Dermoscopy in the diagnosis of tinea nigra plantaris

Tinea nigra is a relatively uncommon dermatiaceous fungal infection, usually caused by Phaeoannellomyces werneckii, that may mimic a melanocytic lesion. We describe the value of epiluminescent dermoscopy of tinea nigra plantaris compared with other common diagnostic tools and procedures available (clinical appearance, potassium hydroxide [KOH], culture, culture mount preparation, and biopsy). A case of tinea nigra plantaris was evaluated clinically, microscopically with KOH, and dermatoscopically. Dermatoscopic findings were evaluated according to the Stolz system. Dermoscopy, clinical presentation, and microscopy with KOH all confirmed the diagnosis, with dermoscopy being the fastest and simplest procedure. Dermoscopy is a useful clinical adjuntive tool in differentiating tinea nigra from a melanocytic lesion.

Polypoid clear cell acanthoma of the scalp

Clear cell acanthoma (CCA) is a rare, benign epithelial tumor most frequently found on the lower extremities. Its clinical appearance may vary considerably, and cases of multiple lesions have been reported. The diagnosis is made by viewing the characteristic histologic features. This case describes an unusual scalp lesion that clinically and histologically shows unique polypoid features.

Migratory poliosis: A forme fruste of alopecia areata?

We describe a 19-year-old African-American man with a 14-year history of migratory poliosis. We suggest that this phenomenon may represent a forme fruste of alopecia areata.

Galvanic urticaria

A variety of environmental stimuli, such as vibration, ultraviolet radiation, and exposure to water, are recognized as causes of "physical urticaria." A medical student, participating in a demonstration of a galvanic device used in the treatment of hyperhidrosis, demonstrated urticaria in response to this galvanic stimulation.

Environmental skin diseases and the impact of common dermatoses on medical readiness

The environmental extremes in which soldiers exercise and fight, like the environmental extremes in which many civilians encounter occupationally and recreationally, can prove to be a significant cause for morbidity and decreased effectiveness. A variety of skin diseases are related to occupational exposure to dusts and ultraviolet radiation as a well known cause of cutaneous damage. As more is understood about the biochemical factors involved in frostbite injury, treatment recommendations have changed. Too much water, hot or cold, is a continued source of cutaneous misery to the soldier in the field. Finally, even common minor skin ailments can incapacitate the sufferer when confronted with unfavorable environments.

Primary anetoderma

Primary anetoderma is a rare disorder characterized by sac-like herniations and depressions in previously normal skin. On histologic examination, elastic fibers are destroyed by an inflammatory infiltrate. We describe a striking case of primary anetoderma and review the classification, differential diagnosis, causes, and treatment.

Treatment of oral granulation tissue with the flashlamp pulsed dye laser

BACKGROUND

Surgical excision and debridement is the standard therapy for cutaneous and intraoral pyogenic granulomas (PGs). Occasionally the mass of granulation tissue proves unresponsive to the usual treatment methods.

OBJECTIVE

We report a case in which the flashlamp pulsed dye laser (PDL), previously reported as useful in cutaneous PGs, was used in a patient with persistent granulation tissue around dental implant posts.

METHODS

An illustrative case is presented with a brief discussion of the use of lasers in dentistry and in the treatment of PGs.

RESULTS

Previously resolute tissue responded well to a series of treatments with the PDL.

CONCLUSION

The PDL may have utility in this oral condition, providing a new venue for cooperation between dentists and dermatologists.

The "teepee" sign in inflammatory scalp disease

Psoriasis and other diffuse inflammatory diseases of the scalp can cause a unique physical findings that we call the "teepee sign" because the hair forms pyramidal tufts at regular intervals that resemble an American Indian encampment. A pathological mechanism for this finding is proposed, with the description of two cases in Air Force basic trainees, one of a severe seborrheic dermatitis and the other psoriasis. The significance with regard to physical qualification for entry into military service is discussed.

Cutaneous sporotrichosis presenting as a keratoacanthoma

Sporothrix schenckii is a ubiquitous dimorphic fungus with a variety of clinical presentations, including imitation of other diseases such as pyoderma, rosacea, and pyoderma gangrenosum. A case in which sporotrichosis appeared as a keratoacanthoma-like nodule on the lower lip of a young woman is presented, with treatment considerations and diagnostic pitfalls.

Primary cutaneous Aspergillus ustus infection: second reported case

We describe the second case of primary cutaneous Aspergillus ustus infection in an immunocompromised patient. Cutaneous aspergillosis was confirmed both by culture and positive fluorescent antibody staining. Few species of Aspergillus are pathogenic in human beings, and fewer still cause primary cutaneous disease. The only other reported case of aspergillosis from Aspergillus ustus occurred in an immunosuppressed patient who was temporally and geographically separated from ours.

"Toxic sock" syndrome

For several months, a 17-year-old male athlete noticed that his feet had an itchy, burning sensation at the heels and toes. His foot odor had become so malodorous (somewhat akin to rotting fish) that he would not remove his shoes except immediately before washing his feet. Washing made the odor somewhat milder, but only for a short time. The patient had tried an over-the-counter "athlete's foot" powder without results. He had no other health problems and was not taking any medication. The accompanying figure shows the toes of his right foot.

'Dimpling' is not unique to dermatofibromas

The dimpling of the skin with lateral compression or 'Fitzpatrick's sign' is considered by many to be pathognomonic for dermatofibromas (DFs). Despite the description of this sign in all major textbooks, not all DFs dimple and all that dimple are not DFs. Other diagnostic investigations such as the use of dermatoscopy may help to confirm the clinical suspicion of DF.

A polypous carbuncle

A carbuncle usually presents as a deep-seated mass of fistulous tracts between infected hair follicles. We present a case in which what appeared to be an inflamed, benign neoplasm turned out to be a very unusual presentation for this condition, the first we could find in the literature. A 62-year-old woman presented with a bothersome 'mole' on her flank of uncertain duration but it was initially pruritic and irritated by her clothing. Owing to the pain, she wanted its removal. A 1 cm soft, pink, stalked papule revealed multiple, closed,, comedo-like spots on its surface (Fig. 1). The lesion was mildly tender and freely mobile on a broad-based stalk. A pre-biopsy diagnosis of irritated intradermal nevus or neurofibroma was made, and the lesion was blade-shaved flush with the skin surface. Histologically, the papule demonstrated small abscesses which seemed to connect, as well as foci of granulation tissue and marked dermal edema (Fig. 2). Fragments of infundibular epidermis were found throughout the lesion. No residual melanocytic or neural neoplasms were identified.

Eczematous hypersensitivity from aqueous vitamin K injection

Hypoprothrombinemic states are commonly treated with injectable vitamin K. Cutaneous vitamin K hypersensitivity can manifest as eczematous or sclerodermoid lesions and historically has been related to the use of fat-soluble vitamin K1. We present a case of warfarin-induced hypoprothrombinemia treated with aqueous vitamin K1, which resulted in the appearance of eczematous vitamin K1 hypersensitivity.

Necrobiotic xanthogranuloma with paraproteinemia: an evolving presentation

Necrobiotic xanthogranuloma with paraproteinemia is a progressive and destructive process that is often confused both clinically and histologically with other granulomatous and xanthomatous entities. It was first described by Kossard and Winkelmann in 1980. Prior to this, the entity was reported under a variety of names such as atypical multicentric reticulohistiocytosis with paraproteinemia, atypical xanthoma disseminatum, and atypical necrobiosis lipoidica. A 69-year-old woman experienced slightly pruritic and painful papules, plaques, and nodules. Initial biopsy specimens showed a granulomatous process consistent with granuloma annulare. Later biopsy specimens demonstrated histologic changes indicative of necrobiosis lipoidica. The most recent histologic findings are those of necrobiotic xanthogranuloma, with results of laboratory studies revealing a coexistent IgG kappa paraproteinemia. Patients with necrobiotic xanthogranuloma who demonstrate a benign monoclonal proteinemia and are evaluated for several years show a 9 to 11 percent risk of myeloma, amyloidosis, or macroglobulinemia. Multiple treatment regimens have been attempted, none of which are curative. We propose that this entity may be part of an evolutionary process that may start as a granulomatous entity and culminate in a xanthogranulomatous process with an accompanying paraproteinemia.

Mees' lines in a patient with multiple parasitic infections

Mees' lines, or transverse striate leukonychia, are classically associated with arsenic poisoning, but have been described in other cases of acute or chronic illness. Their pathogenesis is thought to be a disruption of nail plate keratinization secondary to systemic stress. Mees' lines are observed in a patient with helminthic and amebic infections and no history of arsenic exposure. This case demonstrates another clinical setting in which Mees' lines can appear, providing further evidence that Mees' lines may chronicle systemic disease.

Intradermal nodular fasciitis presenting as an eyelid mass

BACKGROUND

Nodular fasciitis is a fibroblastic proliferation in which nodules, most commonly appearing on the extremities, develop suddenly and rapidly. Although excisional biopsy is curative, the nodules will often resolve spontaneously; however, the histologic appearance of a pleomorphic spindle cell neoplasm with frequent mitotic figures may raise concern of a more malignant neoplasm and lead to unnecessary and overly aggressive therapy.

METHODS

A case of nodular fasciitis presenting in an unusual location, intradermally at the lateral canthus, is discussed.

RESULTS

Review of the recent literature from other disciplines reveals new insights into the etiology and diagnostic options (fine needle aspiration, tomography, other imaging techniques) for this puzzling disease.

CONCLUSIONS

When nodular fasciitis occurs in an unusual location, such as on the head and neck or at an intradermal location, it will not present as the deep, mobile, nontender nodule described in the dermatologic literature. Fine-needle aspiration and modern imaging techniques may help in the diagnosis and prevent unnecessary surgery for a self-limited condition.

Bullous drug eruption to griseofulvin in a man with Hailey-Hailey disease

Hailey-Hailey disease (chronic benign familial pemphigus) is a blistering disease characterized by episodic maceration and erosions in areas subject to friction and trauma such as the neck, axilla, and other intertriginous areas. We report a case in which a griseofulvin-induced drug eruption led to a generalized vesiculobullous eruption requiring treatment in a burn treatment center. This emphasizes that Hailey-Hailey disease, usually confined to relatively small areas, has the potential to cause blistering throughout the epidermis under certain conditions.

Lichen sclerosus

Lichen sclerosus, usually appearing in the dermatologic literature under the names of lichen sclerosus et atrophicus, balanitis xerotica obliterans, and kraurosis vulvae, is an inflammatory disease with a multifactorial origin. A past association of lichen sclerosus and genital squamous cell carcinoma is not as close as once thought. Once considered primarily a surgical problem, especially when the genitals were involved, lichen sclerosus will respond to a variety of systemic and topical therapies.