A 72-year-old man with a history of thrombotic CVA causing lateral medullary infarction presented with non-healing ulcers of the right side of the face of 5 months' duration. After extensive investigations, a diagnosis of trigeminal trophic syndrome was made. The ulcers progressed relentlessly despite amitriptyline and gabapentin, and he was treated with a combination of carbamazepine and thermoplastic mask occlusion of the right side of his face. Over the next 10 weeks the shallower facial ulcers began to diminish in depth and diameter, and the deeper ulcers stopped progressing. Although the patient showed early signs of healing, he died because of complications from the CVA.
A g‐year‐old girl was seen at our outpatient department with a 5‐year history of a slowly enlarging hyperpigmented area with increased sweating on the right upper chest and back. There was no history of pain or tenderness over the lesion. She was the second child of a nonconsanguineous marriage. The older sibling was healthy and there was no family history of similar complaints. Dermatologic examination revealed a large hyperpigmented plaque involving the right upper chest, extending over the right shoulder to the back (Fig. 1). The margins were well defined with raised borders on the upper part; elsewhere it gradually merged with the adjacent normal skin. Two other well‐defined hyper‐pigmented plaques were seen, one 3 × 3 cm over the nape of neck and another 3 × 1 cm over the right supraclavicular fossa. The lesions were nontender and noncompressible. There was increased sweating on the plaque following physical exertion and the plaque could be mapped out with starch and iodine (Fig. 2). Systemic examination of the child was within normal limits. Routine blood and urine examination was normal. Histologic sections showed an increased number of cross‐sections of sweatglands interspersed with dilated vascular spaces, filled with blood, in the mid and lower dermis (Figs. 3 and 4).
A 71-year-old man with chronic renal failure and on peritoneal dialysis presented with recurrence of multiple keratotic nodules along a surgical scar. This was 6 months after the excision of a recurrent keratotic nodule reported as squamous cell carcinoma from the same site. The lesions were initially reported as squamous cell carcinomas, but on review of histology were consistent with keratoacanthomas. One of the keratoacanthomas showed vascular invasion. These responded well to low-dose acitretin at 10 mg three times per week and the patient stayed in remission after 18 months of follow up.
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