A case of gamasoidosis associated with exposure to a wild lorikeet feeding tray.

Gamasoidosis (acariasis, avian-mite dermatitis or bird-mite dermatitis) is caused by members of the mite superfamily Dermanyssoidea. The mites lay their eggs on the nest of the birds they feed on. The also leave the nest and feed on humans if there is no bird host available. The bites result in urticated plaques and papules. Here we present a case of gamasoidosis from exposure to a wild lorikeet feeding tray.

Pyogenic granuloma in ten children treated with topical imiquimod.

Traditional therapy for pyogenic granuloma is procedural. In young children it can require a general anesthetic and may be complicated by scarring, dyspigmentation, and recurrence. We report a series of 10 children, highlighting the safety and efficacy of topical 5% Imiquimod as an alternative noninvasive treatment of pyogenic granuloma. Ten children with a mean age of 2.5 years and 10.8 week duration of facial pyogenic granuloma lesion were recruited. Treatment regime with topical Imiquimod 5% cream varied in frequency of application and duration according to clinical response. Clinical outcome in the majority of the children was satisfactory. Three had no evidence of disease and five had small hypopigmented or erythematous lesions which were continuing to improve and more acceptable then a surgical scar. One child required a prolonged treatment course, and one progressed to surgical excision when prolonged treatment failed. There were no systemic side effects noted in any of the patients and no recurrence noted with resolution sustained over an average of 9.6 months of follow-up. Imiquimod is a safe, cost-effective, and clinically effective management option in the treatment of pyogenic granuloma.

Metastatic vulval Crohn's disease and infliximab: a case report.

BACKGROUND: Metastatic vulval Crohn's disease is uncommon, and diagnosis is frequently delayed. Topical therapy is often ineffective, and systemic immunosuppressive agents are required. CASE: A 32-year-old Caucasian female with known gastrointestinal Crohn's disease presented with a 7-year history of vulvitis. Perianal biopsy demonstrated typical granulomas. Her disease was resistant to treatment with prednisone and azathioprine; however, infliximab effected good control, and she remains well on 8 weekly infusions 1 year later. CONCLUSION: Biopsy should be performed in patients with vulvitis who have Crohn's disease to rule out metastatic involvement. Infliximab was successfully used in this case to control Crohn's vulvitis.

Fatal delayed presentation of primary melanoma of the penis.

A 60-year-old man presented with a 3-week history of lethargy, anorexia, breathlessness at rest, nausea and vomiting. He had a 5-year history of an undisclosed, enlarging, pigmented mass on his penis. He refused biopsy of this lesion. Fine-needle aspirate of an enlarged inguinal lymph node histologically confirmed a diagnosis of melanoma and widespread metastases were demonstrated by radiological imaging. The patient succumbed to disease within 8 days of diagnosis. Primary penile melanoma, albeit rare, is an important and sensitive dermatological problem, often leading to delayed presentation.

New therapeutic applications for the anticoagulant, activated protein C.

BACKGROUND: Activated protein C (APC) is derived from its precursor, protein C (PC). Originally thought to be synthesised exclusively by the liver, recent reports have shown that PC is also produced by endothelial cells, smooth muscle cells, keratinocytes and some leukocytes. OBJECTIVE: To provide an update on the emerging therapeutic effects of APC. RESULTS/CONCLUSION: APC functions as an anticoagulant with cytoprotective, anti-inflammatory and antiapoptotic properties. In vitro and preclinical data have revealed that APC exerts its protective effects via an intriguing mechanism requiring endothelial protein C receptor and protease activated receptor-1. Approved as a therapeutic agent for severe sepsis, APC is emerging as a potential treatment for a number of autoimmune and inflammatory diseases including spinal cord injury, asthma, chronic wounds and possibly rheumatoid arthritis. The future therapeutic uses of APC look very promising.

Treatment of chronic leg ulcers with topical activated protein C.

BACKGROUND: The treatment of skin ulcers frequently presents a management challenge. Nonhealing wounds with poor response to conventional wound management therapy represent a significant cause of disability, affecting approximately 1% of the global population. Activated protein C is a serine protease with anticoagulant, angiogenic, and anti-inflammatory properties that has shown efficacy in patients for the treatment of severe sepsis. We report 4 cases of nonhealing lower limb skin ulcers that were treated with activated protein C. OBSERVATIONS: The study included 4 patients whose wounds were not improving despite standard wound treatment for 4 months or more. Activated protein C was applied topically to their wounds once weekly for 4 weeks. All 4 patients showed a rapid positive response to treatment that was maintained during a 4-month follow-up period. The treatment was well tolerated, with no remarkable adverse effects or complications. CONCLUSIONS: Activated protein C can stimulate wound healing in patients with skin ulcers that are refractory to conventional wound-healing therapies. The likely mechanism of action is its recognized ability to stimulate angiogenesis and reepithelialization and to inhibit inflammation. Activated protein C has potential as a therapeutic option for patients with chronic skin ulcers.