William Fangman

Interstitial granulomatous dermatitis in a child with chronic uveitis

is a soluble tumor necrosis factor (TNF) receptor fusion protein approved for the treatment of rheumatoid arthritis, psoriatic arthritis, and psoriasis. Etanercept is a well-characterized systemic medication that inhibits the proinflammatory actions of TNF-a, and is associated with an increased risk for both viral and bacterial infections. The occurrence of tinea versicolor in the described patient likely is directly related to therapy with etanercept, as this middle-aged patient displayed a temporal onset of the condition immediately after initiating etanercept therapy on two independent occasions, showed a spontaneous resolution of the condition immediately after discontination of etanercept, and denied ever having the condition when not receiving etanercept. The implication of this and one other case report involving the appearance of tinea versicolor in the context of the TNF-a inhibitor adalimumab is that TNF-a inhibition in the rare predisposed individual allows for the unchecked superficial infection with the organism or organisms responsible for tinea versicolor. This phenomenon also implies that patients not on immunosuppressive therapy who recurrently develop tinea versicolor may have an innate immunodeficiency pertinent to combating cutaneous infection with the relatively innocuous species of Malassezia.

ILVEN‐like Persistent Psoriasiform Dermatitis Confined to a Congenital Becker Nevus

Abstract:  A 10‐year‐old boy presented with a 5‐year history of an intractably pruritic, recalcitrant psoriasiform plaque in a broad vertical band on the left buttock, with histologic as well as clinical features suggestive of an inflammatory linear verrucous epidermal nevus. This lesion was completely superimposed upon a congenital Becker nevus. We postulate that the restricted distribution and persistence of the psoriasiform plaque reflected an inflammatory response limited to the aberrant clone of cells composing the Becker nevus, a manifestation of cutaneous mosaicism that could be characterized as an “inflammatory Becker nevus.”