H.F. Jordaan

Pigmenting pityriasis alba.

Abstract: We conducted a prospective study of 20 patients with pig. menting pityriasis alba (PPA) over a period of two years. Characteristic morphology revealed a central zone of bluish hyperpigmentation surrounded by a hypopigmented, slightly scaly halo of variable width. All patients displayed lesions on the face. Concomitant extrafacial Involvement was uncommon. A significant finding was an associated dermatophyte infection in 13 patients (65%). These patients all received griseoful‐vin 10 mg/kg/day for eight weeks, resulting In the resolution of PPA in seven within 4 to 20 weeks. These were also treated with 1% hydrocortt‐sone. Biopsy specimens from two patients showed similar features, namely, a subacute dermatitis with variable pigment Incontinence, lmmu‐nohistochemical labeling revealed a preponderance of T lymphocytes. Pigmenting pityrlasis alba seems to be a variant of classic pityriasis alba showing a strong association with dermatophyte infection, especially tines capitls. It may be related to Iichenoid melanodermatitis.

Aetiopathogenesis of atopic dermatitis

The aetiopathogenesis of atopic dermatitis (AD) is complex and during recent years much has been learnt regarding the genetic predisposition to the development of this condition and how its interaction with the environment influences clinical manifestations. AD is not a simple condition. An inherited stratum corneum barrier defect, transepidermal water loss, early antigen exposure through the skin and over-hygienic care of the young child seem to be the major drivers in the manifestation of the disease. Many other, more specific, environmental factors may influence the clinical picture in individual patients; some of these have an allergic basis, while others do not. In this article, the terminology used in this issue of CME is explained, the evidence for the different aetiopathological factors is presented and the factors that worsen or improve AD are listed.

Fine‐Needle Aspiration as a Method of Diagnosis of Subcutaneous Fat Necrosis of the Newborn

A 5‐day‐old boy presented with cellulitis‐like, fluctuant lesions since birth. Clinically, subcutaneous fat necrosis was suspected, but an infective lesion could not be excluded. By performing a fine‐needle aspiration biopsy, a diagnosis was established within minutes.

The clinicopathological spectrum of trichoepitheliomas: a retrospective descriptive study

Trichoepithelioma (TE) is a benign adnexal neoplasm derived from basal cells in the hair follicle. Solitary TE occurs sporadically as opposed to the multiple familial variant that presents as an autosomal dominant genodermatosis. The solitary variant can be confused with basal cell carcinoma both clinically and histologically. Multiple familial TEs are a cosmetically disfiguring condition with limited satisfactory treatment options.

Calcific uraemic arteriolopathy (calciphylaxis) in patients on renal replacement therapy

BACKGROUND Calcific uraemic arteriolopathy (calciphylaxis) is an unusual and potentially fatal condition characterised by small-vessel calcification and ischaemic skin necrosis. It mainly affects patients with end-stage renal disease (ESRD) on haemodialysis, but may rarely occur in the absence of ESRD in conditions such as primary hyperparathyroidism, malignancy, alcoholic liver disease and connective tissue disease. METHODS We reviewed the records of all patients diagnosed with calciphylaxis while on renal replacement therapy at Tygerberg Hospital, Cape Town, South Africa, between 1990 and 2014, to describe its presentation, course and final outcome. RESULTS Nineteen patients developed calciphylaxis over this period. Their median age was 34 years and 13 (68.4%) were female. Fifteen (78.9%) had received a kidney transplant. All patients had painful skin lesions that rapidly progressed to infarction. Small-vessel calcification was seen on skin biopsy in 13 patients. Twelve patients had hyperparathyroidism. Several of the transplanted patients had been treated for graft rejection in the year preceding the diagnosis. Treatment consisted of good wound care and efforts to normalise serum calcium and phosphate levels. Five patients received an urgent parathyroidectomy. The outcome was fatal in 17 patients, with sepsis being the main cause of death. CONCLUSIONS In our patients, calciphylaxis carried a worse prognosis than previously reported internationally. It should always be considered in the differential diagnosis of painful skin lesions in the dialysis or transplant patient.

Complete spontaneous regression of a metastatic acral melanoma with associated leukoderma

C utaneous melanoma (CM) is the leading cause of skin cancer mortality worldwide despite constituting only 4% of skin cancers. Acral melanoma (AM) is a distinct variant of CM and is generally associated with a poor prognosis. Complete spontaneous regression of CM is a rare but well described phenomenon. We present an unusual case of a complete spontaneously regressed metastatic AM with melanoma-associated leukoderma.

Bacillary angiomatosis presenting with polymorphic skin lesions

a Immunodeficiency Clinic, Karl Bremer Hospital, Room 12, Outpatient building, Bellville, 7530, South Africa b Infectious Diseases and Medical Microbiology, University of Manitoba, Winnipeg, Canada and Epidemiology for Global Health Institute, University of Antwerp, Antwerp, Belgium Division of Dermatology, Stellenbosch University, Tygerberg Hospital, Parow, South Africa Division of Anatomical Pathology, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Parow, South Africa

Retrospective Value of Skin Biopsy in Histologically Confirmed Cases of the Perivascular Dermatitis Subgroup of the Inflammatory Dermatoses.

Abstract:Skin biopsy is a commonly used and valuable tool in the diagnosis of diseases of the skin. The inflammatory dermatoses are a subgroup that presents diagnostic difficulties from both a clinical and a histopathological perspective. This study examines a particularly challenging subgroup of the inflammatory dermatoses, that is, perivascular dermatitis. The final conclusions of the histological report of 163 biopsies considered to fall into the perivascular dermatitis group were examined, and the value skin biopsy added in the final diagnosis of each case was evaluated. The 2 most valuable potential outcomes of the histopathological report: consistent with clinical diagnosis with strong evidence of a specific diagnosis and new, unexpected, helpful, specific diagnosis, occurred in 40 reports (24.54%).

Education and specialist referral of patients with atopic dermatitis

Educating patients with atopic dermatitis is an essential and necessary part of therapy and particularly important when young children are involved. Quality of life is seriously impaired if patients or their carers do not understand the chronic and relapsing nature of the disease and how it can be treated.

Regional clinical registry data show increased incidence of cutaneous melanoma in Cape Town, South Africa

To the Editor: Cutaneous melanoma is a skin tumour that continues to result in a high mortality rate, particularly in the case of thick tumours and those that are deeply invasive histologically.