Delwyn Dyall-Smith

ADAMS-OLIVER SYNDROME: APLASIA CUTIS CONGENITA, TERMINAL TRANSVERSE LIMB DEFECTS AND CUTIS MARMORATA TELANGIECTATICA CONGENITA

A male infant with the features of Adams‐Oliver syndrome is described. These features included severe aplasia cutis congenita (ACC) of the scalp involving both skin and cranium, a shortened right foot with talipes equinovarus, extensive cutis marmorata telangiectatica congenita and also haemangiomas and ulceration of the abdominal skin. Exposure of the dural membrane was associated with infection, hyponatraemia and finally localised necrosis with herniation of brain and fatal cerebral haemorrhage.

Cutaneous malignancies in renal transplant recipients from Nova Scotia, Canada

Four hundred and seventy‐four Nova Scotian renal transplant recipients were screened, using the records of the Nova Scotia Cancer Registry and the Victoria General Hospital, in a retrospective study, for the development of cutaneous malignancies. Sixteen patients developed a total of 60 squamous cell carcinomas (SCC) and 14 developed 28 basal cell carcinomas (BCC). The survival curve shows that within 10 years of transplant, less than 10% will develop SCC. This is a 16‐fold increase above the rate of SCC in the general population of Nova Scotia, Canada. Age at time of transplantation appears to be a significant determinant of subsequent skin cancer risk. None of the previously reported HLA associations was found to hold in this small study. The role of ultraviolet radiation, due to both geographic and lifestyle exposure, is discussed when comparing to other transplant studies.

Melasma of the forearms

Melasma of the forearms seems to be a relatively common sign which is, to our knowledge, not reported in the literature.1,2 It seems that it may be more common in older patients and especially in postmenopausal women on supplementary oestrogen. The pigmentary change is macular and may be confluent or speckled. Like facial chloasma there is a sharp line of demarcation at the margins. In some, there seems to be an element of erythema.

SWEET'S SYNDROME ASSOCIATED WITH ADENOCARCINOMA OF THE PROSTATE

Sweets syndrome can occur in association with malignancy, in particular acute myeloid leukaemia. It has rarely reported with solid tumours. A case of recurrent Sweets syndrome in a 75 year old man with metastatic prostatic carcinoma is presented.

Subcutaneous fat necrosis of the newborn complicated by hypercalcaemia and thrombocytopenia.

Subcutaneous fat necrosis of the newborn is an uncommon but distinctive condition which appears in the first six weeks of life, associated with variable degrees of hypercalcaemia and which resolves spontaneously over months. We report a case of subcutaneous fat necrosis of the newborn following perinatal distress and complicated by thrombocytopenia and hypercalcaemia.

Dermatoscopy of pigmented extramammary Paget disease simulating melanoma

cider vinegar. It is possible that there was less absorption of the acetic acid in the thickest portion of the mollusca contagiosa papules, leading to the purple rims. The chemical burns healed without intervention. The mollusca did not respond to the acetic acid therapy but subsequently resolved with topical cantharidin. The US Food and Drug Administration mandates that vinegars contain a minimum of 4% acetic acid; however, the concentrations of acetic acid found in commercially available vinegars can range from 4% to 8%, depending on the exact source of the vinegar (Table I). Chemical burns secondary to topical application of vinegar have been rarely reported, but even ulceration has been observed. Of note, the undiluted form, glacial acetic acid, is available for purchase via the Internet and when applied, eg, as a selfadministered facial chemical peel, has led to hypertrophic scarring. Given the increase in the use of alternative therapies for skin disorders, including the application of vinegar to warts, lice, and mollusca, chemical burns caused by acetic acid may increase in incidence.

Fungal eosinophilic pustular folliculitis

A young woman presented with a persistent unilateral erosive and pustular plaque of the forearm. Repeated biopsy was required to make the diagnosis of a fungal cause for her eosinophilic pustular folliculitis.

BENIGN NEONATAL HEMANGIOMATOSIS

Three neonates with numerous cutaneous hemangiomas are presented. Although all three had serious medical problems, in none of these three could visceral hemangiomas be demonstrated. Neonatal hemangiomas can be restricted to the skin.

HYPERTRICHOSIS LANUGINOSA ACQUISITA AND ADENOCARCINOMA OF THE COLON

We report the case of a 48 year old man who developed hypertrichosis lanuginosa acquisita in association with adenocarcinoma of the colon. All laboratory investigations were normal. We present a literature review of this rare but important paraneoplastic sign which is most commonly associated with malignancies of the gastrointestinal tract.

Unique brown star shape on dermatoscopy of generalized Dowling‐Degos disease

An otherwise healthy 49-year-old woman presented with a 15-year history of a slowly extending rash and pigment changes particularly on the thighs and between the breasts. She described episodic pruritus, worse with heat, friction and perspiration. Her family history was unremarkable. Clinical examination revealed numerous generalized 2–4 mm brown and hypopigmented macules. Excoriated papules were seen over the thighs and intermammary skin (Fig. 1). There were pitted acneiform scars with hypoand hyperpigmentation in the perioral area. Dermatoscopy of the papules consistently revealed an irregular star-shaped brown outline on a red–brown background (Fig. 2). Follicular plugging and inclusion cysts were seen centrally. Skin biopsies from papules on the thighs and chest revealed flattened epidermis centrally and on the periphery, adenoid proliferations of the rete ridges in a filiform pattern with basal hyperpigmentation, inclusion cysts and follicular plugging (Fig. 3). Parakeratosis was seen in some lesions, possibly due to excoriation. There were scattered melanophages in the upper papillary dermis. Acantholysis was not seen despite examination of multiple sections of multiple papules. S100, Melan A and HMB45 stains showed increased pigment especially at the periphery. The diagnosis of generalized Dowling-Degos disease was made on the clinical and histological findings.