Trigeminal trophic syndrome from stroke: an under-recognized central neuropathic itch syndrome.

Trigeminal trophic syndrome (TTS) is the historic name for neuropathic self-induced facial ulceration from abnormal sensory symptoms leading to uncontrolled scratching. Anatomic co-localization of sensory loss (numbness) plus neuropathic itch and pain permits painless scratching. If the itch is severe, some patients will scratch to the point of causing self-injury. Patients may be unaware or may conceal the fact that their lesions are self-induced and thus the diagnosis presents a clinical challenge. Many cases remain undiagnosed, leading to unnecessary and ineffective tests, procedures, and prescribing. We document a patient with a central cause of TTS - multiple cerebral vascular accidents - and summarize the presentation, pathogenesis, and treatment options.

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.

Erythrodermic verrucous psoriasis.

Verrucous psoriasis is characterized clinically by symmetric hypertrophic verrucous plaques on an erythematous base and histologically by overlapping features of both verrucae and psoriasis with negative human papilloma virus (HPV) studies. A 46-year-old African-American male presented with an 8-year history of extensive malodorous, symmetric, verrucous plaques manifesting as erythroderma. Biopsies showed epidermal hyperplasia and papillomatosis, parakeratosis with neutrophils, and dilated vessels in the dermal papillae. The polymerase chain reaction of lesional skin was negative for HPV DNA, and T-cell gene rearrangement was negative. The patient was diagnosed with erythrodermic verrucous psoriasis. Verrucous psoriasis is a rare presentation of psoriasis and has only been reported as a localized variant. To the authors' knowledge, erythrodermic verrucous psoriasis has not been reported. This presentation was a diagnostic and therapeutic challenge and serves to heighten the awareness of a unique variant of psoriasis.

Successful treatment of angiofibromata of tuberous sclerosis complex with rapamycin.

Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous syndrome manifesting as hamartomatous growths in multiple organs. We present two cases of patients with TSC and associated facial angiofibromata treated with topical and oral rapamycin and discuss the role for rapamycin in the treatment of these disfiguring lesions. Our patients demonstrated decreased numbers of angiofibromata and less redness with this treatment. This is the first published report on the use of topical rapamycin for the treatment of angiofibromata.

Holistic approach to treatment of intractable central neuropathic itch.

Central neuropathic itch can be a lifelong debilitating condition and treatment challenge. We report a patient with a traumatic brain injury with severe intractable pruritus who failed extensive pharmacologic and nonpharmacologic treatment but responded to a holistic approach using healing touch. We discuss the complexity of this type of neuropathic itch and present a holistic approach as an adjunct to therapy in reducing itch intensity. This case presentation along with the literature discussed suggests a therapeutic strategy for the management of complicated central neuropathic itch.