Subcutaneous nodules of the scalp: preoperative management.

The differential diagnosis of subcutaneous lesions of the scalp is extensive and includes many tumors with intracranial and intraosseous extension. The vast majority of lesions seen by the dermatologist will be benign. However, certain lesional characteristics increase the likelihood of a serious disorder and these must be evaluated preoperatively. We review the important features of subcutaneous scalp lesions and suggest a systematic approach to diagnosis based on patient age, lesion morphology, location, and radiographic findings.

Noma.

We report a case of noma in a debilitated 71-year-old white man. Predisposing factors included malnutrition, preleukemic syndrome, and occult renal adenocarcinoma. The superior third of the patient's lower lip was destroyed before he died.

Unilateral facial telangiectasia macularis eruptiva perstans.

A 36-year-old man developed unilateral facial telangiectases over a 10-year period. Histopathologic examination showed collections of mast cells. This patient has an unusual variant of telangiectasia macularis eruptiva perstans. The differential diagnosis of facial telangiectases is discussed. Mastocytosis should be considered in patients presenting solely with telangiectases.

Pemphigus vulgaris localized to the nose.

Pemphigus often begins with localized oral lesions. Initial localized pemphigus lesions elsewhere are less common. A 65-year-old man who presented with one crusted erosion on his nose was diagnosed as having pemphigus and was treated with local and intralesional steroids. Seven months after the onset of the first lesion, others occurred elsewhere on his skin.

Recurrent fungal infection of the face: diagnostic pitfalls.

Despite many warnings in the literature that tinea faciale is a great imitator, it remains a commonly misdiagnosed disease. A case of facial tinea that presented twice as a diagnostic dilemma is discussed and the difficulties that sometimes arise in diagnosing this condition clinically are emphasized.

Choosing and using a vehicle.

The amount of topical medication needed to cover the body thinly by self-application was measured in twenty-nine adults. It averaged 22 gm and varied with surface area and size of container, but not with sex or instruction. There was no difference in amount used between cream and ointment or between alcoholic liquid and creamy liquid. Application by a trained attendant required less medication than self-application. Self-application of a fluorescent sunscreen skipped many areas.

Bullous pemphigoid and multiple autoimmune diseases. Alopecia universalis, bullous pemphigoid, hypothyroidism, rheumatoid arthritis, and neutropenia in one patient.

A 57-year-old white man developed Hashimoto's thyroiditis, bullous pemphigoid, and autoimmune neutropenia during the last year of his life. In addition, he had alopecia universalis since the age of 21 and rheumatoid arthritis since the age of 38. This unique constellation of autoimmune diseases has not been reported previously. Its significance is discussed in relation to the polyglandular failure syndrome and thymoma-related autoimmune disease.

Livedo reticularis with ulcers and circulating immune complexes.

Livedo reticularis is a reticulate skin pattern that is idiopathic or associated with systemic disease. A 30-year-old white man with livedo reticularis, winter ulcerations, and a peripheral neuropathy is described. His only laboratory abnormality remains the presence of circulating immune complexes. Therapy of this patient's condition and the significance of these immune complexes are discussed.

The use of halcinonide solution, 0.1 percent, in the treatment of eczematous diseases.

Halcinonide solution, 0.1 percent, was used to treat sixty-six patients with eczematous dermatoses. The majority of the responses were excellent, with the condition clearing completely in eight patients within the first week. The total mean amount of medication used by each patient for twice a day application for one or two weeks was less than 24 ml.

Hailey-Hailey disease. Report of a case treated surgically.

A 51-year-old man with Hailey-Hailey disease was treated with a split thickness skin graft of the left axilla. The dramatic improvement in the grafted area is contrasted with the continued disease activity in the untreated axilla and other intertriginous areas. Local excision and grafting, with a resultant decrease in sweating and maceration, is an effective form of therapy for Hailey-Hailey disease.