Accelerated photocarcinogenesis and multifocal squamous cell carcinomas associated with voriconazole and human papillomavirus in HIV - case report.

Voriconazole is an antifungal with known side effects of phototoxicity and photocarcinogenesis. We present a case of HPV-related multifocal squamous cell carcinoma in a 68-year-old man with HIV, due to accelerated photocarcinogenesis associated with long-term use of voriconazole. Histology confirmed SCC with HPV-related features and he was found to have metastases. Multifocal SCC is unusual in association with voriconazole and HIV infection and only one other case has been reported. It is important for clinicians to be aware of the photocarcinogenic effects of voriconazole, especially in patients with HIV.

HIV-related Merkel cell carcinoma: A report of three cases from the UK.

Merkel cell carcinoma (MCC) of the skin is a rare, aggressive and often fatal neuroendocrine skin cancer. The incidence of MCC has significantly increased in the last decades. Factors that have been associated with the development of MCC include infection with Merkel Cell polyomavirus (MCPyV), ultraviolet exposure, hematologic malignancies and immunosuppression.We present three cases of patients living with HIV who were diagnosed with MCC. HIV cases associated with MCC have been rarely reported and to our knowledge, not yet before in the UK.

Long-term management options for sea urchin injury: a case series.

In the UK, sea urchin-related injuries (SUIs) most commonly present in returning travellers. Delayed complications mainly affect the skin but nerves, tendons, joints and bones may also be involved. The management of chronic reactions may be challenging and a variety of approaches have been described. Surgical measures are often undertaken, particularly when retained spines are suspected. We demonstrate, through three cases presenting in the UK with chronic SUIs, that conservative management, surgery and intralesional corticosteroids may all be associated with satisfactory outcomes. Management options should consider the presence of retained spines, injury site, symptoms and importantly, patient preference.

Carbon dioxide laser ablation of dermatosis papulosa nigra: high satisfaction and few complications in patients with pigmented skin.

Dermatosis papulosa nigra (DPN) is a common condition of pigmented skin. Whilst lesions are benign, they may be symptomatic or cosmetically disfiguring. Ablative lasers have previously been reported as a useful therapeutic modality in DPN. We report the largest case series to date of patients with DPN ablated with the carbon dioxide (CO2) laser. A retrospective case note review was conducted of all patients with DPN treated in our laser clinic in the last five years, and a post-treatment telephone survey was undertaken to assess patient satisfaction. Forty-five patients were identified, with a median age of 41 years (range 25-74 years), of whom 37 (82%) were female. The median number of treatments undertaken was three (range 1-10). Of the 18 respondents to the telephone survey, when asked to grade their satisfaction with the procedure out of 10, median response was 9.5 (range 6-10) with nine patients citing the maximum score of 10. All patients replied that their confidence had improved following the procedure and that they would recommend the treatment to other patients. Five respondents (28%) reported recurrence of a few lesions following CO2 laser ablation; the remaining 13 respondents (72%) reported no recurrence of DPN. No respondents reported any other post-procedural complications (including scarring, hypopigmentation and hyperpigmentation). We advocate use of the CO2 laser as a safe, convenient means of treating DPN, with a high degree of patient satisfaction, low recurrence rate and few complications.

Carbon dioxide laser perforation and extirpation of steatocystoma multiplex.

BACKGROUND: Steatocystoma multiplex (SM) is a rare condition that presents as multiple dermal cysts, the appearance of which can have a significant impact on the patients' quality of life. Treatment options for SM are limited to surgical excision. OBJECTIVE: To present our experience of treating 8 SM cases using a novel approach that uses the carbon dioxide (CO2) laser and to explore patients' views about the treatment. METHODS: Patients were identified from our records. All patients had multiple lesions treated using the CO2 laser in the super pulse mode that punctured the cyst. This was followed by extirpating the cyst wall and its contents using a small Volkmann's spoon. Treatment efficacy was assessed clinically and feedback from the patients was sought through a telephone interview. RESULTS: All patients showed significant clinical improvement with minimal scarring and low recurrence rates. High levels of patient satisfaction, which helped to significantly improve their quality of life, were reported with the CO2 laser treatment. CONCLUSION: CO2 laser perforation and extirpation is a successful approach for managing SM that results in high patient satisfaction.

A case of secondary erythromelalgia with unusual histological findings.

Erythromelalgia clinically presents with episodic burning, erythema, and warmth of acral sites. It can be divided into primary and secondary associated with myeloproliferative and autoimmune conditions. Histology commonly shows capillary proliferation, swelling of endothelial cells, perivascular edema, and chronic inflammation with sparse lymphocytic infiltrate. We report a case of a 55-year-old man with classical secondary erythromelalgia clinically; however, he had unusual histological findings on biopsy comprising of acute perivascular infiltrate and perivascular mucin. This is the first report of such findings in the context of secondary erythromelalgia.

GA101 (a Novel Anti-CD20 Monoclonal Antibody)-Induced Lichenoid Eruption.

INTRODUCTION: Obinutuzumab (GA101) is a novel anti-CD20 monoclonal antibody that has been shown to be effective for the treatment of non-Hodgkin's lymphoma, and is currently being evaluated in phase 3 clinical trials. The side-effect profile of the drug is not yet well established. CASE REPORT: The authors report a case of a 62-year-old patient who developed widespread lichenoid eruption as a result of GA101 treatment for his follicular non-Hodgkin's lymphoma. CONCLUSION: This is the first case report of cutaneous side effects of GA101.