Francisco A. Ramos-Caro

Frequency of pre‐existing actinic keratosis in cutaneous squamous cell carcinoma

Background Controversy over the rate of malignant transformation of actinic keratosis (AK) into cutaneous squamous cell carcinoma (SCC) has generated considerable debate regarding the importance of treating all such precancers to preclude their transofrmation. Current changes in US healthcare policy will deny many individuals access to certain simple and effective treatment modalities for precancerous lesions.

Extensive cutaneous hyperpigmentation caused by minocycline

A 65-year-old man had cutaneous hyperpigmentation that had occurred over the previous 2 1/2 years. The hyperpigmentation was extensive and involved the sclerae, nail beds, and total body; the palms and buttocks were spared. Clinical diagnosis was suggestive of hemochromatosis or heavy metal deposition. Histologic and electron microscopic findings were consistent with lysosomal iron deposition. A careful history showed that minocycline was the cause. Its use was discontinued, and after several years the patients pigmentation is gradually returning to normal.

Therapeutic alternatives in cutaneous T-cell lymphoma

Mycosis fungoides and Sézary syndrome, collectively referred to as cutaneous T-cell lymphoma, are non-Hodgkins lymphomas that initially appear in the skin. Early-stage disease, limited to the skin, is best treated with sequential topical therapies such as topical nitrogen mustard, psoralen phototherapy (PUVA), or total-skin electron beam therapy. Photopheresis is the first line of therapy for the patient with erythroderma. Systemic therapy is generally reserved for patients with refractory disease and patients who initially present with extracutaneous involvement. Although there are several treatment options for cutaneous T-cell lymphoma, there have been few randomized comparative trials.

Acute periorbital mucinosis in discoid lupus erythematosus

Periorbital edema associated with lupus erythematosus is not frequently reported. To our knowledge, periorbital edema from increased dermal mucin has not been reported with any form of lupus. We present a patient with discoid lupus exhibiting periorbital edema from massive mucinosis.

Congenital cutaneous candidiasis associated with respiratory distress and elevation of liver function tests: A case report and review of the literature ☆ ☆☆ ★

We describe congenital cutaneous candidiasis (CCC) in a term newborn. The mother had candidal vaginitis 1 week before delivery. At birth, the infant had a generalized, intensely erythematous, papulovesicular eruption, respiratory distress and elevation of liver function tests. The child responded well to intravenous amphotericin B plus topical and oral nystatin. There have been 13 previously reported cases of CCC in infants weighing more than 1500 gm who had evidence of systemic infection. Two deaths were attributed to candidal pneumonia and sepsis. The majority of infants with CCC have infection localized to the skin, but if there is any evidence of respiratory distress or signs of sepsis the possibility of systemic candidiasis and the need for parenteral antifungal therapy must be considered.

Paget's disease of the breast in a man with neurofibromatosis

A 68‐year‐old white man with type 1 neurofibromafosis presented with a 1 ‐year history of a pruritic non‐healing eruption on his left breast. The persistent lesion had been gradually enlarging. This had been unsuccessfully treated with both corticosteroid and antifungal creams. Physical examination of the involved breast revealed a well‐demarcated 5 × 3 cm red, slightly Jnfiltrated piaque with adherent fine white scale and erosions with serous exudate (Fig. 1). The areola was completely obscured by the lesion and the nipple could not be identified. Neither a breast mass nor axillary adenopathy was present. A punch biopsy confirmed the diagnosis of Pagets disease. The patient subsequently underwent a left modified radical mastectomy with ipsilateral lymph node dissection. The final pathology revealed intraductal carcinoma, comedo and noncomedo type, with overlying pagetoid cells in the epidermis (Figs 2–4). Special stains included a positive epithelial membrane antigen, focally positive carcinoembryonic antigen, and negative S‐100. All 21 lymph nodes submitted from the axillary lymph node dissection were negative for tumor.

Azathioprine : a forgotten alternative for treatment of severe psoriasis

A 60-year-old man with a 30-year history of severe psoriasis and psoriatic arthritis has been followed at Gainesville Veterans Administration Medical Center. An extensive work-up, including many skin biopsies, confirmed the diagnosis of psoriasis. Rheumatologic evaluation for joint pain was compatible with psoriatic arthritis. The patient failed conventional psoriatic therapies because of side effects or inadequate response. Specifically, in 1960, he received systemic corticosteroids, but they resulted in severe mental status changes. He had to discontinue methotrexate after 6 years of treatment because of an abnormal liver biopsy

Papular elastolytic giant cell granuloma responding to hydroxychloroquine and quinacrine

A 75‐year‐old Caucasian male with papular elastolytic giant cell granuloma was treated successfully with hydroxychloroquine (200 mg p.o. bid for 4 months). Treatment had to be stopped because of early retinopathy. Treatment was started with quinacrine, which accomplished partial control.

Giant proliferative hemangiomas arising in a port-wine stain

A 57-year-old white man with a long-standing nevus flammeus stain on the posterior aspect of the right side of his scalp had a l-month history of rapidly growinglesions within it. Examination revealed a 4 em, pedunculated, erythematous tumor on the posterior aspect of the inferior parietal scalp on his right side and a 6 em lobulated, pedunculated, oozing hemorrhagic tumor in the occipitalposterior neck region (Fig. I). Both tumors arose in a bright red-purple patch located on the right side of the posterior scalp and neck. Laboratory studies revealed a hematocrit of 15%, most likely caused by oozing of blood from the tumors. The patient was treated with iron replacement, and 2 months later his hematocrit was 35%. Computed tomography of the scalp revealed that both tumors extended to the subcutaneous fat with no involvement of the deeper scalp layers. Both lesions were excised. Histologic findings included a superficial component composed of lobules of capillaries separated by edematous stroma that is consistent with a pyogenic granuloma. The reticular dermis contained

Annular eruption preceding relapsing polychondritis : case report and review of the literature

Relapsing polychondritis (RP) is a rare multisystem disorder affecting cartilaginous tissues, primarily of the ears, nose, larynx, and trachea. RP shows dermatologic manifestations in 35–50% of cases, and may show skin findings as the first sign of disease in 12% of affected patients. There have been reports of urticarial‐like lesions in RP, typically associated with vasculitis, as well as a few reports of erythema multiforme‐like lesions. There has also been one previous report of erythema annulare centrifugum associated with RP, presenting with a histology suggestive of a drug eruption. Our patient presented with urticarial and erythema annulare centrifugum‐like plaques preceding the diagnosis of RP by over 1 year, with an initial histology suggestive of a drug eruption.