Treatment of chromoblastomycosis due to Fonsecaea pedrosoi with low-dose terbinafine.

Chromoblastomycosis, or chromomycosis, is a chronic fungal infection of the skin and subcutaneous tissues caused by a species of dematiaceous fungi. We present a patient with chromoblastomycosis due to Fonsecaea pedrosoi, who was treated with 8 months of terbinafine 250 mg by mouth daily with histologic and mycologic cure.

Multiple fire ant stings: report of 3 cases and review of the literature.

Imported fire ant sting reactions are becoming an increasing problem in the United States. It is important for clinicians to be familiar with their possible cutaneous and noncutaneous presentations. We present 3 cases with multiple fire ant stings, followed by a review of the literature.

Use of cotton-tipped applicators during skin examination and dermatologic surgery.

The cotton-tipped applicator is a widely available and versatile tool for the dermatologist. In addition to the common uses of this inexpensive tool there are many other ways for the dermatologist to use cotton-tipped applicators. From its usefulness in dermatologic examination and potassium hydroxide preparations to its multiple surgical applications, the cotton-tipped applicator is a valuable and underrated tool.

Tretinoin-induced sticky skin: a case report and review of the literature.

Sticky skin has been reported relatively infrequently in the literature in association with etretinate and doxorubicin/ketoconazole administration. It has a poorly understood pathogenesis, and the associated histologic changes have not been described. We report a case of a patient who experienced sticky skin in areas treated with tretinoin. These reverted to normal after cessation of treatment. In comparison to a biopsy taken while the skin was not sticky, the histologic findings included a thickened, compact stratum corneum and granulosum. The basal epithelial cells showed proliferation with slight crowding and a tall, columnar shape. To our knowledge, this is the first report of sticky skin occurring in response to topical retinoid application. We suggest that the histologic changes observed could represent a modified keratin maturation profile.

Temporary ectropion due to topical fluorouracil.

A patient with multiple actinic keratoses was treated with the standard regimen of 5 percent fluorouracil cream. The patient noted bilateral ectropion within two weeks of receiving therapy. The ectropion completely resolved with discontinuation of therapy. This is the first reported case of transient ectropion associated with 5-fluorouracil therapy.

Treatment of tinea nigra with terbinafine.

We present the first reported cases of tinea nigra treated with terbinafine. Two cases responded to treatment with topical terbinafine; one case failed to respond to treatment with systemic terbinafine.

Hypersensitivity reactions to parenteral vitamin K.

Cutaneous hypersensitivity reactions to vitamin K are rare. They occur almost exclusively with fat-soluble vitamin K (K1). The lesion is most commonly a pruritic, indurated plaque at the site where the vitamin was injected. Most plaques resolve within 4 to 8 week without sequelae, but some progress to produce scar-like changes that may last for years.

Basal cell carcinoma. Choosing the best method of treatment for a particular lesion.

Basal cell carcinoma is the most common type of malignant tumor in the United States. The five types of basal cell carcinoma (noduloulcerative, pigmented, morpheaform, and superficial basal cell carcinoma, and premalignant fibroepithelioma) vary in clinical presentation and behavior. Diagnosis is made by skin biopsy. The size, type, and site of a lesion and the age and sex of the patient affect the choice of treatment. Electrodesiccation and curettage, cryosurgery, surgical excision, Mohs' surgery, and radiation therapy are available. Knowledge of these therapies and of when they should and should not be used is important in proper management of basal cell carcinoma.

Neurothekeoma in a 15-year-old boy: case report.

A 15-year-old boy experienced a rapidly enlarging nodule on his left nose. Histologic findings and immunoperoxidase stains were consistent with the diagnosis of neurothekeoma. The patient was treated with local excision local excision without evidence of recurrence.

Extensive cutaneous hyperpigmentation caused by minocycline.

A 65-year-old man had cutaneous hyperpigmentation that had occurred over the previous 2 1/2 years. The hyperpigmentation was extensive and involved the sclerae, nail beds, and total body; the palms and buttocks were spared. Clinical diagnosis was suggestive of hemochromatosis or heavy metal deposition. Histologic and electron microscopic findings were consistent with lysosomal iron deposition. A careful history showed that minocycline was the cause. Its use was discontinued, and after several years the patient's pigmentation is gradually returning to normal.

Acute periorbital mucinosis in discoid lupus erythematosus.

Periorbital edema associated with lupus erythematosus is not frequently reported. To our knowledge, periorbital edema from increased dermal mucin has not been reported with any form of lupus. We present a patient with discoid lupus exhibiting periorbital edema from massive mucinosis.

Congenital cutaneous candidiasis associated with respiratory distress and elevation of liver function tests: a case report and review of the literature.

We describe congenital cutaneous candidiasis (CCC) in a term newborn. The mother had candidal vaginitis 1 week before delivery. At birth, the infant had a generalized, intensely erythematous, papulovesicular eruption, respiratory distress and elevation of liver function tests. The child responded well to intravenous amphotericin B plus topical and oral nystatin. There have been 13 previously reported cases of CCC in infants weighing more than 1500 gm who had evidence of systemic infection. Two deaths were attributed to candidal pneumonia and sepsis. The majority of infants with CCC have infection localized to the skin, but if there is any evidence of respiratory distress or signs of sepsis the possibility of systemic candidiasis and the need for parenteral antifungal therapy must be considered.

Frequency of pre-existing actinic keratosis in cutaneous squamous cell carcinoma.

BACKGROUND: Controversy over the rate of malignant transformation of actinic keratosis (AK) into cutaneous squamous cell carcinoma (SCC) has generated considerable debate regarding the importance of treating all such precancers to preclude their transofrmation. Current changes in US healthcare policy will deny many individuals access to certain simple and effective treatment modalities for precancerous lesions. OBJECTIVE: Our purpose was to determine whether there is a significant association between the presence of cutaneous SCC and pre-existing AK. METHODS: One hundred and sixty five consecutive cases of cutaneous SCC, retrieved from the files of a university-affiliated dermatopathology laboratory serving north-central Florida, were selected for review by a single dermatopathologist (D.M.). Hematoxylin and eosin stained skin tissue slides were examined under light microscopy for the presence of AK in close proximity to, or giving rise to, cutaneous SCC. RESULTS: Of the 165 cutaneous SCC cases reviewed, 82.4% (136 out of 165) were found to have concomitant AK giving rise to and/or in close proximity to SCC. Of the 136 AK-positive SCC cases, 26.7% (44) were identified as superficial SCC arising within an AK (AKSSCC) and 55.7% (92) had AK in close proximity to SCC (AK + SCC). Close proximity is defined to include AK changes located directly adjacent to (on the shoulder of) SCC, to a maximum distance of 8 mm away. CONCLUSIONS: The 82.4% prevalence of concomitant AK and cutaneous SCC in our biopsy population suggests a strong correlation between these two lesions. The fact that 26.7% of these lesions had SCC arising from AK highlights the importance of early recognition and effective treatment for AK.

Toxic epidermal necrolysis: a review.

This article reviews the many facets of toxic epidermal necrolysis. Emphasis is placed on the importance of early diagnosis, burn unit placement, supportive care, and avoidance of systemic steroids. Discussion also includes other therapeutic options and the pathophysiology of the disease.

Multiple endocrine neoplasia type III: case report and review.

Multiple endocrine neoplasia type III (MEN 3), also known as MEN 2b, is a syndrome that may be recognized at a young age by its characteristic numerous mucosal neuromas and marfanoid habitus. These features are generally evident before the development of medullary thyroid carcinoma and pheochromocytoma, allowing for early diagnosis and intervention. Much has been learned recently in this regard to reduce morbidity and mortality. In addition, periodic screening of first-degree relatives of patients with MEN 3 has proved effective in detecting familial cases. Finally, new findings have been made regarding the etiology of MEN 3, with potentially wide-ranging implications.