Histopathological features associated with application of black salve to cutaneous lesions: a series of 16 cases and review of the literature.

AIMS: To document the histopathological features of self-treatment of cutaneous lesions with the escharotic agent black salve. METHODS: Retrospective review of cutaneous lesions treated with black salve retrieved from the files of four pathology practices in Western Australia and review of the published literature. RESULTS: 16 lesions from 11 patients who self administered black salve for the treatment of skin lesions were reviewed. Clinical diagnoses at the time of biopsy included scar, keloid scar, pseudomelanoma, basal cell carcinoma, squamous cell carcinoma and cutaneous necrosis. Histopathological features identified in our series included scarring, granulomatous inflammation, implanted foreign material, reactive stromal atypia and suppurative necrosis. Residual neoplasia was present in two of 16 cases, including a basal cell carcinoma and a melanocytic naevus. An additional 13 lesions in 10 patients were identified in the medical literature, including cases with poor cosmetic outcomes and cases of malignant tumours masked by uncontrolled escharotic treatment. CONCLUSIONS: Availability of black salve through easily accessible internet sites appears to be associated with persisting use of this agent for the self-management of cutaneous lesions. Awareness of the potential complications and range of histopathological features associated with self-administration of escharotic agents is of importance to dermatologists and histopathologists.

Drug-induced dermatomyositis after zoledronic acid.

A 57-year-old woman with prior exposure to bisphosphonates developed myalgia, proximal muscle weakness and lichenoid rash over the upper extremities and face 3 days after infusion of zoledronic acid for the management of osteoporosis. The diagnosis of dermatomyositis was made on the basis of clinical, laboratory and histological findings. This is the first report of drug-induced dermatomyositis secondary to zoledronic acid.

Bowel bypass syndrome/bowel-associated dermatosis arthritis syndrome post laparoscopic gastric bypass surgery.

Bowel bypass syndrome, also known as bowel-associated dermatitis arthritis syndrome, has been described after a range of intestinal bypass procedures. With the increasing trend in laparoscopic gastric bypass surgery, we report an interesting case of bowel-associated dermatitis arthritis syndrome that developed 12 months following this procedure. A 49-year-old woman presented with ulcerating lesions and pustules on the upper and lower limbs, polyarthralgia, fevers and joint effusions. Before the development of these symptoms she was well, with no significant past medical or family history. A skin biopsy taken from the left shin showed superficial to mid-dermal neutrophilic dermatosis, consistent with bowel-associated dermatitis arthritis syndrome. The patient received corticosteroids, antibiotics and colchicine treatment, with control of disease after continuing with colchicine. This case may illustrate another possible complication following bariatric surgery. The significant time period between the initial surgery and the development of bowel-associated dermatitis arthritis syndrome may mean that more cases of this condition will continue to emerge.