Factitious Ulcer Misdiagnosed as Pyoderma Gangrenosum.

Dermatitis artefacta may represent a real challenge for the clinician. As the patient does not admit self-inflicting the lesions, misdiagnosis with other diseases, such as pyoderma gangrenosum, is common. Consequently, these patients normally go through unnecessary tests and receive potentially harmful treatments as clinicians determine their diagnosis. The authors present the case of a recurrent factitious abdominal ulcer that was initially diagnosed and treated as pyoderma gangrenosum. This report focuses on the necessity of suspecting dermatitis artefacta when morphology, history, and treatment failures are difficult to explain. It is essential to establish a supportive and confident approach and avoid initial confrontation. In-patient treatment may be useful and long-term followup may prevent recurrences.

Granulomatous variant of pigmented purpuric dermatosis.

Granulomatous pigmented purpuric dermatosis is a rare entity. Historically, it has been seen in Asians. In this article, we report the case of a white man with this unusual variant. A 65-year-old, white man presented with a 1-year history of asymptomatic purpuric to brown papules on both lower legs and more confluent on dorsum of feet. He had an underlying history of hypertension and hyperlipidemia. Skin biopsy revealed a granulomatous lympho-histocytary inflammatory infiltrate in papillary dermis and superficial reticular dermis with extravasation of red blood cells and siderophages. Periodic acid schiff (PAS), Giemsa and Ziehl-Neelsen stains were negative. A diagnosis of granulomatous pigmented purpuric dermatosis was made. From the 10 cases reported of this granulomatous variant, 6 were associated with hyperlipidemia. We report an additional case with this association.

Facial and axillary apocrine chromhidrosis.

Apocrine chromhidrosis is a rare, chronic, idiopathic disorder, characterized by the excretion of pigmented sweat. A 26-year-old woman presented with a 3-year history of dark blue secretions on bilateral malar cheeks. On examination, upon pressure on the cheeks, a dark blue fluid was expressed, which appeared to arise primarily from the follicle. The patient had not appreciated it, but on examination of her axillae, a very subtle blue coloring was observed. Histopathologic examination revealed apocrine glands in the deep reticular dermis. Bluish cytoplasmic granules were observed in the apocrine epithelium lining, which correspond to lipofuscin granules. The diagnosis of apocrine cromhidrosis was made. We began treatment with 20 percent aluminum chloride hexahydrate solution and capsaicin cream with poor tolerance. Finally, we treated with botulinum toxin type A with a successful response. We report a case of facial and axillary apocrine cromhidrosis with good response to botulinum toxin type A.