Skin Necrosis Following Inadvertent Dermal Injection of Extended-release Buprenorphine.

INTRODUCTION: Extended-release subcutaneous buprenorphine injection is a relatively new formulation and clinicians are still gaining experience with its use. There is sparse literature available on adverse events. We describe a case of skin necrosis associated with the injection site of extended-release buprenorphine. CASE REPORT: A 35-year-old reported immediate swelling and eventual skin breakdown near his buprenorphine injection site. He was found to have ulceration down to the subcutis with no evidence of infection. The patient followed up with dermatology and underwent debridement of the site. The injection site healed with scar formation. DISCUSSION: Although mild to moderate adverse events related to the injection site have been reported in Phase 3 studies of extended-release buprenorphine injection, this is a rare case of skin necrosis requiring surgical intervention and excision of the depot. CONCLUSIONS: This case highlights the potential complication of skin necrosis after inadvertent dermal of extended-release buprenorphine and reviews proper administration techniques.

Alopecia areata mimicking pseudopelade of Brocq.

We report a case of a white woman with discrete, asymmetrical, noninflammatory areas of hair loss clinically suggestive of pseudopelade of Brocq (PB). However, the histologic features revealed a diagnosis of alopecia areata (AA). We discuss the importance of histopathologic examination in the diagnosis of AA.

Periumbilical purpura prior to gastrointestinal involvement in Henoch-Schönlein purpura.

Henoch-Schönlein purpura (HSP) is a systemic vasculitis involving the skin, joints, gastrointestinal tract, and kidneys. While HSP is traditionally considered a disease of children, it also occurs in adults. In both populations, acute gastrointestinal complications and chronic renal involvement are major predictors of mortality. While it has been previously demonstrated that truncal lesions in HSP are associated with underlying renal involvement, a significant proportion of cases with gastrointestinal involvement also have associated truncal lesions. It is unclear at this time whether or not the association of truncal involvement with visceral disease is related to an increased burden of circulating immune complexes or a more specific mechanism. We describe a report of periumbilical purpura antecedent to gastrointestinal involvement in an adult with HSP.

Atypical presentations of herpesvirus infections in patients with chronic lymphocytic leukemia.

The characteristic presentation of herpesvirus infections is a vesicular rash. The initial lesions appear as erythematous papules that turn into grouped vesicles and pustules eventuating into crusts. In most cases, the features are so characteristic that a diagnosis can be made by history and physical examination without further diagnostic testing. However, patients who are immunosuppressed (including those with hematologic malignancies) often have atypical presentations of herpesvirus infections. These cases require a high index of suspicion and appropriate diagnostic testing for proper management. In this report, we describe two patients with chronic lymphocytic leukemia who developed atypical presentations of herpes zoster and herpes simplex infections. Herpetic infections should always be in the differential diagnosis of cutaneous ulcerations with necrosis in patients who are immunocompromised. Because of the atypical appearance of the lesions, the diagnosis may be confused or mistaken for several other conditions.

An extensive case of dermonecrotic arachnidism.

Dermonecrotic arachnidism is the potential cutaneous reaction to spider bite venom. The yellow sac spider, genus Cheiracanthium, is historically considered capable of inducing dermonecrotic lesions. However, recently this belief has been hotly debated. In this article, the authors provide a brief review of dermonecrotic arachnidism and describe a case of a 20-year-old man who developed severe necrosis and edema of the left thigh, buttock, penis, and scrotum following the bite of a yellow sac spider. Notably, the patient wore a tight-fitting garment for multiple hours following the spider bite, thus compressing the envenomated tissue. This is the first case reporting such severe dermonecrosis resulting from a yellow sac spider bite and highlights the potential effects of tissue compression following spider envenomation.

Hydroxyethyl starch-induced pruritus relieved by a combination of menthol and camphor.

Hydroxyethyl starch is a key component of many colloid volume expanders used in hypovolemic shock and otologic disease. Pruritus is a common side effect. Histopathology reveals multiple cytoplasmic vacuoles in dermal macrophages, endothelial cells, and perineural cells with electron-dense foreign material within the said vacuoles. Although classically refractory to treatment with corticosteroids and antihistamines, some benefit has been achieved with capsaicin, ultraviolet light therapy, and oral naltrexone. We present a case responsive to menthol and camphor and discuss the possible therapeutic mechanism.

Xanthoderma: a clinical review.

"Xanthoderma" is a term that describes a yellow to orange macular discoloration of the skin. The cause of this finding ranges from benign to potentially life-threatening disease. To date the literature fails to comprehensively review the various causes and workup of this clinical manifestation. This article discusses the etiopathogenesis of xanthoderma and suggests a novel diagnostic algorithm for the clinician to use in the initial evaluation of this condition.

A 34-year-old man with Darier-White disease: a case report and review of the literature.

Darier-White disease is an uncommon genodermatosis that is commonly under-recognized and is characteristically refractory to treatment. It is most frequently due to an autosomal dominant mutation in an intracellular calcium pump. It can be associated with severe cutaneous infections requiring hospitalization as well as neurologic and psychiatric comorbid disease. There are many treatment modalities described in the literature and systemic retinoids are the most effective. An increased clinical suspicion could possibly lead to a decreased delay in the diagnosis of this disease and an increased quality of life for these patients. We report a case of a man with Darier-White disease followed by a review of the current literature on the pathogenesis, clinical features, diagnosis, and treatment of this cutaneous malady.