The rope sign, a typical and yet infrequent clue.

Cutaneous granulomatous reactions are diverse, both from the clinical and the pathological perspective. Most underlying pathophysiological aspects remain elusive. Interstitial granulomatous dermatitis and palisaded neutrophilic and granulomatous dermatitis have been claimed to be reactions to systemic disorders, such as infectious, inflammatory, or neoplastic conditions. Recently, the overarching term "reactive granulomatous dermatitis" has been coined to unify both entities. We herein report two cases of reactive granulomatous dermatitis presenting with the widely known, albeit infrequent "rope sign" and provide clinicopathological correlation. The two patients included a 53-year-old woman with enlarging erythematous plaques and underlying palpable cords on both sides of trunk near axillae (rope sign), and a 51-year-old woman with personal history of rheumatoid arthritis and a palpable cord on the left aspect of the trunk. Pathological findings were compatible with reactive granulomatous dermatitis in both cases. In conclusion, the rope sign represents a strikingly infrequent but decisive diagnostic clue of reactive granulomatous dermatitis.

Dynamic ultrasound examination: a useful tool for the diagnosis of multiple muscular hernias.

Muscular hernias are an uncommon condition that typically present as subcutaneous nodules on the legs that appear or enlarge while standing or exercising. They are usually asymptomatic, although they may sometimes be tender or painful and may cause cramps, especially in athletes. Physical examination and ultrasound imaging are the key for determining the diagnosis. We present a 67-year-old woman with tender subcutaneous nodules on both lower legs in which dynamic ultrasound examination confirmed the diagnosis of muscular hernias.

Blue ears: a clue to diagnosis of alkaptonuria identified via telemedicine consultation.

Alkaptonuria is a rare autosomal recessive metabolic disorder with wide systemic involvement including pigment deposition. We present an unusual case diagnosed by an image obtained via telemedicine showing pigment deposition in the earlobe. We highlight how this clue may allow prompt diagnosis of alkaptonuria and prevent disease progression. Click https://www.wileyhealthlearning.com/#/online-courses/5da3bb51-40d1-4d42-9c4b-610d68106e25 for the corresponding questions to this CME article.

Successful treatment of knee erythromelalgia with topical oxymetazoline.

Erythromelalgia is an infrequent syndrome with a profound impact on quality of life. Its management is usually challenging and multiple treatments have been reported with variable response rates. To the best of our knowledge, we present the first case of erythromelalgia successfully treated with topical oxymetazoline.

Interstitial granulomatous dermatitis following tocilizumab, a paradoxical reaction?

Interstitial granulomatous dermatitis (IGD) is a rare dermatosis generally seen in the setting of rheumatic diseases, but also hematological disorders, internal malignances, infections, or drug induced. Herein, we report an exceptional case of an IGD with a clear chronological association with tocilizumab onset and cessation in a patient with adult-onset Still's disease. We review the granulomatous cutaneous reactions so far reported with this novel therapy: sarcoidosis, granuloma annulare, and IGD. Tocilizumab is a humanized anti-interleukin 6 receptor monoclonal antibody useful for the treatment of various systemic inflammatory disorders. Lately, it has found useful also for granulomatous diseases such as giant cell arteritis and even a promising response in IGD. Therefore, we believe our case adds the possibility of an IGD presenting as a paradoxical reaction.

Palmoplantar epidermoid cysts: two cases and brief review of the literature.

Palmoplantar epidermoid cysts can range in clinical presentation from an asymptomatic slowly enlarging mass to a painful nodule. We report two cases: an epidermoid cyst on the sole and another on the palm. This article reviews the possible etiology, diagnosis, and prognosis of palmoplantar epidermoid cysts.

Sonographic appearance of subungual squamous cell carcinoma in the hand.

Subungual squamous cell carcinoma is very rare, but it is the most frequent primary malignant tumor of the nail bed. Therefore, its diagnosis and treatment are crucial to ensure a favorable prognosis. We present the sonographic findings in a case of a subungual squamous cell carcinoma. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:212-214, 2018.

Adalimumab-related alopecia in a patient affected by psoriasis.

Alopecia induced by biological therapy is a rare side effect of this type of drugs. A total of 23 patients of psoriasiform eruptions with severe scalp involvement that induced alopecia during anti-tumor necrosis factor (anti-TNF) treatment of non-dermatological conditions have been previously reported. We present a 50-year-old man affected by plaque psoriasis that developed psoriasiform patches with alopecia over his scalp 10 months after initiating treatment with adalimumab. Punch biopsy of the alopecic area on the scalp revealed psoriasiform epidermal changes and alopecia areata-like dermal changes. Along with these findings, there was a dermal inflammatory infiltrate made up of eosinophils and plasma cells. In conclusion, scalp psoriasiform lesions with alopecia in patients treated with anti-TNF agents have been rarely reported. We describe a patient with anti-TNF therapy-related alopecia affected by psoriasis. Our patient has a peculiar histology with features of psoriasis and alopecia areata in addition to eosinophils and plasma cells. This entity may respond to topical treatment. However in patients of severe scalp involvement anti-TNF suspension should be considered.

Pilomatrixoma of the Forearm in an Elderly Male.

Pilomatrixoma or pilomatricoma is a benign adnexal neoplasm originating from the hair matrix, the inner sheath of the hair follicle, and the hair cortex. Although it is considered rare in adults, numerous cases have been documented in the literature. We present a case of an elderly male who sought consultation due to a newly appearing nodular lesion on his left forearm. Several benign and malignant entities were included in the original differential diagnosis. High-frequency ultrasonographic features suggested a cystic neoplasm with calcification and mild intralesional vascularity. Ultimately, histopathological examination confirmed the diagnosis of pilomatricoma. In this study, our aim is to review the importance of the available diagnostic tools, such as dermoscopy, and the emerging utility of cutaneous high-frequency ultrasonography. Some rarer pathological variants are also discussed, including perforating, anetodermic, bullous and pigmented pilomatricoma. We hope that exposure to these clinical, dermoscopic, ultrasonographic, and histopathological images will encourage clinicians to consider pilomatricoma in their differential diagnosis when approaching nodular lesions, regardless of location and patient's age.

Ultrasonographic features of cutaneous myxomas in a patient with Carney complex.

Carney complex is a rare genodermatosis characterized by cardiac and cutaneous myxomas, among other tumors. In the majority of cases, cutaneous myxomas precede the diagnosis of cardiac myxomas, which are the main cause of death in these patients. Despite the fact that the diagnosis of cutaneous myxomas is histopathological, high-frequency ultrasonography plays an essential role in the differential diagnosis with other cutaneous and subcutaneous tumors. The authors of the present study describe, for the first time in the literature, the ultrasonographic features of both variants of cutaneous myxomas, superficial and subcutaneous, in a patient with a Carney complex.

Syphilis in the Setting of Anti-tumor Necrosis Factor Alpha Therapy. / Sífilis en el contexto de tratamiento con anti-TNF alfa.

Inhibitors of tumor necrosis factor-alpha (anti-TNF-alpha) are widely used in different medical specialties. The main adverse effect of these agents is the increased risk of infection. We report the case of a 30-year-old man with ankylosing spondylitis who had begun receiving golimumab two weeks earlier. He presented with a 10-day history of salmon-colored lesions on trunk, palms and soles. The clinical suspicion was secondary syphilis. Treponemal and nontreponemal tests confirmed the diagnosis of syphilis. Lumbar puncture was also performed, although there was no neurological involvement, to rule out neurosyphilis. Cases of syphilis in patients in treatment with TNF-alpha inhibitors are uncommon in the literature and there are no established protocols.

Melanoma in situ and syringoma: a rare collision tumor. Clinical-pathological report of a case.

Collision or contiguous tumors, defined as two or more distinct tumors occurring at one site, are often an unexpected finding and may represent a diagnostic challenge, as clinical and histological presentations do not always coincide. Various combinations of collision tumors have been described with respect to melanocytic lesions, with the most frequently reported being the combination of nevus and basal cell carcinoma. We present an unusual case on the nose involving a melanoma in situ and a clinically-inapparent syringoma, which, to the best of our knowledge, is the first report of this combination.