Preradial myxedema: a case report

We describe a 51-year-old Chinese woman with a 2-year history of swelling of the right forearm and hand, which gradually became hyperpigmented and indurated. This had the typical features of myxedema. The diagnosis was confirmed on histology. She had a past history of thyrotoxicosis and rheumatoid arthritis for which she had undergone treatment. This case is reported as an unusual location of localised myxedema with a literature review and comment on the treatment options. In Singapore only rare similar cases have been reported in the past.

Coexistence of palmoplantar lichen planus and lupus erythematosus with response to treatment using acitretin

Lichen planus and lupus erythematosus may occur as an overlap syndrome. Here we report the clinical characteristics of a 49-year-old man with palmoplantar lichen planus and lupus erythematosus. He showed a remarkable clinical response to treatment with acitretin, which resulted in prolonged remission of the disorder.

A case of lichen myxedematosus with clearly exacerbated skin eruptions after UVB irradiation

We report a 48-year-old male with typical lichen myxedematosus, liver dysfunction, and diabetes mellitus. His skin eruptions were clearly exacerbated after accidental over-irradiation by UVB. These findings were clinically and histologically confirmed. The pathogenesis is still unknown, but we consider it to be due to Koebner phenomenon.

Coexistence of subepidermal calcified nodule and keratosis punctata in a patient with hyperhidrosis

A 47-year-old female with hyperhidrosis developed multiple subepidermal calcified nodules and keratosis punctata on her palms. Although calcification was not detected on eccrine sweat glands around the calcified mass by histologic examination, it was supposed that the eccrine sweat glands may have played a role in inducing these two lesions in our case.

Inflammatory linear verrucous epidermal nevus in patients with positive results of tests for human immunodeficiency virus 1

Inflammatory linear verrucous epidermal nevi are rare lesions that have many similarities to psoriasis on histologic examination, and are resistant to therapy. The two lesions reported occurred in patients with positive results of tests for human immunodeficiency virus 1 and showed features consistent with psoriasis. Results of tests for immunohistochemical markers were also consistent with previous findings and expected staining patterns in lesions of psoriasis. Our findings suggest that inflammatory linear verrucous epidermal nevi represent a clonal dysregulation in growth, probably secondary to an inflammatory stimulus. Since human immunodeficiency virus 1 has been associated with onset and exacerbation of psoriasis, perhaps this virus or another secondary infection associated with human immunodeficiency virus 1 infection could also play a role in the onset of this rare lesion.

Benign cutaneous polyarteritis nodosa in children below 10 years of age--a clinical experience

OBJECTIVE

To report 10 children younger than 10 years of age with benign cutaneous polyarteritis nodosa (BCPAN).

METHODS

Ten children aged 1.25-10 years (mean 4.7 years; M:F = 7:3) were admitted with an unusual vasculitis. The clinical features, laboratory investigations, treatment and follow up data were analysed.

RESULTS

Clinical features of these patients included: fever (10), peripheral gangrene (eight), livido reticularis (four), ulceration, nodules and vesiculobullous lesions alone or in combination (10), black necrotic patches over limbs and trunk (three), and arthralgia or swelling of large joints (seven). Cryoglobulinaemia was transient in three children, lasting for eight months in one of them. Histopathology of the skin lesions revealed vasculitis of small and occasionally medium sized blood vessels in nine of the 10 children. Possible association of BCPAN was noted with diphtheria-pertussistetanus immunisation (one), drugs (two), streptococcal infection (two), wasp sting (one), and falciparum malaria (one). The clinical course was interspersed with remissions and exacerbations. Response to corticosteroids alone occurred in seven patients, while three children needed cytotoxic drugs in addition. In a follow up of 5.6 years (mean) no evidence of systemic involvement was noted.

CONCLUSIONS

A rare form of vasculitis, BCPAN, is reported in children. The features that distinguished our patients from those reported earlier were onset in the first decade of life and higher incidence of peripheral gangrene.

Deep hand infection complicating chickenpox in an otherwise healthy infant

Chickenpox is a common childhood infection, and complications are rare in the healthy child. This report describes a significant complication of varicella in an otherwise healthy infant.

Sweet's syndrome with myelofibrosis and leukemia: partial response to interferon

Sweet's syndrome with malignancy or acute neutrophilic dermatosis (AND) is an unusual cutaneous disorder seen most commonly in association with acute myelogenous leukemia. A large majority of patients with AND and malignancy have neoplasms of hematopoietic, plasma cell or lymphoid nature. The patient reported here had myelofibrosis, chronic myelogenous leukemia and Sweet's syndrome. The individual lesions responded to intralesional interferon-alpha 2, which has not to our knowledge been reported previously. This result, however, was not as great as the response of AND to intralesional steroid injections.

Cutaneous protothecosis and AIDS

Cutaneous protothecosis is an uncommon algal infection with a varied clinical presentation that occurs mainly in immunocompromised patients. We describe a 33-year-old Hispanic woman with AIDS who had a verrucous plaque on the dorsum of her hand. A biopsy specimen revealed organisms suggestive of Prototheca. Culture confirmed the organism to be Prototheca wickerhamii. To our knowledge, this is the first case of cutaneous protothecosis reported in a patient with AIDS.

Neural blockade, urokinase and prostaglandin E1 combination therapy for acute digital ischemia of progressive systemic sclerosis

To treat severe painful digital ulcers on progressive systemic sclerosis (PSS) patients, we developed a new combination therapy which included neural blockade, intravenous urokinase, and prostaglandin E1 infusion. All of these are already recognized treatments for circulatory disturbances in PSS. Although each of them alone has a limited effect on the painful ischemic attack in PSS; in stepwise combination, neural blockade for release of vascular spasm and pain, prostaglandin E1 for further vasodilatation, and urokinase for thrombolysis were effective in the treatment of digital ischemia in two PSS patients. This therapy reduced the necrotic areas predicted before therapy and saved fingers from amputation. It also relieved the intolerable digital pain and effected the recovery of digital function.

Perforating milia-like idiopathic calcinosis cutis and periorbital syringomas in a girl with Down syndrome

An 11-year-old girl with Down syndrome had whitish, milia-like lesions on the acral areas of the limbs, and periorbital syringomas. Calcium deposits were the histologic counterparts of the milia-like lesions. This is the first European report of this feature in Down syndrome.

Plantar Trichophyton rubrum infections may cause dermatophytids on the hands

Over a 2-year period, we saw 37 patients with a diagnosis of dermatophytid on the hands based on 1) culture-proven dermatophytosis on one or both feet; 2) symmetrical, secondary vesicular eruptions on the fingers and/or palmar aspects of the hands; and 3) a resolution in both areas of involvement after treatment of the dermatophytosis on the foot. During the study period, 128 patients had culture-proven dermatophytosis of the feet caused by Trichophyton rubrum. Nine of these (7%) developed dermatophytid. Seventy-eight patients had dermatophytosis of the feet caused by Trichophyton mentagrophytes. Twenty-seven of these (35%) developed dermatophytid. One of 6 patients infected on the feet with Epidermophyton floccosum developed dermatophytid.

Ulcerative and oral lichen planus associated with sicca syndrome and primary biliary cirrhosis

The following case report supports the hypothesis that the coexistence of lichen planus, primary biliary cirrhosis, and sicca syndrome is not co-incidental. The fact that all three diseases are manifest in the same patient substantiates a theory of pathogenesis based on a cell-mediated immune response analogous to that in allogeneic bone marrow transplant recipients with chronic graft-versus-host disease.

Acral Darier's disease: report of a case complicated by Kaposi's varicelliform eruption

We report a case of acral Darier's disease in a 16-year-old Korean boy that was complicated by Kaposi's varicelliform eruption. It is uncommon in Darier's disease for dyskeratotic papules to be limited to acral areas. In our patient, Kaposi's varicelliform eruption occurred on the face where there were no preexisting lesions of Darier's disease.

Onychomycosis is more than a cosmetic problem

The nails serve several important functions and, when they are infected by fungal organisms, these functions are severely impaired. In addition, the quality of life, in terms of self-esteem and social interaction, is adversely affected when fungal nail infections are present. Finally, when finger and/or toenails are abnormal this may interfere with patients' occupations.

Keratosis punctata of the palmar creases. A report on three generations, demonstrating an association with ichthyosis vulgaris and evidence of involvement of the acrosyringium

Five patients in the same family showed small keratotic plugs of the palmar creases. Transmission in lineage was consistent with an autosomal dominant pattern of inheritance. The syndrome was highly associated with ichthyosis vulgaris in several members of the family. The histopathology in two patients revealed a close relation between the plugs and the acrosyringium.

Hereditary palmoplantar keratoderma and dermatophytosis in the northernmost county of Sweden (Norrbotten)

Clinical reports of hereditary palmoplantar keratoderma are generally based on a limited number of patients. In 1967 the prevalence in the northernmost county of Sweden (Norrbotten) was shown to be 0.55%. In 1982 it was possible to trace half of the original propositi from that study. Among these families, a severe clinical form with a presumed recessive inheritance could be distinguished. The clinical pictures in relatives of the original propositi were described, and other diseases were listed together with those in patients from previously performed studies. The frequency of dermatophytosis was 36.2%, which was equal to a prevalence of 37.6%. T. mentagrophytes occurred significantly more often and immunological factors, such as increased presence of blood group A, specific dermatophyte IgG antibodies, precipitating antibodies and an immunological in vitro reaction to keratin, supported differences in the distribution of dermatophytes. However, the amount of keratin was considered the most important factor for the affinity of dermatophytes to the palms and soles. A vesicular eruption along the hyperkeratotic border and a mononuclear cell infiltrate were often reported. Such reactions were interpreted as immunological reactions to dermatophytosis. Scaling and fissuring were considered clinical signs of dermatophyte infections and not a part of the originally reported clinical picture. Results of the histopathological study corresponded to previously reported descriptions of the Unna-Thost variety. However, it has recently been reported that the histopathological picture of this variety was based on histopathological features of epidermolytic palmoplantar keratoderma. The existence on the Continent of the Unna-Thost variety was therefore questioned. Histopathological features of epidermolytic palmoplantar keratoderma were not found in the County of Norrbotten and the designation "Diffuse HPPK type Norrbotten" has therefore been proposed. The histopathological picture of the presumed recessive variety did not differ from that of the dominant variety but ultrastructural characteristics differentiated it from Mal de Meleda and the dominant variety. It was therefore concluded that a new variety with a presumed recessive inheritance was found.

Onychodystrophy in lichen striatus

Lichen striatus is a common childhood eruption, but only rare reports link cutaneous manifestations and onychodystrophy. We report a case of lichen striatus and onychodystrophy in a 12-year-old girl, only the eighth such patient in the dermatologic literature. Nail changes may precede the rash of lichen striatus and should be considered in the differential diagnosis of isolated nail dystrophy in children.