Antonio Ledo

Pityriasis rubra pilaris and human immunodeficiency virus infection

Recently, the occurrence of pityriasis rubra pilaris (PRP) has been reported in patients with HIV infection. It presents different clinical features, and has a poorer prognosis, than the classical adult type of PRP. We report the occurrence of severe PRP in an HlV‐infected patient, and review the previously reported cases of this association. We propose the designation of a new category of PRP (type 6), characterized by the presence of HIV infection, usually without immunosuppression, a poor prognosis and response to treatment, and the development of nodulocystic and lichen spinulosus lesions.

Neutrophilic eccrine hidradenitis in two neutropenic patients.

Neutrophilic eccrine hidradenitis is an uncommon, self-limited dermatosis with a variable clinical presentation. It seems to be due to chemotherapeutic drugs in most cases. Necrosis of the eccrine gland associated with a neutrophilic infiltrate is the histologic hallmark of this disease. We report two additional cases in neutropenic patients with acute myelogenous leukemia in which there was a striking lack of neutrophil infiltration. A new term, drug-associated eccrine hidradenitis, is suggested.

Mucocutaneous Leishmaniasis and HIV

Mucocutaneous leishmaniasis is a rare disease in Europe. Relapses after treatment are more frequent than in visceral leishmaniasis. HIV patients infected by Leishmania have frequently visceral involvement, and responses to treatment are poor. Mucocutaneous leishmaniasis in HIV-infected patients has rarely been reported. A patient with centrofacial granuloma was diagnosed as having mucocutaneous leishmaniasis; simultaneously HIV infection was detected. To our knowledge this is the first case acquired in Europe. Intravenous meglumine antimonate 20 mg/kg/day for 28 days was proven to be useful.

Infectious eccrine hidradenitis

I. Mitsuhashi Y, Hohl D.Dermatitis herpetiforrnis in a patient with acquired immunodeficiency syndrome-related complex [Letter]. J AM ACAD DERMATOL 1988;18:583. 2. Kaplan MH, Sadick, N, McNutt NS, et al. Dermatologic findings and manifestations of acquired immunodeficiency syndrome (AIDS). J AM ACAD DERMATOL 1987;16:485506. 3. Janier M. Manifestations cutanees du SIDA. Ann Dermatol Venereol 1987;114:1487-8. 4. Kotler DP, Gaetz HP, Lange M, et al. Enteropathy associated with the acquired immunodeficiency syndrome. Ann Intern Med 1984;101:421-8.

Vegetating iododerma with underlying systemic diseases: Report of three cases

Three patients with vegetating iododerma as a result of potassium iodide therapy are presented. The first patient had polyarteritis nodosa, the second had monoclonal gammopathy of undertermined significance, and the third had multiple myeloma. Vegetating iododerma probably represents an idiosyncratic response to iodides; patients with polyarteritis nodosa and paraproteinemias may be predisposed.

Complications of 585-nm pulsed dye laser therapy

Background

Hyperkeratosis of the nipple and areola in a patient with cutaneous T-cell lymphoma

A 57-year-old man with a 2-year history of recurrent generalized erythroderma noted hyperkeratotic and verrucous lesions on the nipples and areoias 4 m(jnths prior to admission. His past medical history was relevani because of primary hyperaldosteronism due to sufirarenal adenoma. He has been on treatment with spironolactone (TOO mg/d orally) for 2 years because he refused surgical treatment. Physical examination showed generalized extoliative erythroderma, bilateral inguinal and axillary lymphadenopathy, hyperkeratosis of the palms and soles, and verrucoushyperkeratotic and hyperpigmented lesions on the areoias extending to the nipples (Fig. 1). No hepatosplenomegaly was noted. An extensive workup showecJ a cutaneous T-cell lymphoma (CTCL) (T4N3MoBo). A skin biopsy of the areola revealed a lymphocytic infiltrate in the papillary dermis and atypical lymphoid cells showing epidermotropism, besides a prominent hyperkeratosis and papillomatosis (Figs. 2, 3). Treatment was performed with electron beam irradiation and teleroentgen x-ray therapy to the affected lymph nodes. There was a total disappearance of the cutaneous lesions, including those from the nipples and areoias.

Eruptive Syringoma: Treatment with Topical Tretinoin

Dr. Antonio Ledo, Castellana 167, E-28046, Madrid (Spain) Syringoma is a common benign tumor of eccrine sweat gland origin which usually appears around the eyelids. Eruptive syringoma is a rare variant of syringoma that appears in successive crops on anterior surfaces of the trunk, neck and arms. We present a patient with eruptive syringoma who showed a satisfactory response to therapy with topical tretinoin. Case Report A 23-year-old woman reported a 10-year history of asymptomatic papular lesions located on anterior surfaces of her neck, trunk and arms. Lesions appeared on these areas in successive crops. No other symptoms were present. Physical examination revealed multiple rounded red to brown papules ranging in size from 1 to 5 mm on the anterior surfaces of her neck, trunk and arms (fig. la) and in a smaller number on her flanks and dorsum. A skin biopsy specimen showed, embedded in a fibrous stroma, small ducts, the walls of which were lined by two rows of epithelial cells, and independent strands of basophilic epithelial cells. The lumina of the ducts contained an amorphous material. The diagnosis of eruptive syringoma was established, and treatment with 0.05% tretinoin cream (magistral formulation) once daily was started. The concentration was then progressively increased from 0.05 to 0.1%, in the same excipient (oil-in-water cream). After 4 months, the lesions in the treated areas were flattened and skin-colored (fig. la, b), with a good tolerance. On untreated areas, new lesions went on appearing. Discussion Syringomas are benign appendageal tumors, originating on the intraepidermal eccrine ducts, that appear as small firm papules, redto brown-colored and ranging in size from 1 to 10 mm [1,2]. They occur predominantly in women and may develop at any age, with a peak incidence between the third and fourth decades, although they are not rare in children [3]. The most frequent clinical variant is the one located on the infraocu-lar areas in healthy people, but other clinical

Plasma levels of 8‐methoxypsoralen after bath‐PUVA for psoriasis: relationship to disease severity

Plasma levels of 8‐methoxypsoralen (8‐MOP) were determined by high‐pressure liquid chromato‐graphy in 19 patients with psoriasis who were receiving bath‐PUVA treatment, at different time points after the psoralen bath. The levels of 8‐MOP varied between < 5 ng/ml (lower limit of detection) and 34 ng/ml, and we found a relationship between the plasma psoralen levels and the severity of the disease.

Low-dose intralesional interferon alfa for discoid lupus erythematosus

The hyperpigmentations that occur during pregnancy may result from hormonal changes, a greater population of melanocytes in affected areas or greater sensitivity of the melanocytes to hormonal stimulation.4 Melanocyte-stimulating hormone (MSH), estrogen, and progesterone have each been implicated as causes. However, if these pigmentary changes are classified into two groups based on abnormalities of either MSH or estrogen/progesterone levels, there are specific clinical findings associated with each of these abnormalities as well as an area of overlap. The formation of new lentigines and nevi or darkening and enlargement of preexisting lesions may also result from increased levels of MSH and estrogen/progesterone.4,5 Ellis and Wheeland4 showed that melanocytic nevi excised from pregnant women, women who had delivered within I month, and women who were taking oral contraceptives had increased estrogen and progesterone binding compared with control subjects. Journal of the American Academy of Dermatology