Diagnosing Pemphigus Foliaceus: A Rare Blistering Disease Masquerading as a Common Dermatologic Disorder.

Pemphigus foliaceus (PF) is an autoimmune dermatologic disease that typically presents with painful, superficial blisters that evolve into scaling erosions in a seborrheic distribution. This case study intends to demonstrate that due to the relative scarcity of the disease and its distribution on the body, PF can easily be misdiagnosed. We present a 43-year-old African American male that presented to the dermatology clinic with an 18-month history of non-pruritic, violaceous, scaling patches and plaques most prominent on the malar cheeks, upper chest and upper back. He had been evaluated at an outside hospital with a high suspicion for cutaneous lupus erythematosus (CLE) and seborrheic dermatitis. However, repeated biopsies revealed non-specific spongiotic dermatitis, not consistent with CLE or seborrheic dermatitis. Over the subsequent months, he received treatment for both conditions without improvement in his symptoms. When he was referred to our dermatology clinic, repeat biopsies were obtained which demonstrated acantholysis and dyskeratosis in the granular layer, consistent with PF. Direct immunofluorescence revealed intercellular IgG staining most prominent in the epidermis, also consistent with PF. Finally, enzyme-linked immunosorbent assay for anti-desmoglein 1 returned positive, confirming the diagnosis. Upon review of the previous biopsies, focal areas of acantholysis and dyskeratosis were noted in the granular layer, which would have pointed away from a diagnosis of CLE or seborrheic dermatitis if PF was included in the clinical differential diagnosis. This case serves as a reminder that when there is a discrepancy in clinical-pathologic correlation, it is important to revisit the case and consider other pathologies.

Improving Health-Related Quality of Life in Wounded Warriors: The Promising Benefits of Laser Hair Removal to the Residual Limb-Prosthetic Interface.

BACKGROUND: Wounded warriors with lower limb amputations using prosthetics commonly develop dermatologic complaints at the residual limb-prosthetic interface, which impact their health-related quality of life (HRQOL). To optimize this interface, military dermatologists routinely treat the subset of issues related to the pilosebaceous unit with laser hair removal (LHR). OBJECTIVE: To characterize the impact of residual limb skin conditions on HRQOL in wounded warriors using lower limb prosthetics before and after treatment with LHR. METHODS AND MATERIALS: Twenty wounded warriors with lower limb amputations using prosthetics were administered a validated HRQOL survey, the Skindex-16, before and after an average of 3 treatments of LHR to their residual lower limbs. Responses were statistically analyzed within the symptoms, emotions, and functioning subscales of the survey and in aggregate. RESULTS: Statistically significant (p < .05) improvement in HRQOL was observed across the symptoms, emotions, and functioning subscales and in aggregate. CONCLUSION: Dermatologic complaints at the residual limb-prosthetic interface in patients with traumatic lower limb amputation are well-established in the literature. The authors present the first report subjectively quantifying this impact on HRQOL and the marked improvement observed with LHR to the residual limb.

Botulinum toxin: An effective treatment for prosthesis-related hyperhidrosis in patients with traumatic amputations.

Hyperhidrosis-related to prosthesis use in patients who have suffered a traumatic limb amputation presents itself as a barrier to comfort, prosthesis use and overall quality of life. This review intends to encourage dermatologists to consider the use of botulinum toxin A or B for the treatment of hyperhidrosis in the residual limb and may serve as a stimulus for a modern, in-depth, and more comprehensive study. A review of the literature was conducted using the PubMed database, focusing on hyperhidrosis treatment after traumatic limb amputation. Articles discussing hyperhidrosis treatment for amputations secondary to chronic medical conditions were excluded. Seven case studies published over the last 12 years have demonstrated positive outcomes of this treatment strategy. Overall, there is little data examining this topic and current publications focus primarily on small case series. A larger, double-blind, placebo-controlled study would likely benefit veterans, service members, and civilians.