A 10-year-old Kenyan girl presented with a 9-month history of a persistent, painful eruption of multiple, tender, non-ulcerated, pigmented nodules involving the calves, shins and soles of the feet. She had recurring fevers particularly at night, lethargy, weight loss and a persistent non-productive cough. The Mantoux test was positive. Chest X-ray revealed mild peribronchial thickening in the hilar region but no evidence of hilar lymphadenopathy, consolidation and/or cavitation suggestive of tuberculosis. Sputum and gastric washings were negative for acid-fast bacilli. Histology on a skin biopsy showed a granulomatous panniculitis with no histological evidence of Mycobacterium tuberculosis , consistent with erythema induratum. In view of her constitutional symptoms, chronic non-productive cough and positive Mantoux test, she was diagnosed with pulmonary tuberculosis despite the non-specific chest X-ray and negative bacteriology. Anti-tuberculous therapy was initiated with pyrazinamide, isoniazid and rifampicin for 2 months followed by dual therapy with isoniazid and rifampicin for a further 4 months. Her constitutional and respiratory symptoms and skin eruption cleared within 6 months with treatment. 相似文献
Japan A 56-year-old Japanese woman suffered from chronic persistent hepatitis, which was HBeAg and hepatitis B virus (HBV) DNA positive. In October 1996, her hepatitis deteriorated and was associated with an increase in the HBeAg titer and HBV DNA concentration. The HBeAg titer and HBV DNA concentration were followed on a monthly basis as shown in Table 1 . The serum aspartate transaminase (AST), alanine transaminase (ALT), and total bilirubin reached peaks of 1427 IU/L, 1363 IU/L (8–35), and 2.2 mg/dL (0.2–1.2), respectively. Five weeks later, the patient developed symmetric, well-demarcated, dark, annular, erythematous lesions on the lower and upper extremities and face. The trunk and mucosal surfaces were spared ( Fig. 1 ). We made the clinical diagnosis of erythema multiforme (EM). The eruption cleared spontaneously within 2 weeks. She had no history of a previous eruption, recurrent throat infections, herpes simplex, or drug exposure.
Table 1 Serologic data showing the exacerbation of hepatitis B virus infection 相似文献
A 22-year-old white female student presented to the Emergency Department with a 2-day history of patchy pruritic erythema of the face, neck, and arms with periorbital edema. The eruption began as an isolated patch of nasal erythema, with subsequent extension to involve the entire face. Within 2 days, fine pinpoint papules were noted on the face, anterior chest, neck, and upper extremities. Periorbital edema was present without intraoral abnormalities or laryngeal changes. An erythematous, mildly lichenified plaque was noted on the ventral left wrist. The past medical history was significant for two similar, milder episodes of allergic reactions of uncertain etiology occurring within the previous 2 months. The previous eruptions resolved after treatment with oral loratodine and topical fluocinonide cream 0.05%. The patient denied any history of contact urticaria or new household or personal hygiene contactants, although she did report frequent ingestion of peeled mangoes. Her brother had a history of eczematous dermatitis. In the Emergency Department, the patient was administered intravenous diphenhydramine and a single 50 mg dose of oral prednisone. She continued treatment with a 5-day course of prednisone, 50 mg daily, with loratodine, 20 mg daily, and diphenhydramine as needed; however, no symptomatic improvement was seen over 4 days. She was then advised to restart fluocinonide cream twice daily. Patch testing was performed to the North American Contact Dermatitis Group Standard Series utilizing methods of the International Contact Dermatitis research group with Finn chambers. Mango skin and mango flesh harvested 5 mm below the skin surface were also placed in duplicate and tested under Finn chambers. Positive (1+) reactions were noted to nickel and p-tertbutylphenol formaldehyde resin, and bullous reactions were found to mango skin and surface flesh in duplicate (Fig. 1). Complete avoidance of mango led to resolution of the initial eruption. The clinical relevance of nickel and p-tertbutylphenol formaldehyde resin was thought to be associated with the wrist lesion immediately below a glued portion of a wristwatch strap and metal clasp. 相似文献
A 20‐year‐old woman of south Asian descent was concerned about her dark complexion, predominantly affecting the exposed areas of her body, including the face, neck, upper chest, and extremities. She tried multiple over‐the‐counter products, including topical hydroquinone, kojic acid, and various herbal formulations, without success. Three years previous to her presentation, she was given clobetasol propionate 0.05% cream by a friend, which she applied to the face, neck, upper chest, and arms. After 6 weeks of twice‐daily application, she noted marked improvement of her complexion; thus, she continued to use clobetasol propionate cream thereafter. She applied approximately 10 g of cream daily. One year previous to her presentation, she noticed an asymptomatic eruption of tiny dark‐brown papules and “open pores” on the face, neck, upper chest, and arms. She thought her dark complexion was returning, and continued to use topical corticosteroid for another year without improvement. She was advised to see a dermatologist. Physical examination revealed multiple, dark‐brown, follicular papules involving the face, neck, upper chest, arms, and antecubital areas ( Figs 1–3 ). There was a rough sensation on palpation. On examination with a hand lens, tufts of hairs were visible projecting through each of the tiny papules. Manual attempts to express material from the lesions were unsuccessful. A few of the horny plugs were removed with a sterile needle. Multiple vellus hairs were seen embedded in keratinous material on light microscopy of the extracted plugs ( Fig. 4 ). The patient refused a skin biopsy. Figure 1 Open in figure viewer PowerPoint Dark‐brown follicular papules on the face 相似文献
CASE 1: A 65-year-old woman with essential thrombocythemia (ET) had been taking oral hydroxyurea (HU), 1,000 mg daily, for 7 years. Six months ago, she developed an ulcer on the outer part of her left ankle, which healed spontaneously within 2 months. She presented with a new, tender, shallow ulcer, 2 cm x 2 cm in size, at the same site. Doppler examination revealed thrombosis of the left common femoral vein and a calcified atheroma plaque of the left common femoral artery. The dosage of HU was decreased to 500 mg daily when the platelet counts were found to be within normal levels. The ulcer completely healed within 2 months with occlusive wound dressings, and has not recurred within the follow-up period of 1 year. CASE 2: A 56-year-old women presented with multiple, painful, leg ulcers of 1 year duration. She had been diagnosed as having ET and had been on HU therapy, 1,500 mg/day, for the past 5 years. Interferon-alpha-2b was started 3 months ago, in addition to HU, which was tapered to 1,000 mg daily. She had suffered from hypertension for 20 years treated with nifedipine and enalapril, and had recently been diagnosed with diabetes mellitus which was controlled by diet. Examination revealed three ulcers located on the lateral aspects of both ankles and right distal toe. Arterial and venous Doppler examinations were within normal limits. Histopathology of the ulcer revealed nonspecific changes with a mixed inflammatory cell infiltrate around dermal vessels. The ulcers completely healed within 10 weeks with topical hydrocolloid dressings. After healing, she was lost to follow-up. A year later, it was learned that she had developed a new ulcer at her right heel, 3 months after her last visit (by phone call). This ulcer persisted for 8 months until HU was withdrawn. CASE 3: A 64-year-old woman with ET presented with a painful leg ulcer of 6 months' duration. She had been taking oral HU for 5 years. She had a 20-year history of hypertension treated with lisinopril. Examination revealed a punched-out ulcer of 2 cm x 2 cm over the right lateral malleolus. Doppler examination of the veins revealed insufficiency of the right greater saphenous and femoral veins. Angiography showed multiple stenoses of the right popliteal and femoral arteries. As her platelet count remained high, HU was continued. During the follow-up period of 13 months, the ulcer showed only partial improvement with local wound care. 相似文献
A 45‐year‐old woman from central India reported to clinic with multiple swellings on the face and neck. She had red patches on her forearms and trunk, but there was a predominance of lesions on the face and neck. On examination, her face showed multiple, succulent, erythematous plaques which were mildly pruritic ( Fig. 1 ). There was no discharge. There were also some scattered erythematous papules and nodules on the face ( Fig. 1 ). Examination of the neck revealed multiple erythematous plaques, many of them with a linear orientation and central ulceration and crusting ( Fig. 2 ). The upper extremities showed multiple erythematous plaques, most of which were ulcerated ( Fig. 3 ). Plaques without ulceration had been present for the past 2 years. The patient had been treated in various centers around her village and in Baroda as a case of reactional leprosy. Figure 1 Open in figure viewer PowerPoint Multiple, succulent, erythematous plaques, papules, and nodules on the face 相似文献
A 20-month-old white girl had a 4-month history of an intensely pruritic widespread eruption that began as crops of 1–3-mm papules and vesicles predominantly on her hands and feet. These lesions evolved into pustules after 24–48 h. Identical lesions would then erupt over large areas of her scalp, trunk, and extremities. Her primary care physician initially interpreted this eruption as chickenpox complicated by impetigo, and also considered a diagnosis of scabies. Antiscabetics, topical steroids, oral antibiotics, and antihistamines failed to control the eruption or alleviate the pruritus which interrupted sleep and her dally activities. The lesions waxed and waned, with new crops developing every 2–3 weeks and fading slowly before the next crop appeared. There was no history of significant exposure to pets or insects. The patient was otherwise in reasonable health and without systemic symptoms. No other children in her day care center nor any family members had a similar eruption. The family history was negative for skin disorders. On physical examination, there was an extensive pustular eruption, most pronounced on the hands and feet (Fig. 1), but also involving the legs (Fig. 2), chest, and scalp, which was remarkable for the confluent, crusted lesions. There was sparing of the intertriglnous areas. Burrows were absent. Cultures of the pustules for fungi and bacteria were negative, as were KOH and scabies preparations. Our clinical impression was acropustulosis of infancy. Because of some unusual features of presentation, namely the late age of onset, the widespread distribution, and the severity of the eruption, we obtained a 3-mm punch biopsy of an intact pustule from the right foot. Histopathologic examination of the biopsy specimen revealed a subcorneal, unilocular pustule containing small clusters of neutrophils invading the intact epithelium (Fig. 3). Hyperplasia and spongiosis of the surrounding epidermis were also noted. There was a sparse mononuclear infiltrate in the papillary dermis, occasionally in a perivascular distribution. Eosinophils were absent. Periodic acid-Schiff (PAS) stain was negative for fungal elements. These histologic findings were considered to be representative of acropustulosis of infancy. Prior to starting dapsone therapy, initial laboratory studies, including a complete blood count with differential, platelet count, liver function tests, blood urea nitrogen, creatinine, and G-6-PD level, were obtained and determined to be within normal limits. Dapsone therapy was initiated at 1 mg/kg/day for 1 week and then increased to 2 mg/kg/day. She showed a dramatic response to therapy with clearing of all lesions. The dapsone dose was then slowly reduced over the next few months and discontinued after 11 months without recurrence of the disorder. She was carefully monitored and at no time experienced untoward effects from this medication. 相似文献
An 18 year-old-woman presented with a 1-week history of a psoriasiform eruption on her limbs and trunk that began 1 week after starting metformin hydrochloride. She had taken no other medications. She had no personal or family history of psoriasis. The lesions disappeared within 5 weeks after discontinuation of the drug. In the 4 months following the cessation of metformin hydrochloride, no relapse was observed, but rechallenge with oral metformin again produced the eruption. Metformin hydrochloride should be added to the list of drugs that can cause a psoriasiform eruption. 相似文献
A 16‐year‐old schoolgirl presented with a complaint of enlarging erythematous and mildly pruritic patches located on the buttocks of 2 years’ duration. She had been treated with a potent topical corticosteroid for many months without apparent benefit. She was in otherwise good health. She denied a history of hair infection, previous eruptions, asthma, or hay fever. No one in her family or friends had similar lesions. She had no pets in her house. Examination revealed the presence of two erythematous and slightly indurated plaques measuring approximately 16 cm × 9 cm and 6 cm × 11 cm in diameter on her right and left buttocks, respectively ( Fig. 1 ). Similar progressively enlarging lesions were present on the dorsum of her right hand, extending to the extensor aspect of the forearm and to the lateral, inner, palmar, and extensor aspects of the second, third, and fourth fingers, and on the dorsum of her left hand up to the flexor aspect of the wrist. A few erythematous papules clustering around these plaques in a satellite fashion were also detectable. Her scalp, pubic, axillary, eyebrow, and eyelash hair appeared normal with no concretions or soft, lightly pigmented, white to light‐brown, loosely attached, irregularly spaced nodules. There was no regional or generalized lymphadenopathy or hepatosplenomegaly. Routine laboratory investigations, human immunodeficiency virus (HIV) testing, and standard patch tests were negative. Figure 1 Open in figure viewer PowerPoint Erythematous and slightly indurated plaques on the right and left buttocks 相似文献
A 72-year-old woman presented with a 1-week history of a painful, purpuric, pruritic rash on her legs, buttocks and arms. Skin biopsy revealed histological features typical of leucocytoclastic vasculitis. She was admitted, her usual medications were withheld, and she was commenced on ibuprofen and loratadine. The patient had undergone a laparoscopic cholecystectomy 2 months prior to her rash appearing. She had been having upper abdominal pain for 2 years and, following a more severe acute episode, an abdominal ultrasound scan had revealed a solitary cholelithiasis. Histology of the gallbladder revealed acute fibrinoid vasculitis in two small arteries, on a background of chronic cholecystitis. A mild postoperative wound infection was treated with a short course of cephalexin and no other investigations were conducted. As an inpatient, the patient's rash improved, but she progressed to develop systemic vasculitis and acute renal failure. Renal biopsy showed focal necrotizing glomerulonephritis, consistent with vasculitis. She was subsequently commenced on cyclophosphamide 100 mg daily, prednisolone 50 mg daily and one prophylactic trimethoprim/sulphamethoxazole (160 mg/800 mg) tablet 3 days/week. Following discharge, the patient's cutaneous vasculitis eventually resolved and renal function gradually improved. Her prednisolone was gradually reduced to 7 mg daily and cyclophosphamide was weaned, then substituted with azathioprine 100 mg daily. 相似文献
A healthy 62-year-old woman was referred to our dermatology department with a 1-month history of a pruritic axillary eruption. On examination, multiple erythematous and brownish hyperkeratotic papules were seen in both axillae. Some of these lesions coalesced into plaques, with small areas of sparing, and a background erythematous color was also found in the axillary vaults (Fig. 1). There was no involvement of other intertriginous sites and there were no associated systemic symptoms. The patient was not obese. The patient had removed the hair from her axillae with wax 3 weeks before the development of the eruption. Moreover, she had changed her antiperspirant 1 week before the onset of the lesions. A cutaneous biopsy for histologic analysis was performed. Histologically, the stratum corneum was thickened, with persistent nuclei together with countless small basophilic granules. The granular layer was preserved and, in some areas, hypergranulosis was found (Fig. 2). These findings were characteristic of granular parakeratosis. The cutaneous lesions resolved completely after 1 week of treatment with topical betamethasone dipropionate and gentamicin sulfate (twice daily). The patient was urged to discontinue her use of deodorants. 相似文献
We describe a Japanese girl with generalized lichen nitidus. She had been exposed to Mycobacterium tuberculosis at 6 years of age via her teacher. At 8 years of age, she developed severe contact dermatitis on sun-exposed areas after contact with Japanese lacquer trees. Shortly after, numerous tiny, shiny, flesh-coloured papules developed over the upper part of her body. At 10 years of age, she was exposed to a school outbreak of M. tuberculosis. Her eruption showed no response to topical corticosteroids or oral tranilast, but most of the papules completely disappeared after she had received oral isoniazid for 6 months. 相似文献
A 38-year-old woman, known to be HIV-antibody-positive for 2 months, presented with a progressive swelling of the right thigh of 1-month duration. She had no history of trauma or breaking of the skin. She suffered from oral candidiasis, but had no previous AIDSdefining illness. She had no systemic symptoms such as pulmonary symptoms, weight loss, organ enlargement, or fever. Her laboratory tests were unremarkable, except for a CD4 count of 115/mm3. On examinafion, an ulcerated, fluctuating 3-cm mass with surrounding erythema was noted with only a small volume of purrulent discharge. A punch biopsy, showing a necrotizing inflammation of the hypodermis without granulomas, and a swab and two blood cultures (Isolator 10, DuPont, Wilmington, DE, USA) were performed. The patient was discharged with a diagnosis of a bacterial abscess and treated with pristinamycin, 1 g t.i.d., and local wound care. One month later, the ulceration persisted, but the inflammation and purulent discharge had disappeared. Because direct examination of a Ziehl-Neelsen stained specimen had revealed acid-fast bacilli, later identified as Mycobacterium avium complex, the therapy was changed to clarithromycin, 2 g b.l.d., given for 3 months, complete healing was obtained without incision and drainage. She was given rifabutine, 300 mg once daiiy, 7 months later as her CD4 cell count became <100/mm", No relapse had occurred after a 18-month follow-up. 相似文献
A 45-year-old black woman presented with a chief complaint of an increasing number of "light spots" on her face, upper trunk, and legs. She had a 4-year history of a pruritic eruption on the dorsum of her hands. The eruption was particularly pruritic in the summer months. Other family members, including her sister and her daughters, reportedly had a similar dermatologic problem. The patient had been previously evaluated and biopsied by another dermatologist. The earlier biopsy was nondiagnostic, however, and she presented for further evaluation of this problem. On physical examination, the patient had hypopigmented macules along her jawline (Fig. 1), lateral neck, and upper chest. She had similar hypopigmented macules on her thighs. She had hyperkeratosis of the palmoplantar surface of her hands and feet. The dorsum of her hands had numerous coalescing, shiny, flat-topped, hypopigmented papules (Fig. 2), and several of her fingernails had distal, V-shaped notching. A punch biopsy from a papule on the dorsum of her hand was obtained. The epidermis had corps ronds present with focal areas of acantholysis above the basal layer (Fig. 3). The dermis had sparse, superficial, perivascular infiltrates composed of lymphocytes and histiocytes. These changes were consistent with our clinical diagnosis of Darier's disease (keratosis follicularis). 相似文献
Papular mucinosis is a rare, idiopathic cutaneous mucinosis that is typically chronic and progressively severe. We present a case of a 59-year-old woman with a 6-month history of a dramatic papular eruption on her face and neck, with no associated internal organ involvement. A biopsy specimen demonstrated increased dermal mucin with associated plump fibroblasts, consistent with a diagnosis of papular mucinosis. Multiple therapeutic interventions were unsuccessful, and after 2 years the lesions resolved spontaneously without treatment. During the following 3 years, the patient has had no recurrence of disease. 相似文献
SUMMARY A 9-year-old girl presented with a 6-month history of inflamed tender nodules in the pretibial area. These eventually healed leaving depressed areas of atrophy and loss of subcutaneous tissue. Histology showed a predominantly lymphocytic lobular panniculitis, consistent with connective tissue panniculitis. Investigations revealed an elevated thyroid stimulating hormone, elevated thyroid antiperoxidase antibody and a weakly positive antinuclear antibody (titre 1 in 40). She was commenced on hydroxychloroquine 300 mg daily, which resulted in resolution of the panniculitis. She developed focal vitiligo on the thighs. This gradually improved with 0.1% mometasone furoate ointment. The hydroxychloroquine dose was tapered to 200 mg daily after 12 months, then to 100 mg daily after 18 months therapy. Her thyroid autoantibody levels continued to rise and the hydroxychloroquine was increased again to 300 mg daily. She became borderline hypothyroid. Hashimoto's thyroiditis was diagnosed. Thyroxine was instituted with a resultant improvement in her thyroid blood tests. The lipoatrophy has not developed further during 2-year follow up. 相似文献
A 27-year-old white woman was referred for consultation with regard to the presence of extensive multiple keratotic lesions. She began to develop these lesions at the age of 9 years, with healing of the lesions resulting in scar formation. A biopsy was performed at the age of 16 years, but the patient was unsure of the results. Since then, she had not had any treatment or biopsies, and stated that she had not suffered from any health problems during the intervening period. She was most concerned about the tumors on her heels and soles, which caused difficulty with ambulation. The family history was negative for skin diseases, including melanoma, nonmelanoma skin cancer, psoriasis, and eczema, and positive for Type II diabetes mellitus. A relative reported that the patient's grandfather had similar lesions, but the patient's parents and siblings were healthy. She was married and had one child, a 9-year-old daughter. Her child had no skin lesions. The patient's only medication was Ortho-Tricyclene birth control pills. She had no known drug allergies. Physical examination revealed the presence of multiple lesions on her body (Fig. 1). Her left superior helix contained a well-demarcated, dome-shaped nodule with a rolled, mildly erythematous border with a central hyperkeratotic plug. A similar lesion was present in the scaphoid fossa of the left ear and smaller lesions were scattered on her face. Numerous lesions were present on the arms and legs bilaterally, with the majority of lesions being located on the anterior lower legs. There were also lesions present on the palms and soles. The lesions ranged in size from 5 mm to 3 cm, the largest being a verrucous exophytic nodule on the anterior aspect of her left leg. Overall, there appeared to be two distinct types of lesion. One type appeared round, oval, and symmetric with a central keratotic plug, similar to that on the ear. The other type was larger, more exophytic, and verrucous, including the lesions on the volar surfaces. Also present were numerous, irregularly shaped atrophic scars where previous lesions had healed spontaneously. There were no oral lesions or lesions on her fingernails or toenails, and her teeth and hair were normal. A biopsy was obtained from an early lesion on the right dorsal forearm. Histology revealed an exo-/endophytic growth having a central crater containing keratinous material (Fig. 2). The crater was surrounded by markedly hyperplastic squamous epithelium with large squamous epithelial cells having abundant glassy cytoplasm. Some cells were dyskeratotic. Within the dermis was a dense, chiefly mononuclear inflammatory infiltrate. A buttress of epidermis surrounded the crater. The clinical and pathologic data were consistent with keratoacanthomas. Initial laboratory screenings revealed elevated triglycerides and total cholesterol, 537 mg/dL (normal, < 150 mg/dL) and 225 mg/dL (normal, < 200 mg/dL), respectively, with all other laboratory results within normal limits. In anticipation of starting oral retinoid therapy for her multiple keratoacanthomas, she was referred to her primary care physician for control of hyperlipidemia. After her lipids had been controlled, she was placed on isotretinoin (Accutane) 40 mg/day. There was some interval improvement with regression of some lesions leaving atrophic scars. She was also started on topical application of tazarotene (Tazorac) for all nonresolving lesions. Possible side-effects from the isotretinoin occurred, including dry mouth and eyes. After 8 months of isotretinoin, the patient was switched to acitretin (Soriatane) 25 mg to determine whether it might have a more beneficial effect on the resistant lesions. Many of the larger lesions regressed leaving atrophic scars. The dose of acitretin was subsequently increased to 35 mg because the lesions on her heel and the ball of her foot persisted. Almost all of the lesions resolved, except those on her feet, which are slowly regressing. Currently, the patient is on a regimen of acitretin 25 mg once a day with tazarotene 0.1% gel applied directly to the few residual keratoacanthomas on her feet, which are slowly improving. 相似文献
A 49‐year‐old woman was admitted with generalized pruritus which she had for the last 4 years. Three months ago she developed erythema on her face, alopecia totalis, an erythematous macular eruption with follicular hyperkeratoses on the trunk and limbs ( Fig. 1 ). She had bilateral palpable axillary lymphadenopathy. Histologic examination of the biopsies taken from the erythematous areas on the trunk and scalp revealed a folliculocentric infiltration composed of atypical, small and medium‐sized mononuclear cells, intermingled with reactive lymphocytes, histiocytes, plasmocytes, rare eosinophils, and giant cells without involvement of the epidermis ( Fig. 2 ). The infiltrate surrounded and invaded the hair follicle epithelium without destroying it. With alcian blue staining, only small amounts of mucin were detected within the epithelium of the hair follicles. By the immunohistochemistry performed, folliculocentric infiltration was mainly composed of CD3(+), CD4(+), CD8(–) lymphocytes. A full blood count, peripheral smear, erythrocyte sedimentation rate (ESR), the concentration of nitrogen in the form of urea in the blood (BUN), creatinin, transaminases, serum electrolytes, C‐reactive protein (CRP), IgE, serum lipids, serum lactate dehydrogenase, urinalysis, roentgenogram and CT scan of chest were normal. Beta 2 microglobulin was 3.15 mg/L (normal range 1.2–2.5 mg/L). In the biopsy of the axillary lymph node, there was a focal infiltration of atypical T‐cells in the interfollicular area. She was given psoralen‐UVA (PUVA) treatment for 6 months (85 sessions, in escalating doses with a total 71.8 j/cm2) which resulted in a partial healing of the pruritus, erythematous plaques, follicular hyperkeratoses, and patchy hair regrowth. She then received oral methyl prednisolone, 40 mg daily for 3 weeks and the dose was gradually decreased and eventually reduced to 16 mg daily in 2 months. This resulted in healing of the pruritus, improvement in the erythematous plaques and follicular hyperkeratoses and axillary lymphadenopathy. Beta 2 microglobulin levels decreased to normal range (2.27 mg/L). After taking the 16 mg daily dose of the prednisolone for 6 months, her complaint of itching recurred. Erythematous plaques and follicular hyperkeratoses were noted again. The dosage of the steroids was increased to 40 mg daily and PUVA treatment was restarted. She is currently receiving oral methyl prednisolone and PUVA. Figure Figure 1 Open in figure viewer PowerPoint Follicular papules are seen on the upper extremities 相似文献
An 18-year-old woman was seen in the clinic with complaints of a bizarre hypopigmentation of her skin which her mother said had been present from birth and had been asymptomatic, constant, and permanent. She also complained of a rough eruption which had developed at one year of age and had progressed slightly in size over the years. It was first noticed in the left axilla, groin, parasternal area and posteriorly on the neck and was restricted to the left side of the body. It became inflamed and pruritic, was asymptomatic at times, but never cleared although the patient felt some of the lesion had sloughed off. There were no associated systemic symptoms, no history of seizures, and her psychomotor development was normal. On examination, the main findings were mucocutaneous; she had hypopigmented bands, whorls, and streaks following Blaschko’s lines, the lesions affected the front and the back of her trunk bilaterally, with the arms and thighs also involved. Her face was spared ( Fig. 1a,b ). There was no evidence of atrophy or scarring in the hypopigmented lesions. Figure 1 Open in figure viewer PowerPoint Hypopigmented whorls, bands, and streaks on both front (a) and back (b) of patient. Note also the one-sided distribution of the ILVEN (affecting the neck, left parasternal area, and dorsal surface of the hand) 相似文献
