Archive for February, 2011
Posted by James
A 33-year-old woman presented with a 7-month history of a solitary, well-demarcated, erythematous nodule with brown to black colored crust in the left axilla. The size increased after the patient gave stimulus to the lesion by squeezing it with her hands. There was no previous personal history of skin cancer and no other significant cutaneous or medical history was elicited. Notably she had no history of trauma, chronic axillary inflammation, immune deficiency, or exposure to artificial ionizing radiation or arsenic. There was no family history of skin cancer or other skin disease. On examination, the left axillary vault revealed a solitary, asymptomatic, erythematous nodule with brown to black colored crust measuring 1.0 x 0.8 x 1.5 cm (Fig. 1). No lymphadenopathy was appreciated.
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Posted by James
INTRODUCTION
Basal cell carcinoma (BCC) is the most common skin cancer, occurring more frequently than malignancies of any other tissue or organ with a steadily increasing incidence. Ultraviolet radiation is considered the single most important risk factor for BCC. Additional risk factors include exposure to arsenic, coal tar derivatives, irradiation, scars, burn sites, chronic inflammation, ulcers, and immune deficiency.
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Posted by James
Nail changes have been observed in 10-15% of cancer patients treated with EGFR inhibitors and reported as a late complication (starting usually not earlier than 4-8 weeks) during the treatment course. Inflammation of nail fold, periungual granulation tissue, pyogenic granuloma-like changes, brittle nail, and onycholysis have been reported. Sometimes, superinfection with Staphylococcus
aureus is observed with recalcitrant paronychia.
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Posted by James
A 31-year-old Korean woman with advanced non- small cell lung cancer was referred to our dermatology clinic with periungual granulation, acute paronychia and swelling of lateral nailfolds of both big toes with severe pain (Fig. 1). It was hard for her to walk because of the pain. She has been receiving gefitinib 250 mg daily for the treatment of the lung cancer and her skin symptoms developed 6 months after initiation of the chemotherapy. The patient denied any history of previous trauma or nail dystrophy and cultures for bacteria were negative. As paronychia of fingers and/or toes are often reported 2 to 4 months after gefitinib treatment and, as there was no specific trauma or infection history of the patient, we diagnosed her case as paronychia induced by gefitinib. As the patient wanted to continue her chemotherapy, we tried oral minocycline 50 mg twice daily with topical mupirocin twice a day. Even though her symptoms slightly improved after 4 weeks of treatment, we had to stop minocycline because of severe headache and dizziness. Read the rest of this entry »
Posted by James
INTRODUCTION
Gefitinib (Iressa, ZD1839) is one of the epidermal growth factor receptor (EGFR) inhibitors, approved by the United States Food and Drug Administration (FDA) for the treatment of locally advanced or metastatic non-small cell lung cancer (NSCLC) after failure of both platinum-based and docetaxel chemotherapies. A variety of dermatologic adverse reactions with the treatment of epidermal growth factor (EGFR) inhibitors have been reported in literature, such as acneiform eruption, paronychia, hair changes, dry skin, hypersensitivity reaction, and mucositis. Of these side effects, painful paronychial inflammation of the fingers and toes often leads to significant functional impairment, with decreasing therapeutic compliance. Read the rest of this entry »
Posted by James
PPPXE, also referred as perforating calcific elasto- sis, is an acquired disorder of connective tissue, characterized by localized degeneration and calcification of elastic fibers. It occurs predominantly in middle-aged, multiparous, obese, black women. Patients typically present as an occasionally pruritic, slowly enlarging, hyperpigmented plaque with discrete keratotic papules at the periphery of the lesion. The skin lesion usually locates in the periumbilical region, especially in the supraumbilical area. It is difficult to explain the periumbilical localization of PPPXE, however, it is suggested that the repeated trauma of pregnancy, obesity, abdominal surgery, or massive ascites may act as the initiating factors and result in localized elastic fiber degeneration.
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Posted by James
A 70-year-old obese multiparous woman presented with a 2-year history of gradually enlarging ulcerated plaques on her periumbilical region. On physical examination of the skin lesion, there were two discrete, 0.7 x 0.5 cm and 1.0 x 0.8 cm, yellowish to brownish cobblestoned plaques with central ulceration in the supraumbilical area (Fig. 1A). She had not any history of abdominal surgery or trauma on the abdomen but had a history of 5 vaginal deliveries. Her other medical history was unremarkable. On examination of her body, there were no abnormal findings, including in her cardiovascular and ophthalmologic systems. Laboratory evaluations including complete blood count, blood chemistry analysis and urinalysis were normal.
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