Cutaneous larva migrans in northern climates. A souvenir of your dream vacation.

Three young women recently returned to the metropolitan Detroit area with cutaneous larva migrans. All three had vacationed at a popular club resort on the Caribbean island of Martinique. Cutaneous larva migrans is frequently seen in the southern United States, Central and South America, and other subtropical areas but rarely in northern climates. Several organisms can cause cutaneous larva migrans, or creeping eruption. The larvae of the nematode Ancylostoma braziliense are most often the causative organisms. Travel habits of Americans make it necessary for practitioners in northern climates to be familiar with diseases contracted primarily in warmer locations. The life cycle of causative organisms and current therapy are reviewed.

Eruptive vellus hair cysts--an inherited disorder.

A patient, her mother, and three siblings were noted to have benign papular eruptions--by history or physical examination--that were similar in appearance and distribution. The histologic findings confirm the diagnosis of a recently described entity, eruptive vellus hair cysts. This is the first evidence suggesting a hereditary nature for this disorder.

Heck's disease (focal epithelial hyperplasia).

A patient and his mother noted the insidious appearance of a distinctive benign papular eruption confined to the mucosa of the lips. The clinical pattern and histologic findings fulfill the criteria of a recently described entity, focal epithelial hyperplasia. An electron microscopic search for viral particles was negative. Arguments for both a viral and a hereditary pathogenesis have been put forth, but the etiology of the condition remains controversial. This disorder may be more frequently reported as dermatologists become increasingly aware of its existence.

Cutaneous reaction to spironolactone resembling lupus erythematosus.

A cirrhotic male patient was admitted with a skin eruption. He had been taking spironolactone and hydrochlorothiazide for two months prior to admission. The morphology and distribution of skin lesions resembled that of systemic lupus erythematosus (SLE). Histologic changes in the skin biopsy specimen were consistent with SLE. Biopsy specimens of normal and affected skin were reported to show weak focal deposition of IgM and complement at the dermal-epidermal junction. However, there was a striking absence of serologic evidence of SLE. The rash disappeared when all medications were discontinued and reappeared when the patient was given spironolactone. The character and distribution of the rash after spironolactone administration was identical to the previous lesions. It disappeared again when spironolactone was withdrawn. This response to spironolactone is good evidence that it and not chlorothiazide was responsible for the rash. The latter drug has been reported to cause SLE-like skin changes.