Prior to 1962, some of the most versatile drugs in dermatology were approved by the U.S. Food and Drug Administration (FDA) solely
on the basis of safety. One of these is the combination 10% sodium sulfacetamide and 5% sulfur. Sodium sulfacetamide possesses
anti-inflammatory and antibacterial properties while sulfur is a nonspecific antibacterial and antifungal. A new emollient foam formulation
of 10% sodium sulfacetamide and 5% sulfur allows a thinner application film and leaves behind no residue on hair bearing or nonhair
bearing skin. The sulfur smell is also more quickly dissipated with reduced irritation. This uncontrolled, observational, prospective,
open-label, single site, eight-week study enrolled 24 subjects (eight with rosacea, eight with seborrheic dermatitis, eight with acne
vulgaris) to evaluate the safety and efficacy of this novel foam formulation. At eight weeks, statistically significant improvement was
seen in inflammatory rosacea lesion counts and the signs of seborrheic dermatitis. A 50% reduction was noted in the total acne lesion
counts. These findings confirm the versatility of an emollient 10% sodium sulfacetamide and 5% sulfur foam.
Pravit Asawanonda MD DSc, Thanapong Sutthipong MD, Nattapa Prejawai MD
Idiopathic guttate hypomelanosis (IGH) is a very common skin disorder, although the precise prevalence of which is unknown. There
are no universally safe and efficacious treatments for this condition. The authors report the success of 1% pimecrolimus cream in
inducing repigmentation is this hypomelanotic disorder.
Karthik Krishnamurthy DO, Ashley Walker DO, Charles A. Gropper MD, Cindy Hoffman DO
The association between guttate psoriasis and pityriasis rosea with Streptococcus pyogenes (S. pyogenes) is well established in the
literature; however treatment guidelines and necessity have not been clarified with respect to the infectious etiology. Also, the exact
role of Streptococcus in the immunopathogenesis of these entities, and the associated risk of development of scarlet fever and poststreptococcal
sequelae, are not centrally reported. No single report or case series definitively establishes the coexistence between
guttate psoriasis and post-streptococcal sequelae in the same patient, supporting the theories of autoimmune protection conferred
between these entities. Laboratory investigations and treatment of Streptococcus in the setting of guttate psoriasis are not necessary,
as anti-streptococcal treatment does not significantly modify the course of cutaneous disease, and there is no theoretical or
documented risk of post-streptococcal sequelae. However, due to minimal data, antibiotics may still have a role in pityriasis rosea.
Adam J. Mamelak MD, Adrianna Jackson MD, Rabia Nizamani BS, Ofer Arnon MD,Nanette J. Liegeois MD PhD, Richard J. Redett MD, Patrick J. Byrne MD
Background: Over the ages, the use of leeches in medicine has evolved from haphazard bloodletting to a well-understood physiologic
process with defined, rational applications.
Objective: The authors describe the current role of leech therapy in cutaneous surgery and medicine.
Methods: Case series and review of the literature.
Results: Leech saliva contains anticoagulative, anti-aggregative and vasodilatory components. Combined with the annelid’s mechanical
ability to extract blood, leeches can contribute to patients’ health with minimal risks.
Conclusion: Leeches should be considered as novel therapies for disorders of coagulation and venous congestion. Implementation
of leech treatment should be tempered with the potential adverse effects, including Aeromonas infection and a drop in hematocrit
that might require a blood transfusion.
Jyoti Pathria Mundi MD, Lauren Cerullo MD, Jonathan Cotliar MD
Porokeratosis is hypothesized to be an inherited autosomal dominant disorder with variable penetrance. It has been linked to ultraviolet
(UV) radiation in genetically predisposed individuals, to antibody-related autoimmune disease treated with systemic steroids,
and to other immunosuppressive states including chronic liver disease. The authors describe an unusual case of a patient with newonset
hepatitis of unclear etiology who developed concomitant erythematous annular plaques with atrophic centers and elevated
scaling borders on the lower extremities. The histological features of these lesions were consistent with disseminated superficial
porokeratosis (DSP). The authors present this patient and a review of the literature to support the direct pathological link between
hepatitis and DSP, irrespective of the state of the immune system. Further research would be helpful in clarifying the pathogenesis
of porokeratoses in patients with hepatic dysfunction.
Novie Sroa MD, Shannon Campbell DO, Mark Bechtel MD
Scleromyxedema is a chronic, idiopathic disorder characterized by cutaneous dermal mucin deposition in association with increased
dermal collagen and absence of thyroid disease. The clinical features involve sclerosis of skin with numerous, 2–3 mm, firm, waxy,
papules in a symmetrical distribution pattern. The skin lesions may progress to widespread and indurated plaques resulting in patient
disability via decreased mobility, sclerodactyly and microstomia. Abnormalities in the muscular, neurologic, rheumatologic, pulmonary,
renal and cardiovascular systems may accompany the cutaneous lesions. Multiple attempts at therapeutic interventions have
failed due to inconsistent, unsatisfactory results and/or severe adverse effects.1–6 Herein, the authors describe a case of scleromyxedema
successfully treated with high-dose intravenous immunoglobulin (hdIVIG).
Sarah Latif BA, Garth Fraga MD, Joseph Gadzia MD
Hand-foot syndrome is a common adverse effect of therapy with capecitabine (Xeloda®) for the treatment of various carcinomas.
Symptoms suggesting hand-foot syndrome include pain, pruritus, erythema, tingling and desquamation limited to the palms and
soles of feet. Documented pathological findings are few, but include apoptosis of keratinocytes, bizarre mitotic figures, loss of
polarity of keratinocytes and vacuolar degeneration of the basal layer of the epidermis. A 63-year-old white female presented with
painful, pruritic palmar and plantar erythema and desquamation. A punch biopsy taken from her palm exhibited vacuolization of basal
keratinocytes, but none of the other previously documented findings though there were increased mast cells (18–20 per high power
field). The patient was treated with clobetasol lotion and her symptoms drastically improved in two weeks. The pathologic findings
in this patient suggest new insights in the pathogenesis of hand-foot syndrome from capecitabine leads to a possible explanation for
the edematous or urticarial clinical changes seen in these patients.
Sirunya Silapunt MD and Susan Y. Chon MD
Necrobiotic xanthogranuloma (NXG) presents a therapeutic challenge to clinicians. Generalized NXG has limited treatment options. A
patient presented to the authors with generalized NXG associated with monoclonal gammopathy of unknown significance (MGUS),
a plasma cell dyscrasia considered to be a precursor to multiple myeloma.
The patient was treated with lenalidomide, a derivative of thalidomide with efficacy in treatment of multiple myeloma. Resolution of
paraproteinemia was associated with resolution of NXG.