onychomadesis caused by a new coxsackievirus subtype cv a6
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P6110Neurocutaneous melanosis: Prognosis and treatment options
Alison Galatian, MD, University of Oklahoma Department of Dermatology,Oklahoma City, OK, United States; Pamela Allen, MD, University of OklahomaDepartment of Dermatology, Oklahoma City, OK, United States; Stacie Rougas,MD, University of Oklahoma Department of Dermatology, Oklahoma City, OK,United States
Large congenital melanocytic nevi present a treatment challenge, particularly whencomplicated by central nervous system (CNS) involvement. We present a case ofneurocutaneous melanosis and discuss the prognosis, management, and availabletherapies for cutaneous and CNS disease.
AB176
cial support: None identified.
CommerP6187Onychomadesis caused by a new Coxsackievirus subtype CV A6
Joseph Markey, The University of Texas Medical School-Houston, Houston, TX,United States; Adelaide Hebert, MD, The University of Texas Medical School-Houston, Houston, TX, United States; Omar Pacha, MD, The University of TexasMedical School-Houston, Houston, TX, United States
A 16-month-old African American male developed vesicles of both the hands andfeet, as well as erosions of the oral mucous membranes with fever and onychoma-desis. Recurrent swelling in the fingers and toes occurred, along with recurrent,painful mouth ulcers. The nipples had tender, oozing superficial erosions.Onychomadesis recurred for 2 cycles with nail regrowth and shedding. Thepatient’s nails also became distally dystrophic with horizontal medium brownbands near the distal nail plate. The general health of the child had previously beengood. Initially, clinical findings included fever, with the cutaneous and mucosallesions appearing on the upper inner surface of the lip, and the fingers and toes 1 to2 days later. Clinical diagnosis of hand, foot, and mouth disease was made based onthe physical findings and time course of the illness. The patient was admitted toMemorial Hermann Children’s Hospital subsequent to the resolution of the initialcutaneous vesicular eruptions due to the fever and unusual cutaneous and nailmanifestations. A viral culture of serum via RNA PCR was performed at the time ofhospital admission to isolate and identify the viral strain. The nail findings in thispatient suggest the phenotypic expression described in patients infected byCoxsackievirus subtype A6. The clinical findings in a child diagnosed with hand,foot, and mouth disease from the newly described Coxsackievirus A6 will beemphasized.
cial support: None identified.
CommerJ AM ACAD DERMATOL
P6050Pediatric dermatologic diseases in ancient Greece
C. Perogiani, MD, 1st Dermatology Department of Athens University, Athens,Greece; G. Tsoukalas, MD, MSc, PhD, History of Medicine Department of AthensUniversity, Athens, Greece; I. Tsoukalas, MD, PhD, private practice, Chania,Greece
Background: The recording of pediatric dermatologic diseases of Ancient Greeksand Byzantine writers.
Methods: The collection and study of relevant texts from writers of that period.
Results: Hippocrates claims that the mother should give medicine per os to thenewborn, right after birth, for the prevention of diaper dermatitis; DioscuridesPedanius recommends medical treatment for ulcerative diaper dermatitis with‘‘myrsinion, Lycion, litharge.’’ The latter is considered by Galenus a very good healingmedication; Oribasius, Aetius Amidenus, and Paulus Aegineta suggest: ‘‘powderingthe diaper area with dry myrtle, carnation and rose fruit mixed with a perfume.’’Hippocrates gave the definition of exanthemas; speaking particularly about diseaseslike lichen, leprosy, vitiligo as well as the Phoenix disease (elephantiasis), he pointsout that: ‘‘these diseases can be more easily cured when they apper duringchildhood or juvenile age, especially when they are detected early,’’ describing aspecial treatment for each disease. Aetius recommends a special treatment for favus,with litharge and psymith (lead carbonate): ‘‘grate heather and incence (plantboswellia) andmixe them in wine and radish oil, before applying on the lesions.’’ Forchildren’s lichens, Aetius recommends topical use of ‘‘gum of plums with vinegar.’’Psellus describes the impetigo as ‘‘a turgidity with a hole in the center like ahoneycomb, which spurts liquid like honey, and it is usually located at the nape or atthe axilla.’’
Conclusion: Studding carefully the texts of ancient and Byzantine writers, one canconclude that many of their aspects are consistent with today’s scientificknowledge.
cial support: None identified.
CommerP6473Primary cutaneous plasmacytosis
Amy Kerkvliet, MD, Geisinger Medical Center, Danville, PA, United States;Desmond Shipp, MD, Northwestern University, Chicago, IL, United States;Howard Pride, MD, Geisinger Medical Center, Danville, PA, United States;Tammie Ferringer, MD, Geisinger Medical Center, Danville, PA, United States
Background: Cutaneous plasmacytosis is a rare entity that has been reported almostexclusively in Asian countries and is usually seen in adult males. Primary cutaneousplasmacytosis clinically is characterized by multiple red-brown plaques and nodulestypically located on the trunk. The condition can be systemic if polyclonalhypergammaglobulinemia, lymphadenopathy, cutaneous lesions, and systemicsymptoms such as fever, weight loss, and fatigue are present. We present a case ofprimary cutaneous plasmacytosis in a child.
Case report: A 4-year-old white female presented to the dermatology clinic with a 6-month history of a circular pruritic 1-cm erythematous and edematous plaque with ascant degree of scale on the right forearm. In addition, the patient had asymptomatictiny umbilicated papules on the trunk and extremities, clinically consistent withmolluscum contagiosum. No lymphadenopathy was noted. The patient had beentreated with bactroban, amoxicillin, and hydrocortisone without improvement. Theclinical impression was granulomatous reaction to molluscum, ruptured cyst,persistent nummular eczema, granuloma annulare, or other granulomatous process.A biopsy from the right forearm showed a dense lymphoplasmacytic lichenoid andvacuolar interface dermatitis with pseudoepitheliomatous hyperplasia. The differ-ential diagnosis included arthropod bite, borrelial lymphocytoma, syphilis, and earlylichen striatus. CD3 and CD20 revealed a reactive pattern of dermal lymphocytes. Insitu hybridization staining for kappa and lambda light chains demonstrated a normalpolyclonal restriction pattern. No clonal gene rearrangements were detected in theT and B cell populations. PAS stain was negative for fungus and a Steiner stain wasnegative for spirochetes. Serologic studies for syphilis and Borrelia burgdorferiwere negative. The patient was treated with surgical excision, and has had noadditional symptoms after 8 months of follow-up.
Discussion: The exact pathophysiology of primary cutaneous plasmacytosis remainsunclear. An associationwithmulticentric Castleman disease has been postulated anddevelopment of malignant T-cell lymphoma has been reported. Primary cutaneousplasmacytosis is extremely rare in children, however, the dermatologist anddermatopathologist must be aware of this entity and its associations. It is essentialto evaluate the patient for systemic disease and the development of a moreaggressive disorder.
cial support: None identified.
CommerAPRIL 2013