Antibacterial activity of lidocaine in combination with a bicarbonate buffer.

BACKGROUND: The antibacterial properties of lidocaine have been previously described. Recent reports indicated that the addition of NaHCO3 to lidocaine reduces the pain associated with the injection. This study was conducted to determine the antibacterial activity of lidocaine buffered with NaHCO3. METHODS: Rates of killing of six species of bacteria were determined in the presence of buffered and unbuffered lidocaine. When bacteria were incubated with lidocaine buffered with NaHCO3 at either 25, 50, or 100 mEq/L, there was a decrease of > 99% of all bacteria tested over the 6 hours of the assay. This dramatic rate of killing was not observed in the unbuffered control preparations. RESULTS: The results of this study indicate that NaHCO3 enhances the killing effect that has been described for lidocaine alone. The inability to recover common pathogenic bacteria from biopsy specimens could be the result of exposure to local anesthetic agents such as lidocaine that are buffered with NaHCO3.

Scleredema and smoldering myeloma.

A 46-year-old white man had classic findings of scleredema; subsequently, a monoclonal immunoglobulin G lambda light chain was detected in his serum. Findings of a bone marrow biopsy specimen revealed that he had an increased percentage of plasma cells, some of which were atypical. A diagnosis of scleredema and smoldering myeloma was made.

Acanthosis nigricans and a rectal carcinoid.

Malignant acanthosis nigricans is often related to adenocarcinomas of the gastrointestinal tract, but it has also been found to coexist with tumors of the amine precursor uptake and decarboxylation system. It can precede, accompany, or follow the appearance of the underlying tumor. Evaluation of our patient's new-onset acanthosis nigricans led to the discovery of an asymptomatic rectal carcinoid tumor. To our knowledge, this is the first report of acanthosis nigricans associated with a carcinoid tumor of the rectum. It emphasizes the importance of considering underlying malignancy in the evaluation of patients with acanthosis nigricans.

Lichenoid drug eruption secondary to propranolol.

Propranolol, a widely prescribed beta-adrenergic receptor blocker, has occasionally been associated with adverse cutaneous reactions. We present a case of ulcerative lichenoid drug eruption of the penis secondary to propranolol therapy. This unusual clinical presentation has not been described previously in the literature.

Superficial granulomatous pyoderma.

Superficial granulomatous pyoderma, recently described as a variant of pyoderma gangrenosum, would be better termed pathergic granulomatous cutaneous ulceration as the seven previously described cases, as well as our own two cases, have significant dermal involvement histologically and heal with scarring. In contrast to pyoderma gangrenosum, lesions of superficial granulomatous pyoderma respond to less toxic anti-inflammatory agents.

Cutaneous lesions of histoplasmosis with transepidermal elimination in a patient with acquired immunodeficiency syndrome.

Histoplasma capsulatum is a dimorphic pathogenic fungus that produces a variety of self-limiting disease syndromes in healthy persons, but commonly disseminates in immunocompromised hosts. Although histoplasmosis has been recently described in patients with acquired immunodeficiency syndrome, it is an uncommon finding, occurring in fewer than 0.5 percent of patients with acquired immunodeficiency syndrome. We are reporting a second case of disseminated histoplasmosis presenting as keratotic papules with transepidermal elimination of Histoplasma capsulatum. Our case demonstrates the importance of including histoplasmosis in the differential diagnosis of keratotic papules occurring in patients with acquired immunodeficiency syndrome.

Unusual presentation of cutaneous metastatic malignant melanoma.

This report describes an unusual presentation of cutaneous metastases suspected to have occurred through lymphatic spread in a patient with malignant melanoma. Punctate papular skin lesions correlated histologically with small tumor foci in the papillary dermis.

Yield from total skin examination and effectiveness of skin cancer awareness program. Findings in 874 new dermatology patients.

The authors reviewed 874 dermatology charts to assess the acceptance rate of total skin examination (TSE), incidental skin findings, and patient compliance regarding treatment recommendations. Of the 874 new dermatology patients studied, 707 (80.9%) agreed to TSE. Important incidental findings were found in 151 (21.4%). These included: (1) biopsy specimen-confirmed malignant tumors (malignant melanoma, lentigo maligna, and basal cell and squamous cell carcinoma) in 24 of the 707 patients (3.4%), (2) biopsy specimen-confirmed premalignant tumors (actinic keratosis with dysplasia, Bowenoid actinic keratosis, Bowenoid papulosis, and lentigo with dysplasia, in five (0.7%), (3) clinically diagnosed premalignant actinic keratosis in 64 (9.1%), (4) biopsy specimen-confirmed dysplastic nevi in 17 (2.4%), and (5) congenital nevi in 41 (5.8%). Only 4.2% of the patients returned for a yearly TSE, and only 6.0% were found to follow all recommendations for monthly self examination, yearly professional examination, and sun protection. It is concluded that TSE for all new patients, and on a yearly basis for all return patients, is valuable in the detection of many skin conditions and allows skin cancer screening to be done, since patients for the most part do not follow recommendations for at-home screening.

Carbamazepine-induced eruption histologically mimicking mycosis fungoides.

Carbamazepine is an important drug used in the management of seizures, trigeminal neuralgia, and chronic pain syndromes. It has been associated with a variety of adverse skin reactions including urticaria, lichenoid eruptions, erythroderma, erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. A 39-year-old white male had been started on carbamazepine for intractable pain which resulted from a right foot crush injury. Approximately 3 months after the start of therapy, the patient had developed a generalized skin eruption following an entire day of sun exposure. Skin biopsies revealed an atypical lymphoid infiltrate in the dermis with collections of the atypical lymphocytes within spongiotic vesicles in the epidermis, suggestive of mycosis fungoides. The patient was treated with systemic prednisone. Subsequent biopsies failed to reveal atypical lymphocytes. Previous reports have described spongiotic eruptions with foci of atypical lymphocytes in contact dermatitis and in patients treated with phenytoin. To the best of our knowledge, this is the first reported case of a carbamazepine-induced eruption simulating mycosis fungoides histologically.

Autoimmune hemolytic anemia in a patient with mycosis fungoides.

We report a case of autoimmune hemolytic anemia in a patient with mycosis fungoides. We propose that autoimmune hemolytic anemia may be induced by cutaneous lymphoproliferative diseases. Thus, hemolysis should be considered as a mechanism of anemia in patients with mycosis fungoides.

Procainamide-induced urticarial vasculitis.

Dermatologists are often faced with the difficulty of evaluating drug reactions in patients receiving multiple medications. Unfortunately, few drugs produce distinctive lesions; many types of medications can produce identical eruptions. One common drug-induced eruption is urticaria. We report a specific eruption due to procainamide: urticarial vasculitis.