Case Report of Onychomycosis and Tinea Corporis Due to Microsporum gypseum.

BACKGROUND: Microsporum gypseum is a geophilic dermatophyte that colonises keratinous substances in the soil. Fur-bearing animals carry this dermatophyte but are rarely infected. Human infection can be acquired from the soil, carrier or infected animals, and rarely other humans. M gypseum is an uncommon cause of cutaneous infection in humans and typically manifests as tinea corporis, tinea barbae, and tinea capitis. Onychomycosis is rarely caused by M gypseum. CASE SUMMARY: We present a case of a 32-year-old white man who presented with a red scaly rash and nail dystrophy after adopting a pet rat 10 years prior to presentation. A fungal culture of a nail clipping grew out M gypseum, and the patient was treated with terbinafine daily for 6 weeks for dystrophic onychomycosis and tinea corporis. After the 6 weeks of treatment, the erythema at the proximal nail fold and distal finger had improved but still persisted. An additional 6 weeks of terbinafine daily completely resolved the clinical manifestations of onychomycosis. CONCLUSION: The increase in incidence of M gypseum onychomycosis over the past 2 decades is thought to be due to phylogenetic evolution of the dermatophyte from soil saprophyte to a human parasite. Increasing domestication of mammals is also thought to contribute to increasing incidence. Treatment consists of an extended course of terbinafine or itraconazole.

Filiform Verrucous Sarcoidosis of the Face: A Warty Report.

Sarcoidosis is a multisystem inflammatory condition of unknown etiology. Variability in the cutaneous features of sarcoidosis is profound, and its protean manifestations affirm the condition's designation as one of dermatology's "great mimics." Cutaneous phenotypes of sarcoidosis include but are by no means limited to ichthyosiform, alopecic, erythrodermic, angiolupoid, and verrucous variants. Verrucous sarcoidosis is an exceedingly rare manifestation, and previous reports of this phenotype are limited to 15 cases. Most cases in the extant literature presented on the extremities, with clinical features mimicking that of a common wart, or as verrucous crateriform nodules, ulcers, or cutaneous horns. Only 4 previous reports of facial verrucous sarcoidosis exist in the literature, and to our knowledge, no prior cases have demonstrated filiform lesion morphology. Here we present a case of filiform verrucous sarcoidosis in an otherwise healthy, middle-aged African American man, devoid of internal organ involvement and limited to the face, histopathologically confirmed by the presence of characteristic granulomata devoid of lymphocytic infiltrates.

Extensive Cutaneous Botryomycosis With Subsequent Development of Nocardia-Positive Wound Cultures.

Botryomycosis is a rare, chronic granulomatous infection caused by a response to bacteria, most commonly Staphylococcus aureus. Cutaneous manifestations, such as subcutaneous nodules, nonhealing ulcers, or sinus tracks, typically occur following inoculation of bacteria after trauma. Drainage from the skin lesions may contain yellow grains resembling those seen in actinomycosis and nocardiosis. A 20-year-old Hispanic male presented over the course of several years with a chronic nonhealing left posterior scalp wound. A car hit the patient when he was 2 years old and injured the scalp in the location of the skin lesion. Multiple wound cultures grew methicillin-resistant Staphylococcus aureus (MRSA), and biopsies were consistent with botryomycosis. He was treated with multiple surgical debridements, skin grafts, and various courses of oral and intravenous antibiotics with slight improvement. One reason for poor response to therapy was noncompliance with long-term home antibiotics. The most recent tissue culture grew MRSA in addition to Nocardia mexicana, and he experienced improvement on linezolid and minocycline. Although it is important to exclude nocardiosis and actinomycosis when diagnosing botryomycosis, our patient was diagnosed with botryomycosis after multiple biopsies and positive MRSA cultures 2 years prior to 1 positive N mexicana culture. Our case is a unique presentation of botryomycosis in an individual who subsequently developed Nocardia-positive wound cultures.

Circumscribed palmar hypokeratosis.

Circumscribed palmar hypokeratosis (CPH) is a benign dermatologic condition characterized by local thinning of the stratum corneum. Herein, we present a 52-year-old woman who presented with an asymptomatic pink depressed papule on the right palm. This was treated with clobetasol 0.05% topically twice a day with no improvement.

Increasing Importance and Costs Associated With Publishing for Dermatology Residency Applicants.

The financial costs associated with publishing in academic journals have steadily risen in recent years, reflected by higher publishing fees and the emergence of open access (OA) publishing models. Research remains an essential part of academia and has special significance for residency applicants. Due to recent changes in some objective measures used to rank residency applicants, such as abandoning numerical United States Medical Licensing Examination (USMLE) Step 1 scores and transitioning pre-clinical grades to Pass/Fail, other objective measures have gained significance: in particular, the quality and quantity of research activities including manuscripts, abstracts, and presentations have become more important in residency applications. This has led to a significant increase in the reported number of research experiences and publications to more competitive specialties, including dermatology. Our study analyzes the current financial landscape of publishing in the field of dermatology and the financial burden placed on applicants as well as programs to meet the expected number of research experiences in order to successfully match into a dermatology residency. Through a comprehensive examination of 85 dermatology-based academic journals, we assess the costs and differences of publishing in OA and hybrid OA journals while also exploring potential avenues for mitigating the financial burden of publishing. Our findings indicate that while cost-effective options exist, the financial burden of article processing charges remains substantial.

A Rapidly Growing Forearm Pilomatricoma in an Elderly Patient.

Pilomatricoma is a benign skin tumor of epithelial hair matrix cells that typically presents as a solitary nodule on the head or upper trunk. It occurs most often in children and young adults. While considered uncommon in middle-aged and elderly patients, there are reports of elderly patients with histopathologically diagnosed pilomatricomas; however, these cases primarily occurred on the face. We present a case of an 88-year-old female with a history of non-melanoma skin cancer who presented with a new, rapidly enlarging, biopsy-proven pilomatricoma on the forearm. This case highlights a unique age of onset and location for this skin tumor, suggesting that pilomatricomas are not limited to children and young adults and should be considered in the differential diagnosis of rapidly growing skin lesions in elderly patients. Diagnosis should be confirmed with biopsy in elderly patients, as pilomatricomas may mimic malignant skin lesions.

Sebaceous Carcinoma of the Wrist in an Elderly Woman: A Case Report.

Sebaceous carcinoma is a rare, aggressive cutaneous malignancy most commonly arising from the periocular area. Extraocular locations of sebaceous carcinomas, particularly outside of the head and neck region, are rare and not well-described. We report a case of an 89-year-old Caucasian female with sebaceous carcinoma of the right wrist. She initially presented with a 1.2-centimeter friable nodule on the right wrist. Initial shave biopsy and subsequent pathologic evaluation revealed a basaloid neoplasm with sebaceous differentiation, atypia, and frequent mitoses, consistent with sebaceous carcinoma. The presented case reviews common clinical features and the pertinent histopathology of ocular and extraocular sebaceous carcinoma and provides a literature review of diagnosis, prognosis, and treatment.

Rumpel-Leede Phenomenon Following Radial Artery Catheterisation.

Rumpel-Leede phenomenon is a rarely diagnosed entity that can be seen in patients following the application of tourniquet-like forces to the extremities. This phenomenon describes petechiae and purpura secondary to venous compression and congestion, with its underlying aetiology involving the fragility of capillary vessels within the dermis. This condition is associated with chronic medical conditions such as diabetes mellitus, hypertension, dyslipidemia, peripheral vascular disease and systemic inflammatory diseases, including infections. In addition, patients with coagulopathy including thrombocytopenia or platelet dysfunction from antiplatelet use, or those with thrombotic thrombocytopenic purpura and idiopathic thrombocytopenic purpura, are predisposed to capillary haemorrhage and petechiae formation. In this report, we present a case of a patient who developed Rumpel-Leede phenomenon following catheterisation of the right radial artery with spontaneous resolution - where only five cases have been reported to date - with the aim to make clinicians aware of this condition and to avoid unnecessary interventions. LEARNING POINTS: Rumpel-Leede phenomenon is a benign condition that can be seen after tourniquet-like compression of a limb in those with capillary fragility.Dermatologists and other practitioners should remain aware of the phenomenon, helping to avoid unnecessary investigation.Rumpel-Leede phenomenon self-resolves, with only supportive treatment required with no reported lingering effects to date.

Systemic argyria with severe anemia (hemoglobin 2.4 g/L).

Argyria is a rare disease in which chronic usage of products with a high silver content leads to deposition of silver granules in organs such as the skin, resulting in a permanent blue-gray discoloration. We present a 68-year-old woman with a 10-year history of chronic anemia of unknown etiology who was admitted for progressive generalized weakness, dyspnea, and a widespread slate-gray tint to her skin. She had previously consumed 1 tablespoon per day of colloidal silver orally for 7 years. Hematologic workup on admission showed the hemoglobin to be 2.4 g/dL with low ferritin and normal copper, zinc, and ceruloplasmin, indicating an iron-deficiency anemia. Differentiating the correct etiology of her anemia and skin discoloration was crucial since argyria can cause pseudocyanosis and microcytic anemia secondary to silver-induced copper deficiency. This case highlights the importance of asking and counseling patients about their nonprescription supplements.

Generalized lichen nitidus in a 6-year-old girl with Down syndrome.

Lichen nitidus is a generally asymptomatic disease identified by shiny, flesh-colored papules that are often limited to the trunk, upper limbs, and genitalia. Here, we describe a generalized presentation of lichen nitidus in a 6-year-old girl with Down syndrome. Lichen nitidus shares a known association with Down syndrome, and several case studies document patients with Down syndrome developing generalized lichen nitidus. The extensive nature of our patient's lichen nitidus, as well as the uncommon distribution, particularly on the face, adds to the currently limited primary literature on this subject.

JAAD grand rounds quiz*: Dusky intertriginous plaques and acral erythema after bone marrow transplant.

LEARNING OBJECTIVES: At the conclusion of this learning activity, physician participants should be able to assess their own diagnostic and patient management skills and use the results of this exercise to help determine personal learning needs that can be addressed through subsequent CME involvement. Instructions for claiming CME credit appear in the front advertising section. See last page of Contents for page number. INSTRUCTIONS: In answering each question, refer to the specific directions provided. Because it is often necessary to provide information occurring later in a series that give away answers to earlier questions, please answer the questions in each series in sequence.

Stevens-Johnson syndrome with a recall-like reaction within a donor graft site.

We describe a 69-year-old white man with a recent history of a left forearm sarcoma resection treated with a split-thickness skin graft and radiotherapy who presented with cellulitis of the left forearm, for which a 2-week course of trimethoprim-sulfamethoxazole was prescribed. Ten days into treatment, he presented with flu-like symptoms and a rash. He was eventually diagnosed with Stevens-Johnson syndrome accentuated on the donor split-thickness skin graft on the left thigh region mimicking a recall reaction. There are no other reported cases of Stevens-Johnson syndrome localized within donor graft sites; therefore, this case may represent a novel form of recall reaction.

Incidental rhabdomyomatous mesenchymal hamartoma.

Rhabdomyomatous mesenchymal hamartoma (RMH) is a rare congenital tumor of the dermal and subcutaneous tissues, often presenting as a papule or a pedunculated or sessile mass at the midline on the head and neck. Although RMH is benign, some cases have reported associations with other congenital and syndromic anomalies. Thus, an accurate diagnosis is important, as an internal or systemic evaluation of the patient may be warranted. We report a case of a solitary RMH on the midline upper chest in a healthy 15-year-old girl.

Development of Terry's nails after a gastrointestinal bleed.

Terry's nails are characterized by white opacification of the nails with effacement of the lunula and distal sparing. Described originally in 1954 by Dr. Richard Terry as a common fingernail abnormality in patients with hepatic cirrhosis, Terry's nails are now a known sequelae of other conditions such as congestive heart failure, chronic kidney disease, diabetes mellitus, and malnutrition. Often all nails of the hands are affected. Treatment of the underlying disease may result in resolution. We present a case of a 77-year-old man who developed Terry's nails following an acute gastrointestinal bleed and subsequent hemorrhagic shock. The development of Terry's nails after a gastrointestinal bleed has not been previously reported.

Seborrheic dermatitis with massive facial hyperkeratosis resembling acquired ichthyosis.

Seborrheic dermatitis is a common multifactorial skin disorder favoring the scalp, ears, face, and central chest. We present a case of an elderly woman with new-onset severe seborrheic dermatitis with massive facial hyperkeratosis mimicking ichthyosis. Clinicians should be aware of rare presentations of common conditions and should screen for associated medical comorbidities in new-onset severe skin conditions.

Erythrodermic psoriasis secondary to systemic corticosteroids.

Erythroderma is an uncommon, potentially life-threatening condition, which has many causes, including uncontrolled psoriasis. We present a 58-year-old woman with psoriasis who, after an abrupt discontinuation of systemic corticosteroids, developed erythrodermic psoriasis with extensive body surface involvement requiring hospital admission. Erythrodermic psoriasis requires a high index of suspicion to diagnose it in a timely fashion and treat it to prevent complications.