Psoriasiform pemphigus foliaceus: a report of two cases.

Pemphigus foliaceus (PF) represents an autoimmune blistering disease characterized by the disruption of epidermal intercellular adhesion proteins. Clinical findings include superficial crusted erosions in a seborrheic distribution; however, the disease can rarely present as an exfoliative erythroderma. Histopathologic findings include acantholysis with cleavage within the granular layer. Direct immunofluorescence studies show intercellular IgG and complement deposition. We present two patients, to our dermatology department, with a previous diagnosis of psoriasis, with an exfoliative erythroderma, which ultimately proved to be because of PF based on histopathological features, direct immunofluorescence results and levels of antibodies against desmoglein 1. Both patients responded well to oral prednisone and rituximab. This variant of PF should be entertained in both the clinical differential diagnosis of psoriasiform erythroderma and in the microscopic differential diagnosis of psoriasiform epidermal hyperplasia with focal acantholysis, particularly in patients for whom the clinical history is not classic for psoriasis or for whom conventional psoriasis therapies have not proven beneficial.

Eyelid lipomas: a case report and review of the literature.

Simple lipomas of the eyelid are rare. We present a case of a 61-year-old man, who presented with 6 months of a slowly worsening blepharoptosis. On examination, that patient was noted to have a palpable, soft mass in the medial left upper eyelid. Histopathological examination of the mass revealed mature adipose tissue most consistent with lipoma. Simple lipomas of the eyelid are very unusual but should be considered in the differential diagnosis of patients presenting with mechanical ptosis.

Fibroepithelioma of Pinkus induced by radiotherapy.

Fibroepithelioma of Pinkus (FEP) is a rare cutaneous neoplasm. Evidence supports classification as a variant of either basal cell carcinoma (BCC) or trichoblastoma. Reports of FEP arising in sites of preceding radiation therapy have been documented in the literature, but the relationship between radiotherapy and the development of FEP has not yet been defined. We report a case of FEP following radiation therapy for testicular cancer.

Fixed drug eruption related to ibuprofen presenting as giant bullae on the posterior thigh.

Fixed drug eruptions (FDEs), first described by Bourns in 1889, are solitary or multiple, sharply demarcated, round to oval, edematous and erythematous patches that arise after exposure to a specific medication. They can be pink to dark red to brown and can be larger than 10 cm in size. In almost a third of patients in some case series, these lesions have been reported to progress to vesicles or bullae. Fixed drug eruptions have been associated in up to 40 percent of cases with non-steroidal inflammatory drugs, including ibuprofen. We describe an interesting case of a biopsy-confirmed FDE that presented as large bullae on the posterior thigh after ibuprofen use.

Disseminated histoplasmosis mimicking secondary syphilis.

A 34-year-old, HIV-positive man living in Texas presented with a 2-week history of fever, malaise, myalgias, oral ulcers, and papules on his chest, back, face, and extremities, including the palms. Initially secondary syphilis was suspected. However, RPR was negative. Histopathologic examination revealed a lymphocytic infiltrate with numerous intra-histiocytic fungal organisms. GMS and PAS stains were positive, consistent with the diagnosis of histoplasmosis. We report a case of disseminated histoplasmosis clinically mimicking secondary syphilis.

Evaluating the severity of dermatologic disorders.

Assessment of a patient's disease severity is an essential component of formulating therapeutic strategies. However, disorders of the skin are often not amenable to strict classification criteria, and the dermatologist relies upon personal thresholds of severity when assessing the patient's overall condition. A number of grading systems have arisen, primarily from the need for standardized end points in clinical trials; in some circumstances, these severity assessments may assist the clinician in the evaluation and treatment of dermatologic disease. In this review, we will summarize the results of available severity scores of frequently encountered dermatologic disorders and discuss their utility in the management of disease in a clinician's office.

Cutaneous leishmaniasis in Cuban immigrants to Texas who traveled through the Darién Jungle, Panama.

Cutaneous leishmaniasis is rarely seen in the United States. Four Cuban immigrants traveled along the same route at different times from Cuba to Ecuador, then northward, including through the Darién Jungle in Panama. These patients had chronic ulcerative non-healing skin lesions and were given a diagnosis of leishmaniasis.