ABSTRACT
A 72-year-old woman presented with recurrent painful erythematous nodules and ulcers on both legs. Latent tuberculosis was proven by a positive interferon-gamma release assay, and a histopathology examination revealed septolobular panniculitis with vasculitis. The initial diagnosis was erythema induratum associated with tuberculosis, but the leg ulcers became worse despite anti-tuberculosis medication and wound dressing. Computed tomography angiography showed occlusion of the superficial femoral and popliteal arteries bilaterally, supporting that the vascular event contributes to the ulcers according to the vascular territories. Under the diagnosis of peripheral arterial occlusive disease, she was treated with percutaneous transluminal angioplasty and antiplatelet medication. The skin ulcers were resolved. Elderly patients with erythema induratum have a risk of coincidental peripheral arterial occlusive disease, therefore dermatologists should be aware of the possibility of underlying vascular disease, so even minor trauma like skin biopsy can evoke serious condition shown in this patient. Here, we report a case of drastically aggravated erythema induratum due to co-existing peripheral arterial occlusive disease, which resolved with vascular intervention after not responding to antituberculosis medication.
Subject(s)
Aged , Female , Humans , Angiography , Angioplasty , Arterial Occlusive Diseases , Bandages , Biopsy , Diagnosis , Erythema Induratum , Erythema , Interferon-gamma Release Tests , Latent Tuberculosis , Leg , Leg Ulcer , Panniculitis , Popliteal Artery , Skin , Skin Ulcer , Tuberculosis , Ulcer , Vascular Diseases , Vasculitis , Wounds and InjuriesABSTRACT
Erlotinib inhibits the epidermal growth factor receptor and is used in patients with various cancers. However, it can affect the epidermis and hair because the receptor is expressed in normal skin cells. A 54-year-old woman with metastatic non-small-cell lung cancer presented with erythematous patches over her entire body and severe hair shedding 2 weeks after starting erlotinib. Histopathological examinations showed lymphocytic exocytosis; perivascular infiltration of lymphohistiocytes and eosinophils in the right arm; and marked infiltration of eosinophils, neutrophils, and lymphohistiocytes in the scalp. Erlotinib discontinuation improved hair loss and skin lesions. Hair loss has been reported in 5% of patients taking erlotinib. Our case was unusual in that there was complete baldness, and to our knowledge, no report of complete hair loss and exanthematous drug eruption after erlotinib treatment has been previously reported. Here, we report a case of severe hair loss with concurrent exanthematous drug eruption that may have been linked to erlotinib hypersensitivity.
Subject(s)
Female , Humans , Middle Aged , Alopecia , Arm , Drug Eruptions , Eosinophils , Epidermis , Erlotinib Hydrochloride , Exocytosis , Hair , Hypersensitivity , Lung Neoplasms , Neutrophils , ErbB Receptors , Scalp , SkinABSTRACT
BACKGROUND: A number of anticancer agents are known to induce many adverse reactions in the skin. Related cutaneous adverse drug reactions influence the morbidity, mortality, and anti-cancer regimen of the patients. A multidisciplinary approach to cancer management has been emphasized. OBJECTIVE: To identify the causative anticancer agents and frequency of adverse reactions in the skin. METHODS: We retrospectively reviewed the medical records of patients who consulted at the Dermatology Department of Busan Paik Hospital and Haeundae Paik Hospital from January 2013 to February 2015. RESULTS: A total of 140 patients were enrolled. Among the 45 patients treated with antimetabolite analogs (30 cytarabine, 7 gemcitabine, 3 methotrexate, 2 fludarabine, 2 doxifluridine, and 1 decitabine), exanthematous drug eruption (49.1%) was the most common reaction, followed by hand-foot syndrome (28.3%). Among the 35 patients treated with fluorouracil (22 5-fluorouracil and 13 capecitabine), hand-foot syndrome (47.2%) was the most common, followed by acneiform eruption (25.0%). Among the 24 patients treated with epidermal grow factor receptor inhibitors (10 erlotinib, 10 cetuximab, and 4 gefitinib), acneiform eruption (54.8%) was the most common, followed by xerosis (19.4%). Among the 11 patients treated with anthracyclines (9 doxorubicin, 1 daunorubicin, and 1 idarubicin), acneiform eruption (45.5%) was the most common, followed by hand-foot syndrome (36.4%). Among the 7 patients treated with taxanes (4 docetaxel and 3 paclitaxel), hand-foot syndrome (42.8%) was the most common. Among the 6 patients treated with angiogenesis-inducing inhibitors (3 sorafenib, 2 pazopanib, and 1 sunitinib), hand-foot skin reaction (66.7%) was the most common. Only 2 patients (1.4%) changed treatments due to intolerable skin reactions. CONCLUSION: Clinicians should be aware of the various skin reactions of anticancer agents and predict their clinical course effectively.
Subject(s)
Humans , Acneiform Eruptions , Anthracyclines , Antineoplastic Agents , Cetuximab , Cytarabine , Daunorubicin , Dermatology , Doxorubicin , Drug Eruptions , Drug-Related Side Effects and Adverse Reactions , Erlotinib Hydrochloride , Fluorouracil , Hand-Foot Syndrome , Medical Records , Methotrexate , Mortality , Retrospective Studies , Skin , TaxoidsABSTRACT
An 18-year-old male visited our department complaining of recurrent episodes of an itchy rash after hand washing, showering/bathing, drinking water, and getting rain-soaked. He was diagnosed with aquagenic urticaria after a water provocation test and histopathologic examination. Five months of antihistamine treatment successfully prevented further wheal formation. Aquagenic urticaria is a very unusual form of physical urticaria caused by contact with water. It manifests as pruritic small wheals surrounded by erythema within 30 minutes of exposure. The condition can be diagnosed by a water provocation test. Systemic antihistamines are the first-line treatment, with anticholinergics, phototherapy, or barrier cream used alternatively or additionally. Four cases of aquagenic urticaria have been reported in Korea, but no histopathologic evaluation was reported in the English or Korean literature. Herein, we provide both a case report of aquagenic urticaria diagnosed by the water provocation test and histopathologic examination results for this patient.
Subject(s)
Adolescent , Humans , Male , Cholinergic Antagonists , Drinking Water , Erythema , Exanthema , Hand Disinfection , Histamine Antagonists , Korea , Phototherapy , Urticaria , WaterABSTRACT
A 71-year-old female presented with erythematous ulcerative patches on her right cheek, chest and right upper arm. She admitted to neurosurgery intensive care unit (NSICU) with mental change related to intracerebral hemorrhage. She had no underlying disease. Histopathologic examination of her right upper arm showed multiple non-septated broad hyphae with right-angled branching in dermis. She was diagnosed as primary cutaneous mucormycosis. The fungal culture demonstrated Cunninghamella species. We postulated that mucormycosis occurred after inoculation of fungi following fall down trauma. Mucormycosis, which commonly affects immunocompromised patient, is a rare fungal infection caused by the order Mucorales. Cutaneous mucormycosis is caused either by direct inoculation of fungal spores or by hematologic spread from another primary source. Clinical manifestations are various from indolent ulceration to rapidly progressive necrosis. Mucormycosis can be diagnosed based on the histologic findings and the fungal culture. Mucormycosis by Cunninghamella species have been increasingly reported, but most of them are pulmonary mucormycosis in immunocompromised patients. Herein, we report a rare case of multiple primary cutaneous mucormycosis caused by Cunninghamella species in a patient without underlying disease.
Subject(s)
Aged , Female , Humans , Arm , Cerebral Hemorrhage , Cheek , Cunninghamella , Dermis , Fungi , Hyphae , Immunocompromised Host , Intensive Care Units , Mucorales , Mucormycosis , Necrosis , Neurosurgery , Spores, Fungal , Thorax , UlcerABSTRACT
Microsporum(M.) gypseum, a geophilic dermatophyte, causes dermatophytosis that is characterized by rapid development and resolution. M. gypseum infection is rare due to its low infectivity, and there have been no previous case reports of infection with this dermatophyte after scratch injury by a dog. Here, we report a case of annular, scaly, erythematous plaques on the right ankle of a 5-year-old female patient after being scratched on the leg by a dog. Histopathological examination showed fungal hyphae on the stratum corneum. M. gypseum was identified by tissue culture and polymerase chain reaction. She was treated with sertaconazole cream. In this case, M. gypseum may have been transferred to the scratched area from contaminated soil or from the claws of the dog.
Subject(s)
Animals , Child, Preschool , Dogs , Female , Humans , Ankle , Arthrodermataceae , Hoof and Claw , Hyphae , Leg , Microsporum , Polymerase Chain Reaction , Soil , TineaABSTRACT
Lichen planus is a chronic inflammatory disease that mainly involves the skin and oral mucosa. We report the case of a 57-year-old female who presented with a 6-week history of localized violaceous papules on her back and both extremities. Prior to presentation, she had received acupuncture on her back and both extremities, and 2 weeks later skin lesions occurred along the treated area. From the histopathologic findings of the lesion, the patient was diagnosed with lichen planus and treated with intralesional and topical corticosteroids. Dermatologic diseases such as atypical mycobacterial infection, foreign body granuloma and contact urticaria associated with traditional Korean medicine treatments have been reported. To the best of our knowledge, there has been only one report of eruptive lichen planus triggered by acupuncture in English literature to date. Herein, we report this rare and interesting case of lichen planus related to acupuncture.
Subject(s)
Female , Humans , Middle Aged , Acupuncture , Adrenal Cortex Hormones , Extremities , Granuloma, Foreign-Body , Lichen Planus , Lichens , Mouth Mucosa , Skin , UrticariaABSTRACT
Congenital self-healing reticulohistiocytosis is a variant of cutaneous Langerhans cell histiocytosis seen in newborns. It is characterized by generalized brownish to erythematous papules or nodules that resolve spontaneously within several weeks to months, without involvement of other organs. Erythematous erosive patches or vesicles are rare clinical features of congenital self-healing reticulohistiocytosis; only 11 cases have been reported in the literature. A newborn female presented with erythematous erosive patches and vesicles on the whole body without systemic symptoms. Histopathologically, multiple lymphocytes and histiocytic cells with kidney shaped nuclei were observed in the dermis. Immunohistochemical stain showed positive reactions for CD1a and S100 in histiocytic cells in the dermis. All lesions involuted spontaneously within a month without treatment. Here we report a rare case of congenital self-healing reticulohistiocytosis presenting as erythematous erosive patches and vesicles, with a literature review.
Subject(s)
Female , Humans , Infant, Newborn , Dermis , Histiocytosis, Langerhans-Cell , Kidney , LymphocytesABSTRACT
Vitiligo is a chronic disorder characterized by depigmented macules which can slowly enlarge with the concurrent development of new lesions. Although autologous suction blister epidermal grafting is an established technique for the treatment of recalcitrant, stable vitiligo, the donor tissue graft is not easy to fix at the recipient site, especially in areas such as the joints, face, cutaneous folds, hands, feet, and hair-bearing areas. Therefore, various methods of donor tissue fixation have been attempted. We report two cases of vitiligo treated with suction blister epidermal grafting, with fibrin tissue adhesion. The first case is that of 16-year-old female patient presented with hypopigmented patches on the forehead and frontal scalp area. The other case is that of 32-year-old female patient presented with hypopigmented patches on the chin. We treated them with phototherapy for 1~4 years; however, the lesions were recalcitrant. Therefore, we tried treatment with a suction blister epidermal graft. Because graft fixation is difficult at the recipient sites, fibrin glue was sprayed on the grafts. Thereafter, we applied a porous silicone wound contact layer over the graft area and applied sterile gauze dressing that was left for a week. One week after the procedure, firm fixation of the donor tissue was observed in both cases. Fibrin glue seemed to improve the graft fixation, providng protection against infection and an optimal environment for wound healing. This report suggests that the application of an epidermal graft with fibrin glufixation, can provide the best result in the surgical treatment of stable vitiligo.
Subject(s)
Adolescent , Adult , Female , Humans , Bandages , Blister , Chin , Fibrin , Fibrin Tissue Adhesive , Foot , Forehead , Hand , Joints , Phototherapy , Scalp , Silicones , Skin Transplantation , Suction , Tissue Adhesions , Tissue Donors , Tissue Fixation , Transplants , Vitiligo , Wound Healing , Wounds and InjuriesABSTRACT
No abstract available.