J.A.A. Langtry

Generalized exacerbation of psoriasis associated with imiquimod cream treatment of superficial basal cell carcinomas.

1 Braunstein GD. Gynaecomastia. N Engl J Med 1993; 328: 490–5. 2 Aguirre MA, Velez A, Romero M, Collantes E. Gynaecomastia and sexual impotence associated with methotrexate treatment. J Rheumatol 2002; 29: 1793–4. 3 Callen JP. KulpShorten CL,Wolverton SE. Methotrexate. In: Wolverton, SE, ed. Comprehensive Dermatologic Drug Therapy. WB Saunders, Philadelphia, 2001: 147–164. 4 Sussman A, Leonard JM. Psoriasis, methotrexate and oligospermia. Arch Dermatol 1980; 116: 215–17. 5 Gunther VE. Andrologische Untersuchung en bei der antimetabolite therapie der Psoriasis. Dermatol Monatsschr 1970; 156: 498–502. 6 Van Scott EJ, Reinertson RP. Morphologic and physiologic effects of chemotherapeutic agents in psoriasis. J Invest Dermatol 1959; 33: 357–69. 7 Thomas E, Leroux JL, Blotman F. Gynaecomastia in patients with rheumatoid arthritis treated with methotrexate. J Rheumatol 1994; 21: 1777–8. 8 Del Paine DW, Leek JC, Jakle C, Robbins DL. Gynaecomastia associated with low dose methotrexate therapy. Arthritis Rheum 1983; 26: 691–2. 9 Finger DR, Klipple GL. Gynaecomastia following low dose methotrexate therapy for rheumatoid arthiritis. J Rheumatol 1995; 22: 796–7. 10 Glass AR, Bereberg J. Gynaecomastia after chemotherapy for lymphoma. Arch Intern Med 1979; 139: 1048–9.

Hidradenitis suppurativa in Crohn's disease

Summary Three patients with Crohns disease who developed the clinical features of hidradenitis suppurativa (HS) are reported. To our knowledge this association has not been previously described. These cases illustrate the similarity between cutaneous Crohns and ano‐genital HS once chronic and established.

Dysregulated TRK signalling is a therapeutic target in CYLD defective tumours

Individuals with germline mutations in the tumour-suppressor gene CYLD are at high risk of developing disfiguring cutaneous appendageal tumours, the defining tumour being the highly organised cylindroma. Here, we analysed CYLD mutant tumour genomes by array comparative genomic hybridisation and gene expression microarray analysis. CYLD mutant tumours were characterised by an absence of copy-number aberrations apart from LOH chromosome 16q, the genomic location of the CYLD gene. Gene expression profiling of CYLD mutant tumours showed dysregulated tropomyosin kinase (TRK) signalling, with overexpression of TRKB and TRKC in tumours when compared with perilesional skin. Immunohistochemical analysis of a tumour microarray showed strong membranous TRKB and TRKC staining in cylindromas, as well as elevated levels of ERK phosphorylation and BCL2 expression. Membranous TRKC overexpression was also observed in 70% of sporadic BCCs. RNA interference-mediated silencing of TRKB and TRKC, as well as treatment with the small-molecule TRK inhibitor lestaurtinib, reduced colony formation and proliferation in 3D primary cell cultures established from CYLD mutant tumours. These results suggest that TRK inhibition could be used as a strategy to treat tumours with loss of functional CYLD.

The punch and graft technique: a novel method of surgical treatment for chondrodermatitis nodularis helicis.

Background  Chondrodermatitis nodularis helicis (CDNH) is a painful inflammatory condition affecting the helix of the ear. Several surgical treatments are described in the literature, with different cure rates and cosmetic outcomes.

The difficulty in diagnosis of cutaneous herpes simplex virus infection in patients with AIDS

Three patients with AIDS are described with atypical manifestations of cutaneous herpes simplex virus infection. This infection should be considered in the immuno‐suppressed patient with persistent or bizarre cutaneous ulceration despite negative virological cultures, and in the acutely ill patient with a generalized rash.

Familial Cylindromatosis and Brooke‐Spiegler Syndrome: A Review of Current Therapeutic Approaches and the Surgical Challenges Posed by Two Affected Families

&NA; The authors have indicated no significant interest with commercial supporters.

HIV seropositivity in association with pityriasis lichenoides et varioliformis acuta

We describe a case of PLEVA in an asymptomatic, human immunodeficiency virus (HIV) positive patient. This association has not been previously described. The possible mechanisms involved are discussed.

Cutaneous features of intravascular lymphoma

Intravascular lymphoma (IVL) is a subset of extranodal non‐Hodgkin lymphoma, with an estimated incidence of < 1 case per million people. It is characterised by extensive proliferation of lymphoma cells within small to medium‐sized blood vessels. Most IVLs are B‐cell tumours. IVL can present primarily in any organ system, including the skin. The disease is often disseminated at diagnosis. The overall mortality rate is thought to be > 80%, and > 50% of patients are diagnosed at postmortem examination. There is wide variability in the clinical appearance of cutaneous lesions, which may simulate inflammatory skin disease. Therefore, awareness by dermatologists is important to enable early diagnosis when cutaneous signs are present. We report two patients with unexplained systemic disease and a skin eruption, leading to the diagnosis of IVL, and outline the range of cutaneous features reported.

Treatment of benign digit tip tumours by surgical excision and secondary intention healing with scar quality assessment by epidermal ridge patterns

MADAM, The digit tip is an important functional structure, providing a surface that allows the hand to pinch and grasp. The sensory receptor sites within the glabrous skin of the fingertip allow digital proprioception for this purpose. Various benign skin tumours may present at the fingertip and include acquired digital fibrokeratoma (ADF) and calcinosis cutis. They are often asymptomatic but may be painful if knocked and depending on their site may affect the function of the digit. Cryotherapy, shave excision, curettage and cautery, CO2 laser therapy and surgical excision are treatment options that may be effective for these tumours, depending on the management strategy. We are not aware of any reports of fullthickness excision, wound closure and outcome of elective surgery of benign tumours at this site and report our experience of full-thickness excision of benign lesions of the digit tip that were excised to fat and managed by secondary intention wound healing. Follow-up photography and assessment of the epidermal ridge patterns of the digit tips were performed to document surgical outcome and the extent and quality of scarring. We retrospectively identified patients from surgical records who had benign digit tip lesions treated by full-thickness excision and managed by secondary intention wound healing. Their notes were reviewed for information on the size of the lesion and defect, the duration of healing, the outcome of the wound and any complications that arose. The surgical procedure undertaken was similar for each patient: the digit was anaesthetized with a ring block and the tumour excised with a margin of approximately 1–2 mm. A topical antibiotic ointment and pressure dressing were applied to the wound and the dressing was changed at 2 days, then twice weekly for 2 weeks, then weekly until epithelialized. A sling was provided for all patients with fingertip wounds to be used for the first week postoperatively as required. Photographs of the lesion, wound and scar were taken. Toeprints or fingerprints

Transition from cylindroma to spiradenoma in CYLD‐defective tumours is associated with reduced DKK2 expression

Patients carrying heterozygous germline truncating mutations in the CYLD gene develop multiple primary hair follicle‐related tumours. A highly patterned tumour, termed cylindroma, and a highly disorganized tumour, termed spiradenoma, may both develop in the same patient. Furthermore, histological features of both tumour types have been described within the same tumour specimen. We used three‐dimensional computer‐aided reconstruction of these tumours to demonstrate contiguous growth of cylindromas into spiradenomas, thus suggesting a transition between the two tumour types. To explore factors that may influence cutaneous tumour patterning, genome‐wide transcriptomic analysis of 32 CYLD‐defective tumours was performed. Overexpression of the Wnt/β‐catenin signalling pathway was observed relative to normal perilesional tissue. Morphometric analysis was used to investigate the relationship between Wnt pathway‐related gene expression and tumour organization. This revealed an association between reduced Dickkopf 2 (DKK2—a negative regulator of the Wnt/β‐catenin signalling pathway) expression and loss of tumour patterning. Reduced DKK2 expression was associated with methylation of the DKK2 gene promoter in the majority of tumour samples assayed. RNA interference‐mediated silencing of DKK2 expression in cylindroma primary cell cultures caused an increase in colony formation, cell viability, and anchorage‐independent growth. Using these data, we propose a model where epigenetic programming may influence tumour patterning in patients with CYLD mutations. Copyright