Thursday, September 22, 2016

Airborn Contact Dermatitis?

The patient is an 83 yo woman who has had a recurring pruritic dermatitis located mostly on face, neck and upper chest for two years.  It seems to be more prominent seasonally.  She has a history of a lymphoma ~ five years ago.  She had alopecia universalis for many years that spontaneously remitted ~ two years ago.

O/E:  Florid erythema of face and neck.  Submental area does not appear to be spared.
This woman has a somewhat "leonine" facies.

Diagnosis:  Initially, I thought she had a contact dermatitis or the "red face syndrome" from overuse of topical corticosteroids. She has been off the latter for > 1 year.  The has needed prednisone to control this; but I prefer a long-term medication with less side-effects.  Given her history of lymphoma, further evaluation may be necessary.

Azathioprine versus betamethasone for the treatment of parthenium dermatitis: a randomized controlled study.
Verma KK1, Mahesh R, Srivastava P, Ramam M, Mukhopadhyaya AK.
Indian J Dermatol Venereol Leprol. 2008 Sep-Oct;74(5):453-7
Author information:
CONCLUSIONS: Azathioprine and betamethasone appear to be almost equally effective (P=0.0156 vs. 0.0005) in the treatment of parthenium dermatitis. However, adverse effects and relapses were observed to be more frequent in patients treated with betamethasone. Free Full Text

Tuesday, September 06, 2016

Postiive Band-Aid Sign

The patient is a 77 y.o. man who presented with a number of skin lesions.  He has a past history of non-melanoma skin cancer.

The lesion in question has been present for a few months.  It is an almost 5 cm in diameter exophytic tumor.

Diagnosis:  Probable Squamous Cell Carcinoma.

I anesthetized the lesion and shaved it off.  There was a fair amount of bleeding.  I curretted it and cautrized the base. It was not as soft as a typical SCC or BCC.  Specimen submitted and I'll attach a follow-up with the path.

Pathology:  Well-differentiated squamous cell carcinoma

This is a particularly good example of the "Positive-Band Aid" sign.  Most of us know this, but it has not been well-reported in the literature.  We presented this sign on the VGRD Blog in 2007.

Saturday, September 03, 2016

The Tortured Tube

The patient is a 25 yo man with a 4 mo hx of an eyelid dermatitis.  His mother, a health professional, gave him 0.1% triamcinalone oinment to apply ~ 2 months ago.  It has run out and he came in for an appointment.  He is healthy and has a history of atopic dermatitis that is now quiescent.
Diagnosis and Discussion: I think this is an example of "steroid acne."  It's hard to tell what preceded it.  Most topical corticosteroids when applied for weeks or more to thin skin such as is seen on the face (expecially eyelids or around the mouth) or the genitalia can cause this.  It's a type of steroid addiction.

The standard treatment is to stop the topical steroid, apply cold compresses two time a day and doxycycline 100 mg b.i.d. for a month or more.  The longer this has been going on, the harder it is to treat.

Reference:  Dr. Ken Fowler and I reported a similar patient in 2001.
Tortured tube" sign. Fowler KP, Elpern DJ.  West J Med. 2001 Jun;174(6):383-4. Free FullText Online.