Idiopathic toxic epidermal necrolysis in a pediatric patient.

Stevens-Johnson syndrome and toxic epidermal necrolysis are potentially life-threatening cutaneous diseases that are rarely seen in the pediatric population. We describe a case of a 7-year-old female who presented with fever, cough, mucosal erosions, and a widespread maculopapular eruption with flaccid bullae for 4 days. She had no sick contacts and no new medications, supplements, or vitamins. She then rapidly developed ulcerations in her oral mucosa and genital area, numerous scattered tense bullae throughout her body, and patchy areas of desquamation. Infectious disease workup revealed positivity only for Bordetella parapertussis, and she was subsequently diagnosed with idiopathic toxic epidermal necrolysis.

Extranodal Natural Killer/T-cell Lymphoma Isolated to the Leg: A Case Report.

Extranodal natural killer/T-cell lymphoma (ENKTL) is a subtype of non-Hodgkin's lymphoma, and it is exceedingly rare in North America. The "extranasal" subtype of ENKTL frequently involves the skin and typically has an aggressive course with no current standard of treatment available. In this report, we present a case of cutaneous ENKTL in an otherwise healthy middle-aged male.

Skin Lesions, Foot Drop, and Hand Contractures.

A previously healthy individual in his 20s had 3 months of annular skin lesions, with numbness and paresthesia in the affected areas. Physical examination revealed multiple tattoos, bilateral palpable thickened auricular and ulnar nerves, and claw-hand deformity; test results for rapid plasma reagin, antinuclear antibodies, rheumatoid factor, acid-fast bacilli, mycobacteria, and fungi were negative, and biopsy did not identify Mycobacterium leprae. What is the diagnosis and what would you do next?

Dietary supplements and bleeding.

An estimated one-third of US adults use herbal supplements, often without reporting that use to their physicians. These supplements can potentially alter bleeding and coagulation during surgery and when used concomitantly with anticoagulants. Our objective was to provide a comprehensive review of the evidence of bleeding risks of the most popular herbal and dietary supplements. A PubMed search and review of the literature was performed. We found that garlic and hawthorn supplementation is strongly associated with surgical bleeding independent of anticoagulants. Cordyceps sinensis, echinacea, and aloe vera are loosely associated with surgical bleeding independent of anticoagulants. In patients on anticoagulants, ginkgo biloba, chondroitin-glucosamine, melatonin, turmeric, bilberry, chamomile, fenugreek, milk thistle, and peppermint are associated with bleeding risk. No evidence was found for bleeding with these supplements independent of anticoagulants. Fish oil, ginseng, and saw palmetto are not associated with bleeding. Evidence for overall bleeding risk associated with St. John's wort, ginger, ginkgo biloba, or cranberry supplementation is conflicting. In conclusion, physicians must be aware of the potential anticoagulant effects of these supplements. It is imperative to report dietary and herbal supplement usage to physicians and is best to discontinue nonessential supplement use 2 weeks prior to surgery.

An unusual presentation of eruptive syringomas on the neck.

Dermatologic manifestations can be the initial signs of a systemic disease, and a thorough investigation may be warranted to rule out a life-altering diagnosis. We present a case of an 11-year-old boy with a concurrent presentation of eruptive syringomas and juxtaclavicular beaded lines on his neck. While a biopsy confirmed the benign diagnosis, the initial presentation led to a concerning differential including pseudoxanthoma elasticum and warranted a complete investigation.

Alopecia universalis and onychodystrophy during treatment with adalimumab.

Alopecia universalis, the complete loss of body hair, during anti-tumor necrosis factor-alpha (TNF-α) biologic therapy is a rare occurrence that has infrequently been reported in the literature. In this case, a 50-year-old man with psoriatic arthritis exhibited alopecia universalis with concomitant onychodystrophy 3 months after initiation with adalimumab. Given the role of TNF-α in the pathogenesis of alopecia areata, it would seem unlikely for anti-TNF-α drugs to induce hair loss; however, it is hypothesized that alopecia areata and its variants may not be dependent on TNF-α and that other factors must be involved. It is important to be aware of such associated adverse effects given that many patients undergo therapy with TNF-α-blocking agents.

The impact of biologic agents on health-related quality of life outcomes in patients with psoriasis.

INTRODUCTION: Psoriasis is a common, immune-mediated skin disease often associated with significant physical and psychosocial impairment. Antipsoriatic biologic agents offer patients unparalleled treatment potential in regard to greater skin clearance and overall improved quality of life. Evaluation of the therapeutic efficacy of biologic agents on the full psoriasis disease burden must account for their impact on both physical symptoms, as well as patient-reported, health-related quality of life (HRQoL) measurements. Areas covered: Results from numerous clinical trials demonstrate the significant clinical efficacy of biological agents targeting tumor necrosis factor-α (TNF-α) and the interleukin (IL)-12/23 and IL-17 immune pathways. However, relatively limited data is available evaluating their full effect on quality of life outcomes. This review will discuss the most relevant and up-to-date clinical data on HRQoL measurements related to treatment with these aforementioned biologic agents. Expert commentary: Patient-reported outcomes (i.e. Dermatology Life Quality Index) are being used with increasing frequency in clinical trials, and provide valuable information on the impact of psoriasis on numerous aspects of day-to-day living. These outcomes must also be incorporated in clinical practice, in addition to physical assessment of disease severity, treatment decisions, and therapeutic response in the psoriasis patient population.

Acute exacerbation of myasthenia gravis with topical imiquimod use.

Imiquimod activates the immune system when applied to a local area. We report a patient with a history of well-controlled myasthenia gravis who was prescribed imiquimod for lentigo maligna. Treatment was halted after 2 weeks when the patient reported itching and irritating sensations in his throat, consistent with previous myasthenia exacerbations. The symptoms improved once imiquimod use was discontinued. We advise clinicians to be cautious when prescribing imiquimod to a patient with a history of myasthenia gravis.