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PubMed2002

A granuloma annulare-like eruption associated with the use of amlodipine.

A granuloma annulare-like drug reaction is a rarely encountered clinical entity. A 64-year-old Caucasian female developed a granuloma annulare-like reaction 13 days after starting amlodipine and cleared within 3 months after drug cessation. The eruption consisted of multiple erythematous pruritic papules, distributed symmetrically over the lateral aspects of the legs and thighs, as well as on both palms. Histology showed focal collagen degeneration and significant interstitial histiocytic dermal infiltrate suggestive of granuloma annulare. We review previously reported cases of granuloma annulare-like drug reactions, in the context of a recently proposed classification for drug-induced interstitial granulomatous reactions.

Amlodipine↗
PubMed1977

Cutaneous infection by Cryptococcus laurentii.

Cryptococcus laurentii was isolated twice from cutaneous granulomas in the leg and foot of a 40-year-old man. Histologically the cells of C. laurentii were found in groups in the dermis and also inside giant cells. There was epithelioid cell infiltration in the dermis and subcutis. An atypical mycobacterium was isolated in addition to C. laurentii. Therapy with anti-tuberculous drugs after an initial amphotericin B infusion was found to be satisfactory.

Adult↗
PubMed1999

Allergic contact dermatitis in the United Arab Emirates.

BACKGROUND: No data exist on allergic contact dermatitis (ACD) in the United Arab Emirates (UAE). AIM: Our aim was threefold: (i) to determine the incidence of ACD; (ii) to identify responsible allergens using the European Standard Series, TRUE TEST, and other substances; (iii) to tentatively explore population-specific reactions in Al Ain, UAE. DESIGN: This is a prospective, descriptive, hospital-based, study. SETTING: Tawam Hospital, Al Ain Medical District, UAE. PATIENTS: During the years 1989-1996, 373 patients (male: female = 2 : 3), presenting with cutaneous manifestations possibly related to contact allergy, were patch tested. RESULTS: 93.8% of patients presented with dermatitis affecting mostly the hands (45.1%), feet (21.4%), face (12.6%), and legs (4.6%). Two hundred and twenty-four patients (60%) (male : female = 1 : 2) tested positive for at least one substance. Nickel was the commonest sensitizer (15%) in both genders. "Fragrance mix" (8%), p-tertiary butylphenolformaldehyde (p-TBPF) resin (7.5%), thiomersal (7.5%), chromium (7.2%), cobalt (6.4%), ethylenediamine (6.4%), neomycin (5.1%), and parabens (5.1%) were prominent allergens. Glutardialdehyde, an additional substance tested together with the European Standard Series, scored significantly (4.8%). Variations from the results reported from other countries may be explained by the specific lifestyles and customs of the UAE population. CONCLUSIONS: Substances contained in the TRUE TEST, plus glutardialdehyde, may be considered as the standard series for patch testing in the UAE population.

Adolescent↗
PubMed1997

Bullous lesions in Kaposi's sarcoma: case report.

Bullous lesions have been only rarely described in Kaposi's sarcoma (KS), and their histopathologic features have never been described in detail. We report a case of bullous lesions of KS in an 82-year-old Italian woman. The patient had typical smooth pale reddish-grey slightly-raised KS plaques on the legs, present for at least 10 years. Several dull grayish-pink blisters (0.5 to 2 cm in diameter) affected both dorsa of her feet and ankles symmetrically. Two punch biopsies were taken, one from an infiltrated KS plaque on the right buttock and the other from a bullous lesion on the right foot. Histopathologically, the late KS plaque on the buttock showed typical features of KS, with an increased number of spindle cells arranged in short bundles and extravasation of erythrocytes. The bullous lesion on the foot showed a full-thickness vascular neoplasm involving the upper and lower dermis and the subcutaneous fat. The upper portion of the lesion contained many newly formed, highly-dilated blood vessels, touching the overlying epidermis and separated from it by a narrow band of collagen and endothelial cells; wide, empty spaces characterized the superficial dermis, in which preexisting venules and bands of collagen associated with non-atypical endothelial cells floated. All these findings would suggest a lymphangiomatous lesion, if the presence of specific diagnostic criteria of KS were not recognizable at a deeper level of the lesion. Various criteria actually suggest that the bullous lesion may be regarded as an epiphenomenon of a KS plaque lesion: (a) full-thickness involvement of the reticular dermis and, in this case, also of the subcutaneous fat; (b) dense and patchy lymphoplasmocytic infiltrate typical of plaque lesions and, much less frequently, of patch lesions; (c) presence of ectatic blood vessels, filled with plasma and erythrocytes (pseudoangiomatous findings), a nonpathognomonic but highly characteristic finding of the plaque lesion; and (d) as in the KS plaque lesions, in the bullous lesion as well the reticular dermis was characterized by an increased number of anastomosing bizarrely shaped vascular spaces lined by non-atypical endothelial cells. We hypothesize that the prevalence of lymphangiomatous differentiation in the upper dermis represents one of the many features of KS lesions. When present, it may correlate with the clinical feature of a blister.

Adipose Tissue↗
PubMed1994

The cutaneous signs of eating disorders.

Anorexia nervosa and bulimia nervosa are common yet occult eating disorders which each affect between 1 and 2% of young adult women in the UK (1). Cutaneous signs may provide valuable clues allowing earlier diagnosis. Eating disorders may both imitate (Table I) and complicate other medical illnesses, resulting in unnecessary and expensive investigations. Organic diseases that may be complicated by eating disorders are Crohn's disease (2), diabetes mellitus (3, 4) and human immune deficiency virus disease (5). The concurrence of an additional eating disorder will destabilize the primary medical condition. In anorexia nervosa the mortality rate has been found to be between 15 and 18% (6, 7). Early diagnosis and treatment are essential to reduce the morbidity and mortality of these concealed conditions. This report describes a patient who exhibited excoriations and scars over the dorsum of her hands, leg ulceration and loss of teeth as cutaneous signs of an eating disorder.

Adult↗
PubMed2001

Frequency of toenail onychomycosis in patients with cutaneous manifestations of chronic venous insufficiency.

BACKGROUND: Chronic venous insufficiency (CVI) can originate onychopathy per se. We have anecdotally observed nail changes in patients with CVI, but there are few studies which determine the frequency of both onychopathy and onychomycosis in these patients OBJECTIVE: The aim of the study was to determine the frequency of nail pathology and onychomycosis in patients with CVI PATIENTS AND METHODS: We included 36 adult patients, both men and women, aged from 18 to 59 years, with clinically documented venous leg ulcers. All patients were examined by a dermatologist and the venous leg ulcers were classified according to severity in three grades. The nail changes were described and a mycological examination was performed. We obtained a small fragment of the nail for histological examination. In 27 patients, we also performed functional studies to determine the type of venous insufficiency. RESULTS: The ratio of women to men was 5 : 1. The mean age of patients was 46.39 +/- 8.51 years, men being slightly younger than women. Ten patients had ulcers of grade I severity, 12 had grade II, and 14 had grade III. The overall time of evolution of the cutaneous lesions was 11.02 +/- 10.11. Fourteen patients had superficial venous insufficiency, whereas 13 had deep venous insufficiency. Twenty-two (61.11%) of our patients had nail alterations. These nail changes were related more to the type of vascular affection than with the severity of cutaneous involvement. In more than half of the cases (59.09%), onychomycosis was the cause of the nail changes. The overall frequency of onychomycosis was 36.11%. The etiologic agent of onychomycosis was isolated in 38.46% of the cases, and Trichophyton rubrum was the most frequent agent. The histologic examination of the nail plate showed a low sensitivity (62%) but a high specificity (100%) in the detection of nail plate parasitization. No clinical differences could be established between the nail changes observed in patients with true onychomycosis and those with nonfungal onychopathy. CONCLUSIONS: Nail changes are common in patients with venous leg ulcer, and onychomycosis accounts for slightly more than half of the cases. We therefore recommend a routine mycological examination in patients wit nail changes and cutaneous manifestations of CVI, to diagnose or rule out onychomycosis, and therefore avoid overtreating patients without onychomycosis with antimycotics.

Adult↗
PubMed1989

Trichophyton rubrum abscesses in immunocompromised patients. A case report.

A 72-year-old immunocompromised man with myelodysplastic syndrome who developed multiple erythematous, scaly abscesses like lesions on his left foot and lower leg is described. He also had dry scaly lesions on his soles and lesions on several toe nails. A punch biopsy showed abscesses with fungal elements and Trichophyton rubrum was cultured from skin scales and the biopsy. A diagnosis of T. rubrum abscesses should be suspected in all immunocompromised patients with signs of superficial dermatophyte infection.

Abscess↗
PubMed1995

Prevalence of Candida ciferrii in elderly patients with trophic disorders of the legs.

In order to define the prevalence of Candida ciferrii in onychomycosis, the fungal biota associated with toe nail onyxis was examined in 50 elderly patients with trophic disorders of the legs and in 220 patients without clinical evidence of trophic disorders. Candida ciferrii was more frequent in the first group of patients since it was recovered from 24% of these patients, whereas its prevalence was only 1.4% in the control group. Moreover, the positivity of the direct examination of toe nail scrapings, the absence of any other associated pathogens, and the repeated isolation of this yeast species for some of the patients confirmed its pathogenicity.

Adult↗
PubMed2002

Patch testing in discoid eczema.

Fifty patients of both sexes with clinically suspected discoid eczema were patch tested with the Indian Standard Patch Test Battery approved by the Contact and Occupational Dermatosis Forum of India (CODFI). Most of these patients were young adults between 20 and 39 years old, with a mean age of 36 years. The mean duration of symptoms was 21/2 years. The occupational profiles of the patients included farmers (24%), housewives (18%), students (14%), housewives engaged in farming (12%), shopkeepers (10%), and laborers (8%). The miscellaneous group, including technicians, drivers, cable operators, office workers, and computer operators, accounted for the remaining 14%. The common clinical patterns of presentation of discoid eczema included hands and feet (44%), hands and forearms' (30%), legs and feet (12%) and trunk and limbs (12%). Patch test analysis of these patients revealed that, out of the 50 subjects tested, 28 (56%) reacted to one or more allergens. Potassium dichromate was the most common allergen (20%), followed by nickel (16%), cobalt chloride, and fragrance (12% each) in decreasing order of frequency. Hence, it may be concluded that patch testing should be considered for all patients with severe or persistent discoid eczema because allergic contact dermatitis may be relatively common in such patients and the avoidance of offending allergens may be of substantial benefit to the patients.

Adolescent↗
PubMed2005

Necrolytic acral erythema: a cutaneous sign of hepatitis C virus infection.

BACKGROUND: Hepatitis C virus (HCV) infection is globally epidemic. Several mucocutaneous diseases are well established in association with HCV infection. Few case reports describe the recently recognized HCV-related skin disorder termed necrolytic acral erythema (NAE). METHODS: Thirty patients with NAE were identified in a university-based dermatology clinic in Cairo, Egypt. These patients were observed over time to document the clinical and histologic findings of this disorder. RESULTS: All patients were infected with HCV. Erythematous papules arose most commonly on the dorsal aspect of the feet, particularly the dorsal surface of the great toe. Progression resulted in confluence into erythematous dusky plaques with adherent scale and central erosion. The eruption extended to involve the lower leg and other regions in some patients but never affected palms or soles, the nail bed, nail plate, or mucous membranes. Skin biopsy specimens from fully evolved lesions displayed psoriasiform changes in association with more characteristic findings of keratinocyte necrosis and papillomatosis. LIMITATIONS: We did not perform a prospective review of patients known to be infected with HCV. Patients were identified from a general clinic population and then assayed for HCV serology. CONCLUSIONS: NAE is a distinctive skin disorder associated with HCV infection in all cases reported to date. Recognition of this disease should alert practitioners to the need for viral testing and appropriate counseling of patients.

Adolescent↗
PubMed1998

Subcutaneous granuloma annulare: radiologic appearance.

OBJECTIVE: Granuloma annulare is an uncommon benign inflammatory dermatosis characterized by the formation of dermal papules with a tendency to form rings. There are several clinically distinct forms. The subcutaneous form is the most frequently encountered by radiologists, with the lesion presenting as a superficial mass. There are only a few scattered reports of the imaging appearance of this entity in the literature. We report the radiologic appearance of five cases of subcutaneous granuloma annulare. DESIGN AND PATIENTS: The radiologic images of five patients (three male, two female) with subcutaneous granuloma annulare were retrospectively studied. Mean patient age was 6.4 years (range, 2-13 years). The lesions occurred in the lower leg (two), foot, forearm, and hand. MR images were available for all lesions, gadolinium-enhanced imaging in three cases, radiographs in four, and bone scintigraphy in one. RESULTS: Radiographs showed unmineralized nodular masses localized to the subcutaneous adipose tissue. The size range, in greatest dimension on imaging studies, was 1-4 cm. MR images show a mass with relatively decreased signal intensity on all pulse sequences, with variable but generally relatively well defined margins. There was extensive diffuse enhancement following gadolinium administration. CONCLUSION: The radiologic appearance of subcutaneous granuloma annulare is characteristic, typically demonstrating a nodular soft-tissue mass involving the subcutaneous adipose tissue. MR images show a mass with relatively decreased signal intensity on all pulse sequences and variable but generally well defined margins. There is extensive diffuse enhancement following gadolinium administration. Radiographs show a soft-tissue mass or soft-tissue swelling without evidence of bone involvement or mineralization. This radiologic appearance in a young individual is highly suggestive of subcutaneous granuloma annulare.

Adipose Tissue↗
PubMed2006

Livedoid vasculopathy: further evidence for procoagulant pathogenesis.

OBJECTIVE: To further characterize the clinical and pathologic features, disease associations, and laboratory abnormalities of livedoid vasculopathy. DESIGN: Retrospective study of patients identified from our institutional database from January 1, 1990, to December 31, 2000. SETTING: Tertiary care institution. Patients Forty-five patients with biopsy-proved livedoid vasculopathy. MAIN OUTCOME MEASURES: Clinical presentation, histopathologic diagnosis, results of testing for coagulation abnormalities, and assessment of vascular status. RESULTS: Thirty-two patients (71.1%) were female (mean age, 45 years; age range, 10-85 years). Bilateral lower extremity disease occurred in 36 patients (80.0%), ulceration in 31 (68.9%), and atrophie blanche in 32 (71.1%). In patients tested, transcutaneous oximetry measurements were decreased in 20 (74.1%) of 27, and factor V Leiden mutation (heterozygous) was noted in 2 (22.2%) of 9, decreased activity for protein C or protein S in 2 (13.3%) of 15, prothrombin G20210A gene mutation in 1 (8.3%) of 12, and lupus anticoagulant in 5 (17.9%) of 28. Anticardiolipin antibodies were present in 8 (28.6%) of 28 patients, and elevated homocysteine levels in 3 (14.3%) of 21. Intraluminal thrombosis was observed in 44 (97.8%) of 45 skin biopsy specimens. Direct immunofluorescence disclosed multiple vascular conjugates in 31 (86.1%) of 36 biopsy specimens. CONCLUSIONS: Livedoid vasculopathy was predominantly bilateral, affected the lower extremities, and was associated with ulceration and atrophie blanche. Histologic evidence of intraluminal thrombosis was observed in almost all biopsy specimens reviewed. Laboratory testing revealed numerous heterogeneous coagulation abnormalities, providing further evidence of procoagulant mechanisms.

Adolescent↗
PubMed1994

Clinical relevance of contact allergy to gold sodium thiosulfate.

BACKGROUND: In our routinely patch tested patients with dermatitis gold was shown to be the second most common sensitizer. In most patients it was difficult to explain the source of sensitization to gold and to see any clinical relevance. OBJECTIVE: Our purpose was to elucidate the clinical relevance of contact allergy to gold sodium thiosulfate. METHODS: A questionnaire on gold exposure and gold sensitivity was answered by 156 consecutive patients with dermatitis. In another group of 1056 routinely tested patients data were collected and analyzed regarding factors such as profession, atopy, localization of the dermatitis, and presence of contact allergies. RESULTS: Gold allergy was overrepresented in those having dental gold. In persons with contact allergy to gold a dermatitis on the ears, fingers, or eye area was most frequent. CONCLUSION: Exposure to gold jewelry and to dental gold may be important in the sensitization and elicitation of dermatitis.

Allergens↗
PubMed1979

Content of zinc in serum, urine, hair, and toenails of New Zealand adults.

The content of zinc in samples of serum, hair, and toenails and in a 24 hr urine from groups of the New Zealand population was investigated. The 110 normal healthy adults were mainly male and female students; the female students had a higher serum zinc and hair zinc concentration but a lower urinary zinc excretion than did the male students. The range in values within the normal groups was wide. No strong relationship was found with linear regression analysis or with multiple regression analysis of the data for the male or the female students. Other groups studied were oyster openers with a higher dietary intake of zinc from oysters, industrial workers exposed to zinc in their occupations, and hospital patients with leg ulcers or various dermatoses and with a potentially low zinc status. Only external exposure to zinc from an industrial source (galvanizing) or from the use of zinc-based creams increased the zinc concentration in the samples measured, and then only in hair and toenails. The hospital patients did not appear to have a lower zinc status comparable with adults from other countries. It was concluded that the measurement of zinc in serum, urine, hair, and toenails did not provide a sensitive indication of zinc status.

Adolescent↗