[ANGIOPATHIA HAEMORRHAGICA ET NECROTICANS PERSTANS TOXI-ALLERGICA].
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We have reported two further cases of metastatic Crohn's disease (MC), one of whom presented with a widespread symmetrical perifollicular papular eruption on the arms and legs not previously reported. In view of the varied clinical appearances the incidence may be underestimated and consequently we feel that more patients with Crohn's disease who develop skin lesions should be biopsied.
Chronic neutrophilic leukemia (CNL) is a rare myeloproliferative disorder. Less than 50 cases have been reported. We report the first case of CNL with an associated leukemia cutis. CNL was diagnosed in a 74-year-old white woman in 1998, based on neutrophilic infiltration of the bone marrow and absence of the Philadelphia chromosome. The patient presented to the dermatology service in August 1998 with a 2-week history of a pruritic eruption on the arms, hands, and legs. Physical examination revealed red to violaceous plaques on both thighs and knees, in addition to purpuric patches and plaques on the dorsal hands, arms, and legs. Leukemia cutis was demonstrated on biopsy specimens of several lesional sites. The eruption progressed, despite treatment with topical and systemic corticosteroids. Treatment with systemic chemotherapy did affect partial resolution of the eruption, with parallel decreases in bone pain and white blood cell count, but the disease progressed and the patient ultimately died 5 months after her initial skin findings. Only one other case of CNL with dermatologic manifestations has been reported, CNL associated with a reactional neutrophilic dermatosis. Comparison to and differentiation from this case is discussed. The importance of distinguishing the specific infiltrates of leukemia from the nonspecific infiltrates of reactional dermatoses, such as Sweet's syndrome, is illustrated.
BACKGROUND: Leukocytoclastic vasculitis associated with subacute cutaneous lupus erythematosus (SCLE) was observed by Sontheimer et al. in their first clinical series of patients with SCLE, although recent reports have suggested that its frequency was rare. OBJECTIVE: To evaluate the prevalence of cutaneous leukocytoclastic vasculitis (CLV) in patients with SCLE and to describe the clinicopathologic manifestations, response to treatment and prognosis of this subgroup of patients. METHODS: We reviewed all cases of SCLE seen at the Hospital de la Princesa from 1980 to 1995. RESULTS: Three (9%) of our 27 patients with SCLE exhibited CLV and SCLE. Purpura, maculoerythematous lesions, urticaria, nodules and necrotic lesions on the leg, trunk and palmoplantar regions were present in our patients with CLV and SCLE. Histologically, SCLE-associated CLV was a small-sized vessel leukocytoclastic vasculitis with intravascular thrombosis in the deep dermis and coexistence of lesions of CLV and SCLE. CONCLUSION: In our patients, CLV was self-limited and not associated with a worsened prognosis, with only cutaneous involvement in their further relapses of SCLE.
Contact allergy to oil of turpentine was reported to have become rare. However, the evaluation of standardized data of 45,005 patients tested 1992-1997 in 30 Dermatological Centers associated with the German-Austrian Information Network of Departments of Dermatology (IVDK) showed an increase in positive patch test reactions to turpentine from 0.5% during the years 1992-1995, up to 1.7% in 1996 and 3.1% in 1997. In particular, 17,347 patients tested in 1996-1997 were evaluated in detail by comparing 431 individuals with positive patch test reactions with the rest of the group found negative to turpentine. Using the so-called MOAHLFA index, the following characteristics were shown. Turpentine allergy (a) was found to be significantly less frequent in men and in patients with occupational dermatitis, (b) showed no difference in its association with atopic dermatitis, (c) patients with turpentine allergy had significantly less symptoms of the hands, more symptoms of the legs or in the face and (d) were significantly more often aged over 60 years. Also, patients sensitized to turpentine had increased rates of additional sensitizations. The definite reason for the increase in turpentine sensitization in the population tested here is not clear. Therefore, a detailed exposure analysis is necessary; the new increase in turpentine allergies may be due to popular topical remedies or household chemicals.
BACKGROUND: Para aminobenzoic acid (PABA) derivatives and cinnamate are chemical sunscreens that protect against UVB (290 to 320 nm). They may occasionally produce contact and photocontact sensitization. OBJECTIVE: To report a sensitization to octyl-dimethyl-PABA and photosensitization to 2-ethylhexyl-p-metossicinnamate in a 31-year-old man. METHODS: A patient with a 3-year history of a relapsing dermatitis involving the face, neck, legs, and knees is reported. The eruption had recurred every summer after sunlight exposure. Patch tests with International Contact Dermatitis Research Group (IC-DRG) standard series and the photopatch series (Hermal-Trolab, Reinbek, Germany) using Finn chambers on Scanpor (Norgesplaster A/S, Oslo, Norway) were carried out. RESULTS: We found a positive reaction to Balsam of Peru, fragrance mix, Escalol 507, and Parsol MCX (Hermal-Trolab, Reinbek, Germany). Photopatch test revealed a positive reaction only for Parsol MCX. CONCLUSION: The incidence of allergic contact dermatitis to sunscreens is considered low. Recently sunscreens patch test concentrations have been increased from 2% to 10%. These higher percentages will probably permit the identification of more cases of sunscreens allergy in the near future.
In spring 1992, several farmers in the western part of The Netherlands developed dermatitis on their hands, forearms and face. In some, the legs, trunk and genitals were also affected. Complaints ranged from a mildly itchy, papular rash to a painful, weeping and blistering dermatitis. Medical aid was needed by 5/9 of them. Some of the farmers grew seed potatoes, the others cultivated lilies. All of them had in common that their complaints emerged after repeated application of a new fungicide over several weeks. The fungicide was Shirlan, with fluazinam as its active ingredient. 9 farmers were patch tested with a concentration range of the whole formulation (aq.) and of the active ingredient (pet.). In 7 of 9 farmers, positive patch tests were scored with both the whole formulation (down to 0.01% aq.) and fluazinam itself (down to 0.1% pet.). Patch tests in consecutive control patients (n = 10) were all negative. As it was impossible to substitute fluazinam as the active ingredient, farmers are now supplied with detailed information as to how to avoid skin contact as much as feasible.
INTRODUCTION: Many inherited skin diseases and nevus malformations are distributed according to the Blaschko's lines. Some inflammatory skin diseases are also distributed according to these lines. OBSERVATION: In 1989 a 49-year-old woman presented with an epidermal nevus affecting the left hand and leg from the infancy. In 1994, inflammatory, linear papules occurred on the left leg, obscuring and continuing the previous lesions, on the left thigh and on the left clavicular region. On light microscopy, spongiosis of the epidermis and an infiltrate of lymphocytes and histiocytes in the superficial dermis were shown. Subintrant crops of new inflammatory lesions occurred for a period of two years, whereas the nevus lesions of the left hand persisted unchanged. These findings led to the final diagnosis of blaschkitis associated to epidermal nevus on the same Blaschko's lines. DISCUSSION: The distribution of a skin disease according to the Blaschko's lines underlines the presence in the affected skin of a mutant clone, with a different genetic material as compared with the normal skin. An early mutation giving raise to a mutant clone and affecting the left hemibody could be hypothesized in our case. The mutation probably involved a pleiotropic gene. The latter initially was responsible for thickening of the skin. Moreover, the mutation was also responsible for a particular proneness towards an exogenous factors, able to induce a persistent inflammatory skin eruption following the same lines.
A 67-year-old man presented with a 2-year history of asymptomatic, firm, multiple nodules and plaques and cerebriform hypertrophy of both lower legs and feet, and well-defined, skin-colored, firm nodules and tumors on both hands. He had been diagnosed as having Graves' disease 3 years previously, and had been treated with 10 mg of methimazole and 100 microg of thyroxin (T4) daily for 2 years. Physical examination revealed nonpitting edema, flesh-colored to erythematous, firm, confluent, polypoid nodules and fissured plaques extending from the shins to the dorsa of both feet (Fig. 1), and round to oval, firm, skin-colored, walnut-to-egg-sized tumors on all 10 fingers and the ulnar side of the dorsum of the right hand (Fig. 2). The thyroid gland was diffusely enlarged; however, there was no exophthalmos, and extraocular movements were normal. There was no weight loss, loss of appetite, tremor, heat intolerance, diarrhea, or fatigue. On laboratory evaluation, thyroid-stimulating hormone (TSH) had a markedly low titer of < 0.05 microU/mL (normal: 0.4-5.0), and the TSH receptor antibody was extremely high at 73.8% (normal: < 15%). Serum free triiodothyronine (T3), T4, antimicrosome, and antithyroglobulin antibodies were normal or negative. Skin biopsy samples from the shin and hand disclosed extensive mucin deposition throughout the dermis.
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Triamcinolone was administered sublesionally to 48 patients with various dermatoses of the legs and feet. Results were satisfactory in 94 percent of those treated. Gratifying results were obtained in patients who had suffered from intractable psoriasis of many years' duration, great cosmetic and psychological improvement being noted in these individuals. Side effects consisted mainly of atrophy, which was of insignificant consequence in almost all instances. This administration, performed as directed, is recommended for a great number of skin disorders commonly encountered in podiatry.
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Erosive pustular dermatosis of the leg is a distinct form of spongiform amicrobial pustulosis. The disorder typically affects the lower limbs of elderly patients presenting with chronic venous insufficiency and stasis dermatitis, and has a chronic course. Three elderly patients with chronic venous ulcers are described, who developed pustules and moist eroded lesions on the leg. The clinical and histological features were typical for erosive pustular dermatosis. The lesions rapidly responded to topical treatment with either tacrolimus or corticosteroids. Of note, this condition was associated with a diverticular disease in two patients, while in another patient an epidermoid carcinoma of the tongue was present. Erosive pustular dermatosis of the leg is an uncommon but distinct skin disorder typically associated with trophic changes of the lower limbs. Our observations raise the question of the relation of erosive pustular dermatosis of the leg with the group of neutrophilic dermatoses. Topical immunotherapy with tacrolimus may constitute a novel therapeutic option for this frequently recalcitrant condition.
542 patients (330 women, 212 men) with suspected allergic contact dermatitis were patch tested to standard series allergens between January 1983 and June 1987. Positive reactions were most frequently seen with nickel (17.4%), ethylenediamine (8.7%), formaldehyde (7.4%), colophony (7.0%), potassium dichromate (6.1%) and neomycin (5.7%). Patients with dermatitis involving the legs were significantly more likely to be allergic to ethylenediamine (p = 0.01) and benzocaine (p = 0.04) than those with dermatitis not involving the legs. Neomycin allergy was not associated with dermatitis involving the legs. Patients allergic to ethylenediamine were significantly more likely to be allergic to neomycin than patients not allergic to ethylenediamine (p = 0.002).
We describe two patients with acral keratosis with a striking mosaic or jigsaw-puzzle pattern of keratotic papules on the dorsal aspects of the feet and adjacent parts of the legs. Both patients also showed mild diffuse palmoplantar keratosis and clavus-like lesions over the interphalangeal joints of the toes; one patient also had keratotic papules on the hands and hyperkeratotic plaques over the knees. The differential diagnosis of acral keratoses, including several recently described forms, is briefly discussed.