A case report of inadequately treated acute deep venous thrombus and venous stasis.

Background: Venous stasis dermatitis is a common skin condition that typically affects the lower extremities and may occur secondarily to venous insufficiency which can lead to a pooling of fluid within the legs. The etiology of venous stasis dermatitis is largely related to medical conditions that affect the blood flow to the lower extremities. Chronic occlusion of the common iliac veins and femoral veins can cause a lack of proper blood flow to the lower extremities. When an inferior vena cava (IVC) filter becomes tilted, it can occlude the vessels distal to its placement. Definitive treatment of chronic venous insufficiency is not common and could be improved with a referral to an interventional radiologist. Case Description: Here, we present a case of a venous stasis that is presenting secondary to chronic occlusion of the left common iliac vein and femoral vein due to a tilted and irretrievable IVC filter that was placed more than 5 years prior to presentation. Upon presentation, the patient was unable to ambulate and was suffering from large lower leg ulcers and chronic venous insufficiency secondary to the occluded vessels. The patient was treated with a series of thrombectomies in an outpatient setting until the restoration of venous blood flow was achieved. The improved venous blood flow has reduced the painful leg ulcers both in number and severity-which greatly reduces the patient's likelihood of a secondary infection. Conclusions: This case emphasizes the importance of an interdisciplinary approach to patients who may present to an outpatient dermatology clinic with signs or symptoms of acute or chronic venous insufficiency for a more definitive treatment than the current standard of care.

A rare case report: chronic generalized idiopathic pruritus.

Background: Generalized chronic pruritus (CP) can be associated with seborrheic dermatitis and psoriasis but often can present without any noticeable diagnosis or obvious skin lesion. When not related to a clear diagnosis, CP can be characterized as idiopathic pruritus. CP is both a diagnostically and therapeutically challenging presentation due to the variety of systemic, dermatological, neurological, and psychogenic diseases that must be ruled out before diagnosing idiopathic pruritus. This presentation is often overlooked but can lead to a greatly diminished quality of life for patients who present with idiopathic generalized pruritus. The course of treatment will vary between providers and specialties, however, most dermatologists will attempt control with antihistamines, topical steroids, or oral steroids. The use of gabapentinoids for the treatment of CP is understudied. Gabapentin was initially developed as an antiepileptic that has since been approved to treat neuropathic pain and has a common off-label use in dermatology and can be used to effectively treat CP. Case Description: Here we present a case of a 56-year-old Caucasian male who presented to the outpatient dermatology clinic with new-onset, diffuse, and intense pruritic symptoms that gradually progressed over a period of seven weeks. This case study details a patient with Idiopathic generalized pruritus previously uncontrolled that was well-controlled with the use of gabapentin after trials of other common treatments failed. Conclusions: The understudied off-label use of gabapentin in the case of generalized chronic idiopathic pruritus should be explored and later implemented as a mainstay for patients suffering from uncontrolled CP as it was shown to completely eliminate pruritic symptoms and improve the quality of life for this patient.

Paraneoplastic Granuloma Annulare Associated with Metastatic Lung Cancer.

A 60-year-old Caucasian woman with a 15-year smoking history presented with new, asymptomatic, pink lesions that gradually appeared over a period of 6 weeks. Physical examination revealed erythematous annular and nummular plaques on her upper and lower extremities, chest, and abdomen (Figure 1A and 1B). A shave biopsy from the right thigh revealed focal areas of necrobiotic collagen in the superficial portion of the dermis, surrounded by histiocytes, multinucleated giant cells, and lymphocytes, consistent with granuloma annulare (GA) (Figure 2).1.