Michael Kahana

Painful piezogenic pedal papules in patients with Ehlers-Danlos syndrome

Painful piezogenic pedal papules were observed in 10 of 29 patients with Ehlers-Danlos syndrome. The diagnosis was made by examining each patient while he or she stood with full body weight on the heels and by observing the appearance of the painful papules on the medial, posterior, and lateral aspects of both heels. Biopsy specimens of papules demonstrated a thickened and dense dermis. The subcutaneous fibrous trabeculae were thin, with resultant poor compartmentalization of the fat. Painful piezogenic pedal papules are due to herniation of subcutaneous fat into the dermis, which is possibly due to structural defects of the connective tissue. The high prevalence of painful piezogenic pedal papules in our group of patients (34.5%) makes its direct association with the Ehlers-Danlos syndrome highly feasible, most probably because of the connective tissue defect that occurs in patients with Ehlers-Danlos syndrome.

Pityriasis rotunda in a white patient. Report of the second case and review of the literature.

A 19-year-old white woman with pityriasis rotunda in whom no diagnosable disorder could be demonstrated is reported on herein. Pityriasis rotunda has been described in Oriental and black patients, usually in association with certain serious systemic diseases. Our patient appeared to have the second reported case of pityriasis rotunda in white persons. In both cases the dermatosis occurred in an otherwise healthy individual. Physicians should be alert to the possible occurrence of pityriasis rotunda in white patients. The literature on pityriasis rotunda is reviewed.

Contact Dermatitis due to Karaya Gum and Induced by the Application of Electrodes

I case 1, a 15-year-old woman who suffered from progressive mild idiopathic scoliosis, was treated with transcutaneous electrical muscle stimulation. The electrical stimulus was applied during her sleep through surface contact with karaya electrode pads on the convex side of the curve of her spine, evoking muscle contractions that induced correction of the curvature (Fig. 1). Five days after the initiation of treatment, a red area of swelling accompanied by pruritis appeared at the site of the electrode placement (Fig. 2). Treatment was discontinued for 10 days and later reinstituted, obtaining the same effect. She was treated with 10 mg/day of prednisone for 5 days and then 5 mg/day for an additional 10 days. Due to her severe back pain, treatment with the electrode placement was attempted again, but the rapid deterioration in her skin condition made it necessary to discontinue treatment.

Mucosal involvement of cutaneous leishmaniasis.

Observation chez un homme de 21 ans qui presente un gonflement des levres depuis 6 mois. Des prelevements mettent en evidence de nombreuses leishmanies. La personne avoue avoir ete en voyage plusieurs mois auparavant dans un pays ou la leishmaniose est endemique

Lichen Aureus Occurring in Childhood

A 8-year-old girl presented with a 3-month history of scattered, bruise-like, pigmented patches on the posterior aspect of the left thigh, without previous trauma or previous drug intake. P.ist meciical history and family history were noncontributory. The lesions were usually asymptomatic, but slight pruritus was noted occasionally. Examination indicated golden-hueci patches varying in size from 0.8-1.5 cm in diameter (Figs. 1, 2). A skin biopsy specimen showed a normal epidermis and a band-like lymphohistiocytic infiltrate in the upper dermis with many extravasated erythrocytes (Fig. 3). Staining with potassium ferrocyanide demonstrated dense deposits of hemosiderin in the area of the infiltrate.

Dermatophytosis of the Diaper Area

Six cases of dermatophytosis of the diaper area due to either Epadermophyton floccosum or Trichophyton rubrum are described herein. The clinical and laboratory features of these patients and those reported in the literature are highlighted. Dermatophytosis should be considered in the differential diagnosis of rashes in the diaper area. Most standard remedies for diaper rash will not be effective or may exacerbate diaper dermatophytosis. Recognition of this condition by the clinician will lead to earlier rational treatment and may avoid the delay caused by therapy.

Painful Piezogenic Pedal Papules on a Child with Ehlers‐Danlos Syndrome

Abstract: A 5‐year‐old girl with Ehlers‐Danlos syndrome developed painful piezogenic pedal papules. She had suffered from pain in her heels for the previous two years and had undergone extensive orthopedic examinations that revealed no abnormalities. On admission, she had typical signs associated with piezogenic pedal papules (PPP), with pain induced by standing and disappearance of the lesions and the pain on relief of pressure. These papules were due to hemiation of subcutaneous fat into the dermis, possibly because of structural defects of the connective tissue. To the best of our knowledge, this is the first reported case of painful PPP occurring in childhood. We suggest that the hemiation of subcutaneous fat in our patient was most probably due to the connective tissue defect that occurs in the Ehlers‐Danlos syndrome.