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Infection with the bacteria Mycobacterium kansasii rarely involves the skin. M. kansasii infection of the skin causes the formation of granular papules, or solid, round skin lesions, and nodules, or node-like skin lesions. Skin infection with M. kansasii tends to occur in patients with weakened immunity. A case is described of a 57-year-old black woman who developed skin lesions as a result of M. kansasii infection, which was successfully treated with the antituberculous drugs, isoniazid and streptomycin. The infection recurred seven years later, and again responded when treatment with isoniazid, rifampin, ethambutol hydrochloride, and pyrazinamide was administered. Four years later, the patient developed reddening of the skin, and granular papules and patches on the scalp, forehead, neck, chest wall, and arms. The fungus Histoplasma capsulatum was detected in the skin lesions and the patient was treated with the antifungal agent ketoconazole. H. capsulatum infection is prevalent. Like M. kansasii infection, infection with H. capsulatum rarely causes skin lesions. When immunity is normal, the infection with H. capsulatum is usually confined to the lungs and lymph nodes. Dissemination of the disease to the skin occurs mainly in patients with weakened immunity. The initial infection with M. kansasii may have reduced the immune function of this patient, making her more susceptible to infection with H. capsulatum. (Consumer Summary produced by Reliance Medical Information, Inc.)

The spread of thyroid cancer to the skin rarely occurs. Of seven reported cases, three were identified as papillary cancers, or tumors consisting of papillae, which are nipple-like growths. A case is described of a 59-year-old man with papillary cancer of the thyroid gland. His thyroid was removed and he received radiation treatment to eliminate any residual cancer cells. The cancer recurred a year later and the patient was treated with a higher dose of radioactive iodine. The cancer recurred a second time on the right side of the neck and spread (metastasized) to the left thigh and right side of the chest. Despite further radiation treatment, the cancer cells continued to spread to the lungs and recurred on the left thigh and neck. Three years after the initial diagnosis of thyroid cancer, a red-brown node-like skin lesion was detected on the left side of his scalp, and was removed. The tumor tissue had similar microscopic features to that of other glandular tumors. The tumor secreted mucin, a carbohydrate and protein compound found in mucus, which is released by epithelial cells of the outer skin layer. The detection of epithelial mucin may be useful in differentiating this type of cancer from others. Thyroglobulin, an iodine-containing protein released by the thyroid gland, confirmed the diagnosis of papillary carcinoma of the thyroid gland. (Consumer Summary produced by Reliance Medical Information, Inc.)

The Proteus syndrome is a disorder characterized by the excessive growth of normal tissue resulting in tumors throughout the body. Common features of the disease include megalodactyly, the enlargement of fingers or toes; hemihypertrophy, or overgrowth of the muscles on one side of the body; subcutaneous masses, or growths in the tissue underlying the skin; thickening of the palms of hands and soles of feet; and linear skin lesions, which appear as lines. The disease may result from abnormalities in growth hormone. The skin lesions tend to have abnormal coloring or may appear as wartlike moles. A case is described of a 30-year-old woman with excessive development of the extremities and linear skin lesions. Since infancy, the patient had several typical features of the Proteus syndrome, including megalodactyly of toes on the right foot and fingers of the left hand; skin lesions without normal coloring on the lower limbs; abnormal growths in various tissues; skin thickening; and linear skin lesions. Microscopic examination of the linear skin lesions showed hyperkeratosis, the overgrowth of the horny layer of the skin, and acanthosis, the thickening of the skin layer made up of prickle cells. These cells have rod-shaped projections and connections between each other. Numerous vacuoles and granules were present between the melanocyte cells, which produce the pigment melanin, and keratinocyte cells, which produce the hard protein keratin. (Consumer Summary produced by Reliance Medical Information, Inc.)

Acanthosis nigricans is a rare inflammatory skin disease that is often associated with cancer of the gastrointestinal system. It is characterized by the formation of papillary growths, which are nipple-like protrusions; skin discoloration; and hyperkeratosis, or overgrowth of the horny layer of skin. A case is described of a 51-year-old man who developed discoloration and papillary growths in the underarms; numerous outgrowths of skin; and discoloration around the navel. The patients was diagnosed with acanthosis nigricans. He appeared to be in good health, but had experienced some weight loss. He had a history of high blood pressure, diabetes, gout, and smoking. His father had died of pancreatic cancer. Internal examination of the colon revealed a rectal polyp, a tumor attached by a pedicle, or stalk. Based on microscopic examination, the tumor was diagnosed as a rectal carcinoid, a tumor is derived from argentaffin cells in the intestines, bile ducts, pancreas, bronchus, or ovaries. These tumors secrete serotonin and other substances that affect blood vessels. When the rectal carcinoid was surgically removed, the symptoms of acanthosis nigricans regressed. This is the first reported case of rectal carcinoid associated with the development of acanthosis nigricans. All patients with acanthosis nigricans should be carefully evaluated for underlying cancers. (Consumer Summary produced by Reliance Medical Information, Inc.)

Multilobated T-cell lymphoma is a malignancy of the lymphoid tissue characterized by abnormal immune T-cells, which contain nuclei with many lobes. The chromatin, or structures within the nucleus, tend to be fine, whereas the nucleoli (round structures made up of dense fibers and granules) tend to be very small or undetectable. The multilobated form of peripheral T-cell lymphoma (PTL) often affects sites other than the lymph nodes, such as the skin and bone. Twenty-eight percent of patients with multilobated PTL have skin complications. However, the skin is rarely the primary tissue involved in multilobated PTL, and less than 20 cases of cutaneous (skin-related) multilobated T-cell lymphoma have been reported. Cutaneous multilobated T-cell lymphoma (CMTCL) is usually a chronic disease with a favorable outcome. A case is described of a 74-year-old man who developed CMTCL, which progressed rapidly to death within two years after the onset of disease. The patient had a history of diabetes and severe disease of the coronary arteries, the major blood vessels supplying the heart. A large ulcer on the right leg and enlarged lymph nodes in the right groin area were noted. Microscopic examination of tissue samples from the ulcer and affected lymph nodes confirmed the diagnosis of CMTCL, which was successfully treated with radiation. However, five months later, the patient developed fever, night sweats, and enlargement of the lymph nodes and spleen. He was diagnosed with angioimmunoblastic lymphadenopathy, a disease of the lymph nodes, and was treated with cyclophosphamide, vincristine, and prednisone. Violet-colored, solid, round skin lesions on the right thigh developed, which resolved after radiation treatment. A year later, the patient developed reddish patches on his body and enlarged lymph nodes in the groin area. Despite treatment with cyclophosphamide, vincristine, and prednisone, the disease spread to the lungs, liver, spleen, bones, and bone marrow, and the patient died five months later. This case shows that CMTCL can progress rapidly to a fatal outcome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Certain conditions that are characterized by both skin and bone abnormalities may be grouped into eight categories. These disorders include hereditary diseases; congenital diseases (disorders present at birth); inflammatory conditions; neoplasias (conditions of abnormal tissue growth such as tumors); infections; conditions caused by toxic effects of drugs or environmental factors; calcinosis cutis (disease characterized by calcium deposition in the skin); and osteoma cutis (formation of bony, node-like growths in the skin). The first two categories are described in detail in this article. Some examples of genetic diseases with bone and skin defects include neurofibromatosis (the formation of tumors on peripheral nerves) and alkaptonuria (a disorder of amino acid metabolism in which calcium and pigment are deposited in skin, cartilage, and bone, and general loss of bone tissue occurs). An example of a congenital disorder with bone and skin manifestations is the Sturge-Weber syndrome. This birth-related condition is characterized by port-wine birthmarks along the trigeminal nerve in the face area; blood vessel tumors; deposition of calcium in the brain; mental retardation; epilepsy; and glaucoma, an eye disease. Another congenital disorder, the Proteus syndrome, is characterized by overgrowth of the skeleton on one side of the body; excessive size of one or more fingers; the formation of masses in tissue underlying the skin, soles of feet, and palms of hands; bony growths; birthmarks; a curved spine; and various abnormalities of the skin, endocrine glands, and skeleton. The characteristics of several other genetic and congenital diseases with bone and skin manifestations are also described. (Consumer Summary produced by Reliance Medical Information, Inc.)

Lyme disease is an infectious illness, transmitted to humans by the bite of a tick. Lyme disease has many symptoms, including arthritis, neurologic dysfunction, and cardiac disease. The skin is frequently involved; the classic lesion is erythema migrans, which can appear from 3 to 30 days after the tick bite, and is seen in approximately 60 to 80 percent of patients. Erythema migrans is typically round, raised, red, and expands outward from the center, often with clearing of the redness in the middle. A bump or blister may persist in the center at the bite site. While erythema migrans is usually painless, some patients experience pain, itching, or burning. This rash will resolve within a month if untreated, or within days if the patient is given appropriate antibiotics. Secondary erythema migrans lesions appear weeks to months later, and are multiple. Other skin manifestations of Lyme disease are often reported in Europe, but rarely, if ever, recognized in the US. They include Borrelia lymphocytoma, a red bump usually located on the earlobe in children, and on the nipple in adults. Biopsies of this lesion show large numbers of lymphocytes, or white blood cells. Acrodermatitis chronica atrophicans is a late sign of Lyme disease, is typically seen in the elderly, and ultimately appears as glistening, thin skin with a large number of blood vessels. Another late skin lesion is morphea, a round, hard plaque, white or yellow in the center. Other skin lesions noted in Lyme disease are the rashes associated with the antibiotics used to treat the illness. Recognition of these later skin lesions in Lyme disease may lead to more frequent treatment of otherwise unrecognized cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

A dermatology symposium held in December 1989 in San Francisco focused on the changing nature of AIDS; skin disorders associated with AIDS; prospects for treatment and vaccine; and protection of dermatologists from human immunodeficiency virus (HIV) infection. The AIDS epidemic affects many people in the most productive stage of their lives, and has placed an immense financial burden on the health care system. AIDS has also become a risk for health care personnel, who must comply with universal precautions against blood-borne disease to prevent accidental infection in the workplace. At the same time, health care personnel must provide compassionate care to HIV-infected patients. Dermatologists should be aware of the early signs of HIV infection, particularly skin disorders, and take precautions against infection. Early detection of HIV infection and effective treatment with antiviral agents, such as zidovudine, may prevent the development of symptoms and prolong the survival of HIV-infected patients. In the future, HIV disease may become a chronic rather than fatal illness that is treated to improve long-term survival as in other chronic diseases, such as diabetes or heart disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Recognition of the skin disorders associated with human immunodeficiency virus (HIV) infection permits an early diagnosis of HIV infection. Skin diseases in HIV-infected patients have different characteristics than those in persons with normal immune systems. HIV-related skin disorders that are not malignant can be classified as infectious or noninfectious. Infectious skin diseases may be caused by viruses, bacteria, fungi, and protozoa, or infestations with ectoparasites, such as scabies, mites, and lice. In HIV-infected patients, common inflammatory skin disease may be severe and persistent. HIV-infected patients may also develop unusual inflammatory conditions, which do not occur in persons with normal immune systems. Opportunistic infections are caused by microorganisms that normally do not result in disease, and occur because of the decreased immunity of the patient. Common opportunistic infections and inflammatory skin diseases in HIV-infected patients are described. Some infectious skin disorders include acute HIV exanthem (pink rash on trunk of body and extremities accompanied by low fever and sore throat), herpes simplex, shingles, cytomegalovirus and human papillomavirus infections, syphilis, and scabies. Some noninfectious skin disorders include seborrheic dermatitis-like eruption, hair loss, hives, and psoriasis. Other unusual manifestations or symptoms are described. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pediatric AIDS was first reported in 1982, and 1,908 cases of AIDS in children under 13 years have been diagnosed as of October 1989. More than 80 percent of human immunodeficiency virus (HIV) infections in children result from perinatal exposure, in which an HIV-infected mother transmits the virus to her infant during childbirth. Seventy-two percent of pediatric AIDS patients are from New York, New Jersey, and Florida; 57 percent of HIV-infected children are black, 22 percent are Hispanic, and 20 percent are white. Various aspects of HIV infection in children are discussed. HIV infection in children is associated with progressive impairment of nerve function and opportunistic infections, which are caused by microorganisms that are not normally infective. Skin disorders associated with HIV infection in children result from fungal, bacterial, and viral infections. The HIV-infected child is less responsive to treatment for these skin diseases than healthy children. Some signs of HIV infection include severe seborrheic dermatitis, an inflammatory skin disease of the scalp; vasculitis, inflammation of the blood vessels; and drug eruptions, which are skin reactions to drug therapy. Intravenous gamma-globulin, a blood protein important for developing resistance to infection, may reduce the incidence of severe bacterial infections in AIDS-afflicted children. Intravenous zidovudine was shown to improve the development of nerve function, increase appetite and weight, decrease lymph node disease and enlargement of the liver and spleen, and increase number of CD4 cells, a type of immune cell. Dermatologists should be able to recognize skin disorders associated with pediatric AIDS and provide prompt treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

At the Fifth International Conference on AIDS, more than 12,000 scientists, clinicians, health care workers, and patients gathered in Montreal, Canada in June 1989 to promote a better understanding of AIDS and share knowledge obtained through international research efforts. Topics discussed included epidemiology, clinical symptoms, basic research, AIDS and the individual, AIDS and society, ethics and law, international issues and economic aspects of the disease. Some recently described or unusual cutaneous manifestations of skin disorders associated with AIDS were described. These include epithelioid angiomatosis, an outbreak of blood vessel lesions affecting the entire body; unusual forms of herpes zoster; acute exanthem, or skin rash, associated with human immunodeficiency virus (HIV) disease; cutaneous manifestations of HIV in the Third World; Kaposi's sarcoma; AIDS and HIV infection in children; psoriasis and Reiter's syndrome; syphilis; and bullous, or blister-like, disorders. The effectiveness of the antiviral agent foscarnet and the adverse reactions to zidovudine, a drug commonly used to treat AIDS, are also described. Oral manifestations of the disease were reviewed and include oral candidiasis (a yeast infection of the mouth) and oral hairy leukoplakia (formation of white spots on tongue and cheek). It is important that North American dermatologists participate in the international effort against AIDS. Because skin disease is often a major complication, the dermatologist is often the primary health care professional consulted by AIDS or HIV-infected patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Antibodies are specialized proteins that inactivate foreign invading substances called antigens. Under abnormal conditions, the body may produce antibodies to its own organs and natural products in what is called the autoimmune reaction. Phospholipids are compounds of phosphorus, nitrogen-containing bases and fatty acids, and are important in various functions of the cell. Antibodies to the phospholipid cardiolipin are used as a measure of antibodies to phospholipids, and are associated with an increased risk of blood clotting, an abnormal decrease in blood platelets, increased pressures within the blood vessels supplying the lungs, and recurrent spontaneous abortion or miscarriage. These features have been described as the antiphospholipid syndrome. A case is described of a 22-year-old woman with a rare feature of this syndrome. The patient had anticardiolipin antibodies and widespread skin necrosis, or skin tissue deterioration, and blood clotting in the blood vessels of the dermis, the inner layer of the skin. The patient was treated with a synthetic corticosteroid, prednisolone, which improved the skin lesions. She was discharged three weeks after hospital admission. Re-examination one month later revealed considerable scarring on her legs. The patient was started on treatment with aspirin to prevent platelet aggregation, and thereby reduce the incidence of blood clotting. Within six months, there was no evidence of cardiolipin antibody. (Consumer Summary produced by Reliance Medical Information, Inc.)

Lyme disease is a infection caused by the spirochete Borrelia burgdorferi, which is transmitted by ticks. A skin manifestation that develops in the later stages of Lyme disease is acrodermatitis chronic atrophicans, which is characterized ny redness of the skin, accumulation of fluid in the tissues, and hardening of the skin, most often in the extremities. The skin becomes very wrinkled and takes on the appearance of cigarette paper. These skin lesions may develop before or after the onset of other symptoms of Lyme disease. A case is described of a 12-year-old girl with Lyme disease who developed unusual skin lesions consisting of atrophic (wasted away) skin on the hands, wrists, and ankles. The child had spent summers on Cape Cod, where Lyme disease is prevalent. She had a two-year history of blue-gray hyperpigmentation (increased coloring) and atrophy of the skin on the hands and ankles, but no previous tick bite of symptoms of Lyme disease. Spirochetes were detected in the skin and the patient displayed an immune response specifically against B. burgdorferi proteins, as indicated by immunoblotting analysis. However, antibodies (immune proteins) directed against B. burgdorferi were not detected by the standard enzyme-linked immunosorbent assay (ELISA). She was treated with penicillin and tetracycline, which eliminated the spirochetes, but did not improve the skin lesions. This case was unusual in that the patient was without other more common signs of Lyme disease. The skin lesions were unusual and antibody directed against B. burgdorferi was not detected by ELISA. However, the identification of spirochetes in the lesions and presence of antibodies directed against spirochete proteins, as indicated by immunoblotting, suggested a diagnosis of Lyme disease. The limited antibody response of this patient may be related to genetic factors or variation in the strain of B. burgdorferi. (Consumer Summary produced by Reliance Medical Information, Inc.)

POEMS syndrome, a rare multisystem disease, is a variant of osteosclerotic myeloma and is characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal proteins, and skin changes. Presented herein is a case of POEMS syndrome with flushing. The flushing was intermittent, involving the face and upper third of the trunk, and was associated with hypotension and bronchospasm. Final diagnosis was made by biopsy examination of an axillary lymph node, which showed angiofollicular hyperplasia that stained strongly and selectively for lambda light chains. The patient had most of the typical features of POEMS syndrome but was unique in that her most striking finding was carcinoid-like flushing. The flushing improved with steroid therapy, as did some of the other clinical features of POEMS syndrome but was unique in that her most striking finding was carcinoid-like flushing. The flushing improved with steroid therapy, as did some of the other clinical features of her disease. This case suggests tha idiopathic flushing can be added to the skin changes observed in POEMS syndrome., POEMS syndrome is a condition characterized by polyneuropathy, disease of several nerves; organomegaly, enlargement of organs; endocrinopathy, disease of the endocrine glands; monoclonal protein; and skin changes. Severe disease of the sensory and motor nerves and plasma cell disorders are frequently observed with this condition. A case is described of a 50-year-old woman with POEMS syndrome who developed flushing. The disorder was initially mistaken for carcinoid syndrome, a disorder caused by the spreading of carcinoid tumors, which release factors that control blood vessel constriction and dilation. The patient's flushing occurred intermittently, and involved the face and upper portion of the trunk. The flushing was associated with hypotension, or abnormally low blood pressure, and bronchospasm, or uncontrolled contraction of the airways. Examination of a biopsy specimen from an underarm lymph node revealed angiofollicular hyperplasia, or overgrowth. The patient had many of the symptoms of POEMS syndrome, with the exception of the flushing. Steroid therapy improved the flushing and other clinical features. This case is the first report of flushing associated with POEMS syndrome; the symptom should perhaps be added to the list of skin changes associated with POEMS syndrome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection with human immunodeficiency virus (HIV) is often complicated by skin disorders, such as Kaposi's sarcoma. Recent reports have identified a microorganism in HIV-related skin and blood vessel lesions that resembles the bacillus-type organism that causes cat scratch disease. In cat scratch disease, the bacteria Pasteurella multocida are usually transmitted by the bite or scratch of a cat. The cat scratch bacillus or a similar organism was shown to cause the widespread development of node-like skin lesions in HIV-infected patients. This HIV-related skin disease has been referred to as epithelioid angiomatosis, bacillary angiomatosis, and disseminated cat scratch disease. Epithelioid or bacillary angiomatosis has been treated with a combination of antibiotics, although it remains unclear which antibiotic is most effective. A case is described of a 48-year-old homosexual man with acquired immunodeficiency syndrome (AIDS) and advanced cat scratch disease who responded to treatment with the antibiotic doxycycline. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patients with malignant blood disorders and weakened natural defense mechanisms, or immunosuppression, are very susceptible to infections. Herpes simplex virus infections, which may cause severe ulcers, are common in these patients. Leukemia patients are among those at risk for herpes simplex virus infections. A case is described of a patient with chronic lymphocytic leukemia, a blood disease associated with increased numbers of lymphocytes, a type of white blood cell. He developed a painful ulcer on the penis that was initially diagnosed as leukemia cutis, a skin disorder associated with leukemia. This impression was based on the skin lesion biopsy which indicated an increased white blood cell count. However, other laboratory tests revealed the presence of multinucleated giant cells, a type of cell found in bone marrow, spleen, healing or inflamed tissues, and infections with herpes virus. The nodes in the groin region of this patient were also affected by the herpes infection. The skin lesions improved after treatment with an antiviral agent, acyclovir. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cryptococcosis is a fungal infection caused by Cryptococcus neoformans that tends to infect the brain and its membranes. This fungal disease affects 1.9 to 9.0 percent of AIDS patients. The fungus attacks the skin in the later stages of the disease causing lesions of various shapes and forms. The lesions associated with cryptococcosis may be node-like growths underlying the skin, abscesses, solid, red skin lesions, pus-filled lesions, ulcers, or granular growths. In one reported case of cutaneous (skin-related) cryptococcus in an AIDS patient, the skin lesions resembled molluscum contagiosum, a skin disease characterized by the formation of skin tumors. The cases are described of three HIV-infected patients with widespread cryptococcosis involving the skin. The patients all had a history of intravenous drug abuse. The fungus was detected in the cerebrospinal fluid, which surrounds the brain and spinal cord, and also in the blood and most organs. The lesions resembled molluscum contagiosum in two of the cases, and appeared before the development of other symptoms of cryptococcosis in two cases. Cryptococcosis should be considered as a diagnosis in AIDS patients with skin lesions resembling molluscum contagiosum. Furthermore, the skin lesions are indicative of systemic disease, or cryptococcosis affecting the entire body. Early diagnosis of cryptococcosis is essential to prevent the progression of the infection to the systemic stage. The skin lesions were followed by rapid and fatal deterioration of all three patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection with varicella zoster virus (VZV) has been associated with various nerve complications, including inflammation of the brain, membranes in the brain and spinal cord, the spinal cord itself, and the spinal nerve roots; paralysis of half of the body; nerve pain; and nerve disorders associated with the cranium or skull. These nerve disorders are usually associated with skin rash. A case is described of a 31-year-old man with myelitis, inflammation of the spinal cord, due to VZV infection who did not develop a skin rash. The patient developed pain within the lower back and back of thighs, was unable to retain feces, and retained urine. Within the next eight days, function of his lower extremities deteriorated. The patient was treated with dexamethasone and his condition improved gradually. VZV was detected in his spinal fluid, and the patient was given the antiviral agent acyclovir. The patients was able to regain his walking ability, although his urinary retention persisted. This case shows that infection with VZV can cause nerve disease without evidence of skin rash or without triggering the production of antibodies, immune system proteins. Under such conditions, the presence of VZV may be determined by analysis of spinal fluid. (Consumer Summary produced by Reliance Medical Information, Inc.)

CHICAGO -- Many genetically based periodic fever syndromes have skin signs that may help identify the syndromes on the rare occasions when they occur, Dr. Kathryn M. Edwards said at [...]