Review of erythroplasia of Queyrat and its treatment.

EQ (erythroplasia of Queyrat) manifests itself by single or multiple asymptomatic papules or plaques on the glans penis, or periurethrally, predominantly in uncircumcised men, age range from twenty to eighty years of age. The bright red lesions may be ulcerated. The disease progresses slowly, and the interval between onset and diagnosis may be years. The cause is unknown. Diagnosis is confirmed only by histologic examination. A therapeutic regimen of 5 per cent 5-fluorouracil cream applied to lesion(s) twice daily for four to five weeks has produced a high cure rate and maintained penile integrity and function.

Thyroid acropachy.

Thyroid acropachy (TA) developed in a 48-year-old man at least six years prior to clinically evident and symptomatic hyperthyroidism. The TA prompted a clinical workup for acromegaly on two occasions, with negative results. It usually develops after diagnosis or treatment of hyperthyroidism and usually occurs in conjunction with exophthalmos. In our patient, TA preceded the diagnosis and treatment of hyperthyroidism and was not associated with exophthalmos.

Benign lichenoid keratosis.

Forty patients (39 white, one Oriental) had an isolated asymptomatic lichenoid keratotic lesion varying from bright red to violaceous to brown. The clinical diagnoses included basal cell carcinoma, actinic keratosis, Bowen's disease, and seborrheic keratosis. Histologically, lichenoid features prevailed, often indistinguishable from those of lichen planus. Although the majority of lesions occurred in sun-exposed skin and showed histologic evidence of solar elastosis, changes typical of carcinoma in situ were absent. The correct pathologic diagnosis of benign lichenoid keratosis was initially made in only seven cases.

Sweet's syndrome in subacute cutaneous lupus erythematosus.

A 67-year-old man being treated with prednisone, 15 mg/day, for subacute cutaneous lupus erythematosus developed widespread, tender, erythematous plaques, arthralgias, and fever. Clinically, the cutaneous lesions mimicked lupus erythematosus. The diagnosis of acute febrile neutrophilic dermatosis, or Sweet's syndrome, was confirmed by histologic examination of three biopsy specimens, which revealed prominent dermal edema, extensive infiltration with intact and karyorrhectic polymorphonuclear leukocytes, and perivascular and appendiceal lymphocytes in the absence of leukocytoclastic angitis.

Unilateral palpable purpura. A manifestation of septic emboli from an infected aortofemoral bypass graft eroding the jejunum.

A 48-year-old man had a palpable purpuric eruption of the right lower extremity several years after a right aortofemoral bypass graft for obstructive atherosclerotic disease. Histologic examination revealed a leukocytoclastic angitis, and belated tissue Gram's stains disclosed clumps of Gram-negative organisms. The focus for the unilateral purpura proved to be an erosion of the jejunum by the bypass that yielded Enterobacter aerogenes on culture, as did one preoperative blood sample.

Balloon cell nevus. Summary of the clinical and histologic characteristics.

A 45-year-old man requested excision of an ordinary intradermal nevus. Histologic examination showed that it was composed entirely of balloon cells; to our knowledge, this is only the fifth such case reported.

Treatment of keratoacanthomas with intralesional fluorouracil.

Fourteen patients with 26 keratoacanthomas (KA) were treated weekly with intralesional injections of fluorouracil. Twenty-five lesions cleared in an average of three weeks (range, two to eight weeks) after an average of 2.8 injections. One KA failed to respond after five weekly injections and was excised. No recurrences or meaningful side effects were observed. It appears that treatment of KA with intralesional fluorouracil injections is a safe, effective, and convenient mode ot treatment yielding excellent cosmetic results.

Treatment of cutaneous Kaposi's sarcoma with intralesional vincristine.

A 68-year-old man had lesions of Kaposi's sarcoma that developed continually in a localized area after excisional surgery, electrosurgery, and radiotherapy of previous lesions. His lesions cleared with intralesional injections of vincristine sulfate without any systemic and only minor local side effects. Newly developed lesions, which did not occur on the sites of previous treatment, were also responsive to this form of therapy.

Localized eosinophilic fasciitis.

Two patients developed an erythematous, rock-hard induration of their forearms after strenuous physical activity. Peripheral eosinophilia was noted in one patient, but hypergammaglobulinemia was absent. Systemic corticosteroid treatment resulted in remarkable involution of the process in one patient, while the other experienced spontaneous involution. The histologic changes were those of eosinophilic fasciitis.

Collagènome perforant verruciforme.

Transepidermal elimination of foreign material or altered tissue from the dermis has been reported in the literature with increasing frequency. We recently observed a rather dramatic example of transepidermal elimination of altered collagen that seemed to fit the original description of collagènome perforant verruciforme. Although described in Europe, to our knowledge, this entity has not been reported in the American literature.

Basal cell carcinomas and basal cell carcinoma-like changes overlying dermatofibromas.

Three patients had pigmented nodular basal cell carcinomas overlying dermatofibromas and 19 patients had basal cell carcinoma-like changes. We agree with the view generally held that acanthosis, pseudoepitheliomatous hyperplasia, basal cell buddings, and hair follicle-like proliferations of basal cells represent reactive changes of a spectrum of epidermal alterations overlying dermatofibromas. Contrary to the general opinion, however, we believe that basal cell carcinoma-like changes, superficial multicentric basal cell carcinomas, and nodular basal cell carcinomas represent neoplastic changes of such a spectrum.

Postirradiation malignant fibrous histiocytoma.

A slowly growing, firm, asymptomatic tumor developed in the skin overlying the left scapula of a 72-year-old woman during a six-month period. Twenty-seven years earlier, she had radiation treatment to that site for an intraductal carcinoma of the left breast. The histopathologic diagnosis was malignant fibrous histiocytoma (MFH). The rarity of this late complication of radiation therapy is reflected by a few reports in the medical literature of cutaneous MFH as late radiation sequelae.

Allergic contact dermatitis to topical fluorouracil.

We designed a prospective and retrospective study to determine the incidence of allergic contact dermatitis to topical application of fluorouracil. Intracutaneous and epicutaneous skin tests of various fluorouracil concentrations were given to patients who were to be treated with the drug for actinic keratoses (group A) and to patients who had previously been treated with fluorouracil for actinic keratoses (group B). Six patients in group B had allergic contact dermatitis to topical fluorouracil. The common clinical characteristic of the six patients was a severe pruritic eruption at the site of fluorouracil application. Allergic contact dermatitis should be suspected in the presence of severe pruritus or a severe eczematous response in patients treated with topical fluorouracil.

Atypical fibroxanthoma masquerading as pyogenic granuloma.

An atypical fibroxanthoma on the ear of a 82-year-old man appeared clinically as a pyogenic granuloma. Histopathologically, the lesion had been interpreted as a malignant melanoma before its true nature was identified. Familiarity with this cutaneous pseudomalignant growth is essential to prevent radical surgical procedures.

Allergic contact dermatitis from topical fluorouracil.

An allergic contact dermatitis from fluorouracil developed in two patients 8 and 18 days respectively after institution of topical fluorouracil therapy. The character of the usual irritant dermatitis changed to that of an allergic dermatitis. Epicutaneous patch tests and intradermal tests with fluorourcil were reactive. Histologic specimens of positive test sites revealed the changes expected in allergic contact dermatitis. Twelve control subjects failed to react to intradermal fluorouracil tests.

Primary inoculation tuberculosis of the skin. Prosector's paronychia,.

Subsequent to an autopsy of a tuberculotic cadaver, a pathology resident presented with a painless paronychia and axillary adenopathy after surgical incision and broad-spectrum antibiotics had failed to improve his condition. Demonstration by culture of Mycobacterium tuberculosis var hominis, positive smears, and findings of acid-fast organisms in a skin biopsy specimen proved the diagnosis of tuberculosis. Conversion of a previously negative skin test permitted the diagnosis of primary inoculation tuberculosis of the skin. The disease responded well to treatment with isoniazid, rifampin, and pyridoxine hydrochloride.

Cutaneous lesions in brucellosis.

Two types of eruptions developed in a patient who had a fever of unknown origin: (1) tiny papules on the trunk and proximal extremities and (2) erythema nodosum-like deep dermal nodules on the legs. Brucella agglutinin test results were persistently negative, but B melitensis grew from the blood culture. Brucellosis should be considered in the differential diagnosis of a fever of unknown origin associated with a papular eruption with certain histologic features and/or erythema nodosum-like lesions. The histologic examination of cutaneous lesions may facilitate the diagnosis.

Cylindroma and eccrine spiradenoma coexistent in the same lesion.

Two patients complained of having a tender nodule. One patient had the nodule on the scalp and the other on the face. Each nodule contained a cylindroma and an adjacent eccrine spiradenoma. While eccrine spiradenoma is of eccrine derivation, the origin of cylindroma is controversial because of variable histochemical and enzyme histochemical findings. The presence of cylindroma and eccrine spiradenoma in one clinical nodule contributes circumstantial evidence for the similar derivation of both tumors.

Diffuse cutaneous reticulohistiocytosis.

A 65-year-old man had a diffuse, asymptomatic, cutaneous eruption of 5- to 15-mm reddish-brown, nonscaling papules in arcuate, annular, and serpiginous patterns for one year. The morphologic, light microscopic, and ultrastructural features of the skin lesions were typical of multicentric reticulohistiocytosis; however, the patient had no historic, clinical, laboratory, or roentgenographic evidence of arthritis. Spontaneous involution of the eruption occurred 17 months after onset. Several weeks later subacute myelogenous leukemia developed. The reported occurrence of isolated and multiple reticulohistiocytomas, diffuse cutaneous reticulohistiocytosis without systemic involvement, and multicentric reticulohistiocytosis with identical light microscopic and ultrastructural findings suggests that these conditions probably represent a spectrum of clinical expressions of similar etiologic and pathogenetic mechanisms.

Larva currens. Cutaneous strongyloidiasis.

Strongyloides stercoralis causes a distinctive form of cutaneous larva migrans that is recognized as larva currens. The rapid rate of intracutaneous migration, the cutaneous localization, the chronicity of recurrence, and the frequency of urticarial reaction justify its presentation as a clinically distinguishable form of creeping eruption. This clinical complex should be identified as a cutaneous sign of systemic disease.