Recurrent inverse necrotizing infundibular crystalline folliculitis.

Necrotizing infundibular crystalline folliculitis (NICF) is a rare type of necrotizing folliculitis. The disease typically manifests as folliculocentric papules arising in a seborrheic distribution. Only 23 cases exist in the literature. Most reported cases have arisen spontaneously, but a small number of drug-induced cases in the setting of epidermal-derived growth factor, vascular endothelial-derived growth factor, or PD-1 inhibitor therapy have been reported. Colonization by bacteria and/or yeast occurs frequently. The etiology remains unknown, but some suggest a complex interplay with an aberrant microbiome, sebaceous gland dysfunction, and perturbed EGFR signaling in follicular infundibula. Histopathologic findings include rupture of follicular epithelium, neutrophilic inflammation, and nodular cup-shaped crystal deposits. We present a case of spontaneous, recurrent NICF in an inverse pattern in the inguinal region.

Digital ischaemia and necrosis from oxaliplatin.

Oxaliplatin is a chemotherapeutic agent used in a variety of malignancies such as colorectal cancer and pancreatic cancer. It is a platinum derivative that results in direct cell cytotoxicity with resultant cell death. The most common side effects often noted are neurotoxicity, nausea, vomiting, diarrhoea, hepatotoxicity and myelosuppression. Oxaliplatin induced digital ischaemia and necrosis is a rare side effect that was observed in our patient. In general, digital ischaemia is a rare vascular disorder that is often associated with autoimmune disease. A patient with digital ischaemia due to oxaliplatin will be described in this case report.

Factors affecting choice of repair in Mohs micrographic surgery for non-melanoma skin cancer of the head.

BACKGROUND/OBJECTIVES: In Mohs micrographic surgery (MMS) the dermatologist serves as surgeon, pathologist and reconstructive surgeon. Analysis of the factors that play a part in determining defect size and closure type may result in better patient outcomes. The objective was to identify factors contributing to the defect size and closure method employed in MMS. METHODS: Retrospective analysis of all MMS performed for non-melanoma skin cancers (NMSC) of the head at the Skin and Cancer Foundation Australia, Westmead, between 1 January and 31 December 2007. RESULTS: Tumor size was the main factor involved in the final defect size (r2 : 0.60, P < 0.001), but the sex and age of the patient, tumour pathology, site and surgeon were also significantly associated with the final defect size. In a multivariate analysis, only sex did not remain as an independent factor. Regarding closure method, the age of the patient, defect size, site and surgeon were significantly associated, but patient's age did not remain significant in the multivariate analysis. CONCLUSION: Our study has demonstrated that the performing surgeon is a relevant factor in the determination of defect size and repair methods in MMS. The factors underlying this variability require further study as decisions on closure method should be made objectively, based on patient-related and tumour-related factors. As expected, the location and size of the defect are the other factors that determine the chosen method of repair.

An Unusual Case of Multiple Tendinous Xanthomas Involving the Extremities and the Ears.

Tendinous and subcutaneous xanthomas are nodular deposits of lipid-filled macrophages, which commonly form on the Achilles tendon, hands, feet, elbows, and knees. These nodules are frequently associated with familial hyperlipidemia, a group of diseases involving impaired cholesterol metabolism, and the accelerated development of atherosclerotic plaques. Since xanthomas may precede the diagnosis of hyperlipidemia, early identification can lead to preventative treatment that reduces the risk and morbidity of cardiovascular disease, including myocardial infarction. This case report presents a 43-year-old African-American male with multiple xanthomas involving the Achilles tendon, soles, hands, knees, elbows, and is associated with the unusual involvement of the ear.

Immune-mediated changes in actinic keratosis following topical treatment with imiquimod 5% cream.

BACKGROUND: The objective of this study was to identify the molecular processes responsible for the anti-lesional activity of imiquimod in subjects with actinic keratosis using global gene expression profiling. METHODS: A double-blind, placebo-controlled, randomized study was conducted to evaluate gene expression changes in actinic keratosis treated with imiquimod 5% cream. Male subjects (N = 17) with > or = 5 actinic keratosis on the scalp applied placebo cream or imiquimod 3 times a week on nonconsecutive days for 4 weeks. To elucidate the molecular processes involved in actinic keratosis lesion regression by imiquimod, gene expression analysis using oligonucleotide arrays and real time reverse transcriptase polymerase chain reaction were performed on shave biopsies of lesions taken before and after treatment. RESULTS: Imiquimod modulated the expression of a large number of genes important in both the innate and adaptive immune response, including increased expression of interferon-inducible genes with known antiviral, anti-proliferative and immune modulatory activity, as well as various Toll-like receptors. In addition, imiquimod increased the expression of genes associated with activation of macrophages, dendritic cells, cytotoxic T cells, and natural killer cells, as well as activation of apoptotic pathways. CONCLUSION: Data suggest that topical application of imiquimod stimulates cells in the skin to secrete cytokines and chemokines that lead to inflammatory cell influx into the lesions and subsequent apoptotic and immune cell-mediated destruction of lesions.

Chondrosarcoma of the skull base.

OBJECTIVES: Sarcomas of the skull base are challenging, potentially lethal tumors. Prognosis is considered poor. The present report reviews treatment options and presents a case of treatment with en bloc resection of the temporal bone and adjacent skull base. STUDY DESIGN: Single case report and literature review. RESULTS: Extensive skull base resection for chondrosarcoma can be performed successfully and may be curative. CONCLUSION: There is a role for en bloc resection of large areas of the skull base for treatment of chondrosarcoma. It appears that treatment combining surgery and radiation therapy is most likely to be effective.