| agave americana is a low growing, thick, long-leaved, subtropical plant used for medicinal, commercial, and ornamental purposes. The plant's sap contains calcium oxalate crystals, acrid oils, saponins, and other compounds. Despite these known irritants, agave-induced irritant dermatitis has rarely been reported. Previous case reports have noted a papulovesicular eruption consistent with an irritant contact dermatitis. We report a case of agave-induced purpura in an otherwise healthy patient. Histopathology was consistent with an evolving leukocytoclastic vasculitis. ( info) |
2/459. Respiratory chain complex III [correction of complex] in deficiency with pruritus: a novel vitamin responsive clinical feature. We report a child with an isolated complex III respiratory chain deficiency and global developmental delay who had severe pruritus with elevated plasma bile acid levels. A liver biopsy showed micronodular cirrhosis, and enzymologic evaluation demonstrated an isolated complex III deficiency in both liver and muscle. His pruritus improved and serum bile acid levels decreased after treatment with menadione and vitamin C. ( info) |
3/459. Eyelid pruritus with intravenous morphine. The cause of eyelid pruritus (itching) may be difficult to determine, particularly in preverbal children. Tearing, photophobia, or eye rubbing may be the first manifestation of leukemic infiltration or graft-versus-host disease, necessitating early appropriate therapy. We report a child in whom persistent eye rubbing developed after bone marrow transplantation for leukemia. morphine administration was found to be the cause of this symptom. ( info) |
| pityriasis amiantacea is an easily recognizable cutaneous disease that is characterized by scaling of the scalp and temporary alopecia. The scaling, described as thick and asbestos-like, binds down tufts of hair. The alopecia may be temporary or scarring. Despite a well-established clinical description, no definitive etiology has been uncovered. This disease may represent seborrheic dermatitis, superficial fungal or pyogenic infections, lichen planus, or psoriasis. Histologically, the disease is characterized by eczematous features. We report a case of pityriasis amiantacea in an 11-year-old girl with simultaneous findings of psoriasis as well as review the literature on the etiology of this disease. ( info) |
| We report the first case of vulvar porokeratosis that occurred in a 39-year-old woman with a 30-year history of vulvar pruritus and disfiguring vulvar lesions. Ultrasonic surgical aspiration resulted in resolution of her pruritus and excellent cosmesis. light microscopy revealed characteristic cornoid lamellae and electron microscopy confirmed the diagnosis of vulvar porokeratosis. ( info) |
6/459. Positive skin tests in late reactions to radiographic contrast media. In the last few years delayed reactions several hours after the injection of radiographic and contrast materials (PRC) have been described with increasing frequency. The authors report two observations on patients with delayed reactions in whom intradermoreactions (IDR) and patch tests to a series of ionic and non ionic PRC were studied. After angiography by the venous route in patient n degree 1 a biphasic reaction with an immediate reaction (dyspnea, loss of consciousness) and delayed macro-papular rash appeared, whilst patient n degree 2 developed a generalised sensation of heat, persistent pain at the site of injection immediately and a generalised macro-papular reaction after 24 hours. The skin tests revealed positive delayed reactions of 24 hours and 48 hours by IDR and patch tests to only some PRC with common chains in their structures. The positive skin tests are in favour of immunological reactions and may help in diagnosis of allergy in the patients. ( info) |
| Atopic dermatitis is a common skin disease characterized by severely pruritic eczematous patches, papular and lichenified plaques, excoriations, cracks, and erosions. photopheresis has been shown to ameliorate the signs and symptoms of atopic dermatitis in some patients. We describe successful results with photopheresis for refractory disease in a patient who chronicled his quality of life weekly for more than 15 years before and during extracorporeal photochemotherapy. ( info) |
8/459. Allelic heterogeneity of dominant and recessive COL7A1 mutations underlying epidermolysis bullosa pruriginosa. The inherited mechanobullous disease, dystrophic epidermolysis bullosa, is caused by type VII collagen gene (COL7A1) mutations. We studied six unrelated patients with a distinct clinical subtype of this disease, epidermolysis bullosa pruriginosa, characterized by pruritus, excoriated prurigo nodules, and skin fragility. mutation analysis using polymerase chain reaction amplification of genomic dna, heteroduplex analysis and direct nucleotide sequencing demonstrated pathogenetic COL7A1 mutations in each case. Four patients had a glycine substitution mutation on one COL7A1 allele (G1791E, G2242R, G2369S, and G2713R), a fifth was a compound heterozygote for a splice site mutation (5532 1G-to-A) and a single base pair deletion (7786delG), and a sixth patient was heterozygous for an out-of-frame deletion mutation (6863del16). This study shows that the molecular pathology in patients with the distinctive clinical features of epidermolysis bullosa pruriginosa is heterogeneous and suggests that other factors, in addition to the inherent COL7A1 mutation(s), may be responsible for an epidermolysis bullosa pruriginosa phenotype. ( info) |
| Pretibial epidermolysis bullosa is a rare variant of dystrophic epidermolysis bullosa, characterized by bullae and violaceous lichenoid papules and plaques of the anterior aspects of the legs. A case of pretibial epidermolysis bullosa is presented and the literature is reviewed. ( info) |
10/459. Cutaneous allergic reaction to intramuscular vitamin K1. A 40-year-old woman with no pre-existing hepatic disease developed a cutaneous allergic reaction to intramuscular vitamin K1. She received this medication prophylactically prior to surgery, developed severe localized, and subsequently generalized, dermatitis, beginning 5 days after administration of the Konakion Cremophor-EL form of vitamin K1 by intramuscular injection at four sites on her thighs. Investigation by patch and intradermal testing revealed delayed-type hypersensitivity to Konakion Cremophor-EL, Konakion Mixed micelles and pure vitamin K1, but not Cremophor-EL vehicle alone. This case is unusual because the patient was also shown to be patch test positive to vitamin K3 sodium bisulfite. ( info) |