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Cronkhite-Canada syndrome (CCS) is a rare noninherited condition characterized by gastrointestinal polyposis, alopecia, onychodystrophy, hyperpigmentation, weight loss and diarrhea. We report the case of an 80-year-old patient presenting with weight loss, diarrhea and dystrophic changes of the fingernails. The symptoms began 3 months prior to the admission. In the outpatient area an esophagogastroduodenoscopy and a coloscopy had already been performed, showing a polyposis of the stomach and an unclear generalized colitis. The admission was due to a progressive worsening of the patient's physical condition including further weight loss. The endoscopy showed an unusual continuous ileopancolitis as well as a polyposis of the stomach. The histological examination revealed hyperplastic polyps with a marked stromal edema. Together with the ectodermal changes a CCS was diagnosed and treatment with corticosteroids, intravenous nutrition and proton pump inhibitors was initiated. In the further course of the hospital stay a moderately reduced left ventricular function was diagnosed and the patient had to be temporarily monitored in the intensive care unit due to a prolonged QTc time. In the follow-up 3 months later the patient showed good clinical and endoscopic response to the treatment with cessation of the diarrhea, weight gain of 8 kg and regrowth of the fingernails and head hair; however, the left ventricular function remained moderately impaired.

Pigmentation disorders are a frequent skin problem and incorporate a broad spectrum of diseases, caused by an abnormal melanin pigmentation or also non-melanin pigmentation of the skin. Both hypermelanosis and hypomelanosis can be hereditary or acquired. This article summarizes the treatment approaches that are used in the majority of acquired pigmentation disorders of the skin. The following forms of hypermelanosis are addressed: lentiginosis, hyperpigmentation due to endocrine disorders or other systemic diseases, drug-induced hyperpigmentation. Acquired hypomelanoses include postinflammatory hypomelanosis, chemical depigmentation, idiopathic guttate hypomelanosis and punctate leucoderma. With reference to non-melanin pigmentation, the exogenous pigmentation due to chemicals, metals and drug exposure are discussed. The treatment is primarily based on finding the cause of the alterations to the pigment. The affected area, age and ethnic origin are also important factors. The spectrum of therapeutic options is broad: topical agents, chemical peeling, systemic agents, laser and light-based treatment. As some of these treatment procedures can have side effects, the availability of a protocol that contains information on the drug concentration, dose, parameters for laser treatment and the number of sessions is important. For every disorder the specific dermatological treatment is presented even when some pigmentation alterations that occur in association with systemic diseases, are cured by the treatment of the primary disease. Most diseases are exacerbated by exposure to UV light. Therefore, sun protection is recommended and a cosmetic coverage is indicated.

Pigmentation disorders are among the most common cutaneous changes and occur in up to 60% of all people. They can be genetic or acquired, functionally or cosmetically disturbing, or the expression of a medical disorder. The best treatment options for hyperpigmentation are usually lasers and intense pulsed light (IPL). However, they can also worsen some conditions and are occasionally associated with side effects. A correct diagnosis is therefore essential, taking into account the skin type, the type of pigmentation and how deep the pigmentation is located in the skin. The most common indications for which laser treatment is recommended include genetically predisposed nevi (Becker, Ota, Hora, Ito, acquired bilateral nevus of Ota-like macules [ABNOM]), pigmentation (e.g., lentigines, postinflammatory hyperpigmentation, ephelides, café au lait, nevus spilus, linear and whorled hypermelanosis [LWNH]), nevus cell nevi, exogenous pigments, tattoos and cosmetic pigments.

Competing Interests: Carlos Fritzsche erhielt in den letzten 3 Jahren Vortragshonorare von MSD und GILEAD, sowie Reisekostenunterstützung von GILEAD. Für Elisa Schilling und Femke Böhmer liegen keine Konflikte vor.

Prurigo pigmentosa is a rare inflammatory skin disease of unknown origin, mostly described in the ethnic Japanese population. Etiology and pathogenesis are not completely known. Tetracyclines or dapsone are the therapy of choice. A 17-year-old Swiss patient with Turkish parents presented with pruritic rash on the neck and trunk, which started after a diet. Under therapy with doxycycline over 5 weeks, complete healing with slight reticular hyperpigmentation was observed.

Erythema ab igne (EAI) is a skin lesion, which is characterized by a localized netlike erythema. For the occurrence of the dermatosis a continuous or regular heat exposure and infrared radiation to a skin area is necessary. The reticulated maculae could fade after stopping the heat exposure, persist as hyperpigmentation and in single cases a malignant transformation is possible. We present a patient with bulimia nervosa (BN), who developed an EAI after consequent use of a hot-water bottle. In the context of the eating disorder the patient reported a general feeling of cold. She avoided the contact with the abdomen to prevent a stimulation of the digestion. Therefore the EAI was located predominantly on the medial thighs. After stopping the heat application the EAI faded slightly in the periphery und turned browner., (© Georg Thieme Verlag KG Stuttgart · New York.)

Glomus tumors are benign tumors and are most often localized acral. They usually are diagnosed non-invasively by patient's history, clinical examination, duplex ultrasound and MRI-angiography. Need for intervention depends on the symptoms.

In this patient with tiredness, hyperpigmentation, weight loss, nausea and vomiting, chronic primary adrenal insufficiency (M. Addison) was diagnosed based on the clinical features, the typical electrolyte abnormalities and the reduced morning cortisol together with increased adrenocorticotropic hormone. The detection of autoantibodies against adrenal tissue and 21-hydroxylase revealed an auto-immune adrenalitis as the cause. The additional primary hypothyroidism (with positive thyreoperoxidase-anti-bodies, anti-TPO-antibodies) and the coeliac disease argued for a polyglandular autoimmune syndrome type 2. Treatment with hydrocortisone and with mineralocorticoid and thyroxine later on showed a rapid improvement of clinical symptoms. In patients with Morbus Addison, a screening for associated endocrine disorders is warranted.

Postinflammatory hyperpigmentation (PIH) is a benign but cosmetically disturbing skin lesion, which is notoriously difficult to treat. Standard treatments include topical application of bleaching creams and gels. In this case report, we show that fractional photothermolysis might be a new successful option in the treatment of PIH. Its efficacy must be confirmed by further studies and balanced against possible side effects, but the initial results are promising.

A 73-years old patient came to our outpatient clinic because of a blue discoloration of his hands. Furthermore there was a systemic inflammatory reaction, burning pain and numbness of his feet due to a polyneuropathy, and an indolent enlargement of the cervical lymph nodes. In 1996 and 2001 cervical lymph node resections were done because of localized angiofollicular lymphnode hyperplasia (Castleman's disease). The laboratory values confirmed a systemic inflammatory reaction, a hypothyreosis and a monoclonal gammopathy. A CT-scan showed enlarged cervical, intrathoracic and abdominal lymphnodes and a splenomegaly. So all the criterias for a POEMS syndrome (special form of multiple myeloma) were met with polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes. The generalized lymphadenopathy corresponded histologically to the prior mentioned Castleman's disease. The patient responded well to systemic glucocorticoid treatment and today he is asymptomatic.

Pigmented lesions of the genital mucosa are more frequent in women than in men. They represent a spectrum of different benign entities. A biopsy is always recommended when the diagnosis cannot be made with certainty on clinical examination and dermatoscopy. Differential diagnostic considerations include melanocytic nevi, blue nevi and syndromes featuring lentigines. Malignant melanomas of the penis and vulva are uncommon tumors which usually appear in elderly patients. They frequently present as painless palpable nodules at routine examination. The treatment consists of excision with histological control of the margins. An aggressive surgical approach has not been shown to prolong the poor 5-year survival. Cooperation with gynecologists and urologists is essential for the optimal management of such patients.

Unlabelled: Four case reports of patients with myeloproliferative syndrome receiving therapy with hydroxycarbamide (synonymous: hydroxyurea) and developing streaky longitudinal pigmentation appeared in fingernails and toenails several months after starting this therapy., Background: Pigmentation of finger- and toenails presents a wide range of differential diagnostic considerations. They can be of infectious, melanocytic or exogenous origin or caused by metabolic disorders., Patients and Methods: Three women and one man, ranging in age from 62 and 87 years, were treated with hydroxycarbamide for myeloproliferative syndrome or chronic myelogenous leukemia for five to twelve years. All four patients were Fitzpatrick skin types II., Results: Several months after starting this therapy, they developed streaky longitudinal pigmentation of their fingernails and toenails. In two patients, these findings were diagnosed by chance, whereas two patients sought dermatological advice because of nail pigmentation. In two of the patients the longitudinal pigmentation disappeared a few month after discontinuation of hydroxycarbamide. The melanonychia persisted in another patient, while the fourth was lost to follow-up., Conclusions: When melanonychia is identified in hematology-oncology patients, a careful medical history should be obtained. A list of medications is crucial, since hydroxycarbamide causes nail pigmentation. In each case of nail pigmentation, an acral lentiginous melanoma must be excluded.

The combination of UVB phototherapy with topical application of vitamin D analogs is frequently used for treating psoriasis. This regimen is not only very effective but also has only minimal side effects. Pronounced, persistent hyperpigmentation developed in the psoriatic plaques in a patient who was treated with combined UVB (311 nm) radiation and topical calcipotriol.