Journal of dermatological case reports最新文献

Background: Erythroderma is an uncommon and severe dermatological manifestation of a variety of diseases. It is commonly challenging to find the underlying cause.

Objective: The aim of this study was to analyze the causes of the disease in patients with erythroderma.

Patients and methods: Data including the clinical symptoms, laboratory examinations, histopathology and follow-up information were collected from patients with erythroderma admitted to our department between 2000 and 2010.

Results: One-hundred and three patients diagnosed with erythroderma were identified during this period (11.9% of all hospitalized patients; hospital incidence = 9.4 cases/year). The mean age of onset was 54.4 years (range: 17-89 years) with a male:female ratio of 1.5:1. The most frequent cause of erythroderma was exacerbation of preexisting dermatoses (65.0%), including psoriasis (44.7%) and eczema (16.5%). Drugs (18.4%) and cutaneous T-cell lymphomas (11.7%) induced most of the remaining cases. No cause could be identified in four cases (3.9%). Apart from erythema and scaling, that were present in all patients, clinical findings were dominated by pruritus (97.1%), followed by edema (56.3%), fever (54.4%), palmoplantar keratoderma (50.5%), nail changes (42.7%), liver or spleen enlargement (41.7%) and lymphadenopathy (40.8%).

Conclusions: Although numerous clinical features and laboratory values were abnormal, most findings were non-specific. The skin biopsy yielded a positive clinical correlation in most cases. Our study had a high percentage of erythroderma secondary to preexisting skin disease and a relatively low percentage of idiopathic erythroderma.

Background: Etanercept and other anti-TNF-alpha agents have been indicated as a therapeutic option in severe drug reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis. Etanercept has been shown to quickly reduce the detachment of the epidermis and shorten healing time. Cases of etanercept-induced severe adverse drug reactions were also described.

Main observations: A 27-year-old woman with a 4-year history of etanercept and sulfasalazine treatment for rheumatoid arthritis was admitted with Stevens-Johnson syndrome. The patient received one dose of an OTC drug containing acetaminophen, phenylephrine and pheniramine two days prior to developing fist mucocutaneous symptoms. The most probable causative agent was paracetamol. Throughout the successful routine therapy of Stevens-Johnson syndrome etanercept therapy was continued. Sulfosalazin administration was stopped and administered again after recovery with no recurrence of the skin and mucosal symptoms.

Conclusions: This case indicates that there is no justification for discontinuation of long-term anti-TNF-alpha treatment in patients who develop Stevens- Johnson syndrome / toxic epidermal necrolysis.

Pruritic folliculitis of pregnancy is a noninfective dermatosis of the gestation period characterized by multiple pruritic follicular papules and/or pustules which is not uncommonly mistaken for other similar skin disorders that may occur during pregnancy. In the present article we describe the usefulness of dermoscopy as a supportive diagnostic tool in a case of pruritic folliculitis of pregnancy. The main (always present) dermoscopic clue consisted of a vellus hair in the centre of each papule/pustule. Moreover, most papules showed a central yellowish-orange hue with some dotted vessels and irregular haemorrhagic spots. The detection of the aforementioned dermoscopic features might help distinguish pruritic folliculitis of pregnancy from its main differential diagnoses, mainly including microbial folliculitis, prurigo lesions, and the papular stage of pruritic urticarial papules and plaques of pregnancy, as they typically show different dermoscopic patterns.

Postradiation sarcomas are rare and highly malignant tumors which may appear as a consequence of radiotherapy. They may originate on bone or soft tissues.We report the case of a patient who developed a malignant fibrous histiocytoma 35 years after radiotherapy for a melanoma on her right leg.

Background: Aquagenic keratoderma is a dermatosis characterized by transient whitish and transluscent hyperwrinkling after water exposure. The aim of the current report was to present a sporadic and familial cases of aquagenic keratoderma.

Observation: Sporadic Case: A 38-year-old female patient presented with eruption in the right hand after exposure to water. The patient was placed on systemic acitretin therapy with the diagnosis of idiopathic acquired aquagenic keratoderma. No recurrence occurred during a 6-month follow-up period. Familial Cases: A 55-year-old male patient, who was engaged in fishery, presented to the outpatient clinics of the department of dermatology due to whitish vesicles in the palms of both hands. It was realized that the father, sister, and brother of the patient had similar complaints. The cases were thought to have familial aquagenic keratoderma; however acitretin therapy could not be initiated due to elevated alanine aminotransferase and triglyceride levels. Topical application of salicylic acid 10% and 10% urea containing lotions was effective but did not prevent recurrence.

Conclusion: Systemic acitretin may be an effective agent in the treatment of aquagenic keratoderma, and topical application of 10% salicylic acid and 10% urea-containing lotion did not prevent recurrence.