Miliaria crystallina.

Miliaria crystallina (MC) is an uncommon form of a sweat retention syndrome that chiefly affects neonates. It is more common in hot and humid conditions, such as in tropical regions. It commonly presents as clusters of dewdrop-like vesicles on a nonerythematous base that heals with furfuraceous scaling. A clinical diagnosis is often sufficient. The differential diagnosis is wide and varying. One of the hallmarks of MC is its self-limiting nature. The purpose of this review is to increase awareness of this condition among physicians and dermatologists.

[A newborn with blisters]. / Een neonaat met blaasjes.

This case concerns a newborn with many small transparent vesicles on the forehead, trunk and face. Miliaria crystallina was diagnosed based on the typical presentation. Miliaria crystalline is a transient obstruction of sweat glands resulting in non-inflammatory vesicles. The treatment is simple: cool down.

[Widespread miliaria crystallina: about a case]. / La miliaire cristalline généralisée: à propos d'un cas.

Prickly heat is a benign cutaneous manifestation due to the obstruction of the sweat ducts following excessive exposure to heat, humidity or hyperthermia. We report the case of a 70-year old diabetic female patient treated with insulin, hospitalized in the Intensive Care Unit due to acidocetosic coma secondary to pyelonephritis. The patient had diffuse clear vesicular lesions spread all over the body,(a) firm to palpation, on a healthy skin, suggesting miliaria crystallina. Miliaria crystallina is a benign cutaneous manifestation due to sweat retention secondary to obstruction of the sweat ducts. It is possible to distinguish between miliaria crystallina due to the obstruction in the stratum corneum, miliaria rubra due to the obstruction within the malpighian stratum and miliaria profunda due to an obstrusction in or below the dermoepidermal junction, depending on the level of obstruction. Miliaria crystallina heals spontaneously in a few hours giving rise to a desquamation, as occurred in our patient after regression of febrile syndrome.

Multiple Cutaneous Creamy Papules and Nodules: A Case of Miliarial Gout.

BACKGROUND: Tophaceous gout is the nonarticular deposition of monosodium urate resulting from a disorder in purine metabolism that causes an elevation of serum uric acid. Cutaneous variants of tophaceous gout include papular, nodular, ulcerative, and pustular forms. OBJECTIVE: We present a case of a 67-year-old man who presented with multiple cutaneous creamy white papules and nodules. A biopsy was taken, and a diagnosis of cutaneous tophaceous gout was made. The treatment and pathophysiology are discussed. CONCLUSION: Miliarial gout is a rare form of cutaneous tophaceous gout that is treated using xanthine oxidase inhibitors such as allopurinol and febuxostat or uricosurics such as probenecid.

Rare benign tumours of the nipple.

BACKGROUND: Benign lesions of the breast in total are much more frequent than malignant ones. However, there are no epidemiologic data on the prevalence of benign or malignant tumours of the nipple, and the bibliography on benign nipple tumours in general is limited. AIMS: To present some rare cases of benign nipple tumours and review the literature. MATERIALS AND METHODS: Four cases of rare benign nipple tumours: neurofibromas, wart, leiomyoma and milium are presented. The literature search on benign nipple tumours was performed using MEDLINE, Pubmed, and Cochrane databases with limits: English language, human species and available abstract. The keyword used was 'benign nipple tumours'. RESULTS: The initial search retrieved 337 articles. The papers were reviewed and the articles that referred to benign lesions that appeared at the nipple specifically were identified. Different entities that were described included: neurofibroma, leiomyoma, milium, florid papillomatosis, syringomatous adenoma, nevoid hyperkeratosis, fibroma, pseudolymphoma and haemangioma. DISCUSSION: Differential diagnosis of benign tumours of the nipple can be demanding for the physicians. Many of the symptoms and signs like pruritus, serosanguinous discharge, lichenification, erosion and nodular enlargement are produced by either malignant or benign nipple lesions. Radiology can be unclear in the diagnosis of nipple abnormalities. CONCLUSION: Histological examination of the lesion can be the only definite answer in these cases.

Linear milia en plaque on the forearm.

A 64-year-old man presented with asymptomatic eruption on his right forearm and the dorsum of the hand present for 2 weeks. There was no history of trauma, prolonged sun exposure, or application of or contact with any substance prior to the development of lesions. He was a known hypertensive and diabetic and was taking treatment for these conditions. The rest of his history was noncontributory. On examination, multiple grouped tiny white papules were found on both normal skin and on the erythematous plaque. These papules were of almost uniform size (2-4 mm) and were notable for absence of umbilication. The erythematous plaque was roughly 15 cm in length and was extending along the ulnar border of forearm and dorsum of hand in a linear pattern (Figure 1). The surface temperature of the plaque appeared similar to the surrounding area, and the surface was studded with multiple tiny white papules. There were no lesions suggestive of chronic actinic damage in the surrounding area. The papules revealed solid whitish material on expression with a needle. The rest of the mucocutaneous examination was noncontributory. Based on clinical presentation, a diagnosis of linear milia en plaque was made.

Milia en plaque of the nose: report of a case and successful treatment with topical tretinoin.

Milia are benign, superficial keratinaceous cysts that present as fine, small white papules. Milia en plaque is a rare, challenging-to-treat variant most often seen in the posterior auricular region. A total of 9 cases of milia en plaque have been reported in the pediatric literature to date. We report a case of milia en plaque of the nose in a 7-year-old boy, a novel site of involvement in the pediatric population, and successful treatment with the use of topical tretinoin. Topical retinoids offer an effective treatment option for the management of milia en plaque in the pediatric population.

Multiple eruptive milia.

Multiple eruptive milia (MEM) is a rare skin condition characterized by sudden onset of multiple milia occurring mainly on the head, neck, and trunk. Milia are small, benign, 1- to 4-mm, white keratinous cysts. The lesions generally are asymptomatic and may arise spontaneously or secondary to a number of processes. Multiple eruptive milia are cosmetically troublesome and difficult to treat. We report the case of a 40-year-old man with an abrupt onset of MEM on the face.

The oldest new finding in atopic dermatitis: subclinical miliaria as an origin.

IMPORTANCE: In 1947, Sulzberger and colleagues published a micrograph of a blocked acrosyringium in a patient with atopic dermatitis (AD), believing that it had a large role in the disease process. Lacking appropriate probes, they could not confirm the finding. OBJECTIVE: To confirm the observations by Sulzberger et al on the blockage of sweat ducts in AD in pathologic specimens. DESIGN AND SETTING: Biopsy specimens diagnostic of various inflammatory diseases and with a secondary differential diagnosis of eczema were evaluated at an academic medical center. EXPOSURES: Evidence of ductal obstruction in each specimen was examined following staining with hematoxylin-eosin, periodic acid-Schiff, and Gram stain. MAIN OUTCOMES AND MEASURES: Comparison of biopsy specimens with control specimens and additional controls consisting of noninflamed skin. RESULTS: Using 36 biopsy specimens, this study confirmed the observations by Sulzberger et al on the blockage of sweat ducts in AD. Blocked acrosyringia were noted in each specimen on routine staining with hematoxylin-eosin. The study also confirmed the findings by earlier investigators about the blockage of sweat ducts in miliaria, showing eosinophilic material in the ducts that was positive for periodic acid-Schiff. Previous researchers also observed bacteria in the blockages, and this study demonstrated the same findings in AD, rather than miliaria. CONCLUSION AND RELEVANCE: Subclinical miliaria may be the earliest change in AD and likely initiates the process that causes intense pruritus.

Skin conditions: common skin rashes in infants.

Infants exhibit many skin rashes. Erythema toxicum neonatorum presents as erythematous macules, papules, and pustules on the face, trunk, and extremities; it typically resolves spontaneously within 1 week. Neonatal acne presents as comedones or erythematous papules on the face, scalp, chest, and back. Infantile acne is similar but starts after the neonatal period. Both conditions typically resolve spontaneously; failure to resolve within 1 year warrants evaluation for androgen excess. Neonatal cephalic pustulosis is an acne variant caused by hypersensitivity to Malassezia furfur. It is typically self-limited, but severe cases are managed with topical ketoconazole. Miliaria and milia are caused by sweat retention and present as tiny vesicles or papules; they resolve spontaneously. Contact diaper dermatitis is managed by keeping the diaper area clean and with open air exposure. Diaper dermatitis due to Candida albicans is managed with topical antifungals. Seborrheic dermatitis causes scaling on the scalp. Management involves shampooing and removing scales with a soft brush after applying mineral oil or petrolatum; severe cases are managed with tar or ketoconazole shampoo. Atopic dermatitis is related to food allergy in approximately one-third of children. Food allergy can be confirmed with oral food challenges or skin prick tests. Management includes elimination of irritants and triggers and use of low-potency topical steroids.