Ivan Robertson

Pustular vasculitis of the hands.

BACKGROUND Several patients were observed with a peculiar cutaneous eruption limited to the dorsa of the hands and fingers. Clinically the lesions had some resemblance to those seen in Sweets syndrome, but biopsy specimens showed severe leukocytoclastic vasculitis. OBJECTIVE Our purpose was to characterize this eruption clinically and histologically and compare it with previously described diseases. METHODS Six patients observed since 1977 are described. Skin biopsy specimens were obtained. RESULTS In six women (age, 41 to 79 years) a symmetric eruption of papules and plaques limited to the dorsa of the radial sides of the hands and first three digits developed. The lesions resembled those of Sweets syndrome and were associated with fever, sterile culture, blood neutrophil leukocytosis, nonresponse to antibiotic therapy, and rapid response to prednisone. Biopsy specimens showed a severe leukocytoclastic vasculitis. CONCLUSION These patients appear to have a distinct entity that we have termed pustular vasculitis of the hands.

Cutaneous manifestations of chronic graft-versus-host disease

Graft‐versus‐host disease (GVHD) occurs in a number of clinical settings. It is well recognized after bone marrow transplantation, an increasingly used therapeutic option for haematologicl disorders. Chronic GVHD, occurring at an interval greater than 100 days post‐transplant, has many systemic manifestations, but it is the cutaneous manifestations which are most frequent and often most troubling to the patient In this review article, the wide spectrum of cutaneous chronic GVHD (including involvement of hair, nails and mucosae), and its complications and associations are discussed. The clinical and histological features and management guidelines are presented to assist the dermatologist with diagnosis and treatment of this condition.

Acquired ichthyosis in bone marrow transplant recipients.

BACKGROUND Acquired ichthyosis (AI) has been described in a variety of clinical situations. We have observed cases of ichthyosis in bone marrow transplant recipients. OBJECTIVE Our purpose was to characterize these changes clinically and histologically and to compare them with other cases of acquired ichthyosis. METHODS Skin biopsy specimens were taken before transplantation and from affected areas after transplantation. RESULTS AI was observed in four patients who had received a bone marrow transplant for leukemia. None of the patients had a previous personal or family history of ichthyosis. In all patients graft-versus-host disease developed after transplantation. The eruption clinically and histologically most closely resembled ichthyosis vulgaris. The ichthyotic changes appeared to be unrelated to specific drug therapy. CONCLUSION AI is a previously unreported cutaneous complication of bone marrow transplantation. It may be related to graft-versus-host disease in these patients.

Pityriasis rosea-like eruption after bone marrow transplantation

Bone marrow transplantation is associated with numerous cutaneous complications that may be related to the underlying (preexisting) disease, to pretransplant conditioning, to immunosuppression, to concomitant medication, or to graft-versus-host reaction. We describe four bone marrow transplant recipients with the clinical and histologic features of pityriasis rosea, a hitherto unreported association.

Cutaneous hypersensitivity reactions to freshwater cyanobacteria – human volunteer studies

BackgroundPruritic skin rashes associated with exposure to freshwater cyanobacteria are infrequently reported in the medical and scientific literature, mostly as anecdotal and case reports. Diagnostic dermatological investigations in humans are also infrequently described. We sought to conduct a pilot volunteer study to explore the potential for cyanobacteria to elicit hypersensitivity reactions.MethodsA consecutive series of adult patients presenting for diagnostic skin patch testing at a hospital outpatient clinic were invited to participate. A convenience sample of volunteers matched for age and sex was also enrolled. Patches containing aqueous suspensions of various cyanobacteria at three concentrations were applied for 48 hours; dermatological assessment was made 48 hours and 96 hours after application.Results20 outpatients and 19 reference subjects were recruited into the study. A single outpatient produced unequivocal reactions to several cyanobacteria suspensions; this subject was also the only one of the outpatient group with a diagnosis of atopic dermatitis. No subjects in the reference group developed clinically detectable skin reactions to cyanobacteria.ConclusionThis preliminary clinical study demonstrates that hypersensitivity reactions to cyanobacteria appear to be infrequent in both the general and dermatological outpatient populations. As cyanobacteria are widely distributed in aquatic environments, a better appreciation of risk factors, particularly with respect to allergic predisposition, may help to refine health advice given to people engaging in recreational activities where nuisance cyanobacteria are a problem.

Disseminated lobular capillary haemangioma

A 58‐year‐old woman presented with a 5‐week history of multiple widespread vascular lesions. Histological examination confirmed the clinical diagnosis of disseminated lobular capillary haemangioma. No underlying cause for this eruption could be found. The lesions resolved over the following 2 months without intervention. Reports of disseminated lobular capillary haemangioma are scarce in the literature. In general, this condition does not appear to be related to an underlying disorder and in particular is not a marker for underlying malignancy. No unifying concept as to the aetiology of disseminated lobular capillary haemangioma has been identified. The condition appears to follow a benign course, with spontaneous resolution over 6–12 months.

Localized Chronic Pemphigoid

A case of localized chronic pemphigoid with positive basement membrane zone immuno‐fluorescence is reported. The initial biopsy showed dermal papillary microabscesses resembling dermatitis herpetiformis although a subsequent biopsy revealed a subepidermal bulla.

Birt-Hogg-Dubé syndrome.

We present three members of a Queensland family with clinical and histopathological features consistent with Birt–Hogg–Dubé syndrome. Two of the three family members were able to be screened for associated disorders. The mother of the family was found to have a solitary colonic polyp, a large ovarian cyst and two chorioretinal scars. No associated disorders were found on investigation of one of the two affected sons.

Regressing plane warts--an ultrastructural study.

A patient with multiple plane warts which disappeared spontaneously over a period of several weeks is reported. Electron microscopy revealed numerous apoptotic bodies in the epidermis.

Progression of a myxoid pleomorphic fibroma to myxofibrosarcoma.

A 75‐year‐old man presented with a protuberant stable lesion of many years on his left second toe. Histology on an incisional biopsy showed myxoid pleomorphic fibroma. Over the subsequent 21 months, the lesion enlarged and became exophytic and irregular. Repeat biopsy showed features consistent with a grade III myxofibrosarcoma. Treatment involved amputation of his toe. Six months later he remains well, with no evidence of local recurrence or systemic spread.