Unilateral, circumscribed, chronic dermatitis of the papillary-areolar complex: case report and review of the literature.

Lichen simplex chronicus is a well-described, common pruritic disorder resulting from repeated rubbing and scratching. Typically, only one site is involved. When this site involves the papillary-areolar complex of one breast, the condition is termed unilateral, circumscribed, chronic dermatitis of the papillary-areolar complex. A patient with this uncommon condition is herein reported, and the literature, including a discussion of the differential diagnosis, is reviewed. An aggressive approach to the work-up of such a patient is recommended, to ensure accurate diagnosis and initiation of appropriate therapy.

Invasive trichophyton rubrum infection in an immunocompromised host. Case report and review of the literature.

Typically confined within the keratinized, epithelial layer of the skin and hence categorized among the dermatophytoses, Trichophyton rubrum infections usually present as superficial, scaling eruptions. In certain clinical settings, however, such as in immunosuppressed hosts, deep local invasion, multivisceral dissemination, and even death due to T. rubrum granulomas have been described. A case of multiple, subcutaneous, neutrophilic abscesses due to T. rubrum in an immunosuppressed renal allograft recipient is described. The pathogenesis, diagnosis, and immunology of invasive T. rubrum infections in immunocompromised hosts are reviewed.

Suppurative keloidosis in a black woman.

The development of suppuration and sinus tract formation within previously well developed keloidal scars is a rare event, predominantly occurring in the beard, neck, and presternal areas of black men. Keloidal entrapment of epithelial cystic elements, such as pilosebaceous units, has been suggested as one possible mechanism for the occurrence of suppurative keloids. We report the extremely rare development of a large, submental, submaxillary suppurative keloid in a black woman, with resulting sinus tract formation and intraoral drainage. The important clinical characteristics and treatment of suppurative keloidosis are discussed. The gross pathologic picture of keloidal epithelial-cystic entrapment and inflammation is also demonstrated.

Tick infestation simulating a traumatized, papillomatous nevus.

A patient is described who had a five-week history of agonizing pain in a "mole" on his left inner thigh that clinically was thought to be a traumatized, papillomatous nevus. Biopsy disclosed the presence of the body parts of a hard tick. Much has been written about ticks as agents or vectors of disease. This case demonstrates the less well-described ability of a blood-engorged tick to clinically simulate a traumatized or infarcting skin growth, and it represents the second reported case of the development and persistence of a tick bite nodule following complete surgical removal of all tick parts.

Treatment of recurrent squamous papillomata of the conjunctiva by carbon dioxide laser vaporization.

Complete resection of recurrent conjunctival squamous papillomata frequently may be exceedingly difficult, since such lesions are typically friable and multilobulated. Recurrent lesions often fill the fornicies and spill onto the lid margins. Moreover, since the human papillomavirus (HPV) has been linked to some of these lesions, there remains the further possibility of spread with "cold knife" resection. We discuss the benefits of carbon dioxide laser vaporization therapy for recurrent squamous papillomata of the conjunctiva that have not responded to resection and cryotherapy or topical immunotherapy. The carbon dioxide laser facilitates resection by providing a bloodless field, and reduces the possibility of viral seeding of the conjunctiva by sterilizing the operative site and sealing the lymphatics.

Annular constriction of the glans penis.

An otherwise healthy, 15-year-old white male adolescent presented with a hitherto unreported, traumatically induced, ringlike depression around the glans penis resulting from the circumferential entrapment of a fibrous strand within the glans during infancy. The surgical reconstruction of the lesion and the differential diagnosis of annular constricting lesions of the appendages are discussed.

The failure of immunotherapy with dinitrochlorobenzene and Rhus extract for recurrent conjunctival squamous papillomas.

A 25-year-old white male is described who presented with recurrent conjunctival squamous papillomata. Despite prior reports of successful dinitrochlorobenzene use for tropical immunotherapy, its failure in our patient, and the first documented attempt to employ Rhus oleoresin (poison ivy/oak) extract for topical conjunctival immunotherapy is reported. The role of topical immunotherapy in treating recurrent conjunctival papillomas is discussed.

Autoinoculation herpes of the hand in a child with recurrent herpes labialis.

Herpes simplex virus infections involving the fingers and hands have been reported primarily in medical and dental personnel. A 10-year-old boy is described who presented with herpes simplex virus infection of his left hand two weeks after resolution of an episode of recurrent herpes labialis. Since herpes simplex infections of the fingers and hands may be confused with a variety of other more common conditions, clinicians should be alert to this possibility when diagnosing vesiculopustular lesions of the hands, particularly in medical and dental personnel and in patients with histories of recurrent herpes simplex infections elsewhere. A need for greater patient awareness of the potential for herpes simplex virus autoinoculation is also stressed.

Angiokeratoma vulvae.

A healthy 25-year-old white woman presented with a 2-year history of vaginal pruritus, burning, and dyspareunia. Numerous grayish purple macular and papular lesions, ranging in size from 0.5 to 2.0 mm, were observed on both labia majora. Some were centrally eroded. Biopsy confirmed the diagnosis of angiokeratoma. All lesions were electrocauterized, with the patient under local anesthesia. No new lesions appeared during a 6-month follow-up period, and the patient remained asymptomatic. Vulval angiokeratomas probably occur more commonly than the literature suggests. Occasionally they may be confused with other lesions. Since they are easily treatable, clinicians should be alert for their presence when diagnosing pruritic, painful, or bleeding lesions of the vulvovaginal region.

Bilateral nasal bone osteophytosis associated with short-term oral isotretinoin therapy for cystic acne vulgaris.

Bilateral 2.5 and 3.0 mm nasal bone osteophytes developed five weeks following the initiation of oral isotretinoin therapy (50 mg daily) for severe cystic acne vulgaris in a healthy 30-year-old white woman who had undergone uneventful rhinoplasty 12 years earlier. Histologically mature bone fragments were removed at surgery. Vitamin A and its analogs have been reported to cause hyperostosis of the vertebrae and long bones, but no known reports link them to nasal bone changes. Clinically significant nasal bone osteophytosis may be another adverse reaction to oral isotretinoin therapy.