Balanitis xerotica obliterans and its differential diagnosis.

BACKGROUND: Balanitis xerotica obliterans is a subcategory of lichen sclerosus et atrophicus limited to the male genitalia and is associated with destructive inflammation, phimosis, urethral stenosis, and squamous cell carcinoma. METHODS: The medical literature was searched from 1983-1998 using key words balanitis, lichen, and sclerosis using the MEDLINE system. RESULTS AND CONCLUSIONS: Balanitis xerotica obliterans can be distinguished from other genital dermatoses with similar characteristics through patient history, clinical findings, and laboratory evaluation.. Tzanck smear and cutaneous biopsy, along with a rapid protein reagin test, will provide a definitive diagnosis. Treatment with high-dose topical corticosteroids relieves symptoms, and therapy focuses on prevention of disease progression.

Nonmelanoma skin cancer.

Nonmelanoma skin cancers encompass a vast array of malignancies: adventitial, vascular, neuroendocrine, hematologic, adnexal, and epithelial. The skin is also a major site for metastasis of internal disease. With an understanding of the frequency of presentation, clinical distribution, and appearance, the clinician is able to provide an accurate diagnosis for most lesions. Because there are so many nonmelanoma skin cancers, the focus here is on those with a high frequency or significant morbidity. The treatment of nonmelanoma skin cancer is constantly evolving; therefore, emphasis is on diagnosis.

Massive dystrophic calcinosis cutis secondary to chronic needle trauma.

Extensive dystrophic calcinosis cutis of the hips and anterolateral thighs in a woman with insulin-dependent diabetes mellitus is described. Clinical, histologic, and radiographic data are provided to familiarize the reader with this unique and newly described condition. We speculate that repetitive, chronic, needle trauma in susceptible persons can induce massive dystrophic calcinosis cutis.

Hypophosphatemic vitamin D-resistant rickets, precocious puberty, and the epidermal nevus syndrome.

BACKGROUND: The association of multisystem pathologic conditions and epidermal nevi, known as the epidermal nevus syndrome, includes disorders of bone, central nervous system, eye, kidney, vasculature, body symmetry, and skin. Rarely, vitamin D-resistant rickets has been observed in association with this syndrome. Precocious puberty is another rare finding associated with epidermal nevus syndrome, having been observed in 3 patients. OBSERVATION: A female infant with an extensive epidermal nevus, hypophosphatemia, and precocious puberty is described. Despite medical therapy, the patient's phosphate levels continued to be very low (0.87-0.97 mmol/L), establishing the diagnosis of hypophosphatemic vitamin D-resistant rickets. At 21 months of age, areas of the nevus were excised. Laboratory values obtained shortly after the operation showed a significant, but transient, improvement in the serum phosphate level. After a second excision, maintenance of her serum phosphate level in the range of 1.29 to 1.61 mmol/L was possible. CONCLUSIONS: There is evidence that epidermal nevi produce a potent phosphaturic factor. We hypothesize that limited excision debulked the nevus sufficiently to allow medical management of the hypophosphatemia. Surgical intervention should be considered for patients affected with vitamin D-resistant rickets with epidermal nevi. The cause of the precocious puberty is unknown. It may be hypothesized that the nevus released a factor that induced puberty.

Renaut bodies. Benign disease process mimicking neurotropic tumor infiltration.

BACKGROUND: Mohs micrographic surgery maximizes the potential for complete tumor removal with normal tissue preservation through the histologic examination of all tissue margins. One component of the histologic examination is the evaluation of excised nerves for the presence of tumor infiltration. During such an evaluation, a subperineurial structure was noted. OBSERVATION: Further investigation displayed a discrete, loosely textured, cell-sparse, whorled, subperineurial structure that invaginated into the peripheral nerve. Inflammation was absent and the nuclei were monomorphous. These findings are those seen with Renaut bodies. CONCLUSIONS: Renaut bodies are found at sites of nerve compression. Mechanical factors are thought to play a major role in pathogenesis. Cells comprising the Renaut body are fibroblasts of perineurial origin with the extracellular matrix comprised of collagen fibrils, basal lamina material, and oxytalan filaments. Renaut bodies are important insofar as the surgeon must recognize that they are benign. Histologic characteristics that differentiate Renaut bodies from malignant neurotropic infiltration are: (a) a cell-sparse mass, (b) absence of nuclear atypia, (c) less than expected inflammatory infiltrate, and (d) well-defined borders.

Local anesthetics.

BACKGROUND: Dermatology is dependent upon the effects of local anesthetics for diagnostic and therapeutic interventions. A working knowledge of the drugs' actions and interactions is necessary for anyone aspiring to optimize the benefits derived from the use of local anesthetic agents. OBJECTIVE: This article reviews nerve physiology, pharmacology, classification of local anesthetics, adverse reactions (toxic, drug, allergic), local anesthetic use in pregnancy, alternatives to the "-caine" anesthetics, methods for reducing the pain of infiltration, and new agents under development. CONCLUSION: Local anesthetics are safe and effective. With the understanding of the actions and interactions of this class of drugs, maximum patient safety and satisfaction can be achieved.

Decidualized umbilical endometriosis.

A case of umbilical endometriosis is presented to highlight the challenges in its diagnosis. The etiology, clinical findings, histologic evaluation, prognosis and treatment options are discussed. While cyclic symptomatology may lend evidence to the diagnosis of umbilical endometriosis, history and clinical findings are often equivocal. Decidualization of umbilical endometriosis can be initially confused with a malignant process on histologic evaluation. The potential for malignant degeneration appears low. Surgical intervention is the treatment of choice.

Upper extremity atrophy associated with a giant congenital melanocytic nevus.

Persistent limb atrophy in association with a giant congenital melanocytic nevus is described. This association has not been reported previously.

A new program for hyperactive children.

The magnitude of the problem of hyperactivity among school-age children has attained nationwide attention. The author report on a unique interdisciplinary clinic-based program that was developed to treat this problem. Their article demonstrates that the social work model is an effective tool in treating hyperactivity.