Quantity and quality of sweating in atopic dermatitis.

Sweat may be an important factor in triggering an exacerbation of atopic dermatitis. It was the aim of this study to evaluate a possible correlation between atopic patients and hyperhidrosis-measured by a questionnaire-and to find out whether there are qualitative differences in sweat response-measured by sudomotor activity (sympathetic skin response test, SSR). Included were 100 study participants, of whom 50 were patients with atopic dermatitis and 50 were serving as control group. The frequency of hyperhidrosis is higher in atopic patients than in the control group (30 vs. 16%), but has no statistical significance. In addition, patients with hyperhidrosis and atopic dermatitis have a significantly higher exacerbation rate of atopic dermatitis in summertime. The group of atopic patients shows a statistically significant prolonged SSR latency period, which indicates an insufficient sympathetic innervation. In our tests, type IV allergic patients showed clear differences in terms of SSR latency and amplitude. Atopic patients have a higher incidence of hyperhidrosis. The study clearly shows that there is a dysfunction of sudomotor activity in the sympathetic nervous system of atopic patients. Our findings suggest that a deficient innervation of sweat glands in atopic patients may lead to an increase in the development of type IV allergies.

Carcinoma Cuniculatum of the Right Thenar Region with Bone Involvement and Lymph Node Metastases.

Squamous cell carcinoma (SCC) is the second most common type of skin cancer after basal cell carcinoma (BCC). The overall prevalence of BCC is 3 times higher than that of SCC, but this can vary when looking at specific locations such as the hand, where SCC is much more common than BCC. Carcinoma (or epithelioma) cuniculatum is a rare variant of SCC. It was originally described as a verrucous carcinoma of the soles. Exceptionally, it can arise in other parts of the skin. We report a rare case of carcinoma cuniculatum of the right thenar region with bone and lymph node involvement.

Necrobiotic Xanthogranuloma in a Patient with Multiple Myeloma.

An 82-year-old woman presented with a 9-month history of multiple, well-defined skin lesions on her neck and upper chest, progressively increasing in size. Histological examination of a skin biopsy showed a regular epidermis. In the dermis, granulomatous changes with central necrobiosis were found which extended focally into the subcutaneous fat. The necrobiotic areas were surrounded by Touton cells and foreign-body giant cells. Laboratory analysis revealed leucopenia. Serum electrophoresis and immunofixation disclosed the presence of an IgG-λ paraprotein. Bone marrow aspiration cytology showed 20% plasmatic cells. The skeletal X-ray revealed frontal and occipital osteolytic skull lesions as well as pubic osteolysis. Urinalysis was unremarkable without proteinuria. Based on the clinical, laboratory, and histological findings, necrobiotic xanthogranuloma in association with multiple myeloma was diagnosed. The patient was treated with bortezomib combined with oral dexamethasone. Follow-up at week 13 revealed the complete disappearance of the IgG paraproteinemia. However, the skin lesions remained unchanged. Therefore, bortezomib treatment was discontinued, and systemic corticosteroids were continued at a higher dosage. After the steroid treatment, the lesions markedly flattened.