Linear hypopigmentation and cutaneous atrophy following intra-articular steroid injections for de Quervain's tendonitis.

Intralesional and intra-articular corticosteroids are commonly used therapies in the fields of dermatology, orthopedic surgery and rheumatology. The authors present the case of a 32-year-old female who received intra-articular corticosteroids for de Quervain's tendonitis and developed bilateral hypopigmented patches near the areas of injection. Unilateral linear extension of the hypopigmentation was subsequently noted, presumably secondary to venous or lymphatic uptake of corticosteroid crystals. The patient complained of temperature sensitivity and increased skin fragility affecting all of the hypopigmented areas. A biopsy was performed and MART-1 immunostaining revealed intact melanocytes along the dermal-epidermal junction. The mechanism of corticosteroid-induced hypopigmentation is not well understood, but this biopsy finding supports a decrease in melanocyte function rather than actual loss of melanocytes as the cause of hypopigmentation.

ILVEN-like persistent psoriasiform dermatitis confined to a congenital Becker nevus.

A 10-year-old boy presented with a 5-year history of an intractably pruritic, recalcitrant psoriasiform plaque in a broad vertical band on the left buttock, with histologic as well as clinical features suggestive of an inflammatory linear verrucous epidermal nevus. This lesion was completely superimposed upon a congenital Becker nevus. We postulate that the restricted distribution and persistence of the psoriasiform plaque reflected an inflammatory response limited to the aberrant clone of cells composing the Becker nevus, a manifestation of cutaneous mosaicism that could be characterized as an "inflammatory Becker nevus."

Tufted angioma.

A 4-month-old girl developed coalescing, red-purple, firm plaques with irregular borders and superimposed papules in the left groin. The lesions were tender to palpation and they slowly expanded and became thicker over the next year. Histopathologic evaluation showed multiple, discrete lobules of tightly packed capillaries in a 'cannonball' pattern within the dermis, which confirmed the diagnosis of tufted angioma. The clinical and histopathologic features, natural history, and treatment options for tufted angiomas are reviewed; their relationship to kaposiform hemangioendotheliomas is discussed.

"Pediatric blaschkitis": expanding the spectrum of childhood acquired Blaschko-linear dermatoses.

We describe two young children who developed relapsing, pruritic, papulovesicular eruptions in multiple bands along Blaschko lines on the neck, trunk, and extremities. Skin specimens in both revealed spongiotic dermatitis. This represents the first report of "blaschkitis" in children, providing further evidence that lichen striatus and blaschkitis are related acquired Blaschko-linear dermatoses that exist on a spectrum rather than as the childhood and adult form of a single disease entity. We highlight the features that differentiate blaschkitis from lichen striatus, review the potential roles of cutaneous mosaicism, environmental triggers, and background immunologic state in their pathogenesis, and discuss the spectrum of inflammatory dermatoses that can follow Blaschko lines.

Multiple cutaneous granular-cell tumors.

A 54-year-old woman presented with subcutaneous nodules and a prior diagnosis of multiple, cutaneous granular-cell tumors. The first case of granular cell tumor was reported in 1854. It remains a rare tumor, which is most commonly seen in women. One-half are usually located in the head and neck region, mostly on the tongue. Approximately one third are cutaneous and 25 percent of the cases occur as multiple lesions.

Hepatitis C virus infection, type III cryoglobulinemia, and necrotizing vasculitis.

A 53-year-old man with chronic hepatitis-C virus infection presented with livedo reticularis, purpura, and leg ulcers. A skin biopsy specimen showed a necrotizing vasculitis. The skin biopsy specimen and serology confirmed the diagnosis of type-III cryoglobulinemia. Bone marrow and peripheral blood showed proliferation of atypical CD5-positive B cells that included a monoclonal population. There is growing evidence that chronic hepatitis-C infection can result in immune dysregulation and expansion of autoimmune B cells that produce cryoglobulins.

Keratosis follicularis (Darier-White disease), with an unusual palmoplantar keratoderma.

A 38-year-old woman presented with widespread, hyperkeratotic papules and plaques that had been present since childhood. Her mother, brother, and son have similar lesions. A diagnosis of keratosis follicularis was made, which has been treated with isotretinoin. Palmoplantar lesions of keratosis follicularis have been described as discrete, punctate keratoses, hyperkeratotic papules, small pits, or keratin-filled depressions. This patient has an unusual palmoplantar keratoderma in association with keratosis follicularis. The lesions are elevated, discrete, filiform, hyperkeratotic spires, which coalesce into large, hyperkeratotic plaques on the palms and soles.

Acroangiodermatitis.

A 26-year-old man with a history of chronic primary lymphedema of the left lower extremity presented with elephantiasis, confluent, violaceous, mascerated plaques, and ulcers on the dorsal aspects of the toes of the left foot. Histopathologic examination showed a proliferation of small blood vessels associated with extravasated erythrocytes and hemosiderin deposits consistent with the diagnosis of acroangiodermatitis. Treatment of the focal ulcers includes compression therapy, local wound care, and surgical elimination of the shunt if there is an associated arteriovenous malformation.

Familial multiple angiolipomatosis.

An 80-year-old man presented with a 50-year history of asymptomatic, subcutaneous masses on the arms, trunk, and legs. His father and maternal grandmother had had similar lesions. Histopathologic examination showed a benign angiolipoma; the same diagnosis has been made on several previous biopsy specimens. This patient's history and physical examination support the diagnosis of familial angiolipomatosis, which is a benign, autosomal-dominant condition that may be regarded as a subtype of familial multiple lipomatosis (FML) or as a distinct entity. Management of this condition may include liposuction or surgery to reduce the tumor burden.

Folliculotropic mycosis fungoides.

A 72-year-old man presented with a 4-year history of asymptomatic erythematous plaques on his face, neck, and scalp. He had no systemic symptoms or lymphadenopathy. Histopathologic examination of a skin biopsy specimen showed a dense, diffuse infiltrate of lymphocytes and plasma cells, with epidermotropism and folliculotropism. T-cell receptor (TCR) gene rearrangement analysis performed on skin biopsy specimen showed a monoclonal cell population. A diagnosis of folliculotropic mycosis fungoides (MF) was made. This clinicopathologic variant of MF is usually associated with ordinary patch-plaque lesions. The prognosis of folliculotropic MF is best estimated using the TNM staging criteria. Many clinicians feel that this variant of MF portends a worse prognosis; however, there are no studies to support this idea. Folliculotropic MF may be more resistant to superficial therapies because of the depth of the neoplastic T-cells in the follicle.

Self-healing juvenile cutaneous mucinosis: cases highlighting subcutaneous/fascial involvement.

BACKGROUND: Self-healing juvenile cutaneous mucinosis is a rare disease affecting young people characterized by transient cutaneous lesions and sometimes mild inflammatory symptoms. The deep dermal and subcutaneous features of this disorder have not yet been well described. OBJECTIVE: The purpose of our study was to present 3 cases of self-healing juvenile cutaneous mucinosis in which the histopathologic features caused diagnostic confusion between this disorder and proliferative fasciitis. METHODS: The study includes clinical and histologic findings of 3 patients, complemented by a literature review. RESULTS: The histologic descriptions of nodular lesions in self-healing juvenile cutaneous mucinosis reveal features of proliferative fasciitis, including a myxoid stroma and gangliocyte-like giant cells. LIMITATIONS: Self-healing juvenile cutaneous mucinosis is a rare condition and has not been frequently reported in medical literature. Our findings are based on the pathologic features of 3 patients. CONCLUSIONS: Our findings further elucidate the histologic features of self-healing juvenile cutaneous mucinosis and expand the differential diagnosis for entities in which gangliocyte-like giant cells are noted.

Hypertrophic herpes simplex virus in HIV patients.

In conclusion, HSV lesions in HIV patients can present as chronic, hyperproliferative plaques as opposed to the classic acute ulcerative lesions. Knowledge of this presentation will motivate the physician to be diligent in the diagnostic workup. This may necessitate repeat biopsies and cultures. Due to the high incidence of resistant isolates, sensitivity testing and knowledge of antiviral mechanisms will facilitate treatment in an HIV patient.

Helmets prevent motorcycle injuries with significant economic benefits.

OBJECTIVE: The number of registered motorcycles in the United States has been steadily increasing, as have the number of motorcycle injuries and fatalities. The Midwest has the lowest incidence of helmet use in the country. Iowa in particular has no helmet law. MATERIALS AND METHODS: We conducted a retrospective study of the motorcycle crash victims treated at our level 1 trauma center between 2002 and 2008. Data from 713 motorcycle trauma victims were analyzed for correlations between helmet use and multiple outcome measures. RESULTS: The helmeted cases were similar to the unhelmeted cases in demographic and most crash characteristics. Unhelmeted patients suffered more severe injuries as measured by the Injury Severity Score (P < .01) and Glasgow Coma Score (P < .01) and they had lower survival probability (P = .01). The unhelmeted patients were more likely to be smokers (P < .01), to drink alcohol (P < .01), to use drugs (P < .01), and to be involved in crashes at night (P = .03). Helmeted cases suffered fewer injuries (P < .01). Helmets reduced the risk of injury to the head by at least two thirds (P < .01) and to the cervical spine by at least half (P = .03). Helmeted patients were less likely to require mechanical ventilation or intensive care or to have infections. They were discharged an average of 3 days earlier (P < .01) and were less likely to be discharged to a care facility for additional institutional care (P = .02). Total hospital cost savings exceeded $20,000 (P = .02) per helmeted patient. CONCLUSION: Helmets protect patients from head and neck injuries, which results in less severe injuries and a more benign hospital course. Helmet use results in significant inpatient cost savings plus additional care and social cost savings by reducing the need for further institutional care. We recommend legal and social measures to induce and encourage helmet use.

Postradiation sarcoma: case report and review of the potential complications of therapeutic ionizing radiation.

BACKGROUND: Radiation therapy is an acceptable treatment choice for many cutaneous malignancies. A potential late sequela of ionizing radiation is the development of secondary neoplasms within the treatment field. Although there are well-known cutaneous syndromes in which the use of ionizing radiation is contraindicated, in other clinical situations, physicians may not fully realize the risks associated with this therapeutic modality. OBJECTIVE: Through a case report presentation, a potential adverse consequence of radiation therapy will be discussed. A subsequent review of the literature should allow clinicians to better understand the potential risks of therapeutic radiation. METHODS: A case report and review of the literature are provided. RESULTS: A healthy black male with an unusual distribution of lower extremity squamous cell carcinomas in situ developed a malignant fibrous histiocytoma after radiation therapy. CONCLUSION: Postradiation sarcomas are uncommon complications of radiation therapy; however, the significant metastatic capabilities of these tumors demand that clinicians be aware of the potential risks of primary radiation therapy in the treatment of cutaneous tumors.