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Open Access Publications from the University of California

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Dermatology Online Journal is an open-access, refereed publication intended to meet reference and education needs of the international dermatology community since 1995. Dermatology Online Journal is supported by the Department of Dermatology UC Davis, and by the Northern California Veterans Administration.

Volume 19, Issue 8, 2013

Commentary

Slip, slop, slap, seek, slide - is the message really getting across?

Australia has given a high priority to education programs emphasizing the relationship of sun exposure and skin cancer and teaching about sun safety and sun protection. Have these efforts been successful?

Case Report

Taxane associated subacute cutaneous lupus erythematosus

Numerous medications have been associated with the development of subacute cutaneous lupus erythematosus. A mechanism explaining how unrelated drug classes can lead to subacute cutaneous lupus erythematosus has remained elusive, suggesting that there may be multiple etiologic pathways. Taxanes (docetaxel, paclitaxel, and cabazitaxel) inhibit cell mitosis through microtubule stabilization and their use has uncommonly been associated with subacute cutaneous lupus erythematosus. Recently the antigen recognized by anti-Ro/SS-A antibody (Ro52) has been localized to the cytoplasmic microtubule network. A case report of docetaxel exacerbated subacute cutaneous lupus erythematosus is presented and literature review performed, revealing 11 additional cases of taxane associated subacute cutaneous lupus erythematosus. Taxanes are proposed to exacerbate or induce subacute cutaneous lupus erythematosus in immunogenetically predisposed patients by stabilizing microtubules and affecting Ro/SS-A antigen (Ro52) expression. This may be an under recognized adverse drug reaction because taxanes are used for a defined period and the cutaneous eruption tends to spontaneously improve. Studies analyzing how particular drug classes affect Ro/SS-A antigen expression may be useful in identifying mechanisms of action in drug-induced subacute cutaneous lupus erythematosus.

Mycobacteria infection in an immunocompetent patient with no risk factors: evaluation and management of non-healing majocchi granuloma-type nodule

Atypical mycobacterial infections are more commonly described among immunocompromised patients, although there has been an increasing incidence in recent years of infections in immunocompetent hosts. Normally preceding trauma is a risk factor for infection. We describe a case of Mycobacteria chelonae infection in a healthy individual with no risk factors.

Case Presentation

Clinical and histopathologic findings in cutaneous sting ray wounds: a case report

Human injuries related to stingray attacks include deep puncture wounds, envenomation, and foreign body reactions owing to retained tail fragments. Herein we report a patient who sustained a stingray injury that produced a subcutaneous granulomatous dermatitis and panniculitis with necrobiosis and review the topic of stingray injuries.

Multiple myeloma diagnosed secondary to analysis of a lytic bone lesion encountered during mohs micrographic surgery

An 89-year-old man underwent Mohs micrographic surgery for treatment of a squamous cell carcinoma of the scalp. A lytic bone lesion was found that led to the diagnosis of multiple myeloma.

Unilateral purpura annularis telangiectodes of majocchi in an elderly male: an atypical presentation

Purpura annularis telangiectodes (PAT), also known as Majocchi purpura, is a rare form of pigmented purpuric dermatosis characterized by non-palpable red-brown, occasionally pruritic patches which progress to hyperpigmented halos. Purpura annularis telangiectodes usually presents in female adolescents as benign symmetric lesions with a predilection for the lower extremities. We present an atypical case of unilateral PAT in an elderly male. To our knowledge, our patient at 85-years-old is the oldest PAT and first unilateral purpura annularis telangiectodes case described in the literature.

Trichofolliculoma: a rare variant of hair follicle hamartoma

Trichofolliculoma is a rare hair follicle hamartoma, which is often regarded as a hair follicle tumor. Mostly, it presents as a papule or nodule, involving the skin of the face and scalp area. A central, dilated keratin plugged ostium with vellus hair(s) is often present. We report a 19-year-old woman with typical clinical and histopathological findings of trichofolliculoma.

Polymorphous low-grade adenocarcinoma in the upper lip: a well-described but infrequently recognized tumor.

Polymorphous low-grade adenocarcinoma (PLGA) is a rare malignant neoplasm arising almost exclusively in the minor salivary glands. PLGA occurs primarily in the oral cavity, especially in the palate, followed by the oral mucosa and upper lip [1,2]. Conditions involving these locations are often presented at dermatological clinics. Therefore, dermatologists should consider this entity in the differential diagnosis of the oral cavity tumors. We present a case of PLGA in the upper lip.

Two new cases with costello syndrome

Costello syndrome (CS) was described in 1977 by Costello who reported two unrelated children with a new syndrome comprising short stature, redundant skin of the neck, palms, soles, and fingers, curly hair, papillomata around the mouth and nares, and mental retardation. Several additional cases have been reported since then.  Herein we report two patients with Costello syndrome; one of these patients had associated mesenteric cyst.

Hypopigmented micropapules in apparently quiescent morphea lesions: A manifestation of disease activity.

We present two young patients with morphea or localized scleroderma undergoing systemic treatment, who developed papular lesions on pre-existing sclerotic plaques. Histology was compatible with a papular presentation of morphea and other entities in the differential diagnosis were ruled out. We believe this is a very uncommon presentation of activity in lesions of morphea and should be made known to clinicians so that activity and progression of the disease can be recognized and treated to avoid complications.

Eccrine hidrocystomas presenting as multiple papules on the cheeks

Hidrocystomas are common, benign adnexal neoplasms most frequently found on the eyelids, canthi, or periocular areas. Herein, we report a case of multiple hidrocystomas distributed over less common facial areas: cheeks and cutaneous lips.

Agminated syringocystadenoma papilliferum: a new clinical presentation of a rare benign adnexal neoplasm

Syringocystadenoma papilliferum is a rare adnexal tumor that often occurs as a solitary tumor in the head and neck region, although occurrences on other anatomical locations have been described. Linear configurations have been described, but an agminated form is a more rare and underreported variant of this tumor. We describe a case of a healthy 10-year old female with agminated syringocystadenoma papilliferum occurring on her left supraclavicular region, with the clinical appearance of grouped molluscum contagiosum papules.Case synopsis

A healthy 10-year-old girl was referred for the treatment of a "collection of molluscum contagiosum" of the left supra clavicular region of several years duration. The lesions were asymptomatic and refractory to cryotherapy. The patient was a healthy girl with no significant systemic findings. Cutaneous exam revealed a clustered group of pink, dome shaped, umbilicated papules over a 1.5 x 1 cm area within the left supraclavicular fossa (Figure 1a).

An excisional biopsy was performed. Routine H&E stained sections revealed cystic epidermal invaginations with papillary projections. The superficial portions of the cyst were lined by stratified keratinizing epithelium, whereas the deeper papillated portion exhibited a double layer of basal-like cells and luminal eosinophilic columnar cells with focal decapitation secretion. The papillary structures contained fibrovascular cores and lymphoplasmacytic infiltrates. A component of hamartomatous follicular growth was not identified (Figure 1b-d.).  A diagnosis was made of agminated syringocystadenoma papilliferum.

PHACES syndrome with moyamoya vasculopathy – a case report

“PHACES” (OMIM 606519) is a neurocutaneous disorder, and facial hemangiomas are the hallmark of this syndrome.  The syndrome encompasses posterior fossa brain malformations, facial hemangiomas, arterial anomalies, aortic coarctation, cardiac anomalies, eye abnormalities, and sternal defects.

Photo Vignette

A 29-year-old man with exophytic Kaposi sarcoma and edema of the bilateral legs in the setting of immune reconstitution inflammatory syndrome.

A 29-year-old man with a history of HIV, previously noncompliant with antiretroviral therapy, restarted highly active antiretroviral therapy (HAART) 4 weeks prior to the sudden development of multiple tender exophytic friable tumors and subcutaneous nodules of the thighs. Herein we present a patient with Kaposi sarcoma in the setting of immune reconstitution inflammatory syndrome.

Pityrosporum folliculitis in an immunocompetent patient: clinical case description

The present report concerns Malassezia-related pityrosporum folliculitis in a patient without any predisposing factor. Once the diagnosis had been confirmed by histopathologic exam, the patient was treated with oral ketoconazole and selenium sulfide shampoo; complete remission of the clinical condition was obtained. Thus it could be concluded that in spite of being routinely associated with immunosuppression, this condition may be present in an immunocompetent patient.

Congenital drainage at the base of the neck

Heterotopic salivary gland tissue consists of otherwise normal salivary tissue, but occurs  at a site in which it is normally not present (outside of the major, minor, and accessory salivary glands), with absence of clinical and histological features of branchial cleft anomalies. We herein present a 7-year-old boy with drainage from a small, congenital cystic lesion located at  the base of the neck, which was histologically confirmed as salivary gland tissue.