Porphyria cutanea tarda associated with an acute gastrointestinal bleed: the roles of supplemental iron and blood transfusion.

We describe a case of porphyria cutanea tarda (PCT) induced by blood transfusion and oral iron supplementation in an 80-year-old white woman. The patient experienced acute blood loss from 2 duodenal ulcers 2 months prior to presentation. During her hospitalization for the gastrointestinal bleed, her anemia was treated with blood transfusion, iron supplementation, and erythropoietin. Multiple blistering lesions developed on her skin 2 months after hospital discharge. Clinical and laboratory findings were consistent with a diagnosis of porphyria cutanea tarda. Treatment included discontinuation of iron therapy, local skin care, and phlebotomy, which prevented the development of more lesions. The roles of iron overload and chronic renal disease in the pathogenesis of the porphyria are discussed.

Eruptive xanthomas and chest pain in the absence of coronary artery disease.

Because hyperlipidemia may present as xanthomas, a dermatologist may be the first to diagnose these skin lesions and associated lipid abnormalities. Xanthomas are of concern because of their association with coronary artery disease and pancreatitis. We describe the case of a 40-year-old white male with chest pain and eruptive xanthomas. Laboratory tests revealed severe hypercholesterolemia, hypertriglyceridemia, and diabetes mellitus, and the histopathology of the skin lesions was consistent with eruptive xanthomas. Surprisingly, even with overwhelming risk factors for both atherosclerosis and pancreatitis, this patient did not show evidence of either disease process. After initiating therapy for the diabetes and hyperlipidemia, the patient has had no recurrence of chest pain, and the skin lesions have gradually resolved. The most likely explanation for this patient's pattern of symptoms and laboratory results is the chylomicronemia syndrome, which can be seen in patients with type I or type V hyperlipoproteinemia.

Treatment of acne with a combination clindamycin/benzoyl peroxide gel compared with clindamycin gel, benzoyl peroxide gel and vehicle gel: combined results of two double-blind investigations.

BACKGROUND: It has previously been shown that a combination of erythromycin and benzoyl peroxide is superior to either ingredient when used alone in the treatment of acne. A clindamycin/benzoyl peroxide combination gel might have an advantage over erythromycin/benzoyl peroxide gel because the former does not require refrigeration after it is dispensed. OBJECTIVE: Our purpose was to determine the efficacy and safety of a combination clindamycin/benzoyl peroxide gel when compared with benzoyl peroxide, clindamycin, or vehicle gels. METHODS: In two double-blind, randomized, parallel, vehicle-controlled trials, patients were treated for 11 weeks with once-nightly application of one of the above preparations. Evaluations were performed at 2, 5, 8, and 11 weeks and included lesion counts and assessment of global responses and irritant effects. RESULTS: A total of 334 patients completed the study. All three active preparations were significantly superior to the vehicle in global improvement and in reducing inflammatory lesions and noninflammatory lesions. The combination gel was significantly superior to the two individual agents in global improvement and reduction of inflammatory lesions and also to the clindamycin gel in reducing noninflammatory lesions. There was no significant difference in tolerance to the active gels versus the vehicle gel. CONCLUSION: In the treatment of acne, topical clindamycin/benzoyl peroxide combination gel is well tolerated and superior to either individual ingredient.

Human skin and platelet minoxidil sulfotransferase activities: biochemical properties, correlations and contribution of thermolabile phenol sulfotransferase.

Human scalp skin high speed supernatants were used to test whether minoxidil sulfotransferase (MNX-ST) and phenol sulfotransferase (PST) activities were present. Platelet homogenates from the same skin donors were used to test whether levels of sulfotransferase activities in the blood platelet would reflect levels of the enzyme activities in skin. Dopamine, p-nitrophenol and minoxidil were used as substrates for skin and platelet thermolabile (TL PST), thermostable (TS PST) and MNX-ST activities, respectively. Biochemical properties of each skin enzyme were the same as the platelet enzymes with respect to apparent Km values for substrates, pH optima, thermal stabilities and responses to inhibition by 2,6-dichloro-4-nitrophenol (DCNP). An unexpected finding was that skin and platelet MNX-ST thermal stabilities and responses to DCNP were more similar to TL PST than to TS PST, the enzyme reported to be responsible for MNX-ST activity. There were significant positive correlations of platelet sulfotransferases with the relative levels of activities of the same skin sulfotransferases. Unexpected findings were significant positive correlations of MNX-ST and TL PST activities. Partially purified platelet TS PST assayed with minoxidil as the substrate showed a response to DCNP and thermal stability that were the same as TS PST. Platelet TL PST assayed with minoxidil showed thermal stability and a response to DCNP that were essentially the same as TL PST. The results indicated that not only TS PST, but also TL PST activities in human skin and platelet contributed to MNX-ST activity. It will be feasible to test whether measures of platelet PST activities will predict physiologic responses to minoxidil.

Angiosarcoma of the face and scalp.

A case of angiosarcoma of the head and neck is presented. A review of the clinical and histopathologic features of this tumor is presented.

Orf: case report and literature review.

Ecthyma contagiosum, or orf, is an uncommon dermatosis resulting from cutaneous infection with sheep pox virus. It is generally a benign and self-limited condition. Early clinical recognition is paramount to avoid unnecessary surgical intervention or extensive diagnostic workup. Diagnosis is usually based on a clinically typical skin lesion, characteristic histology, and a history of sheep exposure. We report the case of an infected sheep farmer and review the literature.

Multicentric reticulohistiocytosis in a patient with malignant melanoma: a response to cyclophosphamide and a unique cutaneous feature.

We describe a patient with multicentric reticulohistiocytosis and a history of malignant melanoma. His widely disseminated disease did not affect the site of surgical removal of the malignant melanoma nor the donor site of a skin graft. The multicentric reticulohistiocytosis progressed while the patient was taking nonsteroidal antiinflammatory agents, but showed significant response during a 10-month course of cyclophosphamide. While he was taking the cyclophosphamide, however, his melanoma recurred, and the patient subsequently died.

Treatment of chronic idiopathic urticaria with astemizole.

Astemizole is a new, long-acting H1 receptor antagonist that has proven effective in controlling the signs and symptoms of chronic idiopathic urticaria, without the sedative and anticholinergic side effects that typify use of many antihistamines. In an eight-week open study of 20 patients, astemizole significantly decreased the signs and symptoms of urticaria, as well as the severity of urticaria by anatomic location. Five patients reported complete clearing. Modest weight gain while on chronic therapy appears to be a significant side effect.

Perforating granuloma annulare in a patient with acquired immunodeficiency syndrome. Immunohistologic evaluation of the cellular infiltrate.

The inflammatory infiltrate found in the lesions of perforating granuloma annulare in a patient with acquired immunodeficiency syndrome was analyzed. Double labeling with fluorescent antibody tags fluorescein isothiocyanate-Leu 4 (peripheral T cells) and phycoerythrin-Leu 2a (cytotoxic/suppressor) revealed the infiltrate to consist predominantly of cytotoxic/suppressor T cells. This finding is a reflection of the patient's altered immune status and calls into question the role of specific T-cell subsets in the pathogenesis of granuloma annulare.

Treatment of digital myxoid cysts with carbon dioxide laser vaporization.

Digital myxoid cysts represent a relatively uncommon cutaneous disorder which have often proven refractory to conservative management. We report a series of ten patients with this condition who were effectively treated with carbon dioxide (CO2) laser vaporization. There has been no recurrence of cysts during a follow-up period ranging from 14 to 44 months.

Multiple eruptive vellus hair cysts treated with carbon dioxide laser vaporization.

The use of carbon dioxide laser to treat multiple facial, eruptive vellus hair cysts is described. An excellent cosmetic result without scarring or recurrence of lesions was obtained.