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Use of imiquimod and pimecrolimus cream in the treatment of acne keloidalis nuchae
P590
P592
USE OF IMIQUIMOD AND PIMECROLIMUS CREAM IN THE TREATMENT OF ACNE KELOIDALIS NUCHAE Jerome Barr, MD, Addie Friedman, MD, Hilary Balwin, State University of NewYork Downstate, Hempstead, NY, United States
ANGIOSARCOMA: A CASE REPORT AND REVIEW Greg Houck, DO, Marya Cassandra, DO, Sun Coast Hospital, Saint Petersburg, FL, United States We present a case of an 84-year-old woman who reported an enlarging bruise over her chin and neck of 3 months’ duration. She denied any symptoms, including pain, bleeding, itching, or fatigue. She denied any earlier dermatologic problems. On examination, the submental area and anterior neck revealed an indurated, ecchymotic, and erythematous plaque. There was no evidence of lymphadenopathy. A biopsy from the left side of the neck revealed a malignant vascular tumor consistent with angiosarcoma. Angiosarcoma is an aggressive, highly malignant vascular neoplasm. These tumors are common in elderly white men on the head and neck. The histopathology usually demonstrates anastomosing vascular channels in the dermis lined by plump endothelial cells with markedly hyperchromatic nuclei. Clinical subtypes of angiosarcoma include the head and neck type of elderly people, the chronic lymphedematous type, the radiation-induced type, and a miscellaneous type. The prognosis of angiosarcoma is poor and metastasis is common. Treatment options include early detection and wide excision followed by high-dose radiation.
Acne keloidalis nuchae (AKN) presents as keloidal-like papules and plaques on the posterior neck and occipital scalp in African American men. The exact origin of AKN is unknown. AKN lesions are often painful and psychologically devastating. Unfortunately, there is no therapeutic modality that cures AKN. Current treatments for AKN include cryotherapy; laser therapy; topical, intralesional, and systemic corticosteroids; topical retinoic acid; and topical clindamycin when pustules are present. We investigated the efficacy of topical imiquimod and topical pimecrolimus for the treatment of AKN. Five of 24 patients previously treated with one of the current treatment options enrolled in the study. The patients were randomly assigned either imiquimod cream once daily for 8 weeks or pimecrolimus twice daily for 8 weeks. Response was defined as improvement in number of lesions, average size of lesions, symptoms, and firmness. All 5 patients reported a significant decrease in itching. With imiquimod, the average number of lesions decreased from 12.5 to 9 and with pimecrolimus the average number decreased from 10.3 to 8.5. Pretreatment and posttreatment photographs demonstrate the cosmetic benefits of the treatments. The medications were well tolerated with no reported side effects. Both imiquimod and pimecrolimus were objectively and subjectively effective. They may be beneficial as monotherapy or adjunctive therapy in the treatment of AKN.
Nothing to disclose.
Nothing to disclose.
P593 INVERSE LICHEN PLANUS: AN UNUSUAL MORPHOLOGIC VARIANT OF A CLASSIC PAPULOSQUAMOUS DERMATOSIS Jeannine Hoang, MD, Janine Malone, MD, Jeffrey Callen, MD, University of Louisville, Louisville, KY, United States
P591 WHAT WALKED INTO THE OFFICE TODAY—A BRIEF REVIEW OF PODIATRIC DERMATOLOGY Patricia Ting, BS, University of Calgary, Calgary, AB, Canada Some of the most frequently encountered podiatric dermatoses include viral warts, dermatophyte infections of the skin and toenails, and pitted keratolysis. Traumarelated conditions often consist of black heels and toes, corns and calluses, piezogenic pedal papules, and ulcers. Hyperhidrosis and various forms of contact dermatitis as well as psoriasiform and eczematous diseases are also not uncommon. Less common podiatric skin conditions include a miscellaneous group of keratodermas, skin cancers, psychodermatoses, and secondary manifestations of an underlying systemic disease.
Background: Lichen planus, an idiopathic, inflammatory mucocutaneous condition, is one of the classic papulosquamous dermatoses as well as the prototype for the histological category of lichenoid tissue reactions. The standard textbook description entails an eruption characterized by violaceous, polygonal, flat-topped papules and plaques with overlying, reticulated, fine white scale (Wickham’s striae), commonly affecting flexural wrists and forearms, dorsal hands, trunk, oral mucosa, and anterior lower legs. Dermatologists often associate lichen planus with these ‘‘classic’’ features. However, it is often a more complex disease that can manifest in association with other systemic illnesses and present as one of numerous morphologic variants. In this poster, we highlight an unusual presentation of lichen planus—inverse pattern—and review the many clinical subtypes of this classic papulosquamous disease. Observation: A 51-year-old woman presented with a 6-week history of a pruritic eruption involving the right axilla. She was initially treated for presumed intertrigo with minimal improvement. Over the course of 3 months, new lesions developed that were confined to flexural and intertriginous areas. Physical examination revealed hyperpigmented, slightly scaly papules and plaques involving the right axilla, popliteal fossae, inframammary folds, inguinal folds, and intergluteal cleft. The lesions tended to be arranged in a linear fashion, and some plaques had faint white streaks over the surface (reminiscent of Wickham’s striae). There was no evidence of mucosal, scalp, or palmoplantar involvement, nor were there any nail or cuticular abnormalities. A punch biopsy specimen was obtained from the left inguinal fold, and histopathologic evaluation demonstrated an atrophic lichenoid tissue reaction. Laboratory evaluation was normal, including a negative hepatitis C antibody. She was started on a regimen of tacrolimus ointment, which resulted in improvement of her cutaneous eruption.
Few reviews of podiatric dermatology exist in the literature. By consulting journals, textbooks, and the Internet, a collection of common and rare skin conditions of the feet has been reviewed and compiled with accompanying illustrations and brief descriptions.
Conclusion: Lichen planus is a papulosquamous dermatosis with numerous morphologic presentations. A review of the literature revealed more than 20 clinical variants of disease. However, inverse lichen planus is not often discussed. Consequently, we report a case of inverse lichen planus to highlight this rare and unusual morphologic variant as well as suggest that this pattern be included as one of the clinical subtypes of this papulosquamous dermatosis.
Nothing to disclose.
Nothing to disclose.
P64
J AM ACAD DERMATOL
MARCH 2005
P592
USE OF IMIQUIMOD AND PIMECROLIMUS CREAM IN THE TREATMENT OF ACNE KELOIDALIS NUCHAE Jerome Barr, MD, Addie Friedman, MD, Hilary Balwin, State University of NewYork Downstate, Hempstead, NY, United States
ANGIOSARCOMA: A CASE REPORT AND REVIEW Greg Houck, DO, Marya Cassandra, DO, Sun Coast Hospital, Saint Petersburg, FL, United States We present a case of an 84-year-old woman who reported an enlarging bruise over her chin and neck of 3 months’ duration. She denied any symptoms, including pain, bleeding, itching, or fatigue. She denied any earlier dermatologic problems. On examination, the submental area and anterior neck revealed an indurated, ecchymotic, and erythematous plaque. There was no evidence of lymphadenopathy. A biopsy from the left side of the neck revealed a malignant vascular tumor consistent with angiosarcoma. Angiosarcoma is an aggressive, highly malignant vascular neoplasm. These tumors are common in elderly white men on the head and neck. The histopathology usually demonstrates anastomosing vascular channels in the dermis lined by plump endothelial cells with markedly hyperchromatic nuclei. Clinical subtypes of angiosarcoma include the head and neck type of elderly people, the chronic lymphedematous type, the radiation-induced type, and a miscellaneous type. The prognosis of angiosarcoma is poor and metastasis is common. Treatment options include early detection and wide excision followed by high-dose radiation.
Acne keloidalis nuchae (AKN) presents as keloidal-like papules and plaques on the posterior neck and occipital scalp in African American men. The exact origin of AKN is unknown. AKN lesions are often painful and psychologically devastating. Unfortunately, there is no therapeutic modality that cures AKN. Current treatments for AKN include cryotherapy; laser therapy; topical, intralesional, and systemic corticosteroids; topical retinoic acid; and topical clindamycin when pustules are present. We investigated the efficacy of topical imiquimod and topical pimecrolimus for the treatment of AKN. Five of 24 patients previously treated with one of the current treatment options enrolled in the study. The patients were randomly assigned either imiquimod cream once daily for 8 weeks or pimecrolimus twice daily for 8 weeks. Response was defined as improvement in number of lesions, average size of lesions, symptoms, and firmness. All 5 patients reported a significant decrease in itching. With imiquimod, the average number of lesions decreased from 12.5 to 9 and with pimecrolimus the average number decreased from 10.3 to 8.5. Pretreatment and posttreatment photographs demonstrate the cosmetic benefits of the treatments. The medications were well tolerated with no reported side effects. Both imiquimod and pimecrolimus were objectively and subjectively effective. They may be beneficial as monotherapy or adjunctive therapy in the treatment of AKN.
Nothing to disclose.
Nothing to disclose.
P593 INVERSE LICHEN PLANUS: AN UNUSUAL MORPHOLOGIC VARIANT OF A CLASSIC PAPULOSQUAMOUS DERMATOSIS Jeannine Hoang, MD, Janine Malone, MD, Jeffrey Callen, MD, University of Louisville, Louisville, KY, United States
P591 WHAT WALKED INTO THE OFFICE TODAY—A BRIEF REVIEW OF PODIATRIC DERMATOLOGY Patricia Ting, BS, University of Calgary, Calgary, AB, Canada Some of the most frequently encountered podiatric dermatoses include viral warts, dermatophyte infections of the skin and toenails, and pitted keratolysis. Traumarelated conditions often consist of black heels and toes, corns and calluses, piezogenic pedal papules, and ulcers. Hyperhidrosis and various forms of contact dermatitis as well as psoriasiform and eczematous diseases are also not uncommon. Less common podiatric skin conditions include a miscellaneous group of keratodermas, skin cancers, psychodermatoses, and secondary manifestations of an underlying systemic disease.
Background: Lichen planus, an idiopathic, inflammatory mucocutaneous condition, is one of the classic papulosquamous dermatoses as well as the prototype for the histological category of lichenoid tissue reactions. The standard textbook description entails an eruption characterized by violaceous, polygonal, flat-topped papules and plaques with overlying, reticulated, fine white scale (Wickham’s striae), commonly affecting flexural wrists and forearms, dorsal hands, trunk, oral mucosa, and anterior lower legs. Dermatologists often associate lichen planus with these ‘‘classic’’ features. However, it is often a more complex disease that can manifest in association with other systemic illnesses and present as one of numerous morphologic variants. In this poster, we highlight an unusual presentation of lichen planus—inverse pattern—and review the many clinical subtypes of this classic papulosquamous disease. Observation: A 51-year-old woman presented with a 6-week history of a pruritic eruption involving the right axilla. She was initially treated for presumed intertrigo with minimal improvement. Over the course of 3 months, new lesions developed that were confined to flexural and intertriginous areas. Physical examination revealed hyperpigmented, slightly scaly papules and plaques involving the right axilla, popliteal fossae, inframammary folds, inguinal folds, and intergluteal cleft. The lesions tended to be arranged in a linear fashion, and some plaques had faint white streaks over the surface (reminiscent of Wickham’s striae). There was no evidence of mucosal, scalp, or palmoplantar involvement, nor were there any nail or cuticular abnormalities. A punch biopsy specimen was obtained from the left inguinal fold, and histopathologic evaluation demonstrated an atrophic lichenoid tissue reaction. Laboratory evaluation was normal, including a negative hepatitis C antibody. She was started on a regimen of tacrolimus ointment, which resulted in improvement of her cutaneous eruption.
Few reviews of podiatric dermatology exist in the literature. By consulting journals, textbooks, and the Internet, a collection of common and rare skin conditions of the feet has been reviewed and compiled with accompanying illustrations and brief descriptions.
Conclusion: Lichen planus is a papulosquamous dermatosis with numerous morphologic presentations. A review of the literature revealed more than 20 clinical variants of disease. However, inverse lichen planus is not often discussed. Consequently, we report a case of inverse lichen planus to highlight this rare and unusual morphologic variant as well as suggest that this pattern be included as one of the clinical subtypes of this papulosquamous dermatosis.
Nothing to disclose.
Nothing to disclose.
P64
J AM ACAD DERMATOL
MARCH 2005