Clinical and Experimental Dermatology

Tse, T. W.

doi: 10.1046/j.1365-2230.2003.01322.xpmid: 12950329

Summary Chinese herbal medicines have been shown to be effective in the treatment of atopic eczema. However, the Western scientific/medical literature has not fully examined the potential usefulness of herbal treatments in the management of psoriasis. This article aims to provide an Eastern insight into psoriasis, considering the diagnosis of psoriasis using Chinese medical terminology and its treatment using herbal medicine, as well as how these herbs might work.

Stante, M.; Carli, P.; Massi, D.; De Giorgi, V.

doi: 10.1046/j.1365-2230.2003.01332.xpmid: 12950330

Summary Little is currently known about the relationship between melanocytic naevi and melanoma in terms of neoplastic progression. At histological examination, remnants of a pre‐existing melanocytic naevus adjoining a melanoma are seen in 20–30% of cases. This study investigated dermoscopic features of 108 naevus‐associated melanomas, identified on the basis of histological classification, consecutively observed at a University Department. Because of the risk of misclassification due to destruction of naevus remnants in thick tumours, only lesions of < 1 mm Breslow thickness were considered. We found naevus‐associated melanomas showing atypical pigment networks and regression patterns more frequently than de novo melanomas, while irregular blotches and atypical vascular patterns were found less frequently. Dermatologists should be aware that dermoscopic features of melanoma differ according to the histogenesis of the lesion. Atypical pigment networks and regression patterns are the most useful dermoscopic criteria suggested to make a diagnosis of naevus‐associated melanoma.

Kanwar, A. J.; Dogra, S.; Handa, S.; Parsad, D.; Radotra, B. D.

doi: 10.1046/j.1365-2230.2003.01367.xpmid: 12950331

Summary Lichen planus pigmentosus is a fairly common disorder of pigmentation in Indians, but reports comprising a sizeable number of patients are lacking in the literature. We now describe the clinical and epidemiological features and histopathological findings for 124 lichen planus pigmentosus patients. A retrospective analysis of medical records of patients attending our centre during the past 12 years was undertaken. Of the 124 patients (56 male, 68 female), the majority (48.4%) had the disease for 6 months to 3 years. The face and neck were the commonest sites affected with pigmentation varying from slate grey to brownish‐black. The pattern of pigmentation was mostly diffuse (77.4%), followed by reticular (9.7%), blotchy (7.3%) and perifollicular (5.6%). Lichen planus was noted in 19 patients with typical histopathological changes of the disorder. Lichen planus pigmentosus, a distinct clinical entity commonly encountered in the Indian population, should be considered in the spectrum of lichenoid disorders as a variant of lichen planus.

Ezughah, F. I.; Orpin, S.; Finch, T. M.; Colloby, P. S.

doi: 10.1046/j.1365-2230.2003.01366.xpmid: 12950332

Summary Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissues caused by pigmented fungi. It is primarily a disease of the tropics and subtropics. It is uncommon in the UK where it may occur as an imported disease. We describe a 42‐year‐old lady who developed chromoblastomycosis on her right forearm from Cladosporium, after visiting Malta. The lesion resolved after treatment with itraconazole for 6 months. To our knowledge there are no previous reports of chromoblastomycosis from Malta. We review the clinical course, diagnosis and management of this condition.

Campbell, F. A.; Clark, C.; Holmes, S.

doi: 10.1046/j.1365-2230.2003.01323.xpmid: 12950333

Summary Giant cell arteritis is a systemic disease of the elderly which affects large and medium‐sized arteries and which may occur in association with polymyalgia rheumatica. Scalp necrosis is a rare cutaneous complication of giant cell arteritis, and this dermatological presentation is not commonly reported.1–4 Giant cell arteritis should be considered in all elderly patients with scalp ulceration. We describe two patients who presented in this manner.

Chan, I.; Calonje, E.; Whittaker, S. J.

doi: 10.1046/j.1365-2230.2003.01325.xpmid: 12950334

Summary We report a case of Waldenström's macroglobulinaemia that presented with infiltrated skin nodules and plaques but without systemic symptoms. Cutaneous manifestations such as purpura, oedema, urticaria and ulceration may be seen in Waldenström's macroglobulinaemia and are a consequence of hyperviscosity, cryoglobulinaemia and/or tissue deposition of immunoglobulins. Direct cutaneous infiltration by neoplastic lymphoid cells is less common, and very rare as the initial presentation of Waldenström's macroglobulinaemia.

Ena, P.; Pinna, A.

doi: 10.1046/j.1365-2230.2003.01335.xpmid: 12950335

Summary Classic lamellar ichthyosis is a rare, autosomal recessive, genetically heterogeneous skin disease caused by mutations in the transglutaminase 1 gene. Pseudoainhum is characterized by the appearance of a constricting band around a digit which may lead to spontaneous amputation. We describe a 41‐year‐old man with classic lamellar ichthyosis with unusual eye changes and pseudoainhum of both the fifth and the third right toes. Eye abnormalities included bilateral ectropion of the lower eyelids, chronic blepharitis, and nuclear cataract. A radiometric assay revealed greatly reduced skin transglutaminase activity. To the best of our knowledge, this report is unique as classic lamellar ichthyosis with deficient transglutaminase activity has never been associated with pseudoainhum of the toes and the early development of nuclear cataract.

Leslie, K. S.; Gaffney, K.; Ross, C. N.; Ridley, S.; Barker, T. H.; Garioch, J. J.

doi: 10.1046/j.1365-2230.2003.01336.xpmid: 12950336

Summary Dapsone (4,4′‐diaminodiphenyl sulphone) is used for a variety of dermatological conditions including immunobullous diseases and urticarial vasculitis. Side‐effects are common and include lethargy, headaches, methaemoglobinaemia and haemolysis. Severe adverse effects are rare but the dapsone hypersensitivity syndrome is well recognized. Symptoms include fever, haemolytic anaemia, lymphocytosis and hepatitis. We report a near fatal case of the dapsone hypersensitivity syndrome in a patient with urticarial vasculitis. This diagnosis should be remembered in any patient who becomes unwell whilst taking dapsone.

Wain, E. M.; Setterfield, J.; Judge, M. R.; Harper, J. I.; Pemberton, M. N.; Russell‐Jones, R.

doi: 10.1046/j.1365-2230.2003.01348.xpmid: 12950337

Summary Involvement of the oral mucosa in cutaneous T‐cell lymphoma is uncommon and is usually associated with a poor prognosis (the majority of patients dying from the disease within 3 years of the diagnosis of oral involvement). We report the first case of intraoral mycosis fungoides occurring in a child. In addition, our patient has had intraoral disease for 3 years and is currently systemically well with no evidence of cutaneous or systemic disease progression.

Rho, N.‐K.; Youn, S.‐J.; Park, H.‐S.; Kim, W.‐S.; Lee, E.‐S.

doi: 10.1046/j.1365-2230.2003.01362.xpmid: 12950338

Summary Dystrophic cutaneous calcification may arise at sites of local trauma or in association with various disorders. Calcified nodules of the heel have been reported in high‐risk neonates following repeated heel sticks to draw blood. We present a healthy 2‐year‐old boy with a calcified nodule on the heel secondary to a single heel stick in the neonatal period. The patient was born full‐term at 38 weeks' gestation, with a birth weight appropriate for gestational age. A firm nodule was noticed at the age of 8 months; this became tender. Histology revealed epidermal and subepidermal deposition of calcium. Serum calcium and phosphate levels were normal. Although calcified heel nodules occur mostly in high‐risk neonates, this case suggests that this condition also can occur in healthy children after only a single heel stick. Dermatologists should include this entity in the differential diagnosis of warty papules on the heels of children.