Glenda Wood

Exfoliative Cytology As A Diagnostic Test For Basal Cell Carcinoma: A Meta-Analysis.

Background  Exfoliative cytology is only occasionally used in clinical practice to diagnose basal cell carcinoma (BCC).

GENERALISED GRANULOMA ANNULARE SUCCESSFULLY TREATED WITH PENTOXIFYLLINE

Generalised granuloma annulare (GA) is a chronic disease of unknown aetiology and is recalcitrant to many treatment regimes. Some investigators have suggested that an immune medicated vasculitis may be involved in the pathogenesis of GA. We describe a patient with a ten year history of generalised GA, who showed dramatic clearing of the majority of papules after four weeks of treatment with pentoxifylline. This drug has shown promising results in the treatment of many dermatologic disorders including necroboisis lipoidica diabeticorum, leukocytoclastic vasculitis and Raynauds phenomenon.

Intravascular B-cell lymphoma diagnosed by skin biopsy.

A 58‐year‐old man presented with unexplained fever, constitutional symptoms, worsening respiratory failure and gross, generalized oedema. He was eventually diagnosed with intravascular B‐ cell lymphoma on a random skin biopsy. Examination of the skin showed patchy erythema and induration, with peau d’orange. Despite multiorgan failure requiring intensive care, he responded dramatically to multiagent chemotherapy (six cycles of cyclophosphamide, doxorubicin, vincristine and prednisone) and is currently in clinical remission.

Pyogenic granuloma‐like lesions in a patient using topical tretinoin

A 16‐year‐old male developed numerous pyogenic granuloma like‐lesions across his neck, chest and back after 6 weeks isotretinoin therapy for cystic acne. The isotretinoin was ceased and he was commenced on oral steroids. After 6 weeks, the lesions were almost completely healed. However, due to worsening comedonal acne, the patient was commenced on topical tretinoin cream 0.03% twice daily to his chest. He was reviewed 2 weeks later and, surprisingly, 2 new pyogenic granuloma‐like lesions had developed on his chest. These lesions persisted until the topical tretinoin was ceased 3 months later.

Efficacy, cutaneous tolerance and cosmetic acceptability of desonide 0.05% lotion (Desowen®) versus vehicle in the short-term treatment of facial atopic or seborrhoeic dermatitis

The differences between topical corticosteroids are based mainly on their potency, safety and patient acceptability. The aim of this study was to evaluate a mild‐ to mid‐potent topical corticosteroid, desonide 0.05%, on these three parameters in an Australian cohort of patients with facial seborrhoeic or atopic dermatitis. Eighty‐one adult patients were randomized to receive desonide 0.05% lotion or its vehicle, applied twice daily for 3 weeks under double‐blind conditions. In the active treatment group, 88% of patients had their skin condition cleared or almost cleared and only two patients experienced cutaneous adverse events (rash and pruritus). The acceptability of the lotion was high; 95% of patients stated they would use this topical corticosteroid again. These data support the short‐term use of desonide 0.05% lotion as a suitable agent for the short‐term treatment of facial dermatitis.

A case of autoimmune progesterone dermatitis diagnosed by progesterone pessary

Autoimmune progesterone dermatitis is a rare, cyclical eruption that occurs in the luteal phase of the menstrual cycle and during pregnancy. Many manifestations have been reported including cyclical eczema, urticaria, erythema multiforme, stomatitis and even anaphylaxis. The condition spontaneously resolves after menopause. As histopathology is non‐specific, the diagnosis rests on history with precipitation of the eruption by a progesterone challenge, usually by the intradermal, intramuscular or oral route. We present the case of a 34‐year‐old woman with a premenstrual papular and eczematous eruption that was exacerbated after pregnancy. Biopsy showed subacute spongiotic dermatitis. To confirm the diagnosis, we used an intravaginal progesterone pessary as a provocation challenge. There was recurrence of the rash 12 h after insertion of the pessary with spontaneous resolution thereafter. We propose that use of a progesterone pessary is an effective tool in the diagnosis of autoimmune progesterone dermatitis.

Case of non‐involuting congenital haemangioma

A 4‐year‐old boy presented with a congenital vascular tumour behind his right ear. It had remained unchanged since birth and was asymptomatic. The parents sought a diagnosis and treatment. Doppler ultrasonography demonstrated a fast‐flow, lobulated vascular mass. Histology showed features of a non‐involuting congenital haemangioma. Glucose transporter‐1 staining was negative. The tumour was surgically excised without complication and has not recurred.

Cutaneous adverse effects of hormonal adjuvant therapy for breast cancer: A case of localised urticarial vasculitis following anastrozole therapy and a review of the literature

Hormonal therapy with either tamoxifen or aromatase inhibitors is commonly used to treat women with breast cancer in both the adjuvant and recurrent disease setting. Cutaneous adverse reactions to these drugs have been rarely reported in the literature. We report an unusual case of urticarial vasculitis following the aromatase inhibitor anastrozole that localised to the unilateral trunk and mastectomy scar, and review the literature on the cutaneous adverse effects of hormonal therapy for breast cancer.

Emergency pancreatic resection for glucagonoma associated with severe necrolytic migratory erythema

cial detachable embolization coils are available and there is no evidence of superiority among the coils. The main principle applicable regardless of the embolization coil device is that it is imperative for the aneurysm to be packed as tightly as possible in order to facilitate thrombosis and occlusion of the aneurysm. In our case, there was successful exclusion of the aneurysmal sac with no significant flow noted at the efferent branches. Placement of a stent-graft was considered for complete occlusion of the feeding vessel. This was however not performed given the satisfactory angiographic result, and placement of a stent at this point would have been excessive. Additional stent graft placement at the thoracic aorta would also increase the risk of spinal ischaemia. It is also of the authors’ opinion that a stent-graft would have negated future possibilities of endovascular therapy in this patient. It may be more prudent to follow-up the patient and to place a stent-graft in the future if the need arises. In summary, we report a case of a large mediastinal BAA with short vascular neck that was successfully treated with coil embolization. Endovascular therapy is being increasingly used as it is effective, less invasive and is associated with lesser morbidity and shorter hospital stays as compared to surgical treatment.