Allen Sapadin - Academia.edu (original) (raw)

Papers by Allen Sapadin

Research paper thumbnail of Extensive Mongolian spots associated with Hunter syndrome

Journal of The American Academy of Dermatology, Dec 1, 1998

Research paper thumbnail of Paraneoplastic pemphigus with a pemphigus vegetans-like plaque as the only cutaneous manifestation

Journal of The American Academy of Dermatology, Nov 1, 1998

Research paper thumbnail of Florid eruption of seborrheic keratoses associated with elevated insulin-like growth factor, hypoglycemia, and solitary fibrous tumor of the pleura

International Journal of Dermatology, Dec 1, 2004

A 66-year-old man with a past medical history of hypertension and arthritis was hospitalized and ... more A 66-year-old man with a past medical history of hypertension and arthritis was hospitalized and treated for bacterial pneumonia. Chest X-ray revealed a left-sided chest mass. Computed tomography (CT) scan of the chest demonstrated a large heterogeneously enhancing mass occupying most of the left lower lobe and extending to the inferior aspect of the hilum. It measured 16.6 × 12 cm and caused a mild shift of the mediastinum to the right. The patient declined further work-up or surgical resection of the mass. Dermatologic examination was unremarkable at that time. Over the next 5 months, numerous skin lesions erupted on the patient's trunk. He then experienced several syncopal episodes, at which time he was found to be profoundly hypoglycemic. It was suspected that the chest tumor was producing high serum levels of insulin-like growth factor (IGF) resulting in hypoglycemia and syncope. Serum laboratory investigations were significant for glucose of 20 mg / dL (normal, 60-120 mg / dL), IGF-1 of 39 ng / mL (normal, 152-494 ng / mL), IGF-2 of 927 ng / mL (normal, 210-750 ng / mL), and insulin of < 5.0 microunits (MCU)/ mL (normal, 0-30 MCU/mL). Surgical extirpation of the chest tumor was recommended. The dermatology service was consulted to evaluate whether the numerous skin lesions in the area of planned surgery would pose an increased risk of infection. Cutaneous examination revealed a dense aggregation of pigmented hyperkeratotic plaques with a "stuck-on" appearance, predominantly localized on the trunk. Many were unusually large or darkly pigmented. A particularly dense distribution was apparent on the left side of the chest (Fig. 1a). Numerous large acrochordons were evident on the lower eyelids and in the axillary vaults. Acanthosis nigricans was not present. A biopsy specimen from a hyperkeratotic lesion on the left upper back revealed an acanthotic, hyperpigmented epidermis with a lamellar horn, anastomosing rete, and pseudohorn cysts (Fig. 1b). Left thoracotomy and left lower lobectomy were performed, and surgeons extirpated an 18 × 17 × 10 cm cystic, multilobular, hard tumor (Fig. 2a) adhering to the left diaphragm, left lower lobe, and left parietal pleura. Pathologic examination revealed a highly cellular spindle cell tumor (Fig. 2b). The nuclei were relatively monotonous with few mitoses. No areas of necrosis were identified. These pathologic findings were diagnostic for solitary fibrous tumor of the pleura. After surgery, the patient experienced no further syncopal episodes. The truncal seborrheic keratoses decreased substantially in number, size, and density over the following 6 months. Post-operative laboratory data revealed normalization of the blood glucose, insulin, IGF-1 (191 ng/mL; normal, 71-290 ng / mL), and IGF-2 (515 ng / mL; normal, 358-854 ng / mL).

Research paper thumbnail of Treatment of Scleroderma

Archives of Dermatology, 2002

ABSTRACT The treatment of systemic sclerosis (scleroderma) is difficult and remains a great chall... more ABSTRACT The treatment of systemic sclerosis (scleroderma) is difficult and remains a great challenge to the clinician. Because the cause is unknown, therapies are directed to improve peripheral blood circulation with vasodilators and antiplatelet aggregation drugs, to prevent the synthesis and release of harmful cytokines with immunosuppressant drugs, and to inhibit or reduce fibrosis with agents that reduce collagen synthesis or enhance collagenase production. The purpose of this review is to critically analyze conventional and new treatments of systemic sclerosis and localized scleroderma. The therapeutic options discussed for the treatment of systemic sclerosis include the use of (1) vasodilators (calcium channel blockers [nifedipine], angiotensin-converting enzyme inhibitors [captopril, losartan potassium], and prostaglandins [iloprost, epoprostenol]), (2) immunosuppressant drugs (methotrexate, cyclosporine, cyclophosphamide, and extracorporeal photopheresis), and (3) antifibrotic agents (D-penicillamine, colchicine, interferon gamma, and relaxin). The treatment options reviewed for localized scleroderma include the use of corticosteroids, vitamin D analogues (calcitriol, calcipotriene), UV-A, and methotrexate. Preliminary reports on new therapies for systemic sclerosis are also considered. These include the use of minocycline, psoralen-UV-A, lung transplantation, autologous stem cell transplantation, etanercept, and thalidomide.

Research paper thumbnail of Linear Psoriasis: A Case Report of a 71-Year-Old Female

Skin, Jan 2, 2018

A 71-year-old woman presented to the clinic with a one-month history of pruritic, burning, flaky ... more A 71-year-old woman presented to the clinic with a one-month history of pruritic, burning, flaky pink to dark red erythematous plaques. The lesions had a very narrow, linear, Blashkoid distribution which extended from the left lateral sole to the popliteal region (Figure 1). The right leg also had a similar erythematous plaque located at the pretibial region. The patient had no other lesions or previous history of psoriasis. Punch biopsies were performed which revealed orthokeratosis and mounds of parakeratosis, and traumatized Koebnerization. Elongation of rete ridges was not prominent, however, mild psoriasiform hyperplasia and suprapapillary thinning of the epidermis with Funding: none.

Research paper thumbnail of Zosteriform Darier's disease versus acantholytic dyskeratotic epidermal nevus

PubMed, Aug 22, 2001

Patients with keratotic lesions distributed in a unilateral, linear, zosteriform or localized pat... more Patients with keratotic lesions distributed in a unilateral, linear, zosteriform or localized pattern and revealing histologic features of dyskeratotic acantholysis have been reported. There is still some controversy regarding the appropriate nosologic placement of this entity. Some believe it represents a localized form of Darier s disease, while others argue it is a variant of epidermal nevus. We report a case of a 42-year-old physician who presented with a 15-year history of an asymptomatic eruption that had been diagnosed as "chronic zoster." Physical exam revealed hyperkeratotic papules and plaques in a dermatomal distribution. The controversy regarding the correct nosologic placement of such a patient is discussed.

Research paper thumbnail of Souvenir from the Hamptons - a case of cutaneous larva migrans of six months' duration

PubMed, Jan 5, 2000

Cutaneous larva migrans is a distinctive serpiginous eruption caused by a reaction to burrowing h... more Cutaneous larva migrans is a distinctive serpiginous eruption caused by a reaction to burrowing hookworms. The infection is usually self-limited, normally lasting 2-8 weeks, but may persist for more than a year if misdiagnosed. Biopsies of the creeping eruption rarely reveal an organism. Thus, it is important for the infection to be recognized clinically, so that effective treatment may begin. We found topical thiabendazole to be fast and effective in treating this case of cutaneous larva migrans of six months' duration.

Research paper thumbnail of Calcification of elastic fibers in pseudoxanthoma elasticum

PubMed, May 1, 1996

Pseudoxanthoma elasticum is an inherited disorder of connective tissue that is characterized by c... more Pseudoxanthoma elasticum is an inherited disorder of connective tissue that is characterized by calcification of elastic fibers with associated abnormalities of the skin, ocular, and cardiovascular systems. The genetic defect causing pseudoxanthoma elasticum has not been determined and the diagnosis relies on clinical recognition of skin lesions and histologic demonstration of calcification of elastic fibers that are clumped and fragmented in the dermis. The role of connective tissue components in the etiology of pseudoxanthoma elasticum is reviewed and includes changes in collagen, elastin, glycosaminoglycans, fibronectin, microfibrillar proteins, modifying enzymes of extracellular matrix proteins, fibroblasts, and fibrillins.

Research paper thumbnail of Cutaneous granulomas masquerading as tuberculoid leprosy in a patient with congenital combined immunodeficiency

PubMed, Aug 22, 2001

Combined immunodeficiency disorders are characterized by abnormalities in cellular and humoral im... more Combined immunodeficiency disorders are characterized by abnormalities in cellular and humoral immunity. This classification includes common variable immunodeficiency (CVI), a primary immunodeficiency disorder characterized by hypogammaglobulinemia, recurrent bacterial infections, and significant T-cell abnormalities. Associated autoimmune diseases include rheumatoid arthritis, pernicious anemia, idiopathic thrombocytopenic purpura, and systemic lupus erythematous. Granulomatous lesions in lymphoid tissues, solid organs, and skin have been reported. We describe a patient with CVI who developed cutaneous granulomas with perineural invasion; to our knowledge, this is a previously undescribed feature.

Research paper thumbnail of Kimura's Disease

Case Reports in Medicine, 2009

Kimuras disease is a chronic inflammatory disorder of unknown etiology. It is rare in the West, b... more Kimuras disease is a chronic inflammatory disorder of unknown etiology. It is rare in the West, but endemic in Asia. It typically presents as solitary or multiple subcutaneous nodules, that slowly increase in size. The lesions are variably painful and pruritic. It often accompanied by regional lymphadenopathy, raised serum eosinophil counts, and markedly elevated serum immunoglobulin E levels. Histologically, the lesions are characterized by reactive lymphoid follicles with eosinophilic infiltration and an increased amount of postcapillary venules. The optimal treatment for KD remains controversial. Although the condition seldom resolves spontaneously, malignant transformation has not been reported to date, and the prognosis is good. We describe a male patient with a 4-year pruritic progressive "bump" in front of his left ear. On physical examination, the patient had 2 discrete lesions on the left side of his face near his ear. Postauricularly, there was a 3 × 5 cm erythematous to violaceous, indurated nodule. Preauricularly, there was a similar, but smaller cyst-like nodule. Punch biopsy showed a superficial and deep nodular and interstitial infiltrate, reactive lymphoid follicles with a dense infiltration of eosinophils and areas of eosinophilic follicle lysis. The patient received intralesional triamcinolone acetonide injections 10 mg/cc behind left ear with a good improvement.

Research paper thumbnail of Multiple subcutaneous angiolipomas associated with new-onset diabetes mellitus

International Journal of Dermatology, Nov 1, 2002

A 44‐year‐old Hispanic man, with a past medical history of diabetes mellitus type 2 and cerebrova... more A 44‐year‐old Hispanic man, with a past medical history of diabetes mellitus type 2 and cerebrovascular accident, presented to the Mount Sinai Department of Dermatology with sudden, fast‐growing nodules over both of his shins. Approximately 2 months before the appearance of the nodules, the patient was diagnosed with diabetes mellitus type 2 with hemoglobin A1c (HbA1c) of 8.5%. The patient was taking metformin orally, 500 mg three times daily, at the time of presentation. Six nodules appeared over a period of days. They caused a burning, throbbing pain upon ambulation. Over a period of 6 months, the lumps decreased in size, and two totally disappeared. The resolution of the nodules coincided with the control of the patient's diabetes, as demonstrated by HbA1c of 5.5%. The patient denied trauma to the sites of the nodules. The patient denied any associated purpura or ecchymoses over the nodules. The past medical history was significant for a stroke with residual right hemiparesis at 42 years of age. The family history was negative for similar lesions, but an aunt did have diabetes mellitus type 2. The patient denied alcohol use, smoking, or intravenous drug use.Physical examination was positive for six soft, tender, freely mobile, symmetrical, well‐demarcated, round masses, 1–2 cm in diameter and skin colored, over the anterior aspects of both legs. The patient was obese (body mass index, 38.5). Laboratory tests (barring the initially elevated HbA1c) were normal.One lesion was excised. Histopathology revealed features typical of an angiolipoma (see Fig. 1a,b). A karyotype of the angiolipoma was not performed.(a) Prominent vessels filled with fibrin thrombi at the periphery of mature fat lobules. (b) At higher magnificationimageBecause excision of one angiolipoma produced scarring with a poor cosmetic result, intralesional triamcinolone, 5 mg/mL, was tried without success.

Research paper thumbnail of Current therapy of pemphigus vulgaris

PubMed, Aug 22, 2001

Pemphigus vulgaris (PV) is a potentially fatal autoimmune blistering disease of the skin and muco... more Pemphigus vulgaris (PV) is a potentially fatal autoimmune blistering disease of the skin and mucous membranes, characterized by flaccid bullae that rupture and leave erosions. Its treatment is challenging. Although the use of systemic corticosteroids remains the cornerstone of effective therapeutic regimens for PV, their prolonged administration may lead to serious side effects. It is therefore necessary, for many patients, to add immunosuppressive agents or use immunomodulatory procedures to achieve remission. This paper will summarize the treatments available for PV, while focusing on the most recently available therapeutic options.

Research paper thumbnail of Immunopathogenesis of scleroderma--evolving concepts

PubMed, Aug 22, 2001

Scleroderma, or systemic sclerosis, is a connective tissue disease which may affect various organ... more Scleroderma, or systemic sclerosis, is a connective tissue disease which may affect various organ systems including skin, lungs, gastrointestinal tract, cardiovascular system and kidneys. While the etiology is not clear, it is currently believed that scleroderma may represent an autoimmune response to an unknown antigen. In this regard, there is evidence that both humoral and cellular immunity may play roles. The pathophysiology is complex and consists of three major features: (1) vascular damage; (2) mononuclear cellular infiltrates; and (3) massive deposition of newly synthesized connective tissue, mainly collagen. The major pathologic features of scleroderma and the roles of humoral and cellular immunity in its pathogenesis are reviewed and summarized.

Research paper thumbnail of Cutaneous polyarteritis nodosa after streptococcal necrotizing fasciitis

PubMed, Aug 22, 2001

Polyarteritis nodosa (PAN) is a necrotizing arteritis of small and medium-sized vessels. It may p... more Polyarteritis nodosa (PAN) is a necrotizing arteritis of small and medium-sized vessels. It may present with hypertension and/or renal insufficiency. Peripheral neuropathy, myopathy, joint pains, testicular pain, and ischemic myalgias may also be seen. Gastrointestinal involvement may lead to gangrene of the bowel, peritonitis, perforation, intra-abdominal hemorrhage, and pancreatitis. The cutaneous manifestations include tender subcutaneous nodules grouped along the course of superficial arteries of the lower extremities, with or without an overlying livedo reticularis. Although multisystem involvement is characteristic, sometimes only one organ or system may be involved. Associations with viral hepatitis (both B and C) and streptococcal infection have been established for PAN. Recurrent strep infections of the upper respiratory tract, streptococcal glomerulonephritis and rheumatic fever have previously been linked to PAN. This report extends the spectrum of associated streptococcal infections to include necrotizing fasciitis.

Research paper thumbnail of Temporary tattoo dermatitis

The Journal of Pediatrics, May 1, 2003

Dermatologic conditions are common among persons who have recently traveled. 1 We share our recen... more Dermatologic conditions are common among persons who have recently traveled. 1 We share our recent experience with a young traveler in whom an allergic contact dermatitis to henna developed. While on vacation in the Dominican Republic, an 11-year-old boy had temporary henna tattoos applied to his upper arms bilaterally by a street artist. Two weeks later an erythematous, pruritic rash developed at the tattoo sites. He was seen by his pediatrician, who prescribed topical steroid therapy with fluticasone propionate ointment, oral prednisone, and cetirizine. On referral, examination revealed erythematous patches with accentuation at the borders of the tattoo sites (Figure). In addition, erythematous papules were clustered on the upper chest, face and extensor aspects of the extremities. A biopsy specimen taken from the left wrist revealed spongiotic dermatitis, subacute type with eosinophilia suggesting an id reaction. At follow-up examination one week later, the eruption had cleared completely. Henna is derived from the Lawsonia tree, which grows in the hot climates of India, the Middle East, and North Africa. 2 Skin painting or pseudotattooing is traditionally performed with henna or other labile vegetable substances, primarily in Muslim and Hindu persons. 3 Temporary henna tattoos are becoming more popular, especially among teenagers and travelers, resulting in more extensive henna use worldwide. 4 Allergic and irritant reactions are rare with henna, which is relatively safe. However, additives such as paraphenylenediamine, a well recognized contact allergen that is sometimes mixed with henna to impart color to the pure reddish-brown paste, may result in more common reactions to henna tattooing.

Research paper thumbnail of Lichen planus pemphigoides presenting with a strikingly unilateral distribution

International Journal of Dermatology, Dec 1, 1998

ABSTRACT A 44-year-old Pakistani woman presented with a unilateral eruption of 2 months&#39; ... more ABSTRACT A 44-year-old Pakistani woman presented with a unilateral eruption of 2 months&#39; duration. She was in her usual state of health when she awoke one morning with an acute blistering eruption in the right axilla. At that time she also began to experience &#39;rough spots&#39; on the buccal mucosa. Approximately 4 days later, lesions, including small blisters, appeared at multiple other sites, all in a right-sided distribution. The patient had an 8-year history of hypothyroidism and was treated with levothyroxine. Physical examination revealed a widely distributed and strikingly right-sided eruption. Dark brown macules and patches measuring 0.1-1.2 cm, some of which were confluent, were located in the right axillary area at the site of previous blister formation (Fig. 1a). Close inspection revealed that some of these lesions had a glistening and violaceous appearance at their periphery. Discrete, small, flat-topped papules with similar qualities were also present at this location. Lichenoid lesions were evident in multiple other right- sided areas, including the submammary area, lower back, intergluteal region, buttock (Fig. 1b), inguinal crease, and knee. Similar lesions on the right arm appeared Koebnerized, extending linearly along the lateral aspect of the mid upper arm to the mid forearm. Examination of the oral mucosa revealed violaceous patches with a lacy pattern on the buccal mucosa. The remainder of the examination was unremarkable. Routine bloodwork was noncontributory. Hepatitis C antibodies were negative. Thyroid function tests were within the range of normal, as were a chest X-ray examination and routine urinalysis. Punch biopsy of a lower back lichenoid lesion demonstrated a subepidermal bulla with festooning of the dermal papillae (Fig. 2a). Other features included orthokeratosis, a sparse superficial dermal infiltrate (composed of lymphocytes, histiocytes, and eosinophils), and numerous melanophages. A second biopsy from this region was divided for routine histopathology and direct immunofluorescence (DIF). Histopathologic examination was consistent with lichen planus. The features included compact orthokeratosis, hypergranulosis, and irregular, saw-toothed acanthosis. The basal layer exhibited marked vacuolar change and a band-like lymphohistiocytic infiltrate was present in the superficial-most dermis (Fig. 2b). DIF revealed a conspicuous and linear deposition of immunoglobulin G (IgG), C3, and fibrinogen along the epidermal basement membrane zone. There was no staining with antisera to IgM or IgA. Colloid bodies were not identified. Indirect immunofluorescence studies were negative. Correlating the clinical, histopathologic and immunopathologic findings, a diagnosis of lichen planus pemphigoides was made. Treatment was initiated with prednisone, 60 mg daily, and tapered over the next 4 weeks as the eruption gradually resolved. Topical clobetasone ointment was prescribed for an additional 2 weeks. There have been no recurrences or new blister formation since that time.

Research paper thumbnail of Henoch-Schonlein purpura induced by clarithromycin

International Journal of Dermatology, Sep 1, 1999

... J Infect Dis 1979; 140: 815–817. 7 Ramos-Zepeda R, González-Mendoza A. Metabolic activity of ... more ... J Infect Dis 1979; 140: 815–817. 7 Ramos-Zepeda R, González-Mendoza A. Metabolic activity of phagocytes in experimental sporotrichosis. Mycopathologia 1986; 93: 109–112. ... Henoch–Schönlein purpura. Br J Dermatol 1974; 109: 664. 7 Cream JJ, Gumpel JM, Peachy ...

Research paper thumbnail of Altered Expression of Angiopoietins and Tie2 Endothelium Receptor in Psoriasis

Journal of Investigative Dermatology, May 1, 2001

Research paper thumbnail of Unilateral Verrucous Psoriasis

Cutis, Feb 1, 2021

Verrucous psoriasis is a variant of psoriasis that presents with wartlike clinical features and o... more Verrucous psoriasis is a variant of psoriasis that presents with wartlike clinical features and overlapping histologic features of verruca and psoriasis. The disease typically arises in patients with established psoriasis but can occur de novo. We report the case of an 80-year-old man with a history of hypertension and coronary artery disease who presented with a rash characterized by multiple asymptomatic plaques with overlying verrucous nodules on the left side of the body. The lesions appeared shortly after coronary artery bypass surgery with a saphenous vein graft.

Research paper thumbnail of Purpura fulminans

International Journal of Dermatology, Feb 1, 2003

Research paper thumbnail of Extensive Mongolian spots associated with Hunter syndrome

Journal of The American Academy of Dermatology, Dec 1, 1998

Research paper thumbnail of Paraneoplastic pemphigus with a pemphigus vegetans-like plaque as the only cutaneous manifestation

Journal of The American Academy of Dermatology, Nov 1, 1998

Research paper thumbnail of Florid eruption of seborrheic keratoses associated with elevated insulin-like growth factor, hypoglycemia, and solitary fibrous tumor of the pleura

International Journal of Dermatology, Dec 1, 2004

A 66-year-old man with a past medical history of hypertension and arthritis was hospitalized and ... more A 66-year-old man with a past medical history of hypertension and arthritis was hospitalized and treated for bacterial pneumonia. Chest X-ray revealed a left-sided chest mass. Computed tomography (CT) scan of the chest demonstrated a large heterogeneously enhancing mass occupying most of the left lower lobe and extending to the inferior aspect of the hilum. It measured 16.6 × 12 cm and caused a mild shift of the mediastinum to the right. The patient declined further work-up or surgical resection of the mass. Dermatologic examination was unremarkable at that time. Over the next 5 months, numerous skin lesions erupted on the patient's trunk. He then experienced several syncopal episodes, at which time he was found to be profoundly hypoglycemic. It was suspected that the chest tumor was producing high serum levels of insulin-like growth factor (IGF) resulting in hypoglycemia and syncope. Serum laboratory investigations were significant for glucose of 20 mg / dL (normal, 60-120 mg / dL), IGF-1 of 39 ng / mL (normal, 152-494 ng / mL), IGF-2 of 927 ng / mL (normal, 210-750 ng / mL), and insulin of < 5.0 microunits (MCU)/ mL (normal, 0-30 MCU/mL). Surgical extirpation of the chest tumor was recommended. The dermatology service was consulted to evaluate whether the numerous skin lesions in the area of planned surgery would pose an increased risk of infection. Cutaneous examination revealed a dense aggregation of pigmented hyperkeratotic plaques with a "stuck-on" appearance, predominantly localized on the trunk. Many were unusually large or darkly pigmented. A particularly dense distribution was apparent on the left side of the chest (Fig. 1a). Numerous large acrochordons were evident on the lower eyelids and in the axillary vaults. Acanthosis nigricans was not present. A biopsy specimen from a hyperkeratotic lesion on the left upper back revealed an acanthotic, hyperpigmented epidermis with a lamellar horn, anastomosing rete, and pseudohorn cysts (Fig. 1b). Left thoracotomy and left lower lobectomy were performed, and surgeons extirpated an 18 × 17 × 10 cm cystic, multilobular, hard tumor (Fig. 2a) adhering to the left diaphragm, left lower lobe, and left parietal pleura. Pathologic examination revealed a highly cellular spindle cell tumor (Fig. 2b). The nuclei were relatively monotonous with few mitoses. No areas of necrosis were identified. These pathologic findings were diagnostic for solitary fibrous tumor of the pleura. After surgery, the patient experienced no further syncopal episodes. The truncal seborrheic keratoses decreased substantially in number, size, and density over the following 6 months. Post-operative laboratory data revealed normalization of the blood glucose, insulin, IGF-1 (191 ng/mL; normal, 71-290 ng / mL), and IGF-2 (515 ng / mL; normal, 358-854 ng / mL).

Research paper thumbnail of Treatment of Scleroderma

Archives of Dermatology, 2002

ABSTRACT The treatment of systemic sclerosis (scleroderma) is difficult and remains a great chall... more ABSTRACT The treatment of systemic sclerosis (scleroderma) is difficult and remains a great challenge to the clinician. Because the cause is unknown, therapies are directed to improve peripheral blood circulation with vasodilators and antiplatelet aggregation drugs, to prevent the synthesis and release of harmful cytokines with immunosuppressant drugs, and to inhibit or reduce fibrosis with agents that reduce collagen synthesis or enhance collagenase production. The purpose of this review is to critically analyze conventional and new treatments of systemic sclerosis and localized scleroderma. The therapeutic options discussed for the treatment of systemic sclerosis include the use of (1) vasodilators (calcium channel blockers [nifedipine], angiotensin-converting enzyme inhibitors [captopril, losartan potassium], and prostaglandins [iloprost, epoprostenol]), (2) immunosuppressant drugs (methotrexate, cyclosporine, cyclophosphamide, and extracorporeal photopheresis), and (3) antifibrotic agents (D-penicillamine, colchicine, interferon gamma, and relaxin). The treatment options reviewed for localized scleroderma include the use of corticosteroids, vitamin D analogues (calcitriol, calcipotriene), UV-A, and methotrexate. Preliminary reports on new therapies for systemic sclerosis are also considered. These include the use of minocycline, psoralen-UV-A, lung transplantation, autologous stem cell transplantation, etanercept, and thalidomide.

Research paper thumbnail of Linear Psoriasis: A Case Report of a 71-Year-Old Female

Skin, Jan 2, 2018

A 71-year-old woman presented to the clinic with a one-month history of pruritic, burning, flaky ... more A 71-year-old woman presented to the clinic with a one-month history of pruritic, burning, flaky pink to dark red erythematous plaques. The lesions had a very narrow, linear, Blashkoid distribution which extended from the left lateral sole to the popliteal region (Figure 1). The right leg also had a similar erythematous plaque located at the pretibial region. The patient had no other lesions or previous history of psoriasis. Punch biopsies were performed which revealed orthokeratosis and mounds of parakeratosis, and traumatized Koebnerization. Elongation of rete ridges was not prominent, however, mild psoriasiform hyperplasia and suprapapillary thinning of the epidermis with Funding: none.

Research paper thumbnail of Zosteriform Darier's disease versus acantholytic dyskeratotic epidermal nevus

PubMed, Aug 22, 2001

Patients with keratotic lesions distributed in a unilateral, linear, zosteriform or localized pat... more Patients with keratotic lesions distributed in a unilateral, linear, zosteriform or localized pattern and revealing histologic features of dyskeratotic acantholysis have been reported. There is still some controversy regarding the appropriate nosologic placement of this entity. Some believe it represents a localized form of Darier s disease, while others argue it is a variant of epidermal nevus. We report a case of a 42-year-old physician who presented with a 15-year history of an asymptomatic eruption that had been diagnosed as "chronic zoster." Physical exam revealed hyperkeratotic papules and plaques in a dermatomal distribution. The controversy regarding the correct nosologic placement of such a patient is discussed.

Research paper thumbnail of Souvenir from the Hamptons - a case of cutaneous larva migrans of six months' duration

PubMed, Jan 5, 2000

Cutaneous larva migrans is a distinctive serpiginous eruption caused by a reaction to burrowing h... more Cutaneous larva migrans is a distinctive serpiginous eruption caused by a reaction to burrowing hookworms. The infection is usually self-limited, normally lasting 2-8 weeks, but may persist for more than a year if misdiagnosed. Biopsies of the creeping eruption rarely reveal an organism. Thus, it is important for the infection to be recognized clinically, so that effective treatment may begin. We found topical thiabendazole to be fast and effective in treating this case of cutaneous larva migrans of six months' duration.

Research paper thumbnail of Calcification of elastic fibers in pseudoxanthoma elasticum

PubMed, May 1, 1996

Pseudoxanthoma elasticum is an inherited disorder of connective tissue that is characterized by c... more Pseudoxanthoma elasticum is an inherited disorder of connective tissue that is characterized by calcification of elastic fibers with associated abnormalities of the skin, ocular, and cardiovascular systems. The genetic defect causing pseudoxanthoma elasticum has not been determined and the diagnosis relies on clinical recognition of skin lesions and histologic demonstration of calcification of elastic fibers that are clumped and fragmented in the dermis. The role of connective tissue components in the etiology of pseudoxanthoma elasticum is reviewed and includes changes in collagen, elastin, glycosaminoglycans, fibronectin, microfibrillar proteins, modifying enzymes of extracellular matrix proteins, fibroblasts, and fibrillins.

Research paper thumbnail of Cutaneous granulomas masquerading as tuberculoid leprosy in a patient with congenital combined immunodeficiency

PubMed, Aug 22, 2001

Combined immunodeficiency disorders are characterized by abnormalities in cellular and humoral im... more Combined immunodeficiency disorders are characterized by abnormalities in cellular and humoral immunity. This classification includes common variable immunodeficiency (CVI), a primary immunodeficiency disorder characterized by hypogammaglobulinemia, recurrent bacterial infections, and significant T-cell abnormalities. Associated autoimmune diseases include rheumatoid arthritis, pernicious anemia, idiopathic thrombocytopenic purpura, and systemic lupus erythematous. Granulomatous lesions in lymphoid tissues, solid organs, and skin have been reported. We describe a patient with CVI who developed cutaneous granulomas with perineural invasion; to our knowledge, this is a previously undescribed feature.

Research paper thumbnail of Kimura's Disease

Case Reports in Medicine, 2009

Kimuras disease is a chronic inflammatory disorder of unknown etiology. It is rare in the West, b... more Kimuras disease is a chronic inflammatory disorder of unknown etiology. It is rare in the West, but endemic in Asia. It typically presents as solitary or multiple subcutaneous nodules, that slowly increase in size. The lesions are variably painful and pruritic. It often accompanied by regional lymphadenopathy, raised serum eosinophil counts, and markedly elevated serum immunoglobulin E levels. Histologically, the lesions are characterized by reactive lymphoid follicles with eosinophilic infiltration and an increased amount of postcapillary venules. The optimal treatment for KD remains controversial. Although the condition seldom resolves spontaneously, malignant transformation has not been reported to date, and the prognosis is good. We describe a male patient with a 4-year pruritic progressive "bump" in front of his left ear. On physical examination, the patient had 2 discrete lesions on the left side of his face near his ear. Postauricularly, there was a 3 × 5 cm erythematous to violaceous, indurated nodule. Preauricularly, there was a similar, but smaller cyst-like nodule. Punch biopsy showed a superficial and deep nodular and interstitial infiltrate, reactive lymphoid follicles with a dense infiltration of eosinophils and areas of eosinophilic follicle lysis. The patient received intralesional triamcinolone acetonide injections 10 mg/cc behind left ear with a good improvement.

Research paper thumbnail of Multiple subcutaneous angiolipomas associated with new-onset diabetes mellitus

International Journal of Dermatology, Nov 1, 2002

A 44‐year‐old Hispanic man, with a past medical history of diabetes mellitus type 2 and cerebrova... more A 44‐year‐old Hispanic man, with a past medical history of diabetes mellitus type 2 and cerebrovascular accident, presented to the Mount Sinai Department of Dermatology with sudden, fast‐growing nodules over both of his shins. Approximately 2 months before the appearance of the nodules, the patient was diagnosed with diabetes mellitus type 2 with hemoglobin A1c (HbA1c) of 8.5%. The patient was taking metformin orally, 500 mg three times daily, at the time of presentation. Six nodules appeared over a period of days. They caused a burning, throbbing pain upon ambulation. Over a period of 6 months, the lumps decreased in size, and two totally disappeared. The resolution of the nodules coincided with the control of the patient's diabetes, as demonstrated by HbA1c of 5.5%. The patient denied trauma to the sites of the nodules. The patient denied any associated purpura or ecchymoses over the nodules. The past medical history was significant for a stroke with residual right hemiparesis at 42 years of age. The family history was negative for similar lesions, but an aunt did have diabetes mellitus type 2. The patient denied alcohol use, smoking, or intravenous drug use.Physical examination was positive for six soft, tender, freely mobile, symmetrical, well‐demarcated, round masses, 1–2 cm in diameter and skin colored, over the anterior aspects of both legs. The patient was obese (body mass index, 38.5). Laboratory tests (barring the initially elevated HbA1c) were normal.One lesion was excised. Histopathology revealed features typical of an angiolipoma (see Fig. 1a,b). A karyotype of the angiolipoma was not performed.(a) Prominent vessels filled with fibrin thrombi at the periphery of mature fat lobules. (b) At higher magnificationimageBecause excision of one angiolipoma produced scarring with a poor cosmetic result, intralesional triamcinolone, 5 mg/mL, was tried without success.

Research paper thumbnail of Current therapy of pemphigus vulgaris

PubMed, Aug 22, 2001

Pemphigus vulgaris (PV) is a potentially fatal autoimmune blistering disease of the skin and muco... more Pemphigus vulgaris (PV) is a potentially fatal autoimmune blistering disease of the skin and mucous membranes, characterized by flaccid bullae that rupture and leave erosions. Its treatment is challenging. Although the use of systemic corticosteroids remains the cornerstone of effective therapeutic regimens for PV, their prolonged administration may lead to serious side effects. It is therefore necessary, for many patients, to add immunosuppressive agents or use immunomodulatory procedures to achieve remission. This paper will summarize the treatments available for PV, while focusing on the most recently available therapeutic options.

Research paper thumbnail of Immunopathogenesis of scleroderma--evolving concepts

PubMed, Aug 22, 2001

Scleroderma, or systemic sclerosis, is a connective tissue disease which may affect various organ... more Scleroderma, or systemic sclerosis, is a connective tissue disease which may affect various organ systems including skin, lungs, gastrointestinal tract, cardiovascular system and kidneys. While the etiology is not clear, it is currently believed that scleroderma may represent an autoimmune response to an unknown antigen. In this regard, there is evidence that both humoral and cellular immunity may play roles. The pathophysiology is complex and consists of three major features: (1) vascular damage; (2) mononuclear cellular infiltrates; and (3) massive deposition of newly synthesized connective tissue, mainly collagen. The major pathologic features of scleroderma and the roles of humoral and cellular immunity in its pathogenesis are reviewed and summarized.

Research paper thumbnail of Cutaneous polyarteritis nodosa after streptococcal necrotizing fasciitis

PubMed, Aug 22, 2001

Polyarteritis nodosa (PAN) is a necrotizing arteritis of small and medium-sized vessels. It may p... more Polyarteritis nodosa (PAN) is a necrotizing arteritis of small and medium-sized vessels. It may present with hypertension and/or renal insufficiency. Peripheral neuropathy, myopathy, joint pains, testicular pain, and ischemic myalgias may also be seen. Gastrointestinal involvement may lead to gangrene of the bowel, peritonitis, perforation, intra-abdominal hemorrhage, and pancreatitis. The cutaneous manifestations include tender subcutaneous nodules grouped along the course of superficial arteries of the lower extremities, with or without an overlying livedo reticularis. Although multisystem involvement is characteristic, sometimes only one organ or system may be involved. Associations with viral hepatitis (both B and C) and streptococcal infection have been established for PAN. Recurrent strep infections of the upper respiratory tract, streptococcal glomerulonephritis and rheumatic fever have previously been linked to PAN. This report extends the spectrum of associated streptococcal infections to include necrotizing fasciitis.

Research paper thumbnail of Temporary tattoo dermatitis

The Journal of Pediatrics, May 1, 2003

Dermatologic conditions are common among persons who have recently traveled. 1 We share our recen... more Dermatologic conditions are common among persons who have recently traveled. 1 We share our recent experience with a young traveler in whom an allergic contact dermatitis to henna developed. While on vacation in the Dominican Republic, an 11-year-old boy had temporary henna tattoos applied to his upper arms bilaterally by a street artist. Two weeks later an erythematous, pruritic rash developed at the tattoo sites. He was seen by his pediatrician, who prescribed topical steroid therapy with fluticasone propionate ointment, oral prednisone, and cetirizine. On referral, examination revealed erythematous patches with accentuation at the borders of the tattoo sites (Figure). In addition, erythematous papules were clustered on the upper chest, face and extensor aspects of the extremities. A biopsy specimen taken from the left wrist revealed spongiotic dermatitis, subacute type with eosinophilia suggesting an id reaction. At follow-up examination one week later, the eruption had cleared completely. Henna is derived from the Lawsonia tree, which grows in the hot climates of India, the Middle East, and North Africa. 2 Skin painting or pseudotattooing is traditionally performed with henna or other labile vegetable substances, primarily in Muslim and Hindu persons. 3 Temporary henna tattoos are becoming more popular, especially among teenagers and travelers, resulting in more extensive henna use worldwide. 4 Allergic and irritant reactions are rare with henna, which is relatively safe. However, additives such as paraphenylenediamine, a well recognized contact allergen that is sometimes mixed with henna to impart color to the pure reddish-brown paste, may result in more common reactions to henna tattooing.

Research paper thumbnail of Lichen planus pemphigoides presenting with a strikingly unilateral distribution

International Journal of Dermatology, Dec 1, 1998

ABSTRACT A 44-year-old Pakistani woman presented with a unilateral eruption of 2 months&#39; ... more ABSTRACT A 44-year-old Pakistani woman presented with a unilateral eruption of 2 months&#39; duration. She was in her usual state of health when she awoke one morning with an acute blistering eruption in the right axilla. At that time she also began to experience &#39;rough spots&#39; on the buccal mucosa. Approximately 4 days later, lesions, including small blisters, appeared at multiple other sites, all in a right-sided distribution. The patient had an 8-year history of hypothyroidism and was treated with levothyroxine. Physical examination revealed a widely distributed and strikingly right-sided eruption. Dark brown macules and patches measuring 0.1-1.2 cm, some of which were confluent, were located in the right axillary area at the site of previous blister formation (Fig. 1a). Close inspection revealed that some of these lesions had a glistening and violaceous appearance at their periphery. Discrete, small, flat-topped papules with similar qualities were also present at this location. Lichenoid lesions were evident in multiple other right- sided areas, including the submammary area, lower back, intergluteal region, buttock (Fig. 1b), inguinal crease, and knee. Similar lesions on the right arm appeared Koebnerized, extending linearly along the lateral aspect of the mid upper arm to the mid forearm. Examination of the oral mucosa revealed violaceous patches with a lacy pattern on the buccal mucosa. The remainder of the examination was unremarkable. Routine bloodwork was noncontributory. Hepatitis C antibodies were negative. Thyroid function tests were within the range of normal, as were a chest X-ray examination and routine urinalysis. Punch biopsy of a lower back lichenoid lesion demonstrated a subepidermal bulla with festooning of the dermal papillae (Fig. 2a). Other features included orthokeratosis, a sparse superficial dermal infiltrate (composed of lymphocytes, histiocytes, and eosinophils), and numerous melanophages. A second biopsy from this region was divided for routine histopathology and direct immunofluorescence (DIF). Histopathologic examination was consistent with lichen planus. The features included compact orthokeratosis, hypergranulosis, and irregular, saw-toothed acanthosis. The basal layer exhibited marked vacuolar change and a band-like lymphohistiocytic infiltrate was present in the superficial-most dermis (Fig. 2b). DIF revealed a conspicuous and linear deposition of immunoglobulin G (IgG), C3, and fibrinogen along the epidermal basement membrane zone. There was no staining with antisera to IgM or IgA. Colloid bodies were not identified. Indirect immunofluorescence studies were negative. Correlating the clinical, histopathologic and immunopathologic findings, a diagnosis of lichen planus pemphigoides was made. Treatment was initiated with prednisone, 60 mg daily, and tapered over the next 4 weeks as the eruption gradually resolved. Topical clobetasone ointment was prescribed for an additional 2 weeks. There have been no recurrences or new blister formation since that time.

Research paper thumbnail of Henoch-Schonlein purpura induced by clarithromycin

International Journal of Dermatology, Sep 1, 1999

... J Infect Dis 1979; 140: 815–817. 7 Ramos-Zepeda R, González-Mendoza A. Metabolic activity of ... more ... J Infect Dis 1979; 140: 815–817. 7 Ramos-Zepeda R, González-Mendoza A. Metabolic activity of phagocytes in experimental sporotrichosis. Mycopathologia 1986; 93: 109–112. ... Henoch–Schönlein purpura. Br J Dermatol 1974; 109: 664. 7 Cream JJ, Gumpel JM, Peachy ...

Research paper thumbnail of Altered Expression of Angiopoietins and Tie2 Endothelium Receptor in Psoriasis

Journal of Investigative Dermatology, May 1, 2001

Research paper thumbnail of Unilateral Verrucous Psoriasis

Cutis, Feb 1, 2021

Verrucous psoriasis is a variant of psoriasis that presents with wartlike clinical features and o... more Verrucous psoriasis is a variant of psoriasis that presents with wartlike clinical features and overlapping histologic features of verruca and psoriasis. The disease typically arises in patients with established psoriasis but can occur de novo. We report the case of an 80-year-old man with a history of hypertension and coronary artery disease who presented with a rash characterized by multiple asymptomatic plaques with overlying verrucous nodules on the left side of the body. The lesions appeared shortly after coronary artery bypass surgery with a saphenous vein graft.

Research paper thumbnail of Purpura fulminans

International Journal of Dermatology, Feb 1, 2003