Friday, July 17, 2009

Photodermatitis in a Teenage Girl

Abstract: 8 yr history of photodermatitis in a 17 yo girl

This 17 yo student has an 8 year history of a summer eruption. She has a pruritic eruption of her hands and distal forearms starting in spring and lasting till late fall. In winter her skin is perfectly normal. She has used triamcinalone 0.1% ointment without relief and similarly has not been helped with sunscreens.

O/E: Mild lichenification and a fine micro-papular eruption on the dorsum of the hands. A few serum crusts. No vesicles or h/o vesicles.

Photos (7/16/09)

Note no facial lesions

Diagnosis: Atypical Photodermatitis in a teenaged girl. Consider PCT, Hydroa variant, photoactivated atopoic dermatitis (nothing fits perfectly at this time)

Plan: 24 hour urine for porphyrins. Broad spectrum sunscreen for hands and clobetasol ointment after a 20 minute soak. Not sure biopsy will be helpful, but will do at next visit. PCT would be unusual but the porphyrias need to be ruled out.

Comments and suggestions?

Wednesday, July 08, 2009

Recurrent Toxic Erythema vx. Cellulitis

H.P.I. The patient is a 70 yo woman who has had ~ 10 episodes of a cellulitis-like picture of her legs over the past ten years. She has never had fever or constitutional signs. The process can affect one or both lower extremities. I saw her in 2001 for this and then she was referred by the emergency room yesterday with the same picture. It began with a fall two days ago. She hit her hip -- was in pain and took ibuprofen before this episode. She said she does not recall taking this before other episodes.

O/E: Patchy, fiery erythema of left lower extremity. Very mild erythems of right lower leg (mostly around the ankle).

Clinical Photos:

Labs: Biopsy obtained and CBC ordered

Diagnosis: Is this an atypical cellulitis, or toxic erythema secondary to and NSAID?

If the patient remains afebrile and wbc is normal, I'd be inclined to just watch and wait.

Friday, July 03, 2009

Unusual Pigmentation of Legs

The patient is a healthy 51 yo woman with a 5 - 6 year history of asymptomatic progressive hyperpigmentation of the legs. She is in good general health and takes no medications by mouth. The process started on the calves and has spread proximally to the knees. She has rosacea in addition. She thinks her father has a similar problem.

O/E: Both legs from just above the ankles to the knees show punctate hyperpigmentation. The skin here has a slightly pebbly feel. Other than erythematous papules on both cheeks, the remainder of the cutaneous exam is normal. (There is no sclerodactyly, telangiectasas or sclerotic changes).

Affected skin

Digital Zoom

Normal Skin (adjacent)

Dermoscopic Image

Lab: Biopsies of affected and normal skin were taken.

Diagnosis: Punctate Hyperpigmentation of the Legs. This does not look like the "salt and pepper" picture of scleroderma. Could this be an unusual genodermatosis?

Plan: Present to VGRD. Perhaps get serologies for scleroderma.

References: Nothing helpful found on PubMed.