Faculty Bibliography

Two patients receiving epidermal growth factor receptor inhibitors for cancer treatment developed papulopustular eruptions a few days after starting treatment. One patient is a 56-year-old man with metastatic lung cancer treated with erlotinib. Bacterial cultures of the nares and a pustule showed no growth. The eruption improved with a lowered dose of erlotinib and the application of topical clindamycin solution and triamcinolone cream. The other patient is a 53-year-old man with metastatic rectal cancer treated with cetuximab. Bacterial culture of a pustule grew Staphylococcus aureus, and a skin biopsy specimen showed a suppurative folliculitis. The eruption improved with a two-week course of oral antibiotics and the application of topical clindamycin solution and triamcinolone cream. A papulopustular eruption occurs in up to 90% of patients treated with epidermal growth factor receptor blocking agents and may correlate with a positive response to chemotherapy. Treatment options are based on anecdotal evidence and may include topical antibiotics, topical glucocorticoids, and oral antibiotics for secondary infection

Eumycetoma is a localized, chronic fungal infection of skin and subcutaneous tissues. It is characterized by tumefaction, abscess formation, draining sinuses, and sclerotia (grains) within the abscesses and fistulae. Treatment of eumycetoma is a challenge. Relapse rates are high even when a combination of surgical and medical approaches is utilized. Here we report a case of eumycetoma due to Exophiala jeanselmei arising on the foot of a man from Trinidad, West Indies

A 29-year-old male with AIDS was treated with bleomycin and vincristine for visceral Kaposi's sarcoma. Three days later, he developed two distinct eruptions simultaneously. One eruption was characterized by tender, erythematous, edematous plaques and nodules on the palmar and dorsal surfaces of the hands, forearms, and elbows. The other consisted of grouped, erythematous, hyperpigmented streaks on the trunk, buttocks, and extremities. The patient subsequently received a second treatment consisting of vincristine with adriamycin, without bleomycin, and no cutaneous effects were seen. Diagnoses of flagellate erythema and acral nodular eruption secondary to bleomycin were made and confirmed histopathologically. To our knowledge, this is the first report of two cutaneous side effects of bleomycin appearing simultaneously in a patient with AIDS

A 23-year-old man presented with a 3-year history of painful ulcerations and retiform scarring of his lower extremities. Skin biopsy revealed evidence of thrombotic vasculopathy. Livedoid vasculopathy is an uncommon condition presenting as painful lower extremity ulceration and scarring in the form of irregular, ivory-white, stellate plaques. Its pathogenesis is unclear, but it is thought to result from coagulation and fibrinolytic disorders causing occlusion of dermal vessels

A case of lupus erythematosus (LE) and lichen planus (LP) overlap syndrome in a 71-year-old woman is presented. This disease displays characteristics of both LE and LP. The clinical, histologic, and immunopathologic features of this disorder are reviewed

A healthy 47-year-old woman developed diffuse pustules and edema of the skin after exposure to diltiazem and cephalexin. Bacterial, fungal and viral cultures were sterile suggesting a noninfectious etiology. A skin biopsy showed spongiosis, subcorneal collections of neutrophils, papillary dermal edema and a superficial perivascular mixed cell infiltrate. The clinical and histopathologic findings were consistent with acute generalized exanthematous pustulosis (AGEP). The patient was treated with supportive care and the pustular dermatitis cleared. AGEP is a rare complication of drug therapy and should be considered in the differential diagnosis of patients presenting with acute onset pustular dermatitis. Drug reactions are an uncommon and unpredictable complication of medical therapy. Cutaneous drug reaction rates occur with a frequency of 1% to 8% and can be higher for certain classes of drugs. They can range from mild morbilliform eruptions to more severe forms such as drug-hypersensitivity syndrome, toxic epidermal necrolysis or anaphylaxis. Acute generalized exanthermatous pustulosis (AGEP) is a rare presentation of a drug reaction and can be difficult to distinguish from other pustular dermatoses. Herein we review a case of AGEP and include a discussion of salient clinical and histological features of AGEP