Retiform purpura in a patient with a history of cocaine use

There have been rare published cases of retiform purpura related to cocaine use. Levamisole, a common adulterant, has been implicated as the etiologic agent. We describe a female patient, aged 48 years, with cocaine-related retiform purpura involving her face, abdomen, and legs and alert physicians to the dangers of levamisole-contaminated cocaine.     

Retiform hemangioendothelioma: a case report and review of the literature

BACKGROUND: Retiform hemangioendothelioma (RH) is a rare, recently described vascular neoplasm of low malignant potential. METHODS: We report a case of RH of the foot of a 19-year-old white female. Histologically, the tumor grew as numerous elongated vessels resembling the shape of rete testis with involvement of the skin adnexal structures and subcutaneous adipose tissue. No dissection of collagen by small groups of endothelial cells was seen. Wide local excision was performed and the patient was healthy with no metastasis at 14 months follow-up. RESULTS AND CONCLUSIONS: Our case is discussed in the context of previously reported cases of RH; we also include a review of all cases of RH published to date.     

An approach to the patient with retiform purpura

Retiform purpura consists of branching purpuric lesions caused by a complete blockage of blood flow in the dermal and subcutaneous vasculature. The differential diagnosis for retiform purpura is broad, including vasculitides of the small and medium vessels as well as microvascular occlusion due to thrombotic, infectious, and embolic phenomena. Determining the etiology of this important dermatologic sign can be a diagnostic challenge; however, an organized approach can improve the speed and accuracy of diagnosis and identify an effective treatment. This review focuses on early recognition, evaluation, and treatment of hospitalized patients with retiform purpura. Specifically, vasculitis, protein C and S deficiencies, heparin necrosis, warfarin necrosis, antiphospholipid antibody syndrome, disseminated intravascular coagulation, cryoglobulinemia, calciphylaxis, and cholesterol embolization syndrome will be discussed in detail. These conditions are commonly seen in consultative dermatology and can have multiorgan involvement, complicated laboratory evaluation, and long-term therapeutic implications.     

Retiform hemangioendothelioma: presentation of a case expressing D2-40

Retiform hemangioendothelioma (RH) is a low-grade angiosarcoma with low metastatic risk, usually occurring as a single lesion on the trunk or extremity in middle-aged adults. Histopathology shows a distinctive pattern with arborizing blood vessels arranged in a retiform pattern (similar to rete testis tissue) and focal papillae with fibrosclerotic (hyaline) cores. The blood vessels are lined by comparatively monomorphic endothelial cells, frequently presenting a hobnail pattern. We report a case of RH presenting as an indolent brownish plaque on the back of a 17-year-old male. Surgical resection and sentinel lymph node biopsy showed no evidence of metastasis. In contrast to the recent literature, this case of RH showed positivity for D2-40, a marker of lymphatic endothelium. We also report ultrastructural findings for this case of RH.     

Electrical impedance scanning: a new approach to skin cancer diagnosis

Background/aims: Skin cancer diagnosis depends, to a great extent, on visual inspection and histopathological examination of excised tissues. The aim of this study is to evaluate the ability of electrical impedance scanning to differentiate between benign and malignant skin lesions.
Methods: A preclinical study was conducted on 40 nude mice injected subcutaneously with a human melanoma strain. Impedance measurements were recorded every week to correlate electrical changes with tumor growth and histological findings. A clinical study was also performed on 178 human suspicious skin lesions before excision. The impedance measurements were correlated to the histopathological results.
Results: Normalized conductivity and capacitance, recorded on growing skin tumors in nude mice, were shown to change relative to lesion size. Necrosis, present in most of the larger lesions, was associated with a decrease in the electrical conductivity. Similar electrical parameters were used to classify human melanoma lesions with 92% sensitivity and 67% specificity. In addition, four out of five BCC lesions were correctly diagnosed. Moreover, dysplastic lesions were diagnosed with 91% sensitivity and 59% specificity. For comparison, physicians diagnosed melanoma lesions with 75% sensitivity and 87% specificity and dysplastic lesions with 46% sensitivity and 80% specificity.
Conclusions: The animal study showed that electrical impedance measurements reflect morphological changes related to the growth of a cancerous skin lesion. These findings are in agreement with a preliminary clinical study. Electrical Impedance Scanning can therefore be considered as an objective and non-invasive tool for differentiation between benign and malignant skin lesions.     

Effects of a sunscreen formulation on albino hairless mice: a morphological approach

The purpose of the study was to evaluate the effects of a sunscreen formulation on the skin of albino hairless mice subjected to simulated solar light (SSL) in terms of morphological changes. Young adult albino hairless mice HRS/J (n = 36) were used as an experimental model for determining skin photoaging changes. Mice were irradiated with SSL, and the sunscreen (estimated SPF 30, PF-UVA) was obtained from the Pharmacy College/UFRJ, Brazil. The animals were divided into four groups: non-treated (G1), radiation only (G2), sunscreen-treated (G3) and vehicle + radiation (G4). Animals from groups G2, G3 and G4 were irradiated weekly (5 weeks), with no immobilization. One week after the final exposure, the dorsal skin was observed using a dermatoscopic camera. Biopsies were analyzed in order to quantify neovascularization and to evaluate histological aspects of the skin. Neovascularization was also evaluated with immunohistochemical reactions for the Von Willebrand factor. Animals from G2 displayed classical morphological changes denoting skin photoaging: thickening of the epidermis, increased dermal cellularity, follicular keratosis, sebaceous gland hyperplasia, and angiogenesis. Animals from groups G3 and G1 displayed similar morphological profiles, without these changes. Animals from group G4 showed more morphological changes than group G2, emphasizing the relative importance of the putative photosensitizing components present in the vehicle formulation. The extent of the morphological skin changes suggested that the sunscreen formulation was effective against SSL, and showed the importance of assessing the phototoxicity of vehicle formulations.     

Hyperhidrosis: an approach to diagnosis and management

Hyperhidrosis is defined as focal or generalized excessive sweating with a prevalence of 2.8% of the general population. This medical condition is associated with significant psychosocial morbidity and has a dramatic impact on activities of daily living. A significant proportion of patients do not consult a physician for this condition. Early diagnosis is essential in order to implement management strategies that have excellent efficacy rates and patient satisfaction.     

Photosensitivity in children: an approach to diagnosis and management

Photosensitivity disorders in children include a wide array of conditions, many of which are unique to this age group. Prompt diagnosis of these disorders becomes difficult at times because of the overlapping clinical pictures. Genodermatoses and metabolic disorders may have associated systemic involvement, which may lead to these children presenting to pediatricians who may overlook the photosensitivity. A dermatologist's consultation is essential in such cases for specific instructions and counseling of parents regarding photoprotection in these children. This intervention may improve the quality of life by reducing the morbidity and chances of early mortality. This review includes a comprehensive discussion of the distinguishing clinical features of childhood photodermatoses along with general guidelines regarding their investigation and treatment.     

Holistic approach to diagnosis in psychosomatic dermatology

Three decades ago, two psychosomatic skin clinics were established by this author—one at the Hadassah University Hospital (1955) in Jerusalem, Israel, and one at the Cincinnati General Hospital (1957) in the United States, with the close cooperation and assistance of their Department of Dermatology (headed by Dr. Leon Goldman) and the Department of Psychiatry (headed by Dr. Maurice Levine and Dr. W. Donald Ross.) Postgraduate dermatologists, residents, medical students, and nurses were trained in the close relationship and possible interaction of organic and emotional factors in certain dermatoses. The teaching was conducted by the author, a dermatologist trained in psychiatry and psychosomatic dermatology.A psychiatrist was only occasionally consulted in specifically psychiatric cases.The aim was to enable the dermatologist to gain sufficient knowledge and experience in psychosomatic dermatology that he could directly handle his own patients by a holistic approach. Thus, this method was on a one-to-one (dermatologist-patient) basis, as opposed to the conventional two-to-one (dermatologist-psychiatrist-patient) relationship. This led to interesting seminar sessions with the residents, as well as special conferences with the hospital patients, and case presentations.Long experience in teaching convinced us that the greatest difficulty of postgraduate and resident dermatologists was in making the correct diagnosis of psychosomatic dermatosis. The aim of this paper is to guide the dermatologist in achieving this goal. To be able to make a proper diagnosis of psychosomatic skin disorder, the dermatologist must free himself of some misconceptions relating to the term “psychosomatic.”