PRURITIC RASH IN AN ELDERLY PATIENT WITH UNCONTROLLED DIABETES MELLITUS.

OBJECTIVE: Acquired reactive perforating collagenosis is an uncommon skin disease that belongs to a group of dermatologic disorders characterized by transepidermal elimination of dermal material. It is highly associated with systemic disease, primarily diabetes mellitus and dialysis-dependent chronic renal failure. METHODS: A 70-year-old female with 20 years of poorly controlled type 2 diabetes mellitus presented with a 6-month history of multiple pruritic erythematous papules and nodules with central hyperkeratosis, involving her right dorsal arm. Histologic examination was consistent with acquired reactive perforating collagenosis. In addition to topical treatment of the disease, the patient was referred to endocrinology for appropriate management of her underlying diabetes mellitus. RESULTS: Ideal treatment should involve both the endocrinologist and dermatologist. Control of the underlying systemic disease, in this case diabetes, as well topical or systemic medications can both help to improve this condition. Our patient re-established care with her endocrinologist who adjusted her medication regimen, resulting in improved hemoglobin A1c values. Our patient additionally benefited from topical betamethasone cream, ammonium lactate, and pimecrolimus application. The combined therapy led to resolution of her pruritic rash. CONCLUSION: This case highlights the importance of the skin exam by the endocrinologist, as he or she plays a unique role in identifying this rare and difficult-to-treat dermatologic disease. Early detection and prompt referral to a dermatologist are crucial in preventing progression of disease, treating the disease, and improving the patient's quality of life.

Laptop computer-induced hyperpigmentation.

A 25-year-old afebrile man presented with one year of worsening non-pruritic hyperpigmented non-blanchable reticulated patches and one erosion on his abdomen. He denied trauma, contact with new detergents, and recent travel. He was not taking medications and denied ever having similar skin findings. Further questioning revealed that he positioned his laptop computer directly on his abdomen for several hours every night. His progressive skin findings characterize erythema ab igne, which occurs after repetitive prolonged exposure to temperatures between 43 to 47 degrees Celsius. The hyperpigmentation can occur anywhere on unprotected skin and is an ongoing clinical problem in all demographics as heat sources evolve. Guided questioning of an unsuspecting patient can expedite diagnosis and prevent the development of erosions and ulcers, permanent skin discoloration, and even skin cancers.

Melanoma in an Active Duty Marine.

Given that the majority of active duty service members are young and healthy, potentially malignant diagnoses such as skin cancer may be overlooked. Although melanoma accounts for only approximately 1% of skin cancers, it causes the greatest majority of skin cancer deaths. We present the case of a 27-year-old active duty Marine who presented with a hyperpigmented macule at his lateral neck that was a malignant melanoma in situ. This article reviews risk factors for the development of melanoma, offers guidelines for primary care providers, reviews resources for providers in a deployed or austere environment, offers recommendations for prevention and early diagnosis, and discusses follow up.