Eosinophilic folliculitis occurring after stem cell transplant for acute lymphoblastic leukemia: a case report and review.

BACKGROUND: Eosinophilic folliculitis (EF) comprises classic eosinophilic pustular folliculitis (EPF), human immunodeficiency virus (HIV)-related EF, and infantile EPF subtypes. A fourth proposed subtype describes EF associated with hematologic malignancy. Recently, EF has occurred after bone marrow or stem cell transplantation (SCT). OBJECTIVES: We report a unique case of EF after haploidentical allogeneic SCT for acute lymphoblastic leukemia (ALL) and review the literature for similar cases. METHODS: A 56-year-old, HIV-negative ALL patient presented with an intensely pruritic papulopustular eruption. He had undergone haploidentical allogeneic SCT 65 days earlier, which he had tolerated well. Histopathology revealed a moderately dense perifollicular and perivascular lymphocytic infiltrate with many eosinophils extending from the superficial dermis to the subcutaneous fat. Fungal stains were negative. These findings were highly consistent with EF. RESULTS: Therapy with a class II topical corticosteroid ointment, oral doxepin, and emollients achieved near-resolution of the lesions within eight weeks. Transition to topical tacrolimus 0.1% ointment applied twice daily to residual lesions yielded complete clearance by 12 weeks with mild post-inflammatory hyperpigmentation. The patient's ALL remains in remission. CONCLUSIONS: A fourth proposed subtype of EF is associated with HIV-negative hematologic disease. This subtype is distinguished by a predictable timeframe to presentation and a relatively rapid response to therapy. Although EF is an important consideration in all patients with hematologic malignancy, clinically heightened suspicion is warranted during the 2-3 months after transplant.

Nodular melanoma serendipitously detected by airport full body scanners.

BACKGROUND: Nodular melanoma is the most dangerous form of melanoma and often evades early detection. METHODS: We present a frequently traveling businessman whose nodular melanoma was detected by airport full body scanners. RESULTS: For about 20 flights over 2 months, the airport full body scanners singled out an area on his left lower leg for a pat-down. Dermatologic examination discovered a nodular melanoma in this area, and after surgical excision, the man traveled without incident. CONCLUSION: This case raises the possibility of using full body imaging in the detection of melanomas, especially of the nodular subtype. In its current form, full body scanning would most likely not be sensitive or specific enough to become a recommended screening tool. Nonetheless, for travelers with areas repeatedly singled out by the machines without a known justification, airport scanners could serve as incidental free screening for suspicious nodular lesions that should prompt dermatologist referral.

Resident rounds. Part III: case report: temporary traumatic discoloration from handling moss-covered firewood.

Pattern recognition remains a valuable tool in the accurate diagnosis of dermatologic disease. A comprehensive patient history and physical examination denote cornerstones of medical evaluation, and in our specialty, dermoscopy can supplement data gathering to allocate cutaneous eruptions into appropriate categories. We present a case of acute onset palmar discoloration occurring in an otherwise healthy patient. Correct diagnosis transpired in the clinical setting with tailored questioning based on careful examination and adjunct dermatoscopic evaluation.

Ultraviolet radiation and the athlete: risk, sun safety, and barriers to implementation of protective strategies.

Ultraviolet (UV) radiation plays a pivotal role in the development of both melanoma and non-melanoma skin cancers. Numerous factors potentially place athletes at high risk for developing these cancers. Various prevention strategies ameliorate this risk, including avoiding sun exposure during peak UV exposure hours, applying sunscreen with a sun protection factor of 30 or above before participating in outdoor sports, wearing hats and sunglasses, and reducing exposure with long pants and long-sleeve shirts. The literature, however, cites several barriers to these prevention approaches, including sports' competition rules, the lack of availability of sunscreen, and the lack of information about sun safety behaviors. Sun safety education programs prove effective in getting athletes to participate in prevention strategies. This article reviews the effect of UV radiation on athletes' skin and provides sports medicine clinicians with suggestions to improve the sun safety behaviors of their athletes.

Skin conditions of baseball, cricket, and softball players.

Each year in the United States over 80 million people participate in bat-and-ball sports, for example baseball and softball. Cricket, the world's second most popular sport, is enjoyed by hundreds of millions of participants in such countries as India, Pakistan, Australia, New Zealand, Bangladesh, South Africa, West Indies, Sri Lanka, United Kingdom, and Zimbabwe. Although any player can develop skin disease as a result of participation in these bat-and-ball sports, competitive team athletes are especially prone to skin problems related to infection, trauma, allergy, solar exposure, and other causes. These diseases can produce symptoms that hinder individual athletic performance and participation. In this review, we discuss the diagnosis and best-practice management of skin diseases that can develop as a result of participation in baseball, softball, and cricket.

Skin manifestations of athletes competing in the summer olympics: what a sports medicine physician should know.

Olympic athletes are vulnerable to traumatic, environmental and infectious skin manifestations. Although dermatological complaints are frequent among Olympians, there is a scarcity of literature that reviews sports-related dermatoses among Olympic athletes. A comprehensive review of PREMEDLINE and MEDLINE searches of all available literature through to January 2011 was conducted, focusing on sports-related dermatological presentations as well as the key words 'Olympic athletes' and 'skin diseases'. Common skin conditions can be harmful and even prohibitive for competition. Common aetiologies of dermatological conditions related to sports include: skin infections with dermatophytes such as tinea pedis and tinea corporis, bacteria such as pitted keratolysis, and folliculitis and viruses such as herpes gladiatorum. Frictional dermatoses occur commonly and include athlete's nodules, jogger's itch, frictional blisters, callosities and talon noir. Trauma can cause haematomas such as auricular haematomas. Due to long training hours in the sun, many endurance athletes experience high levels of UV radiation and a higher risk for both melanoma and non-melanoma skin cancer. Pre-existing dermatoses can also be aggravated with practice and competition; in particular, atopic eczema and physical urticarias. Infrequent dermatoses are susceptible to misdiagnosis, delay in treatment and needless biopsies. This review highlights the diagnosis and management of sports-related dermatoses by the following general categories of Olympic sport: endurance, resistance, team sport, and performing arts.

Sunscreen use and availability among female collegiate athletes.

BACKGROUND: Each year more than 250,000 athletes participate on National Collegiate Athletic Association (NCAA) teams. The majority of outdoor NCAA athletes, however, do not use sunscreen on a daily basis. Previous research notes that sunscreen availability represents the main barrier to use among collegiate athletes. OBJECTIVE: We sought to explore the effect of sunscreen availability on its application among outdoor collegiate athletes. METHODS: Participants (n = 83) on NCAA Division IA female golf teams were randomized to form treatment and control groups. Treatment group players placed study-supplemented sunscreen in their golf bags and locker rooms during the study period. Both groups completed self-administered surveys at the beginning and end of the 4-week investigation. RESULTS: The athletes for whom sunscreen was placed in the locker room and bags exhibited a statistically greater use of sunscreen at the end of the study compared with the control group (P = .01). Provision of readily available sunscreen in the locker room resulted in an average of 1.13 more days per week of sunscreen use, after adjustment for baseline use (P = .008). In addition, players with ready access to sunscreen during competitions increased their reapplication, although not significantly, by nearly 20% (P = .10). Sunscreen reapplication during practice did not change for either group. LIMITATIONS: Future investigations should target a larger population of both male and female outdoor collegiate athletes. CONCLUSIONS: The application of sunscreen increased significantly when athletes had easy access to sunscreen during practice and competition. These findings highlight a major opportunity to improve sun-protective behaviors among this vulnerable population.

Aquatic sports dermatoses: part 1. In the water: freshwater dermatoses.

The first of this three-part series on water-related dermatoses involving the athlete will include sports occurring with the majority of time spent in the water. These sports include swimming, diving, scuba, snorkeling and water polo. Numerous authors have described dermatologic conditions commonly seen in swimmers. This series provides an updated and comprehensive review of these water dermatoses. In order to organize the vast number of skin conditions related to water exposure, we divided the skin conditions into groupings of infectious and organism-related dermatoses, irritant and allergic dermatoses and miscellaneous dermatoses. The vast majority of skin conditions involving the water athlete result from chemicals and microbes inhabiting each environment. When considering the effects of swimming on one's skin, it is also useful to differentiate between exposure to freshwater (lakes, ponds and swimming pools) and exposure to saltwater. This review will serve as a guide for dermatologists, sports medicine physicians and other medical practitioners in recognition and treatment of these conditions.

Aquatic sports dematoses. Part 2 - in the water: saltwater dermatoses.

The second part of this three-part series on water-related dermatoses will discuss dermatologic conditions seen in athletes exposed to saltwater. The vast majority of the following dermatoses result from contact with organisms that inhabit saltwater, including bacteria, cnidarians, and echinoderms. This review also will include other dermatoses affecting saltwater athletes and should serve as a guide for dermatologists, sports medicine physicians, and other medical practitioners in recognition and treatment of these dermatoses.

Aquatic sports dermatoses: Part 3. On the water.

The third of this three-part series on water-related sports dermatoses discusses skin changes seen in athletes who participate in sporting activities on top of or nearby water. While also susceptible to several of the freshwater and saltwater dermatoses discussed in parts one and two of the series, these athletes may present with skin changes unique to their particular sports. This updated and comprehensive review details those near-water dermatologic conditions commonly seen in sailors, rowers, fishermen, surfers, windsurfers, rafters, and water skiers, and will serve as a guide for dermatologists, sports medicine physicians and other medical practitioners in recognition and treatment of these conditions.

The psychiatric profile of patients with psychogenic excoriation.

BACKGROUND: Psychogenic excoriation describes patients who excoriate without apparent primary skin abnormality. OBJECTIVE: This study compares the psychiatric profile of patients with psychogenic excoriation with a control group. METHODS: Fifty consecutive patients with psychogenic excoriation were matched with 50 control patients and given a questionnaire related to psychiatric history. RESULTS: Study and control groups differed significantly in relation to psychiatric comorbidity, use of psychotropic drugs, history of depression, and history of bipolar disorder. Psychogenic excoriation was not associated with personal history of other psychiatric disorders or family history of psychiatric comorbidity, except alcoholism. LIMITATIONS: Nonpsychiatrists may have made the psychiatric diagnoses. CONCLUSION: Psychogenic excoriation is significantly associated with psychiatric comorbidity, especially depression and bipolar disorder. Awareness by the patient of a link between the psychiatric disorder and the cutaneous condition may help patients in dealing with the distress caused by the unknown nature of the excoriating behavior.