Should We Stick with Surgical Glues? The Incidence of Dermatitis after 2-Octyl Cyanoacrylate Exposure in 102 Consecutive Breast Cases.

Skin adhesives have become standard in wound closure as alternatives to traditional sutures or as sterile occlusive dressings after surgery of all types. The literature is replete with case reports of contact dermatitis following exposure to cyanoacrylate-based adhesives, such as 2-octyl cyanoacrylate. Nonetheless, it has been the impression of the senior author and others that the incidence of allergic and/or contact dermatitis is much higher than commonly considered. The authors prospectively studied 102 consecutive patients who underwent breast surgery performed by the senior author with 2-octyl cyanoacrylate placed over incisions as an occlusive dressing. Two patients with a known glue allergy did not receive cyanoacrylate at surgery but were scratch tested to confirm the diagnosis. All patients were followed postoperatively. Twelve patients went on to develop significant dermatitis postoperatively after glue placement. Cyanoacrylate was confirmed as the cause of all rashes by allergy scratch testing for a total incidence of 14 percent (14 patients). Given the popularity of cyanoacrylate products across emergency rooms, clinics, and operating rooms, awareness of the true incidence of these reactions may caution against their use in the future. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.

Pyoderma Gangrenosum of the Scalp: A Rare Clinical Variant.

Pyoderma gangrenosum (PG) is a rare, neutrophil-predominant dermatosis that usually presents as a papule or pustule and progresses into a painful ulcer. Clinical and histopathological features are nonspecific, making PG a challenging condition to diagnose. Lesions may occur anywhere on the body; however, the lower extremity is the most common location. Solitary lesions in atypical locations such as the scalp are uncommon, making this clinical variant especially difficult to recognize and diagnose. Although the clinical features and subsequent management of scalp PG might be different from other anatomic sites, the typical presentation and treatment of scalp PG is still unclear. The authors present a recent case of a 34-year-old woman with scalp PG and summarize 16 other cases documented in the literature. This case report and literature review illustrate several similarities and differences between scalp PG and classic PG: (1) scalp PG occurs in a wider age demographic of patients; (2) as with classic PG, inflammatory bowel disease and pregnancy are associated conditions, but head injury and preexisting inflammatory skin conditions of the scalp may be additional predisposing factors for scalp PG; and (3) as with classic PG, scalp PG generally responds well to corticosteroids and immunosuppressive therapy. Scarring occurs in all conditions, though disfigurement and psychosomatic effects may be disproportionately higher in scalp PG.

Subungual exostosis.

Subungual exostosis is an uncommon bony tumor of the distal phalanx most often seen on the hallux. Although this lesion is completely benign, it must be distinguished from a number of other subungual tumors, both benign and malignant. Radiography of the digit is a noninvasive test that should be part of the initial workup whenever subungual exostosis is in the differential diagnosis. Once identified, surgical removal of the exostosis generally is both effective and well tolerated. We present a case of subungual exostosis that was discovered incidentally during a full-body skin examination. We also review the pertinent clinical and histopathologic findings, diagnosis, and treatment of this entity.

Crusted scabies and multiple dosages of ivermectin.

We present the case of a bone marrow transplant patient who was diagnosed with crusted scabies but did not respond to the usual approach with topical permethrin and ivermectin. The Centers for Disease Control and Prevention were contacted and suggested a 7-dose regimen of ivermectin. The patient started to improve remarkably after the third dose, and the skin eruption was resolved after 7 doses. This case supports the use of a more prolonged course of oral ivermectin for crusted scabies in those who fail the conventional approach.

Nonbullous neutrophilic lupus erythematosus: a newly recognized variant of cutaneous lupus erythematosus.

BACKGROUND: Neutrophils in the setting of systemic lupus erythematosus (SLE) are commonly associated with bullous disease. Rare cases of nonbullous neutrophilic lesions have been reported in patients with SLE. OBJECTIVE: This study used clinical and histologic findings of 4 patients to further define the newly emerging entity of nonbullous neutrophilic lupus erythematosus (LE). METHODS: We reviewed the clinical and pathological findings of 4 patients with known SLE who developed urticarial papules, plaques, subcutaneous nodules, or a combination of these. RESULTS: All patients were women with established SLE. Histopathological findings in all patients included an interstitial and perivascular neutrophilic infiltrate with leukocytoclasia, and variable vacuolar alteration along the dermoepidermal junction. Direct immunofluorescence study results in two patients were positive for C3, IgG, and IgM along the basement membrane zone. One patient also presented with neutrophil-rich lupus panniculitis. All clinical lesions resolved with immunomodulating/immunosuppressive agents. LIMITATIONS: This study was limited by the small number of cases. CONCLUSIONS: Nonbullous neutrophilic LE is an important entity to consider in the differential diagnosis of neutrophil-mediated eruptions. In addition, the histologic finding of neutrophils in the setting of lupus should alert one to the possibility of systemic disease.

Overview of hepatitis C and skin.

Hepatitis C (HCV) is the most common cause of chronic liver disease and hepatocellular carcinoma, as well as the leading indication for liver transplantation in the Western world. For many patients, cutaneous manifestations may be the only, the earliest, or the most apparent sign of the underlying infection. The dermatologic manifestations of HCV infection are reviewed.

Dermatology of androgen-related disorders.

Hyperandrogenism in women can be caused by various conditions, the most prevalent of which is polycystic ovary syndrome. Common dermatologic manifestations of hyperandrogenism include hirsutism, acne, acanthosis nigricans, and androgenic alopecia. Hirsute women often have increased activity of 5 alpha-reductase, the enzyme that converts the androgen testosterone to its active metabolite, in hair follicles. Likewise, androgens affect the formation of acne by increasing sebum production from sebaceous glands in the skin. The diagnosis of polycystic ovary syndrome includes a complete history, physical examination with emphasis on evidence of androgen excess, and appropriate laboratory investigation to exclude other causes of hyperandrogenism. Treatments for the dermatologic conditions of hyperandrogenism include lifestyle modification, oral contraceptives, antiandrogens, and insulin-sensitizing medications.

Alopecia areata presenting in 2 kidney-pancreas transplant recipients taking cyclosporine.

Alopecia areata (AA) is an autoimmune disease of uncertain pathogenesis, typically treated with immunomodulators. We report the paradoxical development of AA in two kidney-pancreas transplant recipients receiving immunosuppressive therapy, which included cyclosporine. Review of the literature revealed only 7 other cases of AA occurring in solid organ transplant recipients; all occurred during long-term cyclosporine therapy. The development of AA in this population highlights the complexity of this immunologic disease.

Melanoniquia e hiperpigmentaciónmucocutánea debida a la administración dehidroxiurea a una paciente infectada por VIH / Melanonychia and mucocutaneous hyperpigmentation due to hydroxyurea use in an HIV-infected patient

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