Unna sleeve for neurotic excoriations.

Neurotic excoriations are self-induced skin lesions produced because of compulsive scratching or picking. We present the successful use of the venerable technique of an Unna boot used as an Unna sleeve for neurotic excoriations of the upper extremities.

Adolescent female acne: etiology and management.

Acne vulgaris, a multifactorial condition often conferring significant psychosocial morbidity, affects an estimated 40 million people in the United States. The majority of these individuals are adolescents and young adults. The pathophysiology of the condition is still not fully known, but it is believed to be related in part to excess sebum production, follicular hyperkeratinization, microbial colonization by P acnes, and inflammation. Prior to initiating treatment in a female patient, a hyperandrogenic state must be considered and ruled out through history, physical exam, and laboratory evaluation if necessary. Treatment options are vast and include hormonal therapy among others. Hormonal therapies have long been noted to reduce acne lesions and offer a valuable adjuvant to standard therapy. Hormonal agents are thought to improve acne by blocking the androgen receptor and/or decreasing circulating androgens which leads to decreased sebum production. Hormonal treatment options include spironolactone, other antiandrogens, and oral contraceptives. The use of these agents to effectively treat acne has been demonstrated in several randomized, placebo-controlled clinical trials. Optimal results are often achieved with combination therapy with the goal of targeting multiple pathogenic pathways in acne development.

Delayed diagnosis of epidermal nevus syndrome associated with substantial brain malformations: a case report and review of the literature.

Epidermal nevus syndrome (ENS) often describes a spectrum of different clinical and histologic subtypes of epidermal nevi as well as their genetic and systemic associations. Although the true incidence of ENS is unknown, it is estimated that 8% to 18% of patients with epidermal nevi have systemic disorders. We report a case of ENS in adulthood; on further workup, our patient was found to have substantial central nervous system (CNS) abnormalities. This case highlights the necessity of appropriate workup in patients presenting with epidermal nevi at any age.

Cutaneous B-cell pseudolymphoma due to paraphenylenediamine.

Lymphomatoid contact dermatitis is a form of pseudolymphoma that was first described in 1976 by Orbaneja et al. Since that initial report, a number of allergens have been reported to cause this type of pseudolymphoma. Most cases involve hyperplasia of T cells. We describe a case of cutaneous B-cell pseudolymphoma due to paraphenylenediamine. This report underscores the importance of thorough history and observation when assessing patients with suspected lymphoproliferative processes.