Michele Maroon

Gastric bypass surgery improves psoriasis

Recent studies have found that psoriasis is linked to a higher rate of obesity, and that obesity itself is a risk factor for the development of psoriasis. There are two recent reports of chronic severe psoriasis improving with weight loss after Roux-en-Y gastric bypass surgery. We have observed two patients with body mass indices greater than 50 kg/m(2) who had marked improvement in their psoriasis after gastric bypass surgery. The common link between psoriasis and obesity may be a state of chronic inflammation, including elevated levels of T helper 1 (TH-1) cytokines such as tumor necrosis factor. More recent research has shown that the appetite suppressant leptin is also elevated in patients with psoriasis and obesity, and that levels decrease with weight loss. We conclude that weight loss may be a useful adjunctive therapy for obese patients with psoriasis.

Calcinosis cutis associated with syringomas: a transepidermal elimination disorder in a patient with Down syndrome.

Several cutaneous disorders have been associated with Down syndrome. An increased frequency of syringomas and of elastosis perforans serpinginosa, a transepidermal elimination disorder, have been described. We report the first case of the simultaneous occurrence of transepidermal elimination of calcium associated with syringomas in a patient with Down syndrome who had lesions clinically suggestive of milia.

Dermatology inpatient consultations: A retrospective study

36]), at baseline (T1) and after the 6 months of treatment (T2). Table I shows the mean difference between scores at T1 and T2. Compared to controls, the hypnotically treated patients presented a statistically significant higher decrease in scores for depression (P 1⁄4 .001) and anxiety (P 1⁄4 .009), reflecting a shift from pathological ‘‘high’’ toward ‘‘normal’’ SCL-90 values. Moreover, hypnotherapeutic management was associated with a significant amelioration in the SF-36 mental component summary score, leading to a final score of 50.15 (standard deviation, 10.56), a value that reflects the average HRQOL of the general population. Differences in Skindex 17 subscores, although indicating a better outcome for the hypnosis group, were not significant. Finally, the percentage regrowth of terminal hair at T2 compared with T1 was evaluated in patients receiving hypnotic treatment by visual inspection and photographs of each quadrant of the scalp. Eight patients presented a non-significant hair regrowth of less than 50% at T2. Although evidence-based research demonstrates that hypnosis can decrease anxiety and distress in surgery or in asthma, data on the effect on hypnotherapy on the HRQOL in medical conditions are still limited. In summary, although the number of patients of this study was small and the study was not randomized, results of this prospective cohort study, including a control sample with comparable baseline characteristics, suggest that hypnotherapy has a significant favorable effect on the psychological well-being of the patients. We could not confirm the clinical efficacy of hypnosis in longstanding, refractory forms of AA.

Association of scabies with a bullous pemphigoid-like eruption

We describe a patient with scabies who had an associated bullous pemphigoid-like eruption. Previous reports of this association have appeared in the literature. However, most case reports have described negative or nonspecific findings with direct immunofluorescence in contrast to the intense linear homogenous band of IgG and C3 found in our patient.

Ecchymoses and Edema in a 4‐Month‐Old Boy

A 4-month-old, healthy boy developed white papules on his cheeks and forehead that became ecchymotic. This occurred in association with mild rhinorrhea three weeks after a diphtheria-pertussis-tctanus immunization. Otitis media was diagnosed and treatment was started with oral amoxicillin-clavulinic acid after a single intramuscular injection of ccftriaxone. The purpuric edema progressed to involve the cheeks, ears, and extremities (Fig. 1). The buttocks were spared. Despite the childs impressive cutaneous fmd-

Secondary syphilis and suspected child abuse

A 38-year-old Hispanic woman presented with a widespread papulosquamous eruption with accentuation on the palms and soles (Fig 1, A). Travel history was remarkable for a recent trip to her native country (Dominican Republic). Her 13-year-old son, who accompanied her on the trip, developed a similar rash after their return (Fig 1, B). In addition, the patient noted that her boyfriend, whom she was visiting in the Dominican Republic, had a rash when she arrived. The rapid plasma reagin (RPR) test produced negative findings whereas the skin biopsy specimen from the patient’s foot showed a psoriasiform lichenoid dermatitis teeming with spirochetes highlighted by a Steiner stain. After discussion with the laboratory about the RPR results, serial dilutions proved positive (prozone effect). At follow-up 4 days later, the son was evaluated for his rash. As expected, the patient’s fluorescent treponemal antibody absorption (FTA-ABS) test result was positive, but the son’s test finding was only minimally reactive.