1/27. Chronic factitial ulcer of chin cured by endodontic (root-canal) surgery for underlying periapical abscess. In a determined search for the cause of a "factitial" ulcer of the jaw, consultation with 3 dentists was required before an underlying periapical abscess was discovered. Within 3 months of endodontic surgery, this ulcer of 12 years duration had completely healed and remains healed. Too often dental infection is neither suspected nor detected as a cause of skin disease. ( info) |
2/27. Lichen simplex chronicus of the eyelid. Lichen simplex chronicus is a common dermatosis that rarely affects the eyelids. We report the clinical and pathologic features in the case of a middle-aged man who had lichen simplex chronicus of both lower eyelids. The clinical features suggested the presence of basal cell carcinoma. ( info) |
3/27. strongyloides stercoralis infection presenting as generalized prurigo nodularis and lichen simplex chronicus. strongyloides stercoralis is a parasitic nematode that develops an autoinfective life cycle within the gastrointestinal tract of its human host. The infection produces peripheral eosinophilia and cutaneous eruptions, as well as gastrointestinal or respiratory symptoms. Detection of S stercoralis is difficult through stool examination, but may be demonstrated by ELISA for IgG antibody against the parasite. We describe a patient with chronic S stercoralis infection initially presenting with generalized prurigo nodularis and lichen simplex chronicus. ( info) |
4/27. lupus vulgaris mimicking lichen simplex chronicus. Cutaneous tuberculosis is not an uncommon entity but it often remains undiagnosed and is inappropriately treated due to its varied presentation. We present a 42-year-old male with lupus vulgaris in the perianal area, who was treated as lichen simplex chronicus with steroids for two years. With four drug antitubercular treatment, the patient had a dramatic response. The case is being reported because in this hiv era with the resurgence of tuberculosis, not only will there be an increase in incidence but also more involvement of atypical sites. ( info) |
5/27. Unilateral, circumscribed, chronic dermatitis of the papillary-areolar complex: case report and review of the literature. Lichen simplex chronicus is a well-described, common pruritic disorder resulting from repeated rubbing and scratching. Typically, only one site is involved. When this site involves the papillary-areolar complex of one breast, the condition is termed unilateral, circumscribed, chronic dermatitis of the papillary-areolar complex. A patient with this uncommon condition is herein reported, and the literature, including a discussion of the differential diagnosis, is reviewed. An aggressive approach to the work-up of such a patient is recommended, to ensure accurate diagnosis and initiation of appropriate therapy. ( info) |
6/27. Unusual case presentation of lichen simplex chronicus, Hodgkin's lymphoma, and nonpuerperal hyperprolactinemia-galactorrhea. OBJECTIVE: To report the association of nonpuerperal galactorrhea and severe pruritus with clinical stage IIB Hodgkin's lymphoma. methods: We present a detailed history, findings on physical examination, laboratory data, and results of diagnostic imaging in a 25-year-old woman. A review of the related literature and speculations about possible etiologic factors for this association are provided. RESULTS: Dermatologic evaluation of the patient revealed lichen simplex chronicus with multiple excoriations on the anterior chest area and lower extremities. High serum prolactin concentrations and easily expressible galactorrhea were present. magnetic resonance imaging of the sella with 1-mm cuts, however, revealed a normal pituitary gland. Computed tomography showed multiple enlarged mediastinal lymph nodes, and a left supraclavicular lymph node biopsy revealed the presence of reed-sternberg cells and lymphocyte alterations consistent with the diagnosis of Hodgkin's lymphoma. After one cycle of chemotherapy for management of the lymphoma, parallel reductions in serum prolactin concentrations and galactorrhea were noted. CONCLUSION: Possible causes for this syndrome include afferent mammary nerve stimulation resulting from scratching of pruritic skin and cytokine-induced hypersecretion of prolactin attributable to the lymphoma. Although uncommon, this syndrome may serve as an important harbinger of developing Hodgkin's lymphoma, and its disappearance may signify a therapeutic response. ( info) |
7/27. A new disorder of lymphocyte apoptosis: combination of autoimmunity, infectious lymphadenopathy, double negative T cells, and impaired activation-induced cell death. A new symptom-complex is described characterized by manifestations of autoimmune disease, infectious lymphadenopathy, double negative T cells, and impaired activation-induced cell death that developed in late adolescence. Similarities, but also significant differences, to autoimmune lymphoproliferative syndromes (ALPS, Canale-Smith syndrome) and autoimmune lymphoproliferative disease (ALD, Dianzani syndrome), were observed. The main clinical features were recurrent bacterial infections with subsequent lymphadenopathy due to autoimmune neutropenia. Laboratory results revealed a large proportion of alphabetaTCR positive, CD4 negative, CD8 negative, peripheral T cells, and a decreased apoptosis upon activation with phytohemagglutinin and interleukin 2, but normal Fas-mediated apoptosis. Genetic investigations excluded mutations in Fas gene death domain and in the 4 exons of Fas ligand gene. Despite unknown pathogenesis, this new syndrome might belong to the growing group of diseases with defects in apoptosis. ( info) |
8/27. Giant lichenification of the scalp. Lichenification is characterized clinically by thickening of areas of skin as a result of the itch-scratch cycle and therefore is seen in conditions associated with chronic pruritus. The characteristic feature of giant lichenification is the occurrence of tumour-like growths with a warty cribriform surface. We describe a renal transplant patient presenting with giant lichenification of the scalp following an attack of herpes zoster at the same site. Chronic pruritus following scalp dysaethesia secondary to herpes zoster was considered the most likely explanation for the occurrence of these lesions. ( info) |
9/27. The simplex (differentiated) variant of vulvar intraepithelial neoplasia. BACKGROUND: The simplex (differentiated) variant of vulvar intraepithelial neoplasia is rarely reported. It is regarded as more likely than "classic" carcinoma in situ to be associated with invasion and can be easily mistaken for benign lesions. OBJECTIVE: The objective was to present a case of simplex variant of vulvar intraepithelial neoplasia in a 67-year-old woman that was initially misdiagnosed as lichen simplex chronicus. methods: A case report is reported and the literature is reviewed. RESULTS: Surgical excision with a free margin of 5 mm was performed and no evidence of recurrence was noted during the follow-up period of 6 months. CONCLUSION: The simplex vulvar intraepithelial neoplasia is an easily overlooked premalignant disease, and it can be cured with surgical treatment if diagnosed correctly and early. ( info) |
10/27. Allergic contact dermatitis from hair dye and development of lichen simplex chronicus. Those who dye their hair frequently manifest allergic contact dermatitis (ACD) from p-phenylenediamine (PPD)-containing hair dye. PPD is known to be the most frequent sensitizer in hair dye, but there has been no documentation of this sensitizer having a role in chronic dermatologic conditions. Our department experienced a case of a 62-year-old woman with lichen simplex chronicus (LSC), who complained of aggravation after hair dyeing and made such an association. We conducted a prospective and retrospective study to further evaluate the clinical associations between the two. In our prospective study, patch testing was performed in selected patients who regularly carried out hair dyeing and also had clinical manifestations of LSC. Also a retrospective examination was conducted in cases where patch testing had been performed with PPD in the past for suspected ACD and further selected cases with concurrent LSC and/or other neurodermatitis. 11 and 14 patients in our prospective and retrospective study, respectively, presented with both LSC and positive findings to PPD. 5 (45.5%) and 4 (28.6%) patients in our prospective and retrospective study showed clinical relevance from clinical improvement after stopping use and rechallenge. We report several cases of patients diagnosed as having LSC and/or prurigo nodularis who showed clinical improvement after discontinuing the use of hair dye. The suggestion can therefore be made that hair dye could be a possible aetiologic agent causing LSC in those using hair dyes. ( info) |