Congenital bullous syphilis in a newborn: A novel approach to diagnosis using immunohistochemical staining on a blister roof.

We describe a rare presentation of congenital bullous syphilis in a premature neonate born with extensive skin desquamation. The newborn was noted to have diffuse erythema with widespread, superficial skin desquamation in addition to plantar bullae and erosions, and an absence of mucosal involvement. Immunohistochemical syphilis diagnostic staining was performed on a blister roof, highlighting a novel diagnostic approach for congenital bullous syphilis.

Clinical, Radiologic, and Histopathologic Features that Distinguish a Pigmented Plexiform Neurofibroma from a Congenital Melanocytic Nevus.

A 13-year-old Hispanic boy with no significant medical etymology presented with a chief complaint of widespread brown macules and patches. He had a large and evenly pigmented brown patch, with a centrally located 2.2 cm × 1.2 cm soft and darkly pigmented plaque, which became more apparent with tension applied to the surrounding skin (Figure 1). The patient's mother stated that the plaque was present since birth and had increased in size over time. The clinical differential diagnoses included a congenital melanocytic nevus (CMN), a large café au lait macule (CALM), and a Becker's nevus with a congenital smooth muscle hamartoma.

Diagnosis of Mycosis Fungoides after Dupilumab Treatment for Atopic Dermatitis.

A 46-year-old woman with a medical history of pseudoxanthoma elasticum presented with atopic dermatitis (AD) refractory to topical therapies (topical steroids, tacrolimus, and calcitriol), phototherapy, and excimer laser. Dupilumab was recommended, with resolution of most of her cutaneous infection.

Bullous Amyloidosis Masquerading as Pseudoporphyria.

Amyloidosis is not a singular disease but describes a group of diseases that result from abnormalities in protein folding and metabolism, leading to ß-sheet polymers and amyloid fibrils. Cutaneous involvement is common and may occur as a primary disorder or secondary to systemic disease. Bullous skin changes, however, are rare occurrences in cutaneous amyloidosis. Bullous amyloidosis presents with characteristic histopathologic, immunohistochemical, and immunofluorescence patterns, all of which allow for careful distinction from other similar diseases. Importantly, bullous amyloidosis should prompt consideration of an underlying diagnosis of a lymphoproliferative disorder. We present the case of a woman who was diagnosed with bullous amyloidosis due to multiple myeloma after an extensive workup initially suggested other bullous diseases. We highlight the importance of recognizing this rare entity to prevent delay in diagnosis and management of its underlying cause.

Congenital onychodysplasia of the ring finger presenting as a bifid nail.

Congenital onychodysplasia, or Iso-Kikuchi syndrome, is classically defined as a congenital nail abnormality of one or both index fingers that is often associated with a bone abnormality in the affected finger. We report an unusual case of a 6-year-old girl who presented with an S-shaped, bifid nail of the left ring finger that had been present since birth. X-ray findings were used to confirm a diagnosis of congenital onychodysplasia of the ring finger.

Seeing double: annular diaper rash in twins.

We report a case of dichorionic, diamniotic twins who developed similar erythematous, annular, erosive plaques in the inguinal folds in the first few weeks of life that were refractory to topical antifungals and oral antibiotics. The twins were found to have high transaminase levels, antinuclear antibody positivity, and anti-SSS/Ro) and anti-SSB/La autoantibodies. The rash resolved without scarring by 7 months of age with the use of low-potency topical corticosteroids. We suggest that physicians consider neonatal lupus erythematosus in neonates with atypical eruptions occurring in sun-protected skin.

Life-threatening necrotizing fasciitis.

Necrotizing fasciitis is characterized by a rapidly progressing necrosis of subcutaneous fat and fascia, which can be life-threatening without prompt recognition, surgical intervention, and immediate antibiotic therapy. Necrotizing fasciitis has been subdivided into type 1, or polymicrobial necrotizing fasciitis, and type 2, or group A streptococcal necrotizing fasciitis. In addition, synonyms, such as streptococcal gangrene and "flesh-eating bacteria syndrome," have been used in the literature.

Primary carcinoid tumor of the skin.

We describe the case of a 64-year-old man with a cutaneous carcinoid tumor. Clinical investigation and diagnostic studies failed to reveal an internal primary tumor. Five cases of primary cutaneous carcinoid tumor have been reported in the literature. Interestingly, our patient had coexisting lichen planus, which has been reported previously in association with carcinoid.

Rhabdomyosarcoma arising in a giant congenital melanocytic nevus.

We report the case of a 6-week-old girl who presented with a pedunculated embryonal rhabdomyosarcoma arising in a giant congenital melanocytic nevus (GCMN) on her lower back. There was no associated leptomeningeal involvement. The patient underwent surgical resection of the rhabdomyosarcoma at age 2 months, with subsequent chemotherapy consisting of actinomycin D and vincristine. No recurrences or metastases of tumor have been noted at 5 months of age.