A Recurrent Case of Targetoid Hemosiderotic Hemangioma: A Case Report and a Comprehensive Review of the Literature

Targetoid hemosiderotic hemangioma is an acquired vascular malformation of unknown origin. We report the case of a 31-year-old man with a recurrent and spontaneous regressive targetoid hemosiderotic hemangioma. Diagnosis relied on clinical and histological findings. Physical examination revealed presence of an approximately 2 cm targetoid lesion located on the left arm, and associated with pain after pressure. No trigger agent (trauma, insect sting) was reported. Dermoscopy showed a group of red lacunae centrally, encircled by an intermediate yellow circular homogenous area and a red violaceous homogenous ring in the periphery. The histopathological examination and the immunohistochemical staining of the lesion were characteristic for a hemangioma-like proliferation of vessels in the upper part of the dermis, similar to a targetoid hemosiderotic angioma. We also review epidemiological, clinical, and histopathological findings in 6 similar cases presented in the literature. Spontaneous regression and recurrence have rarely been described in this type of skin lesion.

Commentary on the "Evidence- and Consensus-Based (S3) Guidelines for the Treatment of Actinic Keratosis" Published by the International League of Dermatological Societies in Cooperation with the European Dermatology Forum

In 2015, the International League of Dermatological Societies and the European Dermatology Forum published a guideline for the treatment of actinic keratosis, which is classified as an evidence- and consensus-based S3 guideline. From the point of view of the GD Task Force "Licht.Hautkrebs.Prävention," an interdisciplinary expert panel of the Society for Dermopharmacy for the prevention and treatment of skin cancer, this guideline reveals strengths and weaknesses but, in summary, does not meet the claim for an evidence- and consensus-based S3 guideline.

Balneophototherapy of psoriasis: highly concentrated salt water versus tap water--a randomized, one-blind, right/left comparative study

BACKGROUND/PURPOSE

Apart from climatotherapy and spa therapy, combined treatment with salt water baths and artificial UV radiation (balneophototherapy) has been advocated for the treatment of psoriasis. As there is a lack of controlled studies on balneophototherapy (BPT), we conducted a randomized, one-blind, right/left comparison with salt water versus tap water in order to investigate the significance of the salt concentration in the efficacy of BPT.

METHODS

Ten psoriasis patients with chronic plaques on the elbows were included in the study. One elbow was soaked in 24% NaCl solution and the other in tap water. Subsequently, broadband UVB irradiation was administered. BPT was performed 4 times weekly with a total of 30 treatments.

RESULTS

A highly significant (P<0.001) decrease of the clinical baseline score was observed after 30 treatments; however, there was no significant (P>0.5) difference in clearance of the psoriatic lesions between the sites soaked in salt water and tap water.

CONCLUSION

Our results suggest that any additional benefit of soaking in salt water and tap water in BPT are unlikely to be due to the salinity of the liquids.

Clearance of ichthyosis linearis circumflexa with balneophototherapy

We report a 13-year-old boy suffering from severe ichthyosis linearis circumflexa. Evidence of hair shaft abnormalities and impaired immunity could not be found. The patient was treated with salt water baths and artificial UVB radiation (balneophototherapy) 3-5 times weekly. After 40 treatments with balneophototherapy the skin lesions were almost completely cleared and maintenance UVB monotherapy was performed twice weekly for 2 months. After 4 months, however, the disease relapsed. Balneophototherapy presents a potentially effective and well tolerated phototherapeutic option for ichthyosis linearis circumflexa. As only short periods of remission may be expected, intermittent balneophototherapy would be probably necessary to control the disease.

Deep shave excision of macular melanocytic nevi with the razor blade biopsy technique

BACKGROUND

Shave excision is an established surgical method for removing benign skin lesions for cosmetic and functional reasons. Usually superficial shave excision is performed with a common scalpel blade for the removal of papular nevi. However, there is little known about deep shave excision of macular melanocytic nevi with the razor blade technique.

OBJECTIVE

The present study was undertaken to evaluate the cosmetic outcome of deep shave excision of macular melanocytic nevi with the razor blade technique. Moreover, its potency for sufficient removal of these lesions was investigated.

METHODS

Within routine skin cancer screening 45 outpatients with a total of 77 macular melanocytic nevi were prospectively recruited. Deep shave excisions of these lesions were performed with a double-edged razor blade followed by chemical hemostasis. Histologically all specimens were processed and evaluated in a routine manner. After 6 months the physician and patients evaluated the shave sites for cosmetic outcome with a score graded from 1 to 4 (1 = excellent; 2 = good; 3 = moderate; 4 = poor).

RESULTS

Histologically 88% (68 of 77) of the melanocytic lesions were described as completely excised and 60% (46 of 77) were diagnosed as atypical melanocytic nevi; 12% (9 of 77) of the nevi were incompletely excised on the depth. On average, the deep margin of the specimens (n = 77) was 0.5 mm (range 0-1.8 mm) and the lateral margin was 2 mm (range 0.3-8.2 mm). After 6 months 56 shave sites could be reassessed. We observed mild hypopigmentation in 52% (29 of 56), hyperpigmentation in 32% (18 of 56), and erythema in 23% (13 of 56). Recurrent nevi occurred in 13% (7 of 56). The evaluation of the cosmetic outcome by the patients (mean score 1.7) achieved better results than the evaluation by the physician (mean score 2.5). The cosmetic results showed no significant (P >.05) differences in various anatomic sites.

CONCLUSION

Our data confirm that deep razor blade excision presents a highly useful and inexpensive method for the removal of macular melanocytic nevi that yields adequate specimens for pathologic interpretation. We consider that shave excision with the razor blade technique is potentially much less scarring than full-thickness scalpel excisions of nevi. In particular, this is of great significance for patients with multiple nevi, such as dysplastic nevi syndrome.

[Porphyria cutanea uraemica: an obligate systemic disease in chronic kidney insufficiency?]

Patients with chronic renal failure, especially those receiving maintenance haemodialysis, have a number of dermatological alterations. Some of them are similar to those seen in porphyria cutanea tarda (PCT). Whereas early studies showed normal plasma porphyrin levels, a striking elevation of plasma porphyrins, and particularly of uroporphyrin, has recently been found. We measured the concentrations of porphyrins in the plasma and erythrocytes of 55 patients with chronic renal failure and receiving maintenance haemodialysis and also in 7 patients with PCT and 100 healthy volunteers. The mean concentration of porphyrins in plasma was 2.7-fold, and the maximum concentration, 6-fold the highest value measured in plasma of controls. The mean plasma concentration of uroporphyrin was 6-fold higher up to a maximum value of 37-fold the upper limit of the controls. The plasma porphyrin values of 3 of 7 patients with PCT were on the same high level as those measured in patients undergoing haemodialysis. The mean porphyrin concentration in the erythrocytes of haemodialysis patients were 1.5-fold the control values. Because of the known pathophysiological effect of uroporphyrin, especially its stimulation of the collagen synthesis and the activation of the complement system, we suppose that the porphyria cutanea tarda like skin lesions in patients with chronic renal failure are due to the highly increased uroporphyrin concentration.

[Congenital poikiloderma syndrome with early childhood blister formation (Brain syndrome) and unusual associated neurologic symptoms]

We report on an 8-year-old girl with manifestations of congenital poikiloderma during her first year of life. Macroscopically, there was reticular teleangiectasia on cheeks and thighs, generalized de- and hyperpigmentation, dry skin with pityriasiform scaling and milia as a result of former blister formation. Histologically and ultrastructurally cytoid bodies, probably of keratinocyte origin, were observed. Associated findings were leucocytopenia, hyperlipoproteinaemia, spastic ataxia and lack of teeth. There is consanguinity in the family, but 3 sisters, the parents and the ancestors were completely healthy. Because of transient blister formation on the face, upper arms and elbows we would like to classify our case as Brain syndrome.

[Therapy-induced lindane concentration in breast milk]

Reactions induced by neurotoxic effects with lindane (gamma-hexachlorcyclohexane) after treatment of infants have been reported by different authors. This has led to controversial discussions as to the indication for therapy with lindane in early infancy. To our knowledge there are to date no published reports on the concentration of lindane in mother's milk after local scabies therapy. In a mother treated with lindane for scabies we found elevated levels of lindane in the mother's milk. Compared to average levels of lindane in mother's milk (0.03 ppm, milk-fat) there was a 30-fold increase after three-day treatment and a 66-fold elevation after an additional one-day treatment with lindane. The problems arising and alternative therapy are discussed.