Case Reports in Dermatological Medicine The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Two Basal Cell Carcinomas of the Axillae: A Metastasis or an Independent Development? Sun, 15 Mar 2015 11:28:46 +0000 Cutaneous basal cell carcinoma (BCC) is a common malignancy amongst the elderly. BCC rarely metastasises, and fewer than 300 cases of metastatic BCC have been reported in the literature. Here, we report a case of sequentially developed BCCs located adjacent to each other. We discuss that these BCCs were considered to have developed independently rather than due to metastasis, after referencing previous studies on metastatic BCC. Yuichiro Endo and Yoshiki Miyachi Copyright © 2015 Yuichiro Endo and Yoshiki Miyachi. All rights reserved. Perianal Median Raphe Cyst: A Rare Lesion with Unusual Histology and Localization Sun, 22 Feb 2015 07:37:15 +0000 Median raphe cysts present anywhere between the external urethral meatus and the anus. The cysts can occur at parameatus, glans penis, penile shaft, scrotum, or perineum. Perianal region is an extremely rare location for these lesions. Here we present a 50-year-old male patient who presented with a cystic, fluctuant lesion, located at 12 o’clock in perianal region. Microscopic examination revealed a cystic lesion with keratinized and nonkeratinized stratified squamous epithelium, pseudostratified ciliated epithelium, and scattered goblet cells. The final diagnosis of the lesion was median raphe cyst. Ciliated cells and perianal localization in median raphe cysts are extremely rare characteristics. Betül Ünal, Cumhur İbrahim Başsorgun, Meryem İlkay Eren Karanis, and Gülsüm Özlem Elpek Copyright © 2015 Betül Ünal et al. All rights reserved. Etanercept-Induced Pityriasis Lichenoides Chronica in a Patient with Rheumatoid Arthritis Wed, 18 Feb 2015 11:56:54 +0000 We present a 74-year-old female patient who developed a pityriasis lichenoides chronica (PLC) during etanercept therapy. This association is not described in the literature and might be considered in the spectrum of cutaneous adverse reactions of etanercept. Andrés F. Echeverri, Andrés Vidal, Carlos A. Cañas, Andrés Agualimpia, Gabriel J. Tobón, and Fabio Bonilla-Abadía Copyright © 2015 Andrés F. Echeverri et al. All rights reserved. A Case of Recalcitrant Plantar Warts Associated with Statin Use Wed, 18 Feb 2015 09:47:06 +0000 Background. Plantar warts are a common presenting skin complaint caused by the human papillomavirus. 1st line therapies include cryotherapy and topical salicylic acid. Where there is resistance to these treatments, consideration is made for 2nd line therapies, including intralesional bleomycin, imiquimod, 5-fluorouracil, and photodynamic therapy. We present a case of bilateral persistent plantar warts, resistant to treatment with repeated cryotherapy and topical salicylic acid over a 6-year period. Following a patient initiated decision to discontinue their statin medication, we observed rapid clearance of plantar warts without change to standard therapy or their environment. This case correlates with emerging literature demonstrating a link between statin medication and proliferation of HPV through increased levels of FOXP3+ regulatory T cells. Aaron G. Wernham and Shireen S. Velangi Copyright © 2015 Aaron G. Wernham and Shireen S. Velangi. All rights reserved. Mixed Cutaneous Infection Caused by Mycobacterium szulgai and Mycobacterium intermedium in a Healthy Adult Female: A Rare Case Report Wed, 18 Feb 2015 09:18:14 +0000 Nontuberculous mycobacteria (NTMs) are ubiquitous and are being increasingly reported as human opportunistic infection. Cutaneous infection caused by mixed NTM is extremely rare. We encountered the case of a 46-year-old female, who presented with multiple discharging sinuses over the lower anterior abdominal wall (over a previous appendectomy scar) for the past 2 years. Microscopy and culture of the pus discharge were done to isolate and identify the etiological agent. Finally, GenoType Mycobacterium CM/AS assay proved it to be a mixed infection caused by Mycobacterium szulgai and M. intermedium. The patient was advised a combination of rifampicin 600 mg once daily, ethambutol 600 mg once daily, and clarithromycin 500 mg twice daily to be taken along with periodic follow-up based upon clinical response as well as microbiological response. We emphasize that infections by NTM must be considered in the etiology of nonhealing wounds or sinuses, especially at postsurgical sites. Amresh Kumar Singh, Rungmei S. K. Marak, Anand Kumar Maurya, Manaswini Das, Vijaya Lakshmi Nag, and Tapan N. Dhole Copyright © 2015 Amresh Kumar Singh et al. All rights reserved. Unilateral Oral Mucous Membrane Pemphigoid: Refractory Atypical Presentation Successfully Treated with Intravenous Immunoglobulins Sun, 15 Feb 2015 06:48:51 +0000 A 57-year-old male presented with a 6-month history of blisters and painful erosions on the right buccal mucosa. No skin or other mucosal involvement was seen. The findings of histopathological and direct immunofluorescence examinations were sufficient for the diagnosis of oral mucous membrane pemphigoid in the context of adequate clinical correlation. No response was seen after topical therapies and oral corticosteroids or dapsone. Intravenous immunoglobulin was started and repeated every three weeks. Complete remission was achieved after three cycles and no recurrence was seen after two years of follow-up. The authors report a rare unilateral presentation of oral mucous membrane pemphigoid on the right buccal and hard palate mucosa, without additional involvement during a period of five years. Local trauma or autoimmune factors are possible etiologic factors for this rare disorder, here with unique presentation. André Laureano and Jorge Cardoso Copyright © 2015 André Laureano and Jorge Cardoso. All rights reserved. Harmful Effects of Synthetic Surface-Active Detergents against Atopic Dermatitis Thu, 15 Jan 2015 06:21:03 +0000 We report herein two cases of intractable atopic dermatitis successfully treated by simply avoiding the contact with surface-active detergents in the daily life and living. The detergents were closely related to the exacerbation and remission of the disease. Steroid ointment was no longer used. We discuss that the removal of horny layer lipids by surface-active detergents accelerates the transepidermal water loss and disturbs the barrier function of the epidermis and thus is intimately involved in the pathogenesis of atopic dermatitis. Hajime Deguchi, Riho Aoyama, Hideaki Takahashi, Yoshinari Isobe, and Yutaka Tsutsumi Copyright © 2015 Hajime Deguchi et al. All rights reserved. Acquired Brachial Cutaneous Dyschromatosis in a 60-Year-Old Male: A Case Report and Review of the Literature Wed, 31 Dec 2014 08:43:29 +0000 Acquired brachial cutaneous dyschromatosis is an acquired pigmentary disorder that has been described in only 20 patients but likely affects many more. This case of a man with acquired brachial cutaneous dyschromatosis is unique as most reports are in women. We report the case of a 60-year-old male who presents with an asymptomatic eruption characterized by hyperpigmented and telangiectatic macules coalescing into patches on the bilateral extensor aspects of the forearms which is consistent clinically and histopathologically with acquired brachial cutaneous dyschromatosis. Given its presence in patients with clinical evidence of chronic sun exposure and its histopathological finding of solar elastosis, acquired brachial cutaneous dyschromatosis is likely a disorder caused by cumulative UV damage. However, a possible association between angiotensin-converting enzyme inhibitors and acquired brachial cutaneous dyschromatosis exists. Further investigation is needed to elucidate both the pathogenesis of the disorder and forms of effective management. Treatment of the disorder should begin with current established treatments for disorders of dyspigmentation. Nadia Abidi, Kristen Foering, and Joya Sahu Copyright © 2014 Nadia Abidi et al. All rights reserved. Angioedema due to Systemic Isotretinoin Therapy Tue, 23 Dec 2014 00:10:07 +0000 Angioedema is the swelling of the mucosal membranes as a variant of urticaria induced by hereditary C1 esterase inhibitor enzyme deficiency, certain foods, or drugs. Herein, we report the case of a 23-year-old woman, with mild-moderate acne presenting with widespread facial angioedema on the 2nd day of systemic isotretinoin treatment. The patient had taken no drugs other than isotretinoin in the preceding days and had no known food allergy. Her angioedema was resolved after the isotretinoin was discontinued. We want to draw the attention of dermatologists to this rare adverse allergic effect of isotretinoin which is frequently used in the treatment of acne vulgaris. Pelin Üstüner Copyright © 2014 Pelin Üstüner. All rights reserved. Paraneoplastic Dermatomyositis with Carcinoma Cervix: A Rare Clinical Association Thu, 18 Dec 2014 00:10:34 +0000 Dermatomyositis is an uncommon inflammatory myopathy associated with cutaneous manifestations. It may also occur as paraneoplastic syndrome associated with various malignancies, most common of which being lung, breast, stomach, rectum, kidney, or testicular cancer. A postmenopausal woman presented to us with generalized itching along with skin rash and proximal muscle weakness of 2 years’ duration. Examination revealed heliotrope rash and mechanic hands and muscle power 2/5 in proximal muscle groups of both upper and lower limbs. A clinical diagnosis of dermatomyositis was made which was supported by raised lactate dehydrogenase levels and skin biopsy findings. Past history was significant for vaginal discharge and bleeding per vagina. Further work-up revealed carcinoma cervix and she was referred to oncology department for further management. Temporal relationship and improvement of muscle weakness with treatment of underlying neoplasm supported its paraneoplastic nature. So, final diagnosis of keratinizing squamous cell carcinoma of cervix with paraneoplastic dermatomyositis was made. A nationwide cohort study of 1,012 patients with dermatomyositis in Taiwan revealed only 3 patients with cervical cancer. So this case is being reported for its rare association with carcinoma cervix and to highlight the need of detailed evaluation for underlying malignancies in patients with dermatomyositis. Sumir Kumar, B. B. Mahajan, Sandeep Kaur, and Amarbir Singh Copyright © 2014 Sumir Kumar et al. All rights reserved. A Case of Apparent Contact Dermatitis Caused by Toxocara Infection Tue, 16 Dec 2014 12:58:06 +0000 Infection from Toxocara species may give rise to a large array of clinical symptoms, including apparent manifestations of allergy such as asthma, urticaria/angioedema, and dermatitis. We report a case, thus far not described, of contact dermatitis attributed to nickel allergy but caused by Toxocara infection. The patient was a 53-year-old woman presenting from 10 years a dermatitis affecting head, neck, and thorax. Patch tests initially performed gave a positive result to nickel, but avoidance of contact with nickel did not result in recovery. The patient referred to our Allergy Service in 2010 because of dermatitis to feet. Patch testing confirmed the positive result for nickel, but expanding the investigation a positive result for IgG antibodies to Toxocara was detected by Western blotting and ELISA. Treatment with mebendazole achieved immediate efficacy on feet dermatitis. Then, two courses of treatment with albendazole resulted in complete regression of dermatitis accompanied by development of negative ELISA and Western blotting for Toxocara antibodies. This report adds another misleading presentation of Toxocara infection as apparent contact dermatitis caused by nickel and suggests bearing in mind, in cases of contact dermatitis not responding to avoidance of the responsible hapten and to medical treatment, the possible causative role of Toxocara. Rosanna Qualizza, Eleni Makrì, Laura Losappio, and Cristoforo Incorvaia Copyright © 2014 Rosanna Qualizza et al. All rights reserved. Successful Treatment of Disseminated Subcutaneous Panniculitis-Like T-Cell Lymphoma with Single Agent Oral Cyclosporine as a First Line Therapy Sun, 23 Nov 2014 08:11:47 +0000 Subcutaneous panniculitis-like T-cell lymphoma (SPTL) is a rare cutaneous neoplasm of mature cytotoxic T-cells. Currently there are no standardized therapies for SPTL; however good responses have been seen with chemotherapy regimens generally employed for B-cell lymphomas. Cyclosporine, an immunosuppressant, has shown good responses in relapsed/refractory SPTL; however its use in first line setting is not well established. We, herein, describe a 22-year-old girl with disseminated SPTL who attained complete clinical remission with single agent oral cyclosporine used as a first line therapy. Nida Iqbal and Vinod Raina Copyright © 2014 Nida Iqbal and Vinod Raina. All rights reserved. Vascular Malformation and Common Keratinocytic Nevus of the Soft Type: Phacomatosis Pigmentovascularis Revisited Sun, 23 Nov 2014 00:00:00 +0000 Phacomatosis pigmentovascularis is a rare syndrome characterized by the coexistence of a pigmented nevus and a cutaneous vascular malformation. We report a 5-year-old boy with all the typical findings of phacomatosis pigmentovascularis type Ia. Although its existence according to the traditional classification has been questioned, this case represents a very rare association of a capillary vascular malformation and a common keratinocytic nevus of the soft type. André Laureano, Rodrigo Carvalho, Cristina Amaro, Isabel Freitas, and Jorge Cardoso Copyright © 2014 André Laureano et al. All rights reserved. Diffuse Cutaneous Mucinosis in Dermatomyositis: A Case Report and Review of the Literature Tue, 18 Nov 2014 00:00:00 +0000 We present the case of a patient with dermatomyositis and diffuse cutaneous mucinosis and give an up-to-date detailed review of all the published cases in the English literature describing the demographics, clinical picture, pathology management, and outcomes of this unique group of patients. Alexandra Caitlin Perel-Winkler and Chris T. Derk Copyright © 2014 Alexandra Caitlin Perel-Winkler and Chris T. Derk. All rights reserved. Cutaneous Metastasis of Medullary Carcinoma Thyroid Masquerading as Subcutaneous Nodules Anterior Chest and Mandibular Region Tue, 11 Nov 2014 13:34:25 +0000 Cutaneous metastasis of underlying primary malignancies can present to dermatologist with chief complaints of cutaneous lesions. The underlying malignancy is generally diagnosed much later after a complete assessment of the concerned case. Medullary carcinoma thyroid (MCT) is a relatively uncommon primary neoplasia of the thyroid. Very few cases presenting as cutaneous metastases of MCT have been reported in the literature. Most of the cases which have been reported are of the papillary and the follicular types. We here report a case of a patient who presented in the dermatology clinic with the primary complaint of multiple subcutaneous nodules in anterior chest wall and left side of body of mandible. By systematic application of clinical and diagnostic skills these nodules were diagnosed as cutaneous metastasis of MCT bringing to the forefront a history of previously operated thyroid neoplasm. So clinically, the investigation of a flesh coloured subcutaneous nodule, presenting with a short duration, particularly in scalp, jaw, or anterior chest wall should include possibility of metastastic deposits. A dermatologist should keep a possibility of an internal organ malignancy in patients while investigating a case of flesh coloured subcutaneous nodules, presenting with short duration. A systematic application of clinical and diagnostic skills will eventually lead to such a diagnosis even when not suspected clinically at its primary presentation. A prompt and an emphatic diagnosis and treatment will have its bearing on the eventual outcome in all these patients. Rahul Mannan, Jasmine Kaur, Jasleen Kaur, Sanjay Piplani, Harjot Kaur, and Harleen Kaur Copyright © 2014 Rahul Mannan et al. All rights reserved. Hypertrichotic Giant Nevus Spilus Tardivus and Neurofibroma of the Tongue in Sporadic von Recklinghausen’s Disease Tue, 11 Nov 2014 11:46:22 +0000 Solitary neurofibromas are rare, benign tumours of nonodontogenic origin. The presentation of a solitary neurofibroma on the tongue is an uncommon occurrence and we present such a case here which was discovered in concomitance with multiple neurofibromatosis type 1 (von Recklinghausen’s disease). Such a rare presentation seen in this case is a diagnostic challenge and often clinched only with the aid of histopathological and immunohistochemical examination. This work also discusses the various differential diagnoses that can be considered in similar cases. The presence of a hypertrichotic “giant” nevus spilus tardivus (Becker’s nevus) is also a rare finding in this particular case. We present such a case which will be of interest to the budding dental practitioner. The lesion was excised and the patient followed up without any evidence of malignant transformation. Prabhath Ramakrishnan, Vijay Sylvester, Prathima Sreenivasan, Janisha Vengalath, and Smruthi Valambath Copyright © 2014 Prabhath Ramakrishnan et al. All rights reserved. Expansion of Natural Killer Cells in Peripheral Blood in a Japanese Elderly with Human T-Cell Lymphotropic Virus Type 1-Related Skin Lesions Sun, 09 Nov 2014 12:20:11 +0000 Natural killer (NK) cells were proposed to play an important role in the pathogenesis of human T-cell lymphotropic virus type 1- (HTLV-1-) associated neurologic disease. Our patient was a 77-year-old Japanese man, who had been treated for infective dermatitis associated with HTLV-1 for nearly 10 years. When referred to us, he had facial eczema/edema as well as extensive dermatitis at the neck/upper chest and nuchal area/upper back regions. Dermal lesions had CD3+CD4+ cells, but no NK cells. Flow cytometry of his peripheral blood showed a phenotype of CD2+ (97%), CD3+ (17%), CD4+ (12%), CD7+ (94%), CD8+ (6%), CD11c+ (70%), CD16+ (82%), CD19+ (0%), CD20+ (0%), CD56+ (67%), HLA-DR+ (68%), and NKp46+ (36%). Absolute numbers of CD56+NK cells in the peripheral blood were in a range of 986/μL–1,270/μL. The expanded NK cells in the peripheral blood are considered to be reactive, to maintain the confinement of the HTLV-1-positive CD4+ cells in the skin, and to prevent the progression of the disease. Shinsaku Imashuku, Naoko Kudo, Kagekatsu Kubo, and Kouichi Ohshima Copyright © 2014 Shinsaku Imashuku et al. All rights reserved. A Life Threatening Rash, an Unexpected Cause Sun, 09 Nov 2014 00:00:00 +0000 We describe a 74-year-old man with purpura fulminans and altered sensorium following an acute febrile illness. Intensive sepsis management was to no avail, until institution of doxycycline therapy following confirmation of scrub typhus. Empirical doxycycline needs to be considered in endemic areas for patients presenting with purpura fulminans. Dhiraj Jain, Stalin Viswanathan, and Chandramohan Ramasamy Copyright © 2014 Dhiraj Jain et al. All rights reserved. A Gigantic Anogenital Lesion: Buschke-Lowenstein Tumor Thu, 06 Nov 2014 08:46:31 +0000 Buschke-Lowenstein tumor is a relatively rare sexually transmitted disease. It is a neoplasm of the anogenital region which has benign appearance on histopathology but is locally destructive. It carries a high recurrence rate and a significant potential for malignant transformation. Human papilloma virus has been implicated as an etiologic agent for this tumor. Since this disease is rare and no controlled studies exist, radical excision of this anogenital lesion is generally recommended as the first line therapy and close vigilance and followup are essential. We have discussed an overview of etiopathogenesis, clinical presentation, diagnosis, and management of this uncommonly encountered disease. Rikinder Sandhu, Zaw Min, and Nitin Bhanot Copyright © 2014 Rikinder Sandhu et al. All rights reserved. Majocchi’s Granuloma after Topical Corticosteroids Therapy Thu, 23 Oct 2014 00:00:00 +0000 Majocchi’s granuloma (MG) is an unusual but not rare dermatophyte infection of dermal and subcutaneous tissues. Dermatophytes usually result in the infections of hair, epidermis, and nail, and are rarely involved in deep cutaneous and subcutaneous tissues. Now it is considered that MG includes two forms: one is a small perifollicular papular form and the other is a deep subcutaneous nodular form; the front one mainly occurs in healthy individuals and the latter one usually presents in immunocompromised hosts. The clinical manifestations of MG are many and varied, except the common presentations of erythema, papule and nodules, and Kaposi sarcoma-like and molluscum-like lesions have been reported in literatures (Kim et al. (2011), Bord et al. (2007), and Lillis et al. (2010)). This characteristic induces the difficulty of diagnosis, and thus it is so important and necessary to make direct microscopical and histological examinations. We describe a case of MG over the face in a patient who had been treated with topical corticosteroids over a long time. Fu-qiu Li, Sha Lv, and Jian-xin Xia Copyright © 2014 Fu-qiu Li et al. All rights reserved. Granulomatous Cheilitis: Successful Treatment of Two Recalcitrant Cases with Combination Drug Therapy Wed, 15 Oct 2014 00:00:00 +0000 Granulomatous cheilitis is a rare, idiopathic, inflammatory disorder which usually affects young adults. It is characterized by persistent, diffuse, nontender, soft-to-firm swelling of one or both lips. Various treatment modalities have been suggested. In spite of the best treatment, recurrence of the disease is very common. We report two cases of granulomatous cheilitis treated with a combination of steroids, metronidazole, and minocycline with no signs of relapse at one-year follow-up. Ambika Gupta and Harneet Singh Copyright © 2014 Ambika Gupta and Harneet Singh. All rights reserved. Crusted Demodicosis in an Immunocompetent Pediatric Patient Sun, 12 Oct 2014 00:00:00 +0000 Demodicosis refers to the infestation by Demodex spp., a saprophytic mite of the pilosebaceous unit. Demodex proliferation can result in a number of cutaneous disorders including pustular folliculitis, pityriasis folliculorum, papulopustular, and granulomatous rosacea, among others. We report the case of a 7-year-old female presenting with pruritic grayish crusted lesions over her nose and cheeks, along with facial erythema, papules, and pustules. The father referred chronic use of topical steroids. A potassium hydroxide mount of a pustule scraping revealed several D. folliculorum mites. Oral ivermectin (200 μg/kg, single dose) plus topical permethrin 5% lotion applied for 3 consecutive nights were administered. Oral ivermectin was repeated every week and oral erythromycin plus topical metronidazole cream was added. The facial lesions greatly improved within the following 3 months. While infestation of the pilosebaceous unit by Demodex folliculorum mites is common, only few individuals present symptoms. Demodicosis can present as pruritic papules, pustules, plaques, and granulomatous facial lesions. To our knowledge, this is the first reported case of facial crusted demodicosis in an immunocompetent child. The development of symptoms in this patient could be secondary to local immunosuppression caused by the chronic use of topical steroids. Guillermo Antonio Guerrero-González, Maira Elizabeth Herz-Ruelas, Minerva Gómez-Flores, and Jorge Ocampo-Candiani Copyright © 2014 Guillermo Antonio Guerrero-González et al. All rights reserved. Iatrogenic Anetoderma of Prematurity: A Case Report and Review of the Literature Wed, 08 Oct 2014 08:43:13 +0000 Anetoderma is a skin disorder characterized by focal loss of elastic tissue in the mid dermis, resulting in localized areas of macular depressions or pouchlike herniations of skin. An iatrogenic form of anetoderma has been rarely described in extremely premature infants and has been related to the placement of monitoring devices on the patient skin. Because of the increasing survival of extremely premature infants, it is easy to foresee that the prevalence of anetoderma of prematurity will increase in the next future. Although it is a benign lesion, it persists over time and can lead to significant aesthetic damage with need for surgical correction. Sometimes the diagnosis can be difficult, especially when the atrophic lesions become evident after discharge. Here, we report on a premature infant born at 24 weeks of gestation, who developed multiple anetodermic patches of skin on the trunk at the sites where electrocardiographic electrodes were previously applied. The knowledge of the disease can encourage a more careful management of the skin of extremely premature babies and aid the physicians to diagnose the disease when anetoderma patches are first encountered later in childhood. Laura Maffeis, Lorenza Pugni, Carlo Pietrasanta, Andrea Ronchi, Monica Fumagalli, Carlo Gelmetti, and Fabio Mosca Copyright © 2014 Laura Maffeis et al. All rights reserved. Relapsing Polychondritis Tue, 30 Sep 2014 11:49:53 +0000 Relapsing polychondritis (RP) is a rare systemic disease characterized by recurrent, widespread chondritis of the auricular, nasal, and tracheal cartilages. Additional clinical features include audiovestibular dysfunction, ocular inflammation, vasculitis, myocarditis, and nonerosive arthritis. Although the cause remains unknown, the etiology is suspected to be autoimmune. We describe a case of a 31-year-old woman with a four-month history of bilateral auricular and nasal chondritis. Infectious and neoplastic diseases were excluded by imaging and laboratory examinations. RP was diagnosed based on three McAdam’s criteria. The patient was medicated with oral prednisolone and methotrexate with positive clinical response. In this case clinical history and detailed physical examination were fundamental in concluding the correct diagnosis and administrating the appropriate medication. Beata Sosada, Katarzyna Loza, and Ewelina Bialo-Wojcicka Copyright © 2014 Beata Sosada et al. All rights reserved. Pemphigus Vulgaris Presented with Cheilitis Thu, 25 Sep 2014 13:05:58 +0000 Background. Pemphigus vulgaris is an autoimmune blistering disease affecting the mucous membrane and skin. In 50 to 70% of cases, the initial manifestations of pemphigus vulgaris are oral lesions which may be followed by skin lesions. But it is unusual for the disease to present with initial and solitary persistent lower lip lesions without progression to any other location. Main Observations. We report a 41-year-old woman with dry crusted lesions only on the lower lip, clinically resembling actinic cheilitis and erosive lichen planus, but histopathological evaluation showed unexpected results of suprabasal acantholysis and cleft compatible with pemphigus vulgaris. We treated her with intralesional triamcinolone 10 mg/mL for 2 sessions and 2 g cellcept daily. Patient showed excellent response and lesions resolved completely within 2 months. In one-year follow-up, there was no evidence of relapse or any additional lesion on the other sites. Conclusion. Cheilitis may be the initial and sole manifestation of pemphigus vulgaris. Localized and solitary lesions of pemphigus vulgaris can be treated and controlled without systemic corticosteroids. Zaheer Abbas, Zahra Safaie Naraghi, and Elham Behrangi Copyright © 2014 Zaheer Abbas et al. All rights reserved. A Case of Onychomycosis Caused by Rhodotorula glutinis Thu, 25 Sep 2014 06:50:18 +0000 Rhodotorula spp. have emerged as opportunistic pathogens, particularly in immunocompromised patients. The current study reports a case of onychomycosis caused by Rhodotorula glutinis in a 74-year-old immunocompetent female. The causative agent was identified as R. glutinis based on the pinkish-orange color; mucoid-appearing yeast colonies on Sabouraud Dextrose Agar at 25°C; morphological evaluation in the Corn Meal-Tween 80 agar; observed oval/round budding yeast at 25°C for 72 hours; no observed pseudohyphae; positive urease activity at 25°C for 4 days; and assimilation features detected by API ID 32C kit and automated Vitek Yeast Biochemical Card 2 system. Antifungal susceptibility test results were as follows: amphotericin B (MIC = 0.5 µg/mL), fluconazole (MIC = 128 µg/mL), itraconazole (MIC = 0.125 µg/mL), voriconazole (MIC = 1 µg/mL), posaconazole (MIC = 0.5 µg/mL), anidulafungin (MIC = 0.5 µg/mL), and caspofungin (MIC = 16 µg/mL). Antifungal therapy was initiated with oral itraconazole at a dose of 400 mg/day; seven-day pulse therapy was planned at intervals of three weeks. Clinical recovery was observed in the clinical evaluation of the patient before the start of the third cure. Although R. glutinis has rarely been reported as the causative agent of onychomycosis, it should be considered. Hatice Uludag Altun, Tuba Meral, Emel Turk Aribas, Canan Gorpelioglu, and Nilgun Karabicak Copyright © 2014 Hatice Uludag Altun et al. All rights reserved. Dermatofibroma Arising within a Black Tattoo Tue, 23 Sep 2014 06:57:56 +0000 Many complications have been reported over tattoos, some of which are tumours, such as dermatofibromas. It is important to establish a differential diagnosis because they can resemble other malignant lesions as dermatofibrosarcoma protuberans. We report the development of a dermatofibroma in a 21-year-old man with a tattoo painted two years ago. Alejandro Lobato-Berezo, Micaela Churruca-Grijelmo, Marcela Martínez-Pérez, Adrián Imbernón-Moya, María Elena Vargas-Laguna, Eva Fernández-Cogolludo, Antonio Aguilar-Martínez, and Miguel Ángel Gallego-Valdés Copyright © 2014 Alejandro Lobato-Berezo et al. All rights reserved. Acute Methotrexate Toxicity: A Fatal Condition in Two Cases of Psoriasis Mon, 08 Sep 2014 09:48:52 +0000 We describe two fatal cases of low dose methotrexate (MTX) toxicity in patients with psoriasis, emphasizing the factors that exacerbate MTX toxicity. The first patient was a 50-year-old male of psoriasis on intermittent treatment with MTX. After a treatment-free period of six months, he had self-medication of MTX along with analgesic for joint pain for one week which followed ulceration of the lesions, bone marrow suppression, and eventually death. The second patient was a 37-year-old male of psoriasis, who has taken MTX one week earlier without prior investigations. He had painful ulcerated skin lesions and bone marrow suppression. On investigations, he showed high creatinine level and atrophied, nonfunctioning right kidney on ultrasonography. In spite of dialysis, he succumbed to death. MTX is safe and effective if monitored properly, but inadvertent use may lead to even death also. Prior workup and proper counseling regarding the drug interactions as well as self-medication should be enforced. Pankti Jariwala, Vinay Kumar, Khyati Kothari, Sejal Thakkar, and Dipak Dayabhai Umrigar Copyright © 2014 Pankti Jariwala et al. All rights reserved. Ulcerated Radiodermatitis Induced after Fluoroscopically Guided Stent Implantation Angioplasty Wed, 03 Sep 2014 12:36:04 +0000 Cases of radiation-induced skin injury after fluoroscopically guided procedures have been reported since 1996, though the majority of them have been published in Radiology and Cardiology literature, less frequently in Dermatology journals. Chronic radiation dermatitis induced by fluoroscopy can be difficult to diagnose; a high grade of suspicion is required. We report a case of an obese 46-year-old man with hypertension, dyslipidemia, and severe coronary artery disease. He developed a pruritic and painful atrophic ulcerated skin plaque over his left scapula, six months after fluoroscopically guided stent implantation angioplasty. The diagnosis of radiodermatitis was confirmed histologically. We report this case to emphasize the importance of recognizing fluoroscopy as a cause of radiation dermatitis. A good clinical follow-up at regular intervals is important after long and complicated procedures, since the most prevalent factor for injury is long exposure time. Maira Elizabeth Herz-Ruelas, Minerva Gómez-Flores, Joaquín Moxica-del Angel, Ivett Miranda-Maldonado, Ilse Marilú Gutiérrez-Villarreal, Guillermo Antonio Guerrero-González, and Adriana Orelia Villarreal-Rodríguez Copyright © 2014 Maira Elizabeth Herz-Ruelas et al. All rights reserved. Seborrheic Pemphigoid Mon, 18 Aug 2014 06:29:38 +0000 Seborrheic pemphigoid (SP), first described in 1969 by Schnyder, is a peculiar variant of BP which clinically resembles pemphigus erythematosus, since it is characterized by ruptured bullae and erosions covered with crusts involving the seborrheic areas. To the best of our knowledge, from the first description only four other cases of SP have been reported, of which two are in the English literature. We report an additional case of SP in a 56-year-old man with cervical spondylogenic myelopathy with very impaired mobility. Enzo Errichetti, Giuseppe Stinco, Enrico Pegolo, Nicola di Meo, Giusto Trevisan, and Pasquale Patrone Copyright © 2014 Enzo Errichetti et al. All rights reserved.