Sebaceous Carcinoma of the Wrist in an Elderly Woman: A Case Report.

Sebaceous carcinoma is a rare, aggressive cutaneous malignancy most commonly arising from the periocular area. Extraocular locations of sebaceous carcinomas, particularly outside of the head and neck region, are rare and not well-described. We report a case of an 89-year-old Caucasian female with sebaceous carcinoma of the right wrist. She initially presented with a 1.2-centimeter friable nodule on the right wrist. Initial shave biopsy and subsequent pathologic evaluation revealed a basaloid neoplasm with sebaceous differentiation, atypia, and frequent mitoses, consistent with sebaceous carcinoma. The presented case reviews common clinical features and the pertinent histopathology of ocular and extraocular sebaceous carcinoma and provides a literature review of diagnosis, prognosis, and treatment.

Rumpel-Leede Phenomenon Following Radial Artery Catheterisation.

Rumpel-Leede phenomenon is a rarely diagnosed entity that can be seen in patients following the application of tourniquet-like forces to the extremities. This phenomenon describes petechiae and purpura secondary to venous compression and congestion, with its underlying aetiology involving the fragility of capillary vessels within the dermis. This condition is associated with chronic medical conditions such as diabetes mellitus, hypertension, dyslipidemia, peripheral vascular disease and systemic inflammatory diseases, including infections. In addition, patients with coagulopathy including thrombocytopenia or platelet dysfunction from antiplatelet use, or those with thrombotic thrombocytopenic purpura and idiopathic thrombocytopenic purpura, are predisposed to capillary haemorrhage and petechiae formation. In this report, we present a case of a patient who developed Rumpel-Leede phenomenon following catheterisation of the right radial artery with spontaneous resolution - where only five cases have been reported to date - with the aim to make clinicians aware of this condition and to avoid unnecessary interventions. LEARNING POINTS: Rumpel-Leede phenomenon is a benign condition that can be seen after tourniquet-like compression of a limb in those with capillary fragility.Dermatologists and other practitioners should remain aware of the phenomenon, helping to avoid unnecessary investigation.Rumpel-Leede phenomenon self-resolves, with only supportive treatment required with no reported lingering effects to date.

A Rapidly Growing Forearm Pilomatricoma in an Elderly Patient.

Pilomatricoma is a benign skin tumor of epithelial hair matrix cells that typically presents as a solitary nodule on the head or upper trunk. It occurs most often in children and young adults. While considered uncommon in middle-aged and elderly patients, there are reports of elderly patients with histopathologically diagnosed pilomatricomas; however, these cases primarily occurred on the face. We present a case of an 88-year-old female with a history of non-melanoma skin cancer who presented with a new, rapidly enlarging, biopsy-proven pilomatricoma on the forearm. This case highlights a unique age of onset and location for this skin tumor, suggesting that pilomatricomas are not limited to children and young adults and should be considered in the differential diagnosis of rapidly growing skin lesions in elderly patients. Diagnosis should be confirmed with biopsy in elderly patients, as pilomatricomas may mimic malignant skin lesions.

Systemic argyria with severe anemia (hemoglobin 2.4 g/L).

Argyria is a rare disease in which chronic usage of products with a high silver content leads to deposition of silver granules in organs such as the skin, resulting in a permanent blue-gray discoloration. We present a 68-year-old woman with a 10-year history of chronic anemia of unknown etiology who was admitted for progressive generalized weakness, dyspnea, and a widespread slate-gray tint to her skin. She had previously consumed 1 tablespoon per day of colloidal silver orally for 7 years. Hematologic workup on admission showed the hemoglobin to be 2.4 g/dL with low ferritin and normal copper, zinc, and ceruloplasmin, indicating an iron-deficiency anemia. Differentiating the correct etiology of her anemia and skin discoloration was crucial since argyria can cause pseudocyanosis and microcytic anemia secondary to silver-induced copper deficiency. This case highlights the importance of asking and counseling patients about their nonprescription supplements.

Generalized lichen nitidus in a 6-year-old girl with Down syndrome.

Lichen nitidus is a generally asymptomatic disease identified by shiny, flesh-colored papules that are often limited to the trunk, upper limbs, and genitalia. Here, we describe a generalized presentation of lichen nitidus in a 6-year-old girl with Down syndrome. Lichen nitidus shares a known association with Down syndrome, and several case studies document patients with Down syndrome developing generalized lichen nitidus. The extensive nature of our patient's lichen nitidus, as well as the uncommon distribution, particularly on the face, adds to the currently limited primary literature on this subject.

Seborrheic dermatitis with massive facial hyperkeratosis resembling acquired ichthyosis.

Seborrheic dermatitis is a common multifactorial skin disorder favoring the scalp, ears, face, and central chest. We present a case of an elderly woman with new-onset severe seborrheic dermatitis with massive facial hyperkeratosis mimicking ichthyosis. Clinicians should be aware of rare presentations of common conditions and should screen for associated medical comorbidities in new-onset severe skin conditions.

Erythrodermic psoriasis secondary to systemic corticosteroids.

Erythroderma is an uncommon, potentially life-threatening condition, which has many causes, including uncontrolled psoriasis. We present a 58-year-old woman with psoriasis who, after an abrupt discontinuation of systemic corticosteroids, developed erythrodermic psoriasis with extensive body surface involvement requiring hospital admission. Erythrodermic psoriasis requires a high index of suspicion to diagnose it in a timely fashion and treat it to prevent complications.

Development of Terry's nails after a gastrointestinal bleed.

Terry's nails are characterized by white opacification of the nails with effacement of the lunula and distal sparing. Described originally in 1954 by Dr. Richard Terry as a common fingernail abnormality in patients with hepatic cirrhosis, Terry's nails are now a known sequelae of other conditions such as congestive heart failure, chronic kidney disease, diabetes mellitus, and malnutrition. Often all nails of the hands are affected. Treatment of the underlying disease may result in resolution. We present a case of a 77-year-old man who developed Terry's nails following an acute gastrointestinal bleed and subsequent hemorrhagic shock. The development of Terry's nails after a gastrointestinal bleed has not been previously reported.

Stevens-Johnson syndrome with a recall-like reaction within a donor graft site.

We describe a 69-year-old white man with a recent history of a left forearm sarcoma resection treated with a split-thickness skin graft and radiotherapy who presented with cellulitis of the left forearm, for which a 2-week course of trimethoprim-sulfamethoxazole was prescribed. Ten days into treatment, he presented with flu-like symptoms and a rash. He was eventually diagnosed with Stevens-Johnson syndrome accentuated on the donor split-thickness skin graft on the left thigh region mimicking a recall reaction. There are no other reported cases of Stevens-Johnson syndrome localized within donor graft sites; therefore, this case may represent a novel form of recall reaction.

Incidental rhabdomyomatous mesenchymal hamartoma.

Rhabdomyomatous mesenchymal hamartoma (RMH) is a rare congenital tumor of the dermal and subcutaneous tissues, often presenting as a papule or a pedunculated or sessile mass at the midline on the head and neck. Although RMH is benign, some cases have reported associations with other congenital and syndromic anomalies. Thus, an accurate diagnosis is important, as an internal or systemic evaluation of the patient may be warranted. We report a case of a solitary RMH on the midline upper chest in a healthy 15-year-old girl.

Paraneoplastic eczematous eruption associated with Hodgkin's lymphoma.

Hodgkin's disease (HD) is a common malignant lymphoma that classically presents with painless lymphadenopathy, weight loss, nocturnal sweats, fever, and generalized pruritus. Unlike other lymphoproliferative disorders, cutaneous involvement is uncommon with HD. Diffuse hyperpigmentation, prurigo nodularis, acquired ichthyosis, erythema nodosum, mycosis fungoides, herpes zoster, and vasculitis have all been described as nonspecific or paraneoplastic manifestations of HD. A small set of cases of adult new-onset recalcitrant eczema has recently been described as a nonspecific cutaneous manifestation of HD. In agreement with these reports, we present a case of a 28-year-old woman who initially presented with persistent lymphadenopathy and a pruritic eczematous dermatitis that preceded the diagnosis of HD.

Contrast-induced generalized bullous fixed drug eruption resembling Stevens-Johnson syndrome.

A 59-year-old woman with end-stage renal disease presented for suspected Stevens-Johnson syndrome that was ultimately diagnosed as generalized bullous fixed drug eruption (GBFDE) secondary to the administration of iodinated nonpolar radiocontrast. The patient had three previous episodes of a generalized bullous eruption after a thrombectomy, fistulogram, and an arteriovenous fistula revision, all requiring radiocontrast administration. Biopsies taken after previous eruptions demonstrated full-thickness epidermal necrosis, and she was diagnosed with Stevens-Johnson syndrome thought to be due to allopurinol. However, against medical advice she continued taking allopurinol and remained asymptomatic until the current presentation. Based on the clinical appearance and time frame of the eruptions, the patient was diagnosed with GBFDE due to radiocontrast. GBFDE, a rare variant of a fixed drug eruption, can be misdiagnosed as Stevens-Johnson syndrome due to their overlapping features of drug-induced whole-body blisters and variable degrees of epidermal necrosis.

Urticaria multiforme in a 2-year-old girl.

We describe a 2-year-old girl who presented to the emergency department for a 2-day history of a rapidly spreading, pruritic, erythematous rash. There were large polycyclic annular erythematous wheals on the face, trunk, and extremities. Urticaria multiforme was diagnosed. Systemic antihistamine therapy greatly regressed the dermal lesions in 24 hours. Urticaria multiforme, a benign cutaneous hypersensitivity reaction, is commonly misdiagnosed as erythema multiforme or a serum sickness-like reaction. Our case highlights the importance of differentiating urticaria multiforme to prevent unnecessary tests and provide proper treatment.

Rowell syndrome with recurrence from photoexacerbation: A case report.

Rowell syndrome is a controversial entity composed of erythema multiforme-like lesions coexisting with lupus erythematosus. We describe a case of a 61-year-old male with a history of systemic lupus erythematosus who presented with photoexacerbated flaccid bullae and erosive plaques after repetitive sun exposure. Based on his clinical history, biopsy, and laboratory findings, he fulfilled diagnostic criteria for Rowell syndrome as described by Zeitouni et al. With oral prednisone, hydroxychloroquine, mycophenolate mofetil, and local wound care with petrolatum, the patient's number of lesions decreased, as well as his pain and tenderness. He subsequently did not develop any new erosions. This case highlights the diagnostic criteria of this hybrid clinicopathological syndrome and its nature of photosensitivity.