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A 15-month-old boy presented with 1-4 cm, pink edematous plaques with overlying round erosions and hemorrhagic bullae in the setting of a gastrointestinal illness and was ultimately diagnosed with bullous-type Sweet syndrome. Despite appropriate treatment with oral steroids, the patient's cutaneous lesions healed with secondary anetoderma. This case should prompt practitioners to be aware of bullous-type Sweet syndrome and the possibility of lesions healing with postinflammatory scarring.

Harlequin ichthyosis (HI) is a rare autosomal recessive congenital ichthyosis associated with mutations in the keratinocyte lipid transporter adenosine triphosphate binding cassette A12 (ABCA12),1 leading to disruption in lipid and protease transport into lamellar granules in the granular layer of the epidermis. Subsequent defective desquamation with compensatory hyperkeratinization follows.2 Historically, there has been a high early mortality rate in infants with HI; however, improved neonatal management and the early introduction of systemic retinoids may contribute to improved prognosis. Death in these patients is most commonly caused by sepsis, respiratory failure, or electrolyte imbalances. We report a case of a neonate with HI treated in the first few days of life with acitretin. The patient initially improved but eventually died of pseudomonas sepsis at 6 weeks of age.

Harlequin ichthyosis (HI) is the most severe phenotype of the autosomal recessive congenital ichthyoses. HI is caused by mutations in the lipid transporter adenosine triphosphate binding cassette A 12 (ABCA12). Neonates are born with a distinct clinical appearance, encased in a dense, platelike keratotic scale separated by deep erythematous fissures. Facial features are distorted by severe ectropion, eclabium, flattened nose, and rudimentary ears. Skin barrier function is markedly impaired, which can lead to hypernatremic dehydration, impaired thermoregulation, increased metabolic demands, and increased risk of respiratory dysfunction and infection. Historically, infants with HI did not survive beyond the neonatal period; however, recent advances in neonatal intensive care and coordinated multidisciplinary management have greatly improved survival. In this review, the authors combine the growing HI literature with their collective experiences to provide a comprehensive review of the management of neonates with HI.

The observance during acne follow-ups that information stored within iPLEDGE was discordant with medical charts prompted this study.To evaluate the information acquired and stored within iPLEDGE as it compares to medical charts with a goal of assessing the efficacy of iPLEDGE as a database.This is a multicenter retrospective chart review analyzing congruence and discrepancies between medical chart documentation and iPLEDGE data for all patients who received at least a single dose of isotretinoin from the primary investigators between January 2006 and November 2010.A total of 357 charts were analyzed. Overall congruence between medical chart documentation and iPLEDGE data was observed in only 73.1% of cases. The discrepancy (N=96) was due to a missed dose (prescription recorded in chart but not in iPLEDGE) in 81.4% of cases, or an addition (medication dispensed per iPLEDGE without corresponding chart documentation) in the remainder of cases. Of note, several charts had multiple discrepancies (N=249 total discrepancies).Retrospective chart review study.Given the large percentage of discordant data, our findings question the efficacy of the iPLEDGE system, which is designed to monitor every dispensed isotretinoin dose.

Acne vulgaris is a chronic and ubiquitous skin condition that can result in both physical and psychological scarring. The need for early and aggressive treatment of acne is essential to prevent these deleterious effects. Understanding of acne pathophysiology continues to evolve, leading to new therapeutic targets and the development of advanced treatment regimens. Among the most recent advances in acne therapy are new fixed-drug combination therapies and novel vehicle technologies. Additionally, as the concern for antibiotic resistance grows, treatments involving nonantibiotic therapies are growing in popularity. Dermatologists have also begun to recognize the importance of diet effects on acne progression, as well as the therapeutic role of procedural acne treatments. This review summarizes the most recent developments in acne pathophysiology and discusses new trends in therapy.

A 30-year-old female presents to the office complaining of redness of her face. The patient reports that over the last few months her face is often flushed and she sometimes felt a stinging sensation of her bilateral cheeks. The symptoms are worse after she spends time outside playing tennis or drinking alcohol. She also notices that for several minutes after application of certain facial cleansers and lotions her face would burn. More recently she developed prominent blood vessels along the sides of her nose.

A 58-year-old white female presents to the office with complaints of wrinkles and light brown “sun spots” on her cheeks and forehead. The patient reports that people often mistake her for a much older woman. She admits to frequent sunbathing during the summer months until age 40 with little to no use of sunscreen and feels that her skin changes may be related to this prior sun exposure. She reports feeling overwhelmed by the number of over-the-counter anti-wrinkle creams and would like to know which cosmeceuticals are most effective and will truly help her appear her stated age.

Scleromyxedema is a rare primary cutaneous mucinosis affecting middle-aged adults. It is characterized by dermal mucin deposition with increased collagen in the skin and internal organs. We report a case of a 72-year-old man with classic skin findings of scleromyxedema as well as a monoclonal gammopathy.

Bleeding is a common occurrence during any dermatologic surgery that disrupts blood vessels. The complications of excess bleeding can include delayed wound healing, hematoma formation, infection, dehiscence, and necrosis. In part one of this review, we discussed the pre-operative, intra-operative, and post-operative management of patients undergoing dermatologic surgery. In Part two, we discuss traditional and new topical hemostatic agents used to achieve hemostasis in dermatological procedures and surgery. We will evaluate the caustic and non-caustic hemostatic agents as well as hemostatic dressings. The mechanisms of action, side effect profile, and advantages and disadvantages of the topical hemostatic agents are provided. Sources for this article were found searching the English literature in PubMed for the time period 1940 to March 2012. A thorough bibliography search was also performed and key references examined.

Cutis Verticis Gyrata (CVG) is a rare condition associated with thickening of the skin folds of the scalp and forehead that resembles the appearance of gyri of the brain cortex. These skin lesions can lead to local skin infections as well as cosmetic complaints. Primary CVG has no obvious cause and is often associated with neurological conditions while secondary CVG is due to inflammation or infiltration of the scalp and is associated with endocrine or neoplastic conditions including acromegaly and pachydermoperiostosis. We discuss a complicated case of a 34 year-old male with cutis verticis gyrata presenting simultaneously with hypertrophic osteoarthropathy and a pituitary macroadenoma. The patient was initially suspected of having acromegaly secondary to the pituitary adenoma but further workup showed normal insulin growth factor-1 and growth hormone levels inconsistent with acromegaly. Subsequent workup was consistent with a diagnosis of the complete form of primary hypertrophic osteoarthropathy also known as pachydermoperiostosis.