1/36. Subacute cutaneous lupus erythematosus presenting with generalized poikiloderma. A 64-year-old woman experienced progressive generalized poikiloderma after an episode of sunburn 4 years earlier. The diagnosis of subacute cutaneous lupus erythematosus (SCLE) was confirmed by the presence of anti-Ro/SS-A and antinuclear antibodies, the histology, and the direct immunofluorescent findings (ie, positive lupus band test and "dust-like" epidermal IgG staining pattern). Poikiloderma has not been previously reported in the spectrum of SCLE. As a major pathomechanism of SCLE, photosensitivity might explain this uncommon clinical manifestation of the disease. ( info) |
2/36. Failure of leucovorin rescue to prevent reactivation of a solar burn after high dose methotrexate. A 21-year-old patient with metastatic osteosarcoma was receiving methotrexate with leucovorin rescue every 2 weeks. After the second (of four) infusions of methotrexate, a prior solar burn on an area of skin was reactivated in spite of leucovorin rescue. An area of skin treated 5 months previously by radiation was spared the effects of the reactivation phenomenon. No other toxicities appeared. The reactivation of the solar burn is an example of "false photosensitization" and this cutaneous toxicity is not ameliorated by leucovorin. methotrexate therapy should be delayed until the effects of generalized solar burns have resolved (approximately 1 week). ( info) |
3/36. Mid-dermal elastophagocytosis presenting as a persistent reticulate erythema. Two men are presented with a widespread persistent reticulate erythema concentrated within the chronically sun-damaged skin on their trunk. A fine papular element was present in one case and both lacked annular lesions. One patient was human immunodeficiency virus positive. Multiple skin biopsies showed an interstitial infiltrate of histiocytes containing multiple elastic fibres in the upper dermis. There was scant perivascular lymphocytic inflammation but no evident necrobiosis or palisaded granulomas seen typically with granuloma annulare. Elastic stains showed focal mid-dermal elastolysis. Diffuse reticulate erythema in sun-damaged skin may be a clinical marker for elastophagocytosis. This presentation differs from that previously described with actinic granuloma, diffuse granuloma annulare or the inflammatory phase of mid-dermal elastolysis and expands the clinical spectrum of this phenomenon. ( info) |
| A sun tan is considered a symbol of well-being in our society, but incorrect methods of sun exposure can create serious problems. We present two cases of severe sun-related burns caused by fig leaf decoction used as home-made tanning lotion. Twenty four-thirty six hours after application and sun exposure, patients developed a phytophotodermatitis characterised by erythema, and blister formation involving all the photoexposed areas (45-70% BSA). Their general conditions became rapidly critical and they were admitted to our Burn Centre. The patients were discharged after 11 and 26 days, respectively. Haemolytic anaemia and retinal haemorrhages presented as systemic complications due to the furocoumarins present in the fig leaf decoction. ( info) |
5/36. Ultraviolet recall phenomenon following the use of ampicillin. Ultraviolet recall or sunburn reactivation is an uncommon phenomenon that has been most frequently reported in patients who suffered sunburns and then subsequently underwent therapy with methotrexate. There are very few cases in which antibiotics are involved. We report a case of ultraviolet recall occurring after ampicillin therapy. Our patient suffered severe vesiculobullous skin reaction in areas that had been sunburned only minimally 2 months previously. The patch test was positive only to ampicillin tested in the skin previously affected. ( info) |
6/36. Photo-recall of sunburn induced by radiation therapy 50 years later. A patient is described whose foolish sunbathing practices during adolescence predisposed her to an intense and unpleasant skin reaction during the course of radiation therapy approximately 50 years later. The phenomenon suggests that solar-induced changes in the skin can persist over a very long period of time and emphasizes the need for light-skinned individuals to protect their skin from the intense rays of the sun. ( info) |
7/36. Combined folliculotropic/syringotropic cutaneous T-cell lymphoma without epidermal involvement: report of 2 cases and pathogenic implications. Exclusive involvement of skin appendages in cutaneous T-cell lymphoma (CTCL) is rare, poses significant problems in diagnosis, and may provide insight into mechanisms of T-cell epitheliotropism. We report 2 cases of combined adnexal (folliculotropic/syringotropic) CTCL in which lesions developed only in chronically sun-damaged skin. Although the epidermal layer in both cases was devoid histologically of significant epidermotropism, immunohistochemistry and polymerase chain reaction analyses of deeper samples that included involved adnexae confirmed aberrant antigen expression (dominant CD4 populations with apparent loss of CD7 and/or CD5) and T cell clonality, respectively. It is diagnostically important to recognize adnexal CTCL as a disorder that may be clinically and histologically protean. Additionally, its occurrence in sun-damaged skin in some patients may provide insight into mechanisms of selective epitheliotropism by malignant T cells. ( info) |
8/36. Extensive angiosarcoma on chronically sun-damaged skin. Cutaneous angiosarcoma of the face and scalp is a rare malignant vascular tumor that most often occurs in the white elderly males. No clear etiologic factors have been associated with the development of this aggressive neoplasm. Due to delay in diagnosis, inability to adequately define clinical and surgical margins, and its high local recurrence and metastatic rates, angiosarcomas generally have a poor prognosis. Histologic evaluation of angiosarcoma can be somewhat difficult due to the varying patterns of differentiation. We present a case of angiosarcoma arising on chronically sun-damaged skin and review the histopathology and prognostic factors important in this malignancy. ( info) |
9/36. Grade 3 liposomal-doxorubicin-induced skin toxicity in a patient following complete resolution of moderately severe sunburn. PURPOSE: Palmar-plantar erythrodysesthesia (PPE) is a potentially serious toxicity of a number of cytotoxic chemotherapeutic agents, including liposomal doxorubicin. Activities that may increase the risk of this toxicity should be avoided. CASE REPORT: A patient with platinum-resistant ovarian cancer, responded to, and tolerated (including no skin rash) an initial cycle of liposomal doxorubicin (40 mg/m(2)). Unfortunately, several days before her next scheduled cycle, she developed significant sunburn (intense erythema without blistering). Despite an additional 1-week delay (total of 5 weeks from the prior liposomal doxorubicin), and complete visual recovery from the effects of the sunburn, the patient developed severe (grade 3) PPE involving both hands (pain, pronounced erythema, blistering, without ulceration), and a slightly less extensive reaction of both feet, following subsequent treatment with a 25% reduced dose of the agent (30 mg/m(2)). CONCLUSION: Caution is advised when considering the administration of liposomal doxorubicin following a major sunburn, despite total resolution of the visible effects on the skin. A delay of several weeks may be appropriate to avoid exacerbation by the chemotherapeutic agent of persistent subclinical damage to normal epithelial cells. ( info) |
10/36. Delayed onset of warts over tattoo mark provoked by sunburn. Multiple warts in a 32-year-old-man are reported that developed after tattooing and remaining exclusively confined to that area. The tattooing was done 2.5 years earlier by a professional tattoo artist. It was previously a lesion-free tattoo, but when damaged by sunburn developed multiple skin warts. The ability of a latent virus to induce warts after cutaneous ultraviolet exposure was discussed. ( info) |