine the incidence of leukocytoclastic vasculitis (LV) and the clinical and laboratory data that might indicate its presence. LV was found in 12 patients, none of whom had either clinical or laboratory data to suggest its presence. These results suggest that a small percentage of patients with CIU. 12% in this series, have LV without either clinical or laboratory signs of its existence.     

Oral mucosal MALT lymphoma clinically simulating oral facial granulomatosis

Mucosal associated lymphoid tissue (MALT) lymphoma may have specific clinical associations and molecular aberrations depending on its site of origin. We present a case of oral mucosal MALT lymphoma with clinical features simulating oral-facial granulomatosis. Dermatologists are frequently called upon for the diagnosis and treatment of mucosal lesions. Increased awareness and familiarity with oral mucosal MALT lymphoma and its clinical associations are of significant importance for optimal management of this condition.     

Glycolic acid and its use in dermatology

Glycolic acid has distinctive pharmacologic properties that recommend it for topical use in a range of skin disorders: acne, aging and photoaging, keratoses, age spots. Future studies and more extensive and varied clinical trials would surely point out its therapeutic potential and extend its range of clinical applications.     

Heterogeneity of blastomycosis‐like pyoderma: A selection of cases from the last 35 years

Blastomycosis‐like pyoderma is a form of pyoderma with variable clinical findings and histopathological features. We present a case series of 39 patients collected over a 35‐year period to demonstrate its clinical features and histological findings. The most common clinical presentations found were solitary plaques, solitary nodules, sinuses, crypts, verrucous plaques and discharge, usually on sun‐exposed skin. The most common histopathological findings were chronic granulomatous inflammation, suppurative inflammation, sinus and abscess formation, pseudoepitheliomatous hyperplasia, transepidermal elimination and scarring. We discuss its treatment and the recent literature that has focused on its response to acitretin.     

Adult female acne: a guide to clinical practice

Background: Acne in women is often associated with anxiety and depression, and may persist from adolescence as well as manifest for the first time in adulthood. Genetic and hormonal factors contribute to its etiopathogenesis, and maintenance treatment is required, usually for years, due to its clinical evolution.Objective: To develop a guide for the clinical practice of adult female acne.Methods: A team of five experts with extensive experience in acne conducted a literature review of the main scientific evidence and met to discuss the best practices and personal experiences to develop a guide containing recommendations for the clinical practice of adult female acne.Results: The group of specialists reached consensus on the main guidelines for clinical practice, providing detailed recommendations on clinical picture, etiopathogenesis, laboratory investigation and treatment of adult female acne.Conclusion: Different from teenage acne, adult female acne presents some characteristics and multiple etiopathogenic factors that make its management more complex. This guide provides recommendations for best clinical practices and therapeutic decisions. However, the authors consider that additional studies are needed in order to provide more evidence for adult female acne to be better understood.     

Honey and Wound Healing

Honey has been used to treat wounds throughout the ages. This practice was rooted primarily in tradition and folklore until the late 19th century, when investigators began to characterize its biologic and clinical effects. This overview explores both historic and current insights into honey in its role in wound care. We describe the proposed antimicrobial, immunomodulatory, and physiologic mechanisms of action, and review the clinical evidence of the efficacy of honey in a variety of acute and chronic wound types. We also address additional considerations of safety, quality, and the cost effectiveness of medical-grade honeys. In summary, there is biologic evidence to support the use of honey in modern wound care, and the clinical evidence to date also suggests a benefit. However, further large, well designed, clinical trials are needed to confirm its therapeutic effects.     

Lupus erythematosus profundus: case reports.

Lupus erythematosus profundus is a rare manifestation of lupus. We conducted a study to observe the epidemiologic and clinical aspects of lupus erythematosus profundus, its development into other types of lupus or systemic disease, and its response to treatment. Six patients were followed for variable periods. We conclude that lupus erythematosus profundus is a benign form of lupus, distinguishable by systemic manifestations, clinical evolution and resolution, and heterogeneity in clinical manifestations. A skin biopsy is necessary to make an accurate diagnosis.     

An unusual variant of lichen nitidus: Generalized follicular spinous with perifollicular granulomas

Several unusual variants of lichen nitidus are described in the literature. Spinous follicular lichen nitidus with perifollicular granulomas is one such variant characterized by generalized follicular as well as nonfollicular keratotic papules, which show perifollicular granulomas on histopathology as well as a lichenoid granulomatous tissue reaction typical of lichen nitidus. Owing to its atypical clinical and histopathologic manifestations, it raises several clinical possibilities and can be a diagnostic challenge. We report this rare variant of lichen nitidus in a 19-year-old female, and discuss its clinical and histopathological differential diagnosis.     

All these positive tests to thimerosal

By and large, positive patch tests with thimerosal lack clinical relevance and should cause concern neither to the dermatologist nor to the patient. The substance should be retained in standard test series for scientific purposes, but on clinical grounds its inclusion does not seem to be indicated. Nevertheless, the phenomenon is intriguing in its own right.     

Granuloma annulare photoinduced by paroxetine

Granuloma annulare (GA) is a benign granulomatous skin disease with several clinical manifestations and characteristic histological findings. GA located in photoexposed areas is a rare finding and its association to a drug-induced systemic photosensitivity is even less common. To the best of our knowledge, only one case of systemic drug photosensitivity manifesting as a GA has been reported. We describe a patient with systemic photosensitivity to paroxetine with clinical and histological manifestations of GA, which was confirmed by the photobiological study. The phototest revealed a reduction of the minimal erythematous dose for UVB while taking the paroxetine and its normalization after its withdrawal, which was accompanied by the clinical resolution of the skin eruption. The manifestation of systemic drug photosensitivity as a GA like in our case is exceptional.     

Valor de la resonancia magnética en la dermatomiositis juvenil

—Juvenile dermatomyositis (JDMS) is a multisystemic disease of unknown etiology that is characterized by a non-suppurative inflammation of the skin and the skeletal muscle. Electromyography and muscular biopsy confirm the clinical diagnosis, but they are invasive techniques. Magnetic resonance has proven to be a useful tool for the diagnosis of muscular diseases, although its specificity is limited. MR findings in this disease may be useful in establishing its diagnosis within the clinical context. We present a clinical case compatible with JDMS and review the contributions of NMR in the diagnosis and follow-up of the disease.     

Case of primary localized cutaneous amyloidosis with protean clinical manifestations: lichen, poikiloderma-like, dyschromic and bullous variants

Primary localized cutaneous amyloidosis (PLCA) commonly presents as macular and lichen variants. We present a case of a 27-year-old Chinese woman with cutaneous features of the rarely reported poikiloderma-like, dyschromic and bullous forms of PLCA, and the commoner lichen variant. There were no syndromic associations or systemic involvement, and the various morphological subtypes occurred in isolation from one another. We review the clinical spectrum of PLCA, highlight its protean clinical manifestations in this patient, and discuss its postulated pathogenesis in relation to its histopathological features.     

Atopic Dermatitis: Clinical Connotations,Especially a Focus on Concomitant Atopic Undertones in Immunocompromised/Susceptible Genetic and Metabolic Disorders

Atopic dermatitis (AD) is an intriguing clinical entity. Its clinical connotations are varied, the updates of which are required to be done periodically. An attempt to bring its various facets have been made highlighting its clinical features keeping in view the major and the minor criteria to facilitate the diagnosis, differential diagnosis, complications, and associated dermatoses. The benefit of the current dissertation may percolate to the trainees in dermatology, in addition to revelations that atopic undertones in genetic susceptibility and metabolic disorder may provide substantive insight for the future in the understanding of thus far enigmatic etiopathogenesis of AD.     

Pityriasis rubra pilaris: a clinical review

Pityriasis rubra pilaris is a skin condition with many different clinical presentations. History, histology, clinical presentation, its different classified forms, treatments, and differential diagnoses are reviewed.     

The Rudolph sign of nasal vestibular furunculosis: questions raised by this common but under-recognized nasal mucocutaneous disorder

Nasal vestibular furunculosis is a mucocutaneous disorder commonly seen in the general population. Despite its prevalence in clinical practice, it has been inconsistently described and labeled in the medical literature. We present a case of nasal vestibular furunculosis presenting as recurrent exquisitely tender unilateral erythema and edema of the nasal tip (i.e., the Rudolph sign--as in Rudolph The Red Nosed Reindeer). This symptom complex responded rapidly to topical intranasal mupirocin ointment treatment after having previously failed other treatments including a topical intranasal triple antibiotic ointment and oral doxycycline. This case is instructive as it describes a heretofore under-recognized, but not uncommon, mucocutaneous clinical entity that has been linked to more serious head and neck infections and likely has relevance to the intranasal carriage of Staphylococcus aureus. We review the limited published literature on this mucocutaneous disorder including its nosology and propose future lines of investigation for better defining its clinical significance and pathogenesis.     

Use of optical coherence tomography for the diagnosis of preclinical lesions of circumscribed palmar hypokeratosis

Circumscribed hypokeratosis of palms and soles is a rare dermatosis, usually affecting women. Diagnosis is mainly based on the clinical characteristics, including the clinical appearance and anatomical site of the skin lesions and on the demographic features of the affected patients, usually middle‐aged to elderly women. Skin biopsy may be performed to confirm clinical diagnosis. Optical coherence tomography (OCT) is a technique that has been undergone substantial development in dermatology in recent years, and its use in clinical practice has been growing progressively. Several dermatological conditions have been studied with this tool, but to our knowledge, it has not been used to investigate this form of hypokeratosis. We report a case of circumscribed palmar hypokeratosis for which diagnosis was confirmed by OCT, which was performed as the patient was reluctant to undergo skin biopsy because of its invasiveness. We highlight the potential use of OCT in obtaining a virtual skin biopsy to confirm clinical diagnosis and identify preclinical skin lesions amenable to early treatment.     

糖尿病性包皮龟头炎的诊断与治疗

目的:探讨糖尿病性包皮龟头炎的临床特点和规范治疗方案.方法:对门诊1年内以包皮龟头炎症状就诊的43例病例进行临床分析.结果:糖尿病性包皮龟头炎有其自身特点,诊断和治疗有其特殊性.结论:包皮龟头炎应警惕糖尿病,血糖检测应作为包皮龟头炎的必查项目.     

Malignant melanoma: current survey: classification, prognostic factors, therapy guidelines

Recent statistical studies have extended our knowledge on the biological behavior of malignant melanoma (MM) and have facilitated its classification in clinical stages (I-IV). According to these results, the clinical course of MM is becoming easier to predict. On the basis of clinical and histological criteria (as there are sex of the patient, localization and thickness of the tumor, its histological type and level, irritation, ulceration as well as inflammatory tissue response) patients with high or low prognostic risk can be recognized. Basically, all MM in clinical stages I and II should be totally removed by scalpel excision as early as possible. The following therapeutic measures, however, should be adjusted to the individual prognostic risk of each patient. Since cytostatic treatment of MM in its late metastasizing stages is disappointing, it seems reasonable to apply preventive immunochemotherapy in earlier phases of the disease, particularly in selected patients showing high prognostic risk (p.e. stages Ib and IIa). At present, careful clinical studies on the combined long-term vaccination with BCG and administration of dacarbazine are underway. Their outcome has to be expected within the next 1-2 years. The preliminary trends are contradictory, ranging from a prolonged free interval to no effect at all. In stages III-IV polychemotherapy is now under clinical evaluation, with little success, if any. Dacarbazine, cisplatinum and vindesine are cytostatic drugs which may have some moderate effect in these late phases of the disease.     

Computer-aided diagnosis of genodermatoses

Genodermatoses are not usually easily diagnosed by inexperienced physicians. We developed a computer program to aid their clinical diagnoses and compared its accuracy rate to those of five residents in dermatology. The database of the program contained the clinical findings of 100 genodermatoses. Findings related to the skin, its appendages, mucous membranes and physiognomy were recorded in detail; but the involvements of other organs, only as headings. Twenty test cases were prepared from previously published reports. Their clinical findings were evaluated both by the program and five residents, who were at the end of the third year of their training in dermatology. The program gave the correct diagnosis in all of the test cases, but the residents failed to do so in one to seven cases. The high accuracy rate of the program suggests that it can aid inexperienced physicians in their clinical diagnosis of genodermatoses.