Blue ears: a clue to diagnosis of alkaptonuria identified via telemedicine consultation.

Alkaptonuria is a rare autosomal recessive metabolic disorder with wide systemic involvement including pigment deposition. We present an unusual case diagnosed by an image obtained via telemedicine showing pigment deposition in the earlobe. We highlight how this clue may allow prompt diagnosis of alkaptonuria and prevent disease progression. Click https://www.wileyhealthlearning.com/#/online-courses/5da3bb51-40d1-4d42-9c4b-610d68106e25 for the corresponding questions to this CME article.

Successful treatment of knee erythromelalgia with topical oxymetazoline.

Erythromelalgia is an infrequent syndrome with a profound impact on quality of life. Its management is usually challenging and multiple treatments have been reported with variable response rates. To the best of our knowledge, we present the first case of erythromelalgia successfully treated with topical oxymetazoline.

Adenoma of the nipple: a mimic of breast malignancy.

Adenoma of the nipple is a very uncommon benign neoplasm of lactiferous ducts. Its clinical presentation is variable and it can be easily misdiagnosed as a malignancy such as mammary Paget disease or breast intraductal carcinoma. Although dermoscopy and imaging tests such as ultrasonography or mammography can be of help, histological examination is mandatory to confirm the diagnosis. We describe the clinical, dermoscopic, and histopathological findings in a patient with nipple adenoma and discuss the clinical and histological differential diagnosis as well as the different treatment options.

Interstitial granulomatous dermatitis following tocilizumab, a paradoxical reaction?

Interstitial granulomatous dermatitis (IGD) is a rare dermatosis generally seen in the setting of rheumatic diseases, but also hematological disorders, internal malignances, infections, or drug induced. Herein, we report an exceptional case of an IGD with a clear chronological association with tocilizumab onset and cessation in a patient with adult-onset Still's disease. We review the granulomatous cutaneous reactions so far reported with this novel therapy: sarcoidosis, granuloma annulare, and IGD. Tocilizumab is a humanized anti-interleukin 6 receptor monoclonal antibody useful for the treatment of various systemic inflammatory disorders. Lately, it has found useful also for granulomatous diseases such as giant cell arteritis and even a promising response in IGD. Therefore, we believe our case adds the possibility of an IGD presenting as a paradoxical reaction.