Pruritus in connective tissue and other common systemic disease states.

Pruritus is a common symptom reported in connective tissue and other common systemic disease states. Unfortunately, the unique pathophysiologic etiology of the often chronic and severe pruritus that is a debilitating component of many connective tissue disorders makes treatment with conventional anti-itch agents difficult. As the underlying mechanisms of pruritus have been identified, treatment strategies have evolved. Considering the diversity of available antipruritic therapies and the variability of underlying factors specific to disease states, individualized therapy recommendations are necessary. Important new areas of treatment target the central and peripheral mechanisms of pruritus and include anticonvulsants, antidepressants, opioid antagonists, and phototherapy Further research is necessary to quantify the role of new and novel antipruritic therapies.

Drug-induced subacute cutaneous lupus erythematosus: a paradigm for bedside-to-bench patient-oriented translational clinical investigation.

At least 71 patients have been reported in which their otherwise typical subacute cutaneous lupus erythematosus (SCLE) skin lesions were felt to have been temporally associated with the systemic administration of a drug. The mean age of this cohort of drug-induced SCLE (DI-SCLE) patients was 59 years of age which is somewhat older than the mean age of previously reported idiopathic SCLE patient cohorts. Patients had been taking the suspected triggering drug for weeks to years before the onset of SCLE skin lesions. In addition, it was not unusual for 2-3 months to be required for resolution of the SCLE skin lesions following discontinuation of the triggering drug. A relatively large number of drugs representing different pharmacological classes have been implicated in the induction of SCLE. The drug classes that were more frequently encountered were those used for the treatment of cardiovascular disease, especially hypertension. Calcium channel blockers were especially common in this regard. Elderly individuals being treated for hypertension are often taking multiple classes of drugs that have been implicated in triggering SCLE (thiazide diuretics, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, beta-blockers). An approach to the management of DI-SCLE is presented. Ro/SS-A autoantibodies tended to remain present in the blood after resolution of drug-induced SCLE skin lesions. A common link between the disparate group of drug structures implicated in triggering SCLE is their tendencies to produce photosensitivity and lichenoid drug reactions. This leads to the speculation that DI-SCLE could represent a photo-induced isomorphic/Köebner response in an immunogenetically predisposed host.

An update on the dermatoses of pregnancy.

CONTEXT: The dermatoses of pregnancy represent a group of pathologic skin disturbances that cause considerable distress to the gravid patient. It is important to understand the diagnosis, treatment, and implications of these disorders in order to avert unnecessary discomfort and complications. OBJECTIVES: To describe the specific dermatoses of pregnancy according to an established classification system. DATA SOURCES: Reports identified from PubMed and textbook searches using relevant terms pertaining to the stated questions. CONCLUSION: The dermatoses of pregnancy represent a unique group of disease processes caused or exacerbated by the gravid state. This includes gestational pemphigoid (GP), pruritic urticarial papules and plaques of pregnancy (PUPPP), prurigo of pregnancy (PP), intrahepatic cholestasis of pregnancy (ICP), and impetigo herpetiformis (IH). GP, ICP, and IH may result in serious complications, whereas PUPPP and PP are generally benign processes. Early recognition of these disorders will possibly reduce maternal and fetal morbidity and mortality.

Malignant proliferating pilar tumors arising in KID syndrome: a report of two patients.

We report on two young adults with KID syndrome and follicular hyperkeratosis, hidradenitis suppurativa of the groin, progressive development of proliferative pilar cysts and dissecting cellulitis of the scalp, who developed metastatic malignant pilar tumors. Based on our findings, we believe that cancer surveillance in patients with KID syndrome should include screening for pilar tumors and their early removal to avoid development of malignant proliferating pilar tumors with poor prognosis.

Update on connective tissue diseases in dermatology.

Recent advances in understanding the pathogenesis of autoimmune diseases, including lupus erythematosus, dermatomyositis, and scleroderma, have allowed for reorganization of the classification of these disorders. With these novel stratifications, early identification of rheumatic skin diseases with systemic implications and consistency in designing and executing therapeutic trials will be enhanced. This review will provide a compilation of updates on epidemiology, pathology, evaluation, and classification with a predominant focus on therapeutics, reflecting the growth is this area.

Eccrine angiomatous harmartoma in an infant.

Eccrine angiomatous hamartoma is a nevoid proliferation of eccrine glands and small vessels. It usually presents as a solitary, slow growing nodule, manifesting at birth or in childhood, which can be accompanied by hyperhidrosis and pain on palpation. We report an occurrence in an otherwise healthy 3-month-old girl who had multiple, asymptomatic, nodular lesions with a linear arrangement localized to the inguinal fold. We also review the literature on adnexal hamartomas of infancy.

Erythema migrans and the differential diagnosis of annular erythema.

The diagnosis of Lyme disease (LD) or Lyme borreliosis is often based on the recognition of erythema migrans (EM) because its clinical appearance precedes systemic manifestations of the disease and the antibody response. The clinical basis and variable presentation of EM leave room for diagnostic error and, as a consequence, potential long-term repercussions such as rheumatic, cardiac, ophthalmic, or neurologic complications. Most cases are reported in the Northcentral and Northeastern states. In areas where LD is not endemic, the differential diagnosis of annular erythema may not list EM highly, although all the features of a lesion may fit the typical description of EM. Therefore, a complete understanding of LD and its clinical presentation are key in making a diagnosis, especially in areas with low incidence. We present a hypothetical case report of EM from Oklahoma, a state with low incidence of LD, for the purposes of review of this entity and the differential diagnosis of annular erythema.