Chronic Stasis Dermatitis

Abstract: 68 yo man with chronic dermatitis of left leg

History: The patient has had a chronic dermatitis of left leg for over ten years.  He has been seen at the Wound Care Clinic for over three years.  What worked best in the past was an Unna boot but these are not used as commonly anymore as we have newer, more high-tech types of bandages. 

O/E: He has chronic lymphedema of the left leg, which periodically develops elephantiasis-like changes. The examination woody edema left leg, that is erythematous with crusted areas.  It looks clean today and there is no evidence of secondary infection.

Impression:  Chronic dermatitis of his left leg.  It is most likely a chronic stasis eczema. 

Comments: He has been diligent about home care.  For the time being, he will use wet dressings with a dilute bleach (a half cup of Chlorox per 40 gallons of water in a bathtub) and zinc oxide-like paste.  He will be seen back in two weeks.  Consider going back to an Unna boot.

What are your thoughts?

Unusual Tumor in a 53 yo Man

53-year-old man who was seen for a general skin examination.  He has Crohn's disease and has been on 6-MP for the past 8-10 years.  His gastroenterologist said because of this he should have a skin examination. 

O/E:  The patient has type II skin.  He has a 6 mm in diameter pink papule on the calf of the left leg.  Dermoscopically, this lesion has a dotted vascular pattern.

IMPRESSION:  Lesion left calf.  Etiology unclear.  

Plan:  Excisional biopsy was obtained. 

Reference:
Inflammatory Bowel Disease Treatment and Non-melanoma Skin Cancer: Jacqueline F De Luca, MD, Yun Sun Lee, MD, and Douglas Johnson, MD, Hawaii J Med Public Health. 2012.7:324–325.

Abstract:Immunosuppressant medications for Inflammatory Bowel Disease can help with both symptoms and disease progression. However, like immunosuppressants used in transplant patients, they are now suspect of contributing to nonmelenoma skin cancer (NMSC). Presented is a case of a 57-year-old Jewish man with Crohn's Disease who was diagnosed with a total of 84 NMSCs. We hope to elucidate the risk of immunosuppressants, particularly the thiopurines, on the development of NMSC.