ABSTRACT
Herpetic whitlow is a localized cutaneous viral infection primarily affecting the fingers, caused by herpes simplex virus types 1 (HSV-1) or 2 (HSV-2). It can be recurrent due to behavioral factors associated with eating disorders, such as bulimia nervosa. We would like to introduce "Jehany Sign," suggesting the term for the association of bulimia nervosa with HSV infections. Here, we present the case of a 50-year-old pre-diabetic female with recurrent herpetic whitlow on her left index finger associated with self-induced vomiting and extreme concern about her weight and body shape. Skin examination showed an eroded group of vesicles on an erythematous base on her left finger. The diagnosis was established through history and clinical examination. Upon follow-up, the patient showed complete resolution in one week after receiving topical and systemic acyclovir, which led to a subsequent referral to a psychiatrist for further management regarding bulimia nervosa. This case highlights the importance of a multidisciplinary approach and the complicated connections between eating disorders and dermatological diseases. Recognizing these allows healthcare providers to deliver more comprehensive care, improve patient outcomes, and further study in this area.
ABSTRACT
A segmental pigmentation disorder (SPD) is a form of pigmentary mosaicism. SPD is a hypo- or hyperpigmented patch that has a segmental pattern. A 16-year-old male with an insignificant past medical history presented with symptomless, slowly progressive skin lesions since early childhood. Skin examination revealed well-demarcated, non-scaling, hypopigmented patches on the right upper extremity. A similar spot was located on his right shoulder. Wood's lamp examination showed no enhancement. Differential diagnoses included segmental pigmentation disorder and segmental vitiligo (SV). A skin biopsy was obtained, which revealed normal findings. Based on the above clinicopathological findings, a diagnosis of segmental pigmentation disorder was made. The patient did not receive any treatment but was reassured that he did not have vitiligo.
ABSTRACT
Acquired dermal macular hyperpigmentation (ADMH) is a term used to describe a group of diseases that are characterized by idiopathic macular dermal hypermelanosis. These skin conditions include erythema dyschromicum perstans, lichen planus pigmentosus, and pigmented contact dermatitis, also known as Riehl's melanosis. This case report involves a 55-year-old woman who was generally healthy but who had been experiencing asymptomatic, slowly progressive skin lesions for the previous four years. A thorough inspection of her skin revealed many non-scaly, pin-point follicular brown macules, which in some spots had coalesced into patches across her neck, chest, upper extremities, and back. Darier disease and Dowling-Degos disease were included in the differential diagnosis. The biopsies of the skin revealed follicular plugging. The dermis had pigment incontinence with melanophages and slight perivascular and perifollicular mononuclear cell infiltrates. The patient was diagnosed with a follicular form of ADMH. Patient's skin condition caused her concern. She was reassured and prescribed topical steroids 0.1% betamethasone valerate ointment application twice a day for two days per week (weekends) and 0.1% tacrolimus ointment application twice a day for five days per week for three months. She showed some improvement and was put under periodic follow-ups.
ABSTRACT
Infections of the paranasal sinuses are common and usually occur in patients who are immunocompromised. Many atypical clinical presentations have been reported but rarely in the elderly population. We report a 71-year-old female patient with a 20-year history of an autoimmune disease who had recently become resistant to treatment. Her autoimmune symptoms significantly improved following resection of deeply seated bacterial infection in her paranasal sinuses. She was also diagnosed with cervical cancer. Clinicians should look carefully for hidden infections and/or malignancies in patients lacking response while on immunosuppressive therapy for autoimmune disease.