Birka Brauns

Intralesional steroid injection alleviates nail lichen planus.

A 52-year-old woman with a four-year history of lichen planus (LP) with nail involvement was previously treated with topical steroid ointments without success. Physical examination revealed itching, planar, polygonal purple papules near the wrist with reticular whitish lines (Wickham’s striae). Fingernail plates showed longitudinal ridges, splitting, thinning, brown discoloration, and onychodystrophy (Fig. 1a); one nail was completely lost. Other commonly affected sites including the lumbosacral area, ankles, trunk, and genitooral mucous membranes were inconspicuous. Histopathology of the wrist showed hyperkeratosis with thickening of the granular cell layer, akanthosis, and saw-tooth appearance of the rete pegs. The subepidermal layer and upper corium presented a lymphohistiocytic inflammatory cell infiltration. A nail biopsy was not taken because of the typical histological signs of LP on the wrist and the corresponding clinical signs of nail involvement. In light of the unsuccessful previous treatments and the high degree of suffering of the patient, we injected the affected nails intralesionally with triamcinolone-acetonide 10 mg/ml following Oberst’s anesthesia (slow injection of 5 ml prilocaine 2% distal to the metacarpal-phalangeal in the dorsal aspect on both sides of the finger). The drug was injected once into the proximal nail fold (approximately 2 mg/nail; Fig. 1b). Four months after the injection, clinical examination showed a complete recovery without any side effects, which lasted nearly two years (Fig. 1c). The patient was very satisfied. Because of a local recurrence, the intralesional triamcinolone injections were repeated 2.5 years later. LP is a chronic skin disorder that affects women more than men (ratio 3:2) and occurs most often in middleaged adults. The etiology is unknown. It might be associated with autoimmune diseases, such as diabetes mellitus, alopecia areata, or colitis ulcerosa. The disease has also been reported as a complication of chronic hepatitis B or C. Occurrence after psychosocial stress is observed. 626 (a)

A lurking threat: transfer of peanut allergy through peripheral blood stem cell transplantation.

BackgroundThere exist several reports of atopy and allergen-specific IgE-mediated hypersensitivity transferred by bone marrow transplantation, and it has been concluded that the transfer of allergic reactivity results from adoptive transfer of IgE-producing donor-derived B- and/or plasma cells. To the best of our knowledge we report the first case of peanut allergy after PBSCT.Case PresentationA 55-year-old anciently non allergic man with secondary acute myeloid leukemia (AML) received an allogeneic peripheral blood stem cell transplantation from a matched unrelated donor following reduced-intensity conditioning. On day 32 after PBSCT, while still on prophylactic systemic immunosuppression, the patient noticed a first episode of angioedema with swelling of the nasal and oral mucosa 30 min after consuming peanut puffs. In a second episode, eight months after PBSCT, he again developed angioedema, generalized pruritus and nausea within minutes after eating biscuits containing hazelnut and peanut. Moreover, after topical application of a peanut oil-containing ointment, the patient experienced facial erythema and angioedema. Nine months after PBSCT an evaluation for peanut allergy revealed a highly increased specific IgE to peanut of 75.9 kU/l. Accordingly, skin prick tests for peanut extract were also positive. In consequence, the patient was counseled to strictly avoid peanut-related products, and provided with an emergency set. No adverse allergic events have occurred since for an observation time of 15 months after PBSCT. The stem cell donor was contacted and confirmed intolerance to peanuts. His specific serum IgE pattern nine month after PBSCT harvest was analysed and showed similar sensitization profiles compared to those of the transplant recipient.ConclusionsBecause of the close temporal association between the onset of allergic symptoms in the PBSC recipient it is reasonable to assume that the acquired peanut allergy had been transferred from the donor to the recipient by the PBSC graft.

Morphologic criteria of vesiculobullous skin disorders by in vivo reflectance confocal microscopy.

Reflectance confocal microscopy (RCM) may be a useful method for accurate, rapid, and noninvasive bedside diagnosis of vesiculobullous skin diseases (VSD). The main outcome measure of this study was a descriptive statistical analysis of RCM features associated with selected group of VSD.

Ulcerative necrobiosis lipoidica successfully treated by vacuum-assisted closure therapy

ejd.2011.1445 Auteur(s) : Birka Brauns1 b.brauns@med.uni-goettingen.de, Michael P. Schon1, Markus Zutt2 1 Department of Dermatology, Georg-August-University, Robert-Koch-Str. 40, 37075 Gottingen, Germany 2 Department of Dermatology, Klinikum Bremen Mitte, Germany A 60-year-old woman presented with painful brownish-livid, bizarrely configured plaques, localized on the anterior aspect of both lower legs (figure 1A). The partly sclerotic plaques developed 15 years before and ulcerated intermittently, [...]

Photosensitive form of trichothiodystrophy associated with a novel mutation in the XPD gene

Department of Dermatology, Venereology and Allergology, University Medical Center, Georg August University, G€ ottingen, Germany. Clinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany. DWI – Leibniz Institute for Interactive Materials, Aachen, Germany. Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders, University Medical Center, Georg August University, G€ ottingen, Germany. Lower Saxony Institute of Occupational Dermatology, University Medical Center G€ ottingen and University of Osnabr€ uck, Osnabr€ uck, Germany.

Papulopustular eruption after holiday in a 44-year-old man. Whirlpool dermatitis (pseudomonas folliculitis).

A 44-year-old man presented two days after returning from a 14-day family vacation in Sweden. In the last 3 days he had developed increasing numbers of pruritic skin lesions particularly on the lateral aspects of the trunk. In addition he complained of malaise and reduced general health, tender axillary lymph nodes and tightness in his breasts. Fever and signs and symptoms of a viral infection were not present. With the exception of a mild allergic rhinoconjunctivitis and an infection-associated asthma, he had no history of previous illnesses. The patient was not taking any medications. On the same morning, similar skin lesions were seen in his son and another member of the vacation party. The family had spent their vacation in a vacation complex with a swimming pool. With the exception of numerous mosquitoes, the patient had not noticed insects.

Multiple Slowly Growing Nodular Lesions on the Lower Legs in a 78-Year-Old Obese Woman

A 78-year-old woman presented with a 3-year history of slowly growing painless nodular lesions on both legs that were refractory to topically applied corticosteroids. On physical examination there were approximately 20 erythematous waxy plaques and nodules on edematous lower legs (Figure 1). Twenty years prior, the patient had undergone hysterectomy and adnexectomy followed by radiation for treatment of endometrial cancer. Thereafter, she experienced chronic lymphedema of both legs. Furthermore, the patient has chronic heart failure (NYHA class III), obesity (body mass index [BMI], 32 [calculated as weight in kilograms divided by height in meters squared]), arterial hypertension, and type II diabetes mellitus. For 60 years she had been receiving thyroid hormone therapy with levothyroxine sodium (currently 100 μg/d) for treatment of hypothyroidism. She did not have a history of Graves disease. Results of laboratory investigations, including routine blood tests, tests of liver enzymes, renal function, and thyroid profile, serum protein analysis, immunoglobulin levels, and autoantibody profile were within normal limits. Venous duplex ultrasonography excluded a relevant chronic venous insufficiency. A punch biopsy sample of the lower leg was obtained (Figure 2 and Figure 3). What is your diagnosis?

Sunlight-induced papulovesicular eruption in an 8-year-old girl

© The Authors • Journal compilation

Ulzerierende Plaque innerhalb einer Tätowierung bei einem 49-jährigen Mann

Ein 49-jähriger Mann stellt sich mit einer seit ca. 20 Jahren bestehenden, rezidivierend ulzerierenden Plaque am linken Unterschenkel vor. Vor ca. 21 Jahren, ein Jahr vor Auftreten erster Hautveränderungen, erfolgte im betroffenen Hautareal eine Tätowierung. In den nachfolgenden Jahren waren an Stamm und Extremitäten weitere Tätowierungen durchgeführt worden. Auch hier traten (insbesondere in den roten Farbarealen) nach Monaten bis Jahren kleinere, rezidivierende, entzündliche Plaques auf. Die Vortherapie war mit topischen Steroiden sowie modernen Wundverbänden erfolgt. Außer einem früheren Alkoholabusus bestehen keine relevanten Vorerkrankungen. Medikamente werden nicht eingenommen.

Ulcerative plaque within a tattoo in a 49-year-old man

A 49-year-old man presented with a 20-year history of a recurrent, ulcerative plaque on his left lower leg. Approximately 21 years earlier, one year prior to the initial onset of lesions, the affected area had been tattooed. Over the course of the following years, other parts of the body had also been tattooed. At these sites, too, smaller, recurrent infl ammatory Ulcerative plaque within a tattoo in a 49-year-old man Case for Diagnosis