Fixed erythrodysaesthesia plaque due to intravenous injection of docetaxel

Docetaxel (Taxotere), a semisynthetic taxoid, acts as an antimicrotubule agent and is considered to have great potential in the treatment of non-small cell lung cancer, advanced breast cancer, ovarian cancer and some other tumours. Well-recognized side-effects include dose-limiting neutropenia, fluid retention, myalgia, neuropathy, hypersensitivity reaction, alopecia, mucositis, nail changes and cutaneous reactions such as acral erythema. We describe a unique docetaxel-induced cutaneous reaction presenting as fixed erythematous plaque(s) unrelated to extravasation or previous skin injury; histopathological studies were performed in three of the four cases.

Accurate assessment of tissue expansion in the lower face and anterior neck by a simple measurement technique

A simple, precise method of clinical estimation for the accurate assessment of tissue expansion in the lower face and anterior neck is described using fixed anatomical reference points. The method makes it possible to select the most suitable size of tissue expander and to decide the optimal timing of operation. By recording the baseline data before expansion and repeating measurements as expansion proceeds, the discrepancy of the expectation between the surgeon and patient concerning the postoperative result can also be minimised.

Necrotizing soft tissue infections. Surgical or conservative treatment?

BACKGROUND

Both surgeons and dermatologists are increasingly challenged with the prompt diagnosis and management of severe soft tissue infections. Although early surgical intervention appears to be for life-saving in many patients, especially those diagnosed as necrotizing fasciitis, some patients recover well with only conservative treatment. Because most of these infections have similar initial clinical presentations, there remains a need to find reliable clinical and/or laboratory parameters that can predict the prognosis and to accordingly judge the necessity and timing of operation.

METHODS

We conducted a retrospective study of case records of patients with necrotizing soft tissue infections. The clinical presentation, laboratory findings, management, and therapeutic outcome of 34 cases with necrotizing soft tissue infections were reviewed.

RESULTS

These infections were potentially life-threatening, with an overall mortality of 26.5%. Shock on admission was an extremely grave sign associated with a poor prognosis (P < 0.05). In this grave condition, most (80%) patients died regardless of the choice of treatment. Coagulation parameters, including platelet counts, prothrombin time (PT), and partial thromboplastin time (PTT), were available in 21 patients, of whom 16 had at least one abnormality at their initial presentation. In these 16 patients, those who underwent surgery had a significantly higher survival rate than those who were treated conservatively (P < 0.05). Prolonged PT was significantly associated with a higher mortality (P < 0.05). Surgery did seem to correct coagulopathies. However, in patients presenting with substantial alteration of all three coagulation parameters, there was no significant difference between medical treatment and surgical intervention in terms of mortality. In such cases, mortality was high (75%). On the other hand, the prognoses of patients who presented with normal coagulation profiles were rather good. Most of them recovered well despite the therapeutic option. Surgical treatment did not seem to increase additional benefits on chances of survival. Extent of tissue plane involvement, bacteriology, and site of infection had no significant influence on patients' survival.

CONCLUSIONS

A comprehensive, well-organized, universal approach, regardless of classification, is essential for all suspected cases of necrotizing soft tissue infections. Prompt diagnostic studies are needed, and platelet counts, PT, and PTT are readily available parameters that provide substantial information on diagnosis and treatment, thus avoiding an unwarranted loss of life or unnecessary operative sequelae. Early diagnosis and, in most cases, prompt radical surgical, intervention remain the cornerstone of successful management in these infections.

Low-dose danazol in the treatment of livedoid vasculitis

BACKGROUND

Livedoid vasculitis is characterized clinically by smooth or depressed ivory-white scars surrounded by hyperpigmentation and telangiectasia with or without preceding purpuric infiltrated papules and plaques and histologically by intravascular deposition of fibrin. Its etiology remains obscure and therapy very difficult.

OBJECTIVE

Our purpose was to test the efficacy of low-dose danazol in the treatment of livedoid vasculitis.

METHODS

Seven patients with active lesions of livedoid vasculitis were treated with low-dose danazol (200 mg, orally, daily). Laboratory coagulation and fibrinolysis parameters, including antithrombin III, protein C, protein S, tissue plasminogen activator, plasminogen, alpha 2-antiplasmin and fibrinogen, were evaluated before and during the therapy.

RESULTS

Six of the 7 patients completed the treatment. After the therapy, all 6 patients had rapid cessation of new lesion formation, prompt reduction in their pain and healing of ulcers. A significant elevation of plasminogen and a decrease in fibrinogen levels were noted 1 month after initiation of the therapy (p = 0.028). The level of fibrinogen seemed to parallel the disease activity in individual patients. In addition, in most of these patients, the levels of antithrombin III, protein C, protein S and alpha 2-antiplasmin tended to increase after the treatment. However, the differences were not statistically significant. Abnormalities of tissue plasminogen activator levels were less consistent. Low-dose danazol was well tolerated without major side effects.

CONCLUSION

We concluded that low-dose danazol was effective in the treatment of livedoid vasculitis, without unacceptable side effects.

Facial plaque-type blue nevus and its reconstruction

Blue nevi rarely appear in a plaque form. Because of their rarity and unusual clinical appearance, these nevi may present a diagnostic problem. We described a large plaque-type blue nevus measuring about 9 x 6 cm on the right cheek of a 22-year-old man. It was characterized by several dark-blue macules and papules with intervening areas of faint blue discoloration. Excision of this unusual plaque-type blue nevus with reconstruction using tissue expander was performed successfully. A 6-year postoperative follow-up revealed satisfactory results.

Atypical mycobacterial cervical lymphadenitis associated with Sweet's syndrome

We report the case of a 52-year-old woman with a non-tuberculous (atypical) mycobacterial cervical lymphadenitis, caused by Mycobacterium fortuitum, in association with Sweet's syndrome. The cervical lymphadenitis was resistant to medical treatment, and the Sweet's syndrome occurred intermittently. Systemic steroid treatment was required to control the cutaneous symptoms.

Acquired genital smooth-muscle hamartoma. A case report

Smooth-muscle hamartoma is an uncommon, usually congenital malformation of smooth-muscle origin. When it is acquired, it may be confused with Becker's nevus with a prominent smooth-muscle component. Over the past 3 decades, only two cases of acquired smooth-muscle hamartoma without the concomitant appearance of hairy-pigmented lesions have been reported. We describe a third case. To the best of our knowledge, this is the first case of smooth-muscle hamartoma to occur in the scrotum.

Plaque-type blue nevus on the face: a variant of Ota's nevus?

We describe a plaque-type blue nevus that had been present since birth on the right cheek of a 22-year-old man. It was characterized by several dark blue macules and papules with intervening areas of faint blue discoloration. Histologic examination showed a common blue nevus and a mongolian spot-like dermal melanocytosis in the dark blue and intervening faint blue pigmentary lesions, respectively.