Congenital Milia En Plaque.

Milia en plaque is a rare, benign, localized, entity typically seen in adults after the third decade of life. Although there have been a few cases described in children, we describe the first case in a newborn.

Nevus anelasticus: how should such lesions be classified?

Nevus anelasticus represents a rare entity that is most commonly classified as a connective tissue nevus. It typically presents before 20 years of age with asymmetrically distributed white-to-skin-toned or pink-to-red papules or plaques on the trunk and upper extremities. The lesion is defined histopathologically by the absence or degeneration of elastic fibers in the dermis. We report the case of a healthy 17-year-old female who presented with an asymptomatic slowly progressive plaque on the right inferior areola. Histopathologic examination showed the absence of elastic fibers in the papillary and upper reticular dermis and fragmented elastic tissue fibers in the deep reticular dermis. Although there is ongoing controversy regarding the nosology of this uncommon disorder, we propose that it is a distinct entity based on its histopathologic and clinical features.

Late-onset focal dermal elastosis: an uncommon mimicker of pseudoxanthoma elasticum.

Late-onset focal dermal elastosis is a rare disorder that presents clinically with the development of small white-to-yellow papules simulating pseudoxanthoma elasticum (PXE) in otherwise healthy adults in the seventh through ninth decades. It is characterized histopathologically by foci of increased normal-appearing elastic tissue in the reticular dermis. The disorder lacks any of the systemic complications of PXE and clinically resembles several other elastic tissue disorders that mimic PXE. We report two cases of late-onset focal dermal elastosis. The first is of a 75-year-old female who presented with symmetrically distributed, 2-5 mm white-to-yellow, discrete and coalescing, non-follicular papules on the posterolateral neck, anterior chest and axillae. The second case involves a 39-year-old female who presented with asymptomatic flesh-colored lesions on the posterior neck, back, antecubital and popliteal fossae, thighs, forearms and wrists. Skin biopsies in each case revealed aggregates of elastic fibers in the reticular dermis without calcification. The differential diagnosis of clinical and histopathologic imitators of PXE is discussed.

Papillary dermal elastosis.

We recently came across the article "Papillary dermal elastosis" by Newlove et al published in the October 2011 edition of Dermatology Online Journal. In this paper, the authors described what they interpreted to be the second case of papillary dermal elastosis, an entity we had first identified in 2009. Upon further reading of their histopathologic and clinical description, we believe this case is more consistent with the diagnosis of pseudoxanthoma elasticum-like papillary dermal elastolysis (PXE-PDE).

Epidermotropic metastasis from vulvar squamous cell carcinoma: a rare cutaneous manifestation.

Cutaneous metastases occur in 0.7% to 9% of all malignancies. In women, cutaneous metastases occur most often in breast cancer, followed in order by colorectal carcinoma, melanoma and ovarian carcinoma. Of the squamous cell carcinomas (SCC) that do metastasize, many are exceedingly difficult to differentiate from primary SCC of the skin and are often found in the advanced stages with well-established primary tumor and lymph node involvement. This is an important distinction because metastatic cutaneous SCC is associated with a much poorer prognosis than primary SCC. Cutaneous metastases from vulvar cancers are even less common and have been reported in only 8 cases. We report a rare case of epidermotropic metastatic squamous cell vulvar cancer in a 77-year-old woman.

Papillary dermal elastosis: a unique elastic tissue disorder or an unusual manifestation of pseudoxanthoma elasticum-like papillary dermal elastolysis?

There are numerous acquired elastic tissue disorders, several of which present cutaneously with small yellow-to-white papules resembling plucked chicken skin. Differential diagnoses depend on the abnormalities within the network of elastic tissues. We report a case with distinct histologic features, which may represent a unique elastic tissue disorder or a variant of pseudoxanthoma elasticum-like papillary dermal elastolysis. Our patient's clinical presentation includes scattered 1-2 mm white-to-yellow papules without surface change on the upper back and neck region. Histology is characterized by foci of clumped, granular elastic tissue, which have replaced the oxytalan and elaunin fibers, alternating with foci of decreased concentrations of normal-appearing elastic fibers within the papillary dermis. Given its characteristics, we have termed this novel entity 'papillary dermal elastosis'.

The Burden of Atopic Dermatitis: Summary of a Report for the National Eczema Association.

To assess the patient-level and societal burden of atopic dermatitis, we comprehensively reviewed the literature related to quality of life, social, economic, academic, and occupational impacts. Atopic dermatitis has profound impacts on patient and family quality of life. A conservative estimate of the annual costs of atopic dermatitis in the United States is $5.297 billion (in 2015 USD). People with atopic dermatitis may change their occupation because of their skin disease. Research gaps include quality of life assessments outside of tertiary care centers, impacts on partners and families of adult patients, and updated comprehensive cost estimates.

The impact of tobacco exposure on development of otorrhea after myringotomy tube placement.

INTRODUCTION: Otorrhea is a common sequela after myringotomy with tube placement (MTP). The purpose of this study was to identify any significant relationship between passive tobacco exposure and the development of post-tympanostomy tube otorrhea. METHODS: Retrospective chart review was performed on 774 cases of patients who underwent MTP by a single surgeon at a tertiary pediatric hospital from 2012 to 2014. Patients with multiple medical comorbidities, craniofacial anomalies, syndromes and those over 12 years of age were excluded. Multivariate logistic regression analysis was performed to determine if there was a relationship between risk factors (including tobacco exposure, age, pre-operative diagnosis, operative findings and duration of follow-up) and the development of post-tympanostomy tube otorrhea. RESULTS: One hundred and ninety-one patients (average age of 1.92 years) were included. Overall, 16.8% of patients (32/191) had exposure to tobacco smoke. Of patients with passive smoke exposure, 65.6% (21/32) developed otorrhea, as compared to 45.3% (72/159) of those without tobacco exposure. Passive exposure to tobacco smoke by (OR = 2.307; p = 0.009; 95% CI, 1.734-6.028) and younger age (p = 0.012; 95% CI, 0.602-0.938) were associated with increased risk for otorrhea. DISCUSSION: This study suggests that in a cohort of patients undergoing MTP, passive exposure to tobacco smoke significantly increases the risk of developing post-operative otorrhea. This information is valuable to include in parental preoperative counseling regarding tympanostomy tube placement.

Cutaneous tumors in pregnancy.

Pregnancy alters the frequency and natural course of certain skin tumors. Pregnancy-associated changes in melanocytic nevi are transient, and there is no substantiated evidence of increased risk of malignant transformation of melanocytic nevi in gestation. Characteristic vascular and pigment-related dermatoscopic features are helpful in evaluating pigmented lesions, but a biopsy should be performed for significant change or other worrisome features in a lesion. Outcomes for pregnancy-associated melanoma do not appear to be poorer compared with nonpregnancy melanoma; however, data are limited for advanced (stage III/IV) melanoma. Some studies suggest increased propensity for lymphovascular spread, but more data are needed for definitive conclusions and guidelines on prognostication, workup, and treatment of pregnancy-associated melanoma. Vascular tumors, particularly pyogenic granuloma (granuloma gravidarum), occur with increased frequency and are associated with pro-angiogenic hormonal influences. Dermatofibrosarcoma protuberans has a more aggressive course during pregnancy with both prompt surgical treatment and close monitoring for recurrence being indicated.