Necrotizing vasculitis of the skin and uterine cervix associated with minocycline therapy for acne vulgaris.

In recent years, minocycline has become a commonly used agent for the treatment of acne vulgaris and rosacea. With this increased use have come reports of severe and in some cases life-threatening toxicity, often occurring in otherwise healthy young women after prolonged courses of minocycline. These adverse reactions include hepatotoxicity, drug-induced lupus erythematosus, eosinophilic pneumonitis, and hypersensitivity syndrome. We describe a 35-year-old woman who had necrotizing vasculitis of the skin and uterine cervix after 2 years of minocycline therapy for acne vulgaris. Skin and cervical biopsies revealed acute inflammation involving through-and-through necrosis of vessel walls with thrombosis, focal fibrinoid change, and a perivascular lymphohistiocytic infiltrate. The disease fully resolved within 3 months of discontinuance of the minocycline therapy. Patients should be informed of these rare but potentially serious adverse effects before the initiation of minocycline therapy. Early recognition of these complications can result in complete resolution.

Once-daily tazarotene gel versus twice-daily fluocinonide cream in the treatment of plaque psoriasis.

BACKGROUND: A new class of topical receptor-selective acetylenic retinoids, the first of which is tazarotene, has been developed. OBJECTIVE: Our purpose was to compare the safety, efficacy, and duration of therapeutic effect of 12 weeks of once-daily tazarotene 0.1% and 0.05% gel with that of twice-daily fluocinonide 0.05% cream in the treatment of patients with plaque psoriasis. METHODS: Three hundred forty-eight patients with plaque psoriasis were enrolled and 275 patients completed a multicenter, investigator-masked, randomized, parallel-group clinical trial. RESULTS: Both tazarotene gels were as effective as fluocinonide in reducing plaque elevation after 1 week of treatment, and tazarotene 0.1% gel was similar to fluocinonide in reducing scaling of trunk/limb lesions at all study weeks except week 4. Tazarotene 0. 1% gel was similar to fluocinonide in reducing scaling of knee/elbow lesions at weeks 8 and 12. Fluocinonide had a significantly greater effect on erythema than tazarotene at weeks 2 through 8. However, treatments were not significantly different at week 12, and tazarotene demonstrated significantly better maintenance of therapeutic effect after cessation of therapy. CONCLUSION: Tazarotene 0.1% and 0.05% gels were safe and effective in the treatment of mild-to-moderate plaque psoriasis.

Remember to consider dermatophyte infection when dealing with recalcitrant dermatoses.

BACKGROUND: Superficial fungal infections of the skin are among the most common infections encountered in medicine. The diagnosis is easily confirmed with simple office-based procedures. In certain clinical situations, the diagnosis can be elusive. METHODS: We analyzed clinical data on five patients who came in referral for treatment of a recalcitrant dermatosis. RESULTS: All patients had their diagnosis confirmed by a positive potassium hydroxide preparation from skin scrapings or by a skin biopsy positive for fungal elements. All showed clinical improvement and ultimate resolution of their skin lesions with topical and/or systemic antifungal therapy. CONCLUSIONS: Diagnosis can be complicated by previous use of corticosteroid-containing topical and/or systemic agents, a clinical history closely resembling that of a photosensitive disorder, and a lack of clinical-histopathologic correlation. Laboratory procedures and skin biopsy of an ambiguous appearing lesion can be diagnostic, but an accurate diagnosis is dependent on communication between the clinician and the pathologist. We recommend that office-based procedures be done early in treatment so that subsequent efforts can be directed toward providing appropriate therapies.

Urticaria, angioedema, and rheumatologic disease.

Urticaria and angioedema are common processes that are experienced by 15% to 25% of the population at least once during a lifetime. This article presents an overview of urticaria and angioedema with emphasis on these processes as they relate to rheumatic disease. Discussion includes classification of urticaria and angioedema and recommended evaluation and treatment of patients presenting with such problems.

Cutaneous vasculitis associated with pheochromocytoma.

We describe a patient who presented with constitutional symptoms, severe hypertension, and purpuric lesions over the knees, thighs, and penis. The patient was eventually diagnosed as having multiple endocrine neoplasia type II, with cutaneous leukocytoclastic vasculitis. The cutaneous vasculitis persisted despite treatment with high-dose systemic corticosteroids, but rapidly resolved after the removal of bilateral pheochromocytomas. This case demonstrates cutaneous leukocytoclastic vasculitis in association with pheochromocytoma.

Leukemia cutis presenting as a scrotal ulcer.

A patient with acute nonlymphocytic leukemia developed a painful scrotal ulcer thought initially to be caused by infection. The lesion failed to heal with oral antibiotic therapy and local wound care. Histopathologic examination of a biopsy specimen revealed an infiltrate of leukemic cells. This cutaneous lesion heralded the relapse of acute myelogenous leukemia. A review of the literature indicates that acute nonlymphocytic leukemia rarely presents as an ulcer or on the genitalia, thus emphasizing the uniqueness of this case regarding morphology, and site of presentation. To our knowledge, this is the first case of leukemia cutis presenting as a scrotal ulcer. Therefore leukemia cutis should be added to the differential diagnosis of chronic genital ulcers. Also, because a variety of skin lesions may signify the relapse of leukemia, any skin lesion in a patient with leukemia should be examined by biopsy.