Erythematous Plaques on the Eyelids.

REPORT OF A CASE: A 21-year-old black man presented to the dermatology clinic with a complaint of redness and swelling of the lateral aspect of his right lower eyelid that progressed to the left lower eyelid. These symptoms were exacerbated by exposure to sunlight. Physical examination revealed erythematous plaques with areas of hair loss and scarring of the lower eyelids (Figs 1 and 2). Results of initial laboratory examinations were significant for the following: antinuclear antibody titer, 1:80 (in a speckled pattern), and a normal angiotensin-converting enzyme concentration. The chest roentgenogram was normal. A biopsy specimen of the right lower eyelid was obtained for routine histologic studies (Figs 3 and 4) and direct immunofluorescence (Fig 5). What is your diagnosis? DIAGNOSIS: Discoid lupus erythematosus (DLE). HISTOPATHOLOGIC FINDINGS: The biopsy specimen of the right lower eyelid initially revealed mild-to-moderate chronic inflammatory changes with a patchy lymphohistiocytic infiltrate in a perivascular.

Multiple symmetrical lipomatosis.

We report a patient with multiple symmetrical lipomatosis, which is an unusual subgroup of lipomatous disease. This entity is described along with a brief review of the literature on this disease and associated disorders.

Long-term therapy with low-dose isotretinoin for prevention of basal cell carcinoma: a multicenter clinical trial. Isotretinoin-Basal Cell Carcinoma Study Group.

BACKGROUND: High-dose isotretinoin has been reported to have a prophylactic effect on nonmelanoma skin cancer, although it is associated with significant toxicity. PURPOSE: To test the effectiveness of the long-term administration of low-dose isotretinoin in reducing the occurrence of basal cell carcinoma at a new site in patients with previously treated basal cell carcinomas and to measure the toxicity associated with this regimen, we conducted a clinical trial at eight cancer centers. METHODS: Nine hundred and eighty-one patients with two or more previously confirmed basal cell carcinomas were randomly assigned to receive either 10 mg of isotretinoin or a placebo daily. Patients were followed for 36 months and monitored at 6-month intervals for skin cancer and toxic effects. RESULTS: After 36 months of treatment, no statistically significant difference in either the cumulative percent of patients with an occurrence of basal cell carcinoma at a new site or the annual rate of basal cell carcinoma formation existed between patients receiving isotretinoin and those receiving the placebo. Elevated serum triglycerides, hyperostotic axial skeletal changes, and mucocutaneous reactions were more frequent in the group receiving isotretinoin than in the control group, and these differences were all statistically significant (P less than .001). CONCLUSION: This low-dose regimen of isotretinoin not only is ineffective in reducing the occurrence of basal cell carcinoma at new sites in patients with two or more previously treated basal cell carcinomas but also is associated with significant adverse systemic effects. IMPLICATION: The toxicity associated with the long-term administration of isotretinoin, even at the low dose used in this trial, must be weighted in planning future prevention trials.

Brunsting-Perry pemphigoid simulating basal cell carcinoma.

The cases of three patients whose initial clinical presentations suggested superficial multicentric basal cell carcinoma are reported. Although routine histologic examinations were nonspecific, direct immunofluorescence studies showed immunoglobin and/or complement deposition patterns diagnostic of Brunsting-Perry variant pemphigoid. There is a wide spectrum of clinical presentation of Brunsting-Perry pemphigoid. In cases in which there is a minimum of blistering activity, the use of direct immunofluorescence is invaluable for definitive diagnosis.

Coexistent leprosy and lupus erythematosus.

We present a patient who, while under therapy with systemic corticosteroids to control lupus erythematosus, noted lesions of leprosy (Hansen's disease) on her elbow and knee. The corticosteroids may have played a role in the emergence of the leprosy. Leprosy should be considered in the differential diagnosis of cutaneous lesions with sensory loss to hasten diagnosis and therapy.

Cutaneous foreign body granulomas associated with intravenous drug abuse.

Intravenous drug abuse is a serious medical problem in the United States. We report a new cutaneous manifestation of drug abuse: the development of foreign body granulomas. These may develop months to years after the last intravenous injection and should be considered a possible cutaneous manifestation of systemic talc granulomatosis.

Cutaneous Mycobacterium szulgai infection.

Multiple inflammatory skin lesions and osteomyelitis of the right ankle developed in a 51-year-old man who had been receiving prednisone therapy for several months. Cultures of both the skin and bone lesions yielded Mycobacterium szulgai, a scotochromogenic mycobacterium, which is an unusual human pathogen. The patient's condition responded to treatment with isoniazid, ethambutol hydrochloride, and rifampin.

Pigmentary demarcation lines associated with pregnancy.

Pigmentary demarcation lines are borders of abrupt transition between more deeply pigmented skin and that of lighter pigmentation. Two patients developed these lines on the lower extremities during pregnancy.

Cutaneous lesions in brucellosis.

Two types of eruptions developed in a patient who had a fever of unknown origin: (1) tiny papules on the trunk and proximal extremities and (2) erythema nodosum-like deep dermal nodules on the legs. Brucella agglutinin test results were persistently negative, but B melitensis grew from the blood culture. Brucellosis should be considered in the differential diagnosis of a fever of unknown origin associated with a papular eruption with certain histologic features and/or erythema nodosum-like lesions. The histologic examination of cutaneous lesions may facilitate the diagnosis.

Evans blue dermatitis.

Contact dermatitis developed in five patients due to Evans blue, an azo-type dye used ot outline the lymphatics prior to the injection of a contrast medium in performing lymphangiography. A pathophysiologic mechanism for the development of dermatitis due to Evans blue is proposed.

Erythema multiforme and urticaria. Eruptions induced by chemically related ophthalmic anticholinergic agents.

Erythema multiforme developed in an 80-year-old man following the use of scopolamine hydrobromide ophthalmic drops. The erythema multiforme cleared when the medication was discontinued and recurred on challenge. Later, he was given tropicamide, an anticholinergic ophthalmic preparation that, like scopolamine, has a tropic acid residue. Within 15 minutes an immediate hypersensitivity reaction with generalized urticaria developed in the patient.