A 4-month-old male infant developed pneumonitis following a prolonged exposure to tear gas (CS or orthochlorobenzylidene malononitrile). The patient had a persistent leukocytosis (white blood cell count 20,000 to 30,000/cu mm) with predominance of lymphocytes on peripheral blood smear and had a slow resolution of the pneumonitis radiologically. A discussion of the toxicity of the two most widely used tear gases\p=m-\chlo-roacetophenone (CN) and CS\p=m-\onthe respiratory system indicates that both agents are capable of inducing severe clinical toxicity dependent upon the concentration of the gas.Tear gases which have been used by local law enforcement agencies in the United States for many years are now being used more frequently. The two tear gases most commonly used are chloroacetophenone (US Army designation CN) and orthochlorobenzylidene malononitrile (US Army designation CS). Recently an infant of 4 months of age who was exposed to CS tear gas for a pro¬ longed duration developed pneu¬ monitis and was hospitalized. Report of a CaseA normal four-month-old white infant was exposed to CS gas for two to three hours. He was kept in a house into which police fired CS tear gas canisters in order to subdue a disturbed adult. Immediately upon being taken from the house, the pa¬ tient was seen in the emergency room. He was initially observed to have copious na¬ sal and oral secretions, sneezed and coughed frequently, and required suctioning to relieve upper airway obstruction. On physical examination, the infant was irri¬ table; there were watery secretions in the nose and throat, but there was no cyanosis or skin erythema. Temperature was 98 F (36.8 C) rectally; there were 26 respirations per minute, and pulse rate was 166 beats per minute. His conjunctivae were slightly injected. The lungs were clear to ausculta¬ tion and percussion. The heart rate was in¬ creased but regular and there was no mur¬ mur or abnormal sound on auscultation. The abdomen was distended but there was no visceromegaly or mass. Findings on neurological examination were within nor¬ mal limits. The following laboratory data were obtained: hemoglobin level, 8.6 gm/100 ml; hematocrit value 27.5%; and white blood cell count, 47,000/cu mm; with 64% segmented neutrophils, 23% band forms, 9% lymphocytes, and 3% monocytes. Electrolytes were normal. The blood urea nitrogen value was 21 mg/100 ml; serum glutamic oxaloacetic transaminase value 32 units/100 ml (normal, 8 to 40 units); and lactic dehydrogenase value, 860 units/100 ml (normal, less than 500 units). The chest roentgenogram on admission was clear. An ECG was within normal limits. On the sec¬ ond hospital day, the child had an episode of cyanosis which improved following suctioning. Examination revealed the infant to be in severe respiratory distress with suprasternal retraction and grunting res¬ pirations. There were wheezes and rales bilaterally in the posterior lung fields. The skin in the malar region now had devel¬ oped the changes of a first-degree burn. The liver was palpable 4 cm below t...

Background: Pruritus is a common symptom in psoriasis. However, few studies have assessed the characteristics of pruritus according to morphological phenotypes of psoriasis. Objective: To investigate the characteristics of pruritus according to morphological phenotypes of psoriasis and to assess the association with inflammatory mediators related to pruritus. Methods: Psoriasis patients were divided into 2 groups according to clinical phenotype: eruptive inflammatory (EI) and chronic stable (CS). Clinical data of pruritus were assessed by an itch questionnaire. Serum neuropeptides and cytokines including substance P, histamine, vasoactive intestinal peptide, neuropeptide Y, calcitonin gene-related peptide and interleukin-31 (IL-31) were quantitatively measured. Results: In total, 50 patients with psoriasis (30 male, 20 female; mean age, 45.7 years) were studied (EI, n=15 and CS, n=35). Pruritus was reported by 80% of EI and CS patients. There were no significant differences in prevalence of pruritus, pruritus intensity, severity of psoriasis, serum neuropeptides, or IL-31 between the 2 groups. Conclusion: The morphological phenotype does not seem to be an important factor affecting the prevalence and characteristics of pruritus in psoriasis. (Ann Dermatol 32(1) 1∼7, 2020

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Background Pigmented fungiform papillae of the tongue (PFPT) is a rare benign pigmentary disorder of the tongue. In dark-skinned individuals, PFPT appears to be relatively common. However, limited data exist on PFPT in Korean patients. Objective We aimed to investigate the clinical characteristics of PFPT in Korean patients. Methods Patients diagnosed with PFPT between 1995 and 2021 at the Pusan National University Hospital were included. Clinical characteristics of PFPT, dermoscopic findings, and comorbidities were reviewed. Results A total of 19 patients diagnosed with PFPT were enrolled. The male to female ratio was approximately 1:5. The mean age at diagnosis was 41.1 years (range, 8~67 years). According to Holzwanger’s classification, Type I was the most common (89.5%). PFPT was commonly concomitant with pigmentary disorders, including mucosal melanotic macules, Laugier-Hunziker syndrome, melasma, and melanonychia (6/19, 31.6%). Preceding oral infection or inflammatory lesions were found in four patients (21.1%), and systemic diseases and infectious diseases existed in two patients (10.5%). Dermoscopic examination was performed in seven patients; pigmented border with dichotomized vessels (rose petal pattern, 71.4%) and diffuse pigmentation (cobblestone pattern, 71.4%) were common findings. Conclusion Our study shows PFPT can coexist with pigmentary disorders. Concomitant pigmentary disorder shows an association with sex hormone or susceptibility to abnormal pigmentation may be a possible cause of PFPT.

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