Docetaxel-induced onycholysis: the role of subungual hemorrhage and suppuration.

Nail changes are common side effects of taxane chemotherapeutic agents. Docetaxel (Taxotere) is known to cause a great incidence of nail change. Various types of nail changes have previously been reported as a result of treatment with taxanes. We describe 2 cases of severe nail changes induced by docetaxel. The patients had previously been diagnosed with breast cancer and advanced gastric cancer, respectively. During the course of treatment with docetaxel, nail changes became apparent in both patients. Initially, they complained of nail bed purpura. Subungual hematomas with hemopurulent discharge were later observed in several fingers. Drainage of the hemopurulent material occurred spontaneously in our cases, leading to onycholysis. Following drainage, the pain in the nail with subungual hemoprulent material was relieved immediately and spontaneous healing of the patients' nails was noticed after few months. Subungual hemorrhage and suppuration therefore are considered causes of onycholysis and the pain in these patients. Although systemic or topical antibiotics were not used to treat these patients, antibiotics may be also worthwhile to hasten the drainage of the subungual hematomas and suppuration in patients for quick relief of pain.

Current concepts in the immunopathogenesis of psoriasis.

There is much evidence to support the concept that psoriasis is a type 1 autoimmune disease, primarily mediated by interferon gamma and other inflammatory cytokines. There has been renewed interest in the role of components of the innate immune system, however,and it may be that overlap between the innate and acquired arms of the immune system can better explain immunopathogenesis in psoriasis. Relevant cell types, receptors, and immune mediators within these traditional boundaries of the immune system are discussed.Finally, pathogenic contributions from important psoriatic mouse models and recent genomic data using the new gene chip technology are elaborated.

A case of superficial epithelioma with sebaceous differentiation.

Superficial epithelioma with sebaceous differentiation (SESD) is a rare benign neoplasm with peculiar histopathologic characteristics, which occurs in aged skin. We report upon a case of SESD occurring on the left upper back, which histopathologically is a superficial, multilobular tumor with numerous basaloid cells mixed with sebaceous cells attached to the overlying epidermis. This case represents a solitary benign neoplasm without any associated malignancy.

A case of focal acantholytic dyskeratosis occurring on both the lip and the anal canal.

Focal acantholytic dyskeratosis has a distinctive histological pattern that is associated with various clinical expressions. It rarely occurs on the lip or the perianal area. We report a patient with focal acantholytic dyskeratosis occurring on both the upper lip and the anal canal. Histopathologically, the lesions showed hyperkeratosis, suprabasilar clefting, epidermal acantholysis and dyskeratosis. This case represents the first report of a focal acantholytic dyskeratosis occurring on both the lip and the anal canal.

Cutaneous metastatic malignant fibrous histiocytoma.

Malignant fibrous histiocytoma is the most common soft tissue sarcoma, but cutaneous metastasis of this tumor is quite rare. A 30-year-old female patient had several brownish 0.5 x 0.5-cm papules on her right ankle. Histopathologic examination revealed spindle-shaped tumor cells with cellular pleomorphism and high mitosis (5 of 10 high-power fields), suggestive of malignant fibrous histiocytoma. She had a history of left subcutaneous breast mass that was diagnosed as malignant fibrous histiocytoma 3 years earlier. We report a case of malignant fibrous histiocytoma with pleomorphism mixed with spindle-shaped cells and multinuclear giant cells, which metastasized to the skin.