Susanne Darr-Foit

Occupational contact allergy to the epoxy resin hardener 2-methylpentane-1,5-diamine.

Keywords: 2-methylpentane-1,5-diamine; CAS no. 15520-10-2; contact allergy; epoxy; hardener; resin; case report

Trigeminal neuropathy responding to systemic corticosteroids and methotrexate in a patient with diffuse cutaneous systemic sclerosis

Fourteen years ago, this 60-year-old woman was diagnosed with diffuse cutaneous systemic sclerosis (dcSSc) and was put on extracorporeal photopheresis. Until now, she has received 102 cycles, and returns at six-week intervals. During the first eleven years of the disease, long-term systemic treatments with prednisolone, bosentan, cyclophosphamide, and azathioprine were administered, with unsatisfactory results and progression of the cutaneous condition. Staging examinations showed progressive pulmonary [...]

Posttraumatic irritant contact dermatitis--an underdiagnosed entity?

A 55-year-old woman presented to the Jena University Dermatology Clinic with acute, painful redness and swelling affecting the nail wall of her right third finger. She reported that she had scalded the fingertips on the right hand, especially the third digit, about 30 months previously. After starting work 18 months ago as a cleaning lady, where she had to work 3 hours daily in wet conditions, she noticed altered nail growth on the affected finger. Later she experienced repeated blistering and fissuring as well as scaling on the fingertips of the right hand. The symptoms were limited to the area affected by the scald injury. When working, she wore latex gloves with a cotton lining. Since the symptoms appeared, she had not had a longer break from work. The patient had no history of dermatological or other disease and no known allergies or atopy. When she first came to our clinic, there was mild scaling on the distal phalanges of the right hand; there was also poorly bordered erythema on the distal phalanx of the third finger along with periungual swelling and nail dystrophy with subungual hyperkeratosis (Figures 1a, b). Later, there was increasing inflammatory swelling with paronychia affecting the third finger, and once there was a yellow, creamy secretion. In the meantime there were multiple vesicles on the distal phalanx, with clear or cloudy contents. The remainder of the skin was normal. Clinical letter Fungal testing for dermatophytes was negative as were the results of a candidal smear. Microbiological tests showed Gram-negative cocci (abundant E. coli, as well as Bacillus spp., coagulase-negative staphylococci, poststreptococci, Provotella spp., Bacteroides spp.). The results of allergy testing showed an atopy score (based on Diepgen) of 6 points and hence atopic diathesis was unlikely. Total IgE was normal. Specific IgE-sx1 was 0.41 kU/l (CAP class 1). An atopy screening skin prick test produced a positive reaction to an herb mix (mugwort, ribwort, nettle, dandelion). The results of patch testing (standard series, topical agents, preservatives, disinfectants, rubber series, as well as the patients own substances [gloves and skin protection agents]) were negative. Given that the affected area of the skin was limited to the fingers which had been scalded, and considering that the onset of the skin changes only occurred after repeatedly working in wet conditions, we diagnosed post-traumatic irritant contact dermatitis. The differential diagnosis included tinea of the hand and nails, which was ruled out. Based on the results of allergy tests and the clinical presentation, atopic and allergic contact hand dermatitis were also unlikely, as there was no spread. Microbiological tests revealed Gram-negative paronychia from working in wet conditions. The condition was already chronic. We gave the patient a four-week regimen of topical combination therapy consisting of fusidic acid and betamethasone valerate. This was followed by topical application of a calcineurin inhibitor (tacrolimus 0.1 %) and antifungal therapy (ciclopirox olamine solution and cream) for eight weeks. After positive identification of a pathogen, we administered systemic antibiotic treatment with ciprofloxacin 500 mg b.i.d. for 14 days. Given the overall inadequate response, despite largely avoiding wet working conditions (6-week leave of absence), cream PUVA treatment was administered. This led to gradual improvement of the skin condition.

Buschke-Ollendorff syndrome due to a novel LEMD3 mutation - an unusual case of alopecia

Buschke-Ollendorff syndrome (BOS) (OMIM 166700) is an autosomal dominant connective tissue disorder that was first described in 1928 by Abraham Buschke and Helene Ollendorff-Curth. It is defined by the coexistence of connective tissue nevi and osteopoikilosis with a good prognosis. Skin and skeletal lesions may occur independently [1–3] since affected persons may not express the full phenotype. Here we describe the unusual case of a 60-year-old woman with isolated nevus elasticus and a mutation in the LEMD3 (LEM Domain Containing 3) gene. The patient presented after years of failed topical treatment with external corticosteroids. She reported a hairless area at the occiput with a history of 25 years, and a second lesion nearby that appeared two years ago. The lesions were asymptomatic but she noticed a slight increase in the size of both areas. She also reported bone pain in the large joints and the lower legs. Her first-degree relatives did not report a history of similar lesions or bone diseases. Physical examination showed a triangular, completely hairless yellowish atrophic plaque with a diameter of 10 cm (Figure 1) at the occiput and a similar lesion nearby with a diameter of 4 cm. The lesions had no hair follicle apertures or signs of inflammation, even at the margins. There were no other conspicuous findings at the time of examination. Several causes for scarring alopecia were considered in the differential diagnosis, including lupus erythematosus, scleroderma, lichen planopilaris, pseudopelade of Brocq, skin tumors, nevus elasticus and nevus mucinosus. The antinuclear antibody titer was positive (1 : 500, homogenous and nucleolar pattern, IgG), but test results were negative for autoantibody detection using FEIA (fluorescence enzyme immunoassay) (Scl70, CENP, ds-DNA, CCP) as well as Borrelia serology and the blood glucose profile. Histological workup of two skin biopsies (center and margin) of the more recent lesion stained with hematoxylin-eosin, resorcin-fuchsin and alcian blue showed orthokeratosis and pseudopelade without inflammatory changes, but clearly increased and coarsened elastic fibers in the dermis without evidence of mucin (Figure 2). The biopsy from the margin showed a decreased quantity of hair follicles with perifollicular fibrosis, but no hair follicles were seen in the center. Computed tomography revealed a missing external lamina of the occipital bone underlying the affected skin. Recent radiographs of the spine, hands and feet revealed no foci of fibrosis or sclerosis but evidence of degenerative changes. Based on these findings we suspected Buschke-Ollendorff syndrome (BOS). BOS lesions may have predominantly elastic-type nevi (juvenile elastoma) or predominantly collagen-type nevi (dermatofibrosis lenticularis disseminata) [4–6]. Patients present with skin-colored or yellowish papules, nodules or plaques, which may appear in symmetrical or asymmetrical configurations at any age, but in childhood in the majority of cases [5]. In this context, studies have reported loss of function mutations in the LEMD3 gene [6], which expresses inner Figure 1 Triangular, completely hairless yellowish plaque with a diameter of 10 cm on the occiput of a 60-year-old woman.

Fulminant course of angiosarcoma of the scalp on multimodal therapy with paclitaxel, bevacizumab, and radiation: Correspondence

We report on a 65-year-old patient who presented with a nontender, ulcerated tumor on the right side of the scalp. The lesion had initially started as a small plaque three months earlier. Given the suspected diagnosis of deep trichophytosis, he had initially been treated with a broad-spectrum topical antifungal agent and subsequently with systemic antibiotics, without improvement. Upon admission, clinical examination showed a polycyclic crusted ulcer (15×10 cm) with bluish-livid, indurated margins; the lesion readily bled upon contact. In addition, the right side of the face was marked by diffuse, nontender soft tissue edema. There was no cervical lymphadenopathy. Clinically suspecting angiosarcoma or Kaposis sarcoma, a biopsy revealed epithelioid angiosarcoma, which was confi rmed by immunohistochemical staining for CD31, CD34, podoplanin, and factor XIII. A PET-CT scan and cranial MRI revealed extensive right-sided infi ltration of the galea without osseous involvement, extending across the midline. Spreading across the neck and the anterior chest wall by direct extension, the tumor involved the entire mediastinum and the adjacent parts of the diaphragm, giving rise to bilateral pleural effusions; there were no lymph node or distant metastases (Figure 1 a, b). In this palliative setting, the patient was started on paclitaxel (80 mg/m2 body surface, day 1, 8, 15) and the anti-VEGF antibody bevacizumab (10 mg/ kg body weight every other week), along with radiation therapy. Given its potential radiotoxic effects, paclitaxel was discontinued during radiation therapy. Due to symptomatic, malignant pleural effusions requiring repeated drainage, the patient underwent left-sided pleurodesis, during which pleural metastasis was histologically confi rmed. During on going treatment, the scalp and neck lesions showed signifi cant

Genitales Ulkus am Penis eines 58-jährigen HIV-positiven Patienten nach lokaler Injektion von Methamphetamin (Crystal Meth)

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