An acute, ulcerative, sarcoidal tattoo reaction following SARS-CoV-2 mRNA-1273 vaccination.

Two weeks after her first dose of the SARS-CoV-2 mRNA-1273 (Moderna) vaccine, a 38-year-old woman developed acute-onset pain and ulceration within a tattoo on the distal left leg. Progressive ulceration was noted approximately one week following her second dose of the vaccine. A biopsy revealed sarcoidal granulomas and a dense neutrophilic infiltrate. Ultimately, the final diagnosis of what we have termed a "sarcoidal reaction with a Sweet-like phenomenon" was made; the patient experienced a reduction in pain and re-epithelialization of the ulcers with two weeks of the use of topical clobetasol 0.05% cream twice daily.

Coronary artery ectasia associated with hereditary hemorrhagic telangiectasia.

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) is characterized by a variety of cutaneous, mucosal, and visceral vascular anomalies. A patient with classic hereditary hemorrhagic telangiectasia was shown to have three-vessel coronary artery ectasia without evident atherosclerosis, and association not previously demonstrated. The possibility that coronary artery ectasia may be a manifestation of hereditary hemorrhagic telangiectasia is discussed.

Acute lymphoblastic leukemia in a child with the CHIME neuroectodermal dysplasia syndrome.

The "CHIME" syndrome (MIM#280000) is a rare neuroectodermal disorder comprised of Colobomas of the eye, Heart defects, Ichthyosiform dermatosis, Mental retardation, and Ear defects. We report on the sixth child with this syndrome and the first of these to develop acute lymphoblastic leukemia at age 4 1/2 years. Her major problems included a migratory ichthyosiform dermatosis, multiple skin infections and infestations, bilateral retinal coloboma, developmental delay, seizures, infantile macrosomia, facial anomalies, a duplicated renal collecting system, and conductive hearing loss. Histologic examination of the skin demonstrated findings of an epidermal nevus with deep rete pegs, hyperkeratosis, and a markedly increased granular layer. The cause of the CHIME syndrome is unknown, but the disorder is easily recognized because of the striking phenotype. The diagnosis is important to make because of the potential for associated congenital heart disease, neurologic compromise, possible autosomal recessive inheritance, and possible association with malignancy.

Segmental neurofibromatosis in an octogenarian.

A case of segmental neurofibromatosis (SNF) in an octogenarian is presented. The patient's lesions were first noted when he was 74 years of age. This variant of neurofibromatosis (Riccardi's classification, NF-V) is most typically seen in childhood or young adulthood. To the best of our knowledge, our patient's SNF is the first case to present in the eighth decade of life. Physicians working with geriatric patients should be aware of this entity and its lack of genetic heritability or systemic manifestations.

Recurrent toxin-mediated perineal erythema.

BACKGROUND: Important new diseases due to bacterial toxins functioning as superantigens have been described with increasing frequency within recent years. Toxic shock syndrome, recalcitrant erythematous desquamating disorder, streptococcal toxic shock-like syndrome, and, most recently, mucocutaneous lymph node syndrome (Kawasaki disease) have been etiologically linked with certain staphylococcal and streptococcal toxins. We describe two patients with a novel clinical presentation of toxin-mediated disease, which shares certain clinical features with mucocutaneous lymph node syndrome. OBSERVATIONS: Two otherwise healthy young male adults developed recurrent erysipelaslike perineal erythema, which regularly erupted within 1 to 2 days of the onset of acute pharyngitis. Accompanying signs included mucosal changes and acral erythema with desquamation. Throat cultures obtained during the acute episodes yielded toxin-producing Staphylococcus aureus from one patient and toxin-producing Streptococcus pyogenes from the other. CONCLUSION: The recurrent nature, age predilection, and clinical presentation suggest that our patients display a unique clinical syndrome due to toxin-producing bacteria.

Xerosis in hypothyroidism: a potential role for the use of topical thyroid hormone in euthyroid patients.

Xerosis is an extraordinarily common problem in dermatology. Despite the knowledge of well recognized aggravating factors, its etiology is an enigma, and the management of the condition is often suboptimal. Dry skin may be a manifestation of hypothyroidism. The nature of this association is reviewed, culminating in the speculation that topical thyroid hormone may represent a useful modality in euthyroid patients with xerosis or other disorders of keratinization.

Reticulate hyperpigmentation.

Disorders that are characterized by a reticulate pattern of pigmentation are reviewed. Dyskeratosis congenita (DKC) is the prototype of these. In addition to reticulate hyperpigmentation, mucosal leukoplakia, bone marrow dysfunction, cytogenetic instability, and a predisposition to malignancy are characteristic of DKC. The most common pattern of inheritance is X-linked, with heterozygous females showing variable expression, most likely depending on tissue-specific patterns of random X-inactivation. Other reticulate pigmentary disorders reviewed include the Naegeli-Franceschetti-Jadassohn syndrome, X-linked reticulate pigmentary disorder, dermatopathia pigmentosa reticularis, Dowling-Degos disease, dyschromatosis, confluent and reticulated papillomatosis of Gougerot and Carteaud, reticulate acropigmentation of Kitamura, and Revescz syndrome. Diagnosis, treatment, and sometimes genetic counseling remain problematic for these entities. The pathophysiology of these disorders is unknown, but will certainly be aided greatly by the future identification of the underlying genes.

Diltiazem-induced drug eruption sparing seborrheic keratoses.

A case of a diltiazem-induced morbilliform drug eruption, which spared the circumferential margin of seborrheic keratoses, is presented. Hypotheses regarding the pathogenesis of this novel exanthem are discussed. The potential mechanisms may be immunologic involving cytokines, or due to diminished levels of prostaglandin E2, altered optical properties of the skin, mechanical pressure phenomena, or altered local vasoconstriction secondary to diltiazem itself.

Psychotropic agent-induced black hairy tongue.

Black hairy tongue is characterized by an abnormal coating of the dorsal surface of the tongue. Although the cause is unknown, several precipitating factors may be implicated in the pathogenesis of this disorder. A case is presented in which black hairy tongue appeared subsequent to the administration of fluoxetine hydrochloride, thiothixene hydrochloride, benztropine mesylate, and clonazepam for bipolar affective disorder.

Necrobiosis lipoidica treated with topical tretinoin.

Necrobiosis lipoidica is often resistant to therapeutic intervention. Lesions are atrophic and frequently ulcerate. A case is presented in which atrophy was diminished by the application of topical tretinoin. The practical and theoretical use of topical tretinoin in this disorder is reviewed.

Hereditary papulotranslucent acrokeratoderma.

Hereditary papulotranslucent acrokeratoderma (HPA) is a rare autosomal dominant genodermatosis, characterized by persistent, asymptomatic, yellow-white translucent papules and plaques of the hands and feet. A case of HPA is presented and the literature of this variant of punctate keratoderma is reviewed.

Submandibular abscess caused by Eikenella corrodens.

Eikenella corrodens is a slow-growing, facultative, anaerobic, gram-negative bacillus that is part of the normal oral flora and is found in dental plaque. It has become increasingly recognized as a pathogen in nonimmunocompromised and immunocompromised hosts. A case of a submandibular abscess due to Eikenella corrodens, which was successfully treated by administration of cefuroxime accompanied by incision and drainage, is presented. Dermatologists need to be aware of this pathogen is the evaluation of suppurative lesions of the head and neck.

Acute generalized exanthemic pustulosis.

Acute generalized exanthemic pustulosis often presents dramatically with the abrupt onset of a widespread pustular eruption on an erythematous base, with a frequently positive Nikolsky sign. In most cases, penicillins or macrolides are causally related. The main differential diagnosis of a generalized pustular eruption in a febrile patient is pustular psoriasis, which can be differentiated on both a clinical and histologic basis.

Penile premalignant fibroepithelioma of Pinkus.

A 63-year-old man with a premalignant fibroepithelioma of Pinkus on the base of his penis is presented. Penile premalignant fibroepitheliomas have not, to the best of our knowledge, been previously described. Because fibroepithelioma of Pinkus is a morphological variant of a basal cell epithelioma, we believe that clinically benign fibroma-like lesions appearing on the penis should be biopsied to rule out the presence of this premalignant lesion.

Eruptive familial angiolipomas occurring during pregnancy.

Multiple angiolipomas presenting acutely in a pregnant woman are described. To the best of our knowledge, onset of this eruption during pregnancy has not been reported previously.

Complete remission of refractory dyshidrotic eczema with the use of radiation therapy.

Dyshidrotic eczema is a chronic, enigmatic condition that usually affects the hands and feet. Modern-technique radiation therapy using megavoltage equipment for the treatment of dyshidrotic eczema has not been described in the literature before. A dramatic clinical response to low-dose external beam radiation therapy was observed in a patient refractory to multiple forms of topical and systemic agents. Complete resolution of this severe presentation of dyshidrosis occurred within 1 month following therapy, with a durable response at 6 months. Withdrawal of oral steroids, without flare of disease, was possible after 6 weeks, with the patient remaining free of medication at the 6-month interval. Complete remission of severe dyshidrotic eczema is achievable using low-dose external beam megavoltage therapy in situations where other forms of conventional therapies have failed. Lasting remission may allow for the complete withdrawal of oral or topical agents, which may become harmful with chronic use.