Does erysipelas-like rash after hip replacement exist?

BACKGROUND: Orthopaedic implants are known to rarely induce or exacerbate dermatitis in metal-allergic patients. In the late 1990s, hypersensitivity to prosthetic material has been suspected to induce recurrent aseptic localized cellulitis. Patients presented with recurrent eruption of the skin overlying the implant, associated with fever. An aseptic origin of this new syndrome was hypothesized as no evidence of microbial involvement could be found and because antibiotic treatment was apparently inefficient. OBSERVATIONS: We observed 4 similar cases. All patients recovered after suppression of factors predisposing to erysipelas (gluteal portal of entry, anti-inflammatory drugs) and appropriate antibiotic therapy. DISCUSSION: Our conviction is that these manifestations are authentic infectious cellulitis. Delayed thigh erysipelas after hip surgery is a distinctive form of cellulitis, characterized by its unusual topography, its rapid outcome and the possibility to be recurrent.

Oral calcitriol: a new therapeutic agent in cutaneous lichen sclerosis.

BACKGROUND: Lichen sclerosus remains an elusive disease with an uncertain relationship to morphea and scleroderma. The disorder has been difficult to treat, with no consistent and reproducible efficacious therapy. Recently, a beneficial effect of treatment with oral calcitriol (1-25 dihydroxyvitamin D3) in patients with scleroderma or morphea was described. This fact could be ascribed to the immunomodulatory effects of calcitriol observed in vitro and to inhibition of fibroblastic growth. Because of the success of calcitriol in localized scleroderma, we attempted this therapy in a patient with LS. OBSERVATION: One patient with cutaneous generalized LS resistant to different therapeutics was treated with calcitriol in an oral daily dose of 0.5 mcg. After 6 months of treatment, the skin extensibility increased, and the lesions improved. The improvement persisted after discontinuation of therapy during a follow-up period of one year. The only side effect was hypercalciuria, which resolved with dose reduction. CONCLUSION: Calcitriol has shown a beneficial effect in scleroderma and morphea during open studies. A case is reported of a patient with LS who had a dramatic response to calcitriol. Double blind, placebo-controlled trials are needed to assess the therapeutic value of calcitriol in patients with LS.

[Hypomelanosis of Ito in a girl with Trisomy 13 mosaicism: a cytogenetic study]. / Etude cytogénétique d'une hypomélanose de Ito chez une malade atteinte d'une trisomie 13 en mosaïque.

BACKGROUND: Hypomelanosis of Ito was first described by Ito in 1952 as incontinentia pigmenti achromians. The consistent feature of the disease is a characteristic cutaneous hypopigmentation area following the lines of Blaschko, but the clinical manifestations are varied and hypomelanosis of Ito is regarded as a neurocutaneous syndrome. Hypomelanosis of Ito is sporadic but is probably a non-specific expression of chromosomal mosaicism; we report a case with four clones. CASE REPORT: We report the case of a 26 year-old woman with neurocutaneous hypomelanosis of Ito and Trisomy 13 mosaicism. She also exhibited skeletal and ophthalmologic disorders. Immunohistology revealed a PS100 and Melan A decrease in hypopigmented skin. Cytogenetic study of normal and hypopigmented skin fibroblasts showed mosaicism with four clones. DISCUSSION: This is the third case of Trisomy 13 mosaicism associated with hypomelanosis of Ito, although other anomalies on chromosome 13 have been described. Happle published "phylloid" pigmented cases, which are mainly associated with Trisomy 13. This is the first observation of four-clone mosaicism and can be explained by successive mutations during embryogenesis. Anomalies on chromosomes 5,6 and 21 have never been described. The definition of hypomelanosis of Ito is not well established and the disease is presently included in a group of "pigmentary dysplasia" with genetic mosaicism.

Lymphomatoid papulosis: a localized form with acral pustular involvement.

We report a localized form of lymphomatoid papulosis (LyP) presenting as pustular papules of the hands. The histopathology revealed a moderate inflammatory infiltrate composed of atypical pleomorphic large lymphocytes with atypical mitosis and large nuclei. Epidermotropism could be observed. These atypical cells expressed CD4 and CD30. Laboratory examinations and bone marrow explorations remained negative. The clinical presentation of this case of LyP is unusual. Only histopathological features allowed to diagnose LyP. The knowledge that LyP may be associated with neoplasia or lymphoma underlines the need for a long-term follow-up of these patients.