Stevens-Johnson syndrome limited to multiple sites of radiation therapy in a patient receiving phenobarbital.

Stevens-Johnson syndrome (SJS) is a severe cutaneous eruption that most often appears as an adverse reaction to a medication. There have been 21 reported cases of atypical erythema multiforme, toxic epidermal necrolysis, and SJS arising in patients receiving radiation therapy in addition to phenytoin, phenobarbital, or carbamazepine. We report the second case of SJS resulting from concomitant phenobarbital and radiation therapy, in which the eruption was limited to the sites of radiation, which were multiple.

A novel helix termination mutation in keratin 10 in annular epidermolytic ichthyosis, a variant of bullous congenital ichthyosiform erythroderma.

Annular epidermolytic ichthyosis is a distinct phenotypic variant of bullous congenital ichthyosiform erythroderma that has recently been described in two separate kindreds. Individuals with this variant present with bullous ichthyosis in early childhood and hyperkeratotic lichenified plaques in the flexural areas and extensor surfaces at later ages. Characteristically, they also develop intermittent bouts of annular and polycyclic, erythematous, scaly plaques on the trunk and proximal extremities. We now describe a third kindred with annular epidermolytic ichthyosis. Molecular analysis of this family revealed a novel mutation resulting in an isoleucine to threonine substitution at residue 107 (codon 446) within the highly conserved helix termination motif at the end of the rod domain of keratin 10.

Numerous eruptive lesions of panniculitis associated with group A streptococcus bacteremia in an immunocompetent child.

A previously healthy 13-month-old boy developed group A beta-hemolytic streptococcus bacteremia coinciding with numerous eruptive subcutaneous lesions primarily on his extremities. Skin biopsy revealed infectious panniculitis; gram-positive cocci were present within both fat lobules and septa. Molecular genetic analysis of an isolate from the patient's blood revealed an emm type 4 organism displaying the emm chromosomal pattern E that is characteristic of opacity factor-producing strains; the organism also harbored the gene encoding for streptococcal pyrogenic exotoxin C (speC). To our knowledge, this clinical presentation has not yet been described in the spectrum of infections directly caused by group A beta-hemolytic streptococci.

T-cell technology in the diagnosis & management of cutaneous T-cell lymphoma.

Cutaneous T-cell lymphoma (CTCL) is a malignancy of mature, clonal, helper (CD4+) T-cells that have a propensity for localizing in the skin. This article discusses the new immunologic and molecular advances and their practical application in the management of CTCL.

Preoperative assessment of the elderly patient.

Preoperative assessment of the elderly patient for surgery is vital to the success of the surgical procedure. A thorough evaluation must first begin with an understanding of the physiologic and pathophysiologic changes unique to the elderly patient and the aging skin. A complete preoperative assessment entails assessing the patient and dermatologic problem, preparing the patient and caregivers for the surgery and its expected outcomes, and highlighting issues and problems that need to be managed prior to the procedure. With the continued growth of the geriatric population, all dermatologic surgeons should be aware of the special issues related to their geriatric patients. With heightened awareness of and screening for potential pitfalls in the elderly surgical patient, adverse outcomes can be avoided.