Simin Ada

Nicolau syndrome aggravated by cold application after i.m. diclofenac

Nicolau syndrome is a rare but well‐recognized cutaneous adverse drug reaction at the site of i.m. injection of certain drugs. Clinically, it is characterized by severe pain immediately after the injection followed by an erythematous reticular patch that may result in a necrotic ulcer and scarring at the injection site. We describe a 60‐year‐old woman with a painful, violaceous, crusted plaque after i.m. diclofenac administration to her right buttock. She had applied an ice pack to this area immediately after the injection to relieve the pain without any benefit. A clinical diagnosis of Nicolau syndrome due to diclofenac injection was made, and reconstructive surgery of the wound was performed. Although diclofenac is a widely used non‐steroidal anti‐inflammatory drug, Nicolau syndrome following i.m. diclofenac injection has rarely been reported in the published work. Application of a cold compress was considered an aggravating factor in our patient.

Mucocutaneous disorders in renal transplant recipients receiving sirolimus-based immunosuppressive therapy: a prospective, case–control study

Sirolimus (SRL) has some dermatologic complications including acneiform eruptions, edema, aphthous ulceration, and onychopathy. However, controlled studies reporting the prevalence and clinical characteristics of mucocutaneous disorders are scarce.

The evaluation of primary idiopathic focal hyperhidrosis patients in terms of alexithymia.

The aim of this study was to evaluate the primary focal hyperhidrosis patients in terms of alexithymia. Participants (n = 50) diagnosed with primary focal hyperhidrosis by a dermatologist were referred to a psychiatrist and evaluated via Structured Clinical Interview for DSM-IV Axis I Disorders and Toronto Alexithymia Scale-20. The rate of alexithymia was 45.6 percent and 18.2 percent, respectively, for primary focal hyperhidrosis and control participants (n = 44). Multivariate analysis of variance results showed that the primary focal hyperhidrosis group scored significantly higher than the control group in Difficulty Identifying Feelings and Difficulty Describing Feelings subscales, and total score. Psychotherapeutic interventions can increase the chances of dermatological treatment success and can have a positive impact on the quality of life in chronic cases.

CD8+ poikilodermatous mycosis fungoides with a nonaggressive clinical behaviour and a good response to psoralen plus ultraviolet A treatment

with a looped cord, amniotic band syndrome, linear and whorled hypomelanosis, linear epidermal naevus and incontinentia pigmenti. Histopathological features have varied, although only three cases have been biopsied. One case revealed postinflammatory hyperpigmentation, while two cases revealed lentiginous melanocytic hyperplasia and basal layer hyperpigmentation, without pigment incontinence. In our original case series describing sock-line hyperpigmentation, we carefully distinguished our five cases from 10 cases in the literature of a similar entity termed ‘acquired raised bands of infancy’. Whereas acquired raised bands of infancy is characterized by skin-coloured, linear, often diagonal plaques involving the arms, trunk, and ⁄or legs (thighs in addition to calves), sock-line hyperpigmentation is characterized by hyperpigmented, horizontal lesions limited to the ankle or calf. In contrast to sock-line hyperpigmentation, acquired raised bands of infancy has been associated with amniotic bands in utero, limb constrictions and limb defects including foreshortened toes and clubfoot, and pregnancy complications such as pre-eclampsia, prematurity and placental abruption. Recently, Marque et al. reported three new patients they diagnosed with acquired raised bands of infancy, who had lesions similar to the lesions of sock-line hyperpigmentation. The authors proposed an acquired posttraumatic pathogenesis based on a close temporal association with wearing socks in two cases, a clinical appearance resembling sock lines in two cases, and dermal infiltrates of adipocytes along vessels and ⁄or eccrine ducts in the two cases that were biopsied (findings similar to those in post-traumatic piezogenic papules of the feet). Although Marque et al. classified these three patients as having raised limb bands, we believe that several of their patients may be better classified as having sock-line hyperpigmentation based on the presence of multiple features not typically found in acquired raised bands of infancy, including horizontal directionality, erythema preceding the appearance of limb bands, hyperpigmentation and the association with socks. Sock-line lesions appear to have a benign course. However, ongoing collection of cases and further follow-up is needed to better characterize the natural history of lesions.

Eosinophilic ulcer of the tongue

A 76‐year‐old woman presented with a 1‐month history of a rapidly expanding painful ulcerated nodule on her tongue following tooth extraction. Triamcinolone acetonide ointment was applied twice daily for 1 month without any benefit. The histopathology of the excision specimen was consistent with an eosinophilic ulcer of the oral mucosa. There has been no recurrence 12 months later.

Ciprofloxacin-induced generalized bullous fixed drug eruption

1. Vincent SD, Fotos PG, Baker KA, Williams TP. Oral lichen planus: The clinical, histological and therapeutic features of 100 cases. Oral Surg Oral Med Oral Pathol 1990;70:165-71. 2. Eisen D. The evaluation of cutaneous, genital, scalp, nail, esophageal, and ocular involvement in patients with oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;91:431-6. 3. Van der Meij EH, Schepman PK, Van der Waal I. The possible character of oral lichen planus and oral lichenoid lesions: A prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:164-71. 4. Bachmeyer C, Benchaa B, Roauth B, Petitjean S, Danne O, Blum L. Lichen planus: An unusual case of oesophageal stricture. J Eur Acad Dermatol Venereol 2007; [in press]. 5. Regezi JA, Sciubba JJ, Jordan RC. White lesions. In: Oral pathology. 4th ed. St. Louis, USA: edited by Saunders; 2003. p. 75-109.

Prevalence of cutaneous bacterial infections and nasal carriage of Staphylococcus aureus in recipients of renal transplants.

Background.  Renal transplant recipients (RTRs) often develop bacterial infections as a result of their long‐term immunosuppressive treatment. However, there is no published case–control study of cutaneous bacterial infections in this population, and the prevalence of nasal Staphyloccus aureus carriage and its role in cutaneous bacterial infections in RTRs are not known.

Diagnosis of Variant Klinefelter Syndrome in a 21-Year-Old Male Who Presented with Sparse Facial Hair

Dear editor: Klinefelter syndrome (KS) describes a sex chromosomal aneuploidy caused by the addition of at least one extra X chromosome to normal male karyotype, XY. It is the most common disorder of sex chromosomes with a prevalence of one in 600 males1. Variants of KS are characterized by the addition of an extra X or Y chromosome to classic karyotype 47,XXY. Although somatic malformations and mental retardation are more severe in these variants, most cases remain undiagnosed till puberty when the symptoms of androgen deficiency are recognized2,3. A 21-year-old male presented with sparse facial hair since the onset of puberty. His medical history revealed cryptorchidism, delayed neuromotor development, and mild mental retardation recognized in early childhood. His parents were nonconsanguineous, and there was no history of a genetic disease in the family. On physical examination, the facial (Fig. 1A) and axillary hair (Fig. 1B) were sparse whereas other body hair was in normal density. His height and weight were 193 cm and 103 kg, respectively, and the feminine distribution of the adipose tissue was striking on examination (Fig. 1C). He had dysmorphic features consisting of hypodontia, hypoplastic teeth, prognatism, short filtrum (Fig. 1A), gynecomastia (Fig. 1C), clinodactily, and fusiform shaped fingers. Chromosome analysis of a peripheral blood sample disclosed a 48,XXXY karyotype, compatible with the diagnosis of variant KS. Fig. 1 (A) Sparse facial hair, prognatism and short filtrum. (B) Sparse axillary hair