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This Month in Archives of Dermatology
November 2010

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Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Dermatol. 2010;146(11):1218. doi:10.1001/archdermatol.2010.329
Hidradenitis Suppurativa and Concomitant Pyoderma Gangrenosum

Hidradenitis suppurativa (HS) and pyoderma gangrenosum (PG) have rarely been reported in the same patient. In this case series, Hsiao et al identify 11 patients with an overlapping presentation of HS and PG. A female predominance is noted, and slightly more than half of patients had PG lesions in the same sites affected by their HS. Both diseases are characterized by an intense neutrophil-mediated inflammatory response, and they may share a common dysregulation of the innate immune system. Although systemic corticosteroids remain the first-line treatment for PG, they are rarely used for HS. Anti–tumor necrosis factor and anti–interleukin 1 therapies have been effective in treating both PG and HS and may be used increasingly in the future to treat such patients.

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Early White Discoloration of Infantile Hemangioma

Infantile hemangiomas (IHs) are the most common benign vascular tumors of infancy. Ulceration is the most common complication. In this case series, Maguiness et al describe early white discoloration of the surface of the IH that heralded extensive, relentless ulceration. This so-called early white discoloration of IH appears to be highly sensitive and relatively specific for predicting hemangioma ulceration. Especially in infants younger than 3 months, clinicians should be aware of this phenomenon as heralding ulceration rather than early involution. Early excision, topical becaplermin treatment, laser therapy, and oral propranolol were useful in expediting healing and controlling pain.

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Dermoscopic Island

Dermoscopy can be a powerful tool in the diagnosis of melanoma. However, only a few dermoscopic descriptors specific for thin melanomas have been identified. In this evaluation of dermoscopic images of in situ melanomas, invasive melanomas, and atypical nevi, Borsari et al describe a dermoscopic appearance characteristic of thin melanomas. These “dermoscopic islands” (DIs) appear as well-circumscribed areas with a uniform dermoscopic pattern that differs from that of the rest of the lesion. Because DIs were found mainly in early invasive and in situ melanomas, their presence may aid early diagnosis of melanoma.

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“Bullfrog Neck,” a Unique Morphologic Trait in HIV Lipodystrophy

Shortly after the US Food and Drug Administration approved protease inhibitors for human immunodeficiency virus (HIV) therapy, clinicians began reporting unique changes in body fat distribution among treated patients. Lipodystrophy (fat loss in the face, arms, and legs) and lipohypertrophy (fat gain in the abdomen and back of the neck) accompanied elevated levels of triglycerides, cholesterol, and glucose. Rarer presentations of lipodystrophy include multiple lipomatoses and suprapubic fat pads. In this case series, Tierney and Hanke describe the dysmorphic features of the increase in neck circumference, or “bullfrog neck,” in patients with HIV lipodystrophy. Given the substantial effect on quality of life and the metabolic consequences, the authors deem further investigation into prevention and treatment of this condition essential.

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The Association of Bullous Pemphigoid With Cerebrovascular Disease and Dementia

Bullous pemphigoid (BP) is a debilitating autoimmune bullous disease of the elderly. Various neurologic diseases have been described in association with BP. Although the precise pathologic mechanism remains obscure, BP antigens or their isoforms have been identified in brain and neuronal tissue. Autoantibody cross-reactivity or exposure of hidden antigens in the brain triggering an immune response are possible mechanisms. In this case-control study, Taghipour et al demonstrate that neurologic disorders have a significantly higher prevalence in patients with BP than in control subjects of similar age and that cerebrovascular disease and dementia account for this association. Neurologic disease may be a predisposing factor for BP.

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