Verruca Vulgaris Eruption Arising in the Setting of a Tyrosine Kinase Inhibitor.

A 71-year-old female with breast cancer presented with a generalized papular rash that began following the initiation of rebastinib. Examination revealed scattered pink to skin-colored verrucous papules on the forehead, extremities, and back. A biopsy showed hyperkeratosis, hypergranulosis, digitated epidermal hyperplasia, and dilated blood vessels at the tips of dermal papillae consistent with verruca vulgaris. The patient discontinued rebastinib due to muscle weakness and the lesions resolved. Rebastinib is an antineoplastic agent that targets several tyrosine kinases. Tyrosine kinase inhibitors (TKI) frequently cause cutaneous adverse events, but to date, there have been no reported cases of a verruca vulgaris eruption arising in the setting of TKI treatment. Recent studies indicate that TKIs can have immunosuppressive effects by decreasing T-cell levels. We postulate that rebastinib induced an immunosuppressive state in our patient which permitted human papillomavirus (HPV) proliferation. To our knowledge, this is the first report describing a verruca vulgaris eruption with TKI therapy.

A case of dermatofibrosarcoma protuberans and reflectance confocal microscopy of a post-surgical skin graft.

Dermatofibrosarcoma protuberans (DFSP) is an overall rare malignancy yet is one of the most common cutaneous sarcomas. The diagnosis of DFSP is typically made following histopathologic examination of the lesion, classically revealing a storiform pattern of spindle cells with elongated nuclei infiltrating the dermis and subcutis. Surgical excision is the standard treatment. Local recurrence is estimated to occur in 20-50% of cases, thus frequent postsurgical monitoring is required. Noninvasive imaging modalities offer a potential alternative to multiple repeat biopsies. We report the first case where reflectance confocal microscopy accompanied clinical examination in monitoring for DFSP recurrence postsurgical excision.

Trichoblastomas Mimicking Basal Cell Carcinoma: The Importance of Identification and Differentiation.

Trichoblastoma is a rare, slow-growing, benign cutaneous tumor derived from follicular germinative cells. Trichoblastoma commonly appears as an asymptomatic, symmetrical, well-circumscribed, skin-colored to brown or blue-black papule or nodule. It may appear clinically and histologically similar to basal cell carcinoma, making its diagnosis challenging. Even on dermoscopy, it is challenging to differentiate trichoblastoma from basal cell carcinoma. In practice, it is important to differentiate the two, because the choice of treatment and resulting prognosis differ between the lesions. Surgical biopsy to analyze histopathological and immunohistochemical differences is the gold standard for diagnosing and differentiating trichoblastoma from basal cell carcinoma. Trichoblastoma typically has a favorable prognosis, with a low incidence of recurrence, progression or association with malignancy. This paper provides a review of the epidemiology, clinical presentation, dermoscopy, histology, immunochemistry, treatment, and prognosis of trichoblastoma.

Synthesis, Characterization, and Investigation of the Antimicrobial Activity of Cetylpyridinium Tetrachlorozincate.

Cetylpyridinium tetrachlorozincate (referred to herein as (CP)2ZnCl4) was synthesized and its solid-state structure was elucidated via single-crystal X-ray diffraction (SC-XRD), revealing a stoichiometry of C42H76Cl4N2Zn with two cetylpyridinium (CP) cations per [ZnCl4]2- tetrahedra. Crystal structures at 100 and 298 K exhibited a zig-zag pattern with alternating alkyl chains and zinc units. The material showed potential for application as a broad-spectrum antimicrobial agent, to reduce volatile sulfur compounds (VSCs) generated by bacteria, and in the fabrication of advanced functional materials. Minimum inhibitory concentration (MIC) of (CP)2ZnCl4 was 60, 6, and 6 µg mL-1 for Salmonella enterica, Staphylococcus aureus, and Streptococcus mutans, respectively. The MIC values of (CP)2ZnCl4 were comparable to that of pure cetylpyridinium chloride (CPC), despite the fact that approximately 16% of the bactericidal CPC is replaced with bacteriostatic ZnCl2 in the structure. A modified layer-by-layer deposition technique was implemented to synthesize mesoporous silica (i.e., SBA-15) loaded with approximately 9.0 wt % CPC and 8.9 wt % Zn.

A rare case of primary dermal clear cell sarcoma with focal epidermotropism: An entity difficult to distinguish from melanoma.

Clear cell sarcoma (CCS) is an uncommon soft-tissue sarcoma that only rarely arises within the dermis. It is challenging to distinguish dermal CCS from nodular, primary dermal, or metastatic melanoma, as they share morphologic features and immunoprofiles. We describe a dermal CCS in a 25-year-old man with a cutaneous groin mass. The lesion was initially diagnosed as melanoma, likely metastatic. On consultation, in addition to a melanoma-like tumor in the dermis, we identified focal infiltration of tumor cells into the overlying epidermis (epidermotropism), resembling primary nodular or metastatic melanoma. Given the patient's age and absence of a history of primary melanoma, fluorescence in situ hybridization (FISH) was performed, which revealed separation of the 5' and 3' EWSR1 probe signals on chromosome 22q12, prompting a diagnosis of CCS. Our case highlights the histopathological, immunohistochemical, and ultrastructural similarities between CCS and melanoma, and the consequent potential for major diagnostic confusion. In such cases, FISH analysis remains the key to diagnosis. CCS should be considered in patients with a melanoma-like tumor in the dermis or subcutaneous tissue without epidermal (or with minimal) involvement, or prior to diagnosing metastatic melanoma in the absence of a known history of primary melanoma, especially in young individuals.

Assessment of Shave Removal Without Further Excision in the Treatment of Spitz Nevi: A Retrospective Study of 58 Cases.

BACKGROUND: Spitz nevi (or tumors) are noncancerous growths that are found particularly in the pediatric population. Their histologic features overlap with melanoma, but they have a favorable prognosis, even when showing atypical features. OBJECTIVES: The aim of this research is to examine whether Spitz nevi can be sufficiently removed by adequate shave excisions without a subsequent excision. METHODS: Melan-A stained shave removal specimens (SRS) were obtained for 58 consecutively diagnosed Spitz nevi, along with slides of their postshave excision specimens. The SRS were reviewed for negative (clear) margins, defined as no neoplastic melanocytes detected within <0.2 mm of the deep and lateral margins of the specimen. Postshave excision specimens were reviewed for residual or recurrent lesions. RESULTS: The 15 shave excision specimens with negative margins had no corresponding residual lesions on postshave specimens. There were no recurrences in any of the cases in an average of 17 months of follow-up. CONCLUSIONS: Observation may be a logical approach for the management of Spitz nevi when shave removal achieves clear margins and the lesion lacks atypical features.

Botulinum toxin: Pharmacology and injectable administration for the treatment of primary hyperhidrosis.

Hyperhidrosis is a dermatological condition defined by excessive sweating beyond thermoregulatory needs with significant effects on patients' quality of life. Hyperhidrosis is categorized as primary or secondary: primary hyperhidrosis is mostly focal and idiopathic, whereas secondary hyperhidrosis is commonly generalized and caused by an underlying medical condition or use of medications. Various surgical and nonsurgical therapies exist for primary hyperhidrosis. Although botulinum toxin is one of the deadliest toxins known, when used in small doses, it is one of the most effective therapies for primary hyperhidrosis. Botulinum toxin injections are widely used as a second-line primary hyperhidrosis treatment option once topical treatment strategies have failed. This article provides an overview of the commercially available botulinum toxin formulations and their applications in the treatment of primary hyperhidrosis.

The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review: Therapeutic options.

Hyperhidrosis (HH) is a chronic disorder of excess sweat production that may have a significant adverse effect on quality of life. A variety of treatment modalities currently exist to manage HH. Initial treatment includes lifestyle and behavioral recommendations. Antiperspirants are regarded as the first-line therapy for primary focal HH and can provide significant benefit. Iontophoresis is the primary remedy for palmar and plantar HH. Botulinum toxin injections are administered at the dermal-subcutaneous junction and serve as a safe and effective treatment option for focal HH. Oral systemic agents are reserved for treatment-resistant cases or for generalized HH. Energy-delivering devices such as lasers, ultrasound technology, microwave thermolysis, and fractional microneedle radiofrequency may also be utilized to reduce focal sweating. Surgery may be considered when more conservative treatments have failed. Local surgical techniques, particularly for axillary HH, include excision, curettage, liposuction, or a combination of these techniques. Sympathectomy is the treatment of last resort when conservative treatments are unsuccessful or intolerable, and after accepting secondary compensatory HH as a potential complication. A review of treatment modalities for HH and a sequenced approach are presented.

The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review: Etiology and clinical work-up.

Hyperhidrosis (HH) is a dermatologic disorder defined by sweat production exceeding thermoregulatory needs. Clinically, HH is diagnosed when excess sweating creates significant emotional, physical, or social discomfort, causing a negative impact on the patient's quality of life. Existing data imply that this condition may affect at least 4.8% of the US population. The etiology of HH may stem from a complex autonomic nervous system dysfunction, resulting in neurogenic overactivity of otherwise normal eccrine sweat glands. Alternatively, HH may be a result of aberrant central control of emotions. This condition is categorized as primary or secondary HH. Approximately 93% of patients with HH have primary HH, of whom >90% have a typical focal and bilateral distribution affecting the axillae, palms, soles, and craniofacial areas. Secondary HH presents in a more generalized and asymmetric distribution and is generated by various underlying diseases or medications. Secondary causes of HH need to be excluded before diagnosing primary HH.

A Water-Soluble Cationic Zinc Lysine Precursor for Coating ZnO on Biomaterial Surfaces.

A novel water-soluble cationic zinc lysine coordination compound, [Zn[(C6H14N2O2)]2Cl]Cl·2H2O (1), has been designed and synthesized and its crystal structure determined. The aqueous solution of this coordination compound is not only transparent and stable at room temperature but it is also nearly neutral (pH ∼ 7). It is worth noting that zinc oxide (ZnO) forms in situ upon dilution of a solution of the compound. The bioactivity of ZnO has been confirmed using an Alarma Blue assay. These unique properties allow the coordination compound to gently grow ZnO coating with excellent antibacterial benefits onto biomaterial surfaces in a facile and safe manner.