PM-SCL autoantibody positive scleroderma with polymyositis (mechanic's hand: clinical aid in the diagnosis)

This report concerns a 56-year-old-woman presenting PM-SCL autoantibody positive scleroderma with dermatomyositis (scleromyositis) and concomitant interstitial lung fibrosis. The recently observed overlapping syndrome is characterized by the presence of specific autoantibodies, HLA-type association and benign course. A new skin symptom ("mechanic's hands") predicts the disease, in particular the interstitial lung pathology, which is its most relevant internal manifestation.

Oral manifestations of papular-purpuric 'gloves and socks' syndrome due to parvovirus B19 infection: the first case presented in Greece and review of the literature

Papular-purpuric 'gloves and socks' syndrome (PPGSS) is a novel, rare, self-limited dermatosis initially described in 1990. It is characterized by painful, pruritic edema and erythema, rapidly evolving to papular-purpuric lesions on the distal extremities, in a gloves-and-socks distribution, accompanied by fever and oral lesions such as petechiae, vesiculopustules and small erosions. Parvovirus B19 has been implicated in most cases as the etiological factor. Herein we present the first case of PPGSS in a 42-year-old Greek man with von Willebrand disease. On admission the patient was febrile, and presented acral edema and erythema rapidly followed by purpuric lesions on the same sites, and palatal petechiae. Complete remission of the exanthem occurred 7 days after hospitalization. Clinical and laboratory evaluation including serologic tests and PCR, confirmed the presence of parvovirus B19. Review of the existing literature on this novel syndrome and its association with parvovirus B19 is also presented.

Psoriasiform eruption induced by infliximab

OBJECTIVE

To report a case of psoriasiform eruption induced by infliximab.

CASE SUMMARY

A 46-year-old woman with enterocutaneous fistula secondary to Crohn's disease developed pruriginous, erythematous, desquamative plaques on her elbows, knees, hands, and buttocks after receiving the second and third doses of intravenous infliximab. Histologic examination showed a lichenoid pattern. No new cutaneous lesions appeared after cessation of infliximab therapy.

DISCUSSION

Several cutaneous reactions secondary to infliximab, a monoclonal antibody against tumor necrosis factor-alfa, have been described. Psoriasiform dermatitis has not been reported as a cutaneous reaction to infliximab, but there have been several previous reports of psoriasiform dermatitis secondary to other drugs. An objective causality assessment revealed that the adverse event was probable.

CONCLUSIONS

This is the first report of a clinico-pathologic dissociated pattern of cutaneous reaction showing a histopathologic picture of lichenoid dermatitis resulting from infliximab treatment.

Three cases of 'mechanic's hands' associated with interstitial pneumonia: possible involvement with foot lesions

We describe three cases of the rare combination of lateral erythema and hyperkeratosis of the fingers that typify a condition known as 'Mechanic's Hands'. The first and the third cases were unusual in that the condition was associated with cutaneous involvement of the feet and interstitial pneumonia but not with myositis, or with only mild muscular involvement, while the second case was typical, being accompanied by myositis and detectable antibodies against histidyl transferase. We propose that Mechanic's Hands can occur in association with foot lesions and interstitial pneumonia, even if it is not accompanied by myositis.

Pseudoainhum in chronic psoriasis

Pseudoainhum is a term used to describe the presence of constricting bands of the extremities due to a variety of underlying causes. Progression of the lesions can cause irreversible damage and autoamputation of the affected digit. This report documents a rare association of pseudoainhum and psoriasis and emphasizes the importance of recognizing this condition.

[Acromelanosis]

Acromelanosis is an independent disease entity, characterized by increased skin pigmentation, usually located on the acral areas of the fingers and toes. It is mostly seen in newborns or during the first years of life. Only a few cases of this entity have previously been described in the medical literature. In some of these cases, the cutaneous lesions spread to affect large parts of the skin surface. A possible association with other benign and malignant diseases has been proposed. Differential diagnosis must be made with a wide variety of systemic and dermatologic conditions, especially dermatoses with acral distribution of macular hyperpigmentation, including acropigmentation. In this article, we report a new case of acromelanosis in a 5-week-old girl showing two peculiar clinical features: associated melanosis of the genital mucosa and stabilization of the lesions after an initial phase of progression and proximal spread. In addition, the most important features of this rare cutaneous disease are discussed.

[ Usefulness of laboratory investigations for the diagnosis of acrodermatitis chronica atrophicans. ]

The authors report a clinical case of acrodermatitis chronica atrophicans in a 65 year old diabetic woman. The characteristic cutaneous lesion restricted to the dorsal aspect of the left hand has been evolved since two years, together with a progressive development of a typical Dupuytren disease. This yielded a contracture of the last 3 phalanges of the same left hand. Confirmatory techniques included the histology of the skin, the reactivity of specific-IgG antibodies showing high avidity and Western blot. Of this, the immunodominant antigens which were extracted from 3 genospecies of Borrelia sensu lato i.e. Bb sensu stricto, Bb garinii, Bb afzelii were compatible with past infection. Apart from the diabetic status which may have predisposed the patient to the development of Dupuytren disease, the authors question about the potential role of Borrelia burgdorferi in the occurrence of this associated disease.

HIV seronegative eosinophilic pustular folliculitis successfully treated with metronidazole

We describe a patient with eosinophilic pustular folliculitis (EPF) who initially responded to oral indomethacin, the most often-used therapy for EPF, but eventually became refractory to continuous administrations. Treatment with metronidazole resulted in complete clearance of the lesion.

Myeloma-associated systemic amyloidosis presenting with acquired digital cutis laxa-like changes

A 59-year-old woman presented with a 6-year history of lax skin on the distal fingers of both hands, as well as a recent increase in the size of her tongue. Histopathology of skin from her distal finger showed amyloid deposition and bone marrow biopsy revealed an underlying plasma cell dyscrasia. Initial treatment with cyclophosphamide, vincristine, adriamycin and methylprednisolone has produced a significant reduction in the swelling of both her hands and tongue. Acquired digital cutis laxa-like changes are a rare cutaneous manifestation of systemic amyloidosis.

Autoimmune polyglandular syndrome (APS) type 1 and candida onychomycosis

A 21-year-old female presented at age 2 years with a chronic mucocutaneous candidiasis and at age 3 alopecia totalis. Later, chronic hypoparathyroidism and autoimmune adrenal insufficiency appeared. In addition, malabsorption syndrome and signs of pernicious anaemia occurred. The onychomycosis totally improved under systemic treatment with fluconazole (Diflucan), endocrine and organ failure with replacement therapy. The autoimmune polyglandular syndrome (APS 1) is a rare autosomal recessive inherited disease. Chronic mucocutaneous candidiasis (CMC) generally presents very early in life and is the most frequent of the three main diseases of APS type 1 (chronic hypoparathyroidism, autoimmune Addison's disease). It can be considered as a precocious marker of APS type 1. Consequently, all patients affected by isolated CMC, especially children, should be evaluated and carefully followed up by immunological, biochemical, and clinical tests to recognize signs and symptoms of imminent or ongoing endocrine glandular failure.

Clinical utility of telangiectasia of hands in scleroderma and other rheumatic disorders

Telangiectasia of the hands were observed in 76% of patients with scleroderma (n = 53) as compared with 12% of patients with other rheumatic disorders (n = 100) and in 13% of healthy subjects (n = 30). In scleroderma, telangiectasia of the hands were commonly multiple (mean number +/- SD = 22.9+/-30.1) with 7.3% being >1 mm in size. They were found in greater numbers in those patients with the limited subtype. The distribution of telangiectasia was observed on all but 4 of 158 sectors of the hand with significant higher numbers on the ventral surface of the digits. Significant associations of telangiectasia of the hands were also observed with numbers of telangiectasia on face and lips (p = 0.001), disease duration (p = 0.002), surface area of digital calcinosis (p = 0.03) and with the presence of the centromere antibody (p = 0.005). Possible associations were observed with prior gastrointestinal bleeds (particularly with telangiectasia >1 mm) and with isolated pulmonary hypertension. No significant correlation was found between number of telangiectasia and with nailfold capillary size or density. In conclusion, multiple telangiectasia of the hands were most commonly observed in patients with the centromere positive, limited subtype of scleroderma of long duration. Their pathogenesis is unknown.

Resolution of dyshidrotic dermatitis of the hand after treatment with continuous positive airway pressure for obstructive sleep apnea

Eczema of the palm and obstructive sleep apnea (OSA) are common disorders. Proinflammatory cytokines and cell adhesion molecules are elevated in both of these disorders. We describe an unusual patient with OSA who had recurrent free remission of dermatitis after treatment with continuous positive airway pressure. We speculate that the resolution of the patient's skin condition may reflect the effects of increased tissue oxygenation during sleep, reduced sleep fragmentation, and/or a reduction in sympathetic tone associated with successful sleep apnea treatment.

Coexistent infections on a child's distal phalanx: blistering dactylitis and herpetic whitlow

We report a case of coexistent Staphylococcus aureus and herpes simplex virus (HSV) infections responsible for a bullous and vesicular eruption on a child's distal phalanx. Blistering distal dactylitis (BDD), a superficial infection of the distal portion of the finger, is seen most commonly in children and is caused by either beta-hemolytic streptococci or S aureus. Herpetic whitlow, also a blistering infection found on children's distal fingers, is a bacteriologic sterile infection caused by HSV-1 or HSV-2. In this report, we note that these infections may coexist on the distal phalanx. This case has implications for diagnosis and treatment of children's blistering hand diseases.