Periorbital edema as the presenting sign of dermatomyositis.

BACKGROUND: Periorbital edema can occur in dermatomyositis, which is characterized by symmetric macular erythema, Gottron's papules, Gottron's sign, periungual telangiectasia, heliotrope rash, and poikilodermatous macules on the shoulders, arms, or upper back (shawl sign). CASE REPORT: We report the case of an 81-year-old man with dramatic periorbital edema. It was not until he was hospitalized with dysphagia 6 months after developing the edema that the diagnosis of dermatomyositis was considered. RESULTS: Laboratory tests, skin biopsy, and electromyography resulted in a diagnosis of dermatomyositis. CONCLUSIONS: Periorbital edema may appear as the presenting cutaneous manifestation of dermatomyositis.

Nevoid basal cell carcinoma syndrome and non-Hodgkin's lymphoma.

Nevoid basal cell carcinoma syndrome (NBCCS) is a hereditary disorder with a predilection for numerous basal cell carcinomas in addition to odontogenic keratocysts, palmoplantar pitting, and skeletal malformations. NBCCS has been associated with a number of benign and malignant neoplasms. We report the first case of NBCCS in association with non-Hodgkin's lymphoma.

The dermatologist in military operations.

The military dermatologist has a specific and significant role in military operations--in time of war as well as in peace. Many dermatologists are unfamiliar with the impact that our specialty and cutaneous disease has upon the ability of the military to fulfill the missions, duties, and responsibilities assigned by our government. This article highlights a few of the recent or ongoing types of military operations in which our specialty plays a prominent part.

Traumatic arteriovenous fistula of the upper lip.

Traumatic arteriovenous fistulas can present days to years following penetrating trauma and are often challenging to diagnose and manage. Patients may present to the dermatologist with unilateral varicose veins or a pulsatile mass. Our case illustrates the value of palpation in a careful systematic approach to any new lesion, especially in the context of previous penetrating trauma. We also discuss the nomenclature of arteriovenous communications and review their current management.

Autoimmune idiopathic thrombocytopenic purpura with the subsequent occurrence of systemic lupus erythematosus.

Cutaneous manifestations of petechiae, purpura, and ecchymosis can lead the physician to discover an underlying platelet abnormality. Autoimmune idiopathic thrombocytopenic purpura (AITP) is a diagnosis of exclusion, mediated by a destructive IgG antibody response to the platelets' membrane components. In addition to showing evidence of cutaneous and mucosal bleeding (ie, epistaxis, hematuria), patients with AITP are at an increased risk for systemic lupus erythematosus (SLE). Therefore, it is suggested that patients with AITP be closely monitored for SLE.

Idarubicin-induced pigmentary changes of the nails.

A case of acute myelocytic leukemia of the FAB-M2 subtype in a patient who experienced pigmentary nail changes in conjunction with idarubicin therapy is presented. Although doxorubicin and daunorubicin have been reported to cause nail pigmentation changes, this is the first case report to describe these changes with idarubicin.

Cutaneous herpes simplex virus, type I, in association with Staphylococcus aureus in an infant.

A 9-month-old infant was diagnosed as having impetigo of the central face. Her clinical condition deteriorated despite treatment with intravenous antibiotics. Viral and bacterial cultures grew herpes simplex virus type I and Staphylococcus aureus, respectively. The patient's condition improved rapidly with antiviral treatment in combination with antibiotics. Recognition of the possibility of a combined viral and bacterial infection is important so that adequate treatment is not delayed.

A pityriasis rosea-like eruption secondary to bacillus Calmette-Guérin therapy for bladder cancer.

The use of bacillus Calmette-Guérin (BCG) for the treatment of bladder cancer has been followed by reports documenting adverse reactions. Eruptions of the skin have been included (although not well described) in the list of side effects. We report a pityriasis rosea-like rash secondary to BCG therapy for bladder cancer. Although the treatment was interrupted because of this reaction, the medication was restarted later with only a mild transient recurrence of the eruption.

Docetaxel (Taxotere) associated scleroderma-like changes of the lower extremities. A report of three cases.

BACKGROUND: Docetaxel (Taxotere) is a microtubule-stabilizing agent that is potentially important in chemotherapy for a variety of malignancies. METHODS: A clinical study of the cutaneous reactions experienced by a group of patients receiving docetaxel chemotherapy was undertaken. Patients were examined before initiation of therapy, before and after each cycle of therapy, and were followed subsequent to the completion of docetaxel chemotherapy. RESULTS: Three patients developed diffuse lower extremity edema (3-18 kg) and subsequent scleroderma-like changes after receiving multiple cycles of docetaxel therapy. These patients had different underlying malignancies and dissimilar prior therapy. Rheumatoid factor, antinuclear antibodies, anticentromere, and topoisomerase antibodies were not present in any patient. The diffuse lower extremity edema did not resolve with diuretic therapy. Cutaneous biopsies in two patients revealed diffuse sclerosis. One patient had a normal lymphangiogram during the edematous phase. Discontinuation of docetaxel correlated with resolution of edema and softening of the skin. CONCLUSION: The etiology of the scleroderma-like skin changes is unclear but appears to be either a toxic effect of docetaxel or an effect of polysorbate 80 (Tween 80), the vehicle for docetaxel.

Acute cutaneous reactions to docetaxel, a new chemotherapeutic agent.

BACKGROUND: Docetaxel (RP 56976) is a new chemotherapeutic agent that has shown promise in a number of animal studies and is currently undergoing phase I and phase II trials. Early in the phase I trials, it was noted that a significant number of patients were experiencing a variety of cutaneous complaints, so we elected to prospectively evaluate the cutaneous reactions occurring during the first three courses of therapy in the first 12 patients enrolled for phase I chemotherapy at our institutions. OBSERVATIONS: All but one patient had some type of cutaneous eruption over the three courses of therapy. Of the 27 evaluable courses of docetaxel given, 19 (70%) resulted in a cutaneous eruption with four (21%) being asymptomatic and 15 (79%) being at least mildly symptomatic. The most common reaction seen was characterized by discrete erythematous to violaceous patches or edematous plaques similar to acral erythema. CONCLUSION: Although a majority of patients receiving docetaxel experience some degree of cutaneous reaction, the eruptions are usually mildly symptomatic and almost always self-limiting.

Seborrheic keratosis with trichilemmomas masquerading as melanoma.

Seborrheic keratoses are benign lesions and, generally, are easily diagnosed based on clinical criteria. However, several types of benign as well as malignant lesions have been found associated with seborrheic keratoses, thus confusing the clinical picture. Presented is the first reported case of trichilemmomas occurring within seborrheic keratosis and masquerading as melanoma with regression. Biopsy of unusual seborrheic keratoses is recommended.

Two unusual cases of anhidrosis.

Many disorders produce anhidrosis, including abnormalities of the central or peripheral nervous system. Tumors, infarcts, injuries, or hemorrhages of the brain can be the cause. We describe two patients with anhidrosis due to neurologic causes. One patient had an acquired complete left unilateral anhidrosis without an ipsilateral Horner's syndrome. The other patient showed the second case associated with congenital Horner's syndrome reported in the dermatologic literature. The patient with unilateral anhidrosis had multiple infarcts noted on computed axial tomography and magnetic resonance imaging of his head and spine, which were thought to be the cause of his anhidrosis. Congenital Horner's syndrome is rare, but can be differentiated from other causes of Horner's syndrome by the finding of hypochromia of the affected iris, as in our patient. We present two patients with anhidrosis due to conditions with which the practitioner may not be familiar.

Unusual serpentine hyperpigmentation associated with 5-fluorouracil. Case report and review of cutaneous manifestations associated with systemic 5-fluorouracil.

A variety of cutaneous reactions have been reported with the use of systemic 5-fluorouracil. Our patient had serpentine hyperpigmented streaks appearing 5 days after bolus infusion of 5-fluorouracil. The patient also had other skin eruptions, that is, inflammation of actinic keratoses and folliculitis limited to the forehead; these reactions have been reported previously with 5-fluorouracil medication. We report this case and review the literature on skin manifestations associated with 5-fluorouracil therapy.