Cutis
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Alcohol can be used as a diagnostic aid for patients with dyschromia commonly seen in terra firma-forme dermatosis, confluent and reticulate papillomatosis, and acanthosis nigricans. Although biopsy can definitively determine diagnosis, proper utilization of isopropyl alcohol may avert unnecessary procedures.
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Case Reports
Prolonged pustular eruption from hydroxychloroquine: an unusual case of acute generalized exanthematous pustulosis.
Acute generalized exanthematous pustulosis (AGEP) is a rare cutaneous eruption that often is a reaction to medications, most commonly antibiotics. Clinically, AGEP closely mimics pustular psoriasis and also is similar to subcorneal pustular dermatosis and IgA pemphigus. For clinicians, it is important to differentiate AGEP from pustular psoriasis. ⋯ We report a case of AGEP after HCQ administration that did not follow the usual course of resolution after medication cessation. The patient continued to experience cutaneous eruptions that waxed and waned for 81 days. Hydroxychloroquine has a particularly long half-life and is a known cause of AGEP; therefore, it is possible that HCQ-induced AGEP may not follow the typical rapid recovery time.
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Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are considered to be among the most severe dermatologic emergencies with high risk for morbidity and mortality if managed poorly. These disease processes usually are the result of a reaction to antipsychotic or antibiotic medications, though the complete list of potential causative drugs is extensive. ⋯ Over the last several years, reports advocating the benefits of cyclosporine, corticosteroids, and intravenous immunoglobulin (IVIG) have shown variable responses in their treatment of SJS/TEN. In this article, cyclosporine and its potential as an emerging therapeutic option for SJS/TEN patients is discussed.
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Postinflammatory hyperpigmentation (PIH) has posed a substantial challenge for patients with higher Fitzpatrick skin types, specifically types III to VI. Treatment modalities pose a number of limitations due to the number of treatments required, potential side effects, and overall efficacy. Fortunately, multiple therapies have been delineated that can be moderately to highly efficacious in treating PIH in patients with skin of color. This article will review some of these modalities and procedures for this common patient concern.
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Acute generalized exanthematous pustulosis (AGEP) is a potentially widespread, pustular, cutaneous eruption commonly associated with drug administration. We report a case of AGEP associated with the antianginal, anti-ischemic agent ranolazine. The patient, an 83-year-old man, had a validation score of 10 out of 12 in accordance with the EuroSCAR criteria (8-12 is considered definitive), although it may have been higher had blood work been performed prior to diagnosis and treatment. After ranolazine was discontinued and a course of tapered oral prednisone was prescribed, the rash resolved with subsequent desquamation.