Sight-threatening ocular manifestations of acute febrile neutrophilic dermatosis (Sweet's syndrome).

Sweet's syndrome is a primarily dermatologic disorder with many features of systemic inflammation. It is generally characterized by a neutrophilic dermatosis in the setting of fever and an elevated white blood cell count. Inflammation has been described to occur in many organ systems including the lung, bone, liver, spleen, brain and eye. Ocular inflammation is a well-known comorbidity that may occur in the setting of Sweet's syndrome, including conjunctivitis, episcleritis, scleritis, iritis and choroiditis, among other forms. In the current article, we have compiled a series of cases that describe three separate patients who demonstrated a rare form of ocular involvement in Sweet's syndrome, retinal vasculitis. The evidence from these three cases and other reports in recent ophthalmologic literature suggest overlapping of ocular manifestations of Sweet's syndrome and the closely related Behçet's disease. It is important to be aware of the sometimes challenging differential between these two disorders and their sight-threatening complications.

Letter: Treatment-resistant pyoderma gangrenosum.

Pyoderma gangrenosum (PG) is an uncommon neutrophilic dermatosis that can have a chronic course often leading to ulceration and extreme tenderness. Treatment is often directed toward reducing the inflammatory process to prevent progression of the ulcer and minimize pain. The mainstay of therapy is systemic corticosteroids. Other immunosuppressants have been utilized in cases of PG resistant to corticosteroids, including cyclosporine and tacrolimus. A patient with severe and recalcitrant PG was prescribed systemic corticosteroids and cyclosporine but continued to have progression of her disease warranting admission to the hospital. Her hospital course was complicated requiring hospitalization for one month. Although her health was deteriorating, her PG improved in the hospital setting with corticosteroids without concomitant cyclosporine. The patient admitted to non-compliance with her medication in the outpatient setting, attributing her behavior mainly to depression. Pyoderma gangrenosum can be recalcitrant to any form of therapy and medication non-adherence must be considered a potential cause.

Febrile ulceronecrotic Mucha-Habermann disease (pityriasis lichenoides et varioliformis acuta fulminans) presenting as Stevens-Johnson syndrome.

We present two pediatric patients with pityriasis lichenoides et varioliformis acuta fulminans whose admitting diagnosis was Stevens Johnson Syndrome. The patients were successfully treated with methotrexate and prednisone. These cases highlight the importance of early recognition and treatment of this disease to prevent further morbidity and a potentially fatal prognosis.

Asymptomatic lower lip hyperpigmentation from Laugier-Hunziker syndrome.

Laugier-Hunziker syndrome is a rare mucocutaneous pigmentary disorder. It is considered benign, but other mucocutaneous pigmentation disorders are in the differential diagnosis and should be ruled out. This report describes a woman with pigmentation of the labial mucosa of the lower lip who was successfully treated with a Q-switched 532-nm laser.

Vitamin E and allergic contact dermatitis.

Reports of vitamin E-induced allergic contact dermatitis (ACD) and frequent use of vitamin-E derivatives (tocopherol, tocopheryl linoleate, tocopherol acetate, etc) in skin care products deserves further investigation into tolerability and suitability of vitamin E in skin care preparations. A PubMed search was conducted to review the prevalence of vitamin E-induced ACD. It revealed 931 cases of vitamin E-induced ACD mainly from one large study. There were no reported deaths and only three patients required hospitalization for treatment. It appears that vitamin E-induced ACD is an uncommon phenomenon; incidence is low despite its widespread use in skin care products. Given its antioxidant and photoprotective properties, vitamin E should remain an ingredient in skin care products.

Case report: Fluocinonide-induced perioral dermatitis in a patient with psoriasis.

Topical corticosteroids are the primary treatment for psoriasis. A patient with psoriasis being treated with topical fluocinonide for lesions on the extremities developed an erythematous facial eruption consistent with perioral dermatitis. When topical agents are applied, they often end up in unintended areas. The potential for drug-induced perioral dermatitis should be considered in psoriasis patients treated with potent topical corticosteroids.