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Sarecycline is a tetracycline-derived oral antibiotic, specifically designed for acne, and is approved by the Food and Drug Administration (FDA) in 2018 for the treatment of inflammatory lesions of non-nodular moderate to severe acne vulgaris (AV) in patients 9 years of age and older. It has been decades since a novel systemic antibiotic was approved to treat AV, a disease that affects up to 90% of teenagers and young adults worldwide and lasts well into adulthood. Sarecycline holds promise to yield fewer side effects than other commonly used broad-spectrum tetracyclines, including minocycline and doxycycline. The narrower spectrum of antibacterial activity of sarecycline, which specifically targets C. acnes and some Gram-positive bacteria with little or no activity against Gram-negative bacteria, suggests not only the potential for reduced emergence of antibiotic-resistant bacterial strains but also less disruption of the human gut microflora. Here, we review the key preclinical and clinical evidence on sarecycline.

FMX101 4% topical minocycline foam has been shown to be an effective and safe treatment for acne vulgaris (AV).To further evaluate the efficacy and safety of FMX101 4% in treating moderate to severe acne vulgaris.A 12-week, multicenter, randomized (1:1), double-blind, vehicle-controlled study was conducted. Coprimary end points were the absolute change in inflammatory lesion count from baseline and the rate of treatment success (Investigator's Global Assessment score of 0 or 1 with a ≥2-grade improvement).There were 1488 participants in the intent-to-treat population. The FMX101 4% group had significantly greater reductions in the number of inflammatory lesions from baseline (P .0001) and a greater rate of treatment success based on Investigator's Global Assessment (P .0001) versus the foam vehicle group at week 12. FMX101 4% was generally safe and well tolerated.The efficacy and safety of FMX101 4% were not characterized in participants with mild AV.FMX101 4% topical minocycline foam was effective and safe for the treatment of moderate to severe AV.

Sarecycline is a novel, narrow-spectrum, once-daily tetracycline-derived oral antibiotic that is FDA-approved in the US to be taken with or without food for moderate-to-severe acne vulgaris for ages 9 years of age and older. Sarecycline possesses anti-inflammatory properties and potent activity against Gram-positive bacteria, including activity against multiple strains of Cutibacterium acnes, while exhibiting minimal activity against enteric aerobic Gram-negative bacteria. Unlike many acne studies, sarecycline was investigated for chest and back acne. Significant reduction in inflammatory lesions was seen at week 12 at 1.5 mg/kg/day of sarecycline, with statistically significant improvement seen as early as week 3. No reports of phototoxicity, dizziness, pseudotumor cerebri or lupus but 1.2% nausea and 1.2% vaginal candidiasis was reported in the pivotal Phase III studies.

Transfusion-dependent β-thalassemia (TDT) and sickle cell disease (SCD) are severe monogenic diseases with severe and potentially life-threatening manifestations. BCL11A is a transcription factor that represses γ-globin expression and fetal hemoglobin in erythroid cells. We performed electroporation of CD34+ hematopoietic stem and progenitor cells obtained from healthy donors, with CRISPR-Cas9 targeting the BCL11A erythroid-specific enhancer. Approximately 80% of the alleles at this locus were modified, with no evidence of off-target editing. After undergoing myeloablation, two patients - one with TDT and the other with SCD - received autologous CD34+ cells edited with CRISPR-Cas9 targeting the same BCL11A enhancer. More than a year later, both patients had high levels of allelic editing in bone marrow and blood, increases in fetal hemoglobin that were distributed pancellularly, transfusion independence, and (in the patient with SCD) elimination of vaso-occlusive episodes. (Funded by CRISPR Therapeutics and Vertex Pharmaceuticals; ClinicalTrials.gov numbers, NCT03655678 for CLIMB THAL-111 and NCT03745287 for CLIMB SCD-121.).

Calcipotriene 0.005% plus betamethasone dipropionate 0.064% (Cal/BD) aerosol foam is a topical agent indicated for the treatment of plaque psoriasis. While topical treatments are typically reserved for milder disease, in clinical trials with Cal/BD foam, the vast majority of patients had beyond-mild psoriasis at baseline, and multiple studies (including subgroup analyses from randomized controlled trials and other small-scale studies) have demonstrated favorable outcomes with the use of Cal/BD foam in this population. The objective of this article is to review existing data on the efficacy, safety, and cost-effectiveness of Cal/BD foam used in patients with beyond-mild psoriasis, either alone as topical monotherapy or as adjunctive therapy. Practical recommendations for managing beyond-mild psoriasis with Cal/BD foam are also provided. J Drugs Dermatol. 2020;19(8): doi:10.36849/JDD.2020.5300.

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This prospective, parallel-group, randomized, double-blind, multicenter study compared the efficacy and safety of FV-100 with valacyclovir for reducing pain associated with acute herpes zoster (HZ). Patients, ≥50 years of age, diagnosed with HZ within 72 h of lesion appearance who had HZ-associated pain, were randomized 1:1:1 to a 7-day course of either FV-100 200 mg QD (n = 117), FV-100 400 mg QD (n = 116), or valacyclovir 1000 mg TID (n =117). Efficacy was evaluated on the basis of the burden of illness (BOI; Zoster Brief Pain Inventory scores); incidence and duration of clinically significant pain (CSP); pain scores; incidence and severity of post-herpetic neuralgia (PHN); and times to full lesion crusting and to lesion healing. Safety was evaluated on the basis of adverse event (AE)/SAE profiles, changes in laboratory and vital signs values, and results of electrocardiograms. The burden of illness scores for pain through 30 days were 114.5, 110.3, and 118.0 for FV-100 200 mg, FV-100 400 mg, and valacyclovir 3000 mg, respectively. The incidences of PHN at 90 days for FV-100 200 mg, FV-100 400 mg, and valacyclovir 3000 mg were 17.8%, 12.4%, and 20.2%, respectively. Adverse event and SAE profiles of the two FV-100 and the valacyclovir groups were similar and no untoward signals or trends were evident. These results demonstrate a potential for FV-100 as an antiviral for the treatment of shingles that could both reduce the pain burden of the acute episode and reduce the incidence of PHN compared with available treatments.

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Rosacea is a chronic inflammatory dermatologic condition that can often be disfiguring with significant negative impact on patients' quality of life. Sanrosa (brimonidine tartate) is a novel therapeutic agent targeting the facial flushing and erythema of rosacea through its α₂ adrenergic receptor agonist activity. The goal of this article is to discuss current treatment options for rosacea and the properties of brimonidine tartate as well as the evidence surrounding its efficacy and safety profile.

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not available. Disclosures: Study sponsored by Mayne Pharma. Copyright 2018 SKIN

Angela Y Moore, Blakely S RichardsonArlington Center for Dermatology, Arlington, Texas, USAAbstract: Psoriasis is a chronic T-cell-mediated inflammatory disease that primarily affects the skin and joints. Patients with moderate to severe psoriasis constitute about 30% of the psoriasis population. Treatment of this group is challenging due to the long-term side effects, toxicities and inconvenience of conventional treatments such as phototherapy, methotrexate and cyclosporine. However, recent advances in our understanding of the pathogenesis of psoriasis have led to the popular use of biologics, which offer a safer, more convenient and effective targeted therapy. Adalimumab was originally approved for treating rheumatoid arthritis. Currently, adalimumab is also approved for treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy or when other systemic therapies are medically less appropriate. Since the onset of the use of biologics, there have been concerns over safety and efficacy when used as long-term therapy. This paper reviews all publications, posters and abstracts reporting original data on the efficacy and/or safety of adalimumab in patients treated for chronic plaque psoriasis for more than 1 year.Keywords: psoriasis, adalimumab, biologics

We present the case of a 31-year-old patient who developed widespread mycetoma across her back and shoulders caused by Cladophialophora bantiana 16 years after injury to those sites from tornado debris. The patient also had a history of systemic lupus erythematosus treated with systemic steroids. Systemic antifungal treatment with fluconazole and itraconazole proved ineffective, and surgical debridement was required. Nine other culture-confirmed cases of cutaneous infection with this organism have been reported worldwide. This type of infection can occur in immunocompromised or immunocompetent patients, and may respond to systemic antifungals or surgery.

Background: The effect of smoking on human papillomavirus (HPV) activity and subsequent dysplasia and neoplasia remains controversial Objective: To determine any reported effects of smoking on either HPV activity or HPV-related dysplasia/cancer using retrospective analysis of the literature from 1966 through 1998 via Toxline and PubMed to search for “smoking,” “papillomavirus,” and “cancer.” Conclusion: Several recent large studies demonstrated that smoking was associated with a greater incidence of cervical, vulvar, penile, anal, oral, and head and neck cancer in a dose-dependent fashion, while other studies did not show any correlation between smoking and cervical dysplasia after multivariate adjustment. Recent studies have also indicated that smoking may be more closely related to high-grade lesions of the cervix and vulva. These data provide evidence of an association between HPV, smoking, and cancer. Progression of dysplasia likewise seems to be associated with smoking. Several groups have attempted to discern whether the connection between smoking and cervical cancer is from local immunosuppression and/or from direct carcinogenic effects.

Sexually transmitted diseases are a persistent problem in the United States and throughout the world. Many of these infections involve the skin and may be encountered in the field of dermatology. This 3-part review highlights the cutaneous features, diagnosis, and treatment of 11 of the most common sexually transmitted diseases, other than AIDS. The second part of this series focuses on anogenital warts, chronic viral hepatitis, molluscum contagiosum, scabies, and pediculosis pubis. Additional features, such as epidemiology and transmission of the organism, are discussed when applicable. (J Am Acad Dermatol 1999;41:661-77.)At the conclusion of this learning activity, participants should be familiar with the clinical features, diagnosis, and treatment of sexually transmitted diseases (excluding AIDS) which have cutaneous presentations or involvement.

D ermatologists play a key role in the identification, treatment, and prevention of sexually transmitted diseases (STDs). Intended to support that role, this synopsis is organized into two parts. First, general references and articles relating to global issues of sexually transmitted diseases are identified. Then, the STDs most pertinent to dermatology are covered, with references both to general reviews and specific current issues. Only publications after 1990 are included.

Mycobacterium kansasii infections of the skin have been described in 31 previously published cases. The median age of these patients is 43 years, and male patients are more frequently affected than female patients. Most patients (72%) with this infection have some alteration of their immune status, but disseminated infection is relatively uncommon (22%). We present the first reported case of cutaneous M. kansasii infection in a patient with previously diagnosed systemic lupus erythematosus. The clinical presentation is similar to that expected in lupus profundus. While the duration of treatment is long (18 months), this case demonstrates that rifampin combined with at least 2 other antibiotics can provide excellent results. Clarithromycin has demonstrated encouraging in vitro results against M. kansasii but has not yet been reported for treatment of cutaneous infections.

Genital herpes, an incurable viral disease that can have a devastating impact on affected patients, is a serious public health concern affecting one in four Americans. Episodic treatment with nucleoside analogs for 3-5 days is the most common method of treatment; however, since maximum viral replication occurs within 24 hours after the onset of symptoms, single-day patient-initiated episodic treatment may be a better option. A recent study evaluated the effectiveness of patient-initiated single-day famciclovir versus placebo in the treatment of genital herpes and found that single-day famciclovir decreased healing time and the duration of pain and other symptoms, and increased the proportion of patients who did not progress to a full outbreak. Compared with previous studies, the results of single-day therapy are similar to or better than the results of conventional therapies of 2-5 days' duration. In addition, the convenience of single-day treatment may lead to greater patient adherence and improved overall management of recurrent herpes outbreaks.

The incidence of human papillomavirus (HPV) and HPV-related anal cancer has been increasing at an alarming rate. Human immunodeficiency virus-positive patients are at a particularly high risk, with prevalence increasing rapidly in this population as life expectancies have increased. Screening has been very effective in reducing the morbidity and mortality of HPV-related cervical cancer, which suggests its role in reducing the burden of HPV-related anal cancer as well. With appropriate screening, patient education and treatment, the incidence of HPV-related anal cancer may be greatly reduced.

Human papillomavirus (HPV) and molluscum contagiosum virus (MCV) are double-stranded DNA viruses that cause two different sexually transmitted diseases (STDs), that is, condyloma acuminamm and mol][uscum contagiosum. 1' 2 Some I-IPV types are oncogenic and can cause neoplastic changes, resulting in cervical intraepithefial neoplasia (CIN) and vulvar intraepithelial neoplasia (VIN). 1 Various therapies exist for treating HI?V-associated lesions. 3 For some current and potential future therapies, differentiation between condyloma acuminamm and molluscum contagiosum lesions as well as identification of simultaneous infections may be important in determining treatment. In addition, condyloma acuminamm and molluscure contagiosum are present in more than 50% and in 10% to 20% of HIV-seropositive patients, respectively. 4-5 In this patient population, HPV-associated squamous cell carcinomas (SCCs) are more aggressive. 4 Molluscum contagiosum in patients with HIV infection can also be severely disfiguring and stigmatizing because it is a late manifestation of AIDS~ 5-r7 Determination of HPV coinfection in MCV lesions in patients with HIV may be valuable in identifying oncogenic HPV subtypes. For these reasons and because no studies have examined the coexistence of these two DNA viruses, we undertook this study. PATIENTS AND METHODS

Analysis was undertaken of 107 patients with mycosis fungoides who presented to St. Vincent's Hospital, Melbourne, during 1977-95. The mean age at diagnosis (55 years) was significantly older than the mean age of onset of symptoms (48 years). The mean duration of follow-up was 7.7 years. Urban residence was over-represented in this group of patients and in those with mycosis fungoides recorded at the State Cancer Registry. Eighty-four per cent were diagnosed at Stage I or II of the disease. Presentation with disease more advanced than Stage I was more likely to be found in males. Disease localized only to the trunk accounted for 45% of all patients. The mean number of biopsies prior to diagnosis was 1.4 but two-thirds were diagnosed at first biopsy. Almost 85% of patients had as their initial treatment either PUVA (44.9%), topical steroids (20.6%) or topical nitrogen mustard (18.7%) and 57% received only one or two treatment modalities during the period of the study. Stage at presentation was not related to the likelihood of clearance following treatment, recurrence, progression to a more advanced stage of disease or survival.

Congenital smooth muscle hamartoma usually manifests as a well-circumscribed, hyperpigmented plaque, frequently hypertrichotic, on the trunk or extremities. We report such a lesion in a 7-month-old girl that presented as a linear, mottled, purplish red plaque appearing in areas to be atrophic, involving her right buttock, posterior thigh and leg, and fifth toe. Although the clinical appearance suggested linear morphea, a biopsy specimen had numerous haphazardly oriented bundles of smooth muscle in the reticular dermis. Masson trichrome staining, smooth muscle specific actin, and electron microscopic studies confirmed the smooth muscle nature of the cells. A diagnosis of smooth muscle hamartoma was made. To our knowledge, this linear clinical presentation has not been described previously.

Topical 5-fluorouracil (5-FU) has been used for the treatment of dermatological conditions for nearly half a century. Although the indications for 5-FU approved by the US Food and Drug Administration include actinic keratosis and superficial basal cell carcinoma, studies also have demonstrated therapeutic efficacy for 5-FU in the treatment of many other dermatological conditions, including squamous cell carcinoma in situ, warts, psoriasis of the nail, keratoacanthoma, and vitiligo. This review discusses clinical data which support the use of 5-FU for these disease states.

background. The histopathologic effects of curative doses of radiation therapy on cutaneous squamous cell carcinoma (SCC) have not been well described in the dermatologic literature. objective. To understand the histopathologic process of cutaneous SCC involution following radiation treatment. methods. Hematoxylin-eosin stain and immunoperoxidase stains for keratin were performed on tissue from the site of a primary cutaneous SCC 2 months after completion of fractionated radiation therapy (7000 cGy total) but prior to clinical involution. results. Histopathological examination of the irradiated SCC revealed dermal keratin pearls and keratinocytic necrosis resembling apoptosis as well as inflammation and foreign body giant cell reaction. Immunoperoxidase staining for keratin revealed cellular remnants of cutaneous SCC without intact keratinocytic nuclei within giant cells. conclusion. Complete clinical resolution of the SCC over the next several weeks without recurrence after 15 months confirmed the histopathologic findings of tumor destruction by primary radiation therapy.

The Mycobacterium avium complex (MAC) consists of M avium and M intracellulare, which are closely related organisms that cannot be differentiated by standard laboratory methods.1 These microorganisms are ubiquitous saprophytes that are commonly found in tap water, soil, dairy products, animals, and house dust.2-4 In patients with AIDS, MAC is the most common cause of bacteremia. Both the respiratory and gastrointestinal tracts serve as portals of entry for systemic infection.2 Skin involvement secondary to disseminated disease is uncommon, and primary skin infection is rare.5,6

Although etanercept is used as a continuous therapy for moderate to severe plaque psoriasis, intermittent use may be necessary in some instances.In this randomized, open-label study, we evaluated the effectiveness and safety of continuous versus interrupted etanercept therapy.All patients received uninterrupted etanercept 50 mg twice weekly during the first 12 weeks, followed by either continuous (n = 1272) or interrupted (n = 1274) etanercept 50 mg once weekly in the next 12 weeks. The primary effectiveness end point was the proportion of responders (those who achieved a Physician's Global Assessment [PGA] scoreor=2 and improvement from baseline) at week 24. Secondary end points included the PGA "clear/almost clear" status, the PGA Scalp Psoriasis score, and the Dermatology Life Quality Index. A modified intent-to-treat analysis was performed.At week 12, comparable high proportions of responders were reported in the continuous (71.3%) and interrupted (72.0%) arms. However, the proportion of responders at week 24 was greater in the continuous group than in the interrupted group (71.0% vs 59.5%; P.0001). Similar results were observed in secondary end points. The mean number of etanercept doses (1 dose = 50 mg) received by patients in the continuous group was 33.4, compared with 28.0 in the interrupted group. Etanercept was well tolerated in both treatment arms.We examined one round of discontinuation and re-treatment; interrupted therapy provided less total medication to responding patients.Continuous and interrupted etanercept therapy was effective and generally well tolerated in patients with psoriasis, with greater improvements observed in the continuous arm at week 24. Most patients regained their response after reinitiation of etanercept.

First described by Shelley and Wood in 1977, 1 mid-dermal elastolysis (MDE) is a rare acquired disorder in which there is a bandlike absence of elastic tissue limited to the mid-dermis. In their patient, MDE developed in an area previously involved with recurrent episodes of urticaria. We describe a 15-year-old white girl with well-circumscribed, minimally palpable yellow-white plaques and wrinkling diagnosed histologically as MDE in areas clincally diagnosed 5 years previously as granuloma annulare. As in the first described patient, five years elapsed between clearance of the original skin lesions and the clinical appearance of MDE. To our knowldege, we report the first adolescent case of MDE localized to previous sites of lesions clinically consistent with granuloma annulare and propose that MDE represents an abnormal end-stage reaction to multiple processes. (J Am Acad Dermatol 1997;37:870-2.)

Mucoepidermoid carcinomas are malignant neoplasms that rarely involve the skin. Composed of both mucus-secreting cells and epidermoid-type cells in various proportions, mucoepidermoid carcinomas occur most commonly in salivary glands. In this case report, we describe a high-grade mucoepidermoid carcinoma with cutaneous involvement. Although this patient was referred for Mohs' micrographic surgery, further evaluation showed either direct or metastatic extension from the parotid gland to skin and distant metastases to the lung and bone. Despite extensive bone involvement, serum levels of ionized calcium, phosphorus, and lactate dehydrogenase remained normal. In view of the widespread metastases, the treatment plan was altered to radiotherapy and chemotherapy instead of surgery. Instructive lessons from this case include the recognition by dermatologists of this rare entity, the importance of a detailed history and complete evaluation of the patient before determining appropriate therapy, and the necessity of individualizing diagnostic tests to a particular patient.

coidal granuloma, granulomatous vasculitis, Kaposi's sarcoma, and pseudolymphoma. 1-3 To our knowledge, the literature contains only one observation of a lymphoma occurring under the same circumstances. 4 In our patient, the papulonodular eruption of C LL developed in healing lesions of varicella. The presence of the same clonal rearrangement of the immunoglobu~in heavy chain gene in the skin, blood, and bone maJxow showed that this patient had specific cutaneous lesions of B-cell CLL. PCR clearly identified the presence o f VZV in the cutaneous lesions, whereas it is absent f rom the bone marrow and from the leukocytes of the peripheral blood. It is likely that this represents a nonspecific stimulation of the B lymphocytes.

background. The incidence of nonmelanoma skin cancer, the most common form of cancer in the United States, continues to increase. It is important that physicians know what treatment modalities will be the most efficacious. objective. The purpose of this study was to compare recurrence rates by treatment modality for primary basal and squamous cell carcinomas in a private dermatological practice. methods. Between June 1993 and December 1994, 268 consecutive primary nonmelanomic tumors were treated by surgical excision or electrodesiccation and curettage in our practice. The charts of the 191 patients treated were retrospectively reviewed, and recurrence data were compared by treatment modality. results. The recurrence rates between the two types of treatment were not found to be significantly different. conclusion. In contrast to other studies reported from academic centers in which surgical excision has been found to have lower recurrence rates than tumors treated with curettage and electrodesiccation, this study found recurrence rates for two treatments to be approximately the same.

(Background) We have demonstrated that down-regulation of hMSH3 results in low levels of microsatellite instability (MSI-L) and elevated microsatellite alterations at selected tetranucleotide repeats (EMAST) in tissue cultured cell lines. Primary tumor tissues exhibiting MSIL and/or EMAST from stage II/III CRC show intra-tumor depression of hMSH3 and upregulation of GLUT1 that is a marker for hypoxia. In vitro, hypoxia induces down-regulation of hMSH3 and the development of EMAST in CRC cell lines. Finally, Stage II/III primary CRC exhibitingMSI-L/EMAST has a shorter recurrence-free survival than that of microsatellite stable counterparts not exhibiting MSI-L/EMAST. These results support the concept that intra-tumor hypoxia may induce MSI-L/EMAST through down-regulation of hMSH3 and enhance the aggressiveness of primary CRC, leading to recurrence and/or distant metastasis. Thus, MSI-L/EMAST could be a marker for identifying genetic and/or epigenetic changes that control recurrence and/or distant metastasis from primary CRC. We previously reported that LOH at the SMARCA2 locus on 9p24.3 is significantly high in liver metastasis (LM) exhibiting MSI-L/EMAST (termed moderate MSI: MSI-M) from primary CRC. (Aim) The purpose of this study is to determine the pathobiological significance of MSI-L/EMAST and LOH at SMARCA2 region in CRC. (Methods) Eighty three LMs and 186 primary CRC with known clinicopathological factors and disease outcome were analyzed for MSI/EMAST and LOH at the 9p24.2 region. Significant associations between factors were determined by various statistical analyses. (Results) We proposed that a locus affected by 9p24.2 LOH might promote metastasis from primary CRC; such a locus was mapped to an 80 kb region at the 3' boundary of the SMARCA2 gene. Stage II and III primary CRCs exhibiting MSIM and 9p24.2 LOH were significantly more likely to give rise to a solitary LM suitable for hepatectomy, whereas MSI-M-positive counterparts without 9p24.2 LOH, or highly microsatellite stable (HMSS) tissues were more likely to give rise to simultaneous metastases to multiple organs, and therefore, not suitable for surgical management. Multivariate analysis showed that MSI-M with 9p24.2 LOH in the primary CRC is an independent positive prognostic factor following recurrence (HR = .1981, P=.0007). (Conclusions) The presence or absence of 9p24.2 LOH in Stage II/III primary CRCwithMSI-M is an important determinant of the aggressiveness of the recurrent metastasis.

The HIV epidemic has dramatically altered the field of sexually transmitted diseases (STDs). HIV infection is unique among sexually transmitted diseases because it can modify the clinical presentation and features of other STDs. Conversely, other STDs can affect the transmission of HIV. This review is the third part of a series that has provided a general overview of STDs. In this article, genital ulcer diseases (genital herpes, syphilis, chancroid, lymphogranuloma venereum, and granuloma inguinale), human papillomavirus infection (anogenital warts and subclinical infections), molluscum contagiosum, human herpesvirus 8 infection, viral hepatitis, and ectoparasitic infestations (scabies and pediculosis pubis) are discussed as they occur in HIV-infected hosts. Additional features as they relate to HIV-infected patients, such as epidemiology and transmission, are discussed when applicable. Learning objective: At the conclusion of this learning activity, participants should improve their understanding of sexually transmitted diseases in the HIV-infected host. (J Am Acad Dermatol 2000;43:409–32.)

On September 26, 1997, a male infant was born to a 23year-old gravida 2, para 1 woman. The pregnancy was complicated by premature rupture of the membranes at 19 weeks’ gestation with subsequent oligohydramnios. At 25 weeks’ gestation, the mother was seen in the clinic because for 2 days she had had vaginal spotting, fever, and mild abdominal tenderness. She was admitted to the hospital for the treatment of possible chorioamnionitis, and was started on a regimen of ampicillin sodium, 2 g intravenously every 6 hours; gentamicin sulfate, 120 mg intravenously every 8 hours; and clindamycin phosphate, 900 mg intravenously every 8 hours. Because of her previously mentioned complications, labor was artificially induced with oxytocin, and 2 doses of dexamethasone sodium phosphate, 6 mg, were intramuscularly administered to induce fetal pulmonary maturation. The neonate was delivered vaginally, weighing only 520 g. He had an Apgar score of 1/6 at 5 and 10 minutes, no respiratory effort, and cyanosis. He was noted to have bruising and blistering diffusely of the scalp. An endotracheal tube was introduced, the newborn was stabilized, and a regimen of ampicillin and gentamicin was immediately started for possible sepsis due to maternal chorioamnionitis. The neonate was admitted to the intensive care unit where he remained in a guarded condition. On his fifth day of life, routine laboratory tests disclosed an elevated white blood cell count with an increased number of immature neutrophils. Vancomycin hydrochloride therapy was initiated. Blood cultures were negative for bacteria and fungi, however, and antibiotic therapy was discontinued. On the newborn’s ninth day of life, routine laboratory tests again showed an elevated white blood cell count with an increased number of neutrophils. Cefotaxime sodium therapy was initiated. Blood cultures were again negative for bacteria and fungi, and antibiotic therapy was discontinued. At this time, the newborn still had ecchymosis of the scalp. In addition, he had a 3.5-cm area of truncal ecchymosis with central necrosis (Figure 1). A 6-mm purpuric, necrotic papule was also noted on his back. The inpatient dermatology service was consulted, and punch biopsy specimens of the ecchymotic areas were sent for tissue culture and stains. Histopathological study of the tissue showed necrosis of the skin and subcutaneous tissue, with invasion of the deep dermis by fungi and yeast (Figure 2). Culture of the tissue identified the fungi as Candida parapsilosis and Candida albicans. At this time, cultures of blood and tracheal aspirate specimens became positive for C albicans and C parapsilosis . Necrotizing enterocolitis of candidal origin with a peritoneal abscess also developed that, when aspirated, was also positive for Candida of the same 2 species. Culture of a specimen of the neonate’s cerebrospinal fluid, however, remained negative for growth of the pathogen. The neonate was diagnosed as having congenital disseminated candidiasis and was treated with amphotericin B (1 mg/kg of body weight daily) for 5 weeks, with a total cumulative dose of 33 mg/kg. After 2 weeks of treatment, the skin eruption and fungemia cleared.

Background: Kaposi's sarcoma (KS) accounts for more than 5% of malignancies in immunosuppressed organ transplant patients (OKS). A new herpesvirus (HHV-8) was identified with high prevalence in biopsy specimens of AIDS-KS, endemic KS, and classic KS and in OKS. KS has also been associated with other underlying diseases in patients treated with corticosteroids, but this subset of KS has been reported to contain HHV-8 in only a few case reports. Objective: In this larger study, we determined the prevalence of HHV-8 in seven patients of Jewish origin in whom KS developed during immunosuppressive therapy for different primary diseases (ISKS). Methods: The study included HHV-8 DNA detection by polymerase chain reaction (PCR) coupled with Southern blot and sequence analysis as well as by in situ hybridization. Results: HHV-8 sequences were detected by PCR with confirmation by Southern blot and sequence analysis in 100% of the ISKS samples. Direct sequencing revealed several previously unknown base changes within the 208 bp region from open reading frame 26 (ORF26 208 ) of HHV-8 in ISKS. Conclusion: Ours is the largest known study describing the presence of HHV-8 in iatrogenic KS from immunosuppressed nontransplant patients and provides data of previously unknown sequence variations within the ORF26 of HHV-8 DNA. (J Am Acad Dermatol 1998;38:429-37.)

The clinical and pathologic findings of Kikuchi's histiocytic necrotizing lymphadenitis may mimic those of malignant lymphoma. We describe a 6-year-old boy with generalized lymphadenopathy, spiking fever, chills, myalgias, malaise, and erythematous, crusted papules. Although cutaneous manifestations have been noted in 16% to 40% of patients with histiocytic necrotizing lymphadenitis, only three publications described skin lesions. The skin lesions and affected lymph nodes revealed histiocytic aggregates, atypical lymphoid cells, karyorrhectic debris, and patchy necrosis. Spontaneous resolution occurred in 2 months. Results of serologic studies, Epstein-Barr virus (EBV) latent membrane protein immunoperoxidase staining, EBER-1 RNA in-situ hybridization, and EBV EBNA-1 DNA polymerase chain reaction implicate EBV as the causative agent.