We report two patients who developed intense livedo reticularis clearly related to the administration of interferon alpha 2b as an adjuvant therapy for melanoma. Histological studies showed scattered perivascular infiltrates without vasculitis. Laboratory tests excluded any underlying condition. Resolution of the symptoms was observed in both patients when interferon alpha was withdrawn. These cases highlight the occurrence of livedo reticularis as an uncommon side-effect of interferon alpha treatment.
Laugier-Hunziker syndrome (LHS) is a rare disorder characterized by melanotic pigmentation of the mouth and lips which is frequently associated with longitudinal melanonychia. Laugier and Hunziker described lenticular melanotic pigmentation of the oral cavity and lips in 1970. 1 Some cases have been described in which the neck, thorax, abdomen, fingers and soles have been involved. Fingernails are more frequently involved than the toenails. 2 Melanonychia may also be seen with or after lichen planus (LP). 3,4 We report a case of LHS associated with actinic LP.A 37-year-old Turkish woman was referred to our clinic with melanotic macules on the face, a pruritic annular plaque on the malar area of her face and hyperpigmented streaks on her nails, which had appeared for 19 years, 10 months and 6 years, respectively.Examination revealed the patient's pigmented macules on the lips, gums, buccal mucosa and midline of the hard palate ( fig. 1a). There were melasma and pinkish annular plaque, with a hyperpigmented centre ( fig. 1b). There were longitudinal melanonychia on her fingernails ( fig. 1c) and toenails. Hyperpigmented slate-grey to brown macular lesions were seen over her back. Examination of intertriginous areas did not reveal any evidence of acanthosis nigiricans. The skin phototype according to Fitzpatrick's scale was IV.Results of routine laboratory tests were within normal ranges, including triiodothyronine (T3), thyroxine (T4) and thyrotropin (TSH). The patient had smoked for 20 years. Her mother had melasma. Histopathological examination of pigmented macula on the buccal mucosa showed an accumulation of melanin in the cells of the basal layer of the acanthotic epidermis and an increased number of melanophages in the upper dermis ( fig. 2). Histopathologically, there was thinning of the epidermis with vacuolar alteration of the basal layer, an artifactural cleft between the epidermis and the lichenoid infiltrate and pigment incontinence in the upper dermis on the annular lesion over the cheek (fig. 3).Since the first description by Laugier and Hunziker, many cases of LHS have been reported. 2,[5][6][7] In this syndrome, the essential lesions are manifested as lenticular-pigmented macules, which have different colours (from grey to brown to blueblack) and a smooth surface. Generally symptoms are absent. The most common sites are the lips (especially the lower lip) and the oral cavity (buccal mucosa and hard palate). Other sites such as labial comissure, the gums the floor of the mouth and the tongue are less frequent. Other locations such as the abdomen and the fingers have been involved. Fingernail involvement can present as a single longitudinal 1-2-mm-wide streak or as a double 2-3-mm-wide longitudinal streak on the lateral parts of the nail plate, as a homogeneous pigmentation of the radial or ulnar half of the nail, and complete pigmentation of the nail. All four types of nail involvement may simultaneously involve one or more nails of the fingers and /or toes. 2 fig. 1 (a) Multiple pigmented macules lo...
Atrial myxoma is the most common primary tumour of the heart. Skin manifestations in patients with a cardiac myxoma are frequent and may be due to cutaneous emboli, or may be specific findings as part of more complex syndromes. We present a 33-year-old-man with a history of episodes of pain in both legs and an ischaemic neurological event, who also had episodes of acral papular erythematous lesions on the legs and feet including the soles. The histological finding of dermal vessels occluded by a myxomatous material was the clue to the diagnosis of a cardiac myxoma. The diagnosis of this entity can be very difficult, because of the broad spectrum of clinical features; rarely the skin manifestations lead to the diagnosis of this tumour. The histological recognition of the myxomatous emboli is of vital importance for the diagnosis and treatment of this disease.
Pityriasis rosea (PR)-like eruptions have been associated with several neoplasms and drugs. These eruptions may be atypical. To date, the association of Hodgkin's disease with PR-like eruptions has rarely been reported. We report a 37-year-old patient with clinical lesions of PR-like, systemic symptoms and lymphadenopathies, who was subsequently diagnosed with Hodgkin's disease.
Topical testosterone has been used as a treatment for different vulvar conditions. It is usually well tolerated, although hirsutism and other signs of virilization have been described related to hormonal tests alteration. We report two female patients with vulvar diseases that developed hirsutism after treatment with topical testosterone. Because of its potential virilization, females under this treatment should be closely monitored.
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