Cases reported "Keratosis"

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1/55. Painful pigmented prosthesis pressure papules.

    Two patients who presented with tender hyperkeratotic papules involving their weight-bear.ing amputation stumps were studied. Although these clinical findings are common in the experience of prosthetists, the author has been unable to find any documentation of these findings in the literature. All attempts at relining and reshaping the cups of the original offending prostheses by experienced prosthetists were unsuccessful. The eruption cleared only after entirely new prostheses were designed. It would appear that this condition is due to a poorly fitting prosthesis.
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keywords = eruption
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2/55. Keratosis lichenoides chronica: marked response to calcipotriol ointment.

    Keratosis lichenoides chronica (KCL) is a rare dermatosis characterized by a distinctive seborrheic dermatitis-like facial eruption, together with violaceous, papular, and nodular lesions on the extremities and trunk, typically arranged in a linear and reticulate pattern. KLC is resistant to therapy, although spontaneous remission has been reported. We describe a 35-year-old woman with KLC who had the typical features of widespread violaceous, reticulate, and striae-like eruptions with a prominent keratotic component over a nine-year period and who responded well to treatment with calcipotriol ointment. The immunohistochemical profiles are presented in addition to typical histopathologic features.
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keywords = eruption
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3/55. keratoacanthoma developing on a pigmented patch in incontinentia pigmenti.

    Cutaneous manifestations of incontinentia pigmenti (IP) have classically been described as three sequential stages: an initial vesicobullous stage, a verrucous stage and a stage of swirled pigmentation. Verrucous lesions tend to last longer than vesicobullous eruptions, often persisting until 1 year of age. However, adult patients with verrucous lesions are rare. We report a case of keratoacanthoma with marked dyskeratosis on a pigmented patch in a 20-year-old woman. This tumor, like subungual keratotic tumors of IP, might have been developed as one of the late manifestations of the disease.
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keywords = eruption
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4/55. Acquired crateriform hyperkeratotic papules of the lower limbs: an unusual variant of acrokeratoelastoidosis of Costa.

    We report a man with a 3-year-history of a striking eruption of small, 2-3 mm diameter keratotic, crateriform papules distributed symmetrically over the lower limbs. Morphologically the individual papules closely resembled those described in acrokeratoelastoidosis (AK) of Costa and in focal acral hyperkeratosis of Dowd (FAH). The case is unusual, however, in that there was dramatic involvement of the legs but the hands and feet were largely spared. Current terms used for these entities are unsatisfactory.
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keywords = eruption
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5/55. Zosteriform Darier's disease versus acantholytic dyskeratotic epidermal nevus.

    patients with keratotic lesions distributed in a unilateral, linear, zosteriform or localized pattern and revealing histologic features of dyskeratotic acantholysis have been reported. There is still some controversy regarding the appropriate nosologic placement of this entity. Some believe it represents a localized form of Darier s disease, while others argue it is a variant of epidermal nevus. We report a case of a 42-year-old physician who presented with a 15-year history of an asymptomatic eruption that had been diagnosed as "chronic zoster." Physical exam revealed hyperkeratotic papules and plaques in a dermatomal distribution. The controversy regarding the correct nosologic placement of such a patient is discussed.
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ranking = 1
keywords = eruption
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6/55. Host-vs.-altered-host eruptions in patients on liposomal doxorubicin.

    BACKGROUND: Anthracycline antitumor antibiotics are the most commonly used chemotherapeutic agents. One of these is doxorubicin. Liposomal doxorubicin was developed as a drug delivery system in order to deliver the active drug intracellularly while decreasing the systemic toxicity, particularly hematological and cardiac toxicity. methods: The clinical and histologic findings of the cutaneous eruptions of associated with liposomal doxorubicin are reviewed. RESULTS: The eruptions occurred in three women with metastatic ovarian carcinoma who were treated with liposomal doxorubicin. These three patients developed erythematous macular/papular to plaque cutaneous lesions, and in one patient a vesicular component. The eruptions involved the trunk and extremities approximately 3-4 weeks after completions of therapy. None of the patients had any documented infections, and none of the patients had symptoms other than pruritus. The eruptions cleared over a period of weeks to months. Histologic features included an interface dermatitis with numerous apoptotic/dyskeratotic cells within the epidermis, with involvement the intra-epidermal sweat ducts and the infundibulum of hair follicles. CONCLUSION: We believe that these eruptions represented a chemotherapy induced host-vs.-altered host reaction.
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keywords = eruption
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7/55. Multiple hyperkeratotic spicules and myeloma.

    We report the case of a 58-year-old patient with multiple myeloma with a monoclonal gammopathy of the IgG type, who developed a striking eruption characterized by multiple hyperkeratotic spicules of the face, nose and scalp. light-microscopic studies revealed a follicular orthohyperkeratosis, while direct immunofluorescence microscopy remained negative. Hence, our patient presented features characteristic of a rare distinctive disorder associated with an underlying paraprotein or multiple myeloma, paraneoplastic hyperkeratotic spicules.
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keywords = eruption
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8/55. Keratosis lichenoides chronica. Possible variant of lichen planus.

    A chronic, asymptomatic, keratotic, papular eruption, present for 15 years and resistant to all modes of therapy, was observed in a 49-year-old woman. Many of the papules formed a reticulated configuration over the arms and legs. This case resembles several others that have been described in the literature under different names, ie, keratosis lichenoides chronica, porokeratosis striata, and lichen verrucosus et reticularis. It is likely that all of these names refer to the same condition, constituting a definite clinical entity, which, on the basis of histological study, may represent a variant of lichen planus.
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ranking = 1
keywords = eruption
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9/55. Lichenoid graft vs. host disease following liver transplantation.

    BACKGROUND: Graft vs. host disease (GVHD) is a common complication of bone marrow transplantation (BMT) but is rarely seen after solid organ transplantation. methods: We report a case of lichenoid GVDH arising in a 60-year-old man 10 weeks after orthotopic liver transplantation. RESULTS: skin biopsies revealed changes suggestive of lichenoid GVHD, but histological features differed from those described in post bone marrow (stem cell) transplant GVHD, in that a dense lymphoid infiltrate was present. The brisk infiltrate contained eosinophils that initially led to concern for a lichenoid drug eruption. The patient developed multiorgan GVHD after reduction in immunosuppression. The diagnosis of chronic GVHD was confirmed by the demonstration of chimerism in the patient's peripheral blood. The generalized cutaneous eruption and systemic manifestations responded to salvage therapy including intravenous immunoglobulin infusion, increased immunosuppression with high-dose steroids, mycophenolate mofetil, and systemic and topical tacrolimus. CONCLUSIONS: In interpreting skin biopsies, it is important to recognize that brisk inflammation may be seen in GVHD in the setting of solid organ transplantation, in contrast to the more sparse inflammation typical of GVHD following BMT. The clinical and histologic differential diagnosis included the eruption of lymphocyte recovery, drug reaction, and viral exanthem. We provide a conceptual framework for evaluating generalized cutaneous changes that may occur post transplantation.
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ranking = 3
keywords = eruption
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10/55. The sign of Leser-Trelat in a young woman with osteogenic sarcoma.

    The sign of Leser-Trelat refers to a sudden increase in size and number of seborrheic keratoses associated with internal malignancy. The validity of this cutaneous sign continues to be debated, particularly because of the prevalence of both seborrheic keratoses and malignancy in the elderly population. Preceding inflammatory skin conditions are known to precipitate eruptions of seborrheic keratoses in otherwise healthy persons. These cutaneous lesions may also be associated with other markers of underlying malignancy such as acanthosis nigricans. We present a young female patient with osteogenic sarcoma in whom eruptive seborrheic keratoses developed. We believe this case is representative of the sign of Leser-Trelat.
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ranking = 1
keywords = eruption
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