Eczematous reaction to IVIG for the treatment of dermatomyositis.

The use of high-dose intravenous immunoglobulin (IVIG) is an accepted therapy for patients with refractory dermatomyositis. Cases of eczematous reactions to IVIG have been reported in the literature, but to our knowledge, none in patients being treated for dermatomyositis. We report on the cases of two female patients with refractory dermatomyositis who developed pruritic, scaly pink plaques after receiving high-dose IVIG. This diffuse eczematous skin reaction to high-dose IVIG is a rare adverse event that most often occurs days after administration of therapy. Practitioners should be aware of this entity because the eczematous eruption may be extensive and can commonly worsen with subsequent re-exposure to IVIG.

One-year follow-up of dermoscopy education on the ability of medical students to detect skin cancer.

BACKGROUND: Learning skin cancer detection skills is important, yet many medical schools lack a standardized skin cancer examination (SCE) curriculum. OBJECTIVE: To determine medical students' skills in discriminating benign from malignant skin lesions on a 10-item image-based test one year after receiving a SCE intervention. METHODS: Cohort 1 received SCE teaching only. Cohort 2 received SCE teaching with dermoscopy tutorial, and a dermatoscope. The same test was given to assess students post-intervention and one year later. RESULTS: 43% (n = 145) and 38% (n = 143) of cohorts 1 and 2, respectively, participated one year later. Both cohorts improved or maintained their scores to correctly classify all lesions from post-intervention to one-year follow-up. After one year, cohort 2 maintained higher scores for successful identification of both benign and malignant lesions as compared to cohort 1. CONCLUSION: Medical students receiving a SCE intervention can improve their diagnostic skills after one year, especially with the aid of dermoscopy.

White shiny structures: dermoscopic features revealed under polarized light.

BACKGROUND: White shiny structures, including white shiny lines, white shiny areas and rosettes, are features only observed under polarized dermoscopy (PD). OBJECTIVE: To evaluate the prevalence of the varied morphologies of white shiny structures in melanoma, basal cell carcinoma (BCC), squamous cell carcinoma (SCC), actinic keratosis (AK) and lichen planus-like keratosis (LPLK). METHODS: Retrospective study using dermoscopic images of biopsy-proven melanoma, BCC, SCC, AK and LPLK. RESULTS: A total of 538 lesions were assessed under PD. One or more types of white shiny structures were observed in 38.7% of study lesions (208/538). BCCs were significantly more likely to display a combination of white shiny areas and white shiny lines (short lines and/or ill-defined strands) (31.9%; 61/191) than any other lesions (P<0.001). BCC were more likely than other lesions to have white shiny lines distributed without any organized pattern (P<0.001). Lines in melanoma were significantly more likely than other lesion types to be oriented orthogonally (P<0.001). When white shiny lines were present, melanomas were significantly more likely than other lesions to exhibit short discrete white lines (P<0.001). Rosettes were significantly more likely to be observed in actinic tumours than other lesions (P<0.001). CONCLUSION: The presence of white shiny lines of any length accompanied by white shiny areas is most suggestive of a diagnosis of BCC (P<0.001). Melanomas are more likely to display short white shiny lines in an orthogonal distribution (P<0.001) and without white shiny areas. Actinic tumours are most likely to exhibit rosettes (P<0.001).