Cutaneous phaeohyphomycosis caused by Paraconiothyrium cyclothyrioides.

Paraconiothyrium cyclothyrioides is a recently described coelomycetous fungal species. We present a case in a renal transplant patient with chronic skin lesions of the lower extremities caused by P. cyclothyrioides. Treatment with posaconazole led to complete resolution of the lesions. P. cyclothyrioides should be considered an opportunistic human pathogen in immunocompromised patients.

Unknown: Yellow plaques on the chest and arms present for more than 6 years in an 80-year-old male. Diffuse normolipemic plane xanthomas presenting in association with myelodysplastic syndrome.

Yellow plaques and papules on the skin are hallmarks of xanthomas. These are not always associated with abnormalities in lipid profiles or their associated proteins. In cases of diffuse normolipemic plane xanthomas these cutaneous findings are often associated with myelodyscrasias including monoclonal gammopathy of unknown significance and multiple myeloma. Such clinical presentations may indicate that an evaluation for myelodyscrasias is warranted.

Infection and panniculitis.

Infection-induced panniculitis may result from a number of microbes including bacteria, fungi, and parasites. Viruses have also been implicated as a cause. This type of panniculitis can occur as a primary infection by direct inoculation of infectious microorganisms into the subcutaneous tissue, or secondarily via microbial hematogenous dissemination with subsequent infection of the subcutaneous tissue. Panniculitis is rarely viewed solely in terms of infectious causes. Also, subcutaneous infections are infrequently viewed in terms of infection-induced panniculitis but rather as cutaneous infections with subcutaneous involvement. Little information exists specifically on the subject of infection-induced panniculitis outside of the realm of case reports and case series. In this review, the present authors address panniculitis from the vantage point of infectious causes, focusing on those microorganisms with infection-induced panniculitis reports in the literature. Diagnosis and treatment are also discussed.

Persistent cutaneous hyperpigmentation due to hydroxychloroquinone one year after therapy discontinuation.

Hydroxychloroquine (HCQ) was initially indicated for the treatment of malaria, but more recently its anti-inflammatory and immune modulating properties have been utilized for treatment of multiple dermatologic and rheumatologic diseases. Mucocutaneous bluish-gray dyschromia is a rare side effect with HCQ and little information exists regarding its duration after drug discontinuation. The few existing case reports primarily describe small focal areas of discoloration. More extensive dyschromia has very rarely been reported with HCQ. We report a case of HCQ induced dyschromia diffusely involving the extremities, with minimal resolution one year after treatment discontinuation.

Epidermodysplasia verruciformis and susceptibility to HPV.

PURPOSE OF REVIEW: Epidermodysplasia verruciformis has been addressed in depth in the recent literature despite its rarity. The disease is characterized by a persistence in human papillomavirus infections and development of cutaneous malignancies, usually happening more frequently and at a younger age than in the general population. Because of the role of immunodeficiency to viral antigens eventually leading to cancer, EV has become a model for understanding a viral role in cutaneous oncogenesis. Susceptibility loci for EV have been mapped and encoded protein functions are becoming better understood. Discoveries of novel mutations and further study of EV-associated HPV serotypes in lesional and nonlesional skin of affected patients and the general population may help generate a cohesive theory regarding the true role of a defective immune barrier in oncogenesis.

Clear cell acanthoma: a rare clinical diagnosis prior to biopsy.

BACKGROUND: Clear cell acanthoma is a rare, benign epidermal tumor with a clinical hybrid appearance and a distinct histological one. It is frequently mistaken for other clinical lesions. OBJECTIVE: To evaluate the frequency that clear cell acanthoma was listed in the clinical differential diagnosis of histologically confirmed specimens. METHODS: A regional dermatopathology lab database was evaluated from January 1998 through March 2008 for histologically diagnosed cases of clear cell acanthoma. Clinical data that was submitted with these cases including differential diagnoses was analyzed. RESULTS: During this time period of review, 411 histologically confirmed cases of clear cell acanthoma were identified. This entity was listed as a diagnostic possibility in 11 (2.7%) of the cases. CONCLUSION: Clear cell acanthoma was rarely listed amongst the differential diagnosis of biopsy proven specimens. This may be due to a variable clinical appearance with overlapping features of several other lesions making it difficult to distinguish, or an entity that is rare and not frequently suspected. Additional studies with dermatoscopy may help to further delineate the reasons for the low diagnostic sensitivity.

Shingles vaccine.

IMPORTANCE OF THE FIELD: Herpes zoster or shingles is a condition with the potential to result in severe debilitation. It affects approximately 10 - 30% of the population. Until recently there were only treatments to shorten the duration and lessen the symptoms of herpes zoster, but no practical or approved method of prevention for susceptible immunocompetent adults. The live attenuated zoster vaccine (Zostavax, Merck & Co., Inc.) is effective in preventing shingles in individuals 60 years of age and older and recommended by the Center for Disease Control's (CDC) Advisory Committee for Immunization Practices (ACIP). AREAS COVERED IN THIS REVIEW: Literature related to the live attenuated zoster vaccine is reviewed from its beginnings in the early 1970s through to the present. WHAT THE READER WILL GAIN: Background information on herpes zoster and up to date information on the live attenuated zoster vaccine including pharmacology, efficacy and safety are covered. New areas of research in zoster vaccination are also discussed. TAKE HOME MESSAGE: The live attenuated zoster vaccine is an effective and well-tolerated method of preventing zoster and the potentially debilitating sequelae and is recommended for immunocompetent patients 60 years of age and older. Ongoing clinical trials are investigating new means of effective prevention.