| A 17-year-old woman had a sudden eruption of pustules in her intertriginous areas as well as of erythematosquamous plaques on the scalp, elbows, palms and soles in the third trimester of her first pregnancy. Histopathological evaluation of a biopsy revealed typical changes of pustular psoriasis with parakeratosis and abscesses of neutrophils (Kogoj's spongiform pustules). The diagnosis of pustular psoriasis was established by the typical clinical and histopathological findings. Laboratory parameters showed a highly elevated blood sedimentation rate, hypoferric anemia and decreased albumin levels. serum concentrations of parathormone and its metabolites were normal. After systemic treatment with glucocorticosteroids and antibiotics, the lesions improved but did not clear. After delivery of a healthy boy, therapy was switched to retinoid photochemotherapy with isotretinoin and PUVA that resulted in rapid and complete clearing of the eruption. The coincidence of plaque-type psoriasis and a pustular eruption as described previously in impetigo herpetiformis supports the view that this dermatosis of pregnancy is a variant of generalized pustular psoriasis. ( info) |
2/925. Contact allergy to calcipotriol does exist. Report of an unequivocal case and review of the literature. A 64-year-old woman developed an itchy papulovesicular dermatitis at the periphery of psoriatic plaques on the lower legs after the daily application of calcipotriol ointment (Psorcutan Salbe) for 2 weeks. She had used the same ointment for 4 weeks 6 months before. Patch testing revealed strongly positive reactions to the marketed product and to the active ingredient calcipotriol in a concentration series (2.0, 10.0 and 50.0 microg/ml in isopropyl alcohol). A repeated open application test (ROAT) on the forearms showed a vesicular dermatitis after 4 days on the side that received the calcipotriol ointment, whereas the control with the placebo ointment remained completely negative. Histologic examination of the patch test reaction was in line with the picture of contact allergy. Retesting after 6 months confirmed the hypersensitivity, with a positive reaction even at 0.4 microg/ml. For comparison, the ROAT with calcipotriol ointment was performed for 2 weeks on both forearms of 15 volunteers never exposed to calcipotriol before. Only 2 subjects developed a slight reaction on days 5 and 11, respectively. Based on this case and on previous reports in the literature, calcipotriol must now be regarded as both a contact allergen and an irritant. For patch testing, a concentration of 2 microg/ml in isopropyl alcohol is the most suitable. If the reaction is only weakly positive and not reproducible after some time, it might be of the irritant type. In unclear cases, a ROAT should be performed. A severe papulovesicular dermatitis within 1 week will confirm the presence of contact allergy. ( info) |
3/925. acitretin and AIDS-related Reiter's disease. A patient with AIDS presented with Reiter's syndrome. arthritis and skin lesions responded poorly to nonsteroidal anti-inflammatory drugs and topical corticosteroid therapy. Dramatic improvement was seen 2 weeks after acitretine was added. When Reiter's syndrome recurred 11 months later despite treatment with highly active anti-retroviral drugs and an undetectable plasmatic viral load, acitretin without NSAID or topical treatment was again administered and was rapidly effective. ( info) |
4/925. psoriasis of the penis: Koebner reaction. Following oral genital exposure. Today, there is an apparent increase in oral genital activity among heterosexual groups not only in the united states but also globally. As a result, gonococcal pharyngitis was rediscovered, and primary syphilis of the oral cavity has been recognized with increasing frequency. In addition, physicians are seeing a wide variety of traumatic lesions of the genitals from "hickeys" of the labia to dental imprints and ulcerations of the glans penis. Our patient exhibits an interesting phenomenon recognized readily elsewhere on the skin but infrequently diagnosed on the glans penis. ( info) |
5/925. Geographic lip: a variant of geopgraphic tongue. The following aspects of the classic geographic tongue are discussed: clinical polymorphism with the appearance of annulus migrans, histological appearacne of the spongiform pustule, frequent association with pustular psoriasis and related diseases, and its relationship to psoriasis buccalis. Two cases of geographic lip are described in which annulus migrans was present. In one case, the geographic lip was associated with a plicated lip, a labial form of plicated tongue. ( info) |
6/925. Stress-induced SAPHO syndrome. We describe the case of a woman with the classic combination of features of synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome, including pustulosis palmo-plantaris and anterior chest wall involvement. The varying symptomology, etiology and pathogenesis of this syndrome and the contribution of stress are discussed. The authors ascribe the dearth of reported cases to lack of awareness and recognition of SAPHO, and not to the real incidence of the syndrome. ( info) |
| Our objective was to determine whether tonsillectomy is beneficial in the treatment of recurrent childhood guttate psoriasis that is associated with recurrent streptococcal pharyngitis and tonsillitis. We retrospectively reviewed the cases of two children who were referred to our facility for treatment of repeated exacerbations of psoriasis and recurrent streptococcal pharyngotonsillitis. Both patients experienced a significant improvement in their psoriasis after undergoing adenotonsillectomy, and both were completely free of psoriatic outbreaks after 16 months of follow-up. We conclude that tonsillectomy appears to be of benefit in the treatment of children with recurrent guttate psoriasis and recurrent streptococcal pharyngotonsillitis, and we hope that further investigation will be undertaken. ( info) |
| Recombinant human interferon alpha (alpha IFN) is the only treatment with proven benefit for chronic hepatitis c virus (HCV) infection. Nevertheless its use in some susceptible individuals has led to the development or aggravation of different autoimmune conditions. We report the case of a 20 year old woman on peritoneal dialysis with chronic lobular hepatitis secondary to HCV infection who developed de novo psoriasis 9 months after starting treatment with alpha-IFN. In addition to psoriasis, alpha-IFN prescription was also concurrent with an unexpected and refractory secondary hyperparathyroidism exacerbation initially characterized by a marked reduction of serum calcium levels and a consequential increase of PTH. Both complications disappeared after drug withdrawal. The clinical sequence makes an alpha-IFN-induced autoimmune side effect the most plausible hypothesis. The case is discussed and some possible etiopathogenic factors are briefly reviewed. ( info) |
9/925. Generalized pustular psoriasis following withdrawal of oral cyclosporin treatment for palmo-plantar pustulosis. We report the cases of two patients who developed generalized pustular psoriasis on the withdrawal of oral Cyclosporin treatment for persistent palmoplantar pustulosis. This complication does not appear to have been reported previously. ( info) |
10/925. Bazex syndrome mimicking a primary autoimmune bullous disorder. Bazex syndrome is a paraneoplastic condition that is most frequently associated with squamous cell carcinoma of the upper aerodigestive tract. The lesions affect acral areas of the skin, including hands, feet, ears, nose, and, to a lesser extent, elbows and knees. Lesions mimic psoriasis and dermatitis. paronychia and nail dystrophy are frequent. Bullous lesions have been reported only rarely. We report a patient with Bazex syndrome with predominantly bullous lesions that mimicked a primary autoimmune bullous disorder. ( info) |