The high prevalence of atopic dermatitis in Singapore is similar to that observed in developed countries, suggesting that environmental factors may be important in determining the expression of the disease.
Pyoderma gangrenosum is an uncommon ulcerative skin disorder that is often associated with underlying systemic diseases, the most common of which is inflammatory bowel disease. We report an illustrative case of a 36-year-old woman with pyoderma gangrenosum occurring at surgical sites and at sites of trauma. She had associated Crohn disease. Multiple surgical procedures were performed on this patient, without improvement. Pyoderma gangrenosum can mimic a necrotizing soft tissue infection. Early recognition of the characteristic lesion may prevent unnecessary operations and facilitate effective control with appropriate medical therapy.
A 4-tiionth-old white male infant was referred for evaluation of an asymptomatic nodule on the right palm which was present sitice birth. The parents had heen advised that this lesion would disappear, but instead it had grown rapidly over the previous 2 months. He was the product of a nonnial-tenm gestation and there was no family history of similar skin lesions. He was otherwise healthy.On physical examination, there was a 3-cm diameter red, hard, nontender dermal and subcutaneous nodule on the righl palm (Fig. 1). Overlying this was a 1.5-cm by 1-cm slightly compressible, cystic component. The lesion was mox'able atid did nol appear to be fixed to the underlying tissue. No other masses were seen and the rest of the physical examination was nonnal.An incisional biopsy .specimen was obtained and the histopathology is .shown in Figs. 2 and 3.
WHAT IS YOUR DIAGNOSIS?Figure 2. Histopathology of the lesion.Figure 1, Asymptomatic nodule on the right palm.
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