bluuebunny/crossref_metadata_2025_split huggingface dataset:
Traumatic Transverse Leukonychia
Authors: LCDR Kimberly L. Maino , LCDR Mitchell E. Stashower 
Published: June 2007

A 24‐year‐old white male presented with a 2‐year history of changes to his nails. He stated that the white discoloration had never completely resolved but improved from time to time with the nails appearing to “grow out normally.” He complained of intermittent tenderness at the lateral and proximal nail folds from occasional “infections” that he characterized as increased redness and pus. He worked as an administrative supervisor in a machine shop and he rarely was exposed to cutting oils. Hobbies included mechanical work on his car. The patient had a several‐year history of anxiety symptoms that caused interruption of his sleep patterns. He admitted to biting his fingernails and to tapping his fingernails repeatedly on flat surfaces like a desk on most days. He admitted to constantly picking at the proximal nail fold and hyponychium of the involved fingers. The patient did notice worsening of his fingernails during stressful periods in his life. Past medical history was otherwise negative. He denied medications including chemotherapy and underlying illnesses including thyroid disease. Review of systems was negative. There was no evidence of liver or renal disease. No history of possible arsenic exposure. Family history was negative for skin and nail disease. On physical exam, the patient appeared anxious but otherwise normal. He was directly observed tapping his nails on the armrest of the chair and picking at his nails during the exam. Patient otherwise had normal teeth, hair, and skin. On exam of the nails, multiple transverse white curvilinear bands were noted. The bands were separated by normal pink nail color (Figure 1). The proximal, distal, and lateral nail folds were noted to be slightly erythematous, frayed, and jagged (Figure 2). The cuticle was noted to be frayed and almost absent. The distal nail plate was ragged on the right nail. No frank signs of infection could be appreciated. Potassium hydroxide test was negative. The patient was referred to psychiatry to manage the anxiety symptoms. Multiple transverse bands of white discoloration noted to involve almost all nails image Close‐up view of thumbnails; notice ragged proximal, lateral, and distal nail folds and slight erythema but no frank infection image
Follicular Mycosis Fungoides: Variability of a Rare Entity
Authors: Roeschm Alexander , Schleyer Verena , Landthaler Michael , Vogt Thomas 
Published: June 2007

Objective. Three patients with follicular mycosis fungoides (FMF), a rare variant of folliculotropic cutaneous T‐cell lymphoma, are discussed. Follicular involvement in cutaneous T‐cell lymphoma commonly presents clinically with alopecia, follicular cysts, or comedo‐like lesions usually associated with follicular mucinosis and strong epidermotropism. In contrast, FMF, in a strict sense, has been defined as a lymphocytic infiltration of hair follicles in the absence of both epidermal invasion and follicular mucin. Discussion. Case 1 shows a clinically stable form of FMF characterized by circumscribed alopecia and its persistent resistance to topical therapeutic approaches. In contrast, Cases 2 and 3 demonstrate that classic mycosis fungoides lesions and FMF can occur simultaneously and that transitions occur from mycosis fungoides to FMF and vice versa. These observations strengthen the concept that FMF and mycosis fungoides represent just two variants of one entity of cutaneous T‐cell lymphoma. In Case 3, rapid progression into tumor‐stage mycosis fungoides and the follicular infiltration was controlled with bexarotene. Conclusions. Because it was previously suggested that FMF may have a worse prognosis compared with classic mycosis fungoides, this impressive response to bexarotene is of great clinical interest and may spark new studies employing this novel retinoid for FMF treatment.
Lupus Miliaris Disseminatus Faciei Part I: Significance of Histopathologic Undertones in Diagnosis
Authors: Virendra N. Sehgal , Govind Srivastava , Ashok K. Aggarwal , Vishwanath Reddy , Sonal Sharma 
Published: June 2007

Background. Since its clinical discovery, lupus miliaris disseminatus faciei has sporadically been reported to have different modes of clinicopathologic expression.
Objective. The purpose of this study was to work up a list of histopathologic undertones and to project and propagate lupus miliaris disseminatus faciei as an exclusive entity. An upcoming Part II of this study will present an overview of the disease.
Methods. All patients visiting the outpatient clinic conforming to hitherto accepted clinical features were included to study patients' age and sex, duration of the disease, and above all, conduct a detailed histopathology review. Using the detailed information obtained, an endeavor was made to organize the disease into early, fully developed, and late lesions.
Results. The details of the various parameters were of great help in evolving this modus operandi. The clinical as well as histopathologic features of lupus miliaris disseminatus faciei are fairly distinct and facilitate visualizing the entity as a spectrum comprising early, fully developed, and late lesions. Further studies are called for.
Patch Testing: A Retrospective Analysis of 103 Patients With Emphasis on Practical Aspects for the Clinician
Authors: Mohammad Al‐Helalat , Cohen Steven , Hadi Suhail 
Published: June 2007

Background. Allergic contact dermatitis is a common dermatologic disorder caused by small chemical molecules that can penetrate the skin barrier. Thousands of chemicals capable of inducing allergic contact dermatitis have been identified. To cure allergic contact dermatitis, the allergen should be identified and eliminated from the environment of the patient. Patch testing, utilizing a variety of standard panels of the most frequent allergens, is used to identify the allergen in question. Patch testing is still the gold standard tool used to identify one or more substances that may contribute to the etiology of allergic contact dermatitis.
Objective. To determine the frequency of patch test positivity and to identify the most common allergens in patients with suspected allergic contact dermatitis.
Methods. A retrospective analysis of files of 103 patients who have been clinically diagnosed to have allergic contact dermatitis and have been patch tested using a standard technique with a Northern American Contact Dermatitis Group series.
Results. Sixty‐two patients (60.2%) showed positive reactions to one or more substance. The most common allergens were nickel sulfate, fragrance mix, and neomycin sulfate. There was an increased frequency of positive reactions to fragrance mix and a significant decrease of frequency of thimerosal positive reactions.
Conclusions. Increased awareness of allergens and their potential sources may help to limit the usage of these chemicals in manufacturing consumer products. This may have contributed to decreased prevalence rates of certain allergens such as thimerosal and paraphenylenediamine.
Inoculation Herpes Barbae
Authors: LCDR Eric C. Parlette , LCDR James M. Polo 
Published: June 2007

A 21‐year‐old white man in otherwise excellent general health was referred for a painful, progressive, facial eruption with associated fever, malaise, and cervicofacial lymphadenopathy. The patient reported that a vesicular eruption progressed from the left side of his face to also involve the right side of his face over the 48 hours preceding his clinic visit. He also reported some lesions in his throat and the back of his mouth causing pain and difficulty swallowing. Four to 7 days before presentation to us, the patient noted exposure to his girlfriend's cold sore. Additionally, he complained of a personal history of cold sores, but had no recent outbreaks. Physical examination revealed a somewhat ill man with numerous vesicles and donut‐shaped, 2–4 mm, crusted erosions predominantly on the left side of the bearded facial skin. There were fewer, but similar‐appearing lesions, on the right‐bearded skin. The lesions appeared folliculocentric (Figure). Cervical and submandibular lymphadenopathy was present. Oral exam showed shallow erosions on the tonsillar pillars and soft palate. Genital examination was normal. The remainder of the physical exam was unremarkable. A Tzanck smear of vesicular lesions was positive for balloon cells and many multinucleated giant cells with nuclear molding. A viral culture was performed which, in several days, came back positive for herpes simplex virus. The complete blood cell count documented a white blood cell count of 8000/mm3 with 82.6% neutrophils and 9.0% lymphocytes. Based on the clinical presentation and the positive Tzanck smear, the patient was diagnosed with herpes simplex barbae, most likely spread by shaving. The patient was started on acyclovir 200 mg p.o. five times daily for 10 days. Oxycodone 5 mg in addition to acetaminophen 325 mg (Percocet; Endo Pharmaceuticals, Chadds Ford, PA) was prescribed for pain relief. A 1:1:1 suspension of viscous lidocaine (Xylocaine; AstraZeneca Pharmaceuticals LP, Wilmington, DE), diphenhydramine (Benadryl; Pfizer Inc., New York, NY), and attapulgite (Kaopectate; Pfizer Inc., New York, NY) was given as a swish and spit to relieve the oral discomfort. Good hygiene, no skin‐to‐skin contact with others, and no further shaving to prevent autoinoculation were stressed. He was advised to discard his old razor.
Multiple folliculocentric vesicles and 2–4 mm crusted erosions on an erythematous base image
An Unusual Complication of Erythema Multiforme and Its Treatment
Authors: Yelda Karincaoglu , Basak Kandi Coskun , Muammer Seyhan 
Published: June 2007

A 16‐year‐old boy came to our polyclinic complaining of an eruption on the face and limbs. His history showed that, initially, a blistering eruption developed on the side of his nose, which was followed about 10 days later by mildly painful red lesions that showed a pale center (targetoid lesions) on the face, lips, hands, arms, and feet. The patient stated that he had a similar attack about a year ago, when lesions that developed on his lips crusted after the attack and lip adhesions followed. Dermatological examination showed a large number of papules of 0.5–1 cm diameter with an erythematous periphery and a pale erythematous center on the face, ears, forearm, back of the hand, and palm. Some of the papules had purpuric “targetoid” lesions at the center. Lesions on the lips were papulovesicles and vesicles. In addition, there were adhesions on the commissures of both lips, which limited mouth opening to 25 mm. Clustered erosions with a dry surface were seen on the side of his right nostril (Figure 1). Histopathological investigation of the excisional biopsy taken from the forearm revealed necrotic keratinocytes in the epidermis, vacuolization in basal keratinocytes, and subepidermal blistering. The patient was clinically and histopathologically diagnosed as erythema multiforme. Symptomatic treatment was started and oral acyclovir prophylaxis was given to prevent recurrent nasolabial herpes simplex virus infections. The lesions completely resolved in 2 weeks. After 3 weeks, the patient returned for bilateral labial adhesion surgery. Local anesthesia was induced in upper and lower edges of the lips with lidocaine HCl. Adhesions were separated by a lancet, spare tissues were excised, and both sites were sutured by catgut (Figure 2). Total recovery was achieved, and no adhesion recurrence was observed at 1‐month follow‐up.
A large number of papules with an erythematous periphery and a pale erythematous center; adhesion on the edges of both lips image After treatment image
Pigmentary Mosaicism of Hyperpigmented Type in Two Sisters
Authors: Ahmad Al Aboud , Khalid Al Aboud , Khalid Al Hawsawi , Daifullah Al Aboud , V. Ramesh 
Published: June 2007

A 17‐year‐old girl and her 15‐year‐old sister presented with progressively increasing streaks of reticulate hyperpigmented macules arranged in a whorled pattern over the trunk and extremities (Figure), which appeared soon after birth. The face, palms, soles, eyes, and mucous membranes were spared. Both parents were unrelated Saudis. There was no history of any preceding eruption or any associated systemic abnormality, except for recurrent oral ulcers in both patients for several years. The younger one also had one episode of genital ulcers. Dermatological examination of both parents and the patients' three brothers and one sister were normal with no history of oral ulceration. Examination revealed few aphthous ulcers in either cases, but no joint or eye symptoms. Pathergy testing in both cases was negative. Ophthalmological examination and consultation revealed no signs of Behçet's disease. Routine blood tests did not show any abnormalities. Skin biopsies were taken from pigmented and normal skin in both patients. Histopathological examination of pigmented skin in both cases revealed basal cell hyperpigmentation with pigmentary incontinence. Similar features but in milder form were seen in the biopsies of normal skin in both cases.
Sisters with linear and whorled nevoid hyper‐melanosis image
Community‐Acquired Methicillin‐Resistant Staphylococcus Aureus: Skin Infection Presenting as an Axillary Abscess With Cellulitis in a College Athlete
Authors: Cohen Philip R. 
Published: June 2007

A healthy 19‐year‐old black man without any methicillin‐resistant Staphylococcus aureus risk factors developed axillary boils after he began lifting weights at the university gym in Houston, TX. He presented with a large tender erythematous fluctuant abscess of his right axillae and a superiorly located smaller painful red indurated nodule; the surrounding cellulitis extended into the adjacent tissue (Figure). The abscess was incised, drained, and cultured. Empiric treatment with cephalexin 500 mg q.i.d. was given for 7 days. The culture grew methicillin‐resistant S. aureus. Susceptibility testing of the S. aureus isolate was performed by Laboratory Corp. of America (Houston, TX); the Vitek system (Biomerieux, Hazelwood, MO) was used, and the specimen was incubated for 8 hours. Confirmation of methicillin resistance was performed using a methicillin‐resistant S. aureus plate and the specimen was incubated for 24 hours. In addition to resistance to methicillin, the bacterial isolate was also resistant to ciprofloxacin, erythromycin, and penicillin. The S. aureus strain had intermediate susceptibility to levofloxacin and was susceptible to clindamycin, gentamicin, rifampin, tetracycline, trimethoprim/sulfamethoxazole, and vancomycin. The infection persisted and the antibiotic was changed to double strength trimethoprim/sulfamethoxazole, taken twice daily for 15 days. In addition, topical care included lesional and intranasal application of mupirocin 2% ointment and daily cleaning of the area with 10% povidone‐iodine liquid soap. The skin infection completely resolved without recurrence within 2 weeks.
The right axilla of a weight lifter shows cutaneous community‐acquired methicillin‐resistant infection presenting as a tender red abscess inferiorly with a painful erythematous nodule superiorly and cellulitis of the adjacent tissue. image
With This Eruption, There Is Not a Second to Lues
Authors: Steven D. Burdette , Jill S. Waibel , Jack M. Bernstein , Julian J. Trevino 
Published: June 2007

A 28‐year‐old white man presented to the Emergency Department with a 24‐hour history of an eruption on his extremities, trunk, and face. The patient was known to be HIV positive with a CD4 count of 527 and a viral load of 20,300. He denied fever, chills, malaise, and headache. His social history was significant for the fact that he was in a monogamous homosexual relationship. He had no recent travel, pet exposures, or sick contacts. Physical examination revealed stable vital signs and no documented fever. A maculopapular eruption was present on his face, trunk, and extremities (Figure 1 and 2). There was no palmar or plantar involvement. He was treated with diphenhydramine and topical 2.5% hydrocortisone and advised to return if his condition did not improve. Twelve days after the initial evaluation, the patient consulted us again due to progression of his dermatitis. He had no additional complaints other than an eruption on both palms but neither sole. (Figure 3). The eruption now demonstrated erythematous pink‐red oval macules and papules 1–2 cm in size distributed on his scalp, face, trunk, and arms. A few papules contained fine collarettes of scale. Further questioning revealed that the patient had experienced a tender rectal ulcer 2 months previously. A punch biopsy and rapid plasma reagin were performed. The histopathologic examination revealed interface dermatitis with lymphocytes, plasma cells, occasional neutrophils, and a prominent lymphoplasmacytic perivascular dermatitis with infiltration of the vessel walls. Warthrin‐Starry and Steiner methods demonstrated spirochetes at the dermal‐epidermal junction and in vessel walls, consistent withTreponema pallidum (Figure 4). Rapid plasma reagin and fluorescentTreponema antibody were both reactive with a Venereal Disease Research Laboratory (VDRL) of 1:16. The patient was diagnosed as having secondary syphilis and treated with 2.4 million units of IM benzathine penicillin for 3 weeks. His eruption resolved after the initial treatment and he did not experience a Jarisch‐Herxheimer reaction.
Maculopapular eruption on face image Maculopapular eruption on forearm image Subsequent palmar eruption image Spirochetes at dermal‐epidermal junction and in vessel walls, consistent with Treponema pallidum, Warthin‐Starry stain; original magnification × 100 image
Condyloma With Lichen Nitidus
Authors: Noah S. Scheinfeld , Daniel Lehman 
Published: June 2007

A 32‐year‐old black man presented with two separate eruptions on his penis (Figure). He has had a 10‐year history of asymptomatic 1–3 mm shiny papules on the shaft of his penis. He also has had one asymptomatic verrucous brown plaque 1.5 cm in diameter on his penis. A small shave biopsy was performed for each process. The former showed lymphocytes and histocytes in the papillary dermis in a “ball‐in‐claw” relation to the rete ridges of the epidermis. The latter showed an acanthotic epidermis with papillomatosis. Diagnoses of lichen nitidus and condyloma acuminata were respectively made. As the shiny papules did not bother the patient, but he wanted to be rid of the verrucous plaque, only the latter was treated. Liquid nitrogen was applied to the plaque. The patient was also given podofilox 0.5% gel to apply to the condyloma overnight on Monday, Tuesday, and Wednesday, with a 4‐day respite. This cycle was to be repeated for 3 more weeks. He was examined several more times and treated with cryotherapy and podofilox gel with the near disappearance of the condyloma over 4 months. Lichen nitidus and condyloma acuminata occurring together on the patient's penis image
Delicate Skin Cutting: Management Beyond the Skin and Implications of Superficial Habitual Self‐Mutilation
Authors: Jesleen Ahluwalia , Eve J. Lowenstein 
Published: June 2007

A 16‐year‐old girl accompanied by her mother was noted to have several thin, well healed brown lines on the distal third of her left flexural forearm (Figure). She admits to having recently made these marks by skin cutting. She feels depressed and at times feels life “is not worth living.” She denies alcohol or substance abuse or true suicidal ideation, plan, or intent. Her mother describes her as previously well adjusted and a good student who has become erratic and moody in the past 6 months, with worsening school performance. Her father had a history of depression and alcoholism and died 3 years ago. She is undergoing psychotherapy and pharmacotherapy with sertraline with good results. She has not cut her skin in 3 months. Her mood and behavior have improved.
Distal forearm with hyperpigmented linear scars from delicate skin cutting image
Skin Disease in a Primary Care Practice
Authors: Sari Fieri , Brian Berman , Brian Magrane 
Published: June 2007

Objective. Family medicine physicians treat a large amount of skin disease. Yet, information is lacking regarding which dermatologic disorders are more likely to present to a family medicine physician. Therefore, we performed a chart review at a family medicine private practice in Islamorada, FL, to determine the percentage of patients presenting with dermatologic disease and to identify the most common diseases encountered.
Discussion. On 12 office days in May 2004 to June 2004, 21% of patients seen by a family medicine physician had at least one skin problem, which was the chief complaint 72.2% of the time.
Conclusions. Infectious etiology and inflammatory conditions accounted for the majority of skin disease diagnosed by the physician. Geography and demographics are of great importance when considering which dermatologic diseases are most likely to present to a given physician.
Cheilitis Glandularis in an African‐American Woman: Response to Antibiotic Therapy
Authors: Matthew M. Bender , Melissa Rubenstein , Ted Rosen 
Published: June 2007

A 52‐year‐old black woman presented with a 2‐day history of lower lip swelling 5 days after starting a new medication, lisinopril. She had never experienced similar episodes in the past. She denied shortness of breath, tightening of the throat, swelling of the tongue, generalized cutaneous eruption, urticaria, or pruritus. She also denied symptoms consistent with facial paresis. Her past medical history was significant for hepatitis C infection, coronary artery disease, and hypertriglyceridemia. She had a 15 pack‐year smoking history and denied both alcohol and drug abuse. She had never received a blood transfusion and was HIV negative. Physical examination disclosed a tender, swollen, and erythematous lower lip with induration, oozing, and crusting (Figure 1). Pinpoint openings evident throughout the lip surface exuded a clear, sticky, mucoid secretion. Tongue, parotid glands, and regional lymph nodes were normal. The working diagnosis was angioedema secondary to lisinopril. The presumptive offending drug was discontinued, and conservative therapy (topical clobetasol ointment, oral ranitidine, and oral fexofenadine) was initiated. Despite treatment, signs and symptoms persisted unabated. One week after initial presentation, a punch biopsy of her lower lip was taken to rule out granulomatous cheilitis and sarcoidosis. Histopathology included diffuse lymphohistiocytic infiltrate, minimal microabscess formation, and notable absence of granulomata. There was neither hypertrophy nor detectable abnormality of the salivary glands, with the exception of infiltrating mononuclear cells. Based on the clinical history and compatible pathologic findings, a diagnosis of cheilitis glandularis was made. Specifically, crusting and erosion clinically suggested a diagnosis of the superficial suppurative subtype of cheilitis glandularis. The patient received oral penicillin (dicloxacillin, 1.0 g/d) combined with oral fluoroquinolone (ciprofloxacin, 1.0 g/d). Within 2 weeks of starting the antibiotics, the lip swelling significantly decreased (Figure 2) and the patient was left with a mildly indurated nodule at the labial commissure. Following a 4‐week course of continued antibiotic treatment, the lip returned to near baseline state. At both 6‐month and 1‐year follow‐up visits, the lip remained normal.
Lip at the time of initial presentation. Note marked swelling and crusting image Lip after 2 weeks of antibiotic therapy image