Management of multiple trichoepithelioma: A review of pharmacological therapies.

Trichoepithelioma is a rare benign adnexal neoplasm that can occur in various forms including solitary, multiple, familial or nonfamilial. Multiple facial trichoepithelioma can be associated with significant psychosocial burden. Conventional treatment modalities such as surgical excision and ablative laser have variable results and can be associated with unacceptable complications and tumour regrowth. Pharmacological interventions such as topical and systemic agents are potentially effective but clinical data are limited and treatments are poorly standardised. We review the available evidence to determine the role of pharmacological therapies in the management of multiple trichoepithelioma. Demographic and clinical data were retrospectively collected from the available English literature. Majority of cases treated with pharmacological therapies (93.75%) had a positive treatment outcome, achieving partial lesion response. Adverse effects associated with pharmacological therapies were generally well tolerated and did not interrupt treatment. There are limitations as to how our results can be interpreted owing to the paucity of good quality evidence, spectrum of disease severity, and diversity of study designs utilised in the included articles. Nonetheless, the results of our study indicate that while most pharmacological interventions for multiple trichoepithelioma produce a partial response, they can be employed as effective suppressive therapies, either alone or in conjunction with conventional treatments. The current evidence for pharmacological therapies remains largely anecdotal justifying the need for further clinical studies in this area.

Asymptomatic disseminated telangiectasias: a rare case of cutaneous collagenous vasculopathy.

Cutaneous collagenous vasculopathy (CCV) is a rare idiopathic microangiopathy affecting superficial dermal blood vessels. It is characterized by asymptomatic, disseminated, telangiectatic macules that typically involve the extremities. We report the case of a 58-year-old woman who presented with widespread telangiectasias of three years' duration on the upper extremities and abdomen. Cutaneous collagenous vasculopathy may be underdiagnosed as it is often mistaken for disorders that are morphologically very similar, including generalized essential telangiectasia, hereditary hemorrhagic telangiectasia, and pigmented purpuric dermatosis. The diagnosis of CCV is made histologically and findings feature dilated superficial dermal vessels with thickened walls containing periodic acid-Schiff-positive eosinophilic hyaline material. Effective treatment options for CCV have yet to be established and given its benign disease course, treatment may not be necessary. Pulsed dye laser can be offered to patients for cosmetic improvement but the extent of the disease makes complete lesion clearance challenging in most cases. Given the lesions were asymptomatic our patient declined all offered treatment modalities.

A case of secondary erythromelalgia with perivascular and intramural mucin.

We present a 49-year-old man with type I erythromelalgia, demonstrating a newly reported histological feature of striking perivascular mucin. There is a single previously reported case in the literature describing these histological features. This patient had a comorbid history of primary myelofibrosis diagnosed 2 years prior to his presentation.

Distribution analyses of acquired melanocytic naevi on the trunk.

Acquired melanocytic naevi (AMN) are a well-known risk factor for the development of melanoma. Whereas previous studies have reviewed AMN distributions on individual body sites, the clinical distribution of AMN on the adult trunk has not been thoroughly investigated. We studied 40 participants with 1,282 naevi >5 mm, of which 781 were located on the trunk. Remarkably, 70% of these truncal naevi were located on the back and we produced a continuous mathematical description of decreasing naevus frequency moving dorsolaterally from the back midline. Furthermore we found that for both sexes the mean naevus size was larger on the front as well as on the lower trunk. This distinct pattern, whilst probably being unwritten knowledge (in the dermatology domain), has not been discussed before.

A case of acute generalised exanthematous pustulosis after unprotected sexual intercourse on holidays in bali.

We present the case of a 43-year-old man with a clinical diagnosis of acute generalised exanthematous pustulosis in the setting of a recent 9-day holiday to Bali, Indonesia, to visit a female partner whom he had visited five times this year for unprotected sexual intercourse and from whom he had contracted a sexually transmitted infection. He also reports having taken some Indonesian cold and flu medications and ibuprofen.

Erythema nodosum - a review of an uncommon panniculitis.

Panniculitis, inflammation of the subcutaneous fat, is a relatively uncommon condition that usually presents with inflammatory nodules or plaques. Erythema nodosum (EN) is clinically the most frequent form of panniculitis and is considered a reactive process that may be triggered by a wide variety of stimuli. Whilst up to 55% of EN is considered idiopathic, the most common causes include infections, drugs, systemic illnesses such as sarcoidosis and inflammatory bowel disease, pregnancy, and malignancy. EN typically presents in the teens and 20s, and is seen more commonly in females. It is often preceded by a non-specific prodrome of one to three weeks, which may include fever, malaise, and symptoms of an upper respiratory tract infection. Cutaneous lesions then follow, typically localized on the extensor aspect of the limbs. The lesions are painful rounded or oval, slightly raised, non-ulcerative red nodules. The exact pathogenesis of EN is not understood, although is thought to result from deposition of immune complexes in the venules of the septae in subcutaneous fat, causing a neutrophilic panniculitis. The classical histopathological picture is of a septal panniculitis without vasculitis. However, the pathological features vary with the chronology of the lesions. Even without specific therapy for a causative condition, EN typically resolves without treatment. Therefore, symptomatic support is adequate for the majority of patients.