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Kalb RE, Helm TN, Sperry H, Thakral C, Abraham JL, Kanal E. Gadolinium-induced nephrogenic systemic fibrosis in a patient with an acute and transient kidney injury. Br J Dermatol 2007; 158:607-10. [PMID: 18076707 DOI: 10.1111/j.1365-2133.2007.08369.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Nephrogenic systemic fibrosis (NSF) describes a characteristic fibrosing disorder which typically presents with indurated plaques on the trunk and extremities of patients with advanced renal disease. We present a case of biopsy-confirmed NSF in a patient with severe acute kidney injury with no prior history of renal disease. A 64-year-old man with an acute and severe decrease in glomerular filtration rate underwent magnetic resonance imaging studies with gadolinium contrast (Omniscan) and subsequently developed NSF. His renal disease had normalized at the time his skin disease developed. Skin biopsies revealed findings of NSF and scanning electron microscopy with energy-dispersive X-ray spectroscopy confirmed insoluble gadolinium within lesional tissue.
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Helm TN. Photo quiz. Disseminated superficial actinic porokeratosis. Cutis 2001; 67:286, 296-8. [PMID: 11324388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Kling CW, Helm TN, Narins RB. Photo quiz. Intradermal tophaceous gout. Cutis 2001; 67:196, 205-6. [PMID: 11270291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Helm TN, Bisker E, Bergfeld WF. Lipodystrophy. Cutis 2001; 67:163-4. [PMID: 11236228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Congenital lipodystrophy is an uncommon autosomal recessive disorder that occurs mainly in females and is characterized by loss of subcutaneous fat, insulin-dependent diabetes mellitus, and masculinization due to defective metabolism of fat. Acquired lipodystrophy is now most commonly encountered in patients infected with HIV who take protease inhibitors. We present an illustrative case of lipodystrophy and review the presenting signs allowing for an accurate clinical diagnosis.
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Foley E, Helm TN. Air bag injury and the dermatologist. Cutis 2000; 66:251-2. [PMID: 11109145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Most new car models have driver-side air bags and many also have passenger-side and side-impact air bags. Air bags are known to be dangerous to small children and may cause death, fractures, and cerebral spinal injury. However, the cutaneous manifestations of air bag injury are less well known. Additional potential air bag injuries include retinal damage and high-frequency hearing loss. The following case report illustrates significant burns from a low-impact air bag injury and reviews the pertinent literature.
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Helm TN, Lee J, Helm KF. Spiny keratoderma. Cutis 2000; 66:191-2. [PMID: 11006853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Spiny keratoderma is a descriptive term used to encompass a variety of unusual, disparate keratodermas. Spiny keratoderma has been associated with lipid abnormalities and has been limited to the palms and soles in some individuals. We describe an acquired case of spiny keratoderma in which an adult woman developed filiform lesions predominating on the trunk and proximal extremities. Treatment with topical emollients and keratolytic agents was unsuccessful, but topical tazarotene led to long periods of resolution. She has had no other associated abnormalities. The clinical features and differential diagnosis of spiny keratoderma are reviewed.
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Helm TN. Photo quiz: urticaria pigmentosa. Cutis 2000; 66:172, 177-8. [PMID: 11006849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Paolini TS, Helm TN. Photo quiz. Xanthoma disseminatum. Cutis 2000; 65:351, 377-8, 384. [PMID: 10879300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Helm TN. Photo quiz. What is your diagnosis? Cutis 2000; 65:281, 329-30. [PMID: 10826086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Helm TN, Wirth PB, Helm KF. Inexpensive digital photography in clinical dermatology and dermatologic surgery. Cutis 2000; 65:103-6. [PMID: 10696563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Digital photography can be used to follow clinical improvement in a variety of dermatoses, document pre and postoperative results, and document histologic findings from skin biopsies. Images may be printed as part of text documents and can be filed in conventional medical charts. Images can be transmitted via electronic mail rapidly and to any location. We have found digital photography to be relatively inexpensive and a powerful tool to enhance dermatologic practice.
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Camisa C, Taylor JS, Bernat JR, Helm TN. Contact hypersensitivity to mercury in amalgam restorations may mimic oral lichen planus. Cutis 1999; 63:189-92. [PMID: 10190076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Oral lichenoid lesions caused by hypersensitivity to mercury in amalgam fillings may mimic oral lichen planus on clinical and histologic examination. A positive patch test reaction to more than one mercurial allergen increases confidence in the diagnosis and justifies the removal and replacement of all amalgam fillings with those made of other materials. A complete remission may be expected about 3 months after the last amalgam filling is removed.
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Helm TN, Kalb RE, Helm KF. Granular cell dermatofibroma. A benign tumor that can simulate malignancy. Dermatol Surg 1997; 23:976-8. [PMID: 9357510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report on an unusual dermatofibroma with granular cells. The dermatofibroma contained mitotic figures raising a differential diagnosis that included malignant granular cell tumor. Granular cell dermatofibroma is an uncommon variant, but one that clinicians and surgeons should become aware of to ensure accurate diagnosis.
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Helm TN, Wirth PB, Helm KF. Congenital fascial dystrophy: the stiff skin syndrome. Cutis 1997; 60:153-4. [PMID: 9314621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Congenital fascial dystrophy is an uncommon disorder that may mimic scleroderma. The skin is bound down and feels "wood hard" on palpation of the trunk and extremities. Sclerodactyly, telangiectases, and nail fold changes are not present. Unlike scleroderma, the onset is at birth. Flexion contractures result and other associated abnormalities may include developmental delay and mild hirsutism. We report a typical case to illustrate the clinical and pathologic findings of patients with this disorder.
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Mashek HA, Pham CT, Helm TN, Klaus M. Rheumatoid neutrophilic dermatitis. ARCHIVES OF DERMATOLOGY 1997; 133:757-60. [PMID: 9197831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rheumatoid neutrophilic dermatitis (RND) is a recently recognized, rare cutaneous manifestation of rheumatoid arthritis. It occurs in patients with severe rheumatoid arthritis and is typically asymptomatic. Rheumatoid neutrophilic dermatitis was originally described by Ackerman in 1978. Since that time, 8 patients with this disease have been described in the literature. OBSERVATIONS We report 2 cases of RND. Findings of skin biopsy specimens from both patients revealed characteristic signs of dermal leukocytosis and leukocytoclasia without vasculitis. The pathogenesis of the neutrophilic infiltrate is unclear. Processes that may play a role in the pathogenesis of RND include immune complex activations, cell adhesion and migration, and cytokine release. CONCLUSIONS Rheumatoid neutrophilic dermatitis falls into the spectrum of neutrophilic vascular reactions described by Jorizzo and Daniels. Although early reports suggest that prominent leukocytoclasia is not a feature of RND, our findings confirm the observations of Lowe et al that leukocytoclasia can be seen in RND and may be striking. It is important for dermatologists to be aware of this rare manifestation of rheumatoid arthritis.
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Helm TN, Danziger J, Helm KF. Bilateral plantar amyloidosis: a unique presentation of localized cutaneous amyloidosis. Cutis 1997; 59:142-4. [PMID: 9071554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Nodular amyloidosis is uncommon and is due to a local production of amyloid by aberrant plasma cells. Localized bosselated plantar amyloidosis has been reported before but we present the first case to our knowledge of bilateral plantar amyloidosis. The clinical presentation as well as therapeutic options for this uncommon entity are reviewed.
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Helm TN, Spigel GT, Helm KF. Erythema ab igne caused by a car heater. Cutis 1997; 59:81-2. [PMID: 9040977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Erythema ab igne is a reticulated erythematous hyperpigmented eruption that occurs after chronic exposure to heat. In the past, the shins were the most common area of involvement, but with the widespread availability of central climate control in most buildings the incidence has decreased dramatically. New causes of erythema ab igne have been noted that have been caused by such heat sources as therapeutic chairs with built-in heaters. We present a case in which prolonged and close contact of the legs to a car heater led to erythema ab igne. Practitioners must be aware of the changing causes of erythema ab igne so that an appropriate history can be obtained.
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Bridges AG, Helm TN, Bergfeld WF, Lawlor KB, Dijkstra J. Interleukin-3-induced urticaria-like eruption. J Am Acad Dermatol 1996; 34:1076-8. [PMID: 8647976 DOI: 10.1016/s0190-9622(96)90291-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Ruxin TA, Steck WD, Helm TN, Bergfeld WF, Bolwell BJ. Pseudallescheria boydii in an immunocompromised host. Successful treatment with debridement and itraconazole. ARCHIVES OF DERMATOLOGY 1996; 132:382-4. [PMID: 8629840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Kuivaniemi H, Tromp G, Bergfeld WF, Kay M, Helm TN. Ehlers-Danlos syndrome type IV: a single base substitution of the last nucleotide of exon 34 in COL3A1 leads to exon skipping. J Invest Dermatol 1995; 105:352-6. [PMID: 7665911 DOI: 10.1111/1523-1747.ep12320704] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The Ehlers-Danlos syndrome has been classified into nine phenotypic presentations. Type IV is a variant of particular importance because people affected with this genodermatosis are at great risk of spontaneous hemorrhage from vascular rupture or bowel perforation. Recent molecular advances have identified mutations in the gene for type III procollagen as responsible for Ehlers-Danlos syndrome type IV. We report a case of a 14-year-old male with a typical presentation of the type IV variant who was found to have markedly dilated fibroblast cisternae and varying collagen fibril diameter on ultrastructural study. A novel genetic defect was noted by polymerase chain reaction and DNA sequencing of genetic material isolated from skin fibroblast cultures. Analysis of the gene for type III procollagen revealed a single base mutation in the last nucleotide of exon 34. The mutation led to abnormal RNA splicing and skipping of exon 34 on the mRNA level.
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Clark J, Helm TN, Bergfeld WF. Chronic alopecia. Trichotillomania. ARCHIVES OF DERMATOLOGY 1995; 131:720-1, 723-4. [PMID: 7778928 DOI: 10.1001/archderm.131.6.720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Morgan J, Pierson JC, Helm TN, Steck WD. Draining ulcers with lymphadenopathy. Metastatic basal cell carcinoma. ARCHIVES OF DERMATOLOGY 1995; 131:483-4, 486-7. [PMID: 7726594 DOI: 10.1001/archderm.131.4.483b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Kuhn CA, Helm TN, Bergfeld WF, Glanz S, Steck WD. Acneiform papules on the neck. Elastosis perforans serpiginosa (EPS). ARCHIVES OF DERMATOLOGY 1995; 131:341, 344. [PMID: 7887667 DOI: 10.1001/archderm.131.3.341b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Mullans EA, Helm TN, Taylor JS, Helm KF, Olin JW, Bergfeld WF. Generalized non-Langerhans cell histiocytosis: four cases illustrate a spectrum of disease. Int J Dermatol 1995; 34:106-12. [PMID: 7737766 DOI: 10.1111/j.1365-4362.1995.tb03590.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The proliferation of non-Langerhans cell histiocytes is a poorly understood process of unknown cause. Variation in the clinical features and/or histopathology of histiocytic proliferation has led to subclassification of the general category of non-Langerhans cell histiocytes. Although the current classification may provide some useful generalizations in regard to the anticipated clinical course, wide variability in presentation and outcome make this classification less than optimal when dealing with individual patients. The objectives of the study were to present four cases of generalized non-Langerhans cell histiocytosis. MATERIALS AND METHODS Medical records and slides of four patients diagnosed with non-Langerhans cell histiocytosis at the Cleveland Clinic are reviewed. RESULTS The patients exhibit features of more than one subtype of non-Langerhans cell histiocytosis. CONCLUSION The overlap among the clinical and histologic features of the generalized cutaneous non-Langerhans cell histiocytic disorders suggests that they represent one disease entity with a wide spectrum of presentations rather than many distinct disorders.
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