Omphaloliths: a case series and review of 29 cases in literature.

Omphaloliths are uncommon benign umbilical lesions caused by the accumulation of sebum and keratin into a stone-like concretion. Recognition of this entity can prevent unnecessary procedures and imaging studies for uncomplicated cases. We present three cases of omphaloliths from our department and review all 26 cases previously reported in the English literature with regard to modes of presentation, potential risk factors, complications, and treatment options to guide clinicians. The mean age at presentation was 48 years. Of the 29 cases, 17 (59%) were asymptomatic. Male patients presented at a younger age and were more likely to present with complications compared to females who presented at an older age with asymptomatic lesions (P=0.006). Features of patients described included dementia, hirsutism, a deep or narrow umbilicus, multiple nevi, obesity, and poor hygiene. Two patients developed overlying pyogenic granulomas. Removal of asymptomatic lesions was uncomplicated and done using forceps or following irrigation, with no recurrence. Complications, including localized abscesses and peritonitis, were associated in 41% of patients who were treated surgically; recurrence was noted in one patient. Removal of omphaloliths is recommended, once identified, to reduce risks of complications and patients should be encouraged to improve their personal hygiene.

An intensely pruritic pebbled presentation.

Lichen amyloidosis (LA) is a form of primary localized cutaneous amyloidosis (PLCA) characterized by bilateral intensely itchy domed scaly hyperkeratotic papules. Lichen amyloidosis is rare and affects men more than women. It is uncommonly seen in the western world but more prevalent in Asia. These papules most typically affect the shins and occasionally the arms and torso. Lichen amyloidosis has been reported in association with autoimmune disorders and after prolonged exfoliation and friction of affected skin. We present a 40-year-old woman with LA. In LA, the characteristic histological finding is apple-green birefringence of Congo red-stained preparations observed under polarized light. However, this is not always strongly positive, as in our patient. Other findings may include eosinophilia, periodic acid-Schiff positivity, staining with thioflavin T, and metachromasia after staining with crystal violet or methyl violet. Treatment of LA is difficult and complete clinical remission is seldom achieved. Recent trials revealed beneficial outcomes with topical calcipotriol, phototherapy, acitretin, cyclophosphamide, and laser treatments. A combination of acitretin, antihistamines, topical steroids, and hydrocolloid dressings have been beneficial in our patient with LA.

A gastronomic delight?

Flagellate dermatitis (FD) exhibits a striking clinical appearance similar to whiplash marks. General dermatologists are likely to encounter this clinical appearance as a more localized presentation of phytophotodermatosis. Jellyfish stings may also cause localized linear or FD. Chemotherapeutic agents such as bleomycin, doxorubicin, docetaxel, and trastuzumab are well-recognized causes of a widespread FD and it may more rarely be seen in connective tissue disease such as dermatomyositis or Still disease. In our case, this was a presentation of shiitake mushroom dermatitis.

Treatment of cutaneous larva migrans with a single session of carbon dioxide laser: a study of ten cases in the Philippines.

BACKGROUND: Cutaneous larva migrans (CLM) has a detrimental effect on patients' emotional and physical quality of life. Due to local unavailability of gold standard oral treatments for CLM, carbon dioxide laser was attempted. We present a case series where a single session of carbon dioxide laser treatment was associated with cessation of signs and symptoms of CLM. AIMS: The aim of this study was to assess the efficacy of a single session of carbon dioxide laser in the treatment of CLM. MATERIALS AND METHODS: Ten cases (eight patients) with CLM were treated with one session of carbon dioxide laser treatment and followed up daily for the first week with photographic documentation and then weekly for the next 3 weeks to complete a 4 week follow-up period. RESULTS: The first cases in our series, who received one to two passes of fractional CO2 laser, experienced further larval migration for 2-3 days, after which no more progression was noted. For the next seven cases, we increased the number of CO2 laser passes to 3-4, and noted no further larval migration. At the end of the 4-week follow-up period, all CO2 laser-treated areas were completely healed, leaving postinflammatory hyperpigmentation of the serpiginous track. CONCLUSION: The results of this case series indicate the efficacy of a single session of CO2 laser in treating CLM. Further studies are required to identify the minimum number of passes required to effectively control CLM.

A rapidly growing giant cutaneous horn on the chest.

BACKGROUND: A giant cutaneous horn (GCH) is a morphologic description of conical lesion with a dense, hyperkeratotic protrusion of more than 1 cm in height that resembles an animal horn but without its bony core. These can occur in association with benign, premalignant or malignant cutaneous diseases which can be determined by excision and histopathologic review of the base. A PubMed search (performed June 2015) revealed 54 cases of giant cutaneous horns in world literature. The most common site affected was the scalp followed by lip and leg. The commonest histological diagnosis found was squamous cell carcinoma followed by verruca vulgaris and trichilemmal horns. MAIN OBSERVATION: We present an 85-year-old Filipino female with a one year history of a rapidly growing skin lesion on her upper chest. This was excised fully and histological review of the base demonstrated a keratoacanthoma. CONCLUSIONS: This is the first known occurrence of a giant cutaneous horn on the chest. While giant cutaneous horns are more commonly associated with malignant lesions, differential diagnosis includes benign lesions such as keratoacanthomas. This differential can be considered in a rapidly growing lesion. Excision and histopathologic review of the base of a cutaneous horn are essential to guide potential further therapy.