Focal acral hyperpigmentation in a patient undergoing chemotherapy with capecitabine.

Capecitabine is a prodrug of fluorouracil. Systemic immunosuppression has been reported as a cause of eruptive pigmented lesions, although the mechanisms causing this eruption are not known. A 58-year-old woman undergoing chemotherapy with capecitabine presented with multiple pigmented macules on the skin and tongue, and generalized hyperpigmentation, which finally faded after the drug was discontinued. Capecitabine may induce the growth of normal and dysplastic melanocytic nevi, and lentiginous melanocytic hyperplasia. Careful follow-up is mandatory, since the risk of developing melanoma in these cases remains uncertain.

Halo scalp ring in a premature newborn and review of the literature.

Unusually prolonged pressure on the scalp by the cervical os during or before the delivery may result in a distinctive pattern of annular alopecia that has been referred to as halo scalp ring. This rare form of hair loss is most commonly a temporary, non-scarring process that is attributed to caput succedaneum. We report a new case of halo scalp ring in a premature newborn. Review of previously reported cases suggests that prematurity is an important, previously unrecognized, risk factor for developing a halo scalp ring.

Granular parakeratosis.

A healthy 62-year-old woman was referred to our dermatology department with a 1-month history of a pruritic axillary eruption. On examination, multiple erythematous and brownish hyperkeratotic papules were seen in both axillae. Some of these lesions coalesced into plaques, with small areas of sparing, and a background erythematous color was also found in the axillary vaults (Fig. 1). There was no involvement of other intertriginous sites and there were no associated systemic symptoms. The patient was not obese. The patient had removed the hair from her axillae with wax 3 weeks before the development of the eruption. Moreover, she had changed her antiperspirant 1 week before the onset of the lesions. A cutaneous biopsy for histologic analysis was performed. Histologically, the stratum corneum was thickened, with persistent nuclei together with countless small basophilic granules. The granular layer was preserved and, in some areas, hypergranulosis was found (Fig. 2). These findings were characteristic of granular parakeratosis. The cutaneous lesions resolved completely after 1 week of treatment with topical betamethasone dipropionate and gentamicin sulfate (twice daily). The patient was urged to discontinue her use of deodorants.

Lipschütz acute vulval ulcers associated with primary cytomegalovirus infection.

A previously healthy 16-year-old girl presented with painful acute genital ulcers that appeared in the context of a primary cytomegalovirus infection. Complementary examinations ruled out both venereal disease and other usual causes of genital ulcerations, and the lesions resolved in < 2 weeks with no sequelae or later recurrences. Cytomegalovirus disease should be considered in the screening of acute vulval ulcers.

Granulomatous reactions to permanent cosmetic tattoos successfully treated with topical steroids and allopurinol.

Two female patients presented nodular erythematous lesions overlying a permanent tattooed eyebrow and lip, respectively. Histologic examination showed in both cases epithelioid granulomas in close relation with scattered pigment. Complementary examinations and follow-up disclosed a sarcoidosis. The lesions resolved after treatment with topical steroids and also oral allopurinol in one of the cases. Allopurinol may be an effective treatment for granulomatous reactions to foreign body particles.

Occlusive eccrine hidradenitis presented as a reticulated eruption on the buttocks.

A 13-month-old girl presented a reticulated eruption of 2 months duration located on her buttocks. Histologically, a mononuclear cell inflammatory infiltration was found within and around the eccrine sweat glands, with epithelial cell damage. The lesions were related to several traumatic mechanisms involving the buttocks, such as crawling and repeated trauma with a bathmat carpet.

Desmoplastic giant congenital nevus with progressive depigmentation.

Desmoplastic hairless hypopigmented nevus is an extremely rare sclerotic, alopecic, and progressively hypopigmented giant congenital melanocytic nevus, which is histologically characterized by an intense desmoplasia. A significant trend toward spontaneous involution has been described. We report a case of desmoplastic hairless hypopigmented nevus that underwent a progressive depigmentation associated with loss of its woody consistency. The loss of induration appears to be the main marker for the complete regression of these nevi.