Cindy England Owen

Sweet-like Dermatosis in 2 Patients With Clinical Features of Dermatomyositis and Underlying Autoimmune Disease

BACKGROUND The neutrophilic dermatoses comprise a group of cutaneous disorders that are characterized histopathologically by infiltration of the dermis with mature neutrophils with or without vessel wall destruction. Neutrophilic dermatoses have been reported in association with a variety of autoimmune diseases, most recently as a manifestation of lupus erythematosus. OBSERVATIONS We describe 2 patients with photodistributed violaceous plaques: one with associated heliotrope rash and malar erythema, and the other with scalp involvement and Gottron-like papules. In each case, the biopsy specimen revealed changes compatible with a neutrophilic dermatosis as opposed to an interface dermatitis. The first patient also had a history of Graves disease and primary biliary cirrhosis, while second patient had Wegener granulomatosis. The 2 patients responded to therapy with oral dapsone and prednisone, respectively. CONCLUSIONS The atypical presentation of neutrophilic dermatosis in 2 patients with clinical features of dermatomyositis and intercurrent autoimmune-mediated illnesses may suggest an expansion in the clinical spectrum of parainflammatory neutrophilic dermatoses. The finding of a neutrophilic dermatosis in a biopsy specimen from a patient without a classic clinical presentation should invoke a thoughtful search for underlying immune complex-mediated systemic disease.

Solitary and multiple tumors of follicular infundibulum: a review of 168 cases with emphasis on staining patterns and clinical variants

Tumor of the follicular infundibulum (TFI) is an uncommon benign adnexal tumor that usually presents as a solitary keratotic papule in the head and neck area. Infrequently, it may present as multiple lesions or in association with other conditions. Although it was initially described in 1961, the pathogenesis of this lesion is still controversial.

Fractionated Er:YAG laser versus fully ablative Er:YAG laser for scar revision: Results of a split scar, double blinded, prospective trial.

Ablative laser resurfacing is a common treatment for post‐surgical scars. Fractional ablative laser resurfacing has been an emerging treatment option that is replacing fully ablative lasers in many applications. Data comparing fractionated and fully ablative lasers in treating post‐operative scars are lacking.

Cutaneous manifestations of lung cancer

Skin findings can serve as a clue to internal disease. In this article, cutaneous manifestations of underlying lung malignancy are reviewed. Paraneoplastic dermatoses are rare, but when recognized early, can lead to early diagnosis of an underlying neoplasm. Malignancy-associated dermatoses comprise a broad group of hyperproliferative and inflammatory disorders, disorders caused by tumor production of hormonal or metabolic factors, autoimmune connective tissue diseases, among others. In this review, paraneoplastic syndromes associated with lung malignancy are discussed, including ectopic ACTH syndrome, bronchial carcinoid variant syndrome, secondary hypertrophic osteoarthropathy/digital clubbing, erythema gyratum repens, malignant acanthosis nigricans, sign of Leser-Trélat, tripe palms, hypertrichosis lanuginosa, acrokeratosis paraneoplastica, and dermatomyositis.

Treating Acne With High-Dose Isotretinoin

Importance Isotretinoin is the most effective treatment for acne. The ideal dosing regimen is unknown. Objective To determine the rates of relapse of acne vulgaris and retrial of isotretinoin after high cumulative-dose treatment and the changes to the adverse effect profile.

Anagen Effluvium Caused by Thallium Poisoning

recognizing that the absence of a bite or scratch does not preclude RBF. Moreover, clinicians with a high degree of suspicion for RBF should immediately notify the laboratory to prepare for the unique collection and culture requirements of S moniliformis and, while awaiting the PCR or blood culture results, consider empirical antibiotic treatment.5,6 With increased awareness and understanding of RBF, timely diagnosis and treatment are likely to improve patient outcomes.

Cutaneous Presentation of Methicillin-Resistant Staphylococcus aureus Sepsis in a Healthy Child

Report of a Case | A healthy male toddler presented to the emergency department with abdominal pain and distention, fever, and vomiting of 1 day’s duration. He was found to have “bruises” on both flanks (Figure 1A). Workup for child abuse was initiated, and he was treated with enemas for constipation and intramuscular penicillin after positive streptococcal findings. Over the next 2 days, he developed diffuse papules on the trunk and extremities; his condition rapidly deteriorated requiring intubation, vasopressors, and empirical broadspectrum antibiotics. A dermatology consult was obtained to evaluate his skin eruption. At the time of consult, he was hyponatremic and neutropenic, and the following laboratory values were recorded: aspartate aminotransferase (AST), 45 U/L; alanine aminotransferase (ALT), 142 U/L; C-reactive protein (CRP), greater than 270 mg/L; erythrocyte sedimentation rate, 43 mm/h; and ferritin, 603 ng/mL. (To convert AST and ALT to microkatals per liter, multiply by 0.0167; CRP to nanomoles per liter, 9.524; and ferritin to picomoles per liter, 2.247.) Urinalysis showed proteinuria and hematuria. Computed tomography of the chest and abdomen demonstrated cavitary lesions in his lungs representing necrotizing pneumonia. Areas of nonenhancement within both kidneys were suspected to represent renal abscesses. On physical examination, purpuric retiform patches were found on each flank (1 of them studded with 2 pustules) with erythematous to violaceous papules diffusely scattered on the extremities and trunk (Figure 1B). Punch biopsy specimens were taken from an area of purpura for analysis by frozen section, from a pustule for tissue culture, and from a papule for hematoxylin-eosin staining. Within an hour of obtaining the specimens, the pathologist reported frozen section findings of small organisms within the vasculature suggestive of either fungal spores, likely histoplasmosis, or staphylococcal bacteria. Permanent sections revealed a large neutrophilic pustule with inflammation extending throughout the dermis and prominent necrosis with basophilic structures filling necrotic vascular spaces (Figure 2A). Tissue Gram staining confirmed gram-positive cocci in the vessels (Figure 2B). Tissue culture, blood culture, bronchial washings, and fluid from bilateral empyemas all grew CA-MRSA. Results from transthoracic echocardiogram and bone scans were negative. Magnetic resonance images of the brain showed multifocal lesions, likely septic emboli. Findings from workup for possible immunodeficiency were negative. The patient was sent to a rehabilitation facility to complete a 6-week course of intravenous vancomycin.

Principles of Treatment of Cutaneous Drug Eruptions

Cutaneous drug eruptions are a major health concern and may affect up to 1 % of patients taking systemic medications, and are seen in 2–3 % of hospitalized patients. Most reactions are mild and self-limited upon discontinuation of the medication, but severe and life-threatening reactions are also possible. Appropriate management of patients requires a thorough knowledge of the spectrum of drug reactions, the culpability of suspected medications based on reaction type and timing, patient-specific risk factors for drug reactions, and treatment options to limit mortality and sequelae of drug reactions. Drug reactions can be either acute (e.g., urticaria, exanthematous eruptions, and Stevens Johnson syndrome) or chronic (e.g., acneiform, pigmentary, and psoriasiform eruptions). This chapter will focus on the treatment principles of the acute cutaneous drug eruptions.