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The association of exposure to bleomycin with the development of scleroderma-like cutaneous abnormalities has been reported. We experienced a case of scleroderma involving the hands, feet, and forearms after bleomycin chemotherapy. The present report supports the possible causal relation of bleomycin with scleroderma. Regarding the widespread use of bleomycin, this complication is thought to be under appreciated.
We report the first case of the acral localization of the acquired form of cutis laxa associated with severe rheumatoid arthritis. The skin laxity was preceded by episodes of itching and swelling of the hands and feet. Histopathology showed that the elastic fibers were lost in the areas of cutis laxa and decreased in adjacent skin. The pathogenetic relationship with rheumatoid arthritis or the intake of related drugs is discussed.
Most people develop warts on their hands or feet at some time in their lives. They are most common in childhood, with 4-20% of schoolchildren having warts at any one time. Despite their benign nature, these warts frequently cause concern and prompt consultations with pharmacists, chiropodists, general practitioners or dermatologists. Here we review their management.
Verruciform xanthoma is a rare lesion that occurs most commonly on the oral mucosa but is occasionally seen on the skin. We present a case of multiple verruciform xanthomas occurring on the hand and foot in which there were no preexisting lesions. The current literature on this rare condition is reviewed. The cause of verruciform xanthoma is uncertain, although evidence suggests that the condition may be an unusual reaction pattern rather than a specific lesion.
The use of 8-methoxypsoralen water soaks plus ultraviolet A was evaluated retrospectively in 11 patients with moderate to severe palmoplantar psoriasis that had been resistant to previous topical therapies. Patients received twice- or thrice-weekly 30-minute hand and/or foot soaks in 8-methoxypsoralen, 2.5 mg/L, followed by UVA irradiation. The condition of one patient cleared completely, and seven showed good improvement. The range of treatments required for maximal improvement was 14 to 43 with a mean of 28. The range of maximum UVA dosage per treatment was 3.5 to 17.5 joules/cm2, and the range of cumulative UVA required for maximal improvement was 45 to 388 joules/cm2 with a mean of 165 joules/cm2. The mean serum level of 8-methoxypsoralen 60 minutes after completion of hand and foot soaks was 2.5 +/- 0.5 ng/ml compared with 95.75 +/- 10.43 ng/ml after oral 8-methoxypsoralen, 0.5 mg/kg. In our experience this treatment has been a safe and relatively effective form of therapy for resistant palmoplantar psoriasis.
Papular-purpuric gloves-and-socks syndrome (PPGSS) is a disease characterized by itchy, painful acral erythema with edema, confluent papules, and purpura in a gloves-and-socks distribution and is associated with fever and mucosal lesions. Parvovirus B19 and other viral infections have been proven to be causative agents of this syndrome. Its histological findings have been the non-specific ones of interface dermatitis. Here, we report a case of PPGSS in a 44-year-old man that we believe to be the first such case in Japan. He developed, within one day, a painful edematous eruption with confluent papules and purpura on his hands and feet accompanied by high fever. A unique clinical manifestation in this case was multiple bloody bullae on the toes, which have not been previously described. Serological tests were negative for parvovirus B19, cytomegalovirus, and measles virus.
A 40-year-old male developed a constant hand and foot dermatitis in 1980 while using sorbolene cream as a barrier cream at work. He was forced to leave his trade as a motor mechanic because of his hand dermatitis. It was not until 16 years later that he was diagnosed as having an allergic contact dermatitis to chlorocresol secondary to an endogenous hand and foot dermatitis. Chlorocresol is the preservative used in sorbolene cream as well as many corticosteroid creams. Patch testing carried out in 1983 was negative but had omitted testing with chlorocresol or sorbolene cream.
A patient had sensory radicular neuropathy. The patient demonstrated features characteristic of this entity: (1) recurrent trophic ulcerations of the hands and feet, (2) onset in early adulthood, (3) distal, dissociated loss of pain and temperature sensation far out of proportion to the loss of other sensory perceptions, and (4) complete sparing of motor function.
Juvenile plantar dermatosis seems to be a new skin disease found mainly in children between 3 and 14 years old. The main symptoms are: redness, shiny hyperkeratosis, lamellar scaling and painful fissure formation in weight-bearing parts of the soles and toes. Sometimes the hands also seem to be affected. External factors, occlusive socks and footwear, possibly together with an atopic constitution, are believed to be the cause of the disease, which is very difficult to treat. The findings in 157 published and 23 own cases are discussed.
Eight hundred and ninety seven patients referred by their general practitioner to Health Centre Wart Clinics were interviewed. Seventy one patients (7.9%) were found to have lesions other than cutaneous warts. Females were significantly more likely to have plantar warts on their toes (p less than 0.002) and non-plantar warts on their fingers (p less than 0.03) and less likely to have non-plantar warts on the palms of their hands (p less than 0.03) than males. Patients living in large households (5+ persons) were more likely than patients living in smaller households (2-4 persons) to report an infected co-habitant (p less than 0.001). Patients with periungual warts were significantly more likely to be nailbiters. (p less than 0.001). Patients presenting with warts greater than two years in duration were more likely to have multiple warts than those with warts less than one month in duration (p less than 0.001). Patients who frequently immersed their hands in water were more likely to present with multiple warts on the hands (p less than 0.001). Multiple plantar warts were associated with moist or macerated feet (p less than 0.001). The role of the family doctor in diagnosing and preventing the spread of this infection is discussed.
BACKGROUND: We have observed, in patients undergoing high-dose PUVA treatment, a type of keratosis not previously described. The lesions usually occur on the sides of the palms or soles and are clinically distinct. They are generally painless and often go unnoticed by patients. OBJECTIVE: We sought to further characterize these lesions both clinically and histologically. METHODS: Patients attending a PUVA clinic were screened for these keratoses. Other PUVA-related complications were recorded. Representative lesions were photographed, and biopsy specimens were taken. RESULTS: Biopsy specimens were taken from lesions in 10 patients. All had plaque psoriasis and had received high UVA doses (>1000 J/cm(2)) through PUVA therapy. All patients had PUVA-induced keratoses elsewhere, but the number varied greatly between patients. The hand and foot keratoses were well defined and circular and had a characteristic histologic appearance, with a sharp demarcation between normal and abnormal markedly pale-staining epidermis. CONCLUSION: These lesions are a further cutaneous manifestation of prolonged PUVA therapy.
CAE is a self-limiting toxicity seen with several types of high-dose chemotherapy. Treatment of these patients requires pain management and supportive therapy, including wound care that promotes healing, comfort, mobility, and quality of life and prevents infection. Oncology nurses play an important role in monitoring patients for CAE and providing supportive care.
Recurring scarlatiniform scaled erythema of Féréol-Besnier is a rare disease characterized by recurrent episodes of a prodromal phase with general malaise, head and muscle aches, gastrointestinal complaints and fever followed by an erythematous rash leading to extensive desquamation of the involved skin. It exists in a generalized and localized variant, the latter mainly involving the hands and feet. Its cause is unknown, although it has been speculated that a hyperergic reaction to infectious agents or medications may be etiopathologically involved. A typical case of the localized variant of this obscure disease is described and the common literature is reviewed.
Eleven patients with severe psoriasis involving the palms and soles have been treated using a high-energy source of UV-A and UV-B with no additional topical or systemic photosensitizing drug. The results showed marginal benefit of UV-A alone over conventioonal topical tar therapy. The high energy output of the machine makes it essential that personnel supervising therapy are adequately protected.
Acrokeratoelastoidosis is a genodermatosis characterized by firm papules or plaques on the sides of the hands and feet. Although poorly understood, the lesions may result from an abnormality in the secretion or excretion of elastic material by fibroblasts in the dermis. In this report, we will present a patient with this rare condition and review the clinical and histopathologic features, cause, and differential diagnosis.
An atopic patient with tinea unguium, immediate hypersensitivity to Trichophyton, and elevated specific IgE antibody to Trichophyton had recalcitrant hand and foot eczema that resolved following the administration of systemic antifungal therapy for her tinea unguium. The patient fulfills criteria for the atopic-chronic-dermatophytosis syndrome described by Jones. The authors suggest that the patient's atopic dermatitis may have been exacerbated by her chronic dermatophyte infection and Trichophyton hypersensitivity.
BACKGROUND: Several studies have demonstrated liposomal doxorubicin (Doxil) to be an active antineoplastic agent in platinum-resistant ovarian cancer, with dose limiting toxicity of the standard dosing regimen (50 mg/m(2) q 4 weeks) being severe erythrodysesthesia ("hand-foot syndrome") and stomatitis. We wished to develop a more tolerable liposomal doxorubicin treatment regimen and document its level of activity in a well-defined patient population with platinum/paclitaxel-refractory disease. METHODS AND MATERIALS: Patients with ovarian or fallopian tube cancers or primary peritoneal carcinoma with platinum/paclitaxel-refractory disease (stable or progressive disease following treatment with these agents or previous objective response <3 months in duration) were treated with liposomal doxorubicin at a dose of 40 mg/m(2) q 4 weeks. RESULTS: A total of 49 patients (median age: 60; range 41-81) entered this phase 2 trial. The median number of prior regimens was 2 (range: 1-6). Six (12%) and 4 (8%) patients experienced grade 2 hand-foot syndrome and stomatitis, respectively (no episodes of grade 3). One patient developed grade 3 diarrhea requiring hospitalization for hydration. Six (12%) individuals required dose reductions. The median number of courses of liposomal doxorubicin administered on this protocol was 2 (range: 1-12). Four of 44 patients (9%) evaluable for response exhibited objective and subjective evidence of an antineoplastic effect of therapy. CONCLUSION: This modified liposomal doxorubicin regimen results in less toxicity (stomatitis, hand-foot syndrome) than the standard FDA-approved dose schedule. Definite, although limited, antineoplastic activity is observed in patients with well-defined platinum- and paclitaxel-refractory ovarian cancer.
We studied a white skin type 3 male patient aged 68 years old with a paraneoplastic acrokeratosis of Bazex, suffering from an oesophagus neoplasm. Cutaneous manifestations preceded in months the cancer. Dermatosis affected fingers of hands and feet, soles, nose and helix. Black melanic hyperpigmentation was the first cutaneous sign and were followed by an hyperkeratosis, becoming the most clinical characteristic of the syndrome. The sequence of these signs induces us to suggest that hormonal factors elaborated by the tumoral cells are the ones responsible for the pigmentary changes since they appeared before the hyperkeratosis.