bluuebunny/crossref_metadata_2025 huggingface dataset:
Nuchal fibroma associated with scleredema, diabetes mellitus and organic solvent exposure
Authors: Banney Leith A , Weedon David , Muir James B
Published: March 2003

A case of scleredema diabeticorum of Buschke associated with nuchal fibroma and organic solvent exposure is reported. The patient presented with a neck mass causing discomfort and restriction of movement. Histological examination showed this to be a nuchal fibroma. Additionally, there was widespread induration of the skin of his trunk which was asymptomatic. A biopsy showed features of scleredema. This is the first reported association of these two conditions, both of which show increased and thickened collagen bundles without significant fibroblast proliferation. They differ by the occurrence of mucin in scleredema, although this is not always demonstrable, particularly in late lesions. The possibility that nuchal fibroma is an end stage, localized form of scleredema is canvassed. The patient’s medical history included insulin‐dependent diabetes mellitus with complications of retinal vessel thrombosis and peripheral neuropathy. The patient also had significant past exposure to a wide variety of chemicals, including organic solvents.
Follicular B‐cell pseudolymphoma
Authors: Peretz Eyal , Grunwald Marcelo H , Cagnano E , Halevy Sima
Published: March 2003

A 60‐year‐old woman presented with a 3‐week history of a pruritic papulo‐nodular eruption on the face and trunk after a bee sting. Histological examination showed a predominantly lymphocytic infiltrate with follicular centres and tingible body macrophages. Immunohistochemically, positive staining for both kappa and lambda light chains was noted. The eruption settled with oral antihistamine and topical corticosteroid. These findings support the diagnosis of follicular B‐cell pseudolymphoma.
Allergic contact dermatitis in dentistry
Authors: Rubel Diana M , Watchorn Rosemary B
Published: March 2003

Allergic contact dermatitis (ACD) in dentistry may affect dentists and orthodontists, technicians, nurses and patients. Changes to dental practice in recent years have altered the reported frequencies of allergens causing ACD in both dental personnel and patients. Allergic contact dermatitis to medicaments, metals and glutaraldehyde were previously common allergens in dentistry; however, widespread adoption of rubber gloves by staff has resulted in a significant increase in ACD to glove allergens in both dental staff and their patients, while affording protection against the traditional allergens. Both public concerns about potential toxicity of metals in oral restorations and a greater demand for cosmetic dentistry, have resulted in greater use of acrylics and resins by dental personnel, exposing them to highly allergenic materials. Dermatologists need to be aware of the newer allergenic materials used in dentistry in order to correctly manage skin diseases in this high‐risk group.
Prevalence of delayed hypersensitivity to the European standard series in a self‐selected population
Authors: Greig Jane E , Carson Christine F , Stuckey Martin S , Riley Thomas V
Published: March 2003

There are limited reports of the prevalence of positive reactions in healthy adults to patch tests with standard allergens; there are no recent comprehensive studies from Australia. Healthy adult volunteers (n = 219) from the Western Australian community were patch tested using the European standard series of allergens. Seventy‐seven (35%) reacted to at least one allergen, positive patch tests being most prevalent to nickel sulfate (20%), potassium dichromate (9%), cobalt chloride (6%) and fragrance mix (4%). Prevalence of positive patch tests to nickel and chromate was higher than that reported for another healthy population, which may stem from self‐selection of volunteers or geographical differences, including extent of exposure to allergens.
Steatocystoma multiplex suppurativum: Oral isotretinoin treatment combined with cryotherapy
Authors: Apaydin Rebiay , Bilen Nilgün , Bayramgürler Dilek , Başdaş Füsun , Harova Gökhan , Dökmeci Şeniz
Published: March 2003

A 30‐year‐old man presented with numerous papules, nodules and inflamed cysts. The lesions were located all over the body, including the scalp, except the palms and soles. His mother and one sister had had similar but less extensive lesions. Histopathology of the biopsy specimens obtained from the anterior chest wall, axillae and the back region was consistent with steatocystoma multiplex (SM). A diagnosis of steatocystoma multiplex suppurativum was made. The inflamed lesions were treated with oral isotretinoin (1 mg/kg per daily) for 6 months. At the same time, cryotherapy was used for non‐suppurating lesions smaller than 2 cm. When the patient was evaluated 6 months later, cosmetic results were good. No new lesions have appeared in the subsequent 12‐month follow up.
Permanent alopecia following chemotherapy and bone marrow transplantation
Authors: Tran D , Sinclair Rd , Schwarer Ap , Chow Cw
Published: March 2003

Alopecia can be a psychologically daunting prospect for people requiring cancer chemotherapy. Fortunately, most patients experience only temporary hair loss. We report the case of a 23‐year‐old woman with chronic myeloid leukaemia who developed permanent, near‐total alopecia of her scalp, eyebrows, eyelashes, axillary and pubic hair following busulphan and cyclophosphamide chemotherapy which was used as conditioning prior to allogeneic bone marrow transplantation. The histology from a scalp biopsy revealed hair follicle destruction. Topical minoxidil failed to induce significant re‐growth.
Human immunodeficiency virus‐related primary cutaneous aspergillosis
Authors: Stanford Duncan , Boyle Michael , Gillespie Roderick
Published: March 2003

A 31‐year‐old Caucasian man with AIDS developed a crusted violaceous plaque under adhesive tape near a central venous catheter insertion site. Histological examination demonstrated a ruptured hair follicle containing collections of fungal hyphae typical of Aspergillus spp. A culture of the biopsy material grew Aspergillus fumigatus. The patient responded to removal of the catheter and the occlusive dressing, in addition to itraconazole therapy. Aspergillosis must be considered in the differential diagnosis of cutaneous lesions in human immunodeficiency virus‐infected patients, in particular when the lesion occurs under adhesive tape or an occlusive dressing.
Folliculotropic T‐cell lymphocytosis (mucin‐poor follicular mucinosis)
Authors: Kossard Steven , Rubel Diana
Published: March 2003

A 48‐year‐old man presented with multiple asymptomatic patches of hair loss over his trunk and limbs associated with focal keratotic follicular plugs. Multiple skin biopsies showed a panfollicular lymphocytic infiltrate associated with follicular hyperkeratinization, minimal follicular spongiosis, focal basaloid follicular hyperplasia but no overt follicular mucinosis. The lymphocytes were small and there was no atypia. Immunoperoxidase stains showed that the follicular lymphocytes were T cells and predominantly CD4 positive with HLADr (LN3) expressed on their surface. There were insufficient clinical or histopathological features to make a diagnosis of folliculotropic T‐cell lymphoma. This case currently may be classified best as folliculotropic T‐cell lymphocytosis and may represent a mucin‐poor counterpart of follicular mucinosis. Such cases may pursue an indolent course or may evolve to folliculotropic T‐cell lymphoma, mycosis fungoides or anaplastic lymphoma. The term folliculotropic T‐cell lymphocytosis may be useful for similar cases lacking clinical or histological criteria for lymphoma and lacking follicular mucinosis.
Dermatitis following systemic prednisolone: Patch testing with prednisolone eye drops
Authors: Harris A , McFadden Jp
Published: March 2003

Although positive reactions to topical corticosteroids can occur in over 1% of a patch‐test population, systemic reactions to oral corticosteroids are uncommon. A 45‐year‐old woman who gave a clear history of the generalization of a cutaneous eruption following oral prednisolone was positive on patch testing using prednisolone eye drops.
Skin infections and infestations in Aboriginal communities in northern Australia
Authors: Currie Bart J , Carapetis Jonathan R
Published: March 2003

The most important skin infections in Aboriginal communities in central and northern Australia are scabies and streptococcal pyoderma. Scabies is endemic in many remote Aboriginal communities, with prevalences in children up to 50%. The cycles of scabies transmission underlie much of the pyoderma. Up to 70% of children have skin sores, with group A streptococcus (GAS) the major pathogen. Group A streptococcus is responsible for the continuing outbreaks of post‐streptococcal glomerulonephritis and acute rheumatic fever (ARF). The cycles of scabies transmission in dogs and humans do not appear to significantly overlap. Guidelines have been developed for community control of scabies and skin sores and successful community initiated coordinated programmes have occurred. The anthropophilic dermatophyte Trichophyton rubrum is ubiquitous in many communities, again reflecting living conditions. Other skin infections related to the tropical environment include melioidosis, nocardiosis, Chromobacterium violaceum and chromoblastomycosis. Sustainable and long‐term improvements in scabies, skin sores and GAS‐related disease and tinea require fundamental changes that address social and economic inequities and, in particular, living conditions and overcrowding.
Whiplash rove beetle dermatitis in central Queensland
Authors: Banney Leith A , Wood Dominic J , Francis Glenn D
Published: March 2003

Vesicular dermatitis due to contact with Coleoptera (beetles) is common worldwide, although the condition has been infrequently described in Australia. We document the largest outbreak recognized so far in Australia with a conservative estimate of 250 cases. This occurred in central coastal Queensland over several weeks in late 1998. A survey of the medical practitioners in this district is presented, along with clinical and histopathological illustrations. Our research found that knowledge of the condition was limited even in this region where cases occur each year. This condition is an important differential diagnosis in acute blistering disorders.
Transient reactive papulotranslucent acrokeratoderma associated with cystic fibrosis
Authors: Lowes Michelle A , Khaira Gurpreet Singh , Holt Deborah
Published: March 2003

A 20‐year‐old female with cystic fibrosis presented with a white marginal palmar eruption after exposure to water. There was no family history of keratoderma. A biopsy showed hyperkeratosis around dilated eccrine ostia. These features are similar to a recently described condition, transient reactive papulotranslucent acrokeratoderma. This is thought to be a variant of hereditary papulotranslucent acrokeratoderma, one of the punctate keratodermas. Association with cystic fibrosis has not been described previously.
1,6‐Hexanediol diacrylate: A rapid and potent sensitizer in the printing industry
Authors: Morgan Vanessa A , Fewings John M
Published: March 2003

Printers are exposed to a wide variety of irritants and sensitizers. Allergy developing from a single exposure to any compound is rare. We report two cases of workers in the printing industry who developed allergic contact dermatitis to 1,6‐hexanediol diacrylate (HDDA) within a short period of exposure. The first developed within weeks of exposure to a plastic sheet primed with HDDA. The second developed after a single accidental exposure.
Pemphigus with pemphigoid‐like presentation, associated with squamous cell carcinoma of the tongue
Authors: Wong Kenneth C , Ho Kenneth K
Published: March 2003

A 53‐year‐old woman presented with an inoperable squamous cell carcinoma of the tongue associated with tense large bullae consistent with bullous pemphigoid, preceded by a prodrome of urticarial plaques. The histological findings showed a regenerating subepidermal blister with eosinophils and no acantholysis. Direct immunofluorescence study, however, showed positive staining for IgG and C3 throughout the epidermis consistent with pemphigus. The blistering eruption had no mucosal involvement and responded to low dose corticosteroids. Our patient may represent another presentation of a ‘paraneoplastic pemphigus spectrum’.
Drug‐induced solar urticaria due to tetracycline
Authors: Yap Lee Mei , Foley Peter A , Crouch2 Rohan B , Baker1 Christopher S
Published: March 2003

Solar urticaria is an uncommon disorder characterized by pruritus, erythema and whealing commencing within minutes of exposure to ultraviolet (UV) and visible light, and generally resolves in a few hours. We describe a 28‐year‐old woman who developed pruritus and erythema 5 min after sun exposure while on tetracycline for treatment of perioral dermatitis. Phototesting elicited urticarial reactions in the UVA, UVB and visible spectra. Repeat phototesting after cessation of tetracycline was negative. This report documents the first case of solar urticaria induced by tetracycline.
Epidemiology of cutaneous lupus erythematosus in a tertiary referral centre in Singapore
Authors: Ng Patricia PL , Tan Suat Hoon , Koh Ee Tzun , Tan Tulip
Published: March 2003

The aim of this retrospective study was to investigate the epidemiology, yield of investigations and proportion of patients who develop systemic lupus erythematosus (SLE) among the subsets of cutaneous lupus erythematosus (LE) in the Singapore Asian population. One hundred and twenty‐five patients were diagnosed with cutaneous LE on clinico–pathological correlation, of which 73 had discoid lupus erythematosus (DLE), eight had subacute cutaneous LE (SCLE), 22 had acute LE lesions and the remainder had other less common forms of cutaneous LE. Histology was consistent with LE in 94.4% and suggestive in 4.8%. Direct immunofluorescence was positive in 61% of DLE, 86% of SCLE and 80% of acute LE cases. Antinuclear antibody (ANA) was present in the majority of acute LE (85%) and SCLE (88%) but only in 25% of DLE. Eight patients (11%) presenting with DLE had definite SLE at first presentation and two (2.7%) subsequently several months later. Of these patients, six had only mucocutaneous and serological criteria but two had major organ involvement. Five SCLE patients (63%) fulfilled the criteria for SLE, including two with major organ involvement.
Drug‐related pemphigus and angiotensin converting enzyme inhibitors
Authors: Ong Colin S , Cook Natasha , Lee Stephen
Published: March 2003

A 105‐year‐old woman developed pemphigus foliaceus. She had been on fosinopril, an angiotensin‐converting enzyme inhibitor (ACE inhibitor) for 4 years. Anti‐intercellular cement substance antibodies were positive with titre > 160. She died during admission of an unrelated illness. A 57‐year‐old man developed pemphigus vulgaris after 11 months treatment with quinapril. At 14 months after developing pemphigus, this man continues on prednisone and azathioprine. We speculate that these are cases of ACE‐inhibitor‐related pemphigus and we review ACE‐inhibitor‐related pemphigus.
Keratosis lichenoides chronica: Report of a case developing after erythroderma
Authors: Criado Paulo Ricardo , Valente Neusa Yuriko Sakai , Sittart Jose Alexandre de Souza , Juang Jaqueline Motta , Vasconcellos Cidia
Published: March 2003

A 66‐year‐old male presented with keratosis lichenoides chronica after a presumed drug‐induced erythroderma. After resolution of the erythroderma, slightly scaly erythematous and violaceous papules in a reticular arrangement over the trunk and limbs developed in association with hoarseness, palmoplantar keratoderma, onycholysis and subungual keratosis. Histology from a lichenoid lesion showed pseudo‐epitheliomatous hyperplasia, hyperorthokeratosis, parakeratosis, dyskeratosis, neutrophil exocytosis and focal vacuolar degeneration of the basal layer of the epidermis. There was a band‐like chronic inflammatory infiltrate in the upper dermis. The skin improved with prednisone 40 mg/day for 15 days, leaving atrophic hypopigmented scars. A diagnosis of keratosis lichenoides chronica was made.
Persistent head lice following multiple treatments: Evidence for insecticide resistance inPediculus humanus capitis
Authors: Bailey Anita M , Prociv Paul
Published: March 2003

Viable head lice were found on the scalps of two family members following multiple topical insecticide treatments. The possibility of reinfestation had been reliably excluded. Persistent infestation could be diagnosed only after cutting the hair and combing repeatedly, which allowed visualization of juvenile (nymphal) and adult lice. Insecticide‐resistant headlouse infestations are probably much more common than is generally realised and may persist unnoticed, so that more aggressive approaches will be needed to eradicate these ectoparasites from individuals and communities.
Treatment of ‘angiomas’: A modern commentary
Authors: Rogers Maureen
Published: March 2003

The terminology and classification of vascular birthmarks has been simplified and clarified since 1951. Where treatment is indicated, this also has changed from radiotherapy being the treatment of choice to now having a range of therapeutic options including corticosteroids, α‐interferon, alginate and hydrocolloid dressings, antibiotics, laser and surgery. Another important aspect of the management of haemangiomas is the recognition that certain patterns can be associated with other abnormalities.
PERSONAL REVIEW Expansion techniques after Mohs’ surgery on the face
Authors: Hodgkinson Darryl J , Lam Quoc
Published: March 2003

Mohs’ surgery in the face has established itself as the optimal technique for a high cure rate of basal cell and squamous cell carcinoma occurring in the skin of the face. However, after the resection in Mohs’ surgery, the defects, when extensive, require careful, planned reconstruction in order to produce a good cosmetic result. Although flap reconstruction is available for smaller lesions, larger defects can be covered often by expansion techniques. The expansion technique involves placing a silastic expander of various size and designs underneath the adjacent skin and, over a period of weeks, injecting saline into the expander in order to increase the amount of skin available for future flap reconstruction. This usually represents a two‐stage procedure consisting of the insertion of the expander and, some weeks later, removal of the filled expander when there is sufficient tissue, and using this tissue to reconstruct the initial Mohs’ defect by a flap. When defects are greater than half the aesthetic unit of the face, or greater than one‐third in the forehead, or over 6 cm in the scalp, expansion techniques should be considered for reconstruction.
Dermatomyofibroma: A report of two cases, one occurring in a child
Authors: Mortimore Rohan J , Whitehead Kevin J
Published: March 2003

Dermatomyofibroma is a recently described plaque‐like dermal tumour composed of myofibroblasts that usually presents around the shoulder, axilla and posterior neck, often in young adult females. Here, we present two cases, one from the posterior axilla of a 33‐year‐old female and one from the posterior neck of a 7‐year‐old male. Both were clinically red–brown lesions with histological and immunohistochemical features diagnostic of dermatomyofibroma. There was no evidence of aggressive biologic behaviour with 3 months and 2 months follow up, respectively. While the majority of dermatomyofibromas present in post‐pubescent females, the 7‐year‐old male exemplifies a subgroup occurring in male children which appears to show a particular predilection for the posterior neck.
Mycobacterium abscessus wound infection
Authors: Ozluer Selim M , De'Ambrosis Brian J
Published: March 2003

We report an isolated case of wound infection due to Mycobacterium abscessus following minor cutaneous surgery. The patient had routine skin cancer surgery in a private dermatology practice setting. He presented 2 weeks later with a wound infection which failed to respond to cephalexin. The patient reported that he had walked through salt water and bushes with exposed surgical wounds 1 week postoperatively. Tissue cultures later grew M. abscessus. The patient was successfully treated with oral clarithromycin 500 mg qid of 6 months duration.
Severe cyclical thrombocytopenia in a patient with a large lymphatic–venous malformation: A potential association?
Authors: Wong Li‐Chuen , Rogers Maureen , Lammi Ahti
Published: March 2003

The case is reported of an infant who had a large vascular malformation involving his left arm and axillar. It was initially believed to be purely lymphatic in composition but some venous elements were identified subsequently, at operation. The lesion was unusual in that there was a total absence of skin over one area of it at birth, that it underwent spontaneous shrinkage in the early weeks of life, and that a circumferential scarring developed which led to severe functional disability of the limb. At 12 months of age the patient developed a profound cyclic thrombocytopenia that spontaneously resolved after 1 year. The cause of the platelet cycling is unresolved but might have been secondary to intermittent production by the malformation of a cytokine which was destructive against the platelets.
Mid‐dermal elastophagocytosis presenting as a persistent reticulate erythema
Authors: Bannister Michael J , Rubel Diana M , Kossard Steven
Published: March 2003

Two men are presented with a widespread persistent reticulate erythema concentrated within the chronically sun‐damaged skin on their trunk. A fine papular element was present in one case and both lacked annular lesions. One patient was human immunodeficiency virus positive. Multiple skin biopsies showed an interstitial infiltrate of histiocytes containing multiple elastic fibres in the upper dermis. There was scant perivascular lymphocytic inflammation but no evident necrobiosis or palisaded granulomas seen typically with granuloma annulare. Elastic stains showed focal mid‐dermal elastolysis. Diffuse reticulate erythema in sun‐damaged skin may be a clinical marker for elastophagocytosis. This presentation differs from that previously described with actinic granuloma, diffuse granuloma annulare or the inflammatory phase of mid‐dermal elastolysis and expands the clinical spectrum of this phenomenon.
CONTINUING MEDICAL EDUCATION REVIEW Nail apparatus melanoma
Authors: Thai Keng‐Ee , Young Richard , Sinclair Rodney D
Published: March 2003

Nail apparatus melanoma is a relatively rare variant of melanoma with a disproportionately high mortality when compared with melanoma elsewhere. The aetiology and natural history remain poorly understood. There is no clear epidemiological association with race, skin type or sun exposure. Universally accepted clinical and histological criteria for the diagnosis of early nail apparatus melanoma have not been defined. The two cardinal clinical signs are melanonychia striata and Hutchinson’s sign. These are useful but not pathognomonic of melanoma. Diagnostic delay is frequent and patients commonly have advanced disease at the time of diagnosis. Surgical excision is advocated for treatment of stage I disease; however, the most appropriate re‐excision margins, including the level of amputation where required, have not been determined. Early diagnosis and excision of the tumour is the only treatment known to increase survival. Adjuvant systemic chemotherapy, isolated limb perfusion, and routine elective lymph node dissection have been used, but no survival benefit has been demonstrated.
RESEARCH REPORT Perceptions of acne vulgaris in final year medical student written examination answers
Authors: Green Jack , Sinclair Rodney D
Published: March 2003

Misconceptions exist in the community regarding factors that exacerbate acne vulgaris. In particular stress, diet, lifestyle and personal hygiene are often erroneously claimed to be important factors. In order to investigate whether these common misconceptions persist in medical graduates, we analysed the answers of 215 sixth year medical students, who all subsequently graduated from The University of Melbourne, to a short‐answer question on acne management and exacerbating factors in one of their final year examination papers. With respect to exacerbating factors, 67% of students identified stress, 10% identified lifestyle factors (smoking and alcohol consumption), and 25% claimed poor facial hygiene exacerbated acne. Diet was stated to be an important factor by 41% of students, of whom 12% specifically mentioned chocolate. Persistence of these misconceptions among medical graduates is likely to perpetuate misinformation in the community.
CASE REPORT Subacute cutaneous lupus erythematosus associated with hepatocellular carcinoma
Authors: Ho Covan , Shumack Stephen P , Morris David
Published: March 2003

A 63‐year‐old man with a 4‐year history of metastatic hepatocellular carcinoma secondary to chronic hepatitis B developed a rash affecting his arms, legs, thorax and back. Both clinical and histological examination suggested a diagnosis of subacute cutaneous lupus erythematosus (SCLE). The association of SCLE and hepatocellular carcinoma has not previously been reported. The SCLE persisted without remission and was still present at his death from metastatic hepatocellular carcinoma 3 months later. We also review other reported cases of SCLE as paraneoplastic dermatoses and apply McLean’s criteria for paraneoplastic dermatosis.
CASE REPORT Allergic contact dermatitis to cinchocaine
Authors: Kearney Christopher R , Fewings John
Published: March 2003

A case of allergic contact dermatitis to cinchocaine is presented to highlight the confusion regarding the classification of, and cross‐reactivity between, topical anaesthetic agents and the inadequacy of the use of benzocaine as a single screening agent for topical anaesthetic contact allergy. Our patient presented with a 10‐day history of acute perianal dermatitis. Allergic contact dermatitis to Proctosedyl® ointment, which was applied for 3 weeks prior, was suspected. On patch testing, he reacted to cinchocaine, a constituent of Proctosedyl® ointment, and to the actual product, but had no reaction to benzocaine or lignocaine.
Keratoacanthoma with perineural invasion: A report of 40 cases
Authors: Godbolt Amanda M , Sullivan John J , Weedon David
Published: March 2003

Keratoacanthoma is a unique clinicopathological entity, despite a recent trend to regard it as a variant of squamous cell carcinoma. The occurrence of perineural invasion is an uncommon phenomenon in keratoacanthomas, with a predilection for lesions on the face. We studied a series of 40 cases of keratoacanthoma in which perineural invasion occurred. Of the 40 cases, 27 were from the head or neck region. We found no metastasis or direct death attributable to the presence of perineural invasion in the 35 cases in our series for whom follow‐up data were available. In only one case did local recurrence occur and this was not considered by the authors to be directly attributable to the presence of perineural invasion. These findings add further support to the notion that keratoacanthoma is biologically different from squamous cell carcinoma.
Comparative study of pemphigus vulgaris and pemphigus foliaceus in Singapore
Authors: Goon Anthony Teik‐Jin , Tan Suat‐Hoon
Published: March 2003

This is a retrospective study of all patients diagnosed to have pemphigus in our centre over a 3 year period. The case records of all patients with pemphigus from January 1995 to December 1997 were analysed. Fifty patients were diagnosed to have pemphigus during the study period. The diagnoses were pemphigus vulgaris in 31 patients, pemphigus foliaceus in 16, paraneoplastic pemphigus in two and IgA pemphigus in one. The average titre of anti‐intercellular antibodies in patients with pemphigus vulgaris (1:96) was higher than the titre in patients with pemphigus foliaceus (1:69). The average initial dose of prednisolone required for disease control in patients with pemphigus vulgaris (62 mg/day) was significantly higher than that required for patients with pemphigus foliaceus (44 mg/day). In our study population, pemphigus vulgaris is a more severe and chronic disease than pemphigus foliaceus, as reflected in the higher titre of anti‐intercellular antibodies, higher dose of systemic corticosteroids required for control of the disease, the longer duration to achieve complete remission and longer follow‐up period.
Neutrophilic fixed drug eruption
Authors: Agnew Karen L , Oliver G Fergus
Published: March 2003

A 49‐year‐old man presented with a reproducible, localized amoxycillin–clavulanic acid‐induced eruption. The histopathology from lesional skin revealed a neutrophilic dermatosis. These histological findings have not been reported in previous fixed drug eruptions. A brief review is undertaken comparing fixed drug eruption and the group of neutrophilic dermatoses with our case presentation. We propose a new entity of neutrophilic fixed drug eruption.
Subcutaneous fat necrosis of the newborn following hypothermia and complicated by pain and hypercalcaemia
Authors: Wiadrowski Todd P , Marshman Gillian
Published: March 2003

A female infant was delivered at term with complications of severe meconium aspiration and birth asphyxia. Surface cooling was performed in the first 24 hours as part of the management of her birth asphyxia. Woody erythema was noted at 24 hours, followed by the formation of red–purple nodules on the 6th day. Clinical findings in the first 24 hours were suggestive of cold panniculitis. However, clinical and histological findings progressed to be in keeping with the diagnosis of subcutaneous fat necrosis of the newborn (SCFN). Furthermore, the immediate postnatal period was complicated by pain resistant to treatment with opiates. Asymptomatic hypercalcaemia was noted on periodic testing at 7 weeks and treated by rehydration, diuretics, prednisolone, etidronate and a low‐calcium and ‐vitamin D diet. A review of the clinical and histological findings of the relevant panniculitides occurring in the postnatal period is presented, as well as a review of the treatment of hypercalcaemia in SCFN.
Vulval disease in pre‐pubertal girls
Authors: Fischer Gayle O
Published: March 2003

Children present with vulval complaints less frequently than do adults; although there are many similarities between paediatric and adult groups of patients with vulval disease, there are also important differences. In both groups, dermatitis, psoriasis and lichen sclerosus are the most frequently seen dermatoses. Birthmarks and congenital abnormalities presenting for the first time are more of an issue in children than in adults. Fusion of the labia and streptococcal vulvovaginitis are conditions seen only in the paediatric group. Sexually transmitted diseases such as genital warts and genital herpes are not common in this group and should always raise the possibility of child sexual abuse. Chronic vulvovaginal candidiasis, although a very common problem in adult patients, is not seen in the prepubertal group.
Accuracy and reliability of store‐and‐forward teledermatology: Preliminary results from the St George Teledermatology Project
Authors: Lim Adrian C , Egerton Ian B , See Adrian , Shumack Stephen P
Published: March 2003

Teledermatology is the practice of dermatology across distances (and time) and involves the transfer of electronic information. To be effective and safe, the teledermatology process needs to demonstrate an acceptable level of accuracy and reliability. Accuracy is reflected by the degree of concordance (agreement) between the teledermatology and face‐to‐face diagnoses. Reliability is dependent on how consistently a set of results can be reproduced across different operators. Mean concordance (primary diagnoses) achieved by four dermatologists studying 53 store‐and‐forward diagnostic cases, originating from 49 referred patients, was 79% (range 73–85%). When the differential diagnoses were taken into account, the variation across individual dermatologists narrowed further, with a mean of 86% (range 83–89%). In contrast, the mean general practitioner (GP; n = 11) concordance (GP face‐to‐face vs reference dermatologist store‐and‐forward diagnoses) was 49%. An interim review of all 49 teledermatology patients showed no adverse outcome at the end of 3 months. The ability to request face‐to‐face visits by dermatologists, combined with GPs maintaining primary care of the referred patient, serve as additional safeguards for patients using a telemedicine system. Our results indicate that teledermatology management of referred skin complaints is both accurate and reliable.
Collarette scaling in pityriasis rosea demonstrated by digital epiluminescence dermatoscopy
Authors: Chuh Antonio AT
Published: March 2003

Collarette scaling is a characteristic sign in pityriasis rosea. The use of digital epiluminescence dermatoscopy is proposed to assist in the recognition of this sign as this technique can magnify the lesions, eliminate other epidermal changes, and demonstrate the morphology and direction of scaling.
Review of neurological manifestations in 196 patients with sebaceous naevi
Authors: Davies Derek , Rogers Maureen
Published: March 2003

The incidence of neurological abnormalities in patients with sebaceous naevi may not be as high as has been previously accepted. One hundred and ninety‐six patients with epidermal naevi of the sebaceous type were examined for clinical neurological abnormalities. Ninety‐three per cent of these patients were neurologically normal on examination. Extensive naevi were present in 21% (3/14) of patients with neurological abnormalities and in 5% (9/182) of those without. A centrofacial location of the naevus was found in 21% (3/14) of patients with abnormalities and in 2% (4/182) of neurologically normal patients. A surprising finding was the low yield of abnormalities from neuroimaging in the patients with clinical neurological abnormalities. Imaging was performed in eight of the 14 and was normal in six patients. Despite the lower than expected rate of associated abnormalities and the low yield of abnormal findings from imaging, it is strongly recommended that all patients with sebaceous naevi have a detailed neurological assessment and that imaging be performed on all those in whom clinical abnormalities are demonstrated, as well as on those patients with large naevi involving the centrofacial area.
A granuloma annulare‐like eruption associated with the use of amlodipine
Authors: Lim Adrian C , Hart Kim , Murrell Dédée
Published: March 2003

A granuloma annulare‐like drug reaction is a rarely encountered clinical entity. A 64‐year‐old Caucasian female developed a granuloma annulare‐like reaction 13 days after starting amlodipine and cleared within 3 months after drug cessation. The eruption consisted of multiple erythematous pruritic papules, distributed symmetrically over the lateral aspects of the legs and thighs, as well as on both palms. Histology showed focal collagen degeneration and significant interstitial histiocytic dermal infiltrate suggestive of granuloma annulare. We review previously reported cases of granuloma annulare‐like drug reactions, in the context of a recently proposed classification for drug‐induced interstitial granulomatous reactions.
Epidermolysis bullosa simplex Dowling–Meara due to an arginine to cysteine substitution in exon 1 of keratin 14
Authors: Premaratne Champi , Klingberg Sandra , Glass Ian , Wright Kellie , Murrell Dédée
Published: March 2003

Epidermolysis bullosa simplex (EBS) is a blistering disorder affecting the basal layer of the epidermis usually inherited in an autosomal dominant fashion. Most cases are caused by mutations in the genes encoding keratin 5 (K5) and keratin 14 (K14) and are characterized by cytolysis within the basal layer of the epidermis. We report a patient manifesting the Dowling–Meara variant of EBS in whom we characterized a cytosine to thymine transition at codon 125 (R125C) in K14. This missense mutation is located at the amino terminus of the helical rod domain of the keratin 14 molecule, resulting in defective pairing with K5, thereby disrupting keratin tonofibril integrity.
Two unusual cases of toxic epidermal necrolysis
Authors: Yung Anthony , Agnew Karen , Snow John , Oliver Fergus
Published: March 2003

Two cases of toxic epidermal necrolysis (TEN) are presented. A 27‐year‐old woman presented with peripherally located targetoid plaques, papules, blisters and lip erosions which began 9 days after ‘recreational’ use of ‘speed’ (dexamphetamine and ephedrine) consistent with erythema multiforme major. Three days later she developed widespread lesions with large areas of blistering affecting 40% of body surface area. The diagnosis was revised to TEN. Intravenous cyclosporin led to rapid prevention of new blister formation. A 71‐year‐old woman, 3 months after commencing amiodarone, developed extensive erythema, blistering and erosions affecting 50% of body surface area, with a maculopapular rash affecting the limbs and extremities consistent with a diagnosis of TEN. She developed septicaemia following bilateral pneumonia with pleural effusions and died 7 days after admission.
Primary cutaneous zygomycosis due to Mucor circinelloides
Authors: Chandra Suresh , Woodgyer Alan
Published: March 2003

A 62‐year‐old woman with myelodysplastic syndrome presented with a 4‐week history of a large indurated ulcer with a black eschar on the forearm following trauma. On biopsy a diagnosis of zygomycosis was made as broad, sparsely septate, thin‐walled hyphae were seen in the deep dermis and subcutaneous fat. The zygomycete fungus Mucor circinelloides was cultured from tissue. Further investigation confirmed that the infection was localized to the skin. The 6 × 4 cm lesion was excised and the defect closed with a neurovascular island flap. No other treatment was undertaken. The patient died 6 months later from her haematological disease without recurrence of the fungal infection.
Multiple hereditary glomangiomas: Successful treatment with sclerotherapy
Authors: Parsi Kurosh , Kossard Steven
Published: March 2003

Glomangiomas are characterized by cavernous vascular channels surrounded by glomus cells. Multiple glomangiomas, although usually painless, can be a few centimetres in size and appear as blue phlebectatic lesions. Surgical excision of multiple glomangiomas can lead to scarring and recurrences. Laser treatment using vascular lasers and CO2 lasers has been useful in small, superficial lesions. We present the successful sclerotherapy treatment of multiple glomangiomas using sodium tetradecyl sulphate in a 59‐year‐old man who presented with postoperative recurrence of multiple lesions.
Subacute cutaneous lupus erythematosus presenting in a child
Authors: Ciconte Antoinette , Mills Alan E , Shipley Andrew , Marks Robin
Published: March 2003

A 5‐year‐old girl presented in summer with an erythematous, scaly annular eruption in a malar distribution. She had no symptoms or signs of systemic lupus erythematosus. A diagnosis of subacute cutaneous lupus erythematosus was made on the basis of the clinical and histological features, positive anti‐Ro antibody and a mildly elevated erythrocyte sedimentation rate. All other investigations, including complement studies, were normal. She has responded well to treatment with 0.5% alclometasone ointment and photoprotection.
Congenital annular erythema persisting in a 15‐year‐old girl
Authors: Wong Li‐Chuen , Kakakios Alyson , Rogers Maureen
Published: March 2003

We present a 15‐year‐old girl who has had a persisting extensive annular erythematous eruption since birth. Otherwise, she is healthy and developmentally normal. Multiple investigations throughout the years have been normal or negative. Numerous treatments have been tried, but with little success. Both clinical and histological examination fit no known classification. It is most consistent with annular erythema of infancy but could be the first reported case of a new entity. A review of other causes of annular erythema in infancy is presented.
Basal cell carcinoma of the lip treated with radiotherapy
Authors: Huynh Nghi T , Veness Michael J
Published: March 2003

Basal cell carcinoma (BCC) of the lip is uncommon relative to other cutaneous sites for BCC, such as the central face or scalp. A female predisposition and predilection for the upper lip have been previously documented. A retrospective analysis of patients treated for BCC of the lip was undertaken within the department of Radiation Oncology, Westmead Hospital, Sydney. Twenty patients were identified; 12 women and 8 men. The majority (15/20) had T1 lesions of the upper lip (17/20). Eleven patients were referred for radiotherapy alone and nine for adjuvant radiotherapy following either incomplete excision or local recurrence. With a mean follow up of 36 months no patient has recurred following either definitive or adjuvant radiotherapy. Despite the majority of BCCs of the lip being amenable to surgery fractionated external beam radiotherapy remains an option especially when functional and/or cosmetic concerns are an issue. We present the findings from this small case series and use our findings to illustrate the role of radiotherapy in treating BCC of the lip.
Frontal fibrosing alopecia associated with cutaneous lichen planus in a premenopausal woman
Authors: Faulkner Catherine F , Wilson Niall J , Jones Stephen K
Published: March 2003

A 45‐year‐old premenopausal woman presented with an 18‐month history of a band‐like area of fibrosing alopecia affecting the frontoparietal scalp. She also had marked thinning of the eyebrows. The histopathology was consistent with frontal fibrosing alopecia (FFA). Several months later she developed multiple pruritic papules on the wrists and feet. The clinical presentation and histopathology were consistent with cutaneous lichen planus. Although FFA has been reported to occur with mucosal lichen planus this is the first reported case of FFA associated with cutaneous lichen planus. This provides further evidence that FFA is a variant of lichen planopilaris.
Acral pityriasis lichenoides
Authors: Kossard Steven
Published: March 2003

Two patients presented with acrally located papulosquamous lesions that were polymorphic and had an identical morphology to those of pityriasis lichenoides. The lesions remained localized to the feet and ankles for years. Multiple skin biopsies had the histopathological features of pityriasis lichenoides. In one biopsy syringotropic lymphocytes and early syringolymphoid hyperplasia were observed.

This rare variant of pityriasis lichenoides may be under‐recognized and misdiagnosed as it resembles a variety of papulosquamous disorders particularly psoriasis.
Idiopathic calciphylaxis
Authors: Banky Jeremy P , Dowling John P , Miles Campbell
Published: March 2003

A 68‐year‐old woman presented with a painful necrotic ulcer on her right calf and necrotic breakdown of a left below‐knee amputation stump as a result of calciphylaxis. No cause could be identified and corrected. Treatment comprised wound care, substituting low molecular weight heparin for warfarin, hyperbaric oxygenation and etidronate disodium, none of which were helpful and major limb amputations were considered the best option for this patient.
Multicentric reticulohistiocytosis presenting with a rash and arthralgia
Authors: Hiramanek Navaz , Kossard Steven , Barnetson Ross StC
Published: March 2003

A case of multicentric reticulohistiocytosis in a 53‐year‐old woman with a history of generalized cutaneous eruptions followed by arthralgia is presented. A thorough malignancy screen was performed with negative results. Treatment was commenced with oral prednisone 20 mg daily, which rapidly resulted in marked improvement of joint symptoms and resolution of self‐perceived functional disability. As there was little improvement of her rash, oral azathioprine was added at 100 mg daily. Both drugs were well‐tolerated and the patient was discharged from hospital on these medications. Two months later the azathioprine was reduced to 50 mg per day orally, following a small rise in hepatic transaminases. Within 4 months there had been dramatic improvement in the rash and cutaneous nodules with complete remission of the arthralgia and pruritus. During this time the oral prednisone had gradually been decreased to 10 mg daily. To date only the periungual nodules persist.
Survey of phototherapy practice by dermatologists in Australia
Authors: Huynh Nghi T , Sullivan John R , Commens Christopher A
Published: March 2003

A postal survey was sent to all dermatologists in Australia to determine current phototherapy practices. Questionnaires were returned by 158 (57%) of 277 dermatologists, of whom 112 (71%) provided phototherapy. Large variations existed in attitudes and practice, including indications, contraindications, dosage schedules, equipment maintenance, response to adverse events, and follow‐up arrangements. Cumulative ultraviolet (UV) doses for psoralen and UVA (PUVA) were not calculated by 21%, while 30% did not calculate cumulative doses for UVB. Written informed consent was not obtained by 32%. Phototherapist dermatologists reported 25 patients developing melanoma following PUVA. Only 30% of Australian dermatologists organize regular follow up of patients after phototherapy.

Australians have the highest rates of melanoma and non‐melanoma skin cancers in the world, because of their ancestry and high solar exposure. This makes it inappropriate for Australian dermatologists to rely entirely on foreign safety data when assessing the risks and benefits of phototherapy in Australian patients. There is a need for standardized Australian guidelines that can be prospectively assessed to ensure phototherapy is used to maximize efficacy and minimize risks in Australian patients, given their unique ancestral mix and outdoor lifestyle.
Fatal group A streptococcal necrotizing fasciitis and toxic shock syndrome in a patient with psoriasis and chronic renal impairment
Authors: Chong Alvin H , Burrows Nigel P
Published: March 2003

A 78‐year‐old woman presented with rapid onset of skin pain which evolved into oedema, discoloration and infarction. She was diagnosed with group A β‐haemolytic streptococcus (Streptococcus pyogenes) necrotizing fasciitis and streptococcal toxic shock syndrome. The patient had a past history of psoriasis and end‐stage renal impairment. Despite treatment with multiple antibiotics in an intensive care unit, the skin infarction involving the upper trunk continued to expand and the patient died within 24 hours of hospital admission. Group A streptococcus and Staphylococcus aureus were cultured from a tissue biopsy. Renal failure and compromised skin barrier function are known to predispose to invasive streptococcal infections, but necrotizing fasciitis has only rarely been reported in association with psoriasis. This case illustrates the fulminant nature of the infection.
Staphylococcal scalded skin syndrome complicating acute generalized pustular psoriasis
Authors: Sharkey Michael P , Muir James B
Published: March 2003

A 60‐year‐old woman with psoriasis vulgaris treated with oral cyclosporin and acitretin developed an acute generalized pustular eruption with erythema and associated fever consistent with acute generalized pustular psoriasis. She was admitted to hospital and, despite intravenous fluid replacement, developed acute renal failure. In addition, she developed staphylococcal septicaemia. After transfer to the intensive care unit because of deteriorating renal function, a sudden onset of widespread flaccid blistering (Nikolsky sign positive) and superficial erosions was noted. Histology of a biopsied blister revealed subcorneal splitting of the epidermis consistent with staphylococcal scalded skin syndrome. The patient was treated with intravenous dicloxacillin and the blistering gradually improved over 10 days.