Disfiguring cutaneous manifestation of sarcoidosis treated with thalidomide: a case report.

A patient with sarcoidosis was treated with thalidomide for disfiguring and painful steroid unresponsive sarcoidal granulomas of the skin. The duration of the therapy was 14 months, during which time, the skin lesions resolved almost completely. The initial dosage was 200 mg a day, which was increased to 400 mg a day after 4 months. Episodic paresthesia of the finger tips and one lower extremity was the only side effect noted, which resolved promptly after discontinuation of the drug. The dramatic response of sarcoidal granulomas of the skin to thalidomide observed in this patient demonstrates the usefulness of this drug as a possible long-term monotherapeutic or steroid-sparing agent in the treatment of sarcoidosis.

Parental issues in the treatment of chronic infantile eczema.

Infantile atopic eczema commonly responds readily to treatment. A subset of cases of intractable eczema improve dramatically when empathic understanding and parental education are added to conventional treatment.

Tufted angioma of the thigh.

Tufted angioma or angioblastoma of Nakagawa is a rare vascular tumor that usually appears in early childhood. It frequently is seen as an erythematous to red-brown, frequently indurated plaque that usually occurs on the trunk or neck. Typically tufted angiomas enlarge for a few years and then cease growing and remain stable. Histopathologic findings are pathognomonic. We describe a patient with a tufted angioma of the thigh who sought treatment for paroxysmal episodes of pain. Treatment with topical clobetasol propionate resulted in a decreased frequency of painful episodes.

Cutis marmorata telangiectatica congenita associated with bilateral congenital retinal detachment.

Cutis marmorata telangiectatica congenita is a rare congenital vascular disorder of the skin, characterized by persistent telangiectasia of the cutaneous blood vessels often associated with cutaneous ulcers. The only previously recognized ophthalmic association with this condition has been rare instances of unilateral congenital open angle glaucoma. The authors report their observations in a child in whom this cutaneous disorder was associated with congenital bilateral total retinal detachments and secondary neovascular glaucoma. The retinal detachments produced bilateral leukocoria simulating retinoblastoma. The cutaneous disorder and the ocular findings were confirmed histopathologically.

Psychogenic purpura: a most distressing case.

A case of psychogenic purpura is likely to be unforgettable for everyone concerned. The patient's bizarre and dramatic appearance can frighten both the patient and medical personnel unfamiliar with the condition, causing panic and intense demands for drastic, inappropriate remedies. Our second experience with this condition was such a memorable case. We stress how difficult it can be to withstand the pressures of colleagues, the patient, and his or her family, and how important it sometimes is to be resolute regarding the need for conservative management.

Chronic intractable atopic eczema. Its occurrence as a physical sign of impaired parent-child relationships and psychologic developmental arrest: improvement through parent insight and education.

Atopic eczema of infancy and childhood responds readily and predictably to treatment; only a small percentage remains intractable. Lack of therapeutic response in a proportion of these patients can be attributed to dysfunctional parent-child relationships that lead to physical and emotional developmental arrest. Improvement in parent-child relationships following parental insight into their conflicted feelings permits acceptance of educational recommendations from the physician; it also allows normal development to be resumed and eczema to improve. Eight illustrative cases are reported in which aggressive dermatologic measures were combined with an approach that helped parents recognize conflict and provided education that permitted more appropriate behavioral limit setting. Rapid and sustained improvement in skin, emotional development, and social adjustment resulted.

Neonatal lupus erythematosus. Report of four cases with review of the literature.

We report four newborn infants with a distinctive evanescent cutaneous eruption that clinically and histologically resembled lupus erythematosus; two of the mothers had undifferentiated connective tissue disease. The tendency for lesions to occur in a periorbital location and the association of prominent telangiectasias were characteristic clinical signs in our patients. Immunoglobulin deposition at the basement membrane was demonstrated in one patient. Cytogenetic studies, done to exclude Bloom syndrome, revealed only nonspecific chromosomal abnormalities. A brief review of the literature, with speculations on the possible relationship of these changes to the occurrence of connective tissue disease in the mothers, is included in the discussion.