A itchy vesiculobullous eruption in a patient with chronic lymphocytic leukemia.

Exaggerated reactions to insect bites are characteristic of patients with haemoproliferative disorders, particularly chronic lymphocytic leukaemia (CLL). Skin lesions usually appear after the diagnosis of leukaemia and seem unrelated to laboratory findings, disease course or therapy. Rarely, the eruption may precede the diagnosis of the haematologic malignancy. The patients usually do not recall of insect bites, and the diagnosis may require histological and laboratory investigations to exclude specific lesions or autoimmune bullous diseases. Lesions may run a chronic course and represent a therapeutic challenge. Here, we report an adult patient with CLL who developed itchy recurrent papulovesicular and bullous lesions. Differential diagnosis was made with cutaneous specific lesions of CLL, bullous pemphigoid and pemphigus vulgaris, but laboratory and histological investigations confirmed the diagnosis of an insect bite reaction. The patient was treated with oral H1 anti-histamines and topical corticosteroids under occlusion, with marked improvement after 10 days

Autoimmune progesterone dermatitis.

Autoimmune progesterone dermatitis (APD) is a rare disorder characterized by recurrent polymorphous skin manifestations, which appear or are exacerbated during the luteal phase of the menstrual cycle. The hallmarks for diagnosis include premenstrual flare, its prevention with the inhibition of ovulation, and positive skin reaction to intradermal injection of progesterone. The mainstay of treatment is to inhibit the secretion of endogenous progesterone by suppressing ovulation. Bilateral cophorectomy may be necessary in patients with severe and refractory symptoms. We report herein the case of a 38-year-old woman who developed recurrent and cyclic vesiculobullous eruptions clinically suggestive of erythema multiforme or autoimmune bullous diseases. The skin manifestations turned out to be APD. The patient was treated with tamoxifen 20 mg daily with complete symptom remission after 4 months

Lebbra lepromatosa.

Leprosy is a chronic granulomatous infection primarily affecting the skin and peripheral nerves caused by Mycobacterium leprae, an acid-fast obligate intracellular parasite with low virulence and pathogenicity. The host cell-mediated immunity specific for M. leprae determines the development and the clinico-pathological features of the disease. Lepromatous leprosy is the most severe multibacillary type that manifests in anergic subjects. The Authors describe a 26-year-old Filipino man immigrated in Italy since one year who presented with asymptomatic, poorly defined papules, nodules and hypopigmented macules. Lesions were disseminated, more prominent on the face and trunk, with a bilateral and symmetrical distribution. Histological examination of a nodule revealed a dense dermal infiltrate of foamy macrophages and rare lymphocytes. Zihel-Nielsen stain showed acid-fast bacilli in the cytoplasm of the macrophages and in the dermal nerves, confirming the diagnosis of lepromatus leprosy. Microbiologic findings were compatible with a multibacillary disease. A multidrug therapy with rifampicyn (600 mg monthly), dapsone (100 mg daily) and clofazimin (300 mg monthly and 100 mg daily) resulted in marked improvement of the clinical appearance and microbiological findings after three months