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This article represents a synthesis of the literature from 1960 to the present. The authors refocused their assigned topic from geriatric skin disorders to adult skin disorders. The distinction between adult and nonadult is clearer than the distinction between geriatric and nongeriatric. The topics covered are divided broadly into malignant and nonmalignant entities.
There are a host of metabolic disorders with cutaneous manifestation. Often the clinician can use dermatologic clues that can provide insight into the systemic disease. Cutaneous features may be the first sign of an internal disorder. The authors present a capsule of pertinent clinical information about the more common disorders.
Pretibial myxedema (PTM) is an uncommon, late manifestation of Graves' disease. It is nearly always preceded by significant ophthalmopathy and classically presents as nonpitting (brawny) edema of the lower extremities. We report a case of PTM that is unusual because of its morphologic evolution, that it occurred prior to the diagnosis of Graves' disease, and in the absence of ophthalmopathy.
Candida is a common part of the normal flora in several noncutaneous body sites, but invasion of the skin can occur under certain conditions. A case is presented in which the prolonged wearing of combat boots and damp socks caused an acutely inflamed papulopustular candidiasis of the feet.
Erythema ab igne is a reticulated erythematous hyperpigmented eruption that occurs after chronic exposure to heat. In the past, the shins were the most common area of involvement, but with the widespread availability of central climate control in most buildings the incidence has decreased dramatically. New causes of erythema ab igne have been noted that have been caused by such heat sources as therapeutic chairs with built-in heaters. We present a case in which prolonged and close contact of the legs to a car heater led to erythema ab igne. Practitioners must be aware of the changing causes of erythema ab igne so that an appropriate history can be obtained.
Cutaneous polyarteritis nodosa is a benign form of the disease with cutaneous involvement and occasional systemic manifestations. We report a 51 years old man presenting with malaise, arthralgia, myalgia and nodular, erythematous and painful skin lesions in both legs. The pathological study of these lesions showed a polyarteritis. During hospital stay there was a mild remission of the disease without treatment, but its reappearance during follow lead to the use of prednisone.
Angioma serpiginosum (AS) is a rare vascular naevoid disorder due to ectatic dilation of capillaries in the papillary dermis. The condition is found almost exclusively in females who have grouped erythematous punctate lesions usually on the lower limbs or buttocks, which may be unsightly. We report five patients with AS treated using a Candela SPLT1 pulsed tunable dye laser. All patients had a good to excellent response. The lesion resolved in one patient, virtually resolved in two and is considerably improved in a further patient in whom treatment is continuing. In one patient, the angiomatous lesion improved but the patient developed hyperpigmentation at the treatment site and the treatment has been temporarily suspended. The results suggest that treatment using the pulsed dye laser is very effective for AS and, in most patients, produces an excellent cosmetic result.
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We present an unusual case of linear focal elastosis occurring exclusively on the legs of a 13-year-old girl. An increase of elastic fibres (EF) was demonstrated histologically, and the number of EF in lesional and normal skin was quantified using a video measuring system. EF were found to be increased by about 100% in lesional skin compared with unaffected skin. EF were elongated, thinned and split at their ends with a paintbrush formation.
Sowda skin lesions are of medical and social importance in Yemen. Ivermectin (Mectizan) chose as a control strategy plan in onchocerciasis is active during 3 months for the less on clinical and histological data. After a short increase of itching and oedematous skin aspects clinical signs decrease. Some patients notice an itching rebound after 90 days. Histologically, localized ingratiates, presence of mononuclear cells and melenin loaded histiocytes and eosinophils decreased. The rythm cure has to be studied on a longer period but 3 to 6 months repetition between oral treatment with 200 micrograms/kg dose during two years could be effective.
Nocardia brasiliensis is recognized in the United States as an infectious agent of the skin that may present as an abscess, ulcer, or granuloma with or without "sporotrichoid" spread, and rarely causes systemic disease. Treatment with trimethoprim/sulfamethoxazole is usually curative. We present a patient with multiple erythematous, painful, draining nodules that developed thirty-six months after trauma and subsequent contamination with soil in Bermuda. A foreign body granuloma was suspected clinically, and excision was performed followed by recurrence of the lesions. Histologic examination and culture were consistent with nocardiosis. Differential diagnosis of foreign body granulomas also should include infection with N. brasiliensis even after a long incubation period. Culture and drug susceptibility testing of affected tissue should be performed for diagnosis and management.
We have reported on two cases of pretibial myxedema. In one patient, the pretibial myxedema developed symmetrically half a year after the appearance of endocrine exophthalmos. Recently, acropachy developed as well. In the second case, the pretibial myxedema arose unilaterally in an old cicatricial area, six years after the onset of endocrine exophthalmos. In this syndrome, the development of the whole group of symptoms, dermopathy, ophthalmopathy, and osteopathy at the same time is very rare. The clinical picture is seen in thyroid disorders, as a rule occuring in hyperthyroidism, rarely in hypothyroid or euthyroid states. Apparently, the development of the symptoms does not depend on thyroid hormone production. One of our patients showed conspicuous hyperthyroidism, the other, thyroxin deficiency. The thyreohypophyseal feedback mechanism in this syndrome was examined for the first time by means of TRH stimulation tests. In both patients, thyroid auto-antibodies indicative of autoimmune thyroiditis were demonstrated. A high activity of long acting thyroid stimulator was measured in the one patient's serum.
Two cases of human ringworm caused by the dermatophyte Microsporum nanum are reported from South Australia. M. nanum is the commonest cause of ringworm in pigs and is known to cause porcine infections in Australia. This report shows the value of mycological investigations in determining the possible source of such infections.
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INTRODUCTION: Keratoacanthoma centrifugum marginatum is an uncommon keratoacanthoma of unknown etiology. We report a case suggesting a possible etiological role for a papillomavirus. Etretinate was an effective treatment. CASE REPORT: A 65-year-old woman had keratoacanthoma centrifugum marginatum of the antero-inferior aspect of the lower third of the right leg for 5 years. Fifteen years earlier, an infection had occurred at the same site after a trauma and was treated by oral antibiotics. Surgical exeresis was difficult due to the wide spread of the lesion. Etretinate given at an initial dose of 1 mg/kg/d for 6 weeks then reduced by half for 2 months led to nearly complete cure. DISCUSSION: Keratoacanthoma centrifugum marginatum, verrucous carcinoma and epidermal carcinoma have some histological characteristics in common, suggesting a possible common etiological agent which could be certain strains of the human papillomavirus (HPV). In our case etretinate provided cure, possibly due to its antitumoral activity and perhaps due to its antiviral activity. The presence of koilocytes suggested HPV infection which was confirmed by PCR. This test does not however provide proof of the etiological role of HPV. We are currently studying the presence of HPV in keratoacanthomas and their possible etiological role.