Journal of Dermatology & Dermatologic Surgery-JDDS最新文献

Extramammary Paget’s disease (EMPD) is a rare cancer which involves the skin and apocrine glands. It involves the vulva, perianal region, scrotum, penis and axilla. Primary disease originates from intraepidermal cells and secondary originates from underlying neoplasm. The disease presents with thickened plaque like lesion with erythema or white scaly appearance. The cancers of urinary tract like the bladder, urethra and prostrate are associated with EPMD involving the genitalia and rectal tumours are associated with perianal disease. The disease affects females more than males with the median age being 72 years. Primary perianal EMPD is even rare in presentation. It is a slow growing tumour and the prognosis is usually favourable other than advanced stage and old age. The surgical resection with clear margins is considered to be the standard of care and provides good outcomes. However, if surgery is not feasible other treatment options like imiquimod 5% topical cream and radiation therapy may be offered. We present a young male with perianal EMPD who was managed with surgical resection with clear margins with split skin graft leading to a favourable outcome.

Scarring at the level of the fingertip can cause major problems and discomfort. We report a case of a professional bass player who suffered impaired functionality of his middle finger after surgical treatment of a felon. We performed a collagen induction therapy after plastic reconstruction of the middle finger’s fingertip with an adipofascial turnover flap and two lateral VY flaps. This resulted in a long-term improvement of the previous symptoms and full functional rehabilitation as musician with an esthetically pleasing result.

We are reporting a 33-year old woman with multiple skin-colored, firm, non-tender nodules of varying sizes (ranging between 1 and 1.5 cm), with limited mobility and normal overlying skin. They were distributed mainly on the palmer side of the fingers. History and laboratory examination indicated lack of systemic diseases such as diabetes, rheumatoid arthritis, and tuberculosis. Histopathologic examination confirmed the subcutaneous granuloma annulare (SGA) diagnosis by showing a normal epidermis with palisading granulomas (histocytes and giant cells) surrounding small areas of connective tissue degeneration (central necrobiosis) and mucin accumulation in the reticular dermis and subcutaneous tissues. The patient responded well to two-session course of intra-lesional steroid injections. SGA should be considered by dermatologists in the differential diagnosis of subcutaneous nodules even without concomitant systemic disease and with rare presentation.

Defatting is usually required when patients undergo fullthickness skin grafting. However, this procedure is often burdensome, because it requires both stable fixation and appropriate tensioning of the skin piece. Furthermore, a skin piece may drop on the floor by accident during the defatting process To solve these problems, we present a unique method of full-thickness skin harvesting, which is easy and convenient, and does not require any special devices. The distal end of elliptical skin is not cut off but remains attached to the body like a pedicled flap. The surgeon pulls the end of the skin and puts his finger on the skin surface during the defatting procedure. This looks similar to a barber sharpening a razor using a strop belt. Our “razor strop” defatting method facilitates full-thickness skin harvesting without any need to purchase specialized equipment. We believe that this technique is an effective option for defatting in full-thickness skin grafting

This report presents a sixty year old female with unusual appearance of bilateral xanthelasma palpebrarum of periorbital region. These lesions were approximately 7 cm × 3 cm in dimensions. Patient’s main complaints were aesthetic appearance and hindrance in downward gaze. Considering the size of the lesions surgical excision was planned and the raw area covered with full thickness skin grafts from supra clavicular region. The aesthetic and functional outcome was good. The aim of this case report is to put forward an unusual presentation of xanthelasma, at the same time to keep in mind the surgical excision with full thickness skin grafting as an excellent treatment modality for periorbital xanthelasma palpebrarum especially in large lesions where other modalities have their own limitations.

Background: Multiple dermatofibromas (“DFs”) are defined by the presence of 15 lesions in the same patient or the development of five to eight DFs over the period of 4 months. Fifty-six percent of multiple DFs are associated with other diseases. The most common associated disease is systemic lupus erythematosus (“SLE”) followed by immunodeficiency virus (“HIV”) infection. Main observation: We report a case of a 25-year-old Saudi Arab female with SLE on immunosuppressive drugs with multiple DFs. Conclusion: The most common association with multiple DFs is SLE followed by HIV. Most of the patients with SLE were on immune suppressive medications. Dermatologists, rheumatologists, surgeons and internists should note that patients with SLE who are on immune suppressive medications are at risk of developing multiple DFs.

Interstitial granulomatous dermatitis (IGD) is an uncommon idiopathic dermatitis characterized by variable clinical presentation and a special histopathologic pattern. IGD is in some cases associated with autoimmune connective tissue diseases. Here we describe, IGD in a 35 year old Saudi female systemic lupus erythematosus patient. IGD lesions appeared as multiple asymptomatic erythematous annular plaques symmetrically distributed in the axillae, chest, abdomen and back. The lesions resolved totally within 2 months after systemic corticosteroid treatment.

Background: Injection of dermal fillers is one of the most commonly performed procedures in the cosmetic dermatology practice. As its usage is expanding, the possibility of complications will likely increase.

Objective: To review and summarize the complications associated with hyaluronic acid injections, and to provide a guide to avoiding them and managing these complications if they do occur.

Methods: A comprehensive PubMed and Google scholar electronic database search was performed (2005–July 2015). A total of fifty-five articles were selected and included.

Results: Most of the complications associated with hyaluronic acid filler use are mild, transient and reversible. Serious complications due to vascular occlusion include cutaneous necrosis and blindness, which although rare can occur due to the compression of the vessel or direct intravascular injection.

Conclusion: Injection related side effects are the most commonly seen, which are usually transient. Vascular occlusion is the most severe complication associated with hyaluronic acid filler injection. A thorough understanding of the facial vascular anatomy reduces the risk of vascular occlusion. Early identification of a vascular occlusion and a prompt intervention can significantly decrease the risk of long term sequelae. Guidelines to avoid, identify and manage different hyaluronic acid filler complications have been suggested.

Background: Molluscum contagiosum is a common self-limiting viral infection of the skin. Many therapeutic agents have been used with varying success rates. Objective: To evaluate and compare the effectiveness of topical 10% KOH solution and 25% podophyllin solution as home-based treatments of molluscum contagiosum. Patients and methods: This open randomized comparative therapeutic trial was conducted in the department of dermatology, Al-Yarmouk Teaching Hospital, Baghdad, Iraq between January and October 2015. The patients were divided randomly into two equal groups. Group A patients were treated with 10% KOH solution and those in group B with 25% podophyllin solution. All patients were assessed weekly for 4 weeks for therapeutic response. Results: Fifty-two patients (age: 2–34 years) with MC were enrolled in this study, 25 patients in group A and 20 patients in group B completed the study. Sixteen (64%) patients in group A showed complete clearance of lesions versus 14 (70%) patients in group B. No systemic side effects were reported in both groups and the local side effects were comparable between both groups. Conclusion: Both 10% KOH solution and 25% podophyllin solution are effective local therapies for the treatment of MC with comparable success rates (64% and 70% respectively).

Context

Lichenoid interface dermatitis refers to the histological pattern which is useful for the classification and diagnosis of disorders of a particular group in dermatology with peculiar features.

Aims

To get clinico pathological correlation in lichenoid interface dermatitis which will help in accurate diagnosis by analyzing history, clinical examination as well as histological details of nature and extent of epidermal, interface and dermal changes and the distribution of various inflammatory cell infiltrates.

Methods

After appropriate case selection according to the inclusion criteria, the biopsy was taken and sent for histopathological analysis. It was reviewed and correlation was done in each patient.

Statistical analysis used: kappa correlation analysis.

Results

Out of total 117 cases, 108 were of lichen planus, five were of lichen striatus, two of lichenoid drug eruptions and two of lichen nitidus. Clinico-pathological correlation was present in 70.94% of cases of lichenoid interface dermatitis. Correlation was seen in 100% cases of lichen striatus, and 78% cases of lichen planus.

Conclusions

The most consistent findings in histology in our study were basement membrane degeneration, band like lymphocytic infiltrates and melanin incontinence. Other findings such as hypergranulosis, civatte bodies were not observed frequently.