Nontuberculous mycobacterial infection following cat scratch in the setting of topical steroid use.

Infections due to nontuberculous mycobacteria (NTM) are caused by mycobacterial species other than Mycobacterium tuberculosis, M. leprae, and M. bovis. Patients who are immunocompromised have increased susceptibility to pulmonary, lymphatic, and skin infections by these pathogens. We present a case of a 78-year-old male who presented to dermatology with a left dorsolateral hand infection after sustaining cat scratches in the setting of topical steroid therapy for suspected pyoderma gangrenosum. A shave biopsy of the lesion showed granulomatous dermatitis and associated acid-fast bacilli, while tissue culture grew Mycobacterium chelonae. This case demonstrates cat scratches as an uncommon risk factor for cutaneous NTM disease. Although an association between cat scratches and human NTM infections has only been reported in two previous cases, it must be considered in cases of unusual and persistent cutaneous lesions, especially in immunocompromised patients, even those with only local immunosuppression from topical agents.

Diffuse dermal angiomatosis localized to abdominal striae.

Diffuse dermal angiomatosis is a rare, benign, reactive cutaneous vascular disorder considered to be a distinct variant of reactive angioendotheliomatosis. The disease typically presents in obese patients who smoke and have atherosclerotic risk factors, vasculopathies, or other comorbidities associated with hypoxemia. We present a case of a 40-year-old woman with ulcerated plaques on her abdomen consistent with diffuse dermal angiomatosis on histopathological evaluation. Unique to our patient was localization of the lesions to the abdominal striae.

A feasibility study of the burden of disease of atopic dermatitis using a smartphone research application, myEczema.

BACKGROUND: Our understanding of chronic diseases, such as atopic dermatitis (AD), could benefit from the ability to rapidly collect patient-reported, longitudinal data from a large population. OBJECTIVE: This study aimed to determine whether a smartphone app can be used to collect demographic and longitudinal symptom data and recognize prescribing patterns and affordability of medications to study the burden of AD. METHODS: We collected data using the myEczema smartphone app between July 2017 and April 2018. The data were de-identified and analyzed. RESULTS: A total of 519 users (94.2%) completed the initial demographic survey. The majority of users were female (n = 387; 70.2%) and Caucasian (n = 358; 65.0%). A total of 335 users (60.8%) had at least a university degree and were employed (n = 348; 63.1%). A total of 189 users (29.2%) reported difficulty affording their medications, and 363 users (65.9%) took advantage of the itch score recording feature. Finally, 184 users (33.4%) logged their treatments, with the highest number of users (65.2%) listing topical steroids as one of their treatments. LIMITATIONS: The operating platform was limited to iPhones, and the results were subject to reporting bias. CONCLUSION: A smartphone-based research app can be used to rapidly collect patient-reported data to study the burden of AD and to highlight the prescribing patterns and affordability of medications.

Leg ulceration with histological features of pseudoxanthoma elasticum.

Pseudoxanthoma elasticum (PXE) is an inherited connective tissue disorder with extensive degeneration and calcification of elastic tissue. Histology demonstrates calcified elastic fibers in the mid to lower dermis with a characteristic "steel wool" appearance. A limited number of published cases have described various inflammatory skin diseases presenting with PXE-like histology without clinical manifestations of PXE. Several other conditions associated with abnormal calcium metabolism have also been documented, in which coincidental histological features of PXE have been observed in patients without clinical findings. We present a case of ulceration and lipodermatosclerosis in the setting of venous insufficiency alongside histological features of PXE.

A painful periumbilical rash.

Jacquet's erosive dermatitis, or dermatitis syphiloides posterosiva, is classified as a severe irritant dermatitis characterized by erythematous papules and nodules with erosive, punched-out lesions. It can be found in the perineal distribution and is frequently reported in infants over 6 months of age. In adults, it is associated with urinary or fecal incontinence. We present a case of a 21-year-old white woman with a history of chronic umbilical drainage and a 3-year history of a periumbilical rash with red, friable, well-demarcated papules. Biopsy revealed pseudoepitheliomatous hyperplasia with focal epidermal erosion and a superficial perivascular infiltrate of lymphocytes and plasma cells. Our case sheds light on this uncommon diagnosis in an unlikely location.

Linear IgA bullous dermatosis mimicking oral lichen planus.

Linear IgA bullous dermatosis (LABD) is an autoimmune disease characterized by blisters on the skin and mucous membranes. Polycyclic, grouped bullae on cutaneous skin are the most characteristic clinical feature of LABD. Lesions are often indistinguishable from bullous pemphigoid or may resemble dermatitis herpetiformis. Oral lesions may be seen in 5% to 70% of patients with LABD, and in some cases, the oral mucosa may be the only area of involvement. Herein, we report a patient with LABD involving only the oral mucosa clinically. The entity histologically mimicked oral lichen planus, which challenges accurate diagnosis and emphasizes the importance of direct immunofluorescence.

Chondrodermatitis nodularis helicis: A review of current therapies.

Chondrodermatitis nodularis helicis (CNH) is characterized by a tender nodule located on the helix or antihelix. Age groups impacted by CNH vary from study to study, but the majority of studies report an average age range from 50 to 80 years. Various treatment options have been described in the literature, including surgical techniques, laser therapy, curettage, topical and intralesional corticosteroids, and pressure relieving techniques. The main goal of therapy is to reduce pain and improve clinical appearance. In recent years, new therapies have been described for CNH with great results and lower recurrence rates. It is our hope that this review can serve as a reference for both practitioners and patients looking to treat CNH.

Purpura fulminans associated with acute West Nile virus encephalitis.

Purpura fulminans is a progressive thrombotic disorder that presents with widespread purpura due to deficiency or dysfunction of protein C or protein S. Lesions present as well-demarcated erythematous macules that progress to irregular areas of hemorrhagic necrosis.West Nile virus is a member of the Flaviviridae family transmitted to humans through the bite of various mosquito species. It manifests as West Nile fever in 25% of those infected and less commonly as neuroinvasive disease. An African American man in his fortiespresented with altered mental status and was noted to have evidence of disseminated intravascular coagulation according to his lab data. He then developed dusky skin discoloration and systemic flaccid bullae with desquamation. Biopsy was consistent with purpura fulminans and the patient eventually developed symmetric peripheral gangrene, requiring amputations of all four extremities. Infectious work up revealed positive testing for IgM and IgG antibodies in serum and cerebrospinal fluid leading to the diagnosis of acute West Nile Virus encephalitis. We present this case to describe the rarely reported association of purpura fulminans with West Nile Virus infection.