Alok Vij

Langerhans cell collections, but not eosinophils, are clues to a diagnosis of allergic contact dermatitis in appropriate skin biopsies

Langerhans cell collections (LCCs) and eosinophils are traditionally considered histologic clues to allergic contact dermatitis (ACD), but rigorous histologic analyses are limited. We correlated the presence of LCCs and eosinophils in skin biopsies with patch test results in patients evaluated for ACD.

Low-Dose Naltrexone Treatment of Familial Benign Pemphigus (Hailey-Hailey Disease)

Importance Familial benign pemphigus, or Hailey-Hailey disease (HHD), is a rare and debilitating genetic dermatosis characterized by chronic, recurrent vesicles, erosions, and maceration in flexural areas. Despite the reported therapeutic modalities, such as topical and systemic corticosteroids, systemic immunomodulators, topical and systemic retinoids, and laser, HHD can still be markedly difficult to control. Objective To assess low-dose naltrexone hydrochloride in the treatment of recalcitrant HHD. Design, Setting, and Participants In this case series, 3 patients with biopsy-proven recalcitrant HHD were evaluated in the outpatient dermatology clinic at the Cleveland Clinic. Each patient was treated with low-dose naltrexone hydrochloride at a dosage of 1.5 to 3.0 mg per day. No laboratory monitoring was necessary. Clinical response (healing of erosions, improvement in erythema, and alleviation of pain), adverse effects, and subjective quality of life were monitored throughout the treatment. The study dates were January 2016 to January 2017. Main Outcomes and Measures Objective clinical response as assessed by the treating dermatologist, subjective quality of life as reported by the patient, and recorded adverse effects were monitored throughout the treatment at intervals of 2 to 3 months. Results The 3 patients included a woman in her 40s and 2 men in their 60s. Each patient exhibited at least an 80% improvement in extent of disease, with one patient demonstrating 90% clearance. All 3 patients had substantial improvement in quality of life, with one patient reporting improvement in his depression. No adverse effects were recorded. Conclusions and Relevance Low-dose naltrexone may represent a low-cost and low-risk alternative or adjunct in the treatment of HHD.

Madarosis, milphosis, eyelash trichomegaly, and dermatochalasis ☆

Eyebrows, eyelashes, and eyelids are cosmetically and functionally important periocular landmarks that offer insights into a patients emotional state. Several pathologies exist with respect to the eyebrows, eyelashes, and eyelids. Madarosis refers to loss of the eyebrows or eyelashes; milphosis refers specifically to eyelash loss. Excess growth of eyelash hair is termed trichomegaly. Excess skin in the upper or lower eyelids is called dermatochalasis. Pathology of these important structures can be reflective of important local and systemic disease processes.

Erythrodermic presentation of psoriasis in a patient treated with dupilumab

IL: interleukin Th: T-helper D upilumab is an interleukin (IL)-4 receptor a (IL-4Ra) antagonist that inhibits IL-4 and IL13 signaling, keymediators of T-helper (Th) 2-mediated inflammation. Whereas an immune shift toward Th2 drives atopic dermatitis and thus a blockade in the Th2 inflammatory cascade is an effective treatment, the opposing shift toward Th1 and Th17 cells is implicated in the pathogenesis of psoriasis.We present an erythrodermic presentation of psoriasis in a patient treated with dupilumab for a dermatitis that was clinically diagnosed as atopic dermatitis.

Fungal folliculitis masquerading as acute exanthematous pustulosis.

Concern was raised for antibiotic-related acute exanthematous pustulosis, but punch biopsy revealed the yeast Malassezia.

Vancomycin Hypersensitivity Reaction Presenting with Extensive Oral Ulcerations

Vancomycin therapy can be associated with a hypersensitivity reaction characterized by fever, rash, neutropenia, and other variable manifestations. Here we report a 45-year old man who developed diffuse aphthous-like ulcers as the most prominent manifestation of vancomycin hypersensitivity reaction.

Infection or allergy? The multifaceted nature of vulvar dermatoses☆

Chronic dermatitis or pruritus affecting the female genital and perianal skin can be challenging to properly diagnose and manage. The differential diagnosis generally includes allergic, inflammatory, infectious, and neoplastic conditions. We report the case of a 52-year-old woman with a 6-month history of a progressive, debilitating vulvar and perianal rash that highlights the multifaceted nature of female genital dermatoses.

Trichodystrophies: A hair-raising differential diagnosis☆

The appearance of an individuals hair is said to be reflective of internal health. Patients with hair shaft disorders commonly present with fragile, lusterless, sparse hair in addition to psychosocial distress. Hair shaft disorders may be hereditary or acquired and may present in children or adults. Due to the varied presentations, the differential diagnosis for hair is broad and often confusing. The authors present a question-by-question guide to help clinicians arrive at the correct diagnosis.