Cutaneous findings associated with cardiac myxomas.

The clinical diagnosis of cardiac myxomas remains a challenge despite the advent of echocardiographic technology. These tumors may produce a variety of clinical and laboratory findings that can mimic systemic disease and obscure the proper diagnosis. Although histologically benign, cardiac myxomas may cause significant morbidity and mortality via intracardiac obstruction and arterial embolism. Possible long-term sequelae may be avoided by early recognition and prompt surgical excision. We briefly review the various findings associated with cardiac myxomas (nonfamilial and familial) with emphasis on cutaneous presentations. An illustrative case of left atrial myxoma with cutaneous findings contributing to the diagnosis is discussed. Certain skin lesions and multifocal clinical findings should alert the clinician to consider cardiac myxoma in the differential diagnosis.

Perforating elastosis in necrobiosis lipoidica diabeticorum.

A 58-year-old diabetic woman with necrobiosis lipoidica diabeticorum demonstrated lesions with raised, prominent borders. These areas were found on biopsy to have transepidermal elimination of elastic fibers. We present this case as a unique finding and review the characteristics and possible mechanisms of transepidermal elimination.

Tanning facility compliance with state and federal regulations in North Carolina: a poor performance.

BACKGROUND: Little is known about the compliance of commercial tanning facilities with regulations governing their operation. We inspected some tanning parlors to assess the degree to which they follow federal and North Carolina state regulations. METHODS: An inspection of 32 tanning facilities was conducted between March and May 1991 as part of an ongoing effort to educate tanning parlor operators and proprietors about UV light safety. Compliance with each of 21 distinct state and federal requirements was recorded for each facility. RESULTS: Only 1 of 32 facilities was in complete compliance with both state and federal regulations. The number of infractions ranged from none to 21 (mean [+/- SD] 7.1 +/- 4.1). Nineteen percent of facilities had timers that were not within the required +/- 10% accuracy level. Twenty-two percent also had timers that did not meet Code of Federal Regulations standards. The estimated proportion of the total light output in the UVB spectrum ranged from 0.5% to 5.0% (mean 4.25% +/- 0.95%). CONCLUSIONS: These limited data suggest that many commercial tanning establishments are not uniformly compliant with regulations. Although we cannot extrapolate these findings to other states, we anticipate that facilities in states with less rigorous regulations than North Carolina have similar or inferior safety profiles.

Joint complaints in psoriasis patients.

Four hundred and fifty-nine psoriasis patients seen at the Department of Dermatology, Bowman Gray School of Medicine of Wake Forest University, responded to a questionnaire concerning current or past joint complaints. Of these, 17% reported a previous diagnosis of psoriatic arthritis, and over 53% had a current or past history of arthralgias. Additional information on those patients reporting arthralgias focused on the cutaneous sites of involvement with psoriasis and which joints were most likely to be involved in patients with various types of arthritis. Previous treatments for skin involvement with psoriasis were more aggressive in those patients with a diagnosis of psoriatic arthritis. A significant proportion of patients presenting to dermatologists for treatment of psoriasis have joint complaints, and the percentage of patients with psoriatic arthritis is greater than generally appreciated by non-dermatologists.

Epithelioid sarcoma: clinical and histologic characteristics.

Epithelioid sarcoma is a slow-growing sarcoma that typically occurs on an upper extremity of young men. It commonly arises as a deep soft tissue, subcutaneous, or as a dermal, woody, hard nodule.

Granuloma annulare and disseminated herpes zoster.

A 71-year-old man was admitted to the Wake Forest University/Baptist Hospital Medical Center on February 1, 1989, with pharyngitis and a cutaneous eruption that began that day. The past history was significant for a diagnosis of chronic lymphocytic leukemia (CLL) made in 1984, and for longstanding hypertension, severe coronary artery disease, and prostatic hypertrophy. The patient had required no therapy for his CLL until August, 1988, when he developed hemolytic anemia and was treated with oral chlorambucil, 4 mg/day, and a tapering course of prednisone. By December, 1988, the prednisone therapy had been discontinued, but the patient required hospital admission for pneumococcal pneumonia, which responded well to intravenous antibiotic therapy. One day prior to the current admission the patient complained of persistent fevers, sore throat, productive cough, and headache. He noted a new cutaneous eruption on the day of admission in February, 1989. The past history was positive for occasional herpes stomatitis. The patient did not know if he had previously been infected with varicella. Skin examination revealed multiple (greater than 20), single, and grouped vesicles in a generalized distribution involving the bilateral trunk, head, neck, arms, and legs. The heaviest involvement was on the right posterior auricular area and on the neck. A Tzanck preparation obtained from an early lesion was positive for multinucleated giant cells. Viral culture was negative at 24 hours and at 1 week. A skin biopsy of an early vesicular lesion was performed and revealed intraepidermal vesicles with acantholysis and giant cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Low-dose weekly methotrexate for unusual neutrophilic vascular reactions: cutaneous polyarteritis nodosa and Behçet's disease.

Low-dose weekly methotrexate therapy has been used to treat patients with psoriasis for more than 20 years. This regimen has also been used to treat rheumatoid arthritis, inflammatory bowel disease, primary sclerosing cholangitis, and corticosteroid-dependent asthma. We report two patients with Behçet's disease with cutaneous neutrophilic vascular reactions and three with cutaneous polyarteritis nodosa who responded dramatically to low-dose weekly methotrexate therapy.

The ocular changes of incontinentia pigmenti achromians (hypomelanosis of Ito).

Incontinentia pigmenti achromians is a multisystem hereditary disorder characterized specifically by a whorled or streaked cutaneous hypopigmentation and frequently characterized by numerous neurologic, musculoskeletal, and ocular abnormalities. We present a patient with incontinentia pigmenti achromians in whom the ocular abnormalities included the commonly reported exotropia, myopia, small optic nerve, and hypopigmentation of the fundus, as well as rarely reported corneal asymmetry, pannus, and atropic irides with irregular pupillary margins. The patient also had a cataract in the right eye and a retinal detachment in the left eye.

Severe allergic keratoconjunctivitis and erythema multiforme after a routine eye examination: discerning the cause.

Acute allergic dermatitis of the eyelids with keratoconjunctivitis is associated with a specific triggering factor. Therapy for the acute inflammation can complicate the search for such a factor if the process worsens. We report a case of acute contact dermatitis and keratoconjunctivitis after a routine eye examination to demonstrate the difficulty in evaluating such patients and the role of skin patch testing in determining the cause.

Sclerosing panniculitis. A clinicopathologic assessment.

Six patients with well-circumscribed, indurated, inflammatory plaques of the lower extremity are described. Incisional biopsy specimens in each patient revealed fat necrosis, sclerosis, and a lobular panniculitis. These patients are similar to those described under the designations hypodermitis sclerodermaformis or lipodermatosclerosis. The name sclerosing panniculitis is proposed to unify these conditions. The pathogenesis is unknown, although a role for venous stasis or previous thrombophlebitis has been proposed. Systemic or local anti-inflammatory therapies have not been clinically effective.

Multiple glomus tumors: a role for magnetic resonance imaging in patient evaluation?

Glomus tumors may occur as solitary lesions, or rarely as multiple glomus tumors (MGT). Internal organ involvement in patients with MGT has been reported, but is rare. Magnetic resonance imaging (MRI) has been reported to be useful in evaluating patients with blue rubber bleb nevus syndrome for nongastrointestinal internal organ involvement. Three patients with MGT were evaluated by MRI for both cutaneous and internal involvement. MRI, which is useful in evaluating other vascular lesions, is not useful in the evaluation of patients with multiple glomus tumors. With these results, patients with MGT can be spared the expense of MRI procedure.

Rickettsial diseases.

The rickettsioses have several unifying features. Arthropod vectors are the common means of transmission. Fever, headache, myalgias, and the characteristic eruption (except in Q fever and ehrlichioses) are the hallmarks of the clinical presentation. The diseases share a common pathogenesis, namely, vasculitis, and treatment uniformly consists of tetracycline or chloramphenicol. Distinguishing aspects of these processes include the multitude of different reservoirs, the progression of the rash, and the nonspecific antigen test (Weil-Felix) results.

Neutrophilic vascular reactions.

Dermatologic diseases are classified most commonly by morphology, by pathogenesis, or by etiology. Nontraditional classifications may be useful in terms of providing a reassessment of traditional views about disease interrelationships. This review of dermatoses characterized by neutrophilic infiltrates and dermal vessel changes reveals evidence suggesting that these dermatoses result from immune complex-mediated, neutrophil-induced dermal vessel damage. Therapeutic approaches to these heretofore unlinked dermatoses are remarkably similar.

Psoriatic plaques in Macaca fascicularis.

An adult male cynomolgus monkey (Macaca fascicularis) developed erythematous plaques with adherent white scales on the skin. Microscopically, the epidermis had regular acanthosis with marked parakeratosis, focal absence of stratum granulosum, and spongiform pustules and Munro-like microabscesses. These histologic findings were suggestive of psoriasis vulgaris.

Use of rifampin with penicillin and erythromycin in the treatment of psoriasis. Preliminary report.

The addition of 5 days of rifampin therapy to a 10- or 14-day course of penicillin or erythromycin therapy has been shown to reduce greatly the rate of chronic streptococcal carriage. The empiric use of rifampin in combination with penicillin or erythromycin in nine of nine patients with streptococcal-associated psoriasis appeared to coincide with a marked improvement in their skin.