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As the largest organ in the body, skin can prove the most daunting to diagnose and manage due to the large number of conditions and their uncanny ability to have similar qualities visually. Skin can reflect current trauma or infections or can be a harbinger of an underlying systemic disorder. With knowledge of the most common pediatric skin conditions, it is possible for practitioners to start a child on a basic treatment regimen and then refer to an appropriate specialist for more complex or rare disorders. This article covers the most common skin conditions seen on the lower extremity in the pediatric population.

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Anamnese und klinischer Befund: Eine 53-jahrige Frau litt seit mehreren Jahrzehnten an braunlichen, gelegentlich ulzerierenden Plaques an beiden Unterschenkeln, zeitweise auch am linken Fusrucken. Zusatzlich bestand seit rund 15 Jahren eine progrediente flachige Verhartung am Rucken bei seit uber 40 Jahre bekanntem Typ-1-Diabetes. Untersuchungen und Diagnosen: Bioptisch wurde im Bereich der Unterschenkel eine Necrobiosis lipoidica und am Rucken ein Scleroedema adultorum Buschke gesichert, eine systemische Sklerodermie wurde somit ausgeschlossen. In Laboruntersuchungen zeigte sich kein erhohter ANA-Titer. Therapie und Verlauf: Nach diabetologischem Konsil und optimaler Einstellung der Stoffwechselstorung erfolgte die Behandlung der Necrobiosis lipoidica mit topischen Kortikosteroiden unter Kompression sowie einer Creme-PUVA-Therapie und einer Systemgabe von Pentoxifyllin. Die Ulzera wurden konservativ mit Kurettagen und einer Niederdruck-Wundtherapie (V.A.C.®, KCI) behandelt. Die Therapie des Scleroedema adultorum am Rucken umfasste zunachst eine UVA-1-Lichttherapie, die bei Unvertraglichkeit vorzeitig abgebrochen werden musste. Zusatzlich wurden Bindegewebsmassagen verordnet. Insgesamt zeigte sich ein therapieresistenter Verlauf. Folgerungen: Die Therapieoptionen zur Behandlung bei diabetesassoziierten Hauterkrankungen sind eingeschrankt. Insgesamt handelt es sich bei der Necrobiosis lipoidica und dem Scleroedema adultorum um oft therapierefraktare Leiden, bei denen die optimale Diabeteseinstellung entscheidend ist.

Resume Introduction Le xanthogranulome juvenile (XGJ) est une histiocytose non langerhansienne se presentant classiquement sous la forme de nodules cutanes jaunâtres isoles ou multiples. Des formes cutanees atypiques, lichenoides, reticulees, maculopapuleuses, en plaque ou encore lineaires ont ete decrites a partir d’observations isolees. Nous rapportons le cas d’un nourrisson ayant des XGJ eruptifs en plaque de la jambe gauche. Observation Une enfant de 13 mois avait depuis l’âge de 2 mois des lesions papuleuses rouge orange asymptomatiques evoluant par poussees sur la face anterieure de la jambe gauche, sans placard sous-jacent. La recherche d’un signe de Darier etait negative. L’examen histologique posait le diagnostic de XGJ. Discussion Notre cas se rapproche des XGJ en plaque plutot que d’une forme multiple, dont la topographie est diffuse. Seuls sept cas semblables ont ete rapportes dans la litterature, tous survenus avant cinq mois de vie. La lesion correspondait le plus souvent a une plaque erythemateuse asymptomatique surmontee de petites lesions jaunâtres, de topographie variable et d’apparition parfois progressive. La guerison spontanee etait la regle. Il n’y avait pas d’atteinte systemique. Nous presentons ici un cas unique de xanthogranulomes multiples localises, sans plaque infiltree sous-jacente evidente, evoluant par poussees.

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We present the case of a 49-year-old man with an 18-month history of an intermittently pruritic red-brown reticulate eruption of the medial legs, with occasional blistering. There were areas of scale, crust and superficial erosions. The patient worked long overnight shifts standing in front of hot machinery wearing shorts, and spent time sitting in front of a heater at home. A clinical diagnosis of erythema ab igne (EAI) was made. This settled with heater avoidance and protection of the legs with long trousers, as well as a topical corticosteroid. Histology showed features of cutaneous reactive angiomatosis, a rare condition with various associations but only previously reported once in association with EAI.

Biopsy can cause or worsen ulceration at the incision site, increasing the risk of infection and sepsis.

The skin of the lower extremity can be a helpful diagnostic tool for systemic disease. Diabetes, renal disease, genetic disorders, and even cancer can have cutaneous manifestations in the legs and feet; moreover, proper diagnosis can facilitate earlier treatment of these diseases and not only clear up the skin symptoms but also bring about resolution of the systemic disease causing them. Although not comprehensive, this article discusses many of these disorders presenting with integumentary manifestations in the lower extremities. Where appropriate, it also enumerates the treatments involved, both systemic and localized.

Adverse drug reactions (ADRs) are a common cause of dermatologic consultation, involving 2 to 3 per 100 medical inpatients in the United States. Female patients are 1.3 to 1.5 times more likely to develop ADRs, except in children less than 3 years of age, among whom boys are more often affected. Certain drugs are more frequent causes, including aminopenicillins, trimethoprim-sulfamethoxazole, and nonsteroidal antiinflammatory drugs. Chemotherapeutic agents commonly cause adverse reactions to the skin and nails, with certain agents causing particular patterns of reactions. ADRs can involve any area of the skin; the appendages, including hair and nails; as well as mucosa.

A 27-year-old healthy woman presented to the medical centre with a one-month history of widespread skin lesions with slow clinical progression. The lesions appeared on her thighs, shins, lower abdomen and left arm three weeks after she had travelled to an area endemic for Leishmania major in

Introduccion: la amiloidosis cutanea primaria de tipo nodular es un subtipo de ami­loidosis de presentacion exclusivamente cutanea que afecta principalmente a mujeres, se presenta con nodulos amarillentos brillantes y firmes al tacto, generalmente asinto­maticos. Caso clinico : se presento el caso de una paciente de genero femenino de 46 anos con sintomatologia de cuatro anos de evolucion consistente en la aparicion de lesiones papulosas pequenas en miembros inferiores y en la region lumbosacra, pruriginosas, que no respondieron al tratamiento inicial por medicina general con loratadina. Sin antecedentes personales de importancia. Se sospecha la presencia de amiloidosis; la histologia con tincion Rojo Congo confirmo el diagnostico. No se encontraron hallazgos de enfermedad sistemica. Conclusion : la amiloidosis nodular, generalmente, es una enfermedad de etiologia diversa, inflamatoria, cronica, poco frecuente y de afectacion local en la piel con un pro­nostico bueno. En ocasiones su tratamiento se ve retardado por el diagnostico tardio. Rev.cienc.biomed. 2016;7(1):123-127. PALABRAS CLAVE Amiloidosis; Dermatosis de la pierna; Integumento comun. SUMMARY Introduction: nodular primary cutaneous amyloidosis is a subtype of amyloidosis that is only cutaneous it mainly affects women. It comes up with yellow and bright nodules, hard to the touch, usually asymptomatic. Case report: the case is presented in a 62-year-old female patient, who during four years presented pruritus, little papular lesions in lower limbs and in lumbosacral re­ gion that did not answered to the first medical treatment with loratadine. The patient did not present important clinical record. It is believed the presence of amyloidosis; the histology with Congo red staining confirmed the diagnosis. Systemic disease was not found. Conclusion: usually, nodular amyloidosis is a disease with chronic, inflammatory, di­verse and uncommon etiology; it only affects the skin with good prognosis. Sometimes, its treatment is delayed by late diagnosis. Rev.cienc.biomed. 2016;7(1):123-127. KEYWORDS Amyloidosis; Leg dermatoses; Integumentary system.

Stewart-Bluefarb syndrome (SBS) is a subtype of pseudo-Kaposi sarcoma (PKS), which is associated with congenital arteriovenous malformation. It is a rare syndrome, characterized by cutaneous lesions with onset in the second decade of life. We report a case of SBS in a 33-year-old man presenting with a 15-year history of unilateral, reddish-brown, raised lesions on his right lower leg and the dorsum of his foot. Diagnosis of PKS was confirmed by histopathology and radiology. We report the clinical features, aetiopathogenesis, differential diagnosis and treatment of this rare condition.

Localized bullous pemphigoid is a rare clinical variant of bullous pemphigoid. We report three cases of localized bullous pemphigoid in which the diagnosis was delayed because the presentation simulated other local vesicular or bullous diseases. Localized bullous pemphigoid differs from the generalized form by its more benign course. Early diagnosis will help avoid unnecessary and costly treatment for unrelated conditions.

Background. Keratoacanthoma centrifugum marginatum is a rare variety of keratoacanthoma, usually presented and classified as solitary keratoacanthoma. Reported cases of multiple keratoacanthoma centrifugum marginatum are exceptional in the literature. Observations. A 21-year-old man presented for evaluation of erythematous papules and plaques on both legs that had had a peripheral growth over the past year. Clinical and histologic examination showed typical features of keratoacanthoma centrifugum marginatum. Owing to the multiplicity and size of the lesions, treatment with oral isotretinoin was started. It was ineffective. Subsequent treatment with methotrexate combined with oral prednisone led to the regression of all lesions. Conclusions. The exceptional case of a man with multiple keratoacanthoma centrifugum marginatum is reported. Treatment with methotrexate combined with oral prednisone was effective. This case illustrates how some variants of keratoacanthomas do not really fit into the current classification and how complex the treatment of these tumors is.

Keywords: allergic contact dermatitis; CAS no. 458-37-7; case report; curcumin; turmeric

Nevo epidérmico verrucoso inflamatório linear (Nevil) é uma variante do nevo epidérmico verrucoso que acomete mais comumente o sexo feminino. Clinicamente, é caracterizado por fenômenos inflamatórios recorrentes, conferindo aspecto de dermatite eczematosa crônica ou psoriasiforme, frequentemente unilateral, com prurido intenso, de aparecimento desde o nascimento e de difícil tratamento.

Die papulose akantholytische Dyskeratose ist eine sehr seltene Dermatose, die histologisch eine suprabasale Spaltung mit akantholytischen und dyskeratotischen Zellen zeigt, was dem klassischem Bild des Morbus Darier entspricht, jedoch ist sie erworben und ohne genetische Grundlage. Eine 40-jahrige Patientin zeigte ca. 200 kleine keratotische Papeln an beiden Unterschenkeln, deren histologische Untersuchung in das Bild der Keratosis follicularis hineinpasste. Die elektronenmikroskopische Untersuchung zeigte eine verminderte Desmosomenzahl und eine perinukleare Verteilung der Tonofilamente. Die Lasionen sprachen auf Kryotherapie mit offenem Verfahren gut an.

The development of lichen amyloidosis in a patient with chronic lichen planus is reported. To our knowledge, this is the first report of the coexistence of these 2 diseases. The disparate response of the 2 conditions to etretinate is discussed.

A fixed drug eruption (FDE) is a cutaneous reaction to an ingested drug that recurs at the same site each time the offending drug is taken. Clinical diagnosis may be difficult as patients often do not consider over-the-counter medications or supplements as part of their reported medication list. In addition, patients may take the offending medication so infrequently that the eruption does not occur often enough to easily allow them to deduce the association. The most common offending agents include anti-microbials, non-steroidal anti-inflammatory drugs (NSAIDs), and anti-epileptics. Fixed drug eruptions classically present as a single, sharply demarcated, round erythematous patch or plaque, occasionally with localized bullae. Generalized bullous FDEs, however, are relatively rare and can be confused with Stevens-Johnson Syndrome. We present a case of naproxen-induced generalized bullous FDE in a 50-year-old woman.

Die 57-jahrige, stark ubergewichtige Frau mit chronischem Lipolymphodem bekommt plotzlich Fieber bis 39,2 °C, hat Schuttelfrost, Kopfschmerzen und fuhlt sich abgeschlagen. Am rechten Unterschenkel tritt in kurzer Zeit eine flachige Rotung auf. Die Haut in diesem Bereich spannt und ist sehr druckschmerzhaft.

Eine 23-jahrige Frau hat seit 6 Wochen abdominelle Schmerzen und intermittierende, schmerzhafte Rotungen an beiden Unterschenkeln. Die korperliche Untersuchung ergibt eine druckschmerzhafte Resistenz im rechten Unterbauch. Bei der Inspektion der Beine zeigt sich der in Abb. 1 dargestellte pathologische Hautbefund.