A case of elephantiasis nostras verrucosa treated successfully by a new type of compressive garment.

Elephantiasis nostras verrucosa (ENV) is a clinical manifestation composed of hyperkeratotic, verrucous, and papillomatous lesions and dermal fibrosis, which complicate chronic lymphedema. There is currently no cure for ENV, however, several measures have been used to reduce lymphedema and the resultant pseudoepidermal hyperplasia. Supportive dressings and compression therapy still constitute an important part of the treatment. In this report, we present a 69-year-old male patient with ENV developed due to chronic lymphedema caused by venous insufficiency. After failure of healing with conventional two- and three-layered bandages, and elastic stockings, he was successfully treated by a new type of compression garment. We recommend this user friendly garment for prevention of frictional trauma, contact dermatitis, and secondary infection, which all may complicate compression treatments.

An unusual lesion on the nose: microvenular hemangioma.

Microvenular hemangioma (MVH) is an acquired, benign type of hemangioma that usually manifests itself as a solitary, slowly growing, red to violaceous, asymptomatic papule, plaque or nodule. It is typically located on the trunk or extremities of young adults. It can be difficult to differentiate MVH from other types of hemangioma and Kaposi sarcoma. Herein we report a case of MVH unusual for its location, age of onset, and morphologic features. A 62-year-old man complained of an asymptomatic, bluish-red discoloration on the tip of his nose that had been present for two years. Dermatologic examination showed a violaceous patch 2 × 2 cm in diameter with indistinct borders. Incisional biopsy revealed irregularly branched small or medium-sized vascular spaces lined with benign endothelial cells, positive for CD34 and negative for HHV-8. MVH is a rare lesion, and less than 70 cases have been published to date. A review of 40 reported cases revealed that 15% of MVH patients were over 40 years of age and only 3% of the cases showed macules or patches. A literature survey showed only two cases of MVH located on the facial region, one on the chin and the other on the cheek. Our case was unique for its location and interesting for other rarely encountered features. MVH should be considered in the differential diagnoses of vascular lesions on nasal skin.

A rare complication of follicular hair unit extraction: Kaposi's varicelliform eruption.

Follicular hair unit extraction (FUE) is becoming a popular type of hair transplantation recently. Kaposi's varicelliform eruption (KVE) is an uncommon skin emergency due to cutaneous dissemination of several types of viruses, most notably herpes virus, over the lesions of preexisting skin disorders. A 34-year-old man visited our dermatology outpatient clinic with a blistering, itchy and tender eruption on his head and body. He had undergone follicular FUE for androgenic alopecia 12 days previously, and 5 days after the procedure, umbilicated and/or hemorrhagic vesiculopustules appeared firstly on the occipital scalp skin where the hair units were taken. The lesions had rapidly spread over the upper chest and back. After the operation, he had taken oral methylprednisolone, amoxicillin clavulanate and had used fusidic acid ointment without any benefit. Bacterial culture of the pustules yielded no microorganism, while Tzanck smear from the vesicles revealed multinuclear giant cell groups. Based on a diagnosis of KVE, we treated the patient with oral valacyclovir hydrochloride 1000 mg 3 times a day for 14 days. Symptoms cleared rapidly, pustules and vesicles dried in a few days, and re-epithelialization of the eroded areas started at the end of the first week. The reported complications of FUE include necrosis of the donor site, postoperative hyperesthesia, recipient area folliculitis, keloids, bleeding, infection and pyogenic granuloma. Up to this date there are only three reports of KVE developing just after dermatological surgery, including dermabrasion, laser resurfacing, and skin grafting. According to our knowledge, this is the first case of KVE occurring after the FUE procedure. We think that the traumatic effects and skin barrier disruption due to operation and immune alteration due to postsurgical steroid treatment might have precipitated the activation and dissemination of latent herpesvirus infection.

An Extraordinary Manifestation of Nodular Cystic Fat Necrosis.

Nodular cystic fat necrosis (NCFN) is characterized by mobile subcutaneous nodules composed of necrotic adipocytes encapsulated by fibrous tissue. The classical presentation of NCFN is solitary or multiple, up to 40, discrete nodules scattered usually on the extremities or trunk. Here, the authors present an elderly woman who developed an unusual and striking clinical picture of NCFN, two months after a fall. The patient had a large indurated plaque and subcutaneous nodule with superposing necrotic ulcers. During debridement of the ulcers, nearly 100 small nodules popped up freely along with a brownish discharge. Deep in the ulcer, the authors discovered a dislocated nail that belongs to an old hip prosthesis. Histopathological findings of the nodules were compatible with NCFN.

Acral melanoma with satellitosis, disguised as a longstanding diabetic ulcer: a great mimicry.

Acral lentiginous melanoma affects the palms, soles, and nail apparatus. Around 3-15% of all cutaneous melanomas are located on the foot and have a poorer prognosis than melanoma elsewhere. Possible reasons for this prognostic difference may be omitting this area during routine skin check by both the patient and the physicians, in addition to misdiagnosis of melanoma as other benign skin lesions. We describe here an elderly female patient treated for a non-healing foot ulcer interpreted as a diabetic ulcer, which after 2 years was diagnosed as acral melanoma with satellitosis. Histopathological examination of the amputated distal phalanx revealed an advanced stage melanoma with 1·2 cm Breslow thickness and of Clark level 5. Dermoscopy of the bluish papulonodules scattered on the dorsal foot showed characteristic findings described for metastasis of skin melanoma. This case underlines the importance of considering skin malignancies in case of chronic, non-healing ulcers in diabetic patients. Furthermore, we point out the critical significance of skin examination as a whole, and dermoscopy being an important tool in the diagnosis of melanoma and/or cutaneous melanoma metastasis.

Is it a sarcoidal foreign-body granuloma or a cutaneous sarcoidosis on a permanent eyebrow make-up?

Permanent make-up is a kind of cosmetic tattoo in which the colorants (pigments) are deposited in dermis after piercing the skin by tiny solid needles. It may cause some adverse effects such as local inflammation, infection, and allergic reactions on the skin and even systemic adverse effects such as sarcoidal reactions. Here the case of a 34-year-old woman who has some yellowish hard shiny papules on her eyebrows after having a permanent make-up is described. The histopathological examinations of the papules are diagnosed as sarcoidal foreign-body reactions. All the laboratory investigations were in normal limits except a mild elevation in angiotensin converting enzyme or ACE level. The lesions mostly improved after topical corticosteroid treatment. Sarcoidal foreign-body reaction due to permanent make-up is discussed with this presentation.

Fusarium oxysporum infection of stasis ulcer: eradication with measures aimed to improve stasis.

Fusarium species may cause localised skin infections in immunocompetent individuals. At least half of these infections are preceded by skin breakdown. The lesions are characterised by slow progression and good response to therapy. Here we present a 60-year-old non-diabetic man with stasis ulcers showing Fusarium oxysporum growth in culture of both pus swabs and skin biopsy specimens. The patient was confined to wheelchair because of recurrent sacral chordoma of 15 years duration, which was not under treatment for the last 3 years. Leg ulcers were resistant to antifungal therapy, and healed rapidly after improving of stasis with local and systemic measures.

Collagen-elastic tissue changes and vascular involvement in granuloma annulare: a review of 35 cases.

BACKGROUND: The pathogenesis of granuloma annulare (GA) is unclear. Collagen fiber degeneration is commonly reported, and there are several conflicting studies on elastic fiber and vascular changes associated with GA. In this study, we aimed to evaluate histopathologic characteristics, collagen and elastic tissue changes and vascular changes in GA. METHODS: Clinical records of 35 GA patients were examined alongside serial sections of 38 biopsy specimens from these patients. New sections of biopsy tissue were stained with hematoxylin and eosin, Verhoeff-van Gieson or Alcian blue and then evaluated. RESULTS: Four different histopathologic patterns were observed: interstitial (57.9%), palisadic granulomatous (26.3%), sarcoidal granulomatous (5.3%) and mixed (10.5%). Dermal mucin deposition was determined in 84.2% of specimens. Solar elastosis was observed in only seven specimens, and elastophagocytosis was observed in only two specimens. Collagen and elastic tissue damages were consistent findings in all biopsy specimens. Fibrin thrombi and vasculitic changes were not found in any of the specimens from this patient group. CONCLUSIONS: Elastic and collagen fiber damage are the main accompanying features of GA, which may develop from delayed-type hypersensitivity. Vasculitis does not appear to be a major causative process. Sun exposure also seems to have no major effect on the formation of GA but can be one of the stimulants or predisposing factors.

Colocalization of lipedematous scalp and nevus lipomatosus superficialis: a case report.

Lipedematous scalp (LS) is a rare condition of unknown etiology characterized by a thick, boggy scalp that occurs mostly in adult black females. The main pathologic finding consists of increased thickness of scalp resulting from thickening of the subcutaneous fat layer. Nevus lipomatosus superficialis (NLS) is an uncommon hamartomatous skin tumor characterized by soft, yellowish papules, or cerebriform plaques, usually localized on the buttock or thigh. Here, we report a 46-year-old woman who has NLS localized on the occipital area, accompanied by LS just beneath and peripheral area of this plaque. The diagnoses of NLS and LS were established by histopathological examination. In addition, the increase in subcutaneous fat layer was demonstrated using magnetic resonance imaging. The presented patient is the first case showing colocalization of NLS and LS.

Lipedematous scalp and lipedematous alopecia: report of three cases in white adults.

Lipedematous scalp (LS) and lipedematous alopecia (LA) are rare conditions of unknown etiology characterized by a thick and boggy scalp due to increase in the subcutaneous fat layer. Besides the changes in the texture of skin, varying degrees of hair loss are seen in patients with LA. In this report, we present two cases with LA and one case with LS in white adults. On examination, a boggy and soft swelling of the scalp was detected in all patients. In addition, the patients with LA had alopecic areas over the boggy scalp. Histopathologic examinations of skin biopsy specimens and magnetic resonance imaging of the scalp showed increased thickness of subcutaneous fat tissue in all patients. The exact etiopathogenesis of LA and LS remain unknown. These conditions may be either reactive or compansatory responses versus yet undetected stimuli, or represent a genetic tendency. Both of the these entities have been initially reported mostly in adult black females, however, we believe that LA and LS may well occur in white subjects and may be more widespread and frequently observed than previously supposed.

A case of Papillon-Lefevre syndrome associated with xanthogranulomatous pyelonephritis and hepatitis.

Papillon-Lefevre syndrome (PLS) is an autosomally recessive palmoplantar keratoderma accompanied by psoriasiform plaques on the extensor surfaces of extremities and leading to premature loss of deciduous and permanent teeth by progressive periodontitis. Patients with PLS may exhibit mental retardation, intracranial ectopic calcifications, nail dystrophies and a tendency to various infectious disorders, in addition to skin and oral findings. Herein, we report a 26-year-old man with PLS, who had experienced xanthogranulomatous pyelonephritis and hepatitis during childhood and adolescence. To the best of our knowledge, this is the first report of PLS associated with xanthogranulomatous inflammation.