Skin Necrosis Due to the Extravasation of Irritant Anticancer Agents.

A 70-year-old man with malignant lymphoma was subjected to a fourth course of chemotherapy using gemcitabine and cisplatin. During the intravenous infusion of anticancer agents, pain and redness was observed at the site of insertion. The patient was subsequently treated with the strongest topical steroids and topical cooling agents. However, 2 weeks later, the affected area turned yellow, and the histopathological findings revealed skin necrosis of the entire dermis layer. It took two and a half months to cure the lesion. Close attention should be paid to the development of skin necrosis even when irritant anticancer agents such as gemcitabine and cisplatin are administered.

Perineural xanthoma associated with type 2 diabetes mellitus and hyperlipidemia.

It is well known that patients with diabetes mellitus (DM) may demonstrate skin manifestations, or dermadromes, due to disease-related metabolic, vascular, neurologic, and/or immunologic disturbances; however, the pathogenesis of some of these manifestations remains unknown. Xanthomas often are associated with increased levels of serum cholesterol and/or triglycerides and therefore can present as a dermadrome in patients with a history of uncontrolled DM and hyperlipidemia. The presence of tender lesions in this patient population can indicate a diagnosis of perineural xanthoma. We report a case of perineural xanthoma arising in a patient with type 2 DM and hyperlipidemia.

Linear IgA dermatosis: report of an infantile case and analysis of 213 cases in Japan.

A 3-year-old boy presented with multiple vesicles, showing a rosette-like arrangement around the crusts. Histopathological and immunohistochemical examinations demonstrated subepidermal blistering with neutrophilic infiltration associated with deposition of IgA, but not IgG, linearly distributed along the basement membrane zone (BMZ) of the epidermis. Indirect immunofluorescence revealed circulating antibodies (IgA class, x160) against the BMZ of guinea pig lip skin. Based on the diagnosis of linear IgA dermatosis (LAD) of childhood, administration of dexamethasone (2 mg/day) was started, and the eruptions diminished immediately. Western blot analysis using extract of the HaCaT cell as a substrate, demonstrated the corresponding antigen at 120-kDa molecular weight. There have been 213 cases of LAD reported in Japan including conference abstracts and these were studied to determine whether infantile cases differed from adult ones, and whether cases associated with IgG as well as IgA (IgA/G type), differed from the cases associated with IgA only (IgA type). IgG contributed less frequently to the infantile type (age of onset, < or =15 years) than to the adult type (age of onset, > or =16 years). Clinical appearance did not show any obvious difference between the IgA/G type and IgA type. However, three-quarters of cases showing localization of antigen to the dermal side were the IgA/G type.