Cutaneous sarcoidosis masquerading as chronic cutaneous lupus erythematosus - case report.

BACKGROUND: Sarcoidosis is a multisystemic granulomatous disease of unknown origin. Chronic cutaneous lupus erythematosus (CCLE) is an autoimmune disease that is associated with autoantibody production and T-cell dysfunction. Cutaneous manifestations of sarcoidosis may mimic CCLE and vice versa making it difficult to reach a diagnosis clinically. CASE PRESENTATION: We present a case of a 57-year-old woman with long-standing sarcoidosis who presented to clinic with diffuse painful plaques that were very distinct and suggestive of CCLE. She had a family history of both sarcoidosis and CCLE. The patient was immediately started on topical corticosteroids and oral hydroxychloroquine. Skin biopsy and the absence of direct immunofluorescence confirmed a skin manifestation of her previously diagnosed sarcoidosis, despite the clinical morphology favoring classic CCLE. CONCLUSION: Sarcoidosis may have diverse manifestations and may mimic other disease processes. A detailed history along with a low threshold for biopsy is important for determining a diagnosis.

Vesicular eruption in a 2-year-old boy.

A bath with scented soap prompted a flare of the boy's eczema. Days later, he was hospitalized with diffuse erosions covering 90% of his body. What was the cause?

No more pens: what the 2009 Pharmaceutical Research and Manufacturer's Association code changes really mean.

In 2002, new guidelines for interactions with the pharmaceutical industry and physicians were published as an official code of conduct. Adherence to the guidelines was voluntary, and there were no provisions for discipline to companies who did not subscribe to the code or who subscribed but did not comply. Many of the code standards are routinely violated, sometimes egregiously, with many violations on easy display at national professional meetings. In response to further problems and complaints, tougher code standards-now famous for the specific ban on logo pens and coffee cups-were adopted in 2009. Subscription to the new code is voluntary, and there are no provisions for discipline or punishment for those companies who chose not to subscribe or who may violate its standards.

"I swear!" Physician oaths and their current relevance.

Most graduating medical students will take some sort of oath that is to inspire them to take their proper place in the comradeship of physicians and remind them of their obligations to their patients, society, and their profession. The nature of these oaths has changed over the years as society itself has changed. What may be considered moral, ethical, or legal at one time can appear quaint or outrageous in another time and place. Several classic and newer oaths can be compared and contrasted in what they are tasking the newly minted physician to do.

Key opinion leaders: where they come from and how that affects the drugs you prescribe.

Key opinion leaders (KOLs), also known as thought leaders, are the experts in their field upon whom we depend for original research leading to disease understanding and new therapies. We rely on them to write the articles, author the textbooks, and give the presentations that we absorb to become better dermatologists. KOLs have become intimately entwined with the marketing of pharmaceuticals and medical devices, used not only to lend credibility to claims of efficacy and safety but also to promote anecdotal and off-label use of these medications to increase industry profits. Identification and marketing of the KOLs themselves is being done more and more often by KOL management companies who are hired by industry to turn those involved in medical education and research into efficient and productive members of the sales force.

A different kind of residency--a different kind of resident.

The military dermatologist requires a set of job skills beyond that of the civilian dermatologist. When military dermatologists complete their training, they must be prepared to function in remote locations with limited subspecialty support. Military dermatologists must be competent in the broad range of disciplines that encompass dermatology and have special expertise in tropical and environmental dermatology. They also must maintain a broad knowledge of biological and chemical agents. Three US military training programs currently exist. The largest, in San Antonio, Texas, was formed in 1996 when Wilford Hall Medical Center and Brooke Army Medical Center merged their resources and residents to create a single large program. The contributions of military dermatologists are discussed in the context of how the joint Army/Air Force program is structured to meet a broad set of needs.

Biological warfare from a dermatologic perspective.

Biological warfare agents have been used in this century by both organized armed forces and terrorist organizations. Beset with many problems that limit their tactical value on the battlefield, such "weapons of mass destruction" have tremendous terror appeal. Unusual presentations or clustering of diseases associated with biowarfare might alert the clinician that an attack has occurred. The clinical presentations, current recommended treatments, and preventive measures of agents such as anthrax, smallpox, plague, and the viral hemorrhagic fevers are discussed, as well as some of the issues that have been raised as authorities are considering how and when to resume smallpox vaccinations. References focus on current Internet web sites, which will provide up-to-date information and advice for allergists with immunization questions or who feel they might have encountered a patient with one of these diseases.

Keratosis punctata of the instep.

We present a case of keratosis punctata involving the instep of both feet in addition to palmar and plantar creases, a finding not previously reported to our knowledge. We also discuss a closely related entity, keratosis punctata palmaris et plantaris (KPPP), and why we believe our case does not simply represent a variant of keratosis punctata of the palmar creases (KPPC).

Lichen sclerosus: an atypical presentation.

We describe the case of a 66-year-old Hispanic man with an atypical presentation of lichen sclerosus (LS). The unusual presentation included bilateral axilla involvement (not previously reported to our knowledge), scrotal involvement (not common in men, despite common vulvar involvement in women), and an uncommonly thick plaque on his back.