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We report the first documented case of an atypical form of transient reactive papulotranslucent acrokeratoderma (TRPA) in a patient heterozygous for the ΔF508 CFTR(cystic fibrosis transmembrane conductance regulator) mutation. TRPA represents a condition that classically presents with translucent to white plaques that become evident after water exposure. An atypical form with persistent lesions has also been described. Our patient is a 16-year-old girl with small, white papules coalescing into pebbly plaques on the palms. This condition is exacerbated after 5-10 min of water exposure and is associated with discomfort. The skin biopsy showed expanded stratum corneum, orthohyperkeratosis and dilation of eccrine ducts consisting with TRPA. A cystic fibrosis carrier state, barrier function defect, hyperhidrosis and the intake of cyclooxygenase inhibitors may have been pathogenic factors in our patient.

Limitation of ankle movement may contribute to calf muscle pump failure, which is thought to contribute to venous leg ulcer formation, which affects nearly 1 million Americans. We therefore wished to study ankle movement in patients with venous leg ulcers and its effect on healing. Using goniometry, we measured baseline ankle range of motion in venous leg ulcer patients from a Phase 2 dose-finding study of an allogeneic living cell bioformulation. Two hundred twenty-seven patients were enrolled in four active treatment groups and one standard-care control group, all receiving compression therapy. Goniometry data from a control group of 49 patients without venous disease, from a previous study, was used for comparison. We found patients with active venous leg ulcers had significantly reduced ankle range of motion compared with the control group (p = 0.001). After 12 weeks of therapy, baseline ankle range of motion was not associated with healing, as there was no significant difference between healed and nonhealed groups, suggesting that ankle range of motion is not important in venous leg ulcer healing or, more likely, is overcome by compression. However, patients with venous ulcers located on the leg (as opposed to the ankle) had significantly higher ankle range of motion for plantar flexion and inversion (p = 0.021 and p = 0.034, respectively) and improved healing with both cell bioformulation and standard care (p = 0.011), suggesting that wound location is an important variable for ankle range of motion as well as for healing outcomes.

Understanding and managing patients' expectations can help improve their adherence to treatment for chronic wounds; however, little is known concerning about their expectations regarding healing time. Recruited subjects were asked to predict how long their wounds would take to heal and their charts were reviewed to retrieve real time of healing. We recruited 100 subjects from which 77% have healed. Fifty-three subjects (68.8%) had a longer healing time than they predicted (underestimated), and 17 (22.1%) had a shorter healing time than they predicted (overestimated). Subjects with shorter wound duration history tended to predict shorter healing time than subjects with longer wound duration (p < 0.01). However, wound duration did not affect prediction accuracy (p = 0.65). Subjects with chronic wounds seem more often to underestimate their time of healing. Wound duration significantly influenced patients' prediction time, although it did not make their prediction more accurate. Patient education about expectations may be important as patients often expect their wounds to heal faster than they actually do.

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.com Vancomycin-induced bullous dermatosisMartin Minwoo Kim, Katherine Baquerizo, Pranay Srivastava, Deepthi Lankalapalli, Asmat Ullah ABSTRACT Introduction: Linear IgA bullous dermatosis (LABD) is a rare mucocutaneous immune mediated blistering skin disease seen in various countries that have ranged from less than 0.5 to 2.3 cases per million individuals per year. The presentation can be similar to other bullous dermatoses, yet it has distinctive clinicopathologic and immunologic features that allow prompt recognition and treatment with complete resolution. Case Report: A 54-year-old obese Caucasian male with past medical history of atrial fibrillation on warfarin, hypertension, gastroesophageal reflux disease, benign prostatic hyperplasia, and dyslipidemia presented to the emergency department complaining of a generalized blistering rash that initially surrounded the genitalia a week after being discharged from the hospital following a mechanical fall. All medications were reviewed and skin biopsy was taken. He developed the drug-induced variant of LABD to vancomycin with mucosal involvement and compare the resemblance to other autoimmune blistering diseases such as toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome. This case demonstrates complete resolution of the disease with prompt identification of the underlying disease process based on the clinical and immunohistochemistry findings. Conclusion: Linear IgA bullous dermatosis can be difficult to diagnose as it presents similar to other bullous dermatoses. The problem of differential diagnosis coupled with clinicopathologic and immunologic features of LABD are emphasized to recognize this distinct disease.

Laminin alpha5 is a major component of the skin basement membrane underneath the basal layer keratinocytes of epidermis. The alpha chain of laminins has been shown to contain the primary binding sites for cell surface receptors that mediate cell attachment and migration which are two dynamic key events for keratinocytes during wound re-epithelialization. In this study we first evaluated the role of laminin alpha5 in cell attachment and migration in normal human skin keratinocytes using gene knockdown strategy with RNA interference. Laminin alpha5 specific small interfering RNA (La5 siRNA) was used to block its mRNA expression, reverse transcription and polymerase chain reaction (RT-PCR) was used to examine the mRNA expression, and cell attachment and transwell migration assays were performed. The results showed that cells transfected with La5 siRNA, with laminin alpha5 mRNA knock-down, exhibited much decreased ability of attachment by 68% and 47% at 15 and 30 minutes of incubation, respectively. The cell attachment could also be locked by antibody 4C7, which is specific against laminin alpha5, or by antibodies specific to integrin receptors beta 1 and beta 4. Also keratinocytes with laminin alpha5 mRNA knock-down exhibited markedly reduced rate of cell migration by 91 %, 88% and 52% at 6, 12 and 24 hours, respectively. The cell migration could be blocked by antibody specific to beta 1 integrin receptor. We further evaluated the expression of laminin alpha5 in a porcine second-degree burn wound model in vivo. Significant higher expression of laminin alpha5 was seen shortly after burn and throughout the entire 21-day experiment, with peak at day 10, which closely correlated with the wound re-epithelialization and basement reconstitution. Our studies strongly indicate that laminin alpha5 plays important roles in wound re-epithelialization by promoting keratinocyte attachment and migration.