We recently evaluated a patient with a unique form of nodular colloid degeneration. Lesions consisted of pruritic, purpuric plaques involving the upper and lower extremities and the neck. Examination of a biopsy specimen revealed large, fissured masses of amorphous material in addition to solar elastosis. The amorphous material showed negative reactions to stains for amyloid, and other histochemical studies showed results similar to those for colloid milium. The amorphous masses demonstrated a marked positive reaction to the Verhoeff-van Gieson stain for elastin. Electron microscopic examination revealed masses of degenerated elastic tissue bordered by fibrillar material that resembled amyloid morphologically. We believe this case represents a nodular form of solar degeneration with clinical and histologic resemblances to both colloid milium and cutaneous amyloidosis.
An acrodermatitis enteropathica-like syndrome occurred in two nutritionally compromised patients with prolonged catabolic illnesses. We believe that one must consider conditions associated with hypozincemia when the vermilion border is spared. This is often thought to be characteristic of perioral dermatitis.
We believe that the disease we are reporting is associated with diabetes, particularly in patients on renal dialysis, and the perforation is initiated by scratching. Decreasing pruritus is the only needed treatment as the lesions tend to resolve on their own. While this entity has been called Kyrle's disease, it more correctly is reactive perforating collagenosis, both clinically and histologically. Whether this is a variant of what Kyrle originally described is not clear. We propose that this entity be called reactive perforating collagenosis of diabetes and renal failure.
Flushing disorders are associated with sweating (wet flushes) or without sweating (dry flushes). When associated with systemic symptoms and histaminuria, flushing reactions may easily be confused with mastocytosis or pheochromocytoma. We report a case of a woman with significant transient histaminuria that could be dissociated from episodes of thermal wet flushing. Treatment with clonidine led to a decrease in both frequency and intensity of the flushing reactions.
A patient with rheumatoid arthritis developed nodules and ulcers shortly after treatment with supersaturated potassium iodide (SSKI) drops. The SSKI was administered for thyroid protection during an iodide fibrinogen uptake test to detect phlebothrombosis of the legs. Discontinuation of SSKI was accompanied by regression of all lesions. Previous case reports include other patients who experienced iododerma after receiving low doses of iodides. This should be borne in mind if ever a mass iodide prophylaxis program is undertaken following a nuclear event.
Basal cell carcinoma has been reported to occur in sites of chronic trauma, inflammation, or scarring, and even after a single injury. We report on a patient in whom a nodular basal cell carcinoma developed at the site of venipuncture. The venipuncture occurred six months earlier and the site never healed but gradually progressed to a nodule of basal cell carcinoma. Single injuries may provoke or aggravate the growth of basal cell carcinoma.
An 18-year-old woman had alopecia areata of two years' duration. Initially, the clinical findings were quite characteristic of alopecia areata; however, the hair that grew back into the areas of alopecia remained short and sparse. Histopathologic examination suggested trichotillomania, which was confirmed by shaving a small area on the scalp and observing normal hair regrowth.
Captopril, an oral active dipeptidylcarboxypeptidase inhibitor with antihypertensive properties, has been reported to have the following cutaneous side effects: macular and papular skin eruptions, urticaria, angioedema, mouth ulcers, pemphigus, and pityriasis rosea-like eruptions. Here, to the best of our knowledge, is the first case in which a pityriasis rosea-like eruption evolved into a lichenoid drug eruption. Also discussed is the remarkable similarity in the side effects of captopril, gold compounds, d-penicillamine, and organic mercurials.
