Blastomycosis-like pyoderma in association with recurrent vesicular hand eczema: good response to acitretin

Blastomycosis-like pyoderma, also known as pyoderma vegetans, is an uncommon disease characterized by vegetating skin lesions mimicking blastomycosis or warty tuberculosis, often associated with staphylococcal and streptococcal infections. It is more commonly observed in elderly patients with impaired immunological capacity, and is often unresponsive to various therapeutic modalities. We describe a case of BLP that occurred on the palmar aspect of the left hand in an elderly female, affected with recurrent vesicular hand eczema. The disease resolved completely following the administration of oral acitretin 25 mg/day for 10 weeks.

Successful treatment of hand and foot psoriasis with infliximab

Hand and foot psoriasis is a disabling condition associated with significant quality-of-life issues. It is characterized by hyperkeratosis and/or the development of recurrent crops of sterile pustules with associated erythema, fissuring, and scaling symmetrically localized on palm and soles. Systemic conventional therapies include retinoids, psoralen-UVA (PUVA), methotrexate, and cyclosporine. So far, only limited evidence supports the use of TNF-alfa blockers. Because there are reports of paradoxical induction of pustular psoriasis following the use or withdrawal of infliximab as well as other TNF inhibitors, the use of these agents in palmoplantar psoriasis has been cautioned. The authors describe the clinical characteristics and evolution of 4 adult patients with severe palmoplantar psoriasis who were treated successfully with infliximab. Patient data is available for a minimum of 10 months and as many as 16. One of them with concomitant HCV infection showed no increased viral replication or progression of liver disease for a follow-up of 10 months; afterwards infliximab was stopped because of an infusion-related urticaria. All other patients displayed a good clinical response (> or =PPPASI 50) and were still receiving this regimen at last observation. This report provides preliminary evidence to support a cautious use of infliximab in patients with palmoplantar psoriasis.

Autologous cytokine-induced killer cells in the treatment of multiple myeloma concomitant with lung cancer and paraneoplastic dermatoses

Cytokine-induced killer (CIK) cells have been shown to be effective in the treatment of advanced cancer and minimal residual diseases. We report a multiple myeloma (MM) patient with concomitant lung cancer and paraneoplastic dermatoses, who received cellular immunotherapy with CIK cells which were derived from peripheral blood mononuclear cells (PBMCs) after being primed with anti-cluster of differentiation 3 (CD3) monoclonal antibody, interleukin-2 (IL-2), interferon-γ (IFN-γ) and IL-1. After treatment MM and lung cancer remained stable and no progression or recurrence was observed. Paraneoplastic dermatoses were obviously improved after treatment, which was first reported. No evident side effects were observed. These findings suggested that cellular immunotherapy with CIK cells was safe and effective in this patient with MM and lung cancer, and it might be a potent therapeutic option for paraneoplastic dermatoses.

Neutrophilic dermatosis of the dorsal hands associated with hypopharyngeal carcinoma

Neutrophilic dermatosis of the dorsal hands (NDDH) is a rare and recently described disorder regarded as a subset of neutrophilic dermatosis, similar to superficial pyoderma gangrenosum and pustular vasculitis. Many currently consider it to be a localized variant of Sweet Syndrome. We describe the case of a 63-year-old male patient with NDDH associated with hypopharyngeal carcinoma. A biopsy demonstrated changes consistent with those seen in Sweet Syndrome, with leukocytoclasia but no signs of true vasculitis. Treatment with oral prednisolone resulted in complete resolution of the lesions in 1 month, with no recurrences. The clinical presentation, the histological features, and the excellent response to oral corticosteroid therapy allowed us to classify this case as NDDH. We emphasize the rare association of this entity with a solid tumor.

Circumscribed acral hypokeratosis

BACKGROUND

Circumscribed acral hypokeratosis (CAH) is an idiopathic condition that typically presents as an acquired, solitary, asymptomatic, well-defined, depressed, flat-based deformity, with a slightly raised border on the palm or, rarely, the sole. Histologically, the lesional epidermis is depressed with a characteristic, abrupt, hyperkeratotic, slightly-raised ridge at the transition from normal skin.

OBJECTIVE

We sought to present 3 additional cases of CAH.

METHODS

A review of 3 cases of CAH was performed. Liquid phase polymerase chain reaction (PCR) was conducted to evaluate for human papillomavirus (HPV).

RESULTS

Three cases of CAH were reviewed. One patient had a history of a burn at the site prior to developing the disorder while another patient, as a child, had a history of verruca plantaris in the same location. Lesions were solitary, involving the palm or sole, in 2 cases and in one case they were multiple involving both the palms and the soles. HPV testing detected HPV type 6 in the lesion of one patient who previously was treated for warts in the same location. Topical fluorouracil, calcipotriol ointment under occlusion, and clobetasol ointment under occlusion were unsuccessful in one patient.

LIMITATIONS

In case 2, we were pathology consultants and unable to evaluate the clinical appearance of the lesion.

CONCLUSIONS

CAH may involve palms and/or soles. Lesions may be solitary or multiple, and vary widely in size. We believe that CAH most likely represents a reaction pattern developing in response to various stimuli, including trauma, HPV, or both.

Evaluation of quality of life in patients with toenail onychomycosis by Polish version of an international onychomycosis-specific questionnaire

BACKGROUND

Onychomycosis is the most frequent nail disease, which could impair the patient's quality of life.

OBJECTIVE

The present study was undertaken to evaluate the impact of toenail onychomycosis on quality of life among Polish population.

PATIENTS AND METHODS

Three thousand nine-hundred and four (3904: 2269 females and 1635 males) individuals fulfilled an international onychomycosis-specific quality-of-life questionnaire consisting of statements regarding social, emotional and symptoms problems. All patients had toenail onychomycosis confirmed by the positive direct microscopic examination and/or by the positive mycologic culture. Seven hundred and sixty-seven patients simultaneously had fingernail onychomycosis. All patients were divided into subgroups according to sex, age, education level, place of living, type of onychomycosis, number of involved toenails, fingernails involvement, duration of illness and previously used antimycotic therapy.

RESULTS

Most of the patients demonstrated significantly reduced quality of life. The degree of life impairment varied between analysed subgroups. Patients with more advanced toenail onychomycosis and with fingernail involvement were more seriously affected. Both social and emotional impairments were more pronounced in female than in male patients, although there were no differences according to symptoms. Moreover, patients with better educational level and people living in towns or cities were more emotionally and socially affected by onychomycosis, although people living in the country or with poorer education level presented with significantly more severe symptoms.

CONCLUSIONS

Toenail onychomycosis is still a serious medical problem, which can significantly reduce the patient's quality of life.

Syndrome of remitting seronegative symmetrical synovitis with pitting oedema (RS3PE)

RS3PE syndrome, often mimicking rheumatoid arthritis (RA) or polymyalgia rheumatica (PMR), has puzzled the rheumatologists until late'80s. Though the nature of the disease still remains illusive, the outcome is excellent. This present study analyzes the clinical, radiological and immunogenetical characteristics of five patients diagnosed with RS3PE syndrome, with review of literature.

Contact sensitivity and atopic dermatitis: association with prognosis, a follow-up study in 801 atopic patients

The influence of contact sensitivities on the course of atopic dermatitis (AD) is not known. The objective of the study is to find the course of AD in atopic patients with and without contact sensitivities. A total of 801 atopic patients were studied and patch tested in 1983/84. A questionnaire focusing on the occurrence of dermatitis was sent to these patients 16 years later. During the follow up the number of symptom-free patients increased from 36.7% to 40.7%. In patients with positive patch-test reactions, 30.1% were symptom free in 1983/84 and 38.3% at the follow up (P= 0.001). Among those with positive patch-test reactions to fragrance mix and/or balsam of Peru, the number of symptom-free patients had increased the most: from 26.9% to 42.6% (P= 0.0095), and a similar tendency was seen among those with nickel allergy. The occurrence of dermatitis did not change among patients without contact sensitivities. Thus, the study concluded that contact allergy does not impair the prognosis of dermatitis in atopic patients.

Calcinosis cutis of the fingertip associated with Raynaud's phenomenon

Cutaneous calcification may be divided into four major categories: (i) dystrophic; (ii) metastatic; (iii) idiopathic; and (iv) iatrogenic. Dystrophic calcification is the most common type of calcinosis cutis and is associated with a variety of diseases. It most notably occurs in connective tissue diseases. Diffuse and limited cutaneous systemic sclerosis is an example of connective tissue diseases that frequently show calcinosis. We experienced a case of fingertip calcinosis cutis associated with Raynaud's phenomenon. The patient had no previous trauma, skin lesion or systemic connective tissue disease. We propose that calcinosis cutis of the fingertip may result from chronic ischemic injury caused by Raynaud's phenomenon.