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Symptomatic zinc deficiency in a one-year-old child precipitated by changing from formula to cow's milk.

The case of a one-year-old girl with symptomatic zinc deficiency is presented. She had been misdiagnosed as having impetigo and/or candidiasis and had been treated with topical antifungal agents and both oral and topical antibiotic agents without success during the four months before she presented. Zinc replacement led to rapid improvement. Her nutritional history suggests that weaning from formula to cow's milk precipitated her eruption. The clinical findings, differential diagnosis, and treatment of zinc deficiency are reviewed.

Acrodermatitis↗

Histological study of necrolytic acral erythema.

Described in 1996, necrolytic acral erythema remains the sole diagnostic cutaneous marker for hepatitis C virus infection. To date only eight cases have been described in literature, a fact that makes full histological description and appreciation of the disease process inadequate. Thirty necrolytic acral erythema cases were biopsied and detailed histological description was performed by three separate dermatopathologists who were blinded as to clinical presentation. Clinicopathological correlation was used to evaluate the disease progress. In the early stage, there is moderate regular acanthosis with variable spongiosis and inflammation, progressing to a picture resembling nummular eczema. In its fully evolved form, necrolytic acral erythema shows psoriasiform epidermal hyperplasia with marked papillomatosis. Associated findings include parakeratosis, focal hypergranulosis, subcorneal pustule, epidermal pallor, necrotic keratinocytes, which sometimes become confluent in the upper epidermis and/or track along the acrosyringia, vascular ectasia and papillary dermal inflammation. Late stage samples display some remaining acanthosis with variable inflammation. Pigment incontinence is seen in all stages.

Acrodermatitis↗

Propionic acidemia and zinc deficiency presenting as necrolytic migratory erythema.

Necrolytic migratory erythema was first described in 1942 in a patient with pancreatic islet cell carcinoma. The disease can, however, have other etiologies including nutritional dermatoses. Here, we describe the clinicopathological picture of a 7-year-old female patient who presented with necrolytic migratory erythema which we believe is secondary to a rare combination of zinc deficiency and propionic acidemia.

Acrodermatitis↗

[Paraneoplastic acrokeratosis].

Paraneoplastic acrokeratosis is a distinctive dermatosis observed only in patients with either carcinoma of the upper respiratory and digestive tract or with metastatic lymphnodes in the cervical or mediastinal region. The characteristics of this dermatosis are: acral beginning, erythematous, squamous and hyperkeratotic plaques with centripedal spreading and healing only after successful treatment of the carcinoma. An allergic or toxic skin reaction to a substance formed by the tumor cells is discussed as causative agent. The author gives a review of the symptoms, the course of the disease, of histological and biochemical data and of the differential diagnosis as reported in the literature.

Acrodermatitis↗

Bazex syndrome (paraneoplastic acrokeratosis).

Bazex syndrome (paraneoplastic acrokeratosis) is characterized by the presence of hyperkeratotic lesions on the nose, ears, palms, and soles that appear in association with malignancies of the upper aerodigestive tract, most often a squamous cell carcinoma. We present a case of Bazex syndrome and provide a review of the literature.

Acrodermatitis↗

Acrokeratosis Verruciformis of Hopf: a localized variant.

Acrokeratosis Verruciformis of Hopf (AKV) is a rare autosomal dominant genodermatosis. It usually develops during early childhood affecting both sexes equally. Typically, the lesions are warty to convex, brownish to skin-colored papules on the dorsa of the hands and feet, forearms and legs. A possible relationship with Darier disease has long been postulated on a clinical basis mainly. But recently, evidence has suggested that AKV and Darier disease are allelic disorders. I am reporting these two unrelated cases as a unilateral localized variant of AKV.

Acrodermatitis↗

[Zinc (Zn)].

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Acrodermatitis↗

[Early acroparesthesia in females: a sign disclosing heterozygote Fabry disease].

Heterozygous Fabry's disease has an inconstant expression and very few complications. The theory of X-chromosome inactivation which, according to Lyon, occurs hazardly, is illustrated by the fact that the disease is expressed even in hemizygous women. Ophthalmic manifestations, as detected by the slit lamp method, are almost constant, 80 p. 100 of women with the disease having a verticillate cornea. Angiokeratoma is present in 20 p. 100 of the cases. Episodes of paraesthesia of the hands and feet are less common; in most cases they are attributed to the disease retrospectively, during family investigations. In two girls aged 10 and 11 years respectively and without history of Fabry's disease the only symptom suggestive of the diagnosis was paroxysmal acroparaesthesia. In one of the girls acroparaesthesia was associated with acrocyanosis, livedo and acro-osteolysis, but concordance was the only argument in favour of a link with Fabry's disease. Alterations of the extremities have been reported in this disease, including palmar erythema and a bluish discoloration of the palms due to dilatation of the superficial veins. Only two cases of livedo have been published. Acrosteolysis has never been documented in Fabry's disease, and its presence must be confirmed in further cases. The diagnosis of heterozygous Fabry's disease in these 2 girls was confirmed by the finding of ceramide trihexoside in urine and by leucocyte alpha-galactosidase levels that were 25 to 30 p. 100 of values obtained in controls. A study of the family of one of the girls showed that the father was involved; this hemizygous type of the disease with a 10 p. 100 alphagalactosidase level was totally asymptomatic.(ABSTRACT TRUNCATED AT 250 WORDS)

Acrodermatitis↗

Cutaneous paraneoplastic syndrome (acrokeratosis paraneoplastica) preceding squamous cell carcinoma of the glottic larynx.

Paraneoplastic syndromes that occur in the minority of cancer patients are the produced signs and symptoms at distant sites from the tumour or its metastases. These syndromes may occur due to the production of substances by tumoural lesions that directly or indirectly cause distant symptoms or depletion of normal substances or host response to the tumours. A paraneoplastic syndrome may be the first sign of a malignancy so its recognition may be critical for early cancer detection. Most of the paraneoplastic syndromes associated with head and neck tumours are endocrinologic or neurologic; dermatologic syndromes are less common. Head and neck cancers also have occasionally been reported in association with paraneoplastic syndromes and to date there are only a few cases in the literature about the presence of a cutaneous paraneoplastic syndrome as the first manifestation of a laryngeal cancer, especially glottic larynx cancer. A wide variety of cutaneous syndromes are associated with malignancies and these syndromes may precede, follow, or be concurrent with the underlying malignancy. In this report we present a case with cutaneous syndrome of acrokeratosis paraneoplastica preceding squamous cell carcinoma of glottic larynx, and review the other cutaneous paraneoplastic syndromes reported in the literature.

Acrodermatitis↗

[Paraneoplastic Bazex acrokeratosis--disease course in palliative therapy of cancer of the base of the tongue].

A 62-year old quarryman developed distinct, erythematosquamous and keratotic lesions associated with subungual hyperkeratosis and nail detachment on all fingertips within 9 months. Subsequently, scaly erythema of the nose and of the auricles appeared. Clinically paraneoplastic acrokeratosis Bazex (APB) was diagnosed. Thorough endoscopic examination revealed an asymptomatic squamous cell carcinoma at the base of the tongue, which had already metastasized to the regional lymph nodes. Impressive regression of most of the relevant skin symptoms occurred during combined neck dissection and radiotherapy. A survey of recent reports on APB in the literature is given.

Acrodermatitis↗

Gloves and socks syndrome caused by parvovirus B19 infection.

The papular purpuric gloves and socks syndrome (PPGSS) is an uncommon dermatosis with a typical purpuric exanthem limited to hands and feet; it occurs mainly in young adults. We report a case of a 19-year-old man with an acute febrile illness accompanied by purpuric and papular lesions located mostly on the dorsal areas of his hands and feet. Serologic analysis for parvovirus B19 yielded positive results. The diagnosis of PPGSS was made. The eruption cleared without therapy in 12 days with plantar and palmar desquamation. Parvovirus B19 and some other viral infections have been proven to be causative agents of this syndrome.

Acrodermatitis↗

[Pseudo-Kaposi syndromes of vascular origin].

Pseudo-Kaposi's Sarcoma with vascular disease concern mainly acroangiodermatitis described by Mali--(with chronic venous insufficiency)--, arteriovenous malformations with angiodermatitis described by Stewart and Bluefarb, and pseudo-Kaposi's Sarcoma occurring after placement of arteriovenous shunt for hemodialysis. Search for relation ships between classical Kaposi's Sarcoma and new AIDS Kaposi's Sarcoma explains new interest devoted to Pseudo-Kaposi's Sarcoma.

Acquired Immunodeficiency Syndrome↗

[Psoriatic acropachydermy].

We report the case of a 55-year old man complaining of painful distal changes in the fingers. At physical examination the distal part of the fingers was enlarged as a result of thickening of the soft parts of the ungueal phalanges, and ungueal dystrophies were present. The patient also had inflammatory arthralgia of the distal interphalangeal (DIP) joints, with limited flexion movements. Interrogation revealed a history of cutaneous psoriasis, and radiography of the hands showed DIP arthritis as well as osteitis and periostitis of the ungueal phalanges. The condition was diagnosed as classical psoriatic arthritis of the DIP type, and psoriatic onycho-pachydermo-periostitis, a new form of psoriatic arthritis recently described by Fournié et al. These authors have put forward a physiopathological hypothesis indicating a direct link between psoriatic inflammatory ungueal lesions and lesions of the ungueal phalanx and its soft parts. We had great difficulty in ascertaining the psoriatic nature of this acropachyderma, and we made successive tentative diagnoses of DIP osteoarthritis, pachydermo-periostitis and acromegaly. In this study, we describe the appearance of the ungueal lesions suggestive of psoriasis, and the other clinical forms of psoriatic arthritis.

Acrodermatitis↗