C. A. Holden

Dowling—Degos disease associated with Kitamura's reticulate acropigmentation

A family with features of Dowling‐Degos disease associated with Kitamuras reticulate acropigmentation is reported. There have been three previous reports describing the association of these two conditions.1–3 Our family extends four generations, and the proband shows some unusual features not typical of Dowling‐disease or Kitamuras reticulate acropigmentation.

Diffuse hypertrichosis and faun-tail naevus as cutaneous markers of spinal dysraphism

Summary We describe two cases of spinal dysraphism where detection of the cutaneous signs − namely a faun‐tail naevus and diffuse hypertrichosis − led to early recognition of the occult neurological abnormalities and institution of corrective surgery. The dermatologist may be the first physician to observe these skin changes and an early neurosurgical referral can prevent subsequent neurological complications.

Sweet's syndrome in association with generalized granuloma annulare in a patient with previous breast carcinoma.

We describe a case of Sweets syndrome in association with generalized granuloma annulare (GA) which presented 3 years after a diagnosis of breast carcinoma. Both Sweets syndrome and generalized GA have been described independently in association with breast carcinoma but have never been described together. Both conditions appeared to respond to oral clofazimine.

Steroid-resistant bullous pemphigoid treated with cyclosporin A

A 70‐year‐old woman with steroid‐resistant bullous pemphigoid, severe osteoporosis, and several crush fractures was given cyclosporin A at a dose of 5 mg/kg/day. Considerable improvement was evident within 4 weeks, and control has been maintained over a period of 14 months allowing reduction of her steroid dose to 4 mg on alternate days.

Amelanotic lentigo maligna melanoma of the face : a case report and review of the literature

Amelanotic lentigo meligna melanoma is rare, only 10 cases over the face having been reported to date in the English literature. In none of these was the diagnosis suspected clinically, being made in all cases only after histopathological examination. We now report an unusual additional case of this uncommon lesion, which quickly progressed from an amclanotic lentigo maligna to an invasive melanoma in a short space of time, and review the literature concerning this condition.

Congenital superficial angiomyxoma.

Superficial angiomyxomas are rare, benign, dermal and subcutaneous tumours. We describe a 12‐year‐old girl who presented with a nodular swelling in the midline of her scalp that had been present since birth. Histological examination revealed an ill‐defined myxoid lesion within the dermis, comprising spindle cells, blood vessels and occasional multi‐nucleate giant cells. Immunohistochemical staining was negative for S‐100, cytokeralin and smooth muscle actin, hut locally positive for CD34, Our patient is unusual in that the angionnxoma was present at birth, which has not previously been described. The importance of screening patients with cutaneous myxomas for cardiac lesions is discussed.

Acquired port wine stain following oral isotretinoin

circles) corresponding to the verrucous part of the lesion, whereas the bluish nodule (Fig. 1, inset) disclosed a mainly diffuse bluish pigmentation forming huge ovoid nests at the periphery. Based on these dermoscopic patterns, a diagnosis of SK associated with a pigmented BCC was considered. Subsequent histological examination of the lesion revealed a pigmented nodular BCC in the bulk of the lesion (Fig. 2). However, also following the diagnostic hint given by dermoscopy, a careful microscopic observation was used and at a closer examination at the border of the lesion, a few nests of benign-appearing basaloid cells within the epidermis, characteristically seen in SK, were observed (Fig. 2, inset). Hence, histopathology confirmed the dermoscopic diagnosis. Although SK is the most common cutaneous neoplasm, it is surprising that its coexistence with other cutaneous neoplasms is so rarely reported. This observation has led some researchers to consider this occurrence as a mere coincidence. In our opinion, this argument is biased by at least two main factors. First, the progressive growth of an aggressive neoplasm might entirely destroy an associated seborrhoeic keratosis. Second, as shown in the present case, a residual seborrhoeic keratosis might be easily overlooked on microscopic examination when limited to few intraepidermal nests. For these reasons, the coexistence of seborrhoeic keratosis with other cutaneous neoplasms might be underdiagnosed. Consequently, dermoscopy is not only helpful in avoiding misdiagnosis but, as already shown in the field of melanocytic lesions, might additionally turn the attention of histopathologists to any peculiar feature of a given lesion and therefore aid the recognition of any minor component of its histologic structure. G. Ferrara, I. Zalaudek,* H. Cabo,† H. P. Soyer,* and G. Argenziano‡ Pathologic Anatomy Service, Gaetano Rummo General Hospital, Benevento, Italy, *Department of Dermatology, Medical University of Graz, Austria, †Department of Dermatology, Hospital de Clı́nicas, University of Buenos Aires, Argentina, ‡Department of Dermatology, Second University of Naples, Naples, Italy E-mail: argenziano@tin.it Accepted for publication 25 January 2005

Trichophyton tonsurans infection mimicking tinea imbricata.

A 44-year-old Afro-Caribbean woman presented with a 5-month history of a widespread pruritic hyperpigmented rash on her trunk and limbs. Minimal scaling was noted. She had no medical history of note and no history of recent travel. She was seen by several doctors and treated with potent topical steroids for a presumed eczematous rash, with little benefit. On examination, there were multiple concentric and annular hyperpigmented rings with minimal scaling, on the trunk (Fig. 1a) and limbs (Fig. 1b). Areas of postinflammatory hypopigmentation within the rings were also present. Tinea imbricata was suspected clinically, although the distance between the rings was greater than in typical tinea imbricata, and characteristically, more scaling would be evident. Skin scrapings for mycology were performed but these were negative. A biopsy was performed, as the rash was worsening. This showed a perivascular chronic inflammatory infiltrate consisting of lymphocytes and neutrophils, and focal evidence of interface dermatitis. Lupus erythematosus was suggested as a diagnosis. However, skin immunofluorescence and antinuclear antibody testing were negative. The patient was commenced on hydroxychloroquine, but despite a slight initial response, the rash continued to deteriorate. Annular erythema was considered as a differential diagnosis and the patient was commenced on oral prednisolone 30 mg once a day. The dose was gradually reduced over the next 4 weeks while further investigations were carried out. No significant improvement was noted during treatment with prednisolone. Further skin scrapings were sent for mycology and these grew Trichophyton tonsurans on culture. The patient was treated with oral terbinafine for 4 weeks. The rash cleared completely, and there is no evidence of recurrence to date. PD

Generalized pustular psoriasis after renal transplantation-failure to suppress with cyclosporin A

There are now several reports describing the beneficial effects of oral cyclosporin A (CyA) therapy in widespread plaque psoriasis1‐4 and a single report of generalized pustular psoriasis of the von Zumbusch variety responding to CyA.5 We report a patient who developed generalized pustular psoriasis provoked by rapid corticosteroid withdrawal after renal transplantation. At the onset of the eruption whole blood CyA levels were above the post‐renal transplant therapeutic range. Management options for pustular psoriasis developing after renal transplantation are discussed.

Cutaneous abscesses due to systemic nocardiosis-a case report

We report a patient with systemic nocardiosis who developed cutaneous abscesses following haematogenous spread from a primary infection in the lung. This case is unusual; first in that the organism assumed a granular form on histological section, and secondly that the patient was not immunocompromised, emphasizing the need to consider nocardiosis in any patient with pleuropulmonary infection and cutaneous abscesses.