The Use of Intralesional Steroids in a Case of Localized Pemphigus Foliaceus

A 37-year-old South-Asian male presented to our clinic with a crusty, verrucous-like, scaly plaque of the left ala of the nose. After ruling out infectious and other epidermal bullous diseases, we finalized a diagnosis of localized pemphigus foliaceus, an exceptionally rare disorder with only 15 cases reported in the literature to date. The hyperkeratotic lesions responded favorably to a 3-week regimen of triamcinolone ointment and a onetime intralesional triamcinolone 2.5 mg/mL injection

Resolution of Post-Surgical Hypergranulation Tissue with Topical Aluminum Chloride

Hypergranulation is the extension of granulation tissue beyond the required amount to close a tissue defect. We report our experience using aluminum chloride to treat a series of two patients with hypergranulation tissue. Both patients had lengthy treatment courses after Mohs surgery with growth of hypergranulation tissue that resolved once aluminum chloride was placed on the wound. Aluminum chloride is a useful hemostatic agent frequently employed in dermatology. It is a readily available and low-cost option for management of hypergranulation after dermatologic procedures. Chronic wounds are a common treatment challenge for clinicians. Due to its affordability and availability, clinicians may consider topical aluminum chloride when managing post-surgical hypergranulation tissue

Desmoplastic Melanoma Arising after 1,064 nm q-Switched Nd:YAG Laser of a Suspected Solar Lentigo

Objectives. To present a case of desmoplastic melanoma (DM) arising after laser therapy of a suspected solar lentigo with the 1,064 nm Q-switched (QS) Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser and discuss the safety of treating suspected solar lentigines with laser therapy. Methods. Case presentation with discussion. Results. We describe a patient who developed DM after 1,064 nm QS Nd:YAG laser therapy to a suspected solar lentigo. Conclusions. Limited generalizable studies regarding the safety of laser therapy for solar lentigines exist, specifically for the 1,064 nm QS Nd:YAG laser. Therefore, we recommend caution is taken when considering laser therapy for these lesions, as well as strong consideration for histologic confirmation prior to therapy

Minocycline-Induced Agranulocytosis Presenting as Ecthyma Gangrenosum

A 51-year-old female with a history of rheumatoid arthritis was admitted for progressive fevers, chills and malaise. Five weeks prior, she started minocycline for an RA exacerbation. Two weeks after starting minocycline she developed an abscess on her right ankle that was treated at an urgent care facility with ceftriaxone and trimethoprim-sulfamethoxazole. She had minimal improvement so was switched to clindamycin. She developed additional abscesses on her right ankle and right axilla and spiking fevers so she was treated with incision and drainage under general anesthesia. Routine blood work obtained prior to surgery revealed severe neutropenia (0.74 103/ul) and the patient was urgently referred to the emergency department.  Skin biopsy was obtained on admission and revealed ulceration, necrosis, acute and chronic inflammation, vasculitis with vascular thrombosis and rod-shaped bacteria in blood vessel walls and lumina consistent with ecthyma gangrenosum. The following day tissue and blood cultures confirmed the growth of Pseudomonas aureginosa. Bone-marrow biopsy showed decreased granulopoiesis and hematopoiesis, and a diagnosis of minocycline-induced agranulocytosis presenting as ecthyma gangrenosum was made.  The patient had dramatic improvement with appropriate antibiotic therapy, discontinuation of minocycline and initiation of filgrastrim. She has remained healthy without recurrence for 17 months.   

Onychomatricoma with Concomitant Subungual Glomus Tumor

Onychomatricoma and glomus tumor are two rare subungual neoplasms with distinct clinical and histopathological features. We report a case of onychomatricoma associated with a glomus tumor in the subungual region of the same finger in a 45-year-old woman. Histopathological examination revealed characteristic findings of both onychomatricoma and glomus tumor. To the best of our knowledge, these two subungual tumors have never before been described occurring concomitantly