Malignant melanoma arising in a seborrheic keratosis.

We report a case of malignant melanoma associated with seborrheic keratosis. This has been reported rarely in the literature, with disagreement regarding whether it is coincidental or whether malignant transformation occurs. Because seborrheic keratoses are common and association with malignant melanoma is very rare, we conclude that the association is coincidental. However, because of the association of other malignancies, a biopsy of any suspect or changing seborrheic keratosis is essential.

Cutaneous ulcers of refractory adult dermatomyositis responsive to intravenous immunoglobulin.

We report the case of a woman from the Bahamas who presented with many of the classic manifestations of dermatomyositis. She responded well to initial therapy, which included oral corticosteroids, low-dosage methotrexate, and hydroxychloroquine. The cutaneous component of her disease flared dramatically months later, and progressed despite aggressive therapy with the higher dosages of the same medications. Therapy with intravenous immunoglobulin (IVIG) was initiated and the patient stopped forming new cutaneous ulcers within 1 to 2 weeks. Theories about the mechanism of action of IVIG, and practical guidelines for its use in treating patients with dermatomyositis, are briefly reviewed.

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.

Acquired digital fibrokeratoma.

Acquired digital fibrokeratomas are benign growths that usually occur on the fingers. These growths have a characteristic clinical and histopathologic appearance and may be easily recognized and treated by family physicians. It is important not to confuse these lesions with other common, possibly malignant, clinical entities. Treatment involves shave excision under local anesthesia.

Ischemic complications of tubular gauze dressings.

BACKGROUND: Ischemic pressure complications associated with tubular gauze digital dressings have been occasionally reported in the medical literature. Previous authors have implicated specific mechanisms. We report a 10th case of this type of complication and hypothesize that a "Chinese finger trap" mechanism was responsible. OBJECTIVE: To compare pressures generated using different application techniques of tubular gauze digital dressings. METHODS: A simple device to measure dressing pressure was constructed. Comparative pressure measurements using different application techniques were obtained. RESULTS: Too many layers, excess longitudinal traction during application, using more than a 90 degrees twist during application, and rolled proximal dressing edges all increased measured pressures significantly. CONCLUSIONS: Physicians and other health care providers involved in the application of these dressings should be aware of their correct application and the mechanisms that may produce complications.

Clinical significance and treatment of xanthomas.

Xanthomas are important clinical manifestations of a variety of disorders, including lipoprotein abnormalities, hypothyroidism, diabetes and certain forms of cancer. Many patients with these lesions are also at risk for premature atherosclerosis. Family physicians are often the first to recognize xanthomas. Early detection and identification of the lesions leads to appropriate diagnosis and treatment of the related diseases.

Counseling patients on proper use of condoms.

The best condoms are made of latex, are lubricated and coated with a spermicide, and have a reservoir tip. Condoms can protect against conception and sexually transmitted diseases, including acquired immunodeficiency syndrome. When condoms are used properly and in combination with vaginal spermicidal foam, the contraceptive failure rate is as low as 1 percent. Failure is more often due to user error than product defect. Recommendations for the proper use of condoms are presented.

Head banging in young children.

Head banging is a rhythmic motor activity that may occur in normal infants and young children, as well as in children with underlying psychiatric or neurologic disease. Once underlying pathology has been excluded, parents should be reassured about the benign nature of the activity.

Maxillary sinus hypoplasia masquerading as chronic sinusitis.

Maxillary sinus hypoplasia is a common condition that may be misdiagnosed as chronic sinusitis. Although hypoplasia can usually be seen on conventional sinus films, computed tomography may be necessary, as in the cases described by the authors in this article.