Blau syndrome is a rare autosomal dominant genodermatosis that demonstrates considerable clinical overlap with early-onset sarcoidosis and is caused by mutations in the CARD15 gene. In addition to synovitis, uveitis, and a generalized papular skin eruption, all characterized by noncaseating granulomas, individuals with Blau syndrome often develop flexion contractures of the proximal interphalangeal joints and other sequelae of chronic progressive arthritis. In this case report, Schaffer et al describe an infant boy with a generalized granulomatous dermatitis in whom a CARD15 gene mutation was revealed. Although family members reported manifestations of Blau syndrome, none developed arthritis, thus supporting the concept that this heritable disorder and early-onset sarcoidosis represent a single disease entity.
Intense pulsed-light (IPL) generates high-intensity short flashes of polychromatic visible light and has demonstrated usefulness in improving cutaneous telangiectasia, pigmented lesions, and photoaging. In this case series, Sorg et al analyzed the skin of 9 patients treated with a single exposure to IPL for 2 known markers of tissue photodamage. Although the demonstrated absence of DNA thymine dimer formation was comforting, IPL treatment induced lipid peroxidation, indicating a significant oxidative stress in the skin.
Imiquimod 5% cream is a topical immune response modifier that has been used off-label to treat malignant melanocytic proliferations such as lentigo maligna and cutaneous melanoma metastases. In this case series, Somani et al describe 3 patients in whom imiquimod was applied to clinically atypical nevi for 12 weeks. Treatment response and adverse effects were evaluated at 4, 8, and 12 weeks after the start of treatment, and the treated lesions were completely excised 1 week after the end of the treatment period. None of the nevi cleared on this regimen, and histologic examination of the nevi immediately after treatment revealed severe atypia at the sites of intense inflammation, highlighting the need to inform consulting dermatopathologists when nevi are excised from sites of field treatment with imiquimod.
Dermoscopy has proven to be a valuable tool in diagnosing pigmented and nonpigmented skin lesions. Classic dermoscopes used only nonpolarized light sources to illuminate the skin. New commercially available dermoscopes exploit the properties of cross-polarized light and allow visualization of skin structures without the need for a liquid interface and direct skin contact with the skin to reduce the amount of light reflected, refracted, and diffracted at the skin surface. In this observational study, Benvenuto-Andrade et al describe the subtle and complementary differences between these instruments in evaluating cutaneous lesions.
A dysplastic nevus shown by clinical photography (A), nonpolarized light contact dermoscopy (NPD) (B), polarized light contact dermoscopy (C), and polarized light noncontact dermoscopy (D). The dark-brown colors are more prominent under polarized light dermoscopy, and more light-brown colors are seen under NPD. In the NPD image there is a blue-white veil (highlighted by a dotted oval), which is less prominent to almost absent in the polarized dermoscopy images.
This Month in Archives of Dermatology. Arch Dermatol. 2007;143(3):298. doi:10.1001/archderm.143.3.298