An acute, ulcerative, sarcoidal tattoo reaction following SARS-CoV-2 mRNA-1273 vaccination.

Two weeks after her first dose of the SARS-CoV-2 mRNA-1273 (Moderna) vaccine, a 38-year-old woman developed acute-onset pain and ulceration within a tattoo on the distal left leg. Progressive ulceration was noted approximately one week following her second dose of the vaccine. A biopsy revealed sarcoidal granulomas and a dense neutrophilic infiltrate. Ultimately, the final diagnosis of what we have termed a "sarcoidal reaction with a Sweet-like phenomenon" was made; the patient experienced a reduction in pain and re-epithelialization of the ulcers with two weeks of the use of topical clobetasol 0.05% cream twice daily.

Aquagenic palmoplantar keratoderma.

Aquagenic palmoplantar keratoderma is an acquired condition characterized by burning and edema limited to the hands after brief immersion in water. The 3 patients described possess a striking similarity to those with transient reactive papulotranslucent acrokeratoderma. All 3 patients manifested the "hand-in-the-bucket" sign, having presented to a physician with a hand immersed in a bucket of water to more promptly demonstrate the physical findings. Aluminum chloride hexahydrate represents a potentially valuable therapeutic option for this unusual condition.

Diltiazem-induced drug eruption sparing seborrheic keratoses.

A case of a diltiazem-induced morbilliform drug eruption, which spared the circumferential margin of seborrheic keratoses, is presented. Hypotheses regarding the pathogenesis of this novel exanthem are discussed. The potential mechanisms may be immunologic involving cytokines, or due to diminished levels of prostaglandin E2, altered optical properties of the skin, mechanical pressure phenomena, or altered local vasoconstriction secondary to diltiazem itself.

Acral steatocystoma multiplex.

Steatocystoma multiplex (SM) is characterized by multiple, widespread cutaneous cystic lesions. These lesions can appear virtually anywhere on the body but are more common in areas where the pilosebaceous apparatus is well developed, such as the trunk (especially the presternal area), neck, axilla, inguinal region, scalp, and proximal extremities. We present a case of a woman with predominantly acrally located SM. To the best of our knowledge, a predominantly acral distribution has never been reported. We hypothesize that this patient's phenotype may be due to her genetic predisposition, possibly involving a familial defect in keratin 17, in combination with "ectopic" acral sebaceous follicles.

Complete remission of refractory dyshidrotic eczema with the use of radiation therapy.

Dyshidrotic eczema is a chronic, enigmatic condition that usually affects the hands and feet. Modern-technique radiation therapy using megavoltage equipment for the treatment of dyshidrotic eczema has not been described in the literature before. A dramatic clinical response to low-dose external beam radiation therapy was observed in a patient refractory to multiple forms of topical and systemic agents. Complete resolution of this severe presentation of dyshidrosis occurred within 1 month following therapy, with a durable response at 6 months. Withdrawal of oral steroids, without flare of disease, was possible after 6 weeks, with the patient remaining free of medication at the 6-month interval. Complete remission of severe dyshidrotic eczema is achievable using low-dose external beam megavoltage therapy in situations where other forms of conventional therapies have failed. Lasting remission may allow for the complete withdrawal of oral or topical agents, which may become harmful with chronic use.

Epidermal maturation arrest.

BACKGROUND: Cutaneous wound repair involves a complex and temporal integration of cytokines, formed blood components, extracellular matrix, and parenchymal cells. The normal healing process can be impeded at any step along its path by a variety of factors. OBJECTIVE: We present four cases of abnormal wound repair in patients whose defects were left to heal by second intention following Mohs micrographic surgery. In particular, these patients experienced an unusual delay in healing with an apparent arrest of epidermal maturation. RESULTS: Each appeared to respond to a topical steroid and/or ibuprofen. The intent of this therapy was to inhibit products of the arachadonic acid cascade or other cytokines that may have been hindering normal epidermal differentiation. CONCLUSION: We present four case reports, a brief review of epidermal reconstitution in wounds, and a possible explanation for why our therapy may have hastened wound repair in our patients.

Hereditary papulotranslucent acrokeratoderma.

Hereditary papulotranslucent acrokeratoderma (HPA) is a rare autosomal dominant genodermatosis, characterized by persistent, asymptomatic, yellow-white translucent papules and plaques of the hands and feet. A case of HPA is presented and the literature of this variant of punctate keratoderma is reviewed.

Acute lymphoblastic leukemia in a child with the CHIME neuroectodermal dysplasia syndrome.

The "CHIME" syndrome (MIM#280000) is a rare neuroectodermal disorder comprised of Colobomas of the eye, Heart defects, Ichthyosiform dermatosis, Mental retardation, and Ear defects. We report on the sixth child with this syndrome and the first of these to develop acute lymphoblastic leukemia at age 4 1/2 years. Her major problems included a migratory ichthyosiform dermatosis, multiple skin infections and infestations, bilateral retinal coloboma, developmental delay, seizures, infantile macrosomia, facial anomalies, a duplicated renal collecting system, and conductive hearing loss. Histologic examination of the skin demonstrated findings of an epidermal nevus with deep rete pegs, hyperkeratosis, and a markedly increased granular layer. The cause of the CHIME syndrome is unknown, but the disorder is easily recognized because of the striking phenotype. The diagnosis is important to make because of the potential for associated congenital heart disease, neurologic compromise, possible autosomal recessive inheritance, and possible association with malignancy.

Urticaria pigmentosa presenting with massive peripheral eosinophilia.

A 5-month-old Hispanic boy had a diffuse eruption and massive peripheral eosinophilia. Mastocytosis was diagnosed by skin biopsy and Giemsa stain. Other causes of eosinophilia were ruled out by bone marrow examination and negative cultures. The patient's course improved with antihistamines and the removal of mast cell degranulating agents. Clinicians need to be aware that mastocytosis should be considered in the differential diagnosis of eosinophilia.

Acquired angioedema.

Acquired angioedema (AAE) is a rare disorder that has been categorized into two forms, AAE-I and AAE-II. AAE-I is associated with other diseases, most commonly B-cell lymphoproliferative disorders. AAE-II is defined by the presence of an autoantibody directed against the C1-inhibitor molecule. Differentiating AAE-I from AAE-II is vital because different therapeutic interventions are required for each type. This review summarizes the clinical aspects, pathophysiology, and management of AAE compared with the types of hereditary angioedema.

Reticulate hyperpigmentation.

Disorders that are characterized by a reticulate pattern of pigmentation are reviewed. Dyskeratosis congenita (DKC) is the prototype of these. In addition to reticulate hyperpigmentation, mucosal leukoplakia, bone marrow dysfunction, cytogenetic instability, and a predisposition to malignancy are characteristic of DKC. The most common pattern of inheritance is X-linked, with heterozygous females showing variable expression, most likely depending on tissue-specific patterns of random X-inactivation. Other reticulate pigmentary disorders reviewed include the Naegeli-Franceschetti-Jadassohn syndrome, X-linked reticulate pigmentary disorder, dermatopathia pigmentosa reticularis, Dowling-Degos disease, dyschromatosis, confluent and reticulated papillomatosis of Gougerot and Carteaud, reticulate acropigmentation of Kitamura, and Revescz syndrome. Diagnosis, treatment, and sometimes genetic counseling remain problematic for these entities. The pathophysiology of these disorders is unknown, but will certainly be aided greatly by the future identification of the underlying genes.

Cutaneous manifestations of thyroid disease.

Cutaneous manifestations of thyroid disease are protean in nature and affect all age groups. This review focuses on normal thyroid gland physiology, specific cutaneous/thyroid lesions such as the thyroglossal duct cyst and metastatic thyroid malignancies, nonspecific cutaneous alterations of the hyperthyroid and hypothyroid states, and the numerous associations of thyroid disease with other cutaneous and/or systemic disorders.