Mt Sahin

Targetoid haemosiderotic haemangioma: dermoscopic monitoring of three cases and review of the literature

Targetoid haemosiderotic haemangioma represents a new, rarely reported, distinctive, benign vascular tumour, characterized histopathologically by a biphasic growth pattern of dilated vascular structures in the superficial dermis lined by prominent hobnail endothelial cells and collagen dissecting, rather narrow neoplastic vessels in deeper parts of the lesion. In the initial stage, the lesion is seen as a small purple or violaceous papule, 2–3 mm in diameter. Over time, the ecchymotic ring expands peripherally until it disappears spontaneously. In the later stages, however, the central papule remains as a slightly raised dermal lesion with a purple to brownish discolouration. We report three cases whose repetitive cyclic morphological changes of targetoid haemosiderotic haemangiomas were monitored dermoscopically at 3‐month follow‐ups. Histopathological examination of each lesion identified the features of targetoid haemosiderotic haemangioma. To the best of our knowledge, our three cases are the first reported in the literature of targetoid haemosiderotic haemangiomas that were regularly monitored by dermoscopic examinations, enabling development of the different stages of the same lesion to be followed.

Trombosed solitary angiokeratoma of Mibelli simulating malignant melanoma: the importance of dermoscopy in differential diagnosis

102 JEADV 2006, 20 , 100–122

Blue naevus with satellitosis mimicking malignant melanoma

Blue naevus is an acquired benign melanocytic naevus. It is a firm, sharply defined dark blue to grey–black papule or nodule, which is likely to arise from the arrested dermal melanocytes in the dermis. In the last few years, blue naevus has attracted much attention due to the recognition of new entities and to its confusion with malignant melanoma. We report a 69‐year‐old man who developed a blue–black nodular lesion with satellitosis on his scalp. Although clinically it was thought to be a malignant melanoma, histopathological investigation and conservative methods such as dermatoscopy and power Doppler ultrasonography did not confirm this diagnosis. Histopathological examination excluded malignant melanoma, as there were no cellular atypia and mitotic activity in either the nodular lesion or the satellitosis. Doppler ultrasonography confirmed the benign nature of the lesion. Dermatoscopic examination showed homogeneous steel‐blue pigmentation with individual blue globules, dots and some brown veils, and confirmed the histopathological diagnosis. To the best of our knowledge, our case is the third reported case of a blue naevus with satellitosis mimicking malignant melanoma.

Generalized granuloma annulare in a patient with type II diabetes mellitus: successful treatment with isotretinoin

JEADV 2006, 20, 100–122

Behçet's disease associated with hidradenitis suppurativa

428 JEADV 2007, 21, 392–435

Transient eruptive seborrhoeic keratoses associated with erythrodermic pityriasis rubra pilaris

In contrast to the sign of Leser-Trélat, which is the appearance of multiple seborrhoeic keratoses in association with underlying internal malignancy, the sudden appearance of seborrhoeic keratoses in association with erythroderma has been described in very few case reports. The initial reports of erythroderma-associated transient eruptive seborrheic keratoses (TESK) included patients with underlying generalized eczema, benign renal tumour, pityriasis rubra pilaris (PRP), psoriasis and erythrodermic drug eruption. A 69-year-old woman with an erythrodermic PRP developed multiple seborrheic keratoses during treatment with etretinate. Her PRP was brought under control with etretinate therapy. At the time this therapy began, the patient noticed the onset of small, reddish-brown verrucous papules on the erythrodermic femoral triangles bilaterally, and that these lesions began to appear in conjunction with the erythrodermic flaring of the PRP. Dermoscopic examination revealed comedo-like openings and milia-like cysts, which are the dermoscopic hallmarks of seborrheic keratosis. Histopathologic examination revealed hyperplastic epidermis overhanging the surrounding skin, uniform basaloid cells, keratin cysts and melanocytes. In conclusion, the clinical, dermoscopic, and pathologic findings were all consistent with seborrheic keratosis. As the erythroderma cleared, more seborrheic keratoses, which had not been present before the recent flare, became evident. On resolution of the erythroderma, the keratoses began to involute and fall off; 4 months after resolution there were no seborrheic keratoses remaining. The appearance of multiple lesions in four patients with generalized erythroderma, clinically and histologically consistent with seborrheic keratoses, was first described by Williams. These lesions were described as acanthoma ; they differed from classic seborrheic keratoses only by their transient nature. The lesions spontaneously involuted within 6 months of clearing of the erythroderma. Barriére et al. reported similar findings, again with the diagnosis of acanthoma and the resolution of skin lesions paralleling resolution of the erythroderma. The two cases of Flugman et al. represent the same phenomenon as in these original descriptions; the descriptive term acanthoma is a semantic distinction based only on the transient nature of these seborrheic keratoses. We believe that our case fits the descriptions by Williams and by Barriére et al. Berman and Winkelmann suggested that the seborrheic keratoses regressed with the same type of mononuclear cell inflammation seen in other spontaneously regressing cutaneous tumours, such as verruca plana, keratoacanthoma, molluscum, and halo nevi. Schwengle and Rampen likewise reported the histologic findings of seborrheic keratoses with mononuclear cell inflammatory infiltrate in their patient with TESK due to erythrodermic PRP. If seborrheic keratoses can arise as a result of an array of diseases, including psoriasis, PRP, benign neoplasms, allergic contact dermatitis, and eczema, then it may be true that erythroderma resulting from any aetiologic factor, including malignancy, may cause seborrheic keratoses. A recent report of eruptive seborrheic keratoses occurring in a postoperative graft site suggests that there may be many other potential aetiologic factors that can cause this transient eruption. The role of etretinate in the regression of the seborrheic keratoses in our patient is not clear. Although systemic retinoid therapy has not been reported to influence the course of seborrheic keratoses, Schumacher and Stüttgen reported an effect of topical retinoic acid in eight patients with such keratoses. In our patient, the seborrheic keratoses regressed further after withdrawal of etretinate therapy and did not recur during follow-up; Schwengle and Rampen’s case was similar. Therefore, it is uncertain whether the lesions regressed after control of the cutaneous inflammation or as a result of the etretinate therapy. The association of eruptive seborrheic keratosis with erythrodermic skin conditions is an important clinical entity that has been underrepresented in the dermatologic literature. TESK is a self-limiting condition that can occur within the context of many different underlying diseases that produce erythroderma. The seborrheic keratoses characteristically involute and disappear as the erythroderma resolves; this process most likely represents regression through mononuclear cell infiltration. Thus, the term TESK should be used to denote cases in which the eruptive lesions are associated with an inflammatory skin condition. We report this case in order to bring TESK to the attention of clinicians and also to review the literature describing erythroderma-induced TESK. To the best of our knowledge, this case represents the second report of TESK associated with erythrodermic PRP.

Malignant eccrine poroma in an unusual location1

Malignant eccrine poroma is a rare skin appendage tumour, originating from the intraepidermal and upper dermal eccrine ducts. The tumour either arises spontaneously or develops in a long‐standing eccrine poroma, generally in elderly people over 60. Clinically, it tends to be a localized lesion, which manifests itself as a nodule or ulcerated tumour, favouring extremities. We report an 83‐year‐old female with an enlarging and bleeding tumour on her lumbosacral region. This lesion first appeared as a small pigmented papule and progressed to an erythematous patch with central papular portion and some peripheral pigmentation. Histopathology revealed malignant eccrine poroma. Also, immunohistochemically, diffuse and intense p53 staining was observed. Regular pigment pattern, brown globules and black dots were seen in dermoscopic examination. After performing a wide excision, 20 months of follow‐up revealed no recurrence or metastasis of the tumour. This case represents an unusually located malignant eccrine poroma with some pigmentation.

Norfloxacin-Induced Toxic Epidermal Necrolysis

OBJECTIVE: To report a case of toxic epidermal necrolysis (TEN) in a man who was treated with oral norfloxacin for prostatitis. CASE SUMMARY: A 40-year-old man presented with a severe skin reaction, which was diagnosed as TEN. He had received norfloxacin 800 mg/day over a 14-day period for prostatitis and, 10 days after finishing the treatment regimen, he developed cutaneous and mucous lesions typical of TEN. After a prolonged hospitalization and treatment with oral prednisolone therapy, fluid resuscitation, and wound dressing, the man recovered. DISCUSSION: TEN is an infrequent, yet often fatal, severe systemic and cutaneous disease that is most often an adverse drug reaction. There are few case reports of TEN induced by fluoroquinolones. A MEDLINE search (1966–February 2005) revealed no reports of toxic epidermal necrolysis, but one incidence of Stevens—Johnson syndrome due to norfloxacin therapy. An objective causality assessment suggests that TEN was probably related to norfloxacin in this patient. CONCLUSIONS: To our knowledge, this is the first case of TEN associated with the use of oral norfloxacin. We hope that this case report creates awareness that norfloxacin-induced TEN is possible.

Adhesive tape technique to enhance potassium hydroxide diagnosis of occult fungal infections

SOLUTION When the lesion is clinically suspect of fungal disease and KOH negative, we use adhesive tape not to take a specimen for direct examination but to produce a moist environment under occlusion. Fungal infections generally occur inmoist or warm areas because fungi can easily flourish under such conditions. We apply plastic tape to the active outer border of their lesion and request that the patient reattach this tape with additional tape whenever it loosens (Fig 1). Fungi therefore flourish under the tape. After 2 to 3 days, there will be a high quality sample for examination, which enables a physician to identify mycelia and spores. This simple technique provides a satisfactory specimen when standard scrapings fail.