Case Reports in Dermatological Medicine The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Cutaneous Squamous Cell Carcinoma with Invasion through Ear Cartilage Mon, 16 May 2016 12:52:12 +0000 Cutaneous squamous cell carcinoma of the ear represents a high-risk tumor location with an increased risk of metastasis and local tissue invasion. However, it is uncommon for these cancers to invade through nearby cartilage. Cartilage invasion is facilitated by matrix metalloproteases, specifically collagenase 3. We present the unusual case of a 76-year-old man with an auricular squamous cell carcinoma that exhibited full-thickness perforation of the scapha cartilage. Permanent sections through the eroded cartilage confirmed tumor invasion extending to the posterior ear skin. Julie Boisen, C. Helen Malone, Brent Kelly, and Richard F. Wagner Jr. Copyright © 2016 Julie Boisen et al. All rights reserved. Paraneoplastic Pemphigus Associated with Follicular Dendritic Cell Tumor in the Mediastinum Mon, 11 Apr 2016 14:27:18 +0000 Paraneoplastic Pemphigus (PNP) is an autoimmune bullous disease characterized by severe stomatitis, polymorphous skin eruptions, and underlying neoplasms. Diagnosis of cutaneous paraneoplastic disorders requires high index of suspicion. We describe a patient with PNP associated with follicular dendritic cell (FDC) tumor in the mediastinum, a rare neoplasm originating from follicular dendritic cells. Its management requires identification of underlying malignancy and treatment of the same. Our patient showed remission of PNP upon excision of the tumor and remained disease-free for 8 years. Aparna Mullangath Prakasan, Anne Jennifer Prabhu, Kanmani Velarasan, Selvamani Backianathan, and Thomas Samuel Ram Copyright © 2016 Aparna Mullangath Prakasan et al. All rights reserved. A Case of Hereditary Leiomyomatosis and Renal Cell Carcinoma Wed, 06 Apr 2016 08:08:49 +0000 A 49-year-old lady presented with multiple recurring painful lesions over her thighs, arms, and back. Past medical history included a left sided nephrectomy for renal cell carcinoma and a hysterectomy for multiple uterine fibroids (leiomyomas). Histopathological examination revealed changes consistent with pilar leiomyomas. Gene mutation analysis confirmed a diagnosis of hereditary leiomyomatosis and renal cell carcinoma. Hereditary leiomyomatosis and renal cell carcinoma is an uncommon autosomal dominant condition characterised by the concurrent presentation of cutaneous and uterine leiomyomas. Renal cell carcinoma associated with this condition is more aggressive and a significant cause of mortality. Due to this association with potentially fatal renal cell carcinoma we felt that it was important to highlight this case with an update on pathophysiology and management. Sarah Mehrtens, David Veitch, Elizabeth Kulakov, and Conal M. Perrett Copyright © 2016 Sarah Mehrtens et al. All rights reserved. Confluent and Reticulated Papillomatosis of Gougerot-Carteaud on Black Skin: Two Observations Tue, 05 Apr 2016 12:47:51 +0000 Confluent and reticulated papillomatosis of Goujerot-Carteaud is a rare and benign skin disease characterized by flat papules taking a reticulated appearance. It is a skin disease of unknown etiology and nosology that is always discussed. This disease preferentially involves the chest and interscapular regions. It is a condition probably underdiagnosed in black skin because it generally simulates a pigmented tinea versicolor. This pathology withstands antifungal treatment but has a particular sensitivity to cyclines thus constituting a distinguishing criterion, useful for diagnosis which should be evoked in front of these reticulated confluent papules. Kouadio Celestin Ahogo, Patrice Ildevert Gbery, Vagamon Bamba, Yao Isidore Kouassi, Elidje Joseph Ecra, Kouame Alesandre Kouassi, and Ange Sylvain Allou Copyright © 2016 Kouadio Celestin Ahogo et al. All rights reserved. Dabigatran in the Treatment of Warfarin-Induced Skin Necrosis: A New Hope Sun, 27 Mar 2016 08:50:28 +0000 Warfarin-induced skin necrosis is an infrequent and well-recognized complication of warfarin treatment. The incidence was estimated between 0.01% and 0.1% whereas a paradoxal prothrombotic state that arises from warfarin therapy seems to be responsible for this life-threatening disease. To the best of our knowledge we present the first case of an old woman diagnosed with warfarin-induced skin necrosis, in whom novel oral anticoagulants and extensive surgical debridement were combined safely with excellent results. Christos Bakoyiannis, Georgios Karaolanis, Nikolaos Patelis, Anastasios Maskanakis, Georgios Tsaples, Christos Klonaris, Sotirios Georgopoulos, and Theodoros Liakakos Copyright © 2016 Christos Bakoyiannis et al. All rights reserved. Acquired Localized Hypertrichosis Induced by Rivastigmine Thu, 17 Mar 2016 09:54:31 +0000 Hypertrichosis is the excessive hair growth in any area of the skin surface. Acquired localized hypertrichosis may be secondary to multiple causes and there is a secondary form due to several drugs, which is usually reversible with discontinuation of the causative agent. Rivastigmine is a reversible and competitive inhibitor of acetylcholinesterase and butyrylcholinesterase used for symptomatic treatment of Alzheimer dementia and Parkinson’s disease. It has an adequate safety profile and cutaneous side effects are unusual. Irritant contact dermatitis, allergic dermatitis, baboon syndrome, and cutaneous rash due to rivastigmine have been reported. We report on a Caucasian 80-year-old male with personal history of Alzheimer’s disease. The patient started therapy with oral rivastigmine one month prior to clinical presentation of localized hypertrichosis on both forearms. Norgalanthamine has been shown to promote hair growth activity via the proliferation of dermal papilla. Acetylcholinesterase inhibitors can induce hair growth. Adrian Imbernón-Moya, Sebastian Podlipnik, Fernando Burgos, Elena Vargas-Laguna, Antonio Aguilar-Martínez, Eva Fernández-Cogolludo, and Miguel Angel Gallego-Valdes Copyright © 2016 Adrian Imbernón-Moya et al. All rights reserved. A Case of Bullous Skin Disease Presenting with Odynophagia: A Diagnostic Challenge Mon, 14 Mar 2016 12:25:22 +0000 We report a case of Epidermolysis Bullosa Acquisita (EBA) that presented as a diagnostic challenge. A 60-year-old Qatari lady presented with odynophagia, oral ulceration, and weight loss. Multiple physicians investigated her for over 6 months with a multitude of tests and serial gastroscopies, all of which failed to reach a conclusive diagnosis. Only after referral to a dermatologist and full body examination was diagnosis finally achieved. After reviewing the literature, we provide a summary of EBA and highlight the importance of comprehensive clinical reviews in order to avoid unnecessary morbidity. G. Kravvas, D. Veitch, and C. M. Perrett Copyright © 2016 G. Kravvas et al. All rights reserved. Child Who Presented with Facial Hematohidrosis Compared with Published Cases Mon, 14 Mar 2016 09:55:18 +0000 Hematohidrosis is a rare condition in which an individual sweats blood from intact, unbroken skin. The aetiology of hematohidrosis is not clear, although various theories exist to explain such a phenomenon. The general consensus however in the literature relates the finding to dermal capillary blood vessels that rupture under extreme emotional or physical stress exuding blood through the skin. In this case report we disclose a case of 12-year-old girl who presented with unusual painless bleeding from her face, eye, and tear duct. The condition was investigated intensively during hospital admission for a cause, and no actual cause was speculated. The management mostly involved supportive care and medical advice. Ali Jafar and Ali Ahmad Copyright © 2016 Ali Jafar and Ali Ahmad. All rights reserved. Eleven Primary Melanomas, Colon Cancer, and Atypical Nevi in the Same Patient: A Case Report and Literature Review Sun, 28 Feb 2016 16:18:35 +0000 Background. As the incidence of cutaneous malignant melanoma increases in the Caucasian population, an increasing population of melanoma survivors is at risk of developing multiple primary melanomas (MPM) as well as secondary primary cancers. Objective. To present a case of a patient with atypical nevi, 11 primary melanomas over 33 years, and colon cancer and to review the literature on multiple primary melanomas, atypical nevi, and correlation of nonmelanoma cancers. Conclusion. The literature indicates that patients with MPM are not uncommon, although 11 primary melanomas are rarely described, that patients with MPM may have a better survival than patients with single primary melanoma, that atypical nevi are a risk marker of not only melanoma in general but also MPM, and that melanoma patients have a significantly increased risk of developing nonmelanoma skin and other cancers, which may be even higher for patients with MPM. Lea Juul Nielsen and Lisbet Rosenkrantz Hölmich Copyright © 2016 Lea Juul Nielsen and Lisbet Rosenkrantz Hölmich. All rights reserved. Treatment of a Refractory Skin Ulcer Using Punch Graft and Autologous Platelet-Rich Plasma Wed, 17 Feb 2016 08:48:35 +0000 Background. Chronic ulceration of the lower legs is a relatively common condition amongst adults: one that causes pain and social distress and results in considerable healthcare and personal costs. The technique of punch grafting offers an alternative approach to the treatment of ulcers of the lower limbs. Objective. Combining platelet-rich plasma and skin graft enhances the efficacy of treating chronic diabetic wounds by enhancing healing rate and decreasing recurrence rate. Platelet-rich plasma could, by stimulating dermal regeneration, increase the take rate after skin grafting or speed up reepithelialization. Methods and Materials. The ulcer was prepared by removing fibrin with a curette and the edges of the ulcer were freshened. The platelet-rich plasma has been infiltrated on the bottom and edges of the ulcer. The punch grafts were placed in 5 mm holes arranged. The ulcer was medicated with hydrogel and a pressure dressing was removed after 8 days. Results. After a few days the patient did not report more pain. Granulation tissue appeared quickly between implants. Most of the grafts were viable in 2-3 weeks. The grafts gradually came together to close the ulcer and were completed in four months. Mauro Carducci, Marcella Bozzetti, Marco Spezia, Giorgio Ripamonti, and Giuseppe Saglietti Copyright © 2016 Mauro Carducci et al. All rights reserved. A 27-Year-Old Severely Immunosuppressed Female with Misleading Clinical Features of Disseminated Cutaneous Sporotrichosis Mon, 04 Jan 2016 09:06:50 +0000 Sporotrichosis is a subacute or chronic granulomatous mycosis caused by fungus of the Sporothrix schenckii complex. It is considered to be a rare condition in most parts of the world. It mostly causes cutaneous infection but can also cause multisystemic disease. Unlike most deep cutaneous mycoses which have a primary pulmonary focus, it is usually caused by direct inoculation of the fungus into the skin causing a classical linear, lymphocutaneous nodular eruption. However, atypical presentations of the condition can occur especially in immunosuppressed individuals. We report the case of a severely immunosuppressed female who presented with disseminated cutaneous sporotrichosis which was initially diagnosed and treated as disseminated cutaneous Kaposi’s sarcoma. Atiyah Patel, Victor Mudenda, Shabir Lakhi, and Owen Ngalamika Copyright © 2016 Atiyah Patel et al. All rights reserved. Idiopathic Thrombocytopenic Purpura Misdiagnosed as Hereditary Angioedema Thu, 24 Dec 2015 12:36:17 +0000 Hereditary angioedema is a rare, but potentially life-threatening genetic disorder that results from an autosomal dominant trait. It is characterized by acute, recurrent attacks of severe local edema, most commonly affecting the skin and mucosa. Swelling in hereditary angioedema patients does however not always have to be caused by angioedema but can relate to other concomitant disorders. In this report we are focusing on misdiagnosis in a patient with known hereditary angioedema, whose bleeding episode caused by idiopathic thrombocytopenic purpura was mistaken for an acute attack of hereditary angioedema. The case illustrates how clinicians can have difficulties in handling patients with rare diseases, especially in the emergency care setting. Michelle Fog Andersen and Anette Bygum Copyright © 2015 Michelle Fog Andersen and Anette Bygum. All rights reserved. Recurrent Thrombotic Vasculopathy in a Former Cocaine User Thu, 17 Dec 2015 11:34:02 +0000 We report a case of a 35-year-old female who presented to the emergency room (ER) complaining of a pruritic rash involving multiple areas of the body. She had a significant history of cocaine use in the past. She had first developed a similar rash in 2013 when she was diagnosed with cocaine-induced vasculitis. Her urine toxicology had been positive for cocaine in the past until July 2013. She was incarcerated and attended a drug rehabilitation program after which she quit cocaine use, which was consistent with negative urine toxicology on subsequent admissions. Further workup did not reveal any other, autoimmune or infectious, etiology of this clinical presentation. The patient underwent biopsy of the skin lesion that was consistent with thrombotic vasculopathy likely secondary to levamisole. Preeti Jadhav, Hassan Tariq, Masooma Niazi, and Giovanni Franchin Copyright © 2015 Preeti Jadhav et al. All rights reserved. Keloidal Scleroderma: Case Report and Review Mon, 30 Nov 2015 15:37:23 +0000 Objective. We report a rare case of keloidal scleroderma and provide an analysis of similar cases. Results. A 41 year-old woman presented with dark brown, indurated, exophytic nodules over the chest along with smaller hyperpigmented plaques scattered over the abdomen, with concomitant sclerodactyly. The clinical, laboratory, and pathological findings were consistent with a diagnosis of keloidal scleroderma. The patient was treated with methotrexate, resulting in reduced firmness of her plaques and no new lesions. A literature review of previously reported cases was performed using keywords including keloidal morphea, keloidal scleroderma, nodular morphea, and nodular scleroderma. In our review, the majority of patients were African American and female. 91% of cases had nodular lesions with distribution on the trunk. The majority of patients exhibited sclerodactyly and pulmonary involvement was reported in 28%1. The majority of patients were ANA positive (63%) and only 10% demonstrated anti-SCL-70 positivity. Conclusion. Keloidal scleroderma is a rare presentation, which can often be clinically confused with keloid and scar formation. Due to this being a rare variant, our knowledge of treatment options and efficacy is limited. Methotrexate could be considered as an initial treatment option for patients with progressive keloidal scleroderma. Sama Kassira, Tarannum Jaleel, Peter Pavlidakey, and Naveed Sami Copyright © 2015 Sama Kassira et al. All rights reserved. A Rare Case of Zosteriform Cutaneous Metastases from a Nasopharyngeal Carcinoma Mon, 30 Nov 2015 09:35:05 +0000 From a clinical point of view, the most common presentations of cutaneous metastatic disease are papules and nodules. However, a wide morphological spectrum of lesions has been described, including erythematous patches or plaques, inflammatory erysipelas-like lesions, diffuse sclerodermiform lesions with induration of the skin, telangiectatic papulovesicles, purpuric plaques mimicking vasculitis, and alopecia areata like scalp lesions. The so-called zosteriform pattern has been described to be in few cases and to the best of our knowledge has never been described associated with a metastasis of a nasopharyngeal carcinoma. This case highlights the relevance of including cutaneous metastases in the differential diagnosis of patients with nonhealing herpes zoster-like lesions, especially in those with underlying neoplasm recently diagnosed. Andrés González García, Emiliano Grillo Fernández, Ignacio Barbolla Díaz, Asunción Ballester, Héctor Pian, and Guadalupe Fraile Copyright © 2015 Andrés González García et al. All rights reserved. An Uncommon Side Effect of Bupropion: A Case of Acute Generalized Exanthematous Pustulosis Tue, 24 Nov 2015 12:28:36 +0000 Acute generalized exanthematous pustulosis (AGEP) is a rare inflammatory dermatosis characterized by multiple nonfollicular pustules that occur on erythematous skin. Despite its similarity to pustular psoriasis and association with fever and leukocytosis, AGEP typically heals quickly. Etiologically, drugs and viruses have been suspected in most cases. Here, we present a case of AGEP, in a woman, that developed 1 day after starting bupropion for smoking cessation, as a rare side effect of the treatment. Hasan Tak, Cengiz Koçak, Gülben Sarıcı, Nazlı Dizen Namdar, and Mehtap Kıdır Copyright © 2015 Hasan Tak et al. All rights reserved. A Rare Colocalization of Lichen Planus and Vitiligo Tue, 24 Nov 2015 12:19:17 +0000 We report an unusual manifestation of vitiligo colocalizing with lichen planus (LP). A 76-year-old Greek male presented with a history of a red, scaly, itchy, asymmetrical patch located at the umbilicus within a well-demarcated depigmented macule of vitiligo. Histology showed features of a lichenoid interface dermatitis, favouring a diagnosis of LP. Colocalization of LP and vitiligo has rarely been reported in the literature. After reviewing the literature, we believe that at present there is insufficient evidence to resolve the uncertainties in the aetiology of this colocalization. It seems to us that the association between LP and vitiligo is more than coincidental, but none of the theories discussed in this paper can sufficiently account for it. Rather, the association is likely to be multifactorial in its pathogenesis. David Veitch, Georgios Kravvas, Sian Hughes, and Christopher Bunker Copyright © 2015 David Veitch et al. All rights reserved. Effectiveness of an Innovative Pulsed Electromagnetic Fields Stimulation in Healing of Untreatable Skin Ulcers in the Frail Elderly: Two Case Reports Sun, 08 Nov 2015 07:32:36 +0000 Introduction. Recalcitrant skin ulcers are a major burden in elderly patients. Specifically, chronic wounds result in significant morbidity and mortality and have a profound economic impact. Pulsed electromagnetic fields (PEMFs) have proved to be a promising therapy for wound healing. Here we describe the first reported case of an innovative PEMF therapy, Emysimmetric Bilateral Stimulation (EBS), used to successfully treat refractory skin ulcers in two elderly and fragile patients. Case Presentation. Two elderly patients developed multiple chronic skin ulcerations. Despite appropriate treatment, the ulcers showed little improvement and the risk of amputation was high. Both patients underwent daily EBS therapy and standard dressing. After few weeks of treatment, major improvements were observed and all ulcers had healed. Conclusion. In patients with refractory ulceration, EBS therapy may be of real benefit in terms of faster healing. This case supports the supportive role for PEMFs in the treatment of skin ulceration in diabetes and is suggestive of a potential benefit of EBS in this clinical condition. Fabio Guerriero, Emanuele Botarelli, Gianni Mele, Lorenzo Polo, Daniele Zoncu, Paolo Renati, Carmelo Sgarlata, Marco Rollone, Giovannoi Ricevuti, Niccolò Maurizi, Matthew Francis, Mariangela Rondanelli, Simone Perna, Davide Guido, and Piero Mannu Copyright © 2015 Fabio Guerriero et al. All rights reserved. Type VI Aplasia Cutis Congenita: Bart’s Syndrome Sun, 01 Nov 2015 12:51:39 +0000 Bart’s syndrome is characterized by aplasia cutis congenita and epidermolysis bullosa. We present the case of a newborn male who developed blisters on the mucous membranes and the skin following congenital localized absence of skin. Bart’s syndrome (BS) is diagnosed clinically based on the disorder’s unique signs and symptoms but histologic evaluation of the skin can help to confirm the final diagnosis. The patient was managed conservatively with topical antibacterial ointment and wet gauze dressing. Periodic follow-up examinations showed complete healing. We emphasized that it is important to use relatively simple methods for optimal healing without the need for complex surgical interventions. Ferit Kulalı, Ahmet Yagmur Bas, Yusuf Kale, Istemi Han Celik, Nihal Demirel, and Sema Apaydın Copyright © 2015 Ferit Kulalı et al. All rights reserved. Melanoma of the Right Foot Simulating Kaposi’s Disease Thu, 08 Oct 2015 09:23:22 +0000 Melanoma is a malignant tumor rarely being described in sub-Saharan Africa. We reported an unusual and atypical clinical presentation. It was a 59-year-old patient who was hospitalized for a monomelic black tumor evolving for 10 years. Histopathological examination confirmed the melanocytic origin of this tumor. Paraclinical assessment did not find any visceral metastasis. A partial resection of the tumor was performed. The patient left the hospital against medical consent due to lack of technical facilities. The delay in the consultation and the lack of knowledge of melanoma by doctors and patients might contribute to the severity and the difficulties of its management. K. A. Kouassi, K. Kassi, K. Kouamé, M. A. Oussou, I. Kouassi, I. P. Gbery, E. J. Ecra, A. Sangare, C. Ahogo, M. Kaloga, P. Yoboue, and J. M. Kanga Copyright © 2015 K. A. Kouassi et al. All rights reserved. Peripheral Ulcerative Keratitis with Pyoderma Gangrenosum Wed, 07 Oct 2015 14:07:23 +0000 Pyoderma gangrenosum is an unusual necrotizing noninfective and ulcerative skin disease whose cause is unknown. Ophthalmic involvement in pyoderma gangrenosum is an unusual event. Only a few cases have been reported, from which we can highlight scleral, corneal, and orbital cases. Peripheral ulcerative keratitis is a process which destroys the peripheral cornea. Its cause is still unknown although it is often associated with autoimmune conditions. Pyoderma gangrenosum should be included in the differential diagnosis of peripheral ulcerative keratitis. Early recognition of these manifestations can vary the prognosis by applying the appropriate treatment. We introduce a 70-year-old woman who suffered pyoderma gangrenosum associated with peripheral ulcerative keratitis in her left eye. The patient’s skin lesions and peripheral keratitis responded successfully to systemic steroids and cyclosporine A. Adrián Imbernón-Moya, Elena Vargas-Laguna, Antonio Aguilar, Miguel Ángel Gallego, Claudia Vergara, and María Fernanda Nistal Copyright © 2015 Adrián Imbernón-Moya et al. All rights reserved. Pulmonary Tuberculosis and Lepromatous Leprosy Coinfection Sun, 04 Oct 2015 12:30:56 +0000 Simultaneous occurrence of leprosy and pulmonary tuberculosis is reported infrequently in the modern era. We report a case of pulmonary tuberculosis diagnosed in patient being treated with glucocorticoids for complications of leprosy (type II reaction). Physicians should recognize that the leprosy patients treated with glucocorticoid may develop tuberculosis. F. A. Sendrasoa, I. M. Ranaivo, O. Raharolahy, M. Andrianarison, L. S. Ramarozatovo, and F. Rapelanoro Rabenja Copyright © 2015 F. A. Sendrasoa et al. All rights reserved. Omalizumab for Urticarial Vasculitis: Case Report and Review of the Literature Tue, 08 Sep 2015 11:52:46 +0000 Urticarial vasculitis is characterised by inflamed itching or burning red patches or wheals that resemble urticaria but persist for greater than 24 hours. It is often idiopathic but is sometimes associated with collagen-vascular disease, particularly systemic lupus erythematosus. Treatment options include oral antihistamines, oral corticosteroids, dapsone, colchicine or hydroxychloroquine. We describe a male patient with urticarial vasculitis who was treated with omalizumab (anti-IgE) with convincing results and provide a review of previous reports of patients with urticarial vasculitis treated with omalizumab. Misbah Nasheela Ghazanfar and Simon Francis Thomsen Copyright © 2015 Misbah Nasheela Ghazanfar and Simon Francis Thomsen. All rights reserved. Reconstruction of a Large Anterior Ear Defect after Mohs Micrographic Surgery with a Cartilage Graft and Postauricular Revolving Door Flap Thu, 03 Sep 2015 11:25:24 +0000 A novel postauricular revolving door island flap and cartilage graft combination was employed to correct a large defect on the anterior ear of an 84-year-old man who underwent Mohs micrographic surgery for an antihelical squamous cell carcinoma. The defect measured 4.6 × 2.4 cm and spanned the antihelix, scapha, a small portion of the helix, and a large segment of underlying cartilage, with loss of structural integrity and anterior folding of the ear. The repair involved harvesting 1.5 cm2 of exposed cartilage from the scaphoid fossa and then sculpting and suturing it to the remnant of the antihelical cartilage in order to recreate the antihelical crura. The skin of the posterior auricle was then incised just below the helical rim and folded anteriorly to cover the cartilage graft. The flap remained attached by a central subcutaneous pedicle, and an island designed using the full-thickness defect as a stencil template was pulled through the cartilage window anteriorly to resurface the anterior ear. This case demonstrates the use of the revolving door flap for coverage of large central ear defects with loss of cartilaginous support and illustrates how cartilage grafts may be used in combination with the flap to improve ear contour after resection. Stephanie Nemir, Lindsey Hunter-Ellul, Vlad Codrea, and Richard Wagner Copyright © 2015 Stephanie Nemir et al. All rights reserved. Buschke-Löwenstein Tumour: Successful Treatment with Minimally Invasive Techniques Mon, 31 Aug 2015 08:30:06 +0000 We report a case of an 80-year-old female who presented with a four-year history of a growing mass in the perianal area with pain and bleeding during defaecation. Clinical examination revealed a locally destructive, cauliflower-like, verrucous mass measuring 10 12 cm in diameter. Histologic findings revealed a moderate degree of dysplasia of the epithelium with koilocytosis atypia, acanthosis, and parakeratosis, features that are consistent with Buschke-Löwenstein tumour. Polymerase-chain-reaction assay for human papillomavirus (HPV) showed an infection with HPV type 11. Full-thickness excision of involved skin was undertaken by cryotherapy and electrocautery over five months. The entire wound was left open to heal by secondary intention. After 3 years of follow-up, the patient has not experienced a recurrence, with excellent functional results, but the cosmetic results were satisfactory. These minimally invasive techniques can be safer and more cost-effective than surgery and the General Practitioner can play a key role in diagnosis. Estefânia Correia and António Santos Copyright © 2015 Estefânia Correia and António Santos. All rights reserved. Methotrexate Treatment in Children with Febrile Ulceronecrotic Mucha-Habermann Disease: Case Report and Literature Review Thu, 27 Aug 2015 13:23:35 +0000 Febrile Ulceronecrotic Mucha-Habermann disease is a rare and potentially fatal variant of pityriasis lichenoides et varioliformis acuta and is characterized by high fever, constitutional symptoms, and acute oncet of ulceronecrotic lesions. We present an 11-year-old male with Febrile Ulceronecrotic Mucha-Habermann disease who was cured with methotrexate and review the use of methotrexate for this disorder in the pediatric age group with the relevant literature. Isil Bulur, Hilal Kaya Erdoğan, Zeynep Nurhan Saracoglu, and Deniz Arık Copyright © 2015 Isil Bulur et al. All rights reserved. Case of Rapid Progression of Hemiatrophy on the Face: A New Clinical Entity? Tue, 25 Aug 2015 10:59:01 +0000 A lot of diseases, including lupus profundus, morphea, lipodystrophy, and Parry-Romberg syndrome, may manifest progressive hemifacial atrophy. These diseases usually progress slowly and rapid progression of atrophy is extremely rare. We report a case of elderly-onset rapid progression of hemifacial atrophy only in three weeks. Our case did not meet variable differential diagnoses. We discuss the clinical character of the patient against the past of literature and suppose it may be a new clinical entity. Hisashi Nomura, Shohei Egami, Tomoaki Yokoyama, and Makoto Sugiura Copyright © 2015 Hisashi Nomura et al. All rights reserved. Lymphatic Malformation, Retinoblastoma, or Facial Cleft: Atypical Presentations of PHACE Syndrome Sun, 28 Jun 2015 11:39:52 +0000 PHACE syndrome is a neurocutaneous disorder characterized by large cervicofacial infantile hemangiomas and associated anomalies: posterior fossa brain malformation, hemangioma, arterial cerebrovascular anomalies, coarctation of the aorta and cardiac defects, and eye/endocrine abnormalities of the brain. When ventral developmental defects (sternal clefting or supraumbilical raphe) are present the condition is termed PHACE. In this report, we describe three PHACE cases that presented unique features (affecting one of the organ systems described for this syndrome) that have not been described previously. In the first case, a definitive PHACE association, the patient presented with an ipsilateral mesenteric lymphatic malformation, at the age of 14 years. In the second case, an anomaly of the posterior segment of the eye, not mentioned before in PHACE literature, a retinoblastoma, has been described. Specific chemotherapy avoided enucleation. And, in the third case, the child presented with an unusual midline frontal bone cleft, corresponding to Tessier 14 cleft. Two patients’ hemangiomas responded well to propranolol therapy. The first one was followed and treated in the pre-propranolol era and had a moderate response to corticoids and interferon. María Fernández-Ibieta and Juan Carlos López-Gutiérrez Copyright © 2015 María Fernández-Ibieta and Juan Carlos López-Gutiérrez. All rights reserved. Clinical Effects of Topical Tacrolimus on Fox-Fordyce Disease Mon, 15 Jun 2015 07:07:42 +0000 Fox-Fordyce Disease (FFD) is a rare, chronic, pruritic, inflammatory disorder of apocrine glands. It is characterized by dome-shaped, firm, discrete, skin-colored, and monomorphic perifollicular papules. The most common sites of involvement are axillae and anogenital and periareolar regions which are rich in apocrine sweat glands. Treatment is difficult. Topical, intralesional steroids, topical tretinoin, adapalene, clindamycin, benzoyl peroxide, oral contraceptives, isotretinoin, phototherapy, electrocauterisation, excision-liposuction and curettage, and fractional carbon dioxide laser are among the treatment options. In the literature, there are articles reporting beneficial effects of pimecrolimus in FFD. Nevertheless, there have not been any reports about the use of tacrolimus in FFD. We report two patients diagnosed with FFD by clinical and histopathologic examination and discussed therapeutic effects of topical tacrolimus on FFD in the light of literature. Hilal Kaya Erdoğan, Işıl Bulur, and Zeliha Kaya Copyright © 2015 Hilal Kaya Erdoğan et al. All rights reserved. Subcutaneous Emphysema Induced by Cryotherapy: A Complication due to Previous Punctures Wed, 10 Jun 2015 12:51:39 +0000 Cryosurgery is a common therapeutic modality used in dermatology; therefore we must be aware of its possible adverse effects. We report a case of a patient with subcutaneous emphysema which occurred following the application of cryotherapy after multiple punctures of local anesthetic and intralesional steroids in a chest keloid scar. Despite the fact that this condition was gradually resolved after expectant observation, we warn about this complication when sprayed cryotherapy is preceded by multiple punctures on cutaneous lesions above bony surfaces. In similar settings, cryotherapy must be first administered or a cotton-tip applicator should be used. Jared Martínez-Coronado, Bertha Torres-Álvarez, and Juan Pablo Castanedo-Cázares Copyright © 2015 Jared Martínez-Coronado et al. All rights reserved.