RESUMO
Pyoderma gangrenosum is often associated with a systemic disease. Cocaine-induced pyoderma gangrenosum, most probably caused by levamisole, has been described recently and typically presents as multiple, large cribriform ulcers. Peri-nuclear antineutrophil cytoplasmic antibody is the most common serological finding. A strong counseling for cocaine cessation, combined with wound care and immunosuppressive therapy, is the mainstay of treatment. We present two cases of cocaine-induced pyoderma gangrenosum and correlate their findings with the typical clinical, histological and serological presentation.
RESUMO
Deep granuloma annulare is an uncommon benign granulomatous skin disorder that presents almost exclusively in the paediatric population. It presents as an asymptomatic subcutaneous nodule with normal overlying skin on distal extremities, the scalp, or the forehead. It shows a deep palisading granuloma with areas of central necrobiosis on histologic examination. Due to its self-limited nature, clinical follow-up is recommended over surgical interventions. We present a case of cephalic deep granuloma annulare in a healthy 5-year-old girl who remains free of recurrence after surgical excision at the 6-month follow-up. Our case emphasizes the importance of differentiating the lesion from its clinical and histopathological mimickers, such as the rheumatoid nodule. The awareness of this entity is important to avoid the overinvestigation and overtreatment of a benign and self-limited disease.
