Therapeutic use of topical corticosteroids in the vesiculobullous lesions of incontinentia pigmenti.

Incontinentia pigmenti (IP) is a rare genodermatosis caused by a mutation of nuclear factor kappa B essential modulator gene. There is no specific treatment for IP, therefore it has been claimed that there is no effective treatment to hasten resolution of any of the phases of IP. However, the initial vesiculobullous stage of IP is characterized histopathologically by eosinophilic inflammation, which is expected to respond to corticosteroids. An 18-day-old female neonate was seen, with vesicles on her trunk and limbs diagnosed as the vesiculobullous stage of IP. The patient was treated with a double-compound cream containing a potent corticosteroid (difluocortolone valerate 0.1%) and an antiseptic (chlorquinaldol 1%), to be applied to the lesions twice daily. Five days later, resolution of the lesions was almost complete. As chlorquinaldol has no known anti-inflammatory activity, we attribute this improvement to difluocortolone valerate. This case shows that early lesions of IP with eosinophilic inflammation are treatable.

Eruptive vellus hair cysts: an effective extraction technique for treatment and diagnosis.

BACKGROUND: Eruptive vellus hair cysts are uncommon developmental anomalies of vellus hair follicles that are observed in young patients. Two patients were evaluated for asymptomatic flesh-coloured papules appearing on the chest, abdomen and axillae. Lesions of both patients were diagnosed histologically as eruptive vellus hair cyst, which is a disorder with no standard treatment option. OBJECTIVE: To introduce an alternative treatment and diagnostic technique for eruptive vellus hair cysts and to evaluate this technique's effectiveness histopathologically. MATERIALS AND METHODS: We treated the lesions by using cautery and a standard dissecting forceps under topical anaesthesia. After puncturing the overlying skin in the centre using the sharp-tipped cautery point, we grasped the base of the cyst using a standard dissecting forceps and we extracted the cysts out. In patient 1, extracted cysts were sent for histopathological examination; in patient 2, microscopic examination of the extracted material was performed in potassium hydroxide preparations. RESULTS: Over 150 cysts were extracted with this technique in two patients. The technique was simple, quick and tolerated well. No lesion recurrence was observed after 4 months. On histopathological examination, extracted cysts were observed to have cyst walls. In patient 2, the diagnosis was made within minutes by microscopic examination of the potassium hydroxide preparations of the extracted material. CONCLUSION: Our extraction technique is a simple and effective treatment option for these cysts. It can be regarded as curative since the cyst walls were also extracted. Microscopic examination of the potassium hydroxide preparation of the extracted cysts suggests that this technique can also be used as a simple diagnostic procedure.

Apolipoprotein E polymorphism and lipoprotein compositions in normolipidaemic xanthelasma patients.

BACKGROUND: Apolipoprotein E (apoE) phenotypes and lipoprotein compositions in xanthelasma patients have been reported in different series. OBJECTIVE: To investigate the apoE polymorphism and lipoprotein compositions in xanthelasma patients by using rapid polymerase chain reaction, and searched for an association between apoE polymorphism and the lipoprotein levels in xanthelasma patients. DESIGN: ApoE polymorphism and the different types of serum lipoproteins were studied in 25 patients with xanthelasma and compared with 27 normal subjects. RESULTS: All of patients were found to be normolipidaemic. The patients had significantly higher concentrations of total cholesterol and apolipoprotein B, and lower concentrations of apolipoprotein A. There was no difference in serum triglyceride, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol concentrations. The distribution of apoE genotypes and alleles was the same in both groups. CONCLUSIONS: The apoB, apoA and cholesterol levels did show statistically significant differences in the direction of an increased risk of atherosclerosis. Patients with xanthelasma demonstrated slight differentiations in the apoE polymorphism and metabolism of lipoproteins that require further clarifications.