Bilateral acute depigmentation of the iris (BADI) and bilateral acute iris transillumination (BAIT): A case series from a center in Brazil.

Bilateral acute depigmentation of the iris and bilateral acute iris transillumination (BAIT) are similar clinical entities. The former causes acute-onset depigmentation of the iris stroma without transillumination, whereas the latter causes depigmentation of the iris pigment epithelium with transillumination. The etiopathogenesis of these conditions is not yet fully understood, but the proposed causes include the use of systemic antibiotics (especially moxifloxacin) and viral triggers. We present a case series of five female patients with a mean age of 41 (32-45) years, all of whom suffered acute onset of bilateral pain and redness of the eyes after moxifloxacin use (oral or topical). It is important for ophthalmologists to be aware of the two forms of iris depigmentation since this case series suggests that SARS-CoV-2 or its empirical treatment with moxifloxacin may trigger iris depigmentation. If this is the case, clinicians will likely see increased incidences of bilateral acute depigmentation of the iris and bilateral acute iris transillumination during and after the COVID-19 pandemic.

Diet-induced carotenodermia: a literature review.

Carotenodermia is a yellow to orange skin discoloration due to epidermal deposition of carotene. This can be due to an abnormality in the conversion of ß-carotene to vitamin A, hyperlipidemia, or high dietary carotene intake. Here, I review approximately 100 previous cases of carotenodermia in humans due to high ß-carotene intake. This literature review revealed that in carotenodermia associated with high ß-carotene intake the discoloration tends to be widespread, mainly in thick areas of the skin (e.g., the palm of the hand), and can last from 14 days to 4.5 years. This review provides a detailed overview of the characteristics of diet-induced carotenodermia.

Chemical peel as an adjuvant treatment in pigmented contact dermatitis: a case series.

A chemical peel is chemexfoliation, a process of application of a chemical substance to the skin that causes controlled chemical destruction of the epidermis with or without part of the dermis leading to skin regeneration and remodeling. It can be classified depending upon the depth of penetration into superficial, medium, and deep peels. Among various indications, peels can be used to enhance treatment within a variety of conditions including skin- rejuvenation, inflammatory disorders like acne, rosacea, acne scar, and pigmentary disorders like melasma, freckles, lentigens, dyschromia, and post-inflammatory pigmentation. We did a chemical peel for six patients with facial melanosis, diagnosed with Riehl melanosis. All patients had visible clinical improvement. Detailed history and informed consent were taken both for photographs and procedures from all patients.

Carotenoderma due to lycopenemia: A case report and evaluation of lycopene deposition in the skin.

Carotenoderma is a yellow-orange coloration of the skin caused by high levels of serum carotenoids, mostly due to the excessive intake of carotenoid-rich foods. The yellowish coloration is typically observed on the palms, soles, and nasolabial folds. Although the physical appearance is prominent, the condition itself is benign and harmless. Diagnosing carotenoderma is not difficult because of its unique manifestations, but its pathophysiology remains unclear. We report a relatively rare case of carotenoderma due to lycopenemia caused by the excessive intake of lycopene-rich vegetables and fruits. Lycopene is a carotenoid component that is distinguished by the high absorption of light around 488 nm. Given these characteristics, we examined a hematoxylin-eosin-stained specimen from the patient and tape-stripped samples by fluorescent microscopy with 488 nm wavelength emission and compared them with normal skin samples. Notably, the patient's samples showed a weaker autofluorescence in the stratum corneum and sweat glands. Furthermore, we measured carotenoid concentrations in the patient's skin noninvasively with Vegecheck® and found a higher score than the average of 24 healthy volunteers. These results support the long-held hypothesis that carotenoids are secreted in sweat and are deposited in the stratum corneum. To the best of our knowledge, no previous reports have measured skin carotenoid levels nor detailed the pathological findings of carotenoderma patients. This case further highlights that the excessive intake of lycopene causes carotenoderma and demonstrates that carotenoid deposition is particularly pronounced in the stratum corneum of the skin.

Bilateral ocular deposit of chlorpromazine / Depósito ocular bilateral de clorpromazina

ABSTRACT Chlorpromazine is a medication widely used in psychiatry for the treatment of psychoses, especially schizophrenia. Since 1964, published articles have been correlating this medication with the appearance of ocular alterations. In this paper, we report the case of a 65-year-old patient with ocular effects due to long-term therapy with chlorpromazine. Biomicroscopy of both eyes presented diffuse granular brown deposits, most prominent at the deep stroma and corneal endothelium level. Also showed anterior subcapsular brown deposits with a stellate pattern in the lens. The total amount exceeds 2.000g (significant for the ocular alterations described) considering the patient's daily dosage of chlorpromazine of 300mg for ten years. After performing complete ophthalmic evaluation and discarding other causes for the ocular deposits, we diagnosed a secondary corneal deposit and cataract due to the use of chlorpromazine. This case reinforces the importance of periodic follow-up with an ophthalmologist for chlorpromazine users to trace ocular changes, heeding the exposure time and its dosage.

RESUMO A clorpromazina é uma medicação muito empregada na psiquiatria para tratamento de psicoses, especialmente em casos de esquizofrenia. Desde 1964 existem artigos publicados que correlacionam o uso dessa medicação com o aparecimento de alterações oculares. Neste trabalho, relatamos o caso de um paciente de 65 anos com efeitos oculares devido à terapia de longo prazo com clorpromazina. A biomicroscopia de ambos os olhos apresentou depósitos granulares difusos e de cor marrom, mais proeminente ao nível do estroma profundo e do endotélio da córnea, além de depósitos castanhos subcapsulares anteriores centrais em um padrão estrelado no cristalino. Considerando a dose diária de clorpromazina de 300mg por 10 anos usada pelo paciente, a quantidade total ultrapassa 2.000g (dose considerada significativa para as alterações oculares descritas). Após avaliação oftalmológica completa e descartado outras causas desses depósitos oculares, foram diagnosticados depósito corneano e catarata secundários ao uso de clorpromazina. O caso apresentado reforça a importância do acompanhamento oftalmolÓgico periÓdico de usuários de clorpromazina para o rastreio de alteraçÕes oculares, atentando-se ao tempo de exposição à droga e à posologia da mesma.

"Transient pseudo-lentigines sign" in burrowing bug pigmentation.

Cutaneous pigmentation due to the arthropod, Cydnidae (a.k.a. burrowing bug), is increasingly being reported in the literature. The transient nature of this pigmentation probably contributes to its underreporting. We report a case of an 8-year-old girl with a sudden onset of hyperpigmented lesions on her index finger, face, and neck due to burrowing bugs. We propose the term "transient pseudo-lentigines sign" to better describe this fleeting arthropod-induced pigmentation.

Unusual cutaneous presentation in a corrosive acid ingestion.

Corrosive digestive tract injuries are considered to be a source of morbidity and mortality worldwide. The cases of acid ingestion in Forensic Medicine practice are not infrequent. Corrosive ingestion usually presents with injuries over the face, oropharynx, esophagus, and gastrointestinal tract. We report a case of a 65-year-old woman who was brought to the emergency department with a history of ingestion of toilet cleaner at her home. Following this, she developed blackish-brown discoloration over the abdomen. The patient survived for less than one day. An autopsy confirmed the perforation of the stomach and small intestine. 500 ml of blackish fluid was present in the peritoneal cavity which resulted in corrosive peritonitis. The chemical examiner's report showed corrosive mixtures comprising sulfate, nitrate, and chloride ions in the peritoneal contents. This case report highlights atypical cutaneous presentation over the abdomen following corrosive acid ingestion, which has not been reported previously. The possible explanation for this cutaneous manifestation was corrosive effects of the underlying viscera due to its close proximation to the abdominal wall and presence of minimal intra-abdominal fat. A direct physical connection between perforation and cutaneous findings was not identified. The case emphasizes the need for a comprehensive approach in managing such cases, analyzing ingested material, and following standard autopsy protocols in case of death.

Chemotherapy-related striate melanonychia: a case report.

BACKGROUND: Chemotherapy medications are reported to cause discoloration of the nails known as melanonychia. Depending on the nail structure affected and the severity of the insult, the clinical features can be variable. There are a great deal of unreported cases of pigmentary nail changes associated with chemotherapy treatment. By sharing our knowledge, we hope to raise the awareness of these nail changes amongst clinicians. Early recognition is crucial to allay anxiety among patients and avoid any unnecessary investigations. CASE PRESENTATION: We present a case of 36-year-old woman of south Asian origin, who developed dark pigmentation in the left thumb nail during neoadjuvant chemotherapy with 5-fluorouracil, epirubicin, cyclophosphamide, and docetaxel (FEC-D) for triple negative breast cancer. Upon examination, the left thumb nail pigmentation was strikingly linear, uniform, and well demarcated extending from proximal nail fold to free margin. Despite the reassuring clinical features, the patient was understandably anxious that this could be a presentation of acral melanoma and was referred to the plastic surgeons for a nail matrix biopsy. Biopsy reassuringly was reported as melanosis and a diagnosis of striate melanonychia was made. The patient was discharged after 2-year follow-up. CONCLUSION: Chemotherapy medications have improved survival rates and patient outcomes. It is important for clinicians to be aware of the association of melanonychia with certain chemotherapy medications to reduce anxiety and allow successful management of these patients without delay. Striate melanonychia in this patient was felt most likely due to the synergistic effect of chemotherapy drugs compounded with racial predisposition. Chemotherapy agents most likely to have contributed include cyclophosphamide, docetaxel, and 5-fluorouracil.