Faculty Bibliography

We present a case of a 48-year-old man with an approximately 30-year history of spiny projections on the palms, which were histopathologically consistent with spiny keratoderma. Spiny keratoderma is a rare entity of unknown etiology that has been described with both hereditary and acquired variants. The hereditary form, which is most likely the diagnosis in our patient, manifests at a younger age and is benign. The acquired variant, which presents in older adults, has been associated with a variety of systemic diseases and malignant conditions. In patients suspected of having acquired spiny keratoderma, an evaluation for malignant conditions may be warranted.

Behcet disease is a multisystem inflammatory disease with features of vasculitis. It undergoes periods of spontaneous remission and relapse. It often affects the skin, blood vessels, central nervous system, joints, gastrointestinal system, eyes, mucous membrane, and other systems, and it can cause substantial morbidity and mortality. The etiology of Behcet disease remains unknown. Current treatment of Behcet disease involves symptomatic relief with prevention of relapse. We describe the treatment of a recalcitrant case of Behcet disease with infliximab and methotrexate. The patient is a 40-year-old Korean woman with tender lesions on the lower extremities of 1.5 years' duration and intermittent oral and genital ulcerations that failed multiple conventional therapies. The patient was placed on a trial of infliximab. She reported resolution of the tender lower extremity lesions and the oral and vaginal ulcerations shortly after the initiation of the anti-tumor necrosis factor agent. The patient was symptom free for 2 years following the initiation of infliximab. She subsequently reported mild breakthrough oral ulcers and joint pain. The treatment regimen was modified by adding methotrexate 7.5 mg weekly, prednisone 5 mg daily, and a shortened treatment interval of infliximab infusion that resulted in resolution of her symptoms.

BACKGROUND: Chemical peels using alpha hydroxy acids have become one of the most frequently requested dermatologic procedures. The use of glycolic acid in superficial chemical peels is now well established. However, the role of glycolic acid in medium-depth chemical peels has yet to be elucidated. OBJECTIVE: We performed a clinical and histologic comparison of 70% glycolic acid versus Jessner's solution as part of a medium-depth chemical peel using 35% trichloroacetic acid (TCA). METHODS: Thirteen patients with actinic keratoses, solar lentigines and fine wrinkling were evaluated prospectively. Each patient was treated with 70% glycolic acid plus 35% TCA (GA-TCA) to the right face and Jessner's solution plus 35% TCA (JS-TCA) to the left face. Clinical and histologic changes were evaluated at 7, 30, and 60 days postoperatively. RESULTS: Clinically, the GA-TCA peel was effective in treating photodamaged skin. The GA-TCA peel was slightly more efficacious in removing actinic keratoses (clinical response score = 1.5) than the JS-TCA peel (clinical response score = 1.0). Histologically, the GA-TCA peel caused the formation of a slightly thicker Grenz zone (mean = 0.053 mm) 60 days postpeel than the JS-TCA peel (mean = 0.048 mm) (not statistically significant). The GA-TCA peel caused more neoelastogenesis than the JS-TCA peel, while the JS-TCA peel resulted in more papillary dermal fibrosis and neovascularization than the GA-TCA peel. CONCLUSION: The GA-TCA peel is a new medium-depth chemical peel that is effective in treating photodamaged skin

Spiny keratoderma of the palms and soles has been rarely reported. Debate exists regarding the proper nosologic classification of this disorder. We describe a patient and her mother with concurrent autosomal dominant polycystic kidney disease with liver cysts