Follicular mucinosis with novel dermoscopic finding: the toothpaste sign.

We describe a case of follicular mucinosis presenting with patchy alopecia affecting the eyebrows. On dermoscopy, white gelatinous material (presumed to be mucin) was visible along the hair shafts of the eyebrow lesions. We propose to call this novel dermoscopic finding the 'toothpaste sign'.

A case of mosaic Goltz syndrome (focal dermal hypoplasia) in a male patient.

We present the case of a boy with a clinical diagnosis of Goltz (focal dermal hypoplasia) syndrome. This is a rare genodermatosis characterized by widespread dysplasia of mesodermal and ectodermal tissues. It is inherited in an X-linked dominant fashion and is normally lethal in male patients. Mutations in the PORCN gene (Xp11.23), the proteins of which are key regulators in embryonic development, have been found to be responsible for the syndrome. Sequencing of the PORCN gene was negative in our patient. This case highlights some of the challenges of obtaining a molecular diagnosis in male patients with suspected Goltz syndrome in the clinical setting.

Hidradenitis suppurativa responding to treatment with infliximab.

A series of four cases of severe recalcitrant hidradenitis suppurativa treated with infliximab is presented. All patients had failed to respond to prior medical and surgical management. Baseline Quantiferon-TB Gold and chest radiograph were carried out before commencement of treatment. No patients had associated Crohn's disease. All patients received induction infusions of infliximab 5 mg/kg at weeks 0, 2 and 6, followed by eight weekly maintenance infusions. The total number of infusions varied between 4 and 6. Skin photography with Sartorius scoring was used to evaluate response to treatment. All patients experienced marked improvement in their disease activity, with a mean 48% improvement in Sartorius score after one infusion (week 2, P < 0.01), and 70% improvement after three infusions (week 14, P < 0.01). Time to relapse following cessation of therapy ranged from 6 weeks to 4 months. Further studies examining the efficacy of infliximab and its effect on the course of the disease, particularly relating to long-term management, are required.

Narrowband UVB therapy as an effective treatment for Schamberg's disease.

A 33-year-old man presented with a 3-month history of a widespread pigmented purpuric eruption over his trunk and limbs. The clinical presentation and histology were consistent with a diagnosis of Schamberg's disease. The rash initially cleared following a short course of oral prednisolone at 25 mg daily for 3 weeks, which was weaned over the subsequent 4 weeks. Topical mometasone furoate ointment 0.1% daily was also applied to active areas. The rash recurred when prednisolone was reduced to below 5 mg per day. To prevent a further recurrence with weaning prednisolone, narrowband UVB therapy was commenced three times per week. The patient was continued on UV therapy over the next 5 months. The rash would flare after 2 to 3 weeks without treatment. The frequency of UV therapy was weaned and the patient remained clear on as little as one treatment every 2 weeks. Any further reduction, however, was associated with a recurrence. Narrowband UVB therapy should be considered for difficult or persistent cases of pigmented purpuric eruption.

Simvastatin-induced rhabdomyolysis following cyclosporine treatment for uveitis.

The purpose of this study was to heighten awareness of a potentially life-threatening drug interaction in patients with chronic uveitis treated with cyclosporine. A 69-year-old female with chronic posterior uveitis was treated with cyclosporine while on concomitant oral simvastatin for hypercholesterolemia. Rhabdomyolysis developed with acute renal failure from the probable interaction between these drugs. Discontinuation of simvastatin and cyclosporine resulted in resolution of rhabdomyolysis and normalization of renal function. Statins are associated with a small, dose-related risk of myopathy, myositis, and rhabdomyolysis. Cyclosporine is a potent inhibitor of simvastatin metabolism, and may therefore facilitate simvastatin-induced rhabdomyolysis. Concomitant use of statins and cyclosporine should be avoided.