Faculty Bibliography

We report a 48 -year-old woman witherythrokeratoderma variabilis, which is a rarehereditary disorder of keratinization, who developednew, painful, blisters within her skin lesions. Thediagnosis of herpes simplex virus infection was madebased on the clinical history and histopathologicfeatures. She was successfully treated withprophylactic valacyclovir, and her herpetic outbreakshave halted. This case serves as a reminder thateven among the most rare skin disorders, commonsecondary complications may be easily overlooked.

A 50-year-old man presented with pruritic, hyperpigmented papules and plaques on the right lower extremity following Blaschko lines. A skin biopsy specimen was consistent with lichen planus (LP). Linear LP accounts for less than 0.2 percent of all patients with LP, and the segmental formation is thought to be due to a postzygotic mutation that affects one of the genes predisposing its development. This loss of heterozygosity may occur from a mutation, deletion, or DNA recombination and leads to the formation of a keratinocyte clone that is more susceptible to development of the skin disease. Histopathologically, linear LP is identical to LP, with the presence of hyperkeratosis, focal hypergranulosis, irregular acanthosis with a sawtooth appearance, vacuolar change of the basal-cell layer, and a dense band-like lymphocytic infiltrate at the dermal-epidermal junction. It is important to differentiate linear LP from lichen striatus, inflammatory linear verrucous epidermal nevus, linear psoriasis, and linear Darier-White disease, which have different presentations clinically and histopathologically

A 68-year-old woman presented with a 3-year history of asymptomatic, yellow-brown plaques on the lower extremities with trauma-related superficial ulcers. A biopsy specimen was consistent with necrobiosis lipoidica. Necrobiosis lipoidica is a chronic granulomatous dermatitis that is associated with diabetes mellitus; however, its pathogenesis remains unclear. Topical glucocorticoids are first-line therapy; however, no treatment has proven efficacy in double-blind, placebo-controlled studies.

Two patients are reported who were treated with 8-methoxypsoralen and ultraviolet A (PUVA) for psoriasis and developed cutaneous lesions of malignant melanoma in situ (atypical melanocytic hyperplasia). One patient received 324.5 joules/cm2 of UVA. Seven months after discontinuing therapy, he developed a superficial spreading melanoma in situ in association with an intradermal nevus on the left posterior thoracic area. The second patient received 2,802 joules/cm of UVA. While on PUVA therapy she developed an in situ lentigo melanoma on her lower lip. To our knowledge only one other psoriatic patient and one patient with vitiligo have developed malignant melanomas after PUVA therapy, so that an increased incidence of malignant melanomas after PUVA therapy, so that an increased incidence of malignant melanoma following PUVA is not documented