Monika Harms

Papular-purpuric “gloves and socks” syndrome

We report five cases of an acute, self-limiting dermatosis that has not been previously described. It consists of a pruritic edema and erythema of the hands and feet in a gloves-and-socks distribution and is associated with oral lesions and fever. The clinical course is characterized by the rapid development of petechial purpura and clearing of lesions within 1 to 2 weeks. The disease appears to affect only young and otherwise healthy persons and occurs mostly during the spring. The etiology is unknown but might be of infectious origin.

The incidence of Sweet's syndrome in Geneva : a retrospective study of 29 cases

Over a 12-year period (1979-1991), 29 cases of Sweets syndrome (SS) were detected in the area of Geneva; 24 patients (82%) could be contacted for follow-up. The majority of SS occurred between 1979 and 1986, then from 1991 on. The annual distribution and especially the absence of cases during 4 years suggest an environmental or even infectious factor in SS. Only 4 cases had an underlying disease (ulcerative colitis, polycythemia, lymphoma, sarcoidosis) whereas in the other, a long-term follow-up, including iterative hematological evaluation, did not reveal any underlying condition. Twelve patients were treated by colchicine, 9 by potassium iodide and 5 by prednisone; in 3 patients remission was spontaneous. Nine patients (28%) relapsed; there was no relationship between the type of drugs used and the frequency of relapses.

An overlap of Cowden's disease and Bannayan-Riley-Ruvalcaba syndrome in the same family.

We describe a family with the unusual association of Cowdens disease and Bannayan-Riley-Ruvalcaba syndrome. The father has characteristic mucocutaneous features that are palmoplantar keratoses, multiple facial papules, oral papillomatoses, lipomas, and vitiligo with involvement of the thyroid and digestive tract. The son presents with pigmented macules of the penis, macrocephaly, and a lipoma that are typical for Bannaya-Riley-Ruvalcaba syndrome. Recent studies have demonstrated that these 2 diseases are allelic disorders at the PTEN locus on chromosome 10q.

Orbital and palpebral paraffinoma

Paraffinoma is a well-recognized complication of paraffin injection. We describe a 44-year-old man who had an ethmoidectomy for chronic sinusitis. A communicating fracture of the ethmoid bone into the orbit occurred intraoperatively. The nasal cavity was subsequently packed with gauze containing a petrolatum-based antibiotic ointment. Bilateral, periocular swelling developed 1 week later. Optical and electron microscopic studies revealed a paraffinoma.

Sebum Excretion Rate in Subjects Treated with Oral all-trans-Retinoic Acid

BACKGROUND AND OBJECTIVE It is generally accepted that the inhibition of sebum excretion has a predictive value for anti-acne activity. Whereas oral 13-cisretinoic acid (13-cis-RA) decreases sebum excretion, it has not been shown so far if oral all-trans-retinoic acid (tretinoin, tRA) does so. The aim of this exploratory study was to investigate the effect of oral tRA on the sebum excretion rate (SER) in young male subjects. METHODS 12 healthy volunteers with a baseline SER above 1.0 microgram/cm2/min were treated with 20 mg/day tRA for 4 weeks. The SER was measured at weeks 2 and 4. Adverse reactions were recorded. RESULTS The mean SER varied from 1.56 at baseline to 1.65 at week 2 and to 1.49 micrograms/cm2/min at week 4. Comparison with values obtained in the same subjects previously treated with either 13-cis-RA or 9-cis-retinoic acid indicated that tRA less sebosuppressive. Mucocutaneous reactions and headache were the most frequent side effects of oral tRA. CONCLUSION The lack of effect on the SER suggests that oral tRA would probably be ineffective against acne. The fact that, of the three isomers tested, only 13-cis-RA (which does not bind to nuclear receptors) shows activity may suggest that sebosuppression is not nuclear receptor mediated. We discuss other hypotheses related to pharmacokinetics.

Photosensibilisation au carprofène (Imadyl®), un nouvel anti-inflammatoire non stéroïdien

Carprofen is a new non-steroidal anti-inflammatory drug and a phenylpropionic acid derivative. It seldom causes pruritus, erythema or urticaria. Since 1 year, we have observed 8 photosensitive eruptions associated with Carprofen, a surprising side effect for this group of derivatives. The skin eruption started from 4 days to 3 weeks after the initiation of the treatment and was always limited to the exposed areas of the skin. The eruption was erythematopapular, but also vesioular or bullous. 2 cases required systemic corticosteroids. Photo patch tests were positive, suggesting a photoallergic process. Phototherapy should be avoided in patients treated with carprofen.

Postmenopausale frontale fibrosierende Alopezie

ZusammenfassungEs wird über 2 Patientinnen mit postmenopausaler frontaler fibrosierender Alopezie (postmenopausal frontal fibrosing alopecia) berichtet. Dieses kürzlich beschriebene Krankheitsbild betrifft Frauen nach der Menopause und zeichnet sich durch ein progressives Zurückweichen des fronto-temporalen und parietalen Haaransatzes aus. Es kommt zur Bildung einer symmetrischen, 3 bis 6 cm breiten bandförmigen vernarbenden Alopeziezone. Histologisch finden sich hauptsächlich im Bereich des Isthmus und des Infundibulums ein entzündliches lymphozytäres perifollikuläres Infiltrat sowie eine Fibrose. Eine unserer zwei Patientinnen wies zusätzlich einen vulvären Lichen sclerosus et atrophicus auf. Eine wirksame Behandlungsmethode für diese postmenopausale Alopezieform ist bis dato nicht bekannt, doch scheint der Krankheitsverlauf selbstlimitierend zu sein.SummaryWe report on two patients with postmenopausal frontal fibrosing alopecia. This recently described disease affects postmenopausal women and is characterized by progressive recession of the frontotemporal and parietal hair margins. It leads to a symmetrical band-like scarring area of alopecia 3–6 cm wide. Histological examination shows perifollicular fibrosis and lymphocytic inflammation concentrated around the isthmus and infundibular areas of the follicles. One of our two patients also had vulvar lichen sclerosus et atrophicus. An effective treatment for this type of postmenopausal alopecia is yet not known, but the course of the disease seems to be self-limited.

Basal Cell Carcinoma of the Earlobe after Auricular Acupuncture

The genesis of familial and sporadic basal cell carcinomas involves activation of the Sonic hedgehog signal transduction pathway. Other known factors for the development of basal cell carcinoma are ultraviolet exposure, X-rays, race, age, gender and decreased DNA repair capacity. We here report the case of a right earlobe sporadic basal cell carcinoma in a 65-year-old woman. This case is unusual because of its earlobe localization and its association with multiple auricular acupuncture treatments. This observation suggests a connection between local traumas, which occur in the course of acupuncture treatment and ear piercing, and the genesis of basal cell carcinoma. The incidence of minor adverse events associated with acupuncture is high, but serious events are uncommon. Acupuncture is not known to date for promoting the development of tumors. This connection remains to be elucidated.

Vulvodynia after CO2 Laser Treatment of the Female Genital Mucosa

We have observed 3 cases of vulvodynia after CO2 laser (pulse or scan) treatment of condylomata acuminata (n = 1) or bowenoid papulosis (n = 2) of the female genital mucosa. Laser treatment was associated with a considerable delay in healing (3–4 months) and chronic pain. The histology of the treated areas showed a scar tissue and severe mucosal atrophy. The occurrence of painful scars following CO2 laser treatment could be related to an inadequate laser technique considering the morphology of the vagina.

Prurigo pigmentosa: 3rd Non-Japanese Case

A 23-year-old woman suffering since 4 years from Prurigo pigmentosa is presented. Histology from an early lesion shows neutrophilic infiltration of epidermis and dermis. Treatment with Dapsone and potassium iodide was effective but failed to prevent recurrences.