Morphoea of the breast in a young girl.

Localized morphoea is an uncommon sclerosing skin disorder. Prognosis is usually good but it may lead to contractures, perturbed limb growth, atrophy, pigmentary changes and cosmetic disturbance. We describe a case of morphoea that developed in one breast in a 9-year-old white female. Treatment comprised topical ammonium lactate 12% cream and tretinoin 0.025% cream but no topical corticosteroids were prescribed. One year later she was noted to have bilateral symmetrical breast development and, although signs of morphoea were still present in one breast, the plaque had softened and there was no breast deformity. It is important to remember that most cases of morphoea improve spontaneously, although a number of possible therapeutic options may be indicated in some patients.

Erythema elevatum diutinum in a patient with human immunodeficiency virus.

Erythema elevatum diutinum (EED) is a chronic cutaneous leukocytoclastic vasculitis. This rare disease is characterized by red, brownish-purple, and yellow papules, plaques, and nodules distributed symmetrically about the extremities. There have been recent reports of the disease in association with infection with the human immunodeficiency virus (HIV). We describe the case of a 51-year-old man with HIV who presented with EED, which was successfully treated with dapsone.

Treatment of facial verrucae with topical imiquimod cream in a patient with human immunodeficiency virus.

Imiquimod is a recently developed imidazoquinolin heterocyclic amine that is an immune response modifier. Treatment with topical 5% imiquimod cream has shown promising results in the treatment of genital warts in immunocompetent individuals. We report here the first case of successful treatment with topical 5% imiquimod cream of facial verrucae in an individual with human immunodeficiency virus.

Pedunculated malignant melanoma.

BACKGROUND: The pedunculated melanoma is an unusual variant of nodular melanoma that presents a challenge in staging and management. OBJECTIVE: We discuss the clinical and histopathologic characteristics of a case of pedunculated melanoma and present a brief review of the literature. METHODS: Routine stain with hematoxylin and eosin was performed on tissue specimens. RESULTS: The pedunculated melanoma was excised. Sentinel lymph node dissection was performed and was negative for the presence of melanoma. CONCLUSIONS: Pedunculated melanoma is a rare type of melanoma. Conventional staging methods for melanoma may not be reliable in this type of tumor. Complete workup, possibly including sentinel lymph node dissection, should be performed in all patients with pedunculated melanomas.

Psoriasis associated with human immunodeficiency virus in an infant.

Psoriasis is commonly reported in association with HIV in adults. A 3-month-old girl with HIV presented with a widespread eruption and was diagnosed with psoriasis. This is the first infant reported with psoriasis in association with HIV infection. The relationship between the two entities is discussed, as is the role of treatment with zidovudine.

Photolocalized varicella in a middle-aged adult.

We report a case of photolocalized varicella occurring in a middle-aged woman. Photolocalized or actinic varicella is rarely described, and most reported cases have occurred in children. This is the first case in a middle-aged adult.

Mucocutaneous fungal colonization in HIV-infected children.

The prevalence of symptomatic mucocutaneous candidiasis in HIV-infected children is well documented. Information, however, of the carriage rate of potential fungal pathogens is lacking. In this study we determined the fungal colonization rate of multiple mucocutaneous sites from 13 HIV-infected and 12 control children. The rate of yeast and mould colonization and the species of fungal isolates were essentially the same for both groups of patients. However, several HIV-infected children asymptomatic for thrush proved to be colonized by Candida albicans, and disseminated colonization with Trichosporon beigelii occurred in one HIV-infected child. All cultures for dermatophytes were negative. While the carriage rate with fungi other than C. albicans was not increased in the HIV-infected group, the isolates recovered are known pathogens in the immunocompromised host and the colonization of these organisms may be a potential source of infection.

Malignant syphilis (lues maligna) and concurrent infection with HIV.

BACKGROUND: During the past 2 1/2 years we observed six patients who had a reactive serology for syphilis, of which four developed widespread noduloulcerative and two vesiculonecrotic lesions. The purpose was to report the occurrence of lues maligna, a rare form of secondary syphilis, in five patients infected with the human immunodeficiency virus (HIV) and in one patient with risk factors for infection. METHODS: Tzanck preparations, viral cultures, and skin biopsies were performed to evaluate the etiology of the lesions. RESULTS: Syphilis serology titers ranged from 1:32 to 1:128 and in one instance was as low as 1:8. Such titers can also be found in patients with the latent form of syphilis. Therefore, confirmation of the clinical diagnosis of lues maligna was dependent on skin biopsies that were compatible with secondary syphilis and negative viral studies that excluded varicella, disseminated varicella-zoster or herpes simplex. Lues maligna takes an aggressive course in HIV-infected patients since four of the patients required hospitalization and the two patients who refused to complete treatment, subsequently developed more severe skin and constitutional symptoms. CONCLUSIONS: HIV-infected patients are at risk for developing lues maligna. Despite its malignant presentation, lues maligna lesions respond rapidly to treatment with penicillin. Secondary syphilis should be added to the list of diseases known to be more aggressive in HIV-infected patients.

Adult onset of inflammatory linear verrucous epidermal nevus in a mother and her daughter.

Inflammatory linear verrucous epidermal nevus (ILVEN) is a rather uncommon dermatosis that typically has an early age of onset, is unilateral, localized, pruritic and relatively refractory to treatment. Atypical presentations of ILVEN have also been described and include late onset in life, widespread involvement and response to treatment. We report the adult onset of an extremely pruritic systemized eruption in both mother and her daughter that clinically and histologically was most compatible with ILVEN. The eruptions were also partially responsive to therapy.