Behçet's disease with unusual cutaneous lesions

A variety of cutaneous lesions may occur in Behçet's disease (BD) both at presentation and over the course of the disease. Skin involvement of the hands and feet has been infrequently observed. We describe a patient with BD with recurrent, multiple, papulonodular cutaneous lesions affecting the palm and fingers of both hands, occurring simultaneously with aphthous stomatitis. The lesions consisted of roundish, erythematous, painful, bluish-red nodules, 0.5-1 cm in diameter, with a "pernio-like" aspect. Histologic examination revealed perivascular neutrophilic infiltrates. We suggest that cutaneous lesions with a pernio-like aspect as observed in our patient may be included in the spectrum of the cutaneous manifestations of Behçet's disease.

Expression of heat shock protein 27 in chromomycosis

We report on a 58-year-old woman with long-lasting (36 years) chromomycosis on the foot and secondary self-inoculation from foot to hand 4 years ago. Mycological classification was performed after culture on Sabouraud glucose agar. We used haematoxylin and eosin and Giemsa staining and an antibody to heat shock protein (HSP) 27 (Stress Gen, Clone G3.1) on paraffin-embedded and cryostat specimens of chromomycosis. The mycological culture revealed the fungus Fonsecaea pedosoi. Histopathology revealed dermal fibrosis with persistent fungi (Medlar bodies), numerous mast cells and pseudoepitheliomatous hyperplasia. Immunohistochemically, HSP 27 was positively identified in F. pedrosoi. Moreover, in differentiating keratinocytes in the pseudoepitheliomatous lesions of chromomycosis, HSP 27 was increasingly expressed from basal layers to stratum spinosum in the epidermis but not in keratinocytes directly bordering Medlar bodies. In chromomycosis, HSP 27 is expressed, in accordance with its role as a marker of differentiation and proliferation, in keratinocytes and also in F. pedrosoi. It remains unknown if these results might explain the therapeutic efficacy of hyperthermic treatment.

A case of herpetic whitlow associated with erythema multiforme

We report a 6-month-old girl with erythema multiforme minor occurring during the course of a herpetic whitlow. Erythema multiforme minor is unusual in infants, and in this population herpes simplex virus has not been reported as a significant etiologic factor. The clinical coexistence of erythema multiforme minor and the herpetic lesion is also atypical. To our knowledge, this is the first report of erythema multiforme minor associated with a concomitant HSV infection in an infant.

Papular-purpuric gloves and socks syndrome associated with acute parvovirus B19 infection: case report and review

The papular-purpuric gloves and socks syndrome (PPGSS) was first described in 1990. This syndrome is characterized by fever, acral pruritus, edema, petechiae, and oral erosions. Subsequently, parvovirus B19 has been implicated, in most cases, as the causative agent of this syndrome. To date, with two exceptions, all published cases of PPGSS have been from Europe and the Middle East and have been mainly reported in the dermatology literature. Herein, we report what we believe to be only the second case of documented parvovirus B19-associated PPGSS occurring in the United States. The patient presented with the typical clinical syndrome, and the diagnosis of acute parvovirus B19 infection was documented by serial serologies that demonstrated development of IgM antibody to virus during the acute phase of infection and seroconversion to IgG antibody in the convalescent period. We then review the existing literature on this unusual syndrome and its association with parvovirus B19.

Sarcoidosis presenting as palmar erythema

Sarcoidosis, a multisystem disease of unknown aetiology, is characterized by the formation of non-caseating granulomas which may involve any organ of the body. The commonest sites of predilection are the lungs, skin and lymph nodes. We now report a patient who presented with palmar erythema which on biopsy confirmed the presence of non-caseating granulomas and who responded to systemic corticosteroids. We are unaware of any previous report in the literature of sarcoidosis presenting in this way.

Eccrine syringofibroadenoma in a patient with erosive palmoplantar lichen planus

We report the case of an 82-year-old woman with a 6-year history of erosive palmoplantar lichen planus associated with eccrine syringofibroadenoma (ESFA). Examination revealed a well-demarcated patche writish of reticulated whitish papular lesions in skin of otherwise normal appearance at the border of erosive lichen planus plaques. These lesions had the histological appearance of ESFA. We suggest that these lesions are induced by the inflammatory remodelling associated with erosive lichen planus and propose to consider ESFA in the context of skin tissue remodelling as a new subtype of ESFA.

[Pachydermodactyly: seven new cases]

INTRODUCTION

Pachydermodactyly is a superficial benign digital fibromatosis usually involving the proximal portions of the fingers. It is clinically characterized by an asymptomatic, bulbous, soft-tissue swelling around proximal phalanges and interphalangeal joints. We report here seven new cases of pachydermodactyly.

CASE REPORTS

Seven patients (4 F, 3 M) ranging in age from 14 to 63 years were studied. Two of them were affected by tuberous sclerosis; two other patients were sisters, one of whom was affected by the transgrediens form of pachydermodactyly. The personal history of two male patients revealed the compulsive habit of interlacing the fingers. Finally a 23-year-old patient was affected by the localized pachydermodactyly. In all the patients roentgenogram and echography of the affected fingers as well as histological and ultrastructural of a cutaneous biopsy examination were carried out. The results of the tests confirmed the diagnosis of pachydermodactyly.

DISCUSSION

Our data suggest that pachydermodactyly is underestimated rather than rare and more frequent in females than in males as until now reported in the literature. We suggest classifying pachydermodactyly into five types: classic pachydermodactyly frequently associated with mechanical trauma, monopachydermodactyly or localized pachydermodactyly, transgrediens pachydermodactyly in which the cutaneous thickness extends to the metacarpophalangeal areas, familial pachydermodactyly which may by transgrediens and pachydermodactyly associated with tuberous sclerosis.

Sporadic dystrophic epidermolysis bullosa with concomitant atopic dermatitis

We describe a patient with sporadic dystrophic epidermolysis bullosa associated with well-documented atopic dermatitis. We discuss this case in relation to a newly described clinical subtype of epidermolysis bullosa known as epidermolysis bullosa pruriginosa, a dystrophic variant associated with prominent pruritus. The relations of this case of sporadic dystrophic epidermolysis bullosa with other dominantly inherited forms of dystrophic epidermolysis bullosa such as the Pasini variant, the pretibial variant, and Bart's syndrome are also discussed. The role of atopic dermatitis in exacerbating dystrophic epidermolysis bullosa in this patient raises an important consideration in the care of this group of patients.

Malignant acanthosis nigricans and tripe palms in a patient with endometrial adenocarcinoma--a case report and review of literature

BACKGROUND

In the world literature, uterine carcinoma associated with paraneoplastic malignant acanthosis nigricans and tripe palms has been mentioned in two review articles. Endometrial adenocarcinoma associated with malignant acanthosis nigricans without tripe palms has been cited in three case reports, and endometrial adenocarcinoma associated with tripe palms without malignant acanthosis nigricans has been cited in one case report. We present the case of a patient with endometrial adenocarcinoma associated with acanthosis nigricans and tripe palms which we have been following for the past 7 years.

METHODS

Our 54-year-old patient had been operated for moderately differentiated endometrial adenocarcinoma. She had also received postoperative radiotherapy.

RESULTS

Three years after surgery, tripe palms and acanthosis nigricans with generalized pruritus occurred. After treatment with etretinate, the skin symptoms were somewhat mitigated while the pruritus persisted. Six years after gynecologic treatment, a solitary inguinal metastatic lymph node of endometrial carcinoma was detected. Following lymphadenectomy there was additional but not complete mitigation of skin symptoms including pruritus.

CONCLUSIONS

In clinical practice the association of malignant acanthosis nigricans and tripe palms with endometrial adenocarcinoma is found extremely rarely. Although the survival time of adenocarcinoma patients with malignant acanthosis nigricans is short, our patient has been treated and followed for more than 7 years.

Nail lichen striatus: clinical features and long-term follow-up of five patients

BACKGROUND

Nail involvement in lichen striatus (LS) is uncommon and has always been reported in association with typical skin lesions.

OBJECTIVE

We attempted to characterize the clinical and pathologic features and the long-term prognosis of nail LS.

METHODS

Five cases of LS of the nail including three cases with exclusive nail involvement were evaluated and the literature reviewed.

RESULTS

Biopsy specimens showed a moderately dense bandlike lymphohistiocytic infiltrate affecting the proximal nailfold, the nail bed, and the nail matrix dermis. Exocytosis with slight spongiosis, focal hypergranulosis, and dyskeratotic cells were detectable in the nail matrix epithelium. Spontaneous regression of the onychodystrophy occurred after 4 to 12 months from the time of diagnosis (mean, 8.4 months).

CONCLUSION

Nail LS is not necessarily associated with skin lesions but can also be an isolated finding. The diagnosis of nail LS should be strongly suspected when a child or a young patient presents with lichen planus-like nail abnormalities localized to the lateral or medial portion of a single nail.

Verrucosis of hands and feet in a patient with combined immune deficiency

In immunocompromised patients, warts occur frequently and can be extensive. We describe a 24-year-old patient with severe therapy-resistant warts. In addition to human papillomavirus infection, he had chronic sinusitis, candidiasis, and atopic dermatitis. Anergy to delayed-type hypersensitivity skin test reaction, significant CD4 lymphopenia, and diminished in vitro T-cell proliferative response and interferon-gamma production indicated a deficiency of cellular immunity. Extremely low concentrations of serum IgM and IgG2 and a severe deficiency of in vitro IgM production pointed also to a humoral immunodeficiency syndrome. This case represents a combination of cellular and humoral immunodeficiencies that has not been previously described in association with warts.

Digital calcification in systemic sclerosis: effective treatment with good tissue preservation using the carbon dioxide laser

Tissue calcification of the fingers associated with limited systemic sclerosis is a common problem and is the source of considerable morbidity as it may be extremely tender and cause considerable functional disability. The current treatment of digital calcification is unsatisfactory. We evaluated the use of the carbon dioxide (CO2) laser in the management of this condition in six patients with the limited form of systemic sclerosis. A total of 21 areas of symptomatic digital calcification of the fingers were treated. Complete resolution of symptoms occurred in 12, moderate response with partial improvement was seen in five, little improvement was observed in two, and recurrence of calcinosis was found in two. The patient's average healing time was 6 weeks (range 4-10). The median duration of follow-up was 20 months (range 12-40). Postoperative infection was seen in two patients, and resolved completely in both with the use of topical and oral antibiotics. We found the CO2 laser a simple and effective treatment for most of the symptomatic lesions of digital calcification, and it may obviate the need for deforming surgery in many cases.

Knuckle pads--a forgotten skin condition: report of a case and review of the literature

A 12-year-old boy presented with knuckle pads, palmar keratoderma, and hand eczema. Since Morginson's description of knuckle pads associated with other dermatoses almost forty years ago, little attention has been given to this disorder. We describe a case and review some of the clinical aspects of this disorder.

Finger pad tophi in gout

OBJECTIVE

To determine frequency and prevalence of finger pad tophaceous deposits in patients with chronic tophaceous gout.

METHODS

We examined 36 consecutive patients with chronic tophaceous gout for intracutaneous tophaceous urate deposits in the fingers pads. Subjects were patients of outpatient clinics at 2 large university hospitals, Emory and the University of Pennsylvania Affiliated Hospital Systems.

RESULTS

Finger pad tophaceous deposits were found in 30.5%, which was surprising, given how few cases are reported.

CONCLUSION

Finger pad tophi may be more common than generally believed.