Tender Cystic Structure on the Back in an Infant.

A 1-year-old Hispanic boy with multiple congenital anomalies including a double-outlet right ventricle, significant scoliosis, kyphosis, and multiple hemivertebrae and hemilamina presented with recurrent febrile episodes. He was found to have Staphylococcus epidermidis meningitis, which persisted despite medical management. On physical examination, a 1×1-cm, tender, erythematous cystic structure with a purulent focus was discovered on the upper portion of his back (Figure 1). His mother noted that the structure was not present at birth, but there was a small red area at the time of delivery that had slowly developed into the lesion shown. T2-weighted sagittal magnetic resonance imaging showed a 4-mm sinus connection from the superficial cystic structure (white arrow) to another 2.4×1.5-cm cystic structure (black arrow) at the level of the hemivertebrae (Figure 2).

Comparative study on bruise reduction treatments after bruise induction using the pulsed dye laser.

BACKGROUND: Several bruise reduction methods have been suggested to decrease postprocedure ecchymoses. Comparing the effectiveness of common bruise reduction therapies provides better evidence of the efficacy of bruise reduction techniques. OBJECTIVE: To compare the effectiveness of cold compresses, hydrogen peroxide, over-the-counter bruise serum, and pulsed dye laser (PDL) in minimizing the time required for bruise resolution. METHODS: Seventeen patients aged 22 to 51 (mean 28) with Fitzpatrick skin types I to IV underwent bruise induction with a PDL to produce five 2- by 2-cm zones of bruising on the lower abdomen. Excluding the control, bruises were randomly treated using a cold compress, bruise serum, 3% hydrogen peroxide-soaked gauze, or PDL. Subjects and two blinded physician evaluators evaluated bruise severity and graded it on a visual analog scale on days 0, 3, and 7. RESULTS: Treatment did not result in statistically significantly shorter bruise resolution time than in controls. PDL-treated bruises took a statistically significantly longer time to resolve than controls. CONCLUSION: Our study showed no significant difference in cold compress, hydrogen peroxide, and over-the-counter serum in reducing time to bruise resolution. PDL therapy resulted in greater bruise severity scores and increased time to bruise resolution when used soon after bruise induction.

Fixed drug eruption related to ibuprofen presenting as giant bullae on the posterior thigh.

Fixed drug eruptions (FDEs), first described by Bourns in 1889, are solitary or multiple, sharply demarcated, round to oval, edematous and erythematous patches that arise after exposure to a specific medication. They can be pink to dark red to brown and can be larger than 10 cm in size. In almost a third of patients in some case series, these lesions have been reported to progress to vesicles or bullae. Fixed drug eruptions have been associated in up to 40 percent of cases with non-steroidal inflammatory drugs, including ibuprofen. We describe an interesting case of a biopsy-confirmed FDE that presented as large bullae on the posterior thigh after ibuprofen use.

A case of vemurafenib-induced keratosis pilaris-like eruption.

Vemurafenib, a selective BRAF kinase inhibitor, is a new anti-cancer drug recently proven to improve survival in patients with metastatic melanoma harboring the BRAF V600E mutation. BRAF is one of three RAF kinases (ARAF, BRAF, CRAF) involved in the MAP kinase pathway. Mutations in BRAF are reported to be present in 40 to 70 percent of melanomas and in lower frequencies in various other malignancies. The BRAF V600E mutation is a specific valine to glutamic acid single substitution that constitutes 80 to 90 percent of reported BRAF mutations. Successful treatment of metastatic melanoma with vemurafenib is not without significant adverse effects. The most common toxic effects of this drug include rash, arthralgia, and fatigue. Less commonly, cases of follicular cystic lesions, keratoacanthoma, and squamous cell carcinoma have also been described. We report a case of a patient with metastatic melanoma treated with vemurafenib, who developed diffuse follicular hyperkeratosis resembling keratosis pilaris. To our knowledge, this is the first reported case of a keratosis pilaris-like side effect of vemurafenib.

Unilateral multisegmental morphea.

There are 5 subtypes of morphea that are based on disease distribution and presentation, including plaque, localized, generalized, linear, and deep morphea. We report a case of a young patient with morphea lesions in scattered locations confined to 1 side of the body, which we have termed unilateral multisegmental morphea.

Denuded congenital lesions: recessive dystrophic epidermolysis bullosa.

Recessive dystrophic epidermolysis bullosa (Hallopeau-Siemens type) (RDEB-HS) is a rare severe mechanobullous disorder resulting from a defect in collagen VII. Patients with RDEB-HS present with generalized blistering and denudation of the skin at birth and have mucosal involvement. The repeated blistering leads to scarring, which may be deforming and result in serious complications. Transmission electron microscopy is currently the gold standard for diagnosis of RDEB-HS.