Genital Rejuvenation of Scrotal and Vulvar Angiokeratomas: Laser Therapy of Scrotum and Vulva Lesions.

Genital rejuvenation requires medical and procedural treatments that can improve the morphology or aesthetics of the scrotum and vagina. Angiokeratomas are benign vascular lesions that my occur on the penis, scrotum, and vulva. These lesions can be of either cosmetic concern or medical significance if they bleed. Laser therapy can be successfully utilized for the treatment of genital angiokeratomas in men and women.

Cutaneous Metastatic Breast Cancer Masked by Hidradenitis Suppurativa.

The appearance of cutaneous metastases from breast carcinoma is variable and can present as nodules or inflammation of the skin, mimicking benign skin conditions. In addition, the skin lesions may be the initial presentation of unsuspected visceral malignancy or the site of either persistence or recurrence of metastatic disease in an oncology patient with a history of a solid tumor. The features of a woman with metastatic breast cancer that presented as a nodule that was masked by her concurrent, new-onset, hidradenitis suppurativa are reported. The diagnosis was suspected when the skin nodule persisted after her hidradenitis suppurativa improved; the diagnosis of cutaneous metastasis was confirmed with a skin biopsy. Occult breast cancer (primary or recurrent disease) may be masked by an inflammatory condition, such as hidradenitis suppurativa. Therefore, if a primary dermatologic condition does not appropriately respond to therapy, pathologic evaluation may be warranted to exclude the possibility of another disease, such as cutaneous metastases from underlying visceral cancer.

Heater-Associated Erythema Ab Igne: Case Report and Review of Thermal-Related Skin Conditions.

Erythema ab igne is a thermal-associated skin condition that can occur secondary to persistent direct or indirect contact with heat. Historically, erythema ab igne has been linked to fireplace and stove exposures; more recently, it has been associated with heaters, hot water bottles, and laptops. A 48-year-old woman presented for the evaluation of hyperpigmented, reticulated macular lesions on her distal legs. Additional history revealed that she had developed erythema ab igne secondary to the use of a space heater underneath her desk at work. Her skin condition stopped progressing with removal of the causative agent. In addition to erythema ab igne, heat-related skin conditions include basal cell carcinomas and squamous cell carcinomas, burns, erythromelalgia, subtypes of urticaria, and ultraviolet-associated disorders. Awareness of thermal-associated skin conditions enables the clinician to establish the appropriate diagnosis based on the associated history of the condition, the morphology of the skin lesion, and, if necessary, correlation with the skin biopsy findings of the cutaneous condition.

Atorvastatin-induced Lichenoid Drug Eruption: A Case Report and Review of Statin-associated Cutaneous Adverse Events.

Statin medications [3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors] are generally used to treat hypercholesterolemia. Lichenoid drug eruptions are a potential cutaneous side effect of medications including antibiotics, antimalarials, and statins. This drug eruption can mimic features of idiopathic lichen planus in clinical presentation and pathology. We describe the case of a 73-year-old man who developed a lichenoid drug eruption secondary to atorvastatin. His clinical features, in addition to histological findings, helped to establish the diagnosis. The cutaneous eruption resolved one month after the cessation of atorvastatin and with corticosteroid therapy. Statins have been associated with adverse events including bullous dermatosis, eosinophilic fasciitis, lichenoid drug eruption, and phototoxicity. Lichenoid drug eruption associated with statin therapy requires discontinuation of the statin medication; an alternative class of medication for the treatment of hypercholesterolemia is usually necessary.

Platelet-Rich Plasma and Genital Rejuvenation.

Platelet-rich plasma (PRP) can be incorporated into the treatment of androgenic alopecia and aging facial skin. Genital rejuvenation involves the management of extrinsic (traumatic) and intrinsic (aging) changes of the vagina and scrotum. Lipofilling-with the additional injection of PRP (with or without hyaluronic acid)-has been used to successfully treat vaginal atrophy and vaginal laxity; the unexpected resolution of lichen sclerosus in one of the women prompts the consideration to initially use PRP for the treatment of this condition not only in women but also men. Additional evaluation of the potential efficacy of PRP for vaginal rejuvenation and scrotal rejuvenation is warranted.

Platelet-rich plasma for androgenic alopecia treatment: A comprehensive review.

Androgenic alopecia (AGA) is a chronic, progressive condition affecting millions of individuals worldwide. Treatment modalities for AGA are limited and our understanding of the pathophysiology underlying the disease is still developing. Platelet-rich plasma (PRP), an autologous collection of concentrated platelets and their respective growth factors, has demonstrated efficacy in limiting AGA. The current understanding of AGA pathogenesis is summarized, including our current understanding regarding androgens, inflammation, and arrector pili muscle loss. Furthermore, the molecular pathways induced by PRP in the context of AGA are discussed to ascertain how PRP can prevent disease progression. Well-designed studies investigating the effect of PRP on AGA patients to provide insight on how PRP should be used to achieve consistent clinical results are also presented. Future investigations should focus on elucidating a unifying theory to connect the currently disparate avenues of AGA pathogenesis. PRP clinical trials should be based on standardized treatment protocols to establish generalizable results.

Subungual nail bed melanoma masquerading as tinea ungium.

Subungual amelanotic melanoma can masquerade as onychomycosis. Recently a man whose amelanotic nail bed melanoma presented as persistent onychodystrophy was reported in the Dermatology Online Journal. The patient had a persistent nail dystrophy; culture and biopsy of the nail demonstrated Candida and dermatophyte infection, respectively. However, he subsequently presented with a nodule that was biopsied and demonstrated melanoma. Similar to that patient, we recently described a 67-year-old woman with a four-year history of persistent nail dystrophy of the left fourth fingernail who had a periodic acid-Schiff staining of the nail plate demonstrating fungal hyphae. Her nail plate subsequently detached, demonstrating a friable nodule; a biopsy of the nodule demonstrated melanoma. In conclusion, in individuals with new morphologic changes to a dystrophic nail or with persistent nail dystrophy despite appropriate therapy, it is important for clinicians to consider performing additional evaluation and possible biopsy to exclude malignancy.

Topical Treatment of Eyebrow Hypotrichosis with Bimatoprost 0.03% Solution: Case Report and Literature Review.

The eyebrows frame the upper margin of the orbit and are an essential feature of the facial landscape. Eyebrow hypotrichosis, also known as madarosis, is characterized by a lack of growth or loss of eyebrow hair. Eyebrow loss can have cosmetic, functional, and social consequences. Eyebrow hypotrichosis can be idiopathic or related to an underlying condition. Bimatoprost 0.03% solution is a prostamide F2α analog indicated for the treatment of glaucoma and ocular hypertension that has also demonstrated efficacy for hair growth; indeed, it is currently approved by the Food and Drug Administration for the treatment of eyelash hypotrichosis. A 60-year-old woman with eyebrow hypotrichosis is described who achieved excellent and sustained growth of her eyebrows with continual daily application of bimatoprost 0.03% solution. We discuss the therapeutic mechanisms of bimatoprost 0.03% solution in hair growth, review other potential modalities for treating eyebrow hypotrichosis, and summarize the findings of investigators who have utilized bimatoprost in the treatment of eyebrow hypotrichosis.

Subungual Amelanotic Melanoma Masquerading as Onychomycosis.

Subungual amelanotic melanoma is rare. In addition, amelanotic melanoma can mimic non-melanocytic tumors. A 67-year-old woman had a four-year history of dystrophy of the left fourth fingernail. Periodic acid-Schiff staining of the nail plate demonstrated fungal hyphae, establishing a diagnosis of tinea unguium. The nail plate subsequently detached and the underlying nail bed showed a red, friable mass that was biopsied and confirmed a diagnosis of melanoma. In conclusion, additional morphologic change of a persistent nail dystrophy-even with a biopsy-confirmed diagnosis of onychomycosis-may require consideration for repeat evaluation, including a biopsy, to exclude the possibility of a subungual malignant tumor.

Sister Mary Joseph Nodule as a Cutaneous Manifestation of Metastatic Appendiceal Adenocarcinoma: Case Report and Literature Review.

Sister Mary Joseph nodule (SMJN) is an uncommon pattern of superficial periumbilical tumor metastasis, with the primary tumor most commonly associated with gynecological or gastrointestinal origins. This manifestation can represent extensive tumor development from any of the intra-abdominal or pelvic structures. Therefore, SMJN carries a poor prognosis, with a two-year survival rate of only 13.5 percent regardless of the etiology of primary cancer. In this case, a 67-year-old man with metastatic mucinous adenocarcinoma of the appendix involving the umbilicus presenting more than five years after the initial cancer diagnosis is reported. The features of patients with metastatic appendiceal carcinoma presenting as SMJN are also reviewed. With the inclusion of our patient, there are six patients who have documented SMJN due to appendiceal carcinoma: two men, two women, and two patients without demographic data. The patients ranged from the ages of 31 to 68 years, with a median age of 56.5 years at cancer diagnosis and 59 years at SMJN diagnosis. In 75 percent of the cases, SMJN was the initial clinical manifestation of a previously unsuspected appendiceal carcinoma and presented clinically one to seven months (median of five months) before the pathologic confirmation of the metastatic appendiceal carcinoma. The likelihood of SMJN presenting as the initial clinical feature of appendiceal cancer may increase in patients with extensive intraperitoneal metastasis in the form of pseudomyxoma peritonei or carcinomatosis. Therefore, the observation of a solitary umbilical nodule should prompt an investigation for an underlying primary neoplasm, as the prognosis after tumor metastasis to the umbilicus is poor.

Hypertrophic Lichen Planus Mimicking Verrucous Lupus Erythematosus.

Lichen planus is an inflammatory skin condition that can affect the hair, mucous membranes, nails, and skin. Cutaneous lichen planus typically presents as papules that are planar, polygonal, pruritic, and purple. Subtypes of lichen planus include actinic, annular, atrophic, eruptive, follicular, hypertrophic, inverse, linear, palmoplantar, pemphigoides, pigmentosus, ulcerative, vesiculobullous, and vulvovaginal. The various clinical presentations of lichen planus can mimic other dermatologic conditions. A 63-year-old woman, who presented with pruritic, hyperkeratotic plaques on the lower legs of two years duration, is described; her lesions were morphologically suggestive of verrucous lupus erythematosus. However, an examination also revealed purple papules on the wrists and white, reticulated patches on the bilateral buccal mucosa. Biopsies demonstrated lichenoid dermatitis while laboratory studies for systemic lupus erythematosus were negative. A correlation of the clinical presentation, pathology, and laboratory studies established a diagnosis of hypertrophic lichen planus. The clinical mimickers of hypertrophic lichen planus are reviewed and the therapeutic treatments for this condition discussed.

Dasatinib-induced Seborrheic Dermatitis-like Eruption.

Dasatinib is an oral tyrosine kinase inhibitor approved for imatinib-resistant chronic myelogenous leukemia. It has been investigated in treating other neoplasms, including non-small-cell lung cancer and a subset of melanomas. Seborrheic dermatitis is characterized by erythematous patches or plaques with scaling typically affecting the external ear, glabella, hair-bearing areas of the face, nasolabial fold, and scalp. Antitumor agents are often associated with mucocutaneous side effects, including seborrheic dermatitis. We describe the case of a 79-year-old woman with a history of sinonasal melanoma who developed a seborrheic dermatitis-like eruption while taking dasatinib. We also review the molecular abnormalities associated with melanoma, summarize the mucocutaneous side effects of dasatinib, and list the other antineoplastic agents associated with a seborrheic dermatitis-like eruption.

Cutaneous HIV-associated Kaposi sarcoma: a potential setting for management by clinical observation.

Kaposi sarcoma (KS) is a malignancy of viral etiology whose course ranges from cutaneous limited lesions to fulminant disease with multi-organ involvement. Four clinical variants of the disease exist: classic, endemic, iatrogenic, and epidemic. Iatrogenic and epidemic variants of Kaposi sarcoma develop in the setting of immune suppression. Transplant recipients who develop iatrogenic KS typically demonstrate improvement of lesions following de-escalation of immunosuppressive therapy. Similarly, HIV-infected patients who begin highly active antiretroviral therapy (HAART) experience immune reconstitution, which can induce KS regression. We describe two patients with varying clinical outcomes of cutaneous-limited HIV-associated KS after immune reconstitution with HAART. We propose that immune reconstitution with HAART, followed by clinical and radiographic surveillance for disease progression, may be an appropriate initial management strategy for limited cutaneous HIV-associated KS. In patients with more extensive disease at presentation or failure of HAART alone, antineoplastic therapy should be instituted.

Cutaneous manifestations of disseminated gonococcemia.

BACKGROUND: Sexually transmitted infections, includingurogenital gonorrheal infection, are a growing healthconcern in the United States. Nearly 50% of cervicalinfections are asymptomatic. If left undiagnosedand untreated, there is a risk of disseminatedinfection. PURPOSE: To describe an 18-year-old womanpresenting with disseminated gonococcal infectionconfirmed by blood cultures, skin biopsy, and urinegonococcal probe. We also describe the presentation,diagnosis, and treatment of disseminated gonococcalinfection, including discussion of the variousmorphologies of cutaneous lesions that have beenreported in the literature. MATERIALS AND METHODS: Thefeatures of a woman with disseminated gonococcalinfection are presented. Using PubMed, the termscutaneous, disseminated, gonococcal, gonorrhea,infection, lesions, manifestations, pustules, skin, andsystemic were searched. Relevant citations wereutilized and discussed. RESULTS: Hemorrhagic pustules,petechiae, and purpuric lesions developed in a youngwoman with fever and joint pain. Blood cultures grewbeta lactamase negative Neisseria gonorrhoeae andthe Neisseria gonorrhoeae/Chlamydia trachomatisprobe was positive for both N. gonorrhoeae and C.trachomatis. Biopsy revealed bulla with neutrophils,extravasated erythrocytes, fibrin deposits in the vesselwalls, and leukocytoclasia. CONCLUSION: Cutaneouslesions of disseminated gonococcal infection caninclude abscesses, cellulitis, petechiae, purpuricmacules, necrotizing fasciitis, and vasculitis. It isimportant for the clinician to recognize the clinicalsigns and symptoms of disseminated gonococcalinfection, particularly the various cutaneousmanifestations.

Associated conditions in patients with multiple dermatofibromas: Case reports and literature review.

Dermatofibromas are benign, fibrohistiocytic, dermal tumors. Solitary dermatofibromas may be incidental findings, whereas multiple dermatofibromas may be associated with systemic conditions or previous therapies. Two women and one man with multiple dermatofibromas and an associated systemic condition, immunosuppression, or both, are described. Nine dermatofibromas developed in a woman with hypothyroidism, optic neuritis, and Arnold Chiari I malformation. Five dermatofibromas developed in a woman with breast cancer who had received several systemic antineoplastic therapies. Eleven dermatofibromas developed in a man with HIV whose systemic therapies included acyclovir, darunavir/cobicistat, dolutegravir, etravirine, and ritonavir. Conditions associated with multiple dermatofibromas include autoimmune diseases, cancer, chromosomal abnormalities, immunodeficiencies, metabolic disturbances, and altered physiologic states such as pregnancy. Medications received by patients with multiple dermatofibromas included immunosuppressive agents, psoriasis therapies, and antineoplastic drugs. Multiple dermatofibromas can be observed in patients with associated medical conditions, systemic therapies, or both. Therefore, in individuals presenting with multiple dermatofibromas, not only evaluation for associated disorders, but also review of prior and current drug therapies, should be considered.

Topical Retinoids: Therapeutic Mechanisms in the Treatment of Photodamaged Skin.

Retinoids are a group of substances comprising vitamin A and its natural and synthetic derivatives. Retinoids were first used in dermatology in 1943 by Straumfjord for acne vulgaris. Since that time, retinoids have been utilized in the management and treatment of various skin conditions, including photoaging. Photodamage of the skin occurs as a consequence of cumulative exposure to solar ultraviolet radiation (UVR) and is characterized by deep wrinkles, easy bruising, inelasticity, mottled pigmentation, roughness, and telangiectasias. The mechanism of UVR-induced photodamage is multifactorial. Retinoids have demonstrated efficacy in the treatment of photoaged skin. Indeed, understanding the pathophysiology of photoaging and the molecular mechanism of retinoids can not only provide insight into the effects retinoids can exert in treating photoaging but also provide the rationale for their use in the treatment of other dermatologic diseases.

Histiocytoid Sweet's syndrome in a patient with myelodsyplastic syndrome: report and review of the literature.

The neutrophilic dermatoses are a group of disorders characterized by skin lesions for which histological examination reveals intense epidermal and/or dermal inflammatory infiltrates composed primarily of neutrophils without evidence of infection. The myelodysplastic syndromes consist of a heterogeneous group of malignant hematopoietic stem cell disorders characterized by dysplastic and inadequate blood cell production with a variable risk of transformation to acute leukemia. Rarely, histiocytoid Sweet's syndrome occurring in patients with myelodysplastic syndrome has been described. We present a case of a 66-year-old woman with a history of myelodysplastic syndrome who developed histiocytoid Sweet's syndrome. We also review the literature and characterize patients with myelodysplastic syndrome who have developed histiocytoid Sweet's syndrome.

Granuloma annulare and necrobiosis lipoidica with sequential occurrence in a patient: report and review of literature.

Granuloma annulare (GA) and necrobiosis lipoidica (NL) are granulomatous diseases of undetermined etiology. Rarely, both dermatoses have been reported to occur concomitantly in patients. GA and NL are characterized histologically by areas of necrobiosis of collagen. The two diseases share some common characteristics, which may suggest that these dermatoses could occur as a spectrum in some patients or possibly share a similar pathogenesis. We report on a 67-year-old Caucasian woman with a history of NL on the anterior shins that later developed lesions of GA on the breasts, trunk, and wrist. We also review the literature and discuss the characteristics of patients with concomitant GA and NL.

Metastatic laryngeal carcinoma mimicking eruptive keratoacanthomas: report of keratoacanthoma-like cutaneous metastases in a radiation port.

Metastatic skin lesions from a primary squamous cell carcinoma of the head and neck have only been reported in 1%-2% of these patients. Hence, skin metastases from laryngeal carcinoma are uncommon. Also, cutaneous metastases clinically presenting as a keratoacanthoma are rare. We describe cutaneous metastases in a radiation port clinically mimicking eruptive keratoacanthomas. Using the PubMed database, an extensive literature search was performed using the keywords cancer, carcinoma, keratoacanthoma, laryngeal, metastases, metastasis, metastatic, mimicking, port, radiation, radiotherapy, radiation, skin, visceral. We were able to summarize the features of patients with keratoacanthoma-like cutaneous metastases and discuss radiation port cutaneous metastases. Cutaneous metastases can be the initial manifestation of a previously undiagnosed malignancy or can present in a patient with an established diagnosis of cancer. Our patient not only developed skin metastases that mimicked eruptive keratoacanthomas, but to the best of our knowledge, is the first individual to develop radiation port cutaneous metastasis from a primary laryngeal carcinoma. The development of cutaneous metastases in an area of skin that has been treated with radiation therapy may result from the treatment altering and/or injuring the site, thereby making it more susceptible to another condition, such as metastatic skin tumors. In patients with an established diagnosis of visceral malignancy, the appearance of new keratoacanthoma-like lesions should prompt the clinician to consider a biopsy in order to establish or exclude the possibility of a cutaneous metastasis.