Paraneoplastic pityriasis rubra pilaris as the presenting manifestation of metastatic squamous cell carcinoma.

Pityriasis rubra pilaris (PRP) is a rare idiopathic papulosquamous eruption. Few cases of PRP have been reported in association with malignancies. We report a case of an 83-year-old Caucasian male who presented with recalcitrant paraneoplastic PRP as the presenting manifestation of metastatic squamous cell carcinoma with unknown primary. Treatment with chemotherapy and radiation led to temporary radiologic and symptomatic regression of the cancer as well as resolution of cutaneous findings. This suggests a direct relationship between the PRP and the underlying malignancy in this patient. This case highlights a rare, but important phenomenon in which PRP may act as a harbinger for underlying malignancy.

Transepithelial elimination in sarcoidosis: a frequent finding.

BACKGROUND: Transepithelial elimination is a process by which dermal materials are expelled through an active epithelial-dermal connective tissue interaction. It has been described as a regular or sporadic occurrence in a variety of dermatologic conditions, including sarcoidosis. OBSERVATION: Our patient demonstrated a rare presentation of sarcoidosis involving the genital region, with histopathologic evidence of transepithelial elimination of granulomas. This prompted us to conduct the first case series documenting the frequency of transepithelial elimination in sarcoidosis. METHODS: Slides of skin biopsies from patients (n = 50) with cutaneous sarcoidosis from the University of Alabama at Birmingham were evaluated for transepithelial elimination. Transepithelial elimination was defined as epithelial channel formation with a sarcoidal-type granuloma completely surrounded by squamous epithelium on the section examined. RESULTS: Transepithelial elimination was found in 9 of 50 cases (18%). CONCLUSION: This is the first report of transepithelial elimination in a lesion of sarcoidosis localized to the vulvar area, and one of only six reports in the English literature documenting cutaneous sarcoidosis with histopathologic evidence of transepithelial elimination. These reports are reviewed herein. Surprisingly, the results from this case series indicate that transepithelial elimination is more common in cutaneous sarcoidosis than one may surmise from the current literature.

Polyarteritis nodosa in childhood: recognition of early dermatologic signs may prevent morbidity.

Systemic polyarteritis nodosa (PAN) is a vasculitis that affects small to medium-size arteries. Onset in childhood is rare and can cause significant morbidity. Often, cutaneous manifestations can provide early clues toward diagnosis. This article describes a case of childhood systemic PAN that presented with fever, a necrotic skin lesion, and oral ulceration. Intestinal perforation complicated this case. Prompt recognition of childhood PAN is important to prevent serious complications.