Numerous large nodules on scalp.

The patient told us that his father had "cysts" on his body, too. This familial connection provided a clue to the diagnosis.

Hemodialysis patient with finger ulcerations.

The patient reported pain and paresthesias of his left ring finger, and his left hand was cooler than his right. An angiogram helped us recognize the cause of his symptoms.

Veterans Speak Up: Current Warnings on Skin Cancer Miss the Target, Suggestions for Improvement.

BACKGROUND: Skin cancer is the most common cancer in the world and its incidence is increasing. Veterans may have increased exposure to risk factors, but data are lacking in terms of their perceptions of skin cancer and the types of prevention strategies that might resonate with this population. OBJECTIVE: This study examines veterans' awareness of the risk factors for skin cancer and importance of sun protection and seeks to identify effective communication and educational strategies for this at-risk population. METHODS: A telephone survey was conducted of 100 veterans, who have been diagnosed with skin cancer at the Audie Murphy Veteran's Hospital in San Antonio, Texas. RESULTS: The majority of respondents' said that their skin cancer resulted from sun exposure and that the best way to prevent skin cancer was to use sunscreen. However, when asked if they believed they were at risk for being diagnosed with skin cancer, most veterans responded that they believed they were at little risk. In response to why veterans did not heed warnings about skin cancer, many replied that they believed skin cancer would not happen to them. A statistically significant increase in usage of sunscreen and sun protectant garments occurred after being diagnosed with skin cancer and education by their physicians. Doctors talking to patients was rated the most effective communication method to inform them about the risks of skin cancer, followed by education during basic training. LIMITATIONS: Recall bias is the major limitation with a retrospective survey design. DISCUSSION: Our results reveal poor patient awareness of the risks of skin cancer and the benefits of sun protection before their diagnosis. The veterans agreed that the physician-patient interaction is the best and most effective means of communication, which is evident by the significant increase in sun protection and sunscreen usage after their diagnosis. Our survey revealed that other effective communication strategies included education in basic training, the use of a veteran spokes model with skin cancer, and the use of images to emphasize the severity of the disease.

Lichen planus mimicking recalcitrant ulcerative psoriasis: when is it time to biopsy?

Hypertrophic lichen planus (LP), also known as LP verrucosus, is a rare disorder that presents as verrucous plaques, typically on the lower extremities and ankles. This variant differs from the common presentation of LP, which appears as flat, polygonal, pink-purple papules spread diffusely on the flexor wrists, trunk, shins, and dorsal aspects of the feet, frequently involving the oral mucosa. Clinically, hypertrophic LP can be confused with psoriasis and usually does not respond to therapy with biologics. We present a case of hypertrophic LP in a 42-year-old woman who had been treated extensively for psoriasis. Although the morphology and location of the hyperkeratotic plaques mimicked psoriasis, biopsy results exhibited characteristic features of hypertrophic LP, and the lesions responded to treatment with acitretin, clobetasol propionate ointment, hydroxychloroquine, and simple wound care. The hypertrophic variant of LP can be extremely challenging to differentiate from psoriasis. Physicians who treat patients with scaly plaques should think beyond psoriasis and consider the hypertrophic variant of LP as a potential diagnosis.

Letter: Adenocarcinoma of the lung associated with pityriasis rubra pilaris.

We describe a case of pityriasis rubra pilaris refractory to conventional treatment, found to be associated with an unrecognized primary adenocarcinoma of the lung. Complete resolution of the eruption followed surgical resection of the tumor.

Loose anagen hair syndrome: an underdiagnosed condition in males.

Loose anagen hair syndrome (LAHS) is a condition of sparse, short hair that is easily and painlessly extracted from the scalp. Since it was first described in the 1980s, it is considered a rare, sporadic condition found predominantly in females. Since then, there have been multiple reports of LAHS occurring in families, suggesting an autosomal dominant inheritance pattern may also be present. An autosomal dominant trait would suggest a more equal sex ratio. We report a case of a boy diagnosed with LAHS and propose that it may be underdiagnosed in males simply because of hairstyle differences between boys and girls.

If at first you don't succeed: a difficult case of Linear IgA.

We present a patient with Linear IgA who was both difficult to diagnose and treat. Numerous biopsies were needed before a positive result could be returned. Trials of multiple systemic agents failed. Eventually, a second trial of dapsone was successful and well-tolerated. The case exemplifies the determination and perseverance that is often required by both patient and physician in pursuit of symptom relief.

Poor compliance with topical corticosteroids for atopic dermatitis despite severe disease.

Electronic monitoring of adherence provides opportunities for new insights into the relationship between adherence and treatment outcomes. We report a patient who was non-adherent to treatment despite a high degree of atopic dermatitis severity. Such patients may be better managed by measures that increase adherence rather than use of more potent, potentially toxic medications.

Topical tacrolimus 0.1% improves symptoms of hand dermatitis in patients treated with a prednisone taper.

BACKGROUND: Hand dermatitis is a chronic inflammatory skin disorder for which systemic immunosuppressive therapy is often needed. Topical treatments could complement the use of systemic corticosteroids. OBJECTIVE: To evaluate symptoms of hand dermatitis in subjects treated with a prednisone taper combined with topical tacrolimus 0.1% ointment versus vehicle. METHODS: Thirty-two subjects with moderate to severe hand dermatitis were enrolled in a randomized double-blind controlled trial. Subjects received a 3-week taper of prednisone and was randomized 2:1 to apply topical tacrolimus or its vehicle twice daily for 12 weeks. Disease severity was evaluated at baseline and at 5 follow-up visits (weeks 1-14). Any occurrence of relapse was recorded by patients. RESULTS: Twenty-two of the 32 subjects (69%) had relapse of their disease. The mean time to recurrence for tacrolimus versus vehicle was 48 versus 39 days, respectively (P = .78). A greater improvement of induration (P = .003) and scaling (P = .003) for patients with tacrolimus compared to vehicle was detected, as well as subjective improvement (%) from week 1 to week 12 (P = .04) compared to vehicle. Improvement in erythema (P < .0001), fissuring (P = .0003), pruritus (P = .06), and investigator's global assessment (P < .0001) with tacrolimus was not found to exceed improvement with vehicle. LIMITATIONS: Small sample size provides limited power to detect differences in response. CONCLUSIONS: Topical tacrolimus improves induration and scaling, and there is a trend suggesting it prolongs the time to recurrence.

Comparison of different compliance behaviors in a clinical trial.

Demographics, regimen complexity, patient attitude, disease severity, and psychology determine a patient's adherence (ie, compliance) behavior. In a study of 30 patients with moderate to severe hand dermatitis, we found 2 extremes of adherence behavior: overusage and underusage. We compared these 2 patients to one patient who engaged in near-ideal usage of medication.