1/6. Type III and type IV hypersensitivity reactions due to mitomycin C.A 71-year-old man developed an exfoliative dermatitis of the palms of the hands and soles of the feet, and a generalized itch, during treatment with intravesical instillations of mitomycin C for an undifferentiated carcinoma of the bladder. patch tests with mitomycin C 0.03%, 0.1% and 0.3% aq. were positive. Because of the serious consequences of this finding, the patient was retested with mitomycin C in pet. (same concentrations), a more stable preparation. This showed clear positive reactions. During this last series of patch tests, he developed palpable purpura on the legs. We postulated that this reaction was an immune-complex-mediated reaction, caused by the 2nd series of patch tests with mitomycin C. To prove this, we performed histopathological and immunofluorescence investigations, and these showed the reaction to be consistent with Henoch-Schonlein-type purpura. We therefore conclude that this patient developed systemic reactions to mitomycin C, characterized by an eczematous dermatitis as well as purpuric reactions. The intravesical installations with mitomycin C have been stopped. The patient's skin problems (the purpura as well as the eczema) have completely resolved and have not recurred.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
2/6. Nodular presentation of eosinophilic cellulitis (Wells' syndrome).Eosinophilic cellulitis is a rare condition of unknown aetiology. The classical presentation is of a tender or mildly pruritic cellulitis-like eruption, that has typical histology characterized by tissue eosinophilia, oedema and "flame" figures. Other reported clinical presentations include papular and nodular eruptions. It may be recurrent, and preceded at a variable time by a pruritic papular eruption. We describe a patient with the rare nodular variant of eosinophilic cellulitis affecting the palms of the hands, which occurred 2 years after a nonspecific pruritic papular eruption, without an obvious precipitant and in the absence of the more typical cellulitis-like plaques.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
3/6. Itching attacks with generalized hyperhydrosis as initial symptoms of Hodgkin's disease.BACKGROUND: Clinical signs of Hodgkin's disease are unexplained weight loss, nocturnal sweating, fever and more or less permanent itching or pain around the affected lymphnodes, especially after alcohol consumption. Paraneoplastic symptoms are major challenges to the dermatologist, particularly if these seem harmless, though somewhat strange, as in the following case. observation: A 35-year-old patient had suffered for about 6 months from paroxysmal severe itching. A transient, generalized hyperhydrosis followed these attacks closely. The itching attacks usually began between the fingers and on the palms of the hands, and then spread to become generalized over the entire integument. The itching attacks commonly occurred three times daily for only a few minutes, while the subsequent severe hyperhydrosis, with cold sweat, lasted up to an hour. CONCLUSIONS: This case illustrates the necessity of considering a malignant underlying disease like Hodgkin's disease, not only in the presence of the well-known B-symptoms, but also when peculiar symptom combinations, like itching attacks and immediately subsequent transient generalized hyperhydrosis are present.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
4/6. Pruritic urticarial papules and plaques of pregnancy presenting in the postpartum period: a case report.BACKGROUND: Pruritic urticarial papules and plaques of pregnancy (PUPPP), also known as polymorphic eruption of pregnancy, is the most common dermatosis of pregnancy. It usually evolves in the third trimester and resolves rapidly postpartum. CASE: A 25-year-old woman complained of an intensely pruritic rash for 2 days. The rash began 10 days postpartum. It began on her abdomen and spread to her buttocks, legs and upper arms. On examination, erythematous papules and urticarial plaques were present in the striae of the abdomen and buttocks and involved the legs, arms and back. No excoriations, vesicles or pustules were present, and there was sparing of the face, palms and soles. The patient was treated with fexofenadine, hydroxyzine, oatmeal baths and cool compresses. Follow-up 2 days later revealed a worsening rash and persistence of severe pruritus. At that time the patient was placed on prednisone, which led to relief of her symptoms and clearing of the rash. DISCUSSION: PUPPP is reported to develop in 0.5% of pregnancies. medline searches of the literature from 1966 to 2003 using the keywords pruritic urticarial papules and plaques of pregnancy or polymorphic eruption of pregnancy and postpartum revealed only 2 other cases of PUPPP developing in the postpartum period. Although the clinical presentation of this patient was typical of that of PUPPP, it demonstrates an unusual time course with its postpartum presentation. CONCLUSION: Dermatoses of pregnancy should remain in the differential diagnosis of rash even weeks after a woman delivers.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
5/6. Pruritic urticarial papules and plaques of pregnancy with unusual and extensive palmoplantar involvement.BACKGROUND: Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a specific dermatosis of pregnancy common to primigravid women in the third trimester. The rash usually begins on the lower abdomen within striae and spreads to the proximal extremities. Involvement of face, palms, and soles is unusual. Although intensely pruritic, the fetus is unaffected, and the condition does not usually recur. It can be difficult to distinguish PUPPP from pemphigoid gestationis, an autoimmune bullous disorder with potential fetal consequences that may recur with subsequent pregnancy, menses, or hormonal therapy. CASE: A young secundagravida at 36 weeks of gestation with monochorionic twins presented with a 3-week history of a pruritic papular eruption that began on the abdomen and spread to the extremities. She had extensive involvement of the distal extremities, including the palmoplantar surfaces, with small vesicles of 2-4 mm on acral skin. Because of her unusual presentation, she was thought initially to have pemphigoid gestationis. Subsequent dermatological evaluation and a biopsy confirmed the diagnosis of PUPPP. Shortly after admission she delivered 2 healthy male infants, and her rash cleared with conservative management. CONCLUSION: Pruritic urticarial papules and plaques of pregnancy often, but not always, spares the face, palms, and soles. Small vesicles can occur in PUPPP, but formation of true bullae is not observed. Careful dermatological examination and cutaneous biopsy can assist in differentiating PUPPP from pemphigoid gestationis, which is essential for treatment and prognosis.- - - - - - - - - - ranking = 7keywords = palm (Clic here for more details about this article) |
6/6. A case of AIDS manifesting pruritic papular eruptions and psoriasiform lesions: an immunohistochemical study of the lesional dermal infiltrates.A 63-year-old man was referred to our department on September 14, 1992, because of multiple red papules with severe itching. Pruritic papular eruption (PPE) in a human immunodeficiency virus (hiv)-infected patient was diagnosed based on the histological findings, the reduction in CD4, and positive results for hiv antibody. In September of 1993, papules and erythematous plaques with scales appeared on both the palms and soles. The erythema was pruritic and spread gradually to the extremities and trunk. These plaques with erythema and scales are similar to those of the psoriatic lesions seen in Reiter's syndrome, although the HLA typing was not B27. Immunohistopathological findings of the papules of PPE and plaques of psoriasiform lesions showed that perivascularly infiltrated cells in the dermis were mostly lymphocytes. The lymphocytes in PPE were positive for CD45 and negative for CD3, CD43, and CD45RO, but the lymphocytes in psoriasiform lesions were positive for CD45, CD3, and CD43. Moreover, 20-30% of these lymphocytes were also intensely positive for CD45RO. These observations were similar to those obtained in the lesional skin of hiv-negative psoriasis, suggesting that there were no significant immunohistopathological differences in the abnormality of local cellular immunity related to the formation of psoriasiform lesions in hiv-negative psoriasis and hiv-positive psoriasis.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |