Treatment of extensive erythema multiforme with topical gentian violet.

Topical and systemic therapies for erythema multiforme have been widely described in the literature. The pathogenesis of erythema multiforme involves increased expression of vascular endothelial growth factor resulting in the promotion of microvascular permeability and angiogenesis. Gentian violet has been shown to have antiangiogenic properties. Here, we present a case of erythema multiforme successfully treated with topical gentian violet. We report the case of a patient who presented with erythema multiforme. Prior pertinent history included diabetes mellitus type I, limiting the clinical use of systemic corticosteroids. Topical gentian violet was used to treat the cutaneous lesions. Our patient responded well to treatment with topical gentian violet with stabilization and resolution of the lesions without using systemic therapy that may pose serious side effects in the setting of other comorbidities such as diabetes mellitus type I. This case highlights the variable therapeutic options available for treatment of erythema multiforme, including topical gentian violet. While further studies are needed, this case demonstrates the antiangiogenic properties and clinical utility of topical gentian violet in the treatment of erythema multiforme.

Severity of cutaneous findings predict the presence of systemic symptoms in pediatric maculopapular cutaneous mastocytosis.

Although the prognosis of maculopapular cutaneous mastocytosis (MPCM), also referred to as urticaria pigmentosa, is often benign, clinicians lack evidence to reliably predict those at risk of associated systemic manifestations. We sought to elucidate clinical markers of disease severity to provide better treatment and prognostic information for individuals with MPCM. A retrospective chart review querying characteristics of children diagnosed with MPCM in the Emory Dermatology Clinic was performed. Follow-up was obtained through a clinical encounter or telephone interview. Linear regression was used to determine predictors of the number of MPCM-related systemic symptoms. Of 67 subjects, 57% were male, and the mean age of onset was 4.5 months. The maximum number of MPCM lesions was 1 to 10 in 16%, 11 to 30 in 33%, 31 to 50 in 25%, 51 to 100 in 6%, and more than 100 in 20% of subjects. For their MPCM lesions, 46% of subjects reported itching, 34% flushing, and 25% blistering. Reported systemic symptoms included diarrhea (22%), abdominal pain (15%), wheezing or dyspnea (13%), vomiting (10%), bone pain (10%), headaches (8%), cough (10%), rhinorrhea (8%), irritability (6%), and anaphylaxis (1.5%). In a multivariate linear regression analysis, the maximum number of MPCM lesions (p = 0.02) and the number of skin symptoms (p < 0.01) were statistically significant predictors of the number of systemic symptoms, controlling for age of onset, body sites involved, and sex. The correlation between cutaneous findings and symptomatology could aid clinicians in identifying individuals with MPCM who might warrant systemic evaluation and therapy.

Jacquet erosive diaper dermatitis: a complication of adult urinary incontinence.

Jacquet erosive diaper dermatitis is typically described as a severe irritant dermatitis of the perianal region. However, Jacquet erosive diaper dermatitis, perianal pseudoverrucous papules and nodules, and granuloma gluteale infantum/ adultorum have been regarded as discrete entities or all part of the same clinical spectrum, representing the result of chronic, severe, irritant contact dermatitis. We present a case of Jacquet erosive diaper dermatitis and a discussion of the clinical spectrum of diseases to which it belongs.

Multiple morphologically distinct cutaneous granular cell tumors occurring in a single patient.

Granular cell tumors (GCTs) typically are benign solitary tumors derived from Schwann cells. The tongue and skin are the most common sites of involvement; however, lesions also can develop in viscera such as the gastrointestinal tract. Multiple cutaneous GCTs in a single patient have been reported, with the lesions being described as subcutaneous papules, nodules, or verrucous nodules. We report the case of a patient who presented with several simultaneously occurring cutaneous GCTs with morphologically distinct clinical appearances ranging from subcutaneous nodules with no overlying epidermal alteration to exophytic moist nodules with eroded surfaces. Histopathology of several lesions was diagnostic of GCTs. This case illustrates the highly varied clinical presentation and morphology of cutaneous GCTs, even those occurring in a single patient. In addition to mimicking other benign neoplasms, GCTs may mimic other disease processes, including malignant lesions, infections, and inflammatory disorders. Skin biopsy generally is required for definitive diagnosis.

Single-day treatment for orolabial and genital herpes: a brief review of pathogenesis and pharmacology.

Herpes simplex virus (HSV) infection is a highly prevalent condition responsible for significant morbidity and occasional mortality each year. Approximately half of all patients infected by HSV will experience at least one recurrence in their lifetime. For these recurrences, traditional therapy has included both suppressive and episodic treatment with nucleoside analogs. In regards to episodic treatment, 2- to 5-day oral regimens are best studied and most commonly reported. As with any medical condition having a well-understood mechanism of action and targeted treatment, therapeutic intervention is only as effective as allowed by patient compliance. Based on these concerns, recent studies have focused on shorter, less complicated, and more affordable options. This review delineates the evidence for single-day treatments of orolabial and genital herpes. Randomized, double-blind studies of both valacyclovir and famciclovir as single-day episodic therapy for HSV have been reported in the literature. Although no head-to-head studies between the drugs have been performed, both regimens produced significant improvement in healing time and symptom resolution over placebo. Single-day therapy for HSV infection is appealing for multiple reasons. First, it simplifies the regimen, increasing likelihood of patient compliance. Additionally, it allows complete delivery of the medication at the onset of symptoms, when viral replication is highest and intervention has greatest effect. Lastly, the reduced number of pills necessary for single versus multiple day therapy decreases the overall cost of treatment per episode, an important factor in modern-day healthcare.